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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
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WHO-5 - WHO (Five) Well-Being Index

- 9/9/21 - 1 form, 1 itemgroup, 5 items, 30 languages
Itemgroup: Over the last two weeks
WHO (Five) Well-Being Index (1998 version) http://www.who-5.org Also called : WHO Five, WHO 5

SF-36 (RAND)

- 9/17/21 - 1 form, 7 itemgroups, 36 items, 1 language
Itemgroups: General Info,Current health limitations,Physical Health related problems during past 4 weeks,Emotional problems during past 4 weeks,Past 4 weeks,Emotions in past 4 weeks,General statements
This document contains the 36-Item Short Form Survey Instrument Version 1 (SF-36) form, developed at RAND as part of the Medical Outcomes Study. RAND owns the copyright. All of the surveys and tools from RAND Health are public documents, available without charge. For more information - e.g. on terms and conditions for use or scoring instructions: https://www.rand.org/health-care/surveys_tools/mos/36-item-short-form.html Changes made to the questionnaire should be made clearly identifiable.

Pancreatic Cancer NCT00058149 Quality of Life - Brief Pain Inventory - 2031356v3.0 - Brief Pain Inventory

- 1/9/15 - 1 form, 2 itemgroups, 23 items, 1 language
Itemgroups: Header,CCRR MODULE
Brief Pain Inventory A Phase III, Randomized Study of Gemcitabine (Fixed-Dose Rate Infusion) and Oxaliplatin (NSC 266046) Versus Gemcitabine (Fixed-Dose Rate Infusion) Versus Gemcitabine (30-Minute Infusion) in Pancreatic Carcinoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AE65F8E1-704E-30A0-E034-0003BA12F5E7

HADS - Hospital Anxiety and Depression Scale (HADS)

- 11/16/18 - 1 form, 1 itemgroup, 14 items, 1 language
Itemgroup: In the past week
Hospital Anxiety and Depression Scale (HADS) was originally developed by [Zigmond, AS; Snaith, RP (1983). "The hospital anxiety and depression scale". Acta Psychiatrica Scandinavica 67 (6): 361–370] and is commonly used by doctors to determine the levels of anxiety and depression that a patient is experiencing. Also used for routine documentation at the University Hospital Muenster (UKM) see http://en.wikipedia.org/wiki/Hospital_Anxiety_and_Depression_Scale

DLQI - Dermatology Life Quality Index (DLQI)

- 9/7/16 - 1 form, 1 itemgroup, 12 items, 17 languages
Itemgroup: Skin problems past week
Details and Conditions of Use see: Finlay A.Y., Khan G.K. Dermatology Life Quality Index (DLQI) - A simple practical measure for routine clinical use. Clinical and Experimental Derm 1994; 19:210-16 Used as routine documentation at the University Hospital in Muenster (UKM).

KIORTH CPChild MS University Hospital Muenster (UKM)

- 11/17/21 - 1 form, 11 itemgroups, 159 items, 1 language
Itemgroups: General information,1. Personal care/ Activities of daily living,2. Positioning, Transferring & Mobility,3. Comfort & Emotions,4. Communication & Social Interaction,5. Health,6. Overall Quality of Life,7. Importance of items to your child's quality of life,8. Facts about your child,9. Facts about you,CPChild result
Hospital Routine Documentation Form at the University Hospital Muenster. Original Form name: KIORTH CPChild MS. German description: CPChild Ein Index zur gesundheitsbezogenen Lebensqualität bei Menschen mit Behinderung

Lung Cancer NCT00096265 Quality of Life - PQ RTOG Phase III Multiple Brain Metastases Fact Subscale - 2277326v3.0 - PQ RTOG Phase III Multiple Brain Metastases Fact Subscale

- 9/27/21 - 1 form, 3 itemgroups, 43 items, 1 language
Itemgroups: Header,Physical Well-Being,Additional Concerns
PQ RTOG Phase III Multiple Brain Metastases Fact Subscale Radiation Therapy and Stereotactic Radiosurgery With or Without Temozolomide or Erlotinib in Treating Patients With Brain Metastases Secondary to Non-Small Cell Lung Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=D7FA7BFE-292F-6626-E034-0003BA12F5E7

Breast Cancer (NCT00053898) - Quality of Life Questionnaire Breast Cancer (NCT00053898)

- 9/20/21 - 1 form, 6 itemgroups, 70 items, 1 language
Itemgroups: Header,Symptom frequency,Problems past 4 weeks,Overall health,Mood,Sexual activity
Quality of Life Questionnaire Anastrozole or Tamoxifen in Treating Postmenopausal Women With Ductal Carcinoma in Situ Who Are Undergoing Lumpectomy and Radiation Therapy NCT00053898 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A0E240A0-FD2A-46A0-E034-080020C9C0E0

Colorectal cancer metastases (NCT00268463) - Quality of Life Form Colorectal Cancer (NSABP C-09 NCT00268463)

- 9/20/21 - 1 form, 8 itemgroups, 94 items, 1 language
Itemgroups: Header,Treatment satisfaction,PHYSICAL WELL-BEING,Social and family well being,EMOTIONAL WELL-BEING,Functional Health,ADDITIONAL CONCERNS,Activity
NSABP Protocol C-09: Quality of Life Form Oxaliplatin and Capecitabine With or Without an Hepatic Arterial Infusion With Floxuridine in Treating Patients Who Are Undergoing Surgery and/or Ablation for Liver Metastases Due to Colorectal Cancer NCT00268463 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FC7E0FCB-064A-58CD-E034-0003BA3F9857

Breast Cancer Chemotherapy (NCT00087178) - Quality of Life Questionnaire (NSABP Protocol B-36 NCT00087178)

- 9/20/21 - 1 form, 2 itemgroups, 94 items, 1 language
Itemgroups: Header,Quality of life
NSABP Protocol B-36 Quality of Life Questionnaire (English Version) Comparison of Two Combination Chemotherapy Regimens in Treating Women With Breast Cancer NCT00087178 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=C907A026-1DAB-1D7C-E034-0003BA12F5E7

Evaluation of a Flexible Dose of Lamotrigine Compared to Placebo as an Adjunctive to Atypical Antipsychotic Agents in Schizophrenia NCT00086593 - Week 12 - Visit 11 or Early Withdrawal

- 9/20/21 - 1 form, 8 itemgroups, 58 items, 1 language
Itemgroups: Early Withdrawal,Vital Signs,Physical Examination,Psychiatric Evaluation,Pharmacokinetic Sampling,Atypical Antipsychotic Dosing,Quality of Life Assessment,Investigational Product Dosing
Study ID: 101464 Clinical Study ID: SCA101464 Study Title: A Multicenter, Randomized, Double-Blind, Parallel Group Study to Evaluate the Efficacy and Safety of a Flexible Dose of Lamotrigine Compared to Placebo as an Adjunctive Therapy to an Atypical Antipsychotic Agent(s) in Subjects with Schizophrenia Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: NCT00086593 https://clinicaltrials.gov/ct2/show/NCT00086593 Sponsor: GlaxoSmithKline Collaborators: N/A Phase: phase 3 Study Recruitment Status: Completed Generic Name: lamotrigine Study Indication: Lamictal XR,Lamictal,LAMICTIN This ODM form contains Week 12 - Visit 11 or Early Withdrawal.

NCT00113399 RTOG-0421 HP: Radiation Therapy Oncology Group Health Utility Measurement Euro (EQ-5D) Miscellaneous Patient Assessment Form

- 9/20/21 - 1 form, 2 itemgroups, 23 items, 1 language
Itemgroups: RTOG clinical trial administrative data,Miscellaneous Patient Assessment
NCT00113399 RTOG-0421 HP: Radiation Therapy Oncology Group Health Utility Measurement Euro (EQ-5D) Miscellaneous Patient Assessment Form Combination Chemotherapy With or Without Radiation Therapy in Treating Patients With Recurrent Head and Neck Cancer That Cannot Be Removed By Surgery Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=EBAEDD99-A13F-1374-E034-0003BA3F9857

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