ID

11290

Description

PRL1013 - Week 4 Recall Evaluation Form NCT01268605 Postoperative Hypersensitivity Randomized Comparative Effectiveness Research Trial (POH RCERT) Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AA2C2281-C10C-C660-E040-BB89AD43194D

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AA2C2281-C10C-C660-E040-BB89AD43194D

Keywords

Versions (3)
  1. 12/18/14 12/18/14 - Martin Dugas
  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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PRL1013 - Week 4 Recall Evaluation Form NCT01268605

English

No Instruction available.

1 forms  
  1. StudyEvent: PRL1013 - Week 4 Recall Evaluation Form
    1. No Instruction available.
Header
Description

Header

Site Code
Description

PractitionersEngagedinAppliedResearchandLearningNetworkClinicalStudySiteIdentifierNumber

Data type

text

Alias
NCI Thesaurus ObjectClass
C15206
UMLS 2011AA ObjectClass
C0008972
NCI Thesaurus ObjectClass-2
C37901
UMLS 2011AA ObjectClass-2
C0205145
NCI Thesaurus ObjectClass-3
C52664
UMLS 2011AA ObjectClass-3
C1709628
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
Date of visit
Description

PatientDentistVisitDate

Data type

date

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C52654
UMLS 2011AA Property
C0011441
NCI Thesaurus Property-2
C25716
UMLS 2011AA Property-2
C0545082
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ValueDomain-2
C25367
Subject 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
Subject Initials
Description

Patient Initials

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
Treatment arm
Description

Protocol Treatment Arm

Data type

text

Alias
NCI Thesaurus ObjectClass
C15368
NCI Thesaurus ObjectClass-2
C42651
UMLS CUI-1
C1522541
NCI Thesaurus Property
C32141
NCI Thesaurus Property-2
C25426
NCI Thesaurus ValueDomain
C25284
Dental status
Description

Dental status

Date of evaluation
Description

Assessment Date

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS CUI-1
C2985720
NCI Thesaurus ObjectClass
C25367
NCI Thesaurus ValueDomain-2
C25367
NCI Thesaurus Property
C38000
Tooth quadrant
Description

ToothMouthQuadrantAnatomicSite

Data type

text

Alias
NCI Thesaurus ObjectClass
C12506
UMLS 2011AA ObjectClass
C0040426
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus Property-2
C12421
UMLS 2011AA Property-2
C0226896
NCI Thesaurus Property-3
C61106
UMLS 2011AA Property-3
C1631280
NCI Thesaurus ValueDomain
C13717
UMLS 2011AA ValueDomain
C1515974
Air velocity
Description

DentalInstrumentationFollow-upAirSpeedDescriptionValue

Data type

float

Alias
NCI Thesaurus ObjectClass
C41136
UMLS 2011AA ObjectClass
C0226984
NCI Thesaurus ObjectClass-2
C16742
UMLS 2011AA ObjectClass-2
C0348000
NCI Thesaurus Property
C16033
UMLS 2011AA Property
C1522577
NCI Thesaurus Property-2
C25365
UMLS 2011AA Property-2
C0678257
NCI Thesaurus Property-3
C73434
UMLS 2011AA Property-3
C0001861
NCI Thesaurus Property-4
C41146
UMLS 2011AA Property-4
C0678536
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
Air stimulation pain level
Description

ToothSensitivityAirStimulationAssessmentScale

Data type

text

Alias
NCI Thesaurus ObjectClass
C12506
UMLS 2011AA ObjectClass
C0040426
NCI Thesaurus ObjectClass-2
C25201
UMLS 2011AA ObjectClass-2
C1522640
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C61406
UMLS 2011AA Property
C1948023
NCI Thesaurus Property-3
C73434
UMLS 2011AA Property-2
C0001861
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Does the pain linger >4 seconds (after removal of air blast)
Description

ToothRemainingColdSensitivityAssessmentInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C12506
UMLS 2011AA ObjectClass
C0040426
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C25201
UMLS 2011AA Property
C1522640
NCI Thesaurus Property-3
C25649
UMLS 2011AA Property-2
C1527428
NCI Thesaurus Property-4
C62180
UMLS 2011AA Property-3
C0009264
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Cold stimulation pain level
Description

ToothSensitivityColdAssessmentScale

Data type

text

Alias
NCI Thesaurus ObjectClass
C12506
UMLS 2011AA ObjectClass
C0040426
NCI Thesaurus ObjectClass-2
C25201
UMLS 2011AA ObjectClass-2
C1522640
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C62180
UMLS 2011AA Property
C0009264
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Time to cold sensation (length of time from pellet application until subjet raises hand)
Description

ToothColdSensitivityAssessmentDuration

Data type

float

Measurement units
  • min
Alias
NCI Thesaurus ObjectClass
C12506
UMLS 2011AA ObjectClass
C0040426
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C25201
UMLS 2011AA Property
C1522640
NCI Thesaurus Property-3
C62180
UMLS 2011AA Property-2
C0009264
NCI Thesaurus ValueDomain
C25330
UMLS 2011AA ValueDomain
C0449238
min
Does the pain linger > 4 seconds
Description

ToothRemainingHotSensitivityAssessmentInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C12506
UMLS 2011AA ObjectClass
C0040426
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C25201
UMLS 2011AA Property
C1522640
NCI Thesaurus Property-3
C25649
UMLS 2011AA Property-2
C1527428
NCI Thesaurus Property-4
C62181
UMLS 2011AA Property-3
C2350229
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
During chewing of food
Description

ToothSensitivityMasticationAssessmentInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C12506
UMLS 2011AA ObjectClass
C0040426
NCI Thesaurus ObjectClass-2
C25201
UMLS 2011AA ObjectClass-2
C1522640
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C62062
UMLS 2011AA Property
C0024888
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
During clenching
Description

ToothSensitivityPressureAssessmentInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C12506
UMLS 2011AA ObjectClass
C0040426
NCI Thesaurus ObjectClass-2
C25201
UMLS 2011AA ObjectClass-2
C1522640
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C25195
UMLS 2011AA Property
C0033095
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Did you check the occlusion on the treated tooth (If "Yes" to either of the above)
Description

DentalOcclusionEvaluationInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus Property
C25214
UMLS 2011AA Property
C0220825
NCI Thesaurus ObjectClass
C62301
UMLS 2011AA ObjectClass
C0011382
Did you adjust the occlusion (If "Yes")
Description

DentalOcclusionAdjustmentInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C62301
UMLS 2011AA ObjectClass
C0011382
NCI Thesaurus Property
C49157
UMLS 2011AA Property
C0456081
Rescue Treatment
Description

Rescue Treatment

Did the patient receive rescue treatment (since the last visit)
Description

RetreatmentAdministeredInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus Property
C25382
UMLS 2011AA Property
C1521801
NCI Thesaurus ObjectClass
C54055
UMLS 2011AA ObjectClass
C0376495
Which rescue treatment was provided
Description

RetreatmentAdministeredType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus Property
C25382
UMLS 2011AA Property
C1521801
NCI Thesaurus ObjectClass
C54055
UMLS 2011AA ObjectClass
C0376495
Date rescue treatment performed
Description

RetreatmentAdministeredDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus Property
C25382
UMLS 2011AA Property
C1521801
NCI Thesaurus ObjectClass
C54055
UMLS 2011AA ObjectClass
C0376495
Was the tooth evaluated for pulpitis
Description

RetreatmentToothPulpitisAssessmentInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C54055
UMLS 2011AA ObjectClass
C0376495
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C12506
UMLS 2011AA Property
C0040426
NCI Thesaurus Property-3
C52595
UMLS 2011AA Property-2
C0034103
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Was there evidence of pulpitis (If "Yes")
Description

RetreatmentToothPulpitisPresentInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C54055
UMLS 2011AA ObjectClass
C0376495
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus Property-2
C12506
UMLS 2011AA Property-2
C0040426
NCI Thesaurus Property-3
C52595
UMLS 2011AA Property-3
C0034103
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Was endodontic therapy performed (If "Yes")
Description

RetreatmentEndodonticTreatmentPerformedInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus Property-2
C52575
UMLS 2011AA Property-2
C0700632
NCI Thesaurus ObjectClass
C54055
UMLS 2011AA ObjectClass
C0376495
Date of endodontic treatment (If "Yes")
Description

RetreatmentEndodonticTreatmentPerformedDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus Property-2
C52575
UMLS 2011AA Property-2
C0700632
NCI Thesaurus ObjectClass
C54055
UMLS 2011AA ObjectClass
C0376495
Economic Impact
Description

Economic Impact

How much time did it take the patient to travel to the dental office today
Description

PatientTravelDentalPhysicianOfficeDistanceDuration

Data type

text

Measurement units
  • min
Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass-2
C53462
UMLS 2011AA ObjectClass-2
C0040802
NCI Thesaurus Property
C41136
UMLS 2011AA Property
C0226984
NCI Thesaurus Property-2
C25167
UMLS 2011AA Property-2
C0012751
NCI Thesaurus Property-3
C16988
UMLS 2011AA Property-3
C0031834
NCI Thesaurus ValueDomain
C25330
UMLS 2011AA ValueDomain
C0449238
How much did it cost the patient to travel to the dental office today (including parking)
Description

PatientTravelDentalPhysicianOfficeCostValue

Data type

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass-2
C53462
UMLS 2011AA ObjectClass-2
C0040802
NCI Thesaurus Property
C41136
UMLS 2011AA Property
C0226984
NCI Thesaurus Property-2
C16988
UMLS 2011AA Property-2
C0031834
NCI Thesaurus Property-3
C69088
UMLS 2011AA Property-3
C0220812
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
NCI Thesaurus ValueDomain-2
C69088
UMLS 2011AA ValueDomain-2
C0220812
Did the patient have to take time away from work to come to the dental office to treat the hypersensitivity
Description

PatientEmploymentAbsentInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C48190
UMLS 2011AA Property
C0332197
NCI Thesaurus Property-2
C25172
UMLS 2011AA Property-2
C0014003
How much time did he/she take off (If "Yes")
Description

PatientEmploymentAbsentDuration

Data type

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C48190
UMLS 2011AA Property
C0332197
NCI Thesaurus Property-2
C25172
UMLS 2011AA Property-2
C0014003
NCI Thesaurus ValueDomain
C25330
UMLS 2011AA ValueDomain
C0449238
What is the total estimated cost for the rescue treatment if patient was not participating in the study
Description

RetreatmentAdministeredCostValue

Data type

text

Alias
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
NCI Thesaurus Property
C25382
UMLS 2011AA Property
C1521801
NCI Thesaurus ObjectClass
C54055
UMLS 2011AA ObjectClass
C0376495
NCI Thesaurus ValueDomain-2
C69088
UMLS 2011AA ValueDomain-2
C0220812
Footer Module
Description

Footer Module

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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1 forms
  1. StudyEvent: PRL1013 - Week 4 Recall Evaluation Form
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header
PractitionersEngagedinAppliedResearchandLearningNetworkClinicalStudySiteIdentifierNumber
Item
Site Code
text
C15206 (NCI Thesaurus ObjectClass)
C0008972 (UMLS 2011AA ObjectClass)
C37901 (NCI Thesaurus ObjectClass-2)
C0205145 (UMLS 2011AA ObjectClass-2)
C52664 (NCI Thesaurus ObjectClass-3)
C1709628 (UMLS 2011AA ObjectClass-3)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
PatientDentistVisitDate
Item
Date of visit
date
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C52654 (NCI Thesaurus Property)
C0011441 (UMLS 2011AA Property)
C25716 (NCI Thesaurus Property-2)
C0545082 (UMLS 2011AA Property-2)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
Patient Study ID
Item
Subject ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25462 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Patient Initials
Item
Subject Initials
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
Item
Treatment arm
text
C15368 (NCI Thesaurus ObjectClass)
C42651 (NCI Thesaurus ObjectClass-2)
C1522541 (UMLS CUI-1)
C32141 (NCI Thesaurus Property)
C25426 (NCI Thesaurus Property-2)
C25284 (NCI Thesaurus ValueDomain)
CL.1
Code List
Treatment arm
CL Item
Restoration With Rmgi (RR)
CL Item
Restoration With Dba (RD)
Item Group
Dental status
Assessment Date
Item
Date of evaluation
date
C25164 (NCI Thesaurus ValueDomain)
C2985720 (UMLS CUI-1)
C25367 (NCI Thesaurus ObjectClass)
C25367 (NCI Thesaurus ValueDomain-2)
C38000 (NCI Thesaurus Property)
Item
Tooth quadrant
text
C12506 (NCI Thesaurus ObjectClass)
C0040426 (UMLS 2011AA ObjectClass)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C12421 (NCI Thesaurus Property-2)
C0226896 (UMLS 2011AA Property-2)
C61106 (NCI Thesaurus Property-3)
C1631280 (UMLS 2011AA Property-3)
C13717 (NCI Thesaurus ValueDomain)
C1515974 (UMLS 2011AA ValueDomain)
CL.13
Code List
Tooth quadrant
CL Item
Lower Left Quadrant (Lower Left)
CL Item
Lower Right Quadrant (Lower Right)
CL Item
Upper Left Quadrant (Upper Left)
CL Item
Upper Right Quadrant (Upper Right)
DentalInstrumentationFollow-upAirSpeedDescriptionValue
Item
Air velocity
float
C41136 (NCI Thesaurus ObjectClass)
C0226984 (UMLS 2011AA ObjectClass)
C16742 (NCI Thesaurus ObjectClass-2)
C0348000 (UMLS 2011AA ObjectClass-2)
C16033 (NCI Thesaurus Property)
C1522577 (UMLS 2011AA Property)
C25365 (NCI Thesaurus Property-2)
C0678257 (UMLS 2011AA Property-2)
C73434 (NCI Thesaurus Property-3)
C0001861 (UMLS 2011AA Property-3)
C41146 (NCI Thesaurus Property-4)
C0678536 (UMLS 2011AA Property-4)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
Item
Air stimulation pain level
text
C12506 (NCI Thesaurus ObjectClass)
C0040426 (UMLS 2011AA ObjectClass)
C25201 (NCI Thesaurus ObjectClass-2)
C1522640 (UMLS 2011AA ObjectClass-2)
C25367 (NCI Thesaurus Property)
C61406 (NCI Thesaurus Property-2)
C1948023 (UMLS 2011AA Property)
C73434 (NCI Thesaurus Property-3)
C0001861 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.3
Code List
Air stimulation pain level
CL Item
0 (0)
C0919414 (NCI Metathesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10 (10)
ToothRemainingColdSensitivityAssessmentInd-2
Item
Does the pain linger >4 seconds (after removal of air blast)
boolean
C12506 (NCI Thesaurus ObjectClass)
C0040426 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C25201 (NCI Thesaurus Property-2)
C1522640 (UMLS 2011AA Property)
C25649 (NCI Thesaurus Property-3)
C1527428 (UMLS 2011AA Property-2)
C62180 (NCI Thesaurus Property-4)
C0009264 (UMLS 2011AA Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
Item
Cold stimulation pain level
text
C12506 (NCI Thesaurus ObjectClass)
C0040426 (UMLS 2011AA ObjectClass)
C25201 (NCI Thesaurus ObjectClass-2)
C1522640 (UMLS 2011AA ObjectClass-2)
C25367 (NCI Thesaurus Property)
C62180 (NCI Thesaurus Property-2)
C0009264 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.5
Code List
Cold stimulation pain level
CL Item
0 (0)
C0919414 (NCI Metathesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10 (10)
ToothColdSensitivityAssessmentDuration
Item
Time to cold sensation (length of time from pellet application until subjet raises hand)
float
C12506 (NCI Thesaurus ObjectClass)
C0040426 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C25201 (NCI Thesaurus Property-2)
C1522640 (UMLS 2011AA Property)
C62180 (NCI Thesaurus Property-3)
C0009264 (UMLS 2011AA Property-2)
C25330 (NCI Thesaurus ValueDomain)
C0449238 (UMLS 2011AA ValueDomain)
ToothRemainingHotSensitivityAssessmentInd-2
Item
Does the pain linger > 4 seconds
boolean
C12506 (NCI Thesaurus ObjectClass)
C0040426 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C25201 (NCI Thesaurus Property-2)
C1522640 (UMLS 2011AA Property)
C25649 (NCI Thesaurus Property-3)
C1527428 (UMLS 2011AA Property-2)
C62181 (NCI Thesaurus Property-4)
C2350229 (UMLS 2011AA Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
ToothSensitivityMasticationAssessmentInd-2
Item
During chewing of food
boolean
C12506 (NCI Thesaurus ObjectClass)
C0040426 (UMLS 2011AA ObjectClass)
C25201 (NCI Thesaurus ObjectClass-2)
C1522640 (UMLS 2011AA ObjectClass-2)
C25367 (NCI Thesaurus Property)
C62062 (NCI Thesaurus Property-2)
C0024888 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
ToothSensitivityPressureAssessmentInd-2
Item
During clenching
boolean
C12506 (NCI Thesaurus ObjectClass)
C0040426 (UMLS 2011AA ObjectClass)
C25201 (NCI Thesaurus ObjectClass-2)
C1522640 (UMLS 2011AA ObjectClass-2)
C25367 (NCI Thesaurus Property)
C25195 (NCI Thesaurus Property-2)
C0033095 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
DentalOcclusionEvaluationInd-2
Item
Did you check the occlusion on the treated tooth (If "Yes" to either of the above)
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C25214 (NCI Thesaurus Property)
C0220825 (UMLS 2011AA Property)
C62301 (NCI Thesaurus ObjectClass)
C0011382 (UMLS 2011AA ObjectClass)
DentalOcclusionAdjustmentInd-2
Item
Did you adjust the occlusion (If "Yes")
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C62301 (NCI Thesaurus ObjectClass)
C0011382 (UMLS 2011AA ObjectClass)
C49157 (NCI Thesaurus Property)
C0456081 (UMLS 2011AA Property)
Item Group
Rescue Treatment
RetreatmentAdministeredInd-2
Item
Did the patient receive rescue treatment (since the last visit)
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C54055 (NCI Thesaurus ObjectClass)
C0376495 (UMLS 2011AA ObjectClass)
Item
Which rescue treatment was provided
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C54055 (NCI Thesaurus ObjectClass)
C0376495 (UMLS 2011AA ObjectClass)
CL.14
Code List
Which rescue treatment was provided
CL Item
Dental Bonding Agent Dental Liner (Liner+DBA)
C42795 (NCI Thesaurus)
C1707677 (UMLS 2011AA)
C62092 (NCI Thesaurus-3)
C1880280 (UMLS 2011AA-4)
CL Item
Dental Bonding Agent (DBA alone)
C62092 (NCI Thesaurus)
C1880280 (UMLS 2011AA)
CL Item
Not Applicable (N/A)
C48660 (NCI Thesaurus)
C1272460 (UMLS 2011AA)
RetreatmentAdministeredDate
Item
Date rescue treatment performed
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C54055 (NCI Thesaurus ObjectClass)
C0376495 (UMLS 2011AA ObjectClass)
RetreatmentToothPulpitisAssessmentInd-2
Item
Was the tooth evaluated for pulpitis
boolean
C54055 (NCI Thesaurus ObjectClass)
C0376495 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C12506 (NCI Thesaurus Property-2)
C0040426 (UMLS 2011AA Property)
C52595 (NCI Thesaurus Property-3)
C0034103 (UMLS 2011AA Property-2)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
RetreatmentToothPulpitisPresentInd-2
Item
Was there evidence of pulpitis (If "Yes")
boolean
C54055 (NCI Thesaurus ObjectClass)
C0376495 (UMLS 2011AA ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C12506 (NCI Thesaurus Property-2)
C0040426 (UMLS 2011AA Property-2)
C52595 (NCI Thesaurus Property-3)
C0034103 (UMLS 2011AA Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
RetreatmentEndodonticTreatmentPerformedInd-2
Item
Was endodontic therapy performed (If "Yes")
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C52575 (NCI Thesaurus Property-2)
C0700632 (UMLS 2011AA Property-2)
C54055 (NCI Thesaurus ObjectClass)
C0376495 (UMLS 2011AA ObjectClass)
RetreatmentEndodonticTreatmentPerformedDate
Item
Date of endodontic treatment (If "Yes")
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C52575 (NCI Thesaurus Property-2)
C0700632 (UMLS 2011AA Property-2)
C54055 (NCI Thesaurus ObjectClass)
C0376495 (UMLS 2011AA ObjectClass)
Item Group
Economic Impact
Item
How much time did it take the patient to travel to the dental office today
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C53462 (NCI Thesaurus ObjectClass-2)
C0040802 (UMLS 2011AA ObjectClass-2)
C41136 (NCI Thesaurus Property)
C0226984 (UMLS 2011AA Property)
C25167 (NCI Thesaurus Property-2)
C0012751 (UMLS 2011AA Property-2)
C16988 (NCI Thesaurus Property-3)
C0031834 (UMLS 2011AA Property-3)
C25330 (NCI Thesaurus ValueDomain)
C0449238 (UMLS 2011AA ValueDomain)
CL.18
Code List
How much time did it take the patient to travel to the dental office today
CL Item
0-15 Minutes (0-15 minutes)
CL Item
16-30 Minutes (16-30 minutes)
CL Item
31-60 Minutes (31-60 minutes)
CL Item
61-90 Minutes (61-90 minutes)
CL Item
91-120 Minutes (91-120 minutes)
CL Item
More Than 120 Minutes (More than 120 minutes)
Item
How much did it cost the patient to travel to the dental office today (including parking)
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C53462 (NCI Thesaurus ObjectClass-2)
C0040802 (UMLS 2011AA ObjectClass-2)
C41136 (NCI Thesaurus Property)
C0226984 (UMLS 2011AA Property)
C16988 (NCI Thesaurus Property-2)
C0031834 (UMLS 2011AA Property-2)
C69088 (NCI Thesaurus Property-3)
C0220812 (UMLS 2011AA Property-3)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C69088 (NCI Thesaurus ValueDomain-2)
C0220812 (UMLS 2011AA ValueDomain-2)
CL.19
Code List
How much did it cost the patient to travel to the dental office today (including parking)
CL Item
$0-10 ($0-10)
CL Item
$11-20 ($11-20)
CL Item
$21-30 ($21-30)
CL Item
More Than $30 (More than $30)
PatientEmploymentAbsentInd-2
Item
Did the patient have to take time away from work to come to the dental office to treat the hypersensitivity
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C48190 (NCI Thesaurus Property)
C0332197 (UMLS 2011AA Property)
C25172 (NCI Thesaurus Property-2)
C0014003 (UMLS 2011AA Property-2)
Item
How much time did he/she take off (If "Yes")
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C48190 (NCI Thesaurus Property)
C0332197 (UMLS 2011AA Property)
C25172 (NCI Thesaurus Property-2)
C0014003 (UMLS 2011AA Property-2)
C25330 (NCI Thesaurus ValueDomain)
C0449238 (UMLS 2011AA ValueDomain)
CL.21
Code List
How much time did he/she take off (If "Yes")
CL Item
0-30 Minutes (0-30 minutes)
CL Item
1-2 Hours (1-2 hours)
CL Item
2-3 Hours (2-3 hours)
CL Item
3-4 Hours (3-4 hours)
CL Item
31-60 Minutes (31-60 minutes)
CL Item
More Than 4 Hours (More than 4 hours)
Item
What is the total estimated cost for the rescue treatment if patient was not participating in the study
text
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C54055 (NCI Thesaurus ObjectClass)
C0376495 (UMLS 2011AA ObjectClass)
C69088 (NCI Thesaurus ValueDomain-2)
C0220812 (UMLS 2011AA ValueDomain-2)
CL.22
Code List
What is the total estimated cost for the rescue treatment if patient was not participating in the study
CL Item
$0-50 ($0-50)
CL Item
$101-150 ($101-150)
CL Item
$151-200 ($151-200)
CL Item
$201-250 ($201-250)
CL Item
$51-100 ($51-100)
CL Item
More Than $250 (More than $250)
Item Group
Footer Module
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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