Form 0920-0995 STD Tx Guidelines Complete Post-course Evaluation
National Network of Sexually Transmitted Disease Clinical Prevention Traning Centers (NNPTC)
Att 21 STD Tx Guidelines Complete Post Course Evaluation wordversion
STD Treatment Guidelines Complete Post -Course Evaluation
OMB: 0920-0995
National Network of Sexually Transmitted Disease Clinical Prevention Training Centers (NNPTC): Evaluation
OMB No. 0920-0995
Attachments 21 & 22
Treatment Guidelines Complete Post-Course Evaluation Instrument
Word version and screenshot
TODAY’S DATE
____________________________ M M D D Y Y |
Your confidential ID number is the first two letters of your FIRST name, the first two letters of your LAST name, the MONTH of your birth, and the DAY of your birth. |
CONFIDENTIAL IDENTIFIER |
STD Treatment Guidelines Complete Post-Course Evaluation
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S1 How satisfied were you with your overall learning experience?
-
very unsatisfied
very satisfied
S2 How satisfied were you with the quality of the content?
-
very unsatisfied
very satisfied
S3 How satisfied were you with the trainer(s)?
-
very unsatisfied
very satisfied
S4 How satisfied were you with the teaching methods?
-
very unsatisfied
very satisfied
S5 What could improve this training?
|
A1 As a result of information presented, do you intend to make changes in your practice or at your worksite
setting?
Yes
No
Not my job
I already use these practices
Other reason (please specify)____________________________________
A2 If yes, please list at least one intended change
|
CE1 Do you believe this activity was influenced by commercial interests?
Yes
No
CE2 Was this presentation evidence-based?
Yes
No
CE3a Were the learning objectives met?
Yes
No
CE3b If the learning objectives were not met, please explain.
|
CHLAMYDIA |
LOC2bef How confident were you in your ability to describe the current CDC screening recommendations for
chlamydia, including extra-genital screening BEFORE the training?
-
not at all confident
very confident
LOC2aft How confident are you AFTER the training?
-
not at all confident
very confident
LOC4bef How confident were you in your ability to treat patients diagnosed with chlamydia and related anogenital syndromes based on the most current CDC treatment recommendations BEFORE the training?
-
not at all confident
very confident
NA
LOC4aft How confident are you AFTER the training?
-
not at all confident
very confident
NA
KC1 What is the CDC recommended regimen for treating asymptomatic uncomplicated chlamydia infection of the cervix, urethra, or rectum?
Acyclovir 1 g twice a day for 7 days
Azithromycin 1 g orally in a single dose or doxycycline 100 mg twice a day for 7 days
Azithromycin 1 g orally in a single dose plus ceftriaxone 250 mg intramuscularly in a single dose
Ciprofloxacin 500 mg orally in a single dose
KC2 What is the recommended follow-up for a non-pregnant patient after diagnosis and treatment of
chlamydia?
A test of cure at 2 weeks, and repeat test at 3 months
A test of cure at 2 weeks, and repeat test at 12 months
Repeat test in 3 months
Repeat test in 12 months
PPC1bef Approximately what % of sexually active asymptomatic female patients under age 25 did you screen
annually for chlamydia BEFORE this training?
-
0%
1-25%
26-50%
51-75%
76-90%
>91%
NA
77
PPC1aft What % do you intend to screen AFTER the training?
-
0%
1-25%
26-50%
51-75%
76-90%
>91%
NA
GONORRHEA |
LOG2bef How confident were you in your ability to describe the current CDC screening recommendations
for gonorrhea, including extra-genital screening BEFORE this training?
-
not at all confident
very confident
LOG2aft How confident are you AFTER the training?
-
not at all confident
very confident
LOG4bef How confident were you in your ability to treat patients with gonorrhea according to current
CDC recommendations in light of antibiotic resistance in N. gonorrhoeae BEFORE this training?
-
not at all confident
very confident
NA
LOG4aft How confident are you AFTER the training?
KG1 What is the recommended treatment for a patient diagnosed with uncomplicated urethral, cervical,
or rectal gonorrhea?
Ceftriaxone 250 mg intramuscularly only
Azithromycin 2 g orally in a single dose only
Ceftriaxone 250 mg intramuscularly plus azithromycin 1 g orally in a single dose
Cefixime 400 mg orally plus doxycycline 100 mg orally BID for 7 days
KG2 What is the recommended follow-up for a non-pregnant patient after diagnosis and treatment of
gonorrhea?
A test of cure at 2 weeks, and repeat test at 3 months
A test of cure at 2 weeks, and repeat test at 12 months
Repeat test in 3 months
Repeat test in 12 months
PPG1bef Approximately what % of sexually active asymptomatic female patients under 25 did you screen
annually for gonorrhea BEFORE this training?
-
0%
1-25%
26-50%
51-75%
76-90%
>91%
NA
77
PPG1aft What % do you intend to screen AFTER the training?
-
0%
1-25%
26-50%
51-75%
76-90%
>91%
NA
PPG3bef Approximately what % of sexually active male patients who have sex with men did you screen
annually for urogenital and extragenital gonorrhea and chlamydia BEFORE this training?
-
0%
1-25%
26-50%
51-75%
76-90%
>91%
NA
PPG3aft What % do you intend to screen AFTER the training?
-
0%
1-25%
26-50%
51-75%
76-90%
>91%
NA
SYPHILIS |
LOS2bef How confident were you in your ability to describe current CDC screening recommendations for
syphilis BEFORE this training?
-
not at all confident
very confident
LOS2aft How confident are you AFTER the training?
-
not at all confident
very confident
LOS3bef How confident were you in your ability to order and interpret the CDC recommended serologic
tests to diagnose syphilis BEFORE this training?
-
not at all confident
very confident
77NA
LOS3aft How confident are you AFTER the training?
-
not at all confident
very confident
NA
LOS4bef How confident were you in your ability to clinically manage patients diagnosed with syphilis based on
CDC treatment, follow-up, and partner management recommendations BEFORE this training?
-
not at all confident
very confident
NA
LOS4aft How confident are you AFTER the training?
-
not at all confident
very confident
NA
KS1 What is the CDC recommended regimen for treating primary and secondary syphilis in adults who are
not HIV+ or pregnant?
Acyclovir 1 g twice a day for 7 days
Azithromycin 1 g orally in a single dose
Benzathine penicillin G 2.4 million units IM in a single dose
Benzathine-procaine penicillin 2.4 million units in a single dose
PPS1bef Approximately what % of your male patients who have sex with men did you screen at least once a year
for syphilis BEFORE this training?
-
0%
1-25%
26-50%
51-75%
76-90%
>91%
NA
PPS1aft What % do you intend to screen AFTER the training?
-
0%
1-25%
26-50%
51-75%
76-90%
>91%
NA
PPS2bef Approximately what % of your pregnant patients did you screen for syphilis BEFORE this training?
-
0%
1-25%
26-50%
51-75%
76-90%
>91%
NA
PPS2aft What % do you intend to screen AFTER the training?
-
0%
1-25%
26-50%
51-75%
76-90%
>91%
NA
PPS3bef Approximately what % of your patients recently diagnosed with syphilis did you test for HIV
BEFORE this training?
-
0%
1-25%
26-50%
51-75%
76-90%
>91%
NA
PPS3aft What % do you intend to screen AFTER the training?
-
0%
1-25%
26-50%
51-75%
76-90%
>91%
NA
EPT As a result of the information presented do you intend to provide Expedited Partner Therapy (EPT) to
heterosexual partners of those diagnosed with gonorrhea and/or chlamydia?
Yes
No
Not applicable to my practice or job
Not allowed in my state/practice
My practice/worksite is in the planning stages to offer EPT
My practice/worksite already offers EPT
EPT was not discussed
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | Course Design and Delivery |
| Author | dreisbach |
| File Modified | 0000-00-00 |
| File Created | 2021-01-14 |
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