ID

10060

Description

CALGB: NEUROBEHAVOIRAL SCALES FORM Comparison of Combination Chemotherapy Regimens in Treating Older Women Who Have Undergone Surgery for Breast Cancer Breast Cancer NCT00024102 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A50CD25E-BDE1-371E-E034-080020C9C0E0

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A50CD25E-BDE1-371E-E034-080020C9C0E0

Keywords

  1. 12/18/14 12/18/14 - Martin Dugas
  2. 3/23/15 3/23/15 - Martin Dugas
Uploaded on

March 23, 2015

DOI

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License

Creative Commons BY-NC 3.0 Legacy

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Breast Cancer CALGB NCT00024102

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  1. StudyEvent: CALGB: NEUROBEHAVOIRAL SCALES FORM
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Header
Description

Header

CALGB Form
Description

CALGBForm

Data type

text

CALGB Study No
Description

CALGBStudyNo

Data type

text

CALGB Patient ID
Description

CALGBPatientID

Data type

text

Date Completed (10.)
Description

DateCompleted

Data type

date

Amended data?
Description

Amended data?

Data type

boolean

Patient's Name
Description

Patient'sName

Data type

text

Participating Group
Description

ParticipatingGroup

Data type

text

Alias
NCI Thesaurus ObjectClass
C17005
UMLS 2011AA ObjectClass
C1257890
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Patient Hospital Number
Description

PatientHospitalNumber

Data type

text

Participating Group Protocol No.
Description

ParticipatingGroupProtocolNo.

Data type

text

Main Member Institution/Adjunct
Description

MainMemberInstitution/Adjunct

Data type

text

Participating Group Patient No.
Description

ParticipatingGroupPatientNo.

Data type

text

Responsible CRA
Description

ResponsibleCRA

Data type

text

Assessment Number
Description

AssessmentNumber

Data type

float

neurobehavioral problems
Description

neurobehavioral problems

Alias
UMLS CUI-1
C0815123
Ability to avoid losing train of thought; distractibility (2.)
Description

Abilitytoavoidlosingtrainofthought;distractibility

Data type

integer

Alias
UMLS CUI-1
C0437529
Ability to focus on goals; carry out a plan (3.)
Description

Abilitytofocusongoals;carryoutaplan

Data type

text

Remembering events from long ago (4.)
Description

Rememberingeventsfromlongago

Data type

text

Remembering new information told to you (5.)
Description

Rememberingnewinformationtoldtoyou

Data type

text

Attention and concentration (6.)
Description

Attentionandconcentration

Data type

text

Ability to reason through a complicated problem (7.)
Description

Abilitytoreasonthroughacomplicatedproblem

Data type

text

Self awareness of problems (8.)
Description

Selfawarenessofproblems

Data type

text

Remembering what you intended to do (9.)
Description

Rememberingwhatyouintendedtodo

Data type

text

Ability to shift easily from one activity to the next
Description

Abilitytoshifteasilyfromoneactivitytothenext

Data type

text

Remembering appointments or meetings (11.)
Description

Rememberingappointmentsormeetings

Data type

text

General alertness (12.)
Description

Generalalertness

Data type

text

Ability to think clearly (13.)
Description

Abilitytothinkclearly

Data type

text

Remembering new information you have read (14.)
Description

Rememberingnewinformationyouhaveread

Data type

text

Remembering where you put things (15.)
Description

Rememberingwhereyouputthings

Data type

text

Ease in initiating or starting activities by oneself (16.)
Description

Easeininitiatingorstartingactivitiesbyoneself

Data type

text

Ability to make decisions (17.)
Description

Abilitytomakedecisions

Data type

text

Remembering information learned long ago (18.)
Description

Rememberinginformationlearnedlongago

Data type

text

Ability to be flexible, rather than rigid or have an overly set manner
Description

Abilitytobeflexible,ratherthanrigidorhaveanoverlysetmanner

Data type

text

Similar models

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  1. StudyEvent: CALGB: NEUROBEHAVOIRAL SCALES FORM
    1. Continue to next page
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header
CALGBForm
Item
CALGB Form
text
CALGBStudyNo
Item
CALGB Study No
text
CALGBPatientID
Item
CALGB Patient ID
text
DateCompleted
Item
Date Completed (10.)
date
Amended data
Item
Amended data?
boolean
Patient'sName
Item
Patient's Name
text
ParticipatingGroup
Item
Participating Group
text
C17005 (NCI Thesaurus ObjectClass)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
PatientHospitalNumber
Item
Patient Hospital Number
text
ParticipatingGroupProtocolNo.
Item
Participating Group Protocol No.
text
MainMemberInstitution/Adjunct
Item
Main Member Institution/Adjunct
text
ParticipatingGroupPatientNo.
Item
Participating Group Patient No.
text
ResponsibleCRA
Item
Responsible CRA
text
AssessmentNumber
Item
Assessment Number
float
Item Group
neurobehavioral problems
C0815123 (UMLS CUI-1)
Item
Ability to avoid losing train of thought; distractibility (2.)
integer
C0437529 (UMLS CUI-1)
Code List
Ability to avoid losing train of thought; distractibility (2.)
CL Item
Above Average (1)
CL Item
Normal Ability (2)
CL Item
Mild Problem (3)
CL Item
Mild to Moderate Problem (4)
CL Item
Moderate Problem (5)
CL Item
Moderate to Severe Problem (6)
CL Item
Severe Problem (7)
Item
Ability to focus on goals; carry out a plan (3.)
text
Code List
Ability to focus on goals; carry out a plan (3.)
CL Item
Above Average (1)
CL Item
Normal Ability (2)
CL Item
Mild Problem (3)
CL Item
Mild to Moderate Problem (4)
CL Item
Moderate Problem (5)
CL Item
Moderate to Severe Problem (6)
CL Item
Severe Problem (7)
Item
Remembering events from long ago (4.)
text
Code List
Remembering events from long ago (4.)
CL Item
Above Average (1)
CL Item
Normal Ability (2)
CL Item
Mild Problem (3)
CL Item
Mild to Moderate Problem (4)
CL Item
Moderate Problem (5)
CL Item
Moderate to Severe Problem (6)
CL Item
Severe Problem (7)
Item
Remembering new information told to you (5.)
text
Code List
Remembering new information told to you (5.)
CL Item
Above Average (1)
CL Item
Normal Ability (2)
CL Item
Mild Problem (3)
CL Item
Mild to Moderate Problem (4)
CL Item
Moderate Problem (5)
CL Item
Moderate to Severe Problem (6)
CL Item
Severe Problem (7)
Item
Attention and concentration (6.)
text
Code List
Attention and concentration (6.)
CL Item
Above Average (1)
CL Item
Normal Ability (2)
CL Item
Mild Problem (3)
CL Item
Mild to Moderate Problem (4)
CL Item
Moderate Problem (5)
CL Item
Moderate to Severe Problem (6)
CL Item
Severe Problem (7)
Item
Ability to reason through a complicated problem (7.)
text
Code List
Ability to reason through a complicated problem (7.)
CL Item
Above Average (Above Average)
CL Item
Normal Ability (Normal Ability)
CL Item
Mild Problem (Mild Problem)
CL Item
Mild To Moderate Problem (Mild to Moderate Problem)
CL Item
Moderate Problem (Moderate Problem)
CL Item
Moderate To Severe Problem (Moderate to Severe Problem)
CL Item
Severe Problem (Severe Problem)
Item
Self awareness of problems (8.)
text
Code List
Self awareness of problems (8.)
CL Item
Above Average (Above Average)
CL Item
Normal Ability (Normal Ability)
CL Item
Mild Problem (Mild Problem)
CL Item
Mild To Moderate Problem (Mild to Moderate Problem)
CL Item
Moderate Problem (Moderate Problem)
CL Item
Moderate To Severe Problem (Moderate to Severe Problem)
CL Item
Severe Problem (Severe Problem)
Item
Remembering what you intended to do (9.)
text
Code List
Remembering what you intended to do (9.)
CL Item
Above Average (Above Average)
CL Item
Normal Ability (Normal Ability)
CL Item
Mild Problem (Mild Problem)
CL Item
Mild To Moderate Problem (Mild to Moderate Problem)
CL Item
Moderate Problem (Moderate Problem)
CL Item
Moderate To Severe Problem (Moderate to Severe Problem)
CL Item
Severe Problem (Severe Problem)
Item
Ability to shift easily from one activity to the next
text
Code List
Ability to shift easily from one activity to the next
CL Item
Above Average (Above Average)
CL Item
Normal Ability (Normal Ability)
CL Item
Mild Problem (Mild Problem)
CL Item
Mild To Moderate Problem (Mild to Moderate Problem)
CL Item
Moderate Problem (Moderate Problem)
CL Item
Moderate To Severe Problem (Moderate to Severe Problem)
CL Item
Severe Problem (Severe Problem)
Item
Remembering appointments or meetings (11.)
text
Code List
Remembering appointments or meetings (11.)
CL Item
Above Average (Above Average)
CL Item
Normal Ability (Normal Ability)
CL Item
Mild Problem (Mild Problem)
CL Item
Mild To Moderate Problem (Mild to Moderate Problem)
CL Item
Moderate Problem (Moderate Problem)
CL Item
Moderate To Severe Problem (Moderate to Severe Problem)
CL Item
Severe Problem (Severe Problem)
Item
General alertness (12.)
text
Code List
General alertness (12.)
CL Item
Above Average (Above Average)
CL Item
Normal Ability (Normal Ability)
CL Item
Mild Problem (Mild Problem)
CL Item
Mild To Moderate Problem (Mild to Moderate Problem)
CL Item
Moderate Problem (Moderate Problem)
CL Item
Moderate To Severe Problem (Moderate to Severe Problem)
CL Item
Severe Problem (Severe Problem)
Item
Ability to think clearly (13.)
text
Code List
Ability to think clearly (13.)
CL Item
Above Average (Above Average)
CL Item
Normal Ability (Normal Ability)
CL Item
Mild Problem (Mild Problem)
CL Item
Mild To Moderate Problem (Mild to Moderate Problem)
CL Item
Moderate Problem (Moderate Problem)
CL Item
Moderate To Severe Problem (Moderate to Severe Problem)
CL Item
Severe Problem (Severe Problem)
Item
Remembering new information you have read (14.)
text
Code List
Remembering new information you have read (14.)
CL Item
Above Average (Above Average)
CL Item
Normal Ability (Normal Ability)
CL Item
Mild Problem (Mild Problem)
CL Item
Mild To Moderate Problem (Mild to Moderate Problem)
CL Item
Moderate Problem (Moderate Problem)
CL Item
Moderate To Severe Problem (Moderate to Severe Problem)
CL Item
Severe Problem (Severe Problem)
Item
Remembering where you put things (15.)
text
Code List
Remembering where you put things (15.)
CL Item
Above Average (Above Average)
CL Item
Normal Ability (Normal Ability)
CL Item
Mild Problem (Mild Problem)
CL Item
Mild To Moderate Problem (Mild to Moderate Problem)
CL Item
Moderate Problem (Moderate Problem)
CL Item
Moderate To Severe Problem (Moderate to Severe Problem)
CL Item
Severe Problem (Severe Problem)
Item
Ease in initiating or starting activities by oneself (16.)
text
Code List
Ease in initiating or starting activities by oneself (16.)
CL Item
Above Average (Above Average)
CL Item
Normal Ability (Normal Ability)
CL Item
Mild Problem (Mild Problem)
CL Item
Mild To Moderate Problem (Mild to Moderate Problem)
CL Item
Moderate Problem (Moderate Problem)
CL Item
Moderate To Severe Problem (Moderate to Severe Problem)
CL Item
Severe Problem (Severe Problem)
Item
Ability to make decisions (17.)
text
Code List
Ability to make decisions (17.)
CL Item
Above Average (Above Average)
CL Item
Normal Ability (Normal Ability)
CL Item
Mild Problem (Mild Problem)
CL Item
Mild To Moderate Problem (Mild to Moderate Problem)
CL Item
Moderate Problem (Moderate Problem)
CL Item
Moderate To Severe Problem (Moderate to Severe Problem)
CL Item
Severe Problem (Severe Problem)
Item
Remembering information learned long ago (18.)
text
Code List
Remembering information learned long ago (18.)
CL Item
Above Average (Above Average)
CL Item
Normal Ability (Normal Ability)
CL Item
Mild Problem (Mild Problem)
CL Item
Mild To Moderate Problem (Mild to Moderate Problem)
CL Item
Moderate Problem (Moderate Problem)
CL Item
Moderate To Severe Problem (Moderate to Severe Problem)
CL Item
Severe Problem (Severe Problem)
Item
Ability to be flexible, rather than rigid or have an overly set manner
text
Code List
Ability to be flexible, rather than rigid or have an overly set manner
CL Item
Above Average (Above Average)
CL Item
Normal Ability (Normal Ability)
CL Item
Mild Problem (Mild Problem)
CL Item
Mild To Moderate Problem (Mild to Moderate Problem)
CL Item
Moderate Problem (Moderate Problem)
CL Item
Moderate To Severe Problem (Moderate to Severe Problem)
CL Item
Severe Problem (Severe Problem)

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