No Instruction available.

1 forms
  1. StudyEvent: PRL1013 - Baseline Evaluation Form
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header
PractitionersEngagedinAppliedResearchandLearningNetworkClinicalStudySiteIdentifierNumber
Item
Site Code
text
C15206 (NCI Thesaurus ObjectClass)
C0008972 (UMLS 2011AA ObjectClass)
C37901 (NCI Thesaurus ObjectClass-2)
C0205145 (UMLS 2011AA ObjectClass-2)
C52664 (NCI Thesaurus ObjectClass-3)
C1709628 (UMLS 2011AA ObjectClass-3)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
PatientDentistVisitDate
Item
Date of visit
date
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C52654 (NCI Thesaurus Property)
C0011441 (UMLS 2011AA Property)
C25716 (NCI Thesaurus Property-2)
C0545082 (UMLS 2011AA Property-2)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
Patient Study ID
Item
Subject ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25462 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Patient Initials
Item
Subject Initials
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
Item
Treatment arm
text
C15368 (NCI Thesaurus ObjectClass)
C42651 (NCI Thesaurus ObjectClass-2)
C1522541 (UMLS CUI-1)
C32141 (NCI Thesaurus Property)
C25426 (NCI Thesaurus Property-2)
C25284 (NCI Thesaurus ValueDomain)
CL.1
Code List
Treatment arm
CL Item
Restoration With Rmgi (RR)
CL Item
Restoration With Dba (RD)
Item Group
Pre-treatment Evaluation
Assessment Date
Item
Date of evaluation
date
C25164 (NCI Thesaurus ValueDomain)
C2985720 (UMLS CUI-1)
C25367 (NCI Thesaurus ObjectClass)
C25367 (NCI Thesaurus ValueDomain-2)
C38000 (NCI Thesaurus Property)
SleepBruxismPatientSelf-ReportPresentInd-2
Item
Has the patient noticed his/her sleep bruxism
boolean
C73425 (NCI Thesaurus ObjectClass)
C0037313 (UMLS 2011AA ObjectClass)
C73511 (NCI Thesaurus ObjectClass-2)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C21089 (NCI Thesaurus Property-2)
C0681906 (UMLS 2011AA Property-2)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
SleepBruxismOtherReportPresentInd-2
Item
Has the patient's partner noted the patient's sleep bruxism
boolean
C73425 (NCI Thesaurus ObjectClass)
C0037313 (UMLS 2011AA ObjectClass)
C73511 (NCI Thesaurus ObjectClass-2)
C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C25626 (NCI Thesaurus Property-2)
C0150312 (UMLS 2011AA Property-2)
C25375 (NCI Thesaurus Property-3)
C0684224 (UMLS 2011AA Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
EnlargementMasseterMusclePresentInd-2
Item
Is enlargement of masseter muscle present
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C13074 (NCI Thesaurus ObjectClass)
C0024876 (UMLS 2011AA ObjectClass)
C73432 (NCI Thesaurus ObjectClass-2)
C1293134 (UMLS 2011AA ObjectClass-2)
MasseterMuscleEnlargementSleepBruxismPresentInd-2
Item
Is enlargement due to sleep bruxism (If "Yes")
boolean
C13074 (NCI Thesaurus ObjectClass)
C0024876 (UMLS 2011AA ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C73425 (NCI Thesaurus Property-2)
C0037313 (UMLS 2011AA Property-2)
C73432 (NCI Thesaurus Property-3)
C1293134 (UMLS 2011AA Property-3)
C73511 (NCI Thesaurus Property-4)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
ToothSleepBruxismAbrasionPresentInd-2
Item
Is heavy wear of the study tooth a result of sleep bruxism
boolean
C12506 (NCI Thesaurus ObjectClass)
C0040426 (UMLS 2011AA ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C73425 (NCI Thesaurus Property-2)
C0037313 (UMLS 2011AA Property-2)
C73511 (NCI Thesaurus Property-3)
C50449 (NCI Thesaurus Property-4)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
MasseterMuscleUponAwakeningDiscomfortAssessmentInd-2
Item
Does the patient experience jaw muscle discomfort, fatigue or pain and jaw lock upon awakening
boolean
C13074 (NCI Thesaurus ObjectClass)
C0024876 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C50535 (NCI Thesaurus Property-2)
C0234215 (UMLS 2011AA Property)
C64921 (NCI Thesaurus Property-3)
C1883476 (UMLS 2011AA Property-2)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
TherapySleepBruxismAdministeredInd-2
Item
Is the patient being treated for sleep bruxism
boolean
C15368 (NCI Thesaurus ObjectClass)
C73425 (NCI Thesaurus Property)
C0037313 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property-2)
C1521801 (UMLS 2011AA Property-2)
C73511 (NCI Thesaurus Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
Item Group
Evaluation Of Caries
Item
Tooth quadrant
text
C12506 (NCI Thesaurus ObjectClass)
C0040426 (UMLS 2011AA ObjectClass)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C12421 (NCI Thesaurus Property-2)
C0226896 (UMLS 2011AA Property-2)
C61106 (NCI Thesaurus Property-3)
C1631280 (UMLS 2011AA Property-3)
C13717 (NCI Thesaurus ValueDomain)
C1515974 (UMLS 2011AA ValueDomain)
CL.9
Code List
Tooth quadrant
CL Item
Lower Left Quadrant (Lower Left)
CL Item
Lower Right Quadrant (Lower Right)
CL Item
Upper Left Quadrant (Upper Left)
CL Item
Upper Right Quadrant (Upper Right)
Item
Caries stage
text
C25372 (NCI Thesaurus ValueDomain)
C0683312 (UMLS 2011AA ValueDomain)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
C52593 (NCI Thesaurus ObjectClass)
C0011334 (UMLS 2011AA ObjectClass)
C25523 (NCI Thesaurus Property-2)
C1522242 (UMLS 2011AA Property-2)
CL.10
Code List
Caries stage
CL Item
Visual Change In Enamel Or Cementum (Visual change in enamel or cementum)
CL Item
Localized Enamel Breakdown, Loss Of Cementum, Dentin Shadow (Localized enamel breakdown, loss of cementum, dentin shadow)
CL Item
Distinct Cavity With Visible Dentin, Extensive Lesion (Distinct cavity with visible dentin, extensive lesion)
Item
Rank dentin caries activity
text
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
C52594 (NCI Thesaurus ObjectClass)
C1707305 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
CL.11
Code List
Rank dentin caries activity
CL Item
Soft, Serous (Soft, serous)
CL Item
Soft, Dry (Soft, dry)
CL Item
Soft, Dry, Granular (Soft, dry, granular)
CL Item
Leathery (Leathery)
CL Item
Firm But Discolored (Firm but discolored)
ToothCrackDiagnosisInd-2
Item
Visual presence of a crack(s) in the pulpal floor dentin
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
C12506 (NCI Thesaurus ObjectClass)
C0040426 (UMLS 2011AA ObjectClass)
C52648 (NCI Thesaurus Property-2)
C1706353 (UMLS 2011AA Property-2)
Item Group
Cavity Measurements
CariesPeriodontalProbeAssessmentMaximumDepthMeasurement
Item
Deepest Cavity Depth (mm)
text
C52593 (NCI Thesaurus ObjectClass)
C0011334 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C62058 (NCI Thesaurus Property-2)
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
C25564 (NCI Thesaurus ValueDomain-2)
C0806909 (UMLS 2011AA ValueDomain-2)
C25333 (NCI Thesaurus ValueDomain-3)
C0205125 (UMLS 2011AA ValueDomain-3)
CariesPeriodontalProbeAssessmentMinimumDepthMeasurement
Item
Shallowest Cavity Depth (mm)
text
C52593 (NCI Thesaurus ObjectClass)
C0011334 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C62058 (NCI Thesaurus Property-2)
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
C25570 (NCI Thesaurus ValueDomain-2)
C1524031 (UMLS 2011AA ValueDomain-2)
C25333 (NCI Thesaurus ValueDomain-3)
C0205125 (UMLS 2011AA ValueDomain-3)
CariesPeriodontalProbeAssessmentLongestDiameterMeasurement
Item
Cavity Length (mm)
text
C52593 (NCI Thesaurus ObjectClass)
C0011334 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C62058 (NCI Thesaurus Property-2)
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
C25285 (NCI Thesaurus ValueDomain-2)
C1301886 (UMLS 2011AA ValueDomain-2)
C25558 (NCI Thesaurus ValueDomain-3)
C1522425 (UMLS 2011AA ValueDomain-3)
CariesPeriodontalProbeAssessmentLongestPerpendicularDiameterMeasurement
Item
Greatest Cavity Width (mm)
text
C52593 (NCI Thesaurus ObjectClass)
C0011334 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C62058 (NCI Thesaurus Property-2)
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
C25285 (NCI Thesaurus ValueDomain-2)
C1301886 (UMLS 2011AA ValueDomain-2)
C25558 (NCI Thesaurus ValueDomain-3)
C1522425 (UMLS 2011AA ValueDomain-3)
C25243 (NCI Thesaurus ValueDomain-4)
CariesPeriodontalProbeAssessmentMinimumPerpendicularDiameterMeasurement
Item
Narrowest Cavity Width (mm)
text
C52593 (NCI Thesaurus ObjectClass)
C0011334 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C62058 (NCI Thesaurus Property-2)
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
C25285 (NCI Thesaurus ValueDomain-2)
C1301886 (UMLS 2011AA ValueDomain-2)
C25570 (NCI Thesaurus ValueDomain-3)
C1524031 (UMLS 2011AA ValueDomain-3)
C25243 (NCI Thesaurus ValueDomain-4)
Item Group
Treatment
DentalCuringInstrumentationDescriptionValue
Item
Curing light output (mW/cm2 [a minimum of 400 mW/cm2])
text
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C16742 (NCI Thesaurus ObjectClass)
C0348000 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
C73513 (NCI Thesaurus ObjectClass-2)
PatientResinModifiedGlassIonomerLinerRandomizationInd-2
Item
Is patient randomized into the RMGI liner with DBA arm
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C25196 (NCI Thesaurus Property)
C0034656 (UMLS 2011AA Property)
C0030705 (NCI Metathesaurus ObjectClass)
C52585 (NCI Thesaurus Property-2)
C1709917 (UMLS 2011AA Property-2)
ResinModifiedGlassIonomerLinerUseInd-2
Item
RMGI Liner applied and cured (If "Yes")
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C25340 (NCI Thesaurus Property)
C0457083 (UMLS 2011AA Property)
C52585 (NCI Thesaurus ObjectClass)
C1709917 (UMLS 2011AA ObjectClass)
DentalRestorationDentalBondingAgentDentalCuringPerformedInd-2
Item
Self-etch dentin bonding agent (DBA) applied and cured
boolean
C60718 (NCI Thesaurus ObjectClass)
C0399059 (UMLS 2011AA ObjectClass)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C62092 (NCI Thesaurus Property-2)
C1880280 (UMLS 2011AA Property-2)
C73513 (NCI Thesaurus Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
DentalRestorationResin-BasedCompositePerformedInd-2
Item
Hybrid resin-based composite (RBC) applied and cured
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C52586 (NCI Thesaurus Property-2)
C1711229 (UMLS 2011AA Property-2)
C60718 (NCI Thesaurus ObjectClass)
C0399059 (UMLS 2011AA ObjectClass)
DentalRestorationCompleteInd-2
Item
Restoration finished?
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C25250 (NCI Thesaurus Property)
C0205197 (UMLS 2011AA Property)
C60718 (NCI Thesaurus ObjectClass)
C0399059 (UMLS 2011AA ObjectClass)
Item
What is your ranking of the risk of future caries in this patient
text
C25367 (NCI Thesaurus Property)
C17102 (NCI Thesaurus Property-2)
C0035647 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
C52593 (NCI Thesaurus ObjectClass)
C0011334 (UMLS 2011AA ObjectClass)
CL.18
Code List
What is your ranking of the risk of future caries in this patient
CL Item
High (High)
C25227 (NCI Thesaurus)
C0205250 (UMLS 2011AA)
CL Item
Moderate (Moderate)
CL Item
Low (Low)
C54722 (NCI Thesaurus)
C0205251 (UMLS 2011AA)
Item Group
Footer Module
Research Comments
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C0947611 (UMLS CUI-1)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
Back to the top of the page 

Contact

Please use this form for feedback, questions and suggestions for improvements.

Fields marked with * are required.

Help

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial