Neurogastroenterology and motility services

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Neurogastroenterology and motility services:

compilation of programs across the North America

Start of Block: Basic information

Q1.1 Does your institution/practice currently offer Neurogastroenterology and Motility services?

o

^{Yes (1)}

o

^{No (2)}

Skip To: Q1.2 If Does your institution/practice currently offer Neurogastroenterology and Motility services? = Yes Skip To: End of Survey If Does your institution/practice currently offer Neurogastroenterology and Motility services?

= No

Q1.2 Are you considered a motility center/motility program?

o

^{Yes (1)}

o

^{No (2)}

Q1.3 Please include the following details of your hospital.

One survey per institution is adequate if you have more than one motility provider.

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o

Name of the center/hospital (12) ________________________________________________

o

University affiliation if any (13) ________________________________________________

o

Address line 1 (14) ________________________________________________

o

Address line 2 (15) ________________________________________________

o

City (16) ________________________________________________

o

State (17) ________________________________________________

o

Zip (18) ________________________________________________

o

Country (19) ________________________________________________

Q1.4 Please describe your hospital type.

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Academic/teaching practice (1)

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Community hospital (2)

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Private practice (3)

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Other (4) ________________________________________________

End of Block: Basic information

Start of Block: Motility program in charge and training details

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Q2.1 Please provide the following details of the motility provider in charge at your center or hospital

o

Name (4) ________________________________________________

o

Email (5) ________________________________________________

o

Phone (6) ________________________________________________

o

Total number of motility providers (physician/NP/PA) (7) ________________________________________________

Q2.2 How did you attain training in neurogastroenterology and motility?

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Self taught (1)

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Within the context of a 3 year pediatric GI fellowship in a center with NGM expert (2)

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4th year advanced fellowship in NGM (3)

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Working alongside NGM expert in a neurogastroenterology center (4)

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Other (5) ________________________________________________

Q2.3 Does your center offer training for neurogastroenterology and motility?

▼ Yes (1) ... No (2)

Skip To: End of Block If Does your center offer training for neurogastroenterology and motility? = No Skip To: Q2.4 If Does your center offer training for neurogastroenterology and motility? = Yes

(4)

Q2.4 Select the type of neurogastroenterology and motility training available at your center.

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Advanced formal 4th year motility fellowship (2)

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Clinical training program (3)

Skip To: Q2.5 If Select the type of neurogastroenterology and motility training available at your center. = Clinical training program

Q2.5 To whom is the motility clinical training program at your institution offered to. Please provide the range of the training duration in the box.

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Pediatric GI fellow (1) ________________________________________________

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Faculty/attending pediatric gastroenterologist seeking further NGM training (2) ________________________________________________

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Advance nurse practitioner/physician assistants (3) ________________________________________________

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Support staff/RNs (4) ________________________________________________

Q2.6 is your center currently involved in neurogastroenterology and motility related research ?

o

^{Yes (21)}

o

^{No (22)}

Skip To: End of Block If is your center currently involved in neurogastroenterology and motility related research ? = No

Skip To: Q2.7 If is your center currently involved in neurogastroenterology and motility related research ? = Yes

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Q2.7 Please select the type of research your center is pursuing.

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Clinical (1)

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Basic (2)

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Translational (3)

End of Block: Motility program in charge and training details Start of Block: UGI motility procedures

Q3.1 Please select from the list of procedures/therapeutics that are available at your center (Upper GI tract)

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Esophageal manometry (1)

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pH impedance probe (2)

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Bravo pH (3)

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Antroduodenal manometry (4)

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Electrogastrography ( EGG) (5)

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EndoFLIP/EsoFLIP (6)

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wireless motility capsule (SmartPill) (8)

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Pyloric Botox (9)

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Pyloric dilation (11)

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Peroral Endoscopic Myotomy (POEM) (12)

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Gastric peroral endoscopic myotomy (G-POEM) (13)

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Neuromodulation (14)

Display This Question:

If Please select from the list of procedures/therapeutics that are available at your center (Upper G... = Neuromodulation

Q3.2 Type of neuromodulation available at your center

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IB stim (1)

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Vagal nerve stimulation (2)

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Gastric electric stimulation (3)

End of Block: UGI motility procedures Start of Block: Loop and merge UGI

Q4.1 What is your estimated annual case volume of ${lm://Field/1}

0 1

5 3 0

4 5

6 0

7 5

9 0

1 0 5

1 2 0

1 3 5

1 5 0 Approximated annual cases ()

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End of Block: Loop and merge UGI

Start of Block: LGI related motility procedures

Q5.1 Please select from the list of procedures/therapeutics that are available at your center (Lower GI tract)

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Anorectal manometry (1)

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Colonic manometry (3)

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Anal botox/dilation (4)

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Endo AnalFLIP (5)

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Neuromodulation (7)

If Please select from the list of procedures/therapeutics that are available at your center (Lower G... = Anorectal manometry

Q5.2 Type of Anorectal manometry available at your hospital

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Water perfused (1)

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High resolution (2)

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^{3 D (3)}

If Please select from the list of procedures/therapeutics that are available at your center (Lower G... = Neuromodulation

(8)

Q5.3 Type of neuromodulation available at your center

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Sacral nerve stimulation (1)

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Tibial nerve stimulation (2)

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Others (3)

End of Block: LGI related motility procedures Start of Block: Loop and merge LGI

Q6.1 What is your estimated annual case volume of ${lm://Field/1}

0 1

0 2 0

3 0

4 0

5 0

6 0

7 0

8 0

9 0

1 0 0 Approximated annual cases ()

End of Block: Loop and merge LGI Start of Block: Other service

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Q7.1 Please select from the list of multidisciplinary programs with motility involvement

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Colorectal program (1)

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Aerodigestive program (2)

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Feeding clinic (3)

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Bowel rehab/pelvic floor/Biofeedback therapy (4)

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Functional GI disorders (5)

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Anorectal malformation (6)

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Spina bifida/myelomeningocele (7)

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Small bowel /multivisceral transplant care clinic (8)

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Dysautonomia program (10)

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Rumination rehab program- specify outpatient or inpatient in the box below (9) ________________________________________________

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Q7.2 Please select from the list available radiology services

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Gastric Emptying Scan (1)

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Sitz mark- transit studies (2)

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Esophageal scintigraphy (3)

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Colonic scintigraphy (4)

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MR defecography (5)

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Endoanal ultrasound (6)

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Video Fluoroscopic swallow study (7) Page Break

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Q7.3 Please select from the list of available ancillary services at your center.

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Psychology (1)

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Social work (2)

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Case manager (3)

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Dietitian (4)

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Physical therapy/biofeedback (5)

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Integrative and complementary medicine (7)

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Pain management specialist (9)

If Please select from the list of available ancillary services at your center. = Integrative and complementary medicine

Q7.4 Type of integrative and complementary medicine and therapy

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Hypnotherapy (1)

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Acupuncture (2)

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Aromatherapy (3)

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Others (4) ________________________________________________

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You have reached at the end of the survey. If you wish to make any changes, please go back and do so now. Otherwise please proceed with the next arrow to submit.

End of Block: Other service