Francesco Ricciardi

A comprehensive review of serious games in health professions

Education of healthcare professionals is of primary importance for patient safety. In some health related professions, education and training have to be practiced during the entire working period and not only limited to school years. The use of new technology such as virtual reality and e-learning brings new possibilities with significant improvement in learning outcomes. Serious gaming describes a technology that can educate and train while entertaining users. This type of training can be very useful for health professions because it improves learning outcomes creating a learner oriented approach and providing a stealth mode of teaching. In some fields it represents an ideal instrument for continuous health professions education also in terms of costs because it is cheaper than traditional training methods that use cadavers or mannequins. In this paper we make a scoping review of serious games developed for health professions and health related fields in order to understand if they are useful tools for health related fields training. Many papers confirmed that serious gaming is a useful technology that improves learning and skills development for health professionals.

An augmented reality application for the radio frequency ablation of the liver tumors

Hepatic cancer is one of the most common solid cancers in the world. As surgery of hepatic cancer is seldom applicable, different solutions have been found to cure this disease. One of these is Liver Radiofrequency Ablation. This technique consists in a needle insertion inside the liver parenchyma in order to reach the tumor and in an injection of a radiofrequency current to cause tumor cell necrosis for hyperthermia. The needle placement task is really difficult because surgeon uses ultrasound, CT or MRI two-dimensional image to guide the needle. In this paper we present an Augmented Reality system to help the surgeon to place the needle as best as possible; the application can also help the surgeon during the preoperative planning because it offers various visualization modality of 3D models of the patients organs obtained from the medical images.

A Pre-operative Planning Module for an Augmented Reality Application in Maxillo-Facial Surgery

Treatment of deformities, diseases or traumas of the facial skeleton is very important for the functional and aesthetic importance of this structure. Craniofacial surgical techniques have had a great development during last decades. However, some problems still remain regarding the accurate repositioning of skeletal components and in defining margins in complex oncological resections. Computer technologies aid surgeons to solve these problems but most of proposed solutions are based on Virtual Reality. Virtual Reality technology provides many advantages but also the disadvantage that the surgeon has to adapt the virtual planning to the real surgical field. Augmented Reality represents the solution to this problem. We are developing an Augmented Reality platform for computer assisted surgery in the field of maxillo-facial surgery. In this paper we present the development of a surgical planning module that is integrated in this platform. The novelty is that this is the first Augmented Reality platform that includes such advanced planning module.

Development of a Serious Game for Laparoscopic Suture Training

Surgeon training in laparoscopic suturing is very important because this task generally requires an high level of experience from the surgeon. Serious gaming refers to a computer games technology where the primary goal is to train the player. In this kind of training the education goal is achieved also ensuring the entertainment and the engagement factors typical of a traditional game. This paper presents the development of a serious game for training on suturing in laparoscopic surgery that is focused on the physical modeling of the virtual environment and on the definition of a set of parameters used to assess the level of skills developed by the trainees.

An Augmented Reality System for Maxillo-Facial Surgery

Maxillo-facial surgery is a surgical field where surgical planning and navigation tools are commonly used but there is still a visualization gap among planned surgical activities and those in the operating room. We propose an Augmented Reality platform that includes a planning module and a drill guidance system. Some laboratory tests on 3D printed mandibles have been carried out in order to evaluate the system guidance uncertainty with different sets of fiducial points. The obtained mean value of guidance uncertainty has been of 1.37 mm when 2 anatomical points and 3 implanted screws were used and 1.43 mm when 5 anatomical points were used. The use of three fixed screws reduces the system mean guidance uncertainty and surgeons judged the augmented reality technology helpful in this kind of surgical procedures.

A Multicenter Survey About Companion Robot Acceptability in Caregivers of Patients with Dementia

In the frame of the European Community funded MARIO, caregivers of 139 dementia patients were recruited in National University of Ireland (NUIG), in Geriatrics Unit of IRCCS “Casa Sollievo della Sofferenza”-Italy (IRCCS) and in Alzheimer Association Bari-Italy (AAB) for a multicenter survey on to determine the needs and preferences of caregivers for improving the assistance of dementia patients, and guiding technological development of MARIO. A six minute video on technological devices and functions of MARIO was showed, and all caregivers fulfilled a 43-item questionnaire that explored four areas: (A) Acceptability, (B) Functionality, (C) Support devices, and (D) Impact. Caregivers declared that to facilitate acceptance (over 17.5%) and to improve functionality of MARIO (over 29%) should be important/likely/useful. Over 20.3% of caregivers reported that following support devices in MARIO could be useful for their patients: (1) for monitoring bed-rest and movements, (2) for monitoring the medication use, (3) for monitoring the ambient environmental conditions, (4) for regulating heating, humidity, lighting and TV channel, (5) for undertaking comprehensive geriatric assessment, (6) for link to care planning, (7) for monitoring physiological deterioration, and (8) for monitoring cognitive deterioration. Over 21.8% of caregivers declared that MARIO should be useful to improve quality of life, quality of care, safety, emergency communications, home-based physical and/or cognitive rehabilitation programs, and to detect isolation and health status changes of their patients. MARIO is a novel approach employing robot companions, and its effect will be: (1) to facilitate and support persons with dementia and their caregivers, and (2) reduce social exclusion and isolation.

Interacting with Dementia: The MARIO Approach

MARIO is a companion robot that aims to help people with dementia (PWD) to battle isolation and loneliness by enabling them to stay socially active by providing a number of applications focused on hobbies (music, movies, etc), staying engaged with communities (reading headlines, reading local twitter feeds etc.) and staying connected with family and friends (telephoning them, reading their news from twitter, etc.). This paper presents the results from the initial trials of MARIO interacting with PWD involving a limited set of applications. It confirms some of the challenges hypothesized at the outset of the study and provides guidelines for future development work.

Managing active and healthy aging with use of caring service robots (MARIO)

Europe has the highest prevalence of dementia in the world; seven million people are currently affected and this is projected to increase to 13.4 million by 2050. Across EU countries, participation of people with dementia in family and civic life is diminished by cultures of exclusion and stigmatisation. Dementia is characterised by impaired mental functioning, language and thinking. These impairments are often accompanied by personality, functional and behavioural changes. To fight loneliness and the effects suffered by people with dementia, effective techniques include those that target change of a person’s perception of loneliness and those that increase a person’s resilience. ICT solutions can be used to increase psychological skills like resilience, and to manage active and healthy aging with the use of caring service robots as will be explored with the EU funded MARIO project that involves 10 partners from 6 EU countries. In this project specific technological tools are adopted that try to create real feelings and affections making it easier for the patient to accept assistance from a robot when - in certain situations - in return the human can also support the machine. The approach targeted in MARIO is the Comprehensive Geriatric Assessment (CGA) on which the Multidimensional Prognosis Index (MPI) is based. Used effectively, the MPI can improve dramatically diagnostic accuracy, optimize medical treatment and health outcomes, improve function and quality of life, reduce use of unnecessary formal services, and institute or improve long-term care management. In MARIO, the service robot will provide information to MPI survey and evaluation process based on its observation of the instrumental activities of daily living and detection of changes regarding them. MARIO aims to address and make progress on the challenging problems of loneliness, isolation and dementia in older persons through multi-faceted interventions delivered by service robots.

Mario Project: A Multicenter Survey About Companion Robot Acceptability In Caregivers Of Patients With Dementia

In the frame of the European Community funded MARIO, caregivers of 139 dementia patients were recruited in National University of Ireland (NUIG), in Geriatrics Unit of IRCCS “Casa Sollievo della Sofferenza”-Italy (IRCCS) and in Alzheimer Association Bari-Italy (AAB) for a multicenter survey on to determine the needs and preferences of caregivers for improving the assistance of dementia patients, and guiding technological development of MARIO. A six minute video on technological devices and functions of MARIO was showed, and all caregivers fulfilled a 43-item questionnaire that explored four areas: (A) Acceptability, (B) Functionality, (C) Support devices, and (D) Impact. Caregivers declared that to facilitate acceptance (over 17.5%) and to improve functionality of MARIO (over 29%) should be important/likely/useful. Over 20.3% of caregivers reported that following support devices in MARIO could be useful for their patients: (1) for monitoring bed-rest and movements, (2) for monitoring the medication use, (3) for monitoring the ambient environmental conditions, (4) for regulating heating, humidity, lighting and TV channel, (5) for undertaking comprehensive geriatric assessment, (6) for link to care planning, (7) for monitoring physiological deterioration, and (8) for monitoring cognitive deterioration. Over 21.8% of caregivers declared that MARIO should be useful to improve quality of life, quality of care, safety, emergency communications, home-based physical and/or cognitive rehabilitation programs, and to detect isolation and health status changes of their patients. MARIO is a novel approach employing robot companions, and its effect will be: (1) to facilitate and support persons with dementia and their caregivers, and (2) reduce social exclusion and isolation.

Implementation of a Solution for the Remote Monitoring of Subjects Affected of Metabolic Diseases: The Metabolink Project

Diabetes represents one of most serious public health disease. The aim of the Metabolink project was to develop a smart solution for elderly people with diabetes and obesity, in order to promote a healthier style of life, improve diabetic control trying to reduce overall cost for the community. It consists of an app for smartphone linked to a system and a process of data collection based on bidimensional barcode (QRcode) and NFC-tag technologies. The system was accepted by all the patients and they learned efficaciously in a few hours how to use it. Unfortunately, we observed a drop-out of about 50% in the first month. Patients remaining in the study refers a slight improvement in the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) and General Satisfaction Questionnaire (GSQ) and they decided to continue to use it after the end of the follow-up.