1. What is the clinical topic/question?
   
2. Is this question related to (check all that apply):
   A rare condition
   A rare condition
   A condition not managed recently
   A diagnostic dilemma
   A need for new clinical information
   A controversial clinical issue
   Other (specify)
   
3. How would you define your findings?:
   Found clinical information that answered my question
   Found clinical information that was related, but did not directly answer my question
   Did not find any clinical information that addressed my question
   Other (specify):
   
   Please type in 1-3 citations of the most relevant articles. If UpToDate is used, please “copy and paste” or type in name of article.
   
   
   
   Please check which databases were used in your research:
   UpToDate
   MDConsult
   PubMed/Medline
   Medscape
   EMedicine Specialties
   Ebscomed
   
4. Define the difficulties in finding relevant information (check all that apply):
   Did not have difficulty finding relevant information
   Not enough full text journals available
   Difficulties in searching
   Insufficient database clinical information coverage
   Access difficulties
   
5. Describe the application of your findings to your practice (Check all that apply and complete the statement):
   Reinforced my clinical decision to
   
   Confirmed a diagnosis of
   
   Reviewed the condition of
   
   Applied new clinical guidelines to management of
   
   Changed course of management (please complete no.6 below)
   Unable to find clinical information that addressed my question
   Other (specify)
   
6. If the course of management and/or diagnosis was changed, how was it changed? (check all that apply)
   Choice of treatment/management
   Changes in pharmaceutical therapy
   Monitoring of therapy
   Referral for a consultation
   Changes in diagnostic tests
   Recommendations for preventative care
   Change in differential diagnosis
   

Evaluation

1. Rate the overall effectiveness of this activity
   
   Poor 1
   2
   3
   4
   5
   Excellent
2. Check all that apply:
   Activity met my objectives
   My search resulted in a change in competence as measured by physician practice application (questions 5 & 6)
   Use of information acquired may result in improved patient care