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: June 10, 2015
Expiration Date: June 10, 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.

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
Education for Clinicians in Training

Last week 417 journal articles were evaluated via DynaMed's Systematic Literature Surveillance and summaries of 125 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.

Herpes Zoster Subunit Vaccine Has 96% 3-year Efficacy Against Herpes Zoster in Immunocompetent Adults ≥ 50 years old

Reference: N Engl J Med 2015 May 28;372(22):2087 (level 1 [likely reliable] evidence)

Herpes zoster (shingles) may occur in persons of any age previously infected with the varicella zoster virus (chickenpox), but it is most common in adults > 60 years old experiencing an age-related decline in immunity (Ann Intern Med 2011 Mar 1;154(5):ITC31). Zostavax, a live zoster vaccine, is recommended for adults ≥ 60 years old, but it is not appropriate for adults with immunodeficiencies (MMWR Morb Mortal Wkly Rep 2015 Feb 6;64(4):91). Zostavax has a reported 3-year efficacy of 51.3% against herpes zoster (absolute risk reduction of 1.7%), but this efficacy decreases with increasing patient age (N Engl J Med 2005 Jun 2;352(22):2271). The first report of an ongoing phase 3 trial was recently published comparing a herpes zoster subunit vaccine vs. placebo in 15,411 immunocompetent adults ≥ 50 years old without history of herpes zoster, herpes zoster vaccination, or varicella vaccination. The subunit vaccine contained 50 mcg recombinant varicella–zoster virus glycoprotein E and a liposome-based AS01B adjuvant system. Two vaccination or placebo doses were administered to adults by intramuscular injection at baseline and 2 months.

All adults received at least 1 study drug dose and were included in the overall analysis. At randomization, 8,926 adults (58%) were assigned to a reactogenicity subgroup and asked to record solicited injection site and systemic reactions for 7 days on a diary card. During the mean 3.2 year follow up, there were 244 confirmed cases of herpes zoster (0.1% with vaccination vs. 3.1% with placebo, absolute risk reduction of 3%). The rate of herpes zoster per 1,000 person-years was 0.4 with the subunit vaccine and 9.3 with placebo in the overall cohort, giving a vaccine efficacy of 96.2% (p < 0.001). These results were consistent across all age groups. Overall, serious adverse events were reported in 9% receiving the subunit vaccine and 8.9% receiving placebo. The reactogenicity subgroup reported a greater percentage of adverse events in the vaccination group within 7 days of administration (84.4% vs. 37.8%), but most were mild to moderate injection site or systemic reactions with grade 3 adverse events reported in 17% with vaccination and 3.2% with placebo (no p value reported).

While the zoster subunit vaccine showed increased reactogenicity compared to placebo, most reactions were mild to moderate with a similar rate of serious adverse events reported in the overall cohort. The high efficacy of the herpes zoster subunit vaccine found in this trial has many important implications. First, there appears to be greater overall efficacy compared to Zostavax. This subunit vaccine also shows no evidence of decreased immunogenicity with age. Finally, unlike the live zoster vaccine, it may also be safe for use in immunocompromised populations because the subunit vaccine does not contain a replicating virus with the potential to cause disease. Immunocompromised patients were excluded from this phase 3 trial, however, so further studies will be required to determine if this vaccine is safe for all older adults. Overall, the results of this trial suggest that this recombinant varicella–zoster virus glycoprotein E subunit vaccine is highly effective for preventing herpes zoster in older immunocompetent adults. The ongoing trial will continue to monitor patients for approximately 60 months to determine the vaccine efficacy over 5 years.

For more information see the Herpes zoster topic in DynaMed.

EBSCO Health’s New DynaMed Plus Delivers Trusted, Evidence-Based Content to Physicians on Any Platform

EBSCO Health recently launched DynaMed Plus, a cross-platform, evidence-based clinical decision support tool that provides clinicians with the ideal blend of evidence and expertise to help them determine optimal patient care paths.

DynaMed Plus helps medical professionals quickly find evidence-based answers to make the best treatment decisions in any location. With DynaMed Plus, clinicians (and their patients) will benefit from:

  • Quickest time-to-answer—Including intelligent auto-suggest, direct-to-section search results, exact match summary display, dynamic linking and quick access to relevant calculators.
  • Concise, accurate overviews and recommendations—For the most common conditions as well as evidence-based recommendations for action.
  • Comprehensive image library—Over 4,000 full-color medical graphics and images to help clinicians make the best decisions.
  • Rigorous editorial process—Subject-specific experts review topics on a daily basis using the DynaMed Plus proprietary evidence-based methodology and quality assurance process.
  • Access to specialty content—Clinicians can view thousands of topics covering emergency medicine, cardiology, oncology, infectious disease, pediatrics, obstetrics and gynecology, and much more.
  • Anywhere, anytime accessDynaMed Plus can be used on iOS and Android mobile devices, making access fast and easy, and providing clinicians with an intuitive and elegant mobile experience.

To read the press release and for more information on DynaMed Plus, click here. For free trial information, click here.

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.