Patients suffering from psychological impairments following critical illness are in need of information

Background: Because critical illness survivors frequently experience several long-term psychological impairments altering quality of life after ICU, there is a trend towards increasing follow-up care, mainly via ICU follow-up clinics. Despite these and other initiatives, understanding of patient's post-ICU needs to help them cope with their problems and subsequently improve quality of life is largely lacking. Our aim was therefore to assess the needs, expectations and wishes in ICU survivors to receive information with the purpose to help them better grasp ICU treatment. In addition, we assessed the perceived burden of psychological trauma after ICU treatment and the health-related quality of life (HRQoL) up to 2.5 years after ICU discharge. Methods: In a multicentre, retrospective cross-sectional cohort study, the needs and preferred intervention methods were assessed using a self-composed inventory in adult mechanically ventilated ICU survivors (n = 43). Additionally, the Impact of Event Scale Revised, the Beck Depression Inventory, the EuroQol-5D-5L, and the Short-Form 12 were used to assess psychological burden and HRQoL. Results: A substantial proportion of all ICU survivors (59%, 95% CI 44% to 74%) suffered from psychological impairments after ICU treatment. Seventy-five percent of these patients expressed a wish to receive information, but only 36% desired to receive this information using a commonly used information brochure. In contrast, 71% of these patients had a wish to receive information using a video film/VR. Furthermore, only 33% of these patients was satisfied with the information provided by their treating hospital. Patients with psychological PICS reported a worse HRQoL as compared to a normative Dutch sample (P < 0.001) and as compared to patients without psychological PICS (P < 0.01). Conclusions: In a Dutch cohort of critical illness survivors, a substantial part of ICU survivors suffer from psychological impairments, such as PTSD and depression, which was associated with a worse HRQoL. These patients are in need of information, have no desire using an information brochure, but are willing to receive information using a video film/virtual reality module. These results support the exploration of such an intervention

Prism Adaptation in Rehabilitation? No Additional Effects of Prism Adaptation on Neglect Recovery in the Subacute Phase Poststroke

Background. Patients with neglect ignore or respond slower to contralesional stimuli. Neglect negatively influences independence in activities of daily living (ADL). Prism adaptation (PA) is one of the most frequently studied treatments, yet there is little evidence regarding positive effects on neglect behavior in ADL. Objective. To assess whether PA in the subacute phase ameliorates neglect in situations of varying complexity. Methods. A total of 70 neglect patients admitted for inpatient stroke rehabilitation received either PA or sham adaptation (SA) for 2 weeks, with full access to standard treatment. There were 7 time-dependent measurements (baseline and 1-4, 6, and 14 weeks after start of treatment). The primary outcome was change of neglect as observed during basic ADL with the Catherine Bergego Scale (CBS). Secondary outcomes were changes in performance on a dynamic multitask (ie, the Mobility Assessment Course [MAC]) and a static paper-and-pencil task (ie, a shape cancellation task [SC]). Results. In all, 34 patients received PA and 35 SA. There were significant time-dependent improvements in performance as measured with the CBS, MAC, and SC (all F > 15.57; P <.001). There was no significant difference in magnitude of improvement between groups on the CBS, MAC, and SC (all F < 2.54; P >.113]. Conclusions. No beneficial effects of PA over SA in the subacute phase poststroke were observed, which was comparable for situations of varying complexity. Heterogeneity of the syndrome, time post–stroke onset, and the content of treatment as usual are discussed. Basic knowledge on subtypes and recovery patterns would aid the development of tailored treatment

Impact of nationwide enhanced implementation of best practices in pancreatic cancer care (PACAP-1): A multicenter stepped-wedge cluster randomized controlled trial

Background: Pancreatic cancer has a very poor prognosis. Best practices for the use of chemotherapy, enzyme replacement therapy, and biliary drainage have been identified but their implementation in daily clinical practice is often suboptimal. We hypothesized that a nationwide program to enhance implementation of these best practices in pancreatic cancer care would improve survival and quality of life. Methods/design: PACAP-1 is a nationwide multicenter stepped-wedge cluster randomized controlled superiority trial. In a per-center stepwise and randomized manner, best practices in pancreatic cancer care regarding the use of (neo)adjuvant and palliative chemotherapy, pancreatic enzyme replacement therapy, and metal biliary stents are implemented in all 17 Dutch pancreatic centers and their regional referral networks during a 6-week initiation period. Per pancreatic center, one multidisciplinary team functions as reference for the other centers in the network. Key best practices were identified from the literature, 3 years of data from existing nationwide registries within the Dutch Pancreatic Cancer Project (PACAP), and national expert meetings. The best practices follow the Dutch guideline on pancreatic cancer and the current state of the literature, and can be executed within daily clinical practice. The implementation process includes monitoring, return visits, and provider feedback in combination with education and reminders. Patient outcomes and compliance are monitored within the PACAP registries. Primary outcome is 1-year overall survival (for all disease stages). Secondary outcomes include quality of life, 3- and 5-year overall survival, and guideline compliance. An improvement of 10% in 1-year overall survival is considered clinically relevant. A 25-month study duration was chosen, which provides 80% statistical power for a mortality reduction of 10.0% in the 17 pancreatic cancer centers, with a required sample size of 2142 patients, corresponding to a 6.6% mortality reduction and 4769 patients nationwide. Discussion: The PACAP-1 trial is designed to evaluate whether a nationwide program for enhanced implementation of best practices in pancreatic cancer care can improve 1-year overall survival and quality of life. Trial registration: ClinicalTrials.gov, NCT03513705. Trial opened for accrual on 22th May 2018

Evidence for the world as an external memory : A trade-off between internal and external visual memory storage

We use visual working memory (VWM) to maintain the visual features of objects in our world. Although the capacity of VWM is limited, it is unlikely that this limit will pose a problem in daily life, as visual information can be supplemented with input from our external visual world by using eye movements. In the current study, we influenced the trade-off between eye movements and VWM utilization by introducing a cost to a saccade. Higher costs were created by adding a delay in stimulus availability to a copying task. We show that increased saccade cost results in less saccades towards the model and an increased dwell time on the model. These results suggest a shift from making eye movements towards taxing internal VWM. Our findings reveal that the trade-off between executing eye-movements and building an internal representation of our world is based on an adaptive mechanism, governed by cost-efficiency

Evidence for the world as an external memory : A trade-off between internal and external visual memory storage

We use visual working memory (VWM) to maintain the visual features of objects in our world. Although the capacity of VWM is limited, it is unlikely that this limit will pose a problem in daily life, as visual information can be supplemented with input from our external visual world by using eye movements. In the current study, we influenced the trade-off between eye movements and VWM utilization by introducing a cost to a saccade. Higher costs were created by adding a delay in stimulus availability to a copying task. We show that increased saccade cost results in less saccades towards the model and an increased dwell time on the model. These results suggest a shift from making eye movements towards taxing internal VWM. Our findings reveal that the trade-off between executing eye-movements and building an internal representation of our world is based on an adaptive mechanism, governed by cost-efficiency

Transsaccadic perception is affected by saccade landing point deviations after saccadic adaptation

Whenever we move our eyes, some visual information obtained before a saccade is combined with the visual information obtained after a saccade. Interestingly, saccades rarely land exactly on the saccade target, which may pose a problem for transsaccadic perception as it could affect the quality of postsaccadic input. Recently, however, we showed that transsaccadic feature integration is actually unaffected by deviations of saccade landing points. Possibly, transsaccadic integration remains unaffected because the presaccadic shift of attention follows the intended saccade target and not the actual saccade landing point during regular saccades. Here, we investigated whether saccade landing point errors can in fact alter transsaccadic perception when the presaccadic shift of attention follows the saccade landing point deviation. Given that saccadic adaptation not only changes the saccade vector, but also the presaccadic shift of attention, we combined a feature report paradigm with saccadic adaptation. Observers reported the color of the saccade target, which occasionally changed slightly during a saccade to the target. This task was performed before and after saccadic adaptation. The results showed that, after adaptation, presaccadic color information became less precise and transsaccadic perception had a stronger reliance on the postsaccadic color estimate. Therefore, although previous studies have shown that transsaccadic perception is generally unaffected by saccade landing point deviations, our results reveal that this cannot be considered a general property of the visual system. When presaccadic shifts of attention follow altered saccade landing points, transsaccadic perception is affected, suggesting that transsaccadic feature perception might be dependent on visual spatial attention

The cost of making an eye movement : A direct link between visual working memory and saccade execution

To facilitate visual continuity across eye movements, the visual system must presaccadically acquire information about the future foveal image. Previous studies have indicated that visual working memory (VWM) affects saccade execution. However, the reverse relation, the effect of saccade execution on VWM load is less clear. To investigate the causal link between saccade execution and VWM, we combined a VWM task and a saccade task. Participants were instructed to remember one, two, or three shapes and performed either a No Saccade-, a Single Saccade- or a Dual (corrective) Saccade-task. The results indicate that items stored in VWM are reported less accurately if a single saccade-or a dual saccade-task is performed next to retaining items in VWM. Importantly, the loss of response accuracy for items retained in VWM by performing a saccade was similar to committing an extra item to VWM. In a second experiment, we observed no cost of executing a saccade for auditory working memory performance, indicating that executing a saccade exclusively taxes the VWM system. Our results suggest that the visual system presaccadically stores the upcoming retinal image, which has a similar VWM load as committing one extra item to memory and interferes with stored VWM content. After the saccade, the visual system can retrieve this item from VWM to evaluate saccade accuracy. Our results support the idea that VWM is a system which is directly linked to saccade execution and promotes visual continuity across saccades

Object files across eye movements : Previous fixations affect the latencies of corrective saccades

One of the factors contributing to a seamless visual experience is object correspondence-that is, the integration of pre- and postsaccadic visual object information into one representation. Previous research had suggested that before the execution of a saccade, a target object is loaded into visual working memory and subsequently is used to locate the target object after the saccade. Until now, studies on object correspondence have not taken previous fixations into account. In the present study, we investigated the influence of previously fixated information on object correspondence. To this end, we adapted a gaze correction paradigm in which a saccade was executed toward either a previously fixated or a novel target. During the saccade, the stimuli were displaced such that the participant's gaze landed between the target stimulus and a distractor. Participants then executed a corrective saccade to the target. The results indicated that these corrective saccades had lower latencies toward previously fixated than toward nonfixated targets, indicating object-specific facilitation. In two follow-up experiments, we showed that presaccadic spatial and object (surface feature) information can contribute separately to the execution of a corrective saccade, as well as in conjunction. Whereas the execution of a corrective saccade to a previously fixated target object at a previously fixated location is slowed down (i.e., inhibition of return), corrective saccades toward either a previously fixated target object or a previously fixated location are facilitated. We concluded that corrective saccades are executed on the basis of object files rather than of unintegrated feature information

Feature integration is unaffected by saccade landing point, even when saccades land outside of the range of regular oculomotor variance

The experience of our visual surroundings appears continuous, contradicting the erratic nature of visual processing due to saccades. A possible way the visual system can construct a continuous experience is by integrating presaccadic and postsaccadic visual input. However, saccades rarely land exactly at the intended location. Feature integration would therefore need to be robust against variations in saccade execution to facilitate visual continuity. In the current study, observers reported a feature (color) of the saccade target, which occasionally changed slightly during the saccade. In transsaccadic change-trials, observers reported a mixture of the preand postsaccadic color, indicating transsaccadic feature integration. Saccade landing distance was not a significant predictor of the reported color. Next, to investigate the influence of more extreme deviations of saccade landing point on color reports, we used a global effect paradigm in a second experiment. In global effect trials, a distractor appeared together with the saccade target, causing most saccades to land in between the saccade target and the distractor. Strikingly, even when saccades land further away (up to 4°) from the saccade target than one would expect under single target conditions, there was no effect of saccade landing point on the reported color.We reason that saccade landing point does not affect feature integration, due to dissociation between the intended saccade target and the actual saccade landing point. Transsaccadic feature integration seems to be a mechanism that is dependent on visual spatial attention, and, as a result, is robust against variance in saccade landing point