September 26, 2012Volume 7 - Issue 39    

DynaMed Weekly Update

For the week ending September 21, 2012

Last week 595 articles were evaluated via DynaMed's Systematic Literature Surveillance and 251 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

Progesterone for Prevention of Preterm Birth Reduces Risk of Adverse Outcomes in Singleton Pregnancies but Increases Risk in Twin Pregnancies

 

Progesterone has been shown to reduce preterm birth in women at high risk due to short cervix (Am J Obstet Gynecol 2012 Feb;206(2):124.e1) or history of preterm birth (Cochrane Database Syst Rev 2009 Apr 15;(2):CD004947). A recent systematic review assessed the effects of prophylactic progesterone on neonatal outcomes in singleton and multiple pregnancies at risk of preterm birth. A total of 16 randomized trials were included (7 with singletons, 7 with twins, 2 with triplets) comparing systemic or vaginal progesterone vs. placebo.

 

In analyses including up to 2,000 singleton pregnancies, progesterone reduced the risk of neonatal death (within 28 days of birth) (risk ratio [RR] 0.49, 95% CI 0.29-0.82, NNT 32-1,000) and reduced risk of respiratory distress syndrome (RDS) (RR 0.68, 95% CI 0.49-0.94, NNT 15-83) (level 1 [likely reliable] evidence). Progesterone was also associated with reduced rates of neonatal intensive care admission (RR 0.41, 95% CI 0.2-0.82, NNT 2-15). There were no significant differences in risks of serious intraventricular hemorrhage, necrotizing enterocolitis, retinopathy, or sepsis.

 

For twin pregnancies, the results were very different. In analyses including up to 4,647 infants, progesterone increased the risk of both RDS (RR 1.22, 95% CI 1.04-1.43, NNH 23-125), and perinatal death (RR 1.6, 95% CI 1.01-2.4, NNH 36-1,000) (Definitions of perinatal death varied across trials but included fetal death and death within either 7 days or 28 days of birth). There was no significant difference in neonatal death following live birth, and there were no significant differences in serious intraventricular hemorrhage, necrotizing enterocolitis, retinopathy, sepsis, or neonatal intensive care unit admission. There were no significant differences in any neonatal outcomes in analysis of 2 trials with 215 triplet pregnancies (Ultrasound Obstet Gynecol 2012 Sep;40(3):257).

 

For more information, see the Prematurity and Prevention of preterm labor and preterm birth topics in DynaMed.

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DynaMed Events  

Family Medicine Education Consortium (FMEC) Northeast Region Meeting, September 28th - 30th, 2012    

Dr. Thomas Hilts will be presenting at the 2012 Family Medicine Education Consortium Northeast Regional Meeting at the Renaissance Cleveland Hotel in Cleveland, Ohio. The topic of the seminar will be "Making a Good Thing Better: Reviewing an Online Evidence-Based Point-of-Care Medical Reference as a Scholarly Activity". Representatives will be available at the DynaMed booth to discuss peer review, mobile access, and free trial information.

 

Visit the Family Medicine Education Consortium website to learn more about the event and for registration information.

 

Cochrane Colloquium, September 30th - October 3rd, 2012 
Editor-in-Chief Dr. Brian Alper will be presenting at the 20th Cochrane Collaboration Colloquium held at the Pullman Hotel in Auckland, New Zealand. The topic of the presentation is "Practice-driving evidence: how frequently does it change?"   

 

Visit the Cochrane Colloquium website to learn more about the event and for registration information.

 

First International Conference on Evidence Based HealthCare (ISEHCON), October 7th - 8th, 2012   

Editor-in-Chief Dr. Brian Alper will be leading a workshop at the First International Conference on Evidence Based Healthcare at the India International Centre in New Delhi, India. The topic of the workshop will be "Best Sources for Evidence-Based Literature for Healthcare Practitioners".   

 

Visit the International Society for Evidence Based Health Care website to learn more about the event and for registration information.

Call for Peer Reviewers

We are currently seeking reviewers for:  

Neonatal herpes 

Neonatal hypoglycemia 

Noninvasive positive pressure ventilation (NPPV) in infants and children 

 

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

CREDITS

Physicians:
0.25 AMA PRA Category I Credit(s)™
Family Physicians: 0.25 Prescribed credits
Nurse Practitioners: 0.25 Contact hours
 
Release Date: September 26, 2012
Expiration Date: September 26, 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; Senior 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

Disclosures  
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.

Accreditation Statements

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: Enduring Material activity, DynaMed Weekly Update, has been reviewed and is acceptable for up to 13 Prescribed credits by the American Academy of Family Physicians. AAFP certification begins March 7, 2012. Term of approval is for one year from this date with the option of yearly renewal. Each Weekly Update is worth .25 Prescribed credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

  

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

 

Program ID: 1102073D

 
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