Does computer-assisted instruction really help to improve the learning process?

OBJECTIVES: We have developed both a computer-assisted instruction (CAI) multimedia program and a textbook on arterial blood gas interpretation with the same content as formal didactic instruction. A prospective, randomized study was designed to compare the outcomes of self-learning using the software and using the textbook. METHODS: 80 third-year medical students were randomly allocated to two groups: the CAI (n=40) and text group (n=40). A 30-item, type-K examination was administered as the pre-test. After the pre-test, the volunteers in the CAI group studied the software program, whereas those in the text group spent their time reading the textbook covering the same material. The post-test was held immediately at the end of a full day of study, and 3 weeks later, the final test was performed without prior notice. A P value of <0.05 was considered to be a statistically significant difference. RESULTS: Students in the text group seemed to fulfil their assignments and improved their scores post-test better than those in the CAI group. After 3 weeks, the final test scores of both groups demonstrated a significant decrease, but showed an insignificant difference between the two groups. CONCLUSION: Text-based learning seems to be a convenient method of education where time is limited. However, with more time available, use of software may be as good as the conventional learning method and can be an alternative tool. The computer-assisted instruction program seems to enhance the learning process.

Cross-validation of a composite pain scale for preschool children within 24 hours of surgery.

This study was designed to cross-validate a composite measure of the pain scales CHEOPS (Children's Hospital of Eastern Ontario Pain Scale), OPS (Objective Pain Scale, simplified for parent use by replacing blood pressure measurement with observation of body language or posture), TPPPS (Toddler Preschool Postoperative Pain Scale) and FLACC (Face, Legs, Activity, Cry, Consolability) in 167 Thai children aged 1-5.5 yr. The pain scales were translated and tested for content, construct and concurrent validity, including inter-rater and intra-rater reliabilities. Discriminative validity in immediate and persistent pain for the age groups < or =3 and >3 yr were also studied. The children's behaviour was videotaped before and after surgery, before analgesia had been given in the post-anaesthesia care unit (PACU), and on the ward. Four observers then rated pain behaviour from rearranged videotapes. The decision to treat pain was based on routine practice and was made by a researcher unaware of the rating procedure. All tools had acceptable content validity and excellent inter-rater and intra-rater reliabilities (intraclass correlation >0.9 and >0.8 respectively). Construct validity was determined by the ability to differentiate the group with no pain before surgery and a high pain level after surgery, before analgesia (P<0.001). The positive correlations among all scales in the PACU and on the ward (r=0.621-0.827, P<0.0001) supported concurrent validity. Use of the kappa statistic indicated that CHEOPS yielded the best agreement with the routine decision to treat pain. The younger and older age groups both yielded very good agreement in the PACU but only moderate agreement on the ward. On the basis of data from this study, we recommend CHEOPS as a valid, reliable and practical tool.

Preoperative autologous blood collection and haemodilution with gelatin solution (gelifundol).

Autologous blood collection and haemodilution with gelatin solution had an effect on the decrease in red blood cells, haemoglobin, haemotocrit, fibrinogen and platelets; however, this technique had no effect on coagulograms, platelet function and haemostasis. In conclusion, this technique is suitable and possibly practical in obtaining sufficient blood for elective surgical patients and is without any undesirable side effects.