May 23, 2012Volume 7 - Issue 21  

DynaMed Weekly Update

For the week ending May 18, 2012

Last week 598 articles were evaluated via DynaMed's Systematic Literature Surveillance and 343 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

Internet-Based Cognitive Behavioral Therapy May Reduce Fatigue and Increase School Attendance in Adolescents with Chronic Fatigue Syndrome


Chronic fatigue syndrome is characterized by severe, disabling fatigue lasting at least 6 months in combination with other symptoms, including musculoskeletal pain, sleep disturbance, and impaired concentration. In adolescents, it may cause extended school absence and impaired academic and social functioning. Cognitive behavioral therapy (CBT) has shown promise for treating chronic fatigue syndrome in adolescents (BMJ 2005 Jan 1;330(7481):14), but access to treatment can be problematic. A new randomized trial evaluated the efficacy of a 6-month internet-based CBT program (FITNET) in 135 adolescents (mean age 16 years, 82% girls) with chronic fatigue syndrome in the Netherlands.


The FITNET program included 21 interactive modules for the patients to work through on the computer, plus support from a trained CBT therapist through email. Patients could send email at any time and received responses once per week at the beginning of the program and later once every 2 weeks. They also received psychoeducational materials and were assigned a school mentor who acted as a coach, advisor, and tutor. In addition, there was a program for parents including email correspondence with the therapist. The control group received usual care with individual and group rehabilitation programs including face-to-face CBT and physical therapy.


At 6 months, the absence of severe fatigue was reported by 85% with FITNET vs. 27% with usual care (p < 0.0001, NNT 2), and full school attendance (defined as < 10% absenteeism) was significantly increased in the FITNET group (75% vs. 16%, p < 0.0001, NNT 2) (level 2 [mid-level] evidence). FITNET was also associated with an increase in normal physical functioning (78% vs. 20%, p < 0.0001, NNT 2) and greater rates of patients reporting a self-rating of completely recovered or much better (78% vs. 27%, p < 0.001, NNT 2) (Lancet 2012 Apr 14;379(9824):1412). FITNET is currently available only in Dutch.


For more information, see the Chronic fatigue syndrome topic in DynaMed.




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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: May 23, 2012
Expiration Date: May 23, 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 enduring 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 1102072L.

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