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Physicians: .25 AMA PRA Category ICreditsTM

Family Physicians: .25 Prescribed credits

Nurse Practitioners: .25 Contact hours

Release Date: February 6, 2013

Expiration Date: February 6, 2014

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.

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 EducationCompany 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 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AAFP: Enduring Material activity, DynaMed EBM Focus, 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 EBM Focus 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: 1210392W


Last week 437 articles were evaluated via DynaMed's Systematic Literature Surveillance and 228 were added to DynaMed content.

Based on criteria for selecting "articles most likely to change clinical practice," one article of significant interest was selected by the DynaMed Editorial Team.

Community-Based Screening Identifies Patients ≥ 75 years old with Atrial Fibrillation Suitable for Anticoagulants for Stroke Prevention

Treatment with oral anticoagulants is recommended for patients with atrial fibrillation and high stroke risk (Chest 2012 Feb;141(2 Suppl):e531S). The standard tool for stroke risk assessment is the CHADS2 score, which assigns a single point for each of Congestive heart failure, Hypertension, Age ≥ 75 years, Diabetes and 2 points for history of Stroke. A score of ≥ 2 is considered high risk. A recent population-based cohort study conducted in Sweden assessed the efficacy of a stepwise screening program to identify patients with high stroke risk who would be suitable for anticoagulant treatment.

Invitations to participate in the screening program were sent to all residents of Halmsted, Sweden aged 75-76 years (1,330 residents). The first step in screening included relevant medical history and a 12-lead electrocardiogram (ECG). Participants in sinus rhythm with no history of atrial fibrillation who had a CHADS2 score ≥ 2 (age plus at least 1 other factor) were invited to perform self ECG recording with a hand-held device for 2 weeks (20-30 seconds twice daily and if palpitations).

Of 848 residents that accepted the screening invitation, 9% (75 participants) were identified as candidates for starting oral anticoagulant treatment. This included 35 patients with a known history of atrial fibrillation who were not already receiving treatment, 10 who were diagnosed with silent atrial fibrillation on the 12-lead ECG, and 30 who were diagnosed with paroxysmal atrial fibrillation. Of these patients, 57 (76%) began anticoagulant treatment. No treatment outcomes were reported (level 3 [lacking direct] evidence) (Circulation 2013 Jan 23 early online) Looking for a reduction in stroke incidence was beyond the scope of this study and demonstrating that screening can lead to lower stroke rates requires additional research. However, this study does indicate that there may be significant numbers of patients eligible for stroke prophylaxis who are not currently being treated and who can be identified through an outreach program.

For more information, see the Atrial fibrillation topic in DynaMed.

DynaMed Extras

Unsupported Beliefs about Obesity and Dieting are Common

A recent special article in The New England Journal of Medicine provides a useful summary of misconceptions about obesity classifying a number of long-held beliefs as either presumptions that are not supported by evidence or myths that are contradicted by evidence. Among the myths are the concepts that rapid weight loss is less effective than gradual weight loss for long-term outcomes, that breastfeeding protects against obesity, and that sexual activity is an effective calorie burner. Presumptions included the ideas that regularly eating breakfast is protective and that yo-yo dieting is associated with increased mortality. (N Engl J Med 2013 Jan 31;368(5):446)

DynaMed Announcement

Welcome to our newly formatted weekly newsletter “DynaMed EBM Focus”. We hope you find it as informative and useful as the “Weekly Update” but with a more intuitive design.

Call for Peer Reviews

We are current seeking reviewers for:

Infective endocarditis
Tumor lysis syndrome

Learn more about the DynaMed Contribution Opportunities

DynaMed Peer Review
Editorial Policies for Reviewers
Education for Clinicians in Training