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ID
510
Beschreibung
AMC-046 Enrollment Form (ENR) Segment A Cidofovir in Treating HIV-Infected Patients With High-Grade Squamous Intraepithelial Lesions of the Skin Near the Anus Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=3BC16E2A-1509-2256-E044-0003BA3F9857
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Stichworte
Versionen (2)
- 26.08.12 26.08.12 -
- 14.03.15 14.03.15 - Martin Dugas
Hochgeladen am
26. August 2012
DOI
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Creative Commons BY-NC 3.0 Legacy
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Anal Cancer NCT00550589 Registration - AMC-046 Enrollment Form (ENR) Segment A - 2685912v1.0
No Instruction available.
- StudyEvent: AMC-046 Enrollment Form (ENR) Segment A
Ähnliche Modelle
No Instruction available.
- StudyEvent: AMC-046 Enrollment Form (ENR) Segment A
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
PrincipalInvestigatorName
Item
Principal Investigator
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C19924 (NCI Thesaurus ObjectClass)
C1521895 (UMLS 2011AA ObjectClass)
C1547383 (UMLS 2011AA ValueDomain)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C19924 (NCI Thesaurus ObjectClass)
C1521895 (UMLS 2011AA ObjectClass)
Item
Inclusion Criteria
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C19707 (NCI Thesaurus ObjectClass)
C1515830 (UMLS 2011AA ObjectClass)
C16112 (NCI Thesaurus Property)
C1516637 (UMLS 2011AA Property)
C25532 (NCI Thesaurus Property)
C1512693 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C0030705 (UMLS 2011AA ObjectClass)
C19707 (NCI Thesaurus ObjectClass)
C1515830 (UMLS 2011AA ObjectClass)
C16112 (NCI Thesaurus Property)
C1516637 (UMLS 2011AA Property)
C25532 (NCI Thesaurus Property)
C1512693 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL Item
Date Of Informed Consent (Date of informed consent)
CL Item
Does The Investigator Believe That The Participant Is Capable Of Complying With The Protocol (Does the investigator believe that the participant is capable of complying with the protocol)
CL Item
Does The Participant Have A Life Expectancy >= 3 Months (Does the participant have a life expectancy >= 3 months)
CL Item
Does The Participant Have Documentation Of Hiv-1 Infection By Any Licensed Elisa Test Kit And Confirmed By Western Blot At Any Time Prior To Study Entry (Does the participant have documentation of HIV-1 infection by any licensed ELISA test kit and confirmed by Western blot at any time prior to study entry)
CL Item
Does The Participant Have The Ability And Willingness To Give Informed Consent (Does the participant have the ability and willingness to give informed consent)
CL Item
If Female, And Of Childbearing Potential, Has The Participant Had A Negative Urine Pregnancy Test Within The Past 7 Days (If female, and of childbearing potential, has the participant had a negative urine pregnancy test within the past 7 days)
CL Item
Participant's Age (in Years) (Participant's age (in years))
Item
Exclusion Criteria
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C19707 (NCI Thesaurus ObjectClass)
C1515830 (UMLS 2011AA ObjectClass)
C16112 (NCI Thesaurus Property)
C1516637 (UMLS 2011AA Property)
C25370 (NCI Thesaurus Property)
C0680251 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C0030705 (UMLS 2011AA ObjectClass)
C19707 (NCI Thesaurus ObjectClass)
C1515830 (UMLS 2011AA ObjectClass)
C16112 (NCI Thesaurus Property)
C1516637 (UMLS 2011AA Property)
C25370 (NCI Thesaurus Property)
C0680251 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL Item
Does The Participant Have Concurrent Neoplasia Requiring Cytotoxic Therapy (Does the participant have concurrent neoplasia requiring cytotoxic therapy)
CL Item
Does The Participant Have Untreated Invasive Cancer Of The Lower Genital Tract (Does the participant have untreated invasive cancer of the lower genital tract)
CL Item
Is The Participant Pregnant Or Breast-feeding (Is the participant pregnant or breast-feeding)
CL Item
Is The Participant Receiving Corticosteroid Treatment, Other Than Replacement Doses (Is the participant receiving corticosteroid treatment, other than replacement doses)
PatientAgeYearCount
Item
Age
double
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C29848 (NCI Thesaurus ValueDomain)
C0439234 (UMLS 2011AA ValueDomain)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C25150 (NCI Thesaurus Property)
C0001779 (UMLS 2011AA Property)
C0030705 (UMLS 2011AA ObjectClass)
C29848 (NCI Thesaurus ValueDomain)
C0439234 (UMLS 2011AA ValueDomain)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C25150 (NCI Thesaurus Property)
C0001779 (UMLS 2011AA Property)
InformedConsentFormSignedDate
Item
Date Informed Consent Signed
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain)
C16468 (NCI Thesaurus ObjectClass)
C0009797 (UMLS 2011AA ObjectClass)
C25679 (NCI Thesaurus Property)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain)
C16468 (NCI Thesaurus ObjectClass)
C0009797 (UMLS 2011AA ObjectClass)
C25679 (NCI Thesaurus Property)
ResearchCommentsText
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0282411 (UMLS 2011AA Property)
C1527021 (UMLS 2011AA ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0282411 (UMLS 2011AA Property)