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Add-on R1

1 forms  
  1. StudyEvent: SE
    1. Add-on R1
Show identification of patient
Description

Show identification of patient

Patient
Description

Dummy item in ItemGroup 'Display patient'

Data type

text

Body dimensions
Description

Body dimensions

Body height
Description

Height

Data type

integer

Measurement units
  • cm
cm
Body weight
Description

Weight

Data type

float

Measurement units
  • kg
kg
Body surface area
Description

BSA

Data type

float

Measurement units
  • m²
m²
BSA calculated
Description

BSA calculated

Data type

float

Measurement units
  • m²
m²
Patient < 1 Year or < 10 kg
Description

Patient younger than 1 year or weight under 10 kg

Data type

integer

Add-on Kurs
Description

Add-on Kurs

Day 1 of this course
Description

Day 1 of course

Data type

date

Course no. (please read help text!)
Description

Number of course

Data type

integer

Delay?
Description

Verzögerung?

Data type

integer

Schedule deviation in this course
Description

Schedule deviation

Data type

integer

Zoledron acid
Description

Zoledronsäure

Data type

float

Measurement units
  • mg
mg
Dose Zoledron acid acc. to protocol
Description

Zoledron acid dose acc. to protocol

Data type

float

Measurement units
  • mg
mg
Concurrent radiotherapy
Description

Concurrent radiotherapy

Data type

integer

Schedule deviation CTC-Code
Description

Schedule deviation CTC-Code

Reason for schedule deviation
Description

Reason for schedule deviation CTC-code

Data type

integer

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Similar models

Add-on R1

1 forms
  1. StudyEvent: SE
    1. Add-on R1
Name
Type
Description | Question | Decode (Coded Value)
Data type
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?
integer
Course delay
Code List
Delay?
CL Item
No (0)
CL Item
Yes, due to toxicity of previous course (1)
CL Item
Yes, due to other reasons (2)
Item
Schedule deviation in this course
integer
NoYes
Code List
Schedule deviation in this course
CL Item
No (0)
CL Item
Yes (1)
Zoledronsäure
Item
Zoledron acid
float
Zoledron acid dose acc. to protocol
Item
Dose Zoledron acid acc. to protocol
float
Item
Concurrent radiotherapy
integer
NoYes
Code List
Concurrent radiotherapy
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)
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