Quick Links

Share with Colleagues
Previous EBM Focus Issues
DynaMed Free Trial
Send Comment to Editor

Join Our Mailing List



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

Release Date: December 31, 2014
Expiration Date: December 31, 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


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: 1405237H2

PEMSoft Mobile

Free Trial of PEMSoft Mobile Available For iPhone, iPad, and Android Devices

The PEMSoft Mobile app, a pediatric evidence-based point-of-care medical reference tool for hospitals, emergency departments, clinics, pediatric group practices, transport services, and medical schools, is now available from EBSCO Health. Designed by pediatricians, emergency physicians and other medical specialists, 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.

Content in the PEMSoft Mobile app covers more than 3,000 conditions and includes a similar number of medical illustrations, clinical images and videos. PEMSoft Mobile also includes explicit step-by-step emergency critical care procedures, information about common pediatric signs and symptoms, and topics covering pediatric injuries and management approaches.

Visit the PEMSoft Mobile App Trial page to access a free trial for both Apple and Android devices.

DynaMed Contribution Opportunities

Become a DynaMed Resident Focus Reviewer
Education for Clinicians in Training

In 2014, the DynaMed Editors considered 28,085 articles and 11,500 articles were included in DynaMed. Each week, from an average of 220 articles added to DynaMed, editors selected articles that were considered "most likely to change clinical practice."

In this "Year in Review" issue, the DynaMed Editors share a recap of the 5 most important articles from 2014. We welcome your comments on how your clinical practice was affected by the information presented. Comments can be sent to DynaMedEditor@ebscohost.com.

We would like to thank our readers for their support and input throughout the year. Your feedback helps improve the DynaMed EBM Focus for the global DynaMed Community.

With our very best wishes for a joyous and peaceful New Year,
The DynaMed Editors.

1. 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.

Click here to continue reading...

2. Arthroscopic Partial Meniscectomy Does Not Improve Symptoms of Degenerative Medial Meniscus Tear in Patients Without Knee Osteoarthritis

Reference: N Engl J Med 2013 Dec 26;369(26):2515 (level 1 [likely reliable] evidence)

Arthroscopic surgeries for patients with established knee osteoarthritis are becoming less common due to a lack of clinical evidence supporting their use. A Cochrane review found that arthroscopic surgery is ineffective for unselected patients with knee osteoarthritis (Cochrane Database Syst Rev 2008 Jan 23;(1):CD005118), based partly on the findings of a randomized trial showing no significant improvement in pain or function scores with either arthroscopic debridement or arthroscopic lavage compared to placebo surgery (N Engl J Med 2002 Jul 11;347(2):81 full-text). Another randomized trial subsequently showed that the addition of arthroscopic surgery to physical and medical therapies did not improve function or pain scores in patients with moderate-to-severe knee osteoarthritis (N Engl J Med 2008 Sep 11;359(11):1097 full-text). More recently, a randomized trial in patients with meniscal tear and knee osteoarthritis showed that arthroscopic partial meniscectomy plus physical therapy did not improve symptoms more than physical therapy alone (N Engl J Med 2013 May 2;368(18):1675 full-text, see DynaMed EBM Focus Volume 8, Issue 13).

Click here to continue reading...

3. 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.

Click here to continue reading...

4. Bilateral Mastectomy May Not Increase Survival Compared to Breast-Conserving Surgery With Radiation in Women With Unilateral Breast Cancer

Reference: JAMA 2014 Sep 3;312(9):902 (level 2 [mid-level] evidence)

Bilateral mastectomy rates have been on the rise among women with early breast cancer in recent years (J Clin Oncol 2009 Sep 1;27(25):4-82, J Clin Oncol 2011 Jun 1;29(16):2158). However, while bilateral mastectomy has been shown to reduce the incidence of breast cancer in women at increased risk (Ann Oncol 2013 Aug;24(8):2029 full-text), the evidence is inconsistent for bilateral mastectomy as a treatment in women with unilateral breast cancer (Cochrane Database Syst Rev 2010 Nov 10;(11):CD002748). Furthermore, no randomized trials have been performed comparing bilateral mastectomy vs. breast-conserving surgery plus radiation. Many women with breast cancer have a preference for bilateral mastectomy based on its perceived benefits, and may object to randomization to less extensive surgery, making it difficult to conduct randomized trials for this particular comparison. A new population-based cohort study evaluated bilateral mastectomy, unilateral mastectomy, and breast-conserving surgery with radiation in 189,734 women with early (stage 0-III) unilateral breast cancer using data collected from 1998 to 2011 in the California Cancer Registry.

Click here to continue reading...

5. In Adults With Unruptured Brain Arteriovenous Malformation, Interventional Therapy Appears to Worsen Outcomes Compared to Medical Management

Reference: Lancet 2014 Feb 15;383(9917):614 (level 2 [mid-level] evidence)

With the increased use of noninvasive neuroimaging, there has been an increase in the detection of brain arteriovenous malformations prior to symptomatic bleeding, but there is currently no clear consensus for the management of these lesions. Patients diagnosed with unruptured or asymptomatic arteriovenous malformations may be managed conservatively or, alternatively, they may be offered interventional therapy with the aim of obliterating the origin of the arteriovenous malformation. Several interventional therapies, including neurosurgery, embolization, and stereotactic radiotherapy have been used successfully in these patients, but there is little clinical evidence to guide the choice of interventional therapy, or to demonstrate its superiority over conservative management. A prospective population-based cohort study in Scotland previously showed that patients receiving interventional therapy for arteriovenous malformation had worse outcomes than those who did not (Lancet Neurol 2008 Mar;7(3):223). Now, a randomized trial compares the addition of interventional therapy to medical management vs. medical management alone in adults with unruptured arteriovenous malformation.

Click here to continue reading...

DynaMed Careers

The DynaMed editorial team is seeking specialist editors in the following fields: ENT, Gastroenterology, Hematology, Oncology (especially Breast cancer, Head and neck cancer, Pancreatic cancer), Ophthalmology, Orthopedics, Pediatric Neurology, and Vascular.

If interested, please send a recent copy of your CV to Rachel Brady at rbrady@ebsco.com.