Risultati di ricerca - Portale di modelli di dati medici (MDM-Portal)

Breast Cancer NCT00310180 Quality of Life - PACCT-1 TAILORx Assessment Compliance Form - 3071476v1.0 - PACCT-1 TAILORx Assessment Compliance Form

- 08/01/15 - 1 modulo, 10 itemgroups, 43 elementi, 1 linguaggio

Itemgroups: Header Module, Header, Section I, Section II - Assessment Not Completed, Indicate reason(s) why form was not completed, Section III Assessment Completed, How was the patient assisted?, What was the reason for assistance?, Who assisted or completed assessment?, Footer Module

PACCT-1 TAILORx Assessment Compliance Form Hormone Therapy With or Without Combination Chemotherapy in Treating Women Who Have Undergone Surgery for Node-Negative Breast Cancer (The TAILORx Trial) Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=84B142E1-7D4C-582E-E040-BB89AD436C2E

Breast Cancer NCT00310180 Quality of Life - PACCT-1 TAILORx FACT - General Form - 3071611v1.0 - PACCT-1 TAILORx FACT - General Form

- 08/01/15 - 1 modulo, 8 itemgroups, 35 elementi, 1 linguaggio

Itemgroups: Header Module, Report Period, Header, Header, PHYSICAL WELL-BEING, SOCIAL/FAMILY WELL-BEING, EMOTIONAL WELL-BEING, FUNCTIONAL WELL-BEING

PACCT-1 TAILORx FACT - General Form Hormone Therapy With or Without Combination Chemotherapy in Treating Women Who Have Undergone Surgery for Node-Negative Breast Cancer (The TAILORx Trial) Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=84B142E1-7E5A-582E-E040-BB89AD436C2E

Leukemia NCT01041703 Quality of Life - E2906 Assessment Compliance Form - 2951978v1.0 - E2906 Assessment Compliance Form

- 08/01/15 - 1 modulo, 11 itemgroups, 49 elementi, 1 linguaggio

Itemgroups: Header Module, Header, On Treatment Report Period, Section I, Section II - E2906 QOL Assessment Not Completed, Indicate reason(s) why form was not completed, Section III Assessment Completed, How was the patient assisted?, What was the reason for assistance?, Who assisted or completed assessment?, Footer Module

E2906 Assessment Compliance Form Clofarabine or Daunorubicin Hydrochloride and Cytarabine Followed By Decitabine or Observation in Treating Older Patients With Newly Diagnosed Acute Myeloid Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=7585B205-CAA4-8BDD-E040-BB89AD430415

Leukemia NCT01041703 Quality of Life - E2906 Quality of Life Assessment Form - FACT - 2952035v1.0 - E2906 Quality of Life Assessment Form - FACT

- 08/01/15 - 1 modulo, 9 itemgroups, 68 elementi, 1 linguaggio

Itemgroups: Header Module, On Treatment Report Period, Header, PHYSICAL WELL-BEING, FUNCTIONAL WELL-BEING, SOCIAL/FAMILY WELL-BEING, EMOTIONAL WELL-BEING, Additional Concerns, FACIT Fatigue Scale

E2906 Quality of Life Assessment Form - FACT Clofarabine or Daunorubicin Hydrochloride and Cytarabine Followed By Decitabine or Observation in Treating Older Patients With Newly Diagnosed Acute Myeloid Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=7586A704-3004-A522-E040-BB89AD4359F8

Melanoma (Skin) NCT01274338 Quality of Life - E1609 Quality of Life Form - 3168557v1.0 - E1609 Quality of Life Form

- 08/01/15 - 1 modulo, 9 itemgroups, 64 elementi, 1 linguaggio

Itemgroups: Header Module, On Treatment Report Period, Off Treatment, PHYSICAL WELL-BEING, SOCIAL/FAMILY WELL-BEING, EMOTIONAL WELL-BEING, FUNCTIONAL WELL-BEING, Section II - FACT-BRM, Section III - FACIT D

E1609 Quality of Life Form Ipilimumab or High-Dose Interferon Alfa-2b in Treating Patients With High-Risk Stage III or Stage IV Melanoma That Has Been Removed by Surgery Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=978ABFF8-A570-C403-E040-BB89AD436599

Breast Cancer NCT00659373 Quality of Life - Quality of Life Module for Trial 24-02 (Form 24-QLM) - 2073726v3.0 - Quality of Life Module for Trial 24-02 (Form 24-QLM)

- 15/12/14 - 1 modulo, 2 itemgroups, 19 elementi, 1 linguaggio

Itemgroups: Problem severity past 2 weeks, CCRR MODULE

Quality of Life Module for Trial 24-02 (Form 24-QLM) Brain Function in Premenopausal Women Receiving Tamoxifen With or Without Ovarian Function Suppression for Early-Stage Breast Cancer on Clinical Trial IBCSG-2402 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B0EA5B57-DF0D-6356-E034-0003BA12F5E7

Cervical Cancer NCT00803062 Quality of Life - GOG-0240 Quality of Life (QOL) Form - 2746943v1.0 - GOG-0240 Quality of Life (QOL) Form

- 11/08/14 - 1 modulo, 5 itemgroups, 34 elementi, 1 linguaggio

Itemgroups: PHYSICAL WELLBEING, FUNCTIONAL WELLBEING, ADDITIONAL CONCERNS, NTX4 Subscale, BRIEF PAIN INVENTORY

GOG-0240 Quality of Life (QOL) Form Paclitaxel and Cisplatin or Topotecan With or Without Bevacizumab in Treating Patients With Stage IVB, Recurrent, or Persistent Cervical Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=4C9230B2-FA5F-0653-E044-0003BA3F9857

Eligibility NCT00699335 Severe Chronic Pain - Eligibility

- 16/04/14 - 1 modulo, 2 itemgroups, 10 elementi, 2 lingue

Itemgroups: Inclusion Criteria, Exclusion Criteria

ODM derived from http://clinicaltrials.gov/show/NCT00699335

Eligibility NCT00420472 Kidney Transplantation - Eligibility

- 09/12/13 - 1 modulo, 2 itemgroups, 7 elementi, 2 lingue

Itemgroups: Inclusion Criteria, Exclusion Criteria

ODM derived from http://clinicaltrials.gov/show/NCT00420472

Sarcoma NCT01016730 Quality of Life - AMC-063 FACT/GOG-Neurotoxicity Questionnaire Form (NTQ) - 3021065v1.0 - AMC-063 FACT/GOG-Neurotoxicity Questionnaire Form (NTQ)

- 19/09/12 - 1 modulo, 3 itemgroups, 13 elementi, 1 linguaggio

Itemgroups: Visit Number, Additional Concerns, Comments

AMC-063 FACT/GOG-Neurotoxicity Questionnaire Form (NTQ) Bortezomib in Treating Patients With Relapsed or Refractory AIDS-Related Kaposi Sarcoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=816407E2-1423-1A8A-E040-BB89AD433DA9

Lymphoma NCT00598169 Quality of Life - AMC-053 FACT/GOG-Neurotoxicity Questionnaire - 2798056v1.0 - AMC-053 FACT/GOG-Neurotoxicity Questionnaire

- 19/09/12 - 1 modulo, 2 itemgroups, 12 elementi, 1 linguaggio

Itemgroups: Additional Concerns, Comments

AMC-053 FACT/GOG-Neurotoxicity Questionnaire Bortezomib, Ifosfamide, Carboplatin, and Etoposide, With or Without Rituximab, in Treating Patients With Relapsed or Refractory AIDS-Related Non-Hodgkin Lymphoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=5B0B1DBC-D18A-02DB-E044-0003BA3F9857

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