JLGH Spring 2025 Recap
Q&A for Extended Learning
Q: Are there safe and effective alternatives to carotid endarterectomy to treat stenosis?
A: The ROADSTER 3 trial demonstrated that transcarotid artery revascularization (TCAR), in standard-risk patients, is safe and effective at treating stenosis without incurring increased risk of stroke. Clinicians should review the study’s data to aid in shared decision-making discussions with patients being offered the procedure.
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Q: In the context of caring for older patients, we must sometimes assess capacity to ensure we are acting in their best interest. What is capacity and how can it be assessed?
A: Capacity is the ability to comprehend relevant information about illness and make decisions that align with personal values and preferences. One option to help evaluate a patient’s capacity in the inpatient setting is to use the University of Toronto’s Aid to Capacity Evaluation (ACE).
Q: What are the three peripherally acting mu-opioid receptor antagonists approved for use in treating opioid-induced constipation, and when can they be used?
A: Methylnaltrexone, naloxegol, and naldemedine can be used after patients have been on opioids for a minimum of four weeks.
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Q: What assessments should clinicians use in the initial workup for older adults with suspected kidney disease?
A: Glomerular filtration rate, electrolytes, and the albumin-to-creatinine ratio. Additionally, tools such as the Kidney Failure Index can help determine the need for further nephrology consultation.
Read the article.
Q: What are some causes of acquired methemoglobinemia?
A: Although methemoglobinemia is rare, use of dapsone, exposure to nitric oxide or nitrates in food or well water, use of isobutyl nitrates, and exposure to topical anesthetics such as benzocaine and lidocaine are all potential causes of this life-threatening condition.
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