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Study Drug Dosing and Treatment Assignment

1 Formulär  
Administrative data
Beskrivning

Administrative data

Alias
UMLS CUI-1
C1320722
Country No.
Beskrivning

Country No.

Datatyp

integer

Alias
UMLS CUI [1,1]
C0454664
UMLS CUI [1,2]
C0600091
Centre No.
Beskrivning

Centre No.

Datatyp

integer

Alias
UMLS CUI [1,1]
C1301943
UMLS CUI [1,2]
C0600091
Subject No.
Beskrivning

Clinical Trial Subject Unique Identifier

Datatyp

integer

Alias
UMLS CUI [1]
C2348585
Subject Initials
Beskrivning

Subject Initials

Datatyp

text

Alias
UMLS CUI [1,1]
C1997894
UMLS CUI [1,2]
C2986440
Date of Visit
Beskrivning

Date of Visit

Datatyp

date

Alias
UMLS CUI [1]
C1320303
Study Drug Dosing
Beskrivning

Study Drug Dosing

Alias
UMLS CUI-1
C0678766
UMLS CUI-2
C0304229
Was study drug given?
Beskrivning

If no, specify reason

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0304229
UMLS CUI [1,2]
C1533734
Specify reason study drug not given
Beskrivning

if applicable

Datatyp

text

Alias
UMLS CUI [1,1]
C1521902
UMLS CUI [1,2]
C0566251
UMLS CUI [1,3]
C0304229
UMLS CUI [1,4]
C1533734
UMLS CUI [1,5]
C1272696
Study Drug Dosing - per Day
Beskrivning

Study Drug Dosing - per Day

Alias
UMLS CUI-1
C0678766
UMLS CUI-2
C0304229
UMLS CUI-3
C2826182
Study Day
Beskrivning

Fill in entire itemgroup for each Day. Note: Day 1 = day of anesthesia induction The first post-operative dose will be 6 hours following surgical closure provided that hemostasis is achieved.Timing of the first post-operative injection of study drug requires strict adherence in patients ≥ 75years, and/or with a body weight < 50 kg and/or a creatinine clearance (cockroft formula) < 50 mLper minute. In these patients the first injection of study drug should be more than 6 hours after surgical closure.The first injection must be performed at least 4 hours after removing of indwelling intrathecal or epidural catheter.The second study drug injection will be 16 to 28 hours after the first injection.The third injection and the following will be once daily at 8:00 a.m. ±2.

Datatyp

integer

Alias
UMLS CUI [1]
C2826182
Dosing of study drug not done?
Beskrivning

If no, give date/time of dose in next item; if yes, specify reason

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0304229
UMLS CUI [1,2]
C0678766
UMLS CUI [1,3]
C1272696
Date and Time of Dosing
Beskrivning

Select either "Not done" in previous item or give date/time of dose. The first post-operative dose will be 6 hours following surgical closure provided that hemostasis is achieved.Timing of the first post-operative injection of study drug requires strict adherence in patients ≥ 75years, and/or with a body weight < 50 kg and/or a creatinine clearance (cockroft formula) < 50 mLper minute. In these patients the first injection of study drug should be more than 6 hours after surgical closure.The first injection must be performed at least 4 hours after removing of indwelling intrathecal or epidural catheter.The second study drug injection will be 16 to 28 hours after the first injection.The third injection and the following will be once daily at 8:00 a.m. ±2.

Datatyp

datetime

Alias
UMLS CUI [1,1]
C1264639
UMLS CUI [1,2]
C0678766
UMLS CUI [1,3]
C0304229
Treatment Number
Beskrivning

Must be completed only once, but, in case of error in treatment allocation, it must be recorded for each Day.

Datatyp

integer

Alias
UMLS CUI [1]
C1522541
Indicate reason if dosing not done or outside time window
Beskrivning

Reason dosing not done or outside requested time

Datatyp

text

Alias
UMLS CUI [1,1]
C0566251
UMLS CUI [1,2]
C0304229
UMLS CUI [1,3]
C0678766
UMLS CUI [1,4]
C1272696
UMLS CUI [2,1]
C0566251
UMLS CUI [2,2]
C0304229
UMLS CUI [2,3]
C0678766
UMLS CUI [2,4]
C3242146
Treatment Assignment
Beskrivning

Treatment Assignment

Alias
UMLS CUI-1
C1522541
Date of randomization
Beskrivning

Date of randomization

Datatyp

date

Alias
UMLS CUI [1,1]
C0034656
UMLS CUI [1,2]
C0011008
Local time of randomization
Beskrivning

Time of randomization

Datatyp

time

Alias
UMLS CUI [1,1]
C0034656
UMLS CUI [1,2]
C0040223
Treatment Number
Beskrivning

Treatment Number

Datatyp

integer

Alias
UMLS CUI [1]
C1522541
Place Drug Label Here
Beskrivning

Drug Label

Datatyp

text

Alias
UMLS CUI [1]
C0013191
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Similar models

Study Drug Dosing and Treatment Assignment

1 Formulär
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
Administrative data
C1320722 (UMLS CUI-1)
Country No.
Item
Country No.
integer
C0454664 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
Centre No.
Item
Centre No.
integer
C1301943 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
Clinical Trial Subject Unique Identifier
Item
Subject No.
integer
C2348585 (UMLS CUI [1])
Subject Initials
Item
Subject Initials
text
C1997894 (UMLS CUI [1,1])
C2986440 (UMLS CUI [1,2])
Date of Visit
Item
Date of Visit
date
C1320303 (UMLS CUI [1])
Item Group
Study Drug Dosing
C0678766 (UMLS CUI-1)
C0304229 (UMLS CUI-2)
Study drug given?
Item
Was study drug given?
boolean
C0304229 (UMLS CUI [1,1])
C1533734 (UMLS CUI [1,2])
Specify reason study drug not given
Item
Specify reason study drug not given
text
C1521902 (UMLS CUI [1,1])
C0566251 (UMLS CUI [1,2])
C0304229 (UMLS CUI [1,3])
C1533734 (UMLS CUI [1,4])
C1272696 (UMLS CUI [1,5])
Item Group
Study Drug Dosing - per Day
C0678766 (UMLS CUI-1)
C0304229 (UMLS CUI-2)
C2826182 (UMLS CUI-3)
Item
Study Day
integer
C2826182 (UMLS CUI [1])
Study Day
Code List
Study Day
CL Item
Day 1 (Post Op) (1)
CL Item
Day 2 (2)
CL Item
Day 3 (3)
CL Item
Day 4 (4)
CL Item
Day 5 (5)
CL Item
Day 6 (6)
CL Item
Day 7 (7)
CL Item
Day 8 (8)
CL Item
Day 9 (9)
CL Item
Extra-Injection (10)
Dosing of study drug not done?
Item
Dosing of study drug not done?
boolean
C0304229 (UMLS CUI [1,1])
C0678766 (UMLS CUI [1,2])
C1272696 (UMLS CUI [1,3])
Date and Time of Dosing
Item
Date and Time of Dosing
datetime
C1264639 (UMLS CUI [1,1])
C0678766 (UMLS CUI [1,2])
C0304229 (UMLS CUI [1,3])
Treatment Number
Item
Treatment Number
integer
C1522541 (UMLS CUI [1])
Reason dosing not done or outside requested time
Item
Indicate reason if dosing not done or outside time window
text
C0566251 (UMLS CUI [1,1])
C0304229 (UMLS CUI [1,2])
C0678766 (UMLS CUI [1,3])
C1272696 (UMLS CUI [1,4])
C0566251 (UMLS CUI [2,1])
C0304229 (UMLS CUI [2,2])
C0678766 (UMLS CUI [2,3])
C3242146 (UMLS CUI [2,4])
Item Group
Treatment Assignment
C1522541 (UMLS CUI-1)
Date of randomization
Item
Date of randomization
date
C0034656 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Time of randomization
Item
Local time of randomization
time
C0034656 (UMLS CUI [1,1])
C0040223 (UMLS CUI [1,2])
Treatment Number
Item
Treatment Number
integer
C1522541 (UMLS CUI [1])
Drug Label
Item
Place Drug Label Here
text
C0013191 (UMLS CUI [1])
Tillbaka till toppen