ID

27234

Beschrijving

Study ID: 101468/188 Clinical Study ID: SKF-101468/188 Study Title:A Study of the Maintained Efficacy and Safety of Ropinirole Versus Placebo in the Long Term Treatment of Restless Legs Syndrome (RLS) 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: Parkinson Disease Module: Patient Continuation

Trefwoorden

Versies (1)
  1. 03-11-17 03-11-17 -
Houder van rechten

GlaxoSmithKline

Geüploaded op

3 november 2017

DOI

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Licentie

Creative Commons BY-NC 3.0
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GSK Ropinirole in Patients Suffering from Restless Legs Syndrome 101468/188

Engels

Patient Continuation

1 Formulieren  
  1. StudyEvent: ODM
    1. Patient Continuation
Patient Continuation
Beschrijving

Patient Continuation

Alias
UMLS CUI-1
C2348568
Is the patient continuing in the study?
Beschrijving

Patient Continuation

Datatype

boolean

Alias
UMLS CUI [1]
C2348568
If ’No’, please mark the primary cause of withdrawal. (Mark one box only).
Beschrijving

primary cause of withdrawal

Datatype

integer

Alias
UMLS CUI [1,1]
C0422727
UMLS CUI [1,2]
C0392360
Primary cause of withdrawal: If 'Other', please specify
Beschrijving

primary cause of withdrawal

Datatype

text

Alias
UMLS CUI [1,1]
C0422727
UMLS CUI [1,2]
C0392360
Investigator’s Signature
Beschrijving

Investigator’s Signature

Datatype

text

Alias
UMLS CUI [1]
C2346576
Investigator’s Signature Date
Beschrijving

Investigator’s Signature Date

Datatype

date

Alias
UMLS CUI [1,1]
C2346576
UMLS CUI [1,2]
C0011008
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Similar models

Patient Continuation

1 Formulieren
  1. StudyEvent: ODM
    1. Patient Continuation
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Patient Continuation
C2348568 (UMLS CUI-1)
Patient Continuation
Item
Is the patient continuing in the study?
boolean
C2348568 (UMLS CUI [1])
Item
If ’No’, please mark the primary cause of withdrawal. (Mark one box only).
integer
C0422727 (UMLS CUI [1,1])
C0392360 (UMLS CUI [1,2])
primary cause of withdrawal
Code List
If ’No’, please mark the primary cause of withdrawal. (Mark one box only).
CL Item
Baseline sign and symptom  (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 (5)
primary cause of withdrawal
Item
Primary cause of withdrawal: If 'Other', please specify
text
C0422727 (UMLS CUI [1,1])
C0392360 (UMLS CUI [1,2])
Investigator’s Signature
Item
Investigator’s Signature
text
C2346576 (UMLS CUI [1])
Investigator’s Signature Date
Item
Investigator’s Signature Date
date
C2346576 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Terug naar het begin van de pagina 

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