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

Release Date: May 20, 2015
Expiration Date: May 20, 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 providership 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 10+, has been reviewed and is acceptable for up to 13.25 Prescribed credits by the American Academy of Family Physicians. AAFP certification begins April 29, 2015. Term of approval is for one year from this date. Each weekly update 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 13.0 contact hour(s) of continuing education by the American Association of Nurse Practitioners. Program ID 1504207. This program was planned in accordance with AANP CE Standards and Policies and AANP Commercial Support Standards.

Last week 552 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 inform clinical practice," one article was selected by the DynaMed Editorial Team.

Mediterranean Diet Associated with Improved Cognitive Function in Older Adults with High Cardiovascular Risk

Reference: JAMA Intern Med 2015 May 11 early online (level 3 [lacking direct] evidence)

In 2010, the estimated prevalence of dementia was 14.7% among adults over 70 years old in the United States (N Engl J Med. 2013 Apr 4;368(14):1326, Neuroepidemiology. 2007;29(1-2):125). Oxidative stress and vascular impairment contribute to age-related cognitive decline, but no effective pharmacological prevention or treatment strategies have been developed to date (Biochem Pharmacol. 2014 Apr 15;88(4):631, Br J Psychiatry. 2013Sep;203(3):255). Previously, the PREDIMED trial showed that a Mediterranean diet supplemented with antioxidant-rich foods could reduce adverse cardiovascular outcomes in high risk patients. A recent subgroup analysis of that trial examined cognitive function in 447 cognitively healthy adults (mean age 67 years) who were randomized to 1 of 2 antioxidant-enriched Mediterranean diets or a control diet. Patients were followed for median 4.1 years.

The study included healthy adults (without cardiovascular disease at enrollment) with type 2 diabetes mellitus or 3 of 5 cardiovascular risk factors including smoking, hypertension, dyslipidemia, overweight or obesity, and family history of early-onset coronary heart disease. Participants were assigned to Mediterranean diet plus extra-virgin olive oil (1 L/week) vs. Mediterranean diet plus nuts (30g/day) vs. control diet (advice to reduce dietary fat), and were assessed for cognitive function at baseline and at trial completion. Compared to control diet, Mediterranean diet plus extra-virgin olive oil associated with greater improvements in the global cognition composite score (p < 0.01) and the frontal function composite score (p < 0.01) and the Mediterranean diet plus nuts was associated with a higher memory composite score (p < 0.05). In addition, all cognitive composite scores significantly decreased from baseline with control diet.

Statistically significant improvements in composite cognitive scores were observed for both Mediterranean diets, and results of this study are strengthened by the long duration of the intervention and wide array of neuropsychological tests used to evaluate cognitive functioning. However, the study is limited by the high loss to follow up, particularly in the control group, and relatively small number of participants receiving tests of frontal function and language. In addition, inclusion of only high vascular risk participants may affect the generalizability of the findings. Overall, the findings suggest that improvement in cognitive function in older adults may be an additional benefit beyond cardiovascular outcomes from a Mediterranean diet supplemented with antioxidant-rich foods. Whether these improvements in neuropsychological testing translate into real-world functional outcomes remains uncertain.

For more information, see the Mediterranean diet topic in DynaMed.

DynaMed Extra

New High-Value Care Advice from the ACP on Screening for Cancer

The American College of Physicians (ACP) has released new advice on high-value care for screening average-risk adults for 5 common types of cancer, including breast cancer, prostate cancer, colorectal cancer, cervical cancer, and ovarian cancer. Screening strategies from several different clinical guidelines and evidence syntheses were reviewed. A “high value” label was given to screening approaches if there was consensus across guidelines that benefits of screening likely outweigh the harms. A “low value” label was used for certain screening approaches considered overly intensive, which are not recommended.

For more information, see the Screening for cancer topic in DynaMed.

Critical Appraisal of the Medical Literature: A Simplified Approach

July 8 – 9, 2015 – Portland State University - Portland, Oregon.

Join our Editorial Board members Sheri Strite and Michael Stuart and improve your critical appraisal skills. We aim to make critical appraisal of the medical literature meaningful, useful, simple, and doable. This program will be particularly helpful to those who routinely evaluate the medical literature.

Visit the Seminar page for more details.

DynaMed Careers

The DynaMed editorial team is seeking specialist editors in the following fields: Gastroenterology, Nephrology, Oncology (especially Breast cancer and Pancreatic cancer), Ophthalmology, and Pediatric Neurology.

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

DynaMed Contribution Opportunities

Become a DynaMed Resident Focus Reviewer
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