ID

11264

Description

NCT00075777 AMC Clinical Trials - Valproic Acid Administration Form for Protocol #038 - PR3802 Valproic Acid in Treating Patients With Kaposi's Sarcoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=DB52DD55-D039-4342-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=DB52DD55-D039-4342-E034-0003BA12F5E7

Keywords

Versions (3)
  1. 9/19/12 9/19/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
  3. 6/27/15 6/27/15 -
Uploaded on

June 27, 2015

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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NCT00075777 AMC Clinical Trials - Valproic Acid Administration Form for Protocol #038 - PR3802

English

No Instruction available.

1 forms  
  1. StudyEvent: AMC Clinical Trials - Valproic Acid Administration Form for Protocol #038 - PR3802
    1. No Instruction available.
Header
Description

Header

Patient Initials
Description

Patient Initials

Data type

text

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

Patient Study ID

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25462
NCI Thesaurus Property-2
C25364
Valproic Acid Assessment
Description

Valproic Acid Assessment

Current Cycle Number
Description

Cycle Number Chemotherapeutics

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2045829
NCI Thesaurus Property
C25471
NCI Thesaurus ObjectClass
C15368
NCI Thesaurus Property-2
C25379
Date of Evaluation
Description

LesionAssessmentDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C3824
UMLS 2011AA ObjectClass
C0221198
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus ValueDomain-2
C25367
Day
Description

TreatmentDayCount

Data type

float

Alias
NCI Thesaurus ValueDomain
C25301
UMLS 2011AA ValueDomain
C0439228
NCI Thesaurus ObjectClass
C15368
NCI Thesaurus ValueDomain-2
C25463
UMLS 2011AA ValueDomain-2
C0750480
Date Agent Administered
Description

DateAgentAdministered

Data type

text

Total # of Capsule(s) Taken per Day
Description

Total#ofCapsule(s)TakenperDay

Data type

text

Date of Day 5
Description

DateofDay5

Data type

text

Date of Day 28
Description

DateofDay28

Data type

text

Total # of Capsule(s) Taken per Day
Description

Total#ofCapsule(s)TakenperDay

Data type

text

Reduction grade
Description

Reduction grade

Data type

text

Start Date
Description

StartDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
Stop Date
Description

StopDate

Data type

date

Alias
NCI Thesaurus Property
C25164
UMLS 2011AA Property
C0011008
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C15368
NCI Thesaurus Property-2
C65125
UMLS 2011AA Property-2
C1947925
Total # of Capsule(s) Taken per Day
Description

Total#ofCapsule(s)TakenperDay

Data type

text

Were there any dose modifications or additions/omissions to protocol treatment?
Description

Dose Modification

Data type

text

Alias
NCI Thesaurus ValueDomain
C25180
UMLS CUI-1
C1707811
NCI Thesaurus ObjectClass
C25256
NCI Thesaurus Property
C25572
NCI Thesaurus ValueDomain-2
C25572
valproic acid serum level checked at 72-96 hours (on or about day 8)?
Description

valproicacidserumlevelcheckedat72-96hours(onoraboutday8)?

Data type

boolean

record serum valproic acid concentration
Description

recordserumvalproicacidconcentration

Data type

text

Is valproic acid therapy discontinued early for the patient?
Description

Isvalproicacidtherapydiscontinuedearlyforthepatient?

Data type

boolean

record serum valproic acid concentration at the drug discontinuation
Description

recordserumvalproicacidconcentrationatthedrugdiscontinuation

Data type

text

Any additional comments about valproic acid administration?
Description

Anyadditionalcommentsaboutvalproicacidadministration?

Data type

boolean

Comments
Description

Research Comments

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS CUI-1
C0947611
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
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Similar models

No Instruction available.

1 forms
  1. StudyEvent: AMC Clinical Trials - Valproic Acid Administration Form for Protocol #038 - PR3802
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header
Patient Initials
Item
Patient Initials
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
Patient Study ID
Item
Patient Study ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25462 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Item Group
Valproic Acid Assessment
Cycle Number Chemotherapeutics
Item
Current Cycle Number
text
C25337 (NCI Thesaurus ValueDomain)
C2045829 (UMLS CUI-1)
C25471 (NCI Thesaurus Property)
C15368 (NCI Thesaurus ObjectClass)
C25379 (NCI Thesaurus Property-2)
LesionAssessmentDate
Item
Date of Evaluation
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C3824 (NCI Thesaurus ObjectClass)
C0221198 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25367 (NCI Thesaurus ValueDomain-2)
TreatmentDayCount
Item
Day
float
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C15368 (NCI Thesaurus ObjectClass)
C25463 (NCI Thesaurus ValueDomain-2)
C0750480 (UMLS 2011AA ValueDomain-2)
DateAgentAdministered
Item
Date Agent Administered
text
Total#ofCapsule(s)TakenperDay
Item
Total # of Capsule(s) Taken per Day
text
DateofDay5
Item
Date of Day 5
text
DateofDay28
Item
Date of Day 28
text
Total#ofCapsule(s)TakenperDay
Item
Total # of Capsule(s) Taken per Day
text
Item
Reduction grade
text
CL.2
Code List
Reduction grade
CL Item
1st reduction (1st reduction)
CL Item
2nd reduction (2nd reduction)
CL Item
3rd reduction (3rd reduction)
CL Item
4th reduction (4th reduction)
StartDate
Item
Start Date
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
StopDate
Item
Stop Date
date
C25164 (NCI Thesaurus Property)
C0011008 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C15368 (NCI Thesaurus ObjectClass)
C65125 (NCI Thesaurus Property-2)
C1947925 (UMLS 2011AA Property-2)
Total#ofCapsule(s)TakenperDay
Item
Total # of Capsule(s) Taken per Day
text
Item
Were there any dose modifications or additions/omissions to protocol treatment?
text
C25180 (NCI Thesaurus ValueDomain)
C1707811 (UMLS CUI-1)
C25256 (NCI Thesaurus ObjectClass)
C25572 (NCI Thesaurus Property)
C25572 (NCI Thesaurus ValueDomain-2)
CL.3
Code List
Were there any dose modifications or additions/omissions to protocol treatment?
CL Item
Yes, Planned (i.e., The Treatment Was Changed According To Protocol Guidelines) (Yes, planned)
CL Item
Yes, Unplanned (i.e., The Treatment Change Was Not Part Of Protocol Guidelines) (Yes, unplanned)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
valproicacidserumlevelcheckedat72-96hours(onoraboutday8)?
Item
valproic acid serum level checked at 72-96 hours (on or about day 8)?
boolean
recordserumvalproicacidconcentration
Item
record serum valproic acid concentration
text
Isvalproicacidtherapydiscontinuedearlyforthepatient?
Item
Is valproic acid therapy discontinued early for the patient?
boolean
recordserumvalproicacidconcentrationatthedrugdiscontinuation
Item
record serum valproic acid concentration at the drug discontinuation
text
Anyadditionalcommentsaboutvalproicacidadministration?
Item
Any additional comments about valproic acid administration?
boolean
Research Comments
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C0947611 (UMLS CUI-1)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
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