ID

6247

Descripción

PRL1013 - Week 1 Recall Evaluation Form Postoperative Hypersensitivity Randomized Comparative Effectiveness Research Trial (POH RCERT) Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AA2ADCC9-4CDC-BB84-E040-BB89AD43774B

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AA2ADCC9-4CDC-BB84-E040-BB89AD43774B

Palabras clave

Versiones (3)
  1. 18/12/14 18/12/14 - Martin Dugas
  2. 9/1/15 9/1/15 - Martin Dugas
  3. 27/6/15 27/6/15 -
Subido en

18 de diciembre de 2014

DOI

Para solicitar uno, por favor iniciar sesión.

Licencia

Creative Commons BY-NC 3.0 Legacy
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Dental Caries NCT01268605 Follow-Up - PRL1013 - Week 1 Recall Evaluation Form - 3261066v1.0

Inglés

No Instruction available.

1 formularios  
  1. StudyEvent: PRL1013 - Week 1 Recall Evaluation Form
    1. No Instruction available.
Header
Descripción

Header

Site Code
Descripción

PractitionersEngagedinAppliedResearchandLearningNetworkClinicalStudySiteIdentifierNumber

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C15206
UMLS 2011AA ObjectClass
C0008972
NCI Thesaurus ObjectClass
C37901
UMLS 2011AA ObjectClass
C0205145
NCI Thesaurus ObjectClass
C52664
UMLS 2011AA ObjectClass
C1709628
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
Date of visit
Descripción

PatientDentistVisitDate

Tipo de datos

date

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C52654
UMLS 2011AA Property
C0011441
NCI Thesaurus Property
C25716
UMLS 2011AA Property
C0545082
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ValueDomain
C25367
Subject ID
Descripción

PatientCoordinatingIdentifierNumber

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25462
UMLS 2011AA Property
C0700114
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Subject Initials
Descripción

PatientInitialsName

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25536
UMLS 2011AA Property
C1555582
Treatment arm
Descripción

ProtocolTreatmentArmAssignmentType

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C15368
NCI Thesaurus ObjectClass
C42651
UMLS 2011AA ObjectClass
C0442711
NCI Thesaurus Property
C32141
UMLS 2011AA Property
C1140618
NCI Thesaurus Property
C25426
UMLS 2011AA Property
C1516050
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Unnamed1
Descripción

Unnamed1

Date of evaluation
Descripción

AssessmentPerformedDate

Tipo de datos

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C25367
NCI Thesaurus ValueDomain
C25367
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
Tooth quadrant
Descripción

ToothMouthQuadrantAnatomicSite

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C12506
UMLS 2011AA ObjectClass
C0040426
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus Property
C12421
UMLS 2011AA Property
C0226896
NCI Thesaurus Property
C61106
UMLS 2011AA Property
C1631280
NCI Thesaurus ValueDomain
C13717
UMLS 2011AA ValueDomain
C1515974
Air velocity
Descripción

DentalInstrumentationFollow-upAirSpeedDescriptionValue

Tipo de datos

double

Alias
NCI Thesaurus ObjectClass
C41136
UMLS 2011AA ObjectClass
C0226984
NCI Thesaurus ObjectClass
C16742
UMLS 2011AA ObjectClass
C0348000
NCI Thesaurus Property
C16033
UMLS 2011AA Property
C1522577
NCI Thesaurus Property
C25365
UMLS 2011AA Property
C0678257
NCI Thesaurus Property
C73434
UMLS 2011AA Property
C0001861
NCI Thesaurus Property
C41146
UMLS 2011AA Property
C0678536
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
Air stimulation pain level
Descripción

ToothSensitivityAirStimulationAssessmentScale

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C12506
UMLS 2011AA ObjectClass
C0040426
NCI Thesaurus ObjectClass
C25201
UMLS 2011AA ObjectClass
C1522640
NCI Thesaurus Property
C25367
NCI Thesaurus Property
C61406
UMLS 2011AA Property
C1948023
NCI Thesaurus Property
C73434
UMLS 2011AA Property
C0001861
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Does the pain linger >4 seconds (after removal of air blast)
Descripción

ToothRemainingColdSensitivityAssessmentInd-2

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C12506
UMLS 2011AA ObjectClass
C0040426
NCI Thesaurus Property
C25367
NCI Thesaurus Property
C25201
UMLS 2011AA Property
C1522640
NCI Thesaurus Property
C25649
UMLS 2011AA Property
C1527428
NCI Thesaurus Property
C62180
UMLS 2011AA Property
C0009264
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Cold stimulation pain level
Descripción

ToothSensitivityColdAssessmentScale

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C12506
UMLS 2011AA ObjectClass
C0040426
NCI Thesaurus ObjectClass
C25201
UMLS 2011AA ObjectClass
C1522640
NCI Thesaurus Property
C25367
NCI Thesaurus Property
C62180
UMLS 2011AA Property
C0009264
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Time to cold sensation (length of time from pellet application until subjet raises hand)
Descripción

ToothColdSensitivityAssessmentDuration

Tipo de datos

double

Unidades de medida
  • min
Alias
NCI Thesaurus ObjectClass
C12506
UMLS 2011AA ObjectClass
C0040426
NCI Thesaurus Property
C25367
NCI Thesaurus Property
C25201
UMLS 2011AA Property
C1522640
NCI Thesaurus Property
C62180
UMLS 2011AA Property
C0009264
NCI Thesaurus ValueDomain
C25330
UMLS 2011AA ValueDomain
C0449238
min
Does the pain linger > 4 seconds
Descripción

ToothRemainingHotSensitivityAssessmentInd-2

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C12506
UMLS 2011AA ObjectClass
C0040426
NCI Thesaurus Property
C25367
NCI Thesaurus Property
C25201
UMLS 2011AA Property
C1522640
NCI Thesaurus Property
C25649
UMLS 2011AA Property
C1527428
NCI Thesaurus Property
C62181
UMLS 2011AA Property
C2350229
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Unnamed3
Descripción

Unnamed3

Tooth quadrant
Descripción

ToothMouthQuadrantAnatomicSite

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C12506
UMLS 2011AA ObjectClass
C0040426
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus Property
C12421
UMLS 2011AA Property
C0226896
NCI Thesaurus Property
C61106
UMLS 2011AA Property
C1631280
NCI Thesaurus ValueDomain
C13717
UMLS 2011AA ValueDomain
C1515974
During chewing of food
Descripción

ToothSensitivityMasticationAssessmentInd-2

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C12506
UMLS 2011AA ObjectClass
C0040426
NCI Thesaurus ObjectClass
C25201
UMLS 2011AA ObjectClass
C1522640
NCI Thesaurus Property
C25367
NCI Thesaurus Property
C62062
UMLS 2011AA Property
C0024888
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
During clenching
Descripción

ToothSensitivityPressureAssessmentInd-2

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C12506
UMLS 2011AA ObjectClass
C0040426
NCI Thesaurus ObjectClass
C25201
UMLS 2011AA ObjectClass
C1522640
NCI Thesaurus Property
C25367
NCI Thesaurus Property
C25195
UMLS 2011AA Property
C0033095
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Did you check the occlusion on the treated tooth (If "Yes" to either of the above)
Descripción

DentalOcclusionEvaluationInd-2

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus Property
C25214
UMLS 2011AA Property
C0220825
NCI Thesaurus ObjectClass
C62301
UMLS 2011AA ObjectClass
C0011382
Did you adjust the occlusion (If "Yes")
Descripción

DentalOcclusionAdjustmentInd-2

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C62301
UMLS 2011AA ObjectClass
C0011382
NCI Thesaurus Property
C49157
UMLS 2011AA Property
C0456081
Rescue Treatment
Descripción

Rescue Treatment

Did the patient receive rescue treatment (since the last visit)
Descripción

RetreatmentAdministeredInd-2

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus Property
C25382
UMLS 2011AA Property
C1521801
NCI Thesaurus ObjectClass
C54055
UMLS 2011AA ObjectClass
C0376495
Tooth quadrant
Descripción

ToothMouthQuadrantAnatomicSite

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C12506
UMLS 2011AA ObjectClass
C0040426
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus Property
C12421
UMLS 2011AA Property
C0226896
NCI Thesaurus Property
C61106
UMLS 2011AA Property
C1631280
NCI Thesaurus ValueDomain
C13717
UMLS 2011AA ValueDomain
C1515974
Which rescue treatment was provided
Descripción

RetreatmentAdministeredType

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus Property
C25382
UMLS 2011AA Property
C1521801
NCI Thesaurus ObjectClass
C54055
UMLS 2011AA ObjectClass
C0376495
Date rescue treatment performed
Descripción

RetreatmentAdministeredDate

Tipo de datos

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus Property
C25382
UMLS 2011AA Property
C1521801
NCI Thesaurus ObjectClass
C54055
UMLS 2011AA ObjectClass
C0376495
Was the tooth evaluated for pulpitis
Descripción

RetreatmentToothPulpitisAssessmentInd-2

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C54055
UMLS 2011AA ObjectClass
C0376495
NCI Thesaurus Property
C25367
NCI Thesaurus Property
C12506
UMLS 2011AA Property
C0040426
NCI Thesaurus Property
C52595
UMLS 2011AA Property
C0034103
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Was there evidence of pulpitis (If "Yes")
Descripción

RetreatmentToothPulpitisPresentInd-2

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C54055
UMLS 2011AA ObjectClass
C0376495
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus Property
C12506
UMLS 2011AA Property
C0040426
NCI Thesaurus Property
C52595
UMLS 2011AA Property
C0034103
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Was endodontic therapy performed (If "Yes")
Descripción

RetreatmentEndodonticTreatmentPerformedInd-2

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus Property
C52575
UMLS 2011AA Property
C0700632
NCI Thesaurus ObjectClass
C54055
UMLS 2011AA ObjectClass
C0376495
Date of endodontic treatment (If "Yes")
Descripción

RetreatmentEndodonticTreatmentPerformedDate

Tipo de datos

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus Property
C52575
UMLS 2011AA Property
C0700632
NCI Thesaurus ObjectClass
C54055
UMLS 2011AA ObjectClass
C0376495
Economic Impact
Descripción

Economic Impact

How much time did it take the patient to travel to the dental office today
Descripción

PatientTravelDentalPhysicianOfficeDistanceDuration

Tipo de datos

text

Unidades de medida
  • min
Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass
C53462
UMLS 2011AA ObjectClass
C0040802
NCI Thesaurus Property
C41136
UMLS 2011AA Property
C0226984
NCI Thesaurus Property
C25167
UMLS 2011AA Property
C0012751
NCI Thesaurus Property
C16988
UMLS 2011AA Property
C0031834
NCI Thesaurus ValueDomain
C25330
UMLS 2011AA ValueDomain
C0449238
How much did it cost the patient to travel to the dental office today (including parking)
Descripción

PatientTravelDentalPhysicianOfficeCostValue

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass
C53462
UMLS 2011AA ObjectClass
C0040802
NCI Thesaurus Property
C41136
UMLS 2011AA Property
C0226984
NCI Thesaurus Property
C16988
UMLS 2011AA Property
C0031834
NCI Thesaurus Property
C69088
UMLS 2011AA Property
C0220812
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
NCI Thesaurus ValueDomain
C69088
UMLS 2011AA ValueDomain
C0220812
Did the patient have to take time away from work to come to the dental office to treat the hypersensitivity
Descripción

PatientEmploymentAbsentInd-2

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C48190
UMLS 2011AA Property
C0332197
NCI Thesaurus Property
C25172
UMLS 2011AA Property
C0014003
How much time did he/she take off (If "Yes")
Descripción

PatientEmploymentAbsentDuration

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C48190
UMLS 2011AA Property
C0332197
NCI Thesaurus Property
C25172
UMLS 2011AA Property
C0014003
NCI Thesaurus ValueDomain
C25330
UMLS 2011AA ValueDomain
C0449238
What is the total estimated cost for the rescue treatment if patient was not participating in the study
Descripción

RetreatmentAdministeredCostValue

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
NCI Thesaurus Property
C25382
UMLS 2011AA Property
C1521801
NCI Thesaurus ObjectClass
C54055
UMLS 2011AA ObjectClass
C0376495
NCI Thesaurus ValueDomain
C69088
UMLS 2011AA ValueDomain
C0220812
Footer Module
Descripción

Footer Module

Comments
Descripción

ResearchCommentsText

Tipo de datos

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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1 formularios
  1. StudyEvent: PRL1013 - Week 1 Recall Evaluation Form
    1. No Instruction available.
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
Header
PractitionersEngagedinAppliedResearchandLearningNetworkClinicalStudySiteIdentifierNumber
Item
Site Code
text
C15206 (NCI Thesaurus ObjectClass)
C0008972 (UMLS 2011AA ObjectClass)
C37901 (NCI Thesaurus ObjectClass)
C0205145 (UMLS 2011AA ObjectClass)
C52664 (NCI Thesaurus ObjectClass)
C1709628 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
PatientDentistVisitDate
Item
Date of visit
date
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C52654 (NCI Thesaurus Property)
C0011441 (UMLS 2011AA Property)
C25716 (NCI Thesaurus Property)
C0545082 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain)
PatientCoordinatingIdentifierNumber
Item
Subject ID
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25462 (NCI Thesaurus Property)
C0700114 (UMLS 2011AA Property)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
PatientInitialsName
Item
Subject Initials
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25536 (NCI Thesaurus Property)
C1555582 (UMLS 2011AA Property)
Item
Treatment arm
text
C15368 (NCI Thesaurus ObjectClass)
C42651 (NCI Thesaurus ObjectClass)
C0442711 (UMLS 2011AA ObjectClass)
C32141 (NCI Thesaurus Property)
C1140618 (UMLS 2011AA Property)
C25426 (NCI Thesaurus Property)
C1516050 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.1
Code List
Treatment arm
CL Item
Restoration With Rmgi (RR)
CL Item
Restoration With Dba (RD)
Item Group
Unnamed1
AssessmentPerformedDate
Item
Date of evaluation
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ObjectClass)
C25367 (NCI Thesaurus ValueDomain)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
Item
Tooth quadrant
text
C12506 (NCI Thesaurus ObjectClass)
C0040426 (UMLS 2011AA ObjectClass)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C12421 (NCI Thesaurus Property)
C0226896 (UMLS 2011AA Property)
C61106 (NCI Thesaurus Property)
C1631280 (UMLS 2011AA Property)
C13717 (NCI Thesaurus ValueDomain)
C1515974 (UMLS 2011AA ValueDomain)
CL.13
Code List
Tooth quadrant
CL Item
Lower Left Quadrant (Lower Left)
CL Item
Lower Right Quadrant (Lower Right)
CL Item
Upper Left Quadrant (Upper Left)
CL Item
Upper Right Quadrant (Upper Right)
DentalInstrumentationFollow-upAirSpeedDescriptionValue
Item
Air velocity
double
C41136 (NCI Thesaurus ObjectClass)
C0226984 (UMLS 2011AA ObjectClass)
C16742 (NCI Thesaurus ObjectClass)
C0348000 (UMLS 2011AA ObjectClass)
C16033 (NCI Thesaurus Property)
C1522577 (UMLS 2011AA Property)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
C73434 (NCI Thesaurus Property)
C0001861 (UMLS 2011AA Property)
C41146 (NCI Thesaurus Property)
C0678536 (UMLS 2011AA Property)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
Item
Air stimulation pain level
text
C12506 (NCI Thesaurus ObjectClass)
C0040426 (UMLS 2011AA ObjectClass)
C25201 (NCI Thesaurus ObjectClass)
C1522640 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C61406 (NCI Thesaurus Property)
C1948023 (UMLS 2011AA Property)
C73434 (NCI Thesaurus Property)
C0001861 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.3
Code List
Air stimulation pain level
CL Item
0 (0)
C0919414 (NCI Metathesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
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
Does the pain linger >4 seconds (after removal of air blast)
text
C12506 (NCI Thesaurus ObjectClass)
C0040426 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C25201 (NCI Thesaurus Property)
C1522640 (UMLS 2011AA Property)
C25649 (NCI Thesaurus Property)
C1527428 (UMLS 2011AA Property)
C62180 (NCI Thesaurus Property)
C0009264 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
CL.4
Code List
Does the pain linger >4 seconds (after removal of air blast)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item
Cold stimulation pain level
text
C12506 (NCI Thesaurus ObjectClass)
C0040426 (UMLS 2011AA ObjectClass)
C25201 (NCI Thesaurus ObjectClass)
C1522640 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C62180 (NCI Thesaurus Property)
C0009264 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.5
Code List
Cold stimulation pain level
CL Item
0 (0)
C0919414 (NCI Metathesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
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)
ToothColdSensitivityAssessmentDuration
Item
Time to cold sensation (length of time from pellet application until subjet raises hand)
double
C12506 (NCI Thesaurus ObjectClass)
C0040426 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C25201 (NCI Thesaurus Property)
C1522640 (UMLS 2011AA Property)
C62180 (NCI Thesaurus Property)
C0009264 (UMLS 2011AA Property)
C25330 (NCI Thesaurus ValueDomain)
C0449238 (UMLS 2011AA ValueDomain)
Item
Does the pain linger > 4 seconds
text
C12506 (NCI Thesaurus ObjectClass)
C0040426 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C25201 (NCI Thesaurus Property)
C1522640 (UMLS 2011AA Property)
C25649 (NCI Thesaurus Property)
C1527428 (UMLS 2011AA Property)
C62181 (NCI Thesaurus Property)
C2350229 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
CL.6
Code List
Does the pain linger > 4 seconds
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item Group
Unnamed3
Item
Tooth quadrant
text
C12506 (NCI Thesaurus ObjectClass)
C0040426 (UMLS 2011AA ObjectClass)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C12421 (NCI Thesaurus Property)
C0226896 (UMLS 2011AA Property)
C61106 (NCI Thesaurus Property)
C1631280 (UMLS 2011AA Property)
C13717 (NCI Thesaurus ValueDomain)
C1515974 (UMLS 2011AA ValueDomain)
CL.13
Code List
Tooth quadrant
CL Item
Lower Left Quadrant (Lower Left)
CL Item
Lower Right Quadrant (Lower Right)
CL Item
Upper Left Quadrant (Upper Left)
CL Item
Upper Right Quadrant (Upper Right)
Item
During chewing of food
text
C12506 (NCI Thesaurus ObjectClass)
C0040426 (UMLS 2011AA ObjectClass)
C25201 (NCI Thesaurus ObjectClass)
C1522640 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C62062 (NCI Thesaurus Property)
C0024888 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
CL.8
Code List
During chewing of food
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item
During clenching
text
C12506 (NCI Thesaurus ObjectClass)
C0040426 (UMLS 2011AA ObjectClass)
C25201 (NCI Thesaurus ObjectClass)
C1522640 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C25195 (NCI Thesaurus Property)
C0033095 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
CL.9
Code List
During clenching
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item
Did you check the occlusion on the treated tooth (If "Yes" to either of the above)
text
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C25214 (NCI Thesaurus Property)
C0220825 (UMLS 2011AA Property)
C62301 (NCI Thesaurus ObjectClass)
C0011382 (UMLS 2011AA ObjectClass)
CL.10
Code List
Did you check the occlusion on the treated tooth (If "Yes" to either of the above)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item
Did you adjust the occlusion (If "Yes")
text
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C62301 (NCI Thesaurus ObjectClass)
C0011382 (UMLS 2011AA ObjectClass)
C49157 (NCI Thesaurus Property)
C0456081 (UMLS 2011AA Property)
CL.11
Code List
Did you adjust the occlusion (If "Yes")
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item Group
Rescue Treatment
Item
Did the patient receive rescue treatment (since the last visit)
text
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C54055 (NCI Thesaurus ObjectClass)
C0376495 (UMLS 2011AA ObjectClass)
CL.12
Code List
Did the patient receive rescue treatment (since the last visit)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item
Tooth quadrant
text
C12506 (NCI Thesaurus ObjectClass)
C0040426 (UMLS 2011AA ObjectClass)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C12421 (NCI Thesaurus Property)
C0226896 (UMLS 2011AA Property)
C61106 (NCI Thesaurus Property)
C1631280 (UMLS 2011AA Property)
C13717 (NCI Thesaurus ValueDomain)
C1515974 (UMLS 2011AA ValueDomain)
CL.13
Code List
Tooth quadrant
CL Item
Lower Left Quadrant (Lower Left)
CL Item
Lower Right Quadrant (Lower Right)
CL Item
Upper Left Quadrant (Upper Left)
CL Item
Upper Right Quadrant (Upper Right)
Item
Which rescue treatment was provided
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C54055 (NCI Thesaurus ObjectClass)
C0376495 (UMLS 2011AA ObjectClass)
CL.14
Code List
Which rescue treatment was provided
CL Item
Dental Bonding Agent Dental Liner (Liner+DBA)
C42795 (NCI Thesaurus)
C1707677 (UMLS 2011AA)
C62092 (NCI Thesaurus)
C1880280 (UMLS 2011AA)
CL Item
Dental Bonding Agent (DBA alone)
C62092 (NCI Thesaurus)
C1880280 (UMLS 2011AA)
CL Item
Not Applicable (N/A)
C48660 (NCI Thesaurus)
C1272460 (UMLS 2011AA)
RetreatmentAdministeredDate
Item
Date rescue treatment performed
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C54055 (NCI Thesaurus ObjectClass)
C0376495 (UMLS 2011AA ObjectClass)
Item
Was the tooth evaluated for pulpitis
text
C54055 (NCI Thesaurus ObjectClass)
C0376495 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C12506 (NCI Thesaurus Property)
C0040426 (UMLS 2011AA Property)
C52595 (NCI Thesaurus Property)
C0034103 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
CL.15
Code List
Was the tooth evaluated for pulpitis
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item
Was there evidence of pulpitis (If "Yes")
text
C54055 (NCI Thesaurus ObjectClass)
C0376495 (UMLS 2011AA ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C12506 (NCI Thesaurus Property)
C0040426 (UMLS 2011AA Property)
C52595 (NCI Thesaurus Property)
C0034103 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
CL.16
Code List
Was there evidence of pulpitis (If "Yes")
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item
Was endodontic therapy performed (If "Yes")
text
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C52575 (NCI Thesaurus Property)
C0700632 (UMLS 2011AA Property)
C54055 (NCI Thesaurus ObjectClass)
C0376495 (UMLS 2011AA ObjectClass)
CL.17
Code List
Was endodontic therapy performed (If "Yes")
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
RetreatmentEndodonticTreatmentPerformedDate
Item
Date of endodontic treatment (If "Yes")
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C52575 (NCI Thesaurus Property)
C0700632 (UMLS 2011AA Property)
C54055 (NCI Thesaurus ObjectClass)
C0376495 (UMLS 2011AA ObjectClass)
Item Group
Economic Impact
Item
How much time did it take the patient to travel to the dental office today
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C53462 (NCI Thesaurus ObjectClass)
C0040802 (UMLS 2011AA ObjectClass)
C41136 (NCI Thesaurus Property)
C0226984 (UMLS 2011AA Property)
C25167 (NCI Thesaurus Property)
C0012751 (UMLS 2011AA Property)
C16988 (NCI Thesaurus Property)
C0031834 (UMLS 2011AA Property)
C25330 (NCI Thesaurus ValueDomain)
C0449238 (UMLS 2011AA ValueDomain)
CL.18
Code List
How much time did it take the patient to travel to the dental office today
CL Item
0-15 Minutes (0-15 minutes)
CL Item
16-30 Minutes (16-30 minutes)
CL Item
31-60 Minutes (31-60 minutes)
CL Item
61-90 Minutes (61-90 minutes)
CL Item
91-120 Minutes (91-120 minutes)
CL Item
More Than 120 Minutes (More than 120 minutes)
Item
How much did it cost the patient to travel to the dental office today (including parking)
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C53462 (NCI Thesaurus ObjectClass)
C0040802 (UMLS 2011AA ObjectClass)
C41136 (NCI Thesaurus Property)
C0226984 (UMLS 2011AA Property)
C16988 (NCI Thesaurus Property)
C0031834 (UMLS 2011AA Property)
C69088 (NCI Thesaurus Property)
C0220812 (UMLS 2011AA Property)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C69088 (NCI Thesaurus ValueDomain)
C0220812 (UMLS 2011AA ValueDomain)
CL.19
Code List
How much did it cost the patient to travel to the dental office today (including parking)
CL Item
$0-10 ($0-10)
CL Item
$11-20 ($11-20)
CL Item
$21-30 ($21-30)
CL Item
More Than $30 (More than $30)
Item
Did the patient have to take time away from work to come to the dental office to treat the hypersensitivity
text
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C48190 (NCI Thesaurus Property)
C0332197 (UMLS 2011AA Property)
C25172 (NCI Thesaurus Property)
C0014003 (UMLS 2011AA Property)
CL.20
Code List
Did the patient have to take time away from work to come to the dental office to treat the hypersensitivity
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item
How much time did he/she take off (If "Yes")
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C48190 (NCI Thesaurus Property)
C0332197 (UMLS 2011AA Property)
C25172 (NCI Thesaurus Property)
C0014003 (UMLS 2011AA Property)
C25330 (NCI Thesaurus ValueDomain)
C0449238 (UMLS 2011AA ValueDomain)
CL.21
Code List
How much time did he/she take off (If "Yes")
CL Item
0-30 Minutes (0-30 minutes)
CL Item
1-2 Hours (1-2 hours)
CL Item
2-3 Hours (2-3 hours)
CL Item
3-4 Hours (3-4 hours)
CL Item
31-60 Minutes (31-60 minutes)
CL Item
More Than 4 Hours (More than 4 hours)
Item
What is the total estimated cost for the rescue treatment if patient was not participating in the study
text
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C54055 (NCI Thesaurus ObjectClass)
C0376495 (UMLS 2011AA ObjectClass)
C69088 (NCI Thesaurus ValueDomain)
C0220812 (UMLS 2011AA ValueDomain)
CL.22
Code List
What is the total estimated cost for the rescue treatment if patient was not participating in the study
CL Item
$0-50 ($0-50)
CL Item
$101-150 ($101-150)
CL Item
$151-200 ($151-200)
CL Item
$201-250 ($201-250)
CL Item
$51-100 ($51-100)
CL Item
More Than $250 (More than $250)
Item Group
Footer Module
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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