Patients' experiences of transfers between care settings in palliative care: an interview study.

BACKGROUND: Palliative patients often suffer from serious illness and commonly move between care settings. As such, transfers of patients can take place between acute hospital based care and community based care in both directions. The involvement of multiple caregivers providing care across settings causes fragmentation of care. To address this challenge and to optimize coordination and continuity of care, we explored experiences of palliative patients regarding their transfers between care settings and the perceived role of the treating family physician. METHODS: Qualitative interview study of 20 palliative patients. Participating settings were the hospital and hospitals' palliative care unit, the nursing home, the home care setting and the palliative day care centre. A constant comparative method was used to analyze data. RESULTS: Although the home was considered the preferred residence, perceptions of unsafety arose in cases of increased symptom burden and when the organization of home care was insufficiently geared to the patients' needs. Both the nursing home and the palliative care unit offered safety and good care when home residence became unfeasible. Upon hospital admission, experiences did not always meet expectations, varying significantly depending on the hospital, type of ward and reason for hospitalization. Perceived issues regarding hospital discharge were premature release, lack of seamless care and home care insufficiently tailored to the patients' needs. The family physician's role assignment ranged from pivotal to minimal. Patients especially expected their family physician to guarantee continuity of care. CONCLUSIONS: Home is considered the preferred place of long-term care, as long as it is perceived a safe environment. A person-centered approach, focusing on the patient's complex needs, is not consistently implemented in palliative care settings. Barriers in inter-professional collaboration need to be tackled to provide high quality care across settings.

Transcutaneous Vagus Nerve Stimulation Does Not Affect Verbal Memory Performance in Healthy Volunteers.

INTRODUCTION: Invasive vagus nerve stimulation (VNS) improves word recognition memory in patients with epilepsy. Recent studies with transcutaneous VNS (tVNS) have also shown positive effects on various subdomains of cognitive functioning in healthy volunteers. In this randomized, controlled, crossover study, we investigated the effect of tVNS on a word recognition memory paradigm in healthy volunteers to further investigate the potential of tVNS in the treatment of cognitive disorders. METHODS: We included 41 healthy participants aged between 18 and 30 years (young age group) and 24 healthy participants aged between 45 and 80 years (older age group). Each participant completed a word recognition memory paradigm during three different conditions: true tVNS, sham, and control. During true tVNS, stimulation was delivered at the cymba conchae. Sham stimulation was delivered by stimulating the earlobe. In the control condition, no stimulation was given. In each condition, participants were asked to remember highlighted words from three test paragraphs. Accuracy scores were calculated for immediate recall after each test paragraph and for delayed recognition at the end of the paradigm. We hypothesized that highlighted words from paragraphs in the true tVNS condition would be more accurately recalled and/or recognized compared to highlighted words from paragraphs in the sham or control condition. RESULTS: In this randomized study, tVNS did not affect the accuracy scores for immediate recall or delayed recognition in both age groups. The younger group showed significantly higher accuracy scores than the older group. The accuracy scores improved over time, and the most recently learned words were better recognized. Participants rated true tVNS as significantly more painful; however, pain was not found to affect accuracy scores. CONCLUSION: In this study, tVNS did not affect verbal memory performance in healthy volunteers. Our results could not replicate the positive effects of invasive VNS on word recognition memory in epilepsy patients. Future research with the aim of improving cognitive function should focus on the rational identification of optimized and individualized stimulation settings primarily in patients with cognitive deficits.

The Impact of Cognitive Load on the Spatial Deployment of Visual Attention: Testing the Role of Interhemispheric Balance With Biparietal Transcranial Direct Current Stimulation.

In healthy individuals, increasing cognitive load induces an asymmetric deployment of visuospatial attention, which favors the right visual space. To date, the neural mechanisms of this left/right attentional asymmetry are poorly understood. The aim of the present study was thus to investigate whether a left/right asymmetry under high cognitive load is due to a shift in the interhemispheric balance between the left and right posterior parietal cortices (PPCs), favoring the left PPC. To this end, healthy participants completed a visuospatial attention detection task under low and high cognitive load, whilst undergoing biparietal transcranial direct current stimulation (tDCS). Three different tDCS conditions were applied in a within-subjects design: sham, anodal left/cathodal right, and cathodal left/anodal right stimulation. The results revealed a left/right attentional asymmetry under high cognitive load in the sham condition. This asymmetry disappeared during cathodal left/anodal right tDCS, yet was not influenced by anodal left/cathodal right tDCS. There were no left/right asymmetries under low cognitive load in any of the conditions. Overall, these findings demonstrate that attentional asymmetries under high cognitive load can be modulated in a polarity-specific fashion by means of tDCS. They thus support the assumption that load-related asymmetries in visuospatial attention are influenced by interhemispheric balance mechanisms between the left and right PPCs.

Asymmetric Spatial Processing Under Cognitive Load.

Spatial attention allows us to selectively process information within a certain location in space. Despite the vast literature on spatial attention, the effect of cognitive load on spatial processing is still not fully understood. In this study we added cognitive load to a spatial processing task, so as to see whether it would differentially impact upon the processing of visual information in the left versus the right hemispace. The main paradigm consisted of a detection task that was performed during the maintenance interval of a verbal working memory task. We found that increasing cognitive working memory load had a more negative impact on detecting targets presented on the left side compared to those on the right side. The strength of the load effect correlated with the strength of the interaction on an individual level. The implications of an asymmetric attentional bias with a relative disadvantage for the left (vs the right) hemispace under high verbal working memory (WM) load are discussed.

Signed reward prediction errors drive declarative learning.

Reward prediction errors (RPEs) are thought to drive learning. This has been established in procedural learning (e.g., classical and operant conditioning). However, empirical evidence on whether RPEs drive declarative learning-a quintessentially human form of learning-remains surprisingly absent. We therefore coupled RPEs to the acquisition of Dutch-Swahili word pairs in a declarative learning paradigm. Signed RPEs (SRPEs; "better-than-expected" signals) during declarative learning improved recognition in a follow-up test, with increasingly positive RPEs leading to better recognition. In addition, classic declarative memory mechanisms such as time-on-task failed to explain recognition performance. The beneficial effect of SRPEs on recognition was subsequently affirmed in a replication study with visual stimuli.