This Week in JAMA FREE

In an analysis of population-based data from 837 795 live-born infants in Denmark, Pasternak and Hviid Article examined the association between first-trimester exposure to acyclovir, valacyclovir, or famciclovir and the risk of major birth defects. The authors report that exposure to acyclovir or valacyclovir in the first trimester of pregnancy was not associated with an increased risk of major birth defects. In an editorial, Mills and Carter Article discuss the study findings and the need for continued investigation of the potential teratogenicity of antiviral drugs.

To assess whether elective intra-aortic balloon pump (IABP) insertion prior to percutaneous coronary intervention (PCI) reduces major adverse cardiac and cardiovascular events in patients with severe left ventricular dysfunction and extensive coronary disease undergoing PCI, Perera and colleagues randomly assigned patients to elective IABP support or to a strategy of IABP insertion only when indicated during PCI (stand-by IABP insertion). The authors found that elective IABP insertion was not associated with a reduced incidence of death, acute myocardial infarction, cerebrovascular events, or need for further revascularization at hospital discharge.

Attention-deficit/hyperactivity disorder (ADHD) in adulthood is not fully treated by pharmacotherapy alone. To assess the efficacy of cognitive behavioral therapy to treat ADHD symptoms not ameliorated by pharmacotherapy, Safren and colleagues randomly assigned 86 adults with ADHD who were symptomatic while receiving medication to 12 individual sessions of either cognitive behavioral therapy or an attention-matched control treatment—relaxation with educational support. The authors report that compared with relaxation with educational support, patients who received cognitive behavioral therapy achieved greater improvement in symptoms through 12 months of follow-up.

Protein kinase C-β—a molecule involved in cell signaling—is implicated in the development of diabetic complications. In a prospective cohort of Chinese patients with type 2 diabetes, Ma and colleagues examined the association of protein kinase C-β gene polymorphisms with incident end-stage renal disease. The authors found that 4 common variants in the protein kinase C-β 1 gene were independently associated with development of end-stage renal disease in Chinese patients with type 2 diabetes.

Pertussis may be overlooked as a cause of chronic cough, particularly in adolescents and adults. In a systematic review, Cornia and colleagues assessed the diagnostic value of 3 classically described pertussis symptoms: paroxysmal cough, posttussive emesis, and inspiratory whoop. The authors found that paroxysmal cough is a common but nonspecific symptom in pertussis infection and the presence of posttussive emesis or inspiratory whoop only modestly increases the likelihood of pertussis infection. Data relating to the diagnostic usefulness of these symptoms in a nonoutbreak setting were limited and of relatively weak quality.

“How do you tell a patient with metastatic renal cell carcinoma that she will get better, when every day the cancer is spreading and devouring every organ?” From “Hope.”

Five years after Hurricane Katrina devastated the Gulf Coast, residents of New Orleans cope with higher than expected rates of posttraumatic stress disorder and other mental health problems. The massive British Petroleum oil spill has retraumatized many.

Minimizing bias in comparative effectiveness research

Health care reform and chronic disease

Population health and comparative effectiveness research

Shared decision making: a continuum

Join Matthew K. Wynia, MD, MPH, Wednesday, September 15, from 2 to 3 PM eastern time to discuss the role of professionalism and self-regulation in medicine for detecting impaired or incompetent physicians. To register, go to http://www.ihi.org/AuthorintheRoom.

Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.

For your patients: Information about pertussis.