ID

22601

Beskrivning

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 Study #: FVF4168g Drug: Ranibizumab Study Title: A Phase III, Double-Masked, Multicenter, Randomized, Sham-Controlled Study Of The Efficacy And Safety Of Ranibizumab Injection In Subjects With Clinically Significant Macular Edema With Center Involvement Secondary To Diabetes Mellitus

Nyckelord

Versioner (2)
  1. 2017-06-08 2017-06-08 -
  2. 2017-06-08 2017-06-08 -
Rättsinnehavare

Genentech, Inc.

Uppladdad den

8 juni 2017

DOI

För en begäran logga in.

Licens

Creative Commons BY-NC 3.0
Modellkommentarer :

Här kan du kommentera modellen. Med hjälp av pratbubblor i Item-grupperna och Item kan du lägga in specifika kommentarer.

Tillbaka till modellkommentarer
Itemgroup-kommentar för :

Item-kommentar för :

Du måste vara inloggad för att kunna ladda ner formulär. Var vänlig logga in eller registrera dig utan kostnad.

ALCOHOL / TOBACCO USE HISTORY (SCREENING) CRFs Roche FVF4168G Macular Edema NCT00473330

Engelsk

ALCOHOL / TOBACCO USE HISTORY (SCREENING) CRFs Roche FVF4168G Macular Edema NCT00473330

1 Formulär  
Patient administration
Beskrivning

Patient administration

Subject Number
Beskrivning

PT

Datatyp

integer

Alias
UMLS CUI [1]
C2348585
Subject Initials:
Beskrivning

PTINIT

Datatyp

text

Alias
UMLS CUI [1,1]
C1997894
UMLS CUI [1,2]
C2986440
Report Date:
Beskrivning

VDT

Datatyp

date

Alias
UMLS CUI [1,1]
C1302584
ALCOHOL / TOBACCO USE HISTORY (SCREENING)
Beskrivning

ALCOHOL / TOBACCO USE HISTORY (SCREENING)

Smoking cigarettes currently:
Beskrivning

Indicate overall tobacco use (check one only).

Datatyp

boolean

Alias
UMLS CUI [1]
C0543414
Packs / day:
Beskrivning

TOBACCO_QUANTITY [TOBQTY1]

Datatyp

float

Alias
UMLS CUI [1]
C3694145
Year started:
Beskrivning

TOBACCO_USE_BEGIN [TOBEG1]

Datatyp

integer

Alias
UMLS CUI [1]
C0425315
Stopped smoking cigarettes:
Beskrivning

TOBACCO_USE_END [TOBEND]

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0425310
Year started:
Beskrivning

TOBACCO_USE_BEGIN [TOBEG2]

Datatyp

integer

Alias
UMLS CUI [1]
C0425315
Year stopped:
Beskrivning

TOBACCO_USE_END [TOBEND]

Datatyp

integer

Alias
UMLS CUI [1]
C0425310
Packs / day when smoked:
Beskrivning

TOBACCO_QUANTITY [TOBQTY2]

Datatyp

float

Alias
UMLS CUI [1]
C3694145
Smoke pipe or cigars currently
Beskrivning

pipe or cigars

Datatyp

boolean

Alias
UMLS CUI [1,1]
C3241966
UMLS CUI [1,2]
C0240766
UMLS CUI [2,1]
C3241966
UMLS CUI [2,2]
C0337666
Smoked pipe or cigars in the past
Beskrivning

pipe or cigars in the past

Datatyp

boolean

Alias
UMLS CUI [1]
C0240766
UMLS CUI [2]
C0337666
Never smoked
Beskrivning

NEVERSMOKED

Datatyp

boolean

Alias
UMLS CUI [1]
C0425293
Do not drink alcohol currently
Beskrivning

Indicate overall alcohol use (check one only).

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0001948
Currently do drink (even occasionally), how often:
Beskrivning

*= A drink is one beer, one glass of wine, one shot of liquor or one mixed drink.

Datatyp

integer

Alias
UMLS CUI [1]
C0001948
Tillbaka till toppen

Similar models

ALCOHOL / TOBACCO USE HISTORY (SCREENING) CRFs Roche FVF4168G Macular Edema NCT00473330

1 Formulär
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
Patient administration
PT
Item
Subject Number
integer
C2348585 (UMLS CUI [1])
PTINIT
Item
Subject Initials:
text
C1997894 (UMLS CUI [1,1])
C2986440 (UMLS CUI [1,2])
VDT
Item
Report Date:
date
C1302584 (UMLS CUI [1,1])
Item Group
ALCOHOL / TOBACCO USE HISTORY (SCREENING)
TOBACCO_USE_HX
Item
Smoking cigarettes currently:
boolean
C0543414 (UMLS CUI [1])
TOBACCO_QUANTITY [TOBQTY1]
Item
Packs / day:
float
C3694145 (UMLS CUI [1])
TOBACCO_USE_BEGIN [TOBEG1]
Item
Year started:
integer
C0425315 (UMLS CUI [1])
TOBACCO_USE_END [TOBEND]
Item
Stopped smoking cigarettes:
boolean
C0425310 (UMLS CUI [1,1])
TOBACCO_USE_BEGIN [TOBEG2]
Item
Year started:
integer
C0425315 (UMLS CUI [1])
TOBACCO_USE_END [TOBEND]
Item
Year stopped:
integer
C0425310 (UMLS CUI [1])
TOBACCO_QUANTITY [TOBQTY2]
Item
Packs / day when smoked:
float
C3694145 (UMLS CUI [1])
pipe or cigars
Item
Smoke pipe or cigars currently
boolean
C3241966 (UMLS CUI [1,1])
C0240766 (UMLS CUI [1,2])
C3241966 (UMLS CUI [2,1])
C0337666 (UMLS CUI [2,2])
pipe or cigars in the past
Item
Smoked pipe or cigars in the past
boolean
C0240766 (UMLS CUI [1])
C0337666 (UMLS CUI [2])
NEVERSMOKED
Item
Never smoked
boolean
C0425293 (UMLS CUI [1])
ALCOHOL_USE_HX [ALCHX]
Item
Do not drink alcohol currently
boolean
C0001948 (UMLS CUI [1,1])
Item
Currently do drink (even occasionally), how often:
integer
C0001948 (UMLS CUI [1])
COUNT_FINGERS [CTFGR]
Code List
Currently do drink (even occasionally), how often:
CL Item
Yes (1)
CL Item
No  (2)
CL Item
Not Done (3)
Tillbaka till toppen 

Kontakt

Använd detta formulär för feedback, frågor och förslag på förbättringar.

Fält markerade med * är obligatoriska.

Hjälp

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial