ID

11421

Beschreibung

BRIEF PAIN INVENTORY (SHORT FORM) NCT00075686 S0205 Gemcitabine With or Without Cetuximab as First-Line Therapy in Treating Patients With Locally Advanced Unresectable or Metastatic Adenocarcinoma of the Pancreas Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A66323E9-44F6-48CB-E034-0003BA0B1A09

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A66323E9-44F6-48CB-E034-0003BA0B1A09

Stichworte

Versionen (3)
  1. 19.09.12 19.09.12 -
  2. 09.01.15 09.01.15 - Martin Dugas
  3. 03.07.15 03.07.15 -
Hochgeladen am

3. Juli 2015

DOI

Für eine Beantragung loggen Sie sich ein.

Lizenz

Creative Commons BY-NC 3.0 Legacy
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BRIEF PAIN INVENTORY (SHORT FORM) NCT00075686

Englisch

No Instruction available.

1 Formulare  
  1. StudyEvent: BRIEF PAIN INVENTORY (SHORT FORM)
    1. No Instruction available.
SWOG clinical trial administrative data
Beschreibung

SWOG clinical trial administrative data

SWOG Patient ID
Beschreibung

SWOGPatientID

Datentyp

text

SWOG Study No.
Beschreibung

SWOGStudyNo.

Datentyp

text

Registration Step
Beschreibung

RegistrationStep

Datentyp

text

Planned Assessment
Beschreibung

PlannedAssessment

Datentyp

text

Patient Initials (L, F M)
Beschreibung

Patient Initials

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
Date of Completion
Beschreibung

FormCompletionDate,Original

Datentyp

date

Institution
Beschreibung

InstitutionName

Datentyp

text

Affiliate
Beschreibung

AffiliateName

Datentyp

text

Physician (1.)
Beschreibung

RegisteredInvestigator

Datentyp

text

Quality of life assessment
Beschreibung

Quality of life assessment

Throughout our lives, most of us have had pain from time to time (such as minor headaches, sprains, and toothaches). Have you had pain other than these everyday kinds of pain today? (2.)
Beschreibung

QualityofLifeUnusualPainAssessmentInd-2

Datentyp

boolean

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus Property
C3303
UMLS 2011AA Property
C0030193
NCI Thesaurus Property-2
C25217
UMLS 2011AA Property-2
C1516048
NCI Thesaurus Property-3
C77967
UMLS 2011AA Property-3
C2700116
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Please rate your pain by selecting the one number that best describes your pain at its WORST in the past 24 hours. (3.)
Beschreibung

PatientWorstPainScale

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C3303
UMLS 2011AA Property
C0030193
NCI Thesaurus Property-2
C25719
UMLS 2011AA Property-2
C1522166
Please rate your pain by selecting the one number that best describes your pain at its LEAST in the past 24 hours. (4.)
Beschreibung

PatientLeastPainScale

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C3303
UMLS 2011AA Property
C0030193
NCI Thesaurus Property-2
C61422
UMLS 2011AA Property-2
C0547044
Please rate your pain by selecting the one number that best describes your pain on the AVERAGE. (5.)
Beschreibung

PatientAveragePainScale

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C3303
UMLS 2011AA Property
C0030193
NCI Thesaurus Property-2
C37917
UMLS 2011AA Property-2
C1510992
Please rate your pain by selecting the one number that tells how much pain you have RIGHT NOW. (6.)
Beschreibung

PatientCurrentPainScale

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25471
UMLS 2011AA Property
C0521116
NCI Thesaurus Property-2
C3303
UMLS 2011AA Property-2
C0030193
Are you receiving treatments or medications for your pain? (7.)
Beschreibung

PainMedicationCurrentAdministrationInd-2

Datentyp

boolean

Alias
NCI Thesaurus ObjectClass
C3303
UMLS 2011AA ObjectClass
C0030193
NCI Thesaurus ObjectClass-2
C459
UMLS 2011AA ObjectClass-2
C0013227
NCI Thesaurus Property
C25471
UMLS 2011AA Property
C0521116
NCI Thesaurus Property-2
C25409
UMLS 2011AA Property-2
C1533734
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
In the past 24 hours, how much RELIEF have pain treatments or medications provided? (Please select the percentage that shows how much.)
Beschreibung

Inthepast24hours,howmuchRELIEFhavepaintreatmentsormedicationsprovided?

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
General Activity (9.)
Beschreibung

GeneralizedActivitiesofDailyLivingPainRestrictedScale

Datentyp

text

Alias
NCI Metathesaurus ObjectClass
C0001288
NCI Thesaurus ObjectClass
C63764
UMLS 2011AA ObjectClass
C0205246
NCI Thesaurus Property
C3303
UMLS 2011AA Property
C0030193
NCI Metathesaurus Property
CL212559
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Mood (10.)
Beschreibung

Mood

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Walking ability (11.)
Beschreibung

Walkingability

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Normal work (includes both work outside the home and housework)
Beschreibung

NormalWorkPainRestrictedScale

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C14165
UMLS 2011AA ObjectClass
C0205307
NCI Metathesaurus ObjectClass
C0043227
NCI Thesaurus Property
C3303
UMLS 2011AA Property
C0030193
NCI Metathesaurus Property
CL212559
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Relations with other people (13.)
Beschreibung

PatientInterpersonalInteractionPainRestrictedScale

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Metathesaurus ObjectClass
C0021797
NCI Thesaurus Property
C3303
UMLS 2011AA Property
C0030193
NCI Metathesaurus Property
CL212559
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Sleep (14.)
Beschreibung

PatientSleepPainRestrictedScale

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Metathesaurus ObjectClass
C0037313
NCI Thesaurus Property
C3303
UMLS 2011AA Property
C0030193
NCI Metathesaurus Property
CL212559
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Enjoyment of life
Beschreibung

PatientEnjoymentofLifePainRestrictedScale

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Metathesaurus ObjectClass
CL196329
NCI Thesaurus Property
C3303
UMLS 2011AA Property
C0030193
NCI Metathesaurus Property
CL212559
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
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Ähnliche Modelle

No Instruction available.

1 Formulare
  1. StudyEvent: BRIEF PAIN INVENTORY (SHORT FORM)
    1. No Instruction available.
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
SWOG clinical trial administrative data
SWOGPatientID
Item
SWOG Patient ID
text
SWOGStudyNo.
Item
SWOG Study No.
text
RegistrationStep
Item
Registration Step
text
Item
Planned Assessment
text
CL.1
Code List
Planned Assessment
CL Item
Prestudy (Prestudy)
CL Item
Week 5 (Week 5)
CL Item
Week 9 (Week 9)
CL Item
Week 13 (Week 13)
CL Item
Week 17 (Week 17)
Patient Initials
Item
Patient Initials (L, F M)
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
FormCompletionDate,Original
Item
Date of Completion
date
InstitutionName
Item
Institution
text
AffiliateName
Item
Affiliate
text
RegisteredInvestigator
Item
Physician (1.)
text
Item Group
Quality of life assessment
QualityofLifeUnusualPainAssessmentInd-2
Item
Throughout our lives, most of us have had pain from time to time (such as minor headaches, sprains, and toothaches). Have you had pain other than these everyday kinds of pain today? (2.)
boolean
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C3303 (NCI Thesaurus Property)
C0030193 (UMLS 2011AA Property)
C25217 (NCI Thesaurus Property-2)
C1516048 (UMLS 2011AA Property-2)
C77967 (NCI Thesaurus Property-3)
C2700116 (UMLS 2011AA Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
Item
Please rate your pain by selecting the one number that best describes your pain at its WORST in the past 24 hours. (3.)
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C3303 (NCI Thesaurus Property)
C0030193 (UMLS 2011AA Property)
C25719 (NCI Thesaurus Property-2)
C1522166 (UMLS 2011AA Property-2)
CL.3
Code List
Please rate your pain by selecting the one number that best describes your pain at its WORST in the past 24 hours. (3.)
CL Item
Whole Number (0)
CL Item
Whole Number (1)
CL Item
Whole Number (2)
CL Item
Whole Number (3)
CL Item
Whole Number (4)
CL Item
Whole Number (5)
CL Item
Whole Number (6)
CL Item
Whole Number (7)
CL Item
Whole Number (8)
CL Item
Whole Number (9)
CL Item
Whole Number (10)
Item
Please rate your pain by selecting the one number that best describes your pain at its LEAST in the past 24 hours. (4.)
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C3303 (NCI Thesaurus Property)
C0030193 (UMLS 2011AA Property)
C61422 (NCI Thesaurus Property-2)
C0547044 (UMLS 2011AA Property-2)
CL.4
Code List
Please rate your pain by selecting the one number that best describes your pain at its LEAST in the past 24 hours. (4.)
CL Item
Whole Number (0)
CL Item
Whole Number (1)
CL Item
Whole Number (2)
CL Item
Whole Number (3)
CL Item
Whole Number (4)
CL Item
Whole Number (5)
CL Item
Whole Number (6)
CL Item
Whole Number (7)
CL Item
Whole Number (8)
CL Item
Whole Number (9)
CL Item
Whole Number (10)
Item
Please rate your pain by selecting the one number that best describes your pain on the AVERAGE. (5.)
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C3303 (NCI Thesaurus Property)
C0030193 (UMLS 2011AA Property)
C37917 (NCI Thesaurus Property-2)
C1510992 (UMLS 2011AA Property-2)
CL.5
Code List
Please rate your pain by selecting the one number that best describes your pain on the AVERAGE. (5.)
CL Item
Whole Number (0)
CL Item
Whole Number (1)
CL Item
Whole Number (2)
CL Item
Whole Number (3)
CL Item
Whole Number (4)
CL Item
Whole Number (5)
CL Item
Whole Number (6)
CL Item
Whole Number (7)
CL Item
Whole Number (8)
CL Item
Whole Number (9)
CL Item
Whole Number (10)
Item
Please rate your pain by selecting the one number that tells how much pain you have RIGHT NOW. (6.)
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25471 (NCI Thesaurus Property)
C0521116 (UMLS 2011AA Property)
C3303 (NCI Thesaurus Property-2)
C0030193 (UMLS 2011AA Property-2)
CL.6
Code List
Please rate your pain by selecting the one number that tells how much pain you have RIGHT NOW. (6.)
CL Item
Whole Number (0)
CL Item
Whole Number (1)
CL Item
Whole Number (2)
CL Item
Whole Number (3)
CL Item
Whole Number (4)
CL Item
Whole Number (5)
CL Item
Whole Number (6)
CL Item
Whole Number (7)
CL Item
Whole Number (8)
CL Item
Whole Number (9)
CL Item
Whole Number (10)
PainMedicationCurrentAdministrationInd-2
Item
Are you receiving treatments or medications for your pain? (7.)
boolean
C3303 (NCI Thesaurus ObjectClass)
C0030193 (UMLS 2011AA ObjectClass)
C459 (NCI Thesaurus ObjectClass-2)
C0013227 (UMLS 2011AA ObjectClass-2)
C25471 (NCI Thesaurus Property)
C0521116 (UMLS 2011AA Property)
C25409 (NCI Thesaurus Property-2)
C1533734 (UMLS 2011AA Property-2)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
Item
In the past 24 hours, how much RELIEF have pain treatments or medications provided? (Please select the percentage that shows how much.)
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.8
Code List
In the past 24 hours, how much RELIEF have pain treatments or medications provided? (Please select the percentage that shows how much.)
CL Item
0% (0%)
CL Item
10% (10%)
CL Item
20% (20%)
CL Item
30% (30%)
CL Item
40% (40%)
CL Item
50% (50%)
CL Item
60% (60%)
CL Item
70% (70%)
CL Item
80% (80%)
CL Item
90% (90%)
CL Item
100% (100%)
Item
General Activity (9.)
text
C0001288 (NCI Metathesaurus ObjectClass)
C63764 (NCI Thesaurus ObjectClass)
C0205246 (UMLS 2011AA ObjectClass)
C3303 (NCI Thesaurus Property)
C0030193 (UMLS 2011AA Property)
CL212559 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.9
Code List
General Activity (9.)
CL Item
Whole Number (0)
C0919414 (NCI Metathesaurus)
CL Item
Whole Number (1)
CL Item
Whole Number (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
Whole Number (3)
CL Item
Whole Number (4)
CL Item
Whole Number (5)
CL Item
Whole Number (6)
CL Item
Whole Number (7)
CL Item
Whole Number (8)
CL Item
Whole Number (9)
CL Item
Whole Number (10)
Item
Mood (10.)
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.10
Code List
Mood (10.)
CL Item
Whole Number (0)
CL Item
Whole Number (1)
CL Item
Whole Number (2)
CL Item
Whole Number (3)
CL Item
Whole Number (4)
CL Item
Whole Number (5)
CL Item
Whole Number (6)
CL Item
Whole Number (7)
CL Item
Whole Number (8)
CL Item
Whole Number (9)
CL Item
Whole Number (10)
Item
Walking ability (11.)
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.11
Code List
Walking ability (11.)
CL Item
Whole Number (0)
CL Item
Whole Number (1)
CL Item
Whole Number (2)
CL Item
Whole Number (3)
CL Item
Whole Number (4)
CL Item
Whole Number (5)
CL Item
Whole Number (6)
CL Item
Whole Number (7)
CL Item
Whole Number (8)
CL Item
Whole Number (9)
CL Item
Whole Number (10)
Item
Normal work (includes both work outside the home and housework)
text
C14165 (NCI Thesaurus ObjectClass)
C0205307 (UMLS 2011AA ObjectClass)
C0043227 (NCI Metathesaurus ObjectClass)
C3303 (NCI Thesaurus Property)
C0030193 (UMLS 2011AA Property)
CL212559 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.12
Code List
Normal work (includes both work outside the home and housework)
CL Item
Whole Number (0)
C0919414 (NCI Metathesaurus)
CL Item
Whole Number (1)
CL Item
Whole Number (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
Whole Number (3)
CL Item
Whole Number (4)
CL Item
Whole Number (5)
CL Item
Whole Number (6)
CL Item
Whole Number (7)
CL Item
Whole Number (8)
CL Item
Whole Number (9)
CL Item
Whole Number (10)
Item
Relations with other people (13.)
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C0021797 (NCI Metathesaurus ObjectClass)
C3303 (NCI Thesaurus Property)
C0030193 (UMLS 2011AA Property)
CL212559 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.13
Code List
Relations with other people (13.)
CL Item
Whole Number (0)
C0919414 (NCI Metathesaurus)
CL Item
Whole Number (1)
CL Item
Whole Number (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
Whole Number (3)
CL Item
Whole Number (4)
CL Item
Whole Number (5)
CL Item
Whole Number (6)
CL Item
Whole Number (7)
CL Item
Whole Number (8)
CL Item
Whole Number (9)
CL Item
Whole Number (10)
Item
Sleep (14.)
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C0037313 (NCI Metathesaurus ObjectClass)
C3303 (NCI Thesaurus Property)
C0030193 (UMLS 2011AA Property)
CL212559 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.14
Code List
Sleep (14.)
CL Item
Whole Number (0)
C0919414 (NCI Metathesaurus)
CL Item
Whole Number (1)
CL Item
Whole Number (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
Whole Number (3)
CL Item
Whole Number (4)
CL Item
Whole Number (5)
CL Item
Whole Number (6)
CL Item
Whole Number (7)
CL Item
Whole Number (8)
CL Item
Whole Number (9)
CL Item
Whole Number (10)
Item
Enjoyment of life
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
CL196329 (NCI Metathesaurus ObjectClass)
C3303 (NCI Thesaurus Property)
C0030193 (UMLS 2011AA Property)
CL212559 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.15
Code List
Enjoyment of life
CL Item
Whole Number (0)
C0919414 (NCI Metathesaurus)
CL Item
Whole Number (1)
CL Item
Whole Number (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
Whole Number (3)
CL Item
Whole Number (4)
CL Item
Whole Number (5)
CL Item
Whole Number (6)
CL Item
Whole Number (7)
CL Item
Whole Number (8)
CL Item
Whole Number (9)
CL Item
Whole Number (10)
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