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9079

Beschreibung

AMC-052 Vital Signs Form (F20) Human Papillomavirus Vaccine Therapy in Treating Men With HIV-1 Infection Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=3952E724-4180-361E-E044-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=3952E724-4180-361E-E044-0003BA3F9857

Stichworte

  1. 19.09.12 19.09.12 -
  2. 08.08.14 08.08.14 - Martin Dugas
  3. 09.01.15 09.01.15 - Martin Dugas
Hochgeladen am

9. Januar 2015

DOI

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Lizenz

Creative Commons BY-NC 3.0 Legacy

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    Infection NCT00513526 On-Study - AMC-052 Vital Signs Form (F20) - 2676717v1.0

    No Instruction available.

    1. StudyEvent: AMC-052 Vital Signs Form (F20)
      1. No Instruction available.
    Header Module
    Beschreibung

    Header Module

    Visit number
    Beschreibung

    Visit number

    Datentyp

    float

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C1549755
    NCI Thesaurus ObjectClass
    C16696
    NCI Thesaurus Property
    C25385
    Header
    Beschreibung

    Header

    Date of evaluation (mm/dd/yyyy)
    Beschreibung

    Assessment Date

    Datentyp

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS CUI-1
    C2985720
    NCI Thesaurus ObjectClass
    C25367
    NCI Thesaurus ValueDomain-2
    C25367
    NCI Thesaurus Property
    C38000
    Time Test Completed (hh:mm)
    Beschreibung

    PatientCompleteVitalSignsPhysicalExaminationTime

    Datentyp

    time

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus Property-2
    C25250
    UMLS 2011AA Property-2
    C0205197
    NCI Metathesaurus Property
    C0518766
    NCI Thesaurus ValueDomain
    C25207
    UMLS 2011AA ValueDomain
    C0040223
    Unnamed2
    Beschreibung

    Unnamed2

    Height (cm in)
    Beschreibung

    Patient Height

    Datentyp

    float

    Maßeinheiten
    • cm
    Alias
    NCI Thesaurus ValueDomain
    C25209
    UMLS CUI-1
    C0489786
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25347
    cm
    Weight (kg lb)
    Beschreibung

    Patient Weight

    Datentyp

    float

    Maßeinheiten
    • Kg
    Alias
    NCI Thesaurus ValueDomain
    C25209
    UMLS CUI-1
    C0005910
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25208
    Kg
    Body Surface Area (m^2)
    Beschreibung

    Body Surface Area

    Datentyp

    float

    Maßeinheiten
    • m2
    Alias
    NCI Thesaurus ObjectClass
    C25190
    UMLS CUI-1
    C0005902
    NCI Thesaurus ValueDomain
    C25712
    NCI Thesaurus Property
    C25157
    m2
    Blood Pressure (mmHg)
    Beschreibung

    Systolic blood pressure

    Datentyp

    float

    Alias
    NCI Thesaurus ValueDomain
    C25209
    UMLS CUI-1
    C0871470
    NCI Thesaurus Property
    C25214
    NCI Thesaurus ObjectClass
    C25298
    Blood pressure (mmHg)
    Beschreibung

    Diastolic blood pressure

    Datentyp

    float

    Alias
    NCI Thesaurus ValueDomain
    C25209
    UMLS CUI-1
    C0428883
    NCI Thesaurus Property
    C25214
    NCI Thesaurus ObjectClass
    C25299
    Heart Rate (beats/min)
    Beschreibung

    PatientVitalSignsHeartRatePhysicalExaminationValue

    Datentyp

    float

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus Property-2
    C49672
    UMLS 2011AA Property-2
    C1704752
    NCI Thesaurus Property-3
    C49677
    UMLS 2011AA Property-3
    C0018810
    NCI Thesaurus ValueDomain
    C25712
    UMLS 2011AA ValueDomain
    C1522609
    Respiratory Rate (/min)
    Beschreibung

    PersonVitalSignsRespiratoryRatePhysicalExaminationValue

    Datentyp

    float

    Alias
    NCI Thesaurus ObjectClass
    C25190
    UMLS 2011AA ObjectClass
    C0027361
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus Property-2
    C49672
    UMLS 2011AA Property-2
    C1704752
    NCI Thesaurus Property-3
    C49678
    UMLS 2011AA Property-3
    C0231832
    NCI Thesaurus ValueDomain
    C25712
    UMLS 2011AA ValueDomain
    C1522609
    Body Temperature (C F)
    Beschreibung

    PersonVitalSignsTemperaturePhysicalExaminationValue

    Datentyp

    float

    Alias
    NCI Thesaurus ObjectClass
    C25190
    UMLS 2011AA ObjectClass
    C0027361
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus Property-2
    C25206
    UMLS 2011AA Property-2
    C0039476
    NCI Thesaurus Property-3
    C49672
    UMLS 2011AA Property-3
    C1704752
    NCI Thesaurus ValueDomain
    C25712
    UMLS 2011AA ValueDomain
    C1522609
    Karnofsky Performance Status (%)
    Beschreibung

    KarnofskyPerformanceStatusScore

    Datentyp

    text

    Alias
    NCI Thesaurus Property
    C25367
    NCI Thesaurus ObjectClass
    C20641
    UMLS 2011AA ObjectClass
    C1518965
    NCI Thesaurus ValueDomain
    C25338
    UMLS 2011AA ValueDomain
    C0449820
    Units (SI=International System of Units & CU=Conventional Units)
    Beschreibung

    PatientVitalSignsPhysicalExaminationUnitofMeasure

    Datentyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Metathesaurus Property
    C0518766
    NCI Thesaurus ValueDomain
    C25709
    UMLS 2011AA ValueDomain
    C1519795
    Footer Module
    Beschreibung

    Footer Module

    Comments
    Beschreibung

    Research Comments

    Datentyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    UMLS CUI-1
    C0947611
    NCI Thesaurus ObjectClass
    C15319
    NCI Thesaurus Property
    C25393

    Ähnliche Modelle

    No Instruction available.

    1. StudyEvent: AMC-052 Vital Signs Form (F20)
      1. No Instruction available.
    Name
    Typ
    Description | Question | Decode (Coded Value)
    Datentyp
    Alias
    Item Group
    Header Module
    Visit number
    Item
    Visit number
    float
    C25337 (NCI Thesaurus ValueDomain)
    C1549755 (UMLS CUI-1)
    C16696 (NCI Thesaurus ObjectClass)
    C25385 (NCI Thesaurus Property)
    Item Group
    Header
    Assessment Date
    Item
    Date of evaluation (mm/dd/yyyy)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C2985720 (UMLS CUI-1)
    C25367 (NCI Thesaurus ObjectClass)
    C25367 (NCI Thesaurus ValueDomain-2)
    C38000 (NCI Thesaurus Property)
    PatientCompleteVitalSignsPhysicalExaminationTime
    Item
    Time Test Completed (hh:mm)
    time
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C25250 (NCI Thesaurus Property-2)
    C0205197 (UMLS 2011AA Property-2)
    C0518766 (NCI Metathesaurus Property)
    C25207 (NCI Thesaurus ValueDomain)
    C0040223 (UMLS 2011AA ValueDomain)
    Item Group
    Unnamed2
    Patient Height
    Item
    Height (cm in)
    float
    C25209 (NCI Thesaurus ValueDomain)
    C0489786 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25347 (NCI Thesaurus Property)
    Patient Weight
    Item
    Weight (kg lb)
    float
    C25209 (NCI Thesaurus ValueDomain)
    C0005910 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25208 (NCI Thesaurus Property)
    Body Surface Area
    Item
    Body Surface Area (m^2)
    float
    C25190 (NCI Thesaurus ObjectClass)
    C0005902 (UMLS CUI-1)
    C25712 (NCI Thesaurus ValueDomain)
    C25157 (NCI Thesaurus Property)
    Systolic blood pressure
    Item
    Blood Pressure (mmHg)
    float
    C25209 (NCI Thesaurus ValueDomain)
    C0871470 (UMLS CUI-1)
    C25214 (NCI Thesaurus Property)
    C25298 (NCI Thesaurus ObjectClass)
    Diastolic blood pressure
    Item
    Blood pressure (mmHg)
    float
    C25209 (NCI Thesaurus ValueDomain)
    C0428883 (UMLS CUI-1)
    C25214 (NCI Thesaurus Property)
    C25299 (NCI Thesaurus ObjectClass)
    PatientVitalSignsHeartRatePhysicalExaminationValue
    Item
    Heart Rate (beats/min)
    float
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C49672 (NCI Thesaurus Property-2)
    C1704752 (UMLS 2011AA Property-2)
    C49677 (NCI Thesaurus Property-3)
    C0018810 (UMLS 2011AA Property-3)
    C25712 (NCI Thesaurus ValueDomain)
    C1522609 (UMLS 2011AA ValueDomain)
    PersonVitalSignsRespiratoryRatePhysicalExaminationValue
    Item
    Respiratory Rate (/min)
    float
    C25190 (NCI Thesaurus ObjectClass)
    C0027361 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C49672 (NCI Thesaurus Property-2)
    C1704752 (UMLS 2011AA Property-2)
    C49678 (NCI Thesaurus Property-3)
    C0231832 (UMLS 2011AA Property-3)
    C25712 (NCI Thesaurus ValueDomain)
    C1522609 (UMLS 2011AA ValueDomain)
    PersonVitalSignsTemperaturePhysicalExaminationValue
    Item
    Body Temperature (C F)
    float
    C25190 (NCI Thesaurus ObjectClass)
    C0027361 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C25206 (NCI Thesaurus Property-2)
    C0039476 (UMLS 2011AA Property-2)
    C49672 (NCI Thesaurus Property-3)
    C1704752 (UMLS 2011AA Property-3)
    C25712 (NCI Thesaurus ValueDomain)
    C1522609 (UMLS 2011AA ValueDomain)
    Item
    Karnofsky Performance Status (%)
    text
    C25367 (NCI Thesaurus Property)
    C20641 (NCI Thesaurus ObjectClass)
    C1518965 (UMLS 2011AA ObjectClass)
    C25338 (NCI Thesaurus ValueDomain)
    C0449820 (UMLS 2011AA ValueDomain)
    Code List
    Karnofsky Performance Status (%)
    CL Item
    Dead (0)
    CL Item
    Moribund, Fatal Processes Progressing Rapidly (10)
    CL Item
    Normal, No Complaints, No Evidence Of Disease (100)
    CL Item
    Very Sick, Hospitalization Indicated. Death Not Imminent (20)
    CL Item
    Severely Disabled, Hospitalization Indicated. Death Not Imminent (30)
    CL Item
    Disabled, Requires Special Care And Assistance (40)
    CL Item
    Requires Considerable Assistance And Frequent Medical Care (50)
    CL Item
    Requires Occasional Assistance, But Is Able To Care For Most Of His/her Needs (60)
    CL Item
    Cares For Self, Unable To Carry On Normal Activity Or To Do Active Work (70)
    CL Item
    Normal Activity With Effort; Some Signs Or Symptoms Of Disease (80)
    CL Item
    Able To Carry On Normal Activity; Minor Signs Or Symptoms Of Disease (90)
    Item
    Units (SI=International System of Units & CU=Conventional Units)
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C0518766 (NCI Metathesaurus Property)
    C25709 (NCI Thesaurus ValueDomain)
    C1519795 (UMLS 2011AA ValueDomain)
    Code List
    Units (SI=International System of Units & CU=Conventional Units)
    CL Item
    Centimeter (cm)
    C49668 (NCI Thesaurus)
    C0475210 (UMLS 2011AA)
    CL Item
    Kilogram (kg)
    C28252 (NCI Thesaurus)
    C0439209 (UMLS 2011AA)
    CL Item
    Square Meter (m^2)
    C42569 (NCI Thesaurus)
    C0457242 (UMLS 2011AA)
    CL Item
    Beats Per Minute:c49673 (beats/min)
    C49673 (NCI Thesaurus)
    C0439385 (UMLS 2011AA)
    CL Item
    Breaths Per Minute:c49674 (breaths/min)
    C49674 (NCI Thesaurus)
    C0439386 (UMLS 2011AA)
    CL Item
    Degree Celsius (C)
    C42559 (NCI Thesaurus)
    C0439237 (UMLS 2011AA)
    CL Item
    Percentage (%)
    C25613 (NCI Thesaurus)
    C0439165 (UMLS 2011AA)
    CL Item
    Inch (in)
    C48500 (NCI Thesaurus)
    C0439204 (UMLS 2011AA)
    CL Item
    Pound (lb)
    C48531 (NCI Thesaurus)
    C0439219 (UMLS 2011AA)
    CL Item
    Millimeter Of Mercury:c49670 (mmHg)
    C49670 (NCI Thesaurus)
    C0439475 (UMLS 2011AA)
    CL Item
    Degree Fahrenheit (F)
    C44277 (NCI Thesaurus)
    C0456628 (UMLS 2011AA)
    Item Group
    Footer Module
    Research Comments
    Item
    Comments
    text
    C25704 (NCI Thesaurus ValueDomain)
    C0947611 (UMLS CUI-1)
    C15319 (NCI Thesaurus ObjectClass)
    C25393 (NCI Thesaurus Property)

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