IN THIS ISSUE OF ARCHIVES OF INTERNAL MEDICINE P 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 C urrentuseofvareniclinetartrate 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 markedinthosewhoreducedbymore 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 findings. See page 770 Intervention to Influence Behaviors Linked to Risk of Chronic Diseases I 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 E 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 I 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 90 ceptions of income disparity, 80 ∗ workload, and stress appeared to 70 ∗ counter the gains from percep60 tions of meaningful work. Thus, 50 40 many of the “next steps” needed 30 to improve the attractiveness of 20 IM and general IM careers may 10 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 718 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 WWW.ARCHINTERNMED.COM ©2011 American Medical Association. All rights reserved. Downloaded From: https://archinte.jamanetwork.com/ on 06/09/2014