0 Bewertungen

ID

11499

Beschreibung

NCT00087178 NSABP PROTOCOL B-36 Form CFMD Missing Data Form for One-Year Cardiac Function Assessment Comparison of Two Combination Chemotherapy Regimens in Treating Women With Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=F4191978-F435-325C-E034-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=F4191978-F435-325C-E034-0003BA3F9857

Stichworte

  1. 26.08.12 26.08.12 -
  2. 09.01.15 09.01.15 - Martin Dugas
  3. 05.07.15 05.07.15 -
Hochgeladen am

5. Juli 2015

DOI

Für eine Beantragung loggen Sie sich ein.

Lizenz

Creative Commons BY-NC 3.0 Legacy

Modell Kommentare :

Hier können Sie das Modell kommentieren. Über die Sprechblasen an den Itemgruppen und Items können Sie diese spezifisch kommentieren.

Itemgroup Kommentare für :

Item Kommentare für :


    Keine Kommentare

    Um Formulare herunterzuladen müssen Sie angemeldet sein. Bitte loggen Sie sich ein oder registrieren Sie sich kostenlos.

    NCT00087178 NSABP PROTOCOL B-36 Form CFMD Missing Data Form for One-Year Cardiac Function Assessment

    Submit this form to the NSABP Biostatistical Center whenever a one-year cardiac function assessment (LVEF) is not obtained. No missing data form is required for patients who have died or had a documented breast cancer or a second primary cancer during the first year on study. Fax to 412-622-2111

    Header module
    Beschreibung

    Header module

    Patient Initials (Last, First Middle)
    Beschreibung

    Patient Initials

    Datentyp

    text

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

    Patient ID NSABP

    Datentyp

    text

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

    Institution Name

    Datentyp

    text

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

    Affiliate Name

    Datentyp

    text

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

    Person Completing Form Last Name

    Datentyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C25190
    UMLS CUI-1
    C1550483
    NCI Thesaurus ObjectClass-2
    C25657
    UMLS CUI-2
    C1301584
    NCI Thesaurus Property
    C25364
    NCI Thesaurus Property-2
    C25551
    NCI Thesaurus ValueDomain
    C25191
    Person Completing Form (First Name)
    Beschreibung

    Person Completing Form First Name

    Datentyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C25190
    UMLS CUI-1
    C1550483
    NCI Thesaurus ObjectClass-2
    C25657
    UMLS CUI-2
    C1443235
    NCI Thesaurus Property
    C25364
    NCI Thesaurus Property-2
    C25509
    NCI Thesaurus ValueDomain
    C25191
    Person Completing Form (Phone)
    Beschreibung

    Person Completing Form Phone

    Datentyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C1550483
    NCI Thesaurus ObjectClass
    C25190
    UMLS CUI-2
    C1515258
    NCI Thesaurus ObjectClass-2
    C25657
    NCI Thesaurus Property
    C25395
    Today's date (Month Day Year)
    Beschreibung

    Today'sDate

    Datentyp

    text

    Are data amended?
    Beschreibung

    Data amended

    Datentyp

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS CUI-1
    C0680532
    NCI Thesaurus ObjectClass
    C25474
    NCI Thesaurus Property
    C25416
    Cardiac Performance Status
    Beschreibung

    Cardiac Performance Status

    Reason Cardiac Function was not Assessed (Mark the main reason. If necessary, add comments below.)
    Beschreibung

    CardiacPerformanceStatusAssessmentNotPerformedReason

    Datentyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C13306
    UMLS 2011AA ObjectClass
    C1522601
    NCI Metathesaurus ObjectClass
    CL092952
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus ValueDomain
    C25638
    UMLS 2011AA ValueDomain
    C0392360
    NCI Metathesaurus ValueDomain
    CL213997
    Comments
    Beschreibung

    Comments

    Comments (optional)
    Beschreibung

    Research Comments

    Datentyp

    text

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

    Ähnliche Modelle

    Submit this form to the NSABP Biostatistical Center whenever a one-year cardiac function assessment (LVEF) is not obtained. No missing data form is required for patients who have died or had a documented breast cancer or a second primary cancer during the first year on study. Fax to 412-622-2111

    Name
    Typ
    Description | Question | Decode (Coded Value)
    Datentyp
    Alias
    Item Group
    Header module
    Patient Initials
    Item
    Patient Initials (Last, First Middle)
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2986440 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25536 (NCI Thesaurus Property)
    Patient ID NSABP
    Item
    Patient ID Number
    text
    C25337 (NCI Thesaurus ValueDomain)
    C2348585 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C1513905 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C15818 (NCI Thesaurus Property-2)
    Institution Name
    Item
    Institution Name
    text
    C25191 (NCI Thesaurus ValueDomain)
    C1301943 (UMLS CUI-1)
    C21541 (NCI Thesaurus ObjectClass)
    C21541 (NCI Thesaurus ValueDomain-2)
    C25364 (NCI Thesaurus Property)
    Affiliate Name
    Item
    Affiliate Name
    text
    C21541 (NCI Thesaurus ObjectClass)
    C1510825 (UMLS CUI-1)
    C25413 (NCI Thesaurus ObjectClass-2)
    C25364 (NCI Thesaurus Property)
    C25191 (NCI Thesaurus ValueDomain)
    C21541 (NCI Thesaurus ValueDomain-2)
    Person Completing Form Last Name
    Item
    Person Completing Form (Last Name)
    text
    C25190 (NCI Thesaurus ObjectClass)
    C1550483 (UMLS CUI-1)
    C25657 (NCI Thesaurus ObjectClass-2)
    C1301584 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25551 (NCI Thesaurus Property-2)
    C25191 (NCI Thesaurus ValueDomain)
    Person Completing Form First Name
    Item
    Person Completing Form (First Name)
    text
    C25190 (NCI Thesaurus ObjectClass)
    C1550483 (UMLS CUI-1)
    C25657 (NCI Thesaurus ObjectClass-2)
    C1443235 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25509 (NCI Thesaurus Property-2)
    C25191 (NCI Thesaurus ValueDomain)
    Person Completing Form Phone
    Item
    Person Completing Form (Phone)
    text
    C25337 (NCI Thesaurus ValueDomain)
    C1550483 (UMLS CUI-1)
    C25190 (NCI Thesaurus ObjectClass)
    C1515258 (UMLS CUI-2)
    C25657 (NCI Thesaurus ObjectClass-2)
    C25395 (NCI Thesaurus Property)
    Today'sDate
    Item
    Today's date (Month Day Year)
    text
    Data amended
    Item
    Are data amended?
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C0680532 (UMLS CUI-1)
    C25474 (NCI Thesaurus ObjectClass)
    C25416 (NCI Thesaurus Property)
    Item Group
    Cardiac Performance Status
    Item
    Reason Cardiac Function was not Assessed (Mark the main reason. If necessary, add comments below.)
    text
    C13306 (NCI Thesaurus ObjectClass)
    C1522601 (UMLS 2011AA ObjectClass)
    CL092952 (NCI Metathesaurus ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C25638 (NCI Thesaurus ValueDomain)
    C0392360 (UMLS 2011AA ValueDomain)
    CL213997 (NCI Metathesaurus ValueDomain)
    Code List
    Reason Cardiac Function was not Assessed (Mark the main reason. If necessary, add comments below.)
    CL Item
    Patient Refused Assessment Or Was Unavailable Because Of Illness Or Emotional Upset (Patient refused assessment or was unavailable because of illness or emotional upset)
    CL Item
    Patient Refused Assessment Or Was Unavailable For A Reason Other Than Illness Or Upset (Patient refused assessment or was unavailable for a reason other than illness or upset)
    CL Item
    Staff Concerned For Patient's Medical Or Emotional Condition (Staff concerned for patient's medical or emotional condition)
    CL Item
    Staff Oversight Or Understaffing (Staff oversight or understaffing)
    Item Group
    Comments
    Research Comments
    Item
    Comments (optional)
    text
    C25704 (NCI Thesaurus ValueDomain)
    C0947611 (UMLS CUI-1)
    C15319 (NCI Thesaurus ObjectClass)
    C25393 (NCI Thesaurus Property)

    Benötigen Sie Hilfe bei der Suche? Um mehr Details zu erfahren und die Suche effektiver nutzen zu können schauen Sie sich doch das entsprechende Video auf unserer Tutorial Seite an.

    Zum Video