ID

9713

Description

Medizinischer Basisbogen Multiple Sklerose http://epi.uni-muenster.de

Link

http://epi.uni-muenster.de

Keywords

Versions (5)
  1. 11/22/14 11/22/14 - Martin Dugas
  2. 11/23/14 11/23/14 - Martin Dugas
  3. 1/19/15 1/19/15 - Martin Dugas
  4. 1/19/15 1/19/15 - Martin Dugas
  5. 1/19/15 1/19/15 - Martin Dugas
Uploaded on

January 19, 2015

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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Multiple Sclerosis - Base Sheet (REGIMS)

German English

Multiple Sclerosis - Base Sheet (REGIMS)

1 forms  
Default Itemgroup
Description

Default Itemgroup

Alias
UMLS CUI-1
C1508263
Patient id
Description

Default item

Data type

text

Alias
UMLS CUI-1
C1549740
Visit date
Data type

date

Measurement units
  • tt.mm.jjjj
Alias
UMLS CUI-1
C1320303
tt.mm.jjjj
Written consent
Data type

boolean

Alias
UMLS CUI-1
C0021430
Zentrums Nr
Description

Medical center

Data type

integer

Alias
UMLS CUI-1
C0565990
Gender
Data type

integer

Alias
UMLS CUI-1
C0079399
Geburtsjahr
Description

Birth Year

Data type

integer

Measurement units
  • JJJJ
Alias
UMLS CUI-1
C2826771
JJJJ
Disease-specific information
Description

Disease-specific information

Alias
UMLS CUI-1
C1820919
Disease onset
Data type

partialDate

Measurement units
  • mm.jjjj
Alias
UMLS CUI-1
C0277793
mm.jjjj
Diagnosis date Multiple Sclerosis
Data type

partialDate

Measurement units
  • mm.jjjj
Alias
UMLS CUI-1
C2316983
UMLS CUI-2
C0026769
mm.jjjj
Clinical course
Data type

integer

Alias
UMLS CUI-1
C0449259
Anzahl der Schübe in den letzten 24 Monaten
Description

Relapse count within 24 months

Data type

text

Alias
UMLS CUI-1
C0035020
UMLS CUI-2
C0449788
EDSS
Data type

float

Alias
UMLS CUI-1
C0451246
EDSS one year ago
Description

EDSS one year ago

Data type

float

Alias
UMLS CUI-1
C0451246
UMLS CUI-2
C3843633
Current Symptoms Multiple Sclerosis
Description

Current Symptoms Multiple Sclerosis

Symptom Multiple Sclerosis
Data type

integer

Alias
UMLS CUI-1
C1457887
UMLS CUI-2
C0026769
Past treatment Multiple Sclerosis
Description

Past treatment Multiple Sclerosis

Alias
UMLS CUI-1
C2945691
UMLS CUI-2
C0026769
Multiple sclerosis no therapy
Description

mentryr_0

Data type

boolean

Alias
UMLS CUI-1
C0026769
UMLS CUI-2
C0746919
Medication
Description

mstrtr_19_0

Data type

integer

Alias
UMLS CUI-1
C0013227
Other medication
Data type

text

Alias
UMLS CUI-1
C1115771
Medication start
Description

msstdtcr19_0

Data type

partialDate

Measurement units
  • mm.jjjj
Alias
UMLS CUI-1
C0451613
mm.jjjj
Medication stopped
Description

msmendtr19_0

Data type

partialDate

Measurement units
  • mm.jjjj
Alias
UMLS CUI-1
C3483769
mm.jjjj
Reason for end of therapy
Description

Reason for end of therapy

Data type

integer

Alias
UMLS CUI-1
C0566251
Other reason
Description

Other reason

Data type

text

Alias
UMLS CUI-1
C3840932
Current treatment Multiple Sclerosis
Description

Current treatment Multiple Sclerosis

Alias
UMLS CUI-1
C2827774
UMLS CUI-2
C0026769
Medication
Description

mstrtr_19_0

Data type

integer

Alias
UMLS CUI-1
C0013227
Other medication
Data type

text

Alias
UMLS CUI-1
C1115771
Medication start
Description

msstdtcr19_0

Data type

partialDate

Measurement units
  • mm.jjjj
Alias
UMLS CUI-1
C0451613
mm.jjjj
Dose per administration
Data type

integer

Alias
UMLS CUI-1
C1960417
Unit
Data type

text

Alias
UMLS CUI-1
C1519795
Frequency
Data type

integer

Measurement units
  • Mal
Alias
UMLS CUI-1
C0439603
Mal
Frequency
Data type

integer

Alias
UMLS CUI-1
C0439603
Unit of time
Data type

integer

Alias
UMLS CUI-1
C0439221
Other administration
Data type

text

Cortisone therapy
Description

Cortisone therapy

Alias
UMLS CUI-1
C0010137
Cortisone therapy
Description

Cortisone therapy

Data type

boolean

Alias
UMLS CUI-1
C0010137
MRT
Description

MRT

Alias
UMLS CUI-1
C0024485
MRT within past 12 months
Data type

integer

Alias
UMLS CUI-1
C0024485
UMLS CUI-2
C3843288
Disease history
Description

Disease history

Alias
UMLS CUI-1
C0683519
Diagnosis
Description

Diagnosis

Data type

integer

Alias
UMLS CUI-1
C0011900
Diagnosis date
Description

Diagnosis date

Data type

partialDate

Measurement units
  • mm.jjjj
Alias
UMLS CUI-1
C2316983
mm.jjjj
Diagnosis details
Description

Diagnosis details

Data type

text

Pharmacotherapy
Description

Pharmacotherapy

Data type

boolean

Alias
UMLS CUI-1
C0013216
Pharmacotherapy details
Description

Pharmacotherapy details

Data type

text

Cancer treatment
Description

Cancer treatment

Data type

integer

Alias
UMLS CUI-1
C0920425
Pregnancy, current
Description

Pregnancy, current

Alias
UMLS CUI-1
C0549206
Current pregnancy
Data type

boolean

Alias
UMLS CUI-1
C0549206
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Similar models

Multiple Sclerosis - Base Sheet (REGIMS)

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Default Itemgroup
C1508263 (UMLS CUI-1)
Patient id
Item
text
C1549740 (UMLS CUI-1)
Visit date
Item
date
C1320303 (UMLS CUI-1)
Written consent
Item
boolean
C0021430 (UMLS CUI-1)
Medical center
Item
Zentrums Nr
integer
C0565990 (UMLS CUI-1)
Item
integer
C0079399 (UMLS CUI-1)
Gender
Code List
Gender
CL Item
 (1)
CL Item
 (2)
Birth Year
Item
Geburtsjahr
integer
C2826771 (UMLS CUI-1)
Item Group
C1820919 (UMLS CUI-1)
Disease onset
Item
partialDate
C0277793 (UMLS CUI-1)
Diagnosis date Multiple Sclerosis
Item
partialDate
C2316983 (UMLS CUI-1)
C0026769 (UMLS CUI-2)
Item
integer
C0449259 (UMLS CUI-1)
Clinical course
Code List
Clinical course
CL Item
 (1)
CL Item
 (2)
CL Item
 (3)
CL Item
 (4)
CL Item
 (5)
Item
Anzahl der Schübe in den letzten 24 Monaten
text
C0035020 (UMLS CUI-1)
C0449788 (UMLS CUI-2)
Relapse count within 24 months
Code List
Anzahl der Schübe in den letzten 24 Monaten
CL Item
0 (0)
CL Item
1 (1)
CL Item
2 (2)
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)
CL Item
>10 (>10)
EDSS
Item
float
C0451246 (UMLS CUI-1)
EDSS one year ago
Item
EDSS one year ago
float
C0451246 (UMLS CUI-1)
C3843633 (UMLS CUI-2)
Item
integer
C1457887 (UMLS CUI-1)
C0026769 (UMLS CUI-2)
Multiple Sclerosis Symptom
Code List
Symptom Multiple Sclerosis
CL Item
 (1)
CL Item
 (2)
CL Item
 (3)
CL Item
 (4)
CL Item
 (5)
CL Item
 (6)
CL Item
 (7)
CL Item
 (8)
CL Item
 (9)
CL Item
 (10)
CL Item
 (11)
CL Item
 (12)
CL Item
 (13)
Item Group
Past treatment Multiple Sclerosis
C2945691 (UMLS CUI-1)
C0026769 (UMLS CUI-2)
Multiple sclerosis no therapy
Item
Multiple sclerosis no therapy
boolean
C0026769 (UMLS CUI-1)
C0746919 (UMLS CUI-2)
Item
Medication
integer
C0013227 (UMLS CUI-1)
Medication
Code List
Medication
CL Item
Interferon beta-1a Injectable Solution (Avonex) (1)
C1237080 (UMLS CUI-1)
CL Item
Interferon beta-1a SC (Rebif 22μg, Rebif 44 μg) (2)
C1698822 (UMLS CUI-1)
CL Item
Interferon beta-1b SC (Betaferon, Extavia) (3)
C1237445 (UMLS CUI-1)
CL Item
Glatirameracetat (Copaxone) (4)
C1236476 (UMLS CUI-1)
CL Item
Natalizumab (Tysabri) (5)
C1172734 (UMLS CUI-1)
CL Item
Fingolimod (Gilenya) (6)
C1699926 (UMLS CUI-1)
CL Item
Azathioprin (7)
C0004482 (UMLS CUI-1)
CL Item
Methotrexat (8)
C0025677 (UMLS CUI-1)
CL Item
Mitoxantron (9)
C0026259 (UMLS CUI-1)
CL Item
Cyclophosphamid (10)
C0010583 (UMLS CUI-1)
CL Item
Rituximab (11)
C0393022 (UMLS CUI-1)
CL Item
Immunglobuline (12)
C0021027 (UMLS CUI-1)
CL Item
Medikation aus einer MS-Studie (13)
CL Item
Alemtuzumab (Lemtrada) (14)
C0383429 (UMLS CUI-1)
CL Item
Teriflunomide (Aubagio) (15)
C1718383 (UMLS CUI-1)
CL Item
Fumarat (BG-12) (Tecfidera) (16)
C3556178 (UMLS CUI-1)
CL Item
Other (17)
C1115771 (UMLS CUI-1)
Other medication
Item
text
C1115771 (UMLS CUI-1)
Medication commenced
Item
Medication start
partialDate
C0451613 (UMLS CUI-1)
Medication stopped
Item
Medication stopped
partialDate
C3483769 (UMLS CUI-1)
Item
Reason for end of therapy
integer
C0566251 (UMLS CUI-1)
Reason for end of therapy
Code List
Reason for end of therapy
CL Item
Unverträglichkeit, z.B. Haut- / allergische Reaktion (1)
CL Item
Nebenwirkungen, z.B. Übelkeit, Zunahme der Spastik (2)
CL Item
Medikation vergessen / aus Patientensicht nicht erforderlich oder möglich (3)
Other reason
Item
Other reason
text
C3840932 (UMLS CUI-1)
Item Group
Current treatment Multiple Sclerosis
C2827774 (UMLS CUI-1)
C0026769 (UMLS CUI-2)
Item
Medication
integer
C0013227 (UMLS CUI-1)
Medication
Code List
Medication
CL Item
Interferon beta-1a Injectable Solution (Avonex) (1)
C1237080 (UMLS CUI-1)
CL Item
Interferon beta-1a SC (Rebif 22μg, Rebif 44 μg) (2)
C1698822 (UMLS CUI-1)
CL Item
Interferon beta-1b SC (Betaferon, Extavia) (3)
C1237445 (UMLS CUI-1)
CL Item
Glatirameracetat (Copaxone) (4)
C1236476 (UMLS CUI-1)
CL Item
Natalizumab (Tysabri) (5)
C1172734 (UMLS CUI-1)
CL Item
Fingolimod (Gilenya) (6)
C1699926 (UMLS CUI-1)
CL Item
Azathioprin (7)
C0004482 (UMLS CUI-1)
CL Item
Methotrexat (8)
C0025677 (UMLS CUI-1)
CL Item
Mitoxantron (9)
C0026259 (UMLS CUI-1)
CL Item
Cyclophosphamid (10)
C0010583 (UMLS CUI-1)
CL Item
Rituximab (11)
C0393022 (UMLS CUI-1)
CL Item
Immunglobuline (12)
C0021027 (UMLS CUI-1)
CL Item
Medikation aus einer MS-Studie (13)
CL Item
Alemtuzumab (Lemtrada) (14)
C0383429 (UMLS CUI-1)
CL Item
Teriflunomide (Aubagio) (15)
C1718383 (UMLS CUI-1)
CL Item
Fumarat (BG-12) (Tecfidera) (16)
C3556178 (UMLS CUI-1)
CL Item
Other (17)
C1115771 (UMLS CUI-1)
Other medication
Item
text
C1115771 (UMLS CUI-1)
Medication commenced
Item
Medication start
partialDate
C0451613 (UMLS CUI-1)
Dose per administration
Item
integer
C1960417 (UMLS CUI-1)
Item
text
C1519795 (UMLS CUI-1)
Unit
Code List
Unit
CL Item
 (mg)
CL Item
 (µg)
Frequency
Item
integer
C0439603 (UMLS CUI-1)
Frequency
Item
integer
C0439603 (UMLS CUI-1)
Item
integer
C0439221 (UMLS CUI-1)
Unit of time
Code List
Unit of time
CL Item
 (1)
CL Item
 (2)
CL Item
 (3)
CL Item
 (4)
CL Item
 (5)
Other administration
Item
text
Item Group
Cortisone therapy
C0010137 (UMLS CUI-1)
Cortisone therapy
Item
Cortisone therapy
boolean
C0010137 (UMLS CUI-1)
Item Group
C0024485 (UMLS CUI-1)
Item
integer
C0024485 (UMLS CUI-1)
C3843288 (UMLS CUI-2)
MRT to diagnose MS
Code List
MRT within past 12 months
CL Item
 (1)
CL Item
 (2)
CL Item
 (3)
CL Item
 (0)
CL Item
 (4)
Item Group
Disease history
C0683519 (UMLS CUI-1)
Item
Diagnosis
integer
C0011900 (UMLS CUI-1)
Diagnosis
Code List
Diagnosis
CL Item
Diabetes mellitus (1)
CL Item
Hypertension (2)
CL Item
Heart failure (3)
CL Item
Arrhythmia (4)
CL Item
Depression (5)
CL Item
Hyperthyroidism or hypothyroidism  (6)
CL Item
Renal disease (7)
CL Item
Pancreatitis (8)
CL Item
Liver cirrhosis (9)
CL Item
Hepatitis B or C (10)
CL Item
Herpes infection (11)
CL Item
Drug allergies (12)
CL Item
Other allergies (13)
CL Item
Autoimmune diseases (e.g. Goodpasture syndrome) (14)
CL Item
HIV-Infection (15)
CL Item
PML (progressive multifocal leukencephalopathia) (16)
CL Item
Pneumonia (17)
CL Item
Recurring urinary infections (>3/3 years) (18)
CL Item
Fungal infections (e.g. esophagus, lung) (19)
CL Item
Other opportunistic infections (e.g. toxoplasmosis) (20)
CL Item
Alopecia (21)
CL Item
Tuberculosis (22)
CL Item
Retinopathia, macular edema or diplopia (23)
CL Item
Skin symptoms regarding s.c. or i.v. drugs (e.g. inflammations, necrosis at injection site) (24)
CL Item
Blood changes (e.g. anemia, thrombopenia, lymphopenia) (25)
CL Item
Migraine and/or tension headache (26)
CL Item
Diarrhoea(>3 days diarrhoea) (27)
CL Item
Arthralgia, spasticity (28)
CL Item
Weight loss or gain (>5 kg) (29)
CL Item
Cancer diseases (30)
CL Item
Other concomitant disease (31)
Diagnosis date
Item
Diagnosis date
partialDate
C2316983 (UMLS CUI-1)
Diagnosis details
Item
Diagnosis details
text
Pharmacotherapy
Item
Pharmacotherapy
boolean
C0013216 (UMLS CUI-1)
Pharmacotherapy details
Item
Pharmacotherapy details
text
Item
Cancer treatment
integer
C0920425 (UMLS CUI-1)
Cancer treatment
Code List
Cancer treatment
CL Item
Operation (1)
CL Item
Bestrahlung (2)
CL Item
Chemotherapie (3)
Item Group
C0549206 (UMLS CUI-1)
Current pregnancy
Item
boolean
C0549206 (UMLS CUI-1)
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