ID

35647

Beschreibung

Study ID: 101468/192 Clinical Study ID: 101468/192 Study Title:A 52 Week Open-Label Extension Study of the Long-Term Safety of Ropinirole in Subjects Suffering from Restless Legs Syndrome (RLS) Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: Sponsor: GlaxoSmithKline Collaborators: N/A Phase: phase 3 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 The study consists of 16 visits which are devided in 3 study books: Book 1: Screening (+Baseline), Day 2, Week 1, Week 2 , Week 3 , Week 4, Week 5, Week 6, Week 7, Week 8 Book 2: Week 12, Week 24, Week 36, Week 48, Week 52, Follow-up Book 3: Early withdrawal and Follow-up Each follow-up Visit takes place 7 +/- 3 days after last dose This document contains the Study Medication Record and Dose reduction form. Study Medication Record has to be filled in for Day 2, Week 1-52 and for early withdrawal. Dose reduction ha to be filled in for Week 1-48.

Stichworte

  1. 13.03.19 13.03.19 -
Rechteinhaber

GlaxoSmithKline

Hochgeladen am

13. März 2019

DOI

Für eine Beantragung loggen Sie sich ein.

Lizenz

Creative Commons BY-NC 3.0

Modell Kommentare :

Hier können Sie das Modell kommentieren. Über die Sprechblasen an den Itemgruppen und Items können Sie diese spezifisch kommentieren.

Itemgroup Kommentare für :

Item Kommentare für :

Um Formulare herunterzuladen müssen Sie angemeldet sein. Bitte loggen Sie sich ein oder registrieren Sie sich kostenlos.

Long-Term Safety of Ropinirole in Subjects Suffering from Restless Legs Syndrome (RLS), 101468/192

Study Medication Record, Dose reduction

Administrative data
Beschreibung

Administrative data

Alias
UMLS CUI-1
C1320722
Centre Number
Beschreibung

Centre Number

Datentyp

text

Alias
UMLS CUI [1,1]
C0600091
UMLS CUI [1,2]
C0019994
Patient Number
Beschreibung

Patient Number

Datentyp

text

Alias
UMLS CUI [1]
C2348585
Patient Initials
Beschreibung

Patient Initials

Datentyp

text

Alias
UMLS CUI [1]
C2986440
Visit Date
Beschreibung

day month year

Datentyp

date

Alias
UMLS CUI [1]
C1320303
Visit Type
Beschreibung

Visit Type

Datentyp

integer

Alias
UMLS CUI [1,1]
C0545082
UMLS CUI [1,2]
C0332307
Study Medication Record
Beschreibung

Study Medication Record

Alias
UMLS CUI-1
C2734539
UMLS CUI-2
C0008972
Please complete the study medication record in the Study Medication and Compliance Section
Beschreibung

Study Medication Record

Datentyp

boolean

Alias
UMLS CUI [1,1]
C2734539
UMLS CUI [1,2]
C0008972
Dose Reduction Between Scheduled Visits
Beschreibung

Dose Reduction Between Scheduled Visits

Alias
UMLS CUI-1
C1707814
If the patient requires a dose reduction between this and the next visit please complete Dose Reductions Due To Adverse Experiences pages
Beschreibung

Dose reduction

Datentyp

boolean

Alias
UMLS CUI [1]
C1707814

Ähnliche Modelle

Study Medication Record, Dose reduction

Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Administrative data
C1320722 (UMLS CUI-1)
Centre Number
Item
Centre Number
text
C0600091 (UMLS CUI [1,1])
C0019994 (UMLS CUI [1,2])
Patient Number
Item
Patient Number
text
C2348585 (UMLS CUI [1])
Patient Initials
Item
Patient Initials
text
C2986440 (UMLS CUI [1])
Visit Date
Item
Visit Date
date
C1320303 (UMLS CUI [1])
Item
Visit Type
integer
C0545082 (UMLS CUI [1,1])
C0332307 (UMLS CUI [1,2])
Code List
Visit Type
CL Item
Day 2 (1)
CL Item
Week 1 (2)
CL Item
Week 2  (3)
CL Item
Week 3  (4)
CL Item
Week 4 (5)
CL Item
Week 5 (6)
CL Item
Week 6 (7)
CL Item
Week 7 (8)
CL Item
Week 8  (9)
CL Item
Week 12 (10)
CL Item
Week 24 (11)
CL Item
Week 36 (12)
CL Item
Week 48 (13)
CL Item
Week 52 (14)
CL Item
Early withdrawal (15)
Item Group
Study Medication Record
C2734539 (UMLS CUI-1)
C0008972 (UMLS CUI-2)
Study Medication Record
Item
Please complete the study medication record in the Study Medication and Compliance Section
boolean
C2734539 (UMLS CUI [1,1])
C0008972 (UMLS CUI [1,2])
Item Group
Dose Reduction Between Scheduled Visits
C1707814 (UMLS CUI-1)
Dose reduction
Item
If the patient requires a dose reduction between this and the next visit please complete Dose Reductions Due To Adverse Experiences pages
boolean
C1707814 (UMLS CUI [1])

Benutzen Sie dieses Formular für Rückmeldungen, Fragen und Verbesserungsvorschläge.

Mit * gekennzeichnete Felder sind notwendig.

Benötigen Sie Hilfe bei der Suche? Um mehr Details zu erfahren und die Suche effektiver nutzen zu können schauen Sie sich doch das entsprechende Video auf unserer Tutorial Seite an.

Zum Video