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

Release Date: August 27, 2014
Expiration Date: August 27, 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: 1405237O

Last week 513 journal articles were evaluated via DynaMed's Systematic Literature Surveillance and summaries of 252 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.

Pulse Oximetry Levels May Overly Influence Hospitalization Decision in Infants With Mild-to-Moderate Bronchiolitis
Reference: JAMA 2014 Aug 20;312(7):712 (level 2 [mid-level] evidence)

Pulse oximetry is routinely used in the assessment and monitoring of children with bronchiolitis. It is a safe and convenient way of measuring oxygenation status, and may detect hypoxemia before it becomes clinically apparent. The American Academy of Pediatrics (AAP) guideline currently recommends that supplemental oxygen should be used in children with bronchiolitis with oxygen saturation persistently ≤ 89% on pulse oximetry (Pediatrics 2006 Oct;118(4):1774 full-text). However, the role of oximetry as part of the decision on whether to admit children to hospital is unclear. A recent randomized trial of 213 infants aged 1-12 months with mild-to-moderate bronchiolitis evaluated the effect of oximetry readings on hospitalization rates.

All infants had oxygen saturation ≥ 88% (mean 97% in each group) at baseline and were randomized to oximetry measurements that were artificially elevated by 3% above true values vs. true oximetry values. The primary outcome was hospitalization within 72 hours or hospital care for ≥ 6 hours due to concerns about respiratory distress. The primary outcome rate was 25% with artificially elevated oximetry display vs. 41% with true oximetry display (p = 0.005). There were no significant between-group differences in the amount of supplemental oxygen administered in the emergency department, or in the length of hospital stay. As well, there was no significant difference in the rate of unscheduled medical visits for bronchiolitis.

Pulse oximetry is one of several different factors used in evaluating the need to admit an infant with bronchiolitis to the hospital, and clinical findings such as respiratory distress or feeding difficulties may indicate a need for hospital admission irrespective of oxygen saturation values. The findings from this trial are consistent with those of a previous observational study that found that oxygen saturation levels were a significant predictor of hospital admission after emergency department evaluation for moderate-to-severe bronchiolitis (Pediatr Emerg Care 2012 Feb;28(2):99). However, the ability to interpret these new results is limited by the fact that most infants in the study had near-normal oxygen saturation at baseline (mean oxygen saturation was 97%, and only 13% overall had oxygen saturation < 94%). Nonetheless, these findings suggest that there may be an overreliance on pulse oximetry in deciding whether to admit infants with mild-to-moderate bronchiolitis to the hospital. These data highlight the need to avoid weighing a single finding in isolation, rather than viewing it as one piece of a larger clinical picture.

For more information see the Bronchiolitis 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.

Visit the PEMSoft page for more information.

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.

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