In This Issue of Archives of Internal Medicine

Preliminary 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.

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Current use of varenicline tartrate is based on alleviating postcessation withdrawal discomfort and does 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 marked in those who reduced by more 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 outcome results. Trials with longer follow-up are now needed to corroborate these findings.

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In 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.

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Elective 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.

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In 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 careers. Persistent unfavorable perceptions of income disparity, workload, and stress appeared to counter the gains from perceptions 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 medical educators and within the realm of health policy.

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