January 29, 2014

DynaMed EBM Journal Volume 9, Issue 5

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Physicians: .25 AMA PRA Category ICreditsTM

Family Physicians: .25 Prescribed credits

Nurse Practitioners: .25 Contact hours

Release Date: January 29, 2014

Expiration Date: January 29, 2015

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: 1304159M


Last week 523 journal articles were evaluated via DynaMed's Systematic Literature Surveillance and summaries of 159 articles were added to DynaMed content.

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

Parent-Delivered Cognitive-Behavioral Therapy May Improve Anxiety in Children
Reference: Br J Psychiatry 2013 Dec;203(6):436 (level 2 [mid-level] evidence)

Anxiety disorders are common in children and can have both immediate and life-long consequences. Cognitive behavioral therapy (CBT) has been shown to be effective for childhood and adolescent anxiety disorders (Cochrane Database Syst Rev 2013 Jun 3;(6):CD004690), but access to treatment may be limited. A recent randomized trial evaluated a low-intensity CBT intervention delivered by parents (with guidance from therapists) for children with anxiety disorders in the United Kingdom.

A total of 194 children aged 7-12 years with diagnosed anxiety disorders (generalized anxiety disorder, social phobia, separation anxiety disorder, panic disorder/agoraphobia, and specific phobias) were randomized to 1 of 2 parent-delivered CBT interventions vs. waitlist control for 12 weeks. In the full-guidance CBT group, parents received a self-help book and had 4 face-to-face meetings and 4 telephone calls with therapists (one contact weekly for the first 8 weeks, total therapist time < 5.5 hours) to provide anxiety education, develop graded exposure plan, and review progress. Parents in the brief-guidance CBT group received similar training and feedback from therapists but with a total of 4 sessions every other week. Families in the waitlist control group were asked to hold off on any anxiety interventions for 12 weeks.

At the end of treatment, rates of recovery from the primary anxiety diagnosis were 50% in the full-guidance CBT group and 25% in the waitlist control group (p = 0.013, NNT 4). In the full-guidance group, 34% of children recovered from all anxiety diagnoses compared to 11% of controls (p = 0.006, NNT 5). Recovery rates were higher in the brief-guidance group than in controls, but the differences were not statistically significant. Both full and brief guidance were associated with higher rates of "much or very much improved" status on clinical global impression ratings compared to control. In a follow-up analysis of 49 children from the full-guidance group at 6 months, 76% no longer met the diagnostic criteria for their primary diagnosis. While the lack of a true attention control condition weakens this trial’s validity, it appears that parent-led CBT may be an effective low-cost first-line approach for treating childhood anxiety disorders before seeking more intensive treatment.

For more information see the Generalized anxiety disorder, Panic disorder, and School refusal topics in Dynamed

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

Call for Peer Reviews

We are currently seeking subspecialty reviewers for our Patient Education Resource Center (PERC). PERC provides fact sheets and discharge instructions for patients leaving the hospital or emergency room. These hand-outs fulfill the meaningful use requirements for the Medicare & Medicare Services Incentive Programs.

Click here to speak with us about becoming a peer reviewer.

DynaMed Careers

Looking for a change? The DynaMed editorial team is expanding and looking for talented and driven individuals. Visit the links below to learn about these exciting opportunities.

Deputy Editor of Cardiology
Deputy Editor of Oncology
Medical Writer
Medical Editor
Associate Managing Editor