Post-Test, Activity Evaluation Form and Application ... - epgonline.org
Post-Test, Activity Evaluation Form and Application ... - epgonline.org
Post-Test, Activity Evaluation Form and Application ... - epgonline.org
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<strong>Post</strong>‐<strong>Test</strong>, <strong>Activity</strong> <strong>Evaluation</strong> <strong>Form</strong> <strong>and</strong> <strong>Application</strong> for Continuing Medical Education Credit<br />
SGLT2 Inhibitors: Assessing the Evidence <strong>and</strong> the Potential Impact on Future Clinical Practice<br />
An on-line multi-lingual independent medical education programme<br />
Date of <strong>Activity</strong>: 12 January 2012<br />
Expires: 12 January 2013<br />
We greatly value your opinion. Please complete this post‐test <strong>and</strong> evaluation <strong>and</strong> fax it back to us. Your responses will be<br />
used in future planning of activities <strong>and</strong> materials.<br />
<strong>Post</strong>‐<strong>Test</strong><br />
Please circle the correct response for each question below<br />
European countries spend approximately what proportion of their<br />
≈ 1% ≈3‐6% ≈10% >10%<br />
healthcare expenditure on diabetes?<br />
What proportion of glucose reabsorption in the kidney is mediated by<br />
SGLT2?<br />
10% 30% 50% 90%<br />
SGLT2 facilitates reabsorption of filtered glucose that is<br />
Insulin‐dependent<br />
Insulin‐independent<br />
Dapagloflozin has been studied in<br />
combination with<br />
Metformin Sulfonylureas Insulin Thiazolidinediones<br />
All of these<br />
agents<br />
A 65 year old patient on metformin 750 mg twice daily was<br />
commenced on dapagliflozin 5 mg once daily. Based on clinical study<br />
data, what further reduction in HbA1C would you expect?<br />
‐ 0.1% ‐0.5% ‐0.7% ‐1.0%<br />
<strong>Activity</strong> <strong>Evaluation</strong><br />
Please tick in one box for each objective<br />
The learning objectives designed for this activity can help me strive<br />
toward:<br />
• State the rationale for targeting glucose reabsorption by the<br />
kidney in patients with diabetes<br />
Not<br />
met<br />
Reinforcement<br />
Moderate<br />
Improvement<br />
Significant<br />
Improvement<br />
Improvement<br />
• Describe current glycemic control of type 2 diabetes <strong>and</strong> current<br />
unmet needs<br />
• Evaluate the evidence for SGLT2 inhibitors as therapy of type 2<br />
diabetes<br />
• Identify how SGLT2 inhibitors might be incorporated into clinical<br />
practice.<br />
Please circle to indicate the extent of your agreement with the<br />
following statements:<br />
1. The information presented at this activity was pertinent to<br />
my professional needs.<br />
Strongly<br />
Disagree<br />
Not sure<br />
Strongly<br />
agree<br />
1 2 3 4 5<br />
2. The teaching <strong>and</strong> learning methods were effective 1 2 3 4 5<br />
3. The information was presented in a fair <strong>and</strong> balanced<br />
manner <strong>and</strong> examined the topic with scientific rigor.<br />
1 2 3 4 5
4. The content of this activity contributes valuable information<br />
that will assist me in improving patient outcomes.<br />
5. Based on my experience today, I would recommend future<br />
activities for diabetes similar to this to my colleagues.<br />
Please rate the faculty:<br />
6. What was your overall rating of the speaker?<br />
– Professor John Wilding<br />
1 2 3 4 5<br />
1 2 3 4 5<br />
Poor‐to‐<br />
Fair<br />
Fair‐to‐<br />
Good<br />
Excellent<br />
1 2 3 4 5<br />
7. Will the information presented cause you to make any changes in your practice? Yes No<br />
Please explain the reason for your answer:<br />
____________________________________________________________________________________________<br />
8. Based upon the information presented in this educational activity, which of the following statements best<br />
reflects your sentiment toward education for SGLT2 inhibitors (circle one)<br />
a. I have learned everything I need to learn about SGLT2 inhibitors<br />
b. I would like to learn more about SGLT2 inhibitors<br />
9. We would be interested in using your topic suggestions as a means to develop future education. What general<br />
comments or additional topics would you suggest for future activities?<br />
______________________________________________________________________<br />
______________________________________________________________________<br />
10. Overall, was this activity satisfactorily free from commercial bias? Yes No<br />
Comments:<br />
____________________________________________________________________________________________<br />
11. Mr DB is a 67 year old, obese, male patient (BMI = 31 kg/m 2 ) who was diagnosed with diabetes 1 year ago. He<br />
has mild hypertension <strong>and</strong> NYHA Class II heart failure (treated with atenolol <strong>and</strong> enalapril) <strong>and</strong> dyslipidemia<br />
(treated with simvastatin). His diabetes has been reasonably well controlled on metformin lg twice daily (the<br />
highest dose he can tolerate) <strong>and</strong> glimepiride 4 mg once daily, but has had several episodes of hypoglycaemia<br />
over the last two months <strong>and</strong> you have decided to stop his sulfonylurea.<br />
Which of the following classes of drugs would NOT be an appropriate option in a patient such as Mr DB?<br />
1. A DPP4 inhibitor<br />
2. A thiazolidinedione<br />
3. A SGLT2 inhibitor<br />
4. A GLP1 agonist<br />
12. Other comments:<br />
______________________________________________________________________<br />
______________________________________________________________________
<strong>Application</strong> for Continuing Medical Education Credit<br />
For purposes of certification, please complete the following information. Please note that we will not forward<br />
or sell your contact information. Please PRINT clearly.<br />
First Name _______________________ Middle Initial __________ Last Name _____________________<br />
Degree: MB/MD or equivalent DO MPharm/PharmD RN NP PA Other<br />
Mailing Address:____________________________________________________________________<br />
City: _________________________________ Country: ___________ <strong>Post</strong>al Code:_____________________<br />
E‐mail Address (REQUIRED TO RECEIVE CERTIFICATE):___________________________________________<br />
Global Education Group <strong>and</strong> Strategic Consultants International are interested in adding to our base of<br />
faculty <strong>and</strong> educational development. To help us better plan for education in this area, <strong>and</strong> to invite you to<br />
partake in future educational development, we may contact you for your expertise. If you opt NOT to be<br />
contacted in the future, please check the box below:<br />
NO, I do NOT want to be contacted in the future.<br />
I certify my actual time spent to complete this educational activity to be (tick one):<br />
I participated in the entire activity <strong>and</strong> claim 1.0 AMA PRA Category 1 Credit TM credits / 1 CPD Credit<br />
I participated in only part of the activity <strong>and</strong> claim _________ credits.<br />
I certify that I have participated in the continuing education activity entitled “SGLT2 Inhibitors: Assessing the<br />
Evidence <strong>and</strong> the Potential Impact on Future Clinical Practice”<br />
Signature: ___________________________________________<br />
Date:____________________________<br />
Please fax this form back to Global on 001 303 648 5311 or email to inquire@globaleducationgroup.com<br />
Only completed forms will be processed for credit. Please allow 6‐8 weeks to receive your certificate. Thank<br />
you for participating in this activity.<br />
For Internal Use Only: Project ID: 1350E / 1351E Date: 5 January 2012