ID

24242

Beschreibung

Part 3 of Module 3 - Baseline, Day 2, Wk 1-8-Cont/Wthd 101468/243 Study ID: 101468/243 Clinical Study ID: 101468/243 Study Title: A 52 Week Open-Label Extension Study of the Long-Term Safety of Ropinirole in Subjects Suffering from Restless Legs Syndrome (RLS) Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: N/A Sponsor:GlaxoSmithKline Collaborators: N/A Phase: Phase 3 Study Recruitment Status: Completed Generic Name: ropinirole Trade Name: Modutab,ZIPEREVE,ZEPREVE,REPREVE,ADARTREL,REQUIP,Zygara; Zygara,ZIPEREVE,ZEPREVE,Requip Depot,REQUIP,REPREVE,Modutab,ADARTREL Study Indication: Restless Legs Syndrome

Stichworte

  1. 27.07.17 27.07.17 -
Rechteinhaber

GlaxoSmithKline

Hochgeladen am

27. Juli 2017

DOI

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Creative Commons BY-NC 3.0

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    GSK study: Ropinirole in RLS patients 101468/243 - Week 1

    GSK study: Ropinirole in RLS patients 101468/243 - Week 1

    Study medication record since last visit
    Beschreibung

    Study medication record since last visit

    Alias
    UMLS CUI-1
    C2734539
    UMLS CUI-2
    C0008972
    Study medication record since last visit
    Beschreibung

    Please complete the study medication record in the Study Medication and Compliance Section at the back of this module.

    Datentyp

    text

    Alias
    UMLS CUI [1,1]
    C2734539
    UMLS CUI [1,2]
    C0008972
    RLS Rating Scale
    Beschreibung

    RLS Rating Scale

    Alias
    UMLS CUI-1
    C0681889
    UMLS CUI-2
    C0035258
    RLS Rating Scale
    Beschreibung

    Please complete the appropriate RLS Rating Scale from the RLS Rating Scale Book

    Datentyp

    text

    Alias
    UMLS CUI [1,1]
    C0681889
    UMLS CUI [1,2]
    C0035258
    Vital signs
    Beschreibung

    Vital signs

    Alias
    UMLS CUI-1
    C0518766
    Pulse
    Beschreibung

    after 5min sitting

    Datentyp

    integer

    Maßeinheiten
    • betas/min
    Alias
    UMLS CUI [1]
    C0232117
    betas/min
    Sitting systolic blood pressure
    Beschreibung

    after 5 minutes sitting

    Datentyp

    integer

    Maßeinheiten
    • mmHg
    Alias
    UMLS CUI [1,1]
    C0871470
    UMLS CUI [1,2]
    C0277814
    mmHg
    Sitting diastolic blood pressure
    Beschreibung

    Sitting diastolic blood pressure

    Datentyp

    integer

    Maßeinheiten
    • mmHg
    Alias
    UMLS CUI [1,1]
    C0428883
    UMLS CUI [1,2]
    C0277814
    mmHg
    Medical Procedures
    Beschreibung

    Medical Procedures

    Alias
    UMLS CUI-1
    C0199171
    Medical Procedures
    Beschreibung

    Please record any medical procedures performed since the last visit in the Medical Procedures section at the back of this module

    Datentyp

    text

    Alias
    UMLS CUI [1]
    C0199171
    Concomitant Medication
    Beschreibung

    Concomitant Medication

    Alias
    UMLS CUI-1
    C2347852
    Concomitant medication
    Beschreibung

    Please record any changes in concomitant medication since the last visit in the Concomitant Medication section at the back of this module

    Datentyp

    text

    Alias
    UMLS CUI [1]
    C2347852
    Adverse reaction
    Beschreibung

    Adverse reaction

    Alias
    UMLS CUI-1
    C0559546
    Adverse reaction
    Beschreibung

    Please record any adverse experiences observed or elicited by the following direct question to the patient: "Have you felt different in any way since the last visit?" in the Adverse Experience section at the back of this module

    Datentyp

    text

    Alias
    UMLS CUI [1]
    C0559546
    Instructions for the investigator
    Beschreibung

    Instructions for the investigator

    Alias
    UMLS CUI-1
    C0302828
    UMLS CUI-2
    C0035173
    Instructions for the investigator
    Beschreibung

    Guided by the CGI Efficacy Index (below) determine dose level to be dispensed and dispense Week 2 study medication. Complete the Study Medication and Compliance Section at the back of this module. If the patient’s dose has been increased at this clinic visit: a) Instruct the patient to return to the clinic this evening or remain to perform orthostatic vital signs*: - 2 sets of pre-dose orthostatic blood pressure and pulse - Patient takes evening dose in the clinic - One set of 2 hour post-dose orthostatic blood pressure and pulse Instruct the patient to take the appropriate number of tablet(s), at the same time, no earlier than 3 hours prior to and no later than one hour prior to bedtime (except on the first night of each new dose increase). Patient must return the bottle(s) with any unused medication at the next visit. Arrange for the patient to return in 7 days (plus or minus 3 days) for the Week 2 clinic visit. * Where possible this visit should be performed in the evening with dosing approximately 8:00 P.M. However, for scheduling convenience, this visit (including dosing) may occur during the afternoon hours (as late in the day as possible) to accomodate the collection of orthostatic blood pressure/pulse assessments during the normal clinic hours.

    Datentyp

    text

    Alias
    UMLS CUI [1,1]
    C0302828
    UMLS CUI [1,2]
    C0035173
    Clinical Global impression
    Beschreibung

    Clinical Global impression

    Alias
    UMLS CUI-1
    C3639708
    Clinical global impression
    Beschreibung

    This section contained Clinical Outcome Assessment data collection questionnaires or indices, which are protected by copyright laws and therefore have been excluded.

    Datentyp

    text

    Alias
    UMLS CUI [1]
    C3639708
    Dose reduction
    Beschreibung

    Dose reduction

    Alias
    UMLS CUI-1
    C1707814
    Dose Reduction
    Beschreibung

    If the patient requires a dose reduction between this and the next visit please complete Dose Reductions Due To Adverse Experiences pages at the back of this module. Dosage reduction may occur between scheduled clinic visits, if necessary. The subject will be instructed to contact the site to arrange a visit should a dose decrease become necessary outside of the regularly specified protocol visit.

    Datentyp

    text

    Alias
    UMLS CUI [1]
    C1707814

    Ähnliche Modelle

    GSK study: Ropinirole in RLS patients 101468/243 - Week 1

    Name
    Typ
    Description | Question | Decode (Coded Value)
    Datentyp
    Alias
    Item Group
    Study medication record since last visit
    C2734539 (UMLS CUI-1)
    C0008972 (UMLS CUI-2)
    Study medication record since last visit
    Item
    Study medication record since last visit
    text
    C2734539 (UMLS CUI [1,1])
    C0008972 (UMLS CUI [1,2])
    Item Group
    RLS Rating Scale
    C0681889 (UMLS CUI-1)
    C0035258 (UMLS CUI-2)
    RLS Rating Scale
    Item
    RLS Rating Scale
    text
    C0681889 (UMLS CUI [1,1])
    C0035258 (UMLS CUI [1,2])
    Item Group
    Vital signs
    C0518766 (UMLS CUI-1)
    Pulse Rate
    Item
    Pulse
    integer
    C0232117 (UMLS CUI [1])
    Sitting systolic blood pressure
    Item
    Sitting systolic blood pressure
    integer
    C0871470 (UMLS CUI [1,1])
    C0277814 (UMLS CUI [1,2])
    Sitting diastolic blood pressure
    Item
    Sitting diastolic blood pressure
    integer
    C0428883 (UMLS CUI [1,1])
    C0277814 (UMLS CUI [1,2])
    Item Group
    Medical Procedures
    C0199171 (UMLS CUI-1)
    Medical Procedures
    Item
    Medical Procedures
    text
    C0199171 (UMLS CUI [1])
    Item Group
    Concomitant Medication
    C2347852 (UMLS CUI-1)
    Concomitant medication
    Item
    Concomitant medication
    text
    C2347852 (UMLS CUI [1])
    Item Group
    Adverse reaction
    C0559546 (UMLS CUI-1)
    Adverse reaction
    Item
    Adverse reaction
    text
    C0559546 (UMLS CUI [1])
    Item Group
    C0302828 (UMLS CUI-1)
    C0035173 (UMLS CUI-2)
    Instructions for the investigator
    Item
    Instructions for the investigator
    text
    C0302828 (UMLS CUI [1,1])
    C0035173 (UMLS CUI [1,2])
    Item Group
    Clinical Global impression
    C3639708 (UMLS CUI-1)
    Clinical global impression
    Item
    Clinical global impression
    text
    C3639708 (UMLS CUI [1])
    Item Group
    Dose reduction
    C1707814 (UMLS CUI-1)
    Dose Reduction
    Item
    Dose Reduction
    text
    C1707814 (UMLS CUI [1])

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