Resultados de la búsqueda - Portal de Modelos de Datos Médicos (MDM-Portal)

Refractory tumors in children (NCT00053963) - Eligibility Worksheet (ADVL0212 NCT00053963)

- 20/3/15 - 1 formulario, 2 itemgroups, 32 items, 1 idioma

Itemgroups: Header, Eligibility criteria

ADVL0212: Eligibility Worksheet FR901228 in Treating Children With Refractory or Recurrent Solid Tumors or Leukemia NCT00053963 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B1EC07E8-6588-30D1-E034-0003BA12F5E7

Recurring cancer children (ADVL0212 NCT00053963) - Reporting Period Worksheet cancer (NCT00053963)

- 22/3/15 - 1 formulario, 5 itemgroups, 58 items, 1 idioma

Itemgroups: Header, Patient characteristics, Concomitant Medication, Patient status, Adverse event

ADVL0212: Reporting Period Worksheet FR901228 in Treating Children With Refractory or Recurrent Solid Tumors or Leukemia NCT00053963 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B1EC15B1-1989-311F-E034-0003BA12F5E7

Pathology Reporting Form - Brain Tumor N0577

- 20/9/21 - 1 formulario, 4 itemgroups, 34 items, 1 idioma

Itemgroups: Header, I. CRA/RN, II. Completed by the NCCTG Pathology reviewer, Comments and Pathology Reporting

North Central Cancer Treatment Group N0577 Pathology Reporting Form - Brain Tumor Radiation Therapy or Radiation Therapy and Temozolomide or Temozolomide Alone in Treating Patients With Newly Diagnosed Anaplastic Glioma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=4CA85A1E-6D87-49C3-E044-0003BA3F9857

Brain and Central Nervous System Tumors NCT00978458 On-Study - E3F05 Neurologic Function Status and KPS Form - 2901661v1.0 - E3F05 Neurologic Function Status and KPS Form

- 8/1/15 - 1 formulario, 7 itemgroups, 22 items, 1 idioma

Itemgroups: Header Module, ON TREATMENT, OFF TREATMENT, Amendment, Vital Status, Patient Characteristics, Footer Module

E3F05 Neurologic Function Status and KPS Form Radiation Therapy With or Without Temozolomide in Treating Patients With Low-Grade Glioma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=6C76FF0A-A486-4EDB-E040-BB89AD4325FA

E3F05 Brain On-Study Form NCT00978458

- 16/6/15 - 1 formulario, 8 itemgroups, 43 items, 1 idioma

Itemgroups: Header Module, Patient demographics, Data amendment, Patient Description Pre-Registration Hematology/Chemistry, Prior Brain Surgery, Motivation for Study Entry, Adverse Events present at time of registration (pre-treatment), Comments

E3F05 Brain On-Study Form NCT00978458 Radiation Therapy With or Without Temozolomide in Treating Patients With Low-Grade Glioma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=6C76FF0A-A556-4EDB-E040-BB89AD4325FA

Brain and Central Nervous System Tumors NCT00053963 Treatment - ADVL0212: Reporting Period Worksheet (Leukemia) - 2172521v3.0 - Reporting Period Worksheet (Leukemia ADVL0212)

- 12/3/15 - 1 formulario, 7 itemgroups, 66 items, 1 idioma

Itemgroups: Header, Patient characteristics, Treatment, Concomitant Medication, New Cancer, Follow-Up, Adverse event

ADVL0212: Reporting Period Worksheet (Leukemia) FR901228 in Treating Children With Refractory or Recurrent Solid Tumors or Leukemia NCT00053963 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=C0F387DC-C9D3-5664-E034-0003BA12F5E7

ACNS0122 Institutional Neuropathology Worksheet NCT00047320

- 21/6/15 - 1 formulario, 4 itemgroups, 15 items, 1 idioma

Itemgroups: Header, Neuropathology, Comments, CCRR MODULE

ACNS0122 Institutional Neuropathology Worksheet NCT00047320 Neoadjuvant Chemotherapy With or Without Second-Look Surgery Followed by Radiation Therapy With or Without Peripheral Stem Cell Transplantation in Treating Patients With Intracranial Germ Cell Tumors Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=BD40C955-FB29-0C2A-E034-0003BA12F5E7

Brain and Central Nervous System Tumors NCT00887146 Pathology - North Central Cancer Treatment Group N0577 Pathology Submission Form - 2745984v1.0 - North Central Cancer Treatment Group N0577 Pathology Submission Form

- 20/9/21 - 1 formulario, 4 itemgroups, 20 items, 1 idioma

Itemgroups: Header, Header, Institution Contact Information (Please Print), Footer Module

North Central Cancer Treatment Group N0577 Pathology Submission Form Radiation Therapy or Radiation Therapy and Temozolomide or Temozolomide Alone in Treating Patients With Newly Diagnosed Anaplastic Glioma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=4C08FC47-BFC6-632C-E044-0003BA3F9857

Neurocognitive Evaluation Summary Form (RTOG 0834)

- 9/1/15 - 1 formulario, 5 itemgroups, 36 items, 1 idioma

Itemgroups: Header, Hopkins Verbal Learning Test - Revised Administration, Trail Making Test Part A, Trail Making Test Part B, Contolled Oral Word Association (COWA)

RTOG 0834/EORTC 26053_22054/NCIC CTG CEC.1: Neurocognitive Evaluation Summary Form Radiation Therapy With or Without Temozolomide in Treating Patients With Anaplastic Glioma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=5A667C59-2D09-6D69-E044-0003BA3F9857

ACNS0122 Neurologic Assessment Worksheet NCT00047320

- 8/1/16 - 1 formulario, 6 itemgroups, 25 items, 1 idioma

Itemgroups: Header, Neurologic Assessment, MENTAL STATUS, CRANIAL NERVES, MOTOR, Comments

ACNS0122 Neurologic Assessment Worksheet NCT00047320 Neoadjuvant Chemotherapy With or Without Second-Look Surgery Followed by Radiation Therapy With or Without Peripheral Stem Cell Transplantation in Treating Patients With Intracranial Germ Cell Tumors Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=BE457FF2-45E3-1E0F-E034-0003BA12F5E7

GBM Neurocognitive Evaluation Summary Form (CS) RTOG 0825 Phase III

- 9/1/15 - 1 formulario, 6 itemgroups, 39 items, 1 idioma

Itemgroups: Header Module, Hopkins Verbal Learning Test - Revised Administration, Trail Making Test Part A, Trail Making Test Part B, Contolled Oral Word Association (COWA), Footer

RTOG 0825 Phase III GBM Neurocognitive Evaluation Summary Form (CS) Temozolomide and Radiation Therapy With or Without Bevacizumab in Treating Patients With Newly Diagnosed Glioblastoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=5BE60D36-11E5-00FF-E044-0003BA3F9857

Brain and Central Nervous System Tumors NCT00053963 Off Treatment - Off Protocol Therapy Follow-up (OPTF) Report (Master) [ADVL0212] - 2077867v3.0 - Off Protocol Therapy Follow-up (OPTF) Report (Master) [ADVL0212]

- 9/1/15 - 1 formulario, 4 itemgroups, 28 items, 1 idioma

Itemgroups: Header, Patient Status Information, Events of Interest, CCRR MODULE

Off Protocol Therapy Follow-up (OPTF) Report (Master) [ADVL0212] FR901228 in Treating Children With Refractory or Recurrent Solid Tumors or Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B24316ED-D5DA-16A3-E034-0003BA12F5E7

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