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CME DEMOGRAPHIC AND EVALUATION FORM
Perspectives from Practice: Early Identification and Treatment Protocols in Managing Severe Sepsis CD-ROM Educational Activity
1. What is your profession? Check all that apply.
MD
DO
RN
PA
  Other

2. Specialty
 

3. Early Identification of Severe Sepsis
Tom Ahrens, DNS, RN, CCNS, FAAN
  Rating Scale: 5=Excellent 4=Very Good 3=Good 2=Fair 1=Poor
 
(A): Knowledge of subject

1     2     3     4     5    
 
(B): Presentation was orderly and understandable

1     2     3     4     5    
 
(C): Use of audiovisual and discussion were effective in helping me learn

1     2     3     4     5    

4. Guidelines, Management Protocols, and Care Bundles
R. Phillip Dellinger, MD
  Rating Scale: 5=Excellent 4=Very Good 3=Good 2=Fair 1=Poor
 
(A): Knowledge of subject

1     2     3     4     5    
 
(B): Presentation was orderly and understandable

1     2     3     4     5    
 
(C): Use of audiovisual and discussion were effective in helping me learn

1     2     3     4     5    

5. Examples From Practice – Case Studies
Marin H. Kollef, MD, FACP, FCCP
  Rating Scale: 5=Excellent 4=Very Good 3=Good 2=Fair 1=Poor
 
(A): Knowledge of subject

1     2     3     4     5    
 
(B): Presentation was orderly and understandable

1     2     3     4     5    
 
(C): Use of audiovisual and discussion were effective in helping me learn

1     2     3     4     5    

6. Please evaluate how well the following learning objectives were met. At the end of this activity, participants should be able to:
  Rating Scale: 5=Excellent 4=Very Good 3=Good 2=Fair 1=Poor
 
(A): Discuss tools and techniques that can facilitate earlier assessment of severe sepsis risk

1     2     3     4     5    
 
(B): List evidence-based guideline recommendations for actions to be taken within 6 hours and 24 hours of severe sepsis diagnosis

1     2     3     4     5    
 
(C): Discuss the benefits of implementing severe sepsis treatment protocols in terms of treatment outcomes

1     2     3     4     5    
 
(D): Identify resources for the development and implementation of severe sepsis treatment protocols

1     2     3     4     5    

7. Was all data reported objectively and with appropriate referencing?
Yes
No

8. Was the overall content of this educational activity presented objectively and free of bias?
Yes
No

9. If you answered 'No' to question 7 or 8, please explain:
 

10. Was the subject matter relevant to your clinical practice?
Yes
No

11. Was the educational format an effective learning method?
Yes
No

12. If you answered 'No' to question 10 or 11, please explain:
 

13. What one question remains unanswered after having participated in this activity?
 

14. Cite one new piece of information learned from this activity.
 

15. What related topics would you like to have offered as future CME activities?
 

16. Did you encounter any technical problems while running this activity on your computer?
Yes
No

17. If yes, please describe the problem
 

18. What are your preferred learning methods? (Check as many as applicable)
Live conferences
CD-ROM
Print materials (eg, monographs)
Internet/Web-based
  Other

19. How did you learn about this educational activity?
CD-ROM
E-mail
  Other

20. Additional Comments:
 

21. CONTINUING EDUCATION CREDIT ATTESTATION
The Center for Accredited Healthcare Education designates this educational activity for a maximum of 1.75 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

The Institute for Medical and Nursing Educaiton designates this educational activity for 1.75 contact hours (0.175 CEUs). Accreditation by the ANCC’s Committee on Accreditation refers to recognition of educational activities and does not imply approval or endorsement of any product.

I certify that I completed this educational activity. The actual amount of time I spent in this activity was:
 
 hours     minutes  (Not to exceed 1 hr(s) 45 mins)

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