GSK study: Ropinirole in RLS patients 101468/243 - Week 2

Study medication record since last visit
Descripción

Study medication record since last visit

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

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

Tipo de datos

text

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

RLS Rating Scale

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

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

Tipo de datos

text

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

Vital signs

Alias
UMLS CUI-1
C0518766
Pulse
Descripción

after 5min sitting

Tipo de datos

integer

Unidades de medida
  • betas/min
Alias
UMLS CUI [1]
C0232117
betas/min
Sitting systolic blood pressure
Descripción

after 5 minutes sitting

Tipo de datos

integer

Unidades de medida
  • mmHg
Alias
UMLS CUI [1,1]
C0871470
UMLS CUI [1,2]
C0277814
mmHg
Sitting diastolic blood pressure
Descripción

Sitting diastolic blood pressure

Tipo de datos

integer

Unidades de medida
  • mmHg
Alias
UMLS CUI [1,1]
C0428883
UMLS CUI [1,2]
C0277814
mmHg
Medical Procedures
Descripción

Medical Procedures

Alias
UMLS CUI-1
C0199171
Medical Procedures
Descripción

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

Tipo de datos

text

Alias
UMLS CUI [1]
C0199171
Concomitant Medication
Descripción

Concomitant Medication

Alias
UMLS CUI-1
C2347852
Concomitant medication
Descripción

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

Tipo de datos

text

Alias
UMLS CUI [1]
C2347852
Adverse reaction
Descripción

Adverse reaction

Alias
UMLS CUI-1
C0559546
Adverse reaction
Descripción

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

Tipo de datos

text

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

Instructions for the investigator

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

Guided by the CGI Efficacy Index (below) determine dose level to be dispensed and dispense Week 3 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 3 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.

Tipo de datos

text

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

Clinical Global impression

Alias
UMLS CUI-1
C3639708
Clinical global impression
Descripción

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

Tipo de datos

text

Alias
UMLS CUI [1]
C3639708
Dose reduction
Descripción

Dose reduction

Alias
UMLS CUI-1
C1707814
Dose Reduction
Descripción

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.

Tipo de datos

text

Alias
UMLS CUI [1]
C1707814

Similar models

GSK study: Ropinirole in RLS patients 101468/243 - Week 2

Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
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])