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Table of contents
  1. 1. Clinical Trial
  2. 2. Routine Documentation
  3. 3. Registry/Cohort Study
  4. 4. Quality Assurance
  5. 5. Data Standard
  6. 6. Patient-Reported Outcome
  7. 7. Medical Specialty
Selected data models

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- 6/6/20 - 1 form, 14 itemgroups, 167 items, 1 language
Itemgroups: Date of visit, Vital signs, 12 lead ECG, Laboratory Procedures, Hematology finding, Laboratory Procedures, Chemistry, Clinical, Laboratory Procedures, Urinalysis, Laboratory Procedures, Hormones, Laboratory Procedures, Free Testosterone Measurement, Laboratory Procedures, Prolactin measurement, Nervous system structure, Evaluation, Ophthalmic examination and evaluation, Blinded Clinical Study, Status, Pregnancy, Information, Conclusion, Clinical Research
- 5/26/20 - 1 form, 6 itemgroups, 45 items, 1 language
Itemgroups: Administrative Data, Mother's relevant medical/family history, Father's Relevant Medical/Family History, Drug Exposures, Subject withdrawal, Reporting Investigator Information
Study ID: 103933 Clinical Study ID: NKV103933 Study Title: A non-randomised, open label, two period cross-over study to determine the excretion balance and metabolic disposition of [14C]-GW679769, administered as single doses of an oral solution and an intravenous infusion to healthy male subjects Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier:N/A Sponsor: GlaxoSmithKline Collaborators: N/A Phase: Phase 1 Study Recruitment Status: Completed Generic Name: casopitant Trade Name: Rezonic,Zunrisa; Zunrisa,Rezonic Study Indication: Nausea and Vomiting, Chemotherapy-Induced Protocol ID: NKV103933 The eligibility to participate was determined during a screening visit within 21 days prior to first dosing day. The study consisted of two dosing periods, each consisting of predose visit, monitoring after dose administration and prior to discharge visit. Dosing periods were separated by a wash-out period of 43 days. The Pregnancy Notification Form is used to report pregnancy to GSK in specific cases specified by the Protocol. This form should be completed according to the protocol reporting requirements. Complete this form for each subject or subject’s partner who becomes pregnant during the study period. Send a copy of the form to GlaxoSmithKline (GSK will provide separately a list of contact names and information) by mail or fax (fax preferred) within two weeks of learning of the pregnancy. Original pages should remain with the subject’s Case Report Form. Note: This form does not routinely need to be completed for subject’s partner pregnancy unless there is specific instruction to do so stated in the protocol.
- 4/30/20 - 1 form, 7 itemgroups, 29 items, 1 language
Itemgroups: Administrative Data, Patient-reported health status, Breastfeeding, Role transition, Mental Health, Satisfaction with Care, Healthcare Responsiveness
ICHOM Pregnancy and Childbirth data collection Version 1.0.3 Published: 10th April 2017 International Consortium for Health Outcomes Measurement (ICHOM), Source: http://www.ichom.org/ Notice: This work was conducted using resources from ICHOM, the International Consortium for Health Outcomes Measurement (www.ICHOM.org). The content is solely the responsibility of the authors and does not necessarily represent the official views of ICHOM. The Pregnancy and Childbirth Standard Set of ICHOM includes outcomes to evaluate maternity care for all women during pregnancy, labor and delivery, and up to six month postpartum. ICHOMs Standard Set also includes a list of case-mix factors to allow for comparisons of outcomes across this broad patient population. Conditions: All women during: Pregnancy | Labor and delivery | Up to six months postpartum This document contains the 6 months postpartum - Patient reported Form. It has to be filled in between 22 and 26 weeks postpartum. Collecting Patient-Reported Outcome Measure: PROMIS-10. As there is an official distribution site for this questionnaire, only the total score will be included in this version of the standard set. For more information see: http://www.nihpromis.org/measures/translations International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form (ICIQ-UI SF). As permission is needed for use of this questionnaire, only the total score will be included in this version of the standard set. For more information see: http:// www.iciq.net/userpolicy.html, https://iciq.net/user-agreement Breastfeeding Self-Efficacy Scale - Short Form (BSES-SF). Free for use in clinical practice, routine outcomes measurement, and clinical research but requires permission from the developer. Please see Dennis, C-L. (2003) The Breastfeeding Self-Efficacy Scale: Psychometric assessment of the short form. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 32, 734-744. For more information see: http://www.cindyleedennis.ca/research/#1-breastfeeding Wexner Scale (Cleveland Clinic Florida Fecal Incontinence Score). Free for use. No license is required. For more information see: Table 2 of Vaizey et al. (1999) Prospective comparison of faecal incontinence grading systems. Gut 44:77-80. Original Publication: Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum. 1993 Jan;36(1):77–97. Mother-to-Infant Bonding Scale (MIBS). As license condition for use of this scale is insufficiently clarified, only the total score will be included in this version of the standard set. The complete scoring guide as well as information on clinical interpretation can be found at: http://www.ncbi.nlm.nih.gov/pubmed/15868385: Taylor, A., Atkins, R., Kumar, R. et al. Arch Womens Ment Health (2005) 8: 45. https://doi.org/10.1007/s00737-005-0074-z Patient Health Questionnaire-2 (PHQ-2). Free for use. No license is required. Scoring and clinical interpretation can be found at: http://www. cqaimh.org/pdf/tool_phq2.pdf For more information see: https://www.phqscreeners.com/ Edinburgh Postnatal Depression Scale (EPDS). Free for use. No license is required. Users may reproduce the scale without permissions provided they respect copyright by quoting the names of the authors, the title and the source of the paper in all reproduced copies. The scoring guide and clinical interpretation can be found in: Cox JL et al (1987) Detection of postnatal depression development of the 10-item Edinburgh Postnatal Depression Scale. Birth Satisfaction Scale - Revised (BSS-R). Free for use in clinical practice, routine outcomes measurement, and clinical research but requires permission from the developer. For more information see: Hollins Martin CJ et al (2014) Development and psychometric properties of the Birth Satisfaction Scale - Revised (BSS-R). Midwifery 30: 610-619 Reference: Nijagal MA, Wissig S, Stowell C, et al. Standardized outcome measures for pregnancy and childbirth, an ICHOM proposal. BMC Health Serv Res. 2018;18(1):953. Published 2018 Dec 11. doi:10.1186/s12913-018-3732-3 The Standard set of ICHOM was supported by the hoag, HCF Research Foundation, Karolinska University Hospital and the Government of South Australia. For this version of the standard set, semantic annotation with UMLS CUIs has been added.
- 4/30/20 - 1 form, 7 itemgroups, 21 items, 1 language
Itemgroups: Administrative Data, Demographic, Obstetric and medical history, Treatment variables, Survival, Severe maternal morbidity, Neonatal morbidity
ICHOM Pregnancy and Childbirth data collection Version 1.0.3 Published: 10th April 2017 International Consortium for Health Outcomes Measurement (ICHOM), Source: http://www.ichom.org/ Notice: This work was conducted using resources from ICHOM, the International Consortium for Health Outcomes Measurement (www.ICHOM.org). The content is solely the responsibility of the authors and does not necessarily represent the official views of ICHOM. The Pregnancy and Childbirth Standard Set of ICHOM includes outcomes to evaluate maternity care for all women during pregnancy, labor and delivery, and up to six month postpartum. ICHOMs Standard Set also includes a list of case-mix factors to allow for comparisons of outcomes across this broad patient population. Conditions: All women during: Pregnancy | Labor and delivery | Up to six months postpartum This document contains the Postnatal checkup - Administrative Data Form. It is the 1st postnatal checkup and has to be filled in between 2 and 8 weeks postpartum. Collecting Patient-Reported Outcome Measure: PROMIS-10. As there is an official distribution site for this questionnaire, only the total score will be included in this version of the standard set. For more information see: http://www.nihpromis.org/measures/translations International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form (ICIQ-UI SF). As permission is needed for use of this questionnaire, only the total score will be included in this version of the standard set. For more information see: http:// www.iciq.net/userpolicy.html, https://iciq.net/user-agreement Breastfeeding Self-Efficacy Scale - Short Form (BSES-SF). Free for use in clinical practice, routine outcomes measurement, and clinical research but requires permission from the developer. Please see Dennis, C-L. (2003) The Breastfeeding Self-Efficacy Scale: Psychometric assessment of the short form. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 32, 734-744. For more information see: http://www.cindyleedennis.ca/research/#1-breastfeeding Wexner Scale (Cleveland Clinic Florida Fecal Incontinence Score). Free for use. No license is required. For more information see: Table 2 of Vaizey et al. (1999) Prospective comparison of faecal incontinence grading systems. Gut 44:77-80. Original Publication: Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum. 1993 Jan;36(1):77–97. Mother-to-Infant Bonding Scale (MIBS). As license condition for use of this scale is insufficiently clarified, only the total score will be included in this version of the standard set. The complete scoring guide as well as information on clinical interpretation can be found at: http://www.ncbi.nlm.nih.gov/pubmed/15868385: Taylor, A., Atkins, R., Kumar, R. et al. Arch Womens Ment Health (2005) 8: 45. https://doi.org/10.1007/s00737-005-0074-z Patient Health Questionnaire-2 (PHQ-2). Free for use. No license is required. Scoring and clinical interpretation can be found at: http://www. cqaimh.org/pdf/tool_phq2.pdf For more information see: https://www.phqscreeners.com/ Edinburgh Postnatal Depression Scale (EPDS). Free for use. No license is required. Users may reproduce the scale without permissions provided they respect copyright by quoting the names of the authors, the title and the source of the paper in all reproduced copies. The scoring guide and clinical interpretation can be found in: Cox JL et al (1987) Detection of postnatal depression development of the 10-item Edinburgh Postnatal Depression Scale. Birth Satisfaction Scale - Revised (BSS-R). Free for use in clinical practice, routine outcomes measurement, and clinical research but requires permission from the developer. For more information see: Hollins Martin CJ et al (2014) Development and psychometric properties of the Birth Satisfaction Scale - Revised (BSS-R). Midwifery 30: 610-619 Reference: Nijagal MA, Wissig S, Stowell C, et al. Standardized outcome measures for pregnancy and childbirth, an ICHOM proposal. BMC Health Serv Res. 2018;18(1):953. Published 2018 Dec 11. doi:10.1186/s12913-018-3732-3 The Standard set of ICHOM was supported by the hoag, HCF Research Foundation, Karolinska University Hospital and the Government of South Australia. For this version of the standard set, semantic annotation with UMLS CUIs has been added.