Patent Publication Number: US-2011054931-A1

Title: Diagnostic System and Method

Description:
CROSS-REFERENCE TO RELATED APPLICATION 
     The present application claims the benefit of United State Provisional Application 60/586,158, filed Jul. 8, 2004, the entirety of which is incorporated herein by reference. 
    
    
     FIELD OF INVENTION 
     The present invention relates generally to the field of diagnosing a medical condition of a person, and specifically to the field of diagnosing a medical condition of a person based on the person&#39;s answers to a set of questions. The invention is particularly suited for the diagnosis of headache based conditions but is not so limited. 
     BACKGROUND OF INVENTION 
     Various methods and systems exist for diagnosing medical conditions. However, many of these diagnostic systems and methods require that the subject person meet with a doctor or other health care professional to either carry out the diagnostic method or interpret the data obtained from the diagnostic system or method. Such diagnostic systems and methods are unsatisfactory because many people dislike meeting and/or consulting with doctors or other health care professionals for diagnosis. This results in many people receiving inadequate or no treatment, thereby resulting in a worsening of the medical condition and/or additional harm to the person. For obvious reasons, this is undesirable. 
     Additionally, many existing diagnostic methods and systems are either very complicated to use or are expensive. Thus, these diagnostic systems and methods result in a large percentage of the population going untreated. Still, other diagnostic systems and methods are unreliable. 
     While diagnostic systems and methods that are purely computer based have become more popular, computer based diagnostic systems require that the user both have a computer and be aware of the diagnostic software. A further drawback of such computer based systems is that they tend to be expensive and require a working knowledge of the software and its functionality. 
     One particular area that has seen an increase in either misdiagnosis or failure of patients to seek diagnosis is that of headaches. Migraine, tension-type headaches, and other types of headache-based medical conditions often go undiagnosed because most primary care physicians do not have the expertise in diagnosing these conditions. Additionally, many people do not want to seek professional attention for a medical condition for which they are uncertain of having. 
     SUMMARY OF THE INVENTION 
     It is therefore an object of the present invention to provide a new diagnostic system and method. 
     Another object of the present invention is to provide a diagnostic system and method that can be used by people for self-diagnosis in the comfort of their own homes. 
     Yet another object of the present invention is to provide a diagnostic system and method that gives a user an indication that there is an increased likelihood of having a medical condition. 
     Still another object of the present invention is to provide a diagnostic system and method that motivates people to seek additional profession help for a medical condition. 
     A further object of the present invention is to provide a diagnostic system and method that is easy to use, understand, and/or distribute. 
     A yet further object of the present invention is to provide a diagnostic system and method that is cost-effective to manufacture. 
     A still further object of the present invention is to provide a system and method for diagnosing headache related medical conditions. 
     These and other object are met by the present invention which, in one embodiment, is a diagnostic system comprising: a form comprising one or more diagnostic questions and one or more possible answers to each question; a first overlay comprising one or more windows and one or more diagnostic fields, wherein when the first overlay is positioned over the form, answers indicative of the user having a first medical condition are visible through the windows of the first overlay; and wherein the one or more diagnostic fields contain criteria for diagnosing the user with the first medical condition based on the user&#39;s selection of answers that are visible through the windows of the first overlay. 
     In another embodiment, the invention is a diagnostic method comprising: a) answering one or more diagnostic questions pertaining to a user&#39;s health by selecting one or more answers, the one or more diagnostic questions and answers being provided on a form; b) positioning a first overlay having one or more windows and one or more diagnostic fields atop the form so that the answers indicative of the user having a first medical condition are visible through the windows of the first overlay; and c) using criteria in the diagnostic fields of the first overlay, diagnosing the user with the first medical condition based on the user&#39;s selection of answers that are visible through the windows of the first overlay. 
     In still another embodiment, the invention is a computer-based diagnostic system comprising: means for displaying an electronic form having one or more diagnostic questions and corresponding answers to the diagnostic question, each set of answers containing at least one answer that is indicative of the user having a first medical condition; means for a user to select one or more of the answers; means for identifying the answers selected by the user that are indicative of the user having the first medical condition; and means for diagnosing the user with the first medical condition based on the user&#39;s selection of answers that are indicative of the user having the first medical condition. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is a front perspective view of a headache diagnostic system according one embodiment of the invention. 
         FIG. 2A  is a front view of the questionnaire form of the headache diagnostic system of  FIG. 1 . 
         FIG. 2B  is a back view of the questionnaire form of the headache diagnostic system of  FIG. 1 . 
         FIG. 3A  is a front view of the diagnostic file of the headache diagnostic system of  FIG. 1  showing the first overlay in detail. 
         FIG. 3B  is a front view of the diagnostic file of the headache diagnostic system of  FIG. 1  showing the second overlay in detail. 
         FIG. 4  is a depiction of the questionnaire form being inserted into the diagnostic file for migraine diagnosis using the headache diagnostic system of  FIG. 1 . 
         FIG. 5  is a front view of the questionnaire form fully inserted into the diagnostic file for migraine diagnosis using the headache diagnostic system of  FIG. 1 . 
         FIG. 6  is a depiction of the questionnaire form being inserted into the diagnostic file for tension-type headache diagnosis using the headache diagnostic system of  FIG. 1 . 
         FIG. 7  is a front view of the questionnaire form fully inserted into the diagnostic file for tension-type headache diagnosis using the headache diagnostic system of  FIG. 1 . 
         FIG. 8  is a schematic of a computer-based headache diagnostic system according to a second embodiment of the present invention. 
     
    
    
     DETAILED DESCRIPTION OF THE DRAWINGS 
       FIG. 1  illustrates a headache diagnostic system  100  according to an embodiment of the present invention. The headache diagnostic system  100  comprises a diagnostic file  2  and a questionnaire sheet/form  3 . While the illustrated embodiment of the diagnostic system  100  is specifically designed for the diagnosis of headaches, such as migraines and tension-type headaches, the invention is not so limited. Those skilled in the art will understand that the invention can be adapted for diagnosis of almost any type of medical condition (mental or physical), health status, or physiological impairment. As used herein, the term diagnosis, and all derivative thereof, is intended to encompass definitive diagnosis of medical conditions along with determinations of increased or decreased likelihood of having or not having a medical condition so that the user can seek a definitive diagnosis from a healthcare professional. 
     The diagnostic file  2  comprises a first overlay  20  and a second overlay  21 . The first and second overlays  20 ,  21  are formed from a single piece of material that is folded in half at crease  22 . Once creased, the first and second overlays  20 ,  21  are connected to one another along the bottom edge  23 . As a result, the first and second overlays  20 ,  21  are connected along two sides, thereby forming a pocket  24  capable of slidably receiving questionnaire form  3  from either of the two open sides. The connection along bottom edge  23  can be accomplished by a low heat weld or the proper use of sutures, staples, adhesive, tape, a tongue and groove assembly, stamping, or the like. A thumbnail cutout  25  is provided along the side of the first overlay  20  along the open lateral side of the diagnostic file  2  so as to afford easy separation of the first and second overlays  20 ,  21  during the insertion of the questionnaire form  3 . This cutout  25  can take on any desired shape or size. 
     In other embodiments of the invention, the first and second overlays  20 ,  21  of the diagnostic file  2  can be separate pieces of material that are connected along one or more edges using one of the above identified connection techniques to form the diagnostic file  2 . The overlays  20 ,  21  can be formed of one or more layers of thin flexible materials, such as plastic, paper, synthetic polymers, or the like. The diagnostic file  2  is preferably sized so that pocket  24  fully receives a standard sized piece of paper, such as A-4 or 8.5×11.5 paper sizes. However, the invention is not limited to any specific material of construction or dimensions. In some embodiments of the invention, only a single overlay  20  or  21  may be used in combination with the questionnaire form  3  to diagnose a medical condition. In such embodiments, the overlay  20  or  21  will be simply positioned over and aligned with the questionnaire form  3  during use. 
     The questionnaire form  3  is a sheet of paper comprising screening questions on one side and diagnostic questions on the opposite side. The screening questions and the diagnostic questions are carefully selected to diagnose a targeted medical condition (in this case migraines and tension-type headaches) and printed on the questionnaire form  3  prior to distribution in a predetermined pattern. This will be discussed in greater detail below. The questionnaire form  3  can be made of a variety of materials which can be written on or otherwise marked, including without limitation, paper, plastic, cardboard, metal, etc. If desired, the questionnaire form  3  can be constructed to be either disposable or reusable. For example, in a reusable embodiment, the questionnaire form  3  may be formed of plastic (or comprise a plastic or polymer coating) from which pencil, ink, or marker indicia can be easily erased. In disposable embodiments, a simple piece of paper may be used for ease of reproduction and to reduce manufacturing costs. 
     Referring now to  FIGS. 2A and 2B , the questionnaire form  3  is illustrated according to an embodiment of the present invention. The questionnaire form  3  is a sheet of paper comprising screening questions  4 - 5  on one side ( FIG. 2A ) and diagnostic questions  6 - 13  on the opposite side ( FIG. 2B ). The questionnaire form  3  is designed with the intention that the user answer the screening questions  4 - 5  on the first side before proceeding to the second side of the questionnaire form to answer the diagnostic questions  6 - 13 . 
     Referring solely to  FIG. 2A , the first side  14  of the questionnaire form  3  comprises two screening questions  4 - 5 . While two screening questions  4 - 5  are used in the example, any number of screening questions may be used. The exact number of screening questions will be dictated on a case-by-case basis, considering such factors as the type of medical condition being diagnosed, target patient group, etc. In some embodiments of the questionnaire form  3 , the screening questions may be omitted. In such embodiments, the first side  14  of the questionnaire form  3  may be identical to the second side  15  ( FIG. 2B ), contain different diagnostic questions, or contain general user instructions and/or advertisements. 
     A choice of corresponding answers  4 A- 4 B and  5 A- 5 B are provided on the first side  14  of the questionnaire form  3  that respectively correspond to the screening questions  4 ,  5 . The first side  14  further comprises instructions  16  for determining whether, based on the user&#39;s answers to the screening questions  4 - 5 , the user needs to proceed with answering the next screening question and/or the diagnostic questions  6 - 13  on the second side  15  of the questionnaire form  3 . 
     In the illustrated embodiment of the questionnaire form  3 , which is designed for migraine and/or tension-type headache diagnosis, the screening questions  4 - 5  respectively pertain to whether the user experienced a headache in the last several years and whether the onset of such headaches affected the user&#39;s ability to carry out their daily routine. Regarding screening question  4  specifically, each possible answers  4 A,  4 B has corresponding instructions  16  which, depending on the answer  4 A,  4 B selected, will direct the user to either proceed to the next screening question  5  or cease further completion of the questionnaire form  3 . Regarding screening question  5  specifically, each possible answers  5 A,  5 B has corresponding instructions  16  which will direct the user to either proceed to answer the diagnostic questions  6 - 13  on the second side  15  of the questionnaire form  3  or cease further completion of the questionnaire form  3 . 
     The screening questions  4 ,  5  are designed so that if the user selects an answer (which in this case are answers  4 B or  5 B) that correspond to instructions  16  that instruct the user to cease further completion of the questionnaire form  3 , the diagnosis is that the user does not have (or at least is not likely to have) the medical condition(s) being screened for, which in this case is migraine and tension-type headaches. However, if the user selects answers (which in this case are both answers  4 A or  5 A) that correspond to instructions  16  that instruct the user to continue with completion of the second side  15  of the questionnaire form  3 , the user has not been screened out, and is likely in need of further diagnosis/inquiry, which in this case is additional diagnosis for migraine and tension-type headaches. 
     Referring now to  FIG. 2B , the second side  15  of the questionnaire form  3  is illustrated. Eight diagnostic questions  6 - 13  are provided on the second side  15  of the questionnaire form  3 . The diagnostic questions  6 - 13  are carefully drafted and selected so that the user&#39;s answers are indicative of the user having or not having a certain medical condition within a reasonable degree of medical certainty, which in this case is migraines and/or tension-type headaches. Specifically, diagnostic question  6  pertains to the frequency of which a user experiences headaches. Diagnostic question  7  pertains to how long the user&#39;s headaches last if no medication is taken. Diagnostic question  8  pertains to whether the user experiences the onset of aura symptoms during headaches, such scintillating scotomata and/or visual defect. Diagnostic question  9  pertains to the location of the headache pain. Diagnostic question  10  pertains to the type of headache pain. Diagnostic question  11  pertains to the severity of the user&#39;s headache pain. Diagnostic question  12  pertains to whether the user&#39;s performance of certain physical activities affects/worsens the headache pain. Diagnostic question  13  pertains to whether the user experiences the onset of additional headache-related symptoms. 
     While a total of eight diagnostic questions  6 - 13  are used in the illustrated questionnaire form, the invention is not so limited. Any combination of the diagnostic questions  6 - 13  can be used and/or other diagnostic questions can be added if desired. However, it is preferable that testing and/or research be performed to determine the proper number, identity, and combination of diagnostic questions that will reliably diagnose the target medical condition(s) within a certain degree of accuracy. It has been determined that the diagnostic questions  6 - 13  are reliable in diagnosing migraine and/or tension-type headaches. 
     Each diagnostic question  6 - 13  has one or more possible answers  6 A- 13 D that correspond to the appropriate diagnostic question  6 - 13 . (Questions and answers having like numerical prefixes correspond to one another.) The answer choices for each diagnostic question  6 - 13  have one or more answers that are indicative of a person having a targeted medical condition, which in this case is migraines and/or tension-type headaches. For example, answers  6 A and  6 B correspond to diagnostic question  6 . As will be explained in detail below with respect to  FIG. 5 , answer  6 A is indicative of the user having migraines, while answer is  6 B is not. Some diagnostic questions  6 - 13  can have multiple answers that are indicative of the user having a targeted medical condition. In some cases, one answer can be indicative of more than one medical condition being targeted. The positioning and arrangement of the answers  6 A- 13 D on the questionnaire form  3  are chosen so that answers indicative of the user having the medical condition being diagnosed are in a corresponding spatial relationship to the windows  26  of the diagnostic file  2 . 
     Referring now to  FIGS. 3A and 3B , the first overlay  20  and second overlay  21  of the diagnostic file  2  are illustrated in detail. The construction of the diagnostic file  2  has already been discussed above in relation to  FIG. 1 . 
       FIG. 3A . is a front view of the first overlay  20 , which is specifically designed for use in combination with the second side  15  of the questionnaire form  3  to diagnose migraines. The first overlay  20  of the diagnostic file  2  comprises a plurality of transparent windows  26  spatially arranged at predetermined locations and designed to be a predetermined size. Each window  26  is designed so that only those answers on the questionnaire form  3  that are indicative of the user having migraines will be visible therethrough when the questionnaire form  3  is fully inserted into the pocket  24  with the second side  15  of the questionnaire form  3  facing the first overlay  20 . While the windows  26  are transparent sections of the first overlay  20 , the windows  26  can be formed in a variety of ways, including cutouts, etc. In some embodiments, the entire overlay  20  may be constructed of a transparent material and the windows  26  may be formed by boxes or other indicia marked on the overlay. 
     The first overlay  20  further comprises a plurality of diagnostic fields  27 . The diagnostic fields  27  contain criteria/instructions for diagnosing the user for migraines based on the user&#39;s selection of answers  6 A- 13 D on the questionnaire form  3  that are visible through the windows  26 . While the diagnostic fields  27  are illustrated as being in a separated/boxed-off areas of the first overlay  20 , the invention is not so limited. In some embodiments, the diagnostic fields  27  may be mere areas on the first overlay  20  containing text without any special delineation or demarcation. Only those answers on the questionnaire form  3  that are indicative of the user having migraines are visible through the windows  26  of the first overlay  20  when the questionnaire form  3  is fully inserted into the diagnostic file  2  (as shown in  FIG. 5 ). The diagnostic fields  27  provide the user and/or health professional with the means to be able to perform a quick and reliable interpretation of the user&#39;s answers with respect to migraine diagnosis. 
       FIG. 3B . is a front view of the second overlay  21 , which is specifically designed for use in combination with the second side  15  of the questionnaire form  3  to diagnose tension-type headaches. Similar to that of the first overlay  20 , the second overlay comprises a plurality of windows  26  and diagnostic fields  27 . However, the positioning and size of each window  26  of the second overlay  21  is designed so that only those answers on questionnaire form  3  that are indicative of the user having tension-type headaches will be visible therethrough when the questionnaire form  3  is fully inserted into the pocket  24  with the second side  15  of the questionnaire form  3  facing the second overlay  21  (as shown in  FIG. 7 ). Additionally, the diagnostic fields  27  of the second overlay  21  contain criteria/instructions for diagnosing the user for tension-type headaches based on the user&#39;s selection of answers  6 A- 13 D on the questionnaire form  3  that are visible through the windows  26  of the second overlay  21 . Only those answers on the questionnaire form  3  that are indicative of the user having tension-type headaches are visible through the windows  26  of the second overlay  21  when the questionnaire form  3  is fully inserted into the diagnostic file  2  with the second side  15  of the questionnaire form  3  facing the second overlay  21  (as shown in  FIG. 7 ). The diagnostic fields  27  provide the user and/or health professional with the means to be able to perform a quick and reliable interpretation of the user&#39;s answers with respect to tension-type headache diagnosis. 
     Referring now to  FIGS. 4 and 5 , the method by which a user is diagnosed with migraines using the headache diagnostic system  100  according to an embodiment of the invention will be discussed. Starting with  FIG. 4 , the headache diagnostic system  100 , which includes the diagnostic file  2  and the questionnaire form  3  is supplied to a user. In some cases, only the questionnaire form  3  will be supplied and a healthcare professional will have the diagnostic file  2 . Upon receiving the questionnaire form  3 , the user first answers the screening question  4 - 5  on the first side  14  of the questionnaire form  3  (as discussed above with respect to  2 A). Assuming that the user answers the screening questions  4 - 5  so that he/she is instructed to continue with answering the diagnostic questions  6 - 13  on the questionnaire form  3 , the user then turns to the second side  15  of the questionnaire form  3 . The user then reads the diagnostic questions  6 - 13  and selects the answers  6 A- 13 D that are indicative of the user&#39;s health and physical conditions. In the illustration, a hypothetical user has selected his/her answers by marking an “X” on all answer that apply to his/her health status. 
     Once the user has completed selecting his/her answers  6 A- 13 D to the diagnostic questions  6 - 13 , the user slides/inserts the questionnaire form  3  into the pocket  24  of the diagnostic file  2  between the first and second overlays  20 ,  21 , as indicated by the arrow. The second side  15  of the questionnaire form  3  faces the first overlay  20  at this time. The user continues to insert/slide the questionnaire form  3  into the diagnostic file  2  until the questionnaire form  3  is fully positioned therein (i.e., in a diagnostic position), as shown in  FIG. 5 . 
     Referring now to  FIG. 5 , the components of the headache diagnostic system  100  are arranged for migraine diagnosis, i.e., the questionnaire form  3  is fully and properly inserted into the pocket  24  of the diagnostic file  2  with the first side  14  facing the first overlay  20 . As can be seen, only those answers  6 A,  7 C,  8 A,  9 A,  10 A,  11 A,  11 B,  12 A,  12 B, and  13 A- 13 D to the diagnostic questions  6 - 13  that are indicative of the user having migraines are aligned with and visible through the windows  26  of the first overlay  20 . The remaining answers to the diagnostic questions  6 - 13  are not aligned with the windows  26  and are not visible therethough. Based on the user&#39;s selection of answers  6 A,  8 A,  9 A,  10 A,  11 B,  12 B and  13 A-D to the diagnostic questions  6 - 13  that are visible through the windows  26  of the first overlay, and according to the criteria set forth in the diagnostic fields  27  of the first overlay  20 , the user can be easily and reliably diagnosed with (or without) migraines. In the hypothetical example, the diagnosis is that there is a very high probability that the user has migraines based on his/her selection of answers  6 A,  8 A,  9 A,  10 A,  11 B,  12 B and  13 A-D. 
     Referring to  FIGS. 6 and 7 , the headache diagnostic system  100  can also be used to diagnose a user with tension-type headaches in a manner very similar to that described above with respect to migraine diagnosis. The only difference is that after the user has completed answering the diagnostic questions  6 - 13 , the questionnaire form  3  is inserted into the diagnostic file  2  with the second side  15  of the questionnaire form  3  facing the second overlay  21 , as shown in  FIG. 6 . 
       FIG. 7  illustrates the components of the headache diagnostic system  100  arranged for tension-type headache diagnosis, i.e., the questionnaire form  3  is fully and properly inserted into the pocket  24  of the diagnostic file  2  with the second side  15  facing the second overlay  21 . When so positioned, only those answers  7 B- 7 E,  9 B,  10 B- 10 D,  11 C,  12 C, and  13 A- 13 D to the diagnostic questions  6 - 13  which are indicative of the user having tension-type headaches are aligned with and visible through the windows  26  of the second overlay  21 . The remaining answers to the diagnostic questions  6 - 13  are not aligned with the windows  26  and are not visible therethrough. Based on the user&#39;s selection of answers  7 B,  10 B, and  13 A- 13 D to the diagnostic questions  6 - 13  that are visible through the windows  26  of the second overlay  21 , and according to the criteria set forth in the diagnostic fields  27  of the second overlay  21 , the user can be easily and reliably diagnosed with (or without) tension-type headaches. In the hypothetical example, the diagnosis is that there is a low probability that the user has tension-type headaches based on his/her selection of answers  6 A- 13 D. 
     It is important to note that the relative spatial arrangement of the answers  6 A- 13 D on the questionnaire form  3  and the windows  26  on the first and second overlays  20 ,  21  is critical to proper diagnosis. Moreover, it is important that the questionnaire form  3  be fully and properly inserted into the diagnostic file  2  so as to avoid an inaccurate diagnosis. 
     The headache diagnostic system  100  can be used by for self diagnosis by a user or can be used by a healthcare professional to assist in diagnosis of migraines and tension-type headaches. For example, the headache diagnostic system  100  (or just the questionnaire form  3 ) can be handed out to patients in the waiting room of a hospital or other healthcare facility for completion by the user. Using the diagnostic file  2 , the doctor or other healthcare professional can then perform the migraine diagnosis based on the answers selected by the user on the questionnaire form  3 . In other circumstances, the user can utilize the headache diagnostic system  100  to perform a self diagnosis in the convenience of his/her home or at any other location. Depending on the resulting self-diagnosis, the user can then set up an appointment with a healthcare professional for further consultation. 
     In some embodiments of the invention, the questionnaire form  3  can have the diagnostic questions  6 - 13  on both sides  14 ,  15 . As a result, when the questionnaire form  3  is inserted into the diagnostic file  2 , the user and/or healthcare professional can perform the migraine and tension-type diagnosis without having to flip the orientation of the questionnaire form  3  in the diagnostic file  2 . In other embodiments of the invention, a folder-like diagnostic file does no have to be used. Instead a single overlay can be used wherein the questionnaire form is simply positioned underneath the overlay in a proper alignment. 
     Turning now to  FIG. 8 , a schematic of a computer based migraine/tension-type headache diagnostic system  200  is illustrated according to a second embodiment of the present invention. The computer-based diagnostic system  200  comprises a display module  260 , a user input device  210 , a signal input port  230 , a suitably programmed microprocessor  250 , and a computer memory medium  240 . The CPU  250 , the memory medium  240 , and the input port  230  are located in a computer housing  220 . 
     The CPU  250  is a suitable microprocessor based programmable logic controller, personal computer, or the like. The CPU  250  is electrically and operably coupled to all components of the system  200  that need to be controlled and/or communicated with. The display module  260  can be a computer monitor or the like. The input device  210  can be a keyboard, a mouse, a joystick, an interactive screen, or the like. 
     The memory medium  240  comprises sufficient memory to store all of the necessary computer code, algorithms, and data necessary for the functioning of the system  200 . The CPU  250  is programmed with the proper algorithms to display an electronic version of the questionnaire form described above on the display module  260 , the ability to facilitate the user to select answers on the electronic questionnaire form using the input device  210 , the ability to identify the answers selected on the electronic questionnaire form that at are indicative of the user having the targeted medical condition, the ability to analyze the answers selected by the user on the electronic questionnaire form, and the ability to output a diagnosis based on the users selected answers and the analysis. As with the system  100 , the computer based system  200  can be used to diagnose any medical condition(s). The diagnosis output can be simple graphical representation of a YES or NO on the display module, or can be a more-detailed diagnosis, including additional instruction on follow-up procedure and the need for definitive diagnosis 
     If desired, the CPU  250  and the memory medium  240  can be programmed to have an electronic version of the diagnostic file and/or single overlays, and perform a virtual insertion of the diagnostic form into the diagnostic file, similar to that described above. The CPU  250  can then perform the analysis based on the location of the answers selected by the user in view of their relationship with the virtual windows. Additionally, the interface on which the electronic questionnaire form is displayed may further comprise a button that can be selected by the user to indicate that the user has completed his/her answering of the form. 
     The foregoing discussion discloses and describes merely exemplary embodiments of the present invention. As will be understood by those skilled in this art, the invention may be embodied in other specific forms without departing from the spirit or essential characteristics thereof.