ID

11606

Beschrijving

AMC-076 Dysplasia Treatment Form (DYS) NCT01164722 Infrared Coagulator Ablation or Observation in Preventing Anal Cancer in HIV-Positive Patients With Anal Neoplasia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A8216D81-B789-F026-E040-BB89AD436DD3

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A8216D81-B789-F026-E040-BB89AD436DD3

Trefwoorden

Versies (3)
  1. 26-08-12 26-08-12 -
  2. 08-07-15 08-07-15 -
  3. 08-07-15 08-07-15 -
Geüploaded op

8 juli 2015

DOI

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Licentie

Creative Commons BY-NC 3.0 Legacy
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AMC-076 Dysplasia Treatment Form (DYS) NCT01164722

Engels

No Instruction available.

1 Formulieren  
  1. StudyEvent: AMC-076 Dysplasia Treatment Form (DYS)
    1. No Instruction available.
Header Module
Beschrijving

Header Module

Visit number
Beschrijving

Number of visits

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25337
NCI Thesaurus ObjectClass
C16696
NCI Thesaurus Property
C25385
UMLS CUI-1
C0008952
Dysplasia Treatment
Beschrijving

Dysplasia Treatment

Was dysplasia present
Beschrijving

Patient with dysplasia

Datatype

boolean

Alias
NCI Thesaurus ValueDomain
C38148
NCI Thesaurus Property
C25626
NCI Thesaurus ObjectClass
C4086
UMLS CUI-1
C0334044
Treatment date (If Yes, mm/dd/yyyy)
Beschrijving

Treatment date (If Yes, mm/dd/yyyy)

Datatype

date

Alias
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus Property
C38000
NCI Thesaurus Property-2
C49236
NCI Thesaurus ObjectClass
C4086
UMLS CUI-1
C3173309
Treatment location (If Yes,)
Beschrijving

Treatment location (If Yes,)

Datatype

text

Alias
NCI Thesaurus ValueDomain
C13717
NCI Thesaurus Property
C25341
NCI Thesaurus Property-2
C25251
NCI Thesaurus ObjectClass
C7379
UMLS CUI-1
C1304837
Perianal lesions treated (If perianal, Check all that apply)
Beschrijving

Perianal lesions treated (If perianal, Check all that apply)

Datatype

text

Alias
NCI Thesaurus ObjectClass
C4086
NCI Thesaurus Property
C38000
NCI Thesaurus Property-2
C49236
NCI Thesaurus Property-3
C43362
NCI Thesaurus Property-4
C44280
NCI Thesaurus ValueDomain
C25284
UMLS CUI-1
C0747465
Other, specify
Beschrijving

Other, specify

Datatype

text

Alias
NCI Thesaurus ObjectClass
C2991
NCI Thesaurus ObjectClass-2
C28048
NCI Thesaurus Property
C25626
NCI Thesaurus Property-2
C4876
NCI Thesaurus ValueDomain
C25685
UMLS CUI-1
C1457887
UMLS CUI-2
C1521902
Intraanal lesions treated (If intraanal, Check all that apply)
Beschrijving

Intraanal lesions treated (If intraanal, Check all that apply)

Datatype

text

Alias
NCI Thesaurus ObjectClass
C4086
NCI Thesaurus Property
C38000
NCI Thesaurus Property-2
C49236
NCI Thesaurus Property-3
C43362
NCI Thesaurus Property-4
C25234
NCI Thesaurus ValueDomain
C25284
UMLS CUI-1
C0334044
UMLS CUI-2
C0884358
UMLS CUI-3
C0087111
Treatment method performed
Beschrijving

Treatment method performed

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25284
NCI Thesaurus Property
C38000
NCI Thesaurus Property-2
C49236
NCI Thesaurus ObjectClass
C4086
UMLS CUI-1
C0087111
UMLS CUI-2
C0334044
Percentage of perianal or intraanal area treated
Beschrijving

Percentage of perianal or intraanal area treated

Datatype

text

Alias
NCI Thesaurus ObjectClass
C4086
NCI Thesaurus Property
C38000
NCI Thesaurus Property-2
C49236
NCI Thesaurus Property-3
C25613
NCI Thesaurus Property-4
C2877
NCI Thesaurus ValueDomain
C25284
UMLS CUI-1
C0087111
UMLS CUI-2
C0439165
UMLS CUI-3
C0347129
Comments
Beschrijving

Comments

Comments
Beschrijving

Comments

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25704
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
UMLS CUI-1
C0282411
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Similar models

No Instruction available.

1 Formulieren
  1. StudyEvent: AMC-076 Dysplasia Treatment Form (DYS)
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Header Module
Hospital Admission Ordinal Number
Item
Visit number
text
C25337 (NCI Thesaurus ValueDomain)
C16696 (NCI Thesaurus ObjectClass)
C25385 (NCI Thesaurus Property)
C0008952 (UMLS CUI-1)
Item Group
Dysplasia Treatment
Dysplasia PresentInd-3
Item
Was dysplasia present
boolean
C38148 (NCI Thesaurus ValueDomain)
C25626 (NCI Thesaurus Property)
C4086 (NCI Thesaurus ObjectClass)
C0334044 (UMLS CUI-1)
Treatment date
Item
Treatment date (If Yes, mm/dd/yyyy)
date
C25164 (NCI Thesaurus ValueDomain)
C38000 (NCI Thesaurus Property)
C49236 (NCI Thesaurus Property-2)
C4086 (NCI Thesaurus ObjectClass)
C3173309 (UMLS CUI-1)
Item
Treatment location (If Yes,)
text
C13717 (NCI Thesaurus ValueDomain)
C25341 (NCI Thesaurus Property)
C25251 (NCI Thesaurus Property-2)
C7379 (NCI Thesaurus ObjectClass)
C1304837 (UMLS CUI-1)
CL.3
Code List
Treatment location (If Yes,)
CL Item
The Perianal Region (Perianal)
CL Item
The Intraanal Region (Intraanal)
Item
Perianal lesions treated (If perianal, Check all that apply)
text
C4086 (NCI Thesaurus ObjectClass)
C38000 (NCI Thesaurus Property)
C49236 (NCI Thesaurus Property-2)
C43362 (NCI Thesaurus Property-3)
C44280 (NCI Thesaurus Property-4)
C25284 (NCI Thesaurus ValueDomain)
C0747465 (UMLS CUI-1)
CL.4
Code List
Perianal lesions treated (If perianal, Check all that apply)
CL Item
High-grade Ain (High-grade AIN)
C1274831 (UMLS CUI-1)
CL Item
Condyloma (Condyloma)
C0302180 (UMLS CUI-1)
CL Item
Low-grade Ain (Low-grade AIN)
C1303266 (UMLS CUI-1)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS CUI-1)
Anal Disease Symptom Present Specify
Item
Other, specify
text
C2991 (NCI Thesaurus ObjectClass)
C28048 (NCI Thesaurus ObjectClass-2)
C25626 (NCI Thesaurus Property)
C4876 (NCI Thesaurus Property-2)
C25685 (NCI Thesaurus ValueDomain)
C1457887 (UMLS CUI-1)
C1521902 (UMLS CUI-2)
Item
Intraanal lesions treated (If intraanal, Check all that apply)
text
C4086 (NCI Thesaurus ObjectClass)
C38000 (NCI Thesaurus Property)
C49236 (NCI Thesaurus Property-2)
C43362 (NCI Thesaurus Property-3)
C25234 (NCI Thesaurus Property-4)
C25284 (NCI Thesaurus ValueDomain)
C0334044 (UMLS CUI-1)
C0884358 (UMLS CUI-2)
C0087111 (UMLS CUI-3)
CL.5
Code List
Intraanal lesions treated (If intraanal, Check all that apply)
CL Item
Condyloma (Condyloma)
C0302180 (UMLS CUI-1)
CL Item
Low-grade Flat Anal Intraepithelial Neoplasia (Low-grade flat AIN)
C1334412 (UMLS CUI-1)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS CUI-1)
Item
Treatment method performed
text
C25284 (NCI Thesaurus ValueDomain)
C38000 (NCI Thesaurus Property)
C49236 (NCI Thesaurus Property-2)
C4086 (NCI Thesaurus ObjectClass)
C0087111 (UMLS CUI-1)
C0334044 (UMLS CUI-2)
CL.6
Code List
Treatment method performed
CL Item
Cauterization (Cautery)
C15199 (NCI Thesaurus)
C0007471 (UMLS 2011AA)
CL Item
Laser (Laser)
C16782 (NCI Thesaurus)
C0023089 (UMLS 2011AA)
CL Item
Infrared Photocoagulation Therapy (IRC)
C62730 (NCI Thesaurus)
C1328010 (UMLS 2011AA)
CL Item
Excision (Excision)
C15232 (NCI Thesaurus)
C0728940 (UMLS 2011AA)
CL Item
Cryotherapy (Cryotherapy)
C40030 (NCI Thesaurus)
C0010412 (UMLS 2011AA)
Item
Percentage of perianal or intraanal area treated
text
C4086 (NCI Thesaurus ObjectClass)
C38000 (NCI Thesaurus Property)
C49236 (NCI Thesaurus Property-2)
C25613 (NCI Thesaurus Property-3)
C2877 (NCI Thesaurus Property-4)
C25284 (NCI Thesaurus ValueDomain)
C0087111 (UMLS CUI-1)
C0439165 (UMLS CUI-2)
C0347129 (UMLS CUI-3)
CL.7
Code List
Percentage of perianal or intraanal area treated
CL Item
6-25% (6-25%)
CL Item
26-50% (26-50%)
CL Item
> 50% (> 50%)
CL Item
5% (<)
Item Group
Comments
ResearchCommentsText
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0282411 (UMLS CUI-1)
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