English

Penultimate Trial Medication Tobacco Use PRoFESS - Prevention Regimen For Effectively Avoiding Second Strokes NCT00153062

1 forms  
Trial Medication Compliance
Description

Trial Medication Compliance

Alias
UMLS CUI-1
C1321605
UMLS CUI-2
C0013227
1. Did the patient take at least 75% of each trial medication
Description

Patient take

Data type

boolean

Alias
UMLS CUI [1]
C0013227
2. If NO, which medication was the patient non compliant with (please indicate all that apply):
Description

In case of non-compliance to study medication, please remind the patient about medication intake requirements.

Data type

integer

Alias
UMLS CUI [1,1]
C0030705
UMLS CUI [1,2]
C0457432
Discontinuation Of Trial Medication
Description

Discontinuation Of Trial Medication

Alias
UMLS CUI-1
C0013227
UMLS CUI-2
C0457454
3. Since the last visit did the patient discontinue trial medication?
Description

Discontinuation Of Trial Medication

Data type

boolean

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0457454
4. If YES, was this a permanent discontinuation?
Description

If the patient permanently discontinued one or more of the trial medications since the previous visit, please record detailed information on the Permanent Termination of Trial Medication page 48. Even if the patient has stopped all trial medication he/she should be encouraged to return for all remaining visits.

Data type

boolean

Alias
UMLS CUI [1,1]
C0457454
UMLS CUI [1,2]
C0205355
Discontinuation Of Trial Medication
Description

Discontinuation Of Trial Medication

Alias
UMLS CUI-1
C0013227
UMLS CUI-2
C0457454
Drug (1-ABC, 2-D, 3-ABCD)
Description

Drug

Data type

integer

Alias
UMLS CUI [1]
C0013227
Date Stopped (dd mon yy)
Description

Date Stopped

Data type

date

Alias
UMLS CUI [1]
C1531784
Date Restarted (mon dd yy)
Description

Date Restarted

Data type

date

Alias
UMLS CUI [1]
C3173309
Was trial medication temporarily stopped due to an Adverse Event?
Description

Trial Medication due to an Adverse Event

Data type

boolean

Alias
UMLS CUI [1,1]
C0877248
UMLS CUI [1,2]
C1531784
If YES enter Adverse Event Name
Description

if Yes

Data type

text

Alias
UMLS CUI [1]
C0877248
Tobacco Use Status
Description

Tobacco Use Status

Alias
UMLS CUI-1
C0543414
UMLS CUI-2
C0449438
5. Has the patient smoked in the last week?
Description

Smoked Last Week

Data type

boolean

Alias
UMLS CUI [1,1]
C0543414
UMLS CUI [1,2]
C2987125
If the patient smoked cigarettes number of cigarettes per day
Description

Number of cigarettes per day

Data type

float

Alias
UMLS CUI [1,1]
C0543414
UMLS CUI [1,2]
C3694146
Back to the top of the page

Similar models

Penultimate Trial Medication Tobacco Use PRoFESS - Prevention Regimen For Effectively Avoiding Second Strokes NCT00153062

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Trial Medication Compliance
C1321605 (UMLS CUI-1)
C0013227 (UMLS CUI-2)
Patient take
Item
1. Did the patient take at least 75% of each trial medication
boolean
C0013227 (UMLS CUI [1])
Item
2. If NO, which medication was the patient non compliant with (please indicate all that apply):
integer
C0030705 (UMLS CUI [1,1])
C0457432 (UMLS CUI [1,2])
if NO
Code List
2. If NO, which medication was the patient non compliant with (please indicate all that apply):
CL Item
Bottle A (1)
CL Item
Bottle B (2)
CL Item
Blister card C (3)
CL Item
Blister card D (4)
Item Group
Discontinuation Of Trial Medication
C0013227 (UMLS CUI-1)
C0457454 (UMLS CUI-2)
Discontinuation Of Trial Medication
Item
3. Since the last visit did the patient discontinue trial medication?
boolean
C0013227 (UMLS CUI [1,1])
C0457454 (UMLS CUI [1,2])
If YES
Item
4. If YES, was this a permanent discontinuation?
boolean
C0457454 (UMLS CUI [1,1])
C0205355 (UMLS CUI [1,2])
Item Group
Discontinuation Of Trial Medication
C0013227 (UMLS CUI-1)
C0457454 (UMLS CUI-2)
Item
Drug (1-ABC, 2-D, 3-ABCD)
integer
C0013227 (UMLS CUI [1])
Drug
Code List
Drug (1-ABC, 2-D, 3-ABCD)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
Date Stopped
Item
Date Stopped (dd mon yy)
date
C1531784 (UMLS CUI [1])
Date Restarted
Item
Date Restarted (mon dd yy)
date
C3173309 (UMLS CUI [1])
Trial Medication due to an Adverse Event
Item
Was trial medication temporarily stopped due to an Adverse Event?
boolean
C0877248 (UMLS CUI [1,1])
C1531784 (UMLS CUI [1,2])
if Yes
Item
If YES enter Adverse Event Name
text
C0877248 (UMLS CUI [1])
Item Group
Tobacco Use Status
C0543414 (UMLS CUI-1)
C0449438 (UMLS CUI-2)
Smoked Last Week
Item
5. Has the patient smoked in the last week?
boolean
C0543414 (UMLS CUI [1,1])
C2987125 (UMLS CUI [1,2])
Number of cigarettes per day
Item
If the patient smoked cigarettes number of cigarettes per day
float
C0543414 (UMLS CUI [1,1])
C3694146 (UMLS CUI [1,2])
Back to the top of the page