ID

13576

Description

Phase 1 clinical trial for intrasurgical hyperthermic intraperitoneal chemoperfusion with cisplatin (HIPEC) in patients with ovarian cancer recidiv EudraCT Nr.: 2010-024352-28 Principal investigator und authorized representative of Sponsor: PD Dr. med. Oliver Zivanovic Center for Obstetrics and Gynaecology University Hospital Bonn Sigmund-Freud-Str. 25 53105 Bonn Sponsor: Rheinische Friedrich-Wilhelms-Universität Bonn represented by the Dean of Medical Faculty

Keywords

Versions (1)
  1. 2/17/16 2/17/16 -
Uploaded on

February 17, 2016

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License

Creative Commons BY-NC 3.0
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Concomitant medication Phase 1 clinical trial for intrasurgical hyperthermic intraperitoneal chemoperfusion with cisplatin (HIPEC) in patients with ovarian cancer recidiv

English

Case Report Form (HIPEC) Concomitant medication

1 forms  
Concomitant Medication Form
Description

Concomitant Medication Form

Patient ID
Description

Patient ID

Data type

integer

Alias
UMLS CUI [1]
C1269815
CRF number
Description

CRF number

Data type

integer

Alias
UMLS CUI [1,1]
C1516308
UMLS CUI [1,2]
C0449788
Concomitant agent name or generic substance
Description

Concomitant Agent

Data type

text

Alias
UMLS CUI [1]
C2347852
Please specify the daily dose of given medication
Description

Concomitant agent

Data type

float

Alias
UMLS CUI [1]
C2347852
Please specify the unit of the daily dose
Description

Concomitant agent

Data type

text

Alias
UMLS CUI [1]
C2347852
Dosage form
Description

Dosage form

Data type

text

Alias
UMLS CUI [1]
C0013058
Drug administration route
Description

Drug Administration Route

Data type

text

Alias
UMLS CUI [1]
C0013153
Indication for concomitant medication
Description

Indication

Data type

text

Alias
UMLS CUI [1]
C2826696
Concomitant agent start date
Description

Concomitant agent start date

Data type

date

Alias
UMLS CUI [1,1]
C2347852
UMLS CUI [1,2]
C0011008
Concomitant agent end date
Description

Concomitant agent end date

Data type

date

Alias
UMLS CUI [1,1]
C2347852
UMLS CUI [1,2]
C0011008
Continuing treatment with concomitant medication
Description

Ongoing treatment

Data type

boolean

Alias
UMLS CUI [1,1]
C0549178
UMLS CUI [1,2]
C2347852
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Similar models

Case Report Form (HIPEC) Concomitant medication

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Concomitant Medication Form
Patient ID
Item
Patient ID
integer
C1269815 (UMLS CUI [1])
CRF number
Item
CRF number
integer
C1516308 (UMLS CUI [1,1])
C0449788 (UMLS CUI [1,2])
Concomitant Agent
Item
Concomitant agent name or generic substance
text
C2347852 (UMLS CUI [1])
Concomitant agent
Item
Please specify the daily dose of given medication
float
C2347852 (UMLS CUI [1])
Concomitant agent
Item
Please specify the unit of the daily dose
text
C2347852 (UMLS CUI [1])
Item
Dosage form
text
C0013058 (UMLS CUI [1])
Dosage form
Code List
Dosage form
CL Item
Tablet (1)
CL Item
creme (2)
CL Item
spray (3)
CL Item
injection (4)
CL Item
suppository (5)
CL Item
oral drops/solution (6)
CL Item
infusion (7)
Item
Drug administration route
text
C0013153 (UMLS CUI [1])
Drug Administration Route
Code List
Drug administration route
CL Item
intramuscular (1)
CL Item
intravenous (2)
CL Item
per os (3)
CL Item
subcutaneous (4)
CL Item
transdermal (5)
CL Item
inhalative (6)
CL Item
rectally (7)
Indication
Item
Indication for concomitant medication
text
C2826696 (UMLS CUI [1])
Concomitant agent start date
Item
Concomitant agent start date
date
C2347852 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Concomitant agent end date
Item
Concomitant agent end date
date
C2347852 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Ongoing treatment
Item
Continuing treatment with concomitant medication
boolean
C0549178 (UMLS CUI [1,1])
C2347852 (UMLS CUI [1,2])
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