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

Release Date: February 18, 2015
Expiration Date: February 18, 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: 1405237O2

DynaMed Contribution Opportunities

Become a DynaMed Resident Focus Reviewer
Education for Clinicians in Training

Last week 551 journal articles were evaluated via DynaMed's Systematic Literature Surveillance and summaries of 170 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.

Human Papillomavirus Vaccination is Not Associated with an Increase in Sexually Transmitted Infections in Adolescent Females

Reference: JAMA Intern Med 2015 Feb 9 early online (level 2 [mid-level] evidence)

Routine human papillomavirus (HPV) vaccination is recommended for all children 11-12 years old and is approved in adolescents and young adults up to 26 years old for the main purpose of preventing HPV associated cancers, particularly cervical cancer (MMWR Recomm Rep 2014 Aug 29;63(RR-05):1, CA Cancer J Clin 2007 Jan-Feb;57(1):7, Obstet Gynecol 2014 Mar;123(3):712, Pediatrics 2012 Mar;129(3):602). Though vaccination rates have been steadily increasing since the quadrivalent HPV vaccine first received FDA approval for girls and women in 2006, missed vaccination opportunities are common. In 2013 vaccine coverage for girls aged 13-17 years was 57.3% for ≥ 1 dose and only 37.6% received all three recommended doses (MMWR Morb Mortal Wkly Rep 2014 Jul 25;63(29):620). Several barriers to vaccination have been reported (Prev Med 2014 Jan;58:22), but the greatest attention has been paid to the effect of vaccination on adolescent sexuality. Specifically, some people have argued that HPV vaccination will lead to earlier sexual activity and increase risky sexual behaviors (J Health Commun 2010 Mar;15(2):205, BMC Public Health 2014 Jul 9;14:700). A recent study compared the incidence of sexually transmitted infections in 21,610 female adolescents aged 12-18 years in the United States receiving at least one dose of the HPV vaccine and 186,501 matched unvaccinated female adolescents using longitudinal insurance data.

Vaccinated and unvaccinated adolescents were matched for age, residence, and health plan, but multiple nonvaccinated controls were allowed for each vaccinated adolescent. Vaccination rates significantly varied by region and the lowest vaccination rates were found in the South. The rate of sexually transmitted infections for the time period including 1 year prior to vaccination and 1 year after vaccination were determined for vaccinated and unvaccinated adolescents. In the year before vaccination, adolescents receiving the HPV vaccine had a significantly higher incidence of any sexually transmitted infection and a higher percentage of oral contraceptive use. To control for these baseline differences, a difference-in-difference analysis was performed comparing the change in the incidence of sexually transmitted infection from 1 year before vaccination to 1 year after vaccination in the vaccinated and unvaccinated groups. The rates of sexually transmitted infections increased in both the vaccinated and unvaccinated populations in the year after vaccination. The difference-in-difference analysis, however, showed no significant difference in sexually transmitted infections comparing vaccinated and unvaccinated adolescents (odds ratio 1.05, 95% CI 0.8-1.38). Similar results were found in subgroup analyses of adolescents aged 12-14 years, adolescents aged 15-18 years, and in adolescents using contraceptive medications.

The results of this study suggest that HPV vaccination is not associated with an increase in sexually transmitted infections. Although adolescents receiving the HPV vaccine had a higher rate of sexually transmitted infections, this difference was established before vaccination occurred and was not the result of HPV vaccination. In contrast, this result suggests that adolescents at an increased risk for sexually transmitted infection may be receiving the HPV vaccine at a higher rate, possibly due to a sexually transmitted infection diagnosis. The increased incidence of sexually transmitted infections observed in both groups of adolescents over time highlights the importance of early HPV vaccination before potential HPV exposure.

For more information, see the Human Papillomavirus Vaccine topic 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.