March 7, 2012
Volume 7 - Issue 10             

DynaMed Weekly Update

For the week ending March 2, 2012  

Last week 305 articles were evaluated via DynaMed's Systematic Literature Surveillance and 191 were added to DynaMed content. 

Based on the editors' criteria of selecting "articles most likely to change clinical practice," one article of significant interest was selected for the DynaMed Weekly Update.

Feature Article

Tai Chi Reduces Falls Compared to Resistance Training in Patients with Parkinson Disease


Patients with Parkinson disease have a high risk of falling, maybe due to impaired movement and balance. While medication can improve some motor deficits including bradykinesia and rigidity, it may be less effective for improving postural instability. Furthermore, though exercise can improve strength and slow the loss of motor function, exercise programs have shown inconsistent efficacy for preventing falls (J Neurol Neurosurg Psychiatry 2007 Jul;78(7):678, Mov Disord 2010 Jul 15;25(9):1217). A recent randomized trial evaluated the effects of tai chi, a balance-based exercise emphasizing slow mind-focused movements, in 195 patients with Parkinson disease.


Patients (mean age 69 years) with mild to moderate Parkinson disease were randomized to tai chi vs. resistance training vs. stretching for 60-minute sessions twice weekly for 24 weeks. The tai chi group received training in 6 movements specifically designed to improve balance and gait, the resistance training group participated in exercise to strengthen muscles involved in balance, posture and gait, and the stretching group performed low intensity exercise in a group setting as an attention control condition.


At the end of treatment, the rate of falls was significantly lower in the tai chi group (62 total falls corresponding to a rate of 0.22 falls per patient-month) than in either the resistance training group (133 falls, 0.51 falls per patient month, p = 0.05 vs. tai chi), or the stretching group (186 falls, 0.62 falls per patient-month, p = 0.005 vs. tai chi) (level 1 [likely reliable] evidence). Tai chi was also associated with significantly greater improvement in balance compared to both groups and significantly greater improvement in gait, strength, and motor scores compared to stretching. There were no serious adverse events in any group (N Engl J Med 2012 Feb 9;366(6):511).


For more information, see the Parkinson disease and Falls in the elderly topics in DynaMed.

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DynaMed Extras

DynaMed Extra: FluMist Quadrivalent Vaccine Approved

The FDA has approved the FluMist Quadrivalent seasonal influenza vaccine for use in people aged 2-49 years. This vaccine contains 2 strains each of influenza virus A and influenza virus B. Like the previously approved FluMist Trivalent vaccine, FluMist Quadrivalent vaccine is given as a nasal spray (FDA Press Release 2012 Feb 29). For more information, see the Influenza Virus Vaccine Live Intranasal topic in DynaMed.


DynaMed Extra: 2012 Childhood Immunization Schedules from the ACIP

The Advisory Committee on Immunization Practices (ACIP) at the Centers for Disease Control and Prevention has released the recommended schedules for childhood immunizations for 2012. These recommendations, highlighting changes from 2011, can be found in MMWR Morbidity and Mortality Weekly Report 2012 Feb 10;61(5):1 full-text. For more information, see the Immunizations topic in DynaMed.


DynaMed Extra: New ADA Position Statement on Diabetes

A number of DynaMed topics have been recently updated with information from a new position statement on the diagnosis and classification of diabetes mellitus issued by The American Diabetes Assocation (ADA) (Diabetes Care. 2012 Jan;35 Suppl 1:S64). For a guide to navigating through DynaMed's coverage of the best available evidence for diabetes care, see Diabetes (list of topics) in DynaMed.

Call for Peer Reviewers

We are currently seeking reviewers for: 

Huntington disease

Trigeminal neuralgia 

Learn more about the DynaMed Contribution Opportunities:

DynaMed Peer Review 

Editorial Policies for Reviewers 

About DynaMed Weekly Update

Prepared by the clinician members of the DynaMed Editorial Team, DynaMed Weekly Update is a compilation of one to five articles selected from DynaMed's Systematic Literature Surveillance as articles most likely to change clinical practice.

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CME Information


0.25 AMA PRA Category I Credit(s)™
Family Physicians: 0.25 Prescribed credits
Nurse Practitioners: 0.25 Contact hours
Release Date: March 7, 2012 
Expiration Date: March 7, 2013
Estimated Completion Time:
15 minutes
There is no fee for this activity.

To Receive Credit 
In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon at the end of the article.

Program Overview

Learning Objectives

Upon successful completion of this educational program, the reader should be able to:
1. Discuss the significance of this article as it relates to your clinical practice.
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.
Faculty Information
Alan Ehrlich, MD - Assistant Clinical Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Deputy Editor, DynaMed, Ipswich, Massachusetts, USA

Michael Fleming, MD, FAAFP - Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company

Dr. Ehrlich, Dr. Fleming, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.
No commercial support has been received for this activity.

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ACCME This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Antidote Education Company and EBSCO Publishing. Antidote is accredited by the ACCME to provide continuing medical education for physicians.  Antidote Education Company designates this educational activity for a maximum of 0.25 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AAFP: This activity, DynaMed Weekly Update 2011, has been reviewed and is acceptable for up to 13 Prescribed credits by the American Academy of Family Physicians. AAFP accreditation begins March 2, 2011. Term of approval is for one year from this date. Each Weekly Update is approved for 0.25 Prescribed credits. Credit may be claimed for one year from the date of each Weekly Update.


AANP: This program is approved for 0.25 contact hour of continuing education by the American Academy of Nurse Practitioners.  

Program ID 1102072A.

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