Physician Name: * Phone: * Email: * 1. What is the clinical topic/question? 2. Is this question related to (check all that apply): 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 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
