Two articles in this issue of JAMA report results of separate randomized clinical trials that assessed the efficacy of 12 weeks of treatment with varenicline, a novel α4β2 nicotinic acetylcholine receptor partial agonist, vs bupropion and placebo, in combination with brief behavioral counseling, for smoking cessation. In these trials reported by Gonzales and colleaguesArticle and Jorenby and colleaguesArticle, treatment with varenicline compared with bupropion or placebo was associated with an increased rate of continuous abstinence from smoking during weeks 9 through 12 of treatment. Varenicline was associated with nausea in 28% to 29% of patients. In a third article, Tonstad and colleaguesArticle report results of a clinical trial that assessed the efficacy of varenicline vs placebo for an additional 12 weeks to prevent relapse in patients who had been randomly assigned to varenicline and had quit smoking during the initial 12-week treatment phase. The authors found that patients who received an additional 12 weeks of varenicline treatment were significantly more likely to remain abstinent from weeks 13 to 24 and to still be abstinent at 52 weeks compared with patients who received placebo. In an editorial, Klesges and colleaguesArticle discuss reasons that varenicline is not likely to be a panacea for smoking cessation.
Hospital performance is monitored and publicly reported for patients with acute myocardial infarction (AMI), but it is not clear that the performance measures reflect patient outcomes. Bradley and colleaguesArticle reviewed 2002-2003 data from 962 hospitals participating in a national registry of AMI to determine correlations among AMI core process measures and the degree to which they explain variation in hospital-specific, risk-standardized, 30-day mortality rates for patients aged 66 years and older with AMI. The authors found that the process measures were correlated but explained only 6% of the hospital-level variation in 30-day mortality rates for patients with AMI. In an editorial, JhaArticle discusses measures of hospital quality, what they have achieved, and how they can be improved.
Incidence of extreme obesity (body mass index [BMI] ≥40) is increasing in the United States, but associated health risks are not well characterized. McTigue and colleagues examined data from the Women's Health Initiative Observational Study to examine the relationships between weight category, mortality, and coronary heart disease (CHD) in women who were aged 50 to 79 years at baseline. The authors found significant positive trends for increasing baseline prevalence of hypertension, diabetes, hyperlipidemia, and cardiovascular diagnoses across increasing weight categories. Increases in all-cause mortality were related to higher weight category but were mediated by the presence of diabetes, hypertension, and hyperlipidemia during the 7-year follow-up.
“I am not unique in being both a single parent and a pediatrician, but sometimes I sit in academic meetings or the precepting room and wonder if I am the only one.” From “Cultural Competency.”
Although the AIDS epidemic has slowed globally and access to anti-HIV drugs has improved, infections are still increasing in certain countries and regions, and prevention programs are failing to reach many of those who are most at risk.
Consumption of 4 g/d of acetaminophen—the maximum recommended daily dose—is associated with elevations in serum alanine aminotransferase (ALT).
Join David Gonzales, PhD, and Stephen Rennard, MD, on Wednesday, August 16, 2006, from 2 to 3 PM eastern time, to discuss efficacy and safety of varenicline for smoking cessation. 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 smoking cessation.
This Week in JAMA . JAMA. 2006;296(1):9. doi:10.1001/jama.296.1.9