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Artikkelissa kuvataan pelimetriikkaa tutkimusaineistona hoitotyön koulutuksen simulaatiopelitutkimuksissa. Pelien käyttämisen erityinen hyöty tutkimuksessa ja oppimisessa liittyy niiden tallentamaan tietoon opiskelijoiden käyttäytymisestä pelaamisen aikana. Pelijärjestelmään tallentuu kaikki pelaajan tekemä toiminta pelissä ja näitä toimintoja kuvaa järjestelmästä kerättävä pelimetriikka. Pelimetriikkaa voidaan käyttää itsenäisenä tutkimusaineistona tai yhdessä muiden tutkimusaineistojen kanssa kuvaamaan opiskelijoiden suoritusta, tietoja ja taitoja pelissä. Pelimetriikan käyttö tutkimusaineistona hoitotieteellisessä koulutustutkimuksessa on vielä vähäistä. Tässä artikkelissa käytetään esimerkkinä hoitotyön simulaatiopelitutkimuksia, joissa hoitotyön opiskelijoiden simulaatiopelin skenaarioiden suorittamista kuvataan pelimetriikan avulla. Tutkimuksissa pelimetriikan mitattavia kohteita olivat suoritettujen skenaarioiden määrä, keskimääräiset pisteet ja keskimääräinen peliaika. Käytettäessä pelimetriikkaa tutkimusaineistona tulosten luotettava tulkinta edellyttää selkeää määrittelyä siitä, mitä tietoa kerätään ja miksi ja miten muuttujia mitataan. Pelijärjestelmien tuottaman tiedon eettinen käyttö edellyttää erityisesti henkilöistä kerättävien tietojen tunnistamiseen liittyvien riskien tunnistamisen ja minimoimisen. Pelimetriikkaa ja tekoälyä hyödyntämällä voidaan kehittää hoitotyön opiskelijoiden tieto- ja taitotasoon mukautuvia simulaatiopelejä vastaamaan paremmin yksilöllisiin oppimistarpeisiin ja saavuttamaan yhä parempaa osaamista työelämään ja haastaviin potilastilanteisiin.

Purpose: Twenty-one patients with cancer were treated with a single round of oncolytic adenovirus ICOVIR-7.Experimental Design: ICOVIR-7 features an RGD-4C modification of the fiber HI-loop of serotype 5 adenovirus for enhanced entry into tumor cells. Tumor selectivity is mediated by an insulator, a modified E2F promoter, and a Rb-binding site deletion of E1A, whereas replication is optimized with E2F binding hairpins and a Kozak sequence. ICOVIR-7 doses ranged from 2 × 1010 to 1 × 1012 viral particles. All patients had advanced and metastatic solid tumors refractory to standard therapies.Results: ICOVIR-7 treatment was well tolerated with mild to moderate fever, fatigue, elevated liver transaminases, chills, and hyponatremia. One patient had grade 3 anemia but no other serious side effects were seen. At baseline, 9 of 21 of patients had neutralizing antibody titers against the ICOVIR-7 capsid. Treatment resulted in neutralizing antibody titer induction within 4 weeks in 16 of 18 patients. No elevations of serum proinflammatory cytokine levels were detected. Viral genomes were detected in the circulation in 18 of 21 of patients after injection and 7 of 15 of the samples were positive 2 to 4 weeks later suggesting viral replication.Conclusions: Overall, objective evidence of antitumor activity was seen in 9 of 17 evaluable patients. In radiological analyses, 5 of 12 evaluable patients had stabilization or reduction in tumor size. These consisted of one partial response, two minor responses and two cases of stable disease, all occurring in patients who had progressive disease before treatment. In summary, ICOVIR-7 treatment is apparently safe, resulting in anticancer activity, and is therefore promising for further clinical testing. Clin Cancer Res; 16(11); 3035–43. ©2010 AACR.

Supplementary Data from Oncolytic Adenovirus ICOVIR-7 in Patients with Advanced and Refractory Solid Tumors

PDF file - 48K, Description of disease at the time of first treatment.

Supplementary Figures 1-6, Tables 1-3 from Oncolytic Adenovirus Coding for Granulocyte Macrophage Colony-Stimulating Factor Induces Antitumoral Immunity in Cancer Patients

PDF file - 1MB, PBMCs of a healthy donor was stimulated with supernatant collected from virus (CGTG-401 or control virus not coding CD40L) infected A549 lung cancer cells and IL-8 production was assessed 12, 24, 48, and 72 h later with FACSArray. The increase demonstrated at later time points indicates biological activity of the virus produced CD40L.

PDF file - 1.1MB, (A) Patient serum samples were analyzed for Th1 induced cytokines interferon-� (IFN-�), tumor necrosis factor-� (TNF-�) and interleukin-2 (IL-2) and Th2 cytokines interleukin-4 (IL-4), interleukin-5 (IL-5) and Interleukin 10 (IL-10). The ratio between Th1 and Th2 type cytokines was assessed. Cytokines levels are reported relative to their baseline level, which was set as 1 and a ratio between Th1/Th2 was calculated for each time point. (B) Malignant ascites of patient R8 and pleural effusion of patient T181 were analyzed for Th1 induced cytokines IFN-� and IL-2, and for Th2 induced IL-10 before and after treatment.

PDF file - 1.2MB, Blood samples for all 9 patients were collected before (baseline) and at several time points after the treatment. Soluble CD40L (sCD40L) and RANTES concentrations in the serum were assessed. Data are presented as median � SD.

Granulocyte macrophage colony-stimulating factor (GMCSF) can mediate antitumor effects by recruiting natural killer cells and by induction of tumor-specific cytotoxic T-cells through antigen-presenting cells. Oncolytic tumor cell–killing can produce a potent costimulatory danger signal and release of tumor epitopes for antigen-presenting cell sampling. Therefore, an oncolytic adenovirus coding for GMCSF was engineered and shown to induce tumor-specific immunity in an immunocompetent syngeneic hamster model. Subsequently, 20 patients with advanced solid tumors refractory to standard therapies were treated with Ad5-D24-GMCSF. Of the 16 radiologically evaluable patients, 2 had complete responses, 1 had a minor response, and 5 had disease stabilization. Responses were frequently seen in injected and noninjected tumors. Treatment was well tolerated and resulted in the induction of both tumor-specific and virus-specific immunity as measured by ELISPOT and pentamer analysis. This is the first time that oncolytic virus–mediated antitumor immunity has been shown in humans. Ad5-D24-GMCSF is promising for further clinical testing. Cancer Res; 70(11); 4297–309. ©2010 AACR.

PDF file - 64K, Adverse reactions. 9 patients total, 6 received concomitant low-lose cyclophosphamide 50 mg/d, 3 did not. Numbers of patients experiencing the reaction at any time during their treatment (including 28d follow-up) is shown. The data is shown for the two subgroups separately in parentheses (cyclophosphamide/none).

PDF file - 41K, Response evaluation of injected and non-injected lesions.

PDF file - 58K, Prior therapies.

PDF file - 2MB, Serum levels for (A) IL-6, (B) IL-8, (C) IL-10, (D) IL-12, (E) TNF-alpha, and (F) IFN-gamma was assessed before and after the treatment. Data are presented separately for patients receiving virus treatment with or without concomitant low dose cyclophosphamide (50 mg/d) and shown as median � SD. NA, sample not available.

PDF file - 69K, Description of historical controls (Pesonen et al. Gene Ther 2010;17:892-904) treated with unarmed oncolytic adenovirus Ad5/3-cox2L-D24.

Aim: To develop an emotional intelligence (EI) test and evaluate its psychometrics for social and healthcare student selection. Design: A cross-sectional methodological design. Methods: The test was developed based on a systematic review and focus group interviews. Content validity was evaluated with expert panels, and preliminary psychometrics with two pilot studies. Descriptive statistics, correlations and item response theory were used. Data Sources: Search was conducted in six databases 2018. Focus group interviews were conducted with educators and professionals in 2019. Expert panels with doctoral students, researchers and educators were conducted in 2020. Pilot tests with students were conducted 2020–2021. The developed test was administered to 4808 applicants 2021. Results: The test included four subscales. Correlations support the test's theoretical structure. The items were mainly easy. Conclusion: The test assesses EI objectively and comprehensively. The item-level distractor analysis can be used for further test development. Impacts: Social care and healthcare students engage in clinical practice early in their studies, and these environments can be emotionally challenging. Assessing EI in student selection with adequate test can help the institutions of higher education to select the students with required abilities to succeed in the studies. The assessment of EI during student selection also provides information higher education institutions could use to develop and provide support interventions. The results may also encourage practice placements to include EI elements as learning objective. The results of this study and especially the use of IRT and detailed distractor analysis to evaluate the psychometric properties of EMI-T can benefit researchers and educators that develop or evaluate objective assessment tools with multiple choice questions. Implications for the profession and/or patient care: Emotional intelligence is important for students to enable professional interaction. publishedVersion

Aim: This study aimed to describe the psychosocial support healthcare profession-als in specialist palliative inpatient units provide to family members of palliative care patients.Design: A qualitative descriptive design.Method: The data were collected with focus group interviews and analysed with in-ductive content analysis.Results: Altogether, 48 healthcare professionals, including physicians, registered nurses and practical nurses, participated in the study. Information sharing was recog-nised as an essential element of support. Methods to improve support of family mem-bers included an opportunity to allocate recourses to the families, systematic support and strengthening healthcare professionals' competence in family care.The healthcare professionals describe their perceptions of psychosocial support for family members primarily through patient care and the patient's situation rather than family needs. Direct support for the family members is realised principally by informa-tion sharing and conversations. Healthcare professionals express their opportunities to implement support focusing on family members' needs restricted by reason of or-ganisational resources.The information can be used when developing and improving family care in pallia-tive care context to recognise the most relevant needs from healthcare profession-als' perspective and also when implementing healthcare professionals' education and training

This study evaluates the effect of nursing staff's renewed consistent pressure ulcer (PU) prevention practice on PU prevalence and the PU prevention implemented for residents. A quasi-experimental intervention study was conducted. The data were collected from 232 residents (n = 115 in intervention and 117 in comparison group) in two public long-term older people care (LOPC) facilities in Finland using the Pressure Ulcer Patient instrument (PUP-Instrument). The facilities were chosen with convenience sampling, after which they were randomly allocated as either intervention or comparison facility. Based on international guidelines for PU prevention, the renewed, consistent PU prevention practice with six areas was developed and implemented using the operational model for evidence-based practices (OMEBP). After the intervention, a significant difference between the intervention and the comparison facility was seen in the prevalence of PUs and in the residents' highest stage of PUs in the sacrum, buttock and hip areas, and heels. Between the facilities, a significant difference was seen in the use of PU and nutrition risk assessment instruments and nutritional supplements, time used for repositioning in the daytime and at night-time, lifting belt use, and avoiding shearing or stretching residents' skin. The successful intervention improved skin integrity in LOPC facilities.

The use of consistent and evidence-based practices is essential in terms of patient safety and quality of care. The purpose of this study was to describe the use of consistent practices in PU prevention based on international care guidelines and to assess the validity and reliability of the pressure ulcer prevention practice (PUPreP) instrument. The data (n = 554) were collected between 2018 and 2019 from nursing professionals working at two hospital districts in Finland using the PUPreP instrument. The instrument consisted of 42 items assessing participants' perceptions of the frequencies of pressure ulcer prevention practices with the following scale: never, sometimes, often, always. The data were analysed using statistical analysis. According to the results, the use of pressure ulcer prevention practices was more frequently described as often. The most frequently used prevention practice was repositioning, and the least frequently used practice was nutrition. Factors related to nursing professionals' pressure ulcer prevention practices were the working sector, education and working frequency in pressure ulcer prevention, and early identification of pressure ulcers. The study results suggest that the evidence-based pressure ulcer prevention practices were followed at a moderate level by nurses. The PuPreP instrument demonstrated validity and reliability, but further development is needed.

Aim To describe healthcare professionals' accessibility and transfer of patients' and family members' end‐of‐life wishes in ACP to the palliative care unit. Design The study used a qualitative descriptive study design. Methods Purposive sampling was used. The data (N = 33) were collected through interviews with physicians, registered nurses, practical nurses and social workers. The data were analysed by inductive content analysis. Results Two main categories emerged. Patients' and family members' end‐of‐life wishes documentation in relation to changing information needs was described in relation to patients' condition and care context. Transfer of patients' and family members' end‐of‐life wishes to palliative care unit included written and verbal communication. Results showed lack of implementation of ACP early, lack of implementation about the holistic interpretation of ACP into medical notes and lack of transferability of ACP into documenting systems impacting on accessibility and realization for the patient and family members at the end‐of‐life.

Effective student selection methods are needed to identify applicants who are expected to complete their studies and succeed professionally. The assessment of emotional intelligence has recently be...

The aim of this correlational, cross‐sectional study was to assess the pressure ulcer prevention attitudes of the nursing staff and to identify factors associated with it both in primary and special health care. The study was conducted with nursing staff (N = 554) working in primary and special health care units in two hospital districts in Finlandin 2018 to 2019. Attitude towards Pressure ulcer Prevention instrument was used for data collection. Demographic data, Pressure Ulcer Prevention Knowledge test, and Pressure Ulcer Prevention Practice instrument were used as background variables. Data were analysed with statistical tests. Nursing staff working in primary care (n = 327) had more positive attitudes towards pressure ulcer prevention than those in specialised care (n = 209; P = .047). Working as a wound care nurse (P = .0005), working experience after graduation (P = .0017), self‐reported pressure ulcer prevention and early detection skills (P

The aim of this scoping review was to describe the instruments used to assess the knowledge and skills of evidence-based practice (EBP) in healthcare settings.A scoping review was undertaken. Three electronic databases (CINAHL, PubMed and Cochrane) were searched in January 2022. The search phrases consisted of the following terms: healthcare professionals, EBP, competence and instrument and their synonyms, keywords and MeSH terms. The database search was run without any limitations. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to support reporting.Ultimately, 39 studies were included; most of them (35) were cross-sectional studies. The studies were conducted in 17 countries. A total of 17 evidence-based knowledge and skills instruments were identified. The Upton and Upton instrument was used in 19 studies. Twelve self-reported instruments were used only once. The psychometric properties of the instruments varied. The reliability was typically reported with Cronbach's alpha coefficient. The content of the EBP knowledge/skills instruments consists of five main categories: EBP, evaluation of current practice, preparation for the implementation of EBP, implementation of evidence and active participation in the development of EBP.Almost all instruments are self-assessment instruments. Validated knowledge tests should be further developed. The instruments emphasise the preparation for the implementation of EBP. Further research is needed to develop instruments for healthcare professionals to assess the knowledge and skills of the implementation of evidence.

This review provides a comprehensive analysis of undergraduate nursing students' exit examinations and indicates that more clinical evaluation methods should be developed to ensure adequate competence.

Background Shared decision-making is a process where the decisions regarding patients' care are done in collaboration with the patient, the patient's family and a healthcare professional or an interdisciplinary team. Shared decision-making is considered to be a part of patient centred care, and it enables patient autonomy which is a cornerstone of palliative care. In the past, research on the experiences of palliative care patients' participation in shared decision-making involving a nurse has been limited as the focus has mainly been on specific medical interventions, rather than holistic palliative care. Objectives To synthesise research findings on patient participation in shared decision-making in palliative care. Research design An integrative literature review. Methods The literature search was conducted by searching computerised databases (CINAHL, PubMed, PsychINFO and COCHRANE). The search resulted in 12 articles. The quality of the included articles was evaluated with JBI checklist, and the data analysis was done using inductive content analysis. Reporting was done according to a PRISMA checklist. Findings Patients do participate in shared decision-making and desire to participate in everyday nursing care decisions, treatment-related medical decisions and end-of-life decisions. The prerequisites for patient participation in shared decision-making are interdisciplinary teamwork, open communication, good patient-healthcare professional relationship, a favourable environment and mutual information. Conclusion Palliative care patients do participate and desire to participate in decisions that cover a much broader range of topics than just medical interventions and this should be addressed in future research and in practise. The main responsibility for successful patient participation in shared decision-making lies with the healthcare professionals and the organisations providing palliative care. There is a need to conduct more research from the patient's perspective and explore the meaning of participating in shared decision-making from the patient's point of view.

Research has shown that nursing students can learn clinical reasoning skills by engaging in simulation games. However, there has been no research regarding the effects of simulation games on clinical reasoning skills when nursing students also engage in virtual reality simulations. Furthermore, by engaging in simulation games, neither game metrics nor their impact on students' self-evaluated clinical reasoning skills has been studied. The purpose of this study was to evaluate the effects of these two kinds of simulation games using a one-group pretest-posttest design. Forty nursing students self-evaluated their clinical reasoning skills in three phases using the Clinical Reasoning Skills scale. Furthermore, the game metrics of the simulation games were analyzed, and the results clearly showed that students' self-evaluated clinical reasoning skills were systematically improved. There was a systematic association between better playing scores and better self-evaluated clinical reasoning skills in playing both kinds of simulation games. Moreover, students engaged more time in the virtual reality simulation than the computer-based simulation game. Overall, the results suggest that the use of a combination of both kinds of simulation games is an effective way for nursing students to learn clinical reasoning skills.

Good learning outcomes can be achieved in clinical reasoning using gamified simulations; however, research on the effectiveness of learning clinical reasoning skills through simulation games is still very limited. The purpose of this study is to evaluate the effectiveness of a simulation game on nursing students’ clinical reasoning skills. This study uses a quasi-experimental, one group, pre-post-test design with one-week interventions that consist of playing five surgical patient scenarios in a simulation game. The data were collected at three universities of applied sciences in Finland (1.3.2018–31.5.2019). The participants (n=376) filled out the Clinical Reasoning Skills Scale before and after playing the game. Descriptive and multivariable analyses were used. Statistically significant differences were found between the background variable categories when examining gaming activity and self-evaluated clinical reasoning skills. The participants rated their clinical reasoning skills as significantly better after playing than before playing the simulation game.

Aim: To describe the practices of nurses concerning palliative sedation in palliative care wards in hospitals. Design: Qualitative descriptive design. Methods: A total of 27 nurses were interviewed in six focus groups and one pair interview; the nurses worked on four palliative care wards in three Finnish hospitals and the interviews took place between May and November 2019. The data were analysed using inductive content analysis. The COREQ checklist was used as a guide for reporting this study. Findings: Three main categories describing nurses' practices concerning palliative sedation were identified: participation in palliative sedation decision-making, sedation implementation and monitoring and information sharing and compassionate care for the patient and relatives. Conclusions: Nurses play a key role throughout palliative sedation on palliative care wards in hospitals. To develop the quality of care, it is recommended to specify the role of nurses in palliative sedation, increase cooperation between nurses and physicians, and enhance palliative sedation education for nurses. publishedVersion

Background The use of game elements motivates students to learn and positively affects students' learning outcomes. The purpose of this review is twofold: to analyze (a) game elements in simulation games and (b) the instruments used to assess nursing students' experiences in learning clinical reasoning (CR) by using simulation games. Method The review includes nine studies retrieved from eight electronic databases. The data were analyzed deductively and inductively. Results The analysis revealed that the use of several game elements in simulation games was rare. Moreover, although several self-developed instruments used to assess students' experiences in learning CR were found, most of the instruments were poorly validated. Conclusions More game elements should be implemented in simulation games used by nursing students to learn CR. Moreover, the instruments used to assess nursing students' experiences in learning CR through simulation games should be further developed and validated.

The aim of this integrative review was to analyse the usage of different virtual reality (VR) technologies in learning and user experiences (UXs) of these technologies in healthcare practice and ed...

Background Clinical decision-making skills of paramedics have been emphasized because of the growing complexity of emergency medicine nursing. A preliminary diagnosis made by a paramedic has an essential role in directing the subsequent care. An accurate preliminary diagnosis improves the patient’s outcome. The research in this area is relatively scarce and there are no previous studies in Finland describing the accuracy of preliminary diagnoses made by paramedics. The aim of this study was to evaluate whether paramedics are making accurate preliminary diagnoses for the patients they are transporting to hospital. In addition, the aim was to describe the variables related to an accurate preliminary diagnosis. Methods A cross-sectional comparative approach was used and conducted through a questionnaire to gather data from the paramedics. A total of 71 paramedics participated in the study and 378 patient cases were included. The paramedics were asked to describe the basic information of a case, to state their preliminary diagnosis, and give their own educational background. The accuracy of the paramedic’s preliminary diagnosis was compared with the discharge diagnosis of the ED physicians retrieved from hospital’s patient records. Logistic regression analysis and a binomial test were used to test the statistical significance. Results The agreement between the paramedics’ preliminary diagnosis vs. hospital diagnosis was 70% (n = 261). Diagnostic accuracy varied according to the medical condition from mental diseases and intoxication (86%, p = 0,000), cerebral strokes (81%, p = 0,007) to infections (31% p = 0,029). The educational background of a bachelor-degree-level paramedic (p = 0,016, 95% Cl 1,7-139,6) and a good self-assessment value (p = 0,003, 95% Cl 1,2-2,7) were related to making a correct diagnosis. Conclusions Paramedics are able to determine preliminary diagnoses at satisfactory level. The relationship between educational background and diagnostic accuracy suggests that there is a definitive need for a specific pre-hospital nursing education.

Reasoning skills are needed in the future work life. As such, it is important that reasoning skills be assessed in higher education, both in the selection phase and during education. This study aim...