Résultats de recherche - Portail des modèles médicaux de données (portail MDM)

ACNS0122 Surgical Checklist Worksheet NCT00047320

- 20/09/2021 - 1 Formulaire, 7 Groupes Item, 22 Eléments de données, 1 Langue

Groupes Item: Header, Primary Surgery, REASON FOR SURGERY, CNS PERI-OPERATIVE COMPLICATIONS, POST-OP STEROIDS USED, Comments, CCRR MODULE

ACNS0122 Surgical Checklist 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=BD7B6161-4826-29D3-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

- 20/09/2021 - 1 Formulaire, 4 Groupes Item, 20 Eléments de données, 1 Langue

Groupes Item: 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

Pathology Reporting Form - Brain Tumor N0577

- 20/09/2021 - 1 Formulaire, 4 Groupes Item, 34 Eléments de données, 1 Langue

Groupes Item: 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 Quality of Life - E3F05 Quality of Life Assessment Form - FACT-BR - 3299831v1.0 - E3F05 Quality of Life Assessment Form - FACT-BR

- 20/09/2021 - 1 Formulaire, 8 Groupes Item, 64 Eléments de données, 1 Langue

Groupes Item: Header Module, Report Period, Header, PHYSICAL WELL-BEING, SOCIAL/FAMILY WELL-BEING, EMOTIONAL WELL-BEING, FUNCTIONAL WELL-BEING, Additional Concerns

E3F05 Quality of Life Assessment Form - FACT-BR 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=B0EE8BE4-1DEE-C782-E040-BB89AD433D2E

Registration Glioblastoma Multiforme N0874 NCT00731731

- 20/09/2021 - 1 Formulaire, 7 Groupes Item, 92 Eléments de données, 1 Langue

Groupes Item: Header, Demographics, Inclusion Criteria, Exclusion Criteria, Registration Check, Grouping Factor, Phase II patients: At the time of registration, the following will also be recorded (see section 7.27 second paragraph)

N0874 Registration (Step 2) Eligibility Checklist NCT00731731 Vorinostat, Temozolomide, and Radiation Therapy in Treating Patients With Newly Diagnosed Glioblastoma Multiforme Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=7E51877D-925A-72BF-E040-BB89AD436E3B

Registration Glioma E3F05 NCT00978458

- 20/09/2021 - 1 Formulaire, 2 Groupes Item, 24 Eléments de données, 1 Langue

Groupes Item: Eligibility, Patient Demographics / Pre-Treatment Characteristics

E3F05 Registration Worksheet (step 1) 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=612A5FBA-FC8E-B3D3-E040-BB89AD437EF0

Brain and Central Nervous System Tumors NCT00884741 On-Study - RTOG 0825: QOL M.D. Anderson Symptom Inventory - 2800871v1.0 - RTOG 0825: QOL M.D. Anderson Symptom Inventory

- 20/09/2021 - 1 Formulaire, 4 Groupes Item, 50 Eléments de données, 1 Langue

Groupes Item: Header Module, QOL Cover Sheet, Part I. M.D. Anderson Symptom Inventory (MDASI-BT), Part II

RTOG 0825: QOL M.D. Anderson Symptom Inventory 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=5BABD9A9-3DF8-0152-E044-0003BA3F9857

Brain and Central Nervous System Tumors NCT00890747 Demographic - AMC-061 Demographic Form (DEM) - 2978032v1.0 - AMC-061 Demographic Form (DEM)

- 17/09/2021 - 1 Formulaire, 1 Groupe Item, 7 Eléments de données, 1 Langue

Groupe Item: Demographics

AMC-061 Demographic Form (DEM) Sunitinib Malate in Treating HIV-Positive Patients With Cancer Undergoing Highly Active Antiretroviral Therapy Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=7C6E3CDA-FFD3-B993-E040-BB89AD432712

Lymphoma NCT00335140 Eligibility - E1F05 Registration Worksheet (step 1) - 2952523v1.0 - E1F05 Registration Worksheet (step 1)

- 17/09/2021 - 1 Formulaire, 3 Groupes Item, 30 Eléments de données, 1 Langue

Groupes Item: Eligibility, Race, Patient Demographics / Pre-Treatment Characteristics

E1F05 Registration Worksheet (step 1) Rituximab and Combination Chemotherapy in Treating Patients With Primary Central Nervous System Lymphoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=75BE18CF-8246-E1B5-E040-BB89AD4301D0

End of Re-Enrollment Titration Period Ropinirole in Parkinson's Disease GSK 101468/196

- 10/10/2017 - 1 Formulaire, 3 Groupes Item, 7 Eléments de données, 1 Langue

Groupes Item: Patient Information, End of Re-Enrollment Titration Period, Investigator Signature

Study ID: 101468/196 Clinical Study ID: 101468/196 Study Title: 101468/196: A Long-Term, Open-Label Continuation Study of Once Daily Administration of Ropinirole CR Tablets to Patients with Parkinson's Disease who Completed the Previous Ropinirole CR Studies 167 or 164 Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: NCT00650104 Sponsor: GlaxoSmithKline Collaborators: N/A Phase: phase 3 Study Recruitment Status: Completed Generic Name: ropinirole Trade Name: Zygara,ZIPEREVE,ZEPREVE,Requip Depot,REQUIP,REPREVE,Modutab,ADARTREL Study Indication : Parkinson DiseaseA Long-Term, Open-Label Continuation Study of Once Daily Adminstration of Ropinirole CR Tablets to Patients with Parkinson's Disease Who Completed the Previous Ropinirole CR Studies - 167 & 164 End of Re-Enrollment Titration Period

HIV Cancer Sunitinib NCT00890747 AMC-061 - Response Evaluation Form (R61)

- 24/06/2017 - 1 Formulaire, 7 Groupes Item, 35 Eléments de données, 1 Langue

Groupes Item: Header Module, Complete Response, Morphologic Complete Remission, Complete Response, Unconfirmed, Complete Response with Incomplete Bone Marrow Recovery, PR, Progressive Disease

AMC-061 Response Evaluation Form (R61) Sunitinib Malate in Treating HIV-Positive Patients With Cancer Undergoing Highly Active Antiretroviral Therapy https://clinicaltrials.gov/ct2/show/NCT00890747

Sunitinib in HIV with Cancer NCT00890747 AMC-061 - HIV Viral Load Form (F40)

- 20/06/2017 - 1 Formulaire, 2 Groupes Item, 9 Eléments de données, 1 Langue

Groupes Item: Header Module, HIV Viral Load

AMC-061 HIV Viral Load Form (F40) Sunitinib Malate in Treating HIV-Positive Patients With Cancer Undergoing Highly Active Antiretroviral Therapy https://clinicaltrials.gov/ct2/show/NCT00890747

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