On Study Form

  1. StudyEvent: ODM
    1. On Study Form
Default Itemgroup
Beskrivning

Default Itemgroup

Height
Beskrivning

Height

Datatyp

float

Måttenheter
  • cm
Alias
UMLS CUI [1]
C0005890
cm
Diagnosis
Beskrivning

Diagnosis

Alias
UMLS CUI-1
C0011900
WHO-AML classification (Appendix A.1, A.2. and A.3)
Beskrivning

WHO-AML classification (Appendix A.1, A.2. and A.3)

Datatyp

text

Alias
UMLS CUI [1,1]
C0043237
UMLS CUI [1,2]
C0023467
UMLS CUI [1,3]
C0008902
FAB type (Appendix A.4)
Beskrivning

FAB type (Appendix A.4)

Datatyp

text

Alias
UMLS CUI [1]
C0457321
History Of Disease And Clincial Status
Beskrivning

History Of Disease And Clincial Status

Alias
UMLS CUI-1
C0683519
UMLS CUI-3
C0449440
Prior MDS
Beskrivning

MDS

Datatyp

integer

Alias
UMLS CUI [1]
C0026986
MDS Date of Diagnosis
Beskrivning

MDS Date of Diagnosis

Datatyp

date

Alias
UMLS CUI [1,1]
C0026986
UMLS CUI [1,2]
C2316983
MDS Subtype
Beskrivning

MDS Subtype

Datatyp

integer

Alias
UMLS CUI [1,1]
C0026986
UMLS CUI [1,2]
C0449560
Other hematological disease(> 3 months duration prior to diagnosis disease under study).
Beskrivning

Hematological disease

Datatyp

integer

Alias
UMLS CUI [1]
C0018939
Hematological disease Date of diagnosis
Beskrivning

Hematological disease Date of diagnosis

Datatyp

date

Alias
UMLS CUI [1,1]
C0018939
UMLS CUI [1,2]
C2316983
Hematological Disease Specification
Beskrivning

Hematological Disease Specification

Datatyp

text

Alias
UMLS CUI [1,1]
C0018939
UMLS CUI [1,2]
C2348235
Other oncological disease
Beskrivning

Oncological disease

Datatyp

integer

Alias
UMLS CUI [1]
C0027651
Oncological disease Date of diagnosis
Beskrivning

Oncological disease Date of diagnosis

Datatyp

date

Alias
UMLS CUI [1,1]
C0027651
UMLS CUI [1,2]
C2316983
Oncological disease Specification
Beskrivning

Oncological disease Specification

Datatyp

text

Alias
UMLS CUI [1,1]
C0027651
UMLS CUI [1,2]
C2348235
Chemotherapy/Radiotherapy
Beskrivning

Chemotherapy/Radiotherapy

Datatyp

boolean

Alias
UMLS CUI [1]
C3665472
UMLS CUI [2]
C1522449
Chemotherapy/Radiotherapy Date or year start
Beskrivning

Chemotherapy/Radiotherapy Date or year start

Datatyp

date

Alias
UMLS CUI [1,1]
C3665472
UMLS CUI [1,2]
C0011008
UMLS CUI [2,1]
C1522449
UMLS CUI [2,2]
C0011008
Chemotherapy/Radiotherapy Specification
Beskrivning

Chemotherapy/Radiotherapy Specification

Datatyp

text

Alias
UMLS CUI [1,1]
C3665472
UMLS CUI [1,2]
C2348235
UMLS CUI [2,1]
C1522449
UMLS CUI [2,2]
C2348235
Exposure to toxic agents (e.g. insecticide)
Beskrivning

Toxic agents

Datatyp

integer

Alias
UMLS CUI [1]
C0522757
Exposure to Toxic agents since year
Beskrivning

Toxic agents

Datatyp

date

Alias
UMLS CUI [1,1]
C0522757
UMLS CUI [1,2]
C0011008
Toxic agents Specification
Beskrivning

Toxic agents Specification

Datatyp

text

Alias
UMLS CUI [1,1]
C0522757
UMLS CUI [1,2]
C2348235
Existence of one (or more) relatives having previously suffered from AML
Beskrivning

Relatives AML

Datatyp

integer

Alias
UMLS CUI [1,1]
C0080103
UMLS CUI [1,2]
C0023467
*Specify family relation
Beskrivning

Family relation

Datatyp

text

Alias
UMLS CUI [1,1]
C0015608
UMLS CUI [1,2]
C0023467
*specify diagnosis
Beskrivning

AML Subtype

Datatyp

text

Alias
UMLS CUI [1,1]
C0449560
UMLS CUI [1,2]
C0023467
*specify age of relative at diagnosis
Beskrivning

Relative Age at Diagnosis

Datatyp

text

Alias
UMLS CUI [1]
C1828181
Extramedullary disease
Beskrivning

Extramedullary disease

Datatyp

integer

Alias
UMLS CUI [1]
C1868812
*Specify site
Beskrivning

Specify site

Datatyp

text

Level of evidence - Physical examination
Beskrivning

Physical examination

Datatyp

integer

Alias
UMLS CUI [1]
C0031809
Level of evidence - Radiologically confirmed
Beskrivning

Radiologic exam

Datatyp

integer

Alias
UMLS CUI [1]
C2985535
Level of evidence - Pathologically confirmed
Beskrivning

Pathologically confirmed

Datatyp

integer

Alias
UMLS CUI [1]
C0019638
Lactate dehydrogenase (LDH) (U/L)
Beskrivning

LDH

Datatyp

float

Alias
UMLS CUI [1]
C0202113
Lactate dehydrogenase ULN
Beskrivning

LDH ULN

Datatyp

float

Alias
UMLS CUI [1,1]
C0202113
UMLS CUI [1,2]
C1519815
Bone Marrow Aspirate
Beskrivning

Bone Marrow Aspirate

Alias
UMLS CUI-1
C0857285
BM aspirate done
Beskrivning

BM aspirate done

Datatyp

integer

Alias
UMLS CUI [1]
C0857285
Evaluable
Beskrivning

Evaluable

Datatyp

text

Alias
UMLS CUI [1]
M
BM sampling date
Beskrivning

BM sampling date

Datatyp

date

Alias
UMLS CUI [1,1]
C0857285
UMLS CUI [1,2]
C0011008
Cellularity
Beskrivning

Cellularity

Datatyp

integer

Alias
UMLS CUI [1]
C1516377
Blasts
Beskrivning

Blasts

Datatyp

float

Måttenheter
  • %
Alias
UMLS CUI [1]
C1982687
%
Promyelocytes
Beskrivning

Promyelocytes

Datatyp

float

Måttenheter
  • %
Alias
UMLS CUI [1]
C0455279
%
Myelocytes
Beskrivning

Myelocytes

Datatyp

float

Måttenheter
  • %
Alias
UMLS CUI [1]
C0369715
%
Metamyelocytes
Beskrivning

Metamyelocytes

Datatyp

float

Måttenheter
  • %
Alias
UMLS CUI [1]
C0229635
%
Neutrophils (segments & bands)
Beskrivning

Neutrophils

Datatyp

float

Måttenheter
  • %
Alias
UMLS CUI [1]
C2238207
%
Monocytes
Beskrivning

Monocytes

Datatyp

float

Måttenheter
  • %
Alias
UMLS CUI [1]
C0026473
%
Eosinophils
Beskrivning

Eosinophils

Datatyp

float

Måttenheter
  • %
Alias
UMLS CUI [1]
C0362902
%
Basophils
Beskrivning

Basophils

Datatyp

float

Måttenheter
  • %
Alias
UMLS CUI [1]
C0200641
%
Erythroblasts
Beskrivning

Erythroblasts

Datatyp

float

Måttenheter
  • %
Alias
UMLS CUI [1]
C0014762
%
Lymphocytes
Beskrivning

Lymphocytes

Datatyp

float

Måttenheter
  • %
Alias
UMLS CUI [1]
C0024264
%
Other*
Beskrivning

Other*

Datatyp

float

Måttenheter
  • %
%
*Specify
Beskrivning

*Specify

Datatyp

text

Auer rods
Beskrivning

Auer rods

Datatyp

integer

Alias
UMLS CUI [1]
C0333828
Dyserythropoiesis
Beskrivning

Dyserythropoiesis

Datatyp

integer

Alias
UMLS CUI [1]
C0221143
Dysmegakaryopoiesis
Beskrivning

Dysmegakaryopoiesis

Datatyp

integer

Alias
UMLS CUI [1]
C3700221
Dysgranulopoiesis
Beskrivning

Dysgranulopoiesis

Datatyp

integer

Alias
UMLS CUI [1]
C0312832
Bone Marrow Biopsy
Beskrivning

Bone Marrow Biopsy

Alias
UMLS CUI-1
C0005954
BM biopsy done
Beskrivning

BM biopsy done

Datatyp

integer

Alias
UMLS CUI [1]
C0005954
Bone marrow biopsy evaluable
Beskrivning

Bone marrow biopsy evaluable

Datatyp

integer

Alias
UMLS CUI [1]
M
Date of BM biopsy
Beskrivning

Date of BM biopsy

Datatyp

date

Alias
UMLS CUI [1,1]
C0005954
UMLS CUI [1,2]
C0011008
Cellularity
Beskrivning

Cellularity

Datatyp

text

Alias
UMLS CUI [1]
C1561532
Clusters of blasts present
Beskrivning

Clusters of blasts present

Datatyp

boolean

Alias
UMLS CUI [1]
C0368761
Blasts (i.e.leukemic blasts) estimated
Beskrivning

Blasts (i.e.leukemic blasts) estimated

Datatyp

float

Måttenheter
  • %
Alias
UMLS CUI [1]
C0587348
%
Peripheral blood evaluation
Beskrivning

Peripheral blood evaluation

Alias
UMLS CUI-1
C0229664
Peripheral blood evaluation
Beskrivning

Peripheral blood evaluation

Datatyp

integer

Alias
UMLS CUI [1]
C0229664
Blood sampling date
Beskrivning

Blood sampling date

Datatyp

date

Alias
UMLS CUI [1,1]
C0005834
UMLS CUI [1,2]
C0011008
Hemoglobin
Beskrivning

Hemoglobin

Datatyp

float

Måttenheter
  • mmol/l
Alias
UMLS CUI [1]
C0019046
mmol/l
Platelets
Beskrivning

Platelets

Datatyp

float

Måttenheter
  • x10^9/l
Alias
UMLS CUI [1]
C0005821
x10^9/l
WBC
Beskrivning

WBC

Datatyp

float

Måttenheter
  • x10^9/l
Alias
UMLS CUI [1]
C0023508
x10^9/l
Blasts
Beskrivning

Blasts

Datatyp

float

Måttenheter
  • %
Alias
UMLS CUI [1]
C0368761
%
Promyelocytes
Beskrivning

Promyelocytes

Datatyp

float

Måttenheter
  • %
Alias
UMLS CUI [1]
C0455279
%
Myelocytes
Beskrivning

Myelocytes

Datatyp

float

Måttenheter
  • %
Alias
UMLS CUI [1]
C0369715
%
Metamyelocytes
Beskrivning

Metamyelocytes

Datatyp

float

Alias
UMLS CUI [1]
C0229635
Neutrophils
Beskrivning

Neutrophils

Datatyp

float

Måttenheter
  • %
Alias
UMLS CUI [1]
C2238207
%
Basophils
Beskrivning

Basophils

Datatyp

float

Måttenheter
  • %
Alias
UMLS CUI [1]
C0200641
%
Lymphocytes
Beskrivning

Lymphocytes

Datatyp

float

Måttenheter
  • %
Alias
UMLS CUI [1]
C0024264
%
Monocytes
Beskrivning

Monocytes

Datatyp

float

Måttenheter
  • %
Alias
UMLS CUI [1]
C0026473
%
Other*
Beskrivning

Other*

Datatyp

float

Måttenheter
  • %
Alias
UMLS CUI [1]
M
%
*Specify
Beskrivning

*Specify

Datatyp

text

Erythroblasts
Beskrivning

Erythroblasts

Datatyp

float

Alias
UMLS CUI [1]
C0014762
Auer rods
Beskrivning

Auer rods

Datatyp

integer

Alias
UMLS CUI [1]
C0333828
Did patient start protocol treatment
Beskrivning

Did patient start protocol treatment

Datatyp

boolean

Alias
UMLS CUI [1]
C0040808
Comments
Beskrivning

Comments

Datatyp

text

Similar models

On Study Form

  1. StudyEvent: ODM
    1. On Study Form
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
Default Itemgroup
Height
Item
Height
float
C0005890 (UMLS CUI [1])
Item Group
C0011900 (UMLS CUI-1)
WHO-AML classification (Appendix A.1, A.2. and A.3)
Item
WHO-AML classification (Appendix A.1, A.2. and A.3)
text
C0043237 (UMLS CUI [1,1])
C0023467 (UMLS CUI [1,2])
C0008902 (UMLS CUI [1,3])
Item
FAB type (Appendix A.4)
text
C0457321 (UMLS CUI [1])
Code List
FAB type (Appendix A.4)
CL Item
M0 1=M1 2=M2 4=M4 5=M5 6=M6 7=M7 8=RAEB 9=RAEB-t 10=AML, not M3 (0)
Item Group
C0683519 (UMLS CUI-1)
C0449440 (UMLS CUI-3)
Item
Prior MDS
integer
C0026986 (UMLS CUI [1])
Code List
Prior MDS
CL Item
no 1=yes 9=unknown (0)
MDS Date of Diagnosis
Item
date
C0026986 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Item
MDS Subtype
integer
C0026986 (UMLS CUI [1,1])
C0449560 (UMLS CUI [1,2])
Code List
MDS Subtype
CL Item
RCUD 2= RA 3= RN (1)
CL Item
RT 5=RARS 6=RCMD (4)
CL Item
RAEB1 8=RAEB2 (7)
CL Item
unknown (9)
CL Item
MDS unclassified (10)
CL Item
MDS associated with isolated del(5q) (11)
Item
Other hematological disease(> 3 months duration prior to diagnosis disease under study).
integer
C0018939 (UMLS CUI [1])
Code List
Other hematological disease(> 3 months duration prior to diagnosis disease under study).
CL Item
no 1=yes 9=unknown (0)
Hematological disease Date of diagnosis
Item
date
C0018939 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Hematological Disease Specification
Item
text
C0018939 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
Item
Other oncological disease
integer
C0027651 (UMLS CUI [1])
Code List
Other oncological disease
CL Item
no 1=yes 9=unknown (0)
Oncological disease Date of diagnosis
Item
Oncological disease Date of diagnosis
date
C0027651 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Oncological disease Specification
Item
text
C0027651 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
Chemotherapy/Radiotherapy
Item
Chemotherapy/Radiotherapy
boolean
C3665472 (UMLS CUI [1])
C1522449 (UMLS CUI [2])
Chemotherapy/Radiotherapy Date or year start
Item
date
C3665472 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
C1522449 (UMLS CUI [2,1])
C0011008 (UMLS CUI [2,2])
Chemotherapy/Radiotherapy Specification
Item
text
C3665472 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
C1522449 (UMLS CUI [2,1])
C2348235 (UMLS CUI [2,2])
Item
Exposure to toxic agents (e.g. insecticide)
integer
C0522757 (UMLS CUI [1])
Code List
Exposure to toxic agents (e.g. insecticide)
CL Item
no 1=yes 9=unknown (0)
Toxic agents
Item
Exposure to Toxic agents since year
date
C0522757 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Toxic agents Specification
Item
text
C0522757 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
Item
Existence of one (or more) relatives having previously suffered from AML
integer
C0080103 (UMLS CUI [1,1])
C0023467 (UMLS CUI [1,2])
Code List
Existence of one (or more) relatives having previously suffered from AML
CL Item
no 1=yes* 9=unknown (0)
Family relation
Item
*Specify family relation
text
C0015608 (UMLS CUI [1,1])
C0023467 (UMLS CUI [1,2])
AML Subtype
Item
*specify diagnosis
text
C0449560 (UMLS CUI [1,1])
C0023467 (UMLS CUI [1,2])
Relative Age at Diagnosis
Item
*specify age of relative at diagnosis
text
C1828181 (UMLS CUI [1])
Item
integer
C1868812 (UMLS CUI [1])
Code List
Extramedullary disease
CL Item
no (go to box 31) 1=skin* 2=CNS* 3=liver* 4=spleen* 5=lymphadenopathy* 8=other* (0)
Specify site
Item
*Specify site
text
Item
Level of evidence - Physical examination
integer
C0031809 (UMLS CUI [1])
Code List
Level of evidence - Physical examination
CL Item
no 1=yes 9=unknown (0)
Item
Level of evidence - Radiologically confirmed
integer
C2985535 (UMLS CUI [1])
Code List
Level of evidence - Radiologically confirmed
CL Item
no 1=yes 9=unknown (0)
Item
Level of evidence - Pathologically confirmed
integer
C0019638 (UMLS CUI [1])
Code List
Level of evidence - Pathologically confirmed
CL Item
no 1=yes 9=unknown (0)
LDH
Item
Lactate dehydrogenase (LDH) (U/L)
float
C0202113 (UMLS CUI [1])
LDH ULN
Item
Lactate dehydrogenase ULN
float
C0202113 (UMLS CUI [1,1])
C1519815 (UMLS CUI [1,2])
Item Group
C0857285 (UMLS CUI-1)
Item
BM aspirate done
integer
C0857285 (UMLS CUI [1])
Code List
BM aspirate done
CL Item
not done (go to box 33) 1=done (0)
Item
text
M (UMLS CUI [1])
Code List
Evaluable
CL Item
no (go to box 33) 1=yes (0)
BM sampling date
Item
BM sampling date
date
C0857285 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item
Cellularity
integer
C1516377 (UMLS CUI [1])
Code List
Cellularity
CL Item
low 2=medium 3=high (1)
Blasts
Item
Blasts
float
C1982687 (UMLS CUI [1])
Promyelocytes
Item
Promyelocytes
float
C0455279 (UMLS CUI [1])
Myelocytes
Item
Myelocytes
float
C0369715 (UMLS CUI [1])
Metamyelocytes
Item
Metamyelocytes
float
C0229635 (UMLS CUI [1])
Neutrophils
Item
Neutrophils (segments & bands)
float
C2238207 (UMLS CUI [1])
Monocytes
Item
Monocytes
float
C0026473 (UMLS CUI [1])
Eosinophils
Item
Eosinophils
float
C0362902 (UMLS CUI [1])
Basophils
Item
Basophils
float
C0200641 (UMLS CUI [1])
Erythroblasts
Item
Erythroblasts
float
C0014762 (UMLS CUI [1])
Lymphocytes
Item
Lymphocytes
float
C0024264 (UMLS CUI [1])
Other*
Item
Other*
float
*Specify
Item
text
Item
Auer rods
integer
C0333828 (UMLS CUI [1])
Code List
Auer rods
CL Item
absent (0)
CL Item
present (1)
Item
Dyserythropoiesis
integer
C0221143 (UMLS CUI [1])
Code List
Dyserythropoiesis
CL Item
no 1=yes (0)
Item
Dysmegakaryopoiesis
integer
C3700221 (UMLS CUI [1])
Code List
Dysmegakaryopoiesis
CL Item
no 1=yes (0)
Item
Dysgranulopoiesis
integer
C0312832 (UMLS CUI [1])
Code List
Dysgranulopoiesis
CL Item
no 1=yes (0)
Item Group
C0005954 (UMLS CUI-1)
Item
integer
C0005954 (UMLS CUI [1])
Code List
BM biopsy done
CL Item
not done (go to box 60) 1=done (0)
Item
integer
M (UMLS CUI [1])
Code List
Bone marrow biopsy evaluable
CL Item
no (go to box 60) 1=yes (0)
Date of BM biopsy
Item
date
C0005954 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item
text
C1561532 (UMLS CUI [1])
Code List
Cellularity
CL Item
low 2=medium 3=high (1)
Clusters of blasts present
Item
boolean
C0368761 (UMLS CUI [1])
Blasts (i.e.leukemic blasts) estimated
Item
float
C0587348 (UMLS CUI [1])
Item Group
C0229664 (UMLS CUI-1)
Item
integer
C0229664 (UMLS CUI [1])
Code List
Peripheral blood evaluation
CL Item
not done 1=done (0)
Blood sampling date
Item
date
C0005834 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Hemoglobin
Item
Hemoglobin
float
C0019046 (UMLS CUI [1])
Platelets
Item
Platelets
float
C0005821 (UMLS CUI [1])
WBC
Item
WBC
float
C0023508 (UMLS CUI [1])
Blasts
Item
Blasts
float
C0368761 (UMLS CUI [1])
Promyelocytes
Item
Promyelocytes
float
C0455279 (UMLS CUI [1])
Myelocytes
Item
Myelocytes
float
C0369715 (UMLS CUI [1])
Metamyelocytes
Item
Metamyelocytes
float
C0229635 (UMLS CUI [1])
Neutrophils
Item
Neutrophils
float
C2238207 (UMLS CUI [1])
Basophils
Item
Basophils
float
C0200641 (UMLS CUI [1])
Lymphocytes
Item
float
C0024264 (UMLS CUI [1])
Monocytes
Item
Monocytes
float
C0026473 (UMLS CUI [1])
Other*
Item
float
M (UMLS CUI [1])
*Specify
Item
text
Erythroblasts
Item
Erythroblasts
float
C0014762 (UMLS CUI [1])
Item
Auer rods
integer
C0333828 (UMLS CUI [1])
Code List
Auer rods
CL Item
absent (0)
CL Item
present (1)
Did patient start protocol treatment
Item
Did patient start protocol treatment
boolean
C0040808 (UMLS CUI [1])
Comments
Item
text