wiki:i2b2 - Onyx import mapping v1

i2b2 Import from Onyx Mapping Version 1

The mapping is made up of 13 questionnaires. These are:

  1. Acute Verbal Consent for samples collection
  2. Participant Consent
  3. Paper Consent
  4. Recruitment Context
  5. Risk Factor
  6. Patient-reported medical history
  7. Samples Preliminary
  8. Blood samples collection
  9. Urine sample collection
  10. End of patient contact
  11. Notes-recorded medical history
  12. Data submission
  13. Conclusion

The mapping of each questionnaire is show in the sections below:

Acute Verbal Consent for samples collection

Export folder: VerbalConsentQuestionnaire

Visible fields on the form:

Label Answer Type Has comment
Was acute verbal consent given Radio button: yes,no n
Name of witness Free text with radio button y

Participant Consent

Export folder: Consent

Visible fields on the form:

Label Answer Type Has comment
Type of consent Radio button: Electronic, Paper n
Consent form language Select: various languages n
Consent Confirmation (paper only?) Radio buttons: 'read and signed', 'refused to sign' n
  • QUESTION: The confirmation comes through as consent_q[1-5] and consent_q[1-5]_signed. Does this relate to the different language options?
  • The only data that appears in i2b2 is an accepted field that only seems to contain NULL values.

Paper Consent

Export folder: ManualConsentQuestionnaire

Visible fields on the form:

Label Answer Type Has comment
Does the participant understand the request for consent? Radio button: yes, no y
Does the participant consent to donate blood and urine Radio button: yes, no y
Does the participant consent to entry in the BRICCS database? Radio button: yes, no y
Does the participant consent to further contact from BRU? Radio button: yes, no y
Does the participant understand the rules of withdrawal? Radio button: yes, no y
  • These values appear in i2b2 as consent_q1, consent_q2, etc and not the actual name of the question. Also, they have leave nodes for the Y and N answers as opposed to the questions having values.

Recruitment Context

Export folder: RecruitmentContextQuestionnaire

Visible fields on the form:

Label Answer Type Has comment
Interview Language Select: languages y
Recruitment episode type Radio button: inpatient, outpatient, healthy control, study specific, don't know y
Inpatient admission type Radio button: Actute, Elective, Don't know y
Hospital Radio button: Glenfield, LGH, LRI, Don't know y
Admitting Ward Select: list of wards, and radio button: don't know y
Admitting Consultant Select: list of consultants, and radio button: don't know y
Outpatient clinic attended select: list of clinics, and radio button: don't know y
Consultant Select: list of consultants, and radio button: don't know y
Study Reference Radio button: GeneFast AS Study, Study Reference2, Study Reference3, Don't know y
  • Yep. In i2b2 the names of the field as opposed to the descriptions. The answers are created as leaf nodes as opposed to enumerated values.

Risk Factor

Export folder: RiskFactorQuestionnaire

Visible fields on the form:

Label Answer Type Has comment
Have you ever smoked or used any tobacco or nicotine product? Radio button: no, yes, prefer not to answer, don't know y
Which of the following have you ever smoked or used? tick boxes: cigarettes, cigars, pipe tobacco, snuff or chewing tobacco, any other y
Have you ever smoked cigarettes on most days? Radio button: no, yes, prefer not to answer, Don't know y
Do you currently smoke cigarettes Radio button: y, n, pnta, dk y
On average, how many cigarettes did you smoke per day when you were smoking the most numeric box, pnta, dk y
How old were you when you began smoking cigarettes on most days numeric box, pnta, dk y
How old were you when you stopped smoking cigarettes numeric box, pnta, dk y
On average, how many cigarettes do you currently smoke per day? numeric box, pnta, dk y
When was the last time you had a cigarette Complex radio buttons: (Select: today, yesterday; Select: hour; Select: minute) or (More than 24 hours) y
Have you ever smoked cigars regularly Radio buttons: y, n, pnta, dk y
Do you currently smoke cigars Radio buttons: y, n, pnta, dk y
On average, how many cigars did you smoke per day when you were smoking the most numeric box, pnta, dk y
How old were you when you began smoking cigars on most days numeric box, pnta, dk y
How old were you when you stopped smoking cigars numeric box, pnta, dk y
On average, how many cigars do you currently smoke per day? numeric box, pnta, dk y
When was the last time you had a cigarette Complex radio buttons: (Select: today, yesterday; Select: hour; Select: minute) or (More than 24 hours) y
Have you ever smoked a pipe regularly Radio buttons: y, n, pnta, dk y
Do you currently smoke a pipe Radio buttons: y, n, pnta, dk y
How much tobacco did you smoke per day when you were smoking the most numeric box, pnta, dk y
How old were you when you began smoking a pipe on most days numeric box, pnta, dk y
How old were you when you stopped smoking a pipe numeric box, pnta, dk y
How much tobacco do you currently smoke per day? numeric box, pnta, dk y
When was the last time you smoked a pipe Complex radio buttons: (Select: today, yesterday; Select: hour; Select: minute) or (More than 24 hours) y
Have you ever used snuff or chewing tobacco regularly Radio buttons: y, n, pnta, dk y
Do you currently use snuff or chewing tobacco Radio buttons: y, n, pnta, dk y
How much snuff or chewing tobacco did you smoke per day when you were using the most numeric box, pnta, dk y
How old were you when you began using snuff or chewing tobacco numeric box, pnta, dk y
How old were you when you stopped using snuff or chewing tobacco numeric box, pnta, dk y
How much snuff or chewing tobacco do you use per week? numeric box, pnta, dk y
When was the last time you has snuff or chewing tobacco Complex radio buttons: (Select: today, yesterday; Select: hour; Select: minute) or (More than 24 hours) y
Have you ever used any other tobacco or nicotine product for at least 6 months y, n, pnta, dk y
Do you currently use any other tobacco or nicotine product y, n, pnta, dk y
How much of the tobacco or nicotine product per week did you use when you were using the most? numeric box, pnta, dk y
How old were you when you began using the tobacco or nicotine product? numeric box, pnta, dk y
How old were you when you stopped using the tobacco or nicotine product? numeroc box, pnta, dk y
How much of the tobacco or nicotine product do you use per week? numeric box, pnta, dk y
When was the last time you had any tobacco or nicotine? Complex radio buttons: (Select: today, yesterday; Select: hour; Select: minute) or (More than 24 hours) y
Have you ever drunk alcohol? y, n, pnta, dk y
Have you ever drunk alcohol at least once per week? y, n, pnta, dk y
Do you currently drink alcohol at least once per week? y, n, pnta, dk y
How many pints of beer do you drink in a typical week? numeric box, pnta, dk y
How many glasses of white wine do you drink in a typical week? numeric box, pnta, dk y
How many glasses of red wine do you drink in a typical week? numeric box, pnta, dk y
How many glasses of rose wine do you drink in a typical week? numeric box, pnta, dk y
How many measures of spirits do you drink in a typical week? numeric box, pnta, dk y
How old were you when you began drinking alcohol? numeric box, pnta, dk y
When was the last time you had a drink containing alcohol? Complex radio buttons: (Select: today, yesterday; Select: hour; Select: minute) or (More than 24 hours) y
How would you describe your diet? Radio buttons: various diets y
If you work, does your work involve any physical activity? Radio buttons y
Apart from work, do you undertake any regular physical exercise over and above that of daily living? Radio buttons y
Number of Family members see below y
How many brothers do you have? numeric, pnta, dk n
How many sisters do you have? numeric, pnta, dk n
How many children do you have? numeric, pnta, dk n
Have any of your relatives suffered angina or other Coronary Artery Disease? see below y
Father Radio buttons: y, n, pnta, dk n
Mother Radio buttons: y, n, pnta, dk n
Brother Radio buttons: y, n, pnta, dk n
Sister Radio buttons: y, n, pnta, dk n
Child Radio buttons: y, n, pnta, dk n
Have any of your relatives suffered a heart attack or Myocardial Infarction? see below y
Father Radio buttons: y, n, pnta, dk n
Mother Radio buttons: y, n, pnta, dk n
Brother Radio buttons: y, n, pnta, dk n
Sister Radio buttons: y, n, pnta, dk n
Child Radio buttons: y, n, pnta, dk n
Have any of your relatives ever been diagnosed with heart failure? see below y
Father Radio buttons: y, n, pnta, dk n
Mother Radio buttons: y, n, pnta, dk n
Brother Radio buttons: y, n, pnta, dk n
Sister Radio buttons: y, n, pnta, dk n
Child Radio buttons: y, n, pnta, dk n
Have any of your relatives ever suffered Atrial Fibrillation (AF)? see below y
Father Radio buttons: y, n, pnta, dk n
Mother Radio buttons: y, n, pnta, dk n
Brother Radio buttons: y, n, pnta, dk n
Sister Radio buttons: y, n, pnta, dk n
Child Radio buttons: y, n, pnta, dk n
Have any of your relatives ever suffered a stroke or CVA? see below y
Father Radio buttons: y, n, pnta, dk n
Mother Radio buttons: y, n, pnta, dk n
Brother Radio buttons: y, n, pnta, dk n
Sister Radio buttons: y, n, pnta, dk n
Child Radio buttons: y, n, pnta, dk n
Have any of your relatives been diagnosed with high blood pressure? see below y
Father Radio buttons: y, n, pnta, dk n
Mother Radio buttons: y, n, pnta, dk n
Brother Radio buttons: y, n, pnta, dk n
Sister Radio buttons: y, n, pnta, dk n
Child Radio buttons: y, n, pnta, dk n
Have any of your relatives been diagnosed with valvular heart disease? see below y
Father Radio buttons: y, n, pnta, dk n
Mother Radio buttons: y, n, pnta, dk n
Brother Radio buttons: y, n, pnta, dk n
Sister Radio buttons: y, n, pnta, dk n
Child Radio buttons: y, n, pnta, dk n
At what age did they first suffer from angina or Coronary Artery Disease? see below y
Father numeric box, pnta, dk n
Mother numeric box, pnta, dk n
Brother numeric box, pnta, dk n
Sister numeric box, pnta, dk n
Child numeric box, pnta, dk n
Have they received treatment for their angina or Coronary Artery Disease? see below y
Father Radio buttons: y, n, pnta, dk n
Mother Radio buttons: y, n, pnta, dk n
Brother Radio buttons: y, n, pnta, dk n
Sister Radio buttons: y, n, pnta, dk n
Child Radio buttons: y, n, pnta, dk n
At what age did they suffer their first heart attack or Myocardial Infarction? see below y
Father numeric box, pnta, dk n
Mother numeric box, pnta, dk n
Brother numeric box, pnta, dk n
Sister numeric box, pnta, dk n
Child numeric box, pnta, dk n
Have they received treatment for their angina or Coronary Artery Disease? see below y
Father Radio buttons: y, n, pnta, dk n
Mother Radio buttons: y, n, pnta, dk n
Brother Radio buttons: y, n, pnta, dk n
Sister Radio buttons: y, n, pnta, dk n
Child Radio buttons: y, n, pnta, dk n
At what age did they first suffer from heart failure? see below y
Father numeric box, pnta, dk n
Mother numeric box, pnta, dk n
Brother numeric box, pnta, dk n
Sister numeric box, pnta, dk n
Child numeric box, pnta, dk n
Have they received treatment for their heart failure? see below y
Father Radio buttons: y, n, pnta, dk n
Mother Radio buttons: y, n, pnta, dk n
Brother Radio buttons: y, n, pnta, dk n
Sister Radio buttons: y, n, pnta, dk n
Child Radio buttons: y, n, pnta, dk n
At what age did they first suffer from Atrial Fibrillation? see below y
Father numeric box, pnta, dk n
Mother numeric box, pnta, dk n
Brother numeric box, pnta, dk n
Sister numeric box, pnta, dk n
Child numeric box, pnta, dk n
Have they received treatment for their Atrial Fibrillation? see below y
Father Radio buttons: y, n, pnta, dk n
Mother Radio buttons: y, n, pnta, dk n
Brother Radio buttons: y, n, pnta, dk n
Sister Radio buttons: y, n, pnta, dk n
Child Radio buttons: y, n, pnta, dk n
At what age did they suffer their first stroke or CVA? see below y
Father numeric box, pnta, dk n
Mother numeric box, pnta, dk n
Brother numeric box, pnta, dk n
Sister numeric box, pnta, dk n
Child numeric box, pnta, dk n
Were they treated for the stroke or CVA? see below y
Father Radio buttons: y, n, pnta, dk n
Mother Radio buttons: y, n, pnta, dk n
Brother Radio buttons: y, n, pnta, dk n
Sister Radio buttons: y, n, pnta, dk n
Child Radio buttons: y, n, pnta, dk n
At what age did they first suffer from high blood pressure? see below y
Father numeric box, pnta, dk n
Mother numeric box, pnta, dk n
Brother numeric box, pnta, dk n
Sister numeric box, pnta, dk n
Child numeric box, pnta, dk n
Have they received treatment for their high blood pressure? see below y
Father Radio buttons: y, n, pnta, dk n
Mother Radio buttons: y, n, pnta, dk n
Brother Radio buttons: y, n, pnta, dk n
Sister Radio buttons: y, n, pnta, dk n
Child Radio buttons: y, n, pnta, dk n
At what age did they first suffer from valvular heart disease? see below y
Father numeric box, pnta, dk n
Mother numeric box, pnta, dk n
Brother numeric box, pnta, dk n
Sister numeric box, pnta, dk n
Child numeric box, pnta, dk n
Have they received treatment for their valvular heart disease? see below y
Father Radio buttons: y, n, pnta, dk n
Mother Radio buttons: y, n, pnta, dk n
Brother Radio buttons: y, n, pnta, dk n
Sister Radio buttons: y, n, pnta, dk n
Child Radio buttons: y, n, pnta, dk n
Are all of your relatives still alive? see below y
Father Radio buttons: y, n, pnta, dk n
Mother Radio buttons: y, n, pnta, dk n
Brother Radio buttons: y, n, pnta, dk n
Sister Radio buttons: y, n, pnta, dk n
Child Radio buttons: y, n, pnta, dk n
Do you know the cause of your father's death? Radio buttons y
Do you know the cause of your Mother's death? Radio buttons y
Do you know the cause of your brother's death? Radio buttons y
Do you know the cause of your sister's death? Radio buttons y
Do you know the cause of your child's death? Radio buttons y
At what age did they die? see below y
Father numeric box, pnta, dk n
Mother numeric box, pnta, dk n
Brother numeric box, pnta, dk n
Sister numeric box, pnta, dk n
Child numeric box, pnta, dk n
Was their death sudden and unexpected? see below y
Father Radio buttons: y, n, pnta, dk n
Mother Radio buttons: y, n, pnta, dk n
Brother Radio buttons: y, n, pnta, dk n
Sister Radio buttons: y, n, pnta, dk n
Child Radio buttons: y, n, pnta, dk n
What is your current marital status? Radio buttons y
Do you live with a spouse or partner? Radio buttons y
How many people live in your household? Radio buttons y
What is your current work status? Radio buttons y
What was the highest level of education you completed? Radio buttons y
Which of the following best describes the work you do or did? Radio buttons y
  • Again all the answers are represented in i2b2 as nodes as opposed to enumerations.
  • Also, there are separate hierarchies for each question and then each family member. What questions might this be used to answer?
  • We can represent the data in multiple ways if this allows us to cover different types of question. For example, aggregate ('Family history of AS') and specific ('Father had AS').

Patient-reported medical history

Export folder: MedicalHistoryInterviewQuestionnaire

Visible fields on the form:

Label Answer Type Has comment
Have you ever suffered from high blood pressure? y, n, pnta, dk y
When did you first suffer from high blood pressure? numeric box, pnta, dk y
Have you received treatment for your high blood pressure? y, n, pnta, dk y
Have you ever suffered from diabetes? y, n, pnta, dk y
Which type of diabetes? radio button list y
When did you first suffer from diabetes? numeric box, pnta, dk y
Have you received treatment for your diabetes? y, n, pnta, dk y
What treatment are you receiving for your diabetes? radio button list y
Have you ever suffered from high cholesterol? y, n, pnta, dk y
When did you first suffer from high cholesterol? numeric box, pnta, dk y
Have you received treatment for your high cholesterol? y, n, pnta, dk y
Have you ever suffered a heart attack or myocardial infarction (M.I.)? y, n, pnta, dk y
How many heart attacks or MIs have you had? numeric box, pnta, dk y
Year of occurrence of each MI (one per instance) numeric box, pnta, dk y
Have you received treatment for your MI? y, n, pnta, dk y
Have you ever had a stroke or a cerebrovascular accident (CVA)? y, n, pnta, dk y
How many CVAs have you suffered? numeric box, pnta, dk y
Year of occurrence of each CVA (one per instance) numeric box, pnta, dk y
Have you received treatment for your CVA? y, n, pnta, dk y
Have you ever suffered from transient ischaemic attack (TIA)? y, n, pnta, dk y
How many TIAs have you suffered? numeric box, pnta, dk y
Year of occurrence of each TIA (one per instance) numeric box, pnta, dk y
Have you received treatment for your TIA? y, n, pnta, dk y
Have you ever suffered from angina? y, n, pnta, dk y
When did you first suffer from angina? numeric box, pnta, dk y
Have you received treatment for your angina? y, n, pnta, dk y
Have you ever suffered from peripheral vascular disease (PVD)? y, n, pnta, dk y
When did you first suffer from peripheral vascular disease (PVD)? numeric box, pnta, dk y
Have you received treatment for your PVD? y, n, pnta, dk y
Have you ever suffered from valvular heart disease? y, n, pnta, dk y
Which type of Valvular Heart Disease have you had? radio button list y
When did you first suffer from valvular heart disease? numeric box, pnta, dk y
Have you received treatment for your valvular heart disease? y, n, pnta, dk y
Have you ever suffered from an aortic aneurysm? y, n, pnta, dk y
When did you first suffer from aortic aneurysm? numeric box, pnta, dk y
Have you received treatment for your aortic aneurysm? y, n, pnta, dk y
Have you ever suffered from chronic renal failure? y, n, pnta, dk y
When did you first suffer from chronic renal failure? numeric box, pnta, dk y
Have you received treatment for your chronic renal failure? y, n, pnta, dk y
Have you ever suffered from chronic obstructive airway disease (COAD) or chronic obstructive pulmonary disease (COPD)? y, n, pnta, dk y
When did you first suffer from COAD or COPD? numeric box, pnta, dk y
Have you received treatment for your COAD or COPD? y, n, pnta, dk y
Have you ever suffered from liver disease? y, n, pnta, dk y
When did you first suffer from liver disease? numeric box, pnta, dk y
Have you received treatment for your liver disease? y, n, pnta, dk y
Have you ever suffered from asthma? y, n, pnta, dk y
When did you first suffer from asthma? numeric box, pnta, dk y
Have you received treatment for your asthma? y, n, pnta, dk y
Have you ever suffered from Atrial Fibrillation (AF)? y, n, pnta, dk y
When did you first suffer from AF? numeric box, pnta, dk y
Have you received treatment for your AF? y, n, pnta, dk y
Have you ever suffered from any other heart rhythm disturbance? y, n, pnta, dk y
When did you first suffer from other heart rhythm disturbance? numeric box, pnta, dk y
Have you received treatment for your other heart rhythm disturbance? y, n, pnta, dk y
Past History of Interventions tickbox list with radio buttons for none & unknown y
How many times have you undergone CABG? numeric box y
Enter the year for each CABG (one per occurrance) numeric box and unknown radio button y
How many times have you undergone Valve Surgery? numeric box y
Enter the year for each Valve_Surgery (one per occurrance) numeric box and unknown radio button y
In which year was your TAVI performed? numeric box and unknown radio button y
How many times have you undergone a Primary PCI? numeric box y
Enter the year for each Primary PCI (one per occurrance) numeric box and unknown radio button y
How many times have you undergone a PCI other than a Primary PCI? numeric box y
When did you have the other PCI procedures? (one per occurrance) numeric box and unknown radio button y
How many times have you had pacemaker surgery? numeric box y
Enter the year for each pacemaker. (one per occurrance) numeric box and unknown radio button y
How many times have you had an ICD implanted? numeric box y
Enter the year for each ICD. (one per occurrance) numeric box and unknown radio button y
How many times have you had DC cardioversion? numeric box y
Enter the year for each DC cardioversion. (one per occurrance) numeric box and unknown radio button y
How many times have you had an LVAD fitted? numeric box y
Enter the year for each LVAD. (one per occurrance) numeric box and unknown radio button y
How many times have you had thrombolysis? numeric box y
Enter the year for each thrombolysis treatment. (one per occurrance) numeric box and unknown radio button y
How many times have you had an ablation? numeric box y
Enter the year for each ablation. (one per occurrance) numeric box and unknown radio button y
How many times have you had an Aortic Balloon Pump fitted? numeric box y
Enter the year for each Aortic Balloon Pump. (one per occurrance) numeric box and unknown radio button y
How many times have you had a bare metal stent fitted? numeric box y
Enter the year for each bare metal stent. (one per occurrance) numeric box and unknown radio button y
How many times have you had a drug-eluting stent fitted? numeric box y
How many times have you had a drug-eluting stent fitted. (one per occurrance) numeric box and unknown radio button y
How many times have you had ? numeric box y
Enter the year for each CPAP. (one per occurrance) numeric box and unknown radio button y
How many times have you had a heart transplant ? numeric box y
Enter the year for each heart transplant. (one per occurrance) numeric box and unknown radio button y
  • Again the question name and not description is being used and the answers are nodes.

Samples Preliminary

Export folder: SamplesPreliminaryQuestionnaire

Visible fields on the form:

Label Answer Type Has comment
Do you have a blood clotting disease such as haemophilia? y,n,pnta,dk y
Have you received a blood transfusion or donated blood in the past 24 hours? y,n,pnta,dk y
Have you received a blood transfusion in the past three months? y,n,pnta,dk y
Have you received radiotherapy or chemotherapy treatment in the past twelve weeks? y,n,pnta,dk y
When was the last time you had something to eat Complex radio buttons: (Select: today, yesterday; Select: hour; Select: minute) or (More than 24 hours) y
When was the last time you had anything to drink other than plain water Complex radio buttons: (Select: today, yesterday; Select: hour; Select: minute) or (More than 24 hours) y
When was the last time you had a drink containing caffeine, including tea, coffee or an energy drink? Complex radio buttons: (Select: today, yesterday; Select: hour; Select: minute) or (More than 24 hours) y
  • Again the question name and not description is being used and the answers are nodes.

Blood samples collection

Export folder: BloodSamplesCollection

I suspect this is going to be more comlicated than I can replicate.

Visible fields on the form:

Label Answer Type Has comment
Tube barcode textbox n
  • There are other questions here, but I couldn't get to them on the test system because I didn't have a bar code.

Urine sample collection

Export folder: UrineSamplesQuestionnaire

I suspect this is going to be more complicated than I can replicate.

Visible fields on the form:

Label Answer Type Has comment
Tube barcode textbox n
  • There are other questions here, but I couldn't get to them on the test system because I didn't have a bar code.

End of patient contact

Export folder: EndContactQuestionnaire

Visible fields on the form:

Label Answer Type Has comment
Measurement around the waist (in centimetres): Numeric, or radio buttons: unable to measure, participant refused y
Measurement around the hips (in centimetres): Numeric, or radio buttons: unable to measure, participant refused y
Skin-fold measurement - biceps (in millimetres): Numeric, or radio buttons: unable to measure, participant refused y
Skin-fold measurement - triceps (in millimetres): Numeric, or radio buttons: unable to measure, participant refused y
Skin-fold measurement - subscapular (in millimetres): Numeric, or radio buttons: unable to measure, participant refused y
Skin-fold measurement - supra-iliac (in millimetres): Numeric, or radio buttons: unable to measure, participant refused y
Primary email address textbox y
Additional email address textbox y
  • Again the test name is used as opposed to the description.
  • A few of these tests are numeric and the values are stored as leaf nodes. However, if the measurement was converted to a number we would still have to record the status as a separate field: i.e., participant refused, unable to measure, measurement made.

Notes-recorded medical history

Export folder: MedicalHistoryQuestionnaire

Visible fields on the form:

Label Answer Type Has comment
Is hypertension documented in the notes? Radio button: y, n, unknown y
Year of onset of high blood pressure? Numeric or Radio button: unknown y
Is diabetes documented in the notes? Radio button: y, n, unknown y
Which type of diabetes? Radio button list y
Year of onset of diabetes? Numeric or Radio button: unknown y
Is high cholesterol documented in the notes? Radio button: y, n, unknown y
Year of onset of high cholesterol? Numeric or Radio button: unknown y
Is heart attack or myocardial infarction (M.I.) documented in the notes? Radio button: y, n, unknown y
How many MIs have been documented? Numeric or Radio button: unknown y
Year of occurrence of each MI: (one per occurrence) Numeric or Radio button: unknown y
Is stroke or a cerebrovascular accident (CVA) documented in the notes? Radio button: y, n, unknown y
How many CVAs have been documented? Numeric or Radio button: unknown y
Year of occurrence of each CVA: (one per occurrence) Numeric or Radio button: unknown y
Is transient ischaemic attack (TIA) documented in the notes? Radio button: y, n, unknown y
How many TIAs have been documented? Numeric or Radio button: unknown y
Year of occurrence of each TIA: (one per occurrence) Numeric or Radio button: unknown y
Is angina documented in the notes? Radio button: y, n, unknown y
Year of onset of angina? Numeric or Radio button: unknown y
Is peripheral vascular disease (PVD) documented in the notes? Radio button: y, n, unknown y
Year of onset of peripheral vascular disease (PVD)? Numeric or Radio button: unknown y
Is valvular heart disease documented in the notes? Radio button: y, n, unknown y
Which type of Valvular Heart Disease? Radio button list y
Year of onset of valvular heart disease? Numeric or Radio button: unknown y
Is an aortic aneurysm documented in the notes? Radio button: y, n, unknown y
Year of onset of aortic aneurysm? Numeric or Radio button: unknown y
Is chronic renal failure documented in the notes? Radio button: y, n, unknown y
Year of onset of chronic renal failure? Numeric or Radio button: unknown y
Is chronic obstructive airway disease (COAD) or chronic obstructive pulmonary disease (COPD) documented in the notes? Radio button: y, n, unknown y
Year of onset of chronic obstructive airway disease (COAD) or chronic obstructive pulmonary disease (COPD)? Numeric or Radio button: unknown y
Is liver disease documented in the notes? Radio button: y, n, unknown y
Year of onset of liver disease? Numeric or Radio button: unknown y
Is asthma documented in the notes? Radio button: y, n, unknown y
Year of onset of asthma? Numeric or Radio button: unknown y
Is Atrial Fibrillation (AF) documented in the notes? Radio button: y, n, unknown y
Year of onset of AF? Numeric or Radio button: unknown y
Is there any other heart rhythm disturbance documented in the notes? Radio button: y, n, unknown y
Year of onset of heart rhythm disturbance? Numeric or Radio button: unknown y
History of Interventions Text box list with radio buttons for none and unknown y
How many times has the participant undergone CABG? numeric box y
Enter the year for each CABG (one per occurrance) numeric box and unknown radio button y
How many times has the participant undergone Valve Surgery? numeric box y
Enter the year for each Valve_Surgery (one per occurrance) numeric box and unknown radio button y
Enter the year TAVI was performed? numeric box and unknown radio button y
How many times has the participant undergone Primary PCI? numeric box y
Enter the year for each Primary PCI (one per occurrance) numeric box and unknown radio button y
How many times has the participant undergone PCI other than Primary PCI? numeric box y
Enter the year of each other PCI? (one per occurrance) numeric box and unknown radio button y
How many times has the participant undergone Pacemaker surgery? numeric box y
Enter the year for each pacemaker. (one per occurrance) numeric box and unknown radio button y
How many times has the participant had a ICD implanted? numeric box y
Enter the year for each ICD. (one per occurrance) numeric box and unknown radio button y
How many times has the participant undergone DC Cardioversion? numeric box y
Enter the year for each DC cardioversion. (one per occurrance) numeric box and unknown radio button y
How many times has the participant had LVAD surgery? numeric box y
Enter the year for each LVAD. (one per occurrance) numeric box and unknown radio button y
How many times has the participant had thrombolysis? numeric box y
Enter the year for each thrombolysis treatment. (one per occurrance) numeric box and unknown radio button y
How many times has the participant had an ablation? numeric box y
Enter the year for each ablation. (one per occurrance) numeric box and unknown radio button y
How many times has the participant had an Aortic Balloon Pump fitted? numeric box y
Enter the year for each Aortic Balloon Pump. (one per occurrance) numeric box and unknown radio button y
How many times has the participant had a bare metal stent fitted? numeric box y
Enter the year for each bare metal stent. (one per occurrance) numeric box and unknown radio button y
How many times has the participant had a drug-eluting stent fitted? numeric box y
Enter the year for each drug-eluting stent. (one per occurrance) numeric box and unknown radio button y
How many times has the participant had CPAP treatment ? numeric box y
Enter the year for each CPAP. (one per occurrance) numeric box and unknown radio button y
How many times has the participant had a heart transplant ? numeric box y
Enter the year for each heart transplant. (one per occurrance) numeric box and unknown radio button y
  • Field names again.
  • Should this be combined with patient-supplied medical history.
  • Some of the data appears multiple times (eg, year of heart transplant) these should be combined into one measure.
  • The various dates (year of onset, year of transplant) should either be converted to age or age should be supplied as duplicate.

Data submission

Export folder: DataSubmissionQuestionnaire

Visible fields on the form:

Label Answer Type Has comment
Principal Symptoms Tickbox list, radio buttons for none or unknown y
Please supply details of the additional symptom(s) text area y
When was the First Onset of Symptoms? (numeric year and select month) or (unknown radio button) y
Presenting Primary Diagnosis radio button list y
Acute associated diagnoses tickbox list with radio button for none y
Please supply details of the other secondary diagnosis text area y
Interventions during this clinical episode see below y
CABG Coronary Artery Bypass Graft Date n
Valve Surgery Date n
TAVI - Transcatheter Aortic Valve Implantation Date n
PPCI - Primary Percutaneous Coronary Intervention Date n
Other PCI Date n
Pacemaker insertion Date n
ICD - Implantable Cardioverter Defibrillator Date n
DC Cardioversion Date n
LVAD - Left Ventricular Assist Device Date n
Thrombolysis Date n
Electrophysiology (EP) / Radiofrequency (RF) Ablation Date n
Coronary Angiography Date n
First recorded Heart Rate during this episode of care numeric or radio button: not recorded n
First recorded Systolic Blood Pressure numeric or radio button: not recorded n
First recorded Diastolic Blood Pressure numeric or radio button: not recorded n
Latest recorded Heart Rate numeric or radio button: not recorded n
Latest recorded Systolic Blood Pressure numeric or radio button: not recorded n
Latest recorded Diastolic Blood Pressure numeric or radio button: not recorded n
Height numeric or radio button: not recorded n
Weight numeric or radio button: not recorded n
  • Field Names
  • Numeric values, not leaves
  • Add these values to the general medical history data?

Conclusion

Export folder: ConclusionQuestionnaire

Visible fields on the form:

Label Answer Type Has comment
Discharge Method Radio button list y
Drugs on discharge or departure from clinic tickbox list or radio buttons: none, unknown
  • Field names.
  • Grouped with the data submission data?
Last modified 10 years ago Last modified on 04/29/13 10:54:45
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