ID

29115

Beschrijving

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)

Trefwoorden

Versies (1)
  1. 26-02-18 26-02-18 -
Houder van rechten

GlaxoSmithKline (GSK)

Geüploaded op

26 februari 2018

DOI

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Licentie

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

Engels

Medical Procedures and Concomitant Medication

1 Formulieren  
Administration
Beschrijving

Administration

Alias
UMLS CUI-1
C1320722
Patient number
Beschrijving

Patient number

Datatype

integer

Alias
UMLS CUI [1]
C1830427
Center Number
Beschrijving

Center Number

Datatype

integer

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

Medical Procedures

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

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

Datatype

boolean

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

Procedure

Datatype

text

Alias
UMLS CUI [1]
C0199171
Indication
Beschrijving

Indication

Datatype

text

Alias
UMLS CUI [1]
C3146298
Procedure start date
Beschrijving

Start Date

Datatype

date

Alias
UMLS CUI [1]
C0808070
Procedure end date
Beschrijving

End Date

Datatype

date

Alias
UMLS CUI [1]
C0806020
Concomitant Medication
Beschrijving

Concomitant Medication

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

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

Datatype

boolean

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

Drug Name

Datatype

text

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

Total Daily Dose

Datatype

integer

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

Medical Illness/Diagnosis

Datatype

text

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

Start Date

Datatype

date

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

End Date

Datatype

integer

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

Continuous medication

Datatype

boolean

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

Medical Procedures and Concomitant Medication

1 Formulieren
Name
Type
Description | Question | Decode (Coded Value)
Datatype
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])
Terug naar het begin van de pagina 

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