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Peripheral T-Cell Lymphomas: Challenges in Diagnosis and Treatment
EVALUATION FORM
Peripheral T-Cell Lymphomas: Challenges in Diagnosis and Treatment Thank you for participating in this CME activity. In order to obtain CME credit, you must complete both the evaluation form and posttest. This activity is sponsored by Hemedicus, Inc.
This activity is supported by an educational grant from Eisai, Inc.
Please answer the following questions and mail or fax this form along with the posttest to: Hemedicus, Inc., 220 Kinderkamack Rd, Suite D, Westwood, NJ 07675, fax: 201– 666-4747. Please circle the appropriate number: 1⫽poor - 5⫽excellent 1. The supplement met the stated objectives 1 2 3 4 5 2. The supplement provided new useful information 1 2 3 4 5 3. The supplement content will be helpful for my future practice 1 2 3 4 5 4. The supplement provided a helpful perspective on PTCL 1 2 3 4 5 5. The supplement met my personal expectations 1 2 3 4 5 6. The supplement will be utilized as a reference tool 1 2 3 4 5 7. Based on your previous knowledge and experience, the level of the supplement is: □ Too basic □ Appropriate □ Too complex 8. This educational activity will result in a change in my practice behavior. □ Strongly agree □ Agree □ Disagree 9. Please list two ways you intend to change your practice as a result of this activity: _______________________________________________________________________________________________ 10. The discussion of the diagnosis and classification of PTCLs will help me in my practice. □ Strongly agree □ Agree □ Disagree If you disagree, please explain: ____________________________________________________________________ 11. After reading this supplement, I will now incorporate new treatments into the therapeutic regimens for patients with PTCL. □ Strongly agree □ Agree □ Disagree If you disagree, please explain: ____________________________________________________________________ 12. Based on the importance of cooperative efforts in PTCL, I will enroll PTCL patients on clinical trials or participate in the PTCL registry when appropriate. □ Strongly agree □ Agree □ Disagree If you disagree, please explain: ____________________________________________________________________ 13. Funding for this supplement has been provided through an unrestricted educational grant from a commercial supporter. Do you feel you were adequately informed of commercial support or potential faculty conflict of interest? □ Yes □ No 14. In your opinion, did you perceive any commercial bias in the activity? □ Yes □ No If yes, please specify _____________________________________________________________________________
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Seminars in Hematology, Vol 47, No 2, Suppl 1, April 2010, p S22
Peripheral T-Cell Lymphomas: Challenges in Diagnosis and Treatment Thank you for participating in this CME activity. In order to obtain CME credit, you must complete both the evaluation form and posttest. This activity is sponsored by Hemedicus, Inc.
This activity is supported by an educational grant from Eisai, Inc.
Please answer the following questions and mail or fax this form along with the posttest to: Hemedicus, Inc., 220 Kinderkamack Rd, Suite D, Westwood, NJ 07675, fax: 201– 666-4747. Please circle the appropriate number: 1⫽poor - 5⫽excellent 1. The supplement met the stated objectives 1 2 3 4 5 2. The supplement provided new useful information 1 2 3 4 5 3. The supplement content will be helpful for my future practice 1 2 3 4 5 4. The supplement provided a helpful perspective on PTCL 1 2 3 4 5 5. The supplement met my personal expectations 1 2 3 4 5 6. The supplement will be utilized as a reference tool 1 2 3 4 5 7. Based on your previous knowledge and experience, the level of the supplement is: □ Too basic □ Appropriate □ Too complex 8. This educational activity will result in a change in my practice behavior. □ Strongly agree □ Agree □ Disagree 9. Please list two ways you intend to change your practice as a result of this activity: _______________________________________________________________________________________________ 10. The discussion of the diagnosis and classification of PTCLs will help me in my practice. □ Strongly agree □ Agree □ Disagree If you disagree, please explain: ____________________________________________________________________ 11. After reading this supplement, I will now incorporate new treatments into the therapeutic regimens for patients with PTCL. □ Strongly agree □ Agree □ Disagree If you disagree, please explain: ____________________________________________________________________ 12. Based on the importance of cooperative efforts in PTCL, I will enroll PTCL patients on clinical trials or participate in the PTCL registry when appropriate. □ Strongly agree □ Agree □ Disagree If you disagree, please explain: ____________________________________________________________________ 13. Funding for this supplement has been provided through an unrestricted educational grant from a commercial supporter. Do you feel you were adequately informed of commercial support or potential faculty conflict of interest? □ Yes □ No 14. In your opinion, did you perceive any commercial bias in the activity? □ Yes □ No If yes, please specify _____________________________________________________________________________
S22
Seminars in Hematology, Vol 47, No 2, Suppl 1, April 2010, p S22