ID

9299

Description

AMC-053 Lymphoma Follow-Up Form (LFU) Bortezomib, Ifosfamide, Carboplatin, and Etoposide, With or Without Rituximab, in Treating Patients With Relapsed or Refractory AIDS-Related Non-Hodgkin Lymphoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=8D6577D4-E51D-6AD1-E040-BB89AD432F6C

Lien

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=8D6577D4-E51D-6AD1-E040-BB89AD432F6C

Mots-clés

  1. 19/09/2012 19/09/2012 -
  2. 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

Modèle Commentaires :

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    NCT00598169 Follow-Up - AMC-053 Lymphoma Follow-Up Form (LFU) - 3127857v1.0

    No Instruction available.

    1. StudyEvent: AMC-053 Lymphoma Follow-Up Form (LFU)
      1. No Instruction available.
    Header
    Description

    Header

    Visit number
    Description

    Visit number

    Type de données

    float

    Alias
    NCI Thesaurus ValueDomain
    C25337 (undefined)
    UMLS CUI-1
    C1549755 (Visit Number)
    NCI Thesaurus ObjectClass
    C16696 (undefined)
    NCI Thesaurus Property
    C25385 (undefined)
    Patient Status
    Description

    Patient Status

    Vital Status
    Description

    Patient Status

    Type de données

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960 (undefined)
    UMLS CUI-1
    C3846084 (undefined)
    NCI Thesaurus ValueDomain
    C18003 (undefined)
    NCI Thesaurus ValueDomain-2
    C25688 (undefined)
    NCI Thesaurus Property
    C25717 (undefined)
    Date of Last Contact or Death (mm/dd/yyyy If participant's status is dead, complete Death Form)
    Description

    Date last contact

    Type de données

    date

    Alias
    NCI Thesaurus ObjectClass
    C16960 (undefined)
    UMLS CUI-1
    C0805839 (Date last contact)
    LOINC
    MTHU010432
    NCI Thesaurus Property
    C25461 (undefined)
    NCI Thesaurus Property-2
    C25551 (undefined)
    NCI Thesaurus ValueDomain
    C25164 (undefined)
    NCI Thesaurus ValueDomain-2
    C25367 (undefined)
    Header
    Description

    Header

    Is the patient receiving any non-protocol cancer therapy not previously reported? (i.e. other than this protocol)
    Description

    Non-protocolTherapyAdministeredInd-3

    Type de données

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148 (undefined)
    UMLS 2011AA ValueDomain
    C1512699 (Yes, No, or Unknown Response)
    NCI Thesaurus ObjectClass
    C15368 (undefined)
    NCI Thesaurus ObjectClass-2
    C25590 (undefined)
    UMLS 2011AA ObjectClass
    C1518384 (Non-Protocol)
    NCI Thesaurus Property
    C25382 (undefined)
    UMLS 2011AA Property
    C1521801 (Having administered)
    Name of Other Non-Protocol Therapy (If "Yes")
    Description

    Non-protocolTherapyOtherAdministeredName

    Type de données

    text

    Alias
    NCI Thesaurus ObjectClass
    C15368 (undefined)
    NCI Thesaurus ObjectClass-2
    C25590 (undefined)
    UMLS 2011AA ObjectClass
    C1518384 (Non-Protocol)
    NCI Thesaurus Property
    C17649 (undefined)
    UMLS 2011AA Property
    C0205394 (Other)
    SNOMED
    74964007
    LOINC
    LP21049-9
    NCI Thesaurus Property-2
    C25382 (undefined)
    UMLS 2011AA Property-2
    C1521801 (Having administered)
    NCI Thesaurus ValueDomain
    C42614 (undefined)
    UMLS 2011AA ValueDomain
    C0027365 (Name)
    SNOMED
    703503000
    LOINC
    LP72974-6
    Date of First Non-Protocol Therapy (mm/dd/yyyy)
    Description

    Non-ProtocolTherapyFirstAdministeredDate

    Type de données

    date

    Alias
    NCI Thesaurus ObjectClass
    C15368 (undefined)
    NCI Thesaurus ObjectClass-2
    C25590 (undefined)
    UMLS 2011AA ObjectClass
    C1518384 (Non-Protocol)
    NCI Thesaurus Property
    C25509 (undefined)
    UMLS 2011AA Property
    C1279901 (Firstly)
    SNOMED
    232714002
    NCI Thesaurus Property-2
    C25382 (undefined)
    UMLS 2011AA Property-2
    C1521801 (Having administered)
    NCI Thesaurus ValueDomain
    C25164 (undefined)
    UMLS 2011AA ValueDomain
    C0011008 (Date in time)
    SNOMED
    410671006
    NCI Thesaurus ValueDomain-2
    C25367 (undefined)
    Comments
    Description

    Comments

    Comments
    Description

    Research Comments

    Type de données

    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)

    Similar models

    No Instruction available.

    1. StudyEvent: AMC-053 Lymphoma Follow-Up Form (LFU)
      1. No Instruction available.
    Name
    Type
    Description | Question | Decode (Coded Value)
    Type de données
    Alias
    Item Group
    Header
    Visit number
    Item
    Visit number
    float
    C25337 (NCI Thesaurus ValueDomain)
    C1549755 (UMLS CUI-1)
    C16696 (NCI Thesaurus ObjectClass)
    C25385 (NCI Thesaurus Property)
    Item Group
    Patient Status
    Item
    Vital Status
    text
    C16960 (NCI Thesaurus ObjectClass)
    C3846084 (UMLS CUI-1)
    C18003 (NCI Thesaurus ValueDomain)
    C25688 (NCI Thesaurus ValueDomain-2)
    C25717 (NCI Thesaurus Property)
    Code List
    Vital Status
    CL Item
    Alive (Alive)
    CL Item
    Dead (Dead)
    CL Item
    Lost To Follow-up (Lost to follow-up)
    Date last contact
    Item
    Date of Last Contact or Death (mm/dd/yyyy If participant's status is dead, complete Death Form)
    date
    C16960 (NCI Thesaurus ObjectClass)
    C0805839 (UMLS CUI-1)
    C25461 (NCI Thesaurus Property)
    C25551 (NCI Thesaurus Property-2)
    C25164 (NCI Thesaurus ValueDomain)
    C25367 (NCI Thesaurus ValueDomain-2)
    Item Group
    Header
    Non-protocolTherapyAdministeredInd-3
    Item
    Is the patient receiving any non-protocol cancer therapy not previously reported? (i.e. other than this protocol)
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C1512699 (UMLS 2011AA ValueDomain)
    C15368 (NCI Thesaurus ObjectClass)
    C25590 (NCI Thesaurus ObjectClass-2)
    C1518384 (UMLS 2011AA ObjectClass)
    C25382 (NCI Thesaurus Property)
    C1521801 (UMLS 2011AA Property)
    Non-protocolTherapyOtherAdministeredName
    Item
    Name of Other Non-Protocol Therapy (If "Yes")
    text
    C15368 (NCI Thesaurus ObjectClass)
    C25590 (NCI Thesaurus ObjectClass-2)
    C1518384 (UMLS 2011AA ObjectClass)
    C17649 (NCI Thesaurus Property)
    C0205394 (UMLS 2011AA Property)
    C25382 (NCI Thesaurus Property-2)
    C1521801 (UMLS 2011AA Property-2)
    C42614 (NCI Thesaurus ValueDomain)
    C0027365 (UMLS 2011AA ValueDomain)
    Non-ProtocolTherapyFirstAdministeredDate
    Item
    Date of First Non-Protocol Therapy (mm/dd/yyyy)
    date
    C15368 (NCI Thesaurus ObjectClass)
    C25590 (NCI Thesaurus ObjectClass-2)
    C1518384 (UMLS 2011AA ObjectClass)
    C25509 (NCI Thesaurus Property)
    C1279901 (UMLS 2011AA Property)
    C25382 (NCI Thesaurus Property-2)
    C1521801 (UMLS 2011AA Property-2)
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C25367 (NCI Thesaurus ValueDomain-2)
    Item Group
    Comments
    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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