ID

1566

Beskrivning

Z6051 Mayo Bowel Function Questionnaire (MBFQ) Laparoscopic-Assisted Resection or Open Resection in Treating Patients With Stage IIA, Stage IIIA, or Stage IIIB Rectal Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=4AEB4B3D-5518-0337-E044-0003BA3F9857

Länk

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=4AEB4B3D-5518-0337-E044-0003BA3F9857

Nyckelord

Versioner (3)
  1. 2012-08-27 2012-08-27 -
  2. 2015-01-09 2015-01-09 - Martin Dugas
  3. 2015-06-26 2015-06-26 -
Uppladdad den

27 augusti 2012

DOI

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Licens

Creative Commons BY-NC 3.0 Legacy
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Colorectal Cancer NCT00726622 Quality of Life - Z6051 Mayo Bowel Function Questionnaire (MBFQ) - 2741266v1.0

Engelsk

No Instruction available.

1 Formulär  
  1. StudyEvent: Z6051 Mayo Bowel Function Questionnaire (MBFQ)
    1. No Instruction available.
Header Module
Beskrivning

Header Module

Visit
Beskrivning

AmericanCollegeofSurgeonsOncologyGroupVisitPeriodAmericanCollegeofSurgeonsOncologyGroupVisitPeriodType

Datatyp

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus Property
C25616
UMLS 2011AA Property
C1948053
NCI Thesaurus ObjectClass
C19712
UMLS 2011AA ObjectClass
C1515944
NCI Thesaurus ObjectClass
C25716
UMLS 2011AA ObjectClass
C0545082
Patient ID (Pt. ID issued during registration unless pt. previously registered to an ACOSOG study.)
Beskrivning

PatientCoordinatingIdentifierNumber

Datatyp

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25462
UMLS 2011AA Property
C0700114
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Patient Initials
Beskrivning

PatientInitialsName

Datatyp

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25536
UMLS 2011AA Property
C1555582
Institution Name
Beskrivning

InstitutionName

Datatyp

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C21541
UMLS 2011AA ObjectClass
C0018704
NCI Thesaurus ValueDomain
C21541
UMLS 2011AA ValueDomain
C0018704
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Institution No.
Beskrivning

InstitutionIdentifierNumber

Datatyp

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C21541
UMLS 2011AA ObjectClass
C0018704
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Date
Beskrivning

AssessmentPerformedDate

Datatyp

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C25367
NCI Thesaurus ValueDomain
C25367
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
Unnamed 1
Beskrivning

Unnamed 1

Overall, would you say that you had problems with your bowel function in the past week?
Beskrivning

BowelPatientProblemAssessmentInd-2

Datatyp

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass
C12736
UMLS 2011AA ObjectClass
C0021853
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property
C28020
UMLS 2011AA Property
C0033213
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
In the past week, what is the greatest number of bowel movements you have had in a day?
Beskrivning

BowelPatientFrequencyAssessmentCount

Datatyp

double

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass
C12736
UMLS 2011AA ObjectClass
C0021853
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property
C25515
UMLS 2011AA Property
C0439603
NCI Thesaurus ValueDomain
C25463
UMLS 2011AA ValueDomain
C0750480
In the past week, have you had a problem causing you to get up at night to have a bowel movement?
Beskrivning

BowelPatientInsomniaAssessmentInd-2

Datatyp

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass
C12736
UMLS 2011AA ObjectClass
C0021853
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property
C28286
UMLS 2011AA Property
C0917801
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
In the past week, have you had a problem causing you to have a bowel movement within 30 minutes of a prior bowel movement?
Beskrivning

BowelPatientFrequencyAssessmentInd-2

Datatyp

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass
C12736
UMLS 2011AA ObjectClass
C0021853
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property
C25515
UMLS 2011AA Property
C0439603
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
In the past week, have you had a problem causing you to lose control of your bowel movements?
Beskrivning

BowelPatientIncontinenceAssessmentInd-2

Datatyp

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass
C12736
UMLS 2011AA ObjectClass
C0021853
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus Property
C0021167
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
In the past week, have you had to wear protective clothing or a pad in case you lost control of a bowel movement?
Beskrivning

BowelPatientUndergarmentAssessmentInd-2

Datatyp

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass
C12736
UMLS 2011AA ObjectClass
C0021853
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus Property
C0453880
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
In the past week, have you had a problem causing you to be unable to tell the difference between a stool and gas?
Beskrivning

BowelPatientFlatulenceAssessmentInd-2

Datatyp

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass
C12736
UMLS 2011AA ObjectClass
C0021853
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property
C37954
UMLS 2011AA Property
C0016204
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
In the past week, have you had a problem causing you to have stools that are liquid?
Beskrivning

BowelPatientDiarrheaSeverityAssessmentInd-2

Datatyp

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass
C12736
UMLS 2011AA ObjectClass
C0021853
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property
C25676
UMLS 2011AA Property
C0439793
NCI Metathesaurus Property
C0011991
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
In the past week, have you found that once you feel the urge to have a bowel movement, you must do so within 15 minutes to avoid an accident?
Beskrivning

BowelPatientDefecationUrgencyAssessmentInd-2

Datatyp

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass
C12736
UMLS 2011AA ObjectClass
C0021853
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus Property
C0426636
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Do you have any other problems or comments you would like to make about your bowel function over the past week
Beskrivning

BowelPatientOtherProblemAssessmentInd-2

Datatyp

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass
C12736
UMLS 2011AA ObjectClass
C0021853
NCI Thesaurus Property
C17649
UMLS 2011AA Property
C0205394
NCI Thesaurus Property
C25367
NCI Thesaurus Property
C28020
UMLS 2011AA Property
C0033213
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Do you have any other problems or comments you would like to make about your bowel function over the past week
Beskrivning

BowelPatientOtherProblemAssessmentSpecify

Datatyp

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass
C12736
UMLS 2011AA ObjectClass
C0021853
NCI Thesaurus Property
C17649
UMLS 2011AA Property
C0205394
NCI Thesaurus Property
C25367
NCI Thesaurus Property
C28020
UMLS 2011AA Property
C0033213
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
Was there any thing that confused or bothered you about the previous questions?
Beskrivning

BowelPatientQuestionnaireConfusionAssessmentInd-2

Datatyp

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass
C12736
UMLS 2011AA ObjectClass
C0021853
NCI Thesaurus Property
C17048
UMLS 2011AA Property
C0034394
NCI Thesaurus Property
C25367
NCI Thesaurus Property
C37928
UMLS 2011AA Property
C0009676
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Was there any thing that confused or bothered you about the previous questions?
Beskrivning

BowelPatientQuestionnaireConfusionAssessmentSpecify

Datatyp

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass
C12736
UMLS 2011AA ObjectClass
C0021853
NCI Thesaurus Property
C17048
UMLS 2011AA Property
C0034394
NCI Thesaurus Property
C25367
NCI Thesaurus Property
C37928
UMLS 2011AA Property
C0009676
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
In the past week, have you had cramping with a bowel movement?
Beskrivning

BowelPatientAbdominalCrampAssessmentInd-2

Datatyp

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass
C12736
UMLS 2011AA ObjectClass
C0021853
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property
C34331
UMLS 2011AA Property
C0000729
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Is your cramping (If yes,)
Beskrivning

BowelPatientAbdominalCrampAssessmentGrade

Datatyp

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass
C12736
UMLS 2011AA ObjectClass
C0021853
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property
C34331
UMLS 2011AA Property
C0000729
NCI Thesaurus ValueDomain
C18000
UMLS 2011AA ValueDomain
C0919553
In the past week, have you had blood in your bowel movement?
Beskrivning

BowelPatientBloodFecesAssessmentInd-2

Datatyp

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass
C12736
UMLS 2011AA ObjectClass
C0021853
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property
C12434
UMLS 2011AA Property
C0229664
NCI Thesaurus Property
C13234
UMLS 2011AA Property
C0015733
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Check the description that best describes the amount of blood in your bowel movement
Beskrivning

BowelPatientBloodFecesAssessmentType

Datatyp

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass
C12736
UMLS 2011AA ObjectClass
C0021853
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property
C12434
UMLS 2011AA Property
C0229664
NCI Thesaurus Property
C13234
UMLS 2011AA Property
C0015733
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
In the past week, how much have problems with bowel movements affected your normal activities?
Beskrivning

BowelPatientRoutineActivityAssessmentGrade

Datatyp

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass
C12736
UMLS 2011AA ObjectClass
C0021853
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property
C43431
UMLS 2011AA Property
C0441655
NCI Thesaurus Property
C47893
UMLS 2011AA Property
C0205547
NCI Thesaurus ValueDomain
C18000
UMLS 2011AA ValueDomain
C0919553
How would you describe your overall Quality of Life?
Beskrivning

PatientQualityofLifeAssessmentScore

Datatyp

text

Alias
NCI Thesaurus Property
C17047
UMLS 2011AA Property
C0518214
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus ValueDomain
C25338
UMLS 2011AA ValueDomain
C0449820
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Similar models

No Instruction available.

1 Formulär
  1. StudyEvent: Z6051 Mayo Bowel Function Questionnaire (MBFQ)
    1. No Instruction available.
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
Header Module
Item
Visit
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25616 (NCI Thesaurus Property)
C1948053 (UMLS 2011AA Property)
C19712 (NCI Thesaurus ObjectClass)
C1515944 (UMLS 2011AA ObjectClass)
C25716 (NCI Thesaurus ObjectClass)
C0545082 (UMLS 2011AA ObjectClass)
CL.1
Code List
Visit
CL Item
1-2 Weeks Post-surgery (1-2 weeks post-surgery)
CL Item
3-4 Weeks Post-surgery (3-4 weeks post-surgery)
CL Item
4-6 Weeks Post-surgery (4-6 weeks post-surgery)
CL Item
Month 3 (Month 3)
CL Item
Month 12 (Month 12)
PatientCoordinatingIdentifierNumber
Item
Patient ID (Pt. ID issued during registration unless pt. previously registered to an ACOSOG study.)
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25462 (NCI Thesaurus Property)
C0700114 (UMLS 2011AA Property)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
PatientInitialsName
Item
Patient Initials
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25536 (NCI Thesaurus Property)
C1555582 (UMLS 2011AA Property)
InstitutionName
Item
Institution Name
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C21541 (NCI Thesaurus ObjectClass)
C0018704 (UMLS 2011AA ObjectClass)
C21541 (NCI Thesaurus ValueDomain)
C0018704 (UMLS 2011AA ValueDomain)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
InstitutionIdentifierNumber
Item
Institution No.
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C21541 (NCI Thesaurus ObjectClass)
C0018704 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
AssessmentPerformedDate
Item
Date
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ObjectClass)
C25367 (NCI Thesaurus ValueDomain)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
Item Group
Unnamed 1
Item
Overall, would you say that you had problems with your bowel function in the past week?
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C12736 (NCI Thesaurus ObjectClass)
C0021853 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
CL.2
Code List
Overall, would you say that you had problems with your bowel function in the past week?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
BowelPatientFrequencyAssessmentCount
Item
In the past week, what is the greatest number of bowel movements you have had in a day?
double
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C12736 (NCI Thesaurus ObjectClass)
C0021853 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25515 (NCI Thesaurus Property)
C0439603 (UMLS 2011AA Property)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
Item
In the past week, have you had a problem causing you to get up at night to have a bowel movement?
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C12736 (NCI Thesaurus ObjectClass)
C0021853 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C28286 (NCI Thesaurus Property)
C0917801 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
CL.3
Code List
In the past week, have you had a problem causing you to get up at night to have a bowel movement?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
In the past week, have you had a problem causing you to have a bowel movement within 30 minutes of a prior bowel movement?
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C12736 (NCI Thesaurus ObjectClass)
C0021853 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25515 (NCI Thesaurus Property)
C0439603 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
CL.4
Code List
In the past week, have you had a problem causing you to have a bowel movement within 30 minutes of a prior bowel movement?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
In the past week, have you had a problem causing you to lose control of your bowel movements?
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C12736 (NCI Thesaurus ObjectClass)
C0021853 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0021167 (NCI Metathesaurus Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
CL.5
Code List
In the past week, have you had a problem causing you to lose control of your bowel movements?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
In the past week, have you had to wear protective clothing or a pad in case you lost control of a bowel movement?
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C12736 (NCI Thesaurus ObjectClass)
C0021853 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0453880 (NCI Metathesaurus Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
CL.6
Code List
In the past week, have you had to wear protective clothing or a pad in case you lost control of a bowel movement?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
In the past week, have you had a problem causing you to be unable to tell the difference between a stool and gas?
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C12736 (NCI Thesaurus ObjectClass)
C0021853 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C37954 (NCI Thesaurus Property)
C0016204 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
CL.7
Code List
In the past week, have you had a problem causing you to be unable to tell the difference between a stool and gas?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
In the past week, have you had a problem causing you to have stools that are liquid?
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C12736 (NCI Thesaurus ObjectClass)
C0021853 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25676 (NCI Thesaurus Property)
C0439793 (UMLS 2011AA Property)
C0011991 (NCI Metathesaurus Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
CL.8
Code List
In the past week, have you had a problem causing you to have stools that are liquid?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
In the past week, have you found that once you feel the urge to have a bowel movement, you must do so within 15 minutes to avoid an accident?
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C12736 (NCI Thesaurus ObjectClass)
C0021853 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0426636 (NCI Metathesaurus Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
CL.9
Code List
In the past week, have you found that once you feel the urge to have a bowel movement, you must do so within 15 minutes to avoid an accident?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Do you have any other problems or comments you would like to make about your bowel function over the past week
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C12736 (NCI Thesaurus ObjectClass)
C0021853 (UMLS 2011AA ObjectClass)
C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
CL.10
Code List
Do you have any other problems or comments you would like to make about your bowel function over the past week
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
BowelPatientOtherProblemAssessmentSpecify
Item
Do you have any other problems or comments you would like to make about your bowel function over the past week
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C12736 (NCI Thesaurus ObjectClass)
C0021853 (UMLS 2011AA ObjectClass)
C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
Item
Was there any thing that confused or bothered you about the previous questions?
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C12736 (NCI Thesaurus ObjectClass)
C0021853 (UMLS 2011AA ObjectClass)
C17048 (NCI Thesaurus Property)
C0034394 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property)
C37928 (NCI Thesaurus Property)
C0009676 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
CL.11
Code List
Was there any thing that confused or bothered you about the previous questions?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
BowelPatientQuestionnaireConfusionAssessmentSpecify
Item
Was there any thing that confused or bothered you about the previous questions?
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C12736 (NCI Thesaurus ObjectClass)
C0021853 (UMLS 2011AA ObjectClass)
C17048 (NCI Thesaurus Property)
C0034394 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property)
C37928 (NCI Thesaurus Property)
C0009676 (UMLS 2011AA Property)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
Item
In the past week, have you had cramping with a bowel movement?
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C12736 (NCI Thesaurus ObjectClass)
C0021853 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C34331 (NCI Thesaurus Property)
C0000729 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
CL.12
Code List
In the past week, have you had cramping with a bowel movement?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Is your cramping (If yes,)
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C12736 (NCI Thesaurus ObjectClass)
C0021853 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C34331 (NCI Thesaurus Property)
C0000729 (UMLS 2011AA Property)
C18000 (NCI Thesaurus ValueDomain)
C0919553 (UMLS 2011AA ValueDomain)
CL.13
Code List
Is your cramping (If yes,)
CL Item
Mild (mild)
C70666 (NCI Thesaurus)
C2945599 (UMLS 2011AA)
CL Item
Moderate (moderate)
CL Item
Severe (severe)
Item
In the past week, have you had blood in your bowel movement?
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C12736 (NCI Thesaurus ObjectClass)
C0021853 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C12434 (NCI Thesaurus Property)
C0229664 (UMLS 2011AA Property)
C13234 (NCI Thesaurus Property)
C0015733 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
CL.14
Code List
In the past week, have you had blood in your bowel movement?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Check the description that best describes the amount of blood in your bowel movement
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C12736 (NCI Thesaurus ObjectClass)
C0021853 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C12434 (NCI Thesaurus Property)
C0229664 (UMLS 2011AA Property)
C13234 (NCI Thesaurus Property)
C0015733 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.15
Code List
Check the description that best describes the amount of blood in your bowel movement
CL Item
Enough To Turn Water In Toliet Bowel Red (Enough to turn water in toliet bowel red)
CL Item
Mixed With Or Coating Bowel Movement (Mixed with or coating bowel movement)
CL Item
On Toliet Tissue Only (On toliet tissue only)
Item
In the past week, how much have problems with bowel movements affected your normal activities?
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C12736 (NCI Thesaurus ObjectClass)
C0021853 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C43431 (NCI Thesaurus Property)
C0441655 (UMLS 2011AA Property)
C47893 (NCI Thesaurus Property)
C0205547 (UMLS 2011AA Property)
C18000 (NCI Thesaurus ValueDomain)
C0919553 (UMLS 2011AA ValueDomain)
CL.16
Code List
In the past week, how much have problems with bowel movements affected your normal activities?
CL Item
Mild - Not Interfering With Normal Life Activities (Mild - not interfering with normal life activities)
CL Item
Moderate - Requires Changes In One's Life Activities Due To Bowel Function (Moderate - requires changes in one's life activities due to bowel function)
CL Item
No Problems (No problems)
CL Item
Severe - Unable To Perform Normal Life Activities Due To Bowel Function (Severe - unable to perform normal life activities due to bowel function)
Item
How would you describe your overall Quality of Life?
text
C17047 (NCI Thesaurus Property)
C0518214 (UMLS 2011AA Property)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25338 (NCI Thesaurus ValueDomain)
C0449820 (UMLS 2011AA ValueDomain)
CL.17
Code List
How would you describe your overall Quality of Life?
CL Item
0 (0)
C0919414 (NCI Metathesaurus)
CL Item
1 (1)
CL Item
10 (10)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
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