Highlights

Pregnancy and isotretinoin

Risks of maternal isotretinoin therapy to the developing fetus are well recognized. However, the isotretinoin pregnancy prevention program in Canada was relatively ineffective over a 15-year period in which nearly 60 000 women in four provinces received prescriptions for the drug. Fewer than a third of participants received prescriptions for oral contraceptives while being treated. Of the 1473 pregnancies that occurred during or up to 42 weeks after treatment, more than 90% were either spontaneously terminated or aborted by medical intervention. See Research, page 723

Time to rename palliative care?

There is a strong stigma attached to palliative care, stigma that may persist even after positive experiences with an early palliative care intervention, find Zimmerman and colleagues in their qualitative study that followed participants in a randomized trial of early palliative care. See Research, page E217

Early palliative care improves quality of life, symptom management and satisfaction with care in patients with advanced cancer. Stigma associated with the term palliative care may be a barrier to timely referral. The term “supportive care” may be viewed more favourably, but barriers to implementation can be addressed only by complete integration into routine oncology care. See Commentary, page 711

Preterm birth and chronic disease risk

Infants born preterm are at increased risk of hypertension, cardiovascular events, diabetes, chronic pulmonary disease, medical complications in pregnancy and possible osteoporosis in adulthood. Maintaining a low threshold for screening with the aim of mitigating risks is prudent, say the authors. See Review, page 736

Sickle cell pain crisis

Do all patients with sickle cell vasoocclusive crisis require admission to hospital? What investigations, if any, are required? How is pain best managed during a crisis? Ward and colleagues address these and other questions on the diagnosis and management of a sickle cell vasocclusive pain crisis. See Decisions, page 745

Cardiac glycoside poisoning from foxglove

An older Chinese couple accidentally ate foxglove leaves and developed signs and symptoms of cardiac glycoside poisoning. The authors describe the differences in management of pharmaceutical and nonpharmaceutical cardiac glycoside poisoning. See Cases, page 747

Myelodysplastic syndrome

Often presenting as fatigue, myelodysplastic syndrome is a common cause of unexplained anemia, especially macrocytic anemia, in older adults. Wells and coauthors discuss recent advances in the diagnosis and management of this condition. See Five things to know about …, page 751

Migration of a port-a-cath

Houston and Yan describe a case in which the catheter tip of an implanted central venous access device migrated from the upper right atrium to the ipsilateral jugular vein. Spontaneous migration of these devices has an incidence of up to 1.8% and typically presents with neck or shoulder pain, venous phlebitis or thrombosis. See Clinical images, page 752