Informazione:
Errore:
ID
3997
Descrizione
Myeloproliferative Erkrankungen Symptom-Erfassungsbogen (MPN-SAF) - German Prof. Steffen Koschmieder skoschmieder@ukaachen.de
Keywords
versioni (1)
- 01/07/13 01/07/13 - Martin Dugas
Caricato su
1 luglio 2013
DOI
Per favore, per richiedere un accesso.
Licenza
Creative Commons BY-NC 3.0 Legacy
Commenti del modello :
Puoi commentare il modello dati qui. Tramite i fumetti nei gruppi di articoli e articoli è possibile aggiungere commenti a quelli in modo specifico.
Commenti del gruppo di articoli per :
Commenti dell'articolo per :
Per scaricare i modelli di dati devi essere registrato. Per favore accesso o registrati GRATIS.
MPN-SAF (Patient) MPN-SAF Protocol_7_1_13 MPN
Similar models
MPN-SAF (Patient)
- StudyEvent: MPN
Name
genere
Description | Question | Decode (Coded Value)
Tipo di dati
Alias
Item Group
Myeloproliferative Diseases Symptom Assessment Form - A validation study
C0027022 (UMLS CUI 2011AB)
425333006 (SNOMEDCT_2012_01_31)
10028576 (MedDRA 14.1)
D47.1 (ICD-10-CM Version 2010)
C1457887 (UMLS CUI 2011AB)
MTHU021540 (LOINC Version 232)
780-789.99 (ICD-9-CM Version 2011)
C1516048 (UMLS CUI 2011AB)
C0034394 (UMLS CUI 2011AB)
C0681836 (UMLS CUI 2011AB)
425333006 (SNOMEDCT_2012_01_31)
10028576 (MedDRA 14.1)
D47.1 (ICD-10-CM Version 2010)
C1457887 (UMLS CUI 2011AB)
MTHU021540 (LOINC Version 232)
780-789.99 (ICD-9-CM Version 2011)
C1516048 (UMLS CUI 2011AB)
C0034394 (UMLS CUI 2011AB)
C0681836 (UMLS CUI 2011AB)
Anonyme Patienten-Identifizierungs-Nummer:
Item
Anonymous patient identification number:
integer
C2346787 (UMLS CUI 2011AB)
C0030705 (UMLS CUI 2011AB)
116154003 (SNOMEDCT_2012_01_31)
C1300638 (UMLS CUI 2011AB)
396278008 (SNOMEDCT_2012_01_31)
C0030705 (UMLS CUI 2011AB)
116154003 (SNOMEDCT_2012_01_31)
C1300638 (UMLS CUI 2011AB)
396278008 (SNOMEDCT_2012_01_31)
Diagnose
Item
Diagnosis:
integer
MF (PMF)
Item
MF (PMF)
string
C0026987 (UMLS CUI 2011AB)
52967002 (SNOMEDCT_2012_01_31)
10028537 (MedDRA 14.1)
D75.81 (ICD-10-CM Version 2010)
289.83 (ICD-9-CM Version 2011)
C0001815 (UMLS CUI 2011AB)
307651005 (SNOMEDCT_2012_01_31)
10028538 (MedDRA 14.1)
D75.81 (ICD-10-CM Version 2010)
238.76 (ICD-9-CM Version 2011)
52967002 (SNOMEDCT_2012_01_31)
10028537 (MedDRA 14.1)
D75.81 (ICD-10-CM Version 2010)
289.83 (ICD-9-CM Version 2011)
C0001815 (UMLS CUI 2011AB)
307651005 (SNOMEDCT_2012_01_31)
10028538 (MedDRA 14.1)
D75.81 (ICD-10-CM Version 2010)
238.76 (ICD-9-CM Version 2011)
MF(Post ET MF)
Item
MF(Post ET MF)
string
C0026987 (UMLS CUI 2011AB)
52967002 (SNOMEDCT_2012_01_31)
10028537 (MedDRA 14.1)
D75.81 (ICD-10-CM Version 2010)
289.83 (ICD-9-CM Version 2011)
C0231290 (UMLS CUI 2011AB)
237679004 (SNOMEDCT_2012_01_31)
C0040028 (UMLS CUI 2011AB)
109994006 (SNOMEDCT_2012_01_31)
10015493 (MedDRA 14.1)
D47.3 (ICD-10-CM Version 2010)
238.71 (ICD-9-CM Version 2011)
C0026987 (UMLS CUI 2011AB)
52967002 (SNOMEDCT_2012_01_31)
10028537 (MedDRA 14.1)
D75.81 (ICD-10-CM Version 2010)
289.83 (ICD-9-CM Version 2011)
52967002 (SNOMEDCT_2012_01_31)
10028537 (MedDRA 14.1)
D75.81 (ICD-10-CM Version 2010)
289.83 (ICD-9-CM Version 2011)
C0231290 (UMLS CUI 2011AB)
237679004 (SNOMEDCT_2012_01_31)
C0040028 (UMLS CUI 2011AB)
109994006 (SNOMEDCT_2012_01_31)
10015493 (MedDRA 14.1)
D47.3 (ICD-10-CM Version 2010)
238.71 (ICD-9-CM Version 2011)
C0026987 (UMLS CUI 2011AB)
52967002 (SNOMEDCT_2012_01_31)
10028537 (MedDRA 14.1)
D75.81 (ICD-10-CM Version 2010)
289.83 (ICD-9-CM Version 2011)
MF(Post PV MF)
Item
MF(Post PV MF)
string
C0026987 (UMLS CUI 2011AB)
52967002 (SNOMEDCT_2012_01_31)
10028537 (MedDRA 14.1)
D75.81 (ICD-10-CM Version 2010)
289.83 (ICD-9-CM Version 2011)
C0231290 (UMLS CUI 2011AB)
237679004 (SNOMEDCT_2012_01_31)
C0032463 (UMLS CUI 2011AB)
109992005 (SNOMEDCT_2012_01_31)
10036057 (MedDRA 14.1)
D45 (ICD-10-CM Version 2010)
238.4 (ICD-9-CM Version 2011)
C0026987 (UMLS CUI 2011AB)
52967002 (SNOMEDCT_2012_01_31)
10028537 (MedDRA 14.1)
D75.81 (ICD-10-CM Version 2010)
289.83 (ICD-9-CM Version 2011)
52967002 (SNOMEDCT_2012_01_31)
10028537 (MedDRA 14.1)
D75.81 (ICD-10-CM Version 2010)
289.83 (ICD-9-CM Version 2011)
C0231290 (UMLS CUI 2011AB)
237679004 (SNOMEDCT_2012_01_31)
C0032463 (UMLS CUI 2011AB)
109992005 (SNOMEDCT_2012_01_31)
10036057 (MedDRA 14.1)
D45 (ICD-10-CM Version 2010)
238.4 (ICD-9-CM Version 2011)
C0026987 (UMLS CUI 2011AB)
52967002 (SNOMEDCT_2012_01_31)
10028537 (MedDRA 14.1)
D75.81 (ICD-10-CM Version 2010)
289.83 (ICD-9-CM Version 2011)
Polycythaemia vera (PV)
Item
Polycythemia vera (PV)
string
C0032463 (UMLS CUI 2011AB)
109992005 (SNOMEDCT_2012_01_31)
10036057 (MedDRA 14.1)
D45 (ICD-10-CM Version 2010)
238.4 (ICD-9-CM Version 2011)
109992005 (SNOMEDCT_2012_01_31)
10036057 (MedDRA 14.1)
D45 (ICD-10-CM Version 2010)
238.4 (ICD-9-CM Version 2011)
Essentielle Thrombozythämie (ET)
Item
Essential Thrombocythemia (ET)
string
C0040028 (UMLS CUI 2011AB)
109994006 (SNOMEDCT_2012_01_31)
10015493 (MedDRA 14.1)
D47.3 (ICD-10-CM Version 2010)
238.71 (ICD-9-CM Version 2011)
109994006 (SNOMEDCT_2012_01_31)
10015493 (MedDRA 14.1)
D47.3 (ICD-10-CM Version 2010)
238.71 (ICD-9-CM Version 2011)
CL Item
Mayo Clinic Arizona (1)
CL Item
Guys and St. Thomas's UK (2)
CL Item
University hospital Freiburg (3)
CL Item
University hospital Ulm (4)
CL Item
University hospital Aachen (5)
Item Group
MPN symptoms last week
C0027022 (UMLS CUI 2011AB)
425333006 (SNOMEDCT_2012_01_31)
10028576 (MedDRA 14.1)
D47.1 (ICD-10-CM Version 2010)
C1457887 (UMLS CUI 2011AB)
MTHU021540 (LOINC Version 232)
780-789.99 (ICD-9-CM Version 2011)
C1516048 (UMLS CUI 2011AB)
425333006 (SNOMEDCT_2012_01_31)
10028576 (MedDRA 14.1)
D47.1 (ICD-10-CM Version 2010)
C1457887 (UMLS CUI 2011AB)
MTHU021540 (LOINC Version 232)
780-789.99 (ICD-9-CM Version 2011)
C1516048 (UMLS CUI 2011AB)
Anleitung
Item
Instructions: Please fill out all questions, as best as able, reflecting how these symptoms affected you over the LAST WEEK unless directed otherwise. Complete forms until the STOP instruction toward the end of the packet.
integer
Item
Please rate your fatigue (weariness/tiredness) by circling the one number that best describes your fatigue right NOW
integer
C0015672 (UMLS CUI 2011AB)
267032009 (SNOMEDCT_2012_01_31)
10016256 (MedDRA 14.1)
MTHU013358 (LOINC Version 232)
R53.83 (ICD-10-CM Version 2010)
E11098 (CTCAE 1105E)
C1948052 (UMLS CUI 2011AB)
267032009 (SNOMEDCT_2012_01_31)
10016256 (MedDRA 14.1)
MTHU013358 (LOINC Version 232)
R53.83 (ICD-10-CM Version 2010)
E11098 (CTCAE 1105E)
C1948052 (UMLS CUI 2011AB)
Code List
Please rate your fatigue (weariness/tiredness) by circling the one number that best describes your fatigue right NOW
CL Item
no fatigue (0)
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
most severe fatigue (10)
Item
Please rate your fatigue (weariness/tiredness) by circling the one number that best describes your USUAL level of fatigue during past 24 hours
integer
CL381509 (UMLS CUI 2011AB)
C0449286 (UMLS CUI 2011AB)
246173007 (SNOMEDCT_2012_01_31)
C0015672 (UMLS CUI 2011AB)
267032009 (SNOMEDCT_2012_01_31)
10016256 (MedDRA 14.1)
MTHU013358 (LOINC Version 232)
R53.83 (ICD-10-CM Version 2010)
E11098 (CTCAE 1105E)
C0347984 (UMLS CUI 2011AB)
371881003 (SNOMEDCT_2012_01_31)
C1517741 (UMLS CUI 2011AB)
C0439584 (UMLS CUI 2011AB)
123027009 (SNOMEDCT_2012_01_31)
C0449286 (UMLS CUI 2011AB)
246173007 (SNOMEDCT_2012_01_31)
C0015672 (UMLS CUI 2011AB)
267032009 (SNOMEDCT_2012_01_31)
10016256 (MedDRA 14.1)
MTHU013358 (LOINC Version 232)
R53.83 (ICD-10-CM Version 2010)
E11098 (CTCAE 1105E)
C0347984 (UMLS CUI 2011AB)
371881003 (SNOMEDCT_2012_01_31)
C1517741 (UMLS CUI 2011AB)
C0439584 (UMLS CUI 2011AB)
123027009 (SNOMEDCT_2012_01_31)
Code List
Please rate your fatigue (weariness/tiredness) by circling the one number that best describes your USUAL level of fatigue during past 24 hours
CL Item
no fatigue (0)
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
most severe fatigue (10)
Item
Please rate your fatigue (weariness/tiredness) by circling the one number that best describes your MAXIMUM level of fatigue during past 24 hours
integer
C1522166 (UMLS CUI 2011AB)
C0449286 (UMLS CUI 2011AB)
246173007 (SNOMEDCT_2012_01_31)
C0015672 (UMLS CUI 2011AB)
267032009 (SNOMEDCT_2012_01_31)
10016256 (MedDRA 14.1)
MTHU013358 (LOINC Version 232)
R53.83 (ICD-10-CM Version 2010)
E11098 (CTCAE 1105E)
C0347984 (UMLS CUI 2011AB)
371881003 (SNOMEDCT_2012_01_31)
C1517741 (UMLS CUI 2011AB)
C0439584 (UMLS CUI 2011AB)
123027009 (SNOMEDCT_2012_01_31)
C0449286 (UMLS CUI 2011AB)
246173007 (SNOMEDCT_2012_01_31)
C0015672 (UMLS CUI 2011AB)
267032009 (SNOMEDCT_2012_01_31)
10016256 (MedDRA 14.1)
MTHU013358 (LOINC Version 232)
R53.83 (ICD-10-CM Version 2010)
E11098 (CTCAE 1105E)
C0347984 (UMLS CUI 2011AB)
371881003 (SNOMEDCT_2012_01_31)
C1517741 (UMLS CUI 2011AB)
C0439584 (UMLS CUI 2011AB)
123027009 (SNOMEDCT_2012_01_31)
Code List
Please rate your fatigue (weariness/tiredness) by circling the one number that best describes your MAXIMUM level of fatigue during past 24 hours
CL Item
no fatigue (0)
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
most severe fatigue (10)
Anleitung2
Item
Circle the one number that describes how, during the past 24 hours, fatigue has interfered with your:
integer
Item
General activity
integer
C0205246 (UMLS CUI 2011AB)
60132005 (SNOMEDCT_2012_01_31)
C0441655 (UMLS CUI 2011AB)
257733005 (SNOMEDCT_2012_01_31)
MTHU002837 (LOINC Version 232)
E001-E030.9 (ICD-9-CM Version 2011)
60132005 (SNOMEDCT_2012_01_31)
C0441655 (UMLS CUI 2011AB)
257733005 (SNOMEDCT_2012_01_31)
MTHU002837 (LOINC Version 232)
E001-E030.9 (ICD-9-CM Version 2011)
CL Item
no limitation (0)
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
maximal limitation (10)
Item
Mood
integer
CL Item
no limitation (0)
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
maximal limitation (10)
CL Item
no limitation (0)
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
maximal limitation (10)
Item
Normal work (includes work both outside the home and daily chores)
integer
C0205307 (UMLS CUI 2011AB)
17621005 (SNOMEDCT_2012_01_31)
N (HL7 V3 2006_05)
C0043227 (UMLS CUI 2011AB)
261041009 (SNOMEDCT_2012_01_31)
C1709359 (UMLS CUI 2011AB)
C0332173 (UMLS CUI 2011AB)
69620002 (SNOMEDCT_2012_01_31)
C0589414 (UMLS CUI 2011AB)
311840008 (SNOMEDCT_2012_01_31)
17621005 (SNOMEDCT_2012_01_31)
N (HL7 V3 2006_05)
C0043227 (UMLS CUI 2011AB)
261041009 (SNOMEDCT_2012_01_31)
C1709359 (UMLS CUI 2011AB)
C0332173 (UMLS CUI 2011AB)
69620002 (SNOMEDCT_2012_01_31)
C0589414 (UMLS CUI 2011AB)
311840008 (SNOMEDCT_2012_01_31)
CL Item
no limitation (0)
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
maximal limitation (10)
Item
Relations with other people
integer
C0699792 (UMLS CUI 2011AB)
263498003 (SNOMEDCT_2012_01_31)
C0205394 (UMLS CUI 2011AB)
74964007 (SNOMEDCT_2012_01_31)
CL428058 (UMLS CUI 2011AB)
263498003 (SNOMEDCT_2012_01_31)
C0205394 (UMLS CUI 2011AB)
74964007 (SNOMEDCT_2012_01_31)
CL428058 (UMLS CUI 2011AB)
CL Item
no limitation (0)
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
maximal limitation (10)
Item
Enjoyment of life
integer
C0424131 (UMLS CUI 2011AB)
247794008 (SNOMEDCT_2012_01_31)
247794008 (SNOMEDCT_2012_01_31)
CL Item
no limitation (0)
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
maximal limitation (10)
Item
Filling up quickly when you eat (Early satiety)
integer
C0239233 (UMLS CUI 2011AB)
442076002 (SNOMEDCT_2012_01_31)
10059186 (MedDRA 14.1)
R68.81 (ICD-10-CM Version 2010)
780.94 (ICD-9-CM Version 2011)
442076002 (SNOMEDCT_2012_01_31)
10059186 (MedDRA 14.1)
R68.81 (ICD-10-CM Version 2010)
780.94 (ICD-9-CM Version 2011)
CL Item
not present (0)
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
most severe symptoms (10)
Item
Abdominal Pain
integer
C0000737 (UMLS CUI 2011AB)
21522001 (SNOMEDCT_2012_01_31)
10000081 (MedDRA 14.1)
MTHU013636 (LOINC Version 232)
R10.9 (ICD-10-CM Version 2010)
789.0 (ICD-9-CM Version 2011)
E10460 (CTCAE 1105E)
21522001 (SNOMEDCT_2012_01_31)
10000081 (MedDRA 14.1)
MTHU013636 (LOINC Version 232)
R10.9 (ICD-10-CM Version 2010)
789.0 (ICD-9-CM Version 2011)
E10460 (CTCAE 1105E)
CL Item
not present (0)
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
most severe symptoms (10)
Item
Abdominal discomfort
integer
C0232487 (UMLS CUI 2011AB)
43364001 (SNOMEDCT_2012_01_31)
10000059 (MedDRA 14.1)
43364001 (SNOMEDCT_2012_01_31)
10000059 (MedDRA 14.1)
CL Item
not present (0)
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
most severe symptoms (10)
Item
Inactivity
integer
C0205254 (UMLS CUI 2011AB)
73425007 (SNOMEDCT_2012_01_31)
10039900 (MedDRA 14.1)
73425007 (SNOMEDCT_2012_01_31)
10039900 (MedDRA 14.1)
CL Item
not present (0)
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
most severe symptoms (10)
Item
Headaches
integer
C0018681 (UMLS CUI 2011AB)
25064002 (SNOMEDCT_2012_01_31)
10019211 (MedDRA 14.1)
MTHU020860 (LOINC Version 232)
R51 (ICD-10-CM Version 2010)
784.0 (ICD-9-CM Version 2011)
E12678 (CTCAE 1105E)
25064002 (SNOMEDCT_2012_01_31)
10019211 (MedDRA 14.1)
MTHU020860 (LOINC Version 232)
R51 (ICD-10-CM Version 2010)
784.0 (ICD-9-CM Version 2011)
E12678 (CTCAE 1105E)
CL Item
not present (0)
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
most severe symptoms (10)
Item
Problems with concentration - Compared to prior to my MPD)
integer
C0858201 (UMLS CUI 2011AB)
10010248 (MedDRA 14.1)
C1707455 (UMLS CUI 2011AB)
C0449438 (UMLS CUI 2011AB)
263490005 (SNOMEDCT_2012_01_31)
MTHU015827 (LOINC Version 232)
C0332152 (UMLS CUI 2011AB)
288556008 (SNOMEDCT_2012_01_31)
C0027022 (UMLS CUI 2011AB)
425333006 (SNOMEDCT_2012_01_31)
10028576 (MedDRA 14.1)
D47.1 (ICD-10-CM Version 2010)
C0011900 (UMLS CUI 2011AB)
439401001 (SNOMEDCT_2012_01_31)
MTHU008876 (LOINC Version 232)
10010248 (MedDRA 14.1)
C1707455 (UMLS CUI 2011AB)
C0449438 (UMLS CUI 2011AB)
263490005 (SNOMEDCT_2012_01_31)
MTHU015827 (LOINC Version 232)
C0332152 (UMLS CUI 2011AB)
288556008 (SNOMEDCT_2012_01_31)
C0027022 (UMLS CUI 2011AB)
425333006 (SNOMEDCT_2012_01_31)
10028576 (MedDRA 14.1)
D47.1 (ICD-10-CM Version 2010)
C0011900 (UMLS CUI 2011AB)
439401001 (SNOMEDCT_2012_01_31)
MTHU008876 (LOINC Version 232)
Code List
Problems with concentration - Compared to prior to my MPD)
CL Item
not present (0)
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
most severe symptoms (10)
Item
Dizziness / Vertigo / Lightheadedness
integer
C0012833 (UMLS CUI 2011AB)
404640003 (SNOMEDCT_2012_01_31)
10013573 (MedDRA 14.1)
E12631 (CTCAE 1105E)
C0042571 (UMLS CUI 2011AB)
399153001 (SNOMEDCT_2012_01_31)
10047340 (MedDRA 14.1)
R42 (ICD-10-CM Version 2010)
780.4 (ICD-9-CM Version 2011)
E10291 (CTCAE 1105E)
C0220870 (UMLS CUI 2011AB)
386705008 (SNOMEDCT_2012_01_31)
10024492 (MedDRA 14.1)
R42 (ICD-10-CM Version 2010)
404640003 (SNOMEDCT_2012_01_31)
10013573 (MedDRA 14.1)
E12631 (CTCAE 1105E)
C0042571 (UMLS CUI 2011AB)
399153001 (SNOMEDCT_2012_01_31)
10047340 (MedDRA 14.1)
R42 (ICD-10-CM Version 2010)
780.4 (ICD-9-CM Version 2011)
E10291 (CTCAE 1105E)
C0220870 (UMLS CUI 2011AB)
386705008 (SNOMEDCT_2012_01_31)
10024492 (MedDRA 14.1)
R42 (ICD-10-CM Version 2010)
CL Item
not present (0)
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
most severe symptoms (10)
Item
Numbness / Tingling (in my hands and feet)
integer
C0028643 (UMLS CUI 2011AB)
44077006 (SNOMEDCT_2012_01_31)
10029829 (MedDRA 14.1)
782.0 (ICD-9-CM Version 2011)
C0542238 (UMLS CUI 2011AB)
10043877 (MedDRA 14.1)
44077006 (SNOMEDCT_2012_01_31)
10029829 (MedDRA 14.1)
782.0 (ICD-9-CM Version 2011)
C0542238 (UMLS CUI 2011AB)
10043877 (MedDRA 14.1)
CL Item
not present (0)
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
most severe symptoms (10)
Item
Difficulty sleeping
integer
C0235162 (UMLS CUI 2011AB)
301345002 (SNOMEDCT_2012_01_31)
10012804 (MedDRA 14.1)
C0332273 (UMLS CUI 2011AB)
112235009 (SNOMEDCT_2012_01_31)
C0240526 (UMLS CUI 2011AB)
2546009 (SNOMEDCT_2012_01_31)
C0393760 (UMLS CUI 2011AB)
59050008 (SNOMEDCT_2012_01_31)
10022035 (MedDRA 14.1)
MTHU039887 (LOINC Version 232)
301345002 (SNOMEDCT_2012_01_31)
10012804 (MedDRA 14.1)
C0332273 (UMLS CUI 2011AB)
112235009 (SNOMEDCT_2012_01_31)
C0240526 (UMLS CUI 2011AB)
2546009 (SNOMEDCT_2012_01_31)
C0393760 (UMLS CUI 2011AB)
59050008 (SNOMEDCT_2012_01_31)
10022035 (MedDRA 14.1)
MTHU039887 (LOINC Version 232)
CL Item
not present (0)
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
most severe symptoms (10)
Item
Depression or sad mood
integer
C0011570 (UMLS CUI 2011AB)
10012378 (MedDRA 14.1)
MTHU013514 (LOINC Version 232)
F32.9 (ICD-10-CM Version 2010)
E12909 (CTCAE 1105E)
C0344315 (UMLS CUI 2011AB)
366979004 (SNOMEDCT_2012_01_31)
10012374 (MedDRA 14.1)
MTHU031608 (LOINC Version 232)
10012378 (MedDRA 14.1)
MTHU013514 (LOINC Version 232)
F32.9 (ICD-10-CM Version 2010)
E12909 (CTCAE 1105E)
C0344315 (UMLS CUI 2011AB)
366979004 (SNOMEDCT_2012_01_31)
10012374 (MedDRA 14.1)
MTHU031608 (LOINC Version 232)
CL Item
not present (0)
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
most severe symptoms (10)
Item
Problems with sexual desire or function
integer
C1409677 (UMLS CUI 2011AB)
Code List
Problems with sexual desire or function
CL Item
not present (0)
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
most severe symptoms (10)
Item
Cough
integer
C0010200 (UMLS CUI 2011AB)
49727002 (SNOMEDCT_2012_01_31)
10011224 (MedDRA 14.1)
R05 (ICD-10-CM Version 2010)
786.2 (ICD-9-CM Version 2011)
E13364 (CTCAE 1105E)
49727002 (SNOMEDCT_2012_01_31)
10011224 (MedDRA 14.1)
R05 (ICD-10-CM Version 2010)
786.2 (ICD-9-CM Version 2011)
E13364 (CTCAE 1105E)
CL Item
not present (0)
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
most severe symptoms (10)
Item
Night sweats
integer
C0028081 (UMLS CUI 2011AB)
42984000 (SNOMEDCT_2012_01_31)
10029410 (MedDRA 14.1)
MTHU013525 (LOINC Version 232)
R61 (ICD-10-CM Version 2010)
42984000 (SNOMEDCT_2012_01_31)
10029410 (MedDRA 14.1)
MTHU013525 (LOINC Version 232)
R61 (ICD-10-CM Version 2010)
CL Item
not present (0)
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
most severe symptoms (10)
Item
Itching (pruritus)
integer
C0033774 (UMLS CUI 2011AB)
418363000 (SNOMEDCT_2012_01_31)
10037087 (MedDRA 14.1)
L29 (ICD-10-CM Version 2010)
698.9 (ICD-9-CM Version 2011)
E13686 (CTCAE 1105E)
418363000 (SNOMEDCT_2012_01_31)
10037087 (MedDRA 14.1)
L29 (ICD-10-CM Version 2010)
698.9 (ICD-9-CM Version 2011)
E13686 (CTCAE 1105E)
CL Item
not present (0)
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
most severe symptoms (10)
Item
Bone pain (diffuse not joint pain or arthritis)
integer
C0151825 (UMLS CUI 2011AB)
12584003 (SNOMEDCT_2012_01_31)
10006002 (MedDRA 14.1)
MTHU020858 (LOINC Version 232)
E12392 (CTCAE 1105E)
C0205219 (UMLS CUI 2011AB)
19648000 (SNOMEDCT_2012_01_31)
C1518422 (UMLS CUI 2011AB)
C0003862 (UMLS CUI 2011AB)
57676002 (SNOMEDCT_2012_01_31)
10003239 (MedDRA 14.1)
MTHU020863 (LOINC Version 232)
M25.5 (ICD-10-CM Version 2010)
719.4 (ICD-9-CM Version 2011)
E12374 (CTCAE 1105E)
C0003864 (UMLS CUI 2011AB)
3723001 (SNOMEDCT_2012_01_31)
10003246 (MedDRA 14.1)
MTHU020793 (LOINC Version 232)
M19.90 (ICD-10-CM Version 2010)
716.9 (ICD-9-CM Version 2011)
E12378 (CTCAE 1105E)
12584003 (SNOMEDCT_2012_01_31)
10006002 (MedDRA 14.1)
MTHU020858 (LOINC Version 232)
E12392 (CTCAE 1105E)
C0205219 (UMLS CUI 2011AB)
19648000 (SNOMEDCT_2012_01_31)
C1518422 (UMLS CUI 2011AB)
C0003862 (UMLS CUI 2011AB)
57676002 (SNOMEDCT_2012_01_31)
10003239 (MedDRA 14.1)
MTHU020863 (LOINC Version 232)
M25.5 (ICD-10-CM Version 2010)
719.4 (ICD-9-CM Version 2011)
E12374 (CTCAE 1105E)
C0003864 (UMLS CUI 2011AB)
3723001 (SNOMEDCT_2012_01_31)
10003246 (MedDRA 14.1)
MTHU020793 (LOINC Version 232)
M19.90 (ICD-10-CM Version 2010)
716.9 (ICD-9-CM Version 2011)
E12378 (CTCAE 1105E)
CL Item
not present (0)
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
most severe symptoms (10)
Item
Fever (> 100 F)
integer
C0015967 (UMLS CUI 2011AB)
386661006 (SNOMEDCT_2012_01_31)
10005911 (MedDRA 14.1)
MTHU013518 (LOINC Version 232)
R50.9 (ICD-10-CM Version 2010)
780.60 (ICD-9-CM Version 2011)
E11102 (CTCAE 1105E)
386661006 (SNOMEDCT_2012_01_31)
10005911 (MedDRA 14.1)
MTHU013518 (LOINC Version 232)
R50.9 (ICD-10-CM Version 2010)
780.60 (ICD-9-CM Version 2011)
E11102 (CTCAE 1105E)
CL Item
not present (0)
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
daily (10)
Item
Unintentional weight loss last 6 months
integer
C2363736 (UMLS CUI 2011AB)
448765001 (SNOMEDCT_2012_01_31)
10068329 (MedDRA 14.1)
C1517741 (UMLS CUI 2011AB)
C0205452 (UMLS CUI 2011AB)
68244004 (SNOMEDCT_2012_01_31)
C0439231 (UMLS CUI 2011AB)
258706009 (SNOMEDCT_2012_01_31)
MO (HL7 V3 2006_05)
448765001 (SNOMEDCT_2012_01_31)
10068329 (MedDRA 14.1)
C1517741 (UMLS CUI 2011AB)
C0205452 (UMLS CUI 2011AB)
68244004 (SNOMEDCT_2012_01_31)
C0439231 (UMLS CUI 2011AB)
258706009 (SNOMEDCT_2012_01_31)
MO (HL7 V3 2006_05)
Code List
Unintentional weight loss last 6 months
CL Item
not present (0)
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
most severe weight loss (10)
Item
What is your overall quality of life?
integer
C1561607 (UMLS CUI 2011AB)
C0518214 (UMLS CUI 2011AB)
405152002 (SNOMEDCT_2012_01_31)
C0518214 (UMLS CUI 2011AB)
405152002 (SNOMEDCT_2012_01_31)
CL Item
very good (0)
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
very bad (10)
Item Group
Additional questions for the patient:
C1524062 (UMLS CUI 2011AB)
MTHU013802 (LOINC Version 232)
C1522634 (UMLS CUI 2011AB)
C0030705 (UMLS CUI 2011AB)
116154003 (SNOMEDCT_2012_01_31)
MTHU013802 (LOINC Version 232)
C1522634 (UMLS CUI 2011AB)
C0030705 (UMLS CUI 2011AB)
116154003 (SNOMEDCT_2012_01_31)
zusätzliche Beschwerden
Item
1. Do you have additional complaints caused by your myeloproliferative disease that are not addressed in this questionnaire? (please enter your complaints here)
string
C1524062 (UMLS CUI 2011AB)
MTHU013802 (LOINC Version 232)
C0277786 (UMLS CUI 2011AB)
409586006 (SNOMEDCT_2012_01_31)
MTHU001077 (LOINC Version 232)
C1314792 (UMLS CUI 2011AB)
134198009 (SNOMEDCT_2012_01_31)
C0027022 (UMLS CUI 2011AB)
425333006 (SNOMEDCT_2012_01_31)
10028576 (MedDRA 14.1)
D47.1 (ICD-10-CM Version 2010)
C1518422 (UMLS CUI 2011AB)
C1706462 (UMLS CUI 2011AB)
C0034394 (UMLS CUI 2011AB)
MTHU013802 (LOINC Version 232)
C0277786 (UMLS CUI 2011AB)
409586006 (SNOMEDCT_2012_01_31)
MTHU001077 (LOINC Version 232)
C1314792 (UMLS CUI 2011AB)
134198009 (SNOMEDCT_2012_01_31)
C0027022 (UMLS CUI 2011AB)
425333006 (SNOMEDCT_2012_01_31)
10028576 (MedDRA 14.1)
D47.1 (ICD-10-CM Version 2010)
C1518422 (UMLS CUI 2011AB)
C1706462 (UMLS CUI 2011AB)
C0034394 (UMLS CUI 2011AB)
Item
2. The MPN-SAF questionnaire was easily to understand
integer
C0027022 (UMLS CUI 2011AB)
425333006 (SNOMEDCT_2012_01_31)
10028576 (MedDRA 14.1)
D47.1 (ICD-10-CM Version 2010)
C1457887 (UMLS CUI 2011AB)
MTHU021540 (LOINC Version 232)
780-789.99 (ICD-9-CM Version 2011)
C1516048 (UMLS CUI 2011AB)
C0034394 (UMLS CUI 2011AB)
C0332219 (UMLS CUI 2011AB)
36203004 (SNOMEDCT_2012_01_31)
C0162340 (UMLS CUI 2011AB)
66216009 (SNOMEDCT_2012_01_31)
425333006 (SNOMEDCT_2012_01_31)
10028576 (MedDRA 14.1)
D47.1 (ICD-10-CM Version 2010)
C1457887 (UMLS CUI 2011AB)
MTHU021540 (LOINC Version 232)
780-789.99 (ICD-9-CM Version 2011)
C1516048 (UMLS CUI 2011AB)
C0034394 (UMLS CUI 2011AB)
C0332219 (UMLS CUI 2011AB)
36203004 (SNOMEDCT_2012_01_31)
C0162340 (UMLS CUI 2011AB)
66216009 (SNOMEDCT_2012_01_31)
CL Item
very easy (0)
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
very difficult (10)
Item
3. The MPN-SAF questionnaire has queried the most complaints caused by the disease
integer
C0027022 (UMLS CUI 2011AB)
425333006 (SNOMEDCT_2012_01_31)
10028576 (MedDRA 14.1)
D47.1 (ICD-10-CM Version 2010)
C1457887 (UMLS CUI 2011AB)
MTHU021540 (LOINC Version 232)
780-789.99 (ICD-9-CM Version 2011)
C1516048 (UMLS CUI 2011AB)
C0034394 (UMLS CUI 2011AB)
C1522634 (UMLS CUI 2011AB)
C0205393 (UMLS CUI 2011AB)
4757001 (SNOMEDCT_2012_01_31)
C0277786 (UMLS CUI 2011AB)
409586006 (SNOMEDCT_2012_01_31)
MTHU001077 (LOINC Version 232)
C1314792 (UMLS CUI 2011AB)
134198009 (SNOMEDCT_2012_01_31)
C0012634 (UMLS CUI 2011AB)
64572001 (SNOMEDCT_2012_01_31)
425333006 (SNOMEDCT_2012_01_31)
10028576 (MedDRA 14.1)
D47.1 (ICD-10-CM Version 2010)
C1457887 (UMLS CUI 2011AB)
MTHU021540 (LOINC Version 232)
780-789.99 (ICD-9-CM Version 2011)
C1516048 (UMLS CUI 2011AB)
C0034394 (UMLS CUI 2011AB)
C1522634 (UMLS CUI 2011AB)
C0205393 (UMLS CUI 2011AB)
4757001 (SNOMEDCT_2012_01_31)
C0277786 (UMLS CUI 2011AB)
409586006 (SNOMEDCT_2012_01_31)
MTHU001077 (LOINC Version 232)
C1314792 (UMLS CUI 2011AB)
134198009 (SNOMEDCT_2012_01_31)
C0012634 (UMLS CUI 2011AB)
64572001 (SNOMEDCT_2012_01_31)
Code List
3. The MPN-SAF questionnaire has queried the most complaints caused by the disease
CL Item
very good (0)
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
very bad (10)