ID
10560
Description
Radiation Therapy Oncology Group Phase III Lung Prophylactic Cranial RT MMSE NCT00048997 Radiation Therapy in Preventing CNS Metastases in Patients With Non-Small Cell Lung Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A5D1AB4A-E01B-3595-E034-080020C9C0E0
Link
Keywords
Versions (3)
- 9/19/12 9/19/12 -
- 5/28/15 5/28/15 -
- 6/3/15 6/3/15 -
Uploaded on
June 3, 2015
DOI
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License
Creative Commons BY-NC 3.0 Legacy
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Radiation Therapy Oncology Group Phase III Lung Prophylactic Cranial RT MMSE NCT00048997
Instructions: To be completed by nurse, data manager or physician. All dates are mm/dd/yy.
- StudyEvent: Radiation Therapy Oncology Group Phase III Lung Prophylactic Cranial RT MMSE
Description
Neurocognitive Evaluation
Description
CalenderDueDate
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ObjectClass
- C19459
- UMLS 2011AA ObjectClass
- C1516147
- NCI Thesaurus Property
- C45263
- UMLS 2011AA Property
- C0678226
Description
Dateofexamination
Data type
text
Description
FirstTreatmentStartDate
Data type
date
Description
Whatistheyear
Data type
text
Description
Whatistheseason
Data type
text
Description
Whatisthedate
Data type
text
Description
Whatistheday
Data type
text
Description
Whatisthemonth
Data type
text
Description
Whatisthe,Score
Data type
text
Description
Wherearewe,state
Data type
text
Description
Wherearewe,country
Data type
text
Description
Wherearewe,town
Data type
text
Description
Wherearewe,hospital
Data type
text
Description
Wherearewe,floor
Data type
text
Description
Wherearewe,Score
Data type
text
Description
RegistrationScore
Data type
text
Description
AttentionandCalculationScore
Data type
text
Description
RecallScore
Data type
text
Description
Pointtothefollowingobjectsandhavepatientnameeach:apencilandawatch
Data type
text
Description
Havethepatientrepeatthefollowing:"Noifs,andsorbuts"
Data type
text
Description
Havethepatientfollowa3stepcommand:"Takeapaperinyourrighthand,folditinhalf,andputitonthefloor."
Data type
text
Description
Showthepatientthestatement"Closeyoureyesandhimreadandobeywhatitsays.
Data type
text
Description
Havethepatientwriteasentencewithasubjectandaverb
Data type
text
Description
Havethepatientcopythefigure
Data type
text
Description
MMSETotalScore
Data type
text
Description
Assesslevelofconsciousnessalongacontinuum
Data type
text
Description
Ifanevaluationisnotdone,providethetimepointmissedandthereason.Ifnoneofthetestsaredone,providethereason.
Data type
text
Description
Name/signatureofpersonperformingexam
Data type
text
Description
Date
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Description
Ccrr Module For Radiation Therapy Oncology Group Phase Iii Lung Prophylactic Cranial Rt Mmse
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Instructions: To be completed by nurse, data manager or physician. All dates are mm/dd/yy.
- StudyEvent: Radiation Therapy Oncology Group Phase III Lung Prophylactic Cranial RT MMSE
C0237753 (UMLS 2011AA ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C19459 (NCI Thesaurus ObjectClass)
C1516147 (UMLS 2011AA ObjectClass)
C45263 (NCI Thesaurus Property)
C0678226 (UMLS 2011AA Property)
C0205448 (UMLS 2011AA)
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C0718338 (UMLS 2011AA)
C0009421 (UMLS 2011AA)
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