ID

29311

Beschreibung

Study part: Smoking/ Alcohol Use Screening. A Phase III, Multicenter, Randomized, Sham Injection-Controlled Study Of The Efficacy And Safety Of Ranibizumab Injection Compared With Sham In Subjects with Macular Edema Secondary To Branch Retinal Vein Occlusion.

Stichworte

Versionen (1)
  1. 18.03.18 18.03.18 -
Rechteinhaber

Roche

Hochgeladen am

18. März 2018

DOI

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Lizenz

Creative Commons BY-NC 3.0
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Smoking/ Alcohol Use Screening Ranibizumab Macular Edema Secondary To Branch Retinal Vein Occlusion FVF4165g

Englisch

Smoking/ Alcohol Use Screening

1 Formulare  
Current and Past Smoking
Beschreibung

Current and Past Smoking

Alias
UMLS CUI-1
C1519384
Subject number:
Beschreibung

Subject number

Datentyp

text

Alias
UMLS CUI [1]
C2348585
Subject initials:
Beschreibung

Subject initials

Datentyp

text

Alias
UMLS CUI [1,1]
C1997894
UMLS CUI [1,2]
C2986440
Visit date:
Beschreibung

Visit date

Datentyp

date

Alias
UMLS CUI [1]
C1320303
Do you smoke cigarettes currently?
Beschreibung

Smoking History

Datentyp

boolean

Alias
UMLS CUI [1]
C1519384
How many cigarettes per day do you smoke (1 pack= 20 cigarettes)?
Beschreibung

number of cigarettes per day

Datentyp

integer

Alias
UMLS CUI [1]
C3694146
At what age did you start smoking cigarettes?
Beschreibung

start smoking age

Datentyp

integer

Alias
UMLS CUI [1]
C3260575
Did you stop smoking cigarettes?
Beschreibung

stopped smoking

Datentyp

boolean

Alias
UMLS CUI [1]
C0425310
At what age did you start smoking cigarettes?
Beschreibung

start smoking age

Datentyp

integer

Alias
UMLS CUI [1]
C3260575
At what age did you stop smoking cigarettes?
Beschreibung

age stopped smoking

Datentyp

integer

Alias
UMLS CUI [1,1]
C0001779
UMLS CUI [1,2]
C0425310
Cigarettes / day when smoked (1 pack = 20 cigarettes)?
Beschreibung

number of cigarettes per day

Datentyp

integer

Alias
UMLS CUI [1]
C3694146
Current Alcohol Consumption
Beschreibung

Current Alcohol Consumption

Alias
UMLS CUI-1
C0001948
In the past 6 months, on average, how many drinks* did you consume per WEEK?
Beschreibung

*= A drink is one beer, one glass of wine, one shot of liquor or one mixed drink.

Datentyp

text

Alias
UMLS CUI [1]
C0001948
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Ähnliche Modelle

Smoking/ Alcohol Use Screening

1 Formulare
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Current and Past Smoking
C1519384 (UMLS CUI-1)
Subject number
Item
Subject number:
text
C2348585 (UMLS CUI [1])
Subject initials
Item
Subject initials:
text
C1997894 (UMLS CUI [1,1])
C2986440 (UMLS CUI [1,2])
Visit date
Item
Visit date:
date
C1320303 (UMLS CUI [1])
Smoking History
Item
Do you smoke cigarettes currently?
boolean
C1519384 (UMLS CUI [1])
number of cigarettes per day
Item
How many cigarettes per day do you smoke (1 pack= 20 cigarettes)?
integer
C3694146 (UMLS CUI [1])
start smoking age
Item
At what age did you start smoking cigarettes?
integer
C3260575 (UMLS CUI [1])
stopped smoking
Item
Did you stop smoking cigarettes?
boolean
C0425310 (UMLS CUI [1])
start smoking age
Item
At what age did you start smoking cigarettes?
integer
C3260575 (UMLS CUI [1])
age stopped smoking
Item
At what age did you stop smoking cigarettes?
integer
C0001779 (UMLS CUI [1,1])
C0425310 (UMLS CUI [1,2])
number of cigarettes per day
Item
Cigarettes / day when smoked (1 pack = 20 cigarettes)?
integer
C3694146 (UMLS CUI [1])
Item Group
Current Alcohol Consumption
C0001948 (UMLS CUI-1)
Item
In the past 6 months, on average, how many drinks* did you consume per WEEK?
text
C0001948 (UMLS CUI [1])
Alcohol Consumption
Code List
In the past 6 months, on average, how many drinks* did you consume per WEEK?
CL Item
Have never drank alcohol (Have never drank alcohol)
CL Item
0 (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8-14 (8-14)
CL Item
>14 (>14)
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Mit * gekennzeichnete Felder sind notwendig.

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