ID

22061

Descripción

HD16 NCT Nr.: NCT00736320 HD16 for Early Stages - Treatment Optimization Trial in the First-line Treatment of Early Stage Hodgkin Lymphoma; Treatment Stratification by Means of FDG-PET. This study is designed to test the non-inferiority of the experimental arm compared to the standard arm in terms of Progression free survival (PFS). HD17 NCT Nr.: NCT01356680 HD17 for Intermediate Stages - Treatment Optimization Trial in the First-Line Treatment of Intermediate Stage Hodgkin Lymphoma.This study is designed to test the non-inferiority of the experimental arm compared to the standard arm in terms of progression free survival (PFS). HD18 NCT Nr.: NCT00515554 HD18 for Advanced Stages in Hodgkins Lymphoma. This study is designed to test: in patients with negative positron-emission tomography (PET) after 2 cycles of BEACOPPesc chemotherapy: whether the number of cycles can be reduced without compromising progression free survival (PFS) (2 further cycles vs. 6 further cycles) for patients with positive PET after 2 cycles: whether intensifying BEACOPPesc chemotherapy by adding Rituximab improves PFS. Permission granted by: Andreas Engert, M.D. Chairman, German Hodgkin Study Group Professor for Internal Medicine Hematology & Oncology University Hospital of Cologne Department of Internal Medicine I Kerpener Str. 62 D-50924 Köln Phone: +49-221-478-5933/5966 Fax: +49-221-478-3778 a.engert@uni-koeln.de

Palabras clave

Versiones (2)
  1. 17/5/17 17/5/17 -
  2. 1/11/18 1/11/18 - Sarah Riepenhausen
Subido en

17 de mayo de 2017

DOI

Para solicitar uno, por favor iniciar sesión.

Licencia

Creative Commons BY-NC 3.0
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German Hodgkin Study Group Study HD16/HD17/HD18 Long term toxicity G6LT DRKS00003455 DRKS00003457

Alemán

Deutsche Hodgkin Studiengruppe: G6LT Nachsorgebogen Langzeittoxizität

1 formularios  
Formularkopf
Descripción

Formularkopf

Alias
UMLS CUI-1
C0600661
Stempel des einsendenden Instituts
Descripción

Stamp of participating institution

Tipo de datos

text

Alias
UMLS CUI [1]
C2347449
Telefonnummer des einsendenden Instituts (bitte mit Durchwahl)
Descripción

Phone number of participating institution

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C2347449
UMLS CUI [1,2]
C1515258
Adresse der verantwortlichen Studienzentrale
Descripción

Address of responsible study center

Tipo de datos

text

Alias
UMLS CUI [1,1]
C2825181
UMLS CUI [1,2]
C1442065
Patientenname
Descripción

Patient Name

Tipo de datos

text

Alias
UMLS CUI [1]
C1299487
Geburtsname
Descripción

Patient birth name

Tipo de datos

text

Alias
UMLS CUI [1]
C1549652
Geburtsdatum
Descripción

Birth Date

Tipo de datos

date

Alias
UMLS CUI [1]
C0421451
Adresse des Patienten
Descripción

Patient address

Tipo de datos

text

Alias
UMLS CUI [1]
C0421449
Datum der Untersuchung
Descripción

Physical Examination date

Tipo de datos

date

Alias
UMLS CUI [1]
C2826643
Studien ID
Descripción

Study ID

Tipo de datos

integer

Alias
UMLS CUI [1]
C2826693
Bogen ID
Descripción

CRF Indentificator

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C1516308
UMLS CUI [1,2]
C0600091
Case ID
Descripción

Case ID

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C1698493
UMLS CUI [1,2]
C0600091
Symptome seit Therapieende
Descripción

Symptome seit Therapieende

Alias
UMLS CUI-1
C0683368
UMLS CUI-2
C0087111
UMLS CUI-3
C1444662
Symptome seit Therapieende
Descripción

Symptoms since treatment end

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C0683368
UMLS CUI [1,2]
C0087111
UMLS CUI [1,3]
C1444662
Belastungsdyspnoe
Descripción

Dyspnea on exertion

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0231807
Ruhedyspnoe
Descripción

Dyspnea at rest

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0743330
Orthopnoe
Descripción

Orthopnea

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0085619
Nykturie
Descripción

Nocturia

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0028734
Leistungsminderung
Descripción

Decrease in endurance

Tipo de datos

boolean

Alias
UMLS CUI [1]
C4062567
Angina pectoris
Descripción

Angina pectoris

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0002962
Myokardinfarkt
Descripción

Myocardial Infarction

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0027051
Palpitationen
Descripción

Palpitations

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0030252
Hypotonie
Descripción

Hypotension

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0020649
Hypertonie
Descripción

Hypertension

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0020538
KHK
Descripción

Coronary heart disease

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0010068
KHK- Lokalisation
Descripción

Coronary heart disease localization

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0010068
UMLS CUI [1,2]
C0475264
Ödeme
Descripción

Edema

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0013604
Ödeme-Lokalisation
Descripción

Edema localization

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0013604
UMLS CUI [1,2]
C0475264
Untersuchungen Kardio
Descripción

Untersuchungen Kardio

Alias
UMLS CUI-1
C0562319
Echokardiographie
Descripción

Echocardiography

Tipo de datos

text

Alias
UMLS CUI [1]
C0013516
LVEF
Descripción

LVEF

Tipo de datos

integer

Unidades de medida
  • %
Alias
UMLS CUI [1]
C0428772
%
E/A
Descripción

E/A

Tipo de datos

integer

Alias
UMLS CUI [1]
C2059591
DT
Descripción

Deceleration Time

Tipo de datos

integer

Unidades de medida
  • ms
Alias
UMLS CUI [1]
C0882996
ms
Tei Index
Descripción

Tei Index

Tipo de datos

float

Alias
UMLS CUI [1]
C2923433
Perikarderguss
Descripción

Pericardial effusion

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0031039
Perikarderguss
Descripción

Pericardial effusion

Tipo de datos

integer

Unidades de medida
  • cm
Alias
UMLS CUI [1]
C0031039
cm
Klappenfunktionsstörungen
Descripción

Heart valve dysfunction

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0018826
UMLS CUI [1,2]
C0277785
Klappenfunktionsstörungen:ja folgende
Descripción

Heart valve dysfunction

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0018826
UMLS CUI [1,2]
C2983555
Regionale Wandbewegungsstörungen
Descripción

Regional cardiac wall motion dysfunction

Tipo de datos

boolean

Alias
UMLS CUI [1]
C2024775
Regionale Wandbewegungsstörungen:ja folgende
Descripción

Regional cardiac wall motion dysfunction type

Tipo de datos

text

Alias
UMLS CUI [1]
C2024775
EKG
Descripción

ECG

Tipo de datos

text

Alias
UMLS CUI [1]
C1623258
Herzfrequenz
Descripción

Heart rate

Tipo de datos

integer

Unidades de medida
  • bpm
Alias
UMLS CUI [1]
C0018810
bpm
Pathologischer Befund
Descripción

ECG findings

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0438154
Pathologischer Befund: ja folgender
Descripción

ECG findings

Tipo de datos

text

Alias
UMLS CUI [1]
C0438154
RR systolisch
Descripción

Blood pressure systolic

Tipo de datos

integer

Unidades de medida
  • mmHg
Alias
UMLS CUI [1]
C0871470
mmHg
RR diastolisch
Descripción

Blood pressure diastolic

Tipo de datos

integer

Unidades de medida
  • mmHg
Alias
UMLS CUI [1]
C0428883
mmHg
Serologie
Descripción

Serology

Tipo de datos

text

Alias
UMLS CUI [1]
C0036743
Kreatinin
Descripción

Creatinine

Tipo de datos

float

Alias
UMLS CUI [1]
C0201976
Einheit
Descripción

Unit used

Tipo de datos

text

Alias
UMLS CUI [1]
C1519795
10 ml Serum für NTproBNP und Troponin T verschickt
Descripción

Serum Troponin T test and NTproBNP

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0585642
UMLS CUI [2]
C1963813
Anamnese Fertilität
Descripción

Anamnese Fertilität

Alias
UMLS CUI-1
C0262926
UMLS CUI-2
C0015895
Anamnese Fertilität
Descripción

Medical history fertility

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0015895
Zyklusanamnese/Spermiogramm
Descripción

Menstrual cycle and spermiogram

Tipo de datos

integer

Alias
UMLS CUI [1]
C0025329
UMLS CUI [2]
C0202533
Zyklusanamnese/Spermiogramm: pathologischer Befund
Descripción

Menstrual cycle and spermiogram

Tipo de datos

text

Alias
UMLS CUI [1]
C0025329
UMLS CUI [2]
C0202533
Kontrazeption
Descripción

nur bei weiblichen Patienten ausfüllen

Tipo de datos

text

Alias
UMLS CUI [1]
C0700589
Hormonelle Verhütung während Therapie
Descripción

Hormonal contraception during treatment

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C2985296
UMLS CUI [1,2]
C2709058
Hormonelle Verhütung während Therapie ja mit:
Descripción

Hormonal contraception method during treatment

Tipo de datos

text

Alias
UMLS CUI [1,1]
C2985296
UMLS CUI [1,2]
C0700589
UMLS CUI [1,3]
C2709058
Aktuelle hormonelle Verhütung
Descripción

Hormonal contraception current

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C2985296
UMLS CUI [1,2]
C0521116
Aktuelle hormonelle Verhütung ja mit:
Descripción

Hormonal contraception current

Tipo de datos

text

Alias
UMLS CUI [1,1]
C2985296
UMLS CUI [1,2]
C0700589
UMLS CUI [1,3]
C0521116
Letzte Einnahme
Descripción

Date last medication intake

Tipo de datos

date

Alias
UMLS CUI [1]
C4029433
Serologie
Descripción

Serology

Tipo de datos

text

Alias
UMLS CUI [1]
C0036743
FSH
Descripción

FSH

Tipo de datos

integer

Alias
UMLS CUI [1]
C0202022
Einheit
Descripción

Unit used

Tipo de datos

text

Alias
UMLS CUI [1]
C1519795
LH
Descripción

LH

Tipo de datos

integer

Alias
UMLS CUI [1]
C0202123
Einheit
Descripción

Unit used

Tipo de datos

text

Alias
UMLS CUI [1]
C1519795
ß-Östradiol
Descripción

Beta estradiol

Tipo de datos

integer

Alias
UMLS CUI [1]
C0014912
Einheit
Descripción

Unit used

Tipo de datos

text

Alias
UMLS CUI [1]
C1519795
Testosteron
Descripción

Testosterone

Tipo de datos

float

Alias
UMLS CUI [1]
C0523912
Einheit
Descripción

Unit used

Tipo de datos

text

Alias
UMLS CUI [1]
C1519795
AMH
Descripción

AMH

Tipo de datos

float

Alias
UMLS CUI [1]
C0066928
Einheit
Descripción

Unit used

Tipo de datos

text

Alias
UMLS CUI [1]
C1519795
Inhibin B
Descripción

Inhibin B

Tipo de datos

integer

Alias
UMLS CUI [1]
C3272959
Einheit
Descripción

Unit used

Tipo de datos

text

Alias
UMLS CUI [1]
C1519795
Schwangerschaften/Kinder nach Therapie
Descripción

Pregnancies post treatment

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C0032961
UMLS CUI [1,2]
C2062974
Anzahl der Schwangerschaften
Descripción

Number of pregnancies

Tipo de datos

integer

Alias
UMLS CUI [1]
C3812254
Abort
Descripción

Miscarriage

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0156543
Anzahl Aborte
Descripción

Number of miscarriages

Tipo de datos

integer

Alias
UMLS CUI [1]
C0429916
Anzahl der Kinder
Descripción

Number of children

Tipo de datos

integer

Alias
UMLS CUI [1]
C2229974
Geburtsdatum
Descripción

Birth Date

Tipo de datos

date

Alias
UMLS CUI [1]
C0421451
Verwendung von Kryokonservat
Descripción

Use of cryopreservation

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C0010405
UMLS CUI [1,2]
C1524063
Ovargewebe
Descripción

Ovarian tissue cryopreservation

Tipo de datos

boolean

Alias
UMLS CUI [1]
C1314154
Spermien
Descripción

Sperm cryopreservation

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0519952
Eizelle befruchtet
Descripción

Cryopreservation of fertilized ovum

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0010405
UMLS CUI [1,2]
C0043544
Eizelle unbefruchtet
Descripción

Cryopreservation of oocyte

Tipo de datos

boolean

Alias
UMLS CUI [1]
C1314155
Komplikationen
Descripción

Complications

Tipo de datos

integer

Alias
UMLS CUI [1]
C0009566
Komplikationen
Descripción

Complications

Tipo de datos

text

Alias
UMLS CUI [1]
C0009566
Untersuchungen Lunge
Descripción

Untersuchungen Lunge

Alias
UMLS CUI-1
C2228454
Lungenfunktion
Descripción

Pulmonary function tests

Tipo de datos

integer

Alias
UMLS CUI [1]
C0024119
Vitalkapazität
Descripción

Vital capacity

Tipo de datos

float

Unidades de medida
  • %
Alias
UMLS CUI [1]
C0042834
%
DLCO
Descripción

DLCO

Tipo de datos

float

Unidades de medida
  • %
Alias
UMLS CUI [1]
C1516251
%
pO2
Descripción

pO2

Tipo de datos

integer

Unidades de medida
  • mmHg
Alias
UMLS CUI [1]
C2317096
mmHg
pCO2
Descripción

pCO2

Tipo de datos

integer

Unidades de medida
  • mmHg
Alias
UMLS CUI [1]
C0201931
mmHg
Thorax: Röntgen
Descripción

Chest X-ray

Tipo de datos

integer

Alias
UMLS CUI [1]
C0039985
Röntgen Thorax: Befund
Descripción

Chest x-ray finding

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0039985
UMLS CUI [1,2]
C1514241
CT-Thorax
Descripción

Computed Tomography chest

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C0040405
UMLS CUI [1,2]
C0817096
CT-Thorax: Befund
Descripción

Computed Tomography chest findings

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0040405
UMLS CUI [1,2]
C0817096
UMLS CUI [1,3]
C1514241
Bleomycin induzierte Toxizität
Descripción

Bleomycin induced toxicity

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0005740
UMLS CUI [1,2]
C1302255
Bemerkungen
Descripción

Bemerkungen

Bemerkungen
Descripción

Comments

Tipo de datos

text

Alias
UMLS CUI [1]
C0947611
Datum
Descripción

Date of completion

Tipo de datos

date

Alias
UMLS CUI [1]
C0011008
Unterschrift des Arztes
Descripción

Physician signature

Tipo de datos

text

Alias
UMLS CUI [1]
C1519316
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Similar models

Deutsche Hodgkin Studiengruppe: G6LT Nachsorgebogen Langzeittoxizität

1 formularios
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
Formularkopf
C0600661 (UMLS CUI-1)
Stamp of participating institution
Item
Stempel des einsendenden Instituts
text
C2347449 (UMLS CUI [1])
Phone number of participating institution
Item
Telefonnummer des einsendenden Instituts (bitte mit Durchwahl)
integer
C2347449 (UMLS CUI [1,1])
C1515258 (UMLS CUI [1,2])
Address of responsible study center
Item
Adresse der verantwortlichen Studienzentrale
text
C2825181 (UMLS CUI [1,1])
C1442065 (UMLS CUI [1,2])
Patient Name
Item
Patientenname
text
C1299487 (UMLS CUI [1])
Patient birth name
Item
Geburtsname
text
C1549652 (UMLS CUI [1])
Birth Date
Item
Geburtsdatum
date
C0421451 (UMLS CUI [1])
Patient address
Item
Adresse des Patienten
text
C0421449 (UMLS CUI [1])
Physical Examination date
Item
Datum der Untersuchung
date
C2826643 (UMLS CUI [1])
Item
Studien ID
integer
C2826693 (UMLS CUI [1])
Study ID
Code List
Studien ID
CL Item
HD16 (1)
CL Item
HD17 (2)
CL Item
HD18 (3)
CRF Indentificator
Item
Bogen ID
integer
C1516308 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
Case ID
Item
Case ID
integer
C1698493 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
Item Group
Symptome seit Therapieende
C0683368 (UMLS CUI-1)
C0087111 (UMLS CUI-2)
C1444662 (UMLS CUI-3)
Item
Symptome seit Therapieende
integer
C0683368 (UMLS CUI [1,1])
C0087111 (UMLS CUI [1,2])
C1444662 (UMLS CUI [1,3])
Symptoms since treatment end
Code List
Symptome seit Therapieende
CL Item
Not done (1)
C1272696 (UMLS CUI-1)
CL Item
Nein (bitte bei "Untersuchungen Kardio" weitermachen) (2)
C1513916 (UMLS CUI-1)
CL Item
Ja (bitte folgendes ausfüllen) (3)
C1514241 (UMLS CUI-1)
Dyspnea on exertion
Item
Belastungsdyspnoe
boolean
C0231807 (UMLS CUI [1])
Dyspnea at rest
Item
Ruhedyspnoe
boolean
C0743330 (UMLS CUI [1])
Orthopnea
Item
Orthopnoe
boolean
C0085619 (UMLS CUI [1])
Nocturia
Item
Nykturie
boolean
C0028734 (UMLS CUI [1])
Decrease in endurance
Item
Leistungsminderung
boolean
C4062567 (UMLS CUI [1])
Angina pectoris
Item
Angina pectoris
boolean
C0002962 (UMLS CUI [1])
Myocardial Infarction
Item
Myokardinfarkt
boolean
C0027051 (UMLS CUI [1])
Palpitations
Item
Palpitationen
boolean
C0030252 (UMLS CUI [1])
Hypotension
Item
Hypotonie
boolean
C0020649 (UMLS CUI [1])
Hypertension
Item
Hypertonie
boolean
C0020538 (UMLS CUI [1])
Coronary heart disease
Item
KHK
boolean
C0010068 (UMLS CUI [1])
Coronary heart disease localization
Item
KHK- Lokalisation
text
C0010068 (UMLS CUI [1,1])
C0475264 (UMLS CUI [1,2])
Edema
Item
Ödeme
boolean
C0013604 (UMLS CUI [1])
Edema localization
Item
Ödeme-Lokalisation
text
C0013604 (UMLS CUI [1,1])
C0475264 (UMLS CUI [1,2])
Item Group
Untersuchungen Kardio
C0562319 (UMLS CUI-1)
Echocardiography
Item
Echokardiographie
text
C0013516 (UMLS CUI [1])
LVEF
Item
LVEF
integer
C0428772 (UMLS CUI [1])
E/A
Item
E/A
integer
C2059591 (UMLS CUI [1])
Deceleration Time
Item
DT
integer
C0882996 (UMLS CUI [1])
Tei Index
Item
Tei Index
float
C2923433 (UMLS CUI [1])
Pericardial effusion
Item
Perikarderguss
boolean
C0031039 (UMLS CUI [1])
Pericardial effusion
Item
Perikarderguss
integer
C0031039 (UMLS CUI [1])
Heart valve dysfunction
Item
Klappenfunktionsstörungen
boolean
C0018826 (UMLS CUI [1,1])
C0277785 (UMLS CUI [1,2])
Heart valve dysfunction
Item
Klappenfunktionsstörungen:ja folgende
text
C0018826 (UMLS CUI [1,1])
C2983555 (UMLS CUI [1,2])
Regional cardiac wall motion dysfunction
Item
Regionale Wandbewegungsstörungen
boolean
C2024775 (UMLS CUI [1])
Regional cardiac wall motion dysfunction type
Item
Regionale Wandbewegungsstörungen:ja folgende
text
C2024775 (UMLS CUI [1])
ECG
Item
EKG
text
C1623258 (UMLS CUI [1])
Heart rate
Item
Herzfrequenz
integer
C0018810 (UMLS CUI [1])
ECG findings
Item
Pathologischer Befund
boolean
C0438154 (UMLS CUI [1])
ECG findings
Item
Pathologischer Befund: ja folgender
text
C0438154 (UMLS CUI [1])
Blood pressure systolic
Item
RR systolisch
integer
C0871470 (UMLS CUI [1])
Blood pressure diastolic
Item
RR diastolisch
integer
C0428883 (UMLS CUI [1])
Serology
Item
Serologie
text
C0036743 (UMLS CUI [1])
Creatinine
Item
Kreatinin
float
C0201976 (UMLS CUI [1])
Unit used
Item
Einheit
text
C1519795 (UMLS CUI [1])
Serum Troponin T test and NTproBNP
Item
10 ml Serum für NTproBNP und Troponin T verschickt
boolean
C0585642 (UMLS CUI [1])
C1963813 (UMLS CUI [2])
Item Group
Anamnese Fertilität
C0262926 (UMLS CUI-1)
C0015895 (UMLS CUI-2)
Medical history fertility
Item
Anamnese Fertilität
boolean
C0262926 (UMLS CUI [1,1])
C0015895 (UMLS CUI [1,2])
Item
Zyklusanamnese/Spermiogramm
integer
C0025329 (UMLS CUI [1])
C0202533 (UMLS CUI [2])
Menstrual cycle and spermiogram
Code List
Zyklusanamnese/Spermiogramm
CL Item
Nein,nicht erfolgt (1)
C1272696 (UMLS CUI-1)
CL Item
Ja,ohne pathologischen Befund (2)
C1513916 (UMLS CUI-1)
CL Item
Ja, pathologischer Befund (3)
C1514241 (UMLS CUI-1)
Item
Zyklusanamnese/Spermiogramm: pathologischer Befund
text
C0025329 (UMLS CUI [1])
C0202533 (UMLS CUI [2])
Menstrual cycle and spermiogram
Code List
Zyklusanamnese/Spermiogramm: pathologischer Befund
Contraception
Item
Kontrazeption
text
C0700589 (UMLS CUI [1])
Hormonal contraception during treatment
Item
Hormonelle Verhütung während Therapie
boolean
C2985296 (UMLS CUI [1,1])
C2709058 (UMLS CUI [1,2])
Hormonal contraception method during treatment
Item
Hormonelle Verhütung während Therapie ja mit:
text
C2985296 (UMLS CUI [1,1])
C0700589 (UMLS CUI [1,2])
C2709058 (UMLS CUI [1,3])
Hormonal contraception current
Item
Aktuelle hormonelle Verhütung
boolean
C2985296 (UMLS CUI [1,1])
C0521116 (UMLS CUI [1,2])
Hormonal contraception current
Item
Aktuelle hormonelle Verhütung ja mit:
text
C2985296 (UMLS CUI [1,1])
C0700589 (UMLS CUI [1,2])
C0521116 (UMLS CUI [1,3])
Date last medication intake
Item
Letzte Einnahme
date
C4029433 (UMLS CUI [1])
Serology
Item
Serologie
text
C0036743 (UMLS CUI [1])
FSH
Item
FSH
integer
C0202022 (UMLS CUI [1])
Unit used
Item
Einheit
text
C1519795 (UMLS CUI [1])
LH
Item
LH
integer
C0202123 (UMLS CUI [1])
Unit used
Item
Einheit
text
C1519795 (UMLS CUI [1])
Beta estradiol
Item
ß-Östradiol
integer
C0014912 (UMLS CUI [1])
Unit used
Item
Einheit
text
C1519795 (UMLS CUI [1])
Testosterone
Item
Testosteron
float
C0523912 (UMLS CUI [1])
Unit used
Item
Einheit
text
C1519795 (UMLS CUI [1])
AMH
Item
AMH
float
C0066928 (UMLS CUI [1])
Unit used
Item
Einheit
text
C1519795 (UMLS CUI [1])
Inhibin B
Item
Inhibin B
integer
C3272959 (UMLS CUI [1])
Unit used
Item
Einheit
text
C1519795 (UMLS CUI [1])
Item
Schwangerschaften/Kinder nach Therapie
integer
C0032961 (UMLS CUI [1,1])
C2062974 (UMLS CUI [1,2])
Pregnancies post treatment
Code List
Schwangerschaften/Kinder nach Therapie
CL Item
Nein (1)
C1513916 (UMLS CUI-1)
CL Item
Ja (bitte folgendes ausfüllen) (2)
C1514241 (UMLS CUI-1)
Number of pregnancies
Item
Anzahl der Schwangerschaften
integer
C3812254 (UMLS CUI [1])
Miscarriage
Item
Abort
boolean
C0156543 (UMLS CUI [1])
Number of miscarriages
Item
Anzahl Aborte
integer
C0429916 (UMLS CUI [1])
Number of children
Item
Anzahl der Kinder
integer
C2229974 (UMLS CUI [1])
Birth Date
Item
Geburtsdatum
date
C0421451 (UMLS CUI [1])
Item
Verwendung von Kryokonservat
integer
C0010405 (UMLS CUI [1,1])
C1524063 (UMLS CUI [1,2])
Pregnancies post treatment
Code List
Verwendung von Kryokonservat
CL Item
Nein (1)
C1513916 (UMLS CUI-1)
CL Item
Ja (bitte folgendes ausfüllen) (2)
C1514241 (UMLS CUI-1)
Ovarian tissue cryopreservation
Item
Ovargewebe
boolean
C1314154 (UMLS CUI [1])
Sperm cryopreservation
Item
Spermien
boolean
C0519952 (UMLS CUI [1])
Cryopreservation of fertilized ovum
Item
Eizelle befruchtet
boolean
C0010405 (UMLS CUI [1,1])
C0043544 (UMLS CUI [1,2])
Cryopreservation of oocyte
Item
Eizelle unbefruchtet
boolean
C1314155 (UMLS CUI [1])
Item
Komplikationen
integer
C0009566 (UMLS CUI [1])
Pregnancies post treatment
Code List
Komplikationen
CL Item
Nein (1)
C1513916 (UMLS CUI-1)
CL Item
Ja (bitte folgendes ausfüllen) (2)
C1514241 (UMLS CUI-1)
Item
Komplikationen
text
C0009566 (UMLS CUI [1])
Pregnancies post treatment
Code List
Komplikationen
Item Group
Untersuchungen Lunge
C2228454 (UMLS CUI-1)
Item
Lungenfunktion
integer
C0024119 (UMLS CUI [1])
Pulmonary function tests
Code List
Lungenfunktion
CL Item
Not done (falls nicht erfolgt) (1)
C1272696 (UMLS CUI-1)
CL Item
Ja (bitte ausfüllen) (2)
C1272695 (UMLS CUI-1)
Vital capacity
Item
Vitalkapazität
float
C0042834 (UMLS CUI [1])
DLCO
Item
DLCO
float
C1516251 (UMLS CUI [1])
pO2
Item
pO2
integer
C2317096 (UMLS CUI [1])
pCO2
Item
pCO2
integer
C0201931 (UMLS CUI [1])
Item
Thorax: Röntgen
integer
C0039985 (UMLS CUI [1])
Menstrual cycle and spermiogram
Code List
Thorax: Röntgen
CL Item
Nein,nicht erfolgt (1)
C1272696 (UMLS CUI-1)
CL Item
Ja,ohne pathologischen Befund (2)
C1513916 (UMLS CUI-1)
CL Item
Ja, pathologischer Befund (3)
C1514241 (UMLS CUI-1)
Chest x-ray finding
Item
Röntgen Thorax: Befund
text
C0039985 (UMLS CUI [1,1])
C1514241 (UMLS CUI [1,2])
Item
CT-Thorax
integer
C0040405 (UMLS CUI [1,1])
C0817096 (UMLS CUI [1,2])
Menstrual cycle and spermiogram
Code List
CT-Thorax
CL Item
Nein,nicht erfolgt (1)
C1272696 (UMLS CUI-1)
CL Item
Ja,ohne pathologischen Befund (2)
C1513916 (UMLS CUI-1)
CL Item
Ja, pathologischer Befund (3)
C1514241 (UMLS CUI-1)
Computed Tomography chest findings
Item
CT-Thorax: Befund
text
C0040405 (UMLS CUI [1,1])
C0817096 (UMLS CUI [1,2])
C1514241 (UMLS CUI [1,3])
Bleomycin induced toxicity
Item
Bleomycin induzierte Toxizität
boolean
C0005740 (UMLS CUI [1,1])
C1302255 (UMLS CUI [1,2])
Item Group
Bemerkungen
Comments
Item
Bemerkungen
text
C0947611 (UMLS CUI [1])
Date of completion
Item
Datum
date
C0011008 (UMLS CUI [1])
Physician signature
Item
Unterschrift des Arztes
text
C1519316 (UMLS CUI [1])
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