ID

1837

Descrição

AMC-052 Screen Failure Predictor Variables Survey Form Human Papillomavirus Vaccine Therapy in Treating Men With HIV-1 Infection Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=77B9D50C-53A6-8752-E040-BB89AD4320A2

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=77B9D50C-53A6-8752-E040-BB89AD4320A2

Palavras-chave

Versões (2)
  1. 19/09/2012 19/09/2012 -
  2. 19/07/2017 19/07/2017 - Martin Dugas
Transferido a

19 de setembro de 2012

DOI

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Licença

Creative Commons BY-NC 3.0
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Infection NCT00513526 Registration - AMC-052 Screen Failure Predictor Variables Survey Form - 2958715v1.0

Inglês

Please provide responses to all questions below. Only data which was previously collected by the research staff should be reported

1 Formulários  
Verbal Consent
Descrição

Verbal Consent

Was verbal consent obtained from the subject
Descrição

SpokenLanguageInformedConsentProcedureCompleteInd-2

Tipo de dados

text

Alias
NCI Thesaurus ObjectClass
C16735
UMLS 2011AA ObjectClass
C0021430
NCI Thesaurus ObjectClass
C51277
UMLS 2011AA ObjectClass
C0424919
NCI Thesaurus Property
C25250
UMLS 2011AA Property
C0205197
NCI Thesaurus Property
C79751
UMLS 2011AA Property
C2700391
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Date verbal consent obtained (mm/dd/yyyy)
Descrição

SpokenLanguageInformedConsentProcedureCompleteDate

Tipo de dados

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus Property
C25250
UMLS 2011AA Property
C0205197
NCI Thesaurus ObjectClass
C16735
UMLS 2011AA ObjectClass
C0021430
NCI Thesaurus ObjectClass
C51277
UMLS 2011AA ObjectClass
C0424919
NCI Thesaurus Property
C79751
UMLS 2011AA Property
C2700391
Cd4+
Descrição

Cd4+

CD4+ Count
Descrição

LaboratoryProcedureCD4-PositiveT-LymphocyteHelper-InducerT-LymphocyteOutcomeCount

Tipo de dados

double

Alias
NCI Thesaurus ObjectClass
C25294
UMLS 2011AA ObjectClass
C0022885
NCI Thesaurus Property
C20200
UMLS 2011AA Property
C1274040
NCI Thesaurus Property
C12537
UMLS 2011AA Property
C0039215
NCI Thesaurus Property
C12538
UMLS 2011AA Property
C0018894
NCI Thesaurus ValueDomain
C25463
UMLS 2011AA ValueDomain
C0750480
Lowest CD4+ count ever reported (i.e. nadir CD4)
Descrição

LaboratoryProcedureCD4+LowestResultCount

Tipo de dados

double

Alias
NCI Thesaurus ObjectClass
C25294
UMLS 2011AA ObjectClass
C0022885
NCI Thesaurus Property
C20200
UMLS 2011AA Property
C1274040
NCI Thesaurus Property
C12537
UMLS 2011AA Property
C0039215
NCI Thesaurus Property
C43517
UMLS 2011AA Property
C1708760
NCI Thesaurus ValueDomain
C25463
UMLS 2011AA ValueDomain
C0750480
Unnamed2
Descrição

Unnamed2

Results of HIV viral load assay (Enter results from right to left.)
Descrição

HumanImmunodeficiencyVirusViralLoadAssayPerformedAmount

Tipo de dados

text

Alias
NCI Thesaurus ObjectClass
C14219
UMLS 2011AA ObjectClass
C0019682
NCI Thesaurus ObjectClass
C51952
UMLS 2011AA ObjectClass
C0376705
NCI Thesaurus ObjectClass
C16341
UMLS 2011AA ObjectClass
C0005507
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus ValueDomain
C25417
HIV viral load value
Descrição

HumanImmunodeficiencyVirusViralLoadAssayPerformedValue

Tipo de dados

double

Alias
NCI Thesaurus ObjectClass
C14219
UMLS 2011AA ObjectClass
C0019682
NCI Thesaurus ObjectClass
C51952
UMLS 2011AA ObjectClass
C0376705
NCI Thesaurus ObjectClass
C16341
UMLS 2011AA ObjectClass
C0005507
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
Method of detection
Descrição

HumanImmunodeficiencyVirusViralLoadAssayPerformedType

Tipo de dados

text

Alias
NCI Thesaurus ObjectClass
C14219
UMLS 2011AA ObjectClass
C0019682
NCI Thesaurus ObjectClass
C51952
UMLS 2011AA ObjectClass
C0376705
NCI Thesaurus ObjectClass
C16341
UMLS 2011AA ObjectClass
C0005507
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Other, specify
Descrição

HumanImmunodeficiencyVirusViralLoadAssayPerformedSpecify

Tipo de dados

text

Alias
NCI Thesaurus ObjectClass
C14219
UMLS 2011AA ObjectClass
C0019682
NCI Thesaurus ObjectClass
C51952
UMLS 2011AA ObjectClass
C0376705
NCI Thesaurus ObjectClass
C16341
UMLS 2011AA ObjectClass
C0005507
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
HIV viral load assay type
Descrição

HumanImmunodeficiencyVirusViralLoadAssayPerformedCategory

Tipo de dados

text

Alias
NCI Thesaurus ObjectClass
C14219
UMLS 2011AA ObjectClass
C0019682
NCI Thesaurus ObjectClass
C51952
UMLS 2011AA ObjectClass
C0376705
NCI Thesaurus ObjectClass
C16341
UMLS 2011AA ObjectClass
C0005507
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus ValueDomain
C25372
UMLS 2011AA ValueDomain
C0683312
Limits of detection (Copies/mL)
Descrição

HumanImmunodeficiencyVirusViralLoadAssayLowerThresholdDetectedNumber

Tipo de dados

double

Alias
NCI Thesaurus ObjectClass
C14219
UMLS 2011AA ObjectClass
C0019682
NCI Thesaurus ObjectClass
C51952
UMLS 2011AA ObjectClass
C0376705
NCI Thesaurus ObjectClass
C16341
UMLS 2011AA ObjectClass
C0005507
NCI Thesaurus Property
C48228
UMLS 2011AA Property
C0449864
NCI Thesaurus Property
C25309
UMLS 2011AA Property
C0441994
NCI Thesaurus Property
C25481
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
Comments
Descrição

Comments

Comments
Descrição

ResearchCommentsText

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
UMLS 2011AA Property
C0282411
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Similar models

Please provide responses to all questions below. Only data which was previously collected by the research staff should be reported

1 Formulários
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de dados
Alias
Item Group
Verbal Consent
Item
Was verbal consent obtained from the subject
text
C16735 (NCI Thesaurus ObjectClass)
C0021430 (UMLS 2011AA ObjectClass)
C51277 (NCI Thesaurus ObjectClass)
C0424919 (UMLS 2011AA ObjectClass)
C25250 (NCI Thesaurus Property)
C0205197 (UMLS 2011AA Property)
C79751 (NCI Thesaurus Property)
C2700391 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
CL.1
Code List
Was verbal consent obtained from the subject
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
SpokenLanguageInformedConsentProcedureCompleteDate
Item
Date verbal consent obtained (mm/dd/yyyy)
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25250 (NCI Thesaurus Property)
C0205197 (UMLS 2011AA Property)
C16735 (NCI Thesaurus ObjectClass)
C0021430 (UMLS 2011AA ObjectClass)
C51277 (NCI Thesaurus ObjectClass)
C0424919 (UMLS 2011AA ObjectClass)
C79751 (NCI Thesaurus Property)
C2700391 (UMLS 2011AA Property)
Item Group
Cd4+
LaboratoryProcedureCD4-PositiveT-LymphocyteHelper-InducerT-LymphocyteOutcomeCount
Item
CD4+ Count
double
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C12537 (NCI Thesaurus Property)
C0039215 (UMLS 2011AA Property)
C12538 (NCI Thesaurus Property)
C0018894 (UMLS 2011AA Property)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
LaboratoryProcedureCD4+LowestResultCount
Item
Lowest CD4+ count ever reported (i.e. nadir CD4)
double
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C12537 (NCI Thesaurus Property)
C0039215 (UMLS 2011AA Property)
C43517 (NCI Thesaurus Property)
C1708760 (UMLS 2011AA Property)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
Item
Results of HIV viral load assay (Enter results from right to left.)
text
C14219 (NCI Thesaurus ObjectClass)
C0019682 (UMLS 2011AA ObjectClass)
C51952 (NCI Thesaurus ObjectClass)
C0376705 (UMLS 2011AA ObjectClass)
C16341 (NCI Thesaurus ObjectClass)
C0005507 (UMLS 2011AA ObjectClass)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C25417 (NCI Thesaurus ValueDomain)
CL.2
Code List
Results of HIV viral load assay (Enter results from right to left.)
CL Item
Greater Than (>) (Greater than (>))
CL Item
Less Than (Less than (<))
CL Item
Equal To (Equal to (=))
CL Item
Undetectable (Undetectable)
HumanImmunodeficiencyVirusViralLoadAssayPerformedValue
Item
HIV viral load value
double
C14219 (NCI Thesaurus ObjectClass)
C0019682 (UMLS 2011AA ObjectClass)
C51952 (NCI Thesaurus ObjectClass)
C0376705 (UMLS 2011AA ObjectClass)
C16341 (NCI Thesaurus ObjectClass)
C0005507 (UMLS 2011AA ObjectClass)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
Item
Method of detection
text
C14219 (NCI Thesaurus ObjectClass)
C0019682 (UMLS 2011AA ObjectClass)
C51952 (NCI Thesaurus ObjectClass)
C0376705 (UMLS 2011AA ObjectClass)
C16341 (NCI Thesaurus ObjectClass)
C0005507 (UMLS 2011AA ObjectClass)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.3
Code List
Method of detection
CL Item
Roche Amplicor Monitor Assay (Roche Amplicor Monitor Assay)
CL Item
Versant Hiv-1 Rna Assay By Branched Dna (Versant HIV-1 RNA assay by branched DNA)
CL Item
Cobas Ampliprep/taqman Hiv-1 Assay (COBAS AmpliPrep/TAQMAN HIV-1 assay)
CL Item
Abbott Realtime Hiv-1 Assay (Abbott RealTime HIV-1 assay)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
HumanImmunodeficiencyVirusViralLoadAssayPerformedSpecify
Item
Other, specify
text
C14219 (NCI Thesaurus ObjectClass)
C0019682 (UMLS 2011AA ObjectClass)
C51952 (NCI Thesaurus ObjectClass)
C0376705 (UMLS 2011AA ObjectClass)
C16341 (NCI Thesaurus ObjectClass)
C0005507 (UMLS 2011AA ObjectClass)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
Item
HIV viral load assay type
text
C14219 (NCI Thesaurus ObjectClass)
C0019682 (UMLS 2011AA ObjectClass)
C51952 (NCI Thesaurus ObjectClass)
C0376705 (UMLS 2011AA ObjectClass)
C16341 (NCI Thesaurus ObjectClass)
C0005507 (UMLS 2011AA ObjectClass)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C25372 (NCI Thesaurus ValueDomain)
C0683312 (UMLS 2011AA ValueDomain)
CL.4
Code List
HIV viral load assay type
CL Item
Standard (Standard)
CL Item
Ultra (Ultra)
HumanImmunodeficiencyVirusViralLoadAssayLowerThresholdDetectedNumber
Item
Limits of detection (Copies/mL)
double
C14219 (NCI Thesaurus ObjectClass)
C0019682 (UMLS 2011AA ObjectClass)
C51952 (NCI Thesaurus ObjectClass)
C0376705 (UMLS 2011AA ObjectClass)
C16341 (NCI Thesaurus ObjectClass)
C0005507 (UMLS 2011AA ObjectClass)
C48228 (NCI Thesaurus Property)
C0449864 (UMLS 2011AA Property)
C25309 (NCI Thesaurus Property)
C0441994 (UMLS 2011AA Property)
C25481 (NCI Thesaurus Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
Item Group
Comments
ResearchCommentsText
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0282411 (UMLS 2011AA Property)
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