| Xformpusher |
|---|
| CDASH Variable | Order | Question Text | Prompt | CRF Completion Instructions | Type | SDTMIG Target Variable | SDTMIG Target Mapping | Controlled Terminology Code List Name | Permissible Values | Pre-Populated Value | Query Display | List Style | Hidden | | SUCATCMCAT | 1 | What is the category of the substance used? | Substance Use Category |
| Text | SUCAT |
|
|
| SMOKING CESSATION PRODUCT |
|
|
| | SUYNCMYN | 2 | Did the subject previously use any products to attempted to quit smoking? |
| Indicate if the subject had used any products to attempted to quit smoking. | Text | SUOCCUR | SUOCCUR where SUTRT=Smoking Cessation Product" | (NY) | Yes; No |
|
|
|
| | FAORRES | 3 | How many times did the subject attempt to quit smoking using a smocking cessation product? | times did the subject attempt to quit smoking |
| Text | FAORRES | FAORRES where FAOBJ ="SMOKING CESSATION PRODUCT" and FATEST= NUMBER OF ATTEMPTS" |
|
|
|
|
|
|
|
RECORD THE INFORMATION FOR THE LAST ATTEMPT TO QUIT FOR EACH TYPE OF PRODUCT USED COMBINATION OF METHODS SHOULD BE LISTED ON TEH SAME LINE ?????? This is a problem..
| Xformpusher |
|---|
| CDASH Variable | Order | Question Text | Prompt | CRF Completion Instructions | Type | SDTMIG Target Variable | SDTMIG Target Mapping | Controlled Terminology Code List Name | Permissible Values | Pre-Populated Value | Query Display | List Style | Hidden | | SUCATCMCAT | 1 | What is the category of the substance used? |
|
|
| SUCAT |
|
|
| SMOKING CESSATION PRODUCT |
|
|
| | SUSCATCMSCAT | 3 | What is the type of product the subject used to attempted to quit smoking? | Substance Use Category | Record the type of product the subject used to attempted to quit smoking. | Text | SUSCAT |
|
| Nicotine Replacement
Therapy (NRT); Pharmaceuticals
other than NRTs; Other
Smoking Cessation aids;
|
|
|
|
| | SUTRTCMTRT | 4 | What was the name of the product the subject used to attempted to quit smoking?
|
|
| Text | SUTRT |
|
|
|
|
|
|
| | SUDSTXTCMDSTXT | 5 | What was the amount of product used to quit smoking? | Amount | Indicate the amount of amount of tobacco product used to quit smoking? | Text | SUDOSE; SUDOSTXT |
|
|
|
| Prompt |
|
| | SUDURCMDUR | 6 | What was the duration of the product usage to quit smoking? | Duration | Provide the duration of the substance use | Text | SUDOSFRQ |
|
|
|
| Prompt |
|
| | SUCDURUCMCDURU | 7 | What was the duration unit of the product used to quit smoking? | Unit | Select the appropriate duration unit of the tobacco product used | Text | SUDUR |
|
| DAYS; MONTHS; YEARS |
| Prompt |
|
| | SUDOSFRQ CMDOSFRQ | 8 | What was the frequency of of the product used to quit smoking | Frequency |
| Text | SUDOSFRQ |
| (FREQ) | QD; EVERY WEEK; QM; PA |
| Prompt |
|
|
|
|