ID

13353

Descripción

Please note: 1) At first hospitalization please enter the antibiotic initially used in the first line! 2) Please enter the medication in chronological order! 3) Obligatory documentation starts with the date the (re-) hospitalization begins! If there is preexisting medication the starting date is determined as follows: a) First hospitalization = Date of first dose of antibiotic! b) Rehospitalization = Date of Rehospitalization! 4) Documentation of the last dose of any of the medication subject for documentation is only necessary until the regular end of the study.

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Versiones (2)
  1. 8/2/16 8/2/16 -
  2. 11/2/16 11/2/16 -
Titular de derechos de autor

CC BY-NC 3.0

Subido en

8 de febrero de 2016

DOI

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Licencia

Creative Commons BY-NC 3.0
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SacBo PZ: Case Report Form Hospitalization Medication subject to documentation

Inglés

SacBo PZ: Case Report Form Hospitalization Medication subject to documentation

1 formularios  
Antibiotics
Descripción

Antibiotics

Alias
UMLS CUI-1
C0003232
Number
Descripción

Number

Tipo de datos

text

Antibiotic group
Descripción

Antibiotic group

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C0003232
UMLS CUI [1,2]
C1515021
What was the indication for the treatment?
Descripción

Indication AAD-CDAD

Tipo de datos

integer

Alias
UMLS CUI [1]
C0578159
UMLS CUI [2]
C0235952
What is the ICD-10 code of the indication?
Descripción

Indication: ICD-10-Code Antibiotic

Tipo de datos

text

Alias
UMLS CUI [1]
C1137110
How was the antibiotic applied?
Descripción

Application of antibiotic

Tipo de datos

integer

Alias
UMLS CUI [1]
C0278296
When was the first dose applied?
Descripción

First dose

Tipo de datos

date

Alias
UMLS CUI [1,1]
C3174092
UMLS CUI [1,2]
C0205435
When was the last dose applied?
Descripción

Date of the last dose

Tipo de datos

date

Alias
UMLS CUI [1]
C1762893
If antibiotic was used: was the treatment terminated because of AAD/CDAD?
Descripción

If antibiotic was used: was the treatment terminated because of AAD/CDAD?

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0871548
When did treatment phase 1 end?
Descripción

According to the data obtained: End of treatment phase 1

Tipo de datos

date

Alias
UMLS CUI [1]
C2348563
Further medication subject to documentation
Descripción

Further medication subject to documentation

Whats is the number of the medication?
Descripción

Number of medication

Tipo de datos

text

What kind of medication was used?
Descripción

Medication

Tipo de datos

integer

Alias
UMLS CUI [1]
C0013227
When was the first dose of the medication used?
Descripción

First dose

Tipo de datos

date

Alias
UMLS CUI [1,1]
C3174092
UMLS CUI [1,2]
C0205435
When was the last dose of the medication used?
Descripción

Last dose

Tipo de datos

date

Alias
UMLS CUI [1]
C1762893
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Similar models

SacBo PZ: Case Report Form Hospitalization Medication subject to documentation

1 formularios
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
Antibiotics
C0003232 (UMLS CUI-1)
Number
Item
Number
text
Item
Antibiotic group
integer
C0003232 (UMLS CUI [1,1])
C1515021 (UMLS CUI [1,2])
Antibiotic group
Code List
Antibiotic group
CL Item
Beta-Lactam (1)
CL Item
Tetracycline (2)
CL Item
Aminoglycoside (3)
CL Item
Macrolide (4)
CL Item
Lincosamide (5)
CL Item
Gyrase inhibitor (6)
CL Item
Sulfonamide (7)
CL Item
Glykopeptide (8)
CL Item
Polypeptide (9)
CL Item
Nitroimidazole Derivative (10)
Item
What was the indication for the treatment?
integer
C0578159 (UMLS CUI [1])
C0235952 (UMLS CUI [2])
Indication AAD-CDAD
Code List
What was the indication for the treatment?
CL Item
Antibiotic-associated diarrhea (1)
CL Item
Clostridium difficile associated diarrhea (2)
Indication: ICD-10-Code Antibiotic
Item
What is the ICD-10 code of the indication?
text
C1137110 (UMLS CUI [1])
Item
How was the antibiotic applied?
integer
C0278296 (UMLS CUI [1])
Application of antibiotic
Code List
How was the antibiotic applied?
CL Item
oral (1)
CL Item
intravenous (2)
CL Item
intramuscular (3)
First dose
Item
When was the first dose applied?
date
C3174092 (UMLS CUI [1,1])
C0205435 (UMLS CUI [1,2])
Last dose
Item
When was the last dose applied?
date
C1762893 (UMLS CUI [1])
Treatment termination because of AAD/CDAD
Item
If antibiotic was used: was the treatment terminated because of AAD/CDAD?
boolean
C0871548 (UMLS CUI [1])
End of treatment phase 1
Item
When did treatment phase 1 end?
date
C2348563 (UMLS CUI [1])
Item Group
Further medication subject to documentation
Number of medication
Item
Whats is the number of the medication?
text
Item
What kind of medication was used?
integer
C0013227 (UMLS CUI [1])
Medication
Code List
What kind of medication was used?
CL Item
Laxatives (1)
CL Item
Opiates causing obstipation / other medication causing obstipation (2)
CL Item
systemic antifungal agents (3)
First dose
Item
When was the first dose of the medication used?
date
C3174092 (UMLS CUI [1,1])
C0205435 (UMLS CUI [1,2])
Last dose
Item
When was the last dose of the medication used?
date
C1762893 (UMLS CUI [1])
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