reliminary evidence suggests
that meditative exercise, such
as tai chi, may have benefits for patients with chronic heart failure. This
multisite, parallel group, randomized controlled trial of 100 outpatients with systolic heart failure compared 12 weeks of tai chi exercise,
as an adjunct to standard care, with
a time-matched attention education control. Tai chi was found to
have potential clinical benefits including enhancement in quality of
life, mood, exercise self-efficacy, and
increased daily activity.
See page 750
Use of Varenicline
for 4 Weeks Before
Quitting Smoking
is based on alleviating postcessationwithdrawaldiscomfortanddoes
not use the effects the drug has on reducing the reward associated with
smoking. In this placebo-controlled
trial, smokers were allocated to start
varenicline treatment 4 weeks prior to
the target quit date. Varenicline preloading reduced the enjoyment of
smoking and smoke intake. It had no
effect on post-quit withdrawal symptoms but increased the 12-week abstinence rate. Efficacy was particularly
than 50% their smoke intake during
the ad lib smoking period. These findings suggest that standard varenicline
treatment starting 1 week before target quit date may give suboptimal outcomeresults.Trialswithlongerfollowuparenowneededtocorroboratethese
See page 770
Intervention to Influence
Behaviors Linked to Risk
of Chronic Diseases
n a multisite cluster-randomized controlled trial, El-Bassel et
al tested the efficacy of an intervention to increase multiple health-
related behaviors in groups of African American human immunodeficiency virus (HIV)–serodiscordant heterosexual couples, who were allocated to an
individual-focused health promotion that addressed multiple health-related behaviors or to a couple-focused HIV/sexually transmitted disease (STD) risk reduction intervention. Health promotion intervention participants were more likely
to report consuming 5 or more servings of fruits and vegetables daily and adhering to physical activity guidelines compared with HIV/STD intervention participants. In the health promotion intervention, compared with the HIV/STD
intervention, participants consumed fatty foods less frequently, more men received prostate cancer screening, and more women received a mammogram.
See page 728
Oophorectomy vs Ovarian Conservation With Hysterectomy
lective bilateral salpingo-oophorectomy (BSO) is routinely offered to women
undergoing hysterectomy for benign conditions to prevent subsequent ovarian cancer. However, the practice of BSO is controversial owing to conflicting
literature on long-term consequences for cardiovascular disease, bone health,
and total mortality. Jacoby et al used longitudinal data from 25 448 menopausal women enrolled in the Women’s Health Initiative Observational Study
with a history of hysterectomy and BSO (56%) or hysterectomy with ovarian
conservation to examine differences in incident cardiovascular events, hip fracture, cancer, and death between groups. In multivariable analysis, BSO was not
associated with an increased risk of fatal and nonfatal coronary heart disease,
coronary artery bypass graft/percutaneous transluminal coronary angioplasty,
stroke, total cardiovascular disease, hip fracture, or death. BSO decreased incident ovarian cancer, but ovarian cancer was rare in both groups. There were no
significant associations for BSO and breast, colorectal, or lung cancer.
See page 760
Changes in Medical Students’ Views of Internal Medicine
Careers From 1990 to 2007
n this study of 2 senior classes of medical students, Schwartz et al found
that, compared with 1990, the 2007 cohort was more satisfied with their
internal medicine (IM) educational experiences and twice as likely to have
had ambulatory care training. Nonetheless, students in 2007 were more attracted to subspecialty IM careers and less interested in general IM. Despite
greater perceived opportunities for meaningful work and esteem in IM, a similar percentage (24%) of students in 2007 chose IM and a much smaller percentage (2% vs 9% in 1990)
planned primary care IM ca100
reers. Persistent unfavorable per∗P < .001
ceptions of income disparity,
workload, and stress appeared to
counter the gains from percep60
tions of meaningful work. Thus,
many of the “next steps” needed
to improve the attractiveness of
IM and general IM careers may
fall outside the purview of medi0
1990 2007
1990 2007
cal educators and within the
Workload and Stress
Meaningful Work
realm of health policy.
ARCH INTERN MED/ VOL 171 (NO. 8), APR 25, 2011
Students Reporting That IM Is or Has Somewhat
or Much More Than Other Specialties, %
Tai Chi Exercise in Patients
With Chronic Heart Failure
See page 744
©2011 American Medical Association. All rights reserved.
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