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Physicians: .25 AMA PRA Category I CreditsTM

Family Physicians: .25 Prescribed credits

Release Date: May 7, 2014

Expiration Date: May 7, 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.

Program ID: 1304159Y

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

DynaMed Contribution Opportunities

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

Last week 503 journal articles were evaluated via DynaMed's Systematic Literature Surveillance and summaries of 241 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.

Urine Dipstick Without Microscopy May Be Used to Rule Out Urinary Tract Infection in Infants < 90 Days Old
Reference: Pediatrics 2014 Apr 28 early online (level 2 [mid-level] evidence)

Serious bacterial infections occur in about 9% of febrile infants aged 1-90 days, with urinary tract infection (UTI) being the most common diagnosis (Pediatrics 2004 Jun;113(6):1662). UTI screening methods include urine dipstick and microscopy of centrifuged urine. Urine dipstick is a relatively simple procedure that can be performed in office settings with minimal training, whereas microscopic examination of urine requires more extensive training. A recent retrospective diagnostic cohort study evaluated both urine dipstick and microscopy for detection of UTI in 6,536 febrile infants aged 1-90 days.

All infants had urine samples obtained by catheterization. The urine dipstick testing used colorimetric interpretation by a semiautomated urine chemistry analyzer. In addition to the comparison with microscopy, a combined analysis was performed, with a positive result defined as positive findings on either urine dipstick or microscopy. The reference standard was urine culture, with UTI defined as presence of > 50,000 colony-forming units/mL of any urinary pathogen. A total of 6,394 infants (98%) with unequivocal urine cultures were included in the analysis.

The prevalence of UTI was about 12% by reference standard. For detection of UTI in the overall analysis, all tests had negative predictive value > 98%. The urine dipstick testing had sensitivity 90.8%, specificity 93.8%, positive predictive value (PPV) 66.8%, and negative predictive value (NPV) 98.7%. Microscopy analysis had sensitivity 90.3%, specificity 91.3%, PPV 58.6%, and NPV 98.6%. The combined urine dipstick and microscopy analysis had sensitivity 94.7%, specificity 87.6%, PPV 51.2%, and NPV 99.2%. The addition of microscopy to urine dipstick was estimated to produce 8 false positive diagnoses of UTI for every diagnosis missed with urine dipstick alone. In 53 infants with subsequent UTI diagnosis after negative urine dipstick, no adverse outcomes were observed.

Urine dipstick testing is a rapid and inexpensive test for detection of UTI that does not require specialized training. These new findings demonstrate that a negative result on urine dipstick testing may rule out UTI in infants < 90 days old. Although adding microscopy analysis to urine dipstick testing resulted in a higher negative predictive value, this must be weighed against an increased number of false positives with combined analysis, which can lead to additional use of healthcare resources and potentially increased antibiotic exposure. Taken together, these data support urine dipstick testing without microscopy for detection of UTI in febrile infants while waiting for urine culture results.

For more information see the Fever without apparent source in infants less than 3 months old topic in DynaMed.

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

News About Mobile Access

On April 16, 2014, Physicians Interactive launched Omnio® 3 for iPhone/iPad/iPod touch as a free update for the existing Skyscape Medical Resources (SMR) app. The Android version will be available by the end of the month. DynaMed is compatible with Omnio 3 on both platforms.

Those users who have Skyscape Medical Resources running on iOS 7 will receive the Omnio 3 update automatically, using the background app update feature that Apple has built into the operating system. Please note that Omnio for iOS supports iOS 7 or higher; Omnio for Android will support version 2.2 or higher.

DynaMed has been moved to the new “References » Library” section. A video showing how to access the Library and to navigate a resource is available in a blog post on omnio.com.

Physicians Interactive have partnered with the original founders of Skyscape at Skyscape Medpresso, Inc., to relaunch SMR as Skyscape Medical Library (SML) – a new app focused on education, and with support for DynaMed on iOS 5 or higher. Users who prefer to continue to use DynaMed within the existing Skyscape interface, should download SML. Learn more about Skyscape Medical Library at Skyscape.com/SML.

For more information and technical support, visit the DynaMed Mobile Access page.

DynaMed Events
May 30-June 3, 2014

DynaMed Founder and Vice President Brian Alper, MD, will be attending the American Society of Clinical Oncology(ASCO) 50th Annual Meeting, held at McCormack Place in Chicago, Illinois. Representatives will be available to discuss peer review, mobile access, and free trial information.

Visit the ASCO 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.