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Penultimate Visit Phone Check Vital Signs Neurological Status Events PRoFESS - Prevention Regimen For Effectively Avoiding Second Strokes NCT00153062

1 Formulários  
Phone Check Of Patient
Descrição

Phone Check Of Patient

Alias
UMLS CUI-1
C0039457
UMLS CUI-2
C1283174
1. Has a phone check been done since last visit?
Descrição

Telephone check

Tipo de dados

boolean

Alias
UMLS CUI [1,1]
C0039457
UMLS CUI [1,2]
C1283174
2. If Yes, date of phone call (dd-mon-yy)
Descrição

if Yes

Tipo de dados

date

Alias
UMLS CUI [1]
C0011008
Visit
Descrição

Visit

Alias
UMLS CUI-1
C0545082
3. Was visit done?
Descrição

Visit done

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0545082
4. If no please indicate reason:
Descrição

If No,reason

Tipo de dados

integer

Alias
UMLS CUI [1]
C0681841
5. If Yes date of penultimate visit (dd-mon-yy)
Descrição

If Yes date of visit 3

Tipo de dados

date

Alias
UMLS CUI [1]
C1320303
6. Type of visit
Descrição

Type of visit

Tipo de dados

integer

Alias
UMLS CUI [1]
C3641100
7. If not patient, indicate source (try to re-establish direct contact with patient)
Descrição

If not patient, indicate source

Tipo de dados

integer

Alias
UMLS CUI [1,1]
C0449416
UMLS CUI [1,2]
C3146298
Vital Signs
Descrição

Vital Signs

Alias
UMLS CUI-1
C0518766
8. Abdominal girth (waist Circumference)
Descrição

Abdominal girth

Tipo de dados

float

Unidades de medida
  • cm
Alias
UMLS CUI [1]
C0232501
cm
9a. Systolic blood pressure after 5 minutes sitting/supine
Descrição

Systolic blood pressure

Tipo de dados

float

Unidades de medida
  • mmHg
Alias
UMLS CUI [1]
C0871470
mmHg
9b. Diastolic Blood Pressure after 5 minutes sitting/supine
Descrição

Diastolic Blood Pressure

Tipo de dados

float

Unidades de medida
  • mmHg
Alias
UMLS CUI [1]
C0428883
mmHg
10. Blood Pressure Position
Descrição

Blood Pressure Position

Tipo de dados

integer

Alias
UMLS CUI [1]
C1828063
Neurological Status
Descrição

Neurological Status

Alias
UMLS CUI-1
C0746866
11. Please check carefully whether the present clinical neurological status is different from baseline to determine if the patient may have experienced a stroke since the last visit
Descrição

Clinical Neurological Status is different

Tipo de dados

integer

Alias
UMLS CUI [1,1]
C0038454
UMLS CUI [1,2]
C2047944
Events
Descrição

Events

Alias
UMLS CUI-1
C0877248
12. Have any Outcome Events or Serious Adverse Events been experienced, or has patient been hospitalised? (See instructions on facing page)
Descrição

Outcome Events or Serious Adverse Events

Tipo de dados

boolean

Alias
UMLS CUI [1]
C1705586
UMLS CUI [2]
C0877248
13. If "YES" please indicate all that apply:
Descrição

If Yes

Tipo de dados

integer

Alias
UMLS CUI [1]
C1521902
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Similar models

Penultimate Visit Phone Check Vital Signs Neurological Status Events PRoFESS - Prevention Regimen For Effectively Avoiding Second Strokes NCT00153062

1 Formulários
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de dados
Alias
Item Group
Phone Check Of Patient
C0039457 (UMLS CUI-1)
C1283174 (UMLS CUI-2)
Telephone check
Item
1. Has a phone check been done since last visit?
boolean
C0039457 (UMLS CUI [1,1])
C1283174 (UMLS CUI [1,2])
if Yes
Item
2. If Yes, date of phone call (dd-mon-yy)
date
C0011008 (UMLS CUI [1])
Item Group
Visit
C0545082 (UMLS CUI-1)
Visit done
Item
3. Was visit done?
boolean
C0545082 (UMLS CUI [1])
Item
4. If no please indicate reason:
integer
C0681841 (UMLS CUI [1])
If No,reason
Code List
4. If no please indicate reason:
CL Item
Patient refuses further information (1)
CL Item
Unable to contact patient or other source (2)
If Yes date of visit 3
Item
5. If Yes date of penultimate visit (dd-mon-yy)
date
C1320303 (UMLS CUI [1])
Item
6. Type of visit
integer
C3641100 (UMLS CUI [1])
Type of visit
Code List
6. Type of visit
CL Item
Clinic (in-person) (1)
CL Item
Telephone (2)
CL Item
Information obtained from source other than patient (3)
Item
7. If not patient, indicate source (try to re-establish direct contact with patient)
integer
C0449416 (UMLS CUI [1,1])
C3146298 (UMLS CUI [1,2])
If not patient, indicate source
Code List
7. If not patient, indicate source (try to re-establish direct contact with patient)
CL Item
Physician (1)
CL Item
Relative or friend (2)
CL Item
Other (3)
Item Group
Vital Signs
C0518766 (UMLS CUI-1)
Abdominal girth
Item
8. Abdominal girth (waist Circumference)
float
C0232501 (UMLS CUI [1])
Systolic blood pressure
Item
9a. Systolic blood pressure after 5 minutes sitting/supine
float
C0871470 (UMLS CUI [1])
Diastolic Blood Pressure
Item
9b. Diastolic Blood Pressure after 5 minutes sitting/supine
float
C0428883 (UMLS CUI [1])
Item
10. Blood Pressure Position
integer
C1828063 (UMLS CUI [1])
Blood Pressure Position
Code List
10. Blood Pressure Position
CL Item
Sitting (1 )
CL Item
Supine (2 )
Item Group
Neurological Status
C0746866 (UMLS CUI-1)
Item
11. Please check carefully whether the present clinical neurological status is different from baseline to determine if the patient may have experienced a stroke since the last visit
integer
C0038454 (UMLS CUI [1,1])
C2047944 (UMLS CUI [1,2])
Clinical Neurological Status is different
Code List
11. Please check carefully whether the present clinical neurological status is different from baseline to determine if the patient may have experienced a stroke since the last visit
CL Item
Unchanged (1)
CL Item
Improved (2)
CL Item
Worsened (3)
Item Group
Events
C0877248 (UMLS CUI-1)
Outcome Events or Serious Adverse Events
Item
12. Have any Outcome Events or Serious Adverse Events been experienced, or has patient been hospitalised? (See instructions on facing page)
boolean
C1705586 (UMLS CUI [1])
C0877248 (UMLS CUI [2])
Item
13. If "YES" please indicate all that apply:
integer
C1521902 (UMLS CUI [1])
If Yes
Code List
13. If "YES" please indicate all that apply:
CL Item
Stroke (1)
CL Item
Myocardial Infarction (2)
CL Item
Death (3)
CL Item
New or worsening congestive heart failure (CHF) (4)
CL Item
Other designated vascular event (5)
CL Item
Hemorrhagic Event (6)
CL Item
Thrombotic Thrombocytopenic purpura (7)
CL Item
Neutropenia (8)
CL Item
Other Hospitalization (9)
CL Item
Newly diagnosed diabetes (10)
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