Teaching methods in medical education have been changing. More recent teaching modalities go beyond the traditional delivery of knowledge, promoting learning motivation and improving teaching and learning outcomes. For example, “gamification” and “serious games” are methodologies that use the principles of games to facilitate learning processes and the acquisition of skills and knowledge, thereby improving the attitude towards learning when compared to traditional teaching methods. Since dermatology is a visual field, images are a key component of different teaching strategies. Likewise, dermoscopy, a non-invasive diagnostic technique that allows the visualization of structures within the epidermis and upper dermis, also uses images and pattern recognition strategies. Although a series of Apps using game-based strategy have been created to teach and facilitate dermoscopy learning, studies are required to demonstrate their effectiveness. In this review, we summarize the current literature. This review summarizes the current evidence of game-based learning strategies in medical education, including dermatology and dermoscopy.
Dear Editors,We read with interest the article by Herzum et al. regarding adequate surgical margins for basal cell carcinoma (BCC) excision on the head and neck with the aid of dermoscopy. 1 We agree that current guidelines-proposed margins for BCC of the head and neck of 5-10 mm are sometimes not feasible due to complex anatomical and functional structures (e. g. eyelids, nose). Mohs micrographic surgery (MMS) or any technique with complete circumferential peripheral and deep margin assessment (CCPDMA) address this aforementioned issue; however, these techniques may not be available in all countries, and require additional resources and workload. 2 For these reasons, Herzum et al. performed a retrospective study evaluating the success rate of narrow surgical margins (1-3 mm) for BCC excision of the head and neck aided with dermoscopy. "Cases" were those with margins defined using dermoscopy and "controls" were those using clinical evaluation alone. The authors included biopsyproven low-risk histopathological subtypes (i. e., superficial and nodular) on the head and neck. No exclusion regarding facial H-zone (i. e., "mask zone" periocular, perioral, ears, cheeks) versus M-zone (forehead, cheeks, scalp) was performed. Histopathological samples were processed with the standard "bread-loafing" technique and not with MMS or CCPDMA techniques.The authors reported that in none of the "cases" (0/66), lateral margins were involved when using 3 mm margins vs 15% (10/66) of the "controls." Even when using narrower margins (1-2 mm), only 7% of cases had involved margins versus 25% of controls. No differences were seen between nodular versus superficial cases. At the one-year follow-up, only one recurrence (0.7%) was observed. Based on these findings, the authors propose that a "narrower" 3-mm excision with dermoscopy-aided margin delineation might be appropriate for small, well-defined, low-risk BCCs of the head and neck.The Herzum et al. study raises some concerning points that should be highlighted in order to interpret the results and before implementing their proposed narrow-margin model. First, margin assessment was evaluated using the "bread-loafing technique" and not MMS/CCPDMA. As they mentioned, <1% of samples are examined with standard
La Academia Americana de Pediatría recomienda que los lactantes menores de un año duerman en posición supina para prevenir el síndrome de muerte súbita en lactantes (SMSL).Objetivo: Describir la posición en que duermen un grupo de lactantes y factores de riesgo asociados al SMSL.Sujetos y Método: Estudio piloto, prospectivo concurrente, de lactantes < 45 días de vida en control sano en Centro Médico San Joaquín UC Christus. Criterios de exclusión: prematurez (edad gestacional < 37 semanas) y patología de base (respiratorias, metabólicas, cardiológicas). Se aplicó encuesta al cuidador principal respecto a datos demográficos y hábitos de sueño, basada en encuesta BISQ (Brief Screening Questionnaire for Infant Sleep Problems) validada en español, dado la inexistencia de instrumentos para < 3 meses.Resultados: Se obtuvo muestra de 100 lactantes de edad 16,78 ± 12,88 días de vida, siendo 57% mujeres. La madre fue el principal informante (84%). El 79% de los lactantes dormían en decúbito supino, 19% lo hacía de lado y 2% en prono. El 66% dormía en cuna en habitación de los padres, 31% en la cama de los padres. El 74% se quedaban dormidos durante la alimentación.El 28% de los lactantes estaban expuestos a tabaquismo pasivo. El 91% cuidadores estaba informado sobre la posición segura de sueño, siendo el principal informante el pediatra (54%).Conclusiones: En esta muestra se encontró alto porcentaje de lactantes < 45 días que duermen en posición no segura, siendo frecuente el colecho. Es importante implementar campañas locales de prevención del SMSL que refuercen el hábito de dormir seguro.
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