ID
16066
Beskrivning
ODM form derived from 15pp EBMT Multiple Sclerosis 13MS please refer to: http://www.ebmt.org/Contents/Data-Management/Registrystructure/MED-ABdatacollectionforms/Pages/MED-AB-data-collection-forms.aspx
Länk
Nyckelord
Versioner (2)
- 2016-04-11 2016-04-11 -
- 2016-06-27 2016-06-27 -
Uppladdad den
27 juni 2016
DOI
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Licens
Creative Commons BY-NC 3.0
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EBMT Multiple Sclerosis Form General Information
15pp EBMT Multiple Sclerosis Form General Information
- StudyEvent: ODM
Beskrivning
PATIENT
Beskrivning
Unique Identification Code (UIC)
Datatyp
text
Alias
- UMLS CUI [1]
- C2348585
Beskrivning
Hospital Unique Patient Number or Code
Datatyp
text
Alias
- UMLS CUI [1]
- C1827636
Beskrivning
Initials
Datatyp
text
Alias
- UMLS CUI [1]
- C2986440
Beskrivning
Date of birth
Datatyp
date
Alias
- UMLS CUI [1]
- C0421451
Beskrivning
Sex
Datatyp
text
Alias
- UMLS CUI [1]
- C0079399
Beskrivning
ABO Group
Datatyp
integer
Alias
- UMLS CUI [1]
- C0000778
Beskrivning
Rh factor
Datatyp
integer
Alias
- UMLS CUI [1]
- C0035403
Beskrivning
DISEASE
Beskrivning
Date of Diagnosis
Datatyp
date
Alias
- UMLS CUI [1]
- C2316983
Beskrivning
Check the disease for which this transplant was performed
Datatyp
integer
Alias
- UMLS CUI [1]
- C0277554
Beskrivning
Primary Disease Diagnosis
Datatyp
integer
Alias
- UMLS CUI [1,1]
- C0277554
- UMLS CUI [1,2]
- C2348235
Beskrivning
MULTIPLE SCLEROSIS
Beskrivning
INITIAL DIAGNOSIS
Beskrivning
has the information requested in this section been submitted with a previous HSCT registration?
Datatyp
text
Alias
- UMLS CUI [1,1]
- C1514821
- UMLS CUI [1,2]
- C0472699
Beskrivning
(Two attacks and clinical evidence of two separate lesions OR Two attacks; clinical evidence of one lesion and paraclinical evidence of another, separate lesion)
Datatyp
integer
Alias
- UMLS CUI [1]
- C0026769
Beskrivning
DIAGNOSTIC CRITERIA laboratory-supported Multiple Sclerosis
Datatyp
integer
Alias
- UMLS CUI [1,1]
- C0026769
- UMLS CUI [1,2]
- C1254595
Beskrivning
FIRST LINE THERAPIES
Beskrivning
First line therapy
Datatyp
integer
Alias
- UMLS CUI [1]
- C1708063
Beskrivning
First line therapy start date
Datatyp
date
Alias
- UMLS CUI [1,1]
- C1708063
- UMLS CUI [1,2]
- C3173308
Beskrivning
Drugs
Datatyp
integer
Alias
- UMLS CUI [1,1]
- C1708063
- UMLS CUI [1,2]
- C0013227
Beskrivning
Drugs
Datatyp
integer
Alias
- UMLS CUI [1]
- C0013216
Beskrivning
Total lymph node (TLI) Irradiation (radiotherapy) Site
Datatyp
integer
Alias
- UMLS CUI [1,1]
- C0024204
- UMLS CUI [1,2]
- C1522449
Beskrivning
Irradiation Craniospinal
Datatyp
integer
Alias
- UMLS CUI [1]
- C3494227
Beskrivning
Other modality
Datatyp
integer
Alias
- UMLS CUI [1]
- C0024226
Beskrivning
Other modality
Datatyp
integer
Alias
- UMLS CUI [1]
- C0032134
Beskrivning
Other, specify modality
Datatyp
integer
Alias
- UMLS CUI [1,1]
- C0695347
- UMLS CUI [1,2]
- C1521902
Beskrivning
DATE OF HSCT
Beskrivning
Date of HSCT
Datatyp
date
Alias
- UMLS CUI [1,1]
- C2584899
Beskrivning
TRANSPLANT TYPE
Datatyp
integer
Alias
- UMLS CUI [1]
- C3840412
Beskrivning
if Transplat type
Datatyp
boolean
Alias
- UMLS CUI [1]
- C0439859
Beskrivning
Date of Autologous: Mobilised
Datatyp
date
Alias
- UMLS CUI [1,1]
- C0439859
- UMLS CUI [1,2]
- C2584899
Beskrivning
STATUS OF DISEASE AT MOBILISATION
Beskrivning
CLINICAL EVALUATION
Datatyp
integer
Alias
- UMLS CUI [1]
- C0451180
Beskrivning
CLINICAL EVALUATION
Datatyp
integer
Alias
- UMLS CUI [1]
- C3826987
Beskrivning
Kurtzke Expanded Disability Status
Datatyp
integer
Alias
- UMLS CUI [1]
- C0451246
Beskrivning
CLINICAL EVALUATION
Datatyp
integer
Alias
- UMLS CUI [1]
- C4066222
Beskrivning
MRI BRAIN SCAN
Datatyp
integer
Alias
- UMLS CUI [1]
- C0412675
Beskrivning
Date of most recent MRI scan of brain
Datatyp
date
Alias
- UMLS CUI [1,1]
- C0412675
- UMLS CUI [1,2]
- C0011008
Beskrivning
Gadolinium-enhancing lesions present Results
Datatyp
text
Alias
- UMLS CUI [1]
- C1333400
Beskrivning
Gadolinium-enhancing lesions present Number
Datatyp
integer
Alias
- UMLS CUI [1]
- C1333400
Beskrivning
STATUS OF DISEASE AT HSCT
Beskrivning
Indicate the disease course between diagnosis and mobilisation/HSCT
Datatyp
integer
Alias
- UMLS CUI [1]
- C0449259
Beskrivning
If DISEASE COURSE not evaluable please explain
Datatyp
text
Alias
- UMLS CUI [1]
- C0449259
Beskrivning
Did the patient progress during the 2-years prior to mobilisation/HSCT?
Datatyp
text
Alias
- UMLS CUI [1]
- C0242656
Beskrivning
If the patient progress during the 2-years prior to mobilisation/HSCT? Number of relapses/progressions
Datatyp
integer
Alias
- UMLS CUI [1]
- C0035020
Beskrivning
CLINICAL EVALUATION
Datatyp
integer
Alias
- UMLS CUI [1]
- C0451180
Beskrivning
CLINICAL EVALUATION
Datatyp
text
Alias
- UMLS CUI [1]
- C3826987
Beskrivning
CLINICAL EVALUATION
Datatyp
integer
Alias
- UMLS CUI [1]
- C0451246
Beskrivning
CLINICAL EVALUATION
Datatyp
integer
Alias
- UMLS CUI [1]
- C4066222
Beskrivning
MRI BRAIN SCAN DONE
Datatyp
text
Alias
- UMLS CUI [1]
- C0412675
Beskrivning
Date of most recent MRI scan of brain
Datatyp
date
Alias
- UMLS CUI [1]
- C0412675
Beskrivning
Date of most recent MRI scan of brain:
Datatyp
integer
Alias
- UMLS CUI [1,1]
- C0412675
- UMLS CUI [1,2]
- C0011008
Beskrivning
Gadolinium-enhancing lesions present
Datatyp
integer
Alias
- UMLS CUI [1]
- C1333400
Beskrivning
ADDITIONAL TREATMENT POST-HSCT
Beskrivning
Did patient receive additional treatment post-HSCT?
Datatyp
boolean
Alias
- UMLS CUI [1]
- C1706712
Beskrivning
Date started if patient receive additional treatment post-HSCT
Datatyp
date
Alias
- UMLS CUI [1,1]
- C1706712
- UMLS CUI [1,2]
- C0808070
Beskrivning
Overall main reason
Datatyp
integer
Alias
- UMLS CUI [1,1]
- C1706712
- UMLS CUI [1,2]
- C1443309
Beskrivning
Overall main reason
Datatyp
integer
Alias
- UMLS CUI [1,1]
- C1706712
- UMLS CUI [1,2]
- C1443309
- UMLS CUI [1,3]
- C1521902
Beskrivning
Drugs administered?
Datatyp
integer
Alias
- UMLS CUI [1]
- C0812987
Beskrivning
If drugs administered: Please mark
Datatyp
integer
Alias
- UMLS CUI [1]
- C0013216
Beskrivning
Site
Datatyp
integer
Alias
- UMLS CUI [1,1]
- C0024204
- UMLS CUI [1,2]
- C1522449
Beskrivning
Irradiation (radiotherapy)
Datatyp
integer
Alias
- UMLS CUI [1]
- C3494227
Beskrivning
Other modality Lymphocytopheresis
Datatyp
integer
Alias
- UMLS CUI [1]
- C0024226
Beskrivning
Other modality Plasmapheresis
Datatyp
integer
Alias
- UMLS CUI [1]
- C0032134
Beskrivning
Other modality
Datatyp
text
Alias
- UMLS CUI [1,1]
- C0695347
- UMLS CUI [1,2]
- C1521902
Beskrivning
STATUS AT 100 DAYS POST-HSCT
Beskrivning
DATE OF EVALUATION
Datatyp
date
Alias
- UMLS CUI [1]
- C2985720
Beskrivning
Score
Datatyp
float
Alias
- UMLS CUI [1]
- C0451180
Beskrivning
Overall score
Datatyp
float
Alias
- UMLS CUI [1]
- C3826987
Beskrivning
Scale (EDSS)
Datatyp
float
Alias
- UMLS CUI [1]
- C0451246
Beskrivning
Score
Datatyp
float
Alias
- UMLS CUI [1]
- C4066222
Beskrivning
MRI BRAIN SCAN DONE
Datatyp
text
Alias
- UMLS CUI [1]
- C0412675
Beskrivning
Are new lesions present on the MRI?
Datatyp
integer
Alias
- UMLS CUI [1,1]
- C0024485
- UMLS CUI [1,2]
- C1274040
Beskrivning
FORMS TO BE FILLED IN
Similar models
15pp EBMT Multiple Sclerosis Form General Information
- StudyEvent: ODM
C2348235 (UMLS CUI [1,2])
C0472699 (UMLS CUI [1,2])
C1254595 (UMLS CUI [1,2])
C3173308 (UMLS CUI [1,2])
C0001617 (UMLS CUI-2)
C1708745 (UMLS CUI-2)
C1522449 (UMLS CUI [1,2])
C1521902 (UMLS CUI [1,2])
C2584899 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,2])
C0808070 (UMLS CUI [1,2])
C1443309 (UMLS CUI [1,2])
C1443309 (UMLS CUI [1,2])
C1521902 (UMLS CUI [1,3])
C1708745 (UMLS CUI-2)
C0444956 (UMLS CUI-2)
C1522449 (UMLS CUI [1,2])
C1521902 (UMLS CUI [1,2])
C0040739 (UMLS CUI [1,2])
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