ID

22017

Beschrijving

Study part: Smoking/ Drinking history. A phase III multinational, randomized, single-blind study of recombinant humanized anti-p185HER2 monoclonal antibody (rhuMAb HER2) in patients with HER2/neu overexpression who have not received prior cytotoxic chemotherapy for metastatic breast cancer. "Terms of use: You may not use this document or the information contained herein to a regulatory authority in connection with an application for a marketing authorization or any other regulatory submission without the express written consent of Roche"

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  1. 14-05-17 14-05-17 -
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Roche

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14 mei 2017

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Creative Commons BY-NC 3.0
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SMOKING / DRINKING HISTORY Roche H0650g Breast Cancer

Engels

SMOKING / DRINKING HISTORY

1 Formulieren  
SMOKING
Beschrijving

SMOKING

Alias
UMLS CUI-1
C1519384
1. DOES THE PATIENT HAVE A HISTORY OF CIGARETTE SMOKING?
Beschrijving

Smoking History

Datatype

boolean

Alias
UMLS CUI [1]
C1519384
IF YES, SPECIFY THE DURATION
Beschrijving

smoking duration

Datatype

integer

Alias
UMLS CUI [1]
C3694955
IF YES, SPECIFY THE AMOUNT OF CIGARETTES/DAY
Beschrijving

number of cigarettes per day

Datatype

integer

Alias
UMLS CUI [1]
C3694146
2. IF QUESTION #1 IS "YES", DOES THE PATIENT CONTINUE TO SMOKE?
Beschrijving

smoking status

Datatype

boolean

Alias
UMLS CUI [1]
C1519386
DRINKING
Beschrijving

DRINKING

Alias
UMLS CUI-1
C0851148
1. HAS THE PATIENT EVER REGULARLY HAD > 5 DRINKS PER WEEK FOR A PERIOD > 1 YEAR?
Beschrijving

drinking

Datatype

boolean

Alias
UMLS CUI [1]
C0851148
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Similar models

SMOKING / DRINKING HISTORY

1 Formulieren
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
SMOKING
C1519384 (UMLS CUI-1)
Smoking History
Item
1. DOES THE PATIENT HAVE A HISTORY OF CIGARETTE SMOKING?
boolean
C1519384 (UMLS CUI [1])
Item
IF YES, SPECIFY THE DURATION
integer
C3694955 (UMLS CUI [1])
smoking duration
Code List
IF YES, SPECIFY THE DURATION
CL Item
< 1 YEAR  (1)
CL Item
1-5 YEARS (2)
CL Item
5-10 YEARS  (3)
CL Item
>10 YEARS (4)
Item
IF YES, SPECIFY THE AMOUNT OF CIGARETTES/DAY
integer
C3694146 (UMLS CUI [1])
number of cigarettes per day
Code List
IF YES, SPECIFY THE AMOUNT OF CIGARETTES/DAY
CL Item
<5 (1)
CL Item
5-10 (2)
CL Item
10-20 (3)
CL Item
20-40 (4)
CL Item
>40 (5)
smoking status
Item
2. IF QUESTION #1 IS "YES", DOES THE PATIENT CONTINUE TO SMOKE?
boolean
C1519386 (UMLS CUI [1])
Item Group
DRINKING
C0851148 (UMLS CUI-1)
drinking
Item
1. HAS THE PATIENT EVER REGULARLY HAD > 5 DRINKS PER WEEK FOR A PERIOD > 1 YEAR?
boolean
C0851148 (UMLS CUI [1])
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