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In This Issue of JAMA
April 14, 2015

Highlights

JAMA. 2015;313(14):1393-1395. doi:10.1001/jama.2014.11679
Research

In a retrospective cohort study involving 322 323 children, Xiang and colleagues assessed the relationship between intrauterine exposure to maternal type 2 diabetes (n = 6496) or gestational diabetes (n = 25 035) and the risk of an autism spectrum disorder diagnosis. In analyses adjusted for potential confounders, the authors found that compared with no diabetes exposure, exposure to maternal gestational diabetes diagnosed before 26 weeks’ gestation—but not maternal preexisting type 2 diabetes—was associated with an increased risk of autism spectrum disorders in the offspring.

Author Video Interview and Continuing Medical Education

Among nonelderly patients with mitral valve disease requiring valve replacement, the best prosthesis—bioprosthetic or mechanical—is not clear. In a retrospective cohort study that involved 3433 patients aged 50 to 69 years who were undergoing primary isolated mitral valve replacement, Chikwe and colleagues assessed survival and major morbidity outcomes during 15 years of follow-up. In a propensity score–matched analysis (664 patient pairs), the authors found no survival difference among patients who received a mechanical vs bioprosthetic valve replacement. Mechanical valves were associated with a lower risk of reoperation but greater risk of bleeding and stroke.

Observational data suggest that patient adherence to dabigatran—a target-specific oral anticoagulant—may be suboptimal and associated with increased risk of stroke and death. To explore site-level, practice-related factors possibly associated with dabigatran adherence, Shore and colleagues analyzed data from 4863 patients prescribed dabigatran at 67 Veterans Administration health care sites. The authors found significant variability in patient medication adherence across sites. Factors associated with higher levels of adherence included appropriate patient selection and pharmacist-led adverse event and adherence monitoring.

Clinical Review & Education

Prabhakaran and colleagues report results of a systematic review of the evidence supporting reperfusion treatment in acute ischemic stroke (68 articles; 108 082 patients). Among the authors’ findings was that intravenous thrombolysis with recombinant tissue plasminogen activator remains the standard of care for patients with moderate to severe neurologic deficits who present within 4.5 hours of symptom onset. Mechanical thrombectomy has been associated with improved outcomes in select patients.

An article in JAMA Surgery reported widespread adoption of damage control resuscitation policies—early administration of blood products, aggressive correction of coagulopathy, and minimization of crystalloid fluids—in forward combat hospitals since 2006 and described trends in combat-related injury type and severity and in-hospital mortality. This From The JAMA Network article by Holcomb and Hoyt highlights the need for comprehensive civilian trauma research.

Schmidt-Hansen and colleagues summarize a Cochrane review (45 studies; 6095 patients) that addressed the accuracy of fludeoxyglucose F 18-positron emission tomography/computed tomography (FDG-PET/CT) imaging to detect mediastinal lymph node involvement in patients with potentially resectable non–small cell lung cancer (NSCLC). The accuracy of FDG-PET/CT imaging alone is insufficient to make a decision about whether to proceed directly to surgery as a single treatment option.

Altkorn and Cifu summarize the 2014 Clinician’s Guide to the Prevention and Treatment of Osteoporosis developed by the National Osteoporosis Foundation. Recommendations include bone mineral density testing for women aged 65 years or older and men aged 70 years or older. Bone mineral density testing may be considered for younger individuals with risk factors or prior (adult) fracture.

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