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Contact #2 Year 2 GSK study Prostatic neoplasms NCT00883909

1 forms  
Administrative data
Description

Administrative data

Session number
Description

Session number

Data type

integer

Subject number
Description

Subject number

Data type

text

Subject contact
Description

Subject contact

Was contact made?
Description

If YES, record the date and type of contact.

Data type

text

Date of contact
Description

Date of contact

Data type

date

Type of contact
Description

Type of contact

Data type

text

Was the subject interview completed?
Description

If YES, ensure that all questions in the CONTACT #2 section have been completed. If NO, check primary reason interview was not completed and do not complete the questions in the CONTACT #2 section.

Data type

text

Primary reason interview was not completed
Description

If subject died, record details on the SERIOUS ADVERSE EVENT pages.

Data type

text

Other, specify
Description

Other primary reason interview was not completed

Data type

text

CONTACT #2 - Since Contact #1 (if contact #1 was performed) OR Since the REDUCE 4 Year Contact (if contact #1 was not performed):
Description

CONTACT #2 - Since Contact #1 (if contact #1 was performed) OR Since the REDUCE 4 Year Contact (if contact #1 was not performed):

1. Have you had any PSA tests?
Description

If YES, Record the date of collection and local PSA results on the PSA RESULTS page.

Data type

text

2. Have you had any biopsies?
Description

If YES, • Enter the biopsy information and the local pathology results on the LOCAL PATHOLOGY RESULTS page. • Send biopsy sample to Central Pathology for Confirmatory Review only if the result is positive for prostate cancer. • If biopsy is positive for PCa enter any available new TNM stage information on the TNM STAGING HISTORY page.

Data type

text

3. Have you had treatment for prostate cancer?
Description

If YES, • Enter surgical treatment for PCa on the PROSTATIC SURGICAL INTERVENTION page; and, • For radical prostatectomy, enter any local pathology information/ result on LOCAL PATHOLOGY RESULTS page. • For radical prostatectomies, send surgical sample to Central Pathology for confirmatory review, regardless of whether the result is positive or negative for prostate cancer. • For all prostate surgeries other than radical prostatectomies, send surgical sample to Central Pathology for confirmatory review only if the result is positive for prostate cancer. • Enter non-surgical treatment for PCa, on the NON-SURGICAL INTERVENTION FOR PROSTATE CANCER page. • Complete any further TNM staging information on the TNM STAGING HISTORY page.

Data type

text

4. Have you had prostate surgery for reasons other than PCa?
Description

If YES, • Enter the prostate surgery information on the PROSTATE SURGICAL INTERVENTION page; and, • Enter local pathology results for the surgery on the LOCAL PATHOLOGY RESULTS page. • Send surgical sample to Central Pathology for confirmatory review only if the result is positive for prostate cancer. • Complete any further TNM staging information on the TNM Staging History page.

Data type

text

5. Have you had any medical problems or hospitalisations?
Description

medical problems or hospitalisations

Data type

text

For site response only: Do any of the medical conditions reported by the patient meet the criteria for a serious adverse event?
Description

If YES, Complete the SERIOUS ADVERSE EVENT pages and ensure they are faxed to GSK within 24 hours of becoming aware of the event.

Data type

text

6. Were there changes in any of your chronic medications (e.g., changes in dose, starting or stopping medications)?
Description

Chronic concomitant medications include all prescription and nonprescription medication including vitamins, supplements and herbal remedies. Specifically include the use of dutasteride [Avodart ®] or finasteride [Proscar ® and Propecia ®]. If YES, • Enter information for all changes in chronic medications on the CONCOMITANT MEDICATIONS page(s).

Data type

text

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Similar models

Contact #2 Year 2 GSK study Prostatic neoplasms NCT00883909

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Administrative data
Session number
Item
Session number
integer
Subject number
Item
Subject number
text
Item Group
Subject contact
Item
Was contact made?
text
Succesful Contact Attempt
Code List
Was contact made?
CL Item
Yes (Y)
CL Item
No (N)
Date of contact
Item
Date of contact
date
Item
Type of contact
text
Type of contact
Code List
Type of contact
CL Item
Telephone (T)
CL Item
Screening Visit (V)
Item
Was the subject interview completed?
text
Succesful Contact Attempt
Code List
Was the subject interview completed?
CL Item
Yes (Y)
CL Item
No (N)
Item
Primary reason interview was not completed
text
Primary reason interview was not completed
Code List
Primary reason interview was not completed
CL Item
Subject died (D)
CL Item
Subject withdrew consent (C)
CL Item
Subject lost to follow-up (F)
CL Item
Other (X)
Other primary reason interview was not completed
Item
Other, specify
text
Item Group
CONTACT #2 - Since Contact #1 (if contact #1 was performed) OR Since the REDUCE 4 Year Contact (if contact #1 was not performed):
Item
1. Have you had any PSA tests?
text
Succesful Contact Attempt
Code List
1. Have you had any PSA tests?
CL Item
Yes (Y)
CL Item
No (N)
Item
2. Have you had any biopsies?
text
Succesful Contact Attempt
Code List
2. Have you had any biopsies?
CL Item
Yes (Y)
CL Item
No (N)
Item
3. Have you had treatment for prostate cancer?
text
Succesful Contact Attempt
Code List
3. Have you had treatment for prostate cancer?
CL Item
Yes (Y)
CL Item
No (N)
Item
4. Have you had prostate surgery for reasons other than PCa?
text
Succesful Contact Attempt
Code List
4. Have you had prostate surgery for reasons other than PCa?
CL Item
Yes (Y)
CL Item
No (N)
Item
5. Have you had any medical problems or hospitalisations?
text
Succesful Contact Attempt
Code List
5. Have you had any medical problems or hospitalisations?
CL Item
Yes (Y)
CL Item
No (N)
Item
For site response only: Do any of the medical conditions reported by the patient meet the criteria for a serious adverse event?
text
Succesful Contact Attempt
Code List
For site response only: Do any of the medical conditions reported by the patient meet the criteria for a serious adverse event?
CL Item
Yes (Y)
CL Item
No (N)
Item
6. Were there changes in any of your chronic medications (e.g., changes in dose, starting or stopping medications)?
text
Succesful Contact Attempt
Code List
6. Were there changes in any of your chronic medications (e.g., changes in dose, starting or stopping medications)?
CL Item
Yes (Y)
CL Item
No (N)
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