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

Release Date: February 11, 2015
Expiration Date: February 11, 2016

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: 1405237N2

DynaMed Contribution Opportunities

Become a DynaMed Resident Focus Reviewer
Education for Clinicians in Training

Last week 477 journal articles were evaluated via DynaMed's Systematic Literature Surveillance and summaries of 181 articles were added to DynaMed content.

Based on criteria for selecting "articles most likely to inform clinical practice," one article was selected by the DynaMed Editorial Team.

Colon Capsule Endoscopy May Detect More Polyps than Computed Tomography Colonography in Patients with Prior Incomplete Colonoscopy

Reference: Gut 2015 Feb;64(2):272 (level 2 [mid-level] evidence)

Colon cancer screening is recommended beginning at age 50 years for adults with an average risk of cancer and optical colonoscopy is the standard screening method (Gastroenterology 2008 May;134(5):1570). Colonoscopy is associated with reduced risk of colon cancer and colon cancer-related mortality (Ann Intern Med 2011 Jan 4;154(1):22, BMJ 2014 Apr 9;348:g2467), but incomplete colonoscopy may significantly increase the risk of missed polyps and adenomas (Colorectal Dis 2015 Jan 21 early online, BMC Gastroenterol 2014 Mar 29;14:56). Two methods of follow-up after incomplete colonoscopy include colon capsule endoscopy and computed tomography (CT) colonography. While both procedures do not require sedation, CT colonography requires air insufflation and also exposes the patient to low-dose radiation, which is associated with a small, but significant, increase in the risk of cancer (Gastrointest Endosc Clin N Am 2010 Apr;20(2):279, Eur J Radiol 2013 Aug;82(8):1159). A recent diagnostic cohort study compared the ability of colon capsule endoscopy and CT colonography to identify polyps at least 6 mm in size in 100 patients (median age 59 years and 66% female) with prior incomplete colonoscopy. The reasons for incomplete colonoscopy included excessive pain in 45%, difficult examination in 38%, and tortuosity of the colon in 17%.

Patients had colon capsule endoscopy followed by CT colonography on the same day and outcome assessors were blinded to the results of the other test. If a polyp or mass at least 6 mm in size was detected on either test, the patient underwent repeat colonoscopy within 1 month. If both tests were negative, however, patients did not receive a repeat colonoscopy and were assessed for missed cancers by clinical follow-up at 1 year. Colon capsule endoscopy detected polyps at least 6 mm in size in 25 patients, with only 1 false positive result and no false negative results. CT colonography, on the other hand, only detected polyps at least 6 mm in size in 14 patients, with 2 false positive results and 12 false negative results. Taken together, the colon capsule endoscopy had a relative sensitivity of 2 (95% CI 1.34-2.98) compared to CT colonography. The remaining 74 patients with negative results on both tests reported no missed cancers during mean 20-month follow-up.

This study shows that colon capsule endoscopy may detect more polyps than CT colonography after an incomplete colonoscopy. The absolute diagnostic accuracy of these tests, however, could not be determined in this study. Patients with negative results on both tests did not have a follow-up colonoscopy and therefore a true false negative rate could not be determined due to the possibility that a patient could have had a false negative result on both tests. The follow-up period was insufficient to clinically rule out a missed cancer and equally important, a missed polyp (a key point of the screening being to detect precancerous lesions). Further studies with longer follow-up durations are necessary to determine the proper management after a negative evaluation with either colon capsule endoscopy or CT colonography.

For more information, see the Colonoscopy and Virtual colonoscopy topics in DynaMed.

DynaMed Introduces New and Improved Mobile App

February 5, 2015

DynaMed users can now access valuable, evidence-based content anywhere with the new DynaMed mobile app. The new app has been redesigned to make it easier and faster for physicians to find answers to clinical questions. The app features an improved user experience, seamless authentication and easy access to the latest clinical content. It provides offline access, and the ability to denote favorites, email topics and write and save notes about particular topics. Users download the complete DynaMed content set and periodically receive notifications to update the content.

The DynaMed app is a complimentary part of personal and institutional DynaMed subscriptions. The app has also been designed for easy, one-time authentication via email, making the process as convenient as possible.

The app can be downloaded from the iTunes Store or Google Play. For more information, please visit the DynaMed Mobile Access page.

Bronchiolitis and Respiratory Distress in Children

PEMSoft Complimentary Webinar
Thursday, February 26, 2015 @ 2:00 pm EDT

Join Sean Fox, MD, Associate Editor-in-Chief of PEMSoft for a short lecture on bronchiolitis and respiratory distress in children.

Dr. Fox is Associate Professor for the Department of Emergency Medicine and Assistant Program Director for Emergency Medicine Residency at Carolinas Medical Center in Charlotte, North Carolina. He is the 2014 recipient of the ACEP National Emergency Medicine Faculty Teaching Award, the chair for the ACEP Pediatric Emergency Medicine Section and the director of the Emergency Medicine residency didactic curriculum. Dr. Fox received his medical degree and a combined residency in Emergency Medicine/Pediatrics at the University of Maryland. He also manages several educational websites geared toward the practice of emergency medicine

Click here to register.

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.