ID

9079

Description

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

Lien

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

Mots-clés

Versions (3)
  1. 19/09/2012 19/09/2012 -
  2. 08/08/2014 08/08/2014 - Martin Dugas
  3. 09/01/2015 09/01/2015 - Martin Dugas
Téléchargé le

9 janvier 2015

DOI

Pour une demande vous connecter.

Licence

Creative Commons BY-NC 3.0 Legacy
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Infection NCT00513526 On-Study - AMC-052 Vital Signs Form (F20) - 2676717v1.0

Anglais

No Instruction available.

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

Header Module

Visit number
Description

Visit number

Type de données

float

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

Header

Date of evaluation (mm/dd/yyyy)
Description

Assessment Date

Type de données

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)
Description

PatientCompleteVitalSignsPhysicalExaminationTime

Type de données

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
Description

Unnamed2

Height (cm in)
Description

Patient Height

Type de données

float

Unités de mesure
  • cm
Alias
NCI Thesaurus ValueDomain
C25209
UMLS CUI-1
C0489786
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25347
cm
Weight (kg lb)
Description

Patient Weight

Type de données

float

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

Body Surface Area

Type de données

float

Unités de mesure
  • m2
Alias
NCI Thesaurus ObjectClass
C25190
UMLS CUI-1
C0005902
NCI Thesaurus ValueDomain
C25712
NCI Thesaurus Property
C25157
m2
Blood Pressure (mmHg)
Description

Systolic blood pressure

Type de données

float

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

Diastolic blood pressure

Type de données

float

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

PatientVitalSignsHeartRatePhysicalExaminationValue

Type de données

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)
Description

PersonVitalSignsRespiratoryRatePhysicalExaminationValue

Type de données

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)
Description

PersonVitalSignsTemperaturePhysicalExaminationValue

Type de données

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 (%)
Description

KarnofskyPerformanceStatusScore

Type de données

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)
Description

PatientVitalSignsPhysicalExaminationUnitofMeasure

Type de données

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
Description

Footer Module

Comments
Description

Research Comments

Type de données

text

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

No Instruction available.

1 Formulaires
  1. StudyEvent: AMC-052 Vital Signs Form (F20)
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Type de données
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)
CL.1
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)
CL.2
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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