ID

29115

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

Versionen (1)
  1. 26.02.18 26.02.18 -
Rechteinhaber

GlaxoSmithKline (GSK)

Hochgeladen am

26. Februar 2018

DOI

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Lizenz

Creative Commons BY-NC 3.0
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Clinical Study, Ropinirole in Patients Suffering from Restless Legs Syndrome (RLS), Study ID: 101468/249, NCT00363857

Englisch

Medical Procedures and Concomitant Medication

1 Formulare  
Administration
Beschreibung

Administration

Alias
UMLS CUI-1
C1320722
Patient number
Beschreibung

Patient number

Datentyp

integer

Alias
UMLS CUI [1]
C1830427
Center Number
Beschreibung

Center Number

Datentyp

integer

Alias
UMLS CUI [1,1]
C1301943
UMLS CUI [1,2]
C0600091
Medical Procedures
Beschreibung

Medical Procedures

Alias
UMLS CUI-1
C0199171
Have any non-medication, therapeutic, diagnostic or surgical procedures been performed since the start of this study?
Beschreibung

If ‘Yes’, please record details below using standard medical terminology (Please print clearly)

Datentyp

boolean

Alias
UMLS CUI [1]
C0199171
UMLS CUI [2]
C0087111
UMLS CUI [3]
C0430022
UMLS CUI [4]
C0543467
Procedure
Beschreibung

Procedure

Datentyp

text

Alias
UMLS CUI [1]
C0199171
Indication
Beschreibung

Indication

Datentyp

text

Alias
UMLS CUI [1]
C3146298
Procedure start date
Beschreibung

Start Date

Datentyp

date

Alias
UMLS CUI [1]
C0808070
Procedure end date
Beschreibung

End Date

Datentyp

date

Alias
UMLS CUI [1]
C0806020
Concomitant Medication
Beschreibung

Concomitant Medication

Alias
UMLS CUI-1
C2347852
Mark box below or complete page with concomitant medication details (Please print clearly).
Beschreibung

Please mark if no new or change in concomitant medication since the Prior and Concomitant Medication page.

Datentyp

boolean

Alias
UMLS CUI [1]
C2347852
Drug Name (Trade Name Preferred)
Beschreibung

Drug Name

Datentyp

text

Alias
UMLS CUI [1]
C0013227
Total Daily Dose (eg 500mg)
Beschreibung

Total Daily Dose

Datentyp

integer

Alias
UMLS CUI [1]
C2348070
Medical Illness/Diagnosis (or symptom in absence of diagnosis)
Beschreibung

Medical Illness/Diagnosis

Datentyp

text

Alias
UMLS CUI [1,1]
C0011900
UMLS CUI [1,2]
C0013227
UMLS CUI [1,3]
C3146298
Start Date (be as precise as possible)
Beschreibung

Start Date

Datentyp

date

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0808070
End Date (or if Continuing mark box)
Beschreibung

End Date

Datentyp

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0806020
If Continuing mark box
Beschreibung

Continuous medication

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0549178
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Ähnliche Modelle

Medical Procedures and Concomitant Medication

1 Formulare
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Administration
C1320722 (UMLS CUI-1)
Patient number
Item
Patient number
integer
C1830427 (UMLS CUI [1])
Center Number
Item
Center Number
integer
C1301943 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
Item Group
Medical Procedures
C0199171 (UMLS CUI-1)
Medical Procedures
Item
Have any non-medication, therapeutic, diagnostic or surgical procedures been performed since the start of this study?
boolean
C0199171 (UMLS CUI [1])
C0087111 (UMLS CUI [2])
C0430022 (UMLS CUI [3])
C0543467 (UMLS CUI [4])
Procedure
Item
Procedure
text
C0199171 (UMLS CUI [1])
Indication
Item
Indication
text
C3146298 (UMLS CUI [1])
Start Date
Item
Procedure start date
date
C0808070 (UMLS CUI [1])
End Date
Item
Procedure end date
date
C0806020 (UMLS CUI [1])
Item Group
Concomitant Medication
C2347852 (UMLS CUI-1)
Concomitant medication
Item
Mark box below or complete page with concomitant medication details (Please print clearly).
boolean
C2347852 (UMLS CUI [1])
Drug Name
Item
Drug Name (Trade Name Preferred)
text
C0013227 (UMLS CUI [1])
Total Daily Dose
Item
Total Daily Dose (eg 500mg)
integer
C2348070 (UMLS CUI [1])
Medical Illness/Diagnosis
Item
Medical Illness/Diagnosis (or symptom in absence of diagnosis)
text
C0011900 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
C3146298 (UMLS CUI [1,3])
Start Date
Item
Start Date (be as precise as possible)
date
C0013227 (UMLS CUI [1,1])
C0808070 (UMLS CUI [1,2])
End Date
Item
End Date (or if Continuing mark box)
integer
C0013227 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
Continuous medication
Item
If Continuing mark box
boolean
C0013227 (UMLS CUI [1,1])
C0549178 (UMLS CUI [1,2])
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