ACNS0122: Endocrine Status Worksheet NCT00047320
ACNS0122: Endocrine Status Worksheet NCT00047320 Neoadjuvant Chemotherapy With or Without Second-Look Surgery Followed by Radiation Therapy With or Without Peripheral Stem Cell Transplantation in Treating Patients With Intracranial Germ Cell Tumors Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=BD9127F7-5FAB-1376-E034-0003BA12F5E7

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  1. StudyEvent: ACNS0122: Endocrine Status Worksheet
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Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
UMLS CUI
Item Group
Header
Institution Name
Item
Name
text
C25191
C1301943
C21541
C21541
C25364
Protocol ID COG
Item
Study Number
text
C25337
C3274381
C25320
C1516477
C25364
Protocol ID COG
Item
Study Number
text
C25337
C3274381
C25320
C1516477
C25364
PatientCOGIdentifierNumber
Item
COG Number
text
C25337
C0237753
C16960
C0030705
C25364
C0600091
C39353
C1516477
Patient Name
Item
Patient Name
text
C25191
C1299487
C16960
C25364
Form Completion Date
Item
Today's date
date
C19464
C1549507
C25250
C25604
C25164
C25367
DataEnteredDate
Item
Date worksheet entered into RDE
date
C25164
C0011008
C25474
C1511726
C37949
C1521975
Item Group
Patient status assessment
Assessment Date
Item
Date of evaluation
date
C25164
C2985720
C25367
C25367
C38000
Item
When was the evaluation done?
text
C20989
C0031809
C25616
C1948053
Code List
When was the evaluation done?
CL Item
Prior To Study Entry (Prior to study entry)
CL Item
On Study (During therapy)
CL Item
Off Treatment (End of therapy)
C25601
C1518544
CL Item
Follow-up (During follow up)
C16033
C1522577
Patient Height
Item
Standing height in cm
float
C25209
C0489786
C16960
C25347
Patient Weight
Item
Weight in kg
float
C25209
C0005910
C16960
C25208
Body Surface Area
Item
BSA
float
C25209
C0005902
C16960
C25157
Item Group
Endocrine Status
ChemistryIGF-1LabSpecifiedValue
Item
Somatomedian C
float
C37984
C0022877
C16414
C0007996
ChemistryIGF-BP3LabSpecifiedValue
Item
IGF-BP3
float
C37984
C0022877
C16414
C0007996
ChemistryCortisolLabSpecifiedValue
Item
Cortisol
float
C37984
C0022877
C16414
C0007996
LaboratoryProcedureSodiumElectrolytesOutcomeSpecifiedValue
Item
Sodium (8 AM Electrolytes)
float
C25294
C0022885
C20200
C1274040
C830
C0037473
C464
C0013832
C25712
C1522609
LaboratoryProcedurePotassiumElectrolytesOutcomeSpecifiedValue
Item
Potassium (8 AM Electrolytes)
float
C25294
C0022885
C20200
C1274040
C464
C0013832
C765
C0032821
C25712
C1522609
LaboratoryProcedureBicarbonateOutcomeSpecifiedValue
Item
Bicarbonate (8 AM Electrolytes)
float
C20200
C1274040
C25294
C0022885
C25712
C1522609
C37918
C0005367
LaboratoryProcedureChlorideIonElectrolytesOutcomeSpecifiedValue
Item
Chloride (8 AM Electrolytes)
float
C25294
C0022885
C20200
C1274040
C464
C0013832
C1741
C0596019
C25712
C1522609
LaboratoryProcedureUrineSpecificGravityOutcomeValue
Item
Urine Specific Gravity
float
C25294
C0022885
C13283
C0042036
C20200
C1274040
C64832
C0037786
C25712
C1522609
HematologyT4LabSpecifiedValue
Item
Free T4
float
C20200
C1274040
C25294
C0022885
HematologyT4LabSpecifiedValue
Item
Free T4
float
C20200
C1274040
C25294
C0022885
ChemistryFSHLabSpecifiedValue
Item
FSH
float
C37984
C0022877
C16414
C0007996
ChemistryTestosteroneLabSpecifiedValue
Item
Testosterone
float
C37984
C0022877
C16414
C0007996
ChemistryEstradiolLabSpecifiedValue
Item
Estradiol
float
C37984
C0022877
C16414
C0007996
ChemistryLHLabSpecifiedValue
Item
LH
float
C37984
C0022877
C16414
C0007996
ChemistryhCGLabSpecifiedValue
Item
hCG
float
C37984
C0022877
C16414
C0007996
BoneAssessmentInd-2
Item
Was radiographic evaluation for bone age done?
boolean
C38147
C1512698
C20989
C0031809
C12366
C0262950
BoneAgeMonthCount
Item
bone age according to Greulich-Pyle Atlas (If yes,)
float
C12366
C0262950
C29846
C0439231
C25463
C0750480
C25365
C0678257
Item Group
Pubertal Status
PubertyBreastStatusScore
Item
Breasts
float
C25365
C0678257
MenarcheStatusInd-3
Item
Menarche
boolean
C38148
C1512699
C25365
C0678257
PubertyHairStatusScore
Item
Pubic hair
float
C25365
C0678257
PubertyHairStatusScore
Item
Pubic hair
float
C25365
C0678257
PubertyGenitaliaStatusScore
Item
Genitalia
float
C25365
C0678257
TestesVolumeMeasurement
Item
Testicular volume
float
C25335
C0449468
Item Group
Comments
Research Comments
Item
Comments
text
C25704
C0947611
C15319
C25393
Item Group
Ccrr Module For Acns0122: Endocrine Status Worksheet