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ID

13805

Beschrijving

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

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Versies (1)
  1. 07-03-16 07-03-16 -
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7 maart 2016

DOI

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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

    Engels

    CABACS Case Report Form [follow up completion form]

    1 Formulieren  
    Follow up completion
    Beschrijving

    Follow up completion

    Patient ID
    Beschrijving

    Patient Study ID

    Datatype

    text

    Alias
    UMLS CUI [1]
    C2348585
    Study end date
    Beschrijving

    Study end date

    Datatype

    date

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

    Type of trial completion

    Datatype

    integer

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

    Premature end of study

    Datatype

    integer

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    Please specify withdrawn IC, kind of comorbidity,death and other reasons for premature end of study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

    Specification

    Datatype

    text

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

    Date of completion

    Datatype

    date

    Alias
    UMLS CUI [1]
    C0011008
    Signature by investigator
    Beschrijving

    Signature

    Datatype

    text

    Alias
    UMLS CUI [1]
    C1519316
    Name of Investigator
    Beschrijving

    Name of Investigator

    Datatype

    text

    Alias
    UMLS CUI [1]
    C0008961
    Terug naar het begin van de pagina

    Similar models

    CABACS Case Report Form [follow up completion form]

    1 Formulieren
    Name
    Type
    Description | Question | Decode (Coded Value)
    Datatype
    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])
    Terug naar het begin van de pagina 

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