Information:

Error:

en ▾

Deutsch
English
Español
Italiano
Français
Português
Svenska
Nederlands

Login
Register
Search
ODM-XML file upload
Create data model
ODM-Edit tool
Metadata Registry
Help
About the MDM portal
Imprint

Login
Register

Search through specific fields of a model

The name of the data model contains study:: name:"study"
The description contains two terms:: description:"double blind"
The copyrightholder contains the term UKM:: copyrightholder:"UKM"
The uploader of the model is Martin Dugas:: uploader:"Martin Dugas"
The keywords contain cancer:: keyword:"cancer"

Refine the search with search operators

Search for groups of words with quotes:: "leukemia myeloid"
Use a wildcard to search for prefixes:: NCT*
With AND/OR/NOT find study without eye nor ear:: study AND NOT (eye OR ear)
Cancer must (+) occur, study not (-):: +cancer -study
You may connect the different search techniques:: name:"form*" AND routine

Actions ▾

ODM-XML file upload
Create data model
ODM-Edit tool
Metadata Registry
About the MDM portal

en ▾

Deutsch
English
Español
Italiano
Français
Português
Svenska
Nederlands

Info
Dialog
Download

Rating Ratings

Description:

On-Study Form Bladder Cancer NCT00014534 CALGB-90104 NCT00014534 NCI Cooperative Group On-Study Form-Revised (CALGB-90104) Combination Chemotherapy in Treating Patients With Bladder Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=BE1B6E9C-942E-7181-E034-0003BA12F5E7

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=BE1B6E9C-942E-7181-E034-0003BA12F5E7

Keywords:

Urinary Bladder Neoplasms

Versions (3) ▾

8/26/12
1/9/15
8/21/15

Uploaded on:

August 21, 2015

DOI:

No DOI assigned. To request one pleaselog in.

License:

Creative Commons BY-NC 3.0 Legacy

Model comments:

You can comment on the data model here. Via the speech bubbles at the itemgroups and items you can add comments to those specificially.

Back to model comments

Itemgroup comments for:

Item comments for:

In order to download data models you must be logged in. Please log in or register for free.

On-Study Form Bladder Cancer NCT00014534 CALGB-90104

English

Details

No Instruction available.

StudyEvent: NCI Cooperative Group On-Study Form-Revised (CALGB-90104)
1. No Instruction available.

Muscle Invasive Bladder Disease: Prior Treatment Affecting The Bladder

Prior Intravesical Therapy (Note: If no, skip to Prior Surgery below)

Yes

No

Type of Prior Immunotherapy

BCG (BCG)

Interferon (Interferon)

Other (Other)

Number of Courses

Agent Start Date

Type of Prior Chemotherapy

Mmc (MMC)

Thiotepa (Thiotepa)

Other (Other)

Number of Courses

Prior Surgery (for urothelial disease)

Yes

No

Prior Surgery Type

Patient Previosly Had A Partial Cystectomy (Partial cystectomy)

Patient Previosly Had A Radical Cystectomy (radical cystectomy)

Patient Previosly Had A Turbt (TURBT)

Patient Previously Had Other Surgery, Specify (Other, specify)

TURBT, specify number

Prior surgery date

Any Other Prior Therapy

Yes

No

Prior Therapy Name

Prior Therapy Date

Chest X-ray assessment date

Chest X-ray results

Negative (negative)

Positive (positive)

Equivocal (equivocal)

Abdominal/pelvic CT assessment date

Not Done (not done)

Normal (normal)

Equivocal (equivocal)

Abnormal-disease Related (abnormal-disease related)

Abnormal-not Disease Related (abnormal-not disease related)

Unknown (unknown)

1000/ul

Peripheral Platelet Count

1000/uL

Bilirubin, total

mg/dL

mg/dL

mg/dL

Creatinine Clearance

mL/min

Alkaline Phosphatase

U/L

Alkaline Phosphatase ULN

U/L

U/L

U/L

Date form completed

Ccrr Module For Nci Cooperative Group On-study Form-revised (calgb-90104)

CALGB Study No.

CALGB Patient ID

Are data amended?

Yes (Yes)

Patient Initials

Participating group

Patient medical record number

Participating group protocol number

Institution/Affiliate

Participating Group Patient ID

Date of Initial Symptom

Has the patient had a prior history of superficial disease?

Yes

No

Number of Prior Occurrences of Papillary

Number of Prior Occurrence of CIS

Date of Initial Pathologic Diagnosis of muscle invasive bladder cancer

Date of Initial Pathologic Diagnosis of muscle invasive bladder cancer

Date of Current pathologic diagnosis for muscle invasive bladder cancer

Date of Most recent prior recurrence for muscle invasive bladder cancer

Histologic Type (mark all that apply)

Transitional Cell Carcinoma (Transitional cell carcinoma)

Other Specify (Other, specify)

Histologic Grade (check the highest grade)

Well Differentiated (G1)

Moderately Differentiated (G2)

Poorly Differentiated (G3)

Tumor Grade Cannot Be Assessed (GX)

Pathologic T Stage (Indicate highest stage at the current presentation of disease)

No Evidence Of Primary Tumor (T0)

Tumor Invades Subepithelial Connective Tissue (T1)

Tumor Invades Superficial Muscles (inner Half) (T2a)

Tumor Invades Deep Muscles (outer Half) (T2b)

Tumor Invades Perivesical Tissue Microscopically (T3a)

3 more items in the detailed view.

Pathologic N Stage (Distant Metastasis)

No Regional Lymph Node Metastasis (N0)

Metastasis In A Single Lymph Node, 2 Cm Or Less In Greatest Dimension (N1)

Metastasis In A Single Lymph Node, More Than 2 Cm But Not More Than 5 Cm In Greatest Dimension; Or Multiple Lymph Nodes, None More Than 5 Cm In Greatest Dimension (N2)

Metastasis In A Lymph Node More Than 5 Cm In Greatest Dimension (N3)

Regional Lymph Nodes Cannot Be Assessed (Nx)

Pathologic M Stage

M0, According To Ajcc Staging Definitions (M0)

Lymph Node Type (unnamed)

Internal Iliac (Internal Iliac)

External Iliac (External Iliac)

Common Iliac (Common Iliac)

Hypogastric (Hypogastric)

Para-aortic (Para-aortic)

Other, Specify (Other, specify)

Lymph Node Involvement (unnamed)

Lymph Nodes Were Not Evaluated For Involvement (not evaluated)

Lymph Nodes Were Evaluated For Involvement, And They Were Positive (positive)

Lymph Nodes Were Evaluated For Involvement, And They Were Negative (negative)

Lymph Nodes Were Evaluated For Involvement, And They Were Equivocal (equivocal)

Unknown Whether The Lymph Nodes Were Evaluated For Involvement (unknown)

Number of Lymph Nodes Examined

Number of Positive Lymph Nodes

Back to the top of the page

Contact

Institute of Medical Informatics
Director: Prof. Dr. Martin Dugas
Albert-Schweitzer-Campus 1, A11
48149 Münster, Germany
Email : imi@uni-muenster.de

In collaboration with

Imprint
Disclaimer
Data Privacy

© 2019 University of Münster

Contact
Help
Cite

Contact

Please use this form for feedback, questions and suggestions for improvements.

Name*

Email*

Message*

Fields marked with * are required.

Login

Email:

Password:

Stay logged in

Forgot password?

Register

Sign in with Certificate