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VAI and/or VAC Courses

1 Formulare  
Show identification of patient
Beschreibung

Show identification of patient

Patient
Beschreibung

Dummy item in ItemGroup 'Display patient'

Datentyp

text

Body dimensions
Beschreibung

Body dimensions

Body height
Beschreibung

Height

Datentyp

integer

Maßeinheiten
  • cm
cm
Body weight
Beschreibung

Weight

Datentyp

float

Maßeinheiten
  • kg
kg
Body surface area
Beschreibung

BSA

Datentyp

float

Maßeinheiten
  • m²
m²
BSA calculated
Beschreibung

BSA calculated

Datentyp

float

Maßeinheiten
  • m²
m²
Patient < 1 Year or < 10 kg
Beschreibung

Patient younger than 1 year or weight under 10 kg

Datentyp

integer

VAI/VAC course
Beschreibung

VAI/VAC course

Day 1 of this course
Beschreibung

Day 1 of course

Datentyp

date

Course no. (please read help text!)
Beschreibung

Number of course

Datentyp

integer

Delay >5 days
Beschreibung

Delay of course > 5 days

Datentyp

integer

Concurrent radiotherapy
Beschreibung

Concurrent radiotherapy

Datentyp

integer

VAI or VAC
Beschreibung

This course is VAI or VAC?

Datentyp

integer

Schedule deviation in this course
Beschreibung

Schedule deviation

Datentyp

integer

Schedule deviation CTC-Code
Beschreibung

Schedule deviation CTC-Code

Reason for schedule deviation
Beschreibung

Reason for schedule deviation CTC-code

Datentyp

integer

Adminstration of VAI or VAC chemotherapy
Beschreibung

Adminstration of VAI or VAC chemotherapy

Vincristine (VCR) cumulative dose per course
Beschreibung

VCR cumulative dose per course

Datentyp

float

Maßeinheiten
  • mg
mg
Vincristine (VCR) cumulative dose per course acc. to protocol
Beschreibung

VCR cumulative dose per course according to protocol

Datentyp

float

Maßeinheiten
  • mg
mg
Actinomycin D (ACT) cumulative dose per course
Beschreibung

ACT cumulative dose per course

Datentyp

float

Maßeinheiten
  • mg
mg
Actinomycin D (ACT) cumulative dose per course acc. to protocol
Beschreibung

ACT cumulative dose per course according to protocol

Datentyp

float

Maßeinheiten
  • mg
mg
Ifosfamide (IFO) cumulative dose per course
Beschreibung

IFO cumulative dose per course

Datentyp

integer

Maßeinheiten
  • mg
mg
Ifosfamide (IFO) cumulative dose per course acc. to protocol
Beschreibung

IFO cumulative dose per course according to protocol

Datentyp

integer

Maßeinheiten
  • mg
mg
Cyclophosphamide (CYC) cumulative dose per course
Beschreibung

CYC cumulative dose per course

Datentyp

integer

Maßeinheiten
  • mg
mg
Cyclophosphamide (CYC) cumulative dose per course acc. to protocol
Beschreibung

CYC cumulative dose per course acc. to protocol

Datentyp

integer

Maßeinheiten
  • mg
mg
Other cytotoxic drug
Beschreibung

Other cytotoxic drug administered

Datentyp

integer

Other cytotoxic drug
Beschreibung

Other cytotoxic drug

Generic drug name
Beschreibung

Generic Name

Datentyp

text

Other generic, specifiy
Beschreibung

Generic name specified

Datentyp

text

Cumulative dose per course
Beschreibung

Other drug cumulative dose per course

Datentyp

float

Maßeinheiten
  • mg
mg
Supportive drug treatment
Beschreibung

Supportive drug treatment

G-CSF/GM-CSF
Beschreibung

G-CSF/GM-CSF verabreicht

Datentyp

integer

Other cytokine treatment (e.g. EPO)
Beschreibung

Other cytokine treatment

Datentyp

integer

Other cytokine spcified
Beschreibung

Other cytokine spcified

Datentyp

text

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Ähnliche Modelle

VAI and/or VAC Courses

1 Formulare
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Dummy item in ItemGroup 'Display patient'
Item
Patient
text
Height
Item
Body height
integer
Weight
Item
Body weight
float
BSA
Item
Body surface area
float
BSA calculated
Item
BSA calculated
float
Item
Patient < 1 Year or < 10 kg
integer
NoYes
Code List
Patient < 1 Year or < 10 kg
CL Item
No (0)
CL Item
Yes (1)
Item Group
Day 1 of course
Item
Day 1 of this course
date
Number of course
Item
Course no. (please read help text!)
integer
Item
Delay >5 days
integer
Course delay
Code List
Delay >5 days
CL Item
No (0)
CL Item
Yes, due to toxicity of previous course (1)
CL Item
Yes, due to other reasons (2)
Item
Concurrent radiotherapy
integer
NoYes
Code List
Concurrent radiotherapy
CL Item
No (0)
CL Item
Yes (1)
Item
VAI or VAC
integer
VAC or VAI
Code List
VAI or VAC
CL Item
VAI (1)
CL Item
VAC (2)
Item
Schedule deviation in this course
integer
NoYes
Code List
Schedule deviation in this course
CL Item
No (0)
CL Item
Yes (1)
Item
Reason for schedule deviation
integer
CTC code
Code List
Reason for schedule deviation
CL Item
General condition (1)
CL Item
Tox. Haemoglobin (11)
CL Item
Tox. WBC (12)
CL Item
Tox. Granulocytes (13)
CL Item
Tox. Platelets (14)
CL Item
Tox. Infection (21)
CL Item
Tox. Fever (22)
CL Item
Tox. Stomatitis (31)
CL Item
Tox. Vomiting (32)
CL Item
Tox. Diarrhoea (33)
CL Item
Tox. Changes in the skin (40)
CL Item
Tox. Creatinine (51)
CL Item
Tox. Proteinuria (52)
CL Item
Tox. Haematuria (53)
CL Item
Tox. Glomerular filtration rate (GFR) (54)
CL Item
Tox. Tubular phosphate reabsorption (55)
CL Item
Tox. Bilirubin (61)
CL Item
Tox. SGOT/SGPT (62)
CL Item
Tox. Cardiac function (71)
CL Item
Tox. ECHO: LV-SF (72)
CL Item
Tox. Central neurotoxicity (81)
CL Item
Tox. Peripheral neurotoxicity (82)
CL Item
Tox. Other toxicity (90)
CL Item
Techical problems (93)
CL Item
Planning problems (94)
CL Item
Patients'/Parents' refusal (95)
CL Item
To little weight/to young (96)
CL Item
Mistake (97)
CL Item
Mobilisation course (98)
CL Item
Radiotherapy (99)
CL Item
Problem of medication (0)
CL Item
Post transplantation course (102)
CL Item
Physician choice/clinical decision (use only if not related to another “good” reason that has it’s own code) (103)
CL Item
Post amputation (104)
VCR cumulative dose per course
Item
Vincristine (VCR) cumulative dose per course
float
VCR cumulative dose per course according to protocol
Item
Vincristine (VCR) cumulative dose per course acc. to protocol
float
ACT cumulative dose per course
Item
Actinomycin D (ACT) cumulative dose per course
float
ACT cumulative dose per course according to protocol
Item
Actinomycin D (ACT) cumulative dose per course acc. to protocol
float
IFO cumulative dose per course
Item
Ifosfamide (IFO) cumulative dose per course
integer
IFO cumulative dose per course according to protocol
Item
Ifosfamide (IFO) cumulative dose per course acc. to protocol
integer
CYC cumulative dose per course
Item
Cyclophosphamide (CYC) cumulative dose per course
integer
CYC cumulative dose per course acc. to protocol
Item
Cyclophosphamide (CYC) cumulative dose per course acc. to protocol
integer
Item
Other cytotoxic drug
integer
NoYes
Code List
Other cytotoxic drug
CL Item
No (0)
CL Item
Yes (1)
Item
Generic drug name
text
Generic Name
Code List
Generic drug name
CL Item
Aclarubicin (1)
CL Item
Actinomycin D (Dactinomycin) (3)
CL Item
Alemtuzumab (62)
CL Item
Amsacrine (Acridinyl, Anisidide, m-AMSA, AMSA, Amsidyl) (4)
CL Item
Antibody 14G2a (14G2a)
CL Item
Antibody ch14.18 (CH1418)
CL Item
Antithymozyten globuline (ATG)
CL Item
Asparaginase (L-asparaginase, Colaspase, L-ASP, Crasnitin, Elspar) (6)
CL Item
Azacytidine (12)
CL Item
Beclomethasone (BEC)
CL Item
Bleomycin (14)
CL Item
Budesonide (59)
CL Item
Busulfan (Busulphan, Busulfanum, Myelosan, BSF) (15)
CL Item
Carboplatin (CBDCA, JM8, NSC 241240) (16)
CL Item
Carmustine (BCNU, 1,3-bis(2-chloroethyl)-l-nitrosourea) (13)
CL Item
Chlorambucil (Chlorambucilum, NSC-3088, WR-139013, Chlorbutinum) (19)
CL Item
Ciclosporin (Cyclosporin) (21)
CL Item
Cisplatin, (Cis-platinum, cis-diamminedichloroplatinum, CDDP, DDP, CIS, Platinum) (22)
CL Item
Cladribine (CdA, 2-CdA, 2-chloro-2'-deoxyadenosine, NSC-105014-F) (18)
CL Item
Coli Asparaginase (9)
CL Item
Dexamethasone (23)
CL Item
Co-trimoxazol (93)
CL Item
Cyclophosphamide (Cyclo, CPA, CPM, CTX, CYC, CYT) (20)
CL Item
Cytarabine (Cytosine Arabinoside, Ara-C, Arabinosylcytosine) (5)
CL Item
Dacarbazine (DIC, Imidazole carboxamide, dimethyl-triazeno-imidazole-carboxamide) (26)
CL Item
Daunorubicin (daunomycin, DNR, rubidomycin) (24)
CL Item
Daunoxome (56)
CL Item
Doxorubicin (Adriamycin, Hydroxyl daunorubicin, Dox, Adria) (25)
CL Item
Epirubicin (4'-epi-doxorubicin, NSC-256942, IMI28, epi DX) (27)
CL Item
Epoetin alfa (Erythropoetin) (ERYPOa)
CL Item
Epoetin beta (Erythropoetin) (ERYPOb)
CL Item
Erwinia-Asparaginase (NSC-106977, Porton Asparaginase) (10)
CL Item
Etanercept (ETAN)
CL Item
Etoposide (VP-16, VP-16-213, EPEG, EPE, epipodophyllotoxin) (55)
CL Item
Fludarabine (2-F-ara-AMP, FAMP, NSC-312887, Fludarabine phosphate) (28)
CL Item
Fluorouracil (5-Fluorouracil, 5FU) (29)
CL Item
Folinic Acid (LV, calcium leucovorin, calcium folinate, citrovorum factor) (37)
CL Item
G-CSF (30)
CL Item
GM-CSF (31)
CL Item
Hydrocortisone (94)
CL Item
Hydroxyurea (32)
CL Item
Idarubicin (33)
CL Item
Ifosfamide (36)
CL Item
Imatinib (STI571)
CL Item
Immunglobuline (human) (60)
CL Item
Interferon ALPHA (34)
CL Item
Interferon GAMMA (35)
CL Item
Interleukin 1 (IL1)
CL Item
Interleukin 12 (IL12)
CL Item
Interleukin 13 (IL13)
CL Item
Interleukin 2 (IL2)
CL Item
Interleukin 3 (IL3)
CL Item
Interleukin 4 (IL4)
CL Item
Interleukin 6 (IL6)
CL Item
Interleukin 7 (IL7)
CL Item
Interleukin 8 (IL8)
CL Item
Lomustine (17)
CL Item
Mechlorethamine (38)
CL Item
Melphalan (39)
CL Item
Mitomycin (MIT)
CL Item
Monoclonal AB (MonoAB)
CL Item
Muromonab (OKT3)
CL Item
Mycophenolat (MMF)
CL Item
Mesna (40)
CL Item
Mitoxantrone (42)
CL Item
Mercaptopurine (43)
CL Item
Methotrexate (44)
CL Item
Nimustine (2)
CL Item
Paclitaxel (47)
CL Item
PEG-ASP (11)
CL Item
Prednisone (45)
CL Item
Procarbazine (46)
CL Item
Rasburicase (57)
CL Item
Rituximab (58)
CL Item
Tacrolimus (FK506)
CL Item
Teniposid (54)
CL Item
Thiotepa (48)
CL Item
Tioguanine (49)
CL Item
Topotecan (TOPO)
CL Item
Treosulfan (61)
CL Item
Tretinoin (ATRA) (ATRA)
CL Item
Trofosfamide (50)
CL Item
Vinblastine (51)
CL Item
Vincristine (52)
CL Item
Vindesine (53)
CL Item
Other (999)
Generic name specified
Item
Other generic, specifiy
text
Other drug cumulative dose per course
Item
Cumulative dose per course
float
Item
G-CSF/GM-CSF
integer
NoYes
Code List
G-CSF/GM-CSF
CL Item
No (0)
CL Item
Yes (1)
Item
Other cytokine treatment (e.g. EPO)
integer
NoYes
Code List
Other cytokine treatment (e.g. EPO)
CL Item
No (0)
CL Item
Yes (1)
Other cytokine spcified
Item
Other cytokine spcified
text
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