ID

13484

Beschreibung

Randomized study with a run-in dose-selection phase to assess the added value of Lenalidomide in combination with standard remission-induction chemotherapy and post-remission treatment in patients aged 18-65 years with previously untreated acute myeloid leukemia (AML) or high risk myelodysplasia (MDS) (IPSS-R risk score> 4.5) Description of Form: Pregnancy Form

Stichworte

Versionen (3)
  1. 10.11.15 10.11.15 -
  2. 28.12.15 28.12.15 -
  3. 11.02.16 11.02.16 -
Hochgeladen am

11. Februar 2016

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.

Zurück zu Modell Kommentaren
Itemgroup Kommentare für :

Item Kommentare für :

Um Formulare herunterzuladen müssen Sie angemeldet sein. Bitte loggen Sie sich ein oder registrieren Sie sich kostenlos.

Pregnancy Form HOVON 132 AML/SAKK 30/13 EudraCT 2013-002843-26

Englisch

Pregnancy Form

1 Formulare  
  1. StudyEvent: ODM
    1. Pregnancy Form
Site Information
Beschreibung

Site Information

Alias
UMLS CUI-1
C2825164
Form completed by
Beschreibung

From completed by

Datentyp

text

Alias
UMLS CUI [1]
C0557514
Telephone Number
Beschreibung

TelephoneNumber

Datentyp

text

Alias
UMLS CUI [1]
C0039457
Date of initial report (within 24 hours)
Beschreibung

Pregnancy Report Date

Datentyp

date

Maßeinheiten
  • dd/mm/yyyy
Alias
UMLS CUI [1,1]
C0032961
UMLS CUI [1,2]
C0011008
dd/mm/yyyy
Date of follow up report (in case of new data).
Beschreibung

Date follow up

Datentyp

date

Maßeinheiten
  • dd/mm/yyyy
Alias
UMLS CUI [1,1]
C1522577
UMLS CUI [1,2]
C0011008
dd/mm/yyyy
Subject Information
Beschreibung

Subject Information

Alias
UMLS CUI-1
C2707520
Who has become pregnant?
Beschreibung

Who has become pregnant

Datentyp

integer

Alias
UMLS CUI [1]
C0032961
Date of Birth
Beschreibung

Date of Birth

Datentyp

date

Maßeinheiten
  • dd/mm/yyyy
Alias
UMLS CUI [1]
C0421451
dd/mm/yyyy
Start date of last menses
Beschreibung

last menses

Datentyp

date

Maßeinheiten
  • dd/mm/yyyy
Alias
UMLS CUI [1]
C0425932
dd/mm/yyyy
Date pregnancy confirmed
Beschreibung

Date pregnancy confirmed

Datentyp

date

Maßeinheiten
  • dd/mm/yyyy
Alias
UMLS CUI [1]
C2584394
dd/mm/yyyy
Anticipated date of childbirth
Beschreibung

Anticipated date of childbirth

Datentyp

date

Maßeinheiten
  • dd/mm/yyyy
Alias
UMLS CUI [1]
C2825543
dd/mm/yyyy
Trial Medication and Outcome
Beschreibung

Trial Medication and Outcome

Alias
UMLS CUI-1
C0013227
UMLS CUI-2
C0032972
Period of treatment/last given treatment at time of conception
Beschreibung

Period of treatment/last given treatment at time of conception

Datentyp

integer

Alias
UMLS CUI [1,1]
C1276413
UMLS CUI [1,2]
C2348792
Pregnancy outcome
Beschreibung

Pregnancy outcome

Datentyp

integer

Alias
UMLS CUI [1]
C0032972
Specify
Beschreibung

Specify

Datentyp

text

Alias
UMLS CUI [1]
C1521902
Comments
Beschreibung

Comments

Alias
UMLS CUI-1
C0947611
Zum Seitenanfang zurückkehren

Ähnliche Modelle

Pregnancy Form

1 Formulare
  1. StudyEvent: ODM
    1. Pregnancy Form
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Site Information
C2825164 (UMLS CUI-1)
From completed by
Item
Form completed by
text
C0557514 (UMLS CUI [1])
TelephoneNumber
Item
Telephone Number
text
C0039457 (UMLS CUI [1])
Pregnancy Report Date
Item
Date of initial report (within 24 hours)
date
C0032961 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Date follow up
Item
Date of follow up report (in case of new data).
date
C1522577 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item Group
Subject Information
C2707520 (UMLS CUI-1)
Item
Who has become pregnant?
integer
C0032961 (UMLS CUI [1])
Who has become pregnant
Code List
Who has become pregnant?
CL Item
female patient  (1)
C0150905 (UMLS CUI-1)
CL Item
partner of male patient (2)
C3874858 (UMLS CUI-1)
Date of Birth
Item
Date of Birth
date
C0421451 (UMLS CUI [1])
last menses
Item
Start date of last menses
date
C0425932 (UMLS CUI [1])
Date pregnancy confirmed
Item
Date pregnancy confirmed
date
C2584394 (UMLS CUI [1])
Anticipated date of childbirth
Item
Anticipated date of childbirth
date
C2825543 (UMLS CUI [1])
Item Group
Trial Medication and Outcome
C0013227 (UMLS CUI-1)
C0032972 (UMLS CUI-2)
Item
Period of treatment/last given treatment at time of conception
integer
C1276413 (UMLS CUI [1,1])
C2348792 (UMLS CUI [1,2])
Period of treatment/last given treatment at time of conception
Code List
Period of treatment/last given treatment at time of conception
CL Item
before start protocol treatment  (0)
C0087111 (UMLS CUI-1)
CL Item
induction cycle I (1)
C3179010 (UMLS CUI-1)
CL Item
induction cycle II  (2)
C3179010 (UMLS CUI-1)
CL Item
post induction cycle III (3)
C3179010 (UMLS CUI-1)
CL Item
autoHSCT  (4)
C0194037 (UMLS CUI-1)
CL Item
alloHSCT (5)
C1705576 (UMLS CUI-1)
CL Item
maintenance (1-6)  (11-16)
C0481504 (UMLS CUI-1)
CL Item
follow up  (17)
C1522577 (UMLS CUI-1)
CL Item
other* (18)
C0205394 (UMLS CUI-1)
Item
Pregnancy outcome
integer
C0032972 (UMLS CUI [1])
Pregnancy outcome
Code List
Pregnancy outcome
CL Item
not known at this date (please send in follow up report when new data are known) (1)
C0439673 (UMLS CUI-1)
CL Item
induced abortion (3)
C1704300 (UMLS CUI-1)
CL Item
spontaneous abortion (4)
C0000786 (UMLS CUI-1)
CL Item
still birth (5)
C0595939 (UMLS CUI-1)
CL Item
neonatal death (6)
C0410916 (UMLS CUI-1)
CL Item
birth defects (7)
C0000768 (UMLS CUI-1)
CL Item
other* (8)
C0205394 (UMLS CUI-1)
CL Item
uneventful (normal/healthy baby) (2)
C0686744 (UMLS CUI-1)
Specify
Item
Specify
text
C1521902 (UMLS CUI [1])
Item Group
Comments
C0947611 (UMLS CUI-1)
Zum Seitenanfang zurückkehren 

Kontakt

Benutzen Sie dieses Formular für Rückmeldungen, Fragen und Verbesserungsvorschläge.

Mit * gekennzeichnete Felder sind notwendig.

Hilfe

Benötigen Sie Hilfe bei der Suche? Um mehr Details zu erfahren und die Suche effektiver nutzen zu können schauen Sie sich doch das entsprechende Video auf unserer Tutorial Seite an.

Zum Video