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

Release Date: May 21, 2014
Expiration Date: May 21, 2015

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 Clinical Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Senior 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: Enduring Material activity, DynaMed EBM Focus, has been reviewed and is acceptable for up to 13 Prescribed credits by the American Academy of Family Physicians. AAFP certification begins March 7, 2012. Term of approval is for one year from this date with the option of yearly renewal. Each EBM Focus is worth .25 Prescribed credits. 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: 1405237B

DynaMed Careers

Looking for a change? The DynaMed editorial team is expanding and looking for talented and driven individuals. Visit the links below to learn about these exciting opportunities.

Deputy Editor of Oncology
Section Editor of Specialty Content

DynaMed Contribution Opportunities

DynaMed Peer Review
Editorial Policies for Reviewers
Education for Clinicians in Training

Last week 383 journal articles were evaluated via DynaMed's Systematic Literature Surveillance and summaries of 237 articles were added to DynaMed content.

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

CAM-S Severity Score May Help Predict 90-Day Mortality and Length of Hospital Stay in Hospitalized Patients ≥ 70 Years Old Without Delirium
Reference: Ann Intern Med 2014 Apr 15;160(8):526 (level 2 [mid-level] evidence)

Hospitalized patients are at an increased risk of delirium, with incidence rates ranging from 3%-29% for new-onset delirium during hospitalization (Age Ageing 2006 Jul;35(4):350 full-text). The Confusion Assessment Method (CAM) is a validated assessment tool that has been shown to reliably identify delirium in several different patient populations (J Am Geriatr Soc 2008 May;56(5):823 full-text), and may be used in screening for delirium on hospital admission. A recent prospective cohort study evaluated a new CAM-Severity (CAM-S) score to predict adverse outcomes in hospitalized patients ≥ 70 years old without delirium on admission.

The derivation cohort included 300 patients ≥ 70 years old from the Successful Aging After Elective Surgery (SAGES) study who were scheduled for major surgery and did not have delirium on hospital admission. The validation cohort included 919 similar hospitalized patients from the Project Recovery study. An additional 355 eligible patients were excluded from the validation cohort for unexplained reasons. The CAM-S short form score was derived using factors from CAM diagnostic assessment tool (total score 0-7 points):

  • acute onset or symptom fluctuation (1 point if present)
  • inattention (1 point if mild or 2 points if marked)
  • disorganized thinking (1 point if mild or 2 points if marked)
  • altered level of consciousness (1 point if mild or 2 points if marked)

The CAM-S score was used to categorize patients into 4 different risk groups: none (0 points), low (1 point), moderate (2 points), and high (3-7 points). In the validation cohort, 90-day mortality was 7% among 598 patients with no risk factors, 15% among 91 patients in the low risk category, 16% among 128 patients in the moderate risk category, and 27% among 102 in the high risk category (p for trend < 0.001). Similarly, adjusted mean length of hospital stay was 6.5 days with no risk factors, 8.8 days for the low risk category, 11.1 days for the moderate risk category, and 12.7 days for the high risk category (p for trend < 0.001). Increased CAM-S short form scores were also associated with increased risk of new nursing home placement, functional decline, and cognitive decline (p for trend < 0.001 for each). The prediction of adverse patient outcomes with the CAM-S short form was also consistent with a 10-item long form of CAM-S (total score 0-19 points).

Although the use of CAM and related diagnostic assessment tools have proved to be helpful for diagnosing delirium in high-risk populations, using the data from the screening assessment to predict adverse outcomes has not been previously described. The findings of this cohort study show that the CAM-S short form score can help predict important patient outcomes such as 90-day mortality and hospital duration, among others. There were some differences in patient characteristics between the derivation and validation cohorts in the study, which may be viewed as a limitation but may also indicate the generalizability of the findings to different patient populations. Altogether, this new tool provides useful information that may help predict adverse outcomes, guide treatment decisions, and potentially monitor response to treatment in some patient populations.

For more information see the Delirium topic in DynaMed.

Special thanks to Sara Martin and Anna Palcheshnikov for their contributions to this week's article.

Earn CME Credit for reading this e-Newsletter. For more information on this educational activity, see the CME sidebar.

News About Mobile Access

On April 16, 2014, Physicians Interactive launched Omnio� 3 for iPhone/iPad/iPod touch as a free update for the existing Skyscape Medical Resources (SMR) app. The Android version will be available by the end of the month. DynaMed is compatible with Omnio 3 on both platforms.

Those users who have Skyscape Medical Resources running on iOS 7 will receive the Omnio 3 update automatically, using the background app update feature that Apple has built into the operating system. Please note that Omnio for iOS supports iOS 7 or higher; Omnio for Android will support version 2.2 or higher.

DynaMed has been moved to the new �References � Library� section. A video showing how to access the Library and to navigate a resource is available in a blog post on omnio.com.

Physicians Interactive have partnered with the original founders of Skyscape at Skyscape Medpresso, Inc., to relaunch SMR as Skyscape Medical Library (SML) � a new app focused on education, and with support for DynaMed on iOS 5 or higher. Users who prefer to continue to use DynaMed within the existing Skyscape interface, should download SML. Learn more about Skyscape Medical Library at Skyscape.com/SML.

For more information and technical support, visit the DynaMed Mobile Access page

DynaMed Events

American Society of Clinical Oncology (ASCO) 50th Annual Meeting
May 30-June 3, 2014

DynaMed Founder and Vice President Brian Alper, MD, will be attending the American Society of Clinical Oncology(ASCO) 50th Annual Meeting, held at McCormack Place in Chicago, Illinois. Representatives will be available to discuss peer review, mobile access, and free trial information.

Visit the ASCO website to learn more about the event and for registration information.

Medical Marijuana: Regs, Responsibilities & Communication
June 18, 2014 / 8am-12:30pm

Senior Deputy Editor Alan Ehrlich, MD, will be attending the Massachusetts Medical Society (MMS) CME Event and Conference on Medical Marijuana: Regs, Responsibilities & Communication, held at the MMS Headquarters at Waltham Woods in Waltham, Massachusetts. Representatives will be available to discuss peer review, mobile access, and free trial information.

Visit the MMS website to learn more about the event and for registration information.

If you would like to meet with a DynaMed representative at any of our conferences, please contact us at DyndMedCommunity@ebscohost.com.

PEMSoft Mobile is Now Live

Access the definitive resource for pediatric clinical information right from your Apple or Android device.

  • Access topics using A-Z index
  • Search content using intuitive navigation
  • View images easily

For more information and technical support, visit the PEMSoft Mobile Access page

Call for Peer Reviews

We are currently seeking subspecialty reviewers for our Patient Education Resource Center (PERC). PERC provides fact sheets and discharge instructions for patients leaving the hospital or emergency room. These hand-outs fulfill the meaningful use requirements for the Medicare & Medicare Services Incentive Programs.

Click here to speak with us about becoming a peer reviewer.