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

Palliative and Hospice Care Tumor-specific Therapies in Palliative Care

- 17/09/2021 - 1 Formulaire, 13 Groupes Item, 43 Eléments de données, 2 Langues

Groupes Item: Date, TT1. Type of therapy, TT2. Number of previous treatments, TT3. Indications, TT4. Agents/Regime/Modus, TT5. Medical indication assessed by, TT6. Palliative prognostic index PPI in pre-treatment/ starting the new indicated tumor treatment, TT7. Was proceding/start of tumor therapy based on consensus in the palliative team?, TT8. What was the subjective success of the tumor therapy?, TT9. Was the tumor therapy determined early?, TT10. If yes, what were the reasons for the discontinuation of tumor therapy?, TT11. Was discontinuation of tumor therapy based on consensus in the palliative team?, TT12. Who completes this questionnaire?

https://www.hope-clara.de/ The HOPE Hospice and Palliative Care Recording standard documentation is used for documentation of palliative care and as an instrument for quality assurance in pallatiave wards, hospices and oncological wards as well as in ambulatory services and palliative teams. This questionnaire is designed to record tumor-specific therapies.

On-Study - Palliative Treatment for Head and Neck Cancer - On-Study Form - 2267713v3.0 - Palliative Treatment for Head and Neck Cancer - On-Study Form

- 20/09/2021 - 1 Formulaire, 9 Groupes Item, 85 Eléments de données, 1 Langue

Groupes Item: CRF Header, Head & Neck: Form Administration, Head & Neck: Patient Assessment, Head & Neck: Disease Description - Initial Diagnosis of Disease, Head & Neck: Disease Description - Current Diagnosis, Head & Neck: Prior Health History - Palliative, Head & Neck: Prior Treatment - Systemic Therapy, Head & Neck: Prior Treatment - Radiation Therapy, Head & Neck: Prior Treatment - Surgery

Palliative Treatment for Head and Neck Cancer - On-Study Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=20B9E4F5-9DD3-2343-E044-0003BA3F9857

Eligibility Disease Burden of Pathients with Incurable Cancer Disease DRKS00007536 NCT02751723 DRKS00007536 - Eligibility Disease Burden of Pathients with Incurable Cancer Disease NCT02751723 DRKS00007536

- 22/06/2017 - 1 Formulaire, 2 Groupes Item, 6 Eléments de données, 1 Langue

Groupes Item: Inclusion Criteria, Exclusion Criteria

Responsible Party: Florian Lordick, MD, Prof. Dr. med. (MD, PhD), University of Leipzig ClinicalTrials.gov Identifier: NCT02751723 History of Changes Other Study ID Numbers: APM Project DRKS00007536 ( Registry Identifier: Deutsches Register Klinischer Studien ) Study First Received: April 14, 2016 Last Updated: May 6, 2017 Individual Participant Data Plan to Share IPD: No Assessment of Disease Burden and Palliative Care Needs of Patients During the Course of Incurable Cancer Disease (APM-Project) ODM derived from: https://clinicaltrials.gov/ct2/show/NCT02751723

Breast Cancer NCT01242800 On-Study - E2108 Step 2 On-Study Form - 3130597v1.0 - E2108 Step 2 On-Study Form

- 20/09/2021 - 1 Formulaire, 8 Groupes Item, 40 Eléments de données, 1 Langue

Groupes Item: Header Module, Header, Amended Data, Patient Characteristics, Disease Description, Treatment Plan, Circulating Tumor Cell (CTC) Enumeration, Comments

E2108 Step 2 On-Study Form Early Surgery or Standard Palliative Therapy in Treating Patients With Stage IV Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=8E2EE15D-B7A5-69C7-E040-BB89AD431929

Breast Cancer NCT01242800 Follow-Up - E2108 Surgical Resection Form - 3145725v1.0 - E2108 Surgical Resection Form

- 09/01/2015 - 1 Formulaire, 3 Groupes Item, 27 Eléments de données, 1 Langue

Groupes Item: General information, Surgery, Footer Module

E2108 Surgical Resection Form Early Surgery or Standard Palliative Therapy in Treating Patients With Stage IV Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=91CE8B54-1649-B633-E040-BB89AD433125

Breast Cancer NCT01242800 Off Treatment - E2108 End-of-Study Form - 3128917v1.0 - E2108 End-of-Study Form

- 09/01/2015 - 1 Formulaire, 6 Groupes Item, 21 Eléments de données, 1 Langue

Groupes Item: Header Module, Header, Amended Data, Vital Status, Section I, Comments

E2108 End-of-Study Form Early Surgery or Standard Palliative Therapy in Treating Patients With Stage IV Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=8DF34112-9349-8BCA-E040-BB89AD4347FD

Breast Cancer NCT01242800 Quality of Life - E2108 Assessment Compliance Form - 3128759v1.0 - E2108 Assessment Compliance Form

- 09/01/2015 - 1 Formulaire, 12 Groupes Item, 49 Eléments de données, 1 Langue

Groupes Item: Header Module, Header, Report Period, Amended Data , 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 the assessment, Comments

E2108 Assessment Compliance Form Early Surgery or Standard Palliative Therapy in Treating Patients With Stage IV Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=8DF2D222-1D4F-10F8-E040-BB89AD432CF6

Breast Cancer NCT01242800 Follow-Up - E2108 Step 2 Follow-up Form - 3130846v1.0 - E2108 Step 2 Follow-up Form

- 20/09/2021 - 1 Formulaire, 12 Groupes Item, 67 Eléments de données, 1 Langue

Groupes Item: Header Module, Header, Amended Data, Report Period, Section I - Vital Status, Section II - Reporting Period, Status of Local-Regional Disease, CHEST WALL, Breast Involvement, Section IV - Status of Distant Disease, Circulating Tumor Cell (CTC) Enumeration, Comments

E2108 Step 2 Follow-up Form Early Surgery or Standard Palliative Therapy in Treating Patients With Stage IV Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=8E30083E-7422-9EAD-E040-BB89AD430E1D

Breast Cancer NCT01242800 On-Study - E2108 Step 1 On-Study Form - ARM S - 3130381v1.0 - E2108 Step 1 On-Study Form - ARM S

- 20/09/2021 - 1 Formulaire, 9 Groupes Item, 59 Eléments de données, 1 Langue

Groupes Item: Header Module, Header, Amended Data, Pre-Registration Evaluation, Disease Description, Metastatic Site(s) of Involvement (At Study Entry), STATUS OF LOCAL-REGIONAL DISEASE - Prior to initiation of Optimal Systemic Therapy, Breast Involvement, Comments

E2108 Step 1 On-Study Form - ARM S Early Surgery or Standard Palliative Therapy in Treating Patients With Stage IV Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=8E2ED499-121B-8389-E040-BB89AD4330F7

Breast Cancer NCT01242800 Quality of Life - E2108 FACT-B + Local Symptoms-9 - 3129088v1.0 - E2108 FACT-B + Local Symptoms-9

- 09/01/2015 - 1 Formulaire, 8 Groupes Item, 59 Eléments de données, 1 Langue

Groupes Item: Header Module, Reporting Period, Header, PHYSICAL WELL-BEING, FUNCTIONAL WELL-BEING, SOCIAL/FAMILY WELL-BEING, EMOTIONAL WELL-BEING, ADDITIONAL CONCERNS

E2108 FACT-B + Local Symptoms-9 Early Surgery or Standard Palliative Therapy in Treating Patients With Stage IV Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=8E06DE1E-7AF1-0A7A-E040-BB89AD43472D

Breast Cancer NCT01242800 On-Study - E2108 Baseline Disease Evaluation Form (RECIST 1.1) - 3129560v1.0 - E2108 Baseline Disease Evaluation Form (RECIST 1.1)

- 09/01/2015 - 1 Formulaire, 8 Groupes Item, 38 Eléments de données, 1 Langue

Groupes Item: Header Module, Header, Amended Data, TARGET LESIONS, TARGET LESIONS - NON NODAL, TARGET LESIONS - NODAL, NONTARGET LESIONS, Footer Module

E2108 Baseline Disease Evaluation Form (RECIST 1.1) Early Surgery or Standard Palliative Therapy in Treating Patients With Stage IV Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=8E091CE3-49A1-4A3C-E040-BB89AD4304A1

Eligibility Hepatocellular Carcinoma NCT01935700

- 27/09/2021 - 1 Formulaire, 2 Groupes Item, 14 Eléments de données, 1 Langue