ID

41757

Beskrivning

Study ID: 103096 Clinical Study ID: 103096 Study Title: A randomised, double blind, placebo controlled, incomplete block, five-way cross-over study to investigate the effect of one week repeat dosing of GW685698X and FP on twenty-four hour serum cortisol in healthy subjects. Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Sponsor: GlaxoSmithKline Phase: Phase 1 Study Recruitment Status: Completed Generic Name: Fluticasone Furoate;Fluticasone Propionate Trade Name: Fluticasone Furoate;Fluticasone Propionate Study Indication: Asthma

Nyckelord

  1. 2021-01-13 2021-01-13 -
Rättsinnehavare

GlaxoSmithKline

Uppladdad den

13 januari 2021

DOI

För en begäran logga in.

Licens

Creative Commons BY 4.0

Modellkommentarer :

Här kan du kommentera modellen. Med hjälp av pratbubblor i Item-grupperna och Item kan du lägga in specifika kommentarer.

Itemgroup-kommentar för :

Item-kommentar för :

Du måste vara inloggad för att kunna ladda ner formulär. Var vänlig logga in eller registrera dig utan kostnad.

Effect of one week repeat dosing of GW685698X and FP on serum cortisol (103096)

Running Logs and End of Study - Status of Treatment Blind; Pharmacogenetic Research; Concomitant Medications

Administrative
Beskrivning

Administrative

Alias
UMLS CUI-1
C1320722
Volunteer Identifier
Beskrivning

Volunteer Identifier

Datatyp

text

Alias
UMLS CUI [1,1]
C1300638
UMLS CUI [1,2]
C0020155
Subject Identifier
Beskrivning

Subject Identifier

Datatyp

text

Alias
UMLS CUI [1]
C2348585
Centre Number
Beskrivning

Centre Number

Datatyp

text

Alias
UMLS CUI [1,1]
C0600091
UMLS CUI [1,2]
C0019994
Status of Treatment Blind
Beskrivning

Status of Treatment Blind

Alias
UMLS CUI-1
C0749659
UMLS CUI-2
C2347038
Was the treatment blind broken during the study?
Beskrivning

Was the treatment blind broken during the study?

Datatyp

boolean

Alias
UMLS CUI [1]
C3897431
Date blind broken
Beskrivning

Date blind broken

Datatyp

date

Alias
UMLS CUI [1,1]
C3897431
UMLS CUI [1,2]
C0011008
Reason blind broken
Beskrivning

Check one Complete Non-Serious Adverse Events, Serious Adverse Event and/or Investigational Product pages, as appropriate.

Datatyp

integer

Alias
UMLS CUI [1,1]
C3897431
UMLS CUI [1,2]
C0392360
Specify other reason blind broken
Beskrivning

Specify other reason blind broken

Datatyp

text

Alias
UMLS CUI [1,1]
C3897431
UMLS CUI [1,2]
C0392360
UMLS CUI [1,3]
C0205394
UMLS CUI [1,4]
C2348235
Pharmacogenetic Research - Consent for PGx-Pharmacogenetic Research
Beskrivning

Pharmacogenetic Research - Consent for PGx-Pharmacogenetic Research

Alias
UMLS CUI-1
C0021430
UMLS CUI-2
C2347500
Has informed consent been obtained for PGx-Pharmacogenetic research?
Beskrivning

Has informed consent been obtained for PGx-Pharmacogenetic research?

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0021430
UMLS CUI [1,2]
C2347500
If yes, record the date informed consent obtained for PGx-Pharmacogenetic research
Beskrivning

If yes, record the date informed consent obtained for PGx-Pharmacogenetic research

Datatyp

date

Alias
UMLS CUI [1,1]
C2347500
UMLS CUI [1,2]
C0021430
UMLS CUI [1,3]
C0011008
If no informed consent obtained, check one reason
Beskrivning

If no informed consent obtained, check one reason

Datatyp

text

Alias
UMLS CUI [1,1]
C0392360
UMLS CUI [1,2]
C0021430
UMLS CUI [1,3]
C1882120
Specify other reason for informed consent not been obtained
Beskrivning

Specify other reason for informed consent not been obtained

Datatyp

text

Alias
UMLS CUI [1,1]
C0021430
UMLS CUI [1,2]
C1882120
UMLS CUI [2,1]
C0392360
UMLS CUI [2,2]
C0205394
UMLS CUI [2,3]
C2348235
Pharmacogenetic Research - Blood Sample Collection (DNA)
Beskrivning

Pharmacogenetic Research - Blood Sample Collection (DNA)

Alias
UMLS CUI-1
C0005834
UMLS CUI-2
C2347500
Has a blood sample been collected for pGx-pharmacogenetic research?
Beskrivning

Has a blood sample been collected for pGx-pharmacogenetic research?

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0005834
UMLS CUI [1,2]
C2347500
If yes, record the date sample taken
Beskrivning

If yes, record the date sample taken

Datatyp

date

Alias
UMLS CUI [1,1]
C2347500
UMLS CUI [1,2]
C0005834
UMLS CUI [1,3]
C0011008
Pharmacogenetic Research - Withdrawal of consent
Beskrivning

Pharmacogenetic Research - Withdrawal of consent

Alias
UMLS CUI-1
C2347500
UMLS CUI-2
C0021430
UMLS CUI-3
C2349954
Has subject withdrawn consent for PGx-Pharmacogenetic research?
Beskrivning

Has subject withdrawn consent for PGx-Pharmacogenetic research?

Datatyp

boolean

Alias
UMLS CUI [1,1]
C2347500
UMLS CUI [1,2]
C0021430
UMLS CUI [1,3]
C2349954
Pharmacogenetic Research - Blood Sample Destruction
Beskrivning

Pharmacogenetic Research - Blood Sample Destruction

Alias
UMLS CUI-1
C2347500
UMLS CUI-2
C1948029
UMLS CUI-3
C0178913
Has a request been made for sample destruction?
Beskrivning

Has a request been made for sample destruction?

Datatyp

boolean

Alias
UMLS CUI [1,1]
C1948029
UMLS CUI [1,2]
C0178913
UMLS CUI [1,3]
C1272683
If request for blood sample destruction has been made, check one reason
Beskrivning

If request for blood sample destruction has been made, check one reason

Datatyp

text

Alias
UMLS CUI [1,1]
C1948029
UMLS CUI [1,2]
C0178913
UMLS CUI [1,3]
C1272683
UMLS CUI [1,4]
C0392360
Specify other reason for request for blood sample destruction.
Beskrivning

Specify other reason for request for blood sample destruction.

Datatyp

text

Alias
UMLS CUI [1,1]
C1948029
UMLS CUI [1,2]
C0178913
UMLS CUI [1,3]
C1272683
UMLS CUI [2,1]
C0392360
UMLS CUI [2,2]
C0205394
UMLS CUI [3]
C2348235
Concomitant Medications
Beskrivning

Concomitant Medications

Alias
UMLS CUI-1
C2347852
Were any concomitant medications taken by the subject during the study?
Beskrivning

If yes, record each medication on a separate line using Trade Names where possible. If the medication is related to a Non-Serious Adverse Event or Serious Adverse Event, details should be expressed using the same terminology.

Datatyp

boolean

Alias
UMLS CUI [1]
C2347852
Concomitant Medications
Beskrivning

Concomitant Medications

Alias
UMLS CUI-1
C2347852
Drug Name
Beskrivning

Trade Name preferred

Datatyp

text

Alias
UMLS CUI [1]
C0013227
Medication Unit Dose
Beskrivning

Medication Unit Dose

Datatyp

float

Alias
UMLS CUI [1]
C2826646
Medication Units
Beskrivning

Medication Units

Datatyp

text

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C1519795
Medication Frequency
Beskrivning

Medication Frequency

Datatyp

text

Alias
UMLS CUI [1]
C3476109
Medication Route
Beskrivning

Medication Route

Datatyp

text

Alias
UMLS CUI [1]
C0013153
Reason for Medications
Beskrivning

Reason for Medications

Datatyp

text

Alias
UMLS CUI [1,1]
C3146298
UMLS CUI [1,2]
C2347852
Medication Start Date
Beskrivning

Medication Start Date

Datatyp

date

Alias
UMLS CUI [1]
C2826734
Medication Start Time
Beskrivning

Medication Start Time

Datatyp

time

Alias
UMLS CUI [1,1]
C2347852
UMLS CUI [1,2]
C1301880
Medication Taken Prior to Study?
Beskrivning

Medication Taken Prior to Study?

Datatyp

boolean

Alias
UMLS CUI [1]
C2826667
Medication Stop Date
Beskrivning

Medication Stop Date

Datatyp

date

Alias
UMLS CUI [1]
C2826744
Medication Stop Time
Beskrivning

Medication Stop Time

Datatyp

time

Alias
UMLS CUI [1]
C2826659
Ongoing Medication?
Beskrivning

Ongoing Medication?

Datatyp

boolean

Alias
UMLS CUI [1]
C2826666

Similar models

Running Logs and End of Study - Status of Treatment Blind; Pharmacogenetic Research; Concomitant Medications

Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
Administrative
C1320722 (UMLS CUI-1)
Volunteer Identifier
Item
Volunteer Identifier
text
C1300638 (UMLS CUI [1,1])
C0020155 (UMLS CUI [1,2])
Subject Identifier
Item
Subject Identifier
text
C2348585 (UMLS CUI [1])
Centre Number
Item
Centre Number
text
C0600091 (UMLS CUI [1,1])
C0019994 (UMLS CUI [1,2])
Item Group
Status of Treatment Blind
C0749659 (UMLS CUI-1)
C2347038 (UMLS CUI-2)
Was the treatment blind broken during the study?
Item
Was the treatment blind broken during the study?
boolean
C3897431 (UMLS CUI [1])
Date blind broken
Item
Date blind broken
date
C3897431 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item
Reason blind broken
integer
C3897431 (UMLS CUI [1,1])
C0392360 (UMLS CUI [1,2])
Code List
Reason blind broken
CL Item
Medical emergency requiring identification of investigational product for further treatment (1)
CL Item
Other, specify (2)
Specify other reason blind broken
Item
Specify other reason blind broken
text
C3897431 (UMLS CUI [1,1])
C0392360 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
C2348235 (UMLS CUI [1,4])
Item Group
Pharmacogenetic Research - Consent for PGx-Pharmacogenetic Research
C0021430 (UMLS CUI-1)
C2347500 (UMLS CUI-2)
Has informed consent been obtained for PGx-Pharmacogenetic research?
Item
Has informed consent been obtained for PGx-Pharmacogenetic research?
boolean
C0021430 (UMLS CUI [1,1])
C2347500 (UMLS CUI [1,2])
If yes, record the date informed consent obtained for PGx-Pharmacogenetic research
Item
If yes, record the date informed consent obtained for PGx-Pharmacogenetic research
date
C2347500 (UMLS CUI [1,1])
C0021430 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
Item
If no informed consent obtained, check one reason
text
C0392360 (UMLS CUI [1,1])
C0021430 (UMLS CUI [1,2])
C1882120 (UMLS CUI [1,3])
Code List
If no informed consent obtained, check one reason
CL Item
Subject declined (1)
CL Item
Subject not asked by Investigator (2)
CL Item
Other, specify (Z)
Specify other reason for informed consent not been obtained
Item
Specify other reason for informed consent not been obtained
text
C0021430 (UMLS CUI [1,1])
C1882120 (UMLS CUI [1,2])
C0392360 (UMLS CUI [2,1])
C0205394 (UMLS CUI [2,2])
C2348235 (UMLS CUI [2,3])
Item Group
Pharmacogenetic Research - Blood Sample Collection (DNA)
C0005834 (UMLS CUI-1)
C2347500 (UMLS CUI-2)
Has a blood sample been collected for pGx-pharmacogenetic research?
Item
Has a blood sample been collected for pGx-pharmacogenetic research?
boolean
C0005834 (UMLS CUI [1,1])
C2347500 (UMLS CUI [1,2])
If yes, record the date sample taken
Item
If yes, record the date sample taken
date
C2347500 (UMLS CUI [1,1])
C0005834 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
Item Group
Pharmacogenetic Research - Withdrawal of consent
C2347500 (UMLS CUI-1)
C0021430 (UMLS CUI-2)
C2349954 (UMLS CUI-3)
Has subject withdrawn consent for PGx-Pharmacogenetic research?
Item
Has subject withdrawn consent for PGx-Pharmacogenetic research?
boolean
C2347500 (UMLS CUI [1,1])
C0021430 (UMLS CUI [1,2])
C2349954 (UMLS CUI [1,3])
Item Group
Pharmacogenetic Research - Blood Sample Destruction
C2347500 (UMLS CUI-1)
C1948029 (UMLS CUI-2)
C0178913 (UMLS CUI-3)
Has a request been made for sample destruction?
Item
Has a request been made for sample destruction?
boolean
C1948029 (UMLS CUI [1,1])
C0178913 (UMLS CUI [1,2])
C1272683 (UMLS CUI [1,3])
Item
If request for blood sample destruction has been made, check one reason
text
C1948029 (UMLS CUI [1,1])
C0178913 (UMLS CUI [1,2])
C1272683 (UMLS CUI [1,3])
C0392360 (UMLS CUI [1,4])
Code List
If request for blood sample destruction has been made, check one reason
CL Item
Subject requested (1)
CL Item
Other, specify (Z)
Specify other reason for request for blood sample destruction.
Item
Specify other reason for request for blood sample destruction.
text
C1948029 (UMLS CUI [1,1])
C0178913 (UMLS CUI [1,2])
C1272683 (UMLS CUI [1,3])
C0392360 (UMLS CUI [2,1])
C0205394 (UMLS CUI [2,2])
C2348235 (UMLS CUI [3])
Item Group
Concomitant Medications
C2347852 (UMLS CUI-1)
Were any concomitant medications taken by the subject during the study?
Item
Were any concomitant medications taken by the subject during the study?
boolean
C2347852 (UMLS CUI [1])
Item Group
Concomitant Medications
C2347852 (UMLS CUI-1)
Drug Name
Item
Drug Name
text
C0013227 (UMLS CUI [1])
Medication Unit Dose
Item
Medication Unit Dose
float
C2826646 (UMLS CUI [1])
Item
Medication Units
text
C0013227 (UMLS CUI [1,1])
C1519795 (UMLS CUI [1,2])
Code List
Medication Units
CL Item
Tablet (TAB)
CL Item
Microlitre (MCL)
CL Item
Mililitre (ML)
CL Item
Litre (L)
CL Item
Microgram (MCG)
CL Item
Miligram (MG)
CL Item
Gram (G)
Item
Medication Frequency
text
C3476109 (UMLS CUI [1])
Code List
Medication Frequency
CL Item
1 x Daily (OD/QD)
CL Item
2 x Daily (BID)
CL Item
3 x Daily (TID)
CL Item
4 x Daily (QID)
CL Item
As required (PRN)
CL Item
Single dose (ONCE)
Item
Medication Route
text
C0013153 (UMLS CUI [1])
Code List
Medication Route
CL Item
Intramuscular (IM)
CL Item
Inhalation (IH)
CL Item
Intravenous (IV)
CL Item
Nasal (NS)
CL Item
Topical (TP)
CL Item
Oral (PO)
CL Item
Vaginal (VG)
Reason for Medications
Item
Reason for Medications
text
C3146298 (UMLS CUI [1,1])
C2347852 (UMLS CUI [1,2])
Medication Start Date
Item
Medication Start Date
date
C2826734 (UMLS CUI [1])
Medication Start Time
Item
Medication Start Time
time
C2347852 (UMLS CUI [1,1])
C1301880 (UMLS CUI [1,2])
Medication Taken Prior to Study?
Item
Medication Taken Prior to Study?
boolean
C2826667 (UMLS CUI [1])
Medication Stop Date
Item
Medication Stop Date
date
C2826744 (UMLS CUI [1])
Medication Stop Time
Item
Medication Stop Time
time
C2826659 (UMLS CUI [1])
Ongoing Medication?
Item
Ongoing Medication?
boolean
C2826666 (UMLS CUI [1])

Använd detta formulär för feedback, frågor och förslag på förbättringar.

Fält markerade med * är obligatoriska.

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