Keuhkokuvaus CareMe-oppimispelin avulla : suunnitelma pelin sisällöstä

Opinnäytetyön tarkoituksena oli tuottaa CareMe-simulaatiopeliin osio röntgenhoitajaopiskelijoille keuhkokuvauksesta. Opinnäytetyön lopputuloksena syntyi suunnitelma, kuinka keuhkokuvausprosessi tulisi etenemään CareMe-simulaatiopelissä. Röntgenhoitajaopiskelijoille ei ole vielä suunniteltu yhtään oppimispeliä CareMe-pelipohjaan. CareMe-oppimispeli sijoittuu terveydenhuollon ympäristöön, jossa opetellaan erilaisten potilastapausten avulla potilaan kohtaamista ja hoitoa erilaisilla toimenpiteillä. Suunnittelimme potilastapauksen röntgenosastolle, jossa röntgenhoitajaopiskelijan tulee suorittaa keuhkokuvaus. Keuhkokuvaus on yleisin röntgenkuvauskohde. Peli alkaa lähetteen lukemisella, käsittää kuvanlaatuun liittyviä tekijöitä, potilaan ohjeistuksen ja loppuu kuvien arkistoimiseen. Peli sisältää erilaisia monivalintatilanteita ja ajastettuja kohtauksia. Lisäksi pelissä on kokeneempi röntgenhoitaja antamassa jatkuvaa palautetta pelaajalle hänen suorituksestaan. Opinnäytetyön teoriapohja perustuu keuhkokuvantamisprosessin eri vaiheisiin, kuvien laatuun ja yleisimpiin virheisiin keuhkokuvissa. Näistä tekijöistä muodostuvat pelin kysymykset. Lisäksi perehdyimme oppimistapoihin ja pelien tapaan opettaa ihmistä, jotta peli tulisi olemaan rakenteeltaan opetusta tukeva. Aloittelevakin röntgenhoitajaopiskelija pystyy opinnäytetyön luettuaan vastaamaan suunnitellun CareMe-pelin kysymyksiin. Jotta suunnittelemamme peli vastaisi kohderyhmämme tarpeita, suoritimme kyselyn ensimmäiselle röntgenharjoittelujaksolle meneville opiskelijoille. Kysely sisälsi peliin suunnittelemamme kysymykset sekä kysymyksiä liittyen opiskelijoiden kokemuksiin pelin sisällöstä ja mielenkiintoisuudesta. Palaute oli positiivista ja osa vastanneista innostui pelistä ideana. Tulevat opinnäytetyöt voisivat koskea muita kuvauskohteita tai -laitteita ja keskittyä enemmän röntgenhoitajan rooliin potilashoitajana tai konehoitajana. Muiden alojen opiskelijat, kuten mediatekniikan opiskelijat, voisivat toteuttaa suunnittelemamme pelin konkreettiseksi tuotteeksi.The purpose of our thesis was to develop a part to the CareMe-learning game about thorax imaging for radiographer students. The outcome of the thesis was an outline on how thorax examination process will progress in the CareMe-learning game. So far, thorax imaging has not been included in the CareMe-learning game for radiographer students. CareMe-learning game is situated in a healthcare environment, where the students play through patient cases on how to face patients and perform various procedures. We developed a patient case for an x-ray department in which a radiographer student performs thorax imaging procedures, since thorax is the most common x-ray examination. The game begins with reading of the referral, and includes questionnaires related to the quality of the images, giving instructions for the patient, and ends with archiving the images. The game includes different multiple-choice situations, and exercises with time limits. In addition, there is a more experienced radiographer character in the game, who gives continuous feedback to the player of her/his performance. The theoretical basis of our thesis is based on the different phases of the thorax imaging process, quality of the images, and the most common mistakes made in thorax imaging. The questions in the game came from these topics. Also, we studied different learning styles, and how games can facilitate the learning process, so that the structure of the game complements teaching. After reading this thesis, even first semester radiographer student is able to answer the questions of our CareMe-learning game. We gave a questionnaire to students, who were about to start their first practical x-ray training period to make sure that the game we developed would meet the needs of the target audience. The questionnaire included the questions we had planned for the game, and questions on how the students perceived the content of the game and whether it was interesting or not. The feedback was positive, and some participants got interested in the game. Future research could include studies on imaging other parts of the body, imaging with different modalities, or focus more on the radiographer’s role in working with patients or machines. Students with different majors, such as media engineering students, could make our plans a reality

Laskimoverinäytteenotto vakuumitekniikalla : opasvideo lähihoitajaopiskelijoille

Laskimoverinäytteen avulla saadaan tietoa potilaan terveydentilasta. Laskimoverinäytteenotto on yleisin näyt-teenottotapa, koska se on helpoiten vakioitavissa ja sillä saadaan otettua suuri näytemäärä kerralla. Laskimoveri-näytteenotto kuuluu muidenkin terveysalan ammattilaisten kuin bioanalyytikoiden työnkuvaan. Tutkimusten mukaan terveydenhuollon henkilöstö ei tiedosta tarpeeksi preanalyyttisten tekijöiden merkitystä tutkimuksen laatuun, vaikka preanalyyttiset virheet muodostavat jopa 70 % kaikista laboratoriotutkimusprosessin virheistä. Preanalytiikalla tarkoitetaan kaikkia toimenpiteitä, jotka tehdään ennen näytteen analysointia. Toiminnallisen opinnäytetyön tarkoituksena oli tuottaa video laskimoverinäytteenotosta Savon ammatti- ja aikuis-opiston lähihoitajaopiskelijoiden opetuskäyttöön. Savon ammatti- ja aikuisopisto kaipasi laajempaa ja tuoreempaa opasvideota laskimoverinäytteenotosta. Opinnäytetyön tavoitteena oli tukea lähihoitajaopiskelijoiden näytteenottoon ja preanalytiikkaan liittyvien asioiden oppimista. Opasvideota voidaan hyödyntää muun opetusmateriaalin ohella harjoiteltaessa laskimoverinäytteenottoa. Työn toimeksiantaja oli Savon ammatti- ja aikuisopisto. Raporttiin koottiin teoriatietoa oppaan tekemisestä sekä laskimoverinäytteenotosta vakuumitekniikalla ja sen prea-nalyyttisistä tekijöistä. Sama laskimoverinäytteenoton teoriatieto sisällytettiin videoon. Videolla esitettiin hoitajan ja potilaan välinen näytteenottotilanne. Opasvideo on kahdeksan minuutin pituinen ja painottuu visuaaliseen ja audi-tiiviseen oppimiseen. Videosta pyydettiin palautetta opettajilta sekä bioanalytiikan opiskelijoilta ja se tallennettiin DVD:n muotoon.Venous blood sample provides information about the patient’s health. Venipuncture is the most common method for collecting samples, because it is easiest to standardise and gives a large amount of sample at once. In addition to the biomedical laboratory scientist, venipuncture is a part of other healthcare professional’s work. Studies show that healthcare personnel are not aware of the effects of preanalytical factors to the quality of the analysis even though preanalytical errors amount up to 70 % of errors in laboratory process. Preanalysis includes every step before the sample analysis. The purpose of this practice-based bachelor’s thesis was to create a video of venipuncture using the vacuum tech-nique. The video is for educational use of the practical nurse students in Savo vocational college. Savo vocational college needed more extensive and renewed educational video. The goal of this bachelor’s thesis was to support learning of venipuncture and preanalytics of the practical nurse students. The educational video can be used in addition to other teaching material when learning venipuncture. The subject of the thesis was received from Savo vocational college. This report was compiled with theoretical knowledge about making a guide together with venipuncture using the vacuum technique and its preanalytical factors. The same theoretical knowledge was included in the video. The video presents a venipuncture situation between phlebotomist and patient.The video is eight minutes long and it focuses on visual and auditive learning. The video received feedback from lecturers and was recorded on DVD

The Relationship Between Sleep Characteristics and Unmet Physical Activity Need in Older Women

Objective: We examined among older women the association of sleep quality, daytime tiredness, and sleep duration with unmet physical activity need, that is, wishing to be more physically active but perceiving no opportunity for it. Method: Cross-sectional logistic regression analyses among women aged 74 to 86 years (Finnish Twin Study on Aging, third wave, n = 302). Results: Thirty-one participants reported unmet physical activity need. Short sleepers had fivefold and long sleepers threefold odds for unmet physical activity need compared with normative sleepers, while for daytime tiredness the odds were double. Presence of daytime tiredness and unmet physical activity coincided with higher prevalence of chronic diseases, depressive symptoms and walking difficulties, which partly explains the observed associations. Poor sleep quality was not associated with unmet physical activity need. Discussion: Older women with nonoptimal sleep characteristics who perceive unmet physical activity need may benefit from solutions that improve their perceived opportunities for physical activity.Peer reviewe

A machine learning approach to small area estimation: predicting the health, housing and well-being of the population of Netherlands.

BACKGROUND: Local policymakers require information about public health, housing and well-being at small geographical areas. A municipality can for example use this information to organize targeted activities with the aim of improving the well-being of their residents. Surveys are often used to gather data, but many neighborhoods can have only few or even zero respondents. In that case, estimating the status of the local population directly from survey responses is prone to be unreliable. METHODS: Small Area Estimation (SAE) is a technique to provide estimates at small geographical levels with only few or even zero respondents. In classical individual-level SAE, a complex statistical regression model is fitted to the survey responses by using auxiliary administrative data for the population as predictors, the missing responses are then predicted and aggregated to the desired geographical level. In this paper we compare gradient boosted trees (XGBoost), a well-known machine learning technique, to a structured additive regression model (STAR) designed for the specific problem of estimating public health and well-being in the whole population of the Netherlands. RESULTS: We compare the accuracy and performance of these models using out-of-sample predictions with five-fold Cross Validation (5CV). We do this for three data sets of different sample sizes and outcome types. Compared to the STAR model, gradient boosted trees are able to improve both the accuracy of the predictions and the total time taken to get these predictions. Even though the models appear quite similar in overall accuracy, the small area predictions at neighborhood level sometimes differ significantly. It may therefore make sense to pursue slightly more accurate models for better predictions into small areas. However, one of the biggest benefits is that XGBoost does not require prior knowledge or model specification. Data preparation and modelling is much easier, since the method automatically handles missing data, non-linear responses, interactions and accounts for spatial correlation structures. CONCLUSIONS: In this paper we provide new nationwide estimates of health, housing and well-being indicators at neighborhood level in the Netherlands, see ’Online materials’. We demonstrate that machine learning provides a good alternative to complex statistical regression modelling for small area estimation in terms of accuracy, robustness, speed and data preparation. These results can be used to make appropriate policy decisions at a local level and make recommendations about which estimation methods are beneficial in terms of accuracy, time and budget constraints

Neighborhood Mobility and Unmet Physical Activity Need in Old Age : A 2-Year Follow-Up

Background: Many older people report a willingness to increase outdoor physical activity (PA), but no opportunities for it, a situation termed as unmet PA need. The authors studied whether lower neighborhood mobility and PA precede the development of unmet PA need. Methods: Community-dwelling 75- to 90-year-old people (n = 700) were interviewed annually for 2 years. Unmet PA need, neighborhood mobility, and PA were self-reported. In addition, accelerometer-based step counts were assessed among a subgroup (n = 156). Results: Logistic regression analyses revealed that lower baseline neighborhood mobility (odds ratio 3.02, 95% confidence interval [1.86, 4.90] vs. daily) and PA (odds ratio 4.37, 95% confidence interval [2.62, 7.29] vs. high) were associated with the development of unmet PA need over 2 years. The participants with higher step counts had a lower risk for unmet PA need (odds ratio 0.68, 95% confidence interval, [0.54, 0.87]). Conclusion: Maintaining higher PA levels and finding solutions for daily outdoor mobility, especially for those with declines in health, may protect from the development of unmet PA need.peerReviewe

Outdoor Mobility and Use of Adaptive or Maladaptive Walking Modifications among Older People

Background. In old age, decline in functioning may cause changes in walking ability. Our aim was to study whether older people who report adaptive, maladaptive or no walking modifications differ in outdoor mobility. Methods. Community-dwelling people aged 75–90 years (N=848) were interviewed at baseline, of whom 761 participated in the 2-year follow-up. Walking modifications were assessed by asking the participants whether they had modified their way of walking 2 kilometers due to their health. Based on the responses, three categories were formed: no walking modifications (reference), adaptive (e.g., walking more slowly, using an aid) and maladaptive walking modifications (reduced frequency of walking, or having given up walking 2 km). Differences between these categories in life-space mobility, autonomy in participation outdoors and unmet physical activity need were analyzed using Generalized Estimation Equations (GEE) models. Results. Participants with maladaptive walking modifications (n=238) reported the most restricted life-space mobility (β -9.6, SE 2.5, p<0.001) and autonomy in participation outdoors (β 1.7, SE 0.6, p=0.004) and the highest prevalence of unmet physical activity need (OR 4.3, 95% CI 1.1–16.5) at baseline and showed a decline in these variables over time. Those with no walking modifications (n=285) at baseline exhibited the best values in all outdoor mobility variables and no change over time. Although at baseline those with adaptive walking modifications (n=325) resembled those with no modifications, their outdoor mobility declined over time. Conclusion. Adopting adaptive modifications may postpone decline in outdoor mobility whereas the use of maladaptive modifications has unfavorable consequences for outdoor mobility.peerReviewe

Perceived Opportunities for Physical Activity and Willingness to Be More Active in Older Adults with Different Physical Activity Levels

This study examined equity in physical activity (PA) by investigating whether perceived opportunity for PA was associated with willingness to be more active. Among community residents (75, 80, or 85 years old, n = 962) perceived opportunity for PA (poor and good), willingness to be more active (not at all, a bit, and a lot), and level of PA (low, moderate, and high) were assessed via questionnaires. Multinomial logistic regression showed that physical activity moderated the association between poor opportunity and willingness to increase PA. Among those with moderate PA, poor opportunity for PA increased the odds of willingness to be a lot more active (multinomial odds ratio, mOR 3.90, 95% confidence interval 2.21–6.87) than not wanting to be more active compared to those perceiving good opportunities. Associations were similar at high PA levels (p < 0.001), but were not found at low PA levels. Those with moderate or high PA wish to increase their activity particularly when the perceived opportunities for activity are not optimal. Among those with low PA, perceived opportunities are not associated with a perceived need to increase physical activity. Increasing equity in physical activity in old age requires provision of support and opportunities at every level of physical activity.peerReviewe

Active aging – resilience and external support as modifiers of the disablement outcome: AGNES cohort study protocol

Abstract Background Population aging increases the need for knowledge on positive aspects of aging, and contributions of older people to their own wellbeing and that of others. We defined active aging as an individual’s striving for elements of wellbeing with activities as per their goals, abilities and opportunities. This study examines associations of health, health behaviors, health literacy and functional abilities, environmental and social support with active aging and wellbeing. We will develop and validate assessment methods for physical activity and physical resilience suitable for research on older people, and examine their associations with active aging and wellbeing. We will examine cohort effects on functional phenotypes underlying active aging and disability. Methods For this population-based study, we plan to recruit 1000 participants aged 75, 80 or 85 years living in central Finland, by drawing personal details from the population register. Participants are interviewed on active aging, wellbeing, disability, environmental and social support, mobility, health behavior and health literacy. Physical activity and heart rate are monitored for 7 days with wearable sensors. Functional tests include hearing, vision, muscle strength, reaction time, exercise tolerance, mobility, and cognitive performance. Clinical examination by a nurse and physician includes an electrocardiogram, tests of blood pressure, orthostatic regulation, arterial stiffness, and lung function, as well as a review of chronic and acute conditions and prescribed medications. C-reactive protein, small blood count, cholesterol and vitamin D are analyzed from blood samples. Associations of factors potentially underlying active aging and wellbeing will be studied using multivariate methods. Cohort effects will be studied by comparing test results of physical and cognitive functioning with results of a cohort examined in 1989–90. Conclusions The current study will renew research on positive gerontology through the novel approach to active aging and by suggesting new biomarkers of resilience and active aging. Therefore, high interdisciplinary impact is expected. This cross-sectional study will not provide knowledge on temporal order of events or causality, but an innovative cross-sectional dataset provides opportunities for emergence of novel creative hypotheses and theories