Information: Detta är inte den senaste versionen av datamodellen. Du hittar en versionsöversikt till vänster under versioner. Den senaste versionen hittar du här.
Information:
Fel:
ID
31317
Beskrivning
Study ID: 104574 Clinical Study ID: AR1104574 Study Title: A randomized blinded pilot trial of fondaparinux sodium (Arixtra®) versus unfractionated heparin in addition to standard therapy in a broad range of patients undergoing percutaneous coronary intervention (ASPIRE) Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: Sponsor: GlaxoSmithKline Collaborators: N/A Phase: Phase 2 Study Recruitment Status: Completed Generic Name: fondaparinux sodium Trade Name: Arixtra Study Indication: Thromboembolism USE THIS PAGE ONLY FOR THOSE PATIENTS WHO DID NOT COMPLETE 30 DAY FOLLOW-UP VISIT (as per protocol, that is, 30-35 days from randomization)
Nyckelord
Versioner (2)
- 2018-08-13 2018-08-13 -
- 2018-08-13 2018-08-13 -
Rättsinnehavare
GlaxoSmithKline
Uppladdad den
13 augusti 2018
DOI
För en begäran logga in.
Licens
Creative Commons BY-NC 3.0
Modellkommentarer :
Här kan du kommentera modellen. Med hjälp av pratbubblor i Item-grupperna och Item kan du lägga in specifika kommentarer.
Itemgroup-kommentar för :
Item-kommentar för :
Du måste vara inloggad för att kunna ladda ner formulär. Var vänlig logga in eller registrera dig utan kostnad.
Fondaparinux sodium (Arixtra) versus unfractionated heparin with patients undergoing PCI; NCT
Similar models
Contact Form
- StudyEvent: ODM
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Patient ID; Centre Number
Item
Patient ID, Centre No.
text
C1269815 (UMLS CUI [1,1])
C2825181 (UMLS CUI [1,2])
C1300638 (UMLS CUI [1,3])
C2825181 (UMLS CUI [1,2])
C1300638 (UMLS CUI [1,3])
Patient ID; Envelope Number
Item
Patient ID, Envelope No.
text
C1269815 (UMLS CUI [1,1])
C2348585 (UMLS CUI [1,2])
C2348585 (UMLS CUI [1,2])
Patient Initials
Item
Patient Initials
text
C2986440 (UMLS CUI [1])
Successful contact made
Item
Has successful contact been made?
boolean
C0332158 (UMLS CUI [1,1])
C0681850 (UMLS CUI [1,2])
C0597535 (UMLS CUI [1,3])
C0681850 (UMLS CUI [1,2])
C0597535 (UMLS CUI [1,3])
Successful contact made; date
Item
Date of this contact
date
C0332158 (UMLS CUI [1,1])
C0681850 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
C0681850 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
date form completed
Item
Date this form completed
date
C0332158 (UMLS CUI [1,1])
C0681850 (UMLS CUI [1,2])
C1115437 (UMLS CUI [1,3])
C0681850 (UMLS CUI [1,2])
C1115437 (UMLS CUI [1,3])
Item
Who made this contact?
text
C0337611 (UMLS CUI [1,1])
C1272683 (UMLS CUI [1,2])
C1272683 (UMLS CUI [1,2])
CL Item
Investigator/Co-Investigator (Investigator/Co-Investigator)
CL Item
Study Nurse (Study Nurse)
CL Item
Other qualified professional (specify) (Other qualified professional (specify))
Item
How were follow-up data obtained?
text
C1522577 (UMLS CUI [1,1])
C0025663 (UMLS CUI [1,2])
C0025663 (UMLS CUI [1,2])
CL Item
late office visit (late office visit)
CL Item
home visit (home visit)
CL Item
written communication (written communication)
CL Item
patient in hospital (patient in hospital)
CL Item
telephone communication (telephone communication)
CL Item
other (specify) (other (specify))
CL Item
patient (patient)
CL Item
patient’s relative (relationship) (patient’s relative (relationship))
CL Item
patient’s physician (patient’s physician)
CL Item
other (please specify) (other (please specify))
Item
Did patient experience death since last seen and before 35 days after randomization?
text
C0011065 (UMLS CUI [1])
Code List
Did patient experience death since last seen and before 35 days after randomization?
CL Item
Unknown (Unknown)
CL Item
No (No)
CL Item
Yes (give date) (Yes (give date))
Item
Did patient experience myocardial (re)infarction since last seen and before 35 days after randomization?
text
C0027051 (UMLS CUI [1])
C0948369 (UMLS CUI [2])
C0948369 (UMLS CUI [2])
Code List
Did patient experience myocardial (re)infarction since last seen and before 35 days after randomization?
CL Item
Unknown (Unknown)
CL Item
No (No)
CL Item
Yes (give date) (Yes (give date))
Item
Did patient experience a stroke since last seen and before 35 days after randomization?
text
C0038454 (UMLS CUI [1])
Code List
Did patient experience a stroke since last seen and before 35 days after randomization?
CL Item
Unknown (Unknown)
CL Item
No (No)
CL Item
Yes (give date) (Yes (give date))
Item
Did patient experience a PCI/stent since last seen and before 35 days after randomization?
text
C1532338 (UMLS CUI [1,1])
C0038257 (UMLS CUI [1,2])
C0038257 (UMLS CUI [1,2])
Code List
Did patient experience a PCI/stent since last seen and before 35 days after randomization?
CL Item
Unknown (Unknown)
CL Item
No (No)
CL Item
Yes (give date) (Yes (give date))
Item
Did patient experience CABG since last seen and before 35 days after randomization?
text
C0010055 (UMLS CUI [1])
Code List
Did patient experience CABG since last seen and before 35 days after randomization?
CL Item
Unknown (Unknown)
CL Item
No (No)
CL Item
Yes (give date) (Yes (give date))
Item
Did patient experience bleeding since last seen and before 35 days after randomization?
text
C0019080 (UMLS CUI [1])
Code List
Did patient experience bleeding since last seen and before 35 days after randomization?
CL Item
Unknown (Unknown)
CL Item
No (No)
CL Item
Yes (give date) (Yes (give date))
Comments
Item
Additional Comments
text
C0947611 (UMLS CUI [1])