ID

26502

Beschreibung

Study ID: 101468/196 Clinical Study ID: 101468/196 Study Title: 101468/196: A Long-Term, Open-Label Continuation Study of Once Daily Administration of Ropinirole CR Tablets to Patients with Parkinson's Disease who Completed the Previous Ropinirole CR Studies 167 or 164 Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: NCT00650104 Sponsor: GlaxoSmithKline Collaborators: N/A Phase: phase 3 Study Recruitment Status: Completed Generic Name: ropinirole Trade Name: Zygara,ZIPEREVE,ZEPREVE,Requip Depot,REQUIP,REPREVE,Modutab,ADARTREL Study Indication : Parkinson DiseaseA Long-Term, Open-Label Continuation Study of Once Daily Adminstration of Ropinirole CR Tablets to Patients with Parkinson's Disease Who Completed the Previous Ropinirole CR Studies - 167 & 164 Unscheduled Visit

Stichworte

Versionen (1)
  1. 18.10.17 18.10.17 -
Rechteinhaber

GlaxoSmithKline

Hochgeladen am

18. Oktober 2017

DOI

Für eine Beantragung loggen Sie sich ein.

Lizenz

Creative Commons BY-NC-ND 3.0
Modell Kommentare :

Hier können Sie das Modell kommentieren. Über die Sprechblasen an den Itemgruppen und Items können Sie diese spezifisch kommentieren.

Zurück zu Modell Kommentaren
Itemgroup Kommentare für :

Item Kommentare für :

Um Formulare herunterzuladen müssen Sie angemeldet sein. Bitte loggen Sie sich ein oder registrieren Sie sich kostenlos.

Unscheduled Visit Ropinirole in Parkinson's Disease GSK 101468/196

Englisch

Unscheduled Visit Ropinirole in Parkinson's Disease GSK 101468/196

1 Formulare  
Patient Information
Beschreibung

Patient Information

Alias
UMLS CUI-1
C1955348
Patient No.
Beschreibung

Patient Number

Datentyp

text

Alias
UMLS CUI [1]
C1830427
Date of Visit
Beschreibung

Date of Visit

Datentyp

date

Maßeinheiten
  • dd-mmm-yyyy
Alias
UMLS CUI [1]
C1320303
dd-mmm-yyyy
Unscheduled Visit
Beschreibung

Unscheduled Visit

Alias
UMLS CUI-1
C0545082
UMLS CUI-2
C3854240
Will the patient continue on study?
Beschreibung

If NO, please complete Study Completion CRFs.

Datentyp

boolean

Alias
UMLS CUI [1]
C0805733
Has the patient experienced an Adverse Event?
Beschreibung

If YES, please record on Adverse Event CRFs.

Datentyp

boolean

Alias
UMLS CUI [1]
C0877248
Will the patient continue on the dose of study medication prescribed at the last study visit?
Beschreibung

Study Drug Dosage

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0178602
UMLS CUI [1,2]
C0304229
Will the patient continue on the dose of study medication prescribed at the last study visit? If NO, please indicate dose of study medication prescribed at this visit:
Beschreibung

Study Drug Dosage Specification

Datentyp

float

Maßeinheiten
  • mg/d
Alias
UMLS CUI [1,1]
C0178602
UMLS CUI [1,2]
C0304229
UMLS CUI [1,3]
C2348235
mg/d
Is the patient being up titrated at this visit?
Beschreibung

If YES, please document pre and post dose Blood Pressure/Pulse management.

Datentyp

boolean

Alias
UMLS CUI [1]
C2983683
Orthostatic Blood Pressure/ Pulse
Beschreibung

Orthostatic Blood Pressure/ Pulse

Alias
UMLS CUI-1
C1095971
Time Point (Time [24-hour clock])
Beschreibung

Repeat on A1 Predose A2 Predose 1h Post-Dose 2h Post-Dose

Datentyp

time

Maßeinheiten
  • 24hr:min
Alias
UMLS CUI [1,1]
C0040223
UMLS CUI [1,2]
C0430022
24hr:min
Semi-Supine Heart Rate
Beschreibung

Semi-Supine Heart Rate

Datentyp

float

Maßeinheiten
  • bpm
Alias
UMLS CUI [1,1]
C0522019
UMLS CUI [1,2]
C0018810
bpm
Standing Heart Rate
Beschreibung

Erect Heart Rate

Datentyp

float

Maßeinheiten
  • bpm
Alias
UMLS CUI [1,1]
C0522014
UMLS CUI [1,2]
C0018810
bpm
Semi-Supine Systolic Blood Pressure
Beschreibung

Semi-Supine Systolic Blood Pressure

Datentyp

float

Maßeinheiten
  • mmHg
Alias
UMLS CUI [1]
C0871470
mmHg
Semi-Supine Diastolic Blood Pressure
Beschreibung

Semi-Supine Diastolic Blood Pressure

Datentyp

float

Maßeinheiten
  • mmHg
Alias
UMLS CUI [1,1]
C0522019
UMLS CUI [1,2]
C0428883
mmHg
Standing Systolic Blood Pressure
Beschreibung

Erect Systolic Blood Pressure

Datentyp

float

Maßeinheiten
  • mmHg
Alias
UMLS CUI [1,1]
C0522014
UMLS CUI [1,2]
C0871470
mmHg
Standing Diastolic Blood Pressure
Beschreibung

Erect Diastolic Blood Pressure

Datentyp

float

Maßeinheiten
  • mmHg
Alias
UMLS CUI [1,1]
C0522014
UMLS CUI [1,2]
C0428883
mmHg
Study Drug Compliance
Beschreibung

Study Drug Compliance

Alias
UMLS CUI-1
C1321605
Total number of tablets dispensed at last visit.
Beschreibung

Split up in groups of 2, 3, 4 or 8 mg.

Datentyp

text

Alias
UMLS CUI [1]
C0805077
Total Number of tablets returned at visit.
Beschreibung

Split up in groups of 2, 3, 4 or 8mg.

Datentyp

text

Alias
UMLS CUI [1]
C2699071
Number of tablets patient should have taken (assuming 100% compliance).
Beschreibung

Split up in groups of 2, 3, 4 or 8mg.

Datentyp

text

Alias
UMLS CUI [1]
C1321605
If there were missed doses, please record. Date
Beschreibung

Missed Dose: Date

Datentyp

date

Maßeinheiten
  • dd-mmm-yyyy
Alias
UMLS CUI [1,1]
C1709043
UMLS CUI [1,2]
C0011008
dd-mmm-yyyy
If there were missed doses, please record. Tablet(s)
Beschreibung

Missed Dose: Tablet

Datentyp

text

Alias
UMLS CUI [1,1]
C1709043
UMLS CUI [1,2]
C0039225
If there were missed doses, please record. Dose in mg
Beschreibung

Missed Dose: Dosage

Datentyp

float

Maßeinheiten
  • mg
Alias
UMLS CUI [1,1]
C1709043
UMLS CUI [1,2]
C0178602
mg
If there were missed doses, please record. Reason
Beschreibung

Missed Dose: Reason

Datentyp

text

Alias
UMLS CUI [1,1]
C1709043
UMLS CUI [1,2]
C0566251
Zum Seitenanfang zurückkehren

Ähnliche Modelle

Unscheduled Visit Ropinirole in Parkinson's Disease GSK 101468/196

1 Formulare
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Patient Information
C1955348 (UMLS CUI-1)
Patient Number
Item
Patient No.
text
C1830427 (UMLS CUI [1])
Date of Visit
Item
Date of Visit
date
C1320303 (UMLS CUI [1])
Item Group
Unscheduled Visit
C0545082 (UMLS CUI-1)
C3854240 (UMLS CUI-2)
Continuation Status
Item
Will the patient continue on study?
boolean
C0805733 (UMLS CUI [1])
Adverse Event
Item
Has the patient experienced an Adverse Event?
boolean
C0877248 (UMLS CUI [1])
Study Drug Dosage
Item
Will the patient continue on the dose of study medication prescribed at the last study visit?
boolean
C0178602 (UMLS CUI [1,1])
C0304229 (UMLS CUI [1,2])
Study Drug Dosage Specification
Item
Will the patient continue on the dose of study medication prescribed at the last study visit? If NO, please indicate dose of study medication prescribed at this visit:
float
C0178602 (UMLS CUI [1,1])
C0304229 (UMLS CUI [1,2])
C2348235 (UMLS CUI [1,3])
Titration
Item
Is the patient being up titrated at this visit?
boolean
C2983683 (UMLS CUI [1])
Item Group
Orthostatic Blood Pressure/ Pulse
C1095971 (UMLS CUI-1)
Time of Examination
Item
Time Point (Time [24-hour clock])
time
C0040223 (UMLS CUI [1,1])
C0430022 (UMLS CUI [1,2])
Semi-Supine Heart Rate
Item
Semi-Supine Heart Rate
float
C0522019 (UMLS CUI [1,1])
C0018810 (UMLS CUI [1,2])
Erect Heart Rate
Item
Standing Heart Rate
float
C0522014 (UMLS CUI [1,1])
C0018810 (UMLS CUI [1,2])
Semi-Supine Systolic Blood Pressure
Item
Semi-Supine Systolic Blood Pressure
float
C0871470 (UMLS CUI [1])
Semi-Supine Diastolic Blood Pressure
Item
Semi-Supine Diastolic Blood Pressure
float
C0522019 (UMLS CUI [1,1])
C0428883 (UMLS CUI [1,2])
Erect Systolic Blood Pressure
Item
Standing Systolic Blood Pressure
float
C0522014 (UMLS CUI [1,1])
C0871470 (UMLS CUI [1,2])
Erect Diastolic Blood Pressure
Item
Standing Diastolic Blood Pressure
float
C0522014 (UMLS CUI [1,1])
C0428883 (UMLS CUI [1,2])
Item Group
Study Drug Compliance
C1321605 (UMLS CUI-1)
Dispensed Amount
Item
Total number of tablets dispensed at last visit.
text
C0805077 (UMLS CUI [1])
Returned Amount
Item
Total Number of tablets returned at visit.
text
C2699071 (UMLS CUI [1])
Compliance
Item
Number of tablets patient should have taken (assuming 100% compliance).
text
C1321605 (UMLS CUI [1])
Missed Dose: Date
Item
If there were missed doses, please record. Date
date
C1709043 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Missed Dose: Tablet
Item
If there were missed doses, please record. Tablet(s)
text
C1709043 (UMLS CUI [1,1])
C0039225 (UMLS CUI [1,2])
Missed Dose: Dosage
Item
If there were missed doses, please record. Dose in mg
float
C1709043 (UMLS CUI [1,1])
C0178602 (UMLS CUI [1,2])
Missed Dose: Reason
Item
If there were missed doses, please record. Reason
text
C1709043 (UMLS CUI [1,1])
C0566251 (UMLS CUI [1,2])
Zum Seitenanfang zurückkehren 

Kontakt

Benutzen Sie dieses Formular für Rückmeldungen, Fragen und Verbesserungsvorschläge.

Mit * gekennzeichnete Felder sind notwendig.

Hilfe

Benötigen Sie Hilfe bei der Suche? Um mehr Details zu erfahren und die Suche effektiver nutzen zu können schauen Sie sich doch das entsprechende Video auf unserer Tutorial Seite an.

Zum Video