ID

26222

Description

Study ID: 101468/125 Clinical Study ID: SKF-101468/125 Study Title: A double-blind, multicentre, flexible dose, L-dopa controlled study of ropinirole to investigate A) neuroprotective effect as measured by 3D PET scanning, and B) ophthalmological safety, in patients with early Parkinson’s disease Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: Sponsor: GlaxoSmithKline Collaborators: N/A Phase: phase 3 Study Recruitment Status: Completed Generic Name: ropinirole Trade Name: requip Study Indication: Restless Legs Syndrome

Keywords

Versions (1)
  1. 10/12/17 10/12/17 -
Copyright Holder

GlaxoSmithKline

Uploaded on

October 12, 2017

DOI

To request one please log in.

License

Creative Commons BY-NC 3.0
Model comments :

You can comment on the data model here. Via the speech bubbles at the itemgroups and items you can add comments to those specificially.

Back to model comments
Itemgroup comments for :

Item comments for :

In order to download data models you must be logged in. Please log in or register for free.

L-dopa controlled study of ropinirole, neuroprotective effect and ophthalmological safety in early Parkinson’s disease 101468/125 Module 1 Screening/Baseline Conclusion

English

L-dopa controlled study of ropinirole, neuroprotective effect and ophthalmological safety in early Parkinson’s disease 101468/125 Module 1 Screening/Baseline Conclusion

1 forms  
Screening Baseline Conclusion
Description

Screening Baseline Conclusion

Will the patient be continued in the study?
Description

Will the patient be continued in the study?

Data type

integer

If withdrawn, please mark primary reason below.
Description

Primary reason for withdrawal

Data type

text

If other reason for withdrawal, please specify
Description

Specification of other reason for withdrawal

Data type

text

Investigator´s signature
Description

Investigator´s signature

Investigator´s signature
Description

I certify that I have reviewed the data in this case report form up to this point and that all the information is complete and accurate.

Data type

text

Date
Description

Date

Data type

date

Back to the top of the page

Similar models

L-dopa controlled study of ropinirole, neuroprotective effect and ophthalmological safety in early Parkinson’s disease 101468/125 Module 1 Screening/Baseline Conclusion

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Screening Baseline Conclusion
Item
Will the patient be continued in the study?
integer
Will the patient be continued in the study?
Code List
Will the patient be continued in the study?
CL Item
Yes (1)
CL Item
No (If No, please mark the PRIMARY reason of exclusion/withdrawal below) (2)
Item
If withdrawn, please mark primary reason below.
text
Primary reason for withdrawal
Code List
If withdrawn, please mark primary reason below.
CL Item
Baseline adverse experience (Complete BAE form) (1)
CL Item
Does not meet inclusion/exclusion criteria (2)
CL Item
Protocol deviation (including non-compliance) (3)
CL Item
Lost to follow-up (4)
CL Item
Other, specify... (5)
Specification of other reason for withdrawal
Item
If other reason for withdrawal, please specify
text
Item Group
Investigator´s signature
Investigator´s signature
Item
Investigator´s signature
text
Date
Item
Date
date
Back to the top of the page 

Contact

Please use this form for feedback, questions and suggestions for improvements.

Fields marked with * are required.

Help

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial