ID

13819

Beschrijving

This study evaluates the effectiveness and safety of MFNS in improving the Treatment of Chronic Sinusitis. ODM derived from:"Randomized Double-blind Clinical Trial on the Efficacy and Safety of 200 mcg BID Mometasone Furoate Nasal Spray (MFNS) or Placebo in the Treatment of Chronic Sinusitis". Leader of the clinical trial: Prof. Dr. med. Karl Hörmann Direktor der Hals-Nasen-Ohren-Klinik / Clinic Director Ear, Nose and Throat Clinic Medical Faculty Mannheim Heidelberg University at the University Medical Centre Mannheim Theodor-Kutzer-Ufer 1-3 68167 Mannheim

Trefwoorden

Versies (1)
  1. 08-03-16 08-03-16 -
Geüploaded op

8 maart 2016

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.

Visit 4 - Clinical Trial on the Efficacy and Safety BID Mometasone Furoate Nasal Spray (MFNS) in the Treatment of Chronic Sinusitis

Engels

Visit 4

1 Formulieren  
  1. StudyEvent: ODM
    1. Visit 4
Header module
Beschrijving

Header module

Visit Number
Beschrijving

Visit Number

Datatype

integer

Alias
UMLS CUI [1]
C1549755
Patient Name
Beschrijving

Patient Name

Datatype

integer

Alias
UMLS CUI [1]
C1299487
Center #
Beschrijving

Center #

Datatype

integer

Alias
UMLS CUI [1]
C0009469
Date
Beschrijving

Date

Datatype

integer

Alias
UMLS CUI [1]
C0011008
Examination
Beschrijving

Examination

Temperature
Beschrijving

Temperature

Datatype

integer

Maateenheden
  • °C
Alias
UMLS CUI [1]
C0005903
°C
Blood pressure
Beschrijving

Blood pressure

Datatype

integer

Alias
UMLS CUI [1]
C0005823
Heart rate
Beschrijving

Heart rate

Datatype

integer

Maateenheden
  • 1/sec
Alias
UMLS CUI [1]
C0018810
1/sec
Examination of nose
Beschrijving

Examination of nose

Datatype

integer

Alias
UMLS CUI [1]
C0558826
Change of sinusitis since last visit
Beschrijving

Change of sinusitis since last visit

Datatype

integer

Alias
UMLS CUI [1]
C0037199
Were Antibiotics administered?
Beschrijving

If yes, please specify type of Antibiotics

Datatype

integer

Alias
UMLS CUI [1]
C0003232
Endoscopy
Beschrijving

Endoscopy

Datatype

integer

Alias
UMLS CUI [1]
C0014245
Endoscopy findings
Beschrijving

Endoscopy findings

Datatype

integer

Alias
UMLS CUI [1,1]
C0014245
UMLS CUI [1,2]
C0243095
Urine pregnancy test
Beschrijving

Urine pregnancy test

Datatype

integer

Alias
UMLS CUI [1]
C0430056
Medication checked and weighed?
Beschrijving

Please state weight

Datatype

integer

Dairy checked?
Beschrijving

Dairy checked?

Datatype

boolean

Alias
UMLS CUI [1]
C0376660
Rhinosinusitis Disability Index (RSBI)
Beschrijving

Rhinosinusitis Disability Index (RSBI)

Rhinosinusitis Disability Index (RSBI)
Beschrijving

The Rhinosinusitis Disability Index (RSDI) is a measure of sinus-related disability. It is a standardized, statistically validated, disease-specific tool and used to investigate the disability suffered patients with rhinologic diagnosis.

Datatype

integer

Alias
UMLS CUI [1,1]
C0948780
UMLS CUI [1,2]
C3826998
Impairment due to chronic sinusitis
Beschrijving

The following questions refer to the effects of chronic sinusitis on your ability to work and your daily activities. Please check the following boxes: 1. Are you currently employed? If no, please continue with question No. 6. The next questions refer to the last 7 days, today excluded: 2. How many hours of work did you miss in the last 7 days due to problems or discomfort resulting from your chronic sinusitis? 3. How many hours of work did you miss in the last 7 days due to other reasons such as holidays or because of participating at this trial? 4. How many hours did you work in the last 7 days in total? If you insert 0 hours, please skip the next question and continue with question 6. 5. How did the chronic sinusitis affect your performance at work in the last 7 days? Please take into consideration those days when the amount and type of work you could accomplish was reduced. Also consider those days when you accomplished less than you had planned to and you did not work as diligently as usual. If the chronic sinusitis had only a minor effect on your work please mark a low number. Mark a high number if you experienced a more severe impairment: 6. How did the chronic sinusitis affect your regular daily activities that are not work related in the last 7 days? Regular activities refer to house and garden work, shopping, education, sport etc.. Please consider the type and amount of your daily activities you could not do. Also consider those days when you accomplished less than you had planned to. If the chronic sinusitis had only a minor effect on your work please mark a low number. Mark a high number if you experienced a more severe impairment:

Datatype

integer

Alias
UMLS CUI [1]
C0681116
Medication
Beschrijving

Medication

Concomitant drug
Beschrijving

Concomitant drug

Datatype

integer

Alias
UMLS CUI [1]
C2347852
PRN medicine
Beschrijving

PRN medicine

Datatype

integer

Non-drug therapy
Beschrijving

Non-drug therapy

Datatype

integer

Alias
UMLS CUI [1]
C3661844
Adverse event
Beschrijving

Adverse event

Did an adverse event occur?
Beschrijving

Did an adverse event occur?

Datatype

integer

Alias
UMLS CUI [1]
C0877248
Is this a serious adverse event ?
Beschrijving

Is this a serious adverse event ?

Datatype

integer

Alias
UMLS CUI [1]
C1519255
Adverse event form
Beschrijving

Adverse event form

Datatype

integer

Alias
UMLS CUI [1]
C0877248
Terug naar het begin van de pagina

Similar models

Visit 4

1 Formulieren
  1. StudyEvent: ODM
    1. Visit 4
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Header module
Visit Number
Item
Visit Number
integer
C1549755 (UMLS CUI [1])
Patient Name
Item
Patient Name
integer
C1299487 (UMLS CUI [1])
Center #
Item
Center #
integer
C0009469 (UMLS CUI [1])
Date
Item
Date
integer
C0011008 (UMLS CUI [1])
Item Group
Examination
Temperature
Item
Temperature
integer
C0005903 (UMLS CUI [1])
Item
Blood pressure
integer
C0005823 (UMLS CUI [1])
Blood pressure
Code List
Blood pressure
CL Item
Systolic (1)
C0871470 (UMLS CUI-1)
CL Item
Diastolic ( 2)
C0428883 (UMLS CUI-1)
Heart rate
Item
Heart rate
integer
C0018810 (UMLS CUI [1])
Item
Examination of nose
integer
C0558826 (UMLS CUI [1])
Examination of nose
Code List
Examination of nose
CL Item
Done (1)
CL Item
Note done (2)
CL Item
Finding (3)
C0243095 (UMLS CUI-1)
Change of sinusitis since last visit
Item
Change of sinusitis since last visit
integer
C0037199 (UMLS CUI [1])
Were Antibiotics administered?
Item
Were Antibiotics administered?
integer
C0003232 (UMLS CUI [1])
Item
Endoscopy
integer
C0014245 (UMLS CUI [1])
Endoscopy
Code List
Endoscopy
CL Item
Done, please state date (1)
C0802603 (UMLS CUI-1)
CL Item
Not done (2)
C1272696 (UMLS CUI-1)
CL Item
Findings (3)
C0243095 (UMLS CUI-1)
Item
Endoscopy findings
integer
C0014245 (UMLS CUI [1,1])
C0243095 (UMLS CUI [1,2])
Endoscopy findings
Code List
Endoscopy findings
CL Item
edema (1)
C0013604 (UMLS CUI-1)
CL Item
flow of secretion (2)
C0036536 (UMLS CUI-1)
CL Item
irritation  (3)
C1706307 (UMLS CUI-1)
CL Item
ulceration (4)
C0041582 (UMLS CUI-1)
Item
Urine pregnancy test
integer
C0430056 (UMLS CUI [1])
Urine pregnancy test
Code List
Urine pregnancy test
CL Item
Result (1)
C2826772 (UMLS CUI-1)
Medication checked and weighed?
Item
Medication checked and weighed?
integer
Dairy checked?
Item
Dairy checked?
boolean
C0376660 (UMLS CUI [1])
Item Group
Rhinosinusitis Disability Index (RSBI)
Item
Rhinosinusitis Disability Index (RSBI)
integer
C0948780 (UMLS CUI [1,1])
C3826998 (UMLS CUI [1,2])
Rhinosinusitis Disability Index (RSBI)
Code List
Rhinosinusitis Disability Index (RSBI)
CL Item
Physical (11 items) (1)
CL Item
1. The pain or pressure in my face makes it difficult for me to concentrate (2)
CL Item
2. The pain in my eyes makes it difficult for me to read (3)
CL Item
3. I have difficulty stooping over to lift objects because of face pressure (4)
CL Item
4. Because of my problem I have difficulty with strenuous yard work and housework (5)
CL Item
5. Straining increases or worsens my problem (6)
CL Item
6. I am inconvenienced by my chronic runny nose (7)
CL Item
7. Food does not taste good because of my change in smell (8)
CL Item
8. My frequent sniffing is irritating to my friends and family (9)
CL Item
9. Because of my problem I don’t sleep well (10)
CL Item
10. I have difficulty with exertion due to my nasal obstruction (11)
CL Item
11. My sexual activity is affected by my problem (12)
CL Item
Functional (9 items) (13)
CL Item
1. Because of my problem I feel handicapped (14)
CL Item
2. Because of my problem I feel restricted in performance of my routine daily activities (15)
CL Item
3. Because of my problem I restrict my recreational activities (16)
CL Item
4. Because of my problem I feel frustrated (17)
CL Item
5. Because of my problem I feel fatigued (18)
CL Item
6. Because of my problem I avoid traveling (19)
CL Item
7. Because of my problem I miss work or social activities (20)
CL Item
8. My outlook on the world is affected by my problem (21)
CL Item
9. Because of my problem I find it difficult to focus my attention away from my problem and on other things (22)
CL Item
Emotional (10 items) (23)
CL Item
1. Because of my problem I feel stressed in relationships with friends and family (24)
CL Item
2. Because of my problem I feel confused (25)
CL Item
3. Because of my problem I have difficulty paying attention (26)
CL Item
4. Because of my problem I avoid being around people (27)
CL Item
5. Because of my problem I am frequently angry (28)
CL Item
6. Because of my problem I do not like to socialize (29)
CL Item
7. Because of my problem I frequently feel tense (30)
CL Item
38. Because of my problem I frequently feel irritable (31)
CL Item
9. Because of my problem I am depressed (32)
CL Item
10.My problem places stress on my relationships with members of my family or friends (33)
Impairment due to chronic sinusitis
Item
Impairment due to chronic sinusitis
integer
C0681116 (UMLS CUI [1])
Item Group
Medication
Item
Concomitant drug
integer
C2347852 (UMLS CUI [1])
Concomitant drug
Code List
Concomitant drug
CL Item
Drug name (1)
C0013227 (UMLS CUI-1)
CL Item
Dosage (2)
C0178602 (UMLS CUI-1)
CL Item
Start of medication (3)
C0451613 (UMLS CUI-1)
CL Item
End of medication (4)
C2826659 (UMLS CUI-1)
CL Item
Indication (5)
C3146298 (UMLS CUI-1)
Item
PRN medicine
integer
PRN medicine
Code List
PRN medicine
CL Item
Drug (1)
C0013227 (UMLS CUI-1)
CL Item
Dosage (2)
C0178602 (UMLS CUI-1)
CL Item
Date (3)
C0011008 (UMLS CUI-1)
CL Item
Indication (4)
C3146298 (UMLS CUI-1)
Item
Non-drug therapy
integer
C3661844 (UMLS CUI [1])
Non-drug therapy
Code List
Non-drug therapy
CL Item
Typ of treatment (1)
CL Item
Start (2)
C0808070 (UMLS CUI-1)
CL Item
End (3)
C0806020 (UMLS CUI-1)
CL Item
Indication (4)
C3146298 (UMLS CUI-1)
Item Group
Adverse event
Did an adverse event occur?
Item
Did an adverse event occur?
integer
C0877248 (UMLS CUI [1])
Is this a serious adverse event ?
Item
Is this a serious adverse event ?
integer
C1519255 (UMLS CUI [1])
Item
Adverse event form
integer
C0877248 (UMLS CUI [1])
Adverse event form
Code List
Adverse event form
CL Item
Description of adverse event icd (1)
C1632372 (UMLS CUI-1)
CL Item
Date and time of adverse event (2)
C2826793 (UMLS CUI-1)
CL Item
Previously in CRF documted (3)
CL Item
Progress (4)
C1335499 (UMLS CUI-1)
CL Item
Related to study drug? (5)
C0013175 (UMLS CUI-1)
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