Search

Introduction: The evaluation of memory is a crucial aspect of both cognitive research and clinical applications, as it offers valuable insights into an individual's cognitive wellbeing and performance. Conventional neuropsychological assessments represent the established method for assessing different aspects of memory. Recent technological advancements, specifically in the field of virtual reality (VR), have introduced novel methods for evaluating memory., Objective: This systematic review aims to examine the current state of memory assessment using VR technologies, assessing the degree of convergence and divergence between VR-based memory assessments and conventional neuropsychological tests., Method: A systematic review of the literature was conducted searching PubMed, PsycINFO, Web of Science databases, leading to the incorporation of 24 studies. Studies were grouped according to the examined memory domain (episodic, prospective, spatial domain). Convergence and divergence validity were examined for each, and information on software and hardware features was collected., Results: This review demonstrates a notable alignment between VR-based memory assessments and conventional neuropsychological tests. Moreover, VR tasks have shown to exhibit associations with executive functions and overall cognitive performance. The inclusion of various ecological contexts, such as residential environments, commercial establishments, and simulated scenarios, serves to augment the ecological validity of memory evaluations conducted in VR., Discussion: The findings indicate that VR assessments demonstrate a functional perspective by effectively capturing the dynamic relationship between memory, executive functions, and overall cognitive performance. Nevertheless, it is imperative to acknowledge and tackle certain constraints that may hinder the widespread adoption and utilization of VR tasks. These limitations encompass factors such as restricted accessibility to VR tasks and the presence of heterogeneity in VR hardware and software. The dynamic and ever-changing nature of VR technology presents a range of potential avenues for future investigation and utilization in the domain of memory evaluation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Mancuso, Sarcinella, Bruni, Arlati, Di Santo, Cavallo, Cipresso and Pedroli.)

Accidents at work may force workers to face abrupt changes in their daily life: one of the most impactful accident cases consists of the worker remaining in a wheelchair. Return To Work (RTW) of wheelchair users in their working age is still challenging, encompassing the expertise of clinical and rehabilitation personnel and social workers to match the workers' residual capabilities with job requirements. This work describes a novel and prototypical knowledge-based Decision Support System (DSS) that matches workers' residual capabilities with job requirements, thus helping vocational therapists and clinical personnel in the RTW decision-making process for WUs. The DSS leverages expert knowledge in the form of ontologies to represent the International Classification of Functioning, Disability, and Health (ICF) and the Occupational Information Network (O*NET). These taxonomies enable both workers' health conditions and job requirements formalization, which are processed to assess the suitability of a job depending on a worker's condition. Consequently, the DSS suggests a list of jobs a wheelchair user can still perform, exploiting his/her residual abilities at their best. The manuscript describes the theoretical approach and technological foundations of such DSS, illustrating its development, its output metric, and application. The developed solution was tested with real wheelchair users' health conditions provided by the Italian National Institute for Insurance against Accidents at Work. The feasibility of an approach based on objective data was thus demonstrated, providing a novel point of view in the critical process of decision-making during RTW., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Wearable sensors are widely used to gather psychophysiological data in the laboratory and real-world applications. However, the accuracy of these devices should be carefully assessed. The study focused on testing the accuracy of the Empatica 4 (E4) wristband for the detection of heart rate variability (HRV) and electrodermal activity (EDA) metrics in stress-inducing conditions and growing-risk driving scenarios. Fourteen healthy subjects were recruited for the experimental campaign, where HRV and EDA were recorded over six experimental conditions (Baseline, Video Clip, Scream, No-Risk Driving, Low-Risk Driving, and High-Risk Driving) and by means of two measurement systems: the E4 device and a gold standard system. The overall quality of the E4 data was investigated; agreement and reliability were assessed by performing a Bland-Altman analysis and by computing the Spearman's correlation coefficient. HRV time-domain parameters reported high reliability levels in Baseline (r > 0.72), Video Clip (r > 0.71), and No-Risk Driving (r > 0.67), while HRV frequency domain parameters were sufficient in Baseline (r > 0.58), Video Clip (r > 0.59), No-Risk (r > 0.51), and Low-Risk Driving (r > 0.52). As for the EDA parameters, no correlation was found. Further studies could enhance the HRV and EDA quality through further optimizations of the acquisition protocol and improvement of the processing algorithms.

Background: Employment is an essential component of life as it provides income, sense of engagement and opportunities for personal development. Unemployment due to disability following an accident may have dramatic social and psychological consequences on individuals; it is thus fundamental to foster return to work of these persons., Objective: The present work was aimed to develop a methodology determining suitable jobs for people living with disability after a job-related accident., Methods: The Occupational Information Network (O*NET) taxonomy was combined with the International Classification of Functioning, Disability and Health (ICF) to match individual resources with specific job requirements. ICF Linking Rules were employed by two independent groups of researchers to associate ICF codes to O*NET skill and ability descriptors., Results: O*NET descriptors were linked to 92 unique ICF codes. A "Criticality score" combining ICF and O*NET features to assess suitability of selected jobs for persons with disabilities was also proposed., Conclusions: The proposed methodology represents a novel instrument to support return to work; the capability to assess specific work-related facets through the lens of both the ICF model and O*NET taxonomy would conceivably provide vocational rehabilitation specialists and occupational therapists with a useful tool fostering job placement of workers with disability.

Introduction: Virtual reality (VR) is a digital technology currently considered to implement rehabilitation programs for children with ADHD, a disorder characterised by inattention, overactivity and impulsiveness. This study presents the results of the acceptance and usability of a VR application developed for children with ADHD aiming to provide an environment capable of supporting the development of the different attentional components. Due to COVID-19 restrictions, this study had the secondary aim of assessing whether a remote evaluation was feasible and meaningful., Methods: A sample of 20 clinical experts (neuro and psychomotor therapists of the developmental age) was involved in assessing the proposed environment. Two different tools have been applied: the Technology Acceptance Model (TAM-3) questionnaire and a semi-structured interview were self-administered. Six sessions were planned in total, and each one lasted 30 min., Results: With respect to the acceptance of the system, the mean of the answers given is for most of the constructs greater than 4, showing agreement among experts. Cronbach alpha and correlations of subscales seem to confirm the reliability of measures. According to results from the interviews, the developed application has shown versatility in being able to be applied to the heterogeneity of the disorder and it was also possible to obtain valuable insights on possible additional features and functionalities. Regarding the secondary aim, the collected outcomes were positive: all the participants were satisfied with what they could perceive about the application., Conclusions: The results of this work pave the way for a future validation study with children due to the active participation of clinicians and their unanimous positive judgement confirming that the application was considered user-friendly and well accepted., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

Mild cognitive impairment (MCI) is an early stage of cognitive abilities loss and puts older adults at higher risk of developing dementia. Virtual reality (VR) could represent a tool for the early assessment of this pathological condition and for administering cognitive training. This work presents a study evaluating the acceptance and the user experience of an immersive VR application representing a supermarket. As the same application had already been assessed in Italy, we aimed to perform the same study in Estonia in order to compare the outcomes in the two populations. Fifteen older adults with MCI were enrolled in one Rehabilitation Center of Estonia and tried the supermarket once. Afterwards, they were administered questionnaires aimed at evaluating their technology acceptance, sense of presence, and cybersickness. Estonian participants reported low side effects and discrete enjoyment, and a sense of presence. Nonetheless, their intention to use the technology decreased after the experience. The comparison between Italian and Estonian older adults showed that cybersickness was comparable, but technology acceptance and sense of presence were significantly lower in the Estonian group. Thus, we argue that: (i) cultural and social backgrounds influence technology acceptance; (ii) technology acceptance was rather mediated by the absence of positive feelings rather than cybersickness.

Background and Study Aim: Advance biliopancreatic endoscopies are nowadays performed in non-operating room anesthesia (NORA) under general anesthesia (GA). We evaluate the outcomes of non-intubated patients in prone position who received GA for endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) in a tertiary referral center for digestive endoscopy., Patients and Methods: Anesthesiological records, anamnestic, and intraoperative data of patients who underwent advanced therapeutic biliopancreatic endoscopies at our tertiary referral center from January 2019 until January 2020 were collected in the present observational study., Results: One hundred fifty-three patients (93 M; median age: 68-year-old; mean ASA status: 2) were considered eligible for a procedure in the prone position with GA in spontaneous breathing. Prone position was always the initial setting. Propofol administration through a target-controlled infusion (TCI) pump was the choice to achieve GA. In our experience, desaturation appears to be the most frequent adverse event, accounting for 35% of cases (55/153). Treatment foresaw additional oxygen through a nasopharyngeal catheter, which proved to be a sufficient measure in almost all patients (52/55). Other adverse events (i.e., inadequate sedative plan, pain, and bradycardia) accounted for 2.6% of cases (4/153)., Conclusions: Non-intubated GA in the prone position may be regarded as a safe procedure, as long as the anesthesiological criteria of exclusion are respected and the anesthesiological team has become acquainted with the peculiar NORA setting and familiar with the management of possible adverse events., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Saudi Journal of Anesthesia.)

Background: Virtual reality (VR) has recently emerged as a promising means for the administration of cognitive training of seniors at risk of dementia. Immersive VR could result in increased engagement and performances; however, its acceptance in older adults with cognitive deficits still has to be assessed., Objective: To assess acceptance and usability of an immersive VR environment requiring real walking and active participants' interaction., Methods: 58 seniors with mild cognitive impairment (MCI, n = 24) or subjective cognitive decline (SCD, n = 31) performed a shopping task in a virtual supermarket displayed through a head-mounted display. Subjective and objective outcomes were evaluated., Results: Immersive VR was well-accepted by all but one participant (TAM3 positive subscales > 5.33), irrespective of the extent of cognitive decline. Participants enjoyed the experience (spatial presence 3.51±0.50, engagement 3.85±0.68, naturalness 3.85±0.82) and reported negligible side-effects (SSQ: 3.74; q1-q3:0-16.83). The environment was considered extremely realistic, such as to induce potentially harmful behaviors: one participant fell while trying to lean on a virtual shelf. Older participants needed more time to conclude trials. Participants with MCI committed more errors in grocery items' selection and experienced less "perceived control" over the environment., Conclusion: Immersive VR was acceptable and enjoyable for older adults in both groups. Cognitive deficits could induce risky behaviors, and cause issues in the interactions with virtual items. Further studies are needed to confirm acceptance of immersive VR in individuals at risk of dementia, and to extend the results to people with more severe symptoms.

Sense of presence (SoP) has recently emerged as one of the key elements promoting the effectiveness of virtual reality-based training programs. In the context of wheelchair simulators (WSs), the effectiveness of the simulation has been sought using different perception and interaction devices, providing the end-users with different levels of SoP. We performed a scoping review searching scientific and grey literature databases with the aim of assessing the extent of published research dealing with SoP and effectiveness of WSs. Sixty-two articles, describing 29 WSs, were included in the review. In spite of promising results, the high heterogeneity of the employed technological solutions, of the training programs and of their outcomes precluded drawing definitive conclusions about the optimal solution for the enhancement of SoP and thus of WSs' effectiveness. Future research should focus on controlled trials in order to help researchers in assessing the most suitable technologies and methodologies for the application of WSs in clinical practice.

A substantial number of patients are at high-risk of intra- or post-operative complications or both. Most perioperative deaths are represented by patients who present insufficient physiological reserve to meet the demands of major surgery. Recognition and management of critical high-risk surgical patients require dedicated and effective teams, capable of preventing, recognize, start treatment with adequate support in time to refer patients to the satisfactory ICU level provision. The main task for health-care planners and managers is to identify and reduce this severe risk and to encourage patient's safety practices. Inadequate tissue perfusion and decreased cellular oxygenation due to hypovolemia, heart dysfunction, reduced cardiovascular reserve, and concomitant diseases are the most common causes of perioperative complications. Hemodynamic, respiratory and careful sequential monitoring have become essential aspects of the clinical practice both for surgeons and intensivists. New monitoring techniques have changed significantly over the past few years and are now able to rapidly identify shock states earlier, define the etiology, and monitor the response to different therapies. Many of these techniques are now minimally invasive or non-invasive. Advanced hemodynamic and respiratory monitoring combines invasive, non-invasive monitoring skills. Non-invasive ultrasound has emerged during the last years as an essential operative and perioperative evaluation tool, and its use is now rapidly growing. Perioperative management guided by appropriate sequential clinical evaluation combined with respiratory and hemodynamic monitoring is an established tool to help clinicians to identify those patients at higher risk in the attempt to reduce the complications rate and potentially improve patient outcomes. This review aims to provide an update of currently available standard concepts and evolving technologies of the various respiratory and hemodynamic monitoring systems for the high-risk surgical patients, highlighting their potential usefulness when integrated with careful clinical evaluation., Competing Interests: Competing interestsNone of the authors have any conflicts of interests to declare. The authors received no pharmaceutical or industrial support for this study. No further direct or indirect financial support or other assets were transferred to the authors or their family members for this study., (© The Author(s). 2019.)

Frailty is a pre-clinical condition that worsens physical health and quality of life. One of the most frequent symptoms of frailty is an increased risk of falling. In order to reduce this risk, we propose an innovative virtual reality motor rehabilitation program based on an immersive tool. All exercises will take place in the CAVE, a four-screen room with a stationary bike. The protocol will include two types of exercises for the improvement of balance: "Positive Bike" and "Avoid the Rocks." We will choose evaluation scales related to the functional aspects and subjective perception of balance. Our aim is to prove that our innovative motor rehabilitation protocol is as effective as or more effective than classical rehabilitation., (Copyright © 2019 Pedroli, Cipresso, Greci, Arlati, Boilini, Stefanelli, Rossi, Goulene, Sacco, Stramba-Badiale, Gaggioli and Riva.)

To illustrate the effectiveness of our intensive multidisciplinary management (IMM) in the treatment of severely ill patients with necrotizing soft tissue infections (NSTIs). A retrospective observational study was conducted in a general ICU. Thirty-two consecutive patients undergoing IMM were carefully compared with 30 consecutive patients receiving a standard management (SM). IMM combined intensive care management, early surgical debridement followed by daily inspection of surgical wounds, close microbiological surveillance, and targeted high-dose antibiotics. IMM was associated with the better decrease of daily SOFA score (p = 0.04). Also, IMM caused + 12% increase in the overall number of surgical procedures (p = 0.022) and a higher number of tissue biopsies/per day (median 0.63 versus 0.32; p = 0.025), leading to a more targeted antimicrobial changes (89.6% vs 51.6%; p < 0.00001). High-dose daptomycin (75% vs 36.7%; p = 0.002) and extended/continuous infusion of beta-lactams (75% vs 43.3%; p = 0.011) were more frequently utilized. A specific efficiency score correlated with the decrease of SOFA score (efficacy) in IMM patients only (p = 0.027). Finally, IMM was associated with a significant lower ICU mortality rate (15.6% vs 40%; p = 0.032). IMM was more effective than SM as it allowed the earlier control of infection and the faster reduction of multiple organ-dysfunction.

Frailty is a clinical condition affecting the elderly population which results in an increased risk of falls. Previous studies demonstrated that falls prevention programs are effective, but they suffer from low adherence, especially when subjects have to train unsupervised in their homes. To try to improve treatment adherence, virtual reality and social media have been proposed as promising strategies for the increase of users' motivation and thus their willingness to practice. In the context of smart homes, this work presents SocialBike, a virtual reality-based application aimed at improving the clinical outcomes of older frail adults in their houses. Indeed, SocialBike is integrated in the "house of the future" framework and proposes a Dual Task training program in which the users are required to cycle on a stationary bike while recognizing target animals or objects appearing along the way. It also implements the possibility of training with other users, thus reducing the risk of social isolation. Within SocialBike, users can choose the multiplayer mode they prefer (i.e., collaborative or competitive), and are allowed to train following their own attitude. SocialBike's validation, refinement, and business model are currently under development, and are briefly discussed as future works., Competing Interests: The authors declare no conflict of interest.

The growing elderly population and the increased incidence of mild cognitive impairment (MCI) and Alzheimer's disease (AD) call for the improvement of the quality and the efficacy of the healthcare and social support services. Exercise and cognitive stimulation have been demonstrated to mitigate cognitive impairment and oxidative stress (OxS) has been recognized as a factor that contributes to the advancement of neurodegenerative diseases. Taking these aspects into account, the impact of a novel virtual reality (VR)-based program combining aerobic exercise and cognitive training has been evaluated in the pilot study proposed here. Ten patients (aged 73.3 ± 5.7 years) with MCI (Mini-Mental State Examination, MMSE: 23.0 ± 3.4) were randomly assigned to either 6 weeks physical and cognitive training (EXP) or control (CTR) group. Evaluations of cognitive profile, by a neuropsychological tests battery, and OxS, by collection of blood and urine samples, were performed before and at the end of the experimental period. The assessment of the patients' opinions toward the intervention was investigated through questionnaires. EXP group showed a tendency towards improvements in the MMSE, in visual-constructive test and visuo-spatial tests of attention, while CTR worsened. EXP group showed a greater improvement than CTR in the executive test, memory functions and verbal fluency. No statistical significance was obtained when comparing within and between both the groups, probably due to small number of subjects examined, which amplifies the effect of the slight heterogeneity in scores recorded. Despite a greater worsening of Daily Living Activities tests, all participants reported a better performance in real life, thanks to the elicited self-perceived improvement. After training intervention OxS (i.e., reactive oxygen species (ROS) production, oxidative damage of lipids and DNA) decreased resulting in significantly (range p < 0.05-0.001) lower in EXP vs. CTR group. Although not conclusive, the recorded effects in the present study are promising and suggest that this proposal would be a useful tool in support of cognitive training reducing OxS too. However, further studies on larger scale samples of patients are needed.

We present the architecture and usability evaluation of virtual reality system-"Positive Bike"-designed for improving cognitive and motor conditions in frail elderly patients. The system consists of a cycle-ergometer integrated in an immersive virtual reality system (CAVE) which allows combining motor and cognitive exercises according to a "dual-task" paradigm. We tested the usability and user's experience of the prototype in a pilot evaluation study that involved five elderly patients. The prototype was tested in one-session training to understand the limitations and areas for improvement of our system. The evaluation consisted in (i) usability assessment using the system usability scale; (ii) evaluation of user's engagement using the flow state scale; and (iii) expert evaluation involving interviews with domain experts. Results showed a good usability, both for system usability scale and the semi-structured interview. The level of flow (i.e., enjoyment with the task at hand) measured using the short flow state scale, was also high. Analysis of semi-structured interview carried out with domain experts provided further indications to improve the system. Overall, these findings show that, despite some limitations, the system is usable and provides an enjoyable user's experience.

Background: Return to work represents an important milestone for workers who were injured during a workplace accident, especially if the injury results in needing a wheelchair for locomotion., Objective: The aim of the study was to design a framework for training novice wheelchair users in regaining autonomy in activities of daily living and in the workplace and for providing medical personnel with objective data on users' health and work-related capabilities., Methods: The framework design was accomplished following the "Usability Engineering Life Cycle" model. According to it, three subsequent steps defined as "Know your User", "Competitive Analysis" and "Participatory Design" have been carried out to devise the described framework., Results: The needs of the end-users of the framework were identified during the first phase; the Competitive Analysis phase addressed standard care solutions, Virtual Reality-based wheelchair simulators, the current methodologies for the assessment of the health condition of people with disability and the use of semantic technologies in human resources. The Participatory Design phase led to the definition of an integrated user-centred framework supporting the return to work of wheelchair users., Conclusion: The results of this work consists in the design of an innovative training process based on virtual reality scenarios and supported by semantic web technologies. In the near future, the design process will proceed in collaboration with the Italian National Institute for Insurance against Accidents at Work (INAIL). The whole framework will be then implemented to support the current vocational rehabilitation process within INAIL premises.

Background: This study aimed to determine the accuracy of commonly used preoperative difficult airway indices as predictors of difficult mask ventilation (DMV) in obese patients (BMI >30 kg/m2)., Methods: In 309 consecutive obese patients undergoing general surgery, the modified Mallampati test, patient's Height/Thyromental distance ratio, Inter-Incisor Distance, Protruding Mandible (PM), history of Obstructive Sleep Apnea and Neck Circumference (NC) were recorded preoperatively. DMV was defined as Grade 3 mask ventilation (MV) by the Han's scale (MV inadequate, unstable or requiring two practitioners). Data are shown as means±SD or number and proportions. Independent DMV predictors were identified by multivariate analysis. The discriminating capacity of the model (ROC curve area) and adjusted weights for the risk factors (odds ratios) were also determined., Results: BMI averaged 42.5±8.3 kg/m2. DMV was reported in 27 out of 309 patients (8.8%; 95%CI 5.6-11.9%). The multivariate analysis retained NC (OR 1.17; P<0.0001), limited PM (1.99; P=0.046) and Mallampati test (OR 2.12; P=0.009) as risk predictors for DMV. Male gender was also included in the final model (OR 1.87; P=0.06) as biologically important variable albeit the borderline statistical significance. The model yielded a good discriminating capacity (ROC curve 0.85). The four parameters were used to create an unweighted prediction score (ROC curve 0.84) with >2 associated factors as the best discriminating point for DMV., Conclusion: Obese patients show increased incidence of DMV with respect to the undifferentiated surgical population. Limited PM, Mallampati test and NC are important DMV predictors.

Background: This study compares ropivacaine and levobupivacaine when administered for cervical plexus block. The authors therefore compared the arterial pressure profile and the incidence of hypotension between drugs., Methods: Forty-eight patients scheduled for carotid artery surgery (American Society of Anesthesiologists [ASA] 2-3) were randomly assigned to receive levobupivacaine or ropivacaine (24 patients each). Neurological status, arterial pressure profile and control of postoperative pain were the main observed parameters. All patients had severe carotid stenosis (>80%) and/or had suffered transient ischemic attacks (TIAs) or preoperative strokes. The same team performed anesthesia and surgery for carotid endarterectomy; the cervical block was performed according to Moore's technique.Arterial pressure, heart rate and S(a)O(2p) were monitored continuously with particular regard to T0 (baseline), T1 (immediately before carotid clamping), T2 (immediately before declamping) and T3 (at the end of the procedure). Hypotension was defined as the fall of arterial systolic pressure 30% below baseline or less than 100 mmHg., Results: Arterial pressure fell significantly in both groups at T1 with respect to T0 (P<0.0001). Levobupivacaine patients showed higher mean arterial pressure on T0 (112+/-12 mmHg versus 103+/-7 mmHg; P<0.05), thus suggesting a more pronounced vasodilator effect, as confirmed by the larger drop of arterial diastolic pressure (P=0.007). An absolute 6% difference of hypotension-related drug was recorded with levobupivacaine (19%) as compared with ropivacaine (13%) (P=0.28)., Conclusions: Levobupivacaine has a greater vasodilatory effect than ropivacaine. Its higher incidence of hypotension, although not statistically significant, suggests ropivacaine as the drug of choice for cervical plexus block.

The case of a 3-year-old boy affected with varicella associated to acute cellulitis by group A beta-hemolytic streptococci is reported. The causes of hospitalization were: high fever, decline of condition, onset of scarlet exanthema and a severe swelling in the inguinoscrotal area, during varicella. The diagnosis of streptococcal infection was confirmed by positive pharyngeal tampon, scarlet exanthema and following rise of ASLO. Since the association of these two infections is reported in literature more and more frequently, the possible causes and precautionary measures are analysed.