ID

24093

Beschrijving

Terms of use: You may not use this document or the information contained herein to a regulatory authority in connection with an application for a marketing authorization or any other regulatory submission without the express written consent of Roche Study #: FVF4168g Drug: Ranibizumab Study Title: A Phase III, Double-Masked, Multicenter, Randomized, Sham-Controlled Study Of The Efficacy And Safety Of Ranibizumab Injection In Subjects With Clinically Significant Macular Edema With Center Involvement Secondary To Diabetes Mellitus

Trefwoorden

Versies (3)
  1. 01-07-17 01-07-17 -
  2. 01-07-17 01-07-17 -
  3. 25-07-17 25-07-17 -
Houder van rechten

Genentech, Inc.

Geüploaded op

25 juli 2017

DOI

Voor een aanvraag inloggen.

Licentie

Creative Commons BY-NC 3.0
Model Commentaren :

Hier kunt u commentaar leveren op het model. U kunt de tekstballonnen bij de itemgroepen en items gebruiken om er specifiek commentaar op te geven.

Terug naar het model Commentaren
Itemgroep Commentaren voor :

Item Commentaren voor :

U moet ingelogd zijn om formulieren te downloaden. AUB inloggen of schrijf u gratis in.

RESCUE LASER ADMINISTRATION AND CRITERIA STUDY EYE (MONTH 3) CRFs Roche FVF4168G Macular Edema NCT00473330

Engels

RESCUE LASER ADMINISTRATION AND CRITERIA STUDY EYE (MONTH 3) CRFs Roche FVF4168G Macular Edema NCT00473330

1 Formulieren  
Patient administration
Beschrijving

Patient administration

Subject Number
Beschrijving

PT

Datatype

integer

Alias
UMLS CUI [1]
C2348585
Subject Initials:
Beschrijving

PTINIT

Datatype

text

Alias
UMLS CUI [1,1]
C1997894
UMLS CUI [1,2]
C2986440
Report Date:
Beschrijving

VDT

Datatype

date

Alias
UMLS CUI [1,1]
C1302584
RESCUE LASER ADMINISTRATION AND CRITERIA STUDY EYE (MONTH 3)
Beschrijving

RESCUE LASER ADMINISTRATION AND CRITERIA STUDY EYE (MONTH 3)

Were protocol-specified anatomical and timeframe criteria met for the rescue laser administration in the study eye?
Beschrijving

[Central foveal thickness (CFT) is 250 μm with < 50 μm reduction from the prior month’s measurement, and laser treatment not received by the subject in the past 3 months.]

Datatype

boolean

Alias
UMLS CUI [1,1]
C0743733
UMLS CUI [1,2]
C1512693
Was rescue laser treatment administered to the study eye?
Beschrijving

TX_RECEIVED (TXREC)

Datatype

boolean

Alias
UMLS CUI [1]
C0743733
Date Administered:
Beschrijving

If Yes (Administered):

Datatype

date

Maateenheden
  • DD/MMM/YY
Alias
UMLS CUI [1,1]
C0743733
UMLS CUI [1,2]
C4255413
DD/MMM/YY
Time Administered:
Beschrijving

TREATMENT_TIME (TXTM)

Datatype

time

Maateenheden
  • 24 hr clock
Alias
UMLS CUI [1,1]
C0743733
UMLS CUI [1,2]
C4255413
24 hr clock
Type of Laser:
Beschrijving

TREATMENT_TYPE (TXTYP)

Datatype

integer

Alias
UMLS CUI [1]
C1275681
UMLS CUI [2]
C1275682
# of Laser Burns:
Beschrijving

LASER_BURNS (LSRBRN)

Datatype

integer

Alias
UMLS CUI [1,1]
C0332708
UMLS CUI [1,2]
C0449788
Power of the Laser:
Beschrijving

LASER_POWER (LSRPWR)

Datatype

integer

Maateenheden
  • mW
Alias
UMLS CUI [1,1]
C0023089
UMLS CUI [1,2]
C3854080
mW
Duration of Laser:
Beschrijving

LASER_DURATION (LSRDUR)

Datatype

integer

Maateenheden
  • seconds
Alias
UMLS CUI [1,1]
C0023089
UMLS CUI [1,2]
C0449238
seconds
undefined item
Beschrijving

If No (Not Administered): If protocol specified anatomical and timeframe criteria for the rescue laser treatment were met but the rescue laser was NOT administered, select one or more reasons below and / or provide other reasons, if applicable:

Datatype

text

Treatment required is too close to the edge of the foveal avascular zone
Beschrijving

INDICATE_REASON (NDRSN1)

Datatype

boolean

Alias
UMLS CUI [1,1]
C0522473
UMLS CUI [1,2]
C1275950
Subject had extensive, adequate prior laser and all leaking microaneurysms associated with edema seen on FA have been laser treated
Beschrijving

INDICATE_REASON (NDRSN2)

Datatype

boolean

Alias
UMLS CUI [1,1]
C0522473
UMLS CUI [1,2]
C0333101
Component of traction on OCT
Beschrijving

INDICATE_REASON (NDRSN3)

Datatype

boolean

Alias
UMLS CUI [1]
C0154828
Significant non-perfusion on FA
Beschrijving

INDICATE_REASON (NDRSN4)

Datatype

boolean

Alias
UMLS CUI [1,1]
C0522473
UMLS CUI [1,2]
C4049512
Subject refused laser treatment
Beschrijving

INDICATE_REASON (NDRSN5)

Datatype

boolean

Alias
UMLS CUI [1,1]
C0522473
UMLS CUI [1,2]
C0749657
Other (specify):
Beschrijving

INDICATE_REASON (NDRSN6)

Datatype

boolean

Alias
UMLS CUI [1,1]
C0522473
UMLS CUI [1,2]
C3840932
Other (specify):
Beschrijving

OTHER_SPECIFY [OTHSP]

Datatype

text

Alias
UMLS CUI [1,1]
C0522473
UMLS CUI [1,2]
C3840932
Terug naar het begin van de pagina

Similar models

RESCUE LASER ADMINISTRATION AND CRITERIA STUDY EYE (MONTH 3) CRFs Roche FVF4168G Macular Edema NCT00473330

1 Formulieren
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Patient administration
PT
Item
Subject Number
integer
C2348585 (UMLS CUI [1])
PTINIT
Item
Subject Initials:
text
C1997894 (UMLS CUI [1,1])
C2986440 (UMLS CUI [1,2])
VDT
Item
Report Date:
date
C1302584 (UMLS CUI [1,1])
Item Group
RESCUE LASER ADMINISTRATION AND CRITERIA STUDY EYE (MONTH 3)
CRIT_NOTMET_CHAR (CRTNMC)
Item
Were protocol-specified anatomical and timeframe criteria met for the rescue laser administration in the study eye?
boolean
C0743733 (UMLS CUI [1,1])
C1512693 (UMLS CUI [1,2])
TX_RECEIVED (TXREC)
Item
Was rescue laser treatment administered to the study eye?
boolean
C0743733 (UMLS CUI [1])
TREATMENT_DATE (TXDT, TXDTF)
Item
Date Administered:
date
C0743733 (UMLS CUI [1,1])
C4255413 (UMLS CUI [1,2])
TREATMENT_TIME (TXTM)
Item
Time Administered:
time
C0743733 (UMLS CUI [1,1])
C4255413 (UMLS CUI [1,2])
Item
Type of Laser:
integer
C1275681 (UMLS CUI [1])
C1275682 (UMLS CUI [2])
TREATMENT_TYPE (TXTYP)
Code List
Type of Laser:
CL Item
Focal  (1)
CL Item
Grid (2)
LASER_BURNS (LSRBRN)
Item
# of Laser Burns:
integer
C0332708 (UMLS CUI [1,1])
C0449788 (UMLS CUI [1,2])
LASER_POWER (LSRPWR)
Item
Power of the Laser:
integer
C0023089 (UMLS CUI [1,1])
C3854080 (UMLS CUI [1,2])
LASER_DURATION (LSRDUR)
Item
Duration of Laser:
integer
C0023089 (UMLS CUI [1,1])
C0449238 (UMLS CUI [1,2])
undefined item
Item
text
INDICATE_REASON (NDRSN1)
Item
Treatment required is too close to the edge of the foveal avascular zone
boolean
C0522473 (UMLS CUI [1,1])
C1275950 (UMLS CUI [1,2])
INDICATE_REASON (NDRSN2)
Item
Subject had extensive, adequate prior laser and all leaking microaneurysms associated with edema seen on FA have been laser treated
boolean
C0522473 (UMLS CUI [1,1])
C0333101 (UMLS CUI [1,2])
INDICATE_REASON (NDRSN3)
Item
Component of traction on OCT
boolean
C0154828 (UMLS CUI [1])
INDICATE_REASON (NDRSN4)
Item
Significant non-perfusion on FA
boolean
C0522473 (UMLS CUI [1,1])
C4049512 (UMLS CUI [1,2])
INDICATE_REASON (NDRSN5)
Item
Subject refused laser treatment
boolean
C0522473 (UMLS CUI [1,1])
C0749657 (UMLS CUI [1,2])
INDICATE_REASON (NDRSN6)
Item
Other (specify):
boolean
C0522473 (UMLS CUI [1,1])
C3840932 (UMLS CUI [1,2])
OTHER_SPECIFY [OTHSP]
Item
Other (specify):
text
C0522473 (UMLS CUI [1,1])
C3840932 (UMLS CUI [1,2])
Terug naar het begin van de pagina 

Contact

Gebruik dit formulier voor feedback, vragen en verbeteringsvoorstellen.

Velden gemarkeerd met een * zijn verplicht.

Help

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial