ID

24249

Beschreibung

Part 10 0f 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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Lizenz

Creative Commons BY-NC 3.0

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GSK study: Ropinirole in RLS patients 101468/243 - Week 8

GSK study: Ropinirole in RLS patients 101468/243 - Week 8

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 Weeks 9 - 12 study medication. Complete the Study Medication and Compliance Section at the back of the next module (book 2). 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 28 days (plus or minus 3 days) for the Week 12 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 change between scheduled visits
Beschreibung

Dose change between scheduled visits

Alias
UMLS CUI-1
C1707811
Dose change between scheduled visits
Beschreibung

If the patient requires a dose change between this and the next visit please complete Dose Changes Due To Adverse Experiences pages at the back of the next module (Book 2).

Datentyp

text

Alias
UMLS CUI [1]
C1707811

Ähnliche Modelle

GSK study: Ropinirole in RLS patients 101468/243 - Week 8

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 change between scheduled visits
C1707811 (UMLS CUI-1)
Dose modification
Item
Dose change between scheduled visits
text
C1707811 (UMLS CUI [1])

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