ID

32003

Beschrijving

Study ID: 106218 Clinical Study ID: TDC106218 Study Title: Study On Bioavailability And Pharmacokinetics Of Various Doses Of Testosterone Administered With And Without Dutasteride  Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier:  Sponsor: GlaxoSmithKline Collaborators: N/A Phase: Phase 1 Study Recruitment Status: Completed Generic Name: testosterone Trade Name: Andropatch,Androderm Study Indication: Hypogonadism, Male

Trefwoorden

  1. 11-10-18 11-10-18 -
  2. 25-02-19 25-02-19 -
Houder van rechten

GSK group of companies

Geüploaded op

11 oktober 2018

DOI

Voor een aanvraag inloggen.

Licentie

Creative Commons BY-NC 3.0

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Bioavailability and Pharmacokinetics of Testosterone with/without Dutasteride - 106218

Physical Examination Form

Medical Conditions
Beschrijving

Medical Conditions

Subject Identifier
Beschrijving

Subject Identifier

Datatype

integer

Diagnosis
Beschrijving

Only in the absence of a diagnosis, record the signs and symptoms on separate lines Diagnosis 1 Diagnosis 2 Diagnosis 3 Diagnosis 4 Diagnosis 5 Diagnosis 6 Diagnosis 7

Datatype

text

Current Diagnosis
Beschrijving

Diagnosis 1 Diagnosis 2 Diagnosis 3 Diagnosis 4 Diagnosis 5 Diagnosis 6 Diagnosis 7

Datatype

boolean

Past Diagnosis
Beschrijving

Diagnosis 1 Diagnosis 2 Diagnosis 3 Diagnosis 4 Diagnosis 5 Diagnosis 6 Diagnosis 7

Datatype

boolean

Physical Examination
Beschrijving

Physical Examination

Date of Assesment
Beschrijving

Date of Assesment

Datatype

date

Indicate current physical findings by marking the appropriate box(es) below and if ABNORMAL, describe concisely:
Beschrijving

[different findings should be separated by either a (:) or a (/)]

Datatype

text

1.Hair and skin
Beschrijving

1.Hair and skin

Datatype

text

2.Lymph nodes
Beschrijving

2.Lymph nodes

Datatype

text

3.Eyes
Beschrijving

3.Eyes

Datatype

text

4.Ears, Nose and Throat
Beschrijving

4.Ears, Nose and Throat

Datatype

text

5.Breasts
Beschrijving

5.Breasts

Datatype

text

6.Respiratory
Beschrijving

6.Respiratory

Datatype

text

7.Cardiovascular
Beschrijving

7.Cardiovascular

Datatype

text

8.Abdomen
Beschrijving

8.Abdomen

Datatype

text

9.Urogenital
Beschrijving

9.Urogenital

Datatype

text

10.Pelvic
Beschrijving

10.Pelvic

Datatype

text

11.Rectal
Beschrijving

11.Rectal

Datatype

text

12.Musculoskeletal
Beschrijving

12.Musculoskeletal

Datatype

text

13.Neurological
Beschrijving

13.Neurological

Datatype

text

14.Mental Status
Beschrijving

14.Mental Status

Datatype

text

Concise Description
Beschrijving

1 Hair and Skin 2 Lymph Nodes 3 Eyes 4 Ears, Nose and Throat 5 Breasts 6 Respiratory 7 Cardiovascular 8 Abdomen 9 Urogenital 10 Pelvic 11 Rectal 12 Musculoskeletal 13 Neurological 14 Mental Status

Datatype

text

Urine Drug, Alcohol and Cotinine Screen
Beschrijving

Urine Drug, Alcohol and Cotinine Screen

Date of sample taken
Beschrijving

Date of sample taken

Datatype

date

Time of sample taken
Beschrijving

Time of sample taken

Datatype

time

Mark appropriate box(es):
Beschrijving

Mark appropriate box(es):

Datatype

text

Cocaine
Beschrijving

Cocaine

Datatype

integer

Amphetamines
Beschrijving

Amphetamines

Datatype

integer

Benzodiazepines
Beschrijving

Benzodiazepines

Datatype

integer

Cannabinoids
Beschrijving

Cannabinoids

Datatype

integer

Opiates
Beschrijving

Opiates

Datatype

text

Barbiturates
Beschrijving

Barbiturates

Datatype

integer

Alcohol
Beschrijving

Alcohol

Datatype

integer

Cotinine
Beschrijving

Cotinine

Datatype

integer

If any of the above are positive, exclude subject from the study.
Beschrijving

If any of the above are positive, exclude subject from the study.

Datatype

text

Serology
Beschrijving

Serology

Date sample taken
Beschrijving

Date sample taken

Datatype

date

Mark appropriate boxes:
Beschrijving

Mark appropriate boxes:

Datatype

text

HIV antibody
Beschrijving

HIV antibody

Datatype

integer

Hepatitis B surface antigen
Beschrijving

Hepatitis B surface antigen

Datatype

integer

Hepatitis C antibody
Beschrijving

Hepatitis C antibody

Datatype

integer

If any of the above are positive, exclude subject from the study.
Beschrijving

If any of the above are positive, exclude subject from the study.

Datatype

text

Vital Signs
Beschrijving

Vital Signs

Date
Beschrijving

Date

Datatype

date

Time
Beschrijving

Time

Datatype

time

Height
Beschrijving

Height

Datatype

integer

Maateenheden
  • cm
cm
Weight
Beschrijving

Weight

Datatype

float

Maateenheden
  • kg
kg
Body mass index
Beschrijving

Body mass index

Datatype

float

Maateenheden
  • kg / m2
kg / m2
Blood pressure Systolic
Beschrijving

Semi-supine

Datatype

integer

Maateenheden
  • mmHg
mmHg
Blood pressure Diastolic
Beschrijving

Semi-supine

Datatype

integer

Maateenheden
  • mmHg
mmHg
Heart rate
Beschrijving

Heart rate

Datatype

integer

Maateenheden
  • bpm
bpm
Temperature
Beschrijving

Temperature

Datatype

float

Maateenheden
  • °C
°C
Respiration rate
Beschrijving

Respiration rate

Datatype

integer

Maateenheden
  • breaths/min
breaths/min
12-lead ECG (Semi-Supine)
Beschrijving

12-lead ECG (Semi-Supine)

Start Date of ECG
Beschrijving

Start Date of ECG

Datatype

date

Start Time of ECG
Beschrijving

Start Time of ECG

Datatype

time

Ventricular Rate
Beschrijving

Ventricular Rate

Datatype

integer

Maateenheden
  • bpm
bpm
PR Interval
Beschrijving

PR Interval

Datatype

integer

Maateenheden
  • msec
msec
QRS Duration
Beschrijving

QRS Duration

Datatype

integer

Maateenheden
  • msec
msec
Uncorrected QT Interval
Beschrijving

Uncorrected QT Interval

Datatype

text

Maateenheden
  • msec
msec
QTc Interval
Beschrijving

QTc Interval

Datatype

integer

Maateenheden
  • msec
msec
Result of the ECG
Beschrijving

mark one:

Datatype

text

Similar models

Physical Examination Form

Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Medical Conditions
Subject Identifier
Item
Subject Identifier
integer
Item
Diagnosis
text
Code List
Diagnosis
CL Item
Diagnosis 1 (Diagnosis 1)
CL Item
Diagnosis 2 (Diagnosis 2)
CL Item
Diagnosis 3 (Diagnosis 3)
CL Item
Diagnosis 4 (Diagnosis 4)
CL Item
Diagnosis 5 (Diagnosis 5)
CL Item
Diagnosis 6 (Diagnosis 6)
CL Item
Diagnosis 7 (Diagnosis 7)
Current Diagnosis
Item
Current Diagnosis
boolean
Past Diagnosis
Item
Past Diagnosis
boolean
Item Group
Physical Examination
Date of Assesment
Item
Date of Assesment
date
Indicate current physical findings by marking the appropriate box(es) below and if ABNORMAL, describe concisely:
Item
Indicate current physical findings by marking the appropriate box(es) below and if ABNORMAL, describe concisely:
text
Item
1.Hair and skin
text
Code List
1.Hair and skin
CL Item
Normal (1)
CL Item
Abnormal (2)
Item
2.Lymph nodes
text
Code List
2.Lymph nodes
CL Item
Normal (1)
CL Item
Abnormal (2)
Item
3.Eyes
text
Code List
3.Eyes
CL Item
Normal (1)
CL Item
Abnormal (2)
Item
4.Ears, Nose and Throat
text
Code List
4.Ears, Nose and Throat
CL Item
Normal (1)
CL Item
Abnormal (2)
Item
5.Breasts
text
Code List
5.Breasts
CL Item
Normal (1)
CL Item
Abnormal (2)
CL Item
Not Done (3)
Item
6.Respiratory
text
Code List
6.Respiratory
CL Item
Normal (1)
CL Item
Abnormal (2)
Item
7.Cardiovascular
text
Code List
7.Cardiovascular
CL Item
Normal (1)
CL Item
Abnormal (2)
Item
8.Abdomen
text
Code List
8.Abdomen
CL Item
Normal (1)
CL Item
Abnormal (2)
Item
9.Urogenital
text
Code List
9.Urogenital
CL Item
Normal (1)
CL Item
Abnormal (2)
CL Item
Not Done (3)
Item
10.Pelvic
text
Code List
10.Pelvic
CL Item
Normal (1)
CL Item
Abnormal (2)
CL Item
Not Done (3)
Item
11.Rectal
text
Code List
11.Rectal
CL Item
Normal (1)
CL Item
Abnormal (2)
CL Item
Not Done (3)
Item
12.Musculoskeletal
text
Code List
12.Musculoskeletal
CL Item
Normal (1)
CL Item
Abnormal (2)
Item
13.Neurological
text
Code List
13.Neurological
CL Item
Normal (1)
CL Item
Abnormal (2)
Item
14.Mental Status
text
Code List
14.Mental Status
CL Item
Normal (1)
CL Item
Abnormal (2)
Concise Description
Item
Concise Description
text
Item Group
Urine Drug, Alcohol and Cotinine Screen
Date of sample taken
Item
Date of sample taken
date
Time of sample taken
Item
Time of sample taken
time
Mark appropriate box(es):
Item
Mark appropriate box(es):
text
Item
Cocaine
integer
Code List
Cocaine
CL Item
Positive (1)
CL Item
Negative (2)
Item
Amphetamines
integer
Code List
Amphetamines
CL Item
Positive (1)
CL Item
Negative (2)
Item
Benzodiazepines
integer
Code List
Benzodiazepines
CL Item
Positive (1)
CL Item
Negative (2)
Item
Cannabinoids
integer
Code List
Cannabinoids
CL Item
Positive (1)
CL Item
Negative (2)
Item
Opiates
text
Code List
Opiates
CL Item
Positive (1)
CL Item
Negative (2)
Item
Barbiturates
integer
Code List
Barbiturates
CL Item
Positive (1)
CL Item
Negative (2)
Item
Alcohol
integer
Code List
Alcohol
CL Item
Positive (1)
CL Item
Negative (2)
Item
Cotinine
integer
Code List
Cotinine
CL Item
Positive (1)
CL Item
Negative (2)
If any of the above are positive, exclude subject from the study.
Item
If any of the above are positive, exclude subject from the study.
text
Item Group
Serology
Date sample taken
Item
Date sample taken
date
Mark appropriate boxes:
Item
Mark appropriate boxes:
text
Item
HIV antibody
integer
Code List
HIV antibody
CL Item
Positive (1)
CL Item
Negative (2)
Item
Hepatitis B surface antigen
integer
Code List
Hepatitis B surface antigen
CL Item
Positive (1)
CL Item
Negative (2)
Item
Hepatitis C antibody
integer
Code List
Hepatitis C antibody
CL Item
Positive (1)
CL Item
Negative (2)
If any of the above are positive, exclude subject from the study.
Item
If any of the above are positive, exclude subject from the study.
text
Item Group
Vital Signs
Date
Item
Date
date
Time
Item
Time
time
Height
Item
Height
integer
Weight
Item
Weight
float
Body mass index
Item
Body mass index
float
Blood pressure Systolic
Item
Blood pressure Systolic
integer
Blood pressure Diastolic
Item
Blood pressure Diastolic
integer
Heart rate
Item
Heart rate
integer
Temperature
Item
Temperature
float
Respiration rate
Item
Respiration rate
integer
Item Group
12-lead ECG (Semi-Supine)
Start Date of ECG
Item
Start Date of ECG
date
Start Time of ECG
Item
Start Time of ECG
time
Ventricular Rate
Item
Ventricular Rate
integer
PR Interval
Item
PR Interval
integer
QRS Duration
Item
QRS Duration
integer
Uncorrected QT Interval
Item
Uncorrected QT Interval
text
QTc Interval
Item
QTc Interval
integer
Item
Result of the ECG
text
Code List
Result of the ECG
CL Item
Normal (1)
CL Item
Abnormal - Not clinocally significant (2)
CL Item
Abnormal - Clinically significant (3)
CL Item
No result (not available) (4)

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