English

Echocardiography CARLA Follow-up

1 forms  
General information
Description

General information

Subject ID
Description

Subject ID

Data type

text

Alias
UMLS CUI [1]
C2348585
Examiner ID
Description

Examiner ID

Data type

text

Date of investigation
Description

Date of investigation

Data type

date

Beginning of investigation
Description

Time of beginning of echocardiografic investigation

Data type

time

Site of echocardiography device
Description

Site of echocardiography device

Data type

integer

Medical history: 1. Heart failure / Myocardial insufficiency
Description

Medical history: 1. Heart failure / Myocardial insufficiency

1. a) Have you been diagnosed with a heart disease?
Description

1. a) Heart disease

Data type

integer

1. b) Do you experience shortness of breath, fatigue, or palpitation during physical activity ?
Description

NYHA I = No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea (shortness of breath) NYHA II = Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea (shortness of breath). NYHA III = Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue, palpitation, or dyspnea. NYHA IV = Unable to carry on any physical activity without discomfort. Symptoms of heart failure at rest. If any physical activity is undertaken, discomfort increases.

Data type

integer

1. c) How often do you have these complaints?
Description

1. c) Frequency of complaints

Data type

integer

Medical history: 2. Angina pectoris / Coronary heart disease
Description

Medical history: 2. Angina pectoris / Coronary heart disease

2. a) Have you been diagnosed with coronary heart disease (CHD)?
Description

2. a) Coronary heart disease

Data type

integer

2. b) Do you experience chest pain during physical activity (angina pectoris)?
Description

Class I – Angina only during strenuous or prolonged physical activity Class II – Slight limitation, with angina only during vigorous physical activity Class III – Symptoms with everyday living activities, i.e., moderate limitation Class IV – Inability to perform any activity without angina or angina at rest, i.e., severe limitation

Data type

integer

2. c) How often do you have these complaints?
Description

2. c) Frequency of complaints

Data type

integer

Medical history: 3. Cardiac arrhythmia
Description

Medical history: 3. Cardiac arrhythmia

Do you suffer/Have you ever suffered from tachycardia?
Description

Tachycardia

Data type

integer

Do you suffer/Have you ever suffered from palpitations?
Description

Palpitations

Data type

integer

Do you suffer/Have you ever suffered from skipped heart beats?
Description

Skipped heart beats

Data type

integer

Cardiac arrhythmia: plain text diagnosis
Description

Cardiac arrhythmia: plain text diagnosis

Data type

text

Medical history: Medical history: Further symptoms of cardiac insufficiency
Description

Medical history: Medical history: Further symptoms of cardiac insufficiency

4. Did you experience a syncope during the past 12 months?
Description

4. Syncopes

Data type

integer

5. Are you able to lie down?
Description

5. Ability to lie down

Data type

integer

6. Do you suffer from water retention in the legs in the evening?
Description

6. Water retention in the legs

Data type

integer

Echocardiography
Description

Echocardiography

Parasternal investigation possible?
Description

Parasternal investigation possible?

Data type

integer

Apical investigation possible?
Description

Apical investigation possible?

Data type

integer

Completeness of investigated parameters
Description

Completeness of investigated parameters

Data type

integer

In case of incompleteness of parameters, please specify reason
Description

If investigated parameters are incomplete, please specify reason

Data type

integer

If other reason applies, please specify
Description

If other reason for incompleteness of parameters, please specify in plain text

Data type

text

Comments
Description

Comments

Data type

text

Control of findings/supervision by (physician ID):
Description

Control of findings/supervision by (physician ID):

Data type

text

End of echocardiography
Description

End of echocardiography

Data type

time

Measurement units
  • hh:mm
hh:mm
Data entry: Echocardiography
Description

Data entry: Echocardiography

1st data entry: DNo.
Description

1st data entry: DNo.

Data type

text

1st data entry: Date
Description

1st data entry: Date

Data type

date

2nd data entry: DNo.
Description

2nd data entry: DNo.

Data type

text

2nd data entry: Date
Description

2nd data entry: Date

Data type

date

1. Echocardiography Online-/Offline-Reading
Description

1. Echocardiography Online-/Offline-Reading

Reader number
Description

Reader number

Data type

text

Date of reading
Description

Date of reading

Data type

date

Beginning of reading
Description

Beginning of reading

Data type

time

Measurement units
  • hh:mm
hh:mm
Completeness of measured parameters
Description

Completeness of measured parameters

Data type

integer

In case of incompleteness of parameters, please specify reason
Description

If investigated parameters are incomplete, please specify reason

Data type

integer

If other reason applies, please specify
Description

If other reason for incompleteness of parameters, please specify in plain text

Data type

text

Comments
Description

Comments

Data type

text

Recommendation Text
Description

On the basis of findings from echocardiography; included in written report

Data type

text

Recommendation
Description

On the basis of findings from echocardiography; included in written report

Data type

integer

In case subject needs to be informed immediately, please specify
Description

Immediate information of subject

Data type

integer

Which results will the subject be informed about?
Description

Which results will the subject be informed about?

Data type

text

Signature of treating physician
Description

TreatingPhysicianSignatureText

Data type

text

Alias
UMLS CUI [1,1]
C1527021
UMLS CUI [1,2]
C1519316
UMLS CUI [1,3]
C1710470
Name of treating physician
Description

Name of treating physician

Data type

text

Data entry: Online-/Offline-Reading
Description

Data entry: Online-/Offline-Reading

1st data entry: DNo.
Description

1st data entry: DNo.

Data type

text

1st data entry: Date
Description

1st data entry: Date

Data type

date

2nd data entry: DNo.
Description

2nd data entry: DNo.

Data type

text

2nd data entry: Date
Description

2nd data entry: Date

Data type

date

2. Echocardiography Offline-Reading
Description

2. Echocardiography Offline-Reading

Subject ID
Description

Subject ID

Data type

text

Alias
UMLS CUI [1]
C2348585
Reader number
Description

Reader number

Data type

text

Date of reading
Description

Date of reading

Data type

date

Beginning of reading
Description

Beginning of reading

Data type

time

Measurement units
  • hh:mm
hh:mm
Completeness of measured parameters
Description

Completeness of measured parameters

Data type

integer

In case of incompleteness of parameters, please specify reason
Description

If investigated parameters are incomplete, please specify reason

Data type

integer

If other reason applies, please specify
Description

If other reason for incompleteness of parameters, please specify in plain text

Data type

text

Comments
Description

Comments

Data type

text

Signature of treating physician
Description

TreatingPhysicianSignatureText

Data type

text

Alias
UMLS CUI [1,1]
C1527021
UMLS CUI [1,2]
C1519316
UMLS CUI [1,3]
C1710470
Name of treating physician
Description

Name of treating physician

Data type

text

End of Echo-Reading
Description

End of Echo-Reading

Data type

time

Measurement units
  • hh:mm
hh:mm
Data entry: Offline-Reading
Description

Data entry: Offline-Reading

1st data entry: DNo.
Description

1st data entry: DNo.

Data type

text

1st data entry: Date
Description

1st data entry: Date

Data type

date

2nd data entry: DNo.
Description

2nd data entry: DNo.

Data type

text

2nd data entry: Date
Description

2nd data entry: Date

Data type

date

Final evaluation of medical investigations
Description

Final evaluation of medical investigations

Physician ID
Description

Physician ID

Data type

text

Date
Description

Date

Data type

date

ECG evaluation: medical diagnosis
Description

ECG evaluation: medical diagnosis

Data type

text

Recommendation Text
Description

On the basis of findings from findings such as blood pressure, ECG, BMI; included in written report

Data type

text

Recommendation
Description

On the basis of findings from echocardiography; included in written report

Data type

integer

In case subject needs to be informed immediately, please specify
Description

Immediate information of subject

Data type

integer

Which results will the subject be informed about?
Description

Which results will the subject be informed about?

Data type

text

Signature of treating physician
Description

TreatingPhysicianSignatureText

Data type

text

Alias
UMLS CUI [1,1]
C1527021
UMLS CUI [1,2]
C1519316
UMLS CUI [1,3]
C1710470
Name of treating physician
Description

Name of treating physician

Data type

text

Data entry: Final evaluation
Description

Data entry: Final evaluation

1st data entry: DNo.
Description

1st data entry: DNo.

Data type

text

1st data entry: Date
Description

1st data entry: Date

Data type

date

2nd data entry: DNo.
Description

2nd data entry: DNo.

Data type

text

2nd data entry: Date
Description

2nd data entry: Date

Data type

date

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Similar models

Echocardiography CARLA Follow-up

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
General information
Subject ID
Item
Subject ID
text
C2348585 (UMLS CUI [1])
Examiner ID
Item
Examiner ID
text
Date of investigation
Item
Date of investigation
date
Beginning of investigation
Item
Beginning of investigation
time
Item
Site of echocardiography device
integer
Site of echocardiography device
Code List
Site of echocardiography device
CL Item
Room no. 119 (on the right, old device) (A)
CL Item
Room no. 111 (on the left, new device) (N)
Item Group
Medical history: 1. Heart failure / Myocardial insufficiency
Item
1. a) Have you been diagnosed with a heart disease?
integer
1. a) Heart disease
Code List
1. a) Have you been diagnosed with a heart disease?
CL Item
Yes (1)
CL Item
No (2)
CL Item
I don't know (-8)
Item
1. b) Do you experience shortness of breath, fatigue, or palpitation during physical activity ?
integer
1. b) NYHA classification of heart failure
Code List
1. b) Do you experience shortness of breath, fatigue, or palpitation during physical activity ?
CL Item
During ordinary physical activity (climbing several floors of stairs; NYHA II) (2)
CL Item
During less than ordinary activity (climbing less than one floor of stairs; NYHA III) (3)
CL Item
At rest and during any physical activity (NYHA IV) (4)
CL Item
No (if 1.a = "Yes" then NYHA = I) (1)
Item
1. c) How often do you have these complaints?
integer
1. c) Frequency of complaints
Code List
1. c) How often do you have these complaints?
CL Item
During any physical activity (1)
CL Item
Max. 5 episodes/day (2)
CL Item
Max. 5 episodes/week (3)
CL Item
Max. 5 episodes/month (4)
Item Group
Medical history: 2. Angina pectoris / Coronary heart disease
Item
2. a) Have you been diagnosed with coronary heart disease (CHD)?
integer
2. a) Coronary heart disease
Code List
2. a) Have you been diagnosed with coronary heart disease (CHD)?
CL Item
Yes (1)
CL Item
No (2)
CL Item
I don't know (-8)
Item
2. b) Do you experience chest pain during physical activity (angina pectoris)?
integer
2. b) CCS grading of angina pectoris
Code List
2. b) Do you experience chest pain during physical activity (angina pectoris)?
CL Item
During ordinary physical activity (climbing several floors of stairs; CCS II) (2)
CL Item
During less than ordinary activity (climbing less than one floor of stairs; CCS III) (3)
CL Item
At rest and during any physical activity (CCS IV) (4)
CL Item
No (if 2.a = "Yes" then CCS = I) (1)
Item
2. c) How often do you have these complaints?
integer
2. c) Frequency of complaints
Code List
2. c) How often do you have these complaints?
CL Item
During any physical activity (1)
CL Item
Max. 5 episodes/day (2)
CL Item
Max. 5 episodes/week (3)
CL Item
Max. 5 episodes/month (4)
Item Group
Medical history: 3. Cardiac arrhythmia
Item
Do you suffer/Have you ever suffered from tachycardia?
integer
Tachycardia
Code List
Do you suffer/Have you ever suffered from tachycardia?
CL Item
Yes (1)
CL Item
No (2)
CL Item
I don't know (-8)
CL Item
Not specified (-9)
Item
Do you suffer/Have you ever suffered from palpitations?
integer
Palpitations / Irregular heart beats
Code List
Do you suffer/Have you ever suffered from palpitations?
CL Item
Yes (1)
CL Item
No (2)
CL Item
I don't know (-8)
CL Item
Not specified (-9)
Item
Do you suffer/Have you ever suffered from skipped heart beats?
integer
Palpitations / Irregular heart beats
Code List
Do you suffer/Have you ever suffered from skipped heart beats?
CL Item
Yes (1)
CL Item
No (2)
CL Item
I don't know (-8)
CL Item
Not specified (-9)
Cardiac arrhythmia: plain text diagnosis
Item
Cardiac arrhythmia: plain text diagnosis
text
Item Group
Medical history: Medical history: Further symptoms of cardiac insufficiency
Item
4. Did you experience a syncope during the past 12 months?
integer
4. Syncopes
Code List
4. Did you experience a syncope during the past 12 months?
CL Item
Yes (1)
CL Item
No (2)
CL Item
I don't know (-8)
CL Item
Not specified (-9)
Item
5. Are you able to lie down?
integer
4. Syncopes
Code List
5. Are you able to lie down?
CL Item
Yes (1)
CL Item
No (2)
CL Item
I don't know (-8)
CL Item
Not specified (-9)
Item
6. Do you suffer from water retention in the legs in the evening?
integer
4. Syncopes
Code List
6. Do you suffer from water retention in the legs in the evening?
CL Item
Yes (1)
CL Item
No (2)
CL Item
I don't know (-8)
CL Item
Not specified (-9)
Item Group
Echocardiography
Item
Parasternal investigation possible?
integer
Parasternal investigability
Code List
Parasternal investigation possible?
CL Item
Fine (1)
CL Item
Limited (2)
CL Item
Not sufficient for analysis (3)
Item
Apical investigation possible?
integer
Parasternal investigability
Code List
Apical investigation possible?
CL Item
Fine (1)
CL Item
Limited (2)
CL Item
Not sufficient for analysis (3)
Item
Completeness of investigated parameters
integer
Completeness of investigated parameters
Code List
Completeness of investigated parameters
CL Item
Complete (1)
CL Item
Incomplete (2)
Item
In case of incompleteness of parameters, please specify reason
integer
Reason for incompleteness of parameters
Code List
In case of incompleteness of parameters, please specify reason
CL Item
Obesity (1)
CL Item
COPD (2)
CL Item
Asthenic physique (3)
CL Item
Other (4)
Item
If other reason applies, please specify
text
Reason for incompleteness of parameters
Code List
If other reason applies, please specify
Comments
Item
Comments
text
Control of findings/supervision by (physician ID):
Item
Control of findings/supervision by (physician ID):
text
End of echocardiography
Item
End of echocardiography
time
Item Group
Data entry: Echocardiography
1st data entry: DNo.
Item
1st data entry: DNo.
text
1st data entry: Date
Item
1st data entry: Date
date
2nd data entry: DNo.
Item
2nd data entry: DNo.
text
2nd data entry: Date
Item
2nd data entry: Date
date
Item Group
1. Echocardiography Online-/Offline-Reading
Reader number
Item
Reader number
text
Date of reading
Item
Date of reading
date
Beginning of reading
Item
Beginning of reading
time
Item
Completeness of measured parameters
integer
Completeness of investigated parameters
Code List
Completeness of measured parameters
CL Item
Complete (1)
CL Item
Incomplete (2)
Item
In case of incompleteness of parameters, please specify reason
integer
Reason for incompleteness of parameters
Code List
In case of incompleteness of parameters, please specify reason
CL Item
Missing images/data (1)
CL Item
Poor quality of images (2)
CL Item
Other (3)
Item
If other reason applies, please specify
text
Reason for incompleteness of parameters
Code List
If other reason applies, please specify
Comments
Item
Comments
text
Recommendation Text
Item
Recommendation Text
text
Item
Recommendation
integer
Recommendation
Code List
Recommendation
CL Item
Visit physician in the near future for control/clarification (1)
CL Item
Visit physician or medical emergency service immediately (2)
CL Item
Subjects needs to be informed immediately about results (3)
Item
In case subject needs to be informed immediately, please specify
integer
Immediate information of subject
Code List
In case subject needs to be informed immediately, please specify
CL Item
By telephone (1)
CL Item
Preliminary dispatch (2)
Item
Which results will the subject be informed about?
text
Immediate information of subject
Code List
Which results will the subject be informed about?
TreatingPhysicianSignatureText
Item
Signature of treating physician
text
C1527021 (UMLS CUI [1,1])
C1519316 (UMLS CUI [1,2])
C1710470 (UMLS CUI [1,3])
Name of treating physician
Item
Name of treating physician
text
Item Group
Data entry: Online-/Offline-Reading
1st data entry: DNo.
Item
1st data entry: DNo.
text
1st data entry: Date
Item
1st data entry: Date
date
2nd data entry: DNo.
Item
2nd data entry: DNo.
text
2nd data entry: Date
Item
2nd data entry: Date
date
Item Group
2. Echocardiography Offline-Reading
Subject ID
Item
Subject ID
text
C2348585 (UMLS CUI [1])
Reader number
Item
Reader number
text
Date of reading
Item
Date of reading
date
Beginning of reading
Item
Beginning of reading
time
Item
Completeness of measured parameters
integer
Completeness of investigated parameters
Code List
Completeness of measured parameters
CL Item
Complete (1)
CL Item
Incomplete (2)
Item
In case of incompleteness of parameters, please specify reason
integer
Reason for incompleteness of parameters
Code List
In case of incompleteness of parameters, please specify reason
CL Item
Missing images/data (1)
CL Item
Poor quality of images (2)
CL Item
Other (3)
Item
If other reason applies, please specify
text
Reason for incompleteness of parameters
Code List
If other reason applies, please specify
Comments
Item
Comments
text
TreatingPhysicianSignatureText
Item
Signature of treating physician
text
C1527021 (UMLS CUI [1,1])
C1519316 (UMLS CUI [1,2])
C1710470 (UMLS CUI [1,3])
Name of treating physician
Item
Name of treating physician
text
End of Echo-Reading
Item
End of Echo-Reading
time
Item Group
Data entry: Offline-Reading
1st data entry: DNo.
Item
1st data entry: DNo.
text
1st data entry: Date
Item
1st data entry: Date
date
2nd data entry: DNo.
Item
2nd data entry: DNo.
text
2nd data entry: Date
Item
2nd data entry: Date
date
Item Group
Final evaluation of medical investigations
Physician ID
Item
Physician ID
text
Date
Item
Date
date
ECG evaluation: medical diagnosis
Item
ECG evaluation: medical diagnosis
text
Recommendation Text
Item
Recommendation Text
text
Item
Recommendation
integer
Recommendation
Code List
Recommendation
CL Item
Visit physician in the near future for control/clarification (1)
CL Item
Visit physician or medical emergency service immediately (2)
CL Item
Subjects needs to be informed immediately about results (3)
Item
In case subject needs to be informed immediately, please specify
integer
Immediate information of subject
Code List
In case subject needs to be informed immediately, please specify
CL Item
By telephone (1)
CL Item
Preliminary dispatch (2)
Item
Which results will the subject be informed about?
text
Immediate information of subject
Code List
Which results will the subject be informed about?
TreatingPhysicianSignatureText
Item
Signature of treating physician
text
C1527021 (UMLS CUI [1,1])
C1519316 (UMLS CUI [1,2])
C1710470 (UMLS CUI [1,3])
Name of treating physician
Item
Name of treating physician
text
Item Group
Data entry: Final evaluation
1st data entry: DNo.
Item
1st data entry: DNo.
text
1st data entry: Date
Item
1st data entry: Date
date
2nd data entry: DNo.
Item
2nd data entry: DNo.
text
2nd data entry: Date
Item
2nd data entry: Date
date
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