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

Document [docx]
Download: docx | pdf


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.









FN

FN

LN

LN

M

M

D

D

CONFIDENTIAL IDENTIFIER






STD Treatment Guidelines Complete Post-Course Evaluation



Public reporting burden of this collection of information is estimated to average 6 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.  An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0995).


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


Shape1 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?

not at all confident

very confident


NA




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


Shape2 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


Shape3 77

NA


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 Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleCourse Design and Delivery
Authordreisbach
File Modified0000-00-00
File Created2022-02-24

© 2024 OMB.report | Privacy Policy