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Physicians: .25 AMA PRA Category I CreditsTM
Family Physicians: .25 Prescribed credits
Nurse Practitioners: .25 Contact hours
Release Date: May 28, 2014
Expiration Date: May 28, 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 above.
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 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: This enduring material activity, DynaMed EBM Focus Volume 9, has been reviewed and is acceptable for up to 15.25 Prescribed credits by the American Academy of Family Physicians. AAFP certification begins March 5, 2014. Term of approval is for one year from this date. Each EBM Focus is approved for .25 Prescribed credits. Credit may be claimed for one year from the date of each update. 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(s) of continuing education by the American Association of Nurse Practitioners. This program was planned in accordance with AANP CE Standards and Policies and AANP Commercial Support Standards.
Program ID: 1405237C
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Last week 587 journal articles were evaluated via DynaMed's Systematic Literature Surveillance and summaries of 275 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.
Pain from corneal abrasion is a common complaint in the emergency department. Topical anesthetics such as tetracaine are known to be effective at reducing ocular pain, with rapid onset and short duration of action. However, the use of topical anesthetics at home after discharge from the acute care setting has been discouraged because of concerns about complications, including delayed healing of the abrasion, based on case reports, studies of tissue samples, and animal studies. A recent randomized trial compared the safety and efficacy of topical tetracaine to saline drops in 122 patients presenting to the emergency department with a corneal abrasion.
All patients had an uncomplicated corneal abrasion and were randomized to topical tetracaine hydrochloride 1% vs. saline and followed for up to 1 month. The interventions were applied by patients at home every 30 minutes while awake as needed, for 24 hours total. All patients received acetaminophen (paracetamol) 1,000 mg orally every 4 hours for 4 doses and chloramphenicol 1% eye ointment. Patients recorded their pain scores every 30 minutes for the first 2 hours after leaving the emergency department, and then every 2 hours while awake for the next 48 hours. The safety of tetracaine was assessed by evaluating corneal healing by slit-lamp exam and fluorescein uptake at 48 hours from discharge, and by comparing persistent symptoms at 48 hours and 1 month. Patients were also asked to rate how well the intervention had worked on a 0-10 numeric rating scale (higher being more effective), after being contacted by telephone at 1 week and/or 1 month.
There were no significant between-group differences in pain scores at any time point evaluated. Fluorescein uptake at 48 hours occurred in 24% with tetracaine vs. 21% with placebo (not significant). Similarly, persistent symptoms at 48 hours occurred in 17% with tetracaine vs. 18% with placebo (not significant. The self-reported effectiveness score among patients responding at 1 week was 7.7 with tetracaine vs. 3.9 with placebo (p < 0.0005) among 80 patients (66% of those randomized) with data available. Results for persistent symptoms and self-reported effectiveness were consistent at 1 month. In addition, no other complications attributed to topical anesthetic were reported. A total of 29 patients (24%) were excluded from the analyses for incorrect enrolment (5%) or for retained rust rings (19%). Patients with retained rust rings were excluded because their persistent symptoms were thought to be mainly attributed to the rust rings themselves and repeated attempts to remove them, rather than any effect of study medication.
In this study, patients rated the overall effectiveness of topical tetracaine significantly higher than placebo when recalling their experience at 1 week or 1 month after presenting with a corneal abrasion. However, the pain scores recorded during the first 48 hours did not significantly favor tetracaine over saline. The reasons for this apparent discrepancy are not clear, but the large variation in pain scores and the fact that pain scores quickly decreased to nearly zero in both groups after 12 hours are likely contributing factors. Importantly, this study found that patients receiving tetracaine had no evidence of delayed corneal healing, persistent symptoms, or any other complications traditionally attributed to topical anesthetics. These findings highlight the fact that laboratory studies evaluating surrogate outcomes, while useful for elucidating pathophysiologic processes, have limited value in determining the efficacy of an intervention in a clinical setting. The use of chloramphenicol may limit the generalizability of these findings, since antibiotic use for corneal abrasion has limited supporting evidence and may not be routinely used in many practices. Itís also possible that the ointment itself provided relief irrespective of the antibiotic, which may explain the steep drop in pain scores in both groups. Further studies are warranted, but in the meantime these results suggest that topical anesthetics used for 24 hours are safe and may be an option for selected patients presenting to the emergency department with a corneal abrasion.
For more information see the Corneal abrasion topic in DynaMed.
Earn CME Credit for reading this e-Newsletter. For more information on this educational activity, see the CME sidebar.
DynaMed EventsAmerican Society of Clinical Oncology (ASCO) 50th Annual Meeting
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.
Medical Marijuana: Regs, Responsibilities & Communication
June 18, 2014 / 8am-12:30pm
Senior Deputy Editor Alan Ehrlich, MD, will be attending the Massachusetts Medical Society (MMS) CME Event and Conference on Medical Marijuana: Regs, Responsibilities & Communication, held at the MMS Headquarters at Waltham Woods in Waltham, Massachusetts. Representatives will be available to discuss peer review, mobile access, and free trial information.
Visit the MMS 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 DyndMedCommunity@ebscohost.com.