Information:
Fel:
ID
20429
Beskrivning
The purpose of the trial is to determine if extended-release dipyridamole + aspirin [Aggrenox, Asasa ntin] is superior to clopidogrel [Plavix], and if telmisartan [Micardis, Gliosartan, Kinzal, Kinzalm ono, Predxal, Pritor, Samertan, Telmisartan] is superior to placebo, in the presence of background antihypertensive therapy, in prevention of a second stroke in patients who have recently suffered a stroke and therefore are at high risk of suffering another one. Source & Descriptions: https://clinicaltrials.gov/ct2/show/NCT00153062?term=NCT00153062&rank=1
Länk
https://clinicaltrials.gov/ct2/show/NCT00153062?term=NCT00153062&rank=1
Nyckelord
Versioner (1)
- 2017-02-22 2017-02-22 -
Uppladdad den
22 februari 2017
DOI
För en begäran logga in.
Licens
Creative Commons BY 4.0
Modellkommentarer :
Här kan du kommentera modellen. Med hjälp av pratbubblor i Item-grupperna och Item kan du lägga in specifika kommentarer.
Itemgroup-kommentar för :
Item-kommentar för :
Du måste vara inloggad för att kunna ladda ner formulär. Var vänlig logga in eller registrera dig utan kostnad.
New Or Worsening Congestive Heart Failure (CHF) Report Form PRoFESS - Prevention Regimen For Effectively Avoiding Second Strokes NCT00153062
New Or Worsening Congestive Heart Failure (CHF) Report Form PRoFESS - Prevention Regimen For Effectively Avoiding Second Strokes NCT00153062
Similar models
New Or Worsening Congestive Heart Failure (CHF) Report Form PRoFESS - Prevention Regimen For Effectively Avoiding Second Strokes NCT00153062
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
New Or Worsening Congestive Heart Failure (CHF) Report FormForm
Date of onset of CHF
Item
1. Date of onset of CHF (dd mon yy)
date
Study Medication
Item
2. Was the patient on study medication within the 7 days prior to the event?
boolean
Item
If NO, which medication was the patient was not taking (please indicate all that apply):
integer
C0030705 (UMLS CUI [1,1])
C0457432 (UMLS CUI [1,2])
C0457432 (UMLS CUI [1,2])
Code List
If NO, which medication was the patient was not taking (please indicate all that apply):
CL Item
Bottle A (1)
CL Item
Bottle B (2)
CL Item
Blister card C (3)
CL Item
Blister card D (4)
Characteristic Symptoms
Item
3. Did the patient experience characteristic symptoms or signs of CHF?
boolean
CL Item
Orthopnea (1)
CL Item
Peripheral edema (2)
CL Item
Elevation of JVP (3)
CL Item
Shortness of breath at rest (4)
CL Item
Shortness of breath during exertion (5)
CL Item
Paraoxysmal nocturnal dyspnea (6)
CL Item
Rales (7)
pulmonary congestion
Item
4. Was evidence of pulmonary congestion confirmed by X-ray?
boolean
C0242073 (UMLS CUI [1])
ejection fraction
Item
5. Was ejection fraction <40% or other evidence of systolic dysfunction?
boolean
If yes
Item
If ejection fraction <40% please provide ejection fraction
float
diastolic dysfunction
Item
6. Was there evidence of diastolic dysfunction?
boolean
C0520863 (UMLS CUI [1])
Item
If evidence of diastolic or systolic dysfunction please indicate which method was used
integer
Code List
If evidence of diastolic or systolic dysfunction please indicate which method was used
CL Item
Radionuclide angiography (1)
CL Item
Echo (2)
CL Item
LV angio (3)
Item
7. Please indicate which of the following events accompanied the CHF: (Indicate all that apply)
integer
Code List
7. Please indicate which of the following events accompanied the CHF: (Indicate all that apply)
CL Item
Anemia (1)
CL Item
Other infections (2)
CL Item
Atrial fibrillation (3)
CL Item
Pneumonia/Respiratory Infection (4)
CL Item
Acute Ischemic event (5)
CL Item
Other Precipitating Cause (6)
Item
8. Please indicate which of the following treatments were given for the CHF: (Indicate all that apply)
integer
Code List
8. Please indicate which of the following treatments were given for the CHF: (Indicate all that apply)
CL Item
Oral diuretics (1)
CL Item
Digoxin (2)
CL Item
IV Inotropes (3)
CL Item
IV diuretics (4)
CL Item
Open Label ACE inhibitors (5)
CL Item
Open Label ARBs (6)
Events Leading to Hospitalization
Item
9. Did the event lead to hospitalization? If Yes please complete the Hospitalization Report Form.
boolean
CL Item
Emergency Room (1)
CL Item
Physician Office (2)
CL Item
Other (3)
Specification
Item
Specify "Other":
text
C2348235 (UMLS CUI [1])
Fatal Event
Item
10. Was the event fatal (death within 28 days). If Yes please complete Death Report Form.
boolean
Item Group
Please remember to fax Supporting Documentation clearly identified with the patient number
Invenstigator´s Declaration
Item
8. Invenstigator´s Declaration By signing and dating this page, I declare that I have reviewed for accuracy all case report form pages for this patient; the information contained on these pages accurately reflects the medical record including the results of tests and evaluations performed in the dates specified.
text
Investigator´s signature
Item
Investigator´s signature
text
C2346576 (UMLS CUI [1])
Date of Signature
Item
Date of Signature
date
C0011008 (UMLS CUI [1,1])
C1519316 (UMLS CUI [1,2])
C1519316 (UMLS CUI [1,2])