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Información:
Error:
ID
9206
Descripción
Radiation Therapy Oncology Group Phase III Lung Prophylactic Cranial RT Activities of Daily Living Scale Radiation Therapy in Preventing CNS Metastases in Patients With Non-Small Cell Lung Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A5472762-3A45-07E6-E034-080020C9C0E0
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Versiones (3)
- 19/9/12 19/9/12 -
- 9/1/15 9/1/15 - Martin Dugas
- 3/7/15 3/7/15 -
Subido en
9 de enero de 2015
DOI
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Licencia
Creative Commons BY-NC 3.0 Legacy
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Lung Cancer NCT00048997 Quality of Life - Radiation Therapy Oncology Group Phase III Lung Prophylactic Cranial RT Activities of Daily Living Scale - 2039894v3.0
No Instruction available.
- StudyEvent: Radiation Therapy Oncology Group Phase III Lung Prophylactic Cranial RT Activities of Daily Living Scale
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No Instruction available.
- StudyEvent: Radiation Therapy Oncology Group Phase III Lung Prophylactic Cranial RT Activities of Daily Living Scale
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Case#
Item
Case #
text
Institution
Item
Institution
text
InstitutionNo.
Item
Institution No.
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
Patient'sName
Item
Patient's Name
text
Patient'sI.D.No.
Item
Patient's I.D. No.
text
Ifthisisarevisedorcorrectedform,indicatebycheckingbox.
Item
If this is a revised or corrected form, indicate by checking box.
text
Ifnotcompletedbypatient,bywhomandwhy?
Item
If not completed by patient, by whom and why? (Self Care Activities)
text
CL Item
No Problem (No problem)
CL Item
Independent, But Slow Or Some Spills (Independent, but slow or some spills)
CL Item
Need Help To Cut Or Pour; Spills Often (Need help to cut or pour; spills often)
CL Item
Must Be Fed Most Foods (Must be fed most foods)
CL Item
Don't Know (Don't know)
CL Item
No Problem (No problem)
CL Item
Independent, But Slow Or Clumsy (Independent, but slow or clumsy)
CL Item
Wrong Sequence, Forget Items (Wrong sequence, forget items)
CL Item
Need Help With Dressing (Need help with dressing)
CL Item
Don't Know (Don't know)
CL Item
No Problem (No problem)
CL Item
Bathe Self, But Needs To Be Reminded (Bathe self, but needs to be reminded)
CL Item
Bathe Self With Assistance (Bathe self with assistance)
CL Item
Must Be Bathed By Others (Must be bathed by others)
CL Item
Don't Know (Don't know)
CL Item
Go To The Bathroom Independently (Go to the bathroom independently)
CL Item
Got To The Bathroom When Reminded; Some Accidents (Got to the bathroom when reminded; some accidents)
CL Item
Needs Assistance For Elimination (Needs assistance for elimination)
CL Item
Have No Control Over Either Bowel Or Bladder (Have no control over either bowel or bladder)
CL Item
Don't Know (Don't know)
CL Item
No Problems (No problems)
CL Item
Move Into And Out Of Bed Or Chair Independently (may Use A Cane Or Walker For Support) (Move into and out of bed or chair independently (may use a cane or walker for support))
CL Item
Move Into And Out Of Bed Or Chair With Assistance (Move into and out of bed or chair with assistance)
CL Item
Do Not Get Out Of Bed (Do not get out of bed)
CL Item
Don't Know (Don't know)
Comments
Item
Comments
text
Patient Initials
Item
Patient Initials
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
DateCompleted
Item
Date completed
date
Item Group
Ccrr Module For Radiation Therapy Oncology Group Phase Iii Lung Prophylactic Cranial Rt Activities Of Daily Living Scale