ID

26133

Beskrivning

AMC-063 FACT/GOG-Neurotoxicity Questionnaire Form (NTQ) Bortezomib in Treating Patients With Relapsed or Refractory AIDS-Related Kaposi Sarcoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=816407E2-1423-1A8A-E040-BB89AD433DA9

Länk

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=816407E2-1423-1A8A-E040-BB89AD433DA9

Nyckelord

Versioner (1)
  1. 2017-10-09 2017-10-09 -
Rättsinnehavare

AIDS Malignancy Consortium

Uppladdad den

9 oktober 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.

AMC-063 FACT/GOG-Neurotoxicity Questionnaire Form (NTQ)

Engelsk

No Instruction available.

1 Formulär  
  1. StudyEvent: AMC-063 FACT/GOG-Neurotoxicity Questionnaire Form (NTQ)
    1. No Instruction available.
Neurotoxicity Questionnaire Form
Beskrivning

Neurotoxicity Questionnaire Form

Alias
UMLS CUI-1
C3899177
UMLS CUI-2
C0276535
Visit number
Beskrivning

Visit number

Datatyp

float

Alias
NCI Thesaurus ValueDomain
C25337
NCI Thesaurus ObjectClass
C16696
NCI Thesaurus Property
C25385
UMLS CUI [1]
C1549755
Neurotoxicity Questionnaire Form
Beskrivning

Neurotoxicity Questionnaire Form

Alias
UMLS CUI-1
C3899177
UMLS CUI-2
C0276535
I have numbness or tingling in my hands
Beskrivning

NeurotoxicityPatientParaesthesiaHandAssessmentQualityofLifeScale

Datatyp

integer

Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus ObjectClass-2
C27961
NCI Thesaurus Property
C20989
NCI Metathesaurus Property
C0239836
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ValueDomain-2
C17047
UMLS CUI [1]
C3829780
I have numbness or tingling in my feet
Beskrivning

NeurotoxicityPatientParaesthesiaFootAssessmentQualityofLifeScale

Datatyp

integer

Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus ObjectClass-2
C27961
NCI Thesaurus Property
C20989
NCI Metathesaurus Property
CL108114
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ValueDomain-2
C17047
UMLS CUI [1]
C3829781
I feel discomfort in my hands
Beskrivning

NeurotoxicityPatientHandDiscomfortAssessmentQualityofLifeScale

Datatyp

integer

Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus ObjectClass-2
C27961
NCI Thesaurus Property
C20989
NCI Thesaurus Property-2
C32712
NCI Metathesaurus Property
CL047845
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ValueDomain-2
C17047
UMLS CUI [1]
C3830164
I feel discomfort in my feet
Beskrivning

NeurotoxicityPatientFootDiscomfortAssessmentQualityofLifeScale

Datatyp

integer

Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus ObjectClass-2
C27961
NCI Thesaurus Property
C20989
NCI Metathesaurus Property
CL050515
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ValueDomain-2
C17047
UMLS CUI [1]
C3830165
I have joint pain or muscle cramps
Beskrivning

NeurotoxicityPatientArthralgiaAssessmentQualityofLifeScale

Datatyp

integer

Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus ObjectClass-2
C27961
NCI Thesaurus Property
C20989
NCI Metathesaurus Property
C0003862
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ValueDomain-2
C17047
UMLS CUI [1]
C3829787
I feel weak all over
Beskrivning

NeurotoxicityPatientMuscleWeaknessAssessmentQualityofLifeScale

Datatyp

integer

Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus ObjectClass-2
C27961
NCI Thesaurus Property
C20989
NCI Metathesaurus Property
C0151786
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ValueDomain-2
C17047
UMLS CUI [1]
C3274923
I have trouble hearing
Beskrivning

NeurotoxicityPatientHearingAssessmentQualityofLifeScale

Datatyp

integer

Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus ObjectClass-2
C27961
NCI Thesaurus Property
C20989
NCI Thesaurus Property-2
C16670
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ValueDomain-2
C17047
UMLS CUI [1]
C3829759
I get a ringing or buzzing in my ears
Beskrivning

NeurotoxicityPatientTinnitusAssessmentQualityofLifeScale

Datatyp

integer

Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus ObjectClass-2
C27961
NCI Thesaurus Property
C20989
NCI Thesaurus Property-2
C50772
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ValueDomain-2
C17047
UMLS CUI [1]
C3829985
I have trouble buttoning buttons
Beskrivning

NeurotoxicityPatientHandCoordinationAssessmentQualityofLifeScale

Datatyp

integer

Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus ObjectClass-2
C27961
NCI Thesaurus Property
C20989
NCI Thesaurus Property-2
C25462
NCI Thesaurus Property-3
C32712
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ValueDomain-2
C17047
UMLS CUI [1]
C3829762
I have trouble feeling the shape of small objects when they are in my hand
Beskrivning

NeurotoxicityPatientHypoaesthesiaAssessmentQualityofLifeScale

Datatyp

integer

Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus ObjectClass-2
C27961
NCI Thesaurus Property
C20989
NCI Metathesaurus Property
C0020580
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ValueDomain-2
C17047
UMLS CUI [1]
C3829760
I have trouble walking
Beskrivning

NeurotoxicityPatientParaparesisAssessmentQualityofLifeScale

Datatyp

integer

Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus ObjectClass-2
C27961
NCI Thesaurus Property
C20989
NCI Metathesaurus Property
C0221166
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ValueDomain-2
C17047
UMLS CUI [1]
C3829756
Comments
Beskrivning

Comments

Alias
UMLS CUI-1
C0947611
UMLS CUI-2
C3899177
Comments
Beskrivning

Research Comments

Datatyp

text

Alias
NCI Thesaurus ValueDomain
C25704
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
UMLS CUI [1,1]
C0947611
UMLS CUI [1,2]
C3899177
Tillbaka till toppen

Similar models

No Instruction available.

1 Formulär
  1. StudyEvent: AMC-063 FACT/GOG-Neurotoxicity Questionnaire Form (NTQ)
    1. No Instruction available.
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
Neurotoxicity Questionnaire Form
C3899177 (UMLS CUI-1)
C0276535 (UMLS CUI-2)
Visit number
Item
Visit number
float
C25337 (NCI Thesaurus ValueDomain)
C16696 (NCI Thesaurus ObjectClass)
C25385 (NCI Thesaurus Property)
C1549755 (UMLS CUI [1])
Item Group
Neurotoxicity Questionnaire Form
C3899177 (UMLS CUI-1)
C0276535 (UMLS CUI-2)
Item
I have numbness or tingling in my hands
integer
C16960 (NCI Thesaurus ObjectClass)
C27961 (NCI Thesaurus ObjectClass-2)
C20989 (NCI Thesaurus Property)
C0239836 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C3829780 (UMLS CUI [1])
CL.1
Code List
I have numbness or tingling in my hands
CL Item
A Little Bit (1)
CL Item
Not At All (2)
CL Item
Quite A Bit (3)
CL Item
Somewhat (4)
CL Item
Very Much (5)
Item
I have numbness or tingling in my feet
integer
C16960 (NCI Thesaurus ObjectClass)
C27961 (NCI Thesaurus ObjectClass-2)
C20989 (NCI Thesaurus Property)
CL108114 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C3829781 (UMLS CUI [1])
CL.1
Code List
I have numbness or tingling in my feet
CL Item
A Little Bit (1)
CL Item
Not At All (2)
CL Item
Quite A Bit (3)
CL Item
Somewhat (4)
CL Item
Very Much (5)
Item
I feel discomfort in my hands
integer
C16960 (NCI Thesaurus ObjectClass)
C27961 (NCI Thesaurus ObjectClass-2)
C20989 (NCI Thesaurus Property)
C32712 (NCI Thesaurus Property-2)
CL047845 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C3830164 (UMLS CUI [1])
CL.1
Code List
I feel discomfort in my hands
CL Item
A Little Bit (1)
CL Item
Not At All (2)
CL Item
Quite A Bit (3)
CL Item
Somewhat (4)
CL Item
Very Much (5)
Item
I feel discomfort in my feet
integer
C16960 (NCI Thesaurus ObjectClass)
C27961 (NCI Thesaurus ObjectClass-2)
C20989 (NCI Thesaurus Property)
CL050515 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C3830165 (UMLS CUI [1])
CL.1
Code List
I feel discomfort in my feet
CL Item
A Little Bit (1)
CL Item
Not At All (2)
CL Item
Quite A Bit (3)
CL Item
Somewhat (4)
CL Item
Very Much (5)
Item
I have joint pain or muscle cramps
integer
C16960 (NCI Thesaurus ObjectClass)
C27961 (NCI Thesaurus ObjectClass-2)
C20989 (NCI Thesaurus Property)
C0003862 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C3829787 (UMLS CUI [1])
CL.1
Code List
I have joint pain or muscle cramps
CL Item
A Little Bit (1)
CL Item
Not At All (2)
CL Item
Quite A Bit (3)
CL Item
Somewhat (4)
CL Item
Very Much (5)
Item
I feel weak all over
integer
C16960 (NCI Thesaurus ObjectClass)
C27961 (NCI Thesaurus ObjectClass-2)
C20989 (NCI Thesaurus Property)
C0151786 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C3274923 (UMLS CUI [1])
CL.1
Code List
I feel weak all over
CL Item
A Little Bit (1)
CL Item
Not At All (2)
CL Item
Quite A Bit (3)
CL Item
Somewhat (4)
CL Item
Very Much (5)
Item
I have trouble hearing
integer
C16960 (NCI Thesaurus ObjectClass)
C27961 (NCI Thesaurus ObjectClass-2)
C20989 (NCI Thesaurus Property)
C16670 (NCI Thesaurus Property-2)
C25664 (NCI Thesaurus ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C3829759 (UMLS CUI [1])
CL.1
Code List
I have trouble hearing
CL Item
A Little Bit (1)
CL Item
Not At All (2)
CL Item
Quite A Bit (3)
CL Item
Somewhat (4)
CL Item
Very Much (5)
Item
I get a ringing or buzzing in my ears
integer
C16960 (NCI Thesaurus ObjectClass)
C27961 (NCI Thesaurus ObjectClass-2)
C20989 (NCI Thesaurus Property)
C50772 (NCI Thesaurus Property-2)
C25664 (NCI Thesaurus ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C3829985 (UMLS CUI [1])
CL.1
Code List
I get a ringing or buzzing in my ears
CL Item
A Little Bit (1)
CL Item
Not At All (2)
CL Item
Quite A Bit (3)
CL Item
Somewhat (4)
CL Item
Very Much (5)
Item
I have trouble buttoning buttons
integer
C16960 (NCI Thesaurus ObjectClass)
C27961 (NCI Thesaurus ObjectClass-2)
C20989 (NCI Thesaurus Property)
C25462 (NCI Thesaurus Property-2)
C32712 (NCI Thesaurus Property-3)
C25664 (NCI Thesaurus ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C3829762 (UMLS CUI [1])
CL.1
Code List
I have trouble buttoning buttons
CL Item
A Little Bit (1)
CL Item
Not At All (2)
CL Item
Quite A Bit (3)
CL Item
Somewhat (4)
CL Item
Very Much (5)
Item
I have trouble feeling the shape of small objects when they are in my hand
integer
C16960 (NCI Thesaurus ObjectClass)
C27961 (NCI Thesaurus ObjectClass-2)
C20989 (NCI Thesaurus Property)
C0020580 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C3829760 (UMLS CUI [1])
CL.1
Code List
I have trouble feeling the shape of small objects when they are in my hand
CL Item
A Little Bit (1)
CL Item
Not At All (2)
CL Item
Quite A Bit (3)
CL Item
Somewhat (4)
CL Item
Very Much (5)
Item
I have trouble walking
integer
C16960 (NCI Thesaurus ObjectClass)
C27961 (NCI Thesaurus ObjectClass-2)
C20989 (NCI Thesaurus Property)
C0221166 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C17047 (NCI Thesaurus ValueDomain-2)
C3829756 (UMLS CUI [1])
CL.1
Code List
I have trouble walking
CL Item
A Little Bit (1)
CL Item
Not At All (2)
CL Item
Quite A Bit (3)
CL Item
Somewhat (4)
CL Item
Very Much (5)
Item Group
Comments
C0947611 (UMLS CUI-1)
C3899177 (UMLS CUI-2)
Research Comments
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0947611 (UMLS CUI [1,1])
C3899177 (UMLS CUI [1,2])
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