Development and Assessment of an Online Computer- Assisted Instruction Method.

Objectives: The purposes of this study were to develop an online computer-assisted instruction method and assess its efficiency in terms of propriety, feasibility, accuracy and utility standards. Method: The sample consisted of third-year medical students and critical care nurses, who volunteered to join the study. Research tools included online activities and student assessments, open-ended questionnaires and students' record profiles. Data was analysed using the percentage, mean, standard deviation, correlation coefficient and t-test. Results: A total of 83 out of 116 third-year medical students (71.55%) and 35 out of 56 critical care nurses (62.50%) registered through the website, and completed the learning courseware. Results of the system efficiency assessment through the tests and open-ended questionnaires showed that it was highly appropriate for use in communicating for learning; it was also found that the system was highly feasible in stimulating learners to continuously plan for self-directed learning and for system accuracy. It appeared that the system had objectivity, construct validity, concurrent validity, and internal reliability; and for system utility, it was found that learners gained high learning achievement and growth scores. Online record profiles revealed that 63 medical students and 35 nurses appreciated the significance of the developed online learning system as fair to full. Conclusion: The online computer-assisted instruction method was highly efficient. Through selfdirected learning, the students were stimulated to apply problem-solving strategies, individual help seeking strategies, and self-regulation, as well as develop critical thinking with discretion for selfassessment and continue learning with a sense of self-actualization and self-esteem.

A multicenter randomized double-blind comparison of remifentanil and alfentanil during total intravenous anaesthesia for out-patient laparoscopic gynaecological procedures.

We compared Remifentanil, an esterase-metabolized opioid, with Alfentanil as part of the total intravenous anesthesia with propofol and atracurium for out-patient laparoscopic gynaecological procedures in a multicenter randomized, double-blind study. We chose Remifentanil 1 mg./kg.for bolus injection and a continuous infusion of 0.25-0.5 microg./kg./min, compared to Alfentanil 20 microg./kg. For bolus injection and a continuous infusion of 0.5-1 microg./kg./min. Fifty-nine patients received Remifentanil, and sixty-three received Alfentanil. Patients who received Remifetanil experienced significantly fewer stress responses to surgical stimuli (p < 0.05) and required fewer additional boluses of study drugs and propofol (p < 0.05) than Alfentanil during the intraoperative period. Response time to verbal commands, spontaneous respiration, adequate respiration and tracheal extubation, were not significantly different between these two opioids. Remifentanil patients, required more fentanyl for post operative pain control, 40 from 59 cases in the Remifentanil group and 22 from 63 cases in the Alfentanil group (p < 0.05) but still showed significantly better recovery of psychomotor function by Aldrete score of ten at 50 and 60 min (p < 0.05) than Alfentanil patients. The incidence of intraoperative bradycardia was significantly higher with Remifentanil. Other incidences of nausea, emesis, urinary retention and postural hypotension were similar. All patients were ready to be discharged from the hospital within two hours after extubation except for one patient in the Alfentanil group who needed five hours of hospital stay because of urinary retention, nausea and severe emesis.