Highlights

Arthroscopic surgery for meniscal tears

Is arthroscopic surgery helpful for the treatment of degenerative meniscal tears in patients with knee pain and mild or no concurrent osteoarthritis? This systematic review and meta-analysis showed that there is little benefit in reducing pain or improving function in either the short or long term. The authors suggest that a trial of nonoperative management should be the first-line treatment for such patients. See Research, page 1057

Cognitive impairment and stroke risk

Cognitive impairment increases the risk of subsequent stroke. This systematic review of cohort studies found a 39% increase in relative risk of stroke after adjusting for potential confounding factors. Cognitive impairment should be recognized as an early manifestation of cerebral infarction, prompting measures to prevent stroke and further deterioration, suggest the authors. See Research, page E536

Melatonin to prevent delirium

Disturbance of the sleep–wake cycle is common in patients with delirium. But which comes first: disrupted sleep or acute cognitive impairment? In patients at high risk of delirium, such as older adults presenting for emergency treatment for hip fracture, could regular administration of melatonin reduce the incidence of delirium? It seems the answer is “no,” according to this pragmatic multicentre, randomized trial conducted in the Netherlands. See Research, page E547

Rehabilitation in advanced cancer

Evidence suggests that rehabilitation interventions that include both physical activity and nutritional components can improve quality of life and augment the treatment for patients with advanced cancer. Canadian palliative care units should expand their use of such services, particularly in early palliative care. See Review, page 1071

Vaccination for health care workers

Do condition-of-service vaccination policies for health care workers comply with the Canadian Charter of Rights and Freedoms? Vanessa Gruben and colleagues discuss the policies and their interpretation in the law. See Analysis, page 1076

Transient monocular vision loss

A 65-year-old man experiences three brief episodes of painless vision loss in his right eye over a month. What clinical clues on history and examination can help determine the cause? Which investigations should be performed urgently? The authors address these and other questions on the management of transient monocular vision loss. See Decisions, page 1085

Refusal of treatment

A 53-year-old woman with a long-standing history of paranoid schizophrenia and advanced renal disease refuses renal dialysis. Kadri and colleagues review the legal and ethical issues health care providers may encounter in this situation. See Cases, page 1087

Dry eye disease

Although dry eye is common, affecting about one-third of people over the age of 50, it can substantially affect quality of life. Sharma and Mather review the latest approaches to managing this condition, noting that excessive use of preserved artificial tears can exacerbate the symptoms. See Five things to know about …, page 1090

Tongue trapped in a water bottle

A 10-year-old healthy girl got her tongue stuck in a metal water bottle by sucking out air and creating a vacuum effect. It’s not an easy fix according to Fernandes and colleagues. See what had to be done. See Clinical images, page 1091