ID

11844

Beschreibung

BIG 2-06 / NCCTG N063D / EGF106708 - Week 25 ALTTO (Adjuvant Lapatinib And/Or Trastuzumab Treatment Optimisation) Study; BIG 2-06/N063D Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=32A4CF7B-C387-422A-E044-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=32A4CF7B-C387-422A-E044-0003BA3F9857

Stichworte

Versionen (4)
  1. 19.09.12 19.09.12 -
  2. 08.08.14 08.08.14 - Martin Dugas
  3. 09.01.15 09.01.15 - Martin Dugas
  4. 07.08.15 07.08.15 - Martin Dugas
Hochgeladen am

7. August 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.

Zurück zu Modell Kommentaren
Itemgroup Kommentare für :

Item Kommentare für :

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

On-Study Form Week 25 Breast Cancer ALTTO BIG 2-06 NCCTG N063D EGF106708 DRKS00003651 NCT00490139

Englisch

No Instruction available.

1 Formulare  
  1. StudyEvent: BIG 2-06 / NCCTG N063D / EGF106708 - Week 25
    1. No Instruction available.
Header Module
Beschreibung

Header Module

Centre No.
Beschreibung

Institution Number

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C1301943
NCI Thesaurus ObjectClass
C21541
UMLS CUI-2
C0805701
NCI Thesaurus Property
C25364
Subject No.
Beschreibung

Patient Study ID

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25462
NCI Thesaurus Property-2
C25364
Patient Status
Beschreibung

Patient Status

Alias
UMLS CUI-1
C0449437
Physical Examination Date
Beschreibung

Physical Examination Date

Datentyp

date

Alias
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C20989
UMLS CUI [1]
C2826643
Not done
Beschreibung

AssessmentMethodText

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C16847
UMLS 2011AA Property
C0449851
Are there any changes since the previous assessment
Beschreibung

PatientModifiedAssessmentInd-2

Datentyp

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C25573
Are there any changes since the previous assessment
Beschreibung

PatientModifiedAssessmentType

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C25573
Date of Last Contact
Beschreibung

LastContactDate

Datentyp

date

Alias
NCI Thesaurus Property
C25164
UMLS 2011AA Property
C0011008
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C47954
UMLS 2011AA ObjectClass
C1705415
NCI Thesaurus ObjectClass-2
C25551
UMLS 2011AA ObjectClass-2
C1517741
Body weight
Beschreibung

Body weight

Datentyp

float

Maßeinheiten
  • kg
Alias
NCI Thesaurus ValueDomain
C25209
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25208
UMLS CUI [1]
C0005910
kg
ECOG Performance Status
Beschreibung

ECOG Performance Status

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS CUI-1
C1520224
NCI Thesaurus Property
C25367
NCI Thesaurus ValueDomain-2
C25491
NCI Thesaurus ObjectClass
C20641
Systolic
Beschreibung

Systolic

Datentyp

integer

Maßeinheiten
  • mmHg
Alias
NCI Thesaurus ValueDomain
C25209
NCI Thesaurus Property
C25214
NCI Thesaurus ObjectClass
C25298
UMLS CUI [1]
C0871470
mmHg
Diastolic
Beschreibung

Diastolic

Datentyp

integer

Maßeinheiten
  • mmHg
Alias
NCI Thesaurus ValueDomain
C25209
NCI Thesaurus Property
C25214
NCI Thesaurus ObjectClass
C25299
UMLS CUI [1]
C0428883
mmHg
Cardiac Monitoring
Beschreibung

Cardiac Monitoring

Date of LVEF
Beschreibung

HeartLVEFTestDate

Datentyp

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C12727
UMLS 2011AA ObjectClass
C0018787
NCI Thesaurus Property
C25294
UMLS 2011AA Property
C0022885
NCI Thesaurus Property-2
C37946
UMLS 2011AA Property-2
C2700377
Left Ventricular Ejection Fraction
Beschreibung

Left Ventricular Ejection Fraction

Datentyp

float

Maßeinheiten
  • %
Alias
NCI Thesaurus ObjectClass
C12727
NCI Thesaurus Property
C25294
NCI Thesaurus Property-2
C37946
NCI Thesaurus ValueDomain
C25613
NCI Thesaurus ValueDomain-2
C25712
UMLS CUI [1]
C0428772
%
Method of Evaluation
Beschreibung

Evaluation method

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS CUI-1
C2911685
NCI Thesaurus ObjectClass
C20989
NCI Thesaurus Property
C16847
LVEF Status
Beschreibung

LVEF Status

Datentyp

integer

Alias
NCI Thesaurus ObjectClass
C12727
NCI Thesaurus Property
C25294
NCI Thesaurus Property-2
C37946
NCI Thesaurus ValueDomain
C25688
UMLS CUI [1]
C0428772
Symptomatic congestive heart failure
Beschreibung

SymptomaticCongestiveHeartFailurePresentInd-3

Datentyp

boolean

Alias
NCI Thesaurus ValueDomain
C38148
NCI Thesaurus Property
C25626
NCI Thesaurus ObjectClass
C3080
NCI Thesaurus ObjectClass-2
C25269
UMLS CUI [1,1]
C0018802
UMLS CUI [1,2]
C0231220
New York Heart Association Classification
Beschreibung

CardiacPerformanceStatusAssessmentFunctionScale

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus ObjectClass
C13306
UMLS 2011AA ObjectClass
C1522601
NCI Metathesaurus ObjectClass
CL092952
Hematology And Biochemistry
Beschreibung

Hematology And Biochemistry

Date of blood specimen collection
Beschreibung

BloodSpecimenCollectionDate

Datentyp

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C12434
UMLS 2011AA ObjectClass
C0229664
NCI Thesaurus ObjectClass-2
C19157
UMLS 2011AA ObjectClass-2
C0370003
NCI Thesaurus Property
C25452
Result
Beschreibung

Result

Datentyp

text

Alias
NCI Thesaurus Property
C20200
NCI Thesaurus ObjectClass
C25294
NCI Thesaurus ValueDomain
C25688
UMLS CUI [1]
C2346633
Zum Seitenanfang zurückkehren

Ähnliche Modelle

No Instruction available.

1 Formulare
  1. StudyEvent: BIG 2-06 / NCCTG N063D / EGF106708 - Week 25
    1. No Instruction available.
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Header Module
Institution Number
Item
Centre No.
text
C25337 (NCI Thesaurus ValueDomain)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass)
C0805701 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
Patient Study ID
Item
Subject No.
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25462 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Item Group
Patient Status
C0449437 (UMLS CUI-1)
Examination Date
Item
Physical Examination Date
date
C25164 (NCI Thesaurus ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C2826643 (UMLS CUI [1])
AssessmentMethodText
Item
Not done
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C16847 (NCI Thesaurus Property)
C0449851 (UMLS 2011AA Property)
PatientModifiedAssessmentInd-2
Item
Are there any changes since the previous assessment
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C25573 (NCI Thesaurus Property-2)
Item
Are there any changes since the previous assessment
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C25573 (NCI Thesaurus Property-2)
CL.2
Code List
Are there any changes since the previous assessment
CL Item
Recurrence Of Disease (Recurrence of disease)
CL Item
Second Primary Malignancy Or Contralateral Breast Cancer (Second primary malignancy or contralateral breast cancer)
CL Item
Significant Cardiac Disease (Significant cardiac disease)
CL Item
Adverse Event (Adverse Event)
C41331 (NCI Thesaurus)
C0877248 (UMLS 2011AA)
CL Item
Death (Death)
C28554 (NCI Thesaurus)
C0011065 (UMLS 2011AA)
CL Item
Lost To Follow-up (Lost To Follow-up)
CL310949 (NCI Metathesaurus)
CL Item
Patient Withdrew Study Consent (Patient withdrew study consent)
CL Item
Patient Withdrew From Treatment And Will Continue With Follow-up (Patient withdrew from treatment and will continue with follow-up)
LastContactDate
Item
Date of Last Contact
date
C25164 (NCI Thesaurus Property)
C0011008 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C47954 (NCI Thesaurus ObjectClass)
C1705415 (UMLS 2011AA ObjectClass)
C25551 (NCI Thesaurus ObjectClass-2)
C1517741 (UMLS 2011AA ObjectClass-2)
Weight
Item
Body weight
float
C25209 (NCI Thesaurus ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C25208 (NCI Thesaurus Property)
C0005910 (UMLS CUI [1])
Item
ECOG Performance Status
text
C25664 (NCI Thesaurus ValueDomain)
C1520224 (UMLS CUI-1)
C25367 (NCI Thesaurus Property)
C25491 (NCI Thesaurus ValueDomain-2)
C20641 (NCI Thesaurus ObjectClass)
CL.3
Code List
ECOG Performance Status
CL Item
Fully Active, Able To Carry On All Pre-disease Performance Without Restriction. (0)
CL Item
Restricted In Physically Strenuous Activity But Ambulatory And Able To Carry Out Work Of A Light Or Sedentary Nature, E.g., Light Housework, Office Work. (1)
CL Item
Ambulatory And Capable Of All Selfcare But Unable To Carry Out Any Work Activities. Up And About More Than 50% Of Waking Hours. (2)
CL Item
Capable Of Only Limited Selfcare, Confined To Bed Or Chair More Than 50% Of Waking Hours. (3)
CL Item
Completely Disabled. Cannot Carry On Any Selfcare. Totally Confined To Bed Or Chair. (4)
CL Item
Dead (5)
Systolic blood pressure
Item
Systolic
integer
C25209 (NCI Thesaurus ValueDomain)
C25214 (NCI Thesaurus Property)
C25298 (NCI Thesaurus ObjectClass)
C0871470 (UMLS CUI [1])
Diastolic blood pressure
Item
Diastolic
integer
C25209 (NCI Thesaurus ValueDomain)
C25214 (NCI Thesaurus Property)
C25299 (NCI Thesaurus ObjectClass)
C0428883 (UMLS CUI [1])
Item Group
Cardiac Monitoring
HeartLVEFTestDate
Item
Date of LVEF
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C12727 (NCI Thesaurus ObjectClass)
C0018787 (UMLS 2011AA ObjectClass)
C25294 (NCI Thesaurus Property)
C0022885 (UMLS 2011AA Property)
C37946 (NCI Thesaurus Property-2)
C2700377 (UMLS 2011AA Property-2)
LVEF
Item
Left Ventricular Ejection Fraction
float
C12727 (NCI Thesaurus ObjectClass)
C25294 (NCI Thesaurus Property)
C37946 (NCI Thesaurus Property-2)
C25613 (NCI Thesaurus ValueDomain)
C25712 (NCI Thesaurus ValueDomain-2)
C0428772 (UMLS CUI [1])
Item
Method of Evaluation
text
C25284 (NCI Thesaurus ValueDomain)
C2911685 (UMLS CUI-1)
C20989 (NCI Thesaurus ObjectClass)
C16847 (NCI Thesaurus Property)
CL.4
Code List
Method of Evaluation
CL Item
Echocardiogram (Echocardiogram)
C37945 (NCI Thesaurus)
C2243117 (UMLS 2011AA)
CL Item
Muga Scan (MUGA scan)
Item
LVEF Status
integer
C12727 (NCI Thesaurus ObjectClass)
C25294 (NCI Thesaurus Property)
C37946 (NCI Thesaurus Property-2)
C25688 (NCI Thesaurus ValueDomain)
C0428772 (UMLS CUI [1])
CL.5
Code List
LVEF Status
CL Item
Normal (1)
C1535947 (UMLS CUI-1)
CL Item
Abnormal - Not Clinically Significant (2)
C0205161 (UMLS CUI-1)
C2985739 (UMLS CUI-2)
C1518422 (UMLS CUI-3)
CL Item
Abnormal - Clinically Significant (3)
C0205161 (UMLS CUI-1)
C2985739 (UMLS CUI-2)
CHF symptomatic
Item
Symptomatic congestive heart failure
boolean
C38148 (NCI Thesaurus ValueDomain)
C25626 (NCI Thesaurus Property)
C3080 (NCI Thesaurus ObjectClass)
C25269 (NCI Thesaurus ObjectClass-2)
C0018802 (UMLS CUI [1,1])
C0231220 (UMLS CUI [1,2])
Item
New York Heart Association Classification
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C13306 (NCI Thesaurus ObjectClass)
C1522601 (UMLS 2011AA ObjectClass)
CL092952 (NCI Metathesaurus ObjectClass)
CL.7
Code List
New York Heart Association Classification
CL Item
Patients With Cardiac Disease But Without Resulting Limitation Of Physical Activity. Ordinary Physical Activity Does Not Cause Undue Fatigue, Palpitation, Dyspnea Or Anginal Pain. (Class I)
CL Item
Patients With Cardiac Disease Resulting In Slight Limitation Of Physical Activity. They Are Comfortable At Rest. Ordinary Physical Activity Results In Fatigue, Palpitation, Dyspnea Or Anginal Pain. (Class II)
CL Item
Patients With Cardiac Disease Resulting In Marked Limitation Of Physical Activity. They Are Comfortable At Rest. Less Than Ordinary Activity Causes Fatigue, Palpitation, Dyspnea Or Anginal Pain. (Class III)
CL Item
Patients With Cardiac Disease Resulting In Inability To Carry On Any Physical Activity Without Discomfort. Symptoms Of Heart Failure Or The Anginal Syndrome May Be Present Even At Rest. If Any Physical Activity Is Undertaken, Discomfort Increases. (Class IV)
Item Group
Hematology And Biochemistry
BloodSpecimenCollectionDate
Item
Date of blood specimen collection
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C12434 (NCI Thesaurus ObjectClass)
C0229664 (UMLS 2011AA ObjectClass)
C19157 (NCI Thesaurus ObjectClass-2)
C0370003 (UMLS 2011AA ObjectClass-2)
C25452 (NCI Thesaurus Property)
Item
Result
text
C20200 (NCI Thesaurus Property)
C25294 (NCI Thesaurus ObjectClass)
C25688 (NCI Thesaurus ValueDomain)
C2346633 (UMLS CUI [1])
CL.8
Code List
Result
CL Item
Normal (Normal)
C14165 (NCI Thesaurus)
C14165 (NCI Thesaurus-3)
C0205307 (UMLS CUI-1)
CL Item
Abnormal - Not Clinically Significant (Abnormal - Not clinically significant)
C0205161 (UMLS CUI-1)
C2985739 (UMLS CUI-2)
C1518422 (UMLS CUI-3)
CL Item
Abnormal - Clinically Significant (Abnormal - Clinically significant)
C0205161 (UMLS CUI-1)
C2985739 (UMLS CUI-2)
Zum Seitenanfang zurückkehren 

Kontakt

Benutzen Sie dieses Formular für Rückmeldungen, Fragen und Verbesserungsvorschläge.

Mit * gekennzeichnete Felder sind notwendig.

Hilfe

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