ID

27114

Description

Original CRFs from: K.Afshar, J. Bleidorn, E. Hummers-Pradier, I. Gágyor. Further details on: http://www.allgemeinmedizin.med.uni-goettingen.de/en/content/research/510_520.html https://clinicaltrials.gov/ct2/show/NCT03151603 Questionnaire Day 0

Link

http://www.allgemeinmedizin.med.uni-goettingen.de/en/content/research/510_520.html

Keywords

Versions (2)
  1. 10/19/17 10/19/17 -
  2. 11/1/17 11/1/17 -
Copyright Holder

K.Afshar, J. Bleidorn, E. Hummers-Pradier, I. Gágyor

Uploaded on

November 1, 2017

DOI

To request one please log in.

License

Creative Commons BY-NC-ND 3.0
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Questionnaire Day 0 REGATTA NCT03151603

German English

Questionnaire Day 0 REGATTA NCT03151603

1 forms  
Patient Information
Description

Patient Information

Alias
UMLS CUI-1
C1955348
Birth Year
Description

Birth Year

Data type

date

Alias
UMLS CUI [1]
C2826771
1. How severe are your symptoms today? - The following questions are about the extent to which your complaints are today, or how strongly you feel affected by your symptoms today. Please tick one answer.
Description

1. How severe are your symptoms today? - The following questions are about the extent to which your complaints are today, or how strongly you feel affected by your symptoms today. Please tick one answer.

Alias
UMLS CUI-1
C1457887
UMLS CUI-2
C0439793
Urgency of micturition
Description

Urgency of micturition

Data type

integer

Alias
UMLS CUI [1]
C0085606
Burning/painful urination
Description

Burning/painful urination

Data type

integer

Alias
UMLS CUI [1]
C0237332
Frequent urination
Description

Frequency of urination

Data type

integer

Alias
UMLS CUI [1]
C2584336
Lower Abdominal Pain
Description

Lower Abdominal Pain

Data type

integer

Alias
UMLS CUI [1]
C0232495
2. How strongly are you affected by your symptoms today? - The following questions are about the extent to which your complaints are today, or how strongly you feel affected by your symptoms today. Please tick one answer.
Description

2. How strongly are you affected by your symptoms today? - The following questions are about the extent to which your complaints are today, or how strongly you feel affected by your symptoms today. Please tick one answer.

Alias
UMLS CUI-1
C1457887
UMLS CUI-2
C0392760
Affected by Urgency of micturition
Description

Affected by Urgency of micturition

Data type

integer

Alias
UMLS CUI [1,1]
C0085606
UMLS CUI [1,2]
C0392760
Affected by Burning/painful urination
Description

Affected by Burning/painful urination

Data type

integer

Alias
UMLS CUI [1,1]
C0237332
UMLS CUI [1,2]
C0392760
Affected by Frequency of urination
Description

Affected by Frequency of urination

Data type

integer

Alias
UMLS CUI [1,1]
C2584336
UMLS CUI [1,2]
C0392760
Affected by Lower Abdominal Pain
Description

Affected by Lower Abdominal Pain

Data type

integer

Alias
UMLS CUI [1,1]
C0232495
UMLS CUI [1,2]
C0392760
3. For how many days do you have your current complaints? - The following questions are about the extent to which your complaints are today, or how strongly you feel affected by your symptoms today. Please tick one answer.
Description

3. For how many days do you have your current complaints? - The following questions are about the extent to which your complaints are today, or how strongly you feel affected by your symptoms today. Please tick one answer.

Alias
UMLS CUI-1
C0436359
For how many days do you have your current complaints?
Description

Duration of Symptoms

Data type

float

Measurement units
  • Tage
Alias
UMLS CUI [1]
C0436359
Tage
4. Do you have increased or changed vaginal discharge? - The following questions are about the extent to which your complaints are today, or how strongly you feel affected by your symptoms today. Please tick one answer.
Description

4. Do you have increased or changed vaginal discharge? - The following questions are about the extent to which your complaints are today, or how strongly you feel affected by your symptoms today. Please tick one answer.

Alias
UMLS CUI-1
C0227791
Do you have increased or changed vaginal discharge?
Description

Vaginal Discharge

Data type

boolean

Alias
UMLS CUI [1]
C0227791
5. How does your urine look like today? - The following questions are about the extent to which your complaints are today, or how strongly you feel affected by your symptoms today. Please tick one answer.
Description

5. How does your urine look like today? - The following questions are about the extent to which your complaints are today, or how strongly you feel affected by your symptoms today. Please tick one answer.

Alias
UMLS CUI-1
C0578511
How does your urine look like today?
Description

Urine Appearance

Data type

text

Alias
UMLS CUI [1]
C0578511
6. Does the urine smell abnormal today? - The following questions are about the extent to which your complaints are today, or how strongly you feel affected by your symptoms today. Please tick one answer.
Description

6. Does the urine smell abnormal today? - The following questions are about the extent to which your complaints are today, or how strongly you feel affected by your symptoms today. Please tick one answer.

Alias
UMLS CUI-1
C1286370
Does the urine smell abnormal today?
Description

Urine Odor

Data type

text

Alias
UMLS CUI [1]
C1286370
7. Do you think your symptoms are a urinary tract infection? - The following questions are about the extent to which your complaints are today, or how strongly you feel affected by your symptoms today. Please tick one answer.
Description

7. Do you think your symptoms are a urinary tract infection? - The following questions are about the extent to which your complaints are today, or how strongly you feel affected by your symptoms today. Please tick one answer.

Alias
UMLS CUI-1
C0042029
UMLS CUI-2
C0750493
Do you think your symptoms are a urinary tract infection?
Description

Suspicious Urinary Tract Infection

Data type

text

Alias
UMLS CUI [1,1]
C0042029
UMLS CUI [1,2]
C0750493
8. Did you have one/several Urinary Tract Infections in the last 6 months? - The following questions are about the extent to which your complaints are today, or how strongly you feel affected by your symptoms today. Please tick one answer.
Description

8. Did you have one/several Urinary Tract Infections in the last 6 months? - The following questions are about the extent to which your complaints are today, or how strongly you feel affected by your symptoms today. Please tick one answer.

Alias
UMLS CUI-1
C0205156
UMLS CUI-2
C0042029
Did you have one/several Urinary Tract Infections in the last 6 months?
Description

Previous Urinary Tract Infection

Data type

boolean

Alias
UMLS CUI [1,1]
C0205156
UMLS CUI [1,2]
C0042029
8.a. If YES, how many urinary tract infections did you have in the last 6 weeks ?
Description

Number of Previous Urinary Tract Infection

Data type

text

Alias
UMLS CUI [1,1]
C0205156
UMLS CUI [1,2]
C0042029
UMLS CUI [1,3]
C0449788
9. When was the last urinary tract infection?
Description

Date of Last Urinary Tract Infection

Data type

text

Alias
UMLS CUI [1,1]
C0042029
UMLS CUI [1,2]
C1517741
UMLS CUI [1,3]
C0011008
Patient Information - The following questions are about the extent to which your complaints are today, or how strongly you feel affected by your symptoms today. Please tick one answer.
Description

Patient Information - The following questions are about the extent to which your complaints are today, or how strongly you feel affected by your symptoms today. Please tick one answer.

Alias
UMLS CUI-1
C1955348
1. Highest Educational Degree?
Description

Educational Status

Data type

text

Alias
UMLS CUI [1]
C0013658
2. Are you employed?
Description

Employment Status

Data type

text

Alias
UMLS CUI [1]
C0242271
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Similar models

Questionnaire Day 0 REGATTA NCT03151603

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Patient Information
C1955348 (UMLS CUI-1)
Birth Year
Item
Birth Year
date
C2826771 (UMLS CUI [1])
Item Group
1. How severe are your symptoms today? - The following questions are about the extent to which your complaints are today, or how strongly you feel affected by your symptoms today. Please tick one answer.
C1457887 (UMLS CUI-1)
C0439793 (UMLS CUI-2)
Item
Urgency of micturition
integer
C0085606 (UMLS CUI [1])
Urgency of micturition
Code List
Urgency of micturition
CL Item
not at all (0)
CL Item
a little (1)
CL Item
moderate (2)
CL Item
strong (3)
CL Item
very strong (4)
Item
Burning/painful urination
integer
C0237332 (UMLS CUI [1])
Burning/painful urination
Code List
Burning/painful urination
CL Item
not at all  (0)
CL Item
a little  (1)
CL Item
moderate  (2)
CL Item
strong  (3)
CL Item
very strong (4)
Item
Frequent urination
integer
C2584336 (UMLS CUI [1])
Frequency of urination
Code List
Frequent urination
CL Item
not at all  (0)
CL Item
a little  (1)
CL Item
moderate  (2)
CL Item
strong  (3)
CL Item
very strong (4)
Item
Lower Abdominal Pain
integer
C0232495 (UMLS CUI [1])
Lower Abdominal Pain
Code List
Lower Abdominal Pain
CL Item
not at all  (0)
CL Item
a little  (1)
CL Item
moderate  (2)
CL Item
strong  (3)
CL Item
very strong (4)
Item Group
2. How strongly are you affected by your symptoms today? - The following questions are about the extent to which your complaints are today, or how strongly you feel affected by your symptoms today. Please tick one answer.
C1457887 (UMLS CUI-1)
C0392760 (UMLS CUI-2)
Item
Affected by Urgency of micturition
integer
C0085606 (UMLS CUI [1,1])
C0392760 (UMLS CUI [1,2])
Urgency of micturition
Code List
Affected by Urgency of micturition
CL Item
not at all (0)
CL Item
a little (1)
CL Item
moderate (2)
CL Item
strong (3)
CL Item
very strong (4)
Item
Affected by Burning/painful urination
integer
C0237332 (UMLS CUI [1,1])
C0392760 (UMLS CUI [1,2])
Burning/painful urination
Code List
Affected by Burning/painful urination
CL Item
not at all  (0)
CL Item
a little  (1)
CL Item
moderate  (2)
CL Item
strong  (3)
CL Item
very strong (4)
Item
Affected by Frequency of urination
integer
C2584336 (UMLS CUI [1,1])
C0392760 (UMLS CUI [1,2])
Frequency of urination
Code List
Affected by Frequency of urination
CL Item
not at all  (0)
CL Item
a little  (1)
CL Item
moderate  (2)
CL Item
strong  (3)
CL Item
very strong (4)
Item
Affected by Lower Abdominal Pain
integer
C0232495 (UMLS CUI [1,1])
C0392760 (UMLS CUI [1,2])
Affected by Lower Abdominal Pain
Code List
Affected by Lower Abdominal Pain
CL Item
not at all  (0)
CL Item
a little  (1)
CL Item
moderate  (2)
CL Item
strong  (3)
CL Item
very strong (4)
Item Group
3. For how many days do you have your current complaints? - The following questions are about the extent to which your complaints are today, or how strongly you feel affected by your symptoms today. Please tick one answer.
C0436359 (UMLS CUI-1)
Duration of Symptoms
Item
For how many days do you have your current complaints?
float
C0436359 (UMLS CUI [1])
Item Group
4. Do you have increased or changed vaginal discharge? - The following questions are about the extent to which your complaints are today, or how strongly you feel affected by your symptoms today. Please tick one answer.
C0227791 (UMLS CUI-1)
Vaginal Discharge
Item
Do you have increased or changed vaginal discharge?
boolean
C0227791 (UMLS CUI [1])
Item Group
5. How does your urine look like today? - The following questions are about the extent to which your complaints are today, or how strongly you feel affected by your symptoms today. Please tick one answer.
C0578511 (UMLS CUI-1)
Item
How does your urine look like today?
text
C0578511 (UMLS CUI [1])
Urine Appearance
Code List
How does your urine look like today?
CL Item
 (klar)
CL Item
 (trüb)
CL Item
 (rötlich)
CL Item
 (weiß nicht)
Item Group
6. Does the urine smell abnormal today? - The following questions are about the extent to which your complaints are today, or how strongly you feel affected by your symptoms today. Please tick one answer.
C1286370 (UMLS CUI-1)
Item
Does the urine smell abnormal today?
text
C1286370 (UMLS CUI [1])
Urine Odor
Code List
Does the urine smell abnormal today?
CL Item
 (Nein)
CL Item
 (Ja)
CL Item
 (Weiß nicht)
Item Group
7. Do you think your symptoms are a urinary tract infection? - The following questions are about the extent to which your complaints are today, or how strongly you feel affected by your symptoms today. Please tick one answer.
C0042029 (UMLS CUI-1)
C0750493 (UMLS CUI-2)
Item
Do you think your symptoms are a urinary tract infection?
text
C0042029 (UMLS CUI [1,1])
C0750493 (UMLS CUI [1,2])
Suspicious Urinary Tract Infection
Code List
Do you think your symptoms are a urinary tract infection?
CL Item
 (Nein)
CL Item
 (Ja)
CL Item
 (Weiß nicht)
Item Group
8. Did you have one/several Urinary Tract Infections in the last 6 months? - The following questions are about the extent to which your complaints are today, or how strongly you feel affected by your symptoms today. Please tick one answer.
C0205156 (UMLS CUI-1)
C0042029 (UMLS CUI-2)
Previous Urinary Tract Infection
Item
Did you have one/several Urinary Tract Infections in the last 6 months?
boolean
C0205156 (UMLS CUI [1,1])
C0042029 (UMLS CUI [1,2])
Item
8.a. If YES, how many urinary tract infections did you have in the last 6 weeks ?
text
C0205156 (UMLS CUI [1,1])
C0042029 (UMLS CUI [1,2])
C0449788 (UMLS CUI [1,3])
Number of Previous Urinary Tract Infection
Code List
8.a. If YES, how many urinary tract infections did you have in the last 6 weeks ?
CL Item
1x (1x)
CL Item
2x (2x)
CL Item
 (mehr als 2x)
Item
9. When was the last urinary tract infection?
text
C0042029 (UMLS CUI [1,1])
C1517741 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
Date of Last Urinary Tract Infection
Code List
9. When was the last urinary tract infection?
CL Item
 (vor mehr als 2 - 4 wochen)
CL Item
 (vor 4 - 8 Wochen)
CL Item
 (vor mehr als 2 Monaten)
Item Group
Patient Information - The following questions are about the extent to which your complaints are today, or how strongly you feel affected by your symptoms today. Please tick one answer.
C1955348 (UMLS CUI-1)
Item
1. Highest Educational Degree?
text
C0013658 (UMLS CUI [1])
Educational Status
Code List
1. Highest Educational Degree?
CL Item
Hauptschule/Volksschule (Hauptschule/Volksschule)
CL Item
Realschule/Polytechnische Oberschule (Realschule/Polytechnische Oberschule)
CL Item
Fachhochschulreife (Fachhochschulreife)
CL Item
Hochschulreife/Abitur (Hochschulreife/Abitur)
CL Item
 (anderer Schulabschluss)
CL Item
 (kein Schulabschluss)
Item
2. Are you employed?
text
C0242271 (UMLS CUI [1])
Employment Status
Code List
2. Are you employed?
CL Item
 (ganztags/Vollzeit)
CL Item
 (halbtags/Teilzeit)
CL Item
 (Ausbildung/Lehre/Studium/Weiterbildung/Umschulung)
CL Item
 (Altersrente)
CL Item
 (Altersteilzeit)
CL Item
 (Ich gehe derzeit keiner Erwerbstätigkeit nach)
CL Item
 (Mini-Job/Ein-Euro-Job/weniger als halbtags)
CL Item
 (sonstiges)
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