This Week in JAMA FREE

Intra-aortic balloon counterpulsation (IABC) mechanically augments coronary blood flow, unloads the left ventricle, and reduces myocardial oxygen demand. In animal models, IABC reduces infarct size when initiated prior to reperfusion. In a randomized trial that enrolled 337 patients with anterior ST-segment elevation myocardial infarction (STEMI) without cardiogenic shock, Patel and colleagues Article found that compared with primary percutaneous coronary intervention alone, initiation of IABC before primary percutaneous intervention was not associated with reduction in infarct size. In an editorial, Ndrepepa and Kastrati Article discuss possible reasons for the failure of IABC to promote myocardial salvage in patients with STEMI and no cardiogenic shock.

Percutaneous carotid stent placement—increasingly used to treat severe carotid atherosclerosis—is technically demanding and associated with a steep learning curve. In an analysis of data from 24 701 Medicare beneficiaries who underwent carotid stenting between 2005 and 2007, Nallamothu and colleagues Article found that treatment by low-volume operators (< 6 procedures per year) and treatment early in an operator's experience (<12 procedures performed) were associated with increased 30-day mortality. In an editorial, Halm Article discusses outcomes of carotid artery stenting in clinical practice.

Saw palmetto fruit extract is a widely used natural product to relieve lower urinary tract symptoms attributed to benign prostatic hyperplasia (BPH). Barry and colleagues randomly assigned 357 men with BPH-related lower urinary tract symptoms to receive either an escalating dose of saw palmetto extract—up to 3 times the 320-mg/d standard dose—or placebo for 72 weeks. The authors report that saw palmetto extract did not reduce lower urinary tract symptoms more than placebo.

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Some evidence suggests that men are at greater age-specific risk for advanced colorectal neoplasia than women, yet the recommended age to initiate screening colonoscopy is not sex-specific. In a nationally representative cohort study of 44 350 Austrian adults undergoing screening colonoscopy, Ferlitsch and colleagues compared the prevalence and number needed to screen for adenomas, advanced adenomas, and colorectal carcinomas in different age groups of men and women. Among the authors' findings were that prevalence and number needed to screen to detect advanced adenomas were comparable at ages 45 to 49 years in men and ages 55 to 59 years in women.

Atypical antipsychotic drugs are commonly used for off-label conditions, including behavioral symptoms of dementia, anxiety, and obsessive-compulsive disorder in adults. In a systematic review that included 162 clinical trials with efficacy outcomes and adverse event data from 231 trials or large observational studies, Maher and colleagues found evidence that atypical antipsychotics are efficacious for only a few off-label conditions. Benefits and harms varied among the drugs, and adverse events were common.

“I have struggled to integrate my experience into my daily life as a physician.” From “In the Still of the Night.”

Spurred by controversy over potential bias in published results from industry-sponsored trials of a product used in spine surgery, data from those trials will undergo independent scrutiny by academic researchers.

USDA supplemental nutrition assistance and soft drinks

Disaster preparedness since 2001

Mental health effects of media exposure to mass trauma

Join Paasche-Orlow, MD, MA, MPH, Wednesday, October 19, from 2 to 3 PM eastern time to discuss caring for patients with limited health literacy. To register, go to http://www.ihi.org/AuthorintheRoom.

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

Ms J, a 46-year-old woman with a history of iron deficiency anemia and 3 miscarriages, was recently diagnosed with celiac disease. How would you treat her illness and what follow-up would you recommend for her and her family? Go to www.jama.com to read the case. Submit your response by October 9 for possible online posting.

For your patients: Information about local anesthesia.