Noviembre-Diciembre
156_v40n6(1)
156_v40n6(1)
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590 - Farm Hosp. 2016;40(6):579-603 Isabel Fernández-Arias and Hae Kyung Kim<br />
Evaluation questionnaire<br />
FUSENGO test<br />
(Testing Session Sub-group)<br />
The objective of this questionnaire is to capture your points of view about the administration device for the treatment with<br />
coagulation factor that you have been trying. Please answer all questions.<br />
Question 1: How long does it take to prepare the device for injection?<br />
Each time you test the device, please record the time it takes to get it ready for injection.<br />
Test Number<br />
1 (practice test)<br />
2<br />
3<br />
4<br />
5<br />
Time (in seconds)<br />
For the following questions, please give a rating from 0 to 10, where 0 is “Not at all” and 10 “Extremely”.<br />
1. How easy was it to prepare clotting factor treatment for injection using this device?<br />
Not at all 0 1 2 3 4 5 6 7 8 9 10 Extremely<br />
2. How easy was it to hold?<br />
Not at all 0 1 2 3 4 5 6 7 8 9 10 Extremely<br />
3. How easy was it to push down the syringe plunger?<br />
Not at all 0 1 2 3 4 5 6 7 8 9 10 Extremely<br />
4. How easy do you think it will be to store clotting factor treatments using this device?<br />
Not at all 0 1 2 3 4 5 6 7 8 9 10 Extremely<br />
5. How easy do you think it will be to get rid of the containers, syringes, needles, and everything that comes with this<br />
clotting factor treatment device once you have used them?<br />
Not at all 0 1 2 3 4 5 6 7 8 9 10 Extremely<br />
6. Please can you give an overall rating for the device, using a scale from 0 to 100, where 0 is “the least desirable” and<br />
10 is “the most desirable”?<br />
Least desirable 0 1 2 3 4 5 6 7 8 9 10 Most desirable<br />
7. If your clotting factor treatmentcame in a device like this, how likely would you be to use this treatment regularly rather<br />
than as when you needed it?<br />
Very unlikely 0 1 2 3 4 5 6 7 8 9 10 Very likely<br />
8. If you are use your current clotting factor treatment regularly, how likely would you be to use treatment more often if<br />
it came in a device like this?<br />
Very unlikely 0 1 2 3 4 5 6 7 8 9 10 Very likely<br />
The following questions are about your current clotting factor treatment.<br />
9. On average, how long does it take you to prepare your clotting factor treatment for injection each time you use it?<br />
minutes
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