October 17, 2012Volume 7 - Issue 42       

DynaMed Weekly Update

For the week ending October 12, 2012

Last week 477 articles were evaluated via DynaMed's Systematic Literature Surveillance and 183 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

Physicians' Warnings to Unfit Drivers May Reduce Emergency Department Visits for Accidents


A number of medical conditions may limit a patient's ability to safely drive an automobile and may increase the risk of accidents. However, placing limits on the driving may affect the patient's quality of life and many patients are reluctant to give up driving voluntarily. One approach to reduce injurious accidents caused by these drivers is for primary care physicians to issue warnings to patients judged unfit to drive. Previous research has been inconclusive on the benefits and costs of such warnings, and concern has been expressed for the effect of warnings on the patient-doctor relationship.  A program for providing driving warnings has been in use in Ontario, Canada since 1968. A recent cohort study analyzed data from 100,075 consecutive patients who received such warnings since 2006.  


Patients ≥ 18 years old (57% male) who received a medical warning from a physician judging them to be potentially unfit to drive due to a medical condition were assessed for emergency department visits over 2 time periods: a baseline period consisting of the 3 years prior to the warning, and a 1-year follow-up period after the warning was issued. Medical conditions for which patients received warnings included alcoholism, epilepsy, dementia, sleep disorder, fainting or dizziness, stroke, diabetes, and depression without psychosis. Most of the warnings (98%) were preemptive coming before the driver experienced a road crash resulting in an emergency room visit. A total of 6,098 physicians participated in the program.


Rates of emergency department visits were compared for the baseline and follow-up periods. Visits due to road crashes in which the patient was a driver were significantly reduced following the warning (4.76 per 1,000 person-years during baseline vs. 2.73 per 1,000 person-years during follow-up,  p < 0.001) (level 2 [mid-level] evidence). However, the rate of accident-related visits during follow-up remained higher than the general population rate of 1.98 per 1,000 person-years during the same period (no p value reported). Furthermore, the rate of emergency visits for depression increased significantly during follow-up (19.15 vs. 23.91 per 1,000 person-years, p < 0.05). In addition, the warnings may have weakened the patient-doctor relationship. During the follow-up period, the number of return visits to the primary care physician who issued the warning dropped by about 0.66 visits per patient compared to the previous year (no p value reported) (N Engl J Med 2012 Sep 27;367(13):1228).


For more information, see the Trauma topic in DynaMed.

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DynaMed Events 

American Academy of Pediatrics (AAP) National Conference & Exhibition, October 20-23, 2012  

Deputy Editor Dr. Mike Woods will be attending the American Academy of Pediatrics National Conference & Exhibition at the Ernest N. Morial Convention Center in New Orleans, Louisiana. Representatives will be available at the DynaMed booth to discuss peer review, mobile access, and free trial information.


Visit the American Academy of Pediatrics website to learn more about the event and for registration information.


Medical Group Management Association (MGMA) Annual Conference, October 22-24, 2012  

Deputy Editor Dr. Cynthia Brown will be attending the 2012 Medical Group Management Association Annual Conference at the Henry B. Gonzalez Convention Center in San Antonio, Texas. Representatives will be available at the DynaMed booth to discuss peer review, mobile access, and free trial information.


Visit the Medical Group Management Association website to learn more about the event and for registration information.


Call for Peer Reviewers

We are currently seeking reviewers for:  

Acute radiation syndrome

Concussion and mild traumatic brain injury 

Moderate to severe traumatic brain injury 

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: October 17, 2012
Expiration Date: October 17, 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

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: 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: 1102073G

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