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Physicians: .25 AMA PRA Category I CreditsTM
Family Physicians: .25 Prescribed credits
Nurse Practitioners: .25 Contact hours

Release Date: July 2, 2014
Expiration Date: July 2, 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.

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: 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: 1405237G

Last week 617 journal articles were evaluated via DynaMed's Systematic Literature Surveillance and summaries of 250 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.

Pelvic Exam Not Recommended for Screening Asymptomatic Nonpregnant Women
Reference: Ann Intern Med 2014;161:67

Pelvic examination is a common part of annual health visits for women as a screening method for cancer and infections. A new evidence-based clinical practice guideline by the American College of Physicians (ACP) found that the harms outweigh the potential benefits, and recommends strongly against screening pelvic examinations in asymptomatic nonpregnant adult women.

The guideline included a systematic review of English-language studies published from 1946 to 2014 to determine the best current evidence for the diagnostic accuracy, benefits, and harms of the screening pelvic examination for detection of cancer, pelvic inflammatory disease, or other benign gynecologic conditions. For cancer detection, across 3 cohort studies with 5,633 asymptomatic women, only 4 cases of ovarian cancer were detected by pelvic examination. And in a randomized trial evaluating screening for ovarian cancer with transvaginal ultrasonography and CA-125 in 78,000 women, the bimanual pelvic examination was dropped after 5 years because no cancer was detected solely by this examination. The ACP is clear in distinguishing the pelvic exam from cervical cancer screening using visual inspection and swabs for cervical cytology, and cervical cancer screening can be completed without a bimanual pelvic examination.

No studies were identified that evaluated the diagnostic accuracy or benefits of pelvic examination for asymptomatic pelvic inflammatory disease, benign conditions, or gynecologic cancer other than cervical or ovarian cancer. Harms identified for the pelvic examination included pain or discomfort reported by 11%-60% in 8 studies with 4,576 women, and fear, embarrassment, or anxiety reported in 10%-80% in 7 studies with 10,702 women. Women experiencing pain or discomfort during their examination were less likely to have a return visit than those not experiencing pain or discomfort in 5 of 5 studies reporting this outcome.

Many aspects of routine care are based on established practice, and have not been subject to rigorous assessment or review. For cancer in particular, there has been a focus in mainstream health messaging that early detection is vital, and many people may not understand that screening carries potential harms that must be weighed against the proposed benefits and may not understand that some of our “standard approaches” can have little or no efficacy for providing early detection that leads to clinical benefit. This is the first evidence-based guideline evaluating screening pelvic examination in this patient population, and the recommendation against this practice will have an important impact on annual wellness visits for a very large number of women.

For more information see the Ovarian cancer screening topic in DynaMed.

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

EBSCO Health Launches Pediatric Clinical Information Mobile App

PEMSoft Now Available For iPhone, iPad, and Android Devices

A mobile app designed specifically for pediatricians, emergency department physicians, physicians-in-training and other medical providers caring for children with acute illnesses and injury, is now available from EBSCO Health, the leading provider of clinical decision support solutions for the healthcare industry.

Designed by pediatricians, emergency physicians and other medical specialists, PEMSoft is a pediatric evidence-based point-of-care medical reference tool for hospitals, emergency departments, clinics, pediatric group practices, transport services, and medical schools. The vast content in PEMSoft addresses the entire spectrum of neonatal, infant, child, adolescent and young adult health. PEMSoft authors adhere to a strict evidence-based editorial policy focused on systematic identification, evaluation and consolidation of practice-changing clinical literature.

The PEMSoft Mobile app includes explicit step-by-step emergency critical care procedures, information about common pediatric signs and symptoms and content covering pediatric injuries and management approaches. More than 3,000 evidence-based pediatric topics and a similar number of medical illustrations, clinical images and videos are also available via the mobile app.

The PEMSoft Mobile App is accessible from both Apple and Android devices.

For more information and technical support, visit the PEMSoft Mobile Access page. To view the official press release, click here.

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.

Section Editor of Specialty Content

DynaMed Contribution Opportunities

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

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.