ID

29389

Beskrivning

Study part: 4 Meter Visual Acuity/ Left Eye Chart 2 Screening. A Phase III, Double-Masked, Multicenter, Randomized, Sham-Controlled Study Of The Efficacy And Safety Of Ranibizumab Injection In Subjects With Clinically Significant Macular Edema With Center Involvement Secondary To Diabetes Mellitus.

Nyckelord

Versioner (1)
  1. 2018-03-21 2018-03-21 -
Rättsinnehavare

Roche

Uppladdad den

21 mars 2018

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 :

  • Senaste
  • Äldsta
  • Önskad
  • Senaste
    • Senaste
    • Äldsta
    • Önskad

Inga kommentarer

Du måste vara inloggad för att kunna ladda ner formulär. Var vänlig logga in eller registrera dig utan kostnad.

4 Meter Visual Acuity/ Left Eye Chart 2 Screening Ranibizumab Macular Edema Diabetes Mellitus FVF4168g

Engelsk

4 Meter Visual Acuity/ Left Eye Chart 2 Screening

1 Formulär  
SECTION I = 4 Meter Test
Beskrivning

SECTION I = 4 Meter Test

Alias
UMLS CUI-1
C0042812
Subject Number:
Beskrivning

Subject Number

Datatyp

text

Alias
UMLS CUI [1]
C2348585
Subject Initials:
Beskrivning

Subject Initials

Datatyp

text

Alias
UMLS CUI [1,1]
C1997894
UMLS CUI [1,2]
C2986440
Visit Date:
Beskrivning

Visit Date

Datatyp

date

Alias
UMLS CUI [1]
C1320303
Test Date:
Beskrivning

Test Date

Datatyp

date

Alias
UMLS CUI [1]
C2826247
Examiner Name (print):
Beskrivning

Investigator name

Datatyp

text

Alias
UMLS CUI [1]
C2826892
Examiner (signature):
Beskrivning

Investigator Signature

Datatyp

text

Alias
UMLS CUI [1]
C2346576
Row
Beskrivning

Row

Datatyp

integer

Alias
UMLS CUI [1]
C1552840
Snellen Equivalent
Beskrivning

Snellen Equivalent

Datatyp

text

Alias
UMLS CUI [1]
C1827708
Chart 2 Letters
Beskrivning

Snellen chart

Datatyp

text

Alias
UMLS CUI [1]
C0183370
Number correct at 4 meters
Beskrivning

number correct

Datatyp

integer

Alias
UMLS CUI [1,1]
C0237753
UMLS CUI [1,2]
C2349182
Total number correct at 4 meters
Beskrivning

Total number correct

Datatyp

integer

Alias
UMLS CUI [1,1]
C4288115
UMLS CUI [1,2]
C2349182
SECTION II = 1 Meter Test ADD +0.75 SPHERE
Beskrivning

SECTION II = 1 Meter Test ADD +0.75 SPHERE

Alias
UMLS CUI-1
C0042812
Row
Beskrivning

Row

Datatyp

integer

Alias
UMLS CUI [1]
C1552840
Snellen Equivalent
Beskrivning

Snellen Equivalent

Datatyp

text

Alias
UMLS CUI [1]
C1827708
Chart 2 Letters
Beskrivning

Snellen chart

Datatyp

text

Alias
UMLS CUI [1]
C0183370
Number correct at 1 meter
Beskrivning

number correct

Datatyp

integer

Alias
UMLS CUI [1,1]
C0237753
UMLS CUI [1,2]
C2349182
Total number correct at 1 meter
Beskrivning

Total number correct

Datatyp

integer

Alias
UMLS CUI [1,1]
C4288115
UMLS CUI [1,2]
C2349182
SECTION III = Computing VA Score & Snellen Equivalent
Beskrivning

SECTION III = Computing VA Score & Snellen Equivalent

Alias
UMLS CUI-1
C2964552
A. Total number correct at 4 meters: (SECTION I)
Beskrivning

Total number correct

Datatyp

text

Alias
UMLS CUI [1,1]
C4288115
UMLS CUI [1,2]
C2349182
B. If A ≥ 4, write 30;otherwise, write zero
Beskrivning

score

Datatyp

text

Alias
UMLS CUI [1]
C0449820
C. Total correct at 1 meter (SECTION II) (If not tested, write zero)
Beskrivning

Total number correct

Datatyp

text

Alias
UMLS CUI [1,1]
C4288115
UMLS CUI [1,2]
C2349182
A + B + C Visual Acuity Score: Left Eye =
Beskrivning

Visual Acuity Score

Datatyp

integer

Alias
UMLS CUI [1,1]
C0042812
UMLS CUI [1,2]
C0449820
SNELLEN EQUIVALENT Left Eye (Most difficult line with 1 or no errors)
Beskrivning

Snellen Equivalent

Datatyp

text

Alias
UMLS CUI [1]
C1827708
OR Snellen Equivalent worse than 20/800
Beskrivning

Snellen Equivalent

Datatyp

text

Alias
UMLS CUI [1]
C1827708
SECTION IV = Low Vision Testing
Beskrivning

SECTION IV = Low Vision Testing

Alias
UMLS CUI-1
C0042793
If visual acuity is not measurable, please test: Count fingers?
Beskrivning

Count fingers

Datatyp

text

Alias
UMLS CUI [1,1]
C0042793
UMLS CUI [1,2]
C0449804
If Yes, maximum distance:
Beskrivning

distance

Datatyp

text

Alias
UMLS CUI [1,1]
C0042793
UMLS CUI [1,2]
C0442747
Hand movement?
Beskrivning

Hand movement

Datatyp

text

Alias
UMLS CUI [1,1]
C0042793
UMLS CUI [1,2]
C0575809
If Yes:
Beskrivning

Direction

Datatyp

text

Alias
UMLS CUI [1,1]
C0042793
UMLS CUI [1,2]
C0449738
Light Perception?
Beskrivning

Light Perception

Datatyp

text

Alias
UMLS CUI [1,1]
C0042793
UMLS CUI [1,2]
C1154616
If Yes:
Beskrivning

Light Perception

Datatyp

text

Alias
UMLS CUI [1,1]
C0042793
UMLS CUI [1,2]
C1154616
Tillbaka till toppen

Similar models

4 Meter Visual Acuity/ Left Eye Chart 2 Screening

1 Formulär
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
SECTION I = 4 Meter Test
C0042812 (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])
Test Date
Item
Test Date:
date
C2826247 (UMLS CUI [1])
Investigator name
Item
Examiner Name (print):
text
C2826892 (UMLS CUI [1])
Investigator Signature
Item
Examiner (signature):
text
C2346576 (UMLS CUI [1])
Item
Row
integer
C1552840 (UMLS CUI [1])
Row
Code List
Row
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 (8)
CL Item
9 (9)
CL Item
10 (10)
CL Item
11 (11)
CL Item
12 (12)
CL Item
13 (13)
CL Item
14 (14)
Item
Snellen Equivalent
text
C1827708 (UMLS CUI [1])
Snellen Equivalent
Code List
Snellen Equivalent
CL Item
20/200 (20/200)
CL Item
20/160 (20/160)
CL Item
20/125 (20/125)
CL Item
20/100 (20/100)
CL Item
20/80 (20/80)
CL Item
20/63 (20/63)
CL Item
20/50 (20/50)
CL Item
20/40 (20/40)
CL Item
20/32 (20/32)
CL Item
20/25 (20/25)
CL Item
20/20 (20/20)
CL Item
20/16 (20/16)
CL Item
20/12.5 (20/12.5)
CL Item
20/10 (20/10)
Item
Chart 2 Letters
text
C0183370 (UMLS CUI [1])
Snellen chart
Code List
Chart 2 Letters
CL Item
N C K Z O (N C K Z O)
CL Item
R H S D K (R H S D K)
CL Item
D O V H R (D O V H R)
CL Item
C Z R H S (C Z R H S)
CL Item
O N H R C (O N H R C)
CL Item
D K S N V (D K S N V)
CL Item
Z S O K N (Z S O K N)
CL Item
C K D N R (C K D N R)
CL Item
S R Z K D (S R Z K D)
CL Item
H Z O V C (H Z O V C)
CL Item
N V D O K (N V D O K)
CL Item
V H C N O (V H C N O)
CL Item
S V H C Z (S V H C Z)
CL Item
O Z D V K (O Z D V K)
number correct
Item
Number correct at 4 meters
integer
C0237753 (UMLS CUI [1,1])
C2349182 (UMLS CUI [1,2])
Total number correct
Item
Total number correct at 4 meters
integer
C4288115 (UMLS CUI [1,1])
C2349182 (UMLS CUI [1,2])
Item Group
SECTION II = 1 Meter Test ADD +0.75 SPHERE
C0042812 (UMLS CUI-1)
Item
Row
integer
C1552840 (UMLS CUI [1])
Row
Code List
Row
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
Item
Snellen Equivalent
text
C1827708 (UMLS CUI [1])
Snellen Equivalent
Code List
Snellen Equivalent
CL Item
20/800 (20/800)
CL Item
20/640 (20/640)
CL Item
20/500 (20/500)
CL Item
20/400 (20/400)
CL Item
20/320 (20/320)
CL Item
20/250 (20/250)
Item
Chart 2 Letters
text
C0183370 (UMLS CUI [1])
Chart 1 Letters
Code List
Chart 2 Letters
CL Item
N C K Z O (N C K Z O)
CL Item
R H S D K (R H S D K)
CL Item
D O V H R (D O V H R)
CL Item
C Z R H S (C Z R H S)
CL Item
O N H R C (O N H R C)
CL Item
D K S N V (D K S N V)
number correct
Item
Number correct at 1 meter
integer
C0237753 (UMLS CUI [1,1])
C2349182 (UMLS CUI [1,2])
Total number correct
Item
Total number correct at 1 meter
integer
C4288115 (UMLS CUI [1,1])
C2349182 (UMLS CUI [1,2])
Item Group
SECTION III = Computing VA Score & Snellen Equivalent
C2964552 (UMLS CUI-1)
Total number correct
Item
A. Total number correct at 4 meters: (SECTION I)
text
C4288115 (UMLS CUI [1,1])
C2349182 (UMLS CUI [1,2])
score
Item
B. If A ≥ 4, write 30;otherwise, write zero
text
C0449820 (UMLS CUI [1])
Total number correct
Item
C. Total correct at 1 meter (SECTION II) (If not tested, write zero)
text
C4288115 (UMLS CUI [1,1])
C2349182 (UMLS CUI [1,2])
Visual Acuity Score
Item
A + B + C Visual Acuity Score: Left Eye =
integer
C0042812 (UMLS CUI [1,1])
C0449820 (UMLS CUI [1,2])
Snellen Equivalent
Item
SNELLEN EQUIVALENT Left Eye (Most difficult line with 1 or no errors)
text
C1827708 (UMLS CUI [1])
Snellen Equivalent
Item
OR Snellen Equivalent worse than 20/800
text
C1827708 (UMLS CUI [1])
Item Group
SECTION IV = Low Vision Testing
C0042793 (UMLS CUI-1)
Item
If visual acuity is not measurable, please test: Count fingers?
text
C0042793 (UMLS CUI [1,1])
C0449804 (UMLS CUI [1,2])
undefined item
Code List
If visual acuity is not measurable, please test: Count fingers?
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Not Done (Not Done)
Item
If Yes, maximum distance:
text
C0042793 (UMLS CUI [1,1])
C0442747 (UMLS CUI [1,2])
undefined item
Code List
If Yes, maximum distance:
CL Item
4 ft (4 ft)
CL Item
2 ft (2 ft)
CL Item
1 ft (1 ft)
Item
Hand movement?
text
C0042793 (UMLS CUI [1,1])
C0575809 (UMLS CUI [1,2])
undefined item
Code List
Hand movement?
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Not Done (Not Done)
Item
If Yes:
text
C0042793 (UMLS CUI [1,1])
C0449738 (UMLS CUI [1,2])
undefined item
Code List
If Yes:
CL Item
With Direction (With Direction)
CL Item
Without Direction (Without Direction)
Item
Light Perception?
text
C0042793 (UMLS CUI [1,1])
C1154616 (UMLS CUI [1,2])
undefined item
Code List
Light Perception?
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Not Done (Not Done)
Item
If Yes:
text
C0042793 (UMLS CUI [1,1])
C1154616 (UMLS CUI [1,2])
undefined item
Code List
If Yes:
CL Item
With Projection (With Projection)
CL Item
Without Projection (Without Projection)
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