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INTRODUCTION: Serious Games (SG) are an educational strategy used in the health professions with positive results in teaching diagnosis and facilitating the application of concepts and knowledge transfer. A type of SG is the branching scenario, which has the potential for a linear story or multiple options to achieve learning goals. There must be evidence for this type of SG's instructional design (InD) and usability. OBJECTIVE: Propose an InD for the branching scenario and rate its usability. MATERIALS AND METHODS: We conducted a two-phase study. In the first phase, we drafted an InD based on the literature review, and then, we applied an expert validation process through a modified Delphi technique. With the consent of InD, we built five branching scenarios. In the second phase, we apply an instrument to measure the SG usability of the branching scenarios in a cross-sectional study with 216 undergraduate medical students. RESULTS: A proposal for an InD for branching scenarios was elaborated. This InD has five dimensions with steps and definitions that help the designer fulfill the requirements for the SG. With the InD, we developed five branching scenarios for undergraduate medical students. Finally, the rates for the usability of the branchings had high scores. The branching SG with multiple options offers different outcomes for the same clinical problem in a single activity. DISCUSSION: The proposal of a specific InD for branching scenarios considered SG theory and was tested, at least in user usability. The steps proposed include the specificity of the requirements of an SG, such as levels, checkpoints, avatars, and gameplay characteristics, among others, in contrast to the other InD that do not explicitly consider them. One of the limitations of this study is that we applied it only using the H5P software to develop branching scenarios with no other evidence of the performance of the InD in different contexts or platforms. CONCLUSIONS: We propose using an InD to construct branching scenarios. This kind of SG has specific characteristics for its correct operation. Using structured steps in developing SG improves the probability of developing decision-making skills. Using an instrument to assess the usability of at least one dimension of the SG is also recommended to identify opportunity areas.
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Resumen: La deshidratación es un estado clínico como consecuencia de la pérdida de agua y solutos, las causas en adultos son diversas, entre ellas están las pérdidas gastrointestinales, renales, alteraciones en la piel (quemaduras) o secuestro del tercer espacio (fracturas). El diagnóstico es clínico, los signos y síntomas determinan el grado de deshidratación y el tratamiento a implementar. En este trabajo se hace una revisión sobre la fisiología, fisiopatología, cuadro clínico, y manejo terapéutico del paciente adulto, ya que existe escasa literatura dirigida a este grupo etario.
Abstract: Dehydration is a clinical state due to the loss of water and solutes; in adults the causes of this clinical state are diverse: gastrointestinal and renal losses, skin alterations (burns) or sequestration of the third space (fractures). The diagnosis is clinical, the signs and symptoms determine the degree of dehydration and the treatment to be implemented. In this work a review is made on the physiology, pathophysiology, clinical picture and therapeutic treatment of the adult patient, since there is little literature directed to this age group.
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Resumen Para la medicina preventiva, la exploración de mama es un elemento valioso con el que se cuenta para buscar en forma intencionada una tumoración sospechosa y realizar una detección oportuna de cáncer; de ahí la importancia de efectuar este procedimiento con la técnica correcta, ya que desde la inspección puede mostrar cambios ostensibles o sutiles, información que se puede corroborar o ampliar con la palpación completa de la mama, que incluirá las zonas de las cadenas ganglionares que con mayor frecuencia se ven afectadas por la diseminación del tumor.
Abstract For preventive medicine breast exploration is an important tool to purposely search for any suspicious tumor and making early cancer detection. For this reason, the performance of the adequate technique to explore the patient´s breast is fundamental for the early detection of any suspicious lesion. The changes in the breast might be either evident or with minimal modifications during the inspection. The information obtained could be confirmed or completed with the complete exploration of the breast including those lymphatic nodes associated with the spread of the tumor.
