IntroductionEndoscopic sinus surgery (ESS) is a current procedure for treating patients with chronic rhinosinusitis (CRS). Image-guided surgery (IGS) for ESS may help reduce complications and improve precision. However, it is uncertain in which cases IGS is beneficial. This work aims to compare ESS with and without IGS in patients with CRS.Methods and analysisPubMed, Embase, Scopus, Web of Science, Scielo, Cochrane Central Register of Controlled Trials, CINAHL, LILACS and Clinicaltrials.gov will be searched for reported clinical trials comparing the quality of life and perioperative outcomes of ESS with and without navigation. The search is planned for 20 April 2022. Three independent authors will select eligible articles and extract their data. The risk of bias will be assessed using the Cochrane Handbook for Systematic Reviews of Interventions. The Grading of Recommendation Assessment, Development and Evaluation method will evaluate the strength of the evidence. Data synthesis will be performed using the Review Manager software V.5.4.1. To assess heterogeneity, I2 statistics will be computed. Additionally, meta-analysis will be performed if the included studies are sufficiently homogenous.Ethics and disseminationThis study reviews published data, and thus it is not necessary to obtain ethical approval. The findings of this systematic review will be published in a peer-reviewed journal.PROSPERO registration numberCRD42020214791.
Resumo: Introdução: As Diretrizes Curriculares Nacionais (DCN) constituem as direções para formação do currículo de um curso. As DCN do curso médico atual foram instituídas há quase uma década. Nesse período, o mundo passou por mudanças sem precedentes, e a educação médica não pode ficar para trás. Desenvolvimento: O ensino médico no Brasil teve nos últimos 100 anos três principais modelos de ensino: desde o flexneriano, passando pela Problem-Based Learning (PBL), até o atual ensino baseado em competências. O entendimento de que o aluno é o centro do processo ensino aprendizagem já está enfatizado nas DCN de 2014, mas será que esse conceito está sendo implementado na prática das instituições de ensino superior? Como as DCN podem ajudar a guiar de forma mais clara e efetiva uma formação médica que vá além do conhecimento técnico e lapidar um profissional humanizado, ético e com olhar para o indivíduo e para a comunidade? Será que precisaremos “reprogramar” o Global Positioning System (GPS), a rota, das DCN depois de enfrentarmos tantas mudanças decorrentes da pandemia da Covid-19? Conclusão: Apesar dos desafios, há crescente envolvimento do corpo docente das instituições de ensino superior nas melhorias necessárias para a formação médica atual.
Objective: The aim of this study was to compare the quality of life and complications of endoscopic sinus surgery, with and without image guidance, in patients with chronic rhinosinusitis. Design and setting: Systematic review and meta-analysis of clinical trials. PubMed, Embase, Scopus, Web of Science, SciELO, Cochrane Central Register of Controlled Trials, LILACS, and ClinicalTrials.gov were searched on April 22, 2022. Main outcome measures: A search strategy was used to retrieve clinical trials that compared the quality of life and complications of endoscopic sinus surgery with and without image guidance from the databases. The risk of bias was assessed using the Cochrane Risk of Bias tool. RevMan 5.4. was used for data synthesis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. The Grading of Recommendations Assessment Development and Evaluation method was used to evaluate the strength of the evidence. Results: A total of 3281 articles were retrieved from the databases. Six studies met the inclusion criteria, and five could be combined by meta-analysis (638 patients). Image guidance showed improved efficacy in opening diseased paranasal sinuses compared with conventional endoscopic sinus surgery (risk ratio: 0.19; 95% confidence interval, 0.04-0.85; p = 0.03). There was a trend toward a reduction in complications with image-guided surgery, although it did not reach statistical significance (risk ratio: 0.53; 95% confidence interval, 0.20-1.41; p = 0.20). Conclusion: Image guidance is an important tool that helps improve surgical results and possibly increases the safety and quality of life of patients with chronic rhinosinusitis.
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