ID

13735

Beschrijving

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

Trefwoorden

  1. 01-03-16 01-03-16 -
Geüploaded op

1 maart 2016

DOI

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Licentie

Creative Commons BY-NC 3.0

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

CABACS Case Report Form [Neurological examination-NIH stroke scale]

NIH Stroke scale
Beschrijving

NIH Stroke scale

Date of visit
Beschrijving

Date

Datatype

date

Alias
UMLS CUI [1]
C0011008
Patient ID
Beschrijving

Patient Study ID

Datatype

text

Alias
UMLS CUI [1]
C2348585
Consciousness
Beschrijving

NIH-Stroke Scale Consciousness

Datatype

text

Alias
UMLS CUI [1,1]
C1697238
UMLS CUI [1,2]
C0517960
Orientation to age and month
Beschrijving

NIH-Stroke Scale Orientation

Datatype

text

Alias
UMLS CUI [1,1]
C1697238
UMLS CUI [1,2]
C2237121
Request patient to close eyes and to squeeze hand
Beschrijving

NIH-Stroke Scale

Datatype

integer

Alias
UMLS CUI [1]
C1697238
Eye movement
Beschrijving

NIH-Stroke Scale Eye movement

Datatype

integer

Alias
UMLS CUI [1,1]
C1697238
UMLS CUI [1,2]
C0015413
Peripheral vision
Beschrijving

NIH-Stroke Scale Peripheral vision

Datatype

integer

Alias
UMLS CUI [1,1]
C1697238
UMLS CUI [1,2]
C0234628
Facial expression
Beschrijving

NIH-Stroke Scale Facial expression

Datatype

text

Alias
UMLS CUI [1,1]
C1697238
UMLS CUI [1,2]
C0015457
Motor function of arms ( one arm at a time)
Beschrijving

NIH-Stroke Scale Motor function of arms

Datatype

integer

Alias
UMLS CUI [1,1]
C1697238
UMLS CUI [1,2]
C0234130
Motor function of legs (One leg at a time)
Beschrijving

NIH-Stroke Scale Motor function of legs

Datatype

integer

Alias
UMLS CUI [1,1]
C1697238
UMLS CUI [1,2]
C0234130
Ataxia
Beschrijving

NIH-Stroke Scale Ataxia

Datatype

integer

Alias
UMLS CUI [1,1]
C1697238
UMLS CUI [1,2]
C0004134
Sensibility
Beschrijving

NIH-Stroke Scale Sensibility

Datatype

integer

Alias
UMLS CUI [1,1]
C1697238
UMLS CUI [1,2]
C0439823
Verbal expression
Beschrijving

NIH-Stroke Scale Verbal expression

Datatype

integer

Alias
UMLS CUI [1,1]
C1697238
UMLS CUI [1,2]
C0150820
Speech
Beschrijving

NIH-Stroke Scale Speech

Datatype

text

Alias
UMLS CUI [1,1]
C1697238
UMLS CUI [1,2]
C0846595
Neglect
Beschrijving

NIH stroke scale Neglect

Datatype

text

Alias
UMLS CUI [1,1]
C1697238
UMLS CUI [1,2]
C0150088
Other neurologic deficits
Beschrijving

NIH stroke scale Other neurologic deficits

Datatype

text

Alias
UMLS CUI [1,1]
C1697238
UMLS CUI [1,2]
C0521654
Please specify other neurologic deficits
Beschrijving

Other neurologic deficits

Datatype

text

Alias
UMLS CUI [1]
C0521654
Date of completion of this form
Beschrijving

Date of completion

Datatype

date

Alias
UMLS CUI [1]
C0011008
Signature by investigator
Beschrijving

Signature

Datatype

text

Alias
UMLS CUI [1]
C1519316
Name of Investigator
Beschrijving

Name of Investigator

Datatype

text

Alias
UMLS CUI [1]
C0008961

Similar models

CABACS Case Report Form [Neurological examination-NIH stroke scale]

Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
NIH Stroke scale
Date
Item
Date of visit
date
C0011008 (UMLS CUI [1])
Patient Study ID
Item
Patient ID
text
C2348585 (UMLS CUI [1])
Item
Consciousness
text
C1697238 (UMLS CUI [1,1])
C0517960 (UMLS CUI [1,2])
Code List
Consciousness
CL Item
awake  (1)
CL Item
dazed,reaction to small stimuli  (2)
CL Item
stuporous,reaction only to repeated or strong stimuli  (3)
CL Item
comatose (4)
Item
Orientation to age and month
text
C1697238 (UMLS CUI [1,1])
C2237121 (UMLS CUI [1,2])
Code List
Orientation to age and month
CL Item
both answers correct  (1)
CL Item
one answer correct  (2)
CL Item
no answer correct (3)
Item
Request patient to close eyes and to squeeze hand
integer
C1697238 (UMLS CUI [1])
Code List
Request patient to close eyes and to squeeze hand
CL Item
followed both requests correctly  (1)
CL Item
followed one request correctly  (2)
CL Item
followed no request correctly (3)
Item
Eye movement
integer
C1697238 (UMLS CUI [1,1])
C0015413 (UMLS CUI [1,2])
Code List
Eye movement
CL Item
normal  (1)
CL Item
partial gaze palsy  (2)
CL Item
forced deviation (total gaze paresis) (3)
Item
Peripheral vision
integer
C1697238 (UMLS CUI [1,1])
C0234628 (UMLS CUI [1,2])
Code List
Peripheral vision
CL Item
normal  (1)
CL Item
partial visual field loss  (2)
CL Item
total hemianopsia  (3)
CL Item
bilateral hemianopsia or blindness (4)
Item
Facial expression
text
C1697238 (UMLS CUI [1,1])
C0015457 (UMLS CUI [1,2])
Code List
Facial expression
CL Item
normal  (1)
CL Item
little asymmetry  (2)
CL Item
partial paresis of lower half of the face  (3)
CL Item
total facial paresis (4)
Item
Motor function of arms ( one arm at a time)
integer
C1697238 (UMLS CUI [1,1])
C0234130 (UMLS CUI [1,2])
Code List
Motor function of arms ( one arm at a time)
CL Item
right: no dropping  (1)
CL Item
right: dropping of arm within 10 sec  (2)
CL Item
right:drops arm onto the pad,raise possible against gravity  (3)
CL Item
right:no active raise against gravity  (4)
CL Item
right:no movement at all  (5)
CL Item
right:amputation or joint immobility  (6)
CL Item
left: no dropping  (7)
CL Item
left: dropping of arm within 10 sec  (8)
CL Item
left:drops arm onto the pad,raise possible against gravity  (9)
CL Item
left:no active raise against gravity  (10)
CL Item
left:no movement at all  (11)
CL Item
left:amputation or joint immobility (12)
Item
Motor function of legs (One leg at a time)
integer
C1697238 (UMLS CUI [1,1])
C0234130 (UMLS CUI [1,2])
Code List
Motor function of legs (One leg at a time)
CL Item
right: no dropping  (1)
CL Item
right: dropping of leg within 10 sec  (2)
CL Item
right:drops leg onto the pad,raise possible against gravity  (3)
CL Item
right:no active raise against gravity  (4)
CL Item
right:no movement at all  (5)
CL Item
right:amputation or joint immobility  (6)
CL Item
left: no dropping  (7)
CL Item
left: dropping of leg within 10 sec  (8)
CL Item
left:drops leg onto the pad,raise possible against gravity  (9)
CL Item
left:no active raise against gravity  (10)
CL Item
left:no movement at all  (11)
CL Item
left:amputation or joint immobility (12)
Item
Ataxia
integer
C1697238 (UMLS CUI [1,1])
C0004134 (UMLS CUI [1,2])
Code List
Ataxia
CL Item
no ataxia or only related to paresis  (1)
CL Item
ataxia of one extremity  (2)
CL Item
ataxia of two or more extremities (3)
Item
Sensibility
integer
C1697238 (UMLS CUI [1,1])
C0439823 (UMLS CUI [1,2])
Code List
Sensibility
CL Item
normal  (1)
CL Item
partial loss of sensibility  (2)
CL Item
severe or total loss of sensibility (3)
Item
Verbal expression
integer
C1697238 (UMLS CUI [1,1])
C0150820 (UMLS CUI [1,2])
Code List
Verbal expression
CL Item
no aphasia  (1)
CL Item
reduced verbal fluency or reduced speech understanding  (2)
CL Item
severe aphasia or fragmented verbal expression  (3)
CL Item
global aphasia/Muteness (4)
Item
Speech
text
C1697238 (UMLS CUI [1,1])
C0846595 (UMLS CUI [1,2])
Code List
Speech
CL Item
normal  (1)
CL Item
slurred speech, but still understandable  (2)
CL Item
mute or unintelligible/ anarthria (3)
Item
Neglect
text
C1697238 (UMLS CUI [1,1])
C0150088 (UMLS CUI [1,2])
Code List
Neglect
CL Item
no neglect  (1)
CL Item
partial hemi-neglect of one quality  (2)
CL Item
severe hemi-neglect of more than one quality (3)
Item
Other neurologic deficits
text
C1697238 (UMLS CUI [1,1])
C0521654 (UMLS CUI [1,2])
Code List
Other neurologic deficits
CL Item
Yes  (1)
CL Item
No (2)
Other neurologic deficits
Item
Please specify other neurologic deficits
text
C0521654 (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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