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ICHOM Type 1 and Type 2 Diabetes in Adults - Annual Characteristics, Patient reported Form

- 20/09/2021 - 1 form, 9 itemgroups, 32 items, 1 language
Itemgroups: Patient ID, Demographic Factors, Lifestyle and Social Factors, Treatment variables, Clinician-reported Outcomes: Chronic Complications, Patient reported Outcomes: Financial Barriers to Care, Patient reported Outcome: Psychological Well-being, Patient-reported outcomes: Diabetes Distress, Patient-reported outcomes: Depression
Type 1 and Type 2 Diabetes in Adults DATA COLLECTION Version 1.0.0 Revised February 28th, 2019 www.ichom.org Notice: This work was conducted using resources from ICHOM, the International Consortium for Health Outcomes Measurement (www.ICHOM.org). The content is solely the responsibility of the authors and does not necessarily represent the official views of ICHOM. Conditions: Type 1 Diabetes | Type 2 Diabetes Excluded Conditions: Diabetes mellitus types other than 1 and 2 | Secondary Diabetes | Gestational Diabetes Population: Adults Aged 18 years and Above Excluded Populations: Children and Young persons below 18 years Treatment Approaches: Non-Pharmacological Therapy | Non-Insulin-based Pharmacological Therapy | Insulin-based Pharmacological Therapy This form is for documentation of characteristics to be reported annually by the patient. If necessary (i.e. information not already on the 6-monthly clinician-reported form) please also fill in the 6-monthly patient-reported form. It is sufficient for the educational status to only be updated every 5 years. Use of the following Scores for this standard set: WHO (Five) Well-Being Index (WHO-5): The WHO-5 is free for all health care organizations, and a license is not needed. There are translations available. The total raw score, ranging from 0 to 25, is multiplied by 4 to give the final score, with 0 representing the worst imaginable well-being and 100 representing the best imaginable well-being. More information (including the WHO-5 Scoring Guide) may be found at www.who-5.org. Problem Areas in Diabetes Questionnaire (PAID): The PAID, authored by Joslin Diabetes Center (http://www.joslin.org), is the copyright of Joslin Diabetes Center (Copyright ©2000, Joslin Diabetes Center). The PAID, provided under license from Joslin Diabetes Center may not be copied, distributed or used in any way without the prior written consent of Joslin Diabetes Center. Contact Susan D. Sjostrom at Joslin Diabetes Center at: susan.sjostrom@joslin.harvard.edu for licensing details and scoring guide. Patient Health Questionnaire (PHQ-9): Copyright by Pfizer: "content found on the PHQ Screeners site is free for download and use as stated within the PHQ Screeners site", please visit http://www.phqscreeners.com/ for more information. For this standard set ICHOM was supported by Imperial College London Diabetes Centre and JDRF. Publication: Nano J, Carinci F, Okunade O, et al. A standard set of person-centred outcomes for diabetes mellitus: results of an international and unified approach. Diabetic Medicine [Internet]. [cited 2020 Mar 4];n/a(n/a). Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/dme.14286 For this version of the standard set, semantic annotation with UMLS CUIs has been added.

NSABP PROTOCOL B-36 Follow-Up Menstrual History Questionnaire NCT00087178

- 03/06/2015 - 1 form, 3 itemgroups, 14 items, 1 language
Itemgroups: Header Module, Menstrual history, CCRR MODULE
NSABP PROTOCOL B-36 Follow-Up Menstrual History Questionnaire NCT00087178 Comparison of Two Combination Chemotherapy Regimens in Treating Women With Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=C891F490-0A7E-745C-E034-0003BA12F5E7

Neoplasms, Breast NCT00490139 Follow-Up - North Central Cancer Treatment Group - Patient Questionnaire Booklet Compliance Form - 2648090v1.0 - North Central Cancer Treatment Group - Patient Questionnaire Booklet Compliance Form

- 09/01/2015 - 1 form, 2 itemgroups, 11 items, 1 language
Itemgroups: Header Module, Header
North Central Cancer Treatment Group - Patient Questionnaire Booklet Compliance Form ALTTO (Adjuvant Lapatinib And/Or Trastuzumab Treatment Optimisation) Study; BIG 2-06/N063D Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=324F19A9-67ED-1E08-E044-0003BA3F9857

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