Engelsk

Treatment History CRFs Multiple Sclerosis Tysabri NCT00027300

1 Formulär  
MS Treatment History
Beskrivning

MS Treatment History

Alias
UMLS CUI-1
C0814462
UMLS CUI-2
C0026769
Has subject received any of the therapies listed below for treatment of MS since the subject was diagnosed with MS?
Beskrivning

further received therapies

Datatyp

boolean

Alias
UMLS CUI [1]
C1514463
UMLS CUI [2]
C0026769
If "YES" provide details.
Beskrivning

If "YES" provide details.

Datatyp

text

Therapy
Beskrivning

Therapy

Datatyp

integer

Alias
UMLS CUI [1]
C0087111
previously received?
Beskrivning

previously received

Datatyp

boolean

Alias
UMLS CUI [1]
C1514463
Duration of Most Recent Treatment (specify number of days, weeks, or month)*
Beskrivning

*Do NOT include steroids taken for non-MS conditions. Do NOT include IV steroids taken for relapse. Only include chronic steroid treatment taken for MS (e.g. booster therapy).

Datatyp

float

Alias
UMLS CUI [1]
C0449238
UMLS CUI [2]
C0439228
UMLS CUI [3]
C0439230
UMLS CUI [4]
C0439231
Date of last dose
Beskrivning

Last Dose

Datatyp

date

Alias
UMLS CUI [1]
C1762893
Tillbaka till toppen

Similar models

Treatment History CRFs Multiple Sclerosis Tysabri NCT00027300

1 Formulär
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
MS Treatment History
C0814462 (UMLS CUI-1)
C0026769 (UMLS CUI-2)
further received therapies
Item
Has subject received any of the therapies listed below for treatment of MS since the subject was diagnosed with MS?
boolean
C1514463 (UMLS CUI [1])
C0026769 (UMLS CUI [2])
If "YES" provide details.
Item
If "YES" provide details.
text
Item
Therapy
integer
C0087111 (UMLS CUI [1])
Theraphy
Code List
Therapy
CL Item
4-Aminopyridine fapridine (4-AP) (1)
CL Item
Azathioprine (2)
CL Item
Cyclophosphamide (3)
CL Item
Cyclosporine (4)
CL Item
Glatiramer acetate (5)
CL Item
Intraveneous immunoglobin (IVIG) (6)
CL Item
Linomide (7)
CL Item
Methotrexate (8)
CL Item
Mitoxantrone (9)
CL Item
Plasmapheresis or cytapheresis (10)
CL Item
Steroids (Do NOT record in shaded areas.)** (11)
CL Item
Interferon beta-1a (specify trade name) (12)
CL Item
Interferon beta-1b (specify trade name) (13)
CL Item
Other (14)
CL Item
Other (15)
previously received
Item
previously received?
boolean
C1514463 (UMLS CUI [1])
Duration
Item
Duration of Most Recent Treatment (specify number of days, weeks, or month)*
float
C0449238 (UMLS CUI [1])
C0439228 (UMLS CUI [2])
C0439230 (UMLS CUI [3])
C0439231 (UMLS CUI [4])
Last Dose
Item
Date of last dose
date
C1762893 (UMLS CUI [1])
Tillbaka till toppen