ID

374

Description

Record the patient's Vital Signs while on study. Please note that if Vital Signs are taken as a part of protocol specific Physical Exam, record those Vital Signs on the Physical Exam eCRF. Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AD24E1F2-5206-264F-E040-BB89AD430ED7

Lien

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AD24E1F2-5206-264F-E040-BB89AD430ED7

Mots-clés

Versions (3)
  1. 25/05/2012 25/05/2012 -
  2. 08/08/2014 08/08/2014 - Martin Dugas
  3. 08/08/2014 08/08/2014 - Martin Dugas
Téléchargé le

25 mai 2012

DOI

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Licence

Creative Commons BY-NC 3.0 Legacy
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Vital Signs - 3281249v1.0

Anglais

No Instruction available.

1 Formulaires  
  1. StudyEvent: Vital Signs
    1. No Instruction available.
Vital Signs
Description

Vital Signs

Visit Date
Description

FormCompletionDate

Type de données

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C40988
UMLS 2011AA ObjectClass
C1516308
NCI Thesaurus Property
C25250
UMLS 2011AA Property
C0205197
Course #
Description

CourseNumber

Type de données

double

Alias
NCI Thesaurus Property
C25337
UMLS 2011AA Property
C0237753
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C25379
UMLS 2011AA ObjectClass
C0750729
Day in Course (Cycle)
Description

CourseDayNumber

Type de données

double

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus Property
C25301
UMLS 2011AA Property
C0439228
NCI Thesaurus ObjectClass
C25379
UMLS 2011AA ObjectClass
C0750729
Date (Enter the date the vital signs were taken.)
Description

EvaluationDate

Type de données

date

Alias
NCI Thesaurus Property
C25164
UMLS 2011AA Property
C0011008
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C25214
UMLS 2011AA ObjectClass
C0220825
Time (Enter the time the vital signs were taken.)
Description

ProcedureTime

Type de données

time

Alias
NCI Thesaurus ObjectClass
C25218
UMLS 2011AA ObjectClass
C1948041
NCI Thesaurus ValueDomain
C25207
UMLS 2011AA ValueDomain
C0040223
NCI Thesaurus ObjectClass
C71104
UMLS 2011AA ObjectClass
C0008976
NCI Thesaurus Property
C42614
UMLS 2011AA Property
C0027365
Notes (If necessary, enter some brief notes.)
Description

ResearchCommentsText

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
UMLS 2011AA Property
C0282411
Performance Status (Karnofsky) (Select a value from the Karnofsky performance status scale.)
Description

KarnofskyPerformanceStatusScore

Type de données

text

Alias
NCI Thesaurus Property
C25367
NCI Thesaurus ObjectClass
C20641
UMLS 2011AA ObjectClass
C1518965
NCI Thesaurus ValueDomain
C25338
UMLS 2011AA ValueDomain
C0449820
Performance Status (Zubrod) (Select a value from the Zubrod/ECOG performance status scale.)
Description

ZubrodPerformanceStatusScore

Type de données

text

Alias
NCI Thesaurus Property
C25367
NCI Thesaurus ObjectClass
C20641
UMLS 2011AA ObjectClass
C1518965
NCI Thesaurus ValueDomain
C25338
UMLS 2011AA ValueDomain
C0449820
Performance Status (Lansky) (Select a value from the Lansky performance status scale.)
Description

LanskyPerformanceStatusScore

Type de données

text

Alias
NCI Thesaurus Property
C25367
NCI Thesaurus ObjectClass
C20641
UMLS 2011AA ObjectClass
C1518965
NCI Thesaurus ValueDomain
C25338
UMLS 2011AA ValueDomain
C0449820
Body Weight (Enter the patient's weight only in kilograms. Use decimal places only for patients under 10kg.)
Description

BodyWeightinKilograms

Type de données

double

Unités de mesure
  • Kg
Alias
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
NCI Thesaurus ObjectClass
C13041
UMLS 2011AA ObjectClass
C1268086
NCI Thesaurus Property
C25208
UMLS 2011AA Property
C0043100
Kg
Height (Enter the patient's height only in centimeters, to one decimal place.)
Description

PersonHeightMeasurement

Type de données

double

Unités de mesure
  • cm
Alias
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C25347
UMLS 2011AA Property
C0489786
cm
BSA (Enter the patient's body surface area in m2 to two decimal places if needed for the calculation of study medication dose level.)
Description

PersonBodySurfaceAreaValue

Type de données

double

Unités de mesure
  • m2
Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
NCI Thesaurus Property
C25157
UMLS 2011AA Property
C0005902
m2
Temperature (Enter the patient's temperature only in Celsius, to one decimal place.)
Description

TemperatureCelsiusScaleValue

Type de données

double

Alias
NCI Thesaurus ObjectClass
C25206
UMLS 2011AA ObjectClass
C0039476
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
NCI Thesaurus Property
C41151
UMLS 2011AA Property
C1516378
NCI Thesaurus ValueDomain
C41151
UMLS 2011AA ValueDomain
C1516378
Pulse (Enter the patient's pulse rate.)
Description

PulseRateMeasurementValue

Type de données

double

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ObjectClass
C25749
UMLS 2011AA ObjectClass
C0391850
NCI Thesaurus Property
C25636
UMLS 2011AA Property
C1521828
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
NCI Thesaurus ValueDomain
C25749
UMLS 2011AA ValueDomain
C0391850
Respiration Rate (Enter the patient's respiration rate.)
Description

PersonVitalSignsRespiratoryRatePhysicalExaminationValue

Type de données

double

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property
C49672
UMLS 2011AA Property
C1704752
NCI Thesaurus Property
C49678
UMLS 2011AA Property
C0231832
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
Systolic BP (Enter the patient's systolic blood pressure.)
Description

SystolicBloodPressureValue

Type de données

double

Unités de mesure
  • mmHg
Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C25367
NCI Thesaurus ObjectClass
C54706
UMLS 2011AA ObjectClass
C0005823
mmHg
Diastolic BP (Enter the patient's diastolic blood pressure.)
Description

DiastolicBloodPressureValue

Type de données

double

Unités de mesure
  • mmHg
Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C25367
NCI Thesaurus ObjectClass
C54706
UMLS 2011AA ObjectClass
C0005823
mmHg
Pulse Ox (Enter the patient's pulse oximetry reading.)
Description

PulseOximetryValue

Type de données

double

Unités de mesure
  • %
Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C25749
UMLS 2011AA ObjectClass
C0391850
NCI Metathesaurus Property
C0040656
%
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Similar models

No Instruction available.

1 Formulaires
  1. StudyEvent: Vital Signs
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Type de données
Alias
Item Group
Vital Signs
FormCompletionDate
Item
Visit Date
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C40988 (NCI Thesaurus ObjectClass)
C1516308 (UMLS 2011AA ObjectClass)
C25250 (NCI Thesaurus Property)
C0205197 (UMLS 2011AA Property)
CourseNumber
Item
Course #
double
C25337 (NCI Thesaurus Property)
C0237753 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25379 (NCI Thesaurus ObjectClass)
C0750729 (UMLS 2011AA ObjectClass)
CourseDayNumber
Item
Day in Course (Cycle)
double
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25301 (NCI Thesaurus Property)
C0439228 (UMLS 2011AA Property)
C25379 (NCI Thesaurus ObjectClass)
C0750729 (UMLS 2011AA ObjectClass)
EvaluationDate
Item
Date (Enter the date the vital signs were taken.)
date
C25164 (NCI Thesaurus Property)
C0011008 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25214 (NCI Thesaurus ObjectClass)
C0220825 (UMLS 2011AA ObjectClass)
ProcedureTime
Item
Time (Enter the time the vital signs were taken.)
time
C25218 (NCI Thesaurus ObjectClass)
C1948041 (UMLS 2011AA ObjectClass)
C25207 (NCI Thesaurus ValueDomain)
C0040223 (UMLS 2011AA ValueDomain)
C71104 (NCI Thesaurus ObjectClass)
C0008976 (UMLS 2011AA ObjectClass)
C42614 (NCI Thesaurus Property)
C0027365 (UMLS 2011AA Property)
ResearchCommentsText
Item
Notes (If necessary, enter some brief notes.)
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0282411 (UMLS 2011AA Property)
Item
Performance Status (Karnofsky) (Select a value from the Karnofsky performance status scale.)
text
C25367 (NCI Thesaurus Property)
C20641 (NCI Thesaurus ObjectClass)
C1518965 (UMLS 2011AA ObjectClass)
C25338 (NCI Thesaurus ValueDomain)
C0449820 (UMLS 2011AA ValueDomain)
CL.1
Code List
Performance Status (Karnofsky) (Select a value from the Karnofsky performance status scale.)
CL Item
Dead (0)
CL Item
Moribund, Fatal Processes Progressing Rapidly (10)
CL Item
Very Sick, Hospitalization Indicated. Death Not Imminent (20)
CL Item
Severely Disabled, Hospitalization Indicated. Death Not Imminent (30)
CL Item
Disabled, Requires Special Care And Assistance (40)
CL Item
Requires Considerable Assistance And Frequent Medical Care (50)
CL Item
Requires Occasional Assistance, But Is Able To Care For Most Of His/her Needs (60)
CL Item
Cares For Self, Unable To Carry On Normal Activity Or To Do Active Work (70)
CL Item
Normal Activity With Effort; Some Signs Or Symptoms Of Disease (80)
CL Item
Able To Carry On Normal Activity; Minor Signs Or Symptoms Of Disease (90)
CL Item
Normal, No Complaints, No Evidence Of Disease (100)
Item
Performance Status (Zubrod) (Select a value from the Zubrod/ECOG performance status scale.)
text
C25367 (NCI Thesaurus Property)
C20641 (NCI Thesaurus ObjectClass)
C1518965 (UMLS 2011AA ObjectClass)
C25338 (NCI Thesaurus ValueDomain)
C0449820 (UMLS 2011AA ValueDomain)
CL.2
Code List
Performance Status (Zubrod) (Select a value from the Zubrod/ECOG performance status scale.)
CL Item
Normal Activity (0)
CL Item
Symptoms, But Nearly Fully Ambulatory (1)
CL Item
Some Bed Time, But Needs To Be In Bed <50% Of Normal Daytime (2)
CL Item
Needs To Be In Bed > 50% Of Normal Daytime (3)
CL Item
Unable To Get Out Of Bed (4)
Item
Performance Status (Lansky) (Select a value from the Lansky performance status scale.)
text
C25367 (NCI Thesaurus Property)
C20641 (NCI Thesaurus ObjectClass)
C1518965 (UMLS 2011AA ObjectClass)
C25338 (NCI Thesaurus ValueDomain)
C0449820 (UMLS 2011AA ValueDomain)
CL.3
Code List
Performance Status (Lansky) (Select a value from the Lansky performance status scale.)
CL Item
Unresponsive (0)
CL Item
No Play; Does Not Get Out Of Bed. (10)
CL Item
Often Sleeping; Play Entirely Limited To Very Passive Activities. (20)
CL Item
In Bed; Needs Assistance Even For Quiet Play. (30)
CL Item
Mostly In Bed; Participates In Quiet Activities. (40)
CL Item
Gets Dressed, But Lies Around Much Of The Day; No Active Play, Able To Participate In All Quiet Play And Activities. (50)
CL Item
Up And Around, But Minimal Active Play; Keeps Busy With Quieter Activities. (60)
CL Item
Both Greater Restriction Of And Less Time Spent In Play Activity (70)
CL Item
Active, But Tires More Quickly (80)
CL Item
Minor Restrictions In Physically Strenuous Activity (90)
CL Item
Fully Active, Normal (100)
BodyWeightinKilograms
Item
Body Weight (Enter the patient's weight only in kilograms. Use decimal places only for patients under 10kg.)
double
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
C13041 (NCI Thesaurus ObjectClass)
C1268086 (UMLS 2011AA ObjectClass)
C25208 (NCI Thesaurus Property)
C0043100 (UMLS 2011AA Property)
PersonHeightMeasurement
Item
Height (Enter the patient's height only in centimeters, to one decimal place.)
double
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25347 (NCI Thesaurus Property)
C0489786 (UMLS 2011AA Property)
PersonBodySurfaceAreaValue
Item
BSA (Enter the patient's body surface area in m2 to two decimal places if needed for the calculation of study medication dose level.)
double
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C25157 (NCI Thesaurus Property)
C0005902 (UMLS 2011AA Property)
TemperatureCelsiusScaleValue
Item
Temperature (Enter the patient's temperature only in Celsius, to one decimal place.)
double
C25206 (NCI Thesaurus ObjectClass)
C0039476 (UMLS 2011AA ObjectClass)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C41151 (NCI Thesaurus Property)
C1516378 (UMLS 2011AA Property)
C41151 (NCI Thesaurus ValueDomain)
C1516378 (UMLS 2011AA ValueDomain)
PulseRateMeasurementValue
Item
Pulse (Enter the patient's pulse rate.)
double
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25749 (NCI Thesaurus ObjectClass)
C0391850 (UMLS 2011AA ObjectClass)
C25636 (NCI Thesaurus Property)
C1521828 (UMLS 2011AA Property)
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
C25749 (NCI Thesaurus ValueDomain)
C0391850 (UMLS 2011AA ValueDomain)
PersonVitalSignsRespiratoryRatePhysicalExaminationValue
Item
Respiration Rate (Enter the patient's respiration rate.)
double
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C49672 (NCI Thesaurus Property)
C1704752 (UMLS 2011AA Property)
C49678 (NCI Thesaurus Property)
C0231832 (UMLS 2011AA Property)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
SystolicBloodPressureValue
Item
Systolic BP (Enter the patient's systolic blood pressure.)
double
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C54706 (NCI Thesaurus ObjectClass)
C0005823 (UMLS 2011AA ObjectClass)
DiastolicBloodPressureValue
Item
Diastolic BP (Enter the patient's diastolic blood pressure.)
double
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C54706 (NCI Thesaurus ObjectClass)
C0005823 (UMLS 2011AA ObjectClass)
PulseOximetryValue
Item
Pulse Ox (Enter the patient's pulse oximetry reading.)
double
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25749 (NCI Thesaurus ObjectClass)
C0391850 (UMLS 2011AA ObjectClass)
C0040656 (NCI Metathesaurus Property)
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