Informationen:
Fehler:
ID
12441
Beschreibung
Hyper-PEI-protocol:a programme with regional deep hyperthermia(RHT)in combination with PEI-chemotherapy.The Hyper-PEI protocol is offered in place of the intensive standard chemotherapy for high-risk patie nts with malignant, extracranial tumors. Patients have a measurable relapsed tumor,or a primary tumor that did not respond sufficiently to treatment according to standard protocols. Responsible MD: PD Dr. med. R Wessalowski, Clinic for pediatric oncology,haematology and immunology UKD, Moorenstr. 5, 40225 Dusseldorf Form has to be completed by cooperating center or clinic after inclusion and sent to the Hyper-PEI director.
Stichworte
Versionen (1)
- 19.11.15 19.11.15 - Julian Varghese
Hochgeladen am
19. November 2015
DOI
Für eine Beantragung loggen Sie sich ein.
Lizenz
Creative Commons BY-NC 3.0
Modell Kommentare :
Hier können Sie das Modell kommentieren. Über die Sprechblasen an den Itemgruppen und Items können Sie diese spezifisch kommentieren.
Itemgroup Kommentare für :
Item Kommentare für :
Um Formulare herunterzuladen müssen Sie angemeldet sein. Bitte loggen Sie sich ein oder registrieren Sie sich kostenlos.
Initial Visit Hyperthermia Treatment Study
Initial Visit Hyperthermia Treatment Study
- StudyEvent: ODM
Ähnliche Modelle
Initial Visit Hyperthermia Treatment Study
- StudyEvent: ODM
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Patient Name
Item
Patient Name
text
C1299487 (UMLS CUI [1])
Inclusion confirmation
Item
Inclusion confirmed by Hyper-PEI leader
boolean
C1512693 (UMLS CUI [1])
Date
Item
Date
date
C0011008 (UMLS CUI [1])
Regimen
Item
Treatment Regimen
text
C0949219 (UMLS CUI [1])
Start date
Item
Start date
date
C0808070 (UMLS CUI [1])
End date
Item
End date
date
C0806020 (UMLS CUI [1])
CL Item
yes no=no not known=not known (yes)
CL Item
yes no=no not known=not known (yes)
CL Item
yes no=no not known=not known (yes)
CL Item
yes no=no not known=not known (yes)
CL Item
yes no=no not known=not known (yes)
CL Item
yes no=no not known=not known (yes)
CL Item
yes no=no not known=not known (yes)
Regimen
Item
Treatment Regimen
text
C0949219 (UMLS CUI [1])
Start date
Item
Start date
date
C0808070 (UMLS CUI [1])
End date
Item
End date
date
C0806020 (UMLS CUI [1])
CL Item
yes no=no not known=not known (yes)
CL Item
yes no=no not known=not known (yes)
CL Item
yes no=no not known=not known (yes)
CL Item
yes no=no not known=not known (yes)
CL Item
yes no=no not known=not known (yes)
CL Item
yes no=no not known=not known (yes)
CL Item
yes no=no not known=not known (yes)
Localisation
Item
Localisation
text
C0475264 (UMLS CUI [1,1])
C0027651 (UMLS CUI [1,2])
C0027651 (UMLS CUI [1,2])
TumorLargestDimensionMeasurement
Item
Dimension 1
float
C0242485 (UMLS CUI [1,1])
C0027651 (UMLS CUI [1,2])
C0027651 (UMLS CUI [1,2])
TumorSecondDimensionMeasurement
Item
Dimension 2
float
C0242485 (UMLS CUI [1,1])
C0027651 (UMLS CUI [1,2])
C0027651 (UMLS CUI [1,2])
CL Item
x-ray, 2=CT, 3=MRI, 4=Ultrasound (1)
Item
Is there evidence of metastasis
text
C2939420 (UMLS CUI [1,1])
C1515974 (UMLS CUI [1,2])
C1515974 (UMLS CUI [1,2])
CL Item
yes , no=no , not known=not known (yes)
MetastasisLargestDimensionMeasurement
Item
Dimension 1
float
C0242485 (UMLS CUI [1,1])
C0027651 (UMLS CUI [1,2])
C0027651 (UMLS CUI [1,2])
MetastasisSecondDimensionMeasurement
Item
Dimension 2
float
C0242485 (UMLS CUI [1,1])
C0027651 (UMLS CUI [1,2])
C0027651 (UMLS CUI [1,2])
CL Item
X-ray , 2=CT , 3=MRI , 4=Ultrasound (1)
Date
Item
Date
date
C0011008 (UMLS CUI [1])
Child Development
Item
Has the childhood development been normal before diagnose
text
C0008071 (UMLS CUI [1])
CL Item
yes , no=no , not know=not known (yes)
CL Item
yes , no=no , not known=not known (yes)
CL Item
yes , no=no , not known=not known (yes)
CL Item
yes , no=no , not known=not known (yes)
Childhood diseases
Item
History of childhood diseases
text
C0489532 (UMLS CUI [1])
CL Item
yes , no=no, not known=not known (yes)
CL Item
yes , no=no , not know=not known (yes)
CL Item
yes , no=no , not known=not known (yes)
CL Item
yes , no=no , not known=not known (yes)
CL Item
yes , no=no , not known=not known (yes)
CL Item
yes , no=no , not known=not known (yes)
CL Item
yes , no=no , not known=not known (yes)
CL Item
yes , no=no, not known=not known (yes)
Side effects
Item
If yes, please specify
text
C0041755 (UMLS CUI [1])
Code List
Other relevant diseases
CL Item
yes , no=no, not known=not known (yes)
Other relevant diseases
Item
If yes, please specify
text
C0012634 (UMLS CUI [1])
CL Item
yes , no=no, not known=not known (yes)
surgery
Item
If yes, please specify
text
C0038895 (UMLS CUI [1])
CL Item
yes , no=no , not known=not known (yes)
CL Item
yes , no=no , not known=not known (yes)
CL Item
yes , no=no, not known=not known (yes)
CL Item
yes , no=no, not known=not known (yes)
CL Item
yes , no=no, not known=not known (yes)
CL Item
yes , no=no, not known=not known (yes)
CL Item
yes , no=no, not known=not known (yes)
CL Item
yes , no=no, not known=not known (yes)
CL Item
yes , no=no, not known=not known (yes)
CL Item
yes , no=no, not known=not known (yes)
Findings
Item
Findings should be enclosed, no older than 4 weeks
text
C0243095 (UMLS CUI [1])
CL Item
infection (1)
CL Item
immunity (2)
CL Item
negative (3)
CL Item
not known (4)
CL Item
infection 2= immunity 3= negative 4= not known (1)
CL Item
infection 2= immunity 3= negative 4= not known (1)
CL Item
infection 2= immunity 3= negative 4= not known (1)
CL Item
infection 2= immunity 3= negative 4= not known (1)
CL Item
infection 2= immunity 3= negative 4= not known (1)
CL Item
infection 2= immunity 3= negative 4= not known (1)
CL Item
infection 2= immunity 3= negative 4= not known (1)
CL Item
infection 2= immunity 3= negative 4= not known (1)
CL Item
infection 2= immunity 3= negative 4= not known (1)
Findings
Item
Findings should be enclosed, no older than 4 weeks
text
C0243095 (UMLS CUI [1])
CL Item
infection 2= immunity 3= negative 4= not known (1)
CL Item
infection 2= immunity 3= negative 4= not known (1)
CL Item
infection 2= immunity 3= negative 4= not known (1)
Date
Item
Date
date
C0011008 (UMLS CUI [1])
Physician
Item
Treating Physician
text
C1710470 (UMLS CUI [1])
Responsible Person Signature
Item
Signature
text
C1550483 (UMLS CUI [1])