Inglés

Early Withdrawal

1 formularios  
  1. StudyEvent: ODM
    1. Early Withdrawal
Vital signs
Descripción

Vital signs

Alias
UMLS CUI-1
C0518766
UMLS CUI-2
C0031809
Sitting blood pressure systolic
Descripción

Sitting blood pressure systolic

Tipo de datos

integer

Unidades de medida
  • mmHg
Alias
UMLS CUI [1,1]
C0871470
UMLS CUI [1,2]
C0277814
mmHg
Sitting blood pressure diastolic
Descripción

Sitting blood pressure diastolic

Tipo de datos

integer

Unidades de medida
  • mmHg
Alias
UMLS CUI [1,1]
C0428883
UMLS CUI [1,2]
C0277814
mmHg
Sitting heart rate
Descripción

Sitting heart rate

Tipo de datos

integer

Unidades de medida
  • beats/min
Alias
UMLS CUI [1,1]
C0018810
UMLS CUI [1,2]
C0277814
beats/min
Weight (without shoes)
Descripción

Weight

Tipo de datos

float

Unidades de medida
  • kg
Alias
UMLS CUI [1]
C0005910
kg
Healthcare resource utilisation - Visits/Contacts with Physicians
Descripción

Healthcare resource utilisation - Visits/Contacts with Physicians

Alias
UMLS CUI-1
C1704738
UMLS CUI-2
C0031831
UMLS CUI-3
C0545082
In the past 4 weeks...did the patient visit your site (for reasons other than study visit) or other medical practitioners?
Descripción

If ’No’, please leave the rest of this page blank If ’Yes’, please describe each visit

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0583555
Date of Visit
Descripción

date of visit physician

Tipo de datos

date

Alias
UMLS CUI [1,1]
C1320303
UMLS CUI [1,2]
C0031831
Type of physician
Descripción

Type of physician

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C0031831
UMLS CUI [1,2]
C0332307
Visit location
Descripción

Visit location

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C0545082
UMLS CUI [1,2]
C0450429
Was the Visit RLS Related?
Descripción

A Directly Related RLS visit is one that in your opinion is specifically related to the patient's RLS (e.g. visits for RLS treatment, testing etc).

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0035258
UMLS CUI [1,2]
C0439849
Were any tests or procedures prescribed or conducted at this visit?
Descripción

tests or procedures prescribed

Tipo de datos

integer

Alias
UMLS CUI [1]
C0430022
UMLS CUI [2]
C0033080
Healthcare resource utilisation - Visits/Contacts with other Paramedical Practitioners
Descripción

Healthcare resource utilisation - Visits/Contacts with other Paramedical Practitioners

Alias
UMLS CUI-1
C1704738
UMLS CUI-2
C0030450
UMLS CUI-3
C0545082
In the past 4 weeks...did the patient visit any or have contact with paramedical practitioners (for reasons other than study visit)?
Descripción

If ’No’, please leave the rest of this page blank If ’Yes’, please describe each visit

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0545082
UMLS CUI [1,2]
C0030450
Date of visit
Descripción

date of visit paramedical practitioner

Tipo de datos

date

Alias
UMLS CUI [1,1]
C0030450
UMLS CUI [1,2]
C1320303
Type of paramedical practitioner
Descripción

Type of paramedical practitioner

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C0030450
UMLS CUI [1,2]
C0332307
Visit location
Descripción

Visit location

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C0545082
UMLS CUI [1,2]
C0450429
Was the visit RLS related?
Descripción

A Directly Related RLS visit is one that in your opinion is specifically related to the patient's RLS (e.g. visits for RLS treatment, testing etc).

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0035258
UMLS CUI [1,2]
C0439849
Healthcare resource utilisation - Hospitalisation
Descripción

Healthcare resource utilisation - Hospitalisation

Alias
UMLS CUI-1
C1704738
UMLS CUI-2
C0019993
In the past 4 weeks...was the patient hospitalised?
Descripción

If ’No’, please leave the rest of this page blank If ’Yes’, please describe each hospitalisation

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0019993
Date of admission
Descripción

date of admission

Tipo de datos

date

Alias
UMLS CUI [1]
C1302393
Date of discharge
Descripción

date of discharge

Tipo de datos

date

Alias
UMLS CUI [1]
C2361123
Main reason for stay
Descripción

Hospitalisation cause

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0019993
UMLS CUI [1,2]
C0392360
Was the Visit RLS Related?
Descripción

A Directly Related RLS visit is one that in your opinion is specifically related to the patient's RLS (e.g. visits for RLS treatment, testing etc). An Indirectly Related RLS visit is one that in your opinion is related to conditions or complications caused by the underlying RLS condition (e.g. visit to treat associated sleep disorders, etc). A Not Related RLS visit is one that in your opinion is related to other reasons.

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0035258
UMLS CUI [1,2]
C0439849
Type of ward
Descripción

type of ward

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C1305702
UMLS CUI [1,2]
C0332307
Length of stay on ward
Descripción

in days

Tipo de datos

integer

Unidades de medida
  • days
Alias
UMLS CUI [1,1]
C1305702
UMLS CUI [1,2]
C0023303
days
Healthcare resource utilisation - accident & emergency / emergency room visits
Descripción

Healthcare resource utilisation - accident & emergency / emergency room visits

Alias
UMLS CUI-1
C1704738
UMLS CUI-2
C0562508
UMLS CUI-3
C0545082
In the past 4 weeks...did the patient visit an Accident and Emergency or EMERGENCY ROOM?
Descripción

If ’No’, please leave the rest of this page blank If ’Yes’, please describe each visit

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0562508
UMLS CUI [1,2]
C0545082
Date of visit
Descripción

Date of visit in A&E

Tipo de datos

date

Alias
UMLS CUI [1,1]
C0562508
UMLS CUI [1,2]
C1320303
Was the visit RLS related?
Descripción

A Directly Related RLS visit is one that in your opinion is specifically related to the patient's RLS (e.g. visits for RLS treatment, testing etc). An Indirectly Related RLS visit is one that in your opinion is related to conditions or complications caused by the underlying RLS condition (e.g. visit to treat associated sleep disorders, etc). A Not Related RLS visit is one that in your opinion is related to other reasons.

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0035258
UMLS CUI [1,2]
C0439849
Laboratory Evaluation
Descripción

Laboratory Evaluation

Alias
UMLS CUI-1
C0022885
UMLS CUI-2
C0430370
Date of blood sample
Descripción

Date of blood sample

Tipo de datos

date

Alias
UMLS CUI [1,1]
C0005834
UMLS CUI [1,2]
C0011008
Were any clinically significant abnormalities detected?
Descripción

If ’Yes’, please record details in the Adverse Experiences and/or SAE Section at the back of this book and repeat at Follow-up.

Tipo de datos

boolean

Alias
UMLS CUI [1]
C1853129
What was the result of the urine dipstick performed at this visit?
Descripción

Please perform a urine dipstick test for presence of blood or protein. If ’Positive’, please record details in the Adverse Experiences and/or SAE Section at the back of this book, send a sample to Quest Diagnostics for further evaluation and repeat at Follow-up.

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C0430370
UMLS CUI [1,2]
C0456984
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Similar models

Early Withdrawal

1 formularios
  1. StudyEvent: ODM
    1. Early Withdrawal
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
Vital signs
C0518766 (UMLS CUI-1)
C0031809 (UMLS CUI-2)
Sitting blood pressure systolic
Item
Sitting blood pressure systolic
integer
C0871470 (UMLS CUI [1,1])
C0277814 (UMLS CUI [1,2])
Sitting blood pressure diastolic
Item
Sitting blood pressure diastolic
integer
C0428883 (UMLS CUI [1,1])
C0277814 (UMLS CUI [1,2])
Sitting heart rate
Item
Sitting heart rate
integer
C0018810 (UMLS CUI [1,1])
C0277814 (UMLS CUI [1,2])
Weight
Item
Weight (without shoes)
float
C0005910 (UMLS CUI [1])
Item Group
Healthcare resource utilisation - Visits/Contacts with Physicians
C1704738 (UMLS CUI-1)
C0031831 (UMLS CUI-2)
C0545082 (UMLS CUI-3)
Visits with physicians
Item
In the past 4 weeks...did the patient visit your site (for reasons other than study visit) or other medical practitioners?
boolean
C0583555 (UMLS CUI [1])
date of visit physician
Item
Date of Visit
date
C1320303 (UMLS CUI [1,1])
C0031831 (UMLS CUI [1,2])
Item
Type of physician
integer
C0031831 (UMLS CUI [1,1])
C0332307 (UMLS CUI [1,2])
Type of physician
Code List
Type of physician
CL Item
Cardiologist (1)
CL Item
Diabetologist (2)
CL Item
Dermatologist (3)
CL Item
Endocrinologist (4)
CL Item
ENT (Ear Nose & Throat) (5)
CL Item
Gastroenterologist (6)
CL Item
General/Internal Medical (7)
CL Item
General Practitioner/Family Practitioner  (8)
CL Item
Geriatrician (9)
CL Item
Gynaecologist (10)
CL Item
Infectious Disease (11)
CL Item
Nephrologist (12)
CL Item
Neurologist (13)
CL Item
Psychiatrist (14)
CL Item
Orthopaedic (15)
CL Item
Oncologist (16)
CL Item
Ophthalmologist (17)
CL Item
Respiratory/Chest Physician  (18)
CL Item
Rheumatologist (19)
CL Item
Urologist (20)
CL Item
Sleep Disorder Specialist  (21)
CL Item
Other (99)
Item
Visit location
integer
C0545082 (UMLS CUI [1,1])
C0450429 (UMLS CUI [1,2])
Visit location
Code List
Visit location
CL Item
Non hospital Office visit (eg GP surgery, Specialist's office etc) (1)
CL Item
Hospital Out Patient visit (2)
CL Item
At the Patient's home / domiciliary visit (3)
Item
Was the Visit RLS Related?
text
C0035258 (UMLS CUI [1,1])
C0439849 (UMLS CUI [1,2])
Related to RLS
Code List
Was the Visit RLS Related?
CL Item
directly (1)
CL Item
indirectly (2)
CL Item
not related (3)
Item
Were any tests or procedures prescribed or conducted at this visit?
integer
C0430022 (UMLS CUI [1])
C0033080 (UMLS CUI [2])
tests or procedures during visit
Code List
Were any tests or procedures prescribed or conducted at this visit?
CL Item
yes (1)
CL Item
no (2)
CL Item
unknown (3)
Item Group
Healthcare resource utilisation - Visits/Contacts with other Paramedical Practitioners
C1704738 (UMLS CUI-1)
C0030450 (UMLS CUI-2)
C0545082 (UMLS CUI-3)
patient visit with paramedical practitioners
Item
In the past 4 weeks...did the patient visit any or have contact with paramedical practitioners (for reasons other than study visit)?
boolean
C0545082 (UMLS CUI [1,1])
C0030450 (UMLS CUI [1,2])
date of visit paramedical practitioner
Item
Date of visit
date
C0030450 (UMLS CUI [1,1])
C1320303 (UMLS CUI [1,2])
Item
Type of paramedical practitioner
integer
C0030450 (UMLS CUI [1,1])
C0332307 (UMLS CUI [1,2])
Type of paramedical practitioner
Code List
Type of paramedical practitioner
CL Item
Acupuncturist (1)
CL Item
Chiropodist/ Footcare Practitioner (2)
CL Item
Chiropractor (3)
CL Item
Dentist (4)
CL Item
Dietician (5)
CL Item
Homeopath/Herbalist (6)
CL Item
Nurse (7)
CL Item
Osteopath (8)
CL Item
Physiotherapist (9)
CL Item
Other (99)
Item
Visit location
integer
C0545082 (UMLS CUI [1,1])
C0450429 (UMLS CUI [1,2])
Visit location
Code List
Visit location
CL Item
Non hospital Office visit (eg GP surgery, Specialist's office etc) (1)
CL Item
Hospital Out Patient visit (2)
CL Item
At the Patient's home / domiciliary visit (3)
Item
Was the visit RLS related?
text
C0035258 (UMLS CUI [1,1])
C0439849 (UMLS CUI [1,2])
Related to RLS
Code List
Was the visit RLS related?
CL Item
directly (1)
CL Item
indirectly (2)
CL Item
not related (3)
Item Group
Healthcare resource utilisation - Hospitalisation
C1704738 (UMLS CUI-1)
C0019993 (UMLS CUI-2)
Hospitalisation
Item
In the past 4 weeks...was the patient hospitalised?
boolean
C0019993 (UMLS CUI [1])
date of admission
Item
Date of admission
date
C1302393 (UMLS CUI [1])
date of discharge
Item
Date of discharge
date
C2361123 (UMLS CUI [1])
Hospitalisation cause
Item
Main reason for stay
text
C0019993 (UMLS CUI [1,1])
C0392360 (UMLS CUI [1,2])
Item
Was the Visit RLS Related?
text
C0035258 (UMLS CUI [1,1])
C0439849 (UMLS CUI [1,2])
Related to RLS
Code List
Was the Visit RLS Related?
CL Item
directly (1)
CL Item
indirectly (2)
CL Item
not related (3)
Item
Type of ward
integer
C1305702 (UMLS CUI [1,1])
C0332307 (UMLS CUI [1,2])
type of ward
Code List
Type of ward
CL Item
Cardiovascular (1)
CL Item
Dermatological (2)
CL Item
Endocrinological (3)
CL Item
ENT (Ear, Nose & Throat)  (4)
CL Item
Gastroenterological (5)
CL Item
General Medical (6)
CL Item
Geriatric (7)
CL Item
Gynaecological (8)
CL Item
Infectious Disease  (9)
CL Item
Nephrological (10)
CL Item
Intensive Care  (11)
CL Item
Neurological  (12)
CL Item
Psychiatric (13)
CL Item
Orthopaedic  (14)
CL Item
Oncology (15)
CL Item
Ophthalmological  (16)
CL Item
Respiratory/Chest  (17)
CL Item
Rheumatological  (18)
CL Item
Urological (19)
CL Item
Other (99)
length of stay on ward
Item
Length of stay on ward
integer
C1305702 (UMLS CUI [1,1])
C0023303 (UMLS CUI [1,2])
Item Group
Healthcare resource utilisation - accident & emergency / emergency room visits
C1704738 (UMLS CUI-1)
C0562508 (UMLS CUI-2)
C0545082 (UMLS CUI-3)
A&E visits
Item
In the past 4 weeks...did the patient visit an Accident and Emergency or EMERGENCY ROOM?
boolean
C0562508 (UMLS CUI [1,1])
C0545082 (UMLS CUI [1,2])
Date of visit in A&E
Item
Date of visit
date
C0562508 (UMLS CUI [1,1])
C1320303 (UMLS CUI [1,2])
Item
Was the visit RLS related?
text
C0035258 (UMLS CUI [1,1])
C0439849 (UMLS CUI [1,2])
Related to RLS
Code List
Was the visit RLS related?
CL Item
directly (1)
CL Item
indirectly (2)
CL Item
not related (3)
Item Group
Laboratory Evaluation
C0022885 (UMLS CUI-1)
C0430370 (UMLS CUI-2)
Date of blood sample
Item
Date of blood sample
date
C0005834 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
abnormalities laboratory
Item
Were any clinically significant abnormalities detected?
boolean
C1853129 (UMLS CUI [1])
Item
What was the result of the urine dipstick performed at this visit?
integer
C0430370 (UMLS CUI [1,1])
C0456984 (UMLS CUI [1,2])
urine dipstick result
Code List
What was the result of the urine dipstick performed at this visit?
CL Item
Negative (1)
CL Item
Positive (2)
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