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March 06, 2013
DynaMed EBM Journal Volume 8, Issue 10
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Credits
Physicians: .25 AMA PRA Category ICreditsTM
Family Physicians: .25 Prescribed credits
Nurse Practitioners: .25 Contact hours
Release Date: March 06, 2013
Expiration Date: March 06, 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
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 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: 1210393A
Last week 368 journal articles were evaluated via DynaMed's Systematic Literature Surveillance and summaries of 232 articles 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.
Oral Misoprostol Reduces Postpartum Hemorrhage During Home-Birth in Low-Resource Settings
Reference: BJOG 2013 Feb;120(3):277 (level 1 [likely reliable] evidence)
Postpartum hemorrhage is a major cause of maternal death in many low-resource countries around the world. While injected oxytocin is commonly used for hemorrhage prophylaxis in institutional settings, its use may be impractical if not impossible in areas where home birth is the norm and even skilled birth attendants are rare. A recent systematic review evaluated the evidence for oral misoprostol for the prevention of postpartum hemorrhage in such settings.
The review included 2 randomized trials and 4 non-randomized controlled trials comparing oral misoprostol vs. placebo or no treatment for women during the third stage of labor. The misoprostol dose was 600 mcg in 5 trials and 400 mcg in the other. Trained health workers administered the drug in 4 trials. In 2 trials, the drug was distributed to pregnant women following counseling during an antenatal visit with instruction for use during birth.
Oral misoprostol reduced the incidence of postpartum hemorrhage in an analysis of 4 studies with 6,072 patients (risk ratio 0.58, 95% CI 0.38-0.87), with an NNT of 14-63 given a hemorrhage rate of 12% in controls. Use of additional uterotonics and rates of referral for hemorrhage were also significantly reduced with misoprostol. Misoprostol was associated with an increased risk of shivering (risk ratio 2.18, 95% CI 1-4.72).
For more information, see the Prophylactic uterotonics in third stage of labor topic in DynaMed.
Earn CME Credit for reading this e-Newsletter.
For more information on this educational activity, see the CME sidebar.
DynaMed Events
Advanced Pediatric Emergency Medicine Assembly (PEM/ACEP), March 12 - 14, 2013
PEMSoft Co-Editor-in-Chief, Ronald A. Dieckmann MD, MPH, FACEP, FAAP will be attending the Advanced Pediatric Emergency Medicine Assembly, held at Disney’s Contemporary Resort in Lake Buena Vista, Florida. Representatives will be available at the DynaMed booth (104) to discuss peer review, mobile access, and free trial information.
Visit the Advanced Pediatric Emergency Medicine Assembly website to learn more about the event and for registration information.
American Academy of Neurology (AAN) Annual Meeting, March 16 - 23, 2013
Deputy Editor Cynthia Brown, MD will be presenting a poster at the 2013 American Academy of Neurology Annual Meeting at the San Diego Convention Center in San Diego, California. The topic of the poster is "Measuring the Rate of Change in Core Evidence and Guidance in Neurology" and will be on display from 7:30am – 12:00pm March 20th.
Visit the American Academy of Neurology website to learn more about the event and for registration information.
Evidence Live 2013, March 25 - 26, 2013
Claire Honeybourne will be presenting a poster on behalf of Editor-in-Chief, Brian Alper, MD, MSPH, FAAFP, at the Evidence Live 2013 annual conference. The conference is being held at the University of Oxford in Oxford, UK. The topic of the poster is "How Frequently Does Our Core Evidence and Guidance Change?" Poster no. 22 will be presented in the 4:00 hour on March 25th.
Visit the Evidence Live website to learn more about the event and for registration information.
American College of Physicians (ACP) Internal Medicine 2013, April 11- 13, 2013
Senior Deputy Editor Larissa Lucas MD, FACP will be attending the American College of Physicians Internal Medicine 2013 conference, held at The Moscone Center in San Francisco, California. Representatives will be available at the DynaMed booth (1402) to discuss peer review, mobile access, and free trial information.
Visit the American College of Physicians website to learn more about the event and for registration information.
If you would like to meet with a DynaMed representative at any of our conferences, please contact us at [email protected].
New Topic Added to DynaMed this Week
Call for Peer Reviews
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