ID

586

Description

AMC-076 Dysplasia Treatment Form (DYS) Infrared Coagulator Ablation or Observation in Preventing Anal Cancer in HIV-Positive Patients With Anal Neoplasia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A8216D81-B789-F026-E040-BB89AD436DD3

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A8216D81-B789-F026-E040-BB89AD436DD3

Keywords

Versions (3)
  1. 8/26/12 8/26/12 -
  2. 7/8/15 7/8/15 -
  3. 7/8/15 7/8/15 -
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August 26, 2012

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Creative Commons BY-NC 3.0 Legacy
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Anal Cancer NCT01164722 Treatment - AMC-076 Dysplasia Treatment Form (DYS) - 3253677v1.0

English

No Instruction available.

1 forms  
  1. StudyEvent: AMC-076 Dysplasia Treatment Form (DYS)
    1. No Instruction available.
Unnamed1
Description

Unnamed1

Visit number
Description

HospitalAdmissionOrdinalNumber

Data type

double

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C16696
UMLS 2011AA ObjectClass
C0019994
NCI Thesaurus Property
C25385
UMLS 2011AA Property
C0809949
Dysplasia Treatment
Description

Dysplasia Treatment

Was dysplasia present
Description

DysplasiaPresentInd-3

Data type

text

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus ObjectClass
C4086
UMLS 2011AA ObjectClass
C0334044
Was dysplasia treated
Description

DysplasiaTherapeuticProcedurePerformedInd-2

Data type

text

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus Property
C49236
UMLS 2011AA Property
C0087111
NCI Thesaurus ObjectClass
C4086
UMLS 2011AA ObjectClass
C0334044
Treatment date (If Yes, mm/dd/yyyy)
Description

DysplasiaTherapeuticProcedurePerformedDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus Property
C49236
UMLS 2011AA Property
C0087111
NCI Thesaurus ObjectClass
C4086
UMLS 2011AA ObjectClass
C0334044
Treatment location (If Yes,)
Description

MalignantAnalNeoplasmPrimarySite

Data type

text

Alias
NCI Thesaurus ValueDomain
C13717
UMLS 2011AA ValueDomain
C1515974
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus Property
C25251
UMLS 2011AA Property
C0205225
NCI Thesaurus ObjectClass
C7379
UMLS 2011AA ObjectClass
C0153446
Perianal lesions treated (If perianal, Check all that apply)
Description

DysplasiaTherapeuticProcedureExternalAnusPerformedType

Data type

text

Alias
NCI Thesaurus ObjectClass
C4086
UMLS 2011AA ObjectClass
C0334044
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus Property
C49236
UMLS 2011AA Property
C0087111
NCI Thesaurus Property
C43362
UMLS 2011AA Property
C0003461
NCI Thesaurus Property
C44280
UMLS 2011AA Property
C0205101
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Intraanal lesions treated (If intraanal, Check all that apply)
Description

DysplasiaTherapeuticProcedureInternalAnusPerformedType

Data type

text

Alias
NCI Thesaurus ObjectClass
C4086
UMLS 2011AA ObjectClass
C0334044
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus Property
C49236
UMLS 2011AA Property
C0087111
NCI Thesaurus Property
C43362
UMLS 2011AA Property
C0003461
NCI Thesaurus Property
C25234
UMLS 2011AA Property
C0205102
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Other, specify
Description

AnalDiseaseSymptomPresentSpecify

Data type

text

Alias
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus ObjectClass
C28048
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus Property
C4876
UMLS 2011AA Property
C1457887
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
Other, specify
Description

AnalDiseaseSymptomPresentSpecify

Data type

text

Alias
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus ObjectClass
C28048
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus Property
C4876
UMLS 2011AA Property
C1457887
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
Treatment method performed
Description

DysplasiaTherapeuticProcedurePerformedType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus Property
C49236
UMLS 2011AA Property
C0087111
NCI Thesaurus ObjectClass
C4086
UMLS 2011AA ObjectClass
C0334044
Percentage of perianal or intraanal area treated
Description

DysplasiaTherapeuticProcedurePercentageAnalNeoplasmPerformedType

Data type

text

Alias
NCI Thesaurus ObjectClass
C4086
UMLS 2011AA ObjectClass
C0334044
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus Property
C49236
UMLS 2011AA Property
C0087111
NCI Thesaurus Property
C25613
UMLS 2011AA Property
C0439165
NCI Thesaurus Property
C2877
UMLS 2011AA Property
C0003463
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Comments
Description

Comments

Comments
Description

ResearchCommentsText

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
UMLS 2011AA Property
C0282411
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Similar models

No Instruction available.

1 forms
  1. StudyEvent: AMC-076 Dysplasia Treatment Form (DYS)
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Unnamed1
HospitalAdmissionOrdinalNumber
Item
Visit number
double
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16696 (NCI Thesaurus ObjectClass)
C0019994 (UMLS 2011AA ObjectClass)
C25385 (NCI Thesaurus Property)
C0809949 (UMLS 2011AA Property)
Item Group
Dysplasia Treatment
Item
Was dysplasia present
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C4086 (NCI Thesaurus ObjectClass)
C0334044 (UMLS 2011AA ObjectClass)
CL.1
Code List
Was dysplasia present
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item
Was dysplasia treated
text
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C49236 (NCI Thesaurus Property)
C0087111 (UMLS 2011AA Property)
C4086 (NCI Thesaurus ObjectClass)
C0334044 (UMLS 2011AA ObjectClass)
CL.2
Code List
Was dysplasia treated
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
DysplasiaTherapeuticProcedurePerformedDate
Item
Treatment date (If Yes, mm/dd/yyyy)
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C49236 (NCI Thesaurus Property)
C0087111 (UMLS 2011AA Property)
C4086 (NCI Thesaurus ObjectClass)
C0334044 (UMLS 2011AA ObjectClass)
Item
Treatment location (If Yes,)
text
C13717 (NCI Thesaurus ValueDomain)
C1515974 (UMLS 2011AA ValueDomain)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C25251 (NCI Thesaurus Property)
C0205225 (UMLS 2011AA Property)
C7379 (NCI Thesaurus ObjectClass)
C0153446 (UMLS 2011AA ObjectClass)
CL.3
Code List
Treatment location (If Yes,)
CL Item
The Perianal Region (Perianal)
CL Item
The Intraanal Region (Intraanal)
Item
Perianal lesions treated (If perianal, Check all that apply)
text
C4086 (NCI Thesaurus ObjectClass)
C0334044 (UMLS 2011AA ObjectClass)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C49236 (NCI Thesaurus Property)
C0087111 (UMLS 2011AA Property)
C43362 (NCI Thesaurus Property)
C0003461 (UMLS 2011AA Property)
C44280 (NCI Thesaurus Property)
C0205101 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.4
Code List
Perianal lesions treated (If perianal, Check all that apply)
CL Item
High-grade Ain (High-grade AIN)
CL Item
Condyloma (Condyloma)
CL Item
Low-grade Ain (Low-grade AIN)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
Item
Intraanal lesions treated (If intraanal, Check all that apply)
text
C4086 (NCI Thesaurus ObjectClass)
C0334044 (UMLS 2011AA ObjectClass)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C49236 (NCI Thesaurus Property)
C0087111 (UMLS 2011AA Property)
C43362 (NCI Thesaurus Property)
C0003461 (UMLS 2011AA Property)
C25234 (NCI Thesaurus Property)
C0205102 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.5
Code List
Intraanal lesions treated (If intraanal, Check all that apply)
CL Item
Condyloma (Condyloma)
CL Item
Low-grade Flat Anal Intraepithelial Neoplasia (Low-grade flat AIN)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
AnalDiseaseSymptomPresentSpecify
Item
Other, specify
text
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C28048 (NCI Thesaurus ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C4876 (NCI Thesaurus Property)
C1457887 (UMLS 2011AA Property)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
AnalDiseaseSymptomPresentSpecify
Item
Other, specify
text
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C28048 (NCI Thesaurus ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C4876 (NCI Thesaurus Property)
C1457887 (UMLS 2011AA Property)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
Item
Treatment method performed
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C49236 (NCI Thesaurus Property)
C0087111 (UMLS 2011AA Property)
C4086 (NCI Thesaurus ObjectClass)
C0334044 (UMLS 2011AA ObjectClass)
CL.6
Code List
Treatment method performed
CL Item
Cauterization (Cautery)
C15199 (NCI Thesaurus)
C0007471 (UMLS 2011AA)
CL Item
Laser (Laser)
C16782 (NCI Thesaurus)
C0023089 (UMLS 2011AA)
CL Item
Infrared Photocoagulation Therapy (IRC)
C62730 (NCI Thesaurus)
C1328010 (UMLS 2011AA)
CL Item
Excision (Excision)
C15232 (NCI Thesaurus)
C0728940 (UMLS 2011AA)
CL Item
Cryotherapy (Cryotherapy)
C40030 (NCI Thesaurus)
C0010412 (UMLS 2011AA)
Item
Percentage of perianal or intraanal area treated
text
C4086 (NCI Thesaurus ObjectClass)
C0334044 (UMLS 2011AA ObjectClass)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C49236 (NCI Thesaurus Property)
C0087111 (UMLS 2011AA Property)
C25613 (NCI Thesaurus Property)
C0439165 (UMLS 2011AA Property)
C2877 (NCI Thesaurus Property)
C0003463 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.7
Code List
Percentage of perianal or intraanal area treated
CL Item
<= 5% (<= 5%)
CL Item
6-25% (6-25%)
CL Item
26-50% (26-50%)
CL Item
> 50% (> 50%)
Item Group
Comments
ResearchCommentsText
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0282411 (UMLS 2011AA Property)
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