ID

29115

Descripción

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)

Palabras clave

Versiones (1)
  1. 26/2/18 26/2/18 -
Titular de derechos de autor

GlaxoSmithKline (GSK)

Subido en

26 de febrero de 2018

DOI

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Licencia

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

Inglés

Medical Procedures and Concomitant Medication

1 formularios  
Administration
Descripción

Administration

Alias
UMLS CUI-1
C1320722
Patient number
Descripción

Patient number

Tipo de datos

integer

Alias
UMLS CUI [1]
C1830427
Center Number
Descripción

Center Number

Tipo de datos

integer

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

Medical Procedures

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

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

Tipo de datos

boolean

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

Procedure

Tipo de datos

text

Alias
UMLS CUI [1]
C0199171
Indication
Descripción

Indication

Tipo de datos

text

Alias
UMLS CUI [1]
C3146298
Procedure start date
Descripción

Start Date

Tipo de datos

date

Alias
UMLS CUI [1]
C0808070
Procedure end date
Descripción

End Date

Tipo de datos

date

Alias
UMLS CUI [1]
C0806020
Concomitant Medication
Descripción

Concomitant Medication

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

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

Tipo de datos

boolean

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

Drug Name

Tipo de datos

text

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

Total Daily Dose

Tipo de datos

integer

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

Medical Illness/Diagnosis

Tipo de datos

text

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

Start Date

Tipo de datos

date

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

End Date

Tipo de datos

integer

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

Continuous medication

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0549178
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Similar models

Medical Procedures and Concomitant Medication

1 formularios
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
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])
Volver a la parte superior de la página 

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