ID

29008

Beschreibung

Study ID: 101468/249 Clinical Study ID: 101468/249 Study Title: A 12-Week, Double-Blind, Placebo Controlled, Parallel Group Study to Assess the Efficacy and Safety of Ropinirole in Patients Suffering from Restless Legs Syndrome (RLS) Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: NCT00363857 Sponsor: GlaxoSmithKline Collaborators: N/A Phase: N/A 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; Restless Legs Syndrome (RLS)

Stichworte

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  1. 20.02.18 20.02.18 -
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GlaxoSmithKline (GSK)

Hochgeladen am

20. Februar 2018

DOI

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Clinical Study, Ropinirole in Patients Suffering from Restless Legs Syndrome (RLS), Study ID: 101468/249, NCT00363857

Englisch

RLS Demographics and Examination Procedure

1 Formulare  
Demography
Beschreibung

Demography

Alias
UMLS CUI-1
C0011298
Date of Birth
Beschreibung

Date of Birth

Datentyp

date

Alias
UMLS CUI [1]
C0421451
Gender
Beschreibung

Gender

Datentyp

text

Alias
UMLS CUI [1]
C0079399
Race
Beschreibung

Race

Datentyp

integer

Alias
UMLS CUI [1]
C0034510
'Other' race, please specify:
Beschreibung

If you answered the previous question with 'other', please specify:

Datentyp

text

Alias
UMLS CUI [1]
C0034510
Vital signs
Beschreibung

Vital signs

Alias
UMLS CUI-1
C0518766
Height (without shoes)
Beschreibung

Height

Datentyp

integer

Maßeinheiten
  • cm / in
Alias
UMLS CUI [1]
C0005890
cm / in
Weight (without shoes)
Beschreibung

Weight

Datentyp

integer

Maßeinheiten
  • kg / lbs
Alias
UMLS CUI [1]
C0005910
kg / lbs
Pulse (after 5 minutes sitting)
Beschreibung

Pulse

Datentyp

integer

Maßeinheiten
  • beats/min
Alias
UMLS CUI [1]
C0232117
beats/min
Sitting Blood Pressure (after 5 minutes sitting), systolic / diastolic
Beschreibung

Sitting Blood Pressure

Datentyp

integer

Maßeinheiten
  • mmHg
Alias
UMLS CUI [1]
C0580946
mmHg
Orthostatic vital signs
Beschreibung

Orthostatic vital signs

Alias
UMLS CUI-1
C0518766
Screening
Beschreibung

Screening

Datentyp

integer

Alias
UMLS CUI [1]
C0220908
Time Vitals taken
Beschreibung

Time

Datentyp

time

Alias
UMLS CUI [1]
C0040223
Blood Pressure systolic / diastolic
Beschreibung

Blood Pressure

Datentyp

integer

Maßeinheiten
  • mmHg
Alias
UMLS CUI [1]
C0005823
mmHg
Pulse
Beschreibung

Pulse

Datentyp

integer

Maßeinheiten
  • beats/min
Alias
UMLS CUI [1]
C0232117
beats/min
Electrocardiogram
Beschreibung

Electrocardiogram

Alias
UMLS CUI-1
C0430456
Date of ECG:
Beschreibung

Date of ECG

Datentyp

date

Alias
UMLS CUI [1]
C2826640
Were any clinically significant abnormalities detected?
Beschreibung

If ’Yes’, please record details on the Significant Medical/Surgical History and Physical Examination or Baseline Signs and Symptoms/SAE pages and repeat prior to baseline.

Datentyp

integer

Alias
UMLS CUI [1]
C0522055
Laboratory evaluation
Beschreibung

Laboratory evaluation

Alias
UMLS CUI-1
C0022885
Date of blood sample:
Beschreibung

Read the instructions on the Quest Diagnostics shipment document and dispatch the samples for analysis accordingly.

Datentyp

date

Alias
UMLS CUI [1,1]
C0005834
UMLS CUI [1,2]
C0011008
Were any clinically significant abnormalities detected?
Beschreibung

If ’Yes’, please record details on the Significant Medical/Surgical History and Physical Examination or Baseline Signs and Symptoms/SAE pages and repeat prior to baseline.

Datentyp

text

Alias
UMLS CUI [1]
C1853129
Pregnancy Dipstick
Beschreibung

Pregnancy Dipstick

Alias
UMLS CUI-1
C0430056
Is the patient a female of child-bearing potential?
Beschreibung

If ’Yes’, please perform a pregnancy dipstick test and record result below.

Datentyp

text

Alias
UMLS CUI [1]
C1960468
Pregnancy Dipstick result
Beschreibung

If ’Positive’, please record details on the Significant Medical/Surgical History and Physical Examination and exclude the patient.

Datentyp

text

Alias
UMLS CUI [1]
C0430056
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Ähnliche Modelle

RLS Demographics and Examination Procedure

1 Formulare
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Demography
C0011298 (UMLS CUI-1)
Date of Birth
Item
Date of Birth
date
C0421451 (UMLS CUI [1])
Item
Gender
text
C0079399 (UMLS CUI [1])
Gender
Code List
Gender
CL Item
Male (M)
CL Item
Female (F)
Item
Race
integer
C0034510 (UMLS CUI [1])
Race
Code List
Race
CL Item
White (1)
CL Item
Black (2)
CL Item
Oriental (3)
CL Item
Other (4)
Race
Item
'Other' race, please specify:
text
C0034510 (UMLS CUI [1])
Item Group
Vital signs
C0518766 (UMLS CUI-1)
Height
Item
Height (without shoes)
integer
C0005890 (UMLS CUI [1])
Weight
Item
Weight (without shoes)
integer
C0005910 (UMLS CUI [1])
Pulse
Item
Pulse (after 5 minutes sitting)
integer
C0232117 (UMLS CUI [1])
Sitting Blood Pressure
Item
Sitting Blood Pressure (after 5 minutes sitting), systolic / diastolic
integer
C0580946 (UMLS CUI [1])
Item Group
Orthostatic vital signs
C0518766 (UMLS CUI-1)
Item
Screening
integer
C0220908 (UMLS CUI [1])
Screening
Code List
Screening
CL Item
After 10 minutes semi-supine (1)
CL Item
After erect for 1 minute (2)
Time
Item
Time Vitals taken
time
C0040223 (UMLS CUI [1])
Blood Pressure
Item
Blood Pressure systolic / diastolic
integer
C0005823 (UMLS CUI [1])
Pulse
Item
Pulse
integer
C0232117 (UMLS CUI [1])
Item Group
Electrocardiogram
C0430456 (UMLS CUI-1)
Date of ECG
Item
Date of ECG:
date
C2826640 (UMLS CUI [1])
Item
Were any clinically significant abnormalities detected?
integer
C0522055 (UMLS CUI [1])
ECG abnormalities
Code List
Were any clinically significant abnormalities detected?
CL Item
No (1)
CL Item
Yes (2)
Item Group
Laboratory evaluation
C0022885 (UMLS CUI-1)
Date of blood sample
Item
Date of blood sample:
date
C0005834 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item
Were any clinically significant abnormalities detected?
text
C1853129 (UMLS CUI [1])
Laboratory abnormalities
Code List
Were any clinically significant abnormalities detected?
CL Item
No (N)
CL Item
Yes (Y)
Item Group
Pregnancy Dipstick
C0430056 (UMLS CUI-1)
Item
Is the patient a female of child-bearing potential?
text
C1960468 (UMLS CUI [1])
Child-bearing potential
Code List
Is the patient a female of child-bearing potential?
CL Item
No (N)
CL Item
Yes (Y)
Item
Pregnancy Dipstick result
text
C0430056 (UMLS CUI [1])
Pregnancy Dipstick
Code List
Pregnancy Dipstick result
CL Item
Negative (NEG)
CL Item
Positive (POS)
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