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Sommario
  1. 1. Test clinico
  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
    1. 7.1. Anestesiologia
    1. 7.2. Dermatologia
    1. 7.3. orecchio naso gola
    1. 7.4. Geriatria
    1. 7.5. Ginecologia / Ostetricia
    1. 7.6. Medicina Interna
      1. Ematologia
      1. Malattie infettive
      1. Cardiologia / Angiologia
      1. pneumologia
      1. Gastroenterologia
      1. Nefrologia
      1. Endocrinologia / Malattie metaboliche
      1. Reumatologia
    1. 7.7. Neurologia
    1. 7.8. Oftalmologia
    1. 7.9. Cure palliative
    1. 7.10. Patologia / Forense
    1. 7.11. Pediatria
    1. 7.12. Psichiatria / Psicosomatica
    1. 7.13. Radiologia
    1. 7.14. Chirurgia
      1. Chirurgia generale / viscerale
      1. Neurochirurgia
      1. Chirurgia plastica
      1. Chirurgia toracica
      1. Trauma / Ortopedia
      1. Chirurgia vascolare
    1. 7.15. Urologia
    1. 7.16. Medicina odontoiatrica / OMS
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Leukemia null Response - SOUTHWEST ONCOLOGY GROUP LEUKEMIA RESPONSE FORM - 2070922v3.0 - SOUTHWEST ONCOLOGY GROUP LEUKEMIA RESPONSE FORM

- 20/08/17 - 1 modulo, 3 itemgroups, 33 elementi, 1 linguaggio
Itemgroups: RESPONSE, Laboratory Values And Extramedullary Disease Involvement, Leukemia Response Form
SOUTHWEST ONCOLOGY GROUP LEUKEMIA RESPONSE FORM Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AEB44CFF-75C7-4219-E034-0003BA12F5E7

Safety and Activity of SRT501 Alone or in Combination with Bortezomib in Patients with Multiple Myeloma NCT00920556 - SRT501, Monotherapy, Cycle __ Day 21 - Physical Examination; Vital Signs; 12-Lead ECG; Hematology; Clinical Chemistry, Coagulation and Electrolytes; Urinalysis; Urinalysis microscopy results; Serum beta-hCG Pregnancy Test; Radiographic Assessment; Disease Marker Assessment; Disease Response; Study Treatment Compliance (Return); New Adverse Events and Concomitant Treatment

- 10/03/19 - 1 modulo, 23 itemgroups, 109 elementi, 1 linguaggio
Itemgroups: Administrative, Visit Date, Was a physical examination performed?, Physical Examination, Vital Signs, 12-Lead ECG, ECG Result, ECG Findings, Hematology, Hematology , Clinical Chemistry, Coagulation and Electrolytes, Clinical Chemistry, Coagulation and Electrolytes , Urinalysis dipstick results, Urinalysis microscopy results, Urinalysis microscopy results , Serum beta-hCG Pregnancy Test, Radiographic Assessment, Radiographic Assessment , Disease Marker Assessment , Disease Marker Assessment , Disease Response, Study Treatment Compliance (Return) , New Adverse Events and Concomitant Treatment
Study ID: 113222 Clinical Study ID: 113222 Study Title: A Phase II, Open Label, Clinical Study to Assess the Safety and Activity of SRT501 Alone or in Combination with Bortezomib in Patients with Multiple Myeloma Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: NCT00920556 Sponsor: GlaxoSmithKline Phase: Phase 2 Study Recruitment Status: Completed Generic Name:5.0g SRT501 Trade Name: Bortezomib Study Indication: Multiple Myeloma

Safety and Activity of SRT501 Alone or in Combination with Bortezomib in Patients with Multiple Myeloma NCT00920556 - SRT501 + Bortezomib Cycle __ Day 21 - Physical Examination; Vital Signs; 12-Lead ECG; Hematology; Clinical Chemistry, Coagulation and Electrolytes; Urinalysis; Urinalysis microscopy results; Serum beta-hCG Pregnancy Test; Radiographic Assessment; Disease Marker Assessment; Disease Response; Study Treatment Compliance (Return); New Adverse Events and Concomitant Treatment

- 10/03/19 - 1 modulo, 23 itemgroups, 107 elementi, 1 linguaggio
Itemgroups: Administrative, Visit Date, Was a physical examination performed?, Physical Examination, Vital Signs, 12-Lead ECG, ECG Result, ECG Findings, Hematology, Hematology , Clinical Chemistry, Coagulation and Electrolytes, Clinical Chemistry, Coagulation and Electrolytes , Urinalysis dipstick results, Urinalysis microscopy results, Urinalysis microscopy results , Serum beta-hCG Pregnancy Test, Radiographic Assessment, Radiographic Assessment , Disease Marker Assessment , Disease Marker Assessment , Disease Response, Study Treatment Compliance (Return) , New Adverse Events and Concomitant Treatment
Study ID: 113222 Clinical Study ID: 113222 Study Title: A Phase II, Open Label, Clinical Study to Assess the Safety and Activity of SRT501 Alone or in Combination with Bortezomib in Patients with Multiple Myeloma Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: NCT00920556 Sponsor: GlaxoSmithKline Phase: Phase 2 Study Recruitment Status: Completed Generic Name:5.0g SRT501 Trade Name: Bortezomib Study Indication: Multiple Myeloma

Safety and Activity of SRT501 Alone or in Combination with Bortezomib in Patients with Multiple Myeloma NCT00920556 - Cycle 2 Day 21 - Physical Examination; Vital Signs; 12-Lead ECG; Hematology; Clinical Chemistry, Coagulation and Electrolytes; Urinalysis; Urinalysis microscopy results; Serum beta-hCG Pregnancy Test; Radiographic Assessment; Disease Marker Assessment; Disease Response; Study Treatment Compliance (Return); New Adverse Events and Concomitant Treatment

- 01/03/19 - 1 modulo, 23 itemgroups, 109 elementi, 1 linguaggio
Itemgroups: Administrative, Visit Date, Was a physical examination performed?, Physical Examination, Vital Signs, 12-Lead ECG, ECG Result, ECG Findings, Hematology, Hematology , Clinical Chemistry, Coagulation and Electrolytes, Clinical Chemistry, Coagulation and Electrolytes , Urinalysis dipstick results, Urinalysis microscopy results, Urinalysis microscopy results , Serum beta-hCG Pregnancy Test, Radiographic Assessment, Radiographic Assessment , Disease Marker Assessment, Disease Marker Assessment , Disease Response, Study Treatment Compliance (Return) , New Adverse Events and Concomitant Treatment
Study ID: 113222 Clinical Study ID: 113222 Study Title: A Phase II, Open Label, Clinical Study to Assess the Safety and Activity of SRT501 Alone or in Combination with Bortezomib in Patients with Multiple Myeloma Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: NCT00920556 Sponsor: GlaxoSmithKline Phase: Phase 2 Study Recruitment Status: Completed Generic Name:5.0g SRT501 Trade Name: Bortezomib Study Indication: Multiple Myeloma

Response - Summary Response/Progression Form for Multiple Myeloma - 2274272v3.0 - Summary Response/Progression Form for Multiple Myeloma

- 09/01/15 - 1 modulo, 3 itemgroups, 20 elementi, 1 linguaggio
Itemgroups: CRF Header, Myeloma Response: Form Administration, Myeloma: Response Assessment
Summary Response/Progression Form for Multiple Myeloma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=D6E1D5FF-F9E0-5430-E034-0003BA12F5E7

Response - Multiple Myeloma - Follow-Up Disease Assessment Form - 2274798v3.0 - Multiple Myeloma - Follow-Up Disease Assessment Form

- 09/01/15 - 1 modulo, 9 itemgroups, 82 elementi, 1 linguaggio
Itemgroups: CRF Header, Myeloma: Form Administration, Myeloma: Assessment Reporting Interval, Myeloma: Protein Studies Response, Myeloma: Peripheral Blood Hematology/Chemistry, Myeloma: Bone and Marrow Response Assessment, Myeloma: Soft Tissue Plasmacytoma Response, Myeloma: Objective Response Assessment, Comments
Multiple Myeloma - Follow-Up Disease Assessment Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=D6E34646-3810-5812-E034-0003BA12F5E7

Acute Leukemia Disease Assessment Form NCT00049517

- 03/06/15 - 1 modulo, 3 itemgroups, 24 elementi, 1 linguaggio
Itemgroups: ECOG clinical trial administrative data, Acute Leukemia Disease assessment, CCRR MODULE
Acute Leukemia Disease Assessment Form NCT00049517 Combination Chemotherapy With or Without Monoclonal Antibody Therapy Followed by Stem Cell Transplant in Treating Patients With Acute Myeloid Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A727ECDC-BAED-2F88-E034-0003BA0B1A09

CALGB-10501 Summary Response / Progression Form for Leukemia NCT00513747

- 18/06/15 - 1 modulo, 4 itemgroups, 26 elementi, 1 linguaggio
Itemgroups: Header, Patient demographics, Leukemia Response Assessment, Comments
CALGB-10501 Summary Response / Progression Form for Leukemia NCT00513747 Early or Delayed Fludarabine and Rituximab in Treating Patients With Previously Untreated Chronic Lymphocytic Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=33F80721-319D-3F50-E044-0003BA3F9857

NCT01041703 Response - E2906 Acute Leukemia Disease Assessment Form - 2951828v1.0 - E2906 Acute Leukemia Disease Assessment Form

- 08/01/15 - 1 modulo, 6 itemgroups, 36 elementi, 1 linguaggio
Itemgroups: Header Module, On Treatment Report Period, OFF TREATMENT, Header, Disease Assessment, Footer Module
E2906 Acute Leukemia Disease Assessment 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-C98E-8BDD-E040-BB89AD430415

Bogen 3 Molekulares Rezidiv Progression DRKS00005243 NCT01657604 Chronic Myeloid Leukemia - Bogen 3 Molekulares Rezidiv Progression

- 17/09/21 - 1 modulo, 9 itemgroups, 30 elementi, 2 lingue
Itemgroups: Adiminstrative Daten I, Geburtsdatum, Adiminstrative Daten II, Transplantationspatient, Rezidiv, Patient ist verstorben, Patient lebt, Gründe für vorzeitiges Ausscheiden aus der Studie, Unterschrift
http://clinicaltrials.gov/ct2/show/NCT01657604

Response - Hodgkins Lymphoma - Follow-Up Disease Assessment Form - 2269525v3.0 - Hodgkins Lymphoma - Follow-Up Disease Assessment Form

- 09/01/15 - 1 modulo, 8 itemgroups, 57 elementi, 1 linguaggio
Itemgroups: CRF Header, Lymphoma: Form Administration, Lymphoma: Measurable Disease Response, Lymphoma: Non-Measurable Disease Response, Lymphoma: New Lesions, Lymphoma: Bone Marrow and Liver Assessment, Hodgkin's Lymphoma: Biochemical and B Symptoms, Hodgkin's Lymphoma: Response Assessment
Hodgkin's Lymphoma - Follow-Up Disease Assessment Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=D5EB536B-A765-64B5-E034-0003BA12F5E7

NHL Ofatumumab NCT01190449 CALGB 50901 - Response Assessment Form NHL Ofatumumab

- 09/06/17 - 1 modulo, 1 ItemGroup, 3 elementi, 2 lingue
ItemGroup: Response Assessment
CALGB 50901 Response Assessment Form Ofatumumab in Treating Patients With Previously Untreated Stage II, Stage III, or Stage IV Follicular Non-Hodgkin Lymphoma https://clinicaltrials.gov/ct2/show/study/NCT01190449

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