Information:
Fel:
ID
44607
Beskrivning
Study part: Visit V5 (Day 140 + - 14). Effectiveness and tolerance of sublingual desensitization with LAIS grass tablets in Patients with an allergic rhinoconjunctivitis caused by grass pollen. A prospective, multi-center, doubleblind, randomized, placebo-controlled Phase III study. Principal Investigator Prof. Dr. med. Ralph Mösges.
Nyckelord
Versioner (2)
- 2016-01-28 2016-01-28 -
- 2021-09-27 2021-09-27 -
Uppladdad den
27 september 2021
DOI
För en begäran logga in.
Licens
Creative Commons BY-NC 3.0
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.
Visit V5_LAIS grass tablets by allergic rhinoconjunctivitis_EudraCT-Nr.2012-004916-79
Similar models
Visit V5 (Day 140 + - 14)
- StudyEvent: ODM
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
date
Item
Date of visit
date
C0011008 (UMLS CUI [1])
Item
Does the patient still take part in the study?
text
C2348568 (UMLS CUI [1])
CL Item
yes (1)
CL Item
no, please then fill up the form "Study completion" (2)
Item
Did the patient take the medication according to the protocol?
text
C1321605 (UMLS CUI [1])
CL Item
always (1)
CL Item
mostly yes (2)
CL Item
mostly no (3)
CL Item
no (4)
details compliance
Item
If the compliance was not always, please mention in detail
text
C0392360 (UMLS CUI [1,1])
C1321605 (UMLS CUI [1,2])
C1321605 (UMLS CUI [1,2])
Comorbidity
Item
Comorbidity? Please fill up the form "Documentation adverse event"
boolean
Concomitant medication
Item
Concomitant medication? Please use the form "Documentation Concomitant medication"
boolean
C2347852 (UMLS CUI [1])
Date
Item
Date for next visit 6 (Day 196 + - 14 days)
date
C0011008 (UMLS CUI [1])
adverse event
Item
Did an adverse event occur during the treatment? (If yes, please use the form "Documentation adverse event")
boolean
C0877248 (UMLS CUI [1])
serious adverse event
Item
Did a serious adverse event occur during the treatment? (If yes, please use the form "Documentation serious adverse events")
boolean
C1519255 (UMLS CUI [1])
adverse event
Item
Are there any undocumented adverse events, which were not recorded during the previous visit? (If yes, please use the form "Documentation adverse event")
boolean
C0877248 (UMLS CUI [1])
Patient diary
Item
Patient diary (part 1) handed out?
boolean
C3890583 (UMLS CUI [1])
Quality of life; Rhinoconjunctivitis
Item
Did the patient fill up the documentation form on quality of life of rhinoconjunctivitis patients?
text
C0034380 (UMLS CUI [1])
C0861155 (UMLS CUI [2])
C0861155 (UMLS CUI [2])
Weight
Item
Weight
float
C0005910 (UMLS CUI [1])
systolic blood pressure
Item
Systolic blood pressure
integer
C0871470 (UMLS CUI [1])
Diastolic blood pressure
Item
Diastolic blood pressure
integer
C0428883 (UMLS CUI [1])
heart rate
Item
Heart rate
integer
C0018810 (UMLS CUI [1])
Item Group
Examination (Rhinoscope)
C0582103 (UMLS CUI-1)
C0183044 (UMLS CUI-2)
C0183044 (UMLS CUI-2)
CL Item
no (1)
CL Item
slight (2)
CL Item
medium (3)
CL Item
strong (4)
CL Item
no (1)
CL Item
slight (2)
CL Item
medium (3)
CL Item
strong (4)
CL Item
no (1)
CL Item
slight (2)
CL Item
medium (3)
CL Item
strong (4)
Item Group
Spirometry or Peak expiratory flow measurement (For asthmatics)
C0037981 (UMLS CUI-1)
C0521299 (UMLS CUI-3)
C0521299 (UMLS CUI-3)
FEV1
Item
FEV1 (age-appropriate standard value)
float
C0748133 (UMLS CUI [1])
FEV1
Item
FEV1
float
C0748133 (UMLS CUI [1])
Ratio; FEV1; standard value
Item
FEV1/ Standard value (If FEV1 < 70% of age appropriate standard value, exclusion)
integer
C0456603 (UMLS CUI [1])
C0588029 (UMLS CUI [2])
C1442989 (UMLS CUI [3])
C0588029 (UMLS CUI [2])
C1442989 (UMLS CUI [3])
Peak expiratory flow measurement
Item
PEF 1
integer
C0521299 (UMLS CUI [1])
Peak expiratory flow measurement
Item
PEF 2
integer
C0521299 (UMLS CUI [1])
Peak expiratory flow measurement
Item
PEF 3
integer
C0521299 (UMLS CUI [1])
Peak expiratory flow measurement
Item
Best PEF
integer
C0521299 (UMLS CUI [1])
Peak expiratory flow measurement
Item
Optimum individual value PEF (If FEV1 < 70% of optimum individual value, exclusion)
integer
C0521299 (UMLS CUI [1])
Item Group
Study medication and Concomitant medication (Taking back of the third study medication box with 8 blister pack)
C0013227 (UMLS CUI-1)
medication study
Item
Number of tablets left (study medication)
integer
C0013227 (UMLS CUI [1,1])
C0008972 (UMLS CUI [1,2])
C0008972 (UMLS CUI [1,2])
medication Demand
Item
Number of tablets left (Loratadin)
integer
C0013227 (UMLS CUI [1,1])
C0441516 (UMLS CUI [1,2])
C0441516 (UMLS CUI [1,2])
details
Item
Mention, if incomplete
text
C1522508 (UMLS CUI [1])
date blood collection
Item
Blood collection on
date
C0011008 (UMLS CUI [1,1])
C0005834 (UMLS CUI [1,2])
C0005834 (UMLS CUI [1,2])
diagnostic allergy
Item
Ig G4 Gräser
float
C0086143 (UMLS CUI [1,1])
C0020517 (UMLS CUI [1,2])
C0020517 (UMLS CUI [1,2])
Hemoglobin
Item
Hemoglobin
float
C0019046 (UMLS CUI [1])
hematocrit
Item
Hematocrit
float
C0518014 (UMLS CUI [1])
Erythrocyte
Item
Erythrocyte
float
C0014772 (UMLS CUI [1])
Thrombocyte
Item
Thrombocyte
float
C0005821 (UMLS CUI [1])
Leucocyte
Item
Leucocyte (total)
float
C0023508 (UMLS CUI [1])
Bilirubin
Item
Bilirubin (total)
float
C1278039 (UMLS CUI [1])
Glutamate pyruvate transaminase
Item
SGPT- Serum Glutamate pyruvate transaminase
float
C0376147 (UMLS CUI [1])
Alkaline phosphatase
Item
Alkaline phosphatase
float
C0201850 (UMLS CUI [1])
Glucose
Item
Glucose
float
C0202042 (UMLS CUI [1])
Creatinine
Item
Creatinine
float
C0201976 (UMLS CUI [1])
Aspartate aminotransferase measurement
Item
SGOT- Aspartate aminotransferase measurement
float
C0201899 (UMLS CUI [1])
C reactive protein
Item
CRP C reactive protein
float
C0201657 (UMLS CUI [1])
Gamma-glutamyl transpeptidase
Item
Gamma-glutamyl transpeptidase
float
C1883012 (UMLS CUI [1])
Antihistamines
Item
Number of antihistamines (oral) handed out
integer
C0019590 (UMLS CUI [1])
Levocabastin
Item
Number of Levocabastin eye drops given out
integer
C0064870 (UMLS CUI [1])
Beclometason
Item
Number of Beclometason nasal sprays given out
integer
C0004905 (UMLS CUI [1])
cortisone; beta agonist
Item
Number of combination of inhaled cortisone + long acting β2-receptor-agonist handed out
integer
C0010137 (UMLS CUI [1])
C0001644 (UMLS CUI [2])
C0001644 (UMLS CUI [2])