Highlights

Equitable access to sick leave

Physicians and public health officials often advise those who are unwell to stay home from work. However, this may not be possible for employees without paid sick leave or job protection. Heymann and Daku comment on Canadian policies to protect sick employees and highlight areas for improvement. See Commentary, page 975

Surgical management of epilepsy

As many as 68% of patients with focal epilepsy do not achieve freedom from seizures after taking two to three antiepileptic drugs. Uncontrolled epilepsy has numerous adverse consequences. Surgical resection of the epileptic focus has good results in selected patients. Jette and colleagues explore the evidence. See Review, page 997

Given that intractable epilepsy adversely affects the developing brain and confers substantial psychosocial burden, referring suitable children for evaluation for epilepsy surgery is important. See Commentary, page 973

Obstructive sleep apnea and cancer

Obstructive sleep apnea was not associated with the prevalence or incidence of cancer. This observational study analyzed clinical and cancer registry data for 10 149 patients who had a diagnostic sleep study between 1994 and 2010 at a single academic hospital. Whether associations might exist with specific cancer subtypes requires further study, say the authors. See Research, page 985

Vascular risk in polymyalgia rheumatica

Patients with polymyalgia rheumatica have an increased risk of vascular events. Based on information from the United Kingdom’s General Practice Research Database on more than 3000 patients with and 12 000 patients without polymyalgia rheumatica, the risk was greatest in the youngest age groups. Attention should be paid to management of risk factors for vascular disease in these patients, suggest the authors. See Research, page E495

Quality improvement in preterm infants

A quality improvement program led to better neonatal outcomes for extremely preterm infants. This prospective cohort study evaluated 6026 infants admitted to 25 tertiary-level neonatal units across Canada during a baseline year and three years thereafter during which site-specific practice changes were implemented. The results show that the program is generalizable, say the authors. See Research, page E485

Inguinal hernia

A 55-year-old man presents with an easily reducible inguinal hernia that has been causing him some discomfort. Does he require investigations to confirm the diagnosis? Should he be referred to a surgeon for repair? Bohnen answers these and other questions in this discussion of inguinal hernias. See Decisions, page 1010

Telemedicine for retinopathy of prematurity

Timely screening for and treatment of retinopathy of prematurity reduce the risk of blindness in premature infants, but access is limited in remote areas. The combination of digital imaging using a pediatric fundus camera with telemedicine may improve access to screening for this condition. See Innovations, page 1012

Bupropion abuse

Bupropion is a commonly used antidepressant and smoking cessation aid; however, its abuse is a growing public health problem. Abusers report receiving a “high” similar to that felt from cocaine abuse. The authors caution that in all cases of bupropion overdose, seizures should be anticipated. See Five things to know about … page 1015

Childhood Aleppo boil

A seven-year-old girl had a crusted papular lesion on her cheek. Polarized dermoscopy showed features consistent with cutaneous leishmaniasis. The authors tell us more about diagnosing and managing this infection. See Clinical images, page 1016