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Simple Steroid replacement therapy changeover- International
1.
In general, would you say your health is
1. Excellent
2. Very good
3. Good
4. Fair
5. Poor
2.
These questions are about how you feel and how things have been with you during the past 7 days. For each question, please give the one answer that comes closest to the way you have been feeling.
How much of the time during the past 7 days . . .
1. All of the Time
2. Most of the Time
3. A Good Bit of the Time
4. Some of the Time
5. A Little of the Time
6. None of the Time
Did you feel full of pep?
1. All of the Time
2. Most of the Time
3. A Good Bit of the Time
4. Some of the Time
5. A Little of the Time
6. None of the Time
Have you been a very nervous person?
1. All of the Time
2. Most of the Time
3. A Good Bit of the Time
4. Some of the Time
5. A Little of the Time
6. None of the Time
Have you felt so down in the dumps that nothing could cheer you up?
1. All of the Time
2. Most of the Time
3. A Good Bit of the Time
4. Some of the Time
5. A Little of the Time
6. None of the Time
Have you felt calm and peaceful?
1. All of the Time
2. Most of the Time
3. A Good Bit of the Time
4. Some of the Time
5. A Little of the Time
6. None of the Time
Did you have a lot of energy?
1. All of the Time
2. Most of the Time
3. A Good Bit of the Time
4. Some of the Time
5. A Little of the Time
6. None of the Time
Have you felt downhearted and blue?
1. All of the Time
2. Most of the Time
3. A Good Bit of the Time
4. Some of the Time
5. A Little of the Time
6. None of the Time
Did you feel worn out?
1. All of the Time
2. Most of the Time
3. A Good Bit of the Time
4. Some of the Time
5. A Little of the Time
6. None of the Time
Have you been a happy person?
1. All of the Time
2. Most of the Time
3. A Good Bit of the Time
4. Some of the Time
5. A Little of the Time
6. None of the Time
Did you feel tired?
1. All of the Time
2. Most of the Time
3. A Good Bit of the Time
4. Some of the Time
5. A Little of the Time
6. None of the Time
Did you feel nauseous?
1. All of the Time
2. Most of the Time
3. A Good Bit of the Time
4. Some of the Time
5. A Little of the Time
6. None of the Time
3.
How convenient is your hydrocortisone or prednisolone replacement therapy?
1. Very convenient
2. Convenient
3. OK
4. Inconvenient
5. Very inconvenient
4.
I am currently on
1. Hydrocortisone
2. Prednisolone
5.
What dose are you taking in total each day (in mg) of hydrocortisone or prednisolone?
6.
I take my prednisolone or hydrocortisone
1. Once daily
2. Twice daily
3. Three times daily
4. Four times daily
I split my dose as follows (eg 10mg in the morning, 5 at lunchtime and 5 at 4pm)
7.
When do you take your FIRST dose in the morning
Immediately on waking before doing anything else
At least 30 minutes after waking
I make sure I have something to eat before taking my first dose
8.
Finally please fill in the following details
Patient Initials and number:
Centre/Location:
Date:
Doctors email address
Any other comments