ID

25568

Descripción

Alcohol Consumption/Smoking History form Study ID: 101468/198 Clinical Study ID: 101468/198 Study Title: An open, randomised, crossover, healthy volunteer study to compare the PK and tolerability of ropinirole as 3 different new formulations with the standard marketed formulation and to study the effects of a high fat meal on a new formulation Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: Sponsor: GlaxoSmithKline Collaborators: N/A Phase: phase 1 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

Palabras clave

Versiones (5)
  1. 29/8/17 29/8/17 -
  2. 5/9/17 5/9/17 -
  3. 6/9/17 6/9/17 -
  4. 5/10/17 5/10/17 -
  5. 9/4/19 9/4/19 -
Titular de derechos de autor

GlaxoSmithKline

Subido en

6 de septiembre de 2017

DOI

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Licencia

Creative Commons BY-NC 3.0
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Alcohol Consumption/Smoking History Ropinirole Restless Legs Syndrome 101468/198

Inglés

Alcohol Consumption/Smoking History Ropinirole Restless Legs Syndrome 101468/198

1 formularios  
Header
Descripción

Header

Alias
UMLS CUI-1
C1320722
Study No.:
Descripción

Study No.:

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0008976
UMLS CUI [1,2]
C0600091
Subject No.:
Descripción

Subject No.:

Tipo de datos

text

Alias
UMLS CUI [1]
C2348585
Panel ID:
Descripción

Panel ID

Tipo de datos

text

Alias
UMLS CUI [1]
C3826248
Visit:
Descripción

Visit

Tipo de datos

text

Alias
UMLS CUI [1]
C0545082
Date
Descripción

DD/MON/YY

Tipo de datos

date

Alias
UMLS CUI [1]
C0011008
Alcohol Consumption
Descripción

Alcohol Consumption

Alias
UMLS CUI-1
C0001948
Average number of units per day
Descripción

1 unit is equivalent to half a pint of beer (ca. 0,57 l), one measure of spirits or one glass of wine.

Tipo de datos

integer

Alias
UMLS CUI [1]
C0560578
Average number of units per week
Descripción

1 unit is equivalent to half a pint of beer (ca. 0,57 l), one measure of spirits or one glass of wine.

Tipo de datos

integer

Alias
UMLS CUI [1]
C0560579
Smoking History
Descripción

Smoking History

Alias
UMLS CUI-1
C1519384
Is the subject a smoker?
Descripción

if Yes, please complete smoking history details

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0543414
Number of years the subject has been a smoker?
Descripción

Smoking years

Tipo de datos

integer

Unidades de medida
  • years
Alias
UMLS CUI [1]
C3694955
years
Average number of cigarettes smoked per day?
Descripción

Cigarettes per day

Tipo de datos

integer

Alias
UMLS CUI [1]
C3694146
Please state what type of tobacco product (eg. pipe, chigar, chewing tobacco or cigarette)
Descripción

Type of tobacco product

Tipo de datos

text

Alias
UMLS CUI [1]
C3166496
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Similar models

Alcohol Consumption/Smoking History Ropinirole Restless Legs Syndrome 101468/198

1 formularios
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
Header
C1320722 (UMLS CUI-1)
Study No.:
Item
Study No.:
text
C0008976 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
Subject No.:
Item
Subject No.:
text
C2348585 (UMLS CUI [1])
Panel ID
Item
Panel ID:
text
C3826248 (UMLS CUI [1])
Visit
Item
Visit:
text
C0545082 (UMLS CUI [1])
Date
Item
Date
date
C0011008 (UMLS CUI [1])
Item Group
Alcohol Consumption
C0001948 (UMLS CUI-1)
Units per day
Item
Average number of units per day
integer
C0560578 (UMLS CUI [1])
Units per week
Item
Average number of units per week
integer
C0560579 (UMLS CUI [1])
Item Group
Smoking History
C1519384 (UMLS CUI-1)
Smoker
Item
Is the subject a smoker?
boolean
C0543414 (UMLS CUI [1])
Smoking years
Item
Number of years the subject has been a smoker?
integer
C3694955 (UMLS CUI [1])
Cigarettes per day
Item
Average number of cigarettes smoked per day?
integer
C3694146 (UMLS CUI [1])
Type of tobacco product
Item
Please state what type of tobacco product (eg. pipe, chigar, chewing tobacco or cigarette)
text
C3166496 (UMLS CUI [1])
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