0 Évaluations
ID

23121

Description

Comparison of Four Combination Chemotherapy Regimens Using Cisplatin in Treating Patients With Stage IVB, Recurrent, or Persistent Cancer of the Cervix GOG Treatment Completion Form 2059221v3.0 https://clinicaltrials.gov/ct2/show/NCT00064077

Lien

https://clinicaltrials.gov/ct2/show/NCT00064077

Mots-clés

Versions (2)
  1. 27/08/2012 27/08/2012 -
  2. 24/06/2017 24/06/2017 - Martin Dugas
Téléchargé le

24 juin 2017

DOI

Pour une demande vous connecter.

Licence

Creative Commons BY 4.0
Modèle Commentaires :

Ici, vous pouvez faire des commentaires sur le modèle. À partir des bulles de texte, vous pouvez laisser des commentaires spécifiques sur les groupes Item et les Item.

Retour au modèle Commentaires
Groupe Item commentaires pour :

Item commentaires pour :

  • Plus récent
  • Plus ancien
  • Favori
  • Plus récent
    • Plus récent
    • Plus ancien
    • Favori

    Aucun commentaire

    Vous devez être connecté pour pouvoir télécharger des formulaires. Veuillez vous connecter ou s’inscrire gratuitement.

    Cervical Cancer Cisplatin NCT00064077 GOG

    Anglais

    FORM Q0

    1 Formulaires  
    1. StudyEvent: GOG Treatment Completion Form
      1. FORM Q0
    Header Module
    Description

    Header Module

    Alias
    UMLS CUI-1
    C1320722
    Date form originally completed
    Description

    Form Completion Date

    Type de données

    date

    Unités de mesure
    • m d y
    Alias
    UMLS CUI [1]
    C1549507
    m d y
    Date form amended
    Description

    Form Amendment Date

    Type de données

    date

    Unités de mesure
    • m d y
    Alias
    UMLS CUI [1,1]
    C0680532
    UMLS CUI [1,2]
    C0011008
    m d y
    Patient Name, Last
    Description

    Patient Lastname

    Type de données

    text

    Alias
    UMLS CUI [1]
    C1301584
    Patient Name, First
    Description

    Patient Firstname

    Type de données

    text

    Alias
    UMLS CUI [1]
    C0421447
    Patient Study ID
    Description

    Patient Study ID

    Type de données

    text

    Alias
    UMLS CUI [1]
    C2348585
    Participating Group Code
    Description

    Participating Clinical Study Organization

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25162
    UMLS CUI [1]
    C2347449
    Participating Group Protocol Number
    Description

    Participating Group Protocol Number

    Type de données

    text

    Alias
    UMLS CUI [1,1]
    C3274381
    UMLS CUI [1,2]
    C2347449
    Participating Patient Study ID
    Description

    Patient Identifier Number

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25608
    NCI Thesaurus Property-2
    C25364
    UMLS CUI [1,1]
    C2348585
    UMLS CUI [1,2]
    C2347449
    Person amending form, last name
    Description

    Responsible Person Reporting Change

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    NCI Thesaurus ObjectClass
    C25190
    NCI Thesaurus Property
    C25364
    UMLS CUI [1,1]
    C0680532
    UMLS CUI [1,2]
    C1547383
    Person Completing Form, Last Name
    Description

    Person Completing Form

    Type de données

    text

    Alias
    UMLS CUI [1]
    C3258039
    COMMENTS
    Description

    Comments

    Type de données

    text

    Alias
    UMLS CUI [1]
    C0947611
    Treatment Schedule
    Description

    Treatment Schedule

    Alias
    UMLS CUI-1
    C0040808
    Total number of cycles given
    Description

    Total Course Number

    Type de données

    integer

    Alias
    UMLS CUI [1]
    C2045831
    Last date (any modality of) protocol therapy was given
    Description

    Treatment End Date

    Type de données

    date

    Unités de mesure
    • m d y
    Alias
    UMLS CUI [1]
    C1531784
    m d y
    Off-treatment Reason
    Description

    Off-treatment Reason

    Alias
    UMLS CUI-1
    C1518544
    UMLS CUI-2
    C0566251
    Reason treatment ended (check only one)
    Description

    Off Treatment Reason

    Type de données

    integer

    Alias
    UMLS CUI [1,1]
    C1518544
    UMLS CUI [1,2]
    C0566251
    Specify toxicity (unnamed)
    Description

    Toxicity

    Type de données

    text

    Alias
    UMLS CUI [1]
    C0013221
    Specify reason (unnamed)
    Description

    Reason Off-Treatment

    Type de données

    text

    Alias
    NCI Thesaurus ObjectClass
    C25638
    NCI Thesaurus ObjectClass-2
    C25601
    NCI Metathesaurus Property
    C0030705
    NCI Thesaurus Property
    C41341
    NCI Thesaurus ValueDomain
    C25685
    UMLS CUI [1,1]
    C1518544
    UMLS CUI [1,2]
    C0566251
    Specify disease
    Description

    Complicating Disease

    Type de données

    text

    Alias
    UMLS CUI [1]
    C0544688
    Will patient receive further treatment?
    Description

    Further Treatment

    Type de données

    boolean

    Alias
    UMLS CUI [1,1]
    C0087111
    UMLS CUI [1,2]
    C1517331
    Specify further treatment
    Description

    Further Treatment, specify

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus ObjectClass-2
    C25519
    NCI Thesaurus Property
    C25382
    UMLS CUI [1,1]
    C0087111
    UMLS CUI [1,2]
    C1517331
    Retour au début de la page

    Similar models

    FORM Q0

    1 Formulaires
    1. StudyEvent: GOG Treatment Completion Form
      1. FORM Q0
    Name
    Type
    Description | Question | Decode (Coded Value)
    Type de données
    Alias
    Item Group
    Header Module
    C1320722 (UMLS CUI-1)
    Form Completion Date
    Item
    Date form originally completed
    date
    C1549507 (UMLS CUI [1])
    Form Amendment Date
    Item
    Date form amended
    date
    C0680532 (UMLS CUI [1,1])
    C0011008 (UMLS CUI [1,2])
    Patient Lastname
    Item
    Patient Name, Last
    text
    C1301584 (UMLS CUI [1])
    Patient Firstname
    Item
    Patient Name, First
    text
    C0421447 (UMLS CUI [1])
    Patient Study ID
    Item
    Patient Study ID
    text
    C2348585 (UMLS CUI [1])
    Participating Clinical Study Organization
    Item
    Participating Group Code
    text
    C25162 (NCI Thesaurus ValueDomain)
    C2347449 (UMLS CUI [1])
    Participating Group Protocol Number
    Item
    Participating Group Protocol Number
    text
    C3274381 (UMLS CUI [1,1])
    C2347449 (UMLS CUI [1,2])
    Patient Identifier Number
    Item
    Participating Patient Study ID
    text
    C25337 (NCI Thesaurus ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C25608 (NCI Thesaurus Property)
    C25364 (NCI Thesaurus Property-2)
    C2348585 (UMLS CUI [1,1])
    C2347449 (UMLS CUI [1,2])
    Responsible Person Reporting Change
    Item
    Person amending form, last name
    text
    C25191 (NCI Thesaurus ValueDomain)
    C25190 (NCI Thesaurus ObjectClass)
    C25364 (NCI Thesaurus Property)
    C0680532 (UMLS CUI [1,1])
    C1547383 (UMLS CUI [1,2])
    Person Completing Form
    Item
    Person Completing Form, Last Name
    text
    C3258039 (UMLS CUI [1])
    Comments
    Item
    COMMENTS
    text
    C0947611 (UMLS CUI [1])
    Item Group
    Treatment Schedule
    C0040808 (UMLS CUI-1)
    Total Course Number
    Item
    Total number of cycles given
    integer
    C2045831 (UMLS CUI [1])
    Treatment End Date
    Item
    Last date (any modality of) protocol therapy was given
    date
    C1531784 (UMLS CUI [1])
    Item Group
    Off-treatment Reason
    C1518544 (UMLS CUI-1)
    C0566251 (UMLS CUI-2)
    Item
    Reason treatment ended (check only one)
    integer
    C1518544 (UMLS CUI [1,1])
    C0566251 (UMLS CUI [1,2])
    CL.1
    Code List
    Reason treatment ended (check only one)
    CL Item
    Routine completion of planned protocol treatment (1)
    C0040808 (UMLS CUI-1)
    C0205197 (UMLS CUI-2)
    CL Item
    Disease progression, relapse during active treatment (2)
    C0242656 (UMLS CUI-1)
    CL Item
    Toxicity/side effects/complications (3)
    C0877248 (UMLS CUI-1)
    CL Item
    Patient withdrawal or refusal for reason other than toxicity (4)
    C0040809 (UMLS CUI-1)
    CL Item
    Death after beginning protocol therapy (5)
    C0011065 (UMLS CUI-1)
    CL Item
    Patient off-treatment for other complicating disease (6)
    C0009566 (UMLS CUI-1)
    CL Item
    Other (7)
    C0205394 (UMLS CUI-1)
    Toxicity
    Item
    Specify toxicity (unnamed)
    text
    C0013221 (UMLS CUI [1])
    Reason Off-Treatment
    Item
    Specify reason (unnamed)
    text
    C25638 (NCI Thesaurus ObjectClass)
    C25601 (NCI Thesaurus ObjectClass-2)
    C0030705 (NCI Metathesaurus Property)
    C41341 (NCI Thesaurus Property)
    C25685 (NCI Thesaurus ValueDomain)
    C1518544 (UMLS CUI [1,1])
    C0566251 (UMLS CUI [1,2])
    Complicating Disease
    Item
    Specify disease
    text
    C0544688 (UMLS CUI [1])
    Further Treatment
    Item
    Will patient receive further treatment?
    boolean
    C0087111 (UMLS CUI [1,1])
    C1517331 (UMLS CUI [1,2])
    Further Treatment, specify
    Item
    Specify further treatment
    text
    C25685 (NCI Thesaurus ValueDomain)
    C15368 (NCI Thesaurus ObjectClass)
    C25519 (NCI Thesaurus ObjectClass-2)
    C25382 (NCI Thesaurus Property)
    C0087111 (UMLS CUI [1,1])
    C1517331 (UMLS CUI [1,2])
    Retour au début de la page 

    Aide

    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