September 4, 2013

DynaMed EBM Journal Volume 8, Issue 36

DynaMed Weekly Updates

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Physicians: .25 AMA PRA Category ICreditsTM

Family Physicians: .25 Prescribed credits

Nurse Practitioners: .25 Contact hours

Release Date: September 4, 2013

Expiration Date: September 4, 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: 1210393R


Last week 296 journal articles were evaluated via DynaMed's Systematic Literature Surveillance and summaries of 156 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.

Home-based Intervention By Social Workers May Reduce Depressive Symptoms for Older African-Americans
Reference: (Ann Intern Med 2013 Aug 6;159(3):243), (level 2 [mid-level] evidence)

The prevalence of clinically relevant depressive symptoms in older African-Americans is higher than in the general public, with estimates of 21% or more (J Am Geriatr Soc. 2004 May;52(5):741), but these individuals may be reluctant to seek treatment due to lack of awareness of symptoms, a perceived stigma associated with seeking care, or limitations in accessing care. A recent randomized trial evaluated the efficacy of the “Beat the Blues” program, a multicomponent, social worker-led intervention bringing depression care management into the home.

A total of 208 African-American patients ≥ 55 years old (mean age 70 years) with depressive symptoms were randomized to the "Beat the Blues" intervention vs. wait-list control for 4 months and followed for 8 months. The intervention consisted of 1-hour at-home sessions with a social worker covering depression education and instruction in symptom identification, stress reduction techniques, and behavioral activation for identifying and achieving goals. The social worker also provided care management with assessment of unmet care needs, referrals, and linking to social and medical services. The sessions were held weekly for up to10 weeks, and biweekly thereafter until 4 months. Patients in the wait list group received no intervention for the first 4 months, and then started the “Beat the Blues” program at 4 months.

Depressive symptoms were assessed with the Patient Health Questionnaire-9 (PHQ-9, range 0-27 points). Remission was defined as a total score < 5 points, and any reduction in score of at least 5 points was considered clinically meaningful. In an analysis of 87% of the randomized patients at 4 months, the remission rates were 43.8% in the “Beat the Blues” group and 26.9% in the control group (p = 0.02, NNT 6). Clinically-meaningful reductions in symptom severity occurred in 64% with the intervention vs. 41% with control (p value not reported). “Beat the Blues” was associated with significant improvements from baseline in anxiety, quality of life, behavioral activation, and functional difficulty. These improvements in depressive symptoms and other outcomes were maintained at 8 months, with no significant changes from their 4-month results. Patients from the control group who participated in the intervention during the second 4 month period showed similar improvements from baseline in depressive symptoms and other measures at the end of treatment.

For more information, see the Depression topic in DynaMed.

Earn CME Credit for reading this e-Newsletter.
For more information on this educational activity, see the CME sidebar.

DynaMed Events

American Academy of Family Physicians (AAFP) Conference, September 24-28, 2013
Senior Deputy Editor Alan Ehrlich, MD, will be attending the American Academy of Family Physicians conference, held at the San Diego Convention Center in San Diego, California. Representatives will be available to discuss peer review, mobile access, and free trial information.

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

If you would like to meet with a DynaMed representative, please contact us at

Call for Peer Reviews

We are currently seeking reviewers for:

Electroconvulsive therapy (ECT) for depression

Social anxiety disorder