ID

32003

Beskrivning

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

Nyckelord

  1. 2018-10-11 2018-10-11 -
  2. 2019-02-25 2019-02-25 -
Rättsinnehavare

GSK group of companies

Uppladdad den

11 oktober 2018

DOI

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Licens

Creative Commons BY-NC 3.0

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Bioavailability and Pharmacokinetics of Testosterone with/without Dutasteride - 106218

Physical Examination Form

Medical Conditions
Beskrivning

Medical Conditions

Subject Identifier
Beskrivning

Subject Identifier

Datatyp

integer

Diagnosis
Beskrivning

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

Datatyp

text

Current Diagnosis
Beskrivning

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

Datatyp

boolean

Past Diagnosis
Beskrivning

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

Datatyp

boolean

Physical Examination
Beskrivning

Physical Examination

Date of Assesment
Beskrivning

Date of Assesment

Datatyp

date

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

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

Datatyp

text

1.Hair and skin
Beskrivning

1.Hair and skin

Datatyp

text

2.Lymph nodes
Beskrivning

2.Lymph nodes

Datatyp

text

3.Eyes
Beskrivning

3.Eyes

Datatyp

text

4.Ears, Nose and Throat
Beskrivning

4.Ears, Nose and Throat

Datatyp

text

5.Breasts
Beskrivning

5.Breasts

Datatyp

text

6.Respiratory
Beskrivning

6.Respiratory

Datatyp

text

7.Cardiovascular
Beskrivning

7.Cardiovascular

Datatyp

text

8.Abdomen
Beskrivning

8.Abdomen

Datatyp

text

9.Urogenital
Beskrivning

9.Urogenital

Datatyp

text

10.Pelvic
Beskrivning

10.Pelvic

Datatyp

text

11.Rectal
Beskrivning

11.Rectal

Datatyp

text

12.Musculoskeletal
Beskrivning

12.Musculoskeletal

Datatyp

text

13.Neurological
Beskrivning

13.Neurological

Datatyp

text

14.Mental Status
Beskrivning

14.Mental Status

Datatyp

text

Concise Description
Beskrivning

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

Datatyp

text

Urine Drug, Alcohol and Cotinine Screen
Beskrivning

Urine Drug, Alcohol and Cotinine Screen

Date of sample taken
Beskrivning

Date of sample taken

Datatyp

date

Time of sample taken
Beskrivning

Time of sample taken

Datatyp

time

Mark appropriate box(es):
Beskrivning

Mark appropriate box(es):

Datatyp

text

Cocaine
Beskrivning

Cocaine

Datatyp

integer

Amphetamines
Beskrivning

Amphetamines

Datatyp

integer

Benzodiazepines
Beskrivning

Benzodiazepines

Datatyp

integer

Cannabinoids
Beskrivning

Cannabinoids

Datatyp

integer

Opiates
Beskrivning

Opiates

Datatyp

text

Barbiturates
Beskrivning

Barbiturates

Datatyp

integer

Alcohol
Beskrivning

Alcohol

Datatyp

integer

Cotinine
Beskrivning

Cotinine

Datatyp

integer

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

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

Datatyp

text

Serology
Beskrivning

Serology

Date sample taken
Beskrivning

Date sample taken

Datatyp

date

Mark appropriate boxes:
Beskrivning

Mark appropriate boxes:

Datatyp

text

HIV antibody
Beskrivning

HIV antibody

Datatyp

integer

Hepatitis B surface antigen
Beskrivning

Hepatitis B surface antigen

Datatyp

integer

Hepatitis C antibody
Beskrivning

Hepatitis C antibody

Datatyp

integer

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

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

Datatyp

text

Vital Signs
Beskrivning

Vital Signs

Date
Beskrivning

Date

Datatyp

date

Time
Beskrivning

Time

Datatyp

time

Height
Beskrivning

Height

Datatyp

integer

Måttenheter
  • cm
cm
Weight
Beskrivning

Weight

Datatyp

float

Måttenheter
  • kg
kg
Body mass index
Beskrivning

Body mass index

Datatyp

float

Måttenheter
  • kg / m2
kg / m2
Blood pressure Systolic
Beskrivning

Semi-supine

Datatyp

integer

Måttenheter
  • mmHg
mmHg
Blood pressure Diastolic
Beskrivning

Semi-supine

Datatyp

integer

Måttenheter
  • mmHg
mmHg
Heart rate
Beskrivning

Heart rate

Datatyp

integer

Måttenheter
  • bpm
bpm
Temperature
Beskrivning

Temperature

Datatyp

float

Måttenheter
  • °C
°C
Respiration rate
Beskrivning

Respiration rate

Datatyp

integer

Måttenheter
  • breaths/min
breaths/min
12-lead ECG (Semi-Supine)
Beskrivning

12-lead ECG (Semi-Supine)

Start Date of ECG
Beskrivning

Start Date of ECG

Datatyp

date

Start Time of ECG
Beskrivning

Start Time of ECG

Datatyp

time

Ventricular Rate
Beskrivning

Ventricular Rate

Datatyp

integer

Måttenheter
  • bpm
bpm
PR Interval
Beskrivning

PR Interval

Datatyp

integer

Måttenheter
  • msec
msec
QRS Duration
Beskrivning

QRS Duration

Datatyp

integer

Måttenheter
  • msec
msec
Uncorrected QT Interval
Beskrivning

Uncorrected QT Interval

Datatyp

text

Måttenheter
  • msec
msec
QTc Interval
Beskrivning

QTc Interval

Datatyp

integer

Måttenheter
  • msec
msec
Result of the ECG
Beskrivning

mark one:

Datatyp

text

Similar models

Physical Examination Form

Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
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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