Patient-reported outcomes for congenital diaphragmatic hernia: A qualitative study.

OBJECTIVE: To identify Patient-reported outcomes (PROs) for parents with a lived experience of a prenatal diagnosis of isolated congenital diaphragmatic hernia (CDH). METHOD: Thematic analysis of in-depth interview transcripts. RESULTS: Interviews (n = 26) identified 11 PROs for given time points throughout the CDH trajectory. At the time of diagnosis, acceptable quality of life was selected as relevant PRO to decide whether to continue or terminate the pregnancy. During pregnancy, (neonatal) survival chances and the eligibility for foetal therapy were prominent outcomes with foetal and maternal complications adding distress. After birth, postnatal management options became the next milestone. When survival was deemed likely, post-hospital discharge complications and future care for infant and child became important. In retrospect, impact on family, bonding, parental mental health, and parental satisfaction with care were reported as relevant outcomes. CONCLUSION: PROs are relevant in addition to hard medical outcomes, as they help parents to make decisions suiting their unique needs and personal situation. Given the knowledge inherently related to the parent's perspective, our findings provide relevant directions for clinicians to support parents and their family in facing challenging decisions in healthcare. The outcomes impacting parents are essential to prepare parents for the steep journey ahead.

Prenatal diagnosis of congenital diaphragmatic hernia: Parental counselling and support needs.

OBJECTIVE: To define the dimensions of patient-centeredness of prenatal care for parents who had a fetus with isolated congenital diaphragmatic hernia (CDH) by exploring their values, experiences, needs and preferences. METHODS: In-depth interviews with parents who were faced with the prenatal diagnosis of isolated CDH. RESULTS: Interviews (n = 18) identified seven dimensions of patient-centeredness. Parental preferences are respected by unconditional acceptance of parental choices and needs. After diagnosis access to care should occur by swift referral to a specialised centre to prevent parents receiving contradictory information. Information and education help parents to gain some sense of control and cope with the many uncertainties. A multidisciplinary team with a coordinating professional is perceived supportive (coordination and integration), and seamless referral between local and treatment centres reduces parental distress (continuity and transition). Family-centred emotional support helps parents to cope with emotions and distress. Informal support by involvement of family and friends and trusted peer-support is of added value. CONCLUSION: The impact of the uncertainty of outcome in this condition is tremendous and needs to be considered when providing prenatal care. After initial diagnosis, one should avoid speculation about the severity of the condition and outcome, and provide swift referral to a specialist centre expert in managing CDH. Provision of realistic and comprehensive information helps parents cope. Multidisciplinary and continuous support throughout the full trajectory, but also integrated psychosocial support should become standard-of-care.

Active exploration improves perceptual sensitivity for virtual 3D objects in visual recognition tasks.

Several studies demonstrated that active exploration as compared to passive observation of a variety of objects leads to improved performance concerning these actively studied objects later on. These results may be specifically due to an improvement in perceptual recognition but in principle they may also be due to a speeding up of responses to actively studied objects. Recently, however, it was suggested that the benefit of active exploration on perceptual recognition may be restricted to a specific class of (biologically relevant) stimuli. By employing measures derived from signal detection theory we were able to show in all our three experiments that active exploration of virtual 3D objects leads to improved perceptual sensitivity in a subsequent test phase. The improvement with these objects means that the benefit of active exploration is not restricted to a specific class of biologically relevant stimuli. The results of our second experiment further demonstrate that the benefit of active exploration is even strong enough to fully compensate for the effect of perceptual degradation, thereby emphasizing the major impact of active exploration. In our third experiment, we explored the possibility that effects of active exploration might be due to major changes in attentional strategies rather than to the action-related aspect. Results revealed that an attentional requirement left the active-passive difference by and large intact supporting the view that the advantage of active object exploration lies in the action itself.

Representing 3D virtual objects: interaction between visuo-spatial ability and type of exploration.

We investigated individual differences in interactively exploring 3D virtual objects. 36 participants explored 24 simple and 24 difficult objects (composed of respectively three and five Biederman geons) actively, passively, or not at all. Both their 3D mental representation of the objects and visuo-spatial ability was assessed. Results show that, regardless of the object's complexity, people with a low VSA benefit from active exploration of objects, where people with a middle or high VSA do not. These findings extend and refine earlier research on interactively learning visuo-spatial information and underline the importance to take individual differences into account.

Navigating through virtual environments: visual realism improves spatial cognition.

Recent advances in computer technology have significantly facilitated the use of virtual environments (VE) for small and medium enterprises (SME). However, achieving visual realism in such VE requires high investments in terms of time and effort, while its usefulness has not yet become apparent from research. Other qualities of VE, such as the use of large displays, proved its effectiveness in enhancing the individual user's spatial cognition. The current study assessed whether the same benefits apply for visual realism in VE. Thirty-two participants were divided into two groups, who explored either a photorealistic or a nonrealistic supermarket presented on a large screen. The participants were asked to navigate through the supermarket on a predetermined route. Subsequently, spatial learning was tested in four pen-and-paper tests that assessed how accurately they had memorized the route and the environment's spatial layout. The study revealed increased spatial learning from the photorealistic compared to the nonrealistic supermarket. Specifically, participants performed better on tests that involved egocentric spatial knowledge. The results suggest visual realism is useful because it increases the user's spatial knowledge in the VE. Therefore, the current study provides clear evidence that it is worthwhile for SME to invest in achieving visual realism in VE.

Feature-based memory-driven attentional capture: visual working memory content affects visual attention.

In 7 experiments, the authors explored whether visual attention (the ability to select relevant visual information) and visual working memory (the ability to retain relevant visual information) share the same content representations. The presence of singleton distractors interfered more strongly with a visual search task when it was accompanied by an additional memory task. Singleton distractors interfered even more when they were identical or related to the object held in memory, but only when it was difficult to verbalize the memory content. Furthermore, this content-specific interaction occurred for features that were relevant to the memory task but not for irrelevant features of the same object or for once-remembered objects that could be forgotten. Finally, memory-related distractors attracted more eye movements but did not result in longer fixations. The results demonstrate memory-driven attentional capture on the basis of content-specific representations.