SIGN UP FREE
Survey Templates Surveys Management of Liver Cirrhosis - COPIED [IQUMFHDXYI

Management of Liver Cirrhosis - COPIED [IQUMFHDXYI

Management of Liver Cirrhosis


1. Please estimate the amount of clinic time spent in each of the following areas of medicine:
0-20%
21-40%
41-60%
61-80%
81-100%
Hepatology
Gastroenterology
Internal Medicine
2. How long have you been practicing medicine?
3. What is your predominant practice type?
4. How many patients do you see in a typical WEEK?
5. How many patients with liver cirrhosis do you see in a given WEEK?
6. Please estimate the percentage of your LIVER patients who have the following insurance:
0-20%
21-40%
41-60%
61-80%
81-100%
Medical/Medicaid
Medicare
Self Pay
HMO
Other ________
1. How frequently do you check liver associated blood tests (i.e. albumin, bilirubin, PT) in patients with liver cirrhosis?
2. (Check all that apply) Which of the following do you routinely recommend to patients with liver cirrhosis?
3. (Check all that apply) Do you recommend vaccinations against the following in patients with liver cirrhosis?
4. (Check all that apply) Do you have the following vaccine in your office?
5. Please estimate the percentage of your patients with liver cirrhosis who have received each of the following vaccinations:
0-20%
21-40%
41-60%
61-80%
81-100%
Unsure
Hepatitis A
Hepatitis B
Pneumovax
Influenza
6. Do you recommend screening cirrhotic patients for liver cancer? If NO, skip to question 8.
7. If you screen for liver cancer, what and how often do you screen with:


No
q3 mos
q6 mos
q1 yr
q2 yrs
Other _____
Unsure
A. Alpha feto protein?
B. With ultrasound?
C. With CT?
D. With MRI?
8. Do you recommend diagnostic paracentesis for first time ascites?
9. (Check all that apply) Which of the following do you recommend in managing initial ascites?
10. (Check all that apply) For which of the following patients would you recommend SBP prohylaxis with antibiotics?
11. What therapy do you recommend for prophylaxis against SBP?
12. (Check all that apply) Which of the following do you recommend in management of MINIMAL encephalopathy?
13. (Check all that apply) Which of the following do you recommend in management of OVERT encephalopathy?
14. Do you recommend a screening EGD when diagnosis of cirrhosis is first diagnosed?
15. If initial screening EGD reveals NO varices, when would you repeat the EGD?
16. (Check all that apply) If EGD shows SMALL, nonbleeding varices, what prophylaxis, if any, would you recommend?
17. If EGD showed SMALL varices, when would you repeat an EGD?
18. (Check all that apply) If EGD shows LARGE, nonbleeding varices, what prophylaxis, if any, would you recommend?
19. If EGD showed LARGE varices, when would you repeat an EGD?
20. (Check all that apply) In patients who survive an acute episode of variceal hemorrhage, what do you recommend to prevent future bleed?

Related templates and questionnaires