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

Release Date: April 29 2015
Expiration Date: April 29, 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 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: 1405237Y2

Last week 544 journal articles were evaluated via DynaMed's Systematic Literature Surveillance and summaries of 173 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.

Nicotine Patch Treatment for 52 Weeks May Be Safe, but May Not Be More Effective than 24 Week Treatment for Smoking Cessation

Reference: JAMA Intern Med 2015 Apr 1;175(4):504 (level 2 [mid-level] evidence)

Cigarette smoking is a leading cause of preventable morbidity and mortality. Approximately 20% of adults in the United States smoke cigarettes and although 69% of smokers report a desire to quit, only 4-7% are successful each year (MMWR Morb Mortal Wkly Rep 2012 Jun 15;61 Suppl:38). Nicotine replacement therapy with transdermal nicotine patches is considered a first-line medication option for the treatment of tobacco use (Am J Prev Med 2008 Aug;35(2):158). While transdermal nicotine replacement significantly increases the likelihood of smoking cessation compared to placebo, the 6-month abstinence rates are usually only around 20% with treatment (Cochrane Database Syst Rev 2012 Nov 14;(11):CD000146, Addiction 2008 Apr;103(4):557). Extending the duration of treatment from the standard 8 weeks to 24 weeks was associated with an increased rate of abstinence at 24 weeks, but no significant differences in abstinence at 52 weeks (Ann Intern Med 2010 Feb 2;152(3):144), suggesting extended treatment may increase the duration of smoking abstinence, but only temporarily. A recent randomized trial attempted to determine the effect of even longer use by comparing nicotine patch treatment for 8 weeks vs. 24 weeks vs. 52 weeks in 525 adult smokers (mean age 46 years) interested in quitting. All included patients smoked ? 10 cigarettes per day and received patches containing 21 mg nicotine plus smoking cessation counseling.

Only 67% of patients completed the assessment at 24 weeks and 60% completed the assessment at 52 weeks, but all randomized patients were included in the analysis. Seven-day point-prevalence abstinence rates were confirmed using breath CO levels at weeks 8, 24, and 52. At week 24, 7-day point-prevalence abstinence was 21.7% with 8 weeks of treatment vs. 27.2% with extended treatment (24 week and 52 week treatment groups combined). Compared to 8 week standard therapy, extended therapy was associated with a longer duration of abstinence before relapse (mean 89 days vs. 72 days, p < 0.001), more abstinence days (mean 80.5 days vs. 68.2 days, p = 0.02), and fewer cigarettes per day on nonabstinent days (mean 5.8 cigarettes vs. 6.4 cigarettes, p = 0.02). At week 52, there were no significant differences in 7-day point prevalence abstinence, duration of abstinence before relapse, or abstinence days comparing 8 or 24 week treatment to 52 week treatment, but treatment for 52 weeks was associated with fewer cigarettes per day on nonabstinent days (mean 5.4 cigarettes vs. 7.5 cigarettes, p = 0.01). There were no significant differences in adverse events among groups. In a secondary analysis comparing 8 week treatment vs. 24 week treatment, 24 week treatment was associated with significantly increased abstinence rates at 24 weeks, but not 52 weeks.

The results of this study suggest that nicotine replacement therapy with a transdermal nicotine patch may be safe for 52 weeks of use, but it may not be more effective than 24 weeks of treatment for increasing smoking abstinence rates. While there were no significant differences in abstinence rates at 24 weeks comparing 8 week treatment to both extended therapy groups, there was a significant difference in the abstinence rate comparing 24 weeks vs. 8 weeks at this time point. Similar to previous results, there were no significant differences comparing 8 vs. 24 week treatment in abstinence rates at 52 weeks. These results suggest that it is safe for patients to use nicotine patches for up to 1 year, although any benefit beyond 6 months remains unproven. Nicotine replacement therapy should be tailored to individual patients for maximum effectiveness.

For more information, see the Nicotine replacement therapy for smoking cessation topic in DynaMed.

Quick Access to Clinical Answers with the DynaMed App

DynaMed users can access valuable evidence-based content anywhere with the updated DynaMed mobile app. The 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 complimentary for all 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.

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.

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