ID

13805

Beskrivning

Coronary Artery Bypass graft surgery in patients with Asymptomatic Carotid Stenosis. A randomized controlled clinical trial. Short title: "CABACS" DRKS Number:DRKS00000521 IRSCTN Number:ISRCTN13486906 Phase:Therapeutic confirmatory(Phase III) Head of clinical trial: Prof. Dr. med. Christian Weimar University Duisburg-Essen Phone: 0201/723-6503 Fax: 0201/723-6948 e-mail: christian.weimar@uk-essen.de University Hospital Essen Hospital for Neurology Hufelandstr. 55 45122 Essen Trial coordinator: Dr. med. Stephan Knipp Phone: 0201/723-4915 Fax: 0201/723-5451 e-mail: stephan.knipp@uk-essen.de University Duisburg-Essen University Hospital Essen Hospital for thoracic- and cardiovascular surgery Hufelandstr. 55 45122 Essen Data Management: Anja Marr Phone: 0201/92239-257 Fax: 0201/92239-333 o. 0201/723-5933 e-mail: anja.marr@uk-essen.de University Hospital Essen Center for clinical trials Essen c/o IMIBE Hufelandstr. 55 45122 Essen Monitoring: Dipl.-Biol. Konstantinos Bilbilis Phone: 0201/92239-252 Fax: 0201/92239-310 e-mail: konstantinos.bilbilis@uk-essen.de University Hospital Essen Center for clinical trials Essen c/o IMIBE Hufelandstr. 55 45122 Essen

Nyckelord

Versioner (1)
  1. 2016-03-07 2016-03-07 -
Uppladdad den

7 mars 2016

DOI

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Licens

Creative Commons BY-NC 3.0
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Follow up completion form Coronary Artery Bypass graft surgery in patients with Asymptomatic Carotid Stenosis DRKS00000521

Engelsk

CABACS Case Report Form [follow up completion form]

1 Formulär  
Follow up completion
Beskrivning

Follow up completion

Patient ID
Beskrivning

Patient Study ID

Datatyp

text

Alias
UMLS CUI [1]
C2348585
Study end date
Beskrivning

Study end date

Datatyp

date

Alias
UMLS CUI [1]
C2983670
Type of trial completion
Beskrivning

Type of trial completion

Datatyp

integer

Alias
UMLS CUI [1]
C2732579
If premature end of study, specify reason
Beskrivning

Premature end of study

Datatyp

integer

Alias
UMLS CUI [1]
C2732579
Please specify withdrawn IC, kind of comorbidity,death and other reasons for premature end of study
Beskrivning

Specification

Datatyp

text

Alias
UMLS CUI [1]
C2348235
Date of completion of this form
Beskrivning

Date of completion

Datatyp

date

Alias
UMLS CUI [1]
C0011008
Signature by investigator
Beskrivning

Signature

Datatyp

text

Alias
UMLS CUI [1]
C1519316
Name of Investigator
Beskrivning

Name of Investigator

Datatyp

text

Alias
UMLS CUI [1]
C0008961
Tillbaka till toppen

Similar models

CABACS Case Report Form [follow up completion form]

1 Formulär
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
Follow up completion
Patient Study ID
Item
Patient ID
text
C2348585 (UMLS CUI [1])
Study end date
Item
Study end date
date
C2983670 (UMLS CUI [1])
Item
Type of trial completion
integer
C2732579 (UMLS CUI [1])
Type of trial completion
Code List
Type of trial completion
CL Item
no follow-up, see completion clinical trial section (0)
CL Item
normal end of study (1)
CL Item
premature end of study (specify) (2)
Item
If premature end of study, specify reason
integer
C2732579 (UMLS CUI [1])
Premature end of study
Code List
If premature end of study, specify reason
CL Item
informed consent withdrawn (1)
CL Item
Patient unable to participate any more due to comorbidity, no legal representative  (2)
CL Item
lost to follow up (3)
CL Item
Death (Investigate further,fill in outcome event form) (4)
CL Item
other reason (5)
Specification
Item
Please specify withdrawn IC, kind of comorbidity,death and other reasons for premature end of study
text
C2348235 (UMLS CUI [1])
Date of completion
Item
Date of completion of this form
date
C0011008 (UMLS CUI [1])
Signature
Item
Signature by investigator
text
C1519316 (UMLS CUI [1])
Name of Investigator
Item
Name of Investigator
text
C0008961 (UMLS CUI [1])
Tillbaka till toppen 

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