ID

6221

Beskrivning

CALGB: NEUROBEHAVOIRAL SCALES FORM Comparison of Combination Chemotherapy Regimens in Treating Older Women Who Have Undergone Surgery for Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A50CD25E-BDE1-371E-E034-080020C9C0E0

Länk

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A50CD25E-BDE1-371E-E034-080020C9C0E0

Nyckelord

Versioner (2)
  1. 2014-12-18 2014-12-18 - Martin Dugas
  2. 2015-03-23 2015-03-23 - Martin Dugas
Uppladdad den

18 december 2014

DOI

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Licens

Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT00024102 Quality of Life - CALGB: NEUROBEHAVOIRAL SCALES FORM - 2044345v3.0

Engelsk

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1 Formulär  
  1. StudyEvent: CALGB: NEUROBEHAVOIRAL SCALES FORM
    1. Continue to next page
Unnamed1
Beskrivning

Unnamed1

CALGB Form
Beskrivning

CALGBForm

Datatyp

text

CALGB Study No
Beskrivning

CALGBStudyNo

Datatyp

text

CALGB Patient ID
Beskrivning

CALGBPatientID

Datatyp

text

Date Completed (10.)
Beskrivning

DateCompleted

Datatyp

date

Amended data?
Beskrivning

Amendeddata?

Datatyp

text

Unnamed2
Beskrivning

Unnamed2

Patient's Name
Beskrivning

Patient'sName

Datatyp

text

Participating Group
Beskrivning

ParticipatingGroup

Datatyp

text

Alias
NCI Thesaurus ObjectClass
C17005
UMLS 2011AA ObjectClass
C1257890
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Patient Hospital Number
Beskrivning

PatientHospitalNumber

Datatyp

text

Participating Group Protocol No.
Beskrivning

ParticipatingGroupProtocolNo.

Datatyp

text

Main Member Institution/Adjunct
Beskrivning

MainMemberInstitution/Adjunct

Datatyp

text

Participating Group Patient No.
Beskrivning

ParticipatingGroupPatientNo.

Datatyp

text

Unnamed3
Beskrivning

Unnamed3

Responsible CRA
Beskrivning

ResponsibleCRA

Datatyp

text

Assessment Number
Beskrivning

AssessmentNumber

Datatyp

double

Unnamed4
Beskrivning

Unnamed4

Unnamed5
Beskrivning

Unnamed5

Patient's Name
Beskrivning

Patient'sName

Datatyp

text

CALGB Form
Beskrivning

CALGBForm

Datatyp

text

CALGB Study No
Beskrivning

CALGBStudyNo

Datatyp

text

CALGB Patient ID
Beskrivning

CALGBPatientID

Datatyp

text

Date Completed (10.)
Beskrivning

DateCompleted

Datatyp

date

Unnamed6
Beskrivning

Unnamed6

Ability to avoid losing train of thought; distractibility (2.)
Beskrivning

Abilitytoavoidlosingtrainofthought;distractibility

Datatyp

text

Ability to focus on goals; carry out a plan (3.)
Beskrivning

Abilitytofocusongoals;carryoutaplan

Datatyp

text

Remembering events from long ago (4.)
Beskrivning

Rememberingeventsfromlongago

Datatyp

text

Remembering new information told to you (5.)
Beskrivning

Rememberingnewinformationtoldtoyou

Datatyp

text

Attention and concentration (6.)
Beskrivning

Attentionandconcentration

Datatyp

text

Ability to reason through a complicated problem (7.)
Beskrivning

Abilitytoreasonthroughacomplicatedproblem

Datatyp

text

Self awareness of problems (8.)
Beskrivning

Selfawarenessofproblems

Datatyp

text

Remembering what you intended to do (9.)
Beskrivning

Rememberingwhatyouintendedtodo

Datatyp

text

Ability to shift easily from one activity to the next
Beskrivning

Abilitytoshifteasilyfromoneactivitytothenext

Datatyp

text

Unnamed7
Beskrivning

Unnamed7

Patient's Name
Beskrivning

Patient'sName

Datatyp

text

CALGB Form
Beskrivning

CALGBForm

Datatyp

text

CALGB Study No
Beskrivning

CALGBStudyNo

Datatyp

text

CALGB Patient ID
Beskrivning

CALGBPatientID

Datatyp

text

Date Completed (10.)
Beskrivning

DateCompleted

Datatyp

date

Unnamed8
Beskrivning

Unnamed8

Remembering appointments or meetings (11.)
Beskrivning

Rememberingappointmentsormeetings

Datatyp

text

General alertness (12.)
Beskrivning

Generalalertness

Datatyp

text

Ability to think clearly (13.)
Beskrivning

Abilitytothinkclearly

Datatyp

text

Remembering new information you have read (14.)
Beskrivning

Rememberingnewinformationyouhaveread

Datatyp

text

Remembering where you put things (15.)
Beskrivning

Rememberingwhereyouputthings

Datatyp

text

Ease in initiating or starting activities by oneself (16.)
Beskrivning

Easeininitiatingorstartingactivitiesbyoneself

Datatyp

text

Ability to make decisions (17.)
Beskrivning

Abilitytomakedecisions

Datatyp

text

Remembering information learned long ago (18.)
Beskrivning

Rememberinginformationlearnedlongago

Datatyp

text

Ability to be flexible, rather than rigid or have an overly set manner
Beskrivning

Abilitytobeflexible,ratherthanrigidorhaveanoverlysetmanner

Datatyp

text

Ccrr Module For Calgb: Neurobehavoiral Scales Form
Beskrivning

Ccrr Module For Calgb: Neurobehavoiral Scales Form

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Similar models

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1 Formulär
  1. StudyEvent: CALGB: NEUROBEHAVOIRAL SCALES FORM
    1. Continue to next page
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
Unnamed1
CALGBForm
Item
CALGB Form
text
CALGBStudyNo
Item
CALGB Study No
text
CALGBPatientID
Item
CALGB Patient ID
text
DateCompleted
Item
Date Completed (10.)
date
Item
Amended data?
text
CL.1
Code List
Amended data?
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item Group
Unnamed2
Patient'sName
Item
Patient's Name
text
ParticipatingGroup
Item
Participating Group
text
C17005 (NCI Thesaurus ObjectClass)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
PatientHospitalNumber
Item
Patient Hospital Number
text
ParticipatingGroupProtocolNo.
Item
Participating Group Protocol No.
text
MainMemberInstitution/Adjunct
Item
Main Member Institution/Adjunct
text
ParticipatingGroupPatientNo.
Item
Participating Group Patient No.
text
Item Group
Unnamed3
ResponsibleCRA
Item
Responsible CRA
text
AssessmentNumber
Item
Assessment Number
double
Item Group
Unnamed4
Item Group
Unnamed5
Patient'sName
Item
Patient's Name
text
CALGBForm
Item
CALGB Form
text
CALGBStudyNo
Item
CALGB Study No
text
CALGBPatientID
Item
CALGB Patient ID
text
DateCompleted
Item
Date Completed (10.)
date
Item Group
Unnamed6
Item
Ability to avoid losing train of thought; distractibility (2.)
text
CL.2
Code List
Ability to avoid losing train of thought; distractibility (2.)
CL Item
Above Average (Above Average)
CL Item
Normal Ability (Normal Ability)
CL Item
Mild Problem (Mild Problem)
CL Item
Mild To Moderate Problem (Mild to Moderate Problem)
CL Item
Moderate Problem (Moderate Problem)
CL Item
Moderate To Severe Problem (Moderate to Severe Problem)
CL Item
Severe Problem (Severe Problem)
Item
Ability to focus on goals; carry out a plan (3.)
text
CL.3
Code List
Ability to focus on goals; carry out a plan (3.)
CL Item
Above Average (Above Average)
CL Item
Normal Ability (Normal Ability)
CL Item
Mild Problem (Mild Problem)
CL Item
Mild To Moderate Problem (Mild to Moderate Problem)
CL Item
Moderate Problem (Moderate Problem)
CL Item
Moderate To Severe Problem (Moderate to Severe Problem)
CL Item
Severe Problem (Severe Problem)
Item
Remembering events from long ago (4.)
text
CL.4
Code List
Remembering events from long ago (4.)
CL Item
Above Average (Above Average)
CL Item
Normal Ability (Normal Ability)
CL Item
Mild Problem (Mild Problem)
CL Item
Mild To Moderate Problem (Mild to Moderate Problem)
CL Item
Moderate Problem (Moderate Problem)
CL Item
Moderate To Severe Problem (Moderate to Severe Problem)
CL Item
Severe Problem (Severe Problem)
Item
Remembering new information told to you (5.)
text
CL.5
Code List
Remembering new information told to you (5.)
CL Item
Above Average (Above Average)
CL Item
Normal Ability (Normal Ability)
CL Item
Mild Problem (Mild Problem)
CL Item
Mild To Moderate Problem (Mild to Moderate Problem)
CL Item
Moderate Problem (Moderate Problem)
CL Item
Moderate To Severe Problem (Moderate to Severe Problem)
CL Item
Severe Problem (Severe Problem)
Item
Attention and concentration (6.)
text
CL.6
Code List
Attention and concentration (6.)
CL Item
Above Average (Above Average)
CL Item
Normal Ability (Normal Ability)
CL Item
Mild Problem (Mild Problem)
CL Item
Mild To Moderate Problem (Mild to Moderate Problem)
CL Item
Moderate Problem (Moderate Problem)
CL Item
Moderate To Severe Problem (Moderate to Severe Problem)
CL Item
Severe Problem (Severe Problem)
Item
Ability to reason through a complicated problem (7.)
text
CL.7
Code List
Ability to reason through a complicated problem (7.)
CL Item
Above Average (Above Average)
CL Item
Normal Ability (Normal Ability)
CL Item
Mild Problem (Mild Problem)
CL Item
Mild To Moderate Problem (Mild to Moderate Problem)
CL Item
Moderate Problem (Moderate Problem)
CL Item
Moderate To Severe Problem (Moderate to Severe Problem)
CL Item
Severe Problem (Severe Problem)
Item
Self awareness of problems (8.)
text
CL.8
Code List
Self awareness of problems (8.)
CL Item
Above Average (Above Average)
CL Item
Normal Ability (Normal Ability)
CL Item
Mild Problem (Mild Problem)
CL Item
Mild To Moderate Problem (Mild to Moderate Problem)
CL Item
Moderate Problem (Moderate Problem)
CL Item
Moderate To Severe Problem (Moderate to Severe Problem)
CL Item
Severe Problem (Severe Problem)
Item
Remembering what you intended to do (9.)
text
CL.9
Code List
Remembering what you intended to do (9.)
CL Item
Above Average (Above Average)
CL Item
Normal Ability (Normal Ability)
CL Item
Mild Problem (Mild Problem)
CL Item
Mild To Moderate Problem (Mild to Moderate Problem)
CL Item
Moderate Problem (Moderate Problem)
CL Item
Moderate To Severe Problem (Moderate to Severe Problem)
CL Item
Severe Problem (Severe Problem)
Item
Ability to shift easily from one activity to the next
text
CL.10
Code List
Ability to shift easily from one activity to the next
CL Item
Above Average (Above Average)
CL Item
Normal Ability (Normal Ability)
CL Item
Mild Problem (Mild Problem)
CL Item
Mild To Moderate Problem (Mild to Moderate Problem)
CL Item
Moderate Problem (Moderate Problem)
CL Item
Moderate To Severe Problem (Moderate to Severe Problem)
CL Item
Severe Problem (Severe Problem)
Item Group
Unnamed7
Patient'sName
Item
Patient's Name
text
CALGBForm
Item
CALGB Form
text
CALGBStudyNo
Item
CALGB Study No
text
CALGBPatientID
Item
CALGB Patient ID
text
DateCompleted
Item
Date Completed (10.)
date
Item Group
Unnamed8
Item
Remembering appointments or meetings (11.)
text
CL.11
Code List
Remembering appointments or meetings (11.)
CL Item
Above Average (Above Average)
CL Item
Normal Ability (Normal Ability)
CL Item
Mild Problem (Mild Problem)
CL Item
Mild To Moderate Problem (Mild to Moderate Problem)
CL Item
Moderate Problem (Moderate Problem)
CL Item
Moderate To Severe Problem (Moderate to Severe Problem)
CL Item
Severe Problem (Severe Problem)
Item
General alertness (12.)
text
CL.12
Code List
General alertness (12.)
CL Item
Above Average (Above Average)
CL Item
Normal Ability (Normal Ability)
CL Item
Mild Problem (Mild Problem)
CL Item
Mild To Moderate Problem (Mild to Moderate Problem)
CL Item
Moderate Problem (Moderate Problem)
CL Item
Moderate To Severe Problem (Moderate to Severe Problem)
CL Item
Severe Problem (Severe Problem)
Item
Ability to think clearly (13.)
text
CL.13
Code List
Ability to think clearly (13.)
CL Item
Above Average (Above Average)
CL Item
Normal Ability (Normal Ability)
CL Item
Mild Problem (Mild Problem)
CL Item
Mild To Moderate Problem (Mild to Moderate Problem)
CL Item
Moderate Problem (Moderate Problem)
CL Item
Moderate To Severe Problem (Moderate to Severe Problem)
CL Item
Severe Problem (Severe Problem)
Item
Remembering new information you have read (14.)
text
CL.14
Code List
Remembering new information you have read (14.)
CL Item
Above Average (Above Average)
CL Item
Normal Ability (Normal Ability)
CL Item
Mild Problem (Mild Problem)
CL Item
Mild To Moderate Problem (Mild to Moderate Problem)
CL Item
Moderate Problem (Moderate Problem)
CL Item
Moderate To Severe Problem (Moderate to Severe Problem)
CL Item
Severe Problem (Severe Problem)
Item
Remembering where you put things (15.)
text
CL.15
Code List
Remembering where you put things (15.)
CL Item
Above Average (Above Average)
CL Item
Normal Ability (Normal Ability)
CL Item
Mild Problem (Mild Problem)
CL Item
Mild To Moderate Problem (Mild to Moderate Problem)
CL Item
Moderate Problem (Moderate Problem)
CL Item
Moderate To Severe Problem (Moderate to Severe Problem)
CL Item
Severe Problem (Severe Problem)
Item
Ease in initiating or starting activities by oneself (16.)
text
CL.16
Code List
Ease in initiating or starting activities by oneself (16.)
CL Item
Above Average (Above Average)
CL Item
Normal Ability (Normal Ability)
CL Item
Mild Problem (Mild Problem)
CL Item
Mild To Moderate Problem (Mild to Moderate Problem)
CL Item
Moderate Problem (Moderate Problem)
CL Item
Moderate To Severe Problem (Moderate to Severe Problem)
CL Item
Severe Problem (Severe Problem)
Item
Ability to make decisions (17.)
text
CL.17
Code List
Ability to make decisions (17.)
CL Item
Above Average (Above Average)
CL Item
Normal Ability (Normal Ability)
CL Item
Mild Problem (Mild Problem)
CL Item
Mild To Moderate Problem (Mild to Moderate Problem)
CL Item
Moderate Problem (Moderate Problem)
CL Item
Moderate To Severe Problem (Moderate to Severe Problem)
CL Item
Severe Problem (Severe Problem)
Item
Remembering information learned long ago (18.)
text
CL.18
Code List
Remembering information learned long ago (18.)
CL Item
Above Average (Above Average)
CL Item
Normal Ability (Normal Ability)
CL Item
Mild Problem (Mild Problem)
CL Item
Mild To Moderate Problem (Mild to Moderate Problem)
CL Item
Moderate Problem (Moderate Problem)
CL Item
Moderate To Severe Problem (Moderate to Severe Problem)
CL Item
Severe Problem (Severe Problem)
Item
Ability to be flexible, rather than rigid or have an overly set manner
text
CL.19
Code List
Ability to be flexible, rather than rigid or have an overly set manner
CL Item
Above Average (Above Average)
CL Item
Normal Ability (Normal Ability)
CL Item
Mild Problem (Mild Problem)
CL Item
Mild To Moderate Problem (Mild to Moderate Problem)
CL Item
Moderate Problem (Moderate Problem)
CL Item
Moderate To Severe Problem (Moderate to Severe Problem)
CL Item
Severe Problem (Severe Problem)
Item Group
Ccrr Module For Calgb: Neurobehavoiral Scales Form
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