ID

8602

Beschreibung

AMC Clinical Trials - Valproic Acid Administration Form for Protocol #038 - PR3802 Valproic Acid in Treating Patients With Kaposi's Sarcoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=DB52DD55-D039-4342-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=DB52DD55-D039-4342-E034-0003BA12F5E7

Stichworte

  1. 19.09.12 19.09.12 -
  2. 09.01.15 09.01.15 - Martin Dugas
  3. 27.06.15 27.06.15 -
Hochgeladen am

9. Januar 2015

DOI

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Lizenz

Creative Commons BY-NC 3.0 Legacy

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Sarcoma NCT00075777 Lab - AMC Clinical Trials - Valproic Acid Administration Form for Protocol #038 - PR3802 - 2281554v3.0

No Instruction available.

  1. StudyEvent: AMC Clinical Trials - Valproic Acid Administration Form for Protocol #038 - PR3802
    1. No Instruction available.
Unnamed 1
Beschreibung

Unnamed 1

Patient Initials
Beschreibung

Patient Initials

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25191 (undefined)
UMLS CUI-1
C2986440 (Person Initials)
NCI Thesaurus ObjectClass
C16960 (undefined)
NCI Thesaurus Property
C25536 (undefined)
Patient Study ID
Beschreibung

Patient Study ID

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25337 (undefined)
UMLS CUI-1
C2348585 (Clinical Trial Subject Unique Identifier)
NCI Thesaurus ObjectClass
C16960 (undefined)
NCI Thesaurus Property
C25462 (undefined)
NCI Thesaurus Property-2
C25364 (undefined)
Current Cycle Number
Beschreibung

Cycle Number Chemotherapeutics

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25337 (undefined)
UMLS CUI-1
C2045829 (chemotherapeutics regimen status cycle number)
NCI Thesaurus Property
C25471 (undefined)
NCI Thesaurus ObjectClass
C15368 (undefined)
NCI Thesaurus Property-2
C25379 (undefined)
Date of Evaluation
Beschreibung

LesionAssessmentDate

Datentyp

date

Alias
NCI Thesaurus ValueDomain
C25164 (undefined)
UMLS 2011AA ValueDomain
C0011008 (Date in time)
SNOMED
410671006
NCI Thesaurus ObjectClass
C3824 (undefined)
UMLS 2011AA ObjectClass
C0221198 (Lesion)
SNOMED
52988006
NCI Thesaurus Property
C20989 (undefined)
UMLS 2011AA Property
C0031809 (Physical Examination)
SNOMED
5880005
LOINC
MTHU028014
NCI Thesaurus ValueDomain-2
C25367 (undefined)
Day
Beschreibung

TreatmentDayCount

Datentyp

float

Alias
NCI Thesaurus ValueDomain
C25301 (undefined)
UMLS 2011AA ValueDomain
C0439228 (day)
SNOMED
258703001
NCI Thesaurus ObjectClass
C15368 (undefined)
NCI Thesaurus ValueDomain-2
C25463 (undefined)
UMLS 2011AA ValueDomain-2
C0750480 (Count)
Date Agent Administered
Beschreibung

DateAgentAdministered

Datentyp

text

Start Date
Beschreibung

StartDate

Datentyp

date

Alias
NCI Thesaurus ValueDomain
C25164 (undefined)
UMLS 2011AA ValueDomain
C0011008 (Date in time)
SNOMED
410671006
Stop Date
Beschreibung

StopDate

Datentyp

date

Alias
NCI Thesaurus Property
C25164 (undefined)
UMLS 2011AA Property
C0011008 (Date in time)
SNOMED
410671006
NCI Thesaurus ValueDomain
C25164 (undefined)
UMLS 2011AA ValueDomain
C0011008 (Date in time)
SNOMED
410671006
NCI Thesaurus ObjectClass
C15368 (undefined)
NCI Thesaurus Property-2
C65125 (undefined)
UMLS 2011AA Property-2
C1947925 (Stop (Instruction Imperative))
Were there any dose modifications or additions/omissions to protocol treatment?
Beschreibung

Dose Modification

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25180 (undefined)
UMLS CUI-1
C1707811 (Dose Modification)
NCI Thesaurus ObjectClass
C25256 (undefined)
NCI Thesaurus Property
C25572 (undefined)
NCI Thesaurus ValueDomain-2
C25572 (undefined)
Comments
Beschreibung

Research Comments

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25704 (undefined)
UMLS CUI-1
C0947611 (Comment)
LOINC
LP72293-1
NCI Thesaurus ObjectClass
C15319 (undefined)
NCI Thesaurus Property
C25393 (undefined)
Total # of Capsule(s) Taken per Day
Beschreibung

Total#ofCapsule(s)TakenperDay

Datentyp

text

Date of Day 5
Beschreibung

DateofDay5

Datentyp

text

Date of Day 28
Beschreibung

DateofDay28

Datentyp

text

Total # of Capsule(s) Taken per Day
Beschreibung

Total#ofCapsule(s)TakenperDay

Datentyp

text

Unnamed question 5
Beschreibung

Unnamedquestion5

Datentyp

text

Total # of Capsule(s) Taken per Day
Beschreibung

Total#ofCapsule(s)TakenperDay

Datentyp

text

valproic acid serum level checked at 72-96 hours (on or about day 8)?
Beschreibung

valproicacidserumlevelcheckedat72-96hours(onoraboutday8)?

Datentyp

boolean

record serum valproic acid concentration
Beschreibung

recordserumvalproicacidconcentration

Datentyp

text

Is valproic acid therapy discontinued early for the patient?
Beschreibung

Isvalproicacidtherapydiscontinuedearlyforthepatient?

Datentyp

boolean

record serum valproic acid concentration at the drug discontinuation
Beschreibung

recordserumvalproicacidconcentrationatthedrugdiscontinuation

Datentyp

text

Any additional comments about valproic acid administration?
Beschreibung

Anyadditionalcommentsaboutvalproicacidadministration?

Datentyp

boolean

Ähnliche Modelle

No Instruction available.

  1. StudyEvent: AMC Clinical Trials - Valproic Acid Administration Form for Protocol #038 - PR3802
    1. No Instruction available.
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Unnamed 1
Patient Initials
Item
Patient Initials
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
Patient Study ID
Item
Patient Study ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25462 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Cycle Number Chemotherapeutics
Item
Current Cycle Number
text
C25337 (NCI Thesaurus ValueDomain)
C2045829 (UMLS CUI-1)
C25471 (NCI Thesaurus Property)
C15368 (NCI Thesaurus ObjectClass)
C25379 (NCI Thesaurus Property-2)
LesionAssessmentDate
Item
Date of Evaluation
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C3824 (NCI Thesaurus ObjectClass)
C0221198 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25367 (NCI Thesaurus ValueDomain-2)
TreatmentDayCount
Item
Day
float
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C15368 (NCI Thesaurus ObjectClass)
C25463 (NCI Thesaurus ValueDomain-2)
C0750480 (UMLS 2011AA ValueDomain-2)
DateAgentAdministered
Item
Date Agent Administered
text
StartDate
Item
Start Date
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
StopDate
Item
Stop Date
date
C25164 (NCI Thesaurus Property)
C0011008 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C15368 (NCI Thesaurus ObjectClass)
C65125 (NCI Thesaurus Property-2)
C1947925 (UMLS 2011AA Property-2)
Item
Were there any dose modifications or additions/omissions to protocol treatment?
text
C25180 (NCI Thesaurus ValueDomain)
C1707811 (UMLS CUI-1)
C25256 (NCI Thesaurus ObjectClass)
C25572 (NCI Thesaurus Property)
C25572 (NCI Thesaurus ValueDomain-2)
Code List
Were there any dose modifications or additions/omissions to protocol treatment?
CL Item
Yes, Planned (i.e., The Treatment Was Changed According To Protocol Guidelines) (Yes, planned)
CL Item
Yes, Unplanned (i.e., The Treatment Change Was Not Part Of Protocol Guidelines) (Yes, unplanned)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Research Comments
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C0947611 (UMLS CUI-1)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
Total#ofCapsule(s)TakenperDay
Item
Total # of Capsule(s) Taken per Day
text
DateofDay5
Item
Date of Day 5
text
DateofDay28
Item
Date of Day 28
text
Total#ofCapsule(s)TakenperDay
Item
Total # of Capsule(s) Taken per Day
text
Item
Unnamed question 5
text
Code List
Unnamed question 5
CL Item
1st reduction (1st reduction)
CL Item
2nd reduction (2nd reduction)
CL Item
3rd reduction (3rd reduction)
CL Item
4th reduction (4th reduction)
Total#ofCapsule(s)TakenperDay
Item
Total # of Capsule(s) Taken per Day
text
valproicacidserumlevelcheckedat72-96hours(onoraboutday8)?
Item
valproic acid serum level checked at 72-96 hours (on or about day 8)?
boolean
recordserumvalproicacidconcentration
Item
record serum valproic acid concentration
text
Isvalproicacidtherapydiscontinuedearlyforthepatient?
Item
Is valproic acid therapy discontinued early for the patient?
boolean
recordserumvalproicacidconcentrationatthedrugdiscontinuation
Item
record serum valproic acid concentration at the drug discontinuation
text
Anyadditionalcommentsaboutvalproicacidadministration?
Item
Any additional comments about valproic acid administration?
boolean

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