ID

12411

Description

Items used as routine documentation for the SAL (Studienallianz Leukämie) study centre of university hospital dresden. ODM derived from original form "AML-Register Therapiebogen-D", converted to ODM format.

Mots-clés

  1. 17/11/2015 17/11/2015 -
  2. 27/11/2015 27/11/2015 -
  3. 11/02/2016 11/02/2016 -
Téléchargé le

17 novembre 2015

DOI

Pour une demande vous connecter.

Licence

Creative Commons BY-NC 3.0

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AML- Register_Therapy form_SAL_University hospital dresden

AML- Register_Therapy form_SAL_University hospital dresden

Patient information
Description

Patient information

Patient name:
Description

Patient name

Type de données

text

Patient ID:
Description

Patient ID

Type de données

integer

Clinic code:
Description

Clinic code

Type de données

integer

Date of birth:
Description

Date of birth

Type de données

date

Gender:
Description

Gender

Type de données

text

Cancer remission by therapy beginning (to be completed from 2nd therapy)
Description

Cancer remission by therapy beginning (to be completed from 2nd therapy)

Date of cancer remission:
Description

date

Type de données

date

Through bone marrow puncture secured?
Description

bone marrow puncture

Type de données

boolean

Remission status:
Description

Remission status

Type de données

text

CR by acute promyelocytic leukemia:
Description

Complete remission

Type de données

text

Recurrence by acute promyelocytic leukemia:
Description

recurrence

Type de données

text

CRi/ CRp:
Description

CRi/ CRp

Type de données

boolean

Partial remission:
Description

Partial remission

Type de données

boolean

Progression / refractory:
Description

Progression; refractory

Type de données

boolean

Can not be assessed:
Description

assessment

Type de données

boolean

Chemotherapy
Description

Chemotherapy

Date of chemotherapy:
Description

Date

Type de données

date

Chemotherapy:
Description

Chemotherapy

Type de données

text

Therapy schema:
Description

Schema

Type de données

text

Medication (chemotherapy)
Description

Medication (chemotherapy)

Medication:
Description

medication

Type de données

text

Chemotherapy start date:
Description

start date

Type de données

date

Days:
Description

days

Type de données

text

Total dose:
Description

dose

Type de données

integer

Unités de mesure
  • mg
mg
Transplantation
Description

Transplantation

Date of transplantation:
Description

date

Type de données

date

Stem cell transplantation centre:
Description

stem Cell transplantation

Type de données

text

Stem cell transplantation type:
Description

Stem cell transplantation type

Type de données

text

Donor:
Description

donor

Type de données

text

Conditioning regimens:
Description

Conditioning regimens

Type de données

text

Toxicity grade III-IV
Description

Toxicity grade III-IV

Creatinine:
Description

creatinine

Type de données

boolean

Hemorrhage:
Description

hemorrhage

Type de données

boolean

Bilirubin:
Description

Bilirubin

Type de données

boolean

Infection:
Description

Infection

Type de données

boolean

Heart:
Description

heart

Type de données

boolean

GvHD:
Description

GvHD

Type de données

boolean

ALAT/ASAT:
Description

ALAT/ASAT

Type de données

boolean

Other:
Description

Other

Type de données

text

Therapy outcome
Description

Therapy outcome

Date of therapy response:
Description

date

Type de données

date

Through bone marrow puncture secured?
Description

bone marrow puncture

Type de données

boolean

Therapy outcome:
Description

therapy outcome

Type de données

text

Similar models

AML- Register_Therapy form_SAL_University hospital dresden

Name
Type
Description | Question | Decode (Coded Value)
Type de données
Alias
Item Group
Patient information
Patient name
Item
Patient name:
text
Patient ID
Item
Patient ID:
integer
Clinic code
Item
Clinic code:
integer
Date of birth
Item
Date of birth:
date
Item
Gender:
text
Code List
Gender:
CL Item
male  (1)
CL Item
female (2)
Item Group
Cancer remission by therapy beginning (to be completed from 2nd therapy)
date
Item
Date of cancer remission:
date
bone marrow puncture
Item
Through bone marrow puncture secured?
boolean
Item
Remission status:
text
Code List
Remission status:
CL Item
good response (blasts under 10%) (1)
CL Item
moderate response (min. halving the number of Blast auf >=10%) (2)
CL Item
no response (no decrease in the blasts, decrease of <50%) (3)
Item
CR by acute promyelocytic leukemia:
text
Code List
CR by acute promyelocytic leukemia:
CL Item
hematological (1)
CL Item
molecular (2)
Item
Recurrence by acute promyelocytic leukemia:
text
Code List
Recurrence by acute promyelocytic leukemia:
CL Item
hematological (1)
CL Item
molecular (2)
CRi/ CRp
Item
CRi/ CRp:
boolean
Partial remission
Item
Partial remission:
boolean
Progression; refractory
Item
Progression / refractory:
boolean
assessment
Item
Can not be assessed:
boolean
Item Group
Chemotherapy
Date
Item
Date of chemotherapy:
date
Item
Chemotherapy:
text
Code List
Chemotherapy:
CL Item
during a study; curative  (1)
CL Item
during a study; palliative (2)
CL Item
outside of a study; curative  (3)
CL Item
outside of a study; palliative (4)
Schema
Item
Therapy schema:
text
Item Group
Medication (chemotherapy)
medication
Item
Medication:
text
start date
Item
Chemotherapy start date:
date
days
Item
Days:
text
dose
Item
Total dose:
integer
Item Group
Transplantation
date
Item
Date of transplantation:
date
stem Cell transplantation
Item
Stem cell transplantation centre:
text
Item
Stem cell transplantation type:
text
Code List
Stem cell transplantation type:
CL Item
Autologous (1)
CL Item
Allogeneic (related) (2)
CL Item
Allogeneic (unrelated) (3)
Item
Donor:
text
Code List
Donor:
CL Item
identical (1)
CL Item
haploidentical  (2)
CL Item
Mismatch (3)
Conditioning regimens
Item
Conditioning regimens:
text
Item Group
Toxicity grade III-IV
creatinine
Item
Creatinine:
boolean
hemorrhage
Item
Hemorrhage:
boolean
Bilirubin
Item
Bilirubin:
boolean
Infection
Item
Infection:
boolean
heart
Item
Heart:
boolean
GvHD
Item
GvHD:
boolean
ALAT/ASAT
Item
ALAT/ASAT:
boolean
Other
Item
Other:
text
Item Group
Therapy outcome
date
Item
Date of therapy response:
date
bone marrow puncture
Item
Through bone marrow puncture secured?
boolean
Item
Therapy outcome:
text
Code List
Therapy outcome:
CL Item
good response (blasts under 10%) (1)
CL Item
moderate response (min. halving the number of Blast auf >=10%) (2)
CL Item
no response (no decrease in the blasts, decrease of <50%) (3)
CL Item
CR by acute promyelocytic leukemia, hematological (4)
CL Item
CR by acute promyelocytic leukemia, molecular (5)
CL Item
Recurrence by acute promyelocytic leukemia, hematological (6)
CL Item
Recurrence by acute promyelocytic leukemia, molecular (7)
CL Item
CRi (8)
CL Item
CRp (9)
CL Item
Partial remission (10)
CL Item
Patient dead (11)
CL Item
Progression / refractory (12)
CL Item
can not be assessed (13)

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