December 19, 2012
Volume 7 - Issue 51 

DynaMed Weekly Update

For the week ending December 14, 2012

Last week 495 articles were evaluated via DynaMed's Systematic Literature Surveillance and 255 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

Primary Care At-Risk Registry May Reduce Hospitalizations but Not Exacerbations in Patients with Severe Asthma


Guidelines for asthma management from the British Thoracic Society and Scottish Intercollegiate Guideline Network (PDF) suggest that primary care practices should maintain a registry of patients with asthma to facilitate management. A recent cluster randomized trial evaluated the efficacy of a patient registry system to reduce adverse outcomes in patients with severe asthma.


Twenty-nine primary care practices in England were randomized to a registry intervention vs. standard care for at-risk patients ≥ 5 years old with severe asthma. The registry intervention included the use of electronic alerts visible to all practice staff to indicate patient at-risk status, and staff training explaining the use of alerts and methods for improving both routine and emergency management of these patients. A total of 911 patients who were identified as at-risk for exacerbation based on British guideline criteria (presence of severe asthma plus at least 1 psychosocial indication that could hinder use of healthcare services and interventions) were enrolled in the trial and followed for 1 year.


In unadjusted analysis, the registry intervention was associated with a significant reduction in hospitalizations for asthma exacerbation (3.3% vs. 6.4% (p = 0.031, NNT 33). However, following adjustment for multiple factors, this difference was not quite statistically significant (p = 0.051) (level 2 [mid-level] evidence). Use of nebulized short-acting beta agonists was also lower in the intervention in unadjusted but not adjusted analyses (7.9% vs. 13.9%, p = 0.016, NNT 17, p = 0.061 in adjusted analysis). There was no significant difference in the incidence rate of moderate-to-severe exacerbations (53.6% vs. 46.5%), and the intervention was actually associated with a weak trend toward increased incidence (p = 0.105) in adjusted analysis. Overall costs were similar between the 2 groups (Thorax 2012 Dec;67(12):1052).


For more information, see the Asthma exacerbation in adults and adolescents 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: December 19, 2012
Expiration Date: December 19, 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: 1210392P

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