ID

23954

Description

Infection NCT00513526 On-Study - AMC-052 High Resolution Anoscopy (HRA) Form - 2676571v1.0 AMC-052 High Resolution Anoscopy (HRA) Form Human Papillomavirus Vaccine Therapy in Treating Men With HIV-1 Infection Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=3950FE87-444E-42CA-E044-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=3950FE87-444E-42CA-E044-0003BA3F9857

Keywords

Versions (2)
  1. 9/19/12 9/19/12 -
  2. 7/19/17 7/19/17 - Martin Dugas
Uploaded on

July 19, 2017

DOI

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Creative Commons BY-NC 3.0
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HIV HPV vaccine NCT00513526 AMC-052

English

No Instruction available.

1 forms  
  1. StudyEvent: AMC-052 High Resolution Anoscopy (HRA) Form
    1. No Instruction available.
Anal symptoms/digital rectal exam
Description

Anal symptoms/digital rectal exam

Alias
UMLS CUI-1
C1384593
Anal symptoms present
Description

Anal Symptoms

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C2991
NCI Thesaurus ObjectClass-2
C28048
NCI Thesaurus Property
C25626
NCI Thesaurus Property-2
C4876
NCI Thesaurus ValueDomain
C38148
UMLS CUI [1]
C0457558
Anal symptoms
Description

Anal Symptoms

Data type

text

Alias
NCI Thesaurus ObjectClass
C2991
NCI Thesaurus ObjectClass-2
C28048
NCI Thesaurus Property
C25626
NCI Thesaurus Property-2
C4876
NCI Thesaurus ValueDomain
C25284
UMLS CUI [1]
C0457558
Other, specify
Description

Anal Symptoms

Data type

text

Alias
NCI Thesaurus ObjectClass
C2991
NCI Thesaurus ObjectClass-2
C28048
NCI Thesaurus Property
C25626
NCI Thesaurus Property-2
C4876
NCI Thesaurus ValueDomain
C25685
UMLS CUI [1]
C0457558
Abnormal digital rectal exam
Description

Abnormal digital rectal exam

Data type

text

Alias
NCI Thesaurus ValueDomain
C25180
NCI Thesaurus Property
C25367
NCI Thesaurus ObjectClass
C17631
NCI Thesaurus Property-2
C25401
UMLS CUI [1,1]
C1384593
UMLS CUI [1,2]
C0205161
Digital rectal exam results
Description

Digital rectal exam

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
NCI Thesaurus Property
C25367
NCI Thesaurus ObjectClass
C17631
NCI Thesaurus Property-2
C25401
UMLS CUI [1]
C1384593
Other, specify
Description

Digital Rectal Examination abnormal

Data type

text

Alias
NCI Thesaurus ObjectClass
C17631
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C25401
NCI Thesaurus ValueDomain
C25685
NCI Thesaurus ValueDomain-2
C25401
UMLS CUI [1,1]
C1384593
UMLS CUI [1,2]
C0205161
UMLS CUI [1,3]
C0205161
Entire squamocolumnar junction visualized
Description

Entire Anal Canal

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C25497
NCI Thesaurus ObjectClass-2
C12375
NCI Thesaurus ObjectClass-3
C25294
NCI Thesaurus Property
C38000
NCI Thesaurus ValueDomain
C38147
UMLS CUI [1,1]
C0227411
UMLS CUI [1,2]
C0439751
Anoscopy findings
Description

Anoscopy findings

Alias
UMLS CUI-1
C0193158
Number of anal biopsies
Description

Biopsy count

Data type

integer

Alias
NCI Thesaurus ValueDomain
C25337
NCI Thesaurus ObjectClass
C15189
NCI Thesaurus Property
C38000
NCI Thesaurus ObjectClass-2
C28048
UMLS CUI [1]
C0449807
Number of perianal biopsies
Description

Biopsies, perianal

Data type

integer

Alias
NCI Thesaurus ObjectClass
C15189
NCI Thesaurus ObjectClass-2
C43362
NCI Thesaurus ObjectClass-3
C52247
NCI Thesaurus Property
C38000
NCI Thesaurus ValueDomain
C25337
UMLS CUI [1,1]
C0449807
UMLS CUI [1,2]
C0442158
Intraanal lesions present
Description

DiseaseInternalAnalLesionPersonalMedicalHistoryInd

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C2991
NCI Thesaurus Property
C3824
NCI Thesaurus Property-2
C25234
NCI Thesaurus Property-3
C28048
NCI Thesaurus Property-4
C18772
NCI Thesaurus ValueDomain
C38147
UMLS CUI [1]
C0740980
Perianal lesions present
Description

Perianal lesion

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C2991
NCI Thesaurus Property
C3824
NCI Thesaurus Property-2
C28048
NCI Thesaurus Property-3
C18772
NCI Thesaurus Property-4
C52247
NCI Thesaurus ValueDomain
C38147
UMLS CUI [1]
C0747465
Intraanal condyloma present
Description

Condyloma anal

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C2991
NCI Thesaurus ObjectClass-2
C14226
NCI Thesaurus Property
C25234
NCI Thesaurus Property-2
C18772
NCI Thesaurus Property-3
C4054
NCI Thesaurus ValueDomain
C38147
UMLS CUI [1]
C0281779
Intraanal lesions suspicious for anal intraepithelial neoplasia present
Description

AnalIntraepithelialNeoplasiaDiseaseInternalAnalLesionPersonalMedicalHistoryInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C2991
NCI Thesaurus ObjectClass-2
C4595
NCI Thesaurus Property
C3824
NCI Thesaurus Property-2
C25234
NCI Thesaurus Property-3
C28048
NCI Thesaurus Property-4
C18772
NCI Thesaurus ValueDomain
C38147
UMLS CUI [1]
C0347129
Perianal condyloma present
Description

HumanPapillomavirusDiseaseAnalCondylomaSurroundingPersonalMedicalHistoryInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C2991
NCI Thesaurus ObjectClass-2
C14226
NCI Thesaurus Property
C18772
NCI Thesaurus Property-2
C52247
NCI Thesaurus Property-3
C4054
NCI Thesaurus ValueDomain
C38147
UMLS CUI [1]
C0747460
Perianal lesions suspicious for anal intraepithelial neoplasia present
Description

AnalIntraepithelialNeoplasiaDiseaseSurroundingAnalLesionPersonalMedicalHistoryInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C2991
NCI Thesaurus ObjectClass-2
C4595
NCI Thesaurus Property
C3824
NCI Thesaurus Property-2
C28048
NCI Thesaurus Property-3
C18772
NCI Thesaurus Property-4
C52247
NCI Thesaurus ValueDomain
C38147
UMLS CUI [1]
C1332271
Genital exam performed
Description

Genital exam

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C20989
NCI Thesaurus Property-2
C38000
NCI Thesaurus Property-3
C13348
NCI Thesaurus ValueDomain
C38147
UMLS CUI [1]
C2239177
Penile or genital condyloma present
Description

HumanPapillomavirusDiseaseGenitalPenisCondylomaPersonalMedicalHistoryInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C2991
NCI Thesaurus ObjectClass-2
C14226
NCI Thesaurus Property
C13348
NCI Thesaurus Property-2
C12409
NCI Thesaurus Property-3
C18772
NCI Thesaurus Property-4
C2960
NCI Thesaurus ValueDomain
C38147
UMLS CUI [1]
C0744357
Other, specify
Description

PatientPhysicalExaminationAnalPerformedSpecify

Data type

text

Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C20989
NCI Thesaurus Property-2
C38000
NCI Thesaurus Property-3
C28048
NCI Thesaurus ValueDomain
C25685
UMLS CUI [1]
C0260879
Comments
Description

Research Comments

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
UMLS CUI [1]
C0947611
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Similar models

No Instruction available.

1 forms
  1. StudyEvent: AMC-052 High Resolution Anoscopy (HRA) Form
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Anal symptoms/digital rectal exam
C1384593 (UMLS CUI-1)
Anal Symptoms
Item
Anal symptoms present
boolean
C2991 (NCI Thesaurus ObjectClass)
C28048 (NCI Thesaurus ObjectClass-2)
C25626 (NCI Thesaurus Property)
C4876 (NCI Thesaurus Property-2)
C38148 (NCI Thesaurus ValueDomain)
C0457558 (UMLS CUI [1])
Item
Anal symptoms
text
C2991 (NCI Thesaurus ObjectClass)
C28048 (NCI Thesaurus ObjectClass-2)
C25626 (NCI Thesaurus Property)
C4876 (NCI Thesaurus Property-2)
C25284 (NCI Thesaurus ValueDomain)
C0457558 (UMLS CUI [1])
CL.2
Code List
Anal symptoms
CL Item
Bleeding (Bleeding)
C0019080 (UMLS CUI-1)
(Comment:en)
CL Item
Irritation (Irritation)
C0441723 (UMLS CUI-1)
(Comment:en)
CL Item
Itching (Itching)
C0033774 (UMLS CUI-1)
(Comment:en)
CL Item
Lump (Lump)
C0240873 (UMLS CUI-1)
(Comment:en)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS CUI-1)
(Comment:en)
CL Item
Pain During Bowel Movement (Pain during bowel movement)
C2032722 (UMLS CUI-1)
(Comment:en)
CL Item
Pain Or Discomfort (Pain or discomfort)
C0030193 (UMLS CUI-1)
(Comment:en)
CL Item
Painful During Receptive Anal Sex (Painful during receptive anal sex)
C2126184 (UMLS CUI-1)
(Comment:en)
Anal Symptoms
Item
Other, specify
text
C2991 (NCI Thesaurus ObjectClass)
C28048 (NCI Thesaurus ObjectClass-2)
C25626 (NCI Thesaurus Property)
C4876 (NCI Thesaurus Property-2)
C25685 (NCI Thesaurus ValueDomain)
C0457558 (UMLS CUI [1])
Item
Abnormal digital rectal exam
text
C25180 (NCI Thesaurus ValueDomain)
C25367 (NCI Thesaurus Property)
C17631 (NCI Thesaurus ObjectClass)
C25401 (NCI Thesaurus Property-2)
C1384593 (UMLS CUI [1,1])
C0205161 (UMLS CUI [1,2])
CL.3
Code List
Abnormal digital rectal exam
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Not Done (Not done)
CL281691 (NCI Metathesaurus)
C1272696 (UMLS CUI-1)
(Comment:en)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS CUI-1)
(Comment:en)
Item
Digital rectal exam results
text
C25284 (NCI Thesaurus ValueDomain)
C25367 (NCI Thesaurus Property)
C17631 (NCI Thesaurus ObjectClass)
C25401 (NCI Thesaurus Property-2)
C1384593 (UMLS CUI [1])
CL.4
Code List
Digital rectal exam results
CL Item
Anal Papilla (Anal papilla)
(Comment:en)
CL Item
Granularity (Granularity)
(Comment:en)
CL Item
Induration (Induration)
C0332534 (UMLS CUI-1)
(Comment:en)
CL Item
Mass Abnormality (Mass)
(Comment:en)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS CUI-1)
(Comment:en)
CL Item
Thickening (Thickening)
C0205400 (UMLS CUI-1)
(Comment:en)
CL Item
Warty Nodularity (Warty nodularity)
(Comment:en)
Digital Rectal Examination abnormal
Item
Other, specify
text
C17631 (NCI Thesaurus ObjectClass)
C25367 (NCI Thesaurus Property)
C25401 (NCI Thesaurus Property-2)
C25685 (NCI Thesaurus ValueDomain)
C25401 (NCI Thesaurus ValueDomain-2)
C1384593 (UMLS CUI [1,1])
C0205161 (UMLS CUI [1,2])
C0205161 (UMLS CUI [1,3])
Entire Anal Canal
Item
Entire squamocolumnar junction visualized
boolean
C25497 (NCI Thesaurus ObjectClass)
C12375 (NCI Thesaurus ObjectClass-2)
C25294 (NCI Thesaurus ObjectClass-3)
C38000 (NCI Thesaurus Property)
C38147 (NCI Thesaurus ValueDomain)
C0227411 (UMLS CUI [1,1])
C0439751 (UMLS CUI [1,2])
Item Group
Anoscopy findings
C0193158 (UMLS CUI-1)
Biopsy count
Item
Number of anal biopsies
integer
C25337 (NCI Thesaurus ValueDomain)
C15189 (NCI Thesaurus ObjectClass)
C38000 (NCI Thesaurus Property)
C28048 (NCI Thesaurus ObjectClass-2)
C0449807 (UMLS CUI [1])
Biopsies, perianal
Item
Number of perianal biopsies
integer
C15189 (NCI Thesaurus ObjectClass)
C43362 (NCI Thesaurus ObjectClass-2)
C52247 (NCI Thesaurus ObjectClass-3)
C38000 (NCI Thesaurus Property)
C25337 (NCI Thesaurus ValueDomain)
C0449807 (UMLS CUI [1,1])
C0442158 (UMLS CUI [1,2])
Anal lesion
Item
Intraanal lesions present
boolean
C2991 (NCI Thesaurus ObjectClass)
C3824 (NCI Thesaurus Property)
C25234 (NCI Thesaurus Property-2)
C28048 (NCI Thesaurus Property-3)
C18772 (NCI Thesaurus Property-4)
C38147 (NCI Thesaurus ValueDomain)
C0740980 (UMLS CUI [1])
Perianal lesion
Item
Perianal lesions present
boolean
C2991 (NCI Thesaurus ObjectClass)
C3824 (NCI Thesaurus Property)
C28048 (NCI Thesaurus Property-2)
C18772 (NCI Thesaurus Property-3)
C52247 (NCI Thesaurus Property-4)
C38147 (NCI Thesaurus ValueDomain)
C0747465 (UMLS CUI [1])
Condyloma anal
Item
Intraanal condyloma present
boolean
C2991 (NCI Thesaurus ObjectClass)
C14226 (NCI Thesaurus ObjectClass-2)
C25234 (NCI Thesaurus Property)
C18772 (NCI Thesaurus Property-2)
C4054 (NCI Thesaurus Property-3)
C38147 (NCI Thesaurus ValueDomain)
C0281779 (UMLS CUI [1])
Anal intraepithelial neoplasia
Item
Intraanal lesions suspicious for anal intraepithelial neoplasia present
boolean
C2991 (NCI Thesaurus ObjectClass)
C4595 (NCI Thesaurus ObjectClass-2)
C3824 (NCI Thesaurus Property)
C25234 (NCI Thesaurus Property-2)
C28048 (NCI Thesaurus Property-3)
C18772 (NCI Thesaurus Property-4)
C38147 (NCI Thesaurus ValueDomain)
C0347129 (UMLS CUI [1])
Perianal condyloma
Item
Perianal condyloma present
boolean
C2991 (NCI Thesaurus ObjectClass)
C14226 (NCI Thesaurus ObjectClass-2)
C18772 (NCI Thesaurus Property)
C52247 (NCI Thesaurus Property-2)
C4054 (NCI Thesaurus Property-3)
C38147 (NCI Thesaurus ValueDomain)
C0747460 (UMLS CUI [1])
Intraepithelial neoplasia, perianal
Item
Perianal lesions suspicious for anal intraepithelial neoplasia present
boolean
C2991 (NCI Thesaurus ObjectClass)
C4595 (NCI Thesaurus ObjectClass-2)
C3824 (NCI Thesaurus Property)
C28048 (NCI Thesaurus Property-2)
C18772 (NCI Thesaurus Property-3)
C52247 (NCI Thesaurus Property-4)
C38147 (NCI Thesaurus ValueDomain)
C1332271 (UMLS CUI [1])
Genital exam
Item
Genital exam performed
boolean
C16960 (NCI Thesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C38000 (NCI Thesaurus Property-2)
C13348 (NCI Thesaurus Property-3)
C38147 (NCI Thesaurus ValueDomain)
C2239177 (UMLS CUI [1])
Genital condyloma
Item
Penile or genital condyloma present
boolean
C2991 (NCI Thesaurus ObjectClass)
C14226 (NCI Thesaurus ObjectClass-2)
C13348 (NCI Thesaurus Property)
C12409 (NCI Thesaurus Property-2)
C18772 (NCI Thesaurus Property-3)
C2960 (NCI Thesaurus Property-4)
C38147 (NCI Thesaurus ValueDomain)
C0744357 (UMLS CUI [1])
Other examination
Item
Other, specify
text
C16960 (NCI Thesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C38000 (NCI Thesaurus Property-2)
C28048 (NCI Thesaurus Property-3)
C25685 (NCI Thesaurus ValueDomain)
C0260879 (UMLS CUI [1])
Research Comments
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0947611 (UMLS CUI [1])
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