MEDB16RestingECGQuestionnaire
type: Questionnaire
node role: treeRoot
id:
  v: MEDB16RestingECGQuestionnaire
text:
  status:
    v: extensions
  div:
    v: Generated Narrative: Questionnaire MEDB16RestingECGQuestionnaire Structure LinkID Text Cardinality Type Flags Description & Constraints<img src="[binary]" alt="doco" style="background-color: inherit"/> MEDB16RestingECG NASA Medical Requirements Integration Document for resting 12-lead ECG assessment. Captures pre- and postflight ECG recordings for cardiovascular evaluation of long-duration flight crew members. Questionnaire https://mitre.org/fhir/space-health/Questionnaire/medb-1-6-resting-ecg#0.5.12 #xD; overview Medical Requirements Overview 0..1 group #xD; overview.mrid-number MRID Number and Title 0..1 display Initial Value: string = MEDB 1.6 Resting ECG #xD; overview.sponsor Sponsor 1..1 choice Options: 1 option Initial Value: Coding = NASA MRID Sponsor Organizations#medical-operations "Medical Operations" #xD; overview.discipline Discipline 0..1 choice Options: 1 option #xD; overview.category Category 1..1 string Initial Value: string = Medical Requirements #xD; overview.references References 0..1 text Initial Value: string = SSP 50260 ISS Medical Operations Requirements Document (MORD); SSP 50667 Medical Evaluations Document (MED) Volume B Section 1.6 #xD; overview.purpose Purpose/Objectives 1..1 text Initial Value: string = To assess pre- and postflight ECG recordings on long-duration flight crew members at rest using a 12-lead electrocardiogram (ECG) #xD; overview.measurement-parameters Measurement Parameters 1..1 string Initial Value: string = 12-lead ECG tracing #xD; overview.deliverables Deliverables 1..1 text Initial Value: string = Pre- and postflight ECG reports related to the cardiovascular examination. #xD; overview.flight-duration Flight Duration 1..1 string Initial Value: string = >= 30 days #xD; overview.number-of-flights Number of Flights 1..1 string Initial Value: string = All #xD; overview.crew-members-required Number and Type of Crew Members Required 1..1 string Initial Value: string = All ISS crew members #xD; preflight-training Preflight Tr…
extension:
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      l: name
    value: Coding
      system:
        v: http://hl7.org/fhir/uv/sdc/CodeSystem/launchContext
        l: launchContext
      code:
        v: patient
  extension:
    url:
      v: type
      l: type
    value: Code
      v: Patient
  extension:
    url:
      v: description
      l: description
    value: String
      v: The astronaut/crewmember subject of this medical requirement
  url:
    v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-launchContext
    l: sdc-questionnaire-launchContext
url:
  v: https://mitre.org/fhir/space-health/Questionnaire/medb-1-6-resting-ecg
  l: medb-1-6-resting-ecg
version:
  v: 0.5.12
name:
  v: MEDB16RestingECG
title:
  v: MEDB 1.6 Resting ECG
status:
  v: active
date:
  v: 2013-12-19
publisher:
  v: MITRE
contact:
  name:
    v: MITRE
  telecom:
    system:
      v: url
    value:
      v: https://www.mitre.org/
description:
  v: NASA Medical Requirements Integration Document for resting 12-lead ECG assessment. Captures pre- and postflight ECG recordings for cardiovascular evaluation of long-duration flight crew members.
purpose:
  v: To assess pre- and postflight ECG recordings on long-duration flight crew members at rest using a 12-lead electrocardiogram (ECG)
copyright:
  v: NASA Johnson Space Center - Medical Requirements Integration Documents (MRIDs) JSC28913
item:
  link id:
    v: overview
  text:
    v: Medical Requirements Overview
  type:
    v: group
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      v: overview.mrid-number
    text:
      v: MRID Number and Title
    type:
      v: display
    initial:
      value: String
        v: MEDB 1.6 Resting ECG
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      v: overview.sponsor
    text:
      v: Sponsor
    type:
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    required:
      v: true
    read only:
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    answer option:
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    initial:
      value: Coding
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      v: overview.discipline
    text:
      v: Discipline
    type:
      v: choice
    required:
      v: false
    read only:
      v: true
    answer option:
      value: Coding
  item:
    link id:
      v: overview.category
    text:
      v: Category
    type:
      v: string
    required:
      v: true
    read only:
      v: true
    initial:
      value: String
        v: Medical Requirements
  item:
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      v: overview.references
    text:
      v: References
    type:
      v: text
    required:
      v: false
    initial:
      value: String
        v: SSP 50260 ISS Medical Operations Requirements Document (MORD); SSP 50667 Medical Evaluations Document (MED) Volume B Section 1.6
  item:
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      v: overview.purpose
    text:
      v: Purpose/Objectives
    type:
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    required:
      v: true
    initial:
      value: String
        v: To assess pre- and postflight ECG recordings on long-duration flight crew members at rest using a 12-lead electrocardiogram (ECG)
  item:
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      v: overview.measurement-parameters
    text:
      v: Measurement Parameters
    type:
      v: string
    required:
      v: true
    initial:
      value: String
        v: 12-lead ECG tracing
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    link id:
      v: overview.deliverables
    text:
      v: Deliverables
    type:
      v: text
    required:
      v: true
    initial:
      value: String
        v: Pre- and postflight ECG reports related to the cardiovascular examination.
  item:
    link id:
      v: overview.flight-duration
    text:
      v: Flight Duration
    type:
      v: string
    required:
      v: true
    initial:
      value: String
        v: >= 30 days
  item:
    link id:
      v: overview.number-of-flights
    text:
      v: Number of Flights
    type:
      v: string
    required:
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    initial:
      value: String
        v: All
  item:
    link id:
      v: overview.crew-members-required
    text:
      v: Number and Type of Crew Members Required
    type:
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v: medical-operations

v: Medical Operations

v: medical-operations

v: Medical Operations

v: cardiovascular

v: Cardiovascular

v: true

value: String
  v: All ISS crew members

link id:
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text:
  v: Preflight Training
type:
  v: group
item:
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    v: preflight-training.na
  text:
    v: No Preflight Training Required
  type:
    v: display

link id:
  v: preflight-activities
text:
  v: Preflight Activities
type:
  v: group
item:
  link id:
    v: preflight-activities.description
  text:
    v: Activity Description
  type:
    v: text
  required:
    v: false
  initial:
    value: String
      v: Subject lies supine for 15 minutes while ECG tracings are recorded from 10 electrode sites (using chest and limb leads).
item:
  link id:
    v: preflight-activities.duration
  text:
    v: Duration (minutes)
  type:
    v: integer
  required:
    v: true
  initial:
    value: Integer
      v: 15
item:
  link id:
    v: preflight-activities.schedule
  text:
    v: Schedule
  type:
    v: string
  required:
    v: true
  initial:
    value: String
      v: AME L-9/6 m to L-10 d & as clinically indicated
item:
  link id:
    v: preflight-activities.flexibility
  text:
    v: Flexibility
  type:
    v: string
  required:
    v: false
  initial:
    value: String
      v: Within specified range
item:
  link id:
    v: preflight-activities.personnel
  text:
    v: Personnel Required
  type:
    v: string
  required:
    v: true
  initial:
    value: String
      v: Lab Technician, crew member
item:
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    v: preflight-activities.hardware
  text:
    v: Preflight Hardware
  type:
    v: choice
  required:
    v: true
  answer option:
    value: Coding
      system:
        v: https://mitre.org/fhir/space-health/CodeSystem/nasa-medical-hardware-cs
        l: nasa-medical-hardware-cs
      code:
        v: 12-lead-ecg
      display:
        v: 12-Lead ECG Machine
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      code:
        v: 12-lead-ecg
      display:
        v: 12-Lead ECG Machine
item:
  link id:
    v: preflight-activities.location
  text:
    v: Test Location
  type:
    v: choice
  required:
    v: true
  repeats:
    v: true
  answer option:
    value: Coding
      system:
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        l: nasa-medical-facility-cs
      code:
        v: jsc
      display:
        v: Johnson Space Center
  answer option:
    value: Coding
      system:
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        l: nasa-medical-facility-cs
      code:
        v: russia-gctc
      display:
        v: Gagarin Cosmonaut Training Center
item:
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  text:
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  type:
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  required:
    v: false
  initial:
    value: String
      v: No caffeine or alcohol for 12 hours prior to testing.
item:
  link id:
    v: preflight-activities.test-date
  text:
    v: Preflight ECG Test Date
  type:
    v: date
  required:
    v: false
item:
  link id:
    v: preflight-activities.test-completed
  text:
    v: Preflight ECG Completed
  type:
    v: boolean
  required:
    v: true
item:
  link id:
    v: preflight-activities.constraints-met
  text:
    v: Pre-test Constraints Met (no caffeine/alcohol 12h)
  type:
    v: boolean
  required:
    v: false

link id:
  v: preflight-ecg-results
text:
  v: Preflight ECG Results
type:
  v: group
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    system:
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    code:
      v: 8867-4
    display:
      v: Heart rate
  text:
    v: Heart Rate (bpm)
  type:
    v: integer
  required:
    v: false
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  link id:
    v: preflight-ecg-results.pr-interval
  code: https://loinc.org/rdf/8625-6
    system:
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      l: loinc.org
    code:
      v: 8625-6
    display:
      v: PR interval
  text:
    v: PR Interval (ms)
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    v: integer
  required:
    v: false
item:
  link id:
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    system:
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      l: loinc.org
    code:
      v: 8633-0
    display:
      v: QRS duration
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    v: QRS Duration (ms)
  type:
    v: integer
  required:
    v: false
item:
  link id:
    v: preflight-ecg-results.qt-interval
  code: https://loinc.org/rdf/8634-8
    system:
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      l: loinc.org
    code:
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    display:
      v: QT interval
  text:
    v: QT Interval (ms)
  type:
    v: integer
  required:
    v: false
item:
  link id:
    v: preflight-ecg-results.qtc-interval
  code: https://loinc.org/rdf/8636-3
    system:
      v: http://loinc.org
      l: loinc.org
    code:
      v: 8636-3
    display:
      v: QT interval corrected
  text:
    v: QTc Interval (ms)
  type:
    v: integer
  required:
    v: false
item:
  link id:
    v: preflight-ecg-results.axis
  text:
    v: QRS Axis (degrees)
  type:
    v: integer
  required:
    v: false
item:
  link id:
    v: preflight-ecg-results.rhythm
  text:
    v: Rhythm
  type:
    v: choice
  required:
    v: false
  answer option:
    value: Coding
      type: http://snomed.info/id/426783006
      system:
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      display:
        v: Sinus rhythm
  answer option:
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      system:
        v: http://snomed.info/sct
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      code:
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      display:
        v: Sinus bradycardia
  answer option:
    value: Coding
      type: http://snomed.info/id/11092001
      system:
        v: http://snomed.info/sct
        l: sct
      code:
        v: 11092001
      display:
        v: Sinus tachycardia
  answer option:
    value: Coding
      type: http://snomed.info/id/49436004
      system:
        v: http://snomed.info/sct
        l: sct
      code:
        v: 49436004
      display:
        v: Atrial fibrillation
  answer option:
    value: Coding
      type: http://snomed.info/id/698247007
      system:
        v: http://snomed.info/sct
        l: sct
      code:
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      display:
        v: Cardiac arrhythmia
item:
  link id:
    v: preflight-ecg-results.interpretation
  code: https://loinc.org/rdf/11524-6
    system:
      v: http://loinc.org
      l: loinc.org
    code:
      v: 11524-6
    display:
      v: EKG study
  text:
    v: ECG Interpretation
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    v: choice
  required:
    v: false
  answer option:
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      system:
        v: http://snomed.info/sct
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  answer option:
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      system:
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      display:
        v: Abnormal
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      system:
        v: http://snomed.info/sct
        l: sct
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        v: 442564008

v: Evaluation not done

link id:
  v: preflight-ecg-results.findings
text:
  v: ECG Findings/Notes
type:
  v: text
required:
  v: false

link id:
  v: inflight-activities
text:
  v: In-Flight Activities
type:
  v: group
item:
  link id:
    v: inflight-activities.na
  text:
    v: No In-Flight Activities
  type:
    v: display

link id:
  v: postflight-activities
text:
  v: Postflight Activities
type:
  v: group
item:
  link id:
    v: postflight-activities.description
  text:
    v: Activity Description
  type:
    v: text
  required:
    v: false
  initial:
    value: String
      v: Subject lies supine for 15 minutes while ECG tracings are recorded from 10 electrode sites (using chest and limb leads).
item:
  link id:
    v: postflight-activities.duration
  text:
    v: Duration (minutes)
  type:
    v: integer
  required:
    v: true
  initial:
    value: Integer
      v: 15
item:
  link id:
    v: postflight-activities.schedule
  text:
    v: Schedule
  type:
    v: string
  required:
    v: true
  initial:
    value: String
      v: R+0/3 days & as clinically indicated
item:
  link id:
    v: postflight-activities.flexibility
  text:
    v: Flexibility
  type:
    v: string
  required:
    v: false
  initial:
    value: String
      v: Within specified range
item:
  link id:
    v: postflight-activities.personnel
  text:
    v: Personnel Required
  type:
    v: string
  required:
    v: true
  initial:
    value: String
      v: Technician, crew member
item:
  link id:
    v: postflight-activities.hardware
  text:
    v: Postflight Hardware
  type:
    v: choice
  required:
    v: true
  answer option:
    value: Coding
      system:
        v: https://mitre.org/fhir/space-health/CodeSystem/nasa-medical-hardware-cs
        l: nasa-medical-hardware-cs
      code:
        v: 12-lead-ecg
      display:
        v: 12-Lead ECG Machine
  initial:
    value: Coding
      system:
        v: https://mitre.org/fhir/space-health/CodeSystem/nasa-medical-hardware-cs
        l: nasa-medical-hardware-cs
      code:
        v: 12-lead-ecg
      display:
        v: 12-Lead ECG Machine
item:
  link id:
    v: postflight-activities.location
  text:
    v: Test Location
  type:
    v: choice
  required:
    v: true
  repeats:
    v: true
  answer option:
    value: Coding
      system:
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        l: nasa-medical-facility-cs
      code:
        v: jsc
      display:
        v: Johnson Space Center
  answer option:
    value: Coding
      system:
        v: https://mitre.org/fhir/space-health/CodeSystem/nasa-medical-facility-cs
        l: nasa-medical-facility-cs
      code:
        v: russia-gctc
      display:
        v: Gagarin Cosmonaut Training Center
item:
  link id:
    v: postflight-activities.constraints
  text:
    v: Constraints/Special Requirements
  type:
    v: text
  required:
    v: false
  initial:
    value: String
      v: No caffeine or alcohol for 12 hours prior to testing.
item:
  link id:
    v: postflight-activities.test-date
  text:
    v: Postflight ECG Test Date
  type:
    v: date
  required:
    v: false
item:
  link id:
    v: postflight-activities.test-completed
  text:
    v: Postflight ECG Completed
  type:
    v: boolean
  required:
    v: true

link id:
  v: postflight-ecg-results
text:
  v: Postflight ECG Results
type:
  v: group
item:
  link id:
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    system:
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      l: loinc.org
    code:
      v: 8867-4
    display:
      v: Heart rate
  text:
    v: Heart Rate (bpm)
  type:
    v: integer
  required:
    v: false
item:
  link id:
    v: postflight-ecg-results.pr-interval
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    system:
      v: http://loinc.org
      l: loinc.org
    code:
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    display:
      v: PR interval
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    v: PR Interval (ms)
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    v: integer
  required:
    v: false
item:
  link id:
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  code: https://loinc.org/rdf/8633-0
    system:
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    code:
      v: 8633-0
    display:
      v: QRS duration
  text:
    v: QRS Duration (ms)
  type:
    v: integer
  required:
    v: false
item:
  link id:
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  code: https://loinc.org/rdf/8634-8
    system:
      v: http://loinc.org
      l: loinc.org
    code:
      v: 8634-8
    display:
      v: QT interval
  text:
    v: QT Interval (ms)
  type:
    v: integer
  required:
    v: false
item:
  link id:
    v: postflight-ecg-results.qtc-interval
  code: https://loinc.org/rdf/8636-3
    system:
      v: http://loinc.org
      l: loinc.org
    code:
      v: 8636-3
    display:
      v: QT interval corrected
  text:
    v: QTc Interval (ms)
  type:
    v: integer
  required:
    v: false
item:
  link id:
    v: postflight-ecg-results.axis
  text:
    v: QRS Axis (degrees)
  type:
    v: integer
  required:
    v: false
item:
  link id:
    v: postflight-ecg-results.rhythm
  text:
    v: Rhythm
  type:
    v: choice
  required:
    v: false
  answer option:
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      system:
        v: http://snomed.info/sct
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      code:
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      display:
        v: Sinus rhythm
  answer option:
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      system:
        v: http://snomed.info/sct
        l: sct
      code:
        v: 49710005
      display:
        v: Sinus bradycardia
  answer option:
    value: Coding
      type: http://snomed.info/id/11092001
      system:
        v: http://snomed.info/sct
        l: sct
      code:
        v: 11092001
      display:
        v: Sinus tachycardia
  answer option:
    value: Coding
      type: http://snomed.info/id/49436004
      system:
        v: http://snomed.info/sct
        l: sct
      code:
        v: 49436004
      display:
        v: Atrial fibrillation
  answer option:
    value: Coding
      type: http://snomed.info/id/698247007
      system:
        v: http://snomed.info/sct
        l: sct
      code:
        v: 698247007
      display:
        v: Cardiac arrhythmia
item:
  link id:
    v: postflight-ecg-results.interpretation
  code: https://loinc.org/rdf/11524-6
    system:
      v: http://loinc.org
      l: loinc.org
    code:
      v: 11524-6
    display:
      v: EKG study
  text:
    v: ECG Interpretation
  type:
    v: choice
  required:
    v: false
  answer option:
    value: Coding
      type: http://snomed.info/id/17621005
      system:
        v: http://snomed.info/sct
        l: sct
      code:
        v: 17621005
      display:
        v: Normal
  answer option:
    value: Coding
      type: http://snomed.info/id/263654008
      system:
        v: http://snomed.info/sct
        l: sct
      code:
        v: 263654008
      display:
        v: Abnormal
  answer option:
    value: Coding
      type: http://snomed.info/id/442564008
      system:
        v: http://snomed.info/sct
        l: sct
      code:
        v: 442564008

v: Evaluation not done

link id:
  v: postflight-ecg-results.findings
text:
  v: ECG Findings/Notes
type:
  v: text
required:
  v: false

link id:
  v: postflight-ecg-results.comparison
text:
  v: Comparison to Preflight ECG
type:
  v: choice
required:
  v: false
answer option:
  value: String
    v: No significant change
answer option:
  value: String
    v: Improved
answer option:
  value: String
    v: New findings
answer option:
  value: String
    v: Unable to compare

link id:
  v: data-delivery
text:
  v: Data Delivery
type:
  v: group
item:
  link id:
    v: data-delivery.pacs-transfer
  text:
    v: Raw Data Transferred to PACS
  type:
    v: boolean
  required:
    v: false
item:
  link id:
    v: data-delivery.pacs-transfer-date
  text:
    v: PACS Transfer Date
  type:
    v: dateTime
  enable when:
    question:
      v: data-delivery.pacs-transfer
    operator:
      v: =
    answer: Boolean
      v: true
  required:
    v: false
item:
  link id:
    v: data-delivery.archive
  text:
    v: Data Archive Systems
  type:
    v: choice
  required:
    v: true
  repeats:
    v: true
  answer option:
    value: Coding
      system:
        v: https://mitre.org/fhir/space-health/CodeSystem/nasa-data-archive-cs
        l: nasa-data-archive-cs
      code:
        v: pacs
      display:
        v: Picture Archiving and Communication System
  answer option:
    value: Coding
      system:
        v: https://mitre.org/fhir/space-health/CodeSystem/nasa-data-archive-cs
        l: nasa-data-archive-cs
      code:
        v: mmis
      display:
        v: Medical Mission Information System
item:
  link id:
    v: data-delivery.preflight-report-available
  text:
    v: Preflight Report Available in MMIS
  type:
    v: boolean
  required:
    v: false
item:
  link id:
    v: data-delivery.postflight-report-available
  text:
    v: Postflight Report Available in MMIS
  type:
    v: boolean
  required:
    v: false

link id:
  v: postflight-debrief
text:
  v: Postflight Debrief
type:
  v: group
item:
  link id:
    v: postflight-debrief.na
  text:
    v: No Postflight Debrief Required
  type:
    v: display