ID

10190

Beschrijving

NSABP PROTOCOL B-36 Cardiac Function Form Comparison of Two Combination Chemotherapy Regimens in Treating Women With Breast Cancer NCT00087178 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=C87A9E46-9ADC-5B40-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=C87A9E46-9ADC-5B40-E034-0003BA12F5E7

Trefwoorden

Versies (1)
  1. 24-04-15 24-04-15 - Martin Dugas
Geüploaded op

24 april 2015

DOI

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Licentie

Creative Commons BY-NC 3.0 Legacy
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Breast Cancer Cardiac Function NSABP B-36 NCT00087178

Engels

No Instruction available.

1 Formulieren  
  1. StudyEvent: NSABP PROTOCOL B-36 Cardiac Function Form
    1. No Instruction available.
Header
Beschrijving

Header

Patient Initials (Last, First Middle)
Beschrijving

Patient Initials (Last, First Middle)

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25191
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
UMLS CUI-1
C2986440
NSABP Patient ID
Beschrijving

PatientNationalSurgicalAdjuvantBreastProjectIdentifierNumber

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25337
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C15818
UMLS CUI-1
C2348585
UMLS CUI-2
C1513905
Institution Name
Beschrijving

Institution Name

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25191
NCI Thesaurus ObjectClass
C21541
NCI Thesaurus ValueDomain-2
C21541
NCI Thesaurus Property
C25364
UMLS CUI-1
C1301943
Affiliate Name
Beschrijving

AffiliatedInstitutionName

Datatype

text

Alias
NCI Thesaurus ObjectClass
C21541
NCI Thesaurus ObjectClass-2
C25413
NCI Thesaurus Property
C25364
NCI Thesaurus ValueDomain
C25191
NCI Thesaurus ValueDomain-2
C21541
UMLS CUI-1
C1510825
Person Completing Form (Phone)
Beschrijving

ResponsiblePersonName

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25191
NCI Thesaurus ObjectClass
C25657
NCI Thesaurus Property
C25364
UMLS CUI-1
C0680379
Are data amended?
Beschrijving

DataAmendedInd-3

Datatype

boolean

Alias
NCI Thesaurus ValueDomain
C38148
NCI Thesaurus ObjectClass
C25474
NCI Thesaurus Property
C25416
UMLS CUI-1
C1691222
Comments
Beschrijving

ResearchCommentsText

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
UMLS 2011AA Property
C0282411
Cardiac function
Beschrijving

Cardiac function

Alias
UMLS CUI-1
C0232164
Time Point
Beschrijving

Time Point

Datatype

text

Date of LVEF ()
Beschrijving

LVEFAssessmentMethodDate

Datatype

date

Maateenheden
  • Month Day Year
Alias
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ObjectClass
C20989
NCI Thesaurus Property
C16847
UMLS CUI-1
C0428772
UMLS CUI-2
C0011008
Month Day Year
Method of Assessment (Every effort should be made to schedule the follow-up MUGA or echocardiogram at the same facility that performed the baseline exam, and the same method of assessment should be used at both time points.)
Beschrijving

AssessmentMethodType

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25284
NCI Thesaurus ObjectClass
C20989
NCI Thesaurus Property
C16847
UMLS CUI-1
C2911685
LVEF
Beschrijving

LVEF

Datatype

float

Maateenheden
  • %
Alias
UMLS CUI-1
C0428772
%
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Similar models

No Instruction available.

1 Formulieren
  1. StudyEvent: NSABP PROTOCOL B-36 Cardiac Function Form
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Header
Patient Initials Name
Item
Patient Initials (Last, First Middle)
text
C25191 (NCI Thesaurus ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
C2986440 (UMLS CUI-1)
NSABP Patient ID
Item
NSABP Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus Property)
C15818 (NCI Thesaurus Property-2)
C2348585 (UMLS CUI-1)
C1513905 (UMLS CUI-2)
Institution Name
Item
Institution Name
text
C25191 (NCI Thesaurus ValueDomain)
C21541 (NCI Thesaurus ObjectClass)
C21541 (NCI Thesaurus ValueDomain-2)
C25364 (NCI Thesaurus Property)
C1301943 (UMLS CUI-1)
Affiliate Name
Item
Affiliate Name
text
C21541 (NCI Thesaurus ObjectClass)
C25413 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
C25191 (NCI Thesaurus ValueDomain)
C21541 (NCI Thesaurus ValueDomain-2)
C1510825 (UMLS CUI-1)
Responsible person
Item
Person Completing Form (Phone)
text
C25191 (NCI Thesaurus ValueDomain)
C25657 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus Property)
C0680379 (UMLS CUI-1)
Data amended
Item
Are data amended?
boolean
C38148 (NCI Thesaurus ValueDomain)
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS CUI-1)
ResearchCommentsText
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0282411 (UMLS 2011AA Property)
Item Group
Cardiac function
C0232164 (UMLS CUI-1)
Item
Time Point
text
CL.2
Code List
Time Point
CL Item
Baseline (0)
C1442488 (UMLS CUI-1)
CL Item
At 12 Months (12m)
C0420338 (UMLS CUI-1)
LVEF date
Item
Date of LVEF ()
date
C25164 (NCI Thesaurus ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C16847 (NCI Thesaurus Property)
C0428772 (UMLS CUI-1)
C0011008 (UMLS CUI-2)
Item
Method of Assessment (Every effort should be made to schedule the follow-up MUGA or echocardiogram at the same facility that performed the baseline exam, and the same method of assessment should be used at both time points.)
text
C25284 (NCI Thesaurus ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C16847 (NCI Thesaurus Property)
C2911685 (UMLS CUI-1)
CL.3
Code List
Method of Assessment (Every effort should be made to schedule the follow-up MUGA or echocardiogram at the same facility that performed the baseline exam, and the same method of assessment should be used at both time points.)
CL Item
MUGA (1)
C0521317 (UMLS CUI-1)
CL Item
ECHO (2)
C0013516 (UMLS CUI-1)
LVEF
Item
LVEF
float
C0428772 (UMLS CUI-1)
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