PASI Psoriasis MIPSO EudraCT 2014-003022-40

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Use of the form
C0457083 (UMLS CUI-1)
C1516308 (UMLS CUI-2)
Item
Form has to be used several times. Please mark the time of use.
integer
C1516308 (UMLS CUI [1,1])
C1265611 (UMLS CUI [1,2])
The time of use
Code List
Form has to be used several times. Please mark the time of use.
CL Item
Screening (1)
CL Item
Visite 1 (Baseline) (2)
CL Item
Visite 2 (Week 4) (3)
CL Item
Visite 3 (Week 8) (4)
CL Item
Visite 4 (Week 12) (5)
CL Item
Visite 5 (Week 16) (6)
CL Item
Visite 6 (Week 20) (7)
CL Item
Visite 7 (Week 24) (8)
CL Item
Termination visite (9)
Item Group
Psoriasis Area and Severity Index
C4528685 (UMLS CUI-1)
Item
Erythema Head / Neck
integer
C4526023 (UMLS CUI [1])
Erythema Head / Neck
Code List
Erythema Head / Neck
CL Item
none (0)
CL Item
mild (1)
CL Item
moderate (2)
CL Item
severe (3)
CL Item
very severe (4)
Item
Erythema Arms
integer
C4526037 (UMLS CUI [1])
Erythema Head / Neck
Code List
Erythema Arms
CL Item
none (0)
CL Item
mild (1)
CL Item
moderate (2)
CL Item
severe (3)
CL Item
very severe (4)
Item
Erythema Trunk (incl. axillae + groins)
integer
C4526030 (UMLS CUI [1])
Erythema Head / Neck
Code List
Erythema Trunk (incl. axillae + groins)
CL Item
none (0)
CL Item
mild (1)
CL Item
moderate (2)
CL Item
severe (3)
CL Item
very severe (4)
Item
Erythema Legs (incl. gluteal)
integer
C4526044 (UMLS CUI [1])
Erythema Head / Neck
Code List
Erythema Legs (incl. gluteal)
CL Item
none (0)
CL Item
mild (1)
CL Item
moderate (2)
CL Item
severe (3)
CL Item
very severe (4)
Item
Induration Head / Neck
integer
C4526024 (UMLS CUI [1])
Erythema Head / Neck
Code List
Induration Head / Neck
CL Item
none (0)
CL Item
mild (1)
CL Item
moderate (2)
CL Item
severe (3)
CL Item
very severe (4)
Item
Induration Arms
integer
C4526038 (UMLS CUI [1])
Erythema Head / Neck
Code List
Induration Arms
CL Item
none (0)
CL Item
mild (1)
CL Item
moderate (2)
CL Item
severe (3)
CL Item
very severe (4)
Item
Induration Trunk (incl. axillae + groins)
integer
C4526031 (UMLS CUI [1])
Erythema Head / Neck
Code List
Induration Trunk (incl. axillae + groins)
CL Item
none (0)
CL Item
mild (1)
CL Item
moderate (2)
CL Item
severe (3)
CL Item
very severe (4)
Item
Induration Legs (incl. gluteal)
integer
C4526045 (UMLS CUI [1])
Erythema Head / Neck
Code List
Induration Legs (incl. gluteal)
CL Item
none (0)
CL Item
mild (1)
CL Item
moderate (2)
CL Item
severe (3)
CL Item
very severe (4)
Item
Desquamation Head / Neck
integer
C4526025 (UMLS CUI [1])
Erythema Head / Neck
Code List
Desquamation Head / Neck
CL Item
none (0)
CL Item
mild (1)
CL Item
moderate (2)
CL Item
severe (3)
CL Item
very severe (4)
Item
Desquamation Arms
integer
C4526039 (UMLS CUI [1])
Erythema Head / Neck
Code List
Desquamation Arms
CL Item
none (0)
CL Item
mild (1)
CL Item
moderate (2)
CL Item
severe (3)
CL Item
very severe (4)
Item
Desquamation Trunk (incl. axillae + groins)
integer
C4526032 (UMLS CUI [1])
Erythema Head / Neck
Code List
Desquamation Trunk (incl. axillae + groins)
CL Item
none (0)
CL Item
mild (1)
CL Item
moderate (2)
CL Item
severe (3)
CL Item
very severe (4)
Item
Desquamation Legs (incl. gluteal)
integer
C4526046 (UMLS CUI [1])
Erythema Head / Neck
Code List
Desquamation Legs (incl. gluteal)
CL Item
none (0)
CL Item
mild (1)
CL Item
moderate (2)
CL Item
severe (3)
CL Item
very severe (4)
Subtotal A1
Item
Subtotal A1: Head/Neck
integer
C4526026 (UMLS CUI [1])
Subtotal A2
Item
Subtotal A2: Arms
integer
C4526040 (UMLS CUI [1])
Subtotal A3
Item
Subtotal A3: Trunk
integer
C4526033 (UMLS CUI [1])
Subtotal A4
Item
Subtotal A4: Legs
integer
C4526047 (UMLS CUI [1])
Item
Affected Area Head / Neck
integer
C4526027 (UMLS CUI [1])
Affected Area Head / Neck
Code List
Affected Area Head / Neck
CL Item
0% (0)
CL Item
<10% (1)
CL Item
≥10-29% (2)
CL Item
≥30-49% (3)
CL Item
≥50-69% (4)
CL Item
≥70-89% (5)
CL Item
≥90-100% (6)
Item
Affected Area Arms
integer
C4526041 (UMLS CUI [1])
Affected Area Head / Neck
Code List
Affected Area Arms
CL Item
0% (0)
CL Item
<10% (1)
CL Item
≥10-29% (2)
CL Item
≥30-49% (3)
CL Item
≥50-69% (4)
CL Item
≥70-89% (5)
CL Item
≥90-100% (6)
Item
Affected Area Trunk (incl. axillae + groins)
integer
C4526034 (UMLS CUI [1])
Affected Area Head / Neck
Code List
Affected Area Trunk (incl. axillae + groins)
CL Item
0% (0)
CL Item
<10% (1)
CL Item
≥10-29% (2)
CL Item
≥30-49% (3)
CL Item
≥50-69% (4)
CL Item
≥70-89% (5)
CL Item
≥90-100% (6)
Item
Affected Area Legs (incl. gluteal)
integer
C4526041 (UMLS CUI [1])
Affected Area Head / Neck
Code List
Affected Area Legs (incl. gluteal)
CL Item
0% (0)
CL Item
<10% (1)
CL Item
≥10-29% (2)
CL Item
≥30-49% (3)
CL Item
≥50-69% (4)
CL Item
≥70-89% (5)
CL Item
≥90-100% (6)
Subtotal B1
Item
Subtotal B1: Head/Neck
integer
C4526028 (UMLS CUI [1])
Subtotal B2
Item
Subtotal B2: Arms
integer
C4526042 (UMLS CUI [1])
Subtotal B3
Item
Subtotal B3: Trunk (incl. axillae + groins)
integer
C4526035 (UMLS CUI [1])
Subtotal B4
Item
Subtotal B4: Legs (incl. gluteal)
integer
C4526049 (UMLS CUI [1])
Subtotal C1
Item
Subtotal C1: Head/Neck
float
C4526029 (UMLS CUI [1])
Subtotal C2
Item
Subtotal C2: Arms
float
C4526043 (UMLS CUI [1])
Subtotal C3
Item
Subtotal C3: Trunk (incl. axillae + groins)
float
C4526036 (UMLS CUI [1])
Subtotal C4
Item
Subtotal C4: Legs (incl. gluteal)
float
C4526050 (UMLS CUI [1])
PASI Total
Item
PASI Total Score
float
C4526051 (UMLS CUI [1])
Total Body Surface Area with Psoriasis
Item
Total Body Surface Area with Psoriasis
integer
C0005902 (UMLS CUI [1,1])
C0033860 (UMLS CUI [1,2])
Signature date
Item
Signature date
date
C0807937 (UMLS CUI [1])
PASI Comments
Item
PASI Comments
text
C4528685 (UMLS CUI [1,1])
C0947611 (UMLS CUI [1,2])
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