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ID

13632

Description

Coronary Artery Bypass graft surgery in patients with Asymptomatic Carotid Stenosis. A randomized controlled clinical trial. Short title: "CABACS" DRKS Number:DRKS00000521 IRSCTN Number:ISRCTN13486906 Phase:Therapeutic confirmatory(Phase III) Head of clinical trial: Prof. Dr. med. Christian Weimar University Duisburg-Essen Phone: 0201/723-6503 Fax: 0201/723-6948 e-mail: christian.weimar@uk-essen.de University Hospital Essen Hospital for Neurology Hufelandstr. 55 45122 Essen Trial coordinator: Dr. med. Stephan Knipp Phone: 0201/723-4915 Fax: 0201/723-5451 e-mail: stephan.knipp@uk-essen.de University Duisburg-Essen University Hospital Essen Hospital for thoracic- and cardiovascular surgery Hufelandstr. 55 45122 Essen Data Management: Anja Marr Phone: 0201/92239-257 Fax: 0201/92239-333 o. 0201/723-5933 e-mail: anja.marr@uk-essen.de University Hospital Essen Center for clinical trials Essen c/o IMIBE Hufelandstr. 55 45122 Essen Monitoring: Dipl.-Biol. Konstantinos Bilbilis Phone: 0201/92239-252 Fax: 0201/92239-310 e-mail: konstantinos.bilbilis@uk-essen.de University Hospital Essen Center for clinical trials Essen c/o IMIBE Hufelandstr. 55 45122 Essen

Keywords

  1. 2/22/16 2/22/16 -
Uploaded on

February 22, 2016

DOI

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License

Creative Commons BY-NC 3.0

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    Medical History Coronary Artery Bypass graft surgery in patients with Asymptomatic Carotid Stenosis DRKS00000521

    CABACS Case Report Form [Medical History]

    Medical history
    Description

    Medical history

    Date of screening for trial
    Description

    Date of screening

    Data type

    date

    Alias
    UMLS CUI [1,1]
    C0011008
    UMLS CUI [1,2]
    C1710477
    Patient ID
    Description

    Patient Study ID

    Data type

    integer

    Alias
    UMLS CUI [1]
    C2348585
    Month of birth
    Description

    Month of birth

    Data type

    integer

    Alias
    UMLS CUI [1]
    C0439231
    Year of birth
    Description

    Year of birth

    Data type

    integer

    Alias
    UMLS CUI [1]
    C2826771
    Gender
    Description

    Gender

    Data type

    integer

    Alias
    UMLS CUI [1]
    C0079399
    Body Height
    Description

    Body Height

    Data type

    integer

    Measurement units
    • cm
    Alias
    UMLS CUI [1]
    C0005890
    cm
    Body Weight
    Description

    Body Weight

    Data type

    float

    Measurement units
    • kg
    Alias
    UMLS CUI [1]
    C0005910
    kg
    Hypertensive disease
    Description

    Hypertension

    Data type

    boolean

    Alias
    UMLS CUI [1]
    C0020538
    Hyperlipidemia
    Description

    Hyperlipidemia

    Data type

    boolean

    Alias
    UMLS CUI [1]
    C0020473
    Smoking status
    Description

    Substance use disorder

    Data type

    text

    Alias
    UMLS CUI [1]
    C0038586
    If you are a former smoker, when did you quit smoking?
    Description

    Former smoker

    Data type

    text

    Alias
    UMLS CUI [1]
    C0337671
    Anatomical position of carotid stenosis
    Description

    Anatomical position of carotid stenosis

    Data type

    text

    Alias
    UMLS CUI [1,1]
    C0007282
    UMLS CUI [1,2]
    C0277809
    Prior carotid TEA
    Description

    Prior carotid TEA

    Data type

    text

    Alias
    UMLS CUI [1,1]
    C0162363
    UMLS CUI [1,2]
    C0007272
    Prior carotid TEA:please give the year of the procedure
    Description

    Prior carotid TEA

    Data type

    integer

    Alias
    UMLS CUI [1]
    C0007272
    Are there any other relevant comorbidities? Please specify below
    Description

    Comorbidities

    Data type

    boolean

    Alias
    UMLS CUI [1]
    C0009488
    Please specify comorbidities by ICD-Code or Diagnosis
    Description

    Comorbidities

    Data type

    text

    Alias
    UMLS CUI [1]
    C0009488
    Please give the year, the comorbidity was first diagnosed
    Description

    Start date

    Data type

    integer

    Alias
    UMLS CUI [1]
    C0011008
    Is the symptom/comorbidity persistent?
    Description

    Ongoing

    Data type

    boolean

    Alias
    UMLS CUI [1]
    C0549178
    Date of completion of this form
    Description

    Date of completion

    Data type

    date

    Alias
    UMLS CUI [1]
    C0011008
    Signature by Investigator
    Description

    Signature

    Data type

    text

    Alias
    UMLS CUI [1]
    C1519316
    Name of Investigator
    Description

    Name of Investigator

    Data type

    text

    Alias
    UMLS CUI [1]
    C0008961

    Similar models

    CABACS Case Report Form [Medical History]

    Name
    Type
    Description | Question | Decode (Coded Value)
    Data type
    Alias
    Item Group
    Medical history
    Date of screening
    Item
    Date of screening for trial
    date
    C0011008 (UMLS CUI [1,1])
    C1710477 (UMLS CUI [1,2])
    Patient Study ID
    Item
    Patient ID
    integer
    C2348585 (UMLS CUI [1])
    Month of birth
    Item
    Month of birth
    integer
    C0439231 (UMLS CUI [1])
    Year of birth
    Item
    Year of birth
    integer
    C2826771 (UMLS CUI [1])
    Item
    Gender
    integer
    C0079399 (UMLS CUI [1])
    Code List
    Gender
    CL Item
    male (1)
    CL Item
    female (2)
    Body Height
    Item
    Body Height
    integer
    C0005890 (UMLS CUI [1])
    Body Weight
    Item
    Body Weight
    float
    C0005910 (UMLS CUI [1])
    Hypertension
    Item
    Hypertensive disease
    boolean
    C0020538 (UMLS CUI [1])
    Hyperlipidemia
    Item
    Hyperlipidemia
    boolean
    C0020473 (UMLS CUI [1])
    Item
    Smoking status
    text
    C0038586 (UMLS CUI [1])
    Code List
    Smoking status
    CL Item
    Never (1)
    CL Item
    Quit smoking (2)
    CL Item
    smoker (3)
    Item
    If you are a former smoker, when did you quit smoking?
    text
    C0337671 (UMLS CUI [1])
    Code List
    If you are a former smoker, when did you quit smoking?
    CL Item
    ≥ 5 years (1)
    CL Item
    < 5 years (2)
    Item
    Anatomical position of carotid stenosis
    text
    C0007282 (UMLS CUI [1,1])
    C0277809 (UMLS CUI [1,2])
    Code List
    Anatomical position of carotid stenosis
    CL Item
    ACC right (1)
    CL Item
    ACC left (2)
    CL Item
    ACI right (3)
    CL Item
    ACI left (4)
    Item
    Prior carotid TEA
    text
    C0162363 (UMLS CUI [1,1])
    C0007272 (UMLS CUI [1,2])
    Code List
    Prior carotid TEA
    CL Item
    No (1)
    CL Item
    right side (2)
    CL Item
    left side (3)
    Prior carotid TEA
    Item
    Prior carotid TEA:please give the year of the procedure
    integer
    C0007272 (UMLS CUI [1])
    Comorbidities
    Item
    Are there any other relevant comorbidities? Please specify below
    boolean
    C0009488 (UMLS CUI [1])
    Comorbidities
    Item
    Please specify comorbidities by ICD-Code or Diagnosis
    text
    C0009488 (UMLS CUI [1])
    Start date
    Item
    Please give the year, the comorbidity was first diagnosed
    integer
    C0011008 (UMLS CUI [1])
    Ongoing
    Item
    Is the symptom/comorbidity persistent?
    boolean
    C0549178 (UMLS CUI [1])
    Date of completion
    Item
    Date of completion of this form
    date
    C0011008 (UMLS CUI [1])
    Signature
    Item
    Signature by Investigator
    text
    C1519316 (UMLS CUI [1])
    Name of Investigator
    Item
    Name of Investigator
    text
    C0008961 (UMLS CUI [1])

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