RESUMO
Data from randomized controlled trials suggest that treating hypertension in the elderly, including octogenarians, may substantially reduce the risk of cardiovascular disease and death. However, treatment remains challenging because of comorbidities and aging-related changes. We present common case scenarios encountered while managing elderly patients with hypertension, including secondary hypertension, adverse effects of drugs, labile hypertension, orthostatic hypotension, and dementia.
Assuntos
Anti-Hipertensivos/uso terapêutico , Hipertensão/tratamento farmacológico , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Demência , Feminino , Objetivos , Humanos , Hipertensão/epidemiologia , Hipertensão/terapia , Estilo de Vida , Masculino , Medição de Risco , Estados Unidos/epidemiologiaRESUMO
OBJECTIVE(S): To determine the feasibility and validity of an objective assessment tool designed to measure the development of mastoidectomy skills by resident trainees in the operating room. STUDY DESIGN: Prospective longitudinal validation study. SETTING: Tertiary referral center and residency training program. SUBJECTS: Otolaryngology residents. MAIN OUTCOME MEASURE: Technical performance as measured over time using Task-Based Checklist (TBC) and Global Rating Scale (GRS) developed for assessment of mastoidectomy skills. RESULTS: : Seventy pairs of evaluations were completed on 15 residents, showing strong correlation between both instruments (r = 0.93; p < 0.0001). Our instrument demonstrated construct validity for both TBC and GRS, showing higher scores with increasing surgical experience in otology. Both instruments showed high interitem reliability with Cronbach alpha coefficients of 0.98 and 0.95 for TBC and GRS, respectively. Regression analysis showed that thinning posterior external auditory canal (p < 0.05) and opening antrum to deepen dissection at sinodural angle (p < 0.05) were the strongest predictors of overall surgical performance. CONCLUSION: Our assessment tool is a feasible and valid method of evaluating acquisition of mastoidectomy skills in the operating room. It can be integrated into surgical teaching in the operating room and yields information for direct formative feedback.
