Anterior fontanelle closure and diagnosis of non-syndromic craniosynostosis: a comparative study using computed tomography

Abstract Objective: Suspicion of early anterior fontanel (AF) closure is a common reason for referral to a pediatric neurosurgeon because of the suspected increased risk of developing craniosynostosis (CS) in spite of the absence of evidence in the literature. The aim of this study was to analyze the association between AF closure and the diagnosis of non-syndromic CS in Brazilian children. Methods: An observational and case-cohort study was conducted to compare the incidence of closed AF between healthy children (group 1) and children diagnosed with non-syndromic CS (group 2) at a pediatric neurosurgery referral center. The accuracies of completely closed AF and diagnosis of CS were assessed. Results: High-resolution three-dimensional reconstruction computed tomography scans were obtained for 140 children aged < 13 months, of whom 62.9% were boys and 37.1% were girls (p < 0.001). The most common types of non-syndromic CS were trigonocephaly (34, 48%) and scaphocephaly (25, 35.7%). Closed fontanel (27, 38.6%) was observed in both groups, and a sensitivity of 36.1%, specificity of 72%, the positive predictive value of 59%, and negative predictive value of 51% were observed in the patients diagnosed with CS when AF closure occurred before the age of 6 months. Conclusion: The results of this comparative study of AF closure and CS diagnosis suggest that early AF closure does not imply a diagnosis of CS. Pediatricians should be aware of the risk of misdiagnosis of CS in cases with a widely open AF in spite of the presence of CS.

O desenvolvimento de competências na formação médica: os desafios de se conciliar as Diretrizes Curriculares Nacionais num cenário educacional em transformação / The development of competencies in medical education: the challenges of reconciling the National Curricular Guidelines in a changing educational scenario

Introdução: Os currículos dos cursos de medicina, no Brasil, são orientados pelas Diretrizes Curriculares Nacionais (DCN) para formação médica a partir das demandas de saúde da coletividade. Muitas instituições têm, hoje, currículos orientados pelas DCN 2001 e DCN 2014. Questiona-se se a formação pelo preconizado nas DCN 2001 deixará lacunas no desenvolvimento de competências para a prática dos egressos. Parte-se da hipótese de que esses podem não ter desenvolvido competências consideradas necessárias para a prática médica. Objetivos: Identificar as competências adquiridas pelos estudantes de medicina no 6º ano de uma faculdade filantrópica de Belo Horizonte. Desvelar se esses estudantes têm as competências preconizadas bem desenvolvidas. Métodos: Pesquisa exploratória e qualitativa, financiada pela FAPEMIG. Entrevistados, escolhidos aleatoriamente, acadêmicos do 12º período de medicina de faculdade filantrópica de Minas Gerais. Após aprovação do Comitê de Ética, os estudantes foram orientados, assinaram o TCLE e responderam a um questionário estruturado. Análise de dados feita mediante técnicas de análise de comunicação, a partir da transcrição das entrevistas. Houve saturação dos dados após entrevista de 6 acadêmicos. Resultados: A totalidade dos entrevistados desconhece as DCN. Identificam bom desenvolvimento de competências na área de Atenção à Saúde e, principalmente, na de Educação em Saúde. Reconhecem que as competências na área de Gestão em Saúde não foram bem trabalhadas. Conclusões: Os entrevistados se sentem preparados para realizarem o atendimento primário dos pacientes, mas identificam falhas, com competências e habilidades não bem desenvolvidas ao longo dos seis anos de formação.(AU)

Introduction: The curricula of medical courses in Brazil are guided by the National Curricular Guidelines (DCN), fundamentals of medical education based on the health demands of the community. Many institutions today have curricula oriented by DCN 2001 and DCN 2014. It is questioned whether the training recommended by the DCN 2001 will leave gaps in the development of skills for the practice of graduates. It is assumed that these may not have developed skills considered necessary for medical practice. Objectives: To identify the competences acquired by medical students in the 6th year of a philanthropic college in Belo Horizonte. Uncovering whether these students have the well-developed competencies advocated. Methods: Exploratory and qualitative research, financed by FAPEMIG. Interviewees, randomly chosen, academics of the 12th period of medicine from the philanthropic college of Minas Gerais. After approval by the Ethics Committee, the students were instructed, signed the TCLE and answered a structured questionnaire. Data analysis performed through communication analysis techniques, from the transcription of interviews. There was saturation of the data after interview of 6 academics. Results: All respondents were unaware of NCDs. They identify good development of competencies in the area of ??Health Care and, especially, in Health Education. They recognize that the competences in the area of ??Health Management have not been well worked. Conclusions: The interviewees feel prepared to perform the primary care of the patients, but identify failures, with skills and abilities not well developed during the six years of training. (AU)