ID

10060

Beschrijving

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

Trefwoorden

  1. 18-12-14 18-12-14 - Martin Dugas
  2. 23-03-15 23-03-15 - Martin Dugas
Geüploaded op

23 maart 2015

DOI

Voor een aanvraag inloggen.

Licentie

Creative Commons BY-NC 3.0 Legacy

Model Commentaren :

Hier kunt u commentaar leveren op het model. U kunt de tekstballonnen bij de itemgroepen en items gebruiken om er specifiek commentaar op te geven.

Itemgroep Commentaren voor :

Item Commentaren voor :

U moet ingelogd zijn om formulieren te downloaden. AUB inloggen of schrijf u gratis in.

Breast Cancer CALGB NCT00024102

Continue to next page

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

Header

CALGB Form
Beschrijving

CALGBForm

Datatype

text

CALGB Study No
Beschrijving

CALGBStudyNo

Datatype

text

CALGB Patient ID
Beschrijving

CALGBPatientID

Datatype

text

Date Completed (10.)
Beschrijving

DateCompleted

Datatype

date

Amended data?
Beschrijving

Amended data?

Datatype

boolean

Patient's Name
Beschrijving

Patient'sName

Datatype

text

Participating Group
Beschrijving

ParticipatingGroup

Datatype

text

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

PatientHospitalNumber

Datatype

text

Participating Group Protocol No.
Beschrijving

ParticipatingGroupProtocolNo.

Datatype

text

Main Member Institution/Adjunct
Beschrijving

MainMemberInstitution/Adjunct

Datatype

text

Participating Group Patient No.
Beschrijving

ParticipatingGroupPatientNo.

Datatype

text

Responsible CRA
Beschrijving

ResponsibleCRA

Datatype

text

Assessment Number
Beschrijving

AssessmentNumber

Datatype

float

neurobehavioral problems
Beschrijving

neurobehavioral problems

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

Abilitytoavoidlosingtrainofthought;distractibility

Datatype

integer

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

Abilitytofocusongoals;carryoutaplan

Datatype

text

Remembering events from long ago (4.)
Beschrijving

Rememberingeventsfromlongago

Datatype

text

Remembering new information told to you (5.)
Beschrijving

Rememberingnewinformationtoldtoyou

Datatype

text

Attention and concentration (6.)
Beschrijving

Attentionandconcentration

Datatype

text

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

Abilitytoreasonthroughacomplicatedproblem

Datatype

text

Self awareness of problems (8.)
Beschrijving

Selfawarenessofproblems

Datatype

text

Remembering what you intended to do (9.)
Beschrijving

Rememberingwhatyouintendedtodo

Datatype

text

Ability to shift easily from one activity to the next
Beschrijving

Abilitytoshifteasilyfromoneactivitytothenext

Datatype

text

Remembering appointments or meetings (11.)
Beschrijving

Rememberingappointmentsormeetings

Datatype

text

General alertness (12.)
Beschrijving

Generalalertness

Datatype

text

Ability to think clearly (13.)
Beschrijving

Abilitytothinkclearly

Datatype

text

Remembering new information you have read (14.)
Beschrijving

Rememberingnewinformationyouhaveread

Datatype

text

Remembering where you put things (15.)
Beschrijving

Rememberingwhereyouputthings

Datatype

text

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

Easeininitiatingorstartingactivitiesbyoneself

Datatype

text

Ability to make decisions (17.)
Beschrijving

Abilitytomakedecisions

Datatype

text

Remembering information learned long ago (18.)
Beschrijving

Rememberinginformationlearnedlongago

Datatype

text

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

Abilitytobeflexible,ratherthanrigidorhaveanoverlysetmanner

Datatype

text

Similar models

Continue to next page

  1. StudyEvent: CALGB: NEUROBEHAVOIRAL SCALES FORM
    1. Continue to next page
Name
Type
Description | Question | Decode (Coded Value)
Datatype
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)

Gebruik dit formulier voor feedback, vragen en verbeteringsvoorstellen.

Velden gemarkeerd met een * zijn verplicht.

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial