Stand: 07.06.2019 - 17:14 (MESZ) Drucken Schließen
Register (Development) "European IPF Network (27.11.2018 - 16:22:51 (MEZ))" Vers. Nr. 64
Inhalt:
Biomaterialien-Templates:
Bio sample #
Diagnosis for CONTROLS:
Diagnosis for CONTROLS item
Generica-Templates:
Generica(extended)
Generica(simple)
Generica(skipped)
Generica(anti-fibrotic)
Side Effects
Upload-Templates:
Thorax-CT
PDF - Upload
Informed Consent:
Informed Consent
Patient´s questionnaire BASELINE:
* biometric data * nature and history of medical complaints * coughing and exploration * other complaints *
* smoking history * previous airway and lung disease *
* other known disease apart from the lung *
* previous medication at the time of evolution of the disease * family history * environmental aspects * professional activities *
Patient´s questionnaire FOLLOW-UP:
Patients questionaire FOLLOW-UP
QoL questionnaires:
SF-36
Mahler Index baseline
Mahler Index followup
EQ-5D
Health economics BASELINE:
health economics BASELINE
Health economics FOLLOWUP:
health economics FOLLOWUP-alt
health economics FOLLOWUP
Print out patients documents:
Patients questionnaire templates Baseline
Patients questionnaire templates Follow-Up 1
Patients questionnaire templates Follow-Up 2
Patients questionnaire templates Follow-Up 3
Patients questionnaire templates Follow-Up 4
Patients questionnaire templates Follow-Up 5
Patients questionnaire templates Follow-Up 6
Patients questionnaire templates Follow-Up X
Patients questionnaire templates Baseline TEST
Patients questionnaire templates Follow-Up TEST X
Physician's questionnaire BASELINE:
*physical examination *clinical chemistry *serology for atypical strains *precipitating antibodies *autoantibody screen
*lung function *Bronchoscopy and bronchoscopic findings *Open Lung biopsy *Echocardiography *Right heart catheter *Obstructive sleep apnea
*exercise tests *HRCT *co morbity *medical measures leading to IPF *interpretation of patients history *diagnosis
*medical treatment
Physician's questionnaire FOLLOWUP:
* Course of disease * Physical examination * Hematology, Clinical Chemistry and Serology * Repeated auto-antibody screen
* Pulmonary function test * Bronchoscopy and bronchoscopic findings * Echocardiography * Right heart catheter * Obstructive sleep apnea
* 6min walk * Spiroergometry * HR-CT results * Co-morbidity * Changes in medical treatment for IPF * Concurrent treatment for pulmonary hypertension * Co-medication
HR-CT:
computer tomography
PDF Upload:
unspecified findings
Biological materials:
bio sample
Final submit form for expert verification:
Final submit form for expert verification
Patient's review status:
Patient's review status
[X] Patient's review result:
Patient's review result
[X] Experts review result:
Experts review result
[X] Pedigree:
Pedigree
[X] Patient status:
Fatal Event Questionnaire
Test
Casenotes:
Fatal Event Questionnaire
Pedigree
CONTROLS and other LUNG DISEASE CATEGORIES all documents:
Fatal Event Questionnaire for CONTROLS
Patient's questionnaire for CONTROLS
Physician's questionnaire for CONTROLS
SF-36 for CONTROLS
Mahler Index baseline for CONTROLS
EQ-5D for CONTROLS
computer tomography
unspecified findings
bio sample
Patients questionnaire templates for CONTROLS
[X] Patient's questionnaire for CONTROLS
Datum: 07.06.2019 - 17:14 (MESZ)
Teilnehmer: Stefan Kuhn
top

Formular-Implementationen   "European IPF Network"   (62)
  Bio sample #      emnpipfbio 
Projekt:
European IPF Network (27.11.2018 - 16:22:51 (MEZ)) { IPF - Register  /  Vers. Nr. 64 - Development  }
Formularfamilie:
Biomaterialien-Templates { Subform }
Formularname (Übersicht): * Bio sample # ]
Verarbeitung: * Benutzereingaben: speichern
Datenbanktabelle: * emnpipfbio ]
Reihenfolge: 10 ] Angezeigte Nr.:  ]
Query Menü: skalierbar
Kommentar Menü: skalierbar
Formularname (Titel): Bio sample # ]
Formular verwendet in: (2) bio sample <mnpipfsmpbio>
bio sample <mnpipfcsmpbio>
{ IASStandardGroup: ........... Standard - vertikal }
Bio Materialien
HTML
<script type="text/javascript" src="https://euripf.med.uni-giessen.de/labid/getlabid"></script>
<script type="text/javascript">
function parseLabID(){        
while(typeof json_encode == 'undefined'){

	}
	jsonData = eval(json_encode);
	var returnCode = jsonData.returnCode;
	var labID = false;
	if(returnCode == "AA"){
		var fldLabID = false;
		var ii = 0;
		labID = jsonData.labID;
		while(fldLabID == false && ii < 30){
    		ii++;
    		var prefix = "ff_bio_2_" + ii;
    		elem = document.getElementsByName(prefix)[0];
    		if(elem){
    			if(elem.value == ""){
        			fldLabID = elem;
        			fldLabID.value = labID;
	    			fldLabID.readOnly = true; 
      			}
      			else{
      				elem.readOnly = true;
      			}
    		}
  		}			
 	}
    else{
    	alert("undefined");
    }
}
function addOnloadEvent(fnc){
  if ( typeof window.addEventListener != "undefined" )
    window.addEventListener( "load", fnc, false );
  else if ( typeof window.attachEvent != "undefined" ) {
    window.attachEvent( "onload", fnc );
  }
  else {
    if ( window.onload != null ) {
      var oldOnload = window.onload;
      window.onload = function ( e ) {
        oldOnload( e );
        window[fnc]();
      };
    }
    else 
      window.onload = fnc;
  }
}
addOnloadEvent(parseLabID);
</script>
Item (HTML) bio_2_alt
<div style="color:grey">
LabID old (do not edit)</div>
    Date of sampling: -- tt.mm.jjjj
bio_1   {Vollständiges Datum (tt.mm.jjjj), Datumsformat: anzeigen}
    LabID (do not edit)  
bio_2   {Textfeld 8}
10.  []  Eingabe notwendig.   "Input required"
   
LabID old (do not edit)
 
bio_2_alt   {Textfeld 8} "LabID old (do not edit)"
    type of specimen
   
bio_3   {Popup (Beschr. Gruppe)}
10.  []  Eingabe nur möglich, wenn ...   "Mussfeld Deklaration"
 10-10 "Type of specimen must be selected" [ ] <> [≠ ungleich Wert] <"NULL" Wert> [] <selbes Subformular>
    date of receipt of sample (to be filled out later) -- tt.mm.jjjj
bio_4   {Datum (tt.mm.jjjj), Datumsformat: anzeigen}
10.  []  Eingabe nur möglich, wenn ...   "Obere Grenze"
 10-10 "Date of receiving must be lower than current date" [ ] <> [≤ kleiner gleich Wert] <aktuelles Datum / Zeit> [] <selbes Subformular>
20.  []  Eingabe nur möglich, wenn ...   "Untere Grenze"
 10-10 "Date of receiving must be later than "date of sampling"" [ ] <> [≥ größer gleich Wert] <Item> [Bio sample # <emnpipfbio> Bio Materialien - Date of sampling: <bio_1>] <selbes Subformular>
Kommentar
Query
{ IASHorizontalGroup: ......... Standard - horizontal }
histo slides
histo slides
ein Bild.tiff  
bio_5_1   {Bild, 50x50} 50x50
ein Bild.tiff  
bio_5_2   {Bild, 50x50} 50x50
ein Bild.tiff  
bio_5_3   {Bild, 50x50} 50x50
ein Bild.tiff  
bio_5_4   {Bild, 50x50} 50x50
ein Bild.tiff  
bio_5_5   {Bild, 50x50} 50x50
Kommentar
Query
{ IASHorizontalGroup: ......... Standard - horizontal }
histo slides
ein Bild.tiff  
bio_6_1   {Bild, 50x50} 50x50
ein Bild.tiff  
bio_6_2   {Bild, 50x50} 50x50
ein Bild.tiff  
bio_6_3   {Bild, 50x50} 50x50
ein Bild.tiff  
bio_6_4   {Bild, 50x50} 50x50
ein Bild.tiff  
bio_6_5   {Bild, 50x50} 50x50
Kommentar
Query

emnpipfbio.bio_3
1. bronchoalveolar lavage (1 - 253)
2. serum (2 - 254)
3. plasma (12 - 6113)
4. EDTA blood (3 - 255)
5. exhaled breath condensate (4 - 256)
6. exhaled air sample (5 - 257)
7. PAX gene blood (6 - 258)
8. transbronchial biopsy (7 - 259)
9. lung tissue post VATS (8 - 260)
10. lung tissue post LTX (9 - 261)
11. histology slides from VATS biopsy (10 - 278)
12. histology slides from LTX explants (11 - 279)
13. electric nose sample (13 - 14838)

  Diagnosis #      emnpipfcdiagitem 
Projekt:
European IPF Network (27.11.2018 - 16:22:51 (MEZ)) { IPF - Register  /  Vers. Nr. 64 - Development  }
Formularfamilie:
Diagnosis for CONTROLS { Subform }
Formularname (Übersicht): * Diagnosis for CONTROLS item ]
Verarbeitung: * Benutzereingaben: speichern
Datenbanktabelle: * emnpipfcdiagitem ]
Reihenfolge: 10 ] Angezeigte Nr.:  ]
Query Menü: skalierbar
Kommentar Menü: skalierbar
Formularname (Titel): Diagnosis # ]
Formular verwendet in: (2) *exercise tests *HRCT *co morbity *medical measures leading to IPF *interpretation of patients history *diagnosis <mnpipfphybaseline3>
Physician's questionnaire for CONTROLS <mnpipfcqphys>
{ IASHorizCombinedSelection: .. Hierarchische Lookuptabellen - nacheinander geladen, horizontal }
Diagnosis item

qdiagitem_1 <lmnpipfcdiag1>   {Lookup Tabelle}

qdiagitem_2 <lmnpipfcdiag2>   {Lookup Tabelle}

qdiagitem_3 <lmnpipfcdiag3>   {Lookup Tabelle}
 

Diagnosis for CONTROLS Cat.2  <lmnpipfcdiag2>     (Setup-DB)
 
emnpipfcdiagitem.qdiagitem_2
1. Non small cell lung cancer (Lung Cancer)
2. Small cell lung cancer (Lung Cancer)
3. undefined lung cancer (Lung Cancer)
4. primarily emphysema (COPD / Emphysema )
5. primarily chronic bronchitis (COPD / Emphysema )
6. alpha 1 antitrypsin deficiency (COPD / Emphysema )
7. allergic (Asthma bronchiale)
8. intrinsic (Asthma bronchiale)
9. miced (Asthma bronchiale)
10. Pulmonary Arterial Hypertension (PAH) (Pulmonary Hypertension)
11. Pulmonary Hypertension (PH) (Pulmonary Hypertension)
12. Pulmonary Hypertension due to chronic thrombotic and/or embolic disease (CTEPH) (Pulmonary Hypertension)
13. Miscellaneous forms of PH (e.g. sarcoidosis) (Pulmonary Hypertension)
14. Community aquired pneumonia (Pneumonia)
15. Hospital acquired pneumonia (Pneumonia)
16. Ventilator associated pneumonia (Pneumonia)
17. Bacterial pneumonia (Pneumonia)
18. Viral pneumonia (Pneumonia)
19. Sarcoidosis (DPLD other than IIP)
20. Exogenic Allergic Alveolitis (DPLD other than IIP)
21. DPLD within the frame of collagenosis (DPLD other than IIP)
22. DPLD within the frame of pneumoconiosis (DPLD other than IIP)
23. DPLD within the frame of vasculitis (DPLD other than IIP)
24. DPLD caused by drugs (DPLD other than IIP)
25. DPLD caused by radiation (DPLD other than IIP)
26. Post ARDS DPLD (DPLD other than IIP)
27. DPLD with chronic inflammatory bowel disease (DPLD other than IIP)
28. DPLD with lysosomal storage diseases (DPLD other than IIP)
29. lymphangioleiomyomatosis (DPLD other than IIP)
30. histiocytosis X (LCH) (DPLD other than IIP)
31. DPLD with other disease (DPLD other than IIP)
32. unclassifiable DPLD (DPLD other than IIP)
Diagnosis for CONTROLS Cat.3  <lmnpipfcdiag3>     (Setup-DB)
 
emnpipfcdiagitem.qdiagitem_3
1. Adeno Carcinoma (Non small cell lung cancer)
2. Squamous Carcinoma (Non small cell lung cancer)
3. Large cell Carcinoma (Non small cell lung cancer)
4. idiopathic PAH (Pulmonary Arterial Hypertension (PAH))
5. familial PAH (Pulmonary Arterial Hypertension (PAH))
6. PAH associated with collagen vascular diseases and others (APAH) (Pulmonary Arterial Hypertension (PAH))
7. PAH associated with pulmonary venous or capillary disease (Pulmonary Arterial Hypertension (PAH))
8. Persistent pulmonary hypertension of the newborn (Pulmonary Arterial Hypertension (PAH))
9. PH associated with left heart disease (Pulmonary Hypertension (PH))
10. PH associated with other lung diseases and/or hypoxemia (Pulmonary Hypertension (PH))
11. DPLD with systemic lupus erythematosus (DPLD within the frame of collagenosis)
12. DPLD with scleroderma / LSSC (DPLD within the frame of collagenosis)
13. DPLD with rheumatoid arthritis (DPLD within the frame of collagenosis)
14. DPLD with polymyositis/dermatomyositis (DPLD within the frame of collagenosis)
15. DPLD with MCTD (DPLD within the frame of collagenosis)
16. DPLD with ankylosing spondylitis (DPLD within the frame of collagenosis)
17. DPLD with other collagenosis (DPLD within the frame of collagenosis)
18. pulmonary asbestosis (DPLD within the frame of pneumoconiosis)
19. silicosis (DPLD within the frame of pneumoconiosis)
20. siderosis (DPLD within the frame of pneumoconiosis)
21. berylliosis (DPLD within the frame of pneumoconiosis)
22. DPLD with other pneumoconiosis (DPLD within the frame of pneumoconiosis)
23. DPLD with Wegener’s granulomatosis (DPLD within the frame of vasculitis)
24. DPLD with Churg-Strauss syndrome (DPLD within the frame of vasculitis)
25. DPLD with panarteriitis nodosa (DPLD within the frame of vasculitis)
26. DPLD with microcopic vasculitis (DPLD within the frame of vasculitis)
27. ILD caused by Amiodarone (DPLD caused by drugs)
28. ILD caused by Bleomycin (DPLD caused by drugs)
29. ILD caused by Nitrofurantoin (DPLD caused by drugs)
30. ILD caused by other drugs (DPLD caused by drugs)
31. Hermansky-Pudlack-Syndrome Interstitial Pneumonitis (HPSIP) (DPLD with lysosomal storage diseases )
32. DPLD with Niemann-Pick disease (DPLD with lysosomal storage diseases )
33. DPLD with Gaucher’s disease (DPLD with lysosomal storage diseases )
34. DPLD with other storage diseases (DPLD with lysosomal storage diseases )
35. DPLD with neurofibromatosis (DPLD with lysosomal storage diseases )
Diagnosis for CONTROLS Cat.1   <lmnpipfcdiag1>     (Setup-DB)
 
emnpipfcdiagitem.qdiagitem_1
1. Healthy volunteer
2. Lung Cancer
3. Pleural Cancer
4. Other malignancies of the lung or the pleura
5. COPD / Emphysema
6. Asthma bronchiale
7. Pulmonary Hypertension
8. Carthageners Syndrome
9. Cystic Fibrosis
10. Obstructive Sleep Apnea
11. Obesitas Hypoventilation Syndrome
12. Central forms of Sleep Apnea
13. Pneumonia
14. Acute bronchitis
15. DPLD other than IIP
16. Left heart failure

  Generica #      emnpipfdrugext 
Projekt:
European IPF Network (27.11.2018 - 16:22:51 (MEZ)) { IPF - Register  /  Vers. Nr. 64 - Development  }
Formularfamilie:
Generica-Templates { Subform }
Formularname (Übersicht): * Generica(extended) ]
Verarbeitung: * Benutzereingaben: speichern
Datenbanktabelle: * emnpipfdrugext ]
Reihenfolge: 11 ] Angezeigte Nr.:  ]
Query Menü: skalierbar
Kommentar Menü: skalierbar
Formularname (Titel): Generica # ]
Formular verwendet in: (2) *medical treatment <mnpipfphybaseline4>
* 6min walk * Spiroergometry * HR-CT results * Co-morbidity * Changes in medical treatment for IPF * Concurrent treatment for pulmonary hypertension * Co-medication <mnpipfqsphf3>
{ IASCatalogGroup: ............ Kataloggruppe - "ATCCodes" }
Katalog öffnen
Generic Name [Q_19]
Generic name
       
qsdrug_1   {Katalogfeld, Ebene 5 / ATC 5th level}
- "Ebene 5" / "ATC 5th level"
    cat_atccodes_5 / atc5thlevel
     
 
qsdrug_1_a   {Katalogfeld, Ebene 5 / 5th level name}
- "Ebene 5" / "5th level name"
    cat_atccodes_5 / x5thlevelname
Hilfe
Kommentar
Query
Hilfe: To select a drug from ATC, click on the button "Catalog" and search the drug (top field in the pop-up window).
Important You must select the drug in level 5 (right part of the table) by clicking the drug name or ATC. Previous level indicate only a family of drugs. Expand the following levels by clicking the arrows on the left.
{ IASHorizontalGroup: ......... Standard - horizontal }
compassionate use
To select a drug from ATC, click on the button "Catalog" and search the drug (top field in the pop-up window).
Important You must select the drug in level 5 (right part of the table) by clicking the drug name or ATC. Previous level indicate only a family of drugs. Expand the following levels by clicking the arrows on the left.
HTML
To select a drug from ATC, click on the button "Catalog" and search the drug (top field in the pop-up window).<br />
<strong>Important</strong>
You must select the drug in level 5 (right part of the table) by clicking the drug name or ATC. Previous level indicate only a family of drugs.
Expand the following levels by clicking the arrows on the left.
compassionate use?
No (0 - -99.0 - 195) Yes (1 - 99.0 - 72)
qsdrug_8   {Horizontal-Radiobutton}
Kommentar
Query
{ IASHorizontalGroup: ......... Standard - horizontal }
RCT
RCT? Name RCT ClinicalTrial.gov number
No (0 - -99.0 - 195) Yes (1 - 99.0 - 72)
qsdrug_9   {Horizontal-Radiobutton}
 
qsdrug_10   {Textfeld 15}
 
qsdrug_11   {Textfeld 15}
Kommentar
Query
{ IASHorizontalGroup: ......... Standard - horizontal }
Dose and Unit
Dose Unit
,  
qsdrug_2   {Nummer 5,2}
mg (3 - 6) µg (2 - 52) ng (1 - 129) U (5 - 229)
qsdrug_3   {Horizontal-Radiobutton}
Kommentar
Query
{ IASHorizontalGroup: ......... Standard - horizontal }
Aplication/Timespan
Route of administration x/day start end
oral (1 - 15) sc (2 - 240) inhal (3 - 158) iv (4 - 76) tc (5 - 243)
qsdrug_4   {Horizontal-Radiobutton}
 
qsdrug_5   {Nummer 2,0}
-- tt.mm.jjjj
qsdrug_6   {Datum (tt.mm.jjjj), Datumsformat: anzeigen}
10.  []  Eingabe nur möglich, wenn ...   "Obere Grenze"
 10-10 "Value must be lower or equals "end"" [ ] <> [≤ kleiner gleich Wert] <Item> [Generica(extended) <emnpipfdrugext> Aplication/Timespan - end <qsdrug_7>] <selbes Subformular>
oder 20-10 " " [Generica(extended) <emnpipfdrugext> Aplication/Timespan - end <qsdrug_7>] <selbes Subformular> [= gleich Wert] <"NULL" Wert> [] <selbes Subformular>
-- tt.mm.jjjj
qsdrug_7   {Datum (tt.mm.jjjj), Datumsformat: anzeigen}
10.  []  Eingabe nur möglich, wenn ...   "Obere Grenze"
 10-10 "Value must be lower than current date" [ ] <> [≤ kleiner gleich Wert] <aktuelles Datum / Zeit> [] <selbes Subformular>
20.  []  Eingabe nur möglich, wenn ...   "Untere Grenze"
 10-10 "Value must be greater than field <strong>start</strong>" [ ] <> [≥ größer gleich Wert] <Item> [Generica(extended) <emnpipfdrugext> Aplication/Timespan - start <qsdrug_6>] <selbes Subformular>
Kommentar
Query

  Generica #      emnpipfdrugsim 
Projekt:
European IPF Network (27.11.2018 - 16:22:51 (MEZ)) { IPF - Register  /  Vers. Nr. 64 - Development  }
Formularfamilie:
Generica-Templates { Subform }
Formularname (Übersicht): * Generica(simple) ]
Verarbeitung: * Benutzereingaben: speichern
Datenbanktabelle: * emnpipfdrugsim ]
Reihenfolge: 21 ] Angezeigte Nr.:  ]
Query Menü: skalierbar
Kommentar Menü: skalierbar
Formularname (Titel): Generica # ]
Formular verwendet in: (4) *exercise tests *HRCT *co morbity *medical measures leading to IPF *interpretation of patients history *diagnosis <mnpipfphybaseline3>
*medical treatment <mnpipfphybaseline4>
* 6min walk * Spiroergometry * HR-CT results * Co-morbidity * Changes in medical treatment for IPF * Concurrent treatment for pulmonary hypertension * Co-medication <mnpipfqsphf3>
Physician's questionnaire for CONTROLS <mnpipfcqphys>
{ IASCatalogGroup: ............ Kataloggruppe - "ATCCodes" }
Katalog öffnen
Generic Name [Q_19]
Generic name
       
qsdrug_1   {Katalogfeld, Ebene 5 / ATC 5th level}
- "Ebene 5" / "ATC 5th level"
    cat_atccodes_5 / atc5thlevel
     
 
qsdrug_1_a   {Katalogfeld, Ebene 5 / 5th level name}
- "Ebene 5" / "5th level name"
    cat_atccodes_5 / x5thlevelname
Hilfe
Kommentar
Query
Hilfe: To select a drug from ATC, click on the button "Catalog" and search the drug (top field in the pop-up window).
Important You must select the drug in level 5 (right part of the table) by clicking the drug name or ATC. Previous level indicate only a family of drugs. Expand the following levels by clicking the arrows on the left.
{ IASHorizontalGroup: ......... Standard - horizontal }
Dose and Unit
To select a drug from ATC, click on the button "Catalog" and search the drug (top field in the pop-up window).
Important You must select the drug in level 5 (right part of the table) by clicking the drug name or ATC. Previous level indicate only a family of drugs. Expand the following levels by clicking the arrows on the left.
HTML
To select a drug from ATC, click on the button "Catalog" and search the drug (top field in the pop-up window).<br />
<strong>Important</strong>
You must select the drug in level 5 (right part of the table) by clicking the drug name or ATC. Previous level indicate only a family of drugs.
Expand the following levels by clicking the arrows on the left.
Dose Unit
,  
qsdrug_2   {Nummer 5,2}
mg (3 - 6) µg (2 - 52) ng (1 - 129) U (5 - 229)
qsdrug_3   {Horizontal-Radiobutton}
Kommentar
Query
{ IASHorizontalGroup: ......... Standard - horizontal }
Aplication/Timespan
Route of administration x/day start end
oral (1 - 15) sc (2 - 240) inhal (3 - 158) iv (4 - 76) tc (5 - 243)
qsdrug_4   {Horizontal-Radiobutton}
 
qsdrug_5   {Nummer 2,0}
-- tt.mm.jjjj
qsdrug_6   {Datum (tt.mm.jjjj), Datumsformat: anzeigen}
10.  []  Eingabe nur möglich, wenn ...   "Obere Grenze"
 10-10 "Value must be lower or equals "end"" [ ] <> [≤ kleiner gleich Wert] <Item> [Generica(simple) <emnpipfdrugsim> Aplication/Timespan - end <qsdrug_7>] <selbes Subformular>
oder 20-10 " " [Generica(simple) <emnpipfdrugsim> Aplication/Timespan - end <qsdrug_7>] <selbes Subformular> [= gleich Wert] <"NULL" Wert> [] <selbes Subformular>
-- tt.mm.jjjj
qsdrug_7   {Datum (tt.mm.jjjj), Datumsformat: anzeigen}
10.  []  Eingabe nur möglich, wenn ...   "Obere Grenze"
 10-10 "Value must be lower than current date" [ ] <> [≤ kleiner gleich Wert] <aktuelles Datum / Zeit> [] <selbes Subformular>
20.  []  Eingabe nur möglich, wenn ...   "Untere Grenze"
 10-10 "Value must be greater than field <strong>start</strong>" [ ] <> [≥ größer gleich Wert] <Item> [Generica(simple) <emnpipfdrugsim> Aplication/Timespan - start <qsdrug_6>] <selbes Subformular>
Kommentar
Query

  Generica #      emnpipfdrugskip 
Projekt:
European IPF Network (27.11.2018 - 16:22:51 (MEZ)) { IPF - Register  /  Vers. Nr. 64 - Development  }
Formularfamilie:
Generica-Templates { Subform }
Formularname (Übersicht): * Generica(skipped) ]
Verarbeitung: * Benutzereingaben: speichern
Datenbanktabelle: * emnpipfdrugskip ]
Reihenfolge: 31 ] Angezeigte Nr.:  ]
Query Menü: skalierbar
Kommentar Menü: skalierbar
Formularname (Titel): Generica # ]
Formular verwendet in: (1) * 6min walk * Spiroergometry * HR-CT results * Co-morbidity * Changes in medical treatment for IPF * Concurrent treatment for pulmonary hypertension * Co-medication <mnpipfqsphf3>
{ IASCatalogGroup: ............ Kataloggruppe - "ATCCodes" }
Katalog öffnen
Generic Name [Q_19]
Generic name
       
qsdrug_1   {Katalogfeld, Ebene 5 / ATC 5th level}
- "Ebene 5" / "ATC 5th level"
    cat_atccodes_5 / atc5thlevel
     
 
qsdrug_1_a   {Katalogfeld, Ebene 5 / 5th level name}
- "Ebene 5" / "5th level name"
    cat_atccodes_5 / x5thlevelname
Hilfe
Kommentar
Query
Hilfe: To select a drug from ATC, click on the button "Catalog" and search the drug (top field in the pop-up window).
Important You must select the drug in level 5 (right part of the table) by clicking the drug name or ATC. Previous level indicate only a family of drugs. Expand the following levels by clicking the arrows on the left.
{ IASHorizontalGroup: ......... Standard - horizontal }
Aplication/Timespan
To select a drug from ATC, click on the button "Catalog" and search the drug (top field in the pop-up window).
Important You must select the drug in level 5 (right part of the table) by clicking the drug name or ATC. Previous level indicate only a family of drugs. Expand the following levels by clicking the arrows on the left.
HTML
To select a drug from ATC, click on the button "Catalog" and search the drug (top field in the pop-up window).<br />
<strong>Important</strong>
You must select the drug in level 5 (right part of the table) by clicking the drug name or ATC. Previous level indicate only a family of drugs.
Expand the following levels by clicking the arrows on the left.
Route of administration x/day start end
oral (1 - 15) sc (2 - 240) inhal (3 - 158) iv (4 - 76) tc (5 - 243)
qsdrug_2   {Horizontal-Radiobutton}
 
qsdrug_3   {Nummer 2,0}
-- tt.mm.jjjj
qsdrug_4   {Datum (tt.mm.jjjj), Datumsformat: anzeigen}
10.  []  Eingabe nur möglich, wenn ...   "Obere Grenze"
 10-10 "Value must be lower or equals "end"" [ ] <> [≤ kleiner gleich Wert] <Item> [Generica(skipped) <emnpipfdrugskip> Aplication/Timespan - end <qsdrug_5>] <selbes Subformular>
oder 20-10 " " [Generica(skipped) <emnpipfdrugskip> Aplication/Timespan - end <qsdrug_5>] <selbes Subformular> [= gleich Wert] <"NULL" Wert> [] <selbes Subformular>
-- tt.mm.jjjj
qsdrug_5   {Datum (tt.mm.jjjj), Datumsformat: anzeigen}
10.  []  Eingabe nur möglich, wenn ...   "Obere Grenze"
 10-10 "Value must be lower than current date" [ ] <> [≤ kleiner gleich Wert] <aktuelles Datum / Zeit> [] <selbes Subformular>
20.  []  Eingabe nur möglich, wenn ...   "Untere Grenze"
 10-10 "Value must be greater than field <strong>start</strong>" [ ] <> [≥ größer gleich Wert] <Item> [Generica(skipped) <emnpipfdrugskip> Aplication/Timespan - start <qsdrug_4>] <selbes Subformular>
Kommentar
Query
{ IASHorizontalGroup: ......... Standard - horizontal }
because of
because of
lack of efficacy side effects interference with comedication patient´s wish costs established therapy available change of dosage
  
qsdrug_6_a   {Checkbox}
10.  []  Für Ausfüllstatus nicht berücksichtigen.   " "
  
qsdrug_6_b   {Checkbox}
10.  []  Für Ausfüllstatus nicht berücksichtigen.   " "
  
qsdrug_6_c   {Checkbox}
10.  []  Für Ausfüllstatus nicht berücksichtigen.   " "
  
qsdrug_6_d   {Checkbox}
10.  []  Für Ausfüllstatus nicht berücksichtigen.   " "
  
qsdrug_6_e   {Checkbox}
10.  []  Für Ausfüllstatus nicht berücksichtigen.   " "
  
qsdrug_6_f   {Checkbox}
10.  []  Für Ausfüllstatus nicht berücksichtigen.   " "
  
qsdrug_6_g   {Checkbox}
10.  []  Für Ausfüllstatus nicht berücksichtigen.   " "
Kommentar
Query

  Generica #      emnpipfdrugpirfenidon 
Projekt:
European IPF Network (27.11.2018 - 16:22:51 (MEZ)) { IPF - Register  /  Vers. Nr. 64 - Development  }
Formularfamilie:
Generica-Templates { Subform }
Formularname (Übersicht): * Generica(anti-fibrotic) ]
Verarbeitung: * Benutzereingaben: speichern
Datenbanktabelle: * emnpipfdrugpirfenidon ]
Reihenfolge: 41 ] Angezeigte Nr.:  ]
Query Menü: skalierbar
Kommentar Menü: skalierbar
Formularname (Titel): Generica # ]
Formular verwendet in: (1) *medical treatment <mnpipfphybaseline4>
{ IASCatalogGroup: ............ Kataloggruppe - "ATCCodes" }
Katalog öffnen
Generic Name [Q_19]
Generic name
       
qsdrug_1   {Katalogfeld, Ebene 5 / ATC 5th level}
- "Ebene 5" / "ATC 5th level"
    cat_atccodes_5 / atc5thlevel
     
 
qsdrug_1_a   {Katalogfeld, Ebene 5 / 5th level name}
- "Ebene 5" / "5th level name"
    cat_atccodes_5 / x5thlevelname
Hilfe
Kommentar
Query
Hilfe: To select a drug from ATC, click on the button "Catalog" and search the drug (top field in the pop-up window).
Important You must select the drug in level 5 (right part of the table) by clicking the drug name or ATC. Previous level indicate only a family of drugs. Expand the following levels by clicking the arrows on the left.
{ IASHorizontalGroup: ......... Standard - horizontal }
Dose and Unit
To select a drug from ATC, click on the button "Catalog" and search the drug (top field in the pop-up window).
Important You must select the drug in level 5 (right part of the table) by clicking the drug name or ATC. Previous level indicate only a family of drugs. Expand the following levels by clicking the arrows on the left.
HTML
To select a drug from ATC, click on the button "Catalog" and search the drug (top field in the pop-up window).<br />
<strong>Important</strong>
You must select the drug in level 5 (right part of the table) by clicking the drug name or ATC. Previous level indicate only a family of drugs.
Expand the following levels by clicking the arrows on the left.
Dose Unit
,  
qsdrug_2   {Nummer 5,2}
mg (3 - 6) µg (2 - 52) ng (1 - 129) U (5 - 229)
qsdrug_3   {Horizontal-Radiobutton}
Kommentar
Query
{ IASHorizontalGroup: ......... Standard - horizontal }
Aplication/Timespan
Route of administration x/day start end
oral (1 - 15) sc (2 - 240) inhal (3 - 158) iv (4 - 76) tc (5 - 243)
qsdrug_4   {Horizontal-Radiobutton}
 
qsdrug_5   {Nummer 2,0}
-- tt.mm.jjjj
qsdrug_6   {Datum (tt.mm.jjjj), Datumsformat: anzeigen}
10.  []  Eingabe nur möglich, wenn ...   "Obere Grenze"
 10-10 "Value must be lower or equals "end"" [ ] <> [≤ kleiner gleich Wert] <Item> [Generica(anti-fibrotic) <emnpipfdrugpirfenidon> Aplication/Timespan - end <qsdrug_7>] <selbes Subformular>
oder 20-10 " " [Generica(anti-fibrotic) <emnpipfdrugpirfenidon> Aplication/Timespan - end <qsdrug_7>] <selbes Subformular> [= gleich Wert] <"NULL" Wert> [] <selbes Subformular>
-- tt.mm.jjjj
qsdrug_7   {Datum (tt.mm.jjjj), Datumsformat: anzeigen}
10.  []  Eingabe nur möglich, wenn ...   "Obere Grenze"
 10-10 "Value must be lower than current date" [ ] <> [≤ kleiner gleich Wert] <aktuelles Datum / Zeit> [] <selbes Subformular>
20.  []  Eingabe nur möglich, wenn ...   "Untere Grenze"
 10-10 "Value must be greater than field <strong>start</strong>" [ ] <> [≥ größer gleich Wert] <Item> [Generica(anti-fibrotic) <emnpipfdrugpirfenidon> Aplication/Timespan - start <qsdrug_6>] <selbes Subformular>
Kommentar
Query

  Side Effects      emnpipfsideeffect 
Projekt:
European IPF Network (27.11.2018 - 16:22:51 (MEZ)) { IPF - Register  /  Vers. Nr. 64 - Development  }
Formularfamilie:
Generica-Templates { Subform }
Formularname (Übersicht): * Side Effects ]
Verarbeitung: * Benutzereingaben: speichern
Datenbanktabelle: * emnpipfsideeffect ]
Reihenfolge: 51 ] Angezeigte Nr.:  ]
Query Menü: skalierbar
Kommentar Menü: skalierbar
Formularname (Titel): Side Effects ]
Formular verwendet in: (2) *medical treatment <mnpipfphybaseline4>
* 6min walk * Spiroergometry * HR-CT results * Co-morbidity * Changes in medical treatment for IPF * Concurrent treatment for pulmonary hypertension * Co-medication <mnpipfqsphf3>
{ IASCatalogGroup: ............ Kataloggruppe - "Side Effects" }
Katalog öffnen
Side effect
Side effect
       
qse_1_a   {Katalogfeld, side_effect / symptom}
- "side_effect" / "symptom"
    cat_meddra_adverse_eff2_2 / symptom
Kommentar
Query
{ IASCatalogGroup: ............ Kataloggruppe - "ATCCodes" }
Katalog öffnen
Generica
Generica
       
qse_2_a   {Katalogfeld, Ebene 5 / ATC 5th level}
- "Ebene 5" / "ATC 5th level"
    cat_atccodes_5 / atc5thlevel
     
 
qse_2_b   {Katalogfeld, Ebene 5 / 5th level name}
- "Ebene 5" / "5th level name"
    cat_atccodes_5 / x5thlevelname
Kommentar
Query
{ IASHorizontalGroup: ......... Standard - horizontal , flexible Spaltenbreite }
Comment
Comment
 
qse_3_a   {Textbereich 3,80}
Kommentar
Query

  CT #      emnpipfhrct 
Projekt:
European IPF Network (27.11.2018 - 16:22:51 (MEZ)) { IPF - Register  /  Vers. Nr. 64 - Development  }
Formularfamilie:
Upload-Templates { Subform }
Formularname (Übersicht): * Thorax-CT ]
Verarbeitung: * Benutzereingaben: speichern
Datenbanktabelle: * emnpipfhrct ]
Reihenfolge: 10 ] Angezeigte Nr.:  ]
Query Menü: skalierbar
Kommentar Menü: skalierbar
Formularname (Titel): CT # ]
Formular verwendet in: (2) computer tomography <mnpipfdcmhrct>
computer tomography <mnpipfcdcmhrct>
{ IASStandardGroup: ........... Standard - vertikal }
DICOM Upload
Please provide CT in the DICOM format only.
    Date of CT: -- tt.mm.jjjj
dcm_1   {Datum (tt.mm.jjjj), Datumsformat: anzeigen}
     
ein Bild.tiff  
dcm_2   {Bild, 150x150} 150x150
    - HRCT
No (0 - -99.0 - 195) Yes (1 - 99.0 - 72)
dcm_3   {Horizontal-Radiobutton}
    - Spiral-CT
No (0 - -99.0 - 195) Yes (1 - 99.0 - 72)
dcm_4   {Horizontal-Radiobutton}
Kommentar
Query

  unspecific findings #      emnpipfunspc 
Projekt:
European IPF Network (27.11.2018 - 16:22:51 (MEZ)) { IPF - Register  /  Vers. Nr. 64 - Development  }
Formularfamilie:
Upload-Templates { Subform }
Formularname (Übersicht): * PDF - Upload ]
Verarbeitung: * Benutzereingaben: speichern
Datenbanktabelle: * emnpipfunspc ]
Reihenfolge: 20 ] Angezeigte Nr.:  ]
Query Menü: skalierbar
Kommentar Menü: skalierbar
Formularname (Titel): unspecific findings # ]
Formular verwendet in: (2) unspecified findings <mnpipfdcmhrct1>
unspecified findings <mnpipfcdcmhrct1>
{ IASStandardGroup: ........... Standard - vertikal }
DICOM Upload
    Date of finding: -- tt.mm.jjjj
file_1   {Datum (tt.mm.jjjj), Datumsformat: anzeigen}
     
ein Bild.tiff  
file_2   {Bild, 150x150} 150x150
Kommentar
Query

  Informed Consent      mnpipfinfcon 
Projekt:
European IPF Network (27.11.2018 - 16:22:51 (MEZ)) { IPF - Register  /  Vers. Nr. 64 - Development  }
Formularfamilie:
Informed Consent { Visit }
Voraussetzungen: --
Nachrichten: --
Import-Formate: --
Formularname (Übersicht): * Informed Consent ]
Verarbeitung: * Benutzereingaben: speichern
Datenbanktabelle: * mnpipfinfcon ]
Reihenfolge: 10 ] Angezeigte Nr.:  ]
Query Menü: skalierbar
Kommentar Menü: skalierbar
Formularname (Titel): Informed Consent ]
Beschreibung (HTML):
HTML

    
Formular-Bezeichnung: Version of informed consent... - Version of informed consent... <qsicb_1> ]
Werte aus vorheriger Visite übernehmen: nur nach Einzelregeln
Regeln und Validierung:
{ IASHeadline: ................ Überschrift }
   
{ IASStandardGroup: ........... Standard - vertikal }
Version of informed consent signed
    Version of informed consent signed
   
qsicb_1   {Popup (Beschr. Gruppe)}
    IC withdrawn
  
qsicb_2   {Checkbox} "IC withdrawn"
10.  []  Für Ausfüllstatus nicht berücksichtigen.   " "
    Date of withdraw -- tt.mm.jjjj
qsicb_3   {Datum (tt.mm.jjjj), Datumsformat: anzeigen} "Date of withdraw"
10.  []  Eingabe nicht möglich, wenn ...   "Eingabe nicht möglich, da "IC withdrawn" nicht markiert ist"
*  10-10 "Field "IC withdrawn" is not checked" [Informed Consent <mnpipfinfcon> Version of informed consent... - IC withdrawn <qsicb_2>] <Baseline> [= gleich Wert] <"NULL" Wert> [] <>
20.  []  Eingabe nur möglich, wenn ...   "Obere Grenze"
 10-10 "Value must be lower than current date" [ ] <> [≤ kleiner gleich Wert] <aktuelles Datum / Zeit> [] <>
Kommentar
Query
{ IASHeadline: ................ Überschrift }
   

qsicb_1
1. in/after 2013 (1 - 22722)
2. before 2013 (0 - 22719)

  Patient's questionnaire BASELINE Page 1/4      mnpipfpatqolbaseline1 
Projekt:
European IPF Network (27.11.2018 - 16:22:51 (MEZ)) { IPF - Register  /  Vers. Nr. 64 - Development  }
Formularfamilie:
Patient´s questionnaire BASELINE { Visit }
Voraussetzungen: --
Nachrichten: --
Import-Formate:
Patients Baseline Import Page1 ]     Identifikator   ]
Pat-ID PID ]    Zus-ID   ]
Visiten Beim Import auswählen ]
Deutsches Zahlenformat (Dezimalzeichen = ",") ]
ja ] Groß- Kleinschreibung bei Variablen ignorieren   nein ] Groß- Kleinschreibung bei Optionswerten ignorieren
ja ] Für den Massenimport zulassen (benötigt mindestens einen CSV-Parser)
Parser
Default Parser ] CsvParser ]   Zeichensatz: < Client-Default > ]   Format-Problem Fehler ]   Trennzeichen ; ]   Text-Begrenzer " ]   nein ] Werte trimmen
Datenvorverarbeitung:
Importfilter
Mapping Einträge
1 ] q_1 ] - Please answer the following... - 1. How tall are you? <qspab_1>  ]
2 ] q_2 ] - Please answer the following... - 2. What is your current... <qspab_2>  ]
3 ] q_3 ] - Please answer the following... - 3. What is your date of birth? <qsbab_3>  ] MM.yyyy ]< aktuelle Sprache > ]
4 ] q_4 ] - Please answer the following... - 4. Which gender are you?... <qspab_4>  ]
1 ] - male (1 - 135) ]
2 ] - female (2 - 24) ]
5 ] q_5_a ] - 5. What is your ethnic origin? - Mother <qspab_5_a>  ]
1 ] - Caucasian (1 - 82) ]
2 ] - African (2 - 179) ]
3 ] - Indian /Indio (3 - 5) ]
4 ] - Asian (4 - 147) ]
5 ] - Pacific Islander / Polynesian (5 - 62) ]
6 ] - Aboriginee (6 - 8) ]
7 ] - Inuit (7 - 153) ]
6 ] q_5_b ] - 5. What is your ethnic origin? - Father <qspab_5_b>  ]
1 ] - Caucasian (1 - 82) ]
2 ] - African (2 - 179) ]
3 ] - Indian /Indio (3 - 5) ]
4 ] - Asian (4 - 147) ]
5 ] - Pacific Islander / Polynesian (5 - 62) ]
6 ] - Aboriginee (6 - 8) ]
7 ] - Inuit (7 - 153) ]
7 ] q_6 ] - 6. I have been experiencing... <qspab_6>  ] MM.yyyy ]< aktuelle Sprache > ]
8 ] q_7_a ] - 7. Breathlessness developed - insidiously <qspab_7_a>  ]
0 ] - No (0 - -99.0 - 195) ]
1 ] - Yes (1 - 99.0 - 72) ]
9 ] q_7_b ] - 7. Breathlessness developed - or acutely <qspab_7_b>  ]
0 ] - No (0 - -99.0 - 195) ]
1 ] - Yes (1 - 99.0 - 72) ]
10 ] q_8 ] - 8. The feeling of... <qspab_8>  ]
0 ] - No (0 - -99.0 - 195) ]
1 ] - Yes (1 - 99.0 - 72) ]
11 ] q_9 ] - 9. Please mark which... <qspab_9>  ]
1 ] - Grade 1: Not troubled by breathlessness except on strenuous exercise (1 - 238) ]
2 ] - Grade 2: Short of breath when hurrying or walking up a slight hill (2 - 226) ]
3 ] - Grade 3: Walks slower than people of same age on level ground because of breathlessness or has to... (3 - 192) ]
4 ] - Grade 4: Stops for breath after walking about 100m or after a few minutes on level ground (4 - 116) ]
5 ] - Grade 5: Too breathless to leave the house, or breathless when dressing or undressing (5 - 65) ]
12 ] q_10_a ] - 10. Are you usually... - during work days <qspab_10_a>  ]
0 ] - No (0 - -99.0 - 195) ]
1 ] - Yes (1 - 99.0 - 72) ]
13 ] q_10_b ] - 10. Are you usually... - on the weekend <qspab_10_b>  ]
0 ] - No (0 - -99.0 - 195) ]
1 ] - Yes (1 - 99.0 - 72) ]
14 ] q_10_c ] - 10. Are you usually... - in your flat / house <qspab_10_c>  ]
0 ] - No (0 - -99.0 - 195) ]
1 ] - Yes (1 - 99.0 - 72) ]
15 ] q_10_d ] - 10. Are you usually... - at the work place <qspab_10_d>  ]
0 ] - No (0 - -99.0 - 195) ]
1 ] - Yes (1 - 99.0 - 72) ]
16 ] q_10_e ] - 10. Are you usually... - at night <qspab_10_e>  ]
0 ] - No (0 - -99.0 - 195) ]
1 ] - Yes (1 - 99.0 - 72) ]
17 ] q_10_f ] - 10. Are you usually... - on other occasions <qspab_10_f>  ]
0 ] - No (0 - -99.0 - 195) ]
1 ] - Yes (1 - 99.0 - 72) ]
18 ] q_11_a ] - 11. Since the onset of your... <qspab_11_a>  ]
1 ] - get worse over time ? (1 - 286) ]
2 ] - remain unchanged ? (2 - 287) ]
3 ] - improve without treatment ? (3 - 288) ]
4 ] - improve in response to medical measures ? (4 - 289) ]
22 ] q_12 ] - 12. Do you suffer from a... <qspab_12>  ]
0 ] - No (0 - -99.0 - 195) ]
1 ] - Yes (1 - 99.0 - 72) ]
23 ] q_13 ] - 13. Do you suffer from... <qspab_13>  ]
0 ] - No (0 - -99.0 - 195) ]
1 ] - Yes (1 - 99.0 - 72) ]
24 ] q_13_a ] - 13. Do you suffer from... - If yes, is the sputum... <qspab_13_a>  ]
0 ] - No (0 - -99.0 - 195) ]
1 ] - Yes (1 - 99.0 - 72) ]
25 ] q_14 ] - 14. Weakness and lassitude <qspab_14>  ]
0 ] - No (0 - -99.0 - 195) ]
1 ] - Yes (1 - 99.0 - 72) ]
26 ] q_15 ] - 15. Loss of appetite <qspab_15>  ]
0 ] - No (0 - -99.0 - 195) ]
1 ] - Yes (1 - 99.0 - 72) ]
27 ] q_16 ] - 16. Increased body temperature <qspab_16>  ]
0 ] - No (0 - -99.0 - 195) ]
1 ] - Yes (1 - 99.0 - 72) ]
28 ] q_17 ] - 17. Extensive night sweat <qspab_17>  ]
0 ] - No (0 - -99.0 - 195) ]
1 ] - Yes (1 - 99.0 - 72) ]
29 ] q_18 ] - 18. Shivering and chills <qspab_18>  ]
0 ] - No (0 - -99.0 - 195) ]
1 ] - Yes (1 - 99.0 - 72) ]
30 ] q_19 ] - 19. Rheumatic pain <qspab_19>  ]
0 ] - No (0 - -99.0 - 195) ]
1 ] - Yes (1 - 99.0 - 72) ]
31 ] q_20 ] - 20. Joint complaints <qspab_20>  ]
0 ] - No (0 - -99.0 - 195) ]
1 ] - Yes (1 - 99.0 - 72) ]
32 ] q_20_a ] - 20. Joint complaints - Painful joints <qspab_20_a>  ]
0 ] - No (0 - -99.0 - 195) ]
1 ] - Yes (1 - 99.0 - 72) ]
33 ] q_20_b ] - 20. Joint complaints - Swelling <qspab_20_b>  ]
0 ] - No (0 - -99.0 - 195) ]
1 ] - Yes (1 - 99.0 - 72) ]
34 ] q_20_c ] - 20. Joint complaints - Stiffness in the morning <qspab_20_c>  ]
0 ] - No (0 - -99.0 - 195) ]
1 ] - Yes (1 - 99.0 - 72) ]
35 ] q_21 ] - 21. Muscle complaints <qspab_21>  ]
0 ] - No (0 - -99.0 - 195) ]
1 ] - Yes (1 - 99.0 - 72) ]
36 ] q_21_a ] - 21. Muscle complaints - Aches in muscles <qspab_21_a>  ]
0 ] - No (0 - -99.0 - 195) ]
1 ] - Yes (1 - 99.0 - 72) ]
37 ] q_22 ] - 22. Affection of the skin <qspab_22>  ]
0 ] - No (0 - -99.0 - 195) ]
1 ] - Yes (1 - 99.0 - 72) ]
38 ] q_22_a ] - 22. Affection of the skin - rash <qspab_22_a>  ]
0 ] - No (0 - -99.0 - 195) ]
1 ] - Yes (1 - 99.0 - 72) ]
39 ] q_22_b ] - 22. Affection of the skin - nodules <qspab_22_b>  ]
0 ] - No (0 - -99.0 - 195) ]
1 ] - Yes (1 - 99.0 - 72) ]
40 ] q_23 ] - 23. Do your hands turn cold... <qspab_23>  ]
0 ] - No (0 - -99.0 - 195) ]
1 ] - Yes (1 - 99.0 - 72) ]
41 ] q_24 ] - 24. Do you experience... <qspab_24>  ]
0 ] - No (0 - -99.0 - 195) ]
1 ] - Yes (1 - 99.0 - 72) ]
42 ] q_25 ] - 25. Enlarged lymph nodes <qspab_25>  ]
0 ] - No (0 - -99.0 - 195) ]
1 ] - Yes (1 - 99.0 - 72) ]
43 ] q_26 ] - 26. Enlarged salivary glands <qspab_26>  ]
0 ] - No (0 - -99.0 - 195) ]
1 ] - Yes (1 - 99.0 - 72) ]
44 ] q_27 ] - 27. Dry mouth <qspab_27>  ]
0 ] - No (0 - -99.0 - 195) ]
1 ] - Yes (1 - 99.0 - 72) ]
45 ] q_28 ] - 28. Sensation of... <qspab_28>  ]
0 ] - No (0 - -99.0 - 195) ]
1 ] - Yes (1 - 99.0 - 72) ]
46 ] q_29 ] - 29. Difficulties in swallowing <qspab_29>  ]
0 ] - No (0 - -99.0 - 195) ]
1 ] - Yes (1 - 99.0 - 72) ]
47 ] q_30 ] - 30. Headaches <qspab_30>  ]
0 ] - No (0 - -99.0 - 195) ]
1 ] - Yes (1 - 99.0 - 72) ]
48 ] q_31 ] - 31. Vision disorders <qspab_31>  ]
0 ] - No (0 - -99.0 - 195) ]
1 ] - Yes (1 - 99.0 - 72) ]
49 ] q_32 ] - 32. Sneezing fits, coryza... <qspab_32>  ]
0 ] - No (0 - -99.0 - 195) ]
1 ] - Yes (1 - 99.0 - 72) ]
50 ] q_33 ] - 33. Chestpain when breathing <qspab_33>  ]
0 ] - No (0 - -99.0 - 195) ]
1 ] - Yes (1 - 99.0 - 72) ]
51 ] q_34 ] - 34. Palpitation at rest or... <qspab_34>  ]
0 ] - No (0 - -99.0 - 195) ]
1 ] - Yes (1 - 99.0 - 72) ]
52 ] q_35 ] - 35. Unintended weight loss... <qspab_35>  ]
0 ] - No (0 - -99.0 - 195) ]
1 ] - Yes (1 - 99.0 - 72) ]
53 ] q_36 ] - 36. Other <qspab_36>  ]
0 ] - No (0 - -99.0 - 195) ]
1 ] - Yes (1 - 99.0 - 72) ]
54 ] q_36_a ] - 36. Other - If yes. Please specify: <qspab_36_a>  ]
55 ] q_10_g ] - 10. Are you usually... - If yes please specify: <qspab_10_g>  ]
Formularname (Übersicht): * * biometric data * nature and history of medical complaints * coughing and exploration * other complaints * ]
Verarbeitung: * Benutzereingaben: speichern
Datenbanktabelle: * mnpipfpatqolbaseline1 ]
Reihenfolge: 2 ] Angezeigte Nr.:  ]
Query Menü: skalierbar
Kommentar Menü: skalierbar
Formularname (Titel): Patient's questionnaire BASELINE Page 1/4 ]
Beschreibung (HTML):
HTML

    
Werte aus vorheriger Visite übernehmen: nur nach Einzelregeln
Regeln und Validierung:
{ IASHeadline: ................ Überschrift }
  Biometric data
{ IASStandardGroup: ........... Standard - vertikal }
Please answer the following questions:
Please answer the following questions:
    1. How tall are you? cm 
qspab_1   {Nummer 3,0}
10.  []  Eingabe nur möglich, wenn ... (nur als Bestätigung)   "Obere Grenze"
 10-10 "Value must be lower or equals 220" [ ] <> [≤ kleiner gleich Wert] <feste Kommazahl> [220.0] <aktuelle Visite>
20.  []  Eingabe nur möglich, wenn ... (nur als Bestätigung)   "Untere Grenze"
 10-10 "Value must be greater or equals 100" [ ] <> [≥ größer gleich Wert] <feste Kommazahl> [100.0] <aktuelle Visite>
30.  []  Nachricht auslösen, wenn ...   "Informieren über Daten-Import"
 10-10 " " [ ] <> [≠ ungleich Wert] <"NULL" Wert> [] <>
"Inform Clinical Expert about Data-Import" "eurIPFnet data import"
"Dear eurIPFnet - Clinical Expert, the data for the patient questionnaire, sent from you by mail, have been imported into the database. The data is now available in the DataCapture online tool."

{Patient: Pat-ID} {Zentrum: Name} {Teilnehmer: Name, Adresse}
"Your eurIPFnet-Team"
    2. What is your current body weight? kg 
qspab_2   {Nummer 3,0}
10.  []  Eingabe nur möglich, wenn ... (nur als Bestätigung)   "Obere Grenze"
 10-10 "Value must be lower or equals 250" [ ] <> [≤ kleiner gleich Wert] <feste Kommazahl> [250.0] <aktuelle Visite>
20.  []  Eingabe nur möglich, wenn ... (nur als Bestätigung)   "Untere Grenze"
 10-10 "Value must be greater or equals 20" [ ] <> [≥ größer gleich Wert] <feste Kommazahl> [20.0] <aktuelle Visite>
    3. What is your date of birth? - mm.jjjj mm/yyyy
qsbab_3   {Datum (mm.jjjj), Datumsformat: anzeigen}
10.  []  Eingabe nur möglich, wenn ... (nur als Bestätigung)   "Obere Grenze"
 10-10 "Patient must be 20 years old or older" [ ] <> [≤ kleiner gleich Wert] <aktuelles Datum / Zeit + Zeitbetrag> [-240 Monate] <aktuelle Visite>
20.  []  Eingabe nur möglich, wenn ... (nur als Bestätigung)   "Untere Grenze"
 10-10 "Value must be greater or equals 1900" [ ] <> [≥ größer gleich Wert] <Datum / Zeit> [01.1900] <aktuelle Visite>
    4. Which gender are you? (please mark the appropriate)
male (1 - 135) female (2 - 24)
qspab_4   {Horizontal-Radiobutton}
Kommentar
Query
{ IASHorizRBMatrix: ........... Radiobutton Matrix - horizontal }
What is your ethnic origin?
5. What is your ethnic origin?
(please mark the appropriate)
Caucasian (1 - 82) African (2 - 179) Indian /Indio (3 - 5) Asian (4 - 147) Pacific Islander / Polynesian (5 - 62) Aboriginee (6 - 8) Inuit (7 - 153)
Mother qspab_5_a
Father qspab_5_b
Kommentar
Query
{ IASHeadline: ................ Überschrift }
  Nature and history of medical complaints
{ IASStandardGroup: ........... Standard - vertikal }
6. I have been experiencing breathlessness since?
6. I have been experiencing breathlessness since?
      - mm.jjjj
qspab_6   {Datum (mm.jjjj), Datumsformat: anzeigen}
10.  []  Eingabe nur möglich, wenn ...   "Obere Grenze"
 10-10 "Value must be lower than current date" [ ] <> [≤ kleiner gleich Wert] <aktuelles Datum / Zeit> [] <aktuelle Visite>
20.  []  Eingabe nur möglich, wenn ...   "Untere Grenze"
 10-10 "Value must be greater or equals 1940" [ ] <> [≥ größer gleich Wert] <Datum / Zeit> [01.1940] <aktuelle Visite>
 
{ IASStandardGroup: ........... Standard - vertikal }
7. Breathlessness developed
7. Breathlessness developed
    insidiously
No (0 - -99.0 - 195) Yes (1 - 99.0 - 72)
qspab_7_a   {Horizontal-Radiobutton}
10.  []  Wertebereich einschränken, wenn ...   "Kriterien gegenseitig ausschliessen"
 10-10 "Value can only be insidiously or acutely" [* biometric data * nature and history of medical complaints * coughing and exploration * other complaints * <mnpipfpatqolbaseline1> 7. Breathlessness developed - or acutely <qspab_7_b>] <aktuelle Visite> [= gleich Wert] <feste Ganzzahl> [Yes (1)Minimaler Wert:0.0Maximaler Wert:0.0] <aktuelle Visite>
    or acutely
No (0 - -99.0 - 195) Yes (1 - 99.0 - 72)
qspab_7_b   {Horizontal-Radiobutton}
10.  []  Wertebereich einschränken, wenn ...   "Kriterien gegenseitig ausschliessen"
 10-10 "Value can only be insidiously or acutely" [* biometric data * nature and history of medical complaints * coughing and exploration * other complaints * <mnpipfpatqolbaseline1> 7. Breathlessness developed - insidiously <qspab_7_a>] <aktuelle Visite> [= gleich Wert] <feste Ganzzahl> [Yes (1)Minimaler Wert:0.0Maximaler Wert:0.0] <aktuelle Visite>
Kommentar
Query
{ IASStandardGroup: ........... Standard - vertikal }
8. The feeling of breathlessness coincided with an “unresolved” upper airway infection with flu-like symptoms (fever, headache, aching muscles and joints, coughing)
8. The feeling of breathlessness coincided with an “unresolved” upper airway infection with flu-like symptoms (fever, headache, aching muscles and joints, coughing)
     
No (0 - -99.0 - 195) Yes (1 - 99.0 - 72)
qspab_8   {Horizontal-Radiobutton}
Kommentar
Query
{ IASStandardGroup: ........... Standard - vertikal }
9. Please mark which statement on breathlessness most appropriately describes your condition
9. Please mark which statement on breathlessness most appropriately describes your condition
     
Grade 1: Not troubled by breathlessness except on strenuous exercise (1 - 238)
Grade 2: Short of breath when hurrying or walking up a slight hill (2 - 226)
Grade 3: Walks slower than people of same age on level ground because of breathlessness or has to stop for breath when walking at own pace (3 - 192)
Grade 4: Stops for breath after walking about 100m or after a few minutes on level ground (4 - 116)
Grade 5: Too breathless to leave the house, or breathless when dressing or undressing (5 - 65)
qspab_9   {Vertical-Radiobutton}
Kommentar
Query
{ IASStandardGroup: ........... Standard - vertikal }
10. Are you usually experiencing worsening of breathlessness in relation to one or more of the following conditions
10. Are you usually experiencing worsening of breathlessness in relation to one or more of the following conditions
    during work days
No (0 - -99.0 - 195) Yes (1 - 99.0 - 72)
qspab_10_a   {Horizontal-Radiobutton}
    on the weekend
No (0 - -99.0 - 195) Yes (1 - 99.0 - 72)
qspab_10_b   {Horizontal-Radiobutton}
    in your flat / house
No (0 - -99.0 - 195) Yes (1 - 99.0 - 72)
qspab_10_c   {Horizontal-Radiobutton}
    at the work place
No (0 - -99.0 - 195) Yes (1 - 99.0 - 72)
qspab_10_d   {Horizontal-Radiobutton}
    at night
No (0 - -99.0 - 195) Yes (1 - 99.0 - 72)
qspab_10_e   {Horizontal-Radiobutton}
    on other occasions
No (0 - -99.0 - 195) Yes (1 - 99.0 - 72)
qspab_10_f   {Horizontal-Radiobutton}
    If yes please specify:  
qspab_10_g   {Textfeld 100}
Kommentar
Query
{ IASStandardGroup: ........... Standard - vertikal }
11. Since the onset of your lung disease, did your feeling of breathlessness:
11. Since the onset of your lung disease, did your feeling of breathlessness:
     
get worse over time ? (1 - 286) remain unchanged ? (2 - 287) improve without treatment ? (3 - 288) improve in response to medical measures ? (4 - 289)
qspab_11_a   {Horizontal-Radiobutton}
Kommentar
Query
{ IASHeadline: ................ Überschrift }
  Coughing and expectoration
{ IASStandardGroup: ........... Standard - vertikal }
12. Do you suffer from a dry coughing ?
12. Do you suffer from a dry coughing ?
     
No (0 - -99.0 - 195) Yes (1 - 99.0 - 72)
qspab_12   {Horizontal-Radiobutton}
10.  []  Wertebereich einschränken, wenn ...   "Vorhergehendes Kriterium nicht erfüllt"
 10-10 "Field "13. Do you suffer from coughing with sputum" is checked with "yes"" [* biometric data * nature and history of medical complaints * coughing and exploration * other complaints * <mnpipfpatqolbaseline1> 13. Do you suffer from... <qspab_13>] <aktuelle Visite> [= gleich Wert] <feste Ganzzahl> [Yes (1)Minimaler Wert:0.0Maximaler Wert:0.0] <aktuelle Visite>
Kommentar
Query
{ IASStandardGroup: ........... Standard - vertikal }
13. Do you suffer from coughing with sputum
13. Do you suffer from coughing with sputum
     
No (0 - -99.0 - 195) Yes (1 - 99.0 - 72)
qspab_13   {Horizontal-Radiobutton}
10.  []  Wertebereich einschränken, wenn ...   "Vorhergehendes Kriterium nicht erfüllt"
 10-10 "Field "12. Do you suffer from dry coughing ?" is checked with "yes"" [* biometric data * nature and history of medical complaints * coughing and exploration * other complaints * <mnpipfpatqolbaseline1> 12. Do you suffer from a... <qspab_12>] <aktuelle Visite> [= gleich Wert] <feste Ganzzahl> [Yes (1)Minimaler Wert:0.0Maximaler Wert:0.0] <aktuelle Visite>
    If yes, is the sputum colored (greyish, yellow/greenish, brownish/black)
No (0 - -99.0 - 195) Yes (1 - 99.0 - 72)
qspab_13_a   {Horizontal-Radiobutton}
10.  []  Wertebereich einschränken, wenn ...   "Wertebereich einschränken, wenn vorhergehendes Kriterium "no""
 10-10 "Value does not match criteria before" [* biometric data * nature and history of medical complaints * coughing and exploration * other complaints * <mnpipfpatqolbaseline1> 13. Do you suffer from... <qspab_13>] <aktuelle Visite> [= gleich Wert] <feste Ganzzahl> [No (0)Minimaler Wert:0.0Maximaler Wert:0.0] <aktuelle Visite>
Kommentar
Query
{ IASHeadline: ................ Überschrift }
  Other complaints and diseases that evolved parallel to the lung disease
{ IASStandardGroup: ........... Standard - vertikal }
14. Weakness and lassitude
14. Weakness and lassitude
     
No (0 - -99.0 - 195) Yes (1 - 99.0 - 72)
qspab_14   {Horizontal-Radiobutton}
Kommentar
Query
{ IASStandardGroup: ........... Standard - vertikal }
15. Loss of appetite
15. Loss of appetite
     
No (0 - -99.0 - 195) Yes (1 - 99.0 - 72)
qspab_15   {Horizontal-Radiobutton}
Kommentar
Query
{ IASStandardGroup: ........... Standard - vertikal }
16. Increased body temperature
16. Increased body temperature
     
No (0 - -99.0 - 195) Yes (1 - 99.0 - 72)
qspab_16   {Horizontal-Radiobutton}
Kommentar
Query
{ IASStandardGroup: ........... Standard - vertikal }
17. Extensive night sweat
17. Extensive night sweat
     
No (0 - -99.0 - 195) Yes (1 - 99.0 - 72)
qspab_17   {Horizontal-Radiobutton}
Kommentar
Query
{ IASStandardGroup: ........... Standard - vertikal }
18. Shivering and chills
18. Shivering and chills
     
No (0 - -99.0 - 195) Yes (1 - 99.0 - 72)
qspab_18   {Horizontal-Radiobutton}
Kommentar
Query
{ IASStandardGroup: ........... Standard - vertikal }
19. Rheumatic pain
19. Rheumatic pain
     
No (0 - -99.0 - 195) Yes (1 - 99.0 - 72)
qspab_19   {Horizontal-Radiobutton}
Kommentar
Query
{ IASStandardGroup: ........... Standard - vertikal }
20. Joint complaints
20. Joint complaints
     
No (0 - -99.0 - 195) Yes (1 - 99.0 - 72)
qspab_20   {Horizontal-Radiobutton}
    Painful joints
No (0 - -99.0 - 195) Yes (1 - 99.0 - 72)
qspab_20_a   {Horizontal-Radiobutton}
10.  []  Wertebereich einschränken, wenn ...   "Vorhergehendes Kriterium = "no""
 10-10 ""Joint complaints" is marked "no"" [* biometric data * nature and history of medical complaints * coughing and exploration * other complaints * <mnpipfpatqolbaseline1> 20. Joint complaints <qspab_20>] <aktuelle Visite> [= gleich Wert] <feste Ganzzahl> [No (0)Minimaler Wert:0.0Maximaler Wert:0.0] <aktuelle Visite>
    Swelling
No (0 - -99.0 - 195) Yes (1 - 99.0 - 72)
qspab_20_b   {Horizontal-Radiobutton}
10.  []  Wertebereich einschränken, wenn ...   "Vorhergehendes Kriterium = "no""
 10-10 ""Joint complaints" is marked "no"" [* biometric data * nature and history of medical complaints * coughing and exploration * other complaints * <mnpipfpatqolbaseline1> 20. Joint complaints <qspab_20>] <aktuelle Visite> [= gleich Wert] <feste Ganzzahl> [No (0)Minimaler Wert:0.0Maximaler Wert:0.0] <aktuelle Visite>
    Stiffness in the morning
No (0 - -99.0 - 195) Yes (1 - 99.0 - 72)
qspab_20_c   {Horizontal-Radiobutton}
10.  []  Wertebereich einschränken, wenn ...   "Vorhergehendes Kriterium = "no""
 10-10 ""Joint complaints" is marked "no"" [* biometric data * nature and history of medical complaints * coughing and exploration * other complaints * <mnpipfpatqolbaseline1> 20. Joint complaints <qspab_20>] <aktuelle Visite> [= gleich Wert] <feste Ganzzahl> [No (0)Minimaler Wert:0.0Maximaler Wert:0.0] <aktuelle Visite>
Kommentar
Query
{ IASStandardGroup: ........... Standard - vertikal }
21. Muscle complaints
21. Muscle complaints
     
No (0 - -99.0 - 195) Yes (1 - 99.0 - 72)
qspab_21   {Horizontal-Radiobutton}
    Aches in muscles
No (0 - -99.0 - 195) Yes (1 - 99.0 - 72)
qspab_21_a   {Horizontal-Radiobutton}
Kommentar
Query
{ IASStandardGroup: ........... Standard - vertikal }
22. Affection of the skin
22. Affection of the skin
     
No (0 - -99.0 - 195) Yes (1 - 99.0 - 72)
qspab_22   {Horizontal-Radiobutton}
    rash
No (0 - -99.0 - 195) Yes (1 - 99.0 - 72)
qspab_22_a   {Horizontal-Radiobutton}
10.  []  Wertebereich einschränken, wenn ...   "Vorhergehendes Kriterium = "no""
 10-10 ""Affection of the skin" is marked "no"" [* biometric data * nature and history of medical complaints * coughing and exploration * other complaints * <mnpipfpatqolbaseline1> 22. Affection of the skin <qspab_22>] <aktuelle Visite> [= gleich Wert] <feste Ganzzahl> [No (0)Minimaler Wert:0.0Maximaler Wert:0.0] <aktuelle Visite>
    nodules
No (0 - -99.0 - 195) Yes (1 - 99.0 - 72)
qspab_22_b   {Horizontal-Radiobutton}
10.  []  Wertebereich einschränken, wenn ...   "Vorhergehendes Kriterium = "no""
 10-10 ""Affection of the skin" is marked "no"" [* biometric data * nature and history of medical complaints * coughing and exploration * other complaints * <mnpipfpatqolbaseline1> 22. Affection of the skin <qspab_22>] <aktuelle Visite> [= gleich Wert] <feste Ganzzahl> [No (0)Minimaler Wert:0.0Maximaler Wert:0.0] <aktuelle Visite>
Kommentar
Query
{ IASStandardGroup: ........... Standard - vertikal }
23. Do your hands turn cold and blue on exposure to the cold ?
23. Do your hands turn cold and blue on exposure to the cold ?
     
No (0 - -99.0 - 195) Yes (1 - 99.0 - 72)
qspab_23   {Horizontal-Radiobutton}
Kommentar
Query
{ IASStandardGroup: ........... Standard - vertikal }
24. Do you experience tightness of the skin ?
24. Do you experience tightness of the skin ?
     
No (0 - -99.0 - 195) Yes (1 - 99.0 - 72)
qspab_24   {Horizontal-Radiobutton}
Kommentar
Query
{ IASStandardGroup: ........... Standard - vertikal }
25. Enlarged lymph nodes
25. Enlarged lymph nodes
     
No (0 - -99.0 - 195) Yes (1 - 99.0 - 72)
qspab_25   {Horizontal-Radiobutton}
Kommentar
Query
{ IASStandardGroup: ........... Standard - vertikal }
26. Enlarged salivary glands
26. Enlarged salivary glands
     
No (0 - -99.0 - 195) Yes (1 - 99.0 - 72)
qspab_26   {Horizontal-Radiobutton}
Kommentar
Query
{ IASStandardGroup: ........... Standard - vertikal }
27. Dry mouth
27. Dry mouth
     
No (0 - -99.0 - 195) Yes (1 - 99.0 - 72)
qspab_27   {Horizontal-Radiobutton}
Kommentar
Query
{ IASStandardGroup: ........... Standard - vertikal }
28. Sensation of sand/grittiness in eyes
28. Sensation of sand/grittiness in eyes
     
No (0 - -99.0 - 195) Yes (1 - 99.0 - 72)
qspab_28   {Horizontal-Radiobutton}
Kommentar