Quick Links

Share with Colleagues
Previous EBM Focus Issues
Become a DynaMed Reviewer
DynaMed Free Trial
Send Comment to Editor

Join Our Mailing List



Physicians: .25 AMA PRA Category I CreditsTM

Family Physicians: .25 Prescribed credits

Nurse Practitioners: .25 Contact hours

Release Date: April 30 2014

Expiration Date: April 30, 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 Education Company 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: 1304159X

Last week 512 journal articles were evaluated via DynaMed's Systematic Literature Surveillance and summaries of 260 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.

Web-based Educational Interventions to Promote MMR Vaccination Do Not Appear to Increase Parental Intent to Vaccinate Their Children
Reference: Pediatrics 2014 Apr;133(4):e835 (level 3 [lacking direct] evidence)

Childhood vaccination has become a contentious issue for many parents, mostly due to safety concerns, all of which have been discredited. In particular, concerns were raised regarding a perceived increase in the risk of autism among vaccinated children. The measles, mumps, and rubella (MMR) virus vaccine, which is often given to children around the same time as the first signs of autism become apparent, has been the target of several anti-vaccination campaigns. Although the original study positing a link between MMR vaccination and developmental disorders has been retracted (Lancet 2010 Feb 6;375(9713):445), and a large body of scientific evidence has consistently shown no link between MMR vaccination and autism, there are still several misconceptions about the safety of the MMR vaccine outside the scientific community. In response, several organizations have developed patient materials that explain the lack of evidence that MMR causes autism. These include the United States Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics. A recent randomized trial evaluated several different interventions designed to promote vaccination with the MMR vaccine.

The trial sampled 4,462 adult parents from an online panel and asked them to complete a short interview. A total of 1,759 parents (39.4% of those sampled) with available interview data were randomized to 1 of 5 web-based interventions: text explaining lack of evidence that MMR causes autism (autism correction), text describing dangers of the diseases prevented by MMR (disease risks), images of children who have diseases prevented by MMR vaccine (disease images), a story regarding an infant who almost died of measles (disease narrative), and text about costs and benefits of bird feeding (control). The vaccine promotion interventions were adapted from current public health authority materials.

Compared to the control group, none of the interventions to promote MMR immunization were associated with significantly increased parental intent to vaccinate a future child with the MMR vaccine. Moreover, the autism correction intervention was associated with decreased parental intent to vaccinate a future child (adjusted odds ratio 0.52, 95% CI 0.32-0.84). A subgroup analysis showed that this significant reduction was confined to parents who were least favorable to vaccination at baseline. There were no other significant differences between any intervention vs. control for parental intent to vaccinate with the MMR vaccine.

In the United States, MMR vaccination coverage among children aged 19-35 months was about 91% in 2012 (MMWR Morb Mortal Wkly Rep 2013 Sep 13;62(36):733 full-text). Although the national average exceeded the Healthy People 2020 target of 90%, there were 15 states with MMR coverage below that target, which has raised concerns of higher incidence of these preventable childhood diseases in areas with lower coverage. The CDC observed 159 cases of measles (including 17 hospitalizations) in 2013 (MMWR Morb Mortal Wkly Rep 2013 Sep 13;62(36):741 full-text), with large outbreaks associated with importation of measles from other countries. These outbreaks highlight the continued need for effective vaccination programs. Unfortunately, the findings of this new randomized trial show that current messaging from public health authorities is not effective for the groups least likely to allow vaccination of their children. Alternative initiatives are needed, and future studies evaluating the effect of messaging on childhood vaccination rates are warranted.

For more information see the Measles, Mumps, and Rubella Vaccine topic in DynaMed.

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

DynaMed Events
May 3-7, 2014

Deputy Editor Thomas Hilts, DO, will be attending the Society of Teachers of Family Medicine (STFM) 47th Annual Spring Conference, held at the Grand Hyatt San Antonio Riverwalk in San Antonio, Texas. 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.

KidsCareEverywhere Blogging from Vietnam

EBSCO Information Services along with PEMSoft and DynaMed are proud sponsors of KidsCareEverywhere. KidsCareEverywhere is a public charity dedicated to transforming pediatric care in under-resourced communities by donating state-of-the-art medical software to public hospitals and training physicians and medical providers in software utilization.

Read about an ongoing initiative in Vietnam at KidsCareEverywhere

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 Oncology
Section Editor of Specialty Content

Learn more about DynaMed Contribution Opportunities

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