ࡱ> sur[@bjbj44 4`ViVi $9998:,,:D<;<;(d;d;d;?<Y< e<.D0D0D0D0D0D0D$FRHTDm<?<?<m<m<TDd;d;iD===m<.d;d;.D=m<.D=L=g=N@@d;0; K9<df@@\D0Dn@,I<I@I@8m<m<=m<m<m<m<m<TDTD@ D"<@ D" TachoSil - experiences with product Dear Doctor, Your experiences with TachoSil are very important to us, and we highly appreciate your feedback regarding TachoSil usage in various surgical procedures. This document is an inspiration to what parametres could be relevant to include, when you choose to share thoughts and experience with us. Below we would like you to fill in your contact details and permit Nycomed to use you experience. Thank you very much for your contribution. Name / Title E-mail Name of the hospital Department Address Country  Copyright I accept that Nycomed can use my experience described in this report and illustrations in any communication regarding the use of TachoSil. Date Signature Please send the form and photos to your local Nycomed contact: Signature and date of Nycomed employee when receiving this form: Photos to illustrate the case - technical demands and description Colour digital photos (at least 1024 X 768 Pixel with at least 24 Bit colour deept). Please precisely describe the orientation (left, right, up, down) and the motives in the photos. A minimum of 3 pictures is desirable. One of the photos must describe the situation of the operation, where TachoSil is used. Preferably with a photo before and after application of TachoSil, and a photo showing if a special application method is used. Experience with product during surgery Preoperative coagulation problems? (relevant lab. results) Other relevant information? Did you use any preoperative scoring system? If so which one? Result of your scoring (add unit): Pre-operative status: A short report of the preoperative status, duration of illness and co morbidity, and the diagnoses please use the International Statistical Classification of Diseases and Health Related Problems ICD- 10th ed. or latest version for the co morbidity and diagnosis.  What is your standard haemostasis technique?  Surgical procedure: State the operation code according to Classification of Surgical Procedures - ICD-9-CSP or latest version and short description, including if anything didnt work as expected.  Why did you choose to use TachoSil in this particular situation?  What is your standard haemostasis technique?  What other techniques did you use to obtain haemostasis?  Did you observe differences in any of the parametres mentioned below due to the use of TachoSil compared with your normal practise: Time of surgeryAmount of transfusionAmount and type of intraveneous fluid Drainage time and volume (if drain was inserted)Time to haemostasis  Your overall impression of TachoSil?  Do you consider this experience valid as a background for a future routine use of TachoSil in this indication?  Would you recommend it to your colleagues?  Please remember to enclose photos. Thanks! 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" # ^ _ ` a b c d e f   > ? p q ' ( ) * + Y Z [ \ ] @> P@UnknownGz Times New Roman5Symbol3& z Arial7&  Verdana;SimSun[SO5& z!Tahoma?5 z Courier New;Wingdings"1h33  !n74 3QH ?v1&TachoSil - experiences with product Linda BasseStine Ohledorff Oh+'0 (4 P \ ht|'TachoSil - experiences with product fach Linda BasseindindNormalaStine Ohledorff2inMicrosoft Word 10.0@@JW@JW ՜.+,D՜.+,X hp  Nycomed { 'TachoSil - experiences with product TitleH@X|_AdHocReviewCycleID_EmailSubject _AuthorEmail_AuthorEmailDisplayName_PreviousAdHocReviewCycleID_ReviewingToolsShownOnceD-Template for collecting TachoSil experience vieLNC@nycomed.comAndersson, Lone Nrgaardachnde  !"#$%&'()*+,-./023456789:;<>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`acdefghiklmnopqtRoot Entry FPҀvData 11Table=IWordDocument4`SummaryInformation(bDocumentSummaryInformation8jCompObjj  FMicrosoft Word Document MSWordDocWord.Document.89q