ID

33162

Beschrijving

Study ID: 107806 Clinical Study ID: RA3107806 Study Title: An open label study to determine the safety, tolerability, excretion balance and pharmacokinetics of Losmapimod, administered as a single dose of an oral solution to healthy adult male subjects Patient Level Data: Clinicaltrials.gov Identifier: NCT00599612 https://clinicaltrials.gov/ct2/show/NCT00599612 Sponsor: GlaxoSmithKline Collaborators: N/A Phase: Phase 1 Study Recruitment Status: Completed Generic Name: losmapimod Trade Name: losmapimod Study Indication: Pulmonary Disease, Chronic Obstructive The study consists of a screening, study visit and follow-up. The protocol identifier for all: RA3107806 This document contains: 1)alcohol intake form. It has to be filled in for screening. 2)alcohol breath test form. It has to be filled in for screening and study visit. 3) drug screen form. It has to be filled in for screening and study visit.

Link

https://clinicaltrials.gov/ct2/show/NCT00599612

Trefwoorden

Versies (2)
  1. 28-11-18 28-11-18 -
  2. 30-11-18 30-11-18 -
Houder van rechten

GlaxoSmithKline

Geüploaded op

30 november 2018

DOI

Voor een aanvraag inloggen.

Licentie

Creative Commons BY-NC 3.0
Model Commentaren :

Hier kunt u commentaar leveren op het model. U kunt de tekstballonnen bij de itemgroepen en items gebruiken om er specifiek commentaar op te geven.

Terug naar het model Commentaren
Itemgroep Commentaren voor :

Item Commentaren voor :

  • Nieuwste
  • Oudste
  • Populair
  • Nieuwste
    • Nieuwste
    • Oudste
    • Populair

Geen commentaren

U moet ingelogd zijn om formulieren te downloaden. AUB inloggen of schrijf u gratis in.

Safety, tolerability, excretion balance and pharmacokinetics of Losmapimod in healthy males, NCT00599612

Engels

Alcohol test, drug screen

1 Formulieren  
Administrative data
Beschrijving

Administrative data

Alias
UMLS CUI-1
C1320722
Subject identifier
Beschrijving

Subject identifier

Datatype

text

Alias
UMLS CUI [1]
C2348585
Visit Description
Beschrijving

Visit Description

Datatype

integer

Alias
UMLS CUI [1,1]
C0545082
UMLS CUI [1,2]
C0678257
ALCOHOL INTAKE
Beschrijving

ALCOHOL INTAKE

Alias
UMLS CUI-1
C0001948
Does the subject consume alcohol?
Beschrijving

Only for screening.

Datatype

text

Alias
UMLS CUI [1]
C0001948
If subject consume alcohol, record the average number of units of alcohol consumed per week
Beschrijving

ALCOHOL CONVERTER: 1 unit of alcohol in UK = 1 measure of spirits, 1/2 pint beer, 1 small glass of wine (125ml) See facing page for conversion guidelines.

Datatype

float

Maateenheden
  • units per week
Alias
UMLS CUI [1,1]
C0001948
UMLS CUI [1,2]
C0560579
units per week
ALCOHOL BREATH TEST
Beschrijving

ALCOHOL BREATH TEST

Alias
UMLS CUI-1
C0202306
Date sample taken
Beschrijving

day month year

Datatype

date

Alias
UMLS CUI [1]
C1302413
Results of sample
Beschrijving

If positive, exclude subject from the study.

Datatype

text

Alias
UMLS CUI [1]
C0456984
DRUG SCREEN
Beschrijving

DRUG SCREEN

Alias
UMLS CUI-1
C0373483
Date of sample taken
Beschrijving

day month year

Datatype

date

Alias
UMLS CUI [1]
C1302413
Time of sample taken
Beschrijving

00:00-23:59

Datatype

time

Alias
UMLS CUI [1,1]
C0040223
UMLS CUI [1,2]
C0200345
Drugs
Beschrijving

Tick appropriate box(es). Note for each drug the result.

Datatype

text

Alias
UMLS CUI [1]
C0033978
Drug result
Beschrijving

Note for each drug the result. If any of the drugs are positive, exclude subject from the study.

Datatype

text

Alias
UMLS CUI [1,1]
C0033978
UMLS CUI [1,2]
C1274040
Terug naar het begin van de pagina

Similar models

Alcohol test, drug screen

1 Formulieren
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Administrative data
C1320722 (UMLS CUI-1)
Subject identifier
Item
Subject identifier
text
C2348585 (UMLS CUI [1])
Item
Visit Description
integer
C0545082 (UMLS CUI [1,1])
C0678257 (UMLS CUI [1,2])
Visit Description
Code List
Visit Description
CL Item
Screening (1)
CL Item
Study visit (2)
Item Group
ALCOHOL INTAKE
C0001948 (UMLS CUI-1)
Item
Does the subject consume alcohol?
text
C0001948 (UMLS CUI [1])
Alcohol consumption
Code List
Does the subject consume alcohol?
CL Item
Yes (Y)
CL Item
No (N)
Alcohol consumption, units per week
Item
If subject consume alcohol, record the average number of units of alcohol consumed per week
float
C0001948 (UMLS CUI [1,1])
C0560579 (UMLS CUI [1,2])
Item Group
ALCOHOL BREATH TEST
C0202306 (UMLS CUI-1)
Date sample taken
Item
Date sample taken
date
C1302413 (UMLS CUI [1])
Item
Results of sample
text
C0456984 (UMLS CUI [1])
Results of sample
Code List
Results of sample
CL Item
Positive (P)
CL Item
Negative (N)
Item Group
DRUG SCREEN
C0373483 (UMLS CUI-1)
Date of sample taken
Item
Date of sample taken
date
C1302413 (UMLS CUI [1])
Time of sample taken
Item
Time of sample taken
time
C0040223 (UMLS CUI [1,1])
C0200345 (UMLS CUI [1,2])
Item
Drugs
text
C0033978 (UMLS CUI [1])
Drugs
Code List
Drugs
CL Item
Cocaine (1)
CL Item
Amphetamines (2)
CL Item
Benzodiazepines (3)
CL Item
Cannabinoids (4)
CL Item
Opiates (5)
CL Item
Barbiturates (6)
CL Item
Methadone (7)
CL Item
Cotinine (8)
Item
Drug result
text
C0033978 (UMLS CUI [1,1])
C1274040 (UMLS CUI [1,2])
Drug result
Code List
Drug result
CL Item
Positive (P)
CL Item
Negative (N)
Terug naar het begin van de pagina 

Contact

Gebruik dit formulier voor feedback, vragen en verbeteringsvoorstellen.

Velden gemarkeerd met een * zijn verplicht.

Help

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial