ID

6536

Descrição

AMC-051 Death Form (F04) Sirolimus in Treating Patients With HIV-Related Kaposi's Sarcoma NCT00450320 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=2FDFA89A-06DD-6018-E044-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=2FDFA89A-06DD-6018-E044-0003BA3F9857

Palavras-chave

Versões (2)
  1. 19/04/2012 19/04/2012 -
  2. 08/01/2015 08/01/2015 - Martin Dugas
Transferido a

8 de janeiro de 2015

DOI

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Licença

Creative Commons BY-NC 3.0 Legacy
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Death Form (F04) Sarcoma (NCT00450320)

Alemão Inglês

Keine Anleitung vorhanden.

1 Formulários  
  1. StudyEvent: AMC-051 Death Form (F04)
    1. Keine Anleitung vorhanden.
CCRR Modul für Todes-Formular - Rf04
Descrição

CCRR Modul für Todes-Formular - Rf04

Datum des letzten Kontaktes oder Todes
Descrição

Date last contact

Tipo de dados

date

Alias
NCI Thesaurus ObjectClass
C16960
UMLS CUI-1
C0805839
NCI Thesaurus Property
C25461
NCI Thesaurus Property-2
C25551
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ValueDomain-2
C25367
Behandlungsstatus (zum Zeitpunkt des Todes)
Descrição

Treatment Status

Tipo de dados

text

Alias
NCI Thesaurus ObjectClass
C15368
NCI Thesaurus ValueDomain
C25688
UMLS CUI-1
C0749659
NCI Thesaurus Property
C25365
Letztes Datum (jede Modalität), an dem die Therapie durchgeführt wurde
Descrição

Treatment End Date

Tipo de dados

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS CUI-1
C1531784
NCI Thesaurus ObjectClass
C15368
NCI Thesaurus Property
C25275
NCI Thesaurus Property-2
C25496
Primäre Ursache des Todes
Descrição

AcquiredImmunodeficiencySyndromePatientPrimaryDeathReason

Tipo de dados

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass-2
C2851
UMLS 2011AA ObjectClass-2
C0001175
NCI Thesaurus Property
C28554
UMLS 2011AA Property
C0011065
NCI Thesaurus Property-2
C25251
UMLS 2011AA Property-2
C0205225
NCI Thesaurus ValueDomain
C25638
UMLS 2011AA ValueDomain
C0392360
Mitursache des Todes
Descrição

AcquiredImmunodeficiencySyndromePatientSecondaryDeathReason

Tipo de dados

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass-2
C2851
UMLS 2011AA ObjectClass-2
C0001175
NCI Thesaurus Property
C28554
UMLS 2011AA Property
C0011065
NCI Thesaurus Property-2
C25667
UMLS 2011AA Property-2
C0175668
NCI Thesaurus ValueDomain
C25638
UMLS 2011AA ValueDomain
C0392360
angeben
Descrição

AcquiredImmunodeficiencySyndromePatientSecondaryDeathSpecify

Tipo de dados

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass-2
C2851
UMLS 2011AA ObjectClass-2
C0001175
NCI Thesaurus Property
C28554
UMLS 2011AA Property
C0011065
NCI Thesaurus Property-2
C25667
UMLS 2011AA Property-2
C0175668
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
Todesursache beschreiben
Descrição

Cause of Death, specify

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS CUI-1
C0007465
NCI Thesaurus ObjectClass
C16960
UMLS CUI-2
C1521902
NCI Thesaurus Property
C28554
Informationen zur Quelle des Todes
Descrição

AcquiredImmunodeficiencySyndromePatientDeathSource

Tipo de dados

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C28554
UMLS 2011AA Property
C0011065
NCI Thesaurus ObjectClass-2
C2851
UMLS 2011AA ObjectClass-2
C0001175
NCI Thesaurus ValueDomain
C25683
UMLS 2011AA ValueDomain
C0449416
Andere, angeben
Descrição

PatientDeathSourceSpecify

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C28554
UMLS 2011AA Property
C0011065
Kommentare
Descrição

Research Comments

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS CUI-1
C0947611
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
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Similar models

Keine Anleitung vorhanden.

1 Formulários
  1. StudyEvent: AMC-051 Death Form (F04)
    1. Keine Anleitung vorhanden.
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de dados
Alias
Item Group
CCRR Modul für Todes-Formular - Rf04
Date last contact
Item
Datum des letzten Kontaktes oder Todes
date
C16960 (NCI Thesaurus ObjectClass)
C0805839 (UMLS CUI-1)
C25461 (NCI Thesaurus Property)
C25551 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
Item
Behandlungsstatus (zum Zeitpunkt des Todes)
text
C15368 (NCI Thesaurus ObjectClass)
C25688 (NCI Thesaurus ValueDomain)
C0749659 (UMLS CUI-1)
C25365 (NCI Thesaurus Property)
CL.1
Code List
Behandlungsstatus (zum Zeitpunkt des Todes)
CL Item
Off-Studie (Off study)
CL Item
In Studie, Off-Protokoll Behandlung (On study, off protocol treatment)
CL Item
In Studie, In-Protokoll Behandlung (On study, on protocol treatment)
Treatment End Date
Item
Letztes Datum (jede Modalität), an dem die Therapie durchgeführt wurde
date
C25164 (NCI Thesaurus ValueDomain)
C1531784 (UMLS CUI-1)
C15368 (NCI Thesaurus ObjectClass)
C25275 (NCI Thesaurus Property)
C25496 (NCI Thesaurus Property-2)
Item
Primäre Ursache des Todes
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C2851 (NCI Thesaurus ObjectClass-2)
C0001175 (UMLS 2011AA ObjectClass-2)
C28554 (NCI Thesaurus Property)
C0011065 (UMLS 2011AA Property)
C25251 (NCI Thesaurus Property-2)
C0205225 (UMLS 2011AA Property-2)
C25638 (NCI Thesaurus ValueDomain)
C0392360 (UMLS 2011AA ValueDomain)
CL.2
Code List
Primäre Ursache des Todes
CL Item
Aufgrund von nicht-malignen Komplikationen der HIV-Erkrankung (Due to Non-malignancy complications of HIV disease)
CL Item
Aufgrund anderer Ursache, angeben (Due to other cause)
CL Item
Aufgrund der Protokoll-Behandlung (Due to protocol treatment)
CL Item
Aufgrund zweiter primärer oder anderer Krebserkrankungen (Due to second primary or other malignancy)
CL Item
Aufgrund dieser Krankheit (Due to this disease)
Item
Mitursache des Todes
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C2851 (NCI Thesaurus ObjectClass-2)
C0001175 (UMLS 2011AA ObjectClass-2)
C28554 (NCI Thesaurus Property)
C0011065 (UMLS 2011AA Property)
C25667 (NCI Thesaurus Property-2)
C0175668 (UMLS 2011AA Property-2)
C25638 (NCI Thesaurus ValueDomain)
C0392360 (UMLS 2011AA ValueDomain)
CL.3
Code List
Mitursache des Todes
CL Item
Aufgrund der Protokoll-Behandlung (Due to protocol treatment)
CL Item
Aufgrund dieser Krankheit (Due to this disease)
CL Item
Aufgrund zweiter primärer oder anderer Krebserkrankungen (Due to second primary or other malignancy)
CL Item
Aufgrund anderer Ursache, angeben (Due to other cause)
CL Item
Aufgrund von nicht-malignen Komplikationen der HIV-Erkrankung (Due to Non-malignancy complications of HIV disease)
AcquiredImmunodeficiencySyndromePatientSecondaryDeathSpecify
Item
angeben
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C2851 (NCI Thesaurus ObjectClass-2)
C0001175 (UMLS 2011AA ObjectClass-2)
C28554 (NCI Thesaurus Property)
C0011065 (UMLS 2011AA Property)
C25667 (NCI Thesaurus Property-2)
C0175668 (UMLS 2011AA Property-2)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
Cause of Death, specify
Item
Todesursache beschreiben
text
C25685 (NCI Thesaurus ValueDomain)
C0007465 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1521902 (UMLS CUI-2)
C28554 (NCI Thesaurus Property)
Item
Informationen zur Quelle des Todes
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C28554 (NCI Thesaurus Property)
C0011065 (UMLS 2011AA Property)
C2851 (NCI Thesaurus ObjectClass-2)
C0001175 (UMLS 2011AA ObjectClass-2)
C25683 (NCI Thesaurus ValueDomain)
C0449416 (UMLS 2011AA ValueDomain)
CL.4
Code List
Informationen zur Quelle des Todes
CL Item
Autopsy (Autopsy)
C25153 (NCI Thesaurus)
C0004398 (UMLS 2011AA)
CL Item
Klinische Evidenz war die Informationsquelle des Patiententodes (Clinical evidence)
CL Item
Kontakt mit dem Arzt (Contact with physician)
CL Item
Totenschein war die Informationsquelle des Patiententodes (Death certificate)
CL Item
Die histologische Beweis war die Informationsquelle des Patiententodes (Histological evidence)
CL Item
Informationen von Freunden und Verwandten (Information from friends and relatives)
CL Item
andere (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
PatientDeathSourceSpecify
Item
Andere, angeben
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C28554 (NCI Thesaurus Property)
C0011065 (UMLS 2011AA Property)
Research Comments
Item
Kommentare
text
C25704 (NCI Thesaurus ValueDomain)
C0947611 (UMLS CUI-1)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
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