ID

34799

Descripción

Discharge Letter Items for semantic analysis in discharge letters of patients diagnosed with Multiple Sclerosis, Neuromyelitis optica spectrum disease or Acute Disseminated Encephalomyelitis from Neurology Department of University Hospital Muenster provided by Prof. Dr. Luisa Klotz.

Palabras clave

27/2/18 27/2/18 -
29/1/19 29/1/19 - Sarah Riepenhausen
27/9/21 27/9/21 -

Titular de derechos de autor

Prof. Dr. Luisa Klotz

Subido en

29 de enero de 2019

DOI

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Licencia

Creative Commons BY-NC 3.0

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Discharge Letter Items Neuroinflammatory Demyelinating Diseases

model
Detalles

Discharge Letter Items 1229450930 Multiple Sclerosis

12 formularios

StudyEvent: DCMSNMOADEM

Name

Tipo

Description | Question | Decode (Coded Value)

Tipo de datos

Alias

Administrative Data

Item Group

C1320722 (UMLS CUI-1)

Document ID

Item

integer

C1300638 (UMLS CUI [1])

Name

Item

text

C0421448 (UMLS CUI [1])

Date of birth

Item

date

C0421451 (UMLS CUI [1])

Care

Item

text

C1550330 (UMLS CUI [1])

undefined item

Code List

Care

CL Item

(Inpatient)

C0021562 (UMLS CUI-1)

CL Item

(Outpatient)

C0029921 (UMLS CUI-1)

Date of Appointment

Item

date

C1320303 (UMLS CUI [1])

Principal Diagnosis

Item Group

Diagnosis and Clinical Course

Item

text

C0011900 (UMLS CUI [1])
C0449259 (UMLS CUI [2,1])
C0026769 (UMLS CUI [2,2])
C0205394 (UMLS CUI [3,1])
C0011302 (UMLS CUI [3,2])
C0205394 (UMLS CUI [4,1])
C0449259 (UMLS CUI [4,2])
C0026769 (UMLS CUI [4,3])

Date of Onset

Item

date

C0574845 (UMLS CUI [1])

Earliest date of diagnosis

Item

date

C2316983 (UMLS CUI [1])

EDSS

Item

integer

C3830336 (UMLS CUI [1])

Previous Therapy Copaxone

Item

boolean

C2114510 (UMLS CUI [1,1])
C0026769 (UMLS CUI [1,2])
C0289884 (UMLS CUI [2])

Previous Therapy Time Range Copaxone

Item

text

C2114510 (UMLS CUI [1,1])
C3173309 (UMLS CUI [1,2])
C2114510 (UMLS CUI [2,1])
C1531784 (UMLS CUI [2,2])

Previous Therapie Benefit Copaxone

Item

text

C0087113 (UMLS CUI [1,1])
C0289884 (UMLS CUI [1,2])
C2114510 (UMLS CUI [1,3])

Previous Therapy Tysabri

Item

boolean

C2114510 (UMLS CUI [1])
C1172734 (UMLS CUI [2])

Previous Therapy Time Range

Item

text

C2114510 (UMLS CUI [1,1])
C3173309 (UMLS CUI [1,2])
C2114510 (UMLS CUI [2,1])
C1531784 (UMLS CUI [2,2])

Previous Therapie Benefit Tysabri

Item

text

C0087113 (UMLS CUI [1,1])
C1172734 (UMLS CUI [1,2])
C2114510 (UMLS CUI [1,3])

Previous Therapy Alemtuzumab

Item

boolean

C2114510 (UMLS CUI [1])
C0383429 (UMLS CUI [2])

Previous Therapy Time Range Alemtuzumab

Item

text

C2114510 (UMLS CUI [1,1])
C3173309 (UMLS CUI [1,2])
C2114510 (UMLS CUI [2,1])
C1531784 (UMLS CUI [2,2])

Risk Stratification of Therapy with Natalizumab

Item Group

C0150323 (UMLS CUI [2,1])
C1172734 (UMLS CUI [2,2])

Previous Immunosuppressive Therapy

Item

boolean

C2114510 (UMLS CUI [1,1])
C0021079 (UMLS CUI [1,2])

Use of Natalizumab

Item

text

C1172734 (UMLS CUI [1,1])
C0444917 (UMLS CUI [1,2])

JCV Antibodies

Item

text

C3511565 (UMLS CUI [1])

Date JCV-Antibody

Item

date

C3511565 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])

L-Selectin

Item

text

C0125090 (UMLS CUI [1])

Secondary Diagnosis

Item Group

C0332138 (UMLS CUI-1)

Arterial Hypertension

Item

boolean

C0020538 (UMLS CUI [1])

CVI

Item

boolean

C1306557 (UMLS CUI [1])

Recurrent Cystitis

Item

boolean

C0581366 (UMLS CUI [1])

Hints of a Collagen Disease

Item

boolean

C0009326 (UMLS CUI [1])

Collagen Disease: ANA

Item

text

C0587178 (UMLS CUI [1])

Collagen Disease: ANA

Code List

Collagen Disease: ANA

CL Item

(positive )

CL Item

(negative)

Collagen Disease: ENA

Item

boolean

C0003243 (UMLS CUI [1])

Collagen Disease: IFT

Item

text

C0282646 (UMLS CUI [1])

Collagen Disease: CTD-Screen

Item

text

C0026272 (UMLS CUI [1])

Collagen Disease: CTD-Screen

Code List

Collagen Disease: CTD-Screen

CL Item

(positive)

CL Item

(negative)

Collagen Disease: anti-ds-DNA

Item

text

C0236300 (UMLS CUI [1])

Collagen Disease: anti-ds-DNA

Code List

Collagen Disease: anti-ds-DNA

CL Item

(negative)

CL Item

(positive)

Collagen Disease: Beta-2-Glycoprotein IgG-Antibodies

Item

text

C2208744 (UMLS CUI [1])

Collagen Disease: Beta-2-Glycoprotein IgG-Antibodies

Code List

Collagen Disease: Beta-2-Glycoprotein IgG-Antibodies

CL Item

(negative)

CL Item

(positive)

Collagen Disease: Capillary Microscopy

Item

text

C0262428 (UMLS CUI [1])

Recurrent Depressive Episodes

Item

text

C0349217 (UMLS CUI [1])

Reason for Admission

Item Group

C0392360 (UMLS CUI-1)
C0809949 (UMLS CUI-2)

Reason for admission

Item

text

C0392360 (UMLS CUI [1,1])
C0809949 (UMLS CUI [1,2])

Summary and Assessment

Item Group

C0743221 (UMLS CUI-1)

Introduction: Reason for current Admission

Item

text

C0809949 (UMLS CUI [1,1])
C0392360 (UMLS CUI [1,2])

Introduction: Department

Item

text

C1704729 (UMLS CUI [1])

Medical history

Item

text

C0262926 (UMLS CUI [1])

Current Symptoms

Item

text

C1457887 (UMLS CUI [1])

Quality of life

Item

boolean

C1963786 (UMLS CUI [1])

Stress

Item

text

C0038435 (UMLS CUI [1])

Susceptibility to infections

Item

boolean

C0521978 (UMLS CUI [1])

Laboratory Results

Item

boolean

C0587081 (UMLS CUI [1])

Findings of neurological Examination

Item

text

C0437208 (UMLS CUI [1])

Walking Distance

Item

float

C0429886 (UMLS CUI [1])

Gait

Item

text

C0016928 (UMLS CUI [1])

Muscle strength Lower Extemity

Item

text

C0023216 (UMLS CUI [1,1])
C0451362 (UMLS CUI [1,2])

Muscle strength

Code List

Muscle strength Lower Extemity

CL Item

(worse than before)

CL Item

(same)

CL Item

(better than before)

EDSS

Item

integer

C3830336 (UMLS CUI [1])

Procedures

Item Group

C2700391 (UMLS CUI-1)

Current Immunosuppressive Therapy

Item

text

C2827774 (UMLS CUI [1])
C0205394 (UMLS CUI [2,1])
C2827774 (UMLS CUI [2,2])

Date Follow-Up Visit

Item

date

C3694716 (UMLS CUI [1])

Recommendation Blood count

Item

boolean

C0545131 (UMLS CUI [1])

Recommendation Physical Therapy

Item

boolean

C0949766 (UMLS CUI [1])

Recommendation MRI Comparison

Item

boolean

C0024485 (UMLS CUI [1])

Multiple sclerosis relapse Therapy Lemtrada

Item

text

C0035020 (UMLS CUI [1,1])
C2827774 (UMLS CUI [1,2])

Further diagnostic procedures

Item

text

C0430022 (UMLS CUI [1])

Other Therapy

Item

text

C0679868 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])

Neurological Examination: Cranial Nerves

Item Group

C0558819 (UMLS CUI-1)

Orientation

Item

text

C0029266 (UMLS CUI [1])

Meningism

Item

text

C0025287 (UMLS CUI [1])

Lhermittes sign

Item

text

C0576702 (UMLS CUI [1])

Lhermittes sign

Code List

Lhermittes sign

CL Item

(positive)

CL Item

(negative)

Percussion Pain Skull

Item

boolean

C0030987 (UMLS CUI [1,1])
C0030193 (UMLS CUI [1,2])
C0037303 (UMLS CUI [1,3])

Cranial Nerves: Visus

Item

integer

C0042812 (UMLS CUI [1])

Cranial Nerves: Pupils regularity

Item

text

C0437592 (UMLS CUI [1])

Cranial Nerves: Consensual pupil reaction to light

Item

text

C0700372 (UMLS CUI [1])

Cranial Nerves: Direct pupil reaction to light

Item

text

C0700372 (UMLS CUI [1,1])
C1947931 (UMLS CUI [1,2])

Cranial Nerves: Visual Field

Item

text

C0858409 (UMLS CUI [1])

Cranial Nerves: Eye Movement

Item

text

C0015413 (UMLS CUI [1])

Cranial Nerves: Saccades

Item

boolean

C0036019 (UMLS CUI [1])

Cranial Nerves: Gaze Palsy

Item

text

C1112261 (UMLS CUI [1])

Cranial Nerves: Diplopia

Item

text

C0012569 (UMLS CUI [1])

Cranial Nerves: Sensory Function

Item

text

C0234292 (UMLS CUI [1])

Cranial Nerves: M.temporalis

Item

text

C1275494 (UMLS CUI [1,1])
C0517349 (UMLS CUI [1,2])

Cranial Nerves: M. masseter

Item

text

C0024876 (UMLS CUI [1,1])
C0517349 (UMLS CUI [1,2])

Cranial Nerves: Facial Muscles

Item

text

C4073201 (UMLS CUI [1])

Cranial Nerves: Hearing Screen

Item

text

C0500425 (UMLS CUI [1])

Soft Palate Movement

Item

text

C2239128 (UMLS CUI [1])

Cranial Nerves: Deviation of uvula

Item

boolean

C0426994 (UMLS CUI [1,1])

Cranial Nerves: Tongue Deviation

Item

boolean

C1328516 (UMLS CUI [1])

Cranial Nerves: M. sternocleidomastoideus

Item

text

C0224153 (UMLS CUI [1,1])
C0517349 (UMLS CUI [1,2])

Cranial Nerves: M. trapezius

Item

text

C0224361 (UMLS CUI [1,1])
C0517349 (UMLS CUI [1,2])

Taste Perception

Item

boolean

C0039336 (UMLS CUI [1])

Smell Perception

Item

boolean

C0037361 (UMLS CUI [1])

Neurological Examination: Motor

Item Group

C2237216 (UMLS CUI-1)

Trophic of Muscles

Item

text

C0437261 (UMLS CUI [1,1])
C0026845 (UMLS CUI [1,2])

Motor tone

Item

text

C0026841 (UMLS CUI [1])

Muscle movement involuntary

Item

boolean

C0221722 (UMLS CUI [1])

Paresis Lower Exremity

Item

text

C0751410 (UMLS CUI [1])

Muscle strength Hip Flexion

Item

text

C2237371 (UMLS CUI [1,1])
C0451362 (UMLS CUI [1,2])

Muscle strength

Code List

Muscle strength Hip Flexion

CL Item

(worse than before)

CL Item

(same)

CL Item

(better than before)

Muscle strength Knee extension

Item

text

C2237139 (UMLS CUI [1,1])
C0451362 (UMLS CUI [1,2])

Muscle strength Knee flexion

Code List

Muscle strength Knee extension

CL Item

(0/5)

CL Item

(1/5)

CL Item

(2/5)

CL Item

(3/5)

CL Item

(4/5)

CL Item

(5/5)

Pronator Drift Test

Item

text

C1504476 (UMLS CUI [1])

Muscular Reflex

Item

text

C0034943 (UMLS CUI [1,1])
C1140618 (UMLS CUI [1,2])

Babinski Reflex

Item

text

C0034935 (UMLS CUI [1])

Neurological Examination: Coordination and Gait

Item Group

Gait

Item

text

C0016928 (UMLS CUI [1])

Heel to toe gait

Item

text

C0231779 (UMLS CUI [1])

Toe-walking gait

Item

text

C0427144 (UMLS CUI [1])

Heel Gait

Item

text

C2243016 (UMLS CUI [1])

Rhomberg Test

Item

text

C1656968 (UMLS CUI [1])

Diadochokinesis

Item

text

C0278157 (UMLS CUI [1])

Diadochokinesis

Code List

Diadochokinesis

CL Item

(Eudiadochokinesis)

CL Item

(Dysdiadochokinesis)

Finger-to-nose test

Item

text

C0278158 (UMLS CUI [1])

Heel-to-knee test

Item

text

C0278160 (UMLS CUI [1])

Neurological Examination: Sensibility

Item Group

C0439823 (UMLS CUI-1)

Hypesthesia Upper Extremity

Item

text

C1140618 (UMLS CUI [1,1])
C0020580 (UMLS CUI [1,2])

Hypesthesia Lower Extremity

Item

text

C0023216 (UMLS CUI [1,1])
C0020580 (UMLS CUI [1,2])

Pallesthesia of Ankle

Item

text

C0003086 (UMLS CUI [1,1])
C0234198 (UMLS CUI [1,2])

Pallesthesia of Ankle

Code List

Pallesthesia of Ankle

CL Item

(0/8)

CL Item

(1/8)

CL Item

(2/8)

CL Item

(3/8)

CL Item

(4/8)

CL Item

(5/8)

CL Item

(6/8)

CL Item

(7/8)

CL Item

(8/8)

Pallesthesia of Knee

Item

text

C0022742 (UMLS CUI [1,1])
C0234198 (UMLS CUI [1,2])

Pallesthesia of Ankle

Code List

Pallesthesia of Knee

CL Item

(0/8)

CL Item

(1/8)

CL Item

(2/8)

CL Item

(3/8)

CL Item

(4/8)

CL Item

(5/8)

CL Item

(6/8)

CL Item

(7/8)

CL Item

(8/8)

Psychological findings

Item Group

C0205486 (UMLS CUI-1)
C0243095 (UMLS CUI-2)

Depressive Mood

Item

boolean

C0852545 (UMLS CUI [1])

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ID

Descripción

Palabras clave

Versiones (3)

Titular de derechos de autor

Subido en

DOI

Licencia

Comentarios del modelo :

Comentarios de grupo de elementos para :

Comentarios del elemento para :

Discharge Letter Items Neuroinflammatory Demyelinating Diseases

Discharge Letter Items 1229450930 Multiple Sclerosis

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