A theory of effective computer-based instruction for adults

Computer-based instruction (CBI) was considered the technological phenomenon to revolutionize education and training. Today, the Internet and computer technology are reported to have significantly altered the education landscape (Johnson & Aragon, 2002). The rapid advances in technology, the need for lifelong learning, and the growth of non-traditional students have encouraged the use of the computer as a method of instructional delivery. Evaluating the effectiveness of CBI as a whole technology is very difficult. The inability to measure effectiveness is attributable in part to the fact that CBI is not just one component, but a complex range of services and activities carried out for instructional and learning purposes (Gibbons & Fairweather, 2000). This study presents a theory of critical components that impact the effectiveness of computer-based instruction for adults. The theory was developed to provide a framework for research to explain or predict effective learning by adults using a desktop computer. The five conclusions drawn from this research are: (1) the characteristics of self-directedness and computer self-efficacy of adult learners play an important role in designing CBI for adults; (2) learning goal level impacts instructional design strategy and instructional control component of CBI design; (3) external support and instructional support are needed to provide a positive CBI experience; (4) CBI design is interwoven with the units of self-directedness, computer self-efficacy, learning goal level, instructional design, and external support; and (5) the theory draws together the isolated variables researchers consider important in the adult learning process and aligns them to provide effective CBI

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Effect of Antiplatelet Therapy on Survival and Organ Support–Free Days in Critically Ill Patients With COVID-19

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