Research Survey
Hello gurls n boys ^_^
this is the first time im posting something here..
pardon me for any mistake ne,, :P
here, i would like to ask a favor from all of you to answer these questions below. this is for my research paper as i'm now in my last term of my studies.. your answers will be use wisely and treat with full confidential status ^^
u can leave the answer in the comment box or pm me if u don't want other people to read your answers ..
ok here it goes,
Title: RELATIONSHIP BETWEEN DEEP VEIN THROMBOSIS AND
PULMONARY EMBOLISM – Investigative/ Awareness Research
Deep Vein Thrombosis or DVT is a type of clot that forms in a major vein of the leg or, less commonly, in the arms, pelvis, or other large veins in the body. DVT can develop into Pulmonary Embolism or PE, a dangerous condition in which the clot detaches from its point of origin and travels to the lungs, where it becomes stuck and prevents blood flow.
PART A : DEMOGRAPHIC DATA
1. Gender
□ Male
□ Female
2. Age
□ < 18 years old
□ 18 – 25 years old
□ 26 – 35 years old
□ 36 – 45 years old
□ 46 – 55 years old
□ > 56 years old
3. Race : .....................................................
4. Occupation
□ Students
□ Housewife
□ Others : …………………………………… (Please state)
5. Pastime / Hobby / Leisure (You may tick more than one choice)
□ Reading
□ Indoor (Playstation, Internet, Television, Radio )
□ Outdoor (Swimming, Gym,Gardening, etc)
□ Other : …………………………….. (Please state)
PART B: Awareness on DVT and PE
1. Do you know what is ….
a. Deep Vein Thrombosis □ Yes □ No
b. Pulmonary Embolism □ Yes □ No
2. DVT or PE or both, happen only to senior citizen. □ Yes □ No
3. DVT can be inherited? □ Yes □ No
4. Factors contributing to DVT and PE are :
□ Hypercoaguability
□ Surgery
□ Accident
□ Inherited
5. Did you know that about 10% - 30% of people who affected by DVT/PE will die within one month of diagnosis. □ Yes □ No
6. Do you aware that in about 25% of people who experience a PE, the first ‘symptom’ is sudden death. □ Yes □ No
7. Can PE cause fatality? □ Yes □ No
8. Did your doctor ever advise or give information on the potential of DVT or PE or both during your stay in the hospital or visits? □ Yes □ No
Part C : Risk and Prevention
9. Tick if you have experienced or undergoing :-
(you may tick more than once)
□ Hospitalization for a medical illness
□ Recent major surgery or injury
□ Personal history of a clotting disorder or previous DVT
□ Increasing age
□ Cancer and cancer treatments
□ Pregnancy and the first 6 weeks after delivery
□ Hormone replacement therapy or birth control products
□ Family history of DVT
□ Extended bed rest
□ Obesity
□ Smoking
□ Prolonged sitting when traveling or playing games or surfing the net (longer than 6 to 8 hours)
10. Compared to 1 year ago, how would you rate the condition of your lungs in general now? (tick one answer)
□ Much better now than 1 year ago
□ Somewhat better now than 1 year ago
□ About the same now as 1 year ago
□ Somewhat worse now than 1 year ago
□ Much worse now than 1 year ago
□ I did not have any problems with my lungs
Tick one :-
11. Have you ever had a blood clot in your legs or lungs? □ Yes □ No
12. Do you have a family history of blood clots in the veins? □ Yes □ No
13. Do you have leg swelling every day? □ Yes □ No
14. Do you have emphysema or COPD? □ Yes □ No
15. Have you had more than three days of continuous bed rest due to injury or illness in past month? □ Yes □ No
16. Have you had a pelvic fracture or a plaster leg cast in the last month? □ Yes □ No
17. Have you had a heart attack ocvbheart failure? □ Yes □ No
18. Have you had major surgery lasting over an hour in the last month? □ Yes □ No
19. Do you weigh over 115 kilograms? □ Yes □ No
The following questions are for WOMEN only
20. Do you use birth control pills or estrogen replacement therapy? □ Yes □ No
21. Are you pregnant or had a baby within the last month? □ Yes □ No
22. Do you realize that the usage of combined (estrogen-containing) forms of hormonal contraception (birth control) is one of the risks of DVT?
□ Yes □ No
~THANK YOU~
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