Page Two

April 8, 2015

Creating Evidence-based Guidelines in 2015

April 8, 2015

Credit AttestationForm

Please complete, sign, and return this form at the conclusion of the webinar, but no later than April 15, 2015in order to qualify forAMA PRA Category 1TM credits and have a certificate e-mailed direct to you.This form should be sent directly to Pamela Keating, J.D., Associate Director, Center for Education & Training,ECRI Institute,via email at ; fax at 610-834-1275; or mail at 5200 Butler Pike, Plymouth Meeting, PA 19462. Thank you.

Please PRINT CLEARLY. This form must be returned to the Registration Desk at the end of the program in order to receive a CME Certificate via Email.

Last Name: ______First Name: ______Degree: ______

Address: ______City: ______State: ______Zip: ______

Telephone: ______Email Address (req for cert): ______

Your evaluation of this activity is extremely important to ECRI Institute and the activity organizers for the development of future activities. A few minutes of your valuable time will greatly influence our planning and service.

  1. Your medical specialty is: ______

Your practice setting is: ______

Your academic degree and/or professional title: ______

  1. To what extent did this activity change your knowledge or attitudes regarding this topic?

 Significant Change

 Moderate Change

 Minor Change

 No Change

Comments: ______

  1. After attending this activity, which oneof the following best describes an action you will take as a result of your participation today?

 Support organization initiatives to implement or improveguideline development.

 Implement techniques or improvements for a guideline development program.

 Discuss possible changes with partners/supervisors.

 Seek additional information.

 Encourage peers and subordinates to learn more about this topic.

 No Action Taken.

 None of the Above/Other: ______

  1. Why did you choose to attend this activity? Please select no more than two:

 Topic

 Learning method

 Program faculty

 Obtaining nursingcontact hours

 Other (pleasebe specific) ______

  1. To what extent did this activity meet the stated learning objectives?

 Fully met the learning objectives

 Somewhat met the learning objectives

 Did not meet the learning objectives

Comments: ______

6. To what extent was this activity objective and scientifically rigorous?

 Very rigorous and balanced

 Somewhat rigorous and balanced

 Lacking in rigor or balance

 Very unbalanced or unscientific

Comments: ______

7. To what extent was this activity free of commercial bias?

 Completely free of commercial bias

 Very free of commercial bias

 Somewhat free of commercial bias

 Somewhat biased

 Very biased

Comments: ______

8. As an educational provider, ECRI Institute would like to evaluate the effectiveness of this activity to address practice

behavior. May we email you within the next few months with a one-question survey to let us know if you took any action related to this

activity?  Yes via email at ______ No

9. FACULTY EVALUATIONAll faculty involved in this live webinar have disclosed in writing that they have no affiliations or financial interest in any corporate organizations involved with products to which their presentation will refer to during this activity. All faculty have further disclosed that no presentations will include a discussion of off-label uses of FDA approved medical devices or pharmaceutical products.

A. Recent Changes in the Guideline Lanscape

Vivian Coates, MBA, Vice President, Information Services and Health Technology Assessment, ECRI Institute

EXCELLENTGOODFAIRPOOR

Clarity and Organization □ □ □ □

Content □ □ □ □

Materials □ □ □ □

B. Systematic Approaches to Systematic Review

Stacey Uhl, MSS, Senior Research Analyst, Health Technology Assessment, ECRI Institute

EXCELLENTGOODFAIRPOOR

Clarity and Organization □ □ □ □

Content □ □ □ □

Materials □ □ □ □

C. Building the Guideline from the Evidence

James Reston, PhD, MPH, Assoicate Director, Health Technology Assessment, ECRI Institute

EXCELLENTGOODFAIRPOOR

Clarity and Organization □ □ □ □

Content □ □ □ □

Materials □ □ □ □

10.Were there any topics not covered in the program that you feel should have been addressed? Please be specific.

______

You must return this Credit Attestation Form to ECRI Institute by no later than April 15, 2015. Credit Attestation form must be returned to the attention of Pamela Keating, J.D., Associate Director, Center for Education & Training, ECRI Institute

via email: ; via fax at (610)834-1275; via mail at 5200 Butler Pike, Plymouth Meeting, PA 19426

Thank you for attending this activity.

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