ID

16070

Beschreibung

NINDS Common Data Elements, Multiple Sclerosis Reproductive and Hormonal History Used from the National Institute of Neurological Disorders and Stroke Common Data Elements (https://www.commondataelements.ninds.nih.gov/) References: Grinnon ST, Miller K, Marler JR, Lu Y, Stout A, Odenkirchen J, Kunitz S. National Institute of Neurological Disorders and Stroke Common Data Element Project - approach and methods. Clin Trials. 2012;9(3):322-9.

Link

https://www.commondataelements.ninds.nih.gov/

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  1. 27.06.16 27.06.16 -
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27. Juni 2016

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NINDS CDE Reproductive and Hormonal History Multiple Sclerosis

Englisch

Reproductive and Hormonal History

1 Formulare  
General Information
Beschreibung

General Information

Alias
UMLS CUI-1
C1508263
Study ID
Beschreibung

Study ID

Datentyp

integer

Alias
UMLS CUI [1]
C2826693
Study site name
Beschreibung

Study site name

Datentyp

text

Alias
UMLS CUI [1]
C2825164
Subject ID
Beschreibung

Subject ID

Datentyp

integer

Alias
UMLS CUI [1]
C2348585
1. Have you ever given birth or fathered a child? (Include current pregnancy and any pregnancies that resulted in early pregnancy loss, whether by choice or not)
Beschreibung

pregnancy

Datentyp

text

Alias
UMLS CUI [1]
C0032961
Pregnancy Data
Beschreibung

Pregnancy Data

Alias
UMLS CUI-1
C3484365
Pregnancy Outcome
Beschreibung

Pregnancy Outcome

Datentyp

text

Alias
UMLS CUI [1]
C0032972
Date
Beschreibung

Date

Datentyp

date

Alias
UMLS CUI [1]
C0011008
Menstruation/Pregnancy
Beschreibung

Menstruation/Pregnancy

Alias
UMLS CUI-1
C0025344
UMLS CUI-2
C0032961
1. Are you of child-bearing potential?
Beschreibung

child-bearing potential

Datentyp

text

Alias
UMLS CUI [1]
C1960468
2. Have you ever had a menstrual period?
Beschreibung

menstrual period

Datentyp

text

Alias
UMLS CUI [1]
C0025329
a. If Yes, what age was your first period?
Beschreibung

menstrual period

Datentyp

text

Alias
UMLS CUI [1]
C0025329
3. Do you use any forms of contraception (periods may be regular or irregular)?
Beschreibung

contraception

Datentyp

text

Alias
UMLS CUI [1]
C0700589
Oral contraceptives – combined pill (“the pill”)
Beschreibung

Combined Oral Contraceptives

Datentyp

boolean

Alias
UMLS CUI [1]
C0009906
Oral contraceptives – progestin-only pill (“minnmi- pill”)
Beschreibung

Progestogen only oral contraceptive

Datentyp

boolean

Alias
UMLS CUI [1]
C0420857
Transdermal patch (i.e., Ortho Evra)
Beschreibung

Transdermal patch

Datentyp

boolean

Alias
UMLS CUI [1]
C0991556
Shot/injection (i.e., Depo-Provera)
Beschreibung

Depo-Provera injections or shots

Datentyp

boolean

Alias
UMLS CUI [1]
C3842800
Vaginal ring (i.e., NuvaRing)
Beschreibung

Vaginal ring

Datentyp

boolean

Alias
UMLS CUI [1]
C0042260
Implantable devices with hormone (i.e., ParaGuard, Mirena)
Beschreibung

Mirena

Datentyp

boolean

Alias
UMLS CUI [1]
C0591811
Abstinence
Beschreibung

Abstinence

Datentyp

boolean

Alias
UMLS CUI [1]
C3843422
None of these
Beschreibung

contraceptive methods

Datentyp

boolean

Alias
UMLS CUI [1]
C0700589
4. Are you currently pregnant?
Beschreibung

currently pregnant

Datentyp

text

Alias
UMLS CUI [1]
C0549206
a. If Yes, indicate your due date:
Beschreibung

date pregnancy

Datentyp

date

Alias
UMLS CUI [1]
C0742974
Menopause
Beschreibung

Menopause

Alias
UMLS CUI-1
C0025320
5. Do you believe you are currently experiencing menopause?
Beschreibung

menopause

Datentyp

boolean

Alias
UMLS CUI [1]
C0025320
a. If Yes, indicate the approximate date of your last menstrual period:
Beschreibung

last menstrual period

Datentyp

date

Alias
UMLS CUI [1]
C0425932
b. Have you taken hormonal therapy?
Beschreibung

hormonal therapy

Datentyp

boolean

Alias
UMLS CUI [1]
C0279025
i. If Yes, specify name of hormonal therapy taken:
Beschreibung

hormonal therapy

Datentyp

text

Alias
UMLS CUI [1]
C0279025
ii. If Yes, indicate which years you started and stopped hormonal therapy:
Beschreibung

start date End Date hormonal therapy

Datentyp

text

Alias
UMLS CUI [1,1]
C0808070
UMLS CUI [1,2]
C0806020
UMLS CUI [1,3]
C0279025
Post-menopause
Beschreibung

Post-menopause

Alias
UMLS CUI-1
C0232970
6. Are you post-menopausal?
Beschreibung

post-menopausal

Datentyp

text

Alias
UMLS CUI [1]
C0232970
a. If Yes, indicate cause:
Beschreibung

Post-menopause hysterectomy chemotherapy

Datentyp

text

Alias
UMLS CUI [1,1]
C0232970
UMLS CUI [1,2]
C0020699
UMLS CUI [1,3]
C3665472
Date of hysterectomy
Beschreibung

date hysterectomy

Datentyp

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0020699
Other hormone-related syndromes
Beschreibung

Other hormone-related syndromes

Alias
UMLS CUI-1
C0014130
7. Any other known hormone-related/endocrine syndromes or disorders?
Beschreibung

endocrine syndromes

Datentyp

text

Alias
UMLS CUI [1]
C0014130
a. If Yes, specify:
Beschreibung

Endocrine System Diseases

Datentyp

text

Alias
UMLS CUI [1]
C0014130
Other
Beschreibung

Other

Datentyp

text

Alias
UMLS CUI [1]
C0205394
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Ähnliche Modelle

Reproductive and Hormonal History

1 Formulare
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
General Information
C1508263 (UMLS CUI-1)
Study ID
Item
Study ID
integer
C2826693 (UMLS CUI [1])
Study site name
Item
Study site name
text
C2825164 (UMLS CUI [1])
Subject ID
Item
Subject ID
integer
C2348585 (UMLS CUI [1])
Item
1. Have you ever given birth or fathered a child? (Include current pregnancy and any pregnancies that resulted in early pregnancy loss, whether by choice or not)
text
C0032961 (UMLS CUI [1])
pregnancy
Code List
1. Have you ever given birth or fathered a child? (Include current pregnancy and any pregnancies that resulted in early pregnancy loss, whether by choice or not)
CL Item
Yes (Please go to the next question)  (1)
CL Item
No (Women, please go to question 3) (2)
CL Item
Unknown (Stop, you are finished) (3)
Item Group
Pregnancy Data
C3484365 (UMLS CUI-1)
Item
Pregnancy Outcome
text
C0032972 (UMLS CUI [1])
Pregnancy Outcome
Code List
Pregnancy Outcome
CL Item
Currently pregnant  (1)
CL Item
Live birth  (2)
CL Item
Miscarriage (3)
CL Item
Therapeutic abortion or elective termination (4)
CL Item
Still birth (5)
Date
Item
Date
date
C0011008 (UMLS CUI [1])
Item Group
Menstruation/Pregnancy
C0025344 (UMLS CUI-1)
C0032961 (UMLS CUI-2)
Item
1. Are you of child-bearing potential?
text
C1960468 (UMLS CUI [1])
child-bearing potential
Code List
1. Are you of child-bearing potential?
CL Item
yes (1)
CL Item
no (2)
CL Item
unknown (3)
Item
2. Have you ever had a menstrual period?
text
C0025329 (UMLS CUI [1])
menstrual period
Code List
2. Have you ever had a menstrual period?
CL Item
yes (1)
CL Item
no (If No, you are finished) (2)
menstrual period
Item
a. If Yes, what age was your first period?
text
C0025329 (UMLS CUI [1])
Item
3. Do you use any forms of contraception (periods may be regular or irregular)?
text
C0700589 (UMLS CUI [1])
contraception
Code List
3. Do you use any forms of contraception (periods may be regular or irregular)?
CL Item
yes ( If Yes, indicate all forms of contraception used (choose all that apply))  (1)
CL Item
no  (2)
CL Item
unknown (3)
Combined Oral Contraceptives
Item
Oral contraceptives – combined pill (“the pill”)
boolean
C0009906 (UMLS CUI [1])
Progestogen only oral contraceptive
Item
Oral contraceptives – progestin-only pill (“minnmi- pill”)
boolean
C0420857 (UMLS CUI [1])
Transdermal patch
Item
Transdermal patch (i.e., Ortho Evra)
boolean
C0991556 (UMLS CUI [1])
Depo-Provera injections or shots
Item
Shot/injection (i.e., Depo-Provera)
boolean
C3842800 (UMLS CUI [1])
Vaginal ring
Item
Vaginal ring (i.e., NuvaRing)
boolean
C0042260 (UMLS CUI [1])
Mirena
Item
Implantable devices with hormone (i.e., ParaGuard, Mirena)
boolean
C0591811 (UMLS CUI [1])
Abstinence
Item
Abstinence
boolean
C3843422 (UMLS CUI [1])
contraceptive methods
Item
None of these
boolean
C0700589 (UMLS CUI [1])
Item
4. Are you currently pregnant?
text
C0549206 (UMLS CUI [1])
currently pregnant
Code List
4. Are you currently pregnant?
CL Item
yes (1)
CL Item
no (2)
CL Item
unknown (3)
date pregnancy
Item
a. If Yes, indicate your due date:
date
C0742974 (UMLS CUI [1])
Item Group
Menopause
C0025320 (UMLS CUI-1)
menopause
Item
5. Do you believe you are currently experiencing menopause?
boolean
C0025320 (UMLS CUI [1])
last menstrual period
Item
a. If Yes, indicate the approximate date of your last menstrual period:
date
C0425932 (UMLS CUI [1])
hormonal therapy
Item
b. Have you taken hormonal therapy?
boolean
C0279025 (UMLS CUI [1])
hormonal therapy
Item
i. If Yes, specify name of hormonal therapy taken:
text
C0279025 (UMLS CUI [1])
start date End Date hormonal therapy
Item
ii. If Yes, indicate which years you started and stopped hormonal therapy:
text
C0808070 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
C0279025 (UMLS CUI [1,3])
Item Group
Post-menopause
C0232970 (UMLS CUI-1)
Item
6. Are you post-menopausal?
text
C0232970 (UMLS CUI [1])
post-menopausal
Code List
6. Are you post-menopausal?
CL Item
yes (1)
CL Item
no (2)
CL Item
unknown (3)
Item
a. If Yes, indicate cause:
text
C0232970 (UMLS CUI [1,1])
C0020699 (UMLS CUI [1,2])
C3665472 (UMLS CUI [1,3])
Post-menopause hysterectomy chemotherapy
Code List
a. If Yes, indicate cause:
CL Item
Natural (1)
CL Item
Surgical (complete hysterectomy – ovaries and uterus removed), (2)
CL Item
Surgical (partial hysterectomy – only uterus removed) (3)
CL Item
Medications or chemotherapy (4)
date hysterectomy
Item
Date of hysterectomy
date
C0011008 (UMLS CUI [1,1])
C0020699 (UMLS CUI [1,2])
Item Group
Other hormone-related syndromes
C0014130 (UMLS CUI-1)
Item
7. Any other known hormone-related/endocrine syndromes or disorders?
text
C0014130 (UMLS CUI [1])
child-bearing potential
Code List
7. Any other known hormone-related/endocrine syndromes or disorders?
CL Item
yes (1)
CL Item
no (2)
CL Item
unknown (3)
Item
a. If Yes, specify:
text
C0014130 (UMLS CUI [1])
Endocrine System Diseases
Code List
a. If Yes, specify:
CL Item
Polycystic ovary syndrome  (1)
CL Item
Hyperthyroidism  (2)
CL Item
Cushing’s syndrome (3)
CL Item
Other, specify (4)
Other
Item
Other
text
C0205394 (UMLS CUI [1])
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