ID

9263

Beschrijving

Brief Pain Inventory A Phase III, Randomized Study of Gemcitabine (Fixed-Dose Rate Infusion) and Oxaliplatin (NSC 266046) Versus Gemcitabine (Fixed-Dose Rate Infusion) Versus Gemcitabine (30-Minute Infusion) in Pancreatic Carcinoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AE65F8E1-704E-30A0-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AE65F8E1-704E-30A0-E034-0003BA12F5E7

Trefwoorden

Versies (2)
  1. 19-09-12 19-09-12 -
  2. 09-01-15 09-01-15 - Martin Dugas
Geüploaded op

9 januari 2015

DOI

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Licentie

Creative Commons BY-NC 3.0 Legacy
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Pancreatic Cancer NCT00058149 Quality of Life - Brief Pain Inventory - 2031356v3.0

Engels

No Instruction available.

1 Formulieren  
  1. StudyEvent: Brief Pain Inventory
    1. No Instruction available.
Header
Beschrijving

Header

Registration Step
Beschrijving

RegistrationStep

Datatype

text

Patient Initials
Beschrijving

Patient Initials

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
ECOG Protocol Number
Beschrijving

ECOGProtocolNumber

Datatype

text

ECOG Protocol Number
Beschrijving

ECOGProtocolNumber

Datatype

text

ECOG Patient ID
Beschrijving

ECOGPatientID

Datatype

text

ECOG Patient ID
Beschrijving

ECOGPatientID

Datatype

text

Participating Group Protocol No.
Beschrijving

ParticipatingGroupProtocolNo.

Datatype

text

Participating Group Patient ID
Beschrijving

ParticipatingGroupPatientID

Datatype

text

Institution/Affiliate
Beschrijving

MainMemberInstitution/Affiliate

Datatype

text

Throughout our lives, most of us have had pain from time to time (such as minor headaches, sprains, and toothaches). Have you had pain other than these everyday kinds of pain today?
Beschrijving

Throughoutourlives,mostofushavehadpainfromtimetotime(suchasminorheadaches,sprains,andtoothaches).Haveyouhadpainotherthantheseeverydaykindsofpaintoday?

Datatype

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Please rate your pain by circling the one number that best describes your pain at its worst in the last 24 hours.
Beschrijving

Pleaserateyourpainbycirclingtheonenumberthatbestdescribesyourpainatitsworstinthelast24hours.

Datatype

text

Please rate your pain by circling the one number that best describes your pain at its least in the last 24 hours.
Beschrijving

Pleaserateyourpainbycirclingtheonenumberthatbestdescribesyourpainatitsleastinthelast24hours.

Datatype

text

Please rate your pain by circling the one number that best describes your pain on the average.
Beschrijving

Pleaserateyourpainbycirclingtheonenumberthatbestdescribesyourpainontheaverage.

Datatype

text

Please rate your pain by circling the one number that tells how much pain you have right now.
Beschrijving

Pleaserateyourpainbycirclingtheonenumberthattellshowmuchpainyouhaverightnow.

Datatype

text

What treatments or medications are you receiving for your pain?
Beschrijving

Whattreatmentsormedicationsareyoureceivingforyourpain?

Datatype

text

In the last 24 hours, how much relief have pain treatments or medications provided? (Please circle the one percentage that most shows how much relief you have received.)
Beschrijving

Inthelast24hours,howmuchreliefhavepaintreatmentsormedicationsprovided?

Datatype

text

Circle the one number that describes, during the past 24 hours, pain has interfered with your general activity.
Beschrijving

Circletheonenumberthatdescribes,duringthepast24hours,painhasinterferedwithyourgeneralactivity.

Datatype

text

Circle the one number that describes, during the past 24 hours, pain has interfered with your mood.
Beschrijving

PatientMoodPainRestrictedScale

Datatype

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Metathesaurus ObjectClass
C0026516
NCI Thesaurus Property
C3303
UMLS 2011AA Property
C0030193
NCI Metathesaurus Property
CL212559
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Circle the one number that describes, during the past 24 hours, pain has interfered with your walking ability.
Beschrijving

PatientWalkingPainRestrictedScale

Datatype

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Metathesaurus ObjectClass
C0080331
NCI Thesaurus Property
C3303
UMLS 2011AA Property
C0030193
NCI Metathesaurus Property
CL212559
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Circle the one number that describes, during the past 24 hours, pain has interfered with your normal walk.
Beschrijving

Circletheonenumberthatdescribes,duringthepast24hours,painhasinterferedwithyournormalwalk.

Datatype

text

Circle the one number that describes, during the past 24 hours, pain has interfered with your relations with other people.
Beschrijving

Circletheonenumberthatdescribes,duringthepast24hours,painhasinterferedwithyourrelationswithotherpeople.

Datatype

text

Circle the one number that describes, during the past 24 hours, pain has interfered with your sleep.
Beschrijving

Circletheonenumberthatdescribes,duringthepast24hours,painhasinterferedwithyoursleep.

Datatype

text

Circle the one number that describes, during the past 24 hours, pain has interfered with your enjoyment of life.
Beschrijving

Circletheonenumberthatdescribes,duringthepast24hours,painhasinterferedwithyourenjoymentoflife.

Datatype

text

Ccrr Module For Brief Pain Inventory
Beschrijving

Ccrr Module For Brief Pain Inventory

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Similar models

No Instruction available.

1 Formulieren
  1. StudyEvent: Brief Pain Inventory
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Header
RegistrationStep
Item
Registration Step
text
Patient Initials
Item
Patient Initials
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
ECOGProtocolNumber
Item
ECOG Protocol Number
text
ECOGProtocolNumber
Item
ECOG Protocol Number
text
ECOGPatientID
Item
ECOG Patient ID
text
ECOGPatientID
Item
ECOG Patient ID
text
ParticipatingGroupProtocolNo.
Item
Participating Group Protocol No.
text
ParticipatingGroupPatientID
Item
Participating Group Patient ID
text
MainMemberInstitution/Affiliate
Item
Institution/Affiliate
text
Throughoutourlives,mostofushavehadpainfromtimetotime(suchasminorheadaches,sprains,andtoothaches).Haveyouhadpainotherthantheseeverydaykindsofpaintoday?
Item
Throughout our lives, most of us have had pain from time to time (such as minor headaches, sprains, and toothaches). Have you had pain other than these everyday kinds of pain today?
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
Item
Please rate your pain by circling the one number that best describes your pain at its worst in the last 24 hours.
text
CL.2
Code List
Please rate your pain by circling the one number that best describes your pain at its worst in the last 24 hours.
CL Item
0 (0)
C0919414 (NCI Metathesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10 (10)
Item
Please rate your pain by circling the one number that best describes your pain at its least in the last 24 hours.
text
CL.3
Code List
Please rate your pain by circling the one number that best describes your pain at its least in the last 24 hours.
CL Item
0 (0)
C0919414 (NCI Metathesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10 (10)
Item
Please rate your pain by circling the one number that best describes your pain on the average.
text
CL.4
Code List
Please rate your pain by circling the one number that best describes your pain on the average.
CL Item
0 (0)
C0919414 (NCI Metathesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10 (10)
Item
Please rate your pain by circling the one number that tells how much pain you have right now.
text
CL.5
Code List
Please rate your pain by circling the one number that tells how much pain you have right now.
CL Item
0 (0)
C0919414 (NCI Metathesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10 (10)
Whattreatmentsormedicationsareyoureceivingforyourpain?
Item
What treatments or medications are you receiving for your pain?
text
Item
In the last 24 hours, how much relief have pain treatments or medications provided? (Please circle the one percentage that most shows how much relief you have received.)
text
CL.6
Code List
In the last 24 hours, how much relief have pain treatments or medications provided? (Please circle the one percentage that most shows how much relief you have received.)
CL Item
10% (10%)
CL Item
20% (20%)
CL Item
0.3 (0.3)
CL Item
0.4 (0.4)
CL Item
50% (50%)
CL Item
60% (60%)
CL Item
70% (70%)
CL Item
80% (80%)
CL Item
0.9 (0.9)
CL Item
100% (100%)
Item
Circle the one number that describes, during the past 24 hours, pain has interfered with your general activity.
text
CL.7
Code List
Circle the one number that describes, during the past 24 hours, pain has interfered with your general activity.
CL Item
0 (0)
C0919414 (NCI Metathesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10 (10)
Item
Circle the one number that describes, during the past 24 hours, pain has interfered with your mood.
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C0026516 (NCI Metathesaurus ObjectClass)
C3303 (NCI Thesaurus Property)
C0030193 (UMLS 2011AA Property)
CL212559 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.8
Code List
Circle the one number that describes, during the past 24 hours, pain has interfered with your mood.
CL Item
0 (0)
C0919414 (NCI Metathesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10 (10)
Item
Circle the one number that describes, during the past 24 hours, pain has interfered with your walking ability.
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C0080331 (NCI Metathesaurus ObjectClass)
C3303 (NCI Thesaurus Property)
C0030193 (UMLS 2011AA Property)
CL212559 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.9
Code List
Circle the one number that describes, during the past 24 hours, pain has interfered with your walking ability.
CL Item
0 (0)
C0919414 (NCI Metathesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10 (10)
Item
Circle the one number that describes, during the past 24 hours, pain has interfered with your normal walk.
text
CL.10
Code List
Circle the one number that describes, during the past 24 hours, pain has interfered with your normal walk.
CL Item
0 (0)
C0919414 (NCI Metathesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10 (10)
Item
Circle the one number that describes, during the past 24 hours, pain has interfered with your relations with other people.
text
CL.11
Code List
Circle the one number that describes, during the past 24 hours, pain has interfered with your relations with other people.
CL Item
0 (0)
C0919414 (NCI Metathesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10 (10)
Item
Circle the one number that describes, during the past 24 hours, pain has interfered with your sleep.
text
CL.12
Code List
Circle the one number that describes, during the past 24 hours, pain has interfered with your sleep.
CL Item
0 (0)
C0919414 (NCI Metathesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10 (10)
Item
Circle the one number that describes, during the past 24 hours, pain has interfered with your enjoyment of life.
text
CL.13
Code List
Circle the one number that describes, during the past 24 hours, pain has interfered with your enjoyment of life.
CL Item
0 (0)
C0919414 (NCI Metathesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10 (10)
Item Group
Ccrr Module For Brief Pain Inventory
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