ID

11774

Descripción

ACNS0122 PBSC Harvest Worksheet NCT00047320 Neoadjuvant Chemotherapy With or Without Second-Look Surgery Followed by Radiation Therapy With or Without Peripheral Stem Cell Transplantation in Treating Patients With Intracranial Germ Cell Tumors Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=BD8E5AF7-9FAF-0089-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=BD8E5AF7-9FAF-0089-E034-0003BA12F5E7

Palabras clave

Versiones (4)
  1. 19/4/12 19/4/12 -
  2. 9/1/15 9/1/15 - Martin Dugas
  3. 3/7/15 3/7/15 -
  4. 31/7/15 31/7/15 - Martin Dugas
Subido en

31 de julio de 2015

DOI

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Licencia

Creative Commons BY-NC 3.0 Legacy
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PBSC Harvest Worksheet Germ Cell Tumors ACNS0122 NCT00047320

Alemán Inglés

No Instruction available.

1 formularios  
  1. StudyEvent: ACNS0122 PBSC Harvest Worksheet
    1. No Instruction available.
Header
Descripción

Header

COG Study No
Descripción

Protocol ID COG

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C3274381
NCI Thesaurus ObjectClass
C25320
UMLS CUI-2
C1516477
NCI Thesaurus Property
C25364
Institution Name
Descripción

Institution Name

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C1301943
NCI Thesaurus ObjectClass
C21541
NCI Thesaurus ValueDomain-2
C21541
NCI Thesaurus Property
C25364
COG Patient ID
Descripción

PatientCOGIdentifierNumber

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus Property-2
C39353
UMLS 2011AA Property-2
C1516477
Patient Initials
Descripción

Patient Initials

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
Today's date
Descripción

Form Completion Date

Tipo de datos

date

Alias
NCI Thesaurus ObjectClass
C19464
UMLS CUI-1
C1549507
NCI Thesaurus Property
C25250
NCI Thesaurus Property-2
C25604
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ValueDomain-2
C25367
Date worksheet entered into RDE
Descripción

DataEnteredDate

Tipo de datos

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C25474
UMLS 2011AA ObjectClass
C1511726
NCI Thesaurus Property
C37949
UMLS 2011AA Property
C1521975
Height / Weight
Descripción

Height / Weight

Height
Descripción

Height

Tipo de datos

float

Unidades de medida
  • cm
Alias
NCI Thesaurus ValueDomain
C25209
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25347
UMLS CUI [1]
C0005890
cm
Body weight
Descripción

Body weight

Tipo de datos

float

Unidades de medida
  • kg
Alias
NCI Thesaurus ValueDomain
C25209
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25208
UMLS CUI [1]
C0005910
kg
Peripheral stem cell transplantation
Descripción

Peripheral stem cell transplantation

Alias
UMLS CUI-1
C0242602
Did the patient have PBSC harvest during this reporting period?
Descripción

PBSCHarvestPerformedInd-2

Tipo de datos

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
Date [PBSC harvest]
Descripción

PBSCHarvestPerformedDate

Tipo de datos

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
Description (number of cells collected)
Descripción

PBSCHarvestCellValue

Tipo de datos

float

Alias
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
Was Bone Marrow harvesting performed?
Descripción

BoneMarrowHarvestPerformedInd-2

Tipo de datos

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
date performed (If yes,)
Descripción

BoneMarrowHarvestPerformedDate

Tipo de datos

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
Organ function
Descripción

Organ function

Did the patient have adequate CD34+ cells collected?
Descripción

PeripheralBloodStemCellCD34+CellHarvestPerformedValue

Tipo de datos

boolean

Alias
NCI Thesaurus ObjectClass
C12946
NCI Thesaurus ObjectClass-2
C37963
NCI Metathesaurus ObjectClass
C0882849
NCI Thesaurus Property
C38000
NCI Thesaurus ValueDomain
C25712
UMLS CUI [1]
C2366946
Does the patient have adequate bone marrow function?
Descripción

PatientBoneMarrowFunctionRequiredInd-2

Tipo de datos

boolean

Alias
NCI Thesaurus ValueDomain
C38147
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25518
UMLS CUI [1]
C0427695
Does the patient have adequate renal function?
Descripción

PatientRenalFunctionRequiredInd-2

Tipo de datos

boolean

Alias
NCI Thesaurus ValueDomain
C38147
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25518
UMLS CUI [1]
C0232805
Does the patient have adequate liver function?
Descripción

PatientLiverFunctionRequiredInd-2

Tipo de datos

boolean

Alias
NCI Thesaurus ValueDomain
C38147
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25518
UMLS CUI [1]
C0232741
Does the patient have adequate Central Nervous System function?
Descripción

PatientCNSFunctionRequiredInd-2

Tipo de datos

boolean

Alias
NCI Thesaurus ValueDomain
C38147
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25518
UMLS CUI [1]
C0683212
Comments
Descripción

Comments

Comments
Descripción

Research Comments

Tipo de datos

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 formularios
  1. StudyEvent: ACNS0122 PBSC Harvest Worksheet
    1. No Instruction available.
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
Header
Protocol ID COG
Item
COG Study No
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1516477 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
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)
PatientCOGIdentifierNumber
Item
COG Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C39353 (NCI Thesaurus Property-2)
C1516477 (UMLS 2011AA Property-2)
Patient Initials
Item
Patient Initials
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
Form Completion Date
Item
Today's date
date
C19464 (NCI Thesaurus ObjectClass)
C1549507 (UMLS CUI-1)
C25250 (NCI Thesaurus Property)
C25604 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
DataEnteredDate
Item
Date worksheet entered into RDE
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C37949 (NCI Thesaurus Property)
C1521975 (UMLS 2011AA Property)
Item Group
Height / Weight
Height
Item
Height
float
C25209 (NCI Thesaurus ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C25347 (NCI Thesaurus Property)
C0005890 (UMLS CUI [1])
Weight
Item
Body weight
float
C25209 (NCI Thesaurus ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C25208 (NCI Thesaurus Property)
C0005910 (UMLS CUI [1])
Item Group
Peripheral stem cell transplantation
C0242602 (UMLS CUI-1)
PBSCHarvestPerformedInd-2
Item
Did the patient have PBSC harvest during this reporting period?
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
PBSCHarvestPerformedDate
Item
Date [PBSC harvest]
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
PBSCHarvestCellValue
Item
Description (number of cells collected)
float
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
BoneMarrowHarvestPerformedInd-2
Item
Was Bone Marrow harvesting performed?
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
BoneMarrowHarvestPerformedDate
Item
date performed (If yes,)
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
Item Group
Organ function
CD34 cell count
Item
Did the patient have adequate CD34+ cells collected?
boolean
C12946 (NCI Thesaurus ObjectClass)
C37963 (NCI Thesaurus ObjectClass-2)
C0882849 (NCI Metathesaurus ObjectClass)
C38000 (NCI Thesaurus Property)
C25712 (NCI Thesaurus ValueDomain)
C2366946 (UMLS CUI [1])
Bone marrow function adequate
Item
Does the patient have adequate bone marrow function?
boolean
C38147 (NCI Thesaurus ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C25518 (NCI Thesaurus Property)
C0427695 (UMLS CUI [1])
Renal function normal
Item
Does the patient have adequate renal function?
boolean
C38147 (NCI Thesaurus ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C25518 (NCI Thesaurus Property)
C0232805 (UMLS CUI [1])
Liver function
Item
Does the patient have adequate liver function?
boolean
C38147 (NCI Thesaurus ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C25518 (NCI Thesaurus Property)
C0232741 (UMLS CUI [1])
CNS function
Item
Does the patient have adequate Central Nervous System function?
boolean
C38147 (NCI Thesaurus ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C25518 (NCI Thesaurus Property)
C0683212 (UMLS CUI [1])
Item Group
Comments
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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