Clinical Chemistry 43: 2015, 1997;
(Clinical Chemistry. 1997;43:2015.)
© 1997 American Association for Clinical Chemistry, Inc.
Acid Base Disorders—Computer-Aided Learning Software on CD-ROM. James Hooper, ed. London: Association of Clinical Biochemists, 1996, $72. ISBN 1-899938-00-1.
Charles G. Durbin, Jr.
Department of Anesthesiology, University of Virginia, Charlottesville, VA 22908
Acid base disorders—computer-aided learning
software on CD-ROM consists of two clinical cases illustrating the
use of acid-base analysis in clinical decision making. In an active
form of learning, the student must make choices to confirm diagnoses
and make management decisions. Tutoring and "consultation" with an
expert are available throughout the entire process. Incorrect diagnoses
are critiqued, and the user is directed to the "library" for
additional study. Multiple-choice questions are presented throughout
each scenario, and a record of student performance is displayed. Each
case consists of five parts: brief history, clinical assessment,
chemical assessment, diagnosis and treatment, and resolution–summary.
Following the case, the student is presented with several brief cases
and questions. A set of essay questions are part of this final stage.
This learning package is most appropriate for residents or
advanced medical students and should be used as a supplement to basic,
didactic instruction. It is also an excellent review for the
established practitioner. It is unlikely that any user will answer all
the questions correctly, as they represent a broad and detailed
investigation of salicylate toxicity and Wilson disease. Differential
diagnosis is emphasized throughout the scenarios. Incorrect diagnoses
are explored only if the student chooses one of them.
The content of the CD-ROM is excellent and the cases are realistic. The
scenarios reflect the British medical system, with junior doctors
providing primary care and Consultants overseeing the process. If one
overlooks the British spellings and phrasing, the text is succinct and
readable for American audiences. Both international and common
laboratory values are used throughout the text. Minimal references are
provided for most topics and many of these are textbooks. The
acid–base calculator tool can be used with "traditional" or SI
values. To complete both cases requires ~2 h (without the essays).
One annoyance is that it is not possible to backtrack in the case: To
repeat a section requires starting the entire program over. The
instruction manual describes a "Backup" button but it did not
appear on my version of the program.
This is a multimedia presentation, and multiple window overlays present
the case and the working tools to the student simultaneously. Despite
an attractive interface design, many of the windows (the arterial blood
gas browser, for instance) require many key or mouse clicks to use.
Also, each window has a different control system (buttons, arrows,
dials, and menus are all used), which creates too many distractions
from the case material. However, anyone familiar with "Windows"
will quickly feel at home navigating the controls. The only audio in
the program are sound effects related to window activities. These are
somewhat distracting but can be disabled. The user tools include the
ability to place bookmarks in the browser (however, not in the
scenarios), a user note pad, and cut-and-paste options for review or
printing. The browser can be run independently of the clinical cases
and used for study. The program could be improved by adding additional
cases to enhance learning opportunities and by adding an instructor
module to help track student performance.
The program can be installed on the hard drive (13 megs of disk
space) or run from the CD-ROM drive (still requiring 7 megs of space).
It will not run with Windows "Large Fonts". This restriction is not
identified in the manual or disk information. I ran it successfully
under both Windows 95 and Windows 3.1. A double-speed or higher CD-ROM
drive provides sufficient speed to run the program; however, to install
it to the hard drive is very slow unless a quad speed or higher is
used.
