PLOS ONE Medicine&Health

Patient-Selection of a Clinical Trial Primary Outcome: The ENHANCE-AF Outcomes Survey

by Randall S. Stafford, Eli N. Rice, Rushil Shah, Mellanie T. Hills, Julio C. Nunes, Katie DeSutter, Amy Lin, Karma Lhamo, Bryant Lin, Ying Lu, Paul J. Wang

Before the initiation of the ENHANCE-AF clinical trial, which tested a novel digital shared decision-making tool to guide the use of anticoagulants in stroke prevention for patients with atrial fibrillation, this study aimed to identify the most appropriate, patient-selected primary outcome and to examine whether outcome selection varied by demographic and clinical characteristics.

Our cross-sectional survey asked 100 participants with atrial fibrillation to rank two alternative scales based on the scales’ ability to reflect their experiences with decision-making for anticoagulation. The Decisional Conflict Scale (DCS), a 16-item scale, measures perceptions of uncertainty in choosing options. The 5-item Decision Regret Scale (DRS) focuses on remorse after a healthcare decision. We included adults with non-valvular AFib and CHA₂DS₂VASc scores of at least 2 for men and 3 for women. Multivariable logistic regression with backward selection identified characteristics independently associated with scale choice.

The DCS was chosen over the DRS by 77% [95% confidence interval (CI) 68 to 85%] of participants. All subgroups designated a preference for the DCS. Those with higher CHA₂DS₂VASc scores (≥5, n = 26) selected the DCS 54% of the time compared with 86% of those with lower scores (p =  0.002). Multiple logistic regression confirmed a weaker preference for the DCS among those with higher CHA₂DS₂VASc scores.

Individuals with atrial fibrillation preferred the DCS over the DRS for measuring their decision-making experiences. As a result of this survey, the DCS was designated as the ENHANCE-AF clinical trial’s primary endpoint.

International Wound Journal

Meta‐analysis comparing different ultrasound detection methods to accurately assess wound healing and scar formation after caesarean section

Abstract

The accurate assessment of wound healing post-caesarean section, especially in twin pregnancies, remains a pivotal concern in obstetrics, given its implications for maternal health and recovery. Traditional methods, including conventional abdominal ultrasonography (CU), have been challenged by the advent of transvaginal ultrasonography (TU), offering potentially enhanced sensitivity and specificity. This meta-analysis directly compares the efficacy of TU and CU in evaluating wound healing and scar formation, crucial for optimizing postoperative care. Results indicate that TU is associated with significantly better outcomes in wound healing, demonstrated by lower REEDA scores (SMD = −20.56, 95% CI: [−27.34.20, −13.77], p < 0.01), and in scar formation reduction, evidenced by lower Manchester Scar Scale scores (SMD = −25.18, 95% CI: [−29.98, −20.39], p < 0.01). These findings underscore the potential of integrating TU into routine post-caesarean evaluation protocols to enhance care quality and patient recovery.

International Wound Journal

Effects of an enhanced recovery after surgery nursing programme on surgical site wound infection and postoperative complications in patients undergoing total knee arthroplasty: A meta‐analysis

Abstract

This meta-analysis aimed to investigate the effects of the enhanced recovery after surgery (ERAS) nursing program on surgical wound infection (SWI) and postoperative complications in patients undergoing total knee arthroplasty (TKA). The PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure and Wanfang databases were searched from the date of establishment of the database until August 2023 for randomised controlled trials (RCTs) that assessed the effects of the ERAS nursing program on SWI and postoperative complications in patients undergoing TKA. The literature was screened, data were extracted by two independent investigators, and the literature quality was assessed using the methods recommended by the Cochrane Collaboration. Data analysis was performed using Stata 17.0 software. Nineteen RCTs with 1580 patients were included in the study. The meta-analysis results showed that the rates of SWI (odds ratio [OR] = 0.19, 95% confidence interval [CI]: 0.10–0.37, p < 0.001) and postoperative complications (OR = 0.18, 95% CI: 0.12–0.25, p < 0.001) were significantly lower in the ERAS intervention group than those in the control group. Therefore, ERAS intervention after TKA can significantly reduce the occurrence of SWI and postoperative complications. It has a remarkable rehabilitation effect and can be widely used in clinical settings.