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Credits
Physicians: .25 AMA PRA Category I CreditsTM
Family Physicians: .25 Prescribed credits
Nurse Practitioners: .25 Contact hours
Release Date: October 1, 2014
Expiration Date: October 1, 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 Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Executive 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
Disclosures
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: 1405237T
DynaMed Contribution Opportunities
Become a DynaMed Resident Focus Reviewer
DynaMed Peer Review
Editorial Policies for Reviewers
Education for Clinicians in Training
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
Last week 386 journal articles were evaluated via DynaMed's Systematic Literature Surveillance and summaries of 195 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.
Addition of Inhaled Corticosteroid to LABA in Older Patients with COPD Associated With Decreased Risk of Death and Hospitalization
Reference: JAMA 2014 Sep 17;312(11):1114 (level 2 [mid-level] evidence)
Chronic obstructive pulmonary disease (COPD) is a major public health problem, currently affecting 210 million people worldwide and projected to be the fourth leading cause of death by 2030 (WHO 2007 PDF). Although no existing COPD medication has been shown to modify long-term lung function, pharmacological interventions such as long-acting beta-agonists (LABAs) and inhaled corticosteroids are routinely used to manage symptoms and complications (GOLD 2013 Feb 13 PDF). A recent Cochrane review of randomized trials found LABAs plus inhaled corticosteroids reduced COPD exacerbations more than LABAs alone, although results on mortality were inconsistent (Cochrane Database Syst Rev 2012 Sep 12;(9):CD006829). A recent Cochrane review of randomized trials found LABAs plus inhaled corticosteroids reduced COPD exacerbations more than LABAs alone, although results on mortality were inconsistent (Cochrane Database Syst Rev 2012 Sep 12;(9):CD006829).
Now, a population-based cohort study investigated COPD hospitalizations and death in 11,872 propensity-matched elderly patients (> 66 years old) with COPD newly prescribed LABAs plus inhaled corticosteroids or LABAs alone. A cohort of 3,160 patients taking LABAs alone were matched with 8,712 patients taking combination therapy based on a propensity score, age, sex, asthma codiagnosis, and COPD duration. Patients were followed for about two and a half years. Compared to LABAs alone, LABAs plus inhaled corticosteroids were associated with a small, but statistically significant, reduction in mortality (55.3% vs. 58.6%, p < 0.001, NNT 31) and COPD hospitalizations (27.8% vs. 30.1%p < 0.001, NNT 44). No significant differences in hospitalizations for pneumonia or fragility fracture were observed.
The results of this large population-based study extend the results of previous randomized trials, showing that the addition of inhaled corticosteroids to LABAs not only decreases the frequency of COPD exacerbations, but may also decrease COPD-related hospitalizations and mortality. The patient population examined in this study matches the patients expected in clinical practice, particularly the inclusion of elderly patients and those with asthma and other comorbidities. However, these findings are limited by the observational design of the study, and a randomized trial would be optimal for confirming these findings.
For more information see the Inhaled corticosteroids for COPD and Bronchodilators for COPD topics in DynaMed.
Earn CME Credit for reading this e-Newsletter. For more information on this educational activity, see the CME sidebar.
DynaMed Events
Family Medicine Midwest Conference: October 10-12, 2014
Deputy Editor Tom Hilts, DO, will be attending the Family Medicine Midwest Conference in Minneapolis, Minnesota. Representatives will be available to discuss peer review, mobile access, and free trial information.
Visit the FMM website to learn more about the event and for registration information.
American Academy of Pediatrics National Conference: October 11-14, 2014
Deputy Editor Mike Woods, MD, MS, FAAP, will be attending the American Academy of Pediatrics National Conference in San Diego, California. Representatives will be available to discuss peer review, mobile access, and free trial information.
Visit the AAP website to learn more about the event and for registration information
American Academy of Family Physicians Conference: October 21-25, 2014
Representatives will be available at the American Academy of Family Physicians Assembly in Washington, District of Columbia to discuss peer review, mobile access, and free trial information.
Executive Deputy Editor Alan Ehrlich, MD, will be attending and will also be presenting on Medical Marijuana: What You Need To Know on Friday at 9:15am and 2:45pm.
Visit the AAFP 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.
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.