Physicians: .25 AMA PRA Category ICreditsTM
Family Physicians: .25 Prescribed credits
Nurse Practitioners: .25 Contact hours
Release Date: April 10, 2013
Expiration Date: April 10, 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.
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.
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.
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: 1210393F
Last week 483 journal articles were evaluated via DynaMed's Systematic Literature Surveillance and summaries of 245 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.
Preoperative Blood Transfusion May Reduce Perioperative Complications in Patients with Sickle Cell Disease
Reference: Lancet 2013 Mar 16;381(9870):930 (level 2 [mid-level] evidence)
The need for surgery is common in patients with sickle cell disease to address both manifestations and complications of the disease, and the rates of surgical complications can be high. Whether preoperative blood transfusions are beneficial in these patients is unclear. One large observational study previously found a decrease in surgical complications with transfusion (Blood 1995 Nov 15;86(10):3676), but others have shown no significant differences. The only previous randomized trial to date compared 2 different transfusion regimens, but now the TAPS trial has compared preoperative transfusion to no transfusion in 67 children and adults with sickle cell disease.
Patients ≥ 1 year old (median age 13 years) with sickle cell disease (hemoglobin SS subtype in 97%) who were having low-risk surgery (e.g. adenoidectomy or inguinal hernia repair) or medium-risk surgery (e.g. cholecystectomy or joint replacement) were randomized to preoperative blood transfusion vs. no transfusion and followed for up to 3 months. Patients having cardiovascular or brain surgery were excluded, as were patients with transfusion within 3 months, acute chest syndrome within 6 months, or history of stroke. The median preoperative hemoglobin levels were 97 g/L (9.7 g/dL) following transfusion in the transfusion group and 77 g/L (7.7 g/dL) in the no transfusion group. The primary outcome was clinically important complications within 30 days of surgery, including infections, sickle cell-related events, transfusion reactions, and cardiovascular events. Life threatening complications and events causing permanent or severe disability were classified as serious adverse events.
Planned enrollment was 405 patients. The trial was terminated early after an unplanned interim analysis of 61 patients indicated a significant decrease in serious adverse events in the transfusion group. In the intention-to-treat population of 67 patients, 3% in the transfusion group and 30% in the no transfusion group had serious adverse events (p = 0.002, NNT 4). The most common adverse event was acute chest syndome. The rates of clinically important complications were 15% with transfusion vs. 39% without transfusion (p = 0.023, NNT 5). There were no significant differences in duration of hospital stay or readmission rates.
For more information, see the Sickle cell disease topic in DynaMed.
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American College of Physicians (ACP) Internal Medicine 2013, April 11- 13, 2013
Senior Deputy Editor Larissa Lucas, MD, FACP, and Deputy Editor Sheila Bond, MD, 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.
Annual Meeting and Exhibition of the Medical Library Association (MLA), May 3-8, 2013
Editor-in-Chief Brian S. Alper, MD, MSPH, FAAFP, will be presenting at the 2013 Annual Meeting and Exhibition of the Medical Library Association, held at the John B. Hynes Veterans Memorial Convention Center in Boston, MA. The topic of the presentation is “The Pace of Change in Practice-Driving Medical Knowledge in New Models of Publishing” and will be presented from 1:30pm to 3:00pm on May 5th. Representatives will be available at the DynaMed booth (216) to discuss peer review, mobile access, and free trial information.
Visit the Medical Library Association website to learn more about the event and for registration information.
Society of Teachers of Family Medicine (STFM) 46th Annual Spring Conference, May 1-5, 2013
Editor-in-Chief Brian S. Alper, MD, MSPH, FAAFP, will be attending the Society of Teachers of Family Medicine (STFM) 46th Annual Spring Conference, held at the Baltimore Marriott Waterfront Hotel in Baltimore, Maryland. Representatives will be available to discuss peer review, mobile access, and free trial information.
Visit the Society of Teachers of Family Medicine 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 DynaMedCommunity@ebscohost.com.