Continuing Education Credit Form

Diabetes Type II
 

The American Association of Colleges of Nursing will award 1.5 contact hours of continuing education (up to a total of 15 hours for the entire Bench to Bedside series) for viewing this tape/CD-ROM as an educational activity.  This Continuing Education Credit (CEC) Form must be submitted to verify you viewed the tape/CD-ROM and earned the credit. 

Steps

1.      Print this copy of the Continuing Education Credit Form

2.      View the videotape or CD-ROM

3.      Complete all information requested

4.      Copy the completed form for your records of contact hours earned.  No additional verification will be sent to you.

5.      Send original copy of completed form to:  CenterNet/HMTV,  529 14th Street, N.W., Suite 1292, Washington, DC 20045

Diabetes Type II is part of the Bench to Bedside Video/CD-ROM Series for clinicians.  At the conclusion of this activity, the learner will be able to:
• Know the major risk factors for type 2 diabetes, be able to identify patients at risk for type 2 diabetes, and know how to test at risk patients to establish a diagnosis of diabetes
• Understand why the prevalence of diabetes is increasing the U.S., the effect this increase may have on the prevalence of cardiovascular disease and other complications of diabetes, and the importance of controlling diabetes in preventing and reducing its complications
• Be knowledgeable about a variety of dietary intervention strategies including lowering caloric intake, lowering fat intake, very low calorie diets, and structured meal plans
• Recognize the importance of increasing physical activity for long-term weight loss maintenance.
• Understand the role of risk factors in the increased incidence of atherosclerosis in type 2 diabetes
• Be aware of the goals of therapy for risk factor modification to reduce atherosclerotic disease in diabetes


(Please print)

 

Name________________________________________________ RN License # and state______________________
                        (Last)                         (M.I.)                        (First)

Address______________________________________________ City/State/Zip_____________________________

 

Date tape viewed______________ CE form printed on:    Signature  _____________________________

 

 

1.   Relationship to program purpose. Learning objectives for “Diabetes Type II” support the overall purpose for which the series is designed.
___Yes   ___Partially   ___No
       

2.  Objectives   Has this program enabled you to have a better understanding of the objectives  listed above:
___Yes   ___Partially   ___No       

   

3.   Presenters

Please rate effectiveness of each presenter:

Judith Fradkin, MD _____Somewhat Effective _____Effective _____Very Effective 
Rena Wing, PhD _____Somewhat Effective _____Effective _____Very Effective 
Robert Ratner, MD _____Somewhat Effective _____Effective _____Very Effective 


4.   Overall Program

Overall this educational activity was:   _____Marginal                       _____Good               _____Excellent

      Comments: