ID

10060

Beschreibung

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

Stichworte

Versionen (2)
  1. 18.12.14 18.12.14 - Martin Dugas
  2. 23.03.15 23.03.15 - Martin Dugas
Hochgeladen am

23. März 2015

DOI

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Lizenz

Creative Commons BY-NC 3.0 Legacy
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Breast Cancer CALGB NCT00024102

Englisch

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1 Formulare  
  1. StudyEvent: CALGB: NEUROBEHAVOIRAL SCALES FORM
    1. Continue to next page
Header
Beschreibung

Header

CALGB Form
Beschreibung

CALGBForm

Datentyp

text

CALGB Study No
Beschreibung

CALGBStudyNo

Datentyp

text

CALGB Patient ID
Beschreibung

CALGBPatientID

Datentyp

text

Date Completed (10.)
Beschreibung

DateCompleted

Datentyp

date

Amended data?
Beschreibung

Amended data?

Datentyp

boolean

Patient's Name
Beschreibung

Patient'sName

Datentyp

text

Participating Group
Beschreibung

ParticipatingGroup

Datentyp

text

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

PatientHospitalNumber

Datentyp

text

Participating Group Protocol No.
Beschreibung

ParticipatingGroupProtocolNo.

Datentyp

text

Main Member Institution/Adjunct
Beschreibung

MainMemberInstitution/Adjunct

Datentyp

text

Participating Group Patient No.
Beschreibung

ParticipatingGroupPatientNo.

Datentyp

text

Responsible CRA
Beschreibung

ResponsibleCRA

Datentyp

text

Assessment Number
Beschreibung

AssessmentNumber

Datentyp

float

neurobehavioral problems
Beschreibung

neurobehavioral problems

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

Abilitytoavoidlosingtrainofthought;distractibility

Datentyp

integer

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

Abilitytofocusongoals;carryoutaplan

Datentyp

text

Remembering events from long ago (4.)
Beschreibung

Rememberingeventsfromlongago

Datentyp

text

Remembering new information told to you (5.)
Beschreibung

Rememberingnewinformationtoldtoyou

Datentyp

text

Attention and concentration (6.)
Beschreibung

Attentionandconcentration

Datentyp

text

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

Abilitytoreasonthroughacomplicatedproblem

Datentyp

text

Self awareness of problems (8.)
Beschreibung

Selfawarenessofproblems

Datentyp

text

Remembering what you intended to do (9.)
Beschreibung

Rememberingwhatyouintendedtodo

Datentyp

text

Ability to shift easily from one activity to the next
Beschreibung

Abilitytoshifteasilyfromoneactivitytothenext

Datentyp

text

Remembering appointments or meetings (11.)
Beschreibung

Rememberingappointmentsormeetings

Datentyp

text

General alertness (12.)
Beschreibung

Generalalertness

Datentyp

text

Ability to think clearly (13.)
Beschreibung

Abilitytothinkclearly

Datentyp

text

Remembering new information you have read (14.)
Beschreibung

Rememberingnewinformationyouhaveread

Datentyp

text

Remembering where you put things (15.)
Beschreibung

Rememberingwhereyouputthings

Datentyp

text

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

Easeininitiatingorstartingactivitiesbyoneself

Datentyp

text

Ability to make decisions (17.)
Beschreibung

Abilitytomakedecisions

Datentyp

text

Remembering information learned long ago (18.)
Beschreibung

Rememberinginformationlearnedlongago

Datentyp

text

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

Abilitytobeflexible,ratherthanrigidorhaveanoverlysetmanner

Datentyp

text

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1 Formulare
  1. StudyEvent: CALGB: NEUROBEHAVOIRAL SCALES FORM
    1. Continue to next page
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
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)
CL.2
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
CL.2
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
CL.2
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
CL.2
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
CL.2
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
CL.7
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
CL.8
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
CL.9
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
CL.10
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
CL.11
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
CL.12
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
CL.13
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
CL.14
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
CL.15
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
CL.16
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
CL.17
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
CL.18
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
CL.19
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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