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VISUAL FUNCTIONING QUESTIONNAIRE - 25 (DAY 0) CRFs Roche FVF4168G Macular Edema NCT00473330

- 27/07/17 - 1 modulo, 2 itemgroups, 39 elementi, 2 lingue

Itemgroups: Patient administration, VISUAL FUNCTIONING QUESTIONNAIRE - 25 (DAY 0)

Terms of use: You may not use this document or the information contained herein to a regulatory authority in connection with an application for a marketing authorization or any other regulatory submission without the express written consent of Roche Study #: FVF4168g Drug: Ranibizumab Study Title: A Phase III, Double-Masked, Multicenter, Randomized, Sham-Controlled Study Of The Efficacy And Safety Of Ranibizumab Injection In Subjects With Clinically Significant Macular Edema With Center Involvement Secondary To Diabetes Mellitus

Drug Safety Patient-Reported Adverse Drug Event Questionnaire Part B

- 16/07/17 - 1 modulo, 1 ItemGroup, 37 elementi, 1 linguaggio

ItemGroup: Side effect

Patient-Reported Adverse Drug Event Questionnaire for the evaluation of drug safety, Part B. Publication granted by Sieta de Vries. Publishing results based on the questionnaire should include the following reference: de Vries, S.T., Mol, P.G.M., de Zeeuw, D. et al. Drug Saf (2013) 36: 765. doi:10.1007/s40264-013-0036-8

RetDQoL (DAY 0) CRFs Roche FVF4170G Macular Edema NCT00473382

- 09/06/17 - 1 modulo, 2 itemgroups, 3 elementi, 1 linguaggio

Itemgroups: Patient administration, RetDQoL (DAY 0)

Terms of use: You may not use this document or the information contained herein to a regulatory authority in connection with an application for a marketing authorization or any other regulatory submission without the express written consent of Roche Study #: FVF4170g Drug: Ranibizumab Study Title: A Phase III, Double-Masked, Multicenter, Randomized, Sham-Controlled Study Of The Efficacy And Safety Of Ranibizumab Injection In Subjects With Clinically Significant Macular Edema With Center Involvement Secondary To Diabetes Mellitus

RetDQoL (DAY 0) CRFs Roche FVF4168G Macular Edema NCT00473330

- 08/06/17 - 1 modulo, 2 itemgroups, 3 elementi, 1 linguaggio

Itemgroups: Patient administration, RetDQoL (DAY 0)

Terms of use: You may not use this document or the information contained herein to a regulatory authority in connection with an application for a marketing authorization or any other regulatory submission without the express written consent of Roche Study #: FVF4168g Drug: Ranibizumab Study Title: A Phase III, Double-Masked, Multicenter, Randomized, Sham-Controlled Study Of The Efficacy And Safety Of Ranibizumab Injection In Subjects With Clinically Significant Macular Edema With Center Involvement Secondary To Diabetes Mellitus

GAD-7

- 02/02/17 - 1 modulo, 1 ItemGroup, 7 elementi, 35 lingue

ItemGroup: GAD-7

The GAD-7 questionnaire is a diagnostic tool for mental health disorders used by health care professionals that is quick and easy for patients to complete. In the mid-1990s, Robert L. Spitzer, MD, Janet B.W. Williams, DSW, and Kurt Kroenke, MD, and colleagues at Columbia University developed the Primary Care Evaluation of Mental Disorders (PRIME-MD), a diagnostic tool containing modules on 12 different mental health disorders. They worked in collaboration with researchers at the Regenstrief Institute at Indiana University and with the support of an educational grant from Pfizer Inc. During the development of PRIME-MD, Drs. Spitzer, Williams and Kroenke, created the PHQ and GAD-7 screeners. The GAD-7 was developed as a brief scale for anxiety. It scores 7 common anxiety symptoms. ODM derived from http://www.phqscreeners.com/

GLOBAL HEALING CENTER - General Health Questionnaire

- 01/02/17 - 1 modulo, 16 itemgroups, 178 elementi, 1 linguaggio

Itemgroups: Overall wellbeing, Do You Have Chronic Inflammation in Your Body?, Poor Nutrition and Lifestyle, Do You Have Abnormal Blood Sugar Levels? Are You Pre-Diabetic or At Risk?, Do You Have Impaired Cellular/Mitochondrial Function?, Exposure to Toxins: Is Your Detoxification Capacity Impaired?, Is Your Home and/or Work Environment Toxic?, Impaired Immune System: What is the Quality of Your Immune System Function?, Is Your Liver Impaired by Your Emotions?, Are Your Kidney and Urinary Systems Functioning Properly?, Do You Have Parasites, Viruses, Fungi, or other Microbes Inside Your Body?, Hormonal Imbalance: Are Your Adrenal Glands Functioning Properly?, Is Your Thyroid Imbalanced?, Are Your Sex Hormones Reduced in Production or Quality?, FOR WOMEN - Is Your Body Out of Balance?, FOR MEN - Is Your Body Out of Balance?

GLOBAL HEALING CENTER - LIVE HEALTHY|General Health Questionnaire Note — This General Health Questionnaire is not intended to diagnose, treat, cure or prevent any disease. No statements herein have been evaluated by the FDA nor is any endorsement thereof implied or given. We advise use of this Questionnaire simply as a starting point for consideration of any negative health symptoms you may be experiencing and potential preventative measures or as a resource for further discussion with your healthcare provider. http://www.globalhealingcenter.com/general-health-questionnaire.html

Patient questionnaire PETAL Study NCT00554164 - Patient questionnaire

- 24/10/16 - 1 modulo, 1 ItemGroup, 32 elementi, 2 lingue

ItemGroup: Patient questionnaire

Positronen-Emissionstomographie-gesteuerte Therapie aggressiver Non-Hodgkin-Lymphome (PETAL-Studie) Universitätsklinikum Essen (UK Essen) EudraCT-Nummer: 2006-001641-33 NCT00554164

Humangenetik Darmkrebs MS University Hospital Muenster (UKM)

- 04/10/16 - 1 modulo, 1 ItemGroup, 7 elementi, 1 linguaggio

ItemGroup: Questionnaire Hereditary Colorectal Carcinoma

Hospital Routine Documentation Form at the University Hospital Muenster. Original Form name: Fragebogen zur Ermittlung des Risikos für familliären Darmkrebs. (c) Humangenetik, Universitätsklinikum Bonn, Institut für Humangenetik, Prof. Dr. med. Markus Nöthen

NINDS CDE Godin Leisure-Time Exercise Questionnaire Multiple Sclerosis - Godin Leisure-Time Exercise Questionnaire

- 31/07/16 - 1 modulo, 1 ItemGroup, 5 elementi, 1 linguaggio

ItemGroup: Questionnaire Time Exercise

NINDS Common Data Elements, Multiple Sclerosis Godin Leisure-Time Exercise Questionnaire Used from the National Institute of Neurological Disorders and Stroke Common Data Elements (https://www.commondataelements.ninds.nih.gov/) References: Grinnon ST, Miller K, Marler JR, Lu Y, Stout A, Odenkirchen J, Kunitz S. National Institute of Neurological Disorders and Stroke Common Data Element Project - approach and methods. Clin Trials. 2012;9(3):322-9.

SIMBO Screening-Instrument zur Erkennung des Bedarfs an Medizinisch-beruflich orientierter Rehabilitation - SIMBO-C Fragebogen

- 24/02/16 - 1 modulo, 1 ItemGroup, 12 elementi, 2 lingue

ItemGroup: SIMBO-C Fragebogen

Quelle: http://www.medizinisch-berufliche-orientierung.de/bausteine/diagnostische_instrumente/#simbo German Federal Pension Insurance Department of Rehabilitation Coordination and Development of Medical and Vocational Rehabilitation Hohenzollerndamm 47 D-10704 Berlin ( +49(0)30 865-81591 (phone) 7 +49(0)30 865-82122 (fax) mailto: dr.marco.streibelt@drv-bund.de

ZUF-8 Fragebogen zur Patientenzufriedenheit

- 24/02/16 - 1 modulo, 1 ItemGroup, 8 elementi, 2 lingue

ItemGroup: ZUF-8 Fragebogen zur Patientenzufriedenheit

Lizenz: CC-BY-NC-ND Quellenangabe: http://www.gfqg.de/downloads.html?file=files/content/downloads/Assessment/ZUF-8%20Fragebogen.pdf Beim Abstract bitte einfügen: „Eine Bitte, bevor Sie den ZUF-8 downloaden: anders als die meisten anderen gebräuchlichen psychometrischen Verfahren stellen wir Ihnen den ZUF-8 hier kostenlos zur Verfügung. Das Instrument wurde mit privaten und öffentlichen Forschungsgeldern entwickelt und soll jedem öffentlich zur Verfügung stehen, der es für seine eigenen Forschungsarbeiten benötigt (kommerzielle Nutzungen ausgeschlossen). Weil wir das Instrument ständig weiterentwickeln haben wir die Bitte an Sie: stellen Sie uns Ihre – anonymisierten – ZUF-8-Daten zur Verfügung, inkl. einer kurzen Beschreibung, in welchem Rahmen sie erhoben wurden. Wir sammeln die Daten hierzu fortlaufend, aktuell liegt eine Stichprobe von über 100.000 Rehapatienten aller wichtigen Hauptindikationen vor. Helfen Sie bitte mit, diese Datenbasis zu erweitern. Damit können wir Ihnen künftig noch bessere Referenzdaten anbieten.

S0337 Cover Sheet for Patient-Completed Questionnaires NCT00445601

- 05/07/15 - 1 modulo, 4 itemgroups, 21 elementi, 1 linguaggio

Itemgroups: Header, Patient response to questionnaire, Form completed by, Comments

S0337 Cover Sheet for Patient-Completed Questionnaires NCT00445601 Gemcitabine After Surgery in Treating Patients With Newly Diagnosed or Recurrent Bladder Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FE26037B-446B-4AC6-E034-0003BA3F9857

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