ID

42947

Description

Rebif New Formulation (RNF) Quality of Life (QOL) Study; ODM derived from: https://clinicaltrials.gov/show/NCT00472797

Link

https://clinicaltrials.gov/show/NCT00472797

Keywords

Versions (2)
  1. 8/28/17 8/28/17 -
  2. 9/17/21 9/17/21 -
Uploaded on

September 17, 2021

DOI

To request one please log in.

License

Creative Commons BY 4.0
Model comments :

You can comment on the data model here. Via the speech bubbles at the itemgroups and items you can add comments to those specificially.

Back to model comments
Itemgroup comments for :

Item comments for :

In order to download data models you must be logged in. Please log in or register for free.

Eligibility Relapsing Multiple Sclerosis NCT00472797

English

Eligibility Relapsing Multiple Sclerosis NCT00472797

1 forms  
Inclusion Criteria
Description

Inclusion Criteria

Alias
UMLS CUI
C1512693
1. subject with a relapsing form of ms; diagnosis of ms is in accordance with the mcdonald criteria
Description

Multiple Sclerosis, Relapsing-Remitting

Data type

boolean

Alias
UMLS CUI [1]
C0751967
2. subject currently taking rebif 44mcg tiw, and has been on this treatment for at least 6 months (24 weeks) prior to study enrollment
Description

Rebif

Data type

boolean

Alias
UMLS CUI [1]
C0752980
3. subject currently using rebiject ii and 29 gauge needle
Description

REBIJECT II | Needle Gauge

Data type

boolean

Alias
UMLS CUI [1]
C3473277
UMLS CUI [2]
C3640175
4. subject is between 18 and 60 years old inclusive
Description

Age

Data type

boolean

Alias
UMLS CUI [1]
C0001779
5. subject is able to read and understand english
Description

Able to read English Language | Comprehension English Language

Data type

boolean

Alias
UMLS CUI [1,1]
C0586740
UMLS CUI [1,2]
C0376245
UMLS CUI [2,1]
C0233733
UMLS CUI [2,2]
C0376245
6. subject is willing to follow study procedures
Description

Protocol Compliance

Data type

boolean

Alias
UMLS CUI [1]
C0525058
7. subject has given written informed consent and signed hipaa
Description

Informed Consent

Data type

boolean

Alias
UMLS CUI [1]
C0021430
8. female subjects must not be either pregnant or breast-feeding and must lack childbearing potential, as defined by either: i) being post-menopausal or surgically sterile, or ii) using a hormonal contraceptive, intra-uterine device, diaphragm with spermicide, or condom with spermicide, for the duration of the study. (confirmation required within 30 days prior to start of the study)
Description

Gender | Pregnancy Absent | Breast Feeding Absent | Childbearing Potential Lacking | Postmenopausal state | Female Sterilization | Hormonal contraception | Intrauterine Devices | Vaginal contraceptive diaphragm | Vaginal Spermicides | Female Condoms

Data type

boolean

Alias
UMLS CUI [1]
C0079399
UMLS CUI [2,1]
C0032961
UMLS CUI [2,2]
C0332197
UMLS CUI [3,1]
C0006147
UMLS CUI [3,2]
C0332197
UMLS CUI [4,1]
C3831118
UMLS CUI [4,2]
C0332268
UMLS CUI [5]
C0232970
UMLS CUI [6]
C0015787
UMLS CUI [7]
C2985296
UMLS CUI [8]
C0021900
UMLS CUI [9]
C0042241
UMLS CUI [10]
C0087145
UMLS CUI [11]
C0221829
Exclusion Criteria
Description

Exclusion Criteria

Alias
UMLS CUI
C0680251
1. use of any other injectable medications on a regular basis during the week prior to the screening period or during the screening or treatment periods. receiving a single injection for treatment or prophylaxis of a condition unrelated to the subject's multiple sclerosis or the subject's rebif® therapy (e.g., receiving a influenza or pneumococcus vaccination) is acceptable
Description

Injectables | Influenza vaccination Acceptable | Pneumococcal immunisation Acceptable

Data type

boolean

Alias
UMLS CUI [1]
C0086466
UMLS CUI [2,1]
C0042200
UMLS CUI [2,2]
C1879533
UMLS CUI [3,1]
C2082604
UMLS CUI [3,2]
C1879533
2. subject receiving ms therapy in addition (i.e., combination therapy) to rebif® within 3 months prior to study enrollment or at any time during study protocol.
Description

Combined Modality Therapy Multiple Sclerosis | Rebif

Data type

boolean

Alias
UMLS CUI [1,1]
C0009429
UMLS CUI [1,2]
C0026769
UMLS CUI [2]
C0752980
3. subjects who have previously been on rebif new formulation (rnf).
Description

Rebif Formulation New

Data type

boolean

Alias
UMLS CUI [1,1]
C0752980
UMLS CUI [1,2]
C0524527
UMLS CUI [1,3]
C0205314
4. subject with progressive forms of multiple sclerosis (ms).
Description

Progressive multiple sclerosis

Data type

boolean

Alias
UMLS CUI [1]
C0393665
5. subject with history of any chronic pain syndrome.
Description

Chronic pain syndrome

Data type

boolean

Alias
UMLS CUI [1]
C1298685
6. subject has any other disease apart from ms that could better explain the subjects signs and symptoms.
Description

Disease Explanation Signs and Symptoms

Data type

boolean

Alias
UMLS CUI [1,1]
C0012634
UMLS CUI [1,2]
C0681841
UMLS CUI [1,3]
C0037088
7. subject has complete transverse myelitis or bilateral optic neuritis.
Description

Complete Transverse Myelitis | Bilateral optic neuritis

Data type

boolean

Alias
UMLS CUI [1,1]
C0026976
UMLS CUI [1,2]
C0205197
UMLS CUI [2]
C0861152
8. subjects that use any investigational drug or experimental procedure within 12 weeks of visit 1.
Description

Investigational New Drugs | Therapy, Investigational

Data type

boolean

Alias
UMLS CUI [1]
C0013230
UMLS CUI [2]
C0949266
9. subject received oral or systemic corticosteroids or acth within 30 days of visit 1 (prior to enrollment).
Description

Adrenal Cortex Hormones Oral | CORTICOSTEROIDS FOR SYSTEMIC USE | Corticotropin

Data type

boolean

Alias
UMLS CUI [1,1]
C0001617
UMLS CUI [1,2]
C1527415
UMLS CUI [2]
C3653708
UMLS CUI [3]
C0001655
10. subject has inadequate liver function, defined by a total bilirubin, aspartate aminotransferase (ast) or alanine aminotransferase (alt) or alkaline phosphatase > 2.5 times the upper limit of the normal values.
Description

Liver Dysfunction | Elevated total bilirubin | Aspartate aminotransferase increased | Alanine aminotransferase increased | Alkaline phosphatase raised

Data type

boolean

Alias
UMLS CUI [1]
C0086565
UMLS CUI [2]
C0741494
UMLS CUI [3]
C0151904
UMLS CUI [4]
C0151905
UMLS CUI [5]
C0151849
11. subject has inadequate bone marrow reserve, defined as a white blood cell count less than 0.5 x lower limit of normal.
Description

Few mature neutrophils in the bone marrow | White blood cell count decreased

Data type

boolean

Alias
UMLS CUI [1]
C2748959
UMLS CUI [2]
C0750394
12. subject suffers from other current autoimmune disease.
Description

Autoimmune Diseases

Data type

boolean

Alias
UMLS CUI [1]
C0004364
13. subject suffers from major medical or psychiatric illness that in the opinion of the investigator creates undue risk to the subject or could affect compliance with the study protocol
Description

Illness Major At risk Patient | Mental disorders Major At risk Patient | Illness Major Affecting Protocol Compliance | Mental disorders Major Affecting Protocol Compliance

Data type

boolean

Alias
UMLS CUI [1,1]
C0221423
UMLS CUI [1,2]
C0205164
UMLS CUI [1,3]
C1444641
UMLS CUI [1,4]
C0030705
UMLS CUI [2,1]
C0004936
UMLS CUI [2,2]
C0205164
UMLS CUI [2,3]
C1444641
UMLS CUI [2,4]
C0030705
UMLS CUI [3,1]
C0221423
UMLS CUI [3,2]
C0205164
UMLS CUI [3,3]
C0392760
UMLS CUI [3,4]
C0525058
UMLS CUI [4,1]
C0004936
UMLS CUI [4,2]
C0205164
UMLS CUI [4,3]
C0392760
UMLS CUI [4,4]
C0525058
14. subject is pregnant or attempting to conceive
Description

Pregnancy | Pregnancy, Planned

Data type

boolean

Alias
UMLS CUI [1]
C0032961
UMLS CUI [2]
C0032992
15. visual or physical impairment that precludes completion of diaries and questionnaires.
Description

Visual Impairment Excludes Subject Diary Completion | Physical impairment Excludes Subject Diary Completion | Visual Impairment Excludes Questionnaires Completion | Physical impairment Excludes Questionnaires Completion

Data type

boolean

Alias
UMLS CUI [1,1]
C3665347
UMLS CUI [1,2]
C0332196
UMLS CUI [1,3]
C3890583
UMLS CUI [1,4]
C0205197
UMLS CUI [2,1]
C0231171
UMLS CUI [2,2]
C0332196
UMLS CUI [2,3]
C3890583
UMLS CUI [2,4]
C0205197
UMLS CUI [3,1]
C3665347
UMLS CUI [3,2]
C0332196
UMLS CUI [3,3]
C0034394
UMLS CUI [3,4]
C0205197
UMLS CUI [4,1]
C0231171
UMLS CUI [4,2]
C0332196
UMLS CUI [4,3]
C0034394
UMLS CUI [4,4]
C0205197
Back to the top of the page

Similar models

Eligibility Relapsing Multiple Sclerosis NCT00472797

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
C1512693 (UMLS CUI)
Multiple Sclerosis, Relapsing-Remitting
Item
1. subject with a relapsing form of ms; diagnosis of ms is in accordance with the mcdonald criteria
boolean
C0751967 (UMLS CUI [1])
Rebif
Item
2. subject currently taking rebif 44mcg tiw, and has been on this treatment for at least 6 months (24 weeks) prior to study enrollment
boolean
C0752980 (UMLS CUI [1])
REBIJECT II | Needle Gauge
Item
3. subject currently using rebiject ii and 29 gauge needle
boolean
C3473277 (UMLS CUI [1])
C3640175 (UMLS CUI [2])
Age
Item
4. subject is between 18 and 60 years old inclusive
boolean
C0001779 (UMLS CUI [1])
Able to read English Language | Comprehension English Language
Item
5. subject is able to read and understand english
boolean
C0586740 (UMLS CUI [1,1])
C0376245 (UMLS CUI [1,2])
C0233733 (UMLS CUI [2,1])
C0376245 (UMLS CUI [2,2])
Protocol Compliance
Item
6. subject is willing to follow study procedures
boolean
C0525058 (UMLS CUI [1])
Informed Consent
Item
7. subject has given written informed consent and signed hipaa
boolean
C0021430 (UMLS CUI [1])
Gender | Pregnancy Absent | Breast Feeding Absent | Childbearing Potential Lacking | Postmenopausal state | Female Sterilization | Hormonal contraception | Intrauterine Devices | Vaginal contraceptive diaphragm | Vaginal Spermicides | Female Condoms
Item
8. female subjects must not be either pregnant or breast-feeding and must lack childbearing potential, as defined by either: i) being post-menopausal or surgically sterile, or ii) using a hormonal contraceptive, intra-uterine device, diaphragm with spermicide, or condom with spermicide, for the duration of the study. (confirmation required within 30 days prior to start of the study)
boolean
C0079399 (UMLS CUI [1])
C0032961 (UMLS CUI [2,1])
C0332197 (UMLS CUI [2,2])
C0006147 (UMLS CUI [3,1])
C0332197 (UMLS CUI [3,2])
C3831118 (UMLS CUI [4,1])
C0332268 (UMLS CUI [4,2])
C0232970 (UMLS CUI [5])
C0015787 (UMLS CUI [6])
C2985296 (UMLS CUI [7])
C0021900 (UMLS CUI [8])
C0042241 (UMLS CUI [9])
C0087145 (UMLS CUI [10])
C0221829 (UMLS CUI [11])
Item Group
C0680251 (UMLS CUI)
Injectables | Influenza vaccination Acceptable | Pneumococcal immunisation Acceptable
Item
1. use of any other injectable medications on a regular basis during the week prior to the screening period or during the screening or treatment periods. receiving a single injection for treatment or prophylaxis of a condition unrelated to the subject's multiple sclerosis or the subject's rebif® therapy (e.g., receiving a influenza or pneumococcus vaccination) is acceptable
boolean
C0086466 (UMLS CUI [1])
C0042200 (UMLS CUI [2,1])
C1879533 (UMLS CUI [2,2])
C2082604 (UMLS CUI [3,1])
C1879533 (UMLS CUI [3,2])
Combined Modality Therapy Multiple Sclerosis | Rebif
Item
2. subject receiving ms therapy in addition (i.e., combination therapy) to rebif® within 3 months prior to study enrollment or at any time during study protocol.
boolean
C0009429 (UMLS CUI [1,1])
C0026769 (UMLS CUI [1,2])
C0752980 (UMLS CUI [2])
Rebif Formulation New
Item
3. subjects who have previously been on rebif new formulation (rnf).
boolean
C0752980 (UMLS CUI [1,1])
C0524527 (UMLS CUI [1,2])
C0205314 (UMLS CUI [1,3])
Progressive multiple sclerosis
Item
4. subject with progressive forms of multiple sclerosis (ms).
boolean
C0393665 (UMLS CUI [1])
Chronic pain syndrome
Item
5. subject with history of any chronic pain syndrome.
boolean
C1298685 (UMLS CUI [1])
Disease Explanation Signs and Symptoms
Item
6. subject has any other disease apart from ms that could better explain the subjects signs and symptoms.
boolean
C0012634 (UMLS CUI [1,1])
C0681841 (UMLS CUI [1,2])
C0037088 (UMLS CUI [1,3])
Complete Transverse Myelitis | Bilateral optic neuritis
Item
7. subject has complete transverse myelitis or bilateral optic neuritis.
boolean
C0026976 (UMLS CUI [1,1])
C0205197 (UMLS CUI [1,2])
C0861152 (UMLS CUI [2])
Investigational New Drugs | Therapy, Investigational
Item
8. subjects that use any investigational drug or experimental procedure within 12 weeks of visit 1.
boolean
C0013230 (UMLS CUI [1])
C0949266 (UMLS CUI [2])
Adrenal Cortex Hormones Oral | CORTICOSTEROIDS FOR SYSTEMIC USE | Corticotropin
Item
9. subject received oral or systemic corticosteroids or acth within 30 days of visit 1 (prior to enrollment).
boolean
C0001617 (UMLS CUI [1,1])
C1527415 (UMLS CUI [1,2])
C3653708 (UMLS CUI [2])
C0001655 (UMLS CUI [3])
Liver Dysfunction | Elevated total bilirubin | Aspartate aminotransferase increased | Alanine aminotransferase increased | Alkaline phosphatase raised
Item
10. subject has inadequate liver function, defined by a total bilirubin, aspartate aminotransferase (ast) or alanine aminotransferase (alt) or alkaline phosphatase > 2.5 times the upper limit of the normal values.
boolean
C0086565 (UMLS CUI [1])
C0741494 (UMLS CUI [2])
C0151904 (UMLS CUI [3])
C0151905 (UMLS CUI [4])
C0151849 (UMLS CUI [5])
Few mature neutrophils in the bone marrow | White blood cell count decreased
Item
11. subject has inadequate bone marrow reserve, defined as a white blood cell count less than 0.5 x lower limit of normal.
boolean
C2748959 (UMLS CUI [1])
C0750394 (UMLS CUI [2])
Autoimmune Diseases
Item
12. subject suffers from other current autoimmune disease.
boolean
C0004364 (UMLS CUI [1])
Illness Major At risk Patient | Mental disorders Major At risk Patient | Illness Major Affecting Protocol Compliance | Mental disorders Major Affecting Protocol Compliance
Item
13. subject suffers from major medical or psychiatric illness that in the opinion of the investigator creates undue risk to the subject or could affect compliance with the study protocol
boolean
C0221423 (UMLS CUI [1,1])
C0205164 (UMLS CUI [1,2])
C1444641 (UMLS CUI [1,3])
C0030705 (UMLS CUI [1,4])
C0004936 (UMLS CUI [2,1])
C0205164 (UMLS CUI [2,2])
C1444641 (UMLS CUI [2,3])
C0030705 (UMLS CUI [2,4])
C0221423 (UMLS CUI [3,1])
C0205164 (UMLS CUI [3,2])
C0392760 (UMLS CUI [3,3])
C0525058 (UMLS CUI [3,4])
C0004936 (UMLS CUI [4,1])
C0205164 (UMLS CUI [4,2])
C0392760 (UMLS CUI [4,3])
C0525058 (UMLS CUI [4,4])
Pregnancy | Pregnancy, Planned
Item
14. subject is pregnant or attempting to conceive
boolean
C0032961 (UMLS CUI [1])
C0032992 (UMLS CUI [2])
Visual Impairment Excludes Subject Diary Completion | Physical impairment Excludes Subject Diary Completion | Visual Impairment Excludes Questionnaires Completion | Physical impairment Excludes Questionnaires Completion
Item
15. visual or physical impairment that precludes completion of diaries and questionnaires.
boolean
C3665347 (UMLS CUI [1,1])
C0332196 (UMLS CUI [1,2])
C3890583 (UMLS CUI [1,3])
C0205197 (UMLS CUI [1,4])
C0231171 (UMLS CUI [2,1])
C0332196 (UMLS CUI [2,2])
C3890583 (UMLS CUI [2,3])
C0205197 (UMLS CUI [2,4])
C3665347 (UMLS CUI [3,1])
C0332196 (UMLS CUI [3,2])
C0034394 (UMLS CUI [3,3])
C0205197 (UMLS CUI [3,4])
C0231171 (UMLS CUI [4,1])
C0332196 (UMLS CUI [4,2])
C0034394 (UMLS CUI [4,3])
C0205197 (UMLS CUI [4,4])
Back to the top of the page 

Contact

Please use this form for feedback, questions and suggestions for improvements.

Fields marked with * are required.

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