ID

43495

Description

Myeloproliferative Erkrankungen Symptom-Erfassungsbogen (MPN-SAF) - German Prof. Steffen Koschmieder skoschmieder@ukaachen.de

Keywords

Versions (2)
  1. 7/1/13 7/1/13 - Martin Dugas
  2. 9/20/21 9/20/21 -
Uploaded on

September 20, 2021

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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MPN-SAF (Doctor) MPN-SAF Protocol_7_1_13 MPN

German English

MPN-SAF (Doctor)

1 forms  
  1. StudyEvent: MPN
    1. MPN-SAF (Doctor)
MPN-SAF physician entered data
Description

MPN-SAF physician entered data

Alias
UMLS CUI 2011AB
C0031831
SNOMEDCT_2012_01_31
309343006
LOINC Version 232
MTHU010489
HL7 V3 2006_05
PHYS
UMLS CUI 2011AB
C1705654
Current Age
Description

Aktuelles Alter

Data type

integer

Alias
UMLS CUI 2011AB
C0521116
SNOMEDCT_2012_01_31
15240007
UMLS CUI 2011AB
C0001779
SNOMEDCT_2012_01_31
397669002
Gender
Description

Geschlecht

Data type

integer

Alias
UMLS CUI 2011AB
C0079399
SNOMEDCT_2012_01_31
263495000
LOINC Version 232
MTHU002975
Type of MPN
Description

Art der MPN

Data type

integer

Alias
UMLS CUI 2011AB
C0332307
SNOMEDCT_2012_01_31
410657003
LOINC Version 232
MTHU013727
UMLS CUI 2011AB
C0027022
SNOMEDCT_2012_01_31
425333006
MedDRA 14.1
10028576
ICD-10-CM Version 2010
D47.1
Date of Diagnosis MPN
Description

Datum der Diagnose MPN

Data type

date

Alias
UMLS CUI 2011AB
C2316983
SNOMEDCT_2012_01_31
432213005
UMLS CUI 2011AB
C0027022
SNOMEDCT_2012_01_31
425333006
MedDRA 14.1
10028576
ICD-10-CM Version 2010
D47.1
Date of Diagnosis of MF
Description

Datum der Diagnose MF

Data type

date

Alias
UMLS CUI 2011AB
C2316983
SNOMEDCT_2012_01_31
432213005
UMLS CUI 2011AB
C0026987
SNOMEDCT_2012_01_31
52967002
MedDRA 14.1
10028537
ICD-10-CM Version 2010
D75.81
ICD-9-CM Version 2011
289.83
Current Spleen Size
Description

aktuelle Milzgröße

Data type

integer

Alias
UMLS CUI 2011AB
C0521116
SNOMEDCT_2012_01_31
15240007
UMLS CUI 2011AB
C0037993
SNOMEDCT_2012_01_31
78961009
LOINC Version 232
MTHU012104
UMLS CUI 2011AB
C0456389
SNOMEDCT_2012_01_31
246115007
LOINC Version 232
MTHU010347
Prior thrombosis from disease?
Description

Frühere Thrombose durch Krankheit

Data type

boolean

Alias
UMLS CUI 2011AB
C0332152
SNOMEDCT_2012_01_31
288556008
UMLS CUI 2011AB
C0040053
SNOMEDCT_2012_01_31
439127006
MedDRA 14.1
10043607
UMLS CUI 2011AB
C1314792
SNOMEDCT_2012_01_31
134198009
UMLS CUI 2011AB
C0012634
SNOMEDCT_2012_01_31
64572001
Prior hemorrhage from disease?
Description

Frühere Blutung durch Krankheit

Data type

boolean

Alias
UMLS CUI 2011AB
C0332152
SNOMEDCT_2012_01_31
288556008
UMLS CUI 2011AB
C0019080
SNOMEDCT_2012_01_31
50960005
MedDRA 14.1
10055798
ICD-10-CM Version 2010
R58
ICD-9-CM Version 2011
459.0
UMLS CUI 2011AB
C1314792
SNOMEDCT_2012_01_31
134198009
UMLS CUI 2011AB
C0012634
SNOMEDCT_2012_01_31
64572001
Requiring red cell transfusions?
Description

Erythrozytentransfusion erforderlich

Data type

boolean

Alias
UMLS CUI 2011AB
C1514873
UMLS CUI 2011AB
C0086252
SNOMEDCT_2012_01_31
116863004
Current MPN therapies (list)
Description

Aktuelle MPN-Therapien (Liste)

Data type

string

Alias
UMLS CUI 2011AB
C0521116
SNOMEDCT_2012_01_31
15240007
UMLS CUI 2011AB
C0027022
SNOMEDCT_2012_01_31
425333006
MedDRA 14.1
10028576
ICD-10-CM Version 2010
D47.1
UMLS CUI 2011AB
C0039798
UMLS CUI 2011AB
C0745732
Prior MPN therapies (list)
Description

Frühere MPN-Therapien (Liste)

Data type

string

Alias
UMLS CUI 2011AB
C0332152
SNOMEDCT_2012_01_31
288556008
UMLS CUI 2011AB
C0027022
SNOMEDCT_2012_01_31
425333006
MedDRA 14.1
10028576
ICD-10-CM Version 2010
D47.1
UMLS CUI 2011AB
C0039798
UMLS CUI 2011AB
C0745732
Blood Count
Description

Blood Count

Alias
UMLS CUI 2011AB
C0005771
SNOMEDCT_2012_01_31
88308000
MedDRA 14.1
10064196
Hemoglobin (g/dL)
Description

Hämoglobin

Data type

float

Alias
UMLS CUI 2011AB
C0019046
SNOMEDCT_2012_01_31
38082009
MedDRA 14.1
10019481
LOINC Version 232
LP14449-0
WBC (x 10E9/L)
Description

WBC

Data type

float

Alias
UMLS CUI 2011AB
C0023508
SNOMEDCT_2012_01_31
767002
LOINC Version 232
6690-2
ANC (x 10E9/L)
Description

ANC

Data type

float

Alias
UMLS CUI 2011AB
C0948762
MedDRA 14.1
10052033
PLT (x 10E9/L)
Description

PLT

Data type

float

Alias
UMLS CUI 2011AB
C0005821
SNOMEDCT_2012_01_31
16378004
LOINC Version 232
MTHU002432
- Blasts present?
Description

Blasten

Data type

boolean

Alias
UMLS CUI 2011AB
C0368761
SNOMEDCT_2012_01_31
312256009
LOINC Version 232
MTHU005201
UMLS CUI 2011AB
C0150312
SNOMEDCT_2012_01_31
52101004
Percentage Blasts
Description

Prozentanteil Blasten

Data type

integer

Alias
UMLS CUI 2011AB
C0439165
SNOMEDCT_2012_01_31
118582008
UMLS CUI 2011AB
C0368761
SNOMEDCT_2012_01_31
312256009
LOINC Version 232
MTHU005201
Symptoms
Description

Symptoms

Alias
UMLS CUI 2011AB
C1457887
LOINC Version 232
MTHU021540
ICD-9-CM Version 2011
780-789.99
Night sweats
Description

Night sweats

Data type

integer

Alias
UMLS CUI 2011AB
C0028081
SNOMEDCT_2012_01_31
42984000
MedDRA 14.1
10029410
LOINC Version 232
MTHU013525
ICD-10-CM Version 2010
R61
Fevers
Description

Fieber

Data type

integer

Alias
UMLS CUI 2011AB
C0015967
SNOMEDCT_2012_01_31
386661006
MedDRA 14.1
10005911
LOINC Version 232
MTHU013518
ICD-10-CM Version 2010
R50.9
ICD-9-CM Version 2011
780.60
CTCAE 1105E
E11102
Fatigue
Description

Müdigkeit

Data type

integer

Alias
UMLS CUI 2011AB
C0015672
SNOMEDCT_2012_01_31
267032009
MedDRA 14.1
10016256
LOINC Version 232
MTHU013358
ICD-10-CM Version 2010
R53.83
CTCAE 1105E
E11098
Weight loss
Description

Gewichtsverlust

Data type

integer

Alias
UMLS CUI 2011AB
C1262477
SNOMEDCT_2012_01_31
89362005
MedDRA 14.1
10047895
LOINC Version 232
MTHU020881
ICD-9-CM Version 2011
783.21
CTCAE 1105E
E12228
Bone pain
Description

Knochenschmerz

Data type

integer

Alias
UMLS CUI 2011AB
C0151825
SNOMEDCT_2012_01_31
12584003
MedDRA 14.1
10006002
LOINC Version 232
MTHU020858
CTCAE 1105E
E12392
Pruritus
Description

Pruritus

Data type

integer

Alias
UMLS CUI 2011AB
C0033774
SNOMEDCT_2012_01_31
418363000
MedDRA 14.1
10037087
ICD-10-CM Version 2010
L29
ICD-9-CM Version 2011
698.9
CTCAE 1105E
E13686
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Similar models

MPN-SAF (Doctor)

1 forms
  1. StudyEvent: MPN
    1. MPN-SAF (Doctor)
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
MPN-SAF physician entered data
C0031831 (UMLS CUI 2011AB)
309343006 (SNOMEDCT_2012_01_31)
MTHU010489 (LOINC Version 232)
PHYS (HL7 V3 2006_05)
C1705654 (UMLS CUI 2011AB)
Aktuelles Alter
Item
Current Age
integer
C0521116 (UMLS CUI 2011AB)
15240007 (SNOMEDCT_2012_01_31)
C0001779 (UMLS CUI 2011AB)
397669002 (SNOMEDCT_2012_01_31)
Item
Gender
integer
C0079399 (UMLS CUI 2011AB)
263495000 (SNOMEDCT_2012_01_31)
MTHU002975 (LOINC Version 232)
Geschlecht
Code List
Gender
CL Item
male (1)
CL Item
female (2)
Item
Type of MPN
integer
C0332307 (UMLS CUI 2011AB)
410657003 (SNOMEDCT_2012_01_31)
MTHU013727 (LOINC Version 232)
C0027022 (UMLS CUI 2011AB)
425333006 (SNOMEDCT_2012_01_31)
10028576 (MedDRA 14.1)
D47.1 (ICD-10-CM Version 2010)
Art der MPN
Code List
Type of MPN
CL Item
ET (1)
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)
CL Item
PV (2)
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)
CL Item
MF (3)
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)
CL Item
PMF  (4)
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)
CL Item
Post ET MF (5)
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)
CL Item
Post PV MF (6)
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)
Datum der Diagnose MPN
Item
Date of Diagnosis MPN
date
C2316983 (UMLS CUI 2011AB)
432213005 (SNOMEDCT_2012_01_31)
C0027022 (UMLS CUI 2011AB)
425333006 (SNOMEDCT_2012_01_31)
10028576 (MedDRA 14.1)
D47.1 (ICD-10-CM Version 2010)
Datum der Diagnose MF
Item
Date of Diagnosis of MF
date
C2316983 (UMLS CUI 2011AB)
432213005 (SNOMEDCT_2012_01_31)
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)
aktuelle Milzgröße
Item
Current Spleen Size
integer
C0521116 (UMLS CUI 2011AB)
15240007 (SNOMEDCT_2012_01_31)
C0037993 (UMLS CUI 2011AB)
78961009 (SNOMEDCT_2012_01_31)
MTHU012104 (LOINC Version 232)
C0456389 (UMLS CUI 2011AB)
246115007 (SNOMEDCT_2012_01_31)
MTHU010347 (LOINC Version 232)
Frühere Thrombose durch Krankheit
Item
Prior thrombosis from disease?
boolean
C0332152 (UMLS CUI 2011AB)
288556008 (SNOMEDCT_2012_01_31)
C0040053 (UMLS CUI 2011AB)
439127006 (SNOMEDCT_2012_01_31)
10043607 (MedDRA 14.1)
C1314792 (UMLS CUI 2011AB)
134198009 (SNOMEDCT_2012_01_31)
C0012634 (UMLS CUI 2011AB)
64572001 (SNOMEDCT_2012_01_31)
Frühere Blutung durch Krankheit
Item
Prior hemorrhage from disease?
boolean
C0332152 (UMLS CUI 2011AB)
288556008 (SNOMEDCT_2012_01_31)
C0019080 (UMLS CUI 2011AB)
50960005 (SNOMEDCT_2012_01_31)
10055798 (MedDRA 14.1)
R58 (ICD-10-CM Version 2010)
459.0 (ICD-9-CM Version 2011)
C1314792 (UMLS CUI 2011AB)
134198009 (SNOMEDCT_2012_01_31)
C0012634 (UMLS CUI 2011AB)
64572001 (SNOMEDCT_2012_01_31)
Erythrozytentransfusion erforderlich
Item
Requiring red cell transfusions?
boolean
C1514873 (UMLS CUI 2011AB)
C0086252 (UMLS CUI 2011AB)
116863004 (SNOMEDCT_2012_01_31)
Aktuelle MPN-Therapien (Liste)
Item
Current MPN therapies (list)
string
C0521116 (UMLS CUI 2011AB)
15240007 (SNOMEDCT_2012_01_31)
C0027022 (UMLS CUI 2011AB)
425333006 (SNOMEDCT_2012_01_31)
10028576 (MedDRA 14.1)
D47.1 (ICD-10-CM Version 2010)
C0039798 (UMLS CUI 2011AB)
C0745732 (UMLS CUI 2011AB)
Frühere MPN-Therapien (Liste)
Item
Prior MPN therapies (list)
string
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)
C0039798 (UMLS CUI 2011AB)
C0745732 (UMLS CUI 2011AB)
Item Group
Blood Count
C0005771 (UMLS CUI 2011AB)
88308000 (SNOMEDCT_2012_01_31)
10064196 (MedDRA 14.1)
Hämoglobin
Item
Hemoglobin (g/dL)
float
C0019046 (UMLS CUI 2011AB)
38082009 (SNOMEDCT_2012_01_31)
10019481 (MedDRA 14.1)
LP14449-0 (LOINC Version 232)
WBC
Item
WBC (x 10E9/L)
float
C0023508 (UMLS CUI 2011AB)
767002 (SNOMEDCT_2012_01_31)
6690-2 (LOINC Version 232)
ANC
Item
ANC (x 10E9/L)
float
C0948762 (UMLS CUI 2011AB)
10052033 (MedDRA 14.1)
PLT
Item
PLT (x 10E9/L)
float
C0005821 (UMLS CUI 2011AB)
16378004 (SNOMEDCT_2012_01_31)
MTHU002432 (LOINC Version 232)
Blasten
Item
- Blasts present?
boolean
C0368761 (UMLS CUI 2011AB)
312256009 (SNOMEDCT_2012_01_31)
MTHU005201 (LOINC Version 232)
C0150312 (UMLS CUI 2011AB)
52101004 (SNOMEDCT_2012_01_31)
Prozentanteil Blasten
Item
Percentage Blasts
integer
C0439165 (UMLS CUI 2011AB)
118582008 (SNOMEDCT_2012_01_31)
C0368761 (UMLS CUI 2011AB)
312256009 (SNOMEDCT_2012_01_31)
MTHU005201 (LOINC Version 232)
Item Group
Symptoms
C1457887 (UMLS CUI 2011AB)
MTHU021540 (LOINC Version 232)
780-789.99 (ICD-9-CM Version 2011)
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)
Night sweats
Code List
Night sweats
CL Item
0 (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
10 (10)
Item
Fevers
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)
Fieber
Code List
Fevers
CL Item
0 (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
10 (10)
Item
Fatigue
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)
Müdigkeit
Code List
Fatigue
CL Item
0 (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
10 (10)
Item
Weight loss
integer
C1262477 (UMLS CUI 2011AB)
89362005 (SNOMEDCT_2012_01_31)
10047895 (MedDRA 14.1)
MTHU020881 (LOINC Version 232)
783.21 (ICD-9-CM Version 2011)
E12228 (CTCAE 1105E)
Gewichtsverlust
Code List
Weight loss
CL Item
0 (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
10 (10)
Item
Bone pain
integer
C0151825 (UMLS CUI 2011AB)
12584003 (SNOMEDCT_2012_01_31)
10006002 (MedDRA 14.1)
MTHU020858 (LOINC Version 232)
E12392 (CTCAE 1105E)
Knochenschmerz
Code List
Bone pain
CL Item
0 (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
10 (10)
Item
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)
Pruritus
Code List
Pruritus
CL Item
0 (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
10 (10)
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