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Sommario
  1. 1. Test clinico
    1. 1.1. Determinazione dell`idoneità
    1. 1.2. Storia medica
    1. 1.3. Esame fisico
    1. 1.4. Punteggio di valutazione
    1. 1.5. Diagnostica Apparativa
    1. 1.6. Laboratorio
    1. 1.7. Patologia / Istologia
    1. 1.8. Consenso
    1. 1.9. Terapia
    1. 1.10. Rapporto operativo
    1. 1.11. Evento avverso
    1. 1.12. Azione supplementare
  2. 2. Documentazione di routine
  3. 3. Registro / studio di coorte
  4. 4. Garanzia di qualità
  5. 5. Dati Standard
  6. 6. Risultato segnalato dal paziente
  7. 7. Specialità mediche
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Pancreatic Cancer NCT00058149 Quality of Life - Brief Pain Inventory - 2031356v3.0 - Brief Pain Inventory

- 09/01/15 - 1 modulo, 2 itemgroups, 23 elementi, 1 linguaggio
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

Visit 24 (Week 240) BG00012 Monotherapy Safety and Efficacy Extension Study in Multiple Sclerosis (MS) (ENDORSE) NCT00835770

- 18/02/22 - 1 modulo, 10 itemgroups, 41 elementi, 1 linguaggio
Itemgroups: Subject Identification, Vital Signs, Physical examination, EDSS Evaluation, Functional System Scores, EDSS, Additional and Results, Visual Function Test, Contrast Sensitivity Evaluation Binocular, Study Drug Accountability, Additional Surveys
The primary objective of this study is to evaluate the long-term safety profile of BG00012 (dimethyl fumarate). Secondary objectives of this study are to evaluate the long-term efficacy of BG00012 using clinical endpoints and disability progression, to evaluate further the long-term effects of BG00012 on multiple sclerosis (MS) brain lesions on magnetic resonance imaging (MRI) scans in participants who had MRI scans as part of Studies 109MS301 (NCT00420212) and 109MS302 (NCT00451451) and to evaluate the long-term effects of BG00012 on health economics assessments and the visual function test. NCT00835770 Part: Visit 24 (Week 240)

Visit 20 (Week 192) BG00012 Monotherapy Safety and Efficacy Extension Study in Multiple Sclerosis (MS) (ENDORSE) NCT00835770

- 17/02/22 - 1 modulo, 10 itemgroups, 42 elementi, 1 linguaggio
Itemgroups: Subject Identification, Vital Signs, Physical examination, EDSS Evaluation, Functional System Scores, EDSS, Additional and Results, Visual Function Test, Contrast Sensitivity Evaluation Binocular, Study Drug Accountability, Additional Surveys
The primary objective of this study is to evaluate the long-term safety profile of BG00012 (dimethyl fumarate). Secondary objectives of this study are to evaluate the long-term efficacy of BG00012 using clinical endpoints and disability progression, to evaluate further the long-term effects of BG00012 on multiple sclerosis (MS) brain lesions on magnetic resonance imaging (MRI) scans in participants who had MRI scans as part of Studies 109MS301 (NCT00420212) and 109MS302 (NCT00451451) and to evaluate the long-term effects of BG00012 on health economics assessments and the visual function test. NCT00835770 Part: Visit 20 (Week 192)

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

- 27/09/21 - 1 modulo, 3 itemgroups, 43 elementi, 1 linguaggio
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)

- 20/09/21 - 1 modulo, 6 itemgroups, 70 elementi, 1 linguaggio
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)

- 20/09/21 - 1 modulo, 8 itemgroups, 94 elementi, 1 linguaggio
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)

- 20/09/21 - 1 modulo, 2 itemgroups, 94 elementi, 1 linguaggio
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

- 20/09/21 - 1 modulo, 8 itemgroups, 58 elementi, 1 linguaggio
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

- 20/09/21 - 1 modulo, 2 itemgroups, 23 elementi, 1 linguaggio
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

RTOG 0920 Phase III Head and Neck Cancer Health Utility Measurement Euro QOL (EQ-5D) Form (HP)

- 20/09/21 - 1 modulo, 4 itemgroups, 38 elementi, 1 linguaggio
Itemgroups: Header Module, QOL Cover Sheet, Health Utility Measurement, Header
RTOG 0920 Phase III Head and Neck Cancer Health Utility Measurement Euro QOL (EQ-5D) Form (HP) Radiation Therapy With or Without Cetuximab in Treating Patients Who Have Undergone Surgery for Locally Advanced Head and Neck Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=5D3C3F4A-8C30-21E8-E044-0003BA3F9857

RTOG-0522 HP: Radiation Therapy Oncology Group Miscellaneous Patient Assessment Form NCT00265941

- 20/09/21 - 1 modulo, 2 itemgroups, 28 elementi, 1 linguaggio
Itemgroups: RTOG clinical trial administrative data, Miscellaneous Patient Assessment
RTOG-00522 HP: Radiation Therapy Oncology Group Miscellaneous Patient Assessment Form NCT00265941 Radiation Therapy and Cisplatin With or Without Cetuximab in Treating Patients With Stage III or Stage IV Head and Neck Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=F5E8260F-4AEB-157F-E034-0003BA3F9857

CALGB Memorial Symptom Assessment Scale Condensed Form NCT00390455

- 20/09/21 - 1 modulo, 4 itemgroups, 38 elementi, 1 linguaggio
Itemgroups: Header, Patient demographics, Memorial Symptom Assessment, Assessment of Quality of Life
CALGB Memorial Symptom Assessment Scale Condensed Form NCT00390455 Fulvestrant With or Without Lapatinib in Treating Postmenopausal Women With Stage III or Stage IV Breast Cancer That is Hormone Receptor-Positive Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=0D7D5091-6484-2392-E044-0003BA3F9857

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