ID
17749
Description
ODM derived from 20pp EBMT Arthritis 14JIA forms on http://www.ebmt.org/
Lien
Mots-clés
Versions (1)
- 02/10/2016 02/10/2016 -
Téléchargé le
2 octobre 2016
DOI
Pour une demande vous connecter.
Licence
Creative Commons BY-NC 3.0
Modèle Commentaires :
Ici, vous pouvez faire des commentaires sur le modèle. À partir des bulles de texte, vous pouvez laisser des commentaires spécifiques sur les groupes Item et les Item.
Groupe Item commentaires pour :
Item commentaires pour :
Vous devez être connecté pour pouvoir télécharger des formulaires. Veuillez vous connecter ou s’inscrire gratuitement.
Genereral information EBMT JUVENILE IDIOPATHIC ARTHRITIS (JIA)
Genereral information EBMT JUVENILE IDIOPATHIC ARTHRITIS (JIA)
- StudyEvent: ODM
Description
Patient
Alias
- UMLS CUI-1
- C0030705
Description
Unique identification code
Type de données
text
Alias
- UMLS CUI [1]
- C1827636
Description
Hospital Unique Patient number or code
Type de données
text
Alias
- UMLS CUI [1]
- C1827636
Description
Initials
Type de données
text
Alias
- UMLS CUI [1]
- C2986440
Description
Patient Firstname
Type de données
text
Alias
- UMLS CUI [1]
- C0421447
Description
Patient Surname
Type de données
text
Alias
- UMLS CUI [1]
- C0421448
Description
Date of birth
Type de données
date
Alias
- UMLS CUI [1]
- C0421451
Description
Gender
Type de données
text
Alias
- UMLS CUI [1]
- C0079399
Description
AB0 Group
Type de données
text
Alias
- UMLS CUI [1]
- C0000778
Description
Rhesus Factor
Type de données
text
Alias
- UMLS CUI [1]
- C0427641
Description
Disease
Alias
- UMLS CUI-1
- C0012634
Description
Date of diagnosis
Type de données
date
Alias
- UMLS CUI [1]
- C2316983
Description
Primary Disease Diagnosis
Type de données
text
Alias
- UMLS CUI [1]
- C0277554
Description
Primary Disease Diagnosis
Type de données
text
Alias
- UMLS CUI [1]
- C0277554
Description
INITIAL DIAGNOSIS
Description
SUBCLASSIFICATION AT DIAGNOSIS
Type de données
integer
Alias
- UMLS CUI [1,1]
- C0011900
- UMLS CUI [1,2]
- C0008902
Description
DISEASE STATUS
Type de données
integer
Alias
- UMLS CUI [1]
- C0421168
Description
LABORATORY DATA
Type de données
integer
Alias
- UMLS CUI [1]
- C0022885
Description
AUTOANTIBODIES
Type de données
boolean
Alias
- UMLS CUI [1]
- C0004358
Description
Specify antibody
Type de données
integer
Alias
- UMLS CUI [1]
- C0003241
Description
FIRST LINE THERAPIES
Description
DISEASE MODIFYING DRUGS AND IMMUNOSUPPRESSANTS
Type de données
boolean
Alias
- UMLS CUI [1]
- C0013227
- UMLS CUI [2]
- C0021081
Description
Yes, mark appropriate box(es)
Type de données
integer
Alias
- UMLS CUI [1]
- C0013227
- UMLS CUI [2]
- C0021081
Description
COMPLICATIONS DUE TO TOXICITY FROM CONVENTIONAL TREATMENT
Type de données
boolean
Alias
- UMLS CUI [1]
- C0040539
Description
if yes, splease specify:
Type de données
integer
Alias
- UMLS CUI [1]
- C0040539
Description
DATE OF HSCT
Description
STATUS OF DISEASE AT MOBILISATION
Description
Eular/ACR 28 joint count, which comprises bilateral shoulders, elbows, wrists, MCPs, PIPs and knees. Appendix B.2)
Type de données
integer
Alias
- UMLS CUI [1]
- C0240094
Description
Eular/ACR 28 joint count, see above
Type de données
integer
Alias
- UMLS CUI [1]
- C0152031
Description
(Appendix B.3)
Type de données
text
Alias
- UMLS CUI [1]
- C0449820
Description
Was morning stiffness present?
Type de données
integer
Alias
- UMLS CUI [1]
- C0457086
Description
Patient's weight
Type de données
integer
Unités de mesure
- kg
Alias
- UMLS CUI [1]
- C0005910
Description
Patient's height
Type de données
integer
Unités de mesure
- cm
Alias
- UMLS CUI [1]
- C0005890
Description
Patient's weight one year prior to time of mobilisation
Type de données
integer
Unités de mesure
- kg
Alias
- UMLS CUI [1]
- C0005910
Description
Patient's height one year prior to time of mobilisation
Type de données
integer
Unités de mesure
- cm
Alias
- UMLS CUI [1]
- C0005890
Description
HAEMATOLOGICAL VALUES
Description
Haemoglobin
Type de données
text
Unités de mesure
- g/dL
Alias
- UMLS CUI [1]
- C0518015
Description
Erythrocyte sedimentation rate
Type de données
integer
Unités de mesure
- mm/hr
Alias
- UMLS CUI [1]
- C1176468
Description
Platelets
Type de données
integer
Unités de mesure
- 109/L
Alias
- UMLS CUI [1]
- C0005821
Description
WBC
Type de données
integer
Alias
- UMLS CUI [1]
- C0023508
Description
CLINICAL AND LABORATORY DATA
Description
Serum creatinine
Type de données
integer
Unités de mesure
- mol/l
Alias
- UMLS CUI [1]
- C0201976
Description
Serum AST
Type de données
integer
Unités de mesure
- IU/l
Alias
- UMLS CUI [1]
- C0004002
Description
Serum ALT
Type de données
integer
Alias
- UMLS CUI [1]
- C0001899
Description
Serum albumin
Type de données
integer
Unités de mesure
- g/dl
Alias
- UMLS CUI [1]
- C0036773
Description
Serum alkaline phosphatase
Type de données
integer
Unités de mesure
- U/l
Alias
- UMLS CUI [1]
- C0201850
Description
Total serum bilirubin
Type de données
integer
Alias
- UMLS CUI [1]
- C1278039
Description
C-reactive protein
Type de données
integer
Alias
- UMLS CUI [1]
- C0006560
Description
AUTOANTIBODIES
Description
RADIOGRAPHIC EVALUATION
Description
Were radiographic bone erosions present?
Type de données
integer
Alias
- UMLS CUI [1]
- C0587240
Description
Was advanced skeletal age of affected joints noted radiographically?
Type de données
integer
Alias
- UMLS CUI [1]
- C3661538
Description
Presence of osteoporotic fractures
Type de données
integer
Alias
- UMLS CUI [1]
- C0521170
Description
HEALTH ASSESSMENT
Description
HEALTH ASSESSMENT QUESTIONNAIRE OR SURVEY COMPLETED
Type de données
boolean
Alias
- UMLS CUI [1]
- C0451208
Description
PATIENT’S SELF ASSESSMENT
Type de données
integer
Alias
- UMLS CUI [1]
- C1256021
Description
Childhood Health Assessment Questionnaire (CHAQ) completed?
Type de données
integer
Alias
- UMLS CUI [1]
- C2732494
Description
Specify range of possible scores for the CHAQ pain sub-scale
Type de données
integer
Alias
- UMLS CUI [1]
- C2960434
Description
Specify range of possible scores for the CHAQ disability sub-scale
Type de données
integer
Alias
- UMLS CUI [1,1]
- C2960434
- UMLS CUI [1,2]
- C0459443
Description
Specify range of possible scores for the CHAQ severity sub-scale
Type de données
integer
Alias
- UMLS CUI [1,1]
- C2960434
- UMLS CUI [1,2]
- C0459443
- UMLS CUI [1,3]
- C0439793
Description
PHYSICIAN’S ASSESSMENT
Description
Did the physician complete a Global Assessment of the patient’s state?
Type de données
boolean
Alias
- UMLS CUI [1]
- C0281858
Description
If yes: Specify range of possible scores for Physician Rated Global Assessment
Type de données
integer
Alias
- UMLS CUI [1]
- C0281858
Description
DISEASE RESPONSE TO THE MOBILISATION TUMRSA2
Type de données
integer
Alias
- UMLS CUI [1]
- C1704632
Description
STATUS OF DISEASE AT HSCT
Description
Eular/ACR 28 joint count, which comprises bilateral shoulders, elbows, wrists, MCPs, PIPs and knees. Appendix B.2)
Type de données
integer
Alias
- UMLS CUI [1]
- C0240094
Description
Eular/ACR 28 joint count, see above
Type de données
integer
Alias
- UMLS CUI [1]
- C0152031
Description
(Appendix B.3)
Type de données
text
Alias
- UMLS CUI [1]
- C0449820
Description
Was morning stiffness present?
Type de données
integer
Alias
- UMLS CUI [1]
- C0457086
Description
Patient's weight
Type de données
integer
Unités de mesure
- kg
Alias
- UMLS CUI [1]
- C0005910
Description
Patient's height
Type de données
integer
Unités de mesure
- cm
Alias
- UMLS CUI [1]
- C0005890
Description
Patient's weight one year prior to time of mobilisation
Type de données
integer
Unités de mesure
- kg
Alias
- UMLS CUI [1]
- C0005910
Description
Patient's height one year prior to time of mobilisation
Type de données
integer
Unités de mesure
- cm
Alias
- UMLS CUI [1]
- C0005890
Description
Haemoglobin
Type de données
text
Unités de mesure
- g/dL
Alias
- UMLS CUI [1]
- C0518015
Description
Erythrocyte sedimentation rate
Type de données
integer
Unités de mesure
- mm/hr
Alias
- UMLS CUI [1]
- C1176468
Description
Platelets
Type de données
integer
Unités de mesure
- 109/L
Alias
- UMLS CUI [1]
- C0005821
Description
WBC
Type de données
integer
Alias
- UMLS CUI [1]
- C0023508
Description
Serum creatinine
Type de données
integer
Unités de mesure
- mol/l
Alias
- UMLS CUI [1]
- C0201976
Description
Serum AST
Type de données
integer
Unités de mesure
- IU/l
Alias
- UMLS CUI [1]
- C0004002
Description
Serum ALT
Type de données
integer
Alias
- UMLS CUI [1]
- C0001899
Description
Serum albumin
Type de données
integer
Unités de mesure
- g/dl
Alias
- UMLS CUI [1]
- C0036773
Description
Serum alkaline phosphatase
Type de données
integer
Unités de mesure
- U/l
Alias
- UMLS CUI [1]
- C0201850
Description
Total serum bilirubin
Type de données
integer
Alias
- UMLS CUI [1]
- C1278039
Description
C-reactive protein
Type de données
integer
Alias
- UMLS CUI [1]
- C0006560
Description
Were tests for autoantibodies done between diagnosis and mobilisation/transplant?
Type de données
boolean
Alias
- UMLS CUI [1]
- C0004358
Description
Specify antibody
Type de données
integer
Description
Were radiographic bone erosions present?
Type de données
integer
Alias
- UMLS CUI [1]
- C0587240
Description
Was advanced skeletal age of affected joints noted radiographically?
Type de données
integer
Alias
- UMLS CUI [1]
- C3661538
Description
Presence of osteoporotic fractures
Type de données
integer
Alias
- UMLS CUI [1]
- C0521170
Description
HEALTH ASSESSMENT QUESTIONNAIRE OR SURVEY COMPLETED
Type de données
boolean
Alias
- UMLS CUI [1]
- C0451208
Description
PATIENT’S SELF ASSESSMENT
Type de données
integer
Alias
- UMLS CUI [1]
- C1256021
Description
Childhood Health Assessment Questionnaire (CHAQ) completed?
Type de données
integer
Alias
- UMLS CUI [1]
- C2732494
Description
Specify range of possible scores for the CHAQ pain sub-scale
Type de données
integer
Alias
- UMLS CUI [1]
- C2960434
Description
Specify range of possible scores for the CHAQ disability sub-scale
Type de données
integer
Alias
- UMLS CUI [1,1]
- C2960434
- UMLS CUI [1,2]
- C0459443
Description
Specify range of possible scores for the CHAQ severity sub-scale
Type de données
integer
Alias
- UMLS CUI [1,1]
- C2960434
- UMLS CUI [1,2]
- C0459443
- UMLS CUI [1,3]
- C0439793
Description
Yes, mark appropriate box(es)
Type de données
integer
Alias
- UMLS CUI [1]
- C0013227
- UMLS CUI [2]
- C0021081
Description
COMPLICATIONS DUE TO TOXICITY FROM CONVENTIONAL TREATMENT
Type de données
boolean
Alias
- UMLS CUI [1]
- C0040539
Description
if yes, splease specify:
Type de données
integer
Alias
- UMLS CUI [1]
- C0040539
Description
STATUS AT 100 DAYS POST-HSCT
Description
Eular/ACR 28 joint count, which comprises bilateral shoulders, elbows, wrists, MCPs, PIPs and knees. Appendix B.2)
Type de données
integer
Alias
- UMLS CUI [1]
- C0240094
Description
Eular/ACR 28 joint count, see above
Type de données
integer
Alias
- UMLS CUI [1]
- C0152031
Description
(Appendix B.3)
Type de données
text
Alias
- UMLS CUI [1]
- C0449820
Description
Was morning stiffness present?
Type de données
integer
Alias
- UMLS CUI [1]
- C0457086
Description
Patient's weight
Type de données
integer
Unités de mesure
- kg
Alias
- UMLS CUI [1]
- C0005910
Description
Patient's height
Type de données
integer
Unités de mesure
- cm
Alias
- UMLS CUI [1]
- C0005890
Description
Patient's weight one year prior to time of mobilisation
Type de données
integer
Unités de mesure
- kg
Alias
- UMLS CUI [1]
- C0005910
Description
Patient's height one year prior to time of mobilisation
Type de données
integer
Unités de mesure
- cm
Alias
- UMLS CUI [1]
- C0005890
Description
Haemoglobin
Type de données
text
Unités de mesure
- g/dL
Alias
- UMLS CUI [1]
- C0518015
Description
Erythrocyte sedimentation rate
Type de données
integer
Unités de mesure
- mm/hr
Alias
- UMLS CUI [1]
- C1176468
Description
Platelets
Type de données
integer
Unités de mesure
- 109/L
Alias
- UMLS CUI [1]
- C0005821
Description
WBC
Type de données
integer
Alias
- UMLS CUI [1]
- C0023508
Description
Serum creatinine
Type de données
integer
Unités de mesure
- mol/l
Alias
- UMLS CUI [1]
- C0201976
Description
Serum AST
Type de données
integer
Unités de mesure
- IU/l
Alias
- UMLS CUI [1]
- C0004002
Description
Serum ALT
Type de données
integer
Alias
- UMLS CUI [1]
- C0001899
Description
Serum albumin
Type de données
integer
Unités de mesure
- g/dl
Alias
- UMLS CUI [1]
- C0036773
Description
Serum alkaline phosphatase
Type de données
integer
Unités de mesure
- U/l
Alias
- UMLS CUI [1]
- C0201850
Description
Total serum bilirubin
Type de données
integer
Alias
- UMLS CUI [1]
- C1278039
Description
C-reactive protein
Type de données
integer
Alias
- UMLS CUI [1]
- C0006560
Description
Were tests for autoantibodies done between diagnosis and mobilisation/transplant?
Type de données
boolean
Alias
- UMLS CUI [1]
- C0004358
Description
Specify antibody
Type de données
integer
Description
Were radiographic bone erosions present?
Type de données
integer
Alias
- UMLS CUI [1]
- C0587240
Description
Was advanced skeletal age of affected joints noted radiographically?
Type de données
integer
Alias
- UMLS CUI [1]
- C3661538
Description
Presence of osteoporotic fractures
Type de données
integer
Alias
- UMLS CUI [1]
- C0521170
Description
HEALTH ASSESSMENT QUESTIONNAIRE OR SURVEY COMPLETED
Type de données
boolean
Alias
- UMLS CUI [1]
- C0451208
Description
PATIENT’S SELF ASSESSMENT
Type de données
integer
Alias
- UMLS CUI [1]
- C1256021
Description
Childhood Health Assessment Questionnaire (CHAQ) completed?
Type de données
integer
Alias
- UMLS CUI [1]
- C2732494
Description
Specify range of possible scores for the CHAQ pain sub-scale
Type de données
integer
Alias
- UMLS CUI [1]
- C2960434
Description
Specify range of possible scores for the CHAQ disability sub-scale
Type de données
integer
Alias
- UMLS CUI [1,1]
- C2960434
- UMLS CUI [1,2]
- C0459443
Description
Specify range of possible scores for the CHAQ severity sub-scale
Type de données
integer
Alias
- UMLS CUI [1,1]
- C2960434
- UMLS CUI [1,2]
- C0459443
- UMLS CUI [1,3]
- C0439793
Description
Yes, mark appropriate box(es)
Type de données
integer
Alias
- UMLS CUI [1]
- C0013227
- UMLS CUI [2]
- C0021081
Description
COMPLICATIONS DUE TO TOXICITY FROM CONVENTIONAL TREATMENT
Type de données
boolean
Alias
- UMLS CUI [1]
- C0040539
Description
if yes, splease specify:
Type de données
integer
Alias
- UMLS CUI [1]
- C0040539
Description
FORMS TO BE FILLED IN
Similar models
Genereral information EBMT JUVENILE IDIOPATHIC ARTHRITIS (JIA)
- StudyEvent: ODM
C0008902 (UMLS CUI [1,2])
C0021081 (UMLS CUI [2])
C0021081 (UMLS CUI [2])
C0011008 (UMLS CUI [1,2])
C1522166 (UMLS CUI-2)
C1299381 (UMLS CUI-2)
C0459443 (UMLS CUI [1,2])
C1522166 (UMLS CUI-2)
C1299381 (UMLS CUI-2)
C0459443 (UMLS CUI [1,2])
C0439793 (UMLS CUI [1,3])
C1522166 (UMLS CUI-2)
C1299381 (UMLS CUI-2)
C1522166 (UMLS CUI-2)
C1299381 (UMLS CUI-2)
C1522166 (UMLS CUI-2)
C1299381 (UMLS CUI-2)
C0459443 (UMLS CUI [1,2])
C1522166 (UMLS CUI-2)
C1299381 (UMLS CUI-2)
C0459443 (UMLS CUI [1,2])
C0439793 (UMLS CUI [1,3])
C1522166 (UMLS CUI-2)
C1299381 (UMLS CUI-2)
C0021081 (UMLS CUI [2])
C1522166 (UMLS CUI-2)
C1299381 (UMLS CUI-2)
C0459443 (UMLS CUI [1,2])
C1522166 (UMLS CUI-2)
C1299381 (UMLS CUI-2)
C0459443 (UMLS CUI [1,2])
C0439793 (UMLS CUI [1,3])
C1522166 (UMLS CUI-2)
C1299381 (UMLS CUI-2)
C0021081 (UMLS CUI [2])