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

Release Date: September 17, 2014
Expiration Date: September 17, 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: 1405237R

Last week 482 journal articles were evaluated via DynaMed's Systematic Literature Surveillance and summaries of 177 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.

Maternal Vaccination Decreases Risk of Influenza in Mothers and Their Infants
Reference: N Engl J Med 2014 Sep 4;371(10):918
for women without HIV infection (level 1 [likely reliable] evidence)
for women with HIV infection (level 2 [mid-level] evidence)

Pregnant women are at increased risk of severe influenza from their second trimester until the early postpartum period, and are considered a priority group for receiving seasonal influenza vaccine by the World Health Organization (Weekly Epidemiological Record PDF) and the Centers for Disease Control and Prevention (MMWR Recomm Rep 2013 Sep 20;62(RR-07):1 full-text). However, data on the efficacy of influenza vaccination in this population is limited, particularly data showing a protective effect on infants after birth. Two recent randomized trials from South Africa evaluated the efficacy of trivalent inactivated influenza vaccination in 2,116 pregnant women not infected with HIV, in 194 pregnant women with HIV infection, and in their newborns up to 24 weeks after birth.

In pregnant women without HIV infection, the rate of laboratory-confirmed influenza was 1.8% with influenza vaccine vs. 3.6% with placebo (p = 0.01). Similarly, among infants born to vaccinated mothers, confirmed influenza infection rates were 1.9% with influenza vaccine vs. 3.6% with placebo (p = 0.01). In pregnant women infected with HIV, the rates of laboratory-confirmed influenza with vaccine vs. placebo were 7% vs. 17% (p = 0.05) in mothers and 5% vs. 6.8% among their infants (not significant). There were no significant differences between the influenza group and the placebo group for rates of nonspecific influenza-like illness or for respiratory illnesses in general, irrespective of HIV infection status.

The protective effect of inactivated influenza vaccine for infants of vaccinated mothers observed in these new trials is consistent with a previous trial conducted in Bangladesh. This previous trial of 340 women found that a similar maternal vaccination reduced laboratory-confirmed influenza cases in infants followed for 24 weeks compared to maternal vaccination with pneumococcal vaccine (N Engl J Med 2008 Oct 9;359(15):1555). This newer and larger trial further solidifies this protective effect in mothers without HIV infection and their infants. It also suggests benefit for HIV-infected mothers as well, a population that may be particularly vulnerable to infection.

For more information see the Influenza in pregnancy topic in DynaMed.

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

DynaMed Extra

Updated ACP Guideline for Nonsurgical Management of Urinary Incontinence in Women

The American College of Physicians (ACP) guidelines for nonsurgical management of urinary incontinence in women have recently been updated (Ann Intern Med 2014 Sep 16;161(6):429 PDF). The guidelines have been incorporated into the Urinary incontinence in women and Behavioral interventions for urinary incontinence topics. For more information, see these topics in DynaMed.

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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