ID

32443

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

To request one please log in.

License

Creative Commons BY-NC 3.0
Model comments :

You can comment on the data model here. Via the speech bubbles at the itemgroups and items you can add comments to those specificially.

Back to model comments
Itemgroup comments for :

Item comments for :

In order to download data models you must be logged in. Please log in or register for free.

German Hodgkin Study Group Study HD16/HD17/HD18 Long term toxicity G6LT DRKS00003455 DRKS00003457

German

Deutsche Hodgkin Studiengruppe: G6LT Nachsorgebogen 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
Symptome seit Therapieende
Description

Symptome seit Therapieende

Alias
UMLS CUI-1
C0683368
UMLS CUI-2
C0087111
UMLS CUI-3
C1444662
Symptome seit Therapieende
Description

Symptoms since treatment end

Data type

integer

Alias
UMLS CUI [1,1]
C0683368
UMLS CUI [1,2]
C0087111
UMLS CUI [1,3]
C1444662
Belastungsdyspnoe
Description

Dyspnea on exertion

Data type

boolean

Alias
UMLS CUI [1]
C0231807
Ruhedyspnoe
Description

Dyspnea at rest

Data type

boolean

Alias
UMLS CUI [1]
C0743330
Orthopnoe
Description

Orthopnea

Data type

boolean

Alias
UMLS CUI [1]
C0085619
Nykturie
Description

Nocturia

Data type

boolean

Alias
UMLS CUI [1]
C0028734
Leistungsminderung
Description

Decrease in endurance

Data type

boolean

Alias
UMLS CUI [1]
C4062567
Angina pectoris
Description

Angina pectoris

Data type

boolean

Alias
UMLS CUI [1]
C0002962
Myokardinfarkt
Description

Myocardial Infarction

Data type

boolean

Alias
UMLS CUI [1]
C0027051
Palpitationen
Description

Palpitations

Data type

boolean

Alias
UMLS CUI [1]
C0030252
Hypotonie
Description

Hypotension

Data type

boolean

Alias
UMLS CUI [1]
C0020649
Hypertonie
Description

Hypertension

Data type

boolean

Alias
UMLS CUI [1]
C0020538
KHK
Description

Coronary heart disease

Data type

boolean

Alias
UMLS CUI [1]
C0010068
KHK- Lokalisation
Description

Coronary heart disease localization

Data type

text

Alias
UMLS CUI [1,1]
C0010068
UMLS CUI [1,2]
C0475264
Ödeme
Description

Edema

Data type

boolean

Alias
UMLS CUI [1]
C0013604
Ödeme-Lokalisation
Description

Edema localization

Data type

text

Alias
UMLS CUI [1,1]
C0013604
UMLS CUI [1,2]
C0475264
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

text

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
Hormonelle Verhütung während Therapie
Description

nur bei weiblichen Patienten ausfüllen

Data type

boolean

Alias
UMLS CUI [1,1]
C2985296
UMLS CUI [1,2]
C2709058
Hormonelle Verhütung während Therapie ja mit:
Description

nur bei weiblichen Patienten ausfüllen

Data type

text

Alias
UMLS CUI [1,1]
C2985296
UMLS CUI [1,2]
C0700589
UMLS CUI [1,3]
C2709058
Aktuelle hormonelle Verhütung
Description

nur bei weiblichen Patienten ausfüllen

Data type

boolean

Alias
UMLS CUI [1,1]
C2985296
UMLS CUI [1,2]
C0521116
Aktuelle hormonelle Verhütung ja mit:
Description

nur bei weiblichen Patienten ausfüllen

Data type

text

Alias
UMLS CUI [1,1]
C2985296
UMLS CUI [1,2]
C0700589
UMLS CUI [1,3]
C0521116
Letzte Einnahme
Description

nur bei weiblichen Patienten ausfüllen

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
Schwangerschaften/Kinder nach Therapie
Description

Pregnancies post treatment

Data type

integer

Alias
UMLS CUI [1,1]
C0032961
UMLS CUI [1,2]
C2062974
Anzahl der Schwangerschaften
Description

Number of pregnancies

Data type

integer

Alias
UMLS CUI [1]
C3812254
Abort
Description

Miscarriage

Data type

boolean

Alias
UMLS CUI [1]
C0156543
Anzahl Aborte
Description

Number of miscarriages

Data type

integer

Alias
UMLS CUI [1]
C0429916
Anzahl der Kinder
Description

Number of children

Data type

integer

Alias
UMLS CUI [1]
C2229974
Geburtsdatum
Description

Birth Date

Data type

date

Alias
UMLS CUI [1]
C0421451
Verwendung von Kryokonservat
Description

Use of cryopreservation

Data type

integer

Alias
UMLS CUI [1,1]
C0010405
UMLS CUI [1,2]
C1524063
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
Eizelle befruchtet
Description

Cryopreservation of fertilized ovum

Data type

boolean

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

Cryopreservation of oocyte

Data type

boolean

Alias
UMLS CUI [1]
C1314155
Komplikationen
Description

Complications

Data type

integer

Alias
UMLS CUI [1]
C0009566
Komplikationen
Description

Complications

Data type

text

Alias
UMLS CUI [1]
C0009566
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
CT-Thorax
Description

Computed Tomography chest

Data type

integer

Alias
UMLS CUI [1,1]
C0040405
UMLS CUI [1,2]
C0817096
CT-Thorax: Befund
Description

Computed Tomography chest findings

Data type

text

Alias
UMLS CUI [1,1]
C0040405
UMLS CUI [1,2]
C0817096
UMLS CUI [1,3]
C1514241
Bleomycin induzierte Toxizität
Description

Bleomycin induced toxicity

Data type

boolean

Alias
UMLS CUI [1,1]
C0005740
UMLS CUI [1,2]
C1302255
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
Back to the top of the page

Similar models

Deutsche Hodgkin Studiengruppe: G6LT Nachsorgebogen 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
Symptome seit Therapieende
C0683368 (UMLS CUI-1)
C0087111 (UMLS CUI-2)
C1444662 (UMLS CUI-3)
Item
Symptome seit Therapieende
integer
C0683368 (UMLS CUI [1,1])
C0087111 (UMLS CUI [1,2])
C1444662 (UMLS CUI [1,3])
Symptoms since treatment end
Code List
Symptome seit Therapieende
CL Item
Not done (1)
C1272696 (UMLS CUI-1)
CL Item
Nein (bitte bei "Untersuchungen Kardio" weitermachen) (2)
C1513916 (UMLS CUI-1)
CL Item
Ja (bitte folgendes ausfüllen) (3)
C1514241 (UMLS CUI-1)
Dyspnea on exertion
Item
Belastungsdyspnoe
boolean
C0231807 (UMLS CUI [1])
Dyspnea at rest
Item
Ruhedyspnoe
boolean
C0743330 (UMLS CUI [1])
Orthopnea
Item
Orthopnoe
boolean
C0085619 (UMLS CUI [1])
Nocturia
Item
Nykturie
boolean
C0028734 (UMLS CUI [1])
Decrease in endurance
Item
Leistungsminderung
boolean
C4062567 (UMLS CUI [1])
Angina pectoris
Item
Angina pectoris
boolean
C0002962 (UMLS CUI [1])
Myocardial Infarction
Item
Myokardinfarkt
boolean
C0027051 (UMLS CUI [1])
Palpitations
Item
Palpitationen
boolean
C0030252 (UMLS CUI [1])
Hypotension
Item
Hypotonie
boolean
C0020649 (UMLS CUI [1])
Hypertension
Item
Hypertonie
boolean
C0020538 (UMLS CUI [1])
Coronary heart disease
Item
KHK
boolean
C0010068 (UMLS CUI [1])
Coronary heart disease localization
Item
KHK- Lokalisation
text
C0010068 (UMLS CUI [1,1])
C0475264 (UMLS CUI [1,2])
Edema
Item
Ödeme
boolean
C0013604 (UMLS CUI [1])
Edema localization
Item
Ödeme-Lokalisation
text
C0013604 (UMLS CUI [1,1])
C0475264 (UMLS CUI [1,2])
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
text
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
Hormonal contraception during treatment
Item
Hormonelle Verhütung während Therapie
boolean
C2985296 (UMLS CUI [1,1])
C2709058 (UMLS CUI [1,2])
Hormonal contraception method during treatment
Item
Hormonelle Verhütung während Therapie ja mit:
text
C2985296 (UMLS CUI [1,1])
C0700589 (UMLS CUI [1,2])
C2709058 (UMLS CUI [1,3])
Hormonal contraception current
Item
Aktuelle hormonelle Verhütung
boolean
C2985296 (UMLS CUI [1,1])
C0521116 (UMLS CUI [1,2])
Hormonal contraception current
Item
Aktuelle hormonelle Verhütung ja mit:
text
C2985296 (UMLS CUI [1,1])
C0700589 (UMLS CUI [1,2])
C0521116 (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
Schwangerschaften/Kinder nach Therapie
integer
C0032961 (UMLS CUI [1,1])
C2062974 (UMLS CUI [1,2])
Pregnancies post treatment
Code List
Schwangerschaften/Kinder nach Therapie
CL Item
Nein (1)
C1513916 (UMLS CUI-1)
CL Item
Ja (bitte folgendes ausfüllen) (2)
C1514241 (UMLS CUI-1)
Number of pregnancies
Item
Anzahl der Schwangerschaften
integer
C3812254 (UMLS CUI [1])
Miscarriage
Item
Abort
boolean
C0156543 (UMLS CUI [1])
Number of miscarriages
Item
Anzahl Aborte
integer
C0429916 (UMLS CUI [1])
Number of children
Item
Anzahl der Kinder
integer
C2229974 (UMLS CUI [1])
Birth Date
Item
Geburtsdatum
date
C0421451 (UMLS CUI [1])
Item
Verwendung von Kryokonservat
integer
C0010405 (UMLS CUI [1,1])
C1524063 (UMLS CUI [1,2])
Pregnancies post treatment
Code List
Verwendung von Kryokonservat
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
Eizelle befruchtet
boolean
C0010405 (UMLS CUI [1,1])
C0043544 (UMLS CUI [1,2])
Cryopreservation of oocyte
Item
Eizelle unbefruchtet
boolean
C1314155 (UMLS CUI [1])
Item
Komplikationen
integer
C0009566 (UMLS CUI [1])
Pregnancies post treatment
Code List
Komplikationen
CL Item
Nein (1)
C1513916 (UMLS CUI-1)
CL Item
Ja (bitte folgendes ausfüllen) (2)
C1514241 (UMLS CUI-1)
Item
Komplikationen
text
C0009566 (UMLS CUI [1])
Pregnancies post treatment
Code List
Komplikationen
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
CT-Thorax
integer
C0040405 (UMLS CUI [1,1])
C0817096 (UMLS CUI [1,2])
Menstrual cycle and spermiogram
Code List
CT-Thorax
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)
Computed Tomography chest findings
Item
CT-Thorax: Befund
text
C0040405 (UMLS CUI [1,1])
C0817096 (UMLS CUI [1,2])
C1514241 (UMLS CUI [1,3])
Bleomycin induced toxicity
Item
Bleomycin induzierte Toxizität
boolean
C0005740 (UMLS CUI [1,1])
C1302255 (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])
Back to the top of the page 

Contact

Please use this form for feedback, questions and suggestions for improvements.

Fields marked with * are required.

Help

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