ID
29055
Beschreibung
Ropinirole Case Report Form GSK RRL100013 GSK Study ID: 100013 Clinical Study ID: RRL100013 A 12-Week, Double-Blind, Placebo-Controlled, Twice-Daily Dosing Study to Assess the Efficacy and Safety of Ropinirole in Patients Suffering from Restless Legs Syndrome (RLS) Requiring Extended Treatment Coverage
Stichworte
Versionen (5)
- 05.10.17 05.10.17 -
- 22.02.18 22.02.18 -
- 22.02.18 22.02.18 -
- 22.02.18 22.02.18 -
- 17.09.21 17.09.21 -
Rechteinhaber
gsk
Hochgeladen am
22. Februar 2018
DOI
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Lizenz
Creative Commons BY-NC 3.0
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Ropinirole Case Report Form GSK RRL100013
STATUS OF TREATMENT BLIND
Beschreibung
PGx-PHARMACOGENETIC RESEARCH INSTRUCTIONS
Beschreibung
The question "Has informed consent been obtained for PGx-Pharmacogenetic research?" should be completed at the beginning of the study. If the question is answered No, I/ one box for reason and do not complete the remainder of the page. WITHDRAWAL OF CONSENT The question "Has the subject withdrawn consent for PGx-Pharmacogenetic research?" must be completed immediately if the subject withdraws consent. Otherwise, it must be completed when the subject leaves the study. It must be completed for all subjects for whom informed consent was obtained for PGx-Pharmacogenetic research. If consent is withdrawn, a request for destruction must be made and Blood Sample Destruction section below completed. BLOOD SAMPLE DESTRUCT/ON Do not complete this section if a blood sample was not collected. The question "Has a request been made for sample destruction?" must be completed immediately if there is a request for sample destruction. Otherwise, it must be completed when the subject leaves the study. It must be completed for all subjects for whom a blood sample was obtained for PGx-Pharmacogenetic research. If the question is answered Yes, I/one box for reason.
Datentyp
text
Alias
- UMLS CUI [1,1]
- C0031325
- UMLS CUI [1,2]
- C1442085
Beschreibung
PGx-PHARMACOGENETIC RESEARCH
Beschreibung
CONSENT FOR PGx-PHARMACOGENETIC RESEARCH
Datentyp
boolean
Alias
- UMLS CUI [1,1]
- C0021430
- UMLS CUI [1,2]
- C2347500
Beschreibung
Informed consent if yes
Datentyp
date
Alias
- UMLS CUI [1]
- C2985782
Beschreibung
Informed consent if no
Datentyp
text
Alias
- UMLS CUI [1]
- C0021430
Beschreibung
BLOOD SAMPLE COLLECTION
Datentyp
boolean
Alias
- UMLS CUI [1]
- C0005834
Beschreibung
If Yes, record the date sample taken
Datentyp
date
Alias
- UMLS CUI [1,1]
- C0005834
- UMLS CUI [1,2]
- C0011008
Beschreibung
WITHDRAWAL OF CONSENT
Datentyp
boolean
Alias
- UMLS CUI [1]
- C1707492
Beschreibung
BLOOD SAMPLE DESTRUCTION
Datentyp
boolean
Alias
- UMLS CUI [1,1]
- C1948029
- UMLS CUI [1,2]
- C0178913
Beschreibung
If Yes: BLOOD SAMPLE DESTRUCTION
Datentyp
integer
Alias
- UMLS CUI [1,1]
- C1948029
- UMLS CUI [1,2]
- C0178913
Beschreibung
The following lists of abbreviations are examples which can be used to aid the completion of the appropriate items on the Concomitant Medications page. These are not all inclusive lists and are for guidance only, other abbreviations not listed may be used if necessary.
Datentyp
text
Alias
- UMLS CUI [1]
- C2347852
Beschreibung
UNITS
Datentyp
text
Alias
- UMLS CUI [1]
- C1519795
Ähnliche Modelle
STATUS OF TREATMENT BLIND
C2347038 (UMLS CUI [1,2])
C2347038 (UMLS CUI [1,2])
(Comment:en)
(Comment:en)
C1442085 (UMLS CUI [1,2])
C2347500 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,2])
C0178913 (UMLS CUI [1,2])
C0178913 (UMLS CUI [1,2])
(Comment:en)
(Comment:en)