ID

6324

Descrição

ECOG Leukemia Cytogenetics Report Form Combination Chemotherapy With or Without Monoclonal Antibody Therapy Followed by Stem Cell Transplant in Treating Patients With Acute Myeloid Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A727E3BC-7882-2F82-E034-0003BA0B1A09

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A727E3BC-7882-2F82-E034-0003BA0B1A09

Palavras-chave

Versões (3)
  1. 18/12/2014 18/12/2014 - Martin Dugas
  2. 02/06/2015 02/06/2015 -
  3. 03/06/2015 03/06/2015 -
Transferido a

18 de dezembro de 2014

DOI

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Licença

Creative Commons BY-NC 3.0 Legacy
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NCT00049517 Pathology - ECOG Leukemia Cytogenetics Report Form - 2053765v3.0

Inglês

No Instruction available.

1 Formulários  
  1. StudyEvent: ECOG Leukemia Cytogenetics Report Form
    1. No Instruction available.
Unnamed1
Descrição

Unnamed1

Cytogeneticist
Descrição

CytogeneticsIdentifier

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ObjectClass
C16487
UMLS 2011AA ObjectClass
C0010802
Phone No.
Descrição

PhoneNumber

Tipo de dados

double

Patient's Name
Descrição

Patient'sName

Tipo de dados

text

ECOG Protocol No.
Descrição

ECOGProtocolNo.

Tipo de dados

text

ECOG Protocol No.
Descrição

ECOGProtocolNo.

Tipo de dados

text

ECOG Patient Seq. No.
Descrição

ECOGPatientID

Tipo de dados

text

ECOG Patient Seq. No.
Descrição

ECOGPatientID

Tipo de dados

text

Participating Group Prot. No.
Descrição

ParticipatingGroupProtocolNo.

Tipo de dados

text

Participating Group Patient ID no.
Descrição

ParticipatingGroupPatientID

Tipo de dados

text

Group
Descrição

ParticipatingGroupName

Tipo de dados

text

Institution
Descrição

InstitutionName

Tipo de dados

text

Step No.
Descrição

StepNo.

Tipo de dados

text

Affiliate
Descrição

AffiliateName

Tipo de dados

text

Unnamed2
Descrição

Unnamed2

Date sample obtained
Descrição

Datesampleobtained

Tipo de dados

text

Is Extra material stored?
Descrição

SpecimenRemainingStorageInd-3

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass
C19157
UMLS 2011AA ObjectClass
C0370003
NCI Thesaurus Property
C25649
UMLS 2011AA Property
C1527428
NCI Thesaurus Property
C60824
UMLS 2011AA Property
C1698986
If yes, specify type (extra material)
Descrição

SpecimenRemainingStorageName

Tipo de dados

text

Alias
NCI Thesaurus ObjectClass
C19157
UMLS 2011AA ObjectClass
C0370003
NCI Thesaurus ValueDomain
C42614
UMLS 2011AA ValueDomain
C0027365
NCI Thesaurus Property
C25649
UMLS 2011AA Property
C1527428
NCI Thesaurus Property
C60824
UMLS 2011AA Property
C1698986
Number Of Metaphases
Descrição

Number Of Metaphases

Bone Marrow, unsimulated short-term culture (metaphases)
Descrição

BoneMarrowMetaphasePresentNumber

Tipo de dados

double

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus ObjectClass
C12431
UMLS 2011AA ObjectClass
C0005953
NCI Thesaurus ObjectClass
C16846
UMLS 2011AA ObjectClass
C0025564
Bone Marrow, direct preparation (metaphases)
Descrição

BoneMarrowDirectMetaphasePresentNumber

Tipo de dados

double

Alias
NCI Thesaurus ObjectClass
C12431
UMLS 2011AA ObjectClass
C0005953
NCI Thesaurus ObjectClass
C16846
UMLS 2011AA ObjectClass
C0025564
NCI Metathesaurus ObjectClass
C0439851
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
Bone Marrow, Stimulated Culture (metaphases)
Descrição

BoneMarrowCultureMetaphasePresentNumber

Tipo de dados

double

Alias
NCI Thesaurus ObjectClass
C12431
UMLS 2011AA ObjectClass
C0005953
NCI Thesaurus ObjectClass
C16478
UMLS 2011AA ObjectClass
C0010453
NCI Thesaurus ObjectClass
C16846
UMLS 2011AA ObjectClass
C0025564
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
Bone Marrow, Stimulated Culture, Specify mitogen (metaphases)
Descrição

BoneMarrowCultureMitogenDescriptionText

Tipo de dados

text

Alias
NCI Thesaurus ObjectClass
C12431
UMLS 2011AA ObjectClass
C0005953
NCI Thesaurus ObjectClass
C16478
UMLS 2011AA ObjectClass
C0010453
NCI Thesaurus ObjectClass
C660
UMLS 2011AA ObjectClass
C0026249
NCI Thesaurus Property
C25365
UMLS 2011AA Property
C0678257
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
Bone Marrow, Other Specify (metaphases)
Descrição

BoneMarrowCultureMethodText

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus Property
C16847
UMLS 2011AA Property
C0449851
NCI Thesaurus ObjectClass
C12431
UMLS 2011AA ObjectClass
C0005953
NCI Thesaurus ObjectClass
C16478
UMLS 2011AA ObjectClass
C0010453
Bone Marrow, Other Specify (metaphases)
Descrição

BoneMarrowCultureMethodText

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus Property
C16847
UMLS 2011AA Property
C0449851
NCI Thesaurus ObjectClass
C12431
UMLS 2011AA ObjectClass
C0005953
NCI Thesaurus ObjectClass
C16478
UMLS 2011AA ObjectClass
C0010453
Peripheral Blood, unsimulated short-term culture (metaphases)
Descrição

PeripheralBloodMetaphasePresentNumber

Tipo de dados

double

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Metathesaurus ObjectClass
C0229664
NCI Thesaurus ObjectClass
C16846
UMLS 2011AA ObjectClass
C0025564
Peripheral Bood, direct preparation (metaphases)
Descrição

PeripheralBood,directpreparation(metaphases)

Tipo de dados

text

Peripheral Bood, Stimulated Culture (metaphases)
Descrição

PeripheralBoodCultureMetaphasePresentNumber

Tipo de dados

double

Alias
NCI Metathesaurus ObjectClass
C0229664
NCI Thesaurus ObjectClass
C16478
UMLS 2011AA ObjectClass
C0010453
NCI Thesaurus ObjectClass
C16846
UMLS 2011AA ObjectClass
C0025564
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
Peripheral Bood, Stimulated Culture, Specify mitogen (metaphases)
Descrição

PeripheralBoodCultureMitogenDescriptionText

Tipo de dados

text

Alias
NCI Metathesaurus ObjectClass
C0229664
NCI Thesaurus ObjectClass
C16478
UMLS 2011AA ObjectClass
C0010453
NCI Thesaurus ObjectClass
C660
UMLS 2011AA ObjectClass
C0026249
NCI Thesaurus Property
C25365
UMLS 2011AA Property
C0678257
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
Peripheral Bood, Other Specify (metaphases)
Descrição

PeripheralBood,OtherSpecify(metaphases)

Tipo de dados

text

Peripheral Bood, Other Specify (metaphases)
Descrição

PeripheralBood,OtherSpecify(metaphases)

Tipo de dados

text

Total Metaphases Analyzed
Descrição

TotalMetaphasesAnalyzed

Tipo de dados

double

Number of Abnormal Metaphases
Descrição

NumberofAbnormalMetaphases

Tipo de dados

double

Number of Karotype Preparations
Descrição

KaryotypeCount

Tipo de dados

double

Are results adequate for banded analysis?
Descrição

MetaphaseAnalysisInd-3

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus Property
C25391
UMLS 2011AA Property
C0936012
NCI Thesaurus ObjectClass
C16846
UMLS 2011AA ObjectClass
C0025564
Were FISH studies done?
Descrição

FISHInd

Tipo de dados

text

If yes, specify probes (FISH)
Descrição

FISHProbe

Tipo de dados

text

Total Interphase nuclei
Descrição

Interphases,TotalNuclei

Tipo de dados

double

Total abnormal interphases
Descrição

Interphases,Abnormal

Tipo de dados

double

Total metaphases
Descrição

FISHMetaphases,Total

Tipo de dados

double

Total abnormal metaphases
Descrição

FISHMetaphases,Abnormal

Tipo de dados

double

Complete karyotype description.
Descrição

KaryotypeDescription

Tipo de dados

text

Investigator
Descrição

RegisteredInvestigator

Tipo de dados

text

Date
Descrição

InvestigatorSignatureDate

Tipo de dados

date

Ccrr Module For Ecog Leukemia Cytogenetics Report Form
Descrição

Ccrr Module For Ecog Leukemia Cytogenetics Report Form

Date specimens collected
Descrição

Datespecimenscollected

Tipo de dados

text

Institution/Affiliate
Descrição

MainMemberInstitution/Affiliate

Tipo de dados

text

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Similar models

No Instruction available.

1 Formulários
  1. StudyEvent: ECOG Leukemia Cytogenetics Report Form
    1. No Instruction available.
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de dados
Alias
Item Group
Unnamed1
CytogeneticsIdentifier
Item
Cytogeneticist
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C16487 (NCI Thesaurus ObjectClass)
C0010802 (UMLS 2011AA ObjectClass)
PhoneNumber
Item
Phone No.
double
Patient'sName
Item
Patient's Name
text
ECOGProtocolNo.
Item
ECOG Protocol No.
text
ECOGProtocolNo.
Item
ECOG Protocol No.
text
ECOGPatientID
Item
ECOG Patient Seq. No.
text
ECOGPatientID
Item
ECOG Patient Seq. No.
text
ParticipatingGroupProtocolNo.
Item
Participating Group Prot. No.
text
ParticipatingGroupPatientID
Item
Participating Group Patient ID no.
text
ParticipatingGroupName
Item
Group
text
InstitutionName
Item
Institution
text
StepNo.
Item
Step No.
text
AffiliateName
Item
Affiliate
text
Item Group
Unnamed2
Datesampleobtained
Item
Date sample obtained
text
Item
Is Extra material stored?
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C25649 (NCI Thesaurus Property)
C1527428 (UMLS 2011AA Property)
C60824 (NCI Thesaurus Property)
C1698986 (UMLS 2011AA Property)
CL.1
Code List
Is Extra material stored?
CL Item
No (no)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
SpecimenRemainingStorageName
Item
If yes, specify type (extra material)
text
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C42614 (NCI Thesaurus ValueDomain)
C0027365 (UMLS 2011AA ValueDomain)
C25649 (NCI Thesaurus Property)
C1527428 (UMLS 2011AA Property)
C60824 (NCI Thesaurus Property)
C1698986 (UMLS 2011AA Property)
Item Group
Number Of Metaphases
BoneMarrowMetaphasePresentNumber
Item
Bone Marrow, unsimulated short-term culture (metaphases)
double
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C12431 (NCI Thesaurus ObjectClass)
C0005953 (UMLS 2011AA ObjectClass)
C16846 (NCI Thesaurus ObjectClass)
C0025564 (UMLS 2011AA ObjectClass)
BoneMarrowDirectMetaphasePresentNumber
Item
Bone Marrow, direct preparation (metaphases)
double
C12431 (NCI Thesaurus ObjectClass)
C0005953 (UMLS 2011AA ObjectClass)
C16846 (NCI Thesaurus ObjectClass)
C0025564 (UMLS 2011AA ObjectClass)
C0439851 (NCI Metathesaurus ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
BoneMarrowCultureMetaphasePresentNumber
Item
Bone Marrow, Stimulated Culture (metaphases)
double
C12431 (NCI Thesaurus ObjectClass)
C0005953 (UMLS 2011AA ObjectClass)
C16478 (NCI Thesaurus ObjectClass)
C0010453 (UMLS 2011AA ObjectClass)
C16846 (NCI Thesaurus ObjectClass)
C0025564 (UMLS 2011AA ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
BoneMarrowCultureMitogenDescriptionText
Item
Bone Marrow, Stimulated Culture, Specify mitogen (metaphases)
text
C12431 (NCI Thesaurus ObjectClass)
C0005953 (UMLS 2011AA ObjectClass)
C16478 (NCI Thesaurus ObjectClass)
C0010453 (UMLS 2011AA ObjectClass)
C660 (NCI Thesaurus ObjectClass)
C0026249 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
BoneMarrowCultureMethodText
Item
Bone Marrow, Other Specify (metaphases)
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C16847 (NCI Thesaurus Property)
C0449851 (UMLS 2011AA Property)
C12431 (NCI Thesaurus ObjectClass)
C0005953 (UMLS 2011AA ObjectClass)
C16478 (NCI Thesaurus ObjectClass)
C0010453 (UMLS 2011AA ObjectClass)
BoneMarrowCultureMethodText
Item
Bone Marrow, Other Specify (metaphases)
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C16847 (NCI Thesaurus Property)
C0449851 (UMLS 2011AA Property)
C12431 (NCI Thesaurus ObjectClass)
C0005953 (UMLS 2011AA ObjectClass)
C16478 (NCI Thesaurus ObjectClass)
C0010453 (UMLS 2011AA ObjectClass)
PeripheralBloodMetaphasePresentNumber
Item
Peripheral Blood, unsimulated short-term culture (metaphases)
double
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C0229664 (NCI Metathesaurus ObjectClass)
C16846 (NCI Thesaurus ObjectClass)
C0025564 (UMLS 2011AA ObjectClass)
PeripheralBood,directpreparation(metaphases)
Item
Peripheral Bood, direct preparation (metaphases)
text
PeripheralBoodCultureMetaphasePresentNumber
Item
Peripheral Bood, Stimulated Culture (metaphases)
double
C0229664 (NCI Metathesaurus ObjectClass)
C16478 (NCI Thesaurus ObjectClass)
C0010453 (UMLS 2011AA ObjectClass)
C16846 (NCI Thesaurus ObjectClass)
C0025564 (UMLS 2011AA ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
PeripheralBoodCultureMitogenDescriptionText
Item
Peripheral Bood, Stimulated Culture, Specify mitogen (metaphases)
text
C0229664 (NCI Metathesaurus ObjectClass)
C16478 (NCI Thesaurus ObjectClass)
C0010453 (UMLS 2011AA ObjectClass)
C660 (NCI Thesaurus ObjectClass)
C0026249 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
PeripheralBood,OtherSpecify(metaphases)
Item
Peripheral Bood, Other Specify (metaphases)
text
PeripheralBood,OtherSpecify(metaphases)
Item
Peripheral Bood, Other Specify (metaphases)
text
TotalMetaphasesAnalyzed
Item
Total Metaphases Analyzed
double
NumberofAbnormalMetaphases
Item
Number of Abnormal Metaphases
double
KaryotypeCount
Item
Number of Karotype Preparations
double
Item
Are results adequate for banded analysis?
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C25391 (NCI Thesaurus Property)
C0936012 (UMLS 2011AA Property)
C16846 (NCI Thesaurus ObjectClass)
C0025564 (UMLS 2011AA ObjectClass)
CL.2
Code List
Are results adequate for banded analysis?
CL Item
No (no)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Were FISH studies done?
text
CL.3
Code List
Were FISH studies done?
CL Item
No (no)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
FISHProbe
Item
If yes, specify probes (FISH)
text
Interphases,TotalNuclei
Item
Total Interphase nuclei
double
Interphases,Abnormal
Item
Total abnormal interphases
double
FISHMetaphases,Total
Item
Total metaphases
double
FISHMetaphases,Abnormal
Item
Total abnormal metaphases
double
KaryotypeDescription
Item
Complete karyotype description.
text
RegisteredInvestigator
Item
Investigator
text
InvestigatorSignatureDate
Item
Date
date
Item Group
Ccrr Module For Ecog Leukemia Cytogenetics Report Form
Datespecimenscollected
Item
Date specimens collected
text
MainMemberInstitution/Affiliate
Item
Institution/Affiliate
text
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