ID

32441

Description

HD16 NCT Nr.: NCT00736320 HD16 for Early Stages - Treatment Optimization Trial in the First-line Treatment of Early Stage Hodgkin Lymphoma; Treatment Stratification by Means of FDG-PET. This study is designed to test the non-inferiority of the experimental arm compared to the standard arm in terms of Progression free survival (PFS). HD17 NCT Nr.: NCT01356680 HD17 for Intermediate Stages - Treatment Optimization Trial in the First-Line Treatment of Intermediate Stage Hodgkin Lymphoma.This study is designed to test the non-inferiority of the experimental arm compared to the standard arm in terms of progression free survival (PFS). HD18 NCT Nr.: NCT00515554 HD18 for Advanced Stages in Hodgkins Lymphoma. This study is designed to test: in patients with negative positron-emission tomography (PET) after 2 cycles of BEACOPPesc chemotherapy: whether the number of cycles can be reduced without compromising progression free survival (PFS) (2 further cycles vs. 6 further cycles) for patients with positive PET after 2 cycles: whether intensifying BEACOPPesc chemotherapy by adding Rituximab improves PFS. Permission granted by: Andreas Engert, M.D. Chairman, German Hodgkin Study Group Professor for Internal Medicine Hematology & Oncology University Hospital of Cologne Department of Internal Medicine I Kerpener Str. 62 D-50924 Köln Phone: +49-221-478-5933/5966 Fax: +49-221-478-3778 a.engert@uni-koeln.de

Keywords

Versions (2)
  1. 5/17/17 5/17/17 -
  2. 11/1/18 11/1/18 - Sarah Riepenhausen
Copyright Holder

German Hodgkin Study Group

Uploaded on

November 1, 2018

DOI

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License

Creative Commons BY-NC 3.0
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German Hodgkin Study Group Study HD16/HD17/HD18 Long term toxicity Base G6LT DRKS00003455 DRKS00003457

German

Deutsche Hodgkin Studiengruppe: G6LT Basisbogen Langzeittoxizität

1 forms  
Formularkopf
Description

Formularkopf

Alias
UMLS CUI-1
C0600661
Stempel des einsendenden Instituts
Description

Stamp of participating institution

Data type

text

Alias
UMLS CUI [1]
C2347449
Telefonnummer des einsendenden Instituts (bitte mit Durchwahl)
Description

Phone number of participating institution

Data type

integer

Alias
UMLS CUI [1,1]
C2347449
UMLS CUI [1,2]
C1515258
Adresse der verantwortlichen Studienzentrale
Description

Address of responsible study center

Data type

text

Alias
UMLS CUI [1,1]
C2825181
UMLS CUI [1,2]
C1442065
Patientenname
Description

Patient Name

Data type

text

Alias
UMLS CUI [1]
C1299487
Geburtsname
Description

Patient birth name

Data type

text

Alias
UMLS CUI [1]
C1549652
Geburtsdatum
Description

Birth Date

Data type

date

Alias
UMLS CUI [1]
C0421451
Adresse des Patienten
Description

Patient address

Data type

text

Alias
UMLS CUI [1]
C0421449
Datum der Untersuchung
Description

Physical Examination date

Data type

date

Alias
UMLS CUI [1]
C2826643
Studien ID
Description

Study ID

Data type

integer

Alias
UMLS CUI [1]
C2826693
Bogen ID
Description

CRF Indentificator

Data type

integer

Alias
UMLS CUI [1,1]
C1516308
UMLS CUI [1,2]
C0600091
Case ID
Description

Case ID

Data type

integer

Alias
UMLS CUI [1,1]
C1698493
UMLS CUI [1,2]
C0600091
Anamnese Kardio
Description

Anamnese Kardio

Alias
UMLS CUI-1
C0007189
UMLS CUI-2
C0262926
Anamnese Kardio durchgeführt?
Description

Falls ja, bitte folgende Fragen ausfüllen.

Data type

boolean

Alias
UMLS CUI [1,1]
C0007189
UMLS CUI [1,2]
C0262926
KHK
Description

Coronary heart disease

Data type

integer

Alias
UMLS CUI [1]
C0010068
Falls ja, KHK Therapie mit:
Description

Coronary heart disease treatment

Data type

text

Alias
UMLS CUI [1,1]
C0010068
UMLS CUI [1,2]
C0087111
Hypertonie
Description

Hypertension

Data type

integer

Alias
UMLS CUI [1]
C0020538
Hypertonie Therapie mit:
Description

Hypertension treatment

Data type

text

Alias
UMLS CUI [1]
C0578998
Hypercholesterinämie
Description

Hypercholesterolemia

Data type

integer

Alias
UMLS CUI [1]
C0020443
Hypercholesterinämie Therapie mit:
Description

Hypercholesterolemia treatment

Data type

text

Alias
UMLS CUI [1,1]
C0020443
UMLS CUI [1,2]
C0087111
Diabetes mellitus Typ I
Description

Diabetes mellitus insulin dependent

Data type

integer

Alias
UMLS CUI [1]
C0011854
Diabetes mellitus Typ I Therapie mit:
Description

Diabetes mellitus insulin dependent treatment

Data type

text

Alias
UMLS CUI [1,1]
C0011854
UMLS CUI [1,2]
C0087111
Diabetes mellitus Typ II
Description

Diabetes mellitus type 2

Data type

integer

Alias
UMLS CUI [1]
C0011860
Diabetes mellitus Typ II Therapie mit:
Description

Diabetes mellitus type 2 treatment

Data type

text

Alias
UMLS CUI [1,1]
C0011860
UMLS CUI [1,2]
C0087111
Familäre KHK Belastung
Description

Family history of coronary heart disease

Data type

boolean

Alias
UMLS CUI [1]
C0455404
Myokardinfarkt
Description

Myocardial Infarction

Data type

boolean

Alias
UMLS CUI [1]
C0027051
Rauchen
Description

Smoking

Data type

boolean

Alias
UMLS CUI [1]
C0453996
Rauchen: pack years
Description

Smoking pack years

Data type

integer

Alias
UMLS CUI [1,1]
C0453996
UMLS CUI [1,2]
C1277691
Thromboseneigung
Description

Thrombosis susceptibility

Data type

boolean

Alias
UMLS CUI [1]
C4016042
Bewegung
Description

Physical activity

Data type

integer

Alias
UMLS CUI [1]
C0026606
Untersuchungen Kardio
Description

Untersuchungen Kardio

Alias
UMLS CUI-1
C0562319
Untersuchungen Kardio durchgeführt?
Description

Cardiological Examination

Data type

boolean

Alias
UMLS CUI [1]
C0562319
Echokardiographie
Description

Echocardiography

Data type

boolean

Alias
UMLS CUI [1]
C0013516
LVEF
Description

LVEF

Data type

integer

Measurement units
  • %
Alias
UMLS CUI [1]
C0428772
%
E/A
Description

E/A

Data type

integer

Alias
UMLS CUI [1]
C2059591
DT
Description

Deceleration Time

Data type

integer

Measurement units
  • ms
Alias
UMLS CUI [1]
C0882996
ms
Tei Index
Description

Tei Index

Data type

float

Alias
UMLS CUI [1]
C2923433
Perikarderguss
Description

Pericardial effusion

Data type

boolean

Alias
UMLS CUI [1]
C0031039
Perikarderguss
Description

Pericardial effusion

Data type

integer

Measurement units
  • cm
Alias
UMLS CUI [1]
C0031039
cm
Klappenfunktionsstörungen
Description

Heart valve dysfunction

Data type

boolean

Alias
UMLS CUI [1,1]
C0018826
UMLS CUI [1,2]
C0277785
Klappenfunktionsstörungen:ja folgende
Description

Heart valve dysfunction

Data type

text

Alias
UMLS CUI [1,1]
C0018826
UMLS CUI [1,2]
C2983555
Regionale Wandbewegungsstörungen
Description

Regional cardiac wall motion dysfunction

Data type

boolean

Alias
UMLS CUI [1]
C2024775
Regionale Wandbewegungsstörungen:ja folgende
Description

Regional cardiac wall motion dysfunction type

Data type

text

Alias
UMLS CUI [1]
C2024775
EKG
Description

ECG

Data type

boolean

Alias
UMLS CUI [1]
C1623258
Herzfrequenz
Description

Heart rate

Data type

integer

Measurement units
  • bpm
Alias
UMLS CUI [1]
C0018810
bpm
Pathologischer Befund
Description

ECG findings

Data type

boolean

Alias
UMLS CUI [1]
C0438154
Pathologischer Befund: ja folgender
Description

ECG findings

Data type

text

Alias
UMLS CUI [1]
C0438154
RR systolisch
Description

Blood pressure systolic

Data type

integer

Measurement units
  • mmHg
Alias
UMLS CUI [1]
C0871470
mmHg
RR diastolisch
Description

Blood pressure diastolic

Data type

integer

Measurement units
  • mmHg
Alias
UMLS CUI [1]
C0428883
mmHg
Serologie
Description

Serology

Data type

boolean

Alias
UMLS CUI [1]
C0036743
Kreatinin
Description

Creatinine

Data type

float

Alias
UMLS CUI [1]
C0201976
Einheit
Description

Creatinine Unit

Data type

text

Alias
UMLS CUI [1,1]
C1519795
UMLS CUI [1,2]
C0201976
10 ml Serum für NTproBNP und Troponin T verschickt
Description

Serum Troponin T test and NTproBNP

Data type

boolean

Alias
UMLS CUI [1,1]
C0585642
UMLS CUI [1,2]
C0370003
UMLS CUI [1,3]
C1515023
UMLS CUI [2,1]
C1963813
UMLS CUI [2,2]
C0370003
UMLS CUI [2,3]
C1515023
Anamnese Fertilität
Description

Anamnese Fertilität

Alias
UMLS CUI-1
C0262926
UMLS CUI-2
C0015895
Anamnese Fertilität
Description

Medical history fertility

Data type

boolean

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0015895
Zyklusanamnese/Spermiogramm
Description

Menstrual cycle and spermiogram

Data type

integer

Alias
UMLS CUI [1]
C0025329
UMLS CUI [2]
C0202533
Zyklusanamnese/Spermiogramm: pathologischer Befund
Description

Menstrual cycle and spermiogram

Data type

text

Alias
UMLS CUI [1]
C0025329
UMLS CUI [2]
C0202533
Kontrazeption
Description

nur bei weiblichen Patienten ausfüllen

Data type

text

Alias
UMLS CUI [1]
C0700589
Hormonelle Verhütung vor Therapie
Description

Hormonal contraception prior to treatment

Data type

boolean

Alias
UMLS CUI [1,1]
C2985296
UMLS CUI [1,2]
C0332152
UMLS CUI [1,3]
C0087111
Hormonelle Verhütung vor Therapie ja mit:
Description

Hormonal contraception method prior to treatment

Data type

text

Alias
UMLS CUI [1,1]
C2985296
UMLS CUI [1,2]
C0332152
UMLS CUI [1,3]
C0087111
Letzte Einnahme
Description

Date last medication intake

Data type

date

Alias
UMLS CUI [1,1]
C2985296
UMLS CUI [1,2]
C4029433
Serologie
Description

Serology

Data type

boolean

Alias
UMLS CUI [1]
C0036743
FSH
Description

FSH

Data type

integer

Alias
UMLS CUI [1]
C0202022
Einheit
Description

FSH Unit

Data type

text

Alias
UMLS CUI [1,1]
C0202022
UMLS CUI [1,2]
C1519795
LH
Description

LH

Data type

integer

Alias
UMLS CUI [1]
C0202123
Einheit
Description

LH Unit

Data type

text

Alias
UMLS CUI [1,1]
C0202123
UMLS CUI [1,2]
C1519795
ß-Östradiol
Description

Beta estradiol

Data type

integer

Alias
UMLS CUI [1]
C0014912
Einheit
Description

Estradiol Unit

Data type

text

Alias
UMLS CUI [1,1]
C0014912
UMLS CUI [1,2]
C1519795
Testosteron
Description

Testosterone

Data type

float

Alias
UMLS CUI [1]
C0523912
Einheit
Description

Testosterone Unit

Data type

text

Alias
UMLS CUI [1,1]
C0523912
UMLS CUI [1,2]
C1519795
AMH
Description

AMH

Data type

float

Alias
UMLS CUI [1]
C0066928
Einheit
Description

AMH Unit

Data type

text

Alias
UMLS CUI [1,1]
C0066928
UMLS CUI [1,2]
C1519795
Inhibin B
Description

Inhibin B

Data type

integer

Alias
UMLS CUI [1]
C3272959
Einheit
Description

Inhibin B Unit

Data type

text

Alias
UMLS CUI [1,1]
C3272959
UMLS CUI [1,2]
C1519795
Wurde eine Kryokonservierung vorgenommen?
Description

Cryopreservation done

Data type

integer

Alias
UMLS CUI [1]
C0010405
Ovargewebe
Description

Ovarian tissue cryopreservation

Data type

boolean

Alias
UMLS CUI [1]
C1314154
Spermien
Description

Sperm cryopreservation

Data type

boolean

Alias
UMLS CUI [1]
C0519952
Eizellen befruchtet
Description

Cryopreservation of fertilized ovum

Data type

boolean

Alias
UMLS CUI [1,1]
C0010405
UMLS CUI [1,2]
C0043544
Eizellen unbefruchtet
Description

Cryopreservation of oocyte

Data type

boolean

Alias
UMLS CUI [1]
C1314155
Anamnese Lunge
Description

Anamnese Lunge

Alias
UMLS CUI-1
C0024109
UMLS CUI-2
C0262926
Anamnese Lunge
Description

Medical history lung

Data type

integer

Alias
UMLS CUI [1,1]
C0024109
UMLS CUI [1,2]
C0262926
Bekannte pulmonale Erkrankung
Description

History of respiratory disease

Data type

boolean

Alias
UMLS CUI [1]
C0455540
Bekannte pulmonale Erkrankung
Description

History of respiratory disease

Data type

text

Alias
UMLS CUI [1]
C0455540
Bekannte pulmonale Erkrankung
Description

History of respiratory disease

Data type

integer

Alias
UMLS CUI [1]
C0455540
Bekannte pulmonale Erkrankung Therapie mit:
Description

History of respiratory disease treatment

Data type

text

Alias
UMLS CUI [1,1]
C0455540
UMLS CUI [1,2]
C0087111
Untersuchungen Lunge
Description

Untersuchungen Lunge

Alias
UMLS CUI-1
C2228454
Lungenfunktion
Description

Pulmonary function tests

Data type

integer

Alias
UMLS CUI [1]
C0024119
Vitalkapazität
Description

Vital capacity

Data type

float

Measurement units
  • %
Alias
UMLS CUI [1]
C0042834
%
DLCO
Description

DLCO

Data type

float

Measurement units
  • %
Alias
UMLS CUI [1]
C1516251
%
pO2
Description

pO2

Data type

integer

Measurement units
  • mmHg
Alias
UMLS CUI [1]
C2317096
mmHg
pCO2
Description

pCO2

Data type

integer

Measurement units
  • mmHg
Alias
UMLS CUI [1]
C0201931
mmHg
Thorax: Röntgen
Description

Chest X-ray

Data type

integer

Alias
UMLS CUI [1]
C0039985
Röntgen Thorax: Befund
Description

Chest x-ray finding

Data type

text

Alias
UMLS CUI [1,1]
C0039985
UMLS CUI [1,2]
C1514241
Bemerkungen
Description

Bemerkungen

Bemerkungen
Description

Comments

Data type

text

Alias
UMLS CUI [1]
C0947611
Datum
Description

Date of completion

Data type

date

Alias
UMLS CUI [1]
C0011008
Unterschrift des Arztes
Description

Physician signature

Data type

text

Alias
UMLS CUI [1]
C1519316
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Similar models

Deutsche Hodgkin Studiengruppe: G6LT Basisbogen Langzeittoxizität

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Formularkopf
C0600661 (UMLS CUI-1)
Stamp of participating institution
Item
Stempel des einsendenden Instituts
text
C2347449 (UMLS CUI [1])
Phone number of participating institution
Item
Telefonnummer des einsendenden Instituts (bitte mit Durchwahl)
integer
C2347449 (UMLS CUI [1,1])
C1515258 (UMLS CUI [1,2])
Address of responsible study center
Item
Adresse der verantwortlichen Studienzentrale
text
C2825181 (UMLS CUI [1,1])
C1442065 (UMLS CUI [1,2])
Patient Name
Item
Patientenname
text
C1299487 (UMLS CUI [1])
Patient birth name
Item
Geburtsname
text
C1549652 (UMLS CUI [1])
Birth Date
Item
Geburtsdatum
date
C0421451 (UMLS CUI [1])
Patient address
Item
Adresse des Patienten
text
C0421449 (UMLS CUI [1])
Physical Examination date
Item
Datum der Untersuchung
date
C2826643 (UMLS CUI [1])
Item
Studien ID
integer
C2826693 (UMLS CUI [1])
Study ID
Code List
Studien ID
CL Item
HD16 (1)
CL Item
HD17 (2)
CL Item
HD18 (3)
CRF Indentificator
Item
Bogen ID
integer
C1516308 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
Case ID
Item
Case ID
integer
C1698493 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
Item Group
Anamnese Kardio
C0007189 (UMLS CUI-1)
C0262926 (UMLS CUI-2)
Cardiological Medical History
Item
Anamnese Kardio durchgeführt?
boolean
C0007189 (UMLS CUI [1,1])
C0262926 (UMLS CUI [1,2])
Item
KHK
integer
C0010068 (UMLS CUI [1])
Coronary heart disease
Code List
KHK
CL Item
Nein (1)
C1298908 (UMLS CUI-1)
CL Item
Ja,keine Therapie (2)
C0746919 (UMLS CUI-1)
CL Item
Ja, Therapie (3)
C0087111 (UMLS CUI-1)
Coronary heart disease treatment
Item
Falls ja, KHK Therapie mit:
text
C0010068 (UMLS CUI [1,1])
C0087111 (UMLS CUI [1,2])
Item
Hypertonie
integer
C0020538 (UMLS CUI [1])
Coronary heart disease
Code List
Hypertonie
CL Item
Nein (1)
C1298908 (UMLS CUI-1)
CL Item
Ja,keine Therapie (2)
C0746919 (UMLS CUI-1)
CL Item
Ja, Therapie (3)
C0087111 (UMLS CUI-1)
Hypertension treatment
Item
Hypertonie Therapie mit:
text
C0578998 (UMLS CUI [1])
Item
Hypercholesterinämie
integer
C0020443 (UMLS CUI [1])
Coronary heart disease
Code List
Hypercholesterinämie
CL Item
Nein (1)
C1298908 (UMLS CUI-1)
CL Item
Ja,keine Therapie (2)
C0746919 (UMLS CUI-1)
CL Item
Ja, Therapie (3)
C0087111 (UMLS CUI-1)
Hypercholesterolemia treatment
Item
Hypercholesterinämie Therapie mit:
text
C0020443 (UMLS CUI [1,1])
C0087111 (UMLS CUI [1,2])
Item
Diabetes mellitus Typ I
integer
C0011854 (UMLS CUI [1])
Coronary heart disease
Code List
Diabetes mellitus Typ I
CL Item
Nein (1)
C1298908 (UMLS CUI-1)
CL Item
Ja,keine Therapie (2)
C0746919 (UMLS CUI-1)
CL Item
Ja, Therapie (3)
C0087111 (UMLS CUI-1)
Diabetes mellitus insulin dependent treatment
Item
Diabetes mellitus Typ I Therapie mit:
text
C0011854 (UMLS CUI [1,1])
C0087111 (UMLS CUI [1,2])
Item
Diabetes mellitus Typ II
integer
C0011860 (UMLS CUI [1])
Coronary heart disease
Code List
Diabetes mellitus Typ II
CL Item
Nein (1)
C1298908 (UMLS CUI-1)
CL Item
Ja,keine Therapie (2)
C0746919 (UMLS CUI-1)
CL Item
Ja, Therapie (3)
C0087111 (UMLS CUI-1)
Item
Diabetes mellitus Typ II Therapie mit:
text
C0011860 (UMLS CUI [1,1])
C0087111 (UMLS CUI [1,2])
Coronary heart disease
Code List
Diabetes mellitus Typ II Therapie mit:
Family history of coronary heart disease
Item
Familäre KHK Belastung
boolean
C0455404 (UMLS CUI [1])
Myocardial Infarction
Item
Myokardinfarkt
boolean
C0027051 (UMLS CUI [1])
Smoking
Item
Rauchen
boolean
C0453996 (UMLS CUI [1])
Smoking pack years
Item
Rauchen: pack years
integer
C0453996 (UMLS CUI [1,1])
C1277691 (UMLS CUI [1,2])
Thrombosis susceptibility
Item
Thromboseneigung
boolean
C4016042 (UMLS CUI [1])
Item
Bewegung
integer
C0026606 (UMLS CUI [1])
Physical activity
Code List
Bewegung
CL Item
Nein (1)
C1298908 (UMLS CUI-1)
CL Item
Ja,Minimum tägl. 30 min (2)
C1705108 (UMLS CUI-1)
C0565665 (UMLS CUI-2)
CL Item
Ja,Sport (3)
C1705108 (UMLS CUI-1)
C0038039 (UMLS CUI-2)
Item Group
Untersuchungen Kardio
C0562319 (UMLS CUI-1)
Cardiological Examination
Item
Untersuchungen Kardio durchgeführt?
boolean
C0562319 (UMLS CUI [1])
Echocardiography
Item
Echokardiographie
boolean
C0013516 (UMLS CUI [1])
LVEF
Item
LVEF
integer
C0428772 (UMLS CUI [1])
E/A
Item
E/A
integer
C2059591 (UMLS CUI [1])
Deceleration Time
Item
DT
integer
C0882996 (UMLS CUI [1])
Tei Index
Item
Tei Index
float
C2923433 (UMLS CUI [1])
Pericardial effusion
Item
Perikarderguss
boolean
C0031039 (UMLS CUI [1])
Pericardial effusion
Item
Perikarderguss
integer
C0031039 (UMLS CUI [1])
Heart valve dysfunction
Item
Klappenfunktionsstörungen
boolean
C0018826 (UMLS CUI [1,1])
C0277785 (UMLS CUI [1,2])
Heart valve dysfunction
Item
Klappenfunktionsstörungen:ja folgende
text
C0018826 (UMLS CUI [1,1])
C2983555 (UMLS CUI [1,2])
Regional cardiac wall motion dysfunction
Item
Regionale Wandbewegungsstörungen
boolean
C2024775 (UMLS CUI [1])
Regional cardiac wall motion dysfunction type
Item
Regionale Wandbewegungsstörungen:ja folgende
text
C2024775 (UMLS CUI [1])
ECG
Item
EKG
boolean
C1623258 (UMLS CUI [1])
Heart rate
Item
Herzfrequenz
integer
C0018810 (UMLS CUI [1])
ECG findings
Item
Pathologischer Befund
boolean
C0438154 (UMLS CUI [1])
ECG findings
Item
Pathologischer Befund: ja folgender
text
C0438154 (UMLS CUI [1])
Blood pressure systolic
Item
RR systolisch
integer
C0871470 (UMLS CUI [1])
Blood pressure diastolic
Item
RR diastolisch
integer
C0428883 (UMLS CUI [1])
Serology
Item
Serologie
boolean
C0036743 (UMLS CUI [1])
Creatinine
Item
Kreatinin
float
C0201976 (UMLS CUI [1])
Creatinine Unit
Item
Einheit
text
C1519795 (UMLS CUI [1,1])
C0201976 (UMLS CUI [1,2])
Serum Troponin T test and NTproBNP
Item
10 ml Serum für NTproBNP und Troponin T verschickt
boolean
C0585642 (UMLS CUI [1,1])
C0370003 (UMLS CUI [1,2])
C1515023 (UMLS CUI [1,3])
C1963813 (UMLS CUI [2,1])
C0370003 (UMLS CUI [2,2])
C1515023 (UMLS CUI [2,3])
Item Group
Anamnese Fertilität
C0262926 (UMLS CUI-1)
C0015895 (UMLS CUI-2)
Medical history fertility
Item
Anamnese Fertilität
boolean
C0262926 (UMLS CUI [1,1])
C0015895 (UMLS CUI [1,2])
Item
Zyklusanamnese/Spermiogramm
integer
C0025329 (UMLS CUI [1])
C0202533 (UMLS CUI [2])
Menstrual cycle and spermiogram
Code List
Zyklusanamnese/Spermiogramm
CL Item
Nein,nicht erfolgt (1)
C1272696 (UMLS CUI-1)
CL Item
Ja,ohne pathologischen Befund (2)
C1513916 (UMLS CUI-1)
CL Item
Ja, pathologischer Befund (3)
C1514241 (UMLS CUI-1)
Item
Zyklusanamnese/Spermiogramm: pathologischer Befund
text
C0025329 (UMLS CUI [1])
C0202533 (UMLS CUI [2])
Menstrual cycle and spermiogram
Code List
Zyklusanamnese/Spermiogramm: pathologischer Befund
Contraception
Item
Kontrazeption
text
C0700589 (UMLS CUI [1])
Hormonal contraception prior to treatment
Item
Hormonelle Verhütung vor Therapie
boolean
C2985296 (UMLS CUI [1,1])
C0332152 (UMLS CUI [1,2])
C0087111 (UMLS CUI [1,3])
Hormonal contraception method prior to treatment
Item
Hormonelle Verhütung vor Therapie ja mit:
text
C2985296 (UMLS CUI [1,1])
C0332152 (UMLS CUI [1,2])
C0087111 (UMLS CUI [1,3])
Date last medication intake
Item
Letzte Einnahme
date
C2985296 (UMLS CUI [1,1])
C4029433 (UMLS CUI [1,2])
Serology
Item
Serologie
boolean
C0036743 (UMLS CUI [1])
FSH
Item
FSH
integer
C0202022 (UMLS CUI [1])
FSH Unit
Item
Einheit
text
C0202022 (UMLS CUI [1,1])
C1519795 (UMLS CUI [1,2])
LH
Item
LH
integer
C0202123 (UMLS CUI [1])
LH Unit
Item
Einheit
text
C0202123 (UMLS CUI [1,1])
C1519795 (UMLS CUI [1,2])
Beta estradiol
Item
ß-Östradiol
integer
C0014912 (UMLS CUI [1])
Estradiol Unit
Item
Einheit
text
C0014912 (UMLS CUI [1,1])
C1519795 (UMLS CUI [1,2])
Testosterone
Item
Testosteron
float
C0523912 (UMLS CUI [1])
Testosterone Unit
Item
Einheit
text
C0523912 (UMLS CUI [1,1])
C1519795 (UMLS CUI [1,2])
AMH
Item
AMH
float
C0066928 (UMLS CUI [1])
AMH Unit
Item
Einheit
text
C0066928 (UMLS CUI [1,1])
C1519795 (UMLS CUI [1,2])
Inhibin B
Item
Inhibin B
integer
C3272959 (UMLS CUI [1])
Inhibin B Unit
Item
Einheit
text
C3272959 (UMLS CUI [1,1])
C1519795 (UMLS CUI [1,2])
Item
Wurde eine Kryokonservierung vorgenommen?
integer
C0010405 (UMLS CUI [1])
Pregnancies post treatment
Code List
Wurde eine Kryokonservierung vorgenommen?
CL Item
Nein (1)
C1513916 (UMLS CUI-1)
CL Item
Ja (bitte folgendes ausfüllen) (2)
C1514241 (UMLS CUI-1)
Ovarian tissue cryopreservation
Item
Ovargewebe
boolean
C1314154 (UMLS CUI [1])
Sperm cryopreservation
Item
Spermien
boolean
C0519952 (UMLS CUI [1])
Cryopreservation of fertilized ovum
Item
Eizellen befruchtet
boolean
C0010405 (UMLS CUI [1,1])
C0043544 (UMLS CUI [1,2])
Cryopreservation of oocyte
Item
Eizellen unbefruchtet
boolean
C1314155 (UMLS CUI [1])
Item Group
Anamnese Lunge
C0024109 (UMLS CUI-1)
C0262926 (UMLS CUI-2)
Item
Anamnese Lunge
integer
C0024109 (UMLS CUI [1,1])
C0262926 (UMLS CUI [1,2])
Pulmonary function tests
Code List
Anamnese Lunge
CL Item
Not done (falls nicht erfolgt) (1)
C1272696 (UMLS CUI-1)
CL Item
Ja (bitte ausfüllen) (2)
C1272695 (UMLS CUI-1)
History of respiratory disease
Item
Bekannte pulmonale Erkrankung
boolean
C0455540 (UMLS CUI [1])
History of respiratory disease
Item
Bekannte pulmonale Erkrankung
text
C0455540 (UMLS CUI [1])
Item
Bekannte pulmonale Erkrankung
integer
C0455540 (UMLS CUI [1])
History of respiratory disease
Code List
Bekannte pulmonale Erkrankung
CL Item
Therapie erforderlich (1)
C0815189 (UMLS CUI-1)
CL Item
Keine Therapie erforderlich (2)
C0087111 (UMLS CUI-1)
C0549184 (UMLS CUI-2)
History of respiratory disease treatment
Item
Bekannte pulmonale Erkrankung Therapie mit:
text
C0455540 (UMLS CUI [1,1])
C0087111 (UMLS CUI [1,2])
Item Group
Untersuchungen Lunge
C2228454 (UMLS CUI-1)
Item
Lungenfunktion
integer
C0024119 (UMLS CUI [1])
Pulmonary function tests
Code List
Lungenfunktion
CL Item
Not done (falls nicht erfolgt) (1)
C1272696 (UMLS CUI-1)
CL Item
Ja (bitte ausfüllen) (2)
C1272695 (UMLS CUI-1)
Vital capacity
Item
Vitalkapazität
float
C0042834 (UMLS CUI [1])
DLCO
Item
DLCO
float
C1516251 (UMLS CUI [1])
pO2
Item
pO2
integer
C2317096 (UMLS CUI [1])
pCO2
Item
pCO2
integer
C0201931 (UMLS CUI [1])
Item
Thorax: Röntgen
integer
C0039985 (UMLS CUI [1])
Menstrual cycle and spermiogram
Code List
Thorax: Röntgen
CL Item
Nein,nicht erfolgt (1)
C1272696 (UMLS CUI-1)
CL Item
Ja,ohne pathologischen Befund (2)
C1513916 (UMLS CUI-1)
CL Item
Ja, pathologischer Befund (3)
C1514241 (UMLS CUI-1)
Chest x-ray finding
Item
Röntgen Thorax: Befund
text
C0039985 (UMLS CUI [1,1])
C1514241 (UMLS CUI [1,2])
Item Group
Bemerkungen
Comments
Item
Bemerkungen
text
C0947611 (UMLS CUI [1])
Date of completion
Item
Datum
date
C0011008 (UMLS CUI [1])
Physician signature
Item
Unterschrift des Arztes
text
C1519316 (UMLS CUI [1])
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