0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
This Week in JAMA | April 24, 2013|

This Week in JAMA FREE

JAMA. 2013;309(16):1655. doi:10.1001/jama.2012.145385.
Text Size: A A A
Published online

PRENATAL EXPOSURE TO VALPROATE AND RISK OF AUTISM

Animal studies and several patient case series have suggested a possible association between in utero exposure to the antiepileptic drug valproate and autism. In a population-based study of 655 615 Danish children born from 1996 to 2006 and followed up for a mean 8.8 years (range, 4-14 years), Christensen and colleagues examined whether prenatal exposure to valproate was associated with an increased risk of autism spectrum disorders. The authors report that maternal use of valproate during pregnancy was associated with an increased risk of autism spectrum disorder and childhood autism in the offspring, even after adjusting for autism risk factors and maternal epilepsy. In an editorial, Meador and Loring discuss risks of in utero exposure to valproate.

See Article, Editorial, and

PERIOPERATIVE Β-BLOCKADE AND MORTALITY POSTSURGERY

Whether perioperative β-blockade is effective and safe for patients undergoing noncardiac surgery is not clear. London and colleagues evaluated exposure to β-blockers on the day of or the day after major noncardiac surgery in a population-based sample of 136 745 patients treated at 104 Veterans Health Administration hospitals between January 1, 2005, and August 31, 2010. Analyses included classification of patients based on revised cardiac risk index (CRI) predictors and propensity-score matching. The authors found that perioperative exposure to β-blockers was associated with lower rates of 30-day all-cause mortality and cardiac morbidity among patients with 2 or more revised CRI factors who underwent nonvascular surgery.

See Article

ADULT FUNCTIONING AFTER CHILDHOOD MENINGITIS

Sequelae of childhood bacterial meningitis include seizure disorders, motor deficits, and cognitive impairment. To examine the relationship between childhood meningitis and functioning in adulthood, Roed and colleagues assessed educational achievement and economic self-sufficiency among 2924 adults who had bacterial meningitis in childhood and compared attainment of these goals with those achieved by individuals matched on age and sex and by siblings of the study participants. The authors found that bacterial meningitis in childhood was associated with lower educational achievement and economic self-sufficiency in adulthood, particularly among individuals with a childhood history of pneumococcal or Haemophilus influenzae meningitis.

See Article

CLINICIAN'S CORNER

Diagnosing an Ectopic Pregnancy

In a systematic review and meta-analysis of 14 studies (including 12 101 patients) reporting on the diagnosis of ectopic pregnancy, Crochet and colleagues assessed the accuracy and precision of patient history, clinical examination, laboratory values, and sonography. The authors found that patient history and clinical examination alone are insufficient to indicate or exclude the possibility of an ectopic pregnancy. Transvaginal sonography is the single best diagnostic modality in this setting. Quantitative (serial) serum human chorionic gonadotropin testing can be a useful addition to the evaluation.

See Article

MEDICAL NEWS & PERSPECTIVES

Patients exposed months ago to contaminated injectable steroids continue to be diagnosed with fungal injections, and some are developing adverse events related to long-term antifungal therapy.

See Article

VIEWPOINTS

ACGME clinical learning environment review program

See Article

Evidence-based persuasion

See Article

DSM-5— notable revisions

See Article

Stemming global trade in substandard medicines

See Article

A PIECE OF MY MIND

“I felt the support of the many hands of fellow colleagues and trainees on my shoulders as I turned to face Jim.” From “One Last Teaching Moment.”

See Article

AUTHOR IN THE ROOM TELECONFERENCE

Join Justin B. Dimick, MD, MPH, Wednesday, May 15, from 2 to 3 PM eastern time to discuss bariatric surgery complications before and after establishing centers of excellence for the procedure. To register, go to http://www.ihi.org/AuthorintheRoom.

EDITOR'S AUDIO SUMMARY

Dr Bauchner summarizes and comments on this week's issue.

Go to www.jama.com.

JAMA PATIENT PAGE

For your patients: Information about low back pain.

See Article

NEXT WEEK

Theme Issue on Child Health

First Page Preview

View Large
First page PDF preview

Tables

References

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.