Modelos de dados selecionados

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S0337 Cover Sheet for Patient-Completed Questionnaires NCT00445601

- 05/07/2015 - 1 Formulário, 4 Grupos de itens, 21 Elementos de dados, 1 Idioma
Grupos de itens: 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

Questionnaire Day 28 REGATTA NCT03151603 - Questionnaire Day 28 REGATTA NCT03151603

- 07/11/2017 - 1 Formulário, 9 Grupos de itens, 89 Elementos de dados, 2 Idiomas
Grupos de itens: General Information, Previous Urinary Tract Infection, Pharmacotherapy, Further Urinary Tract Infection, Pharmacotherapy: Further Urinary Tract Infection, Further Symptoms, Pharmacotherapy: Further Symptoms, Study Medication, Adverse Event
Original CRFs from: K.Afshar, J. Bleidorn, E. Hummers-Pradier, I. Gágyor. Further details on: http://www.allgemeinmedizin.med.uni-goettingen.de/en/content/research/510_520.html https://clinicaltrials.gov/ct2/show/NCT03151603 Questionnaire Day 28

Questionnaire Day 0 REGATTA NCT03151603 - Questionnaire Day 0 REGATTA NCT03151603

- 01/11/2017 - 1 Formulário, 10 Grupos de itens, 19 Elementos de dados, 2 Idiomas
Grupos de itens: Patient Information, Severity of Symptoms, Affected by Symptoms, Duration of Symptoms, Vaginal Discharge, Urine Appearance, Urine Odor, Suspicious Urinary Tract Infection, Previous Urinary Tract Infection, Patient Information
Original CRFs from: K.Afshar, J. Bleidorn, E. Hummers-Pradier, I. Gágyor. Further details on: http://www.allgemeinmedizin.med.uni-goettingen.de/en/content/research/510_520.html https://clinicaltrials.gov/ct2/show/NCT03151603 Questionnaire Day 0

GLOBAL HEALING CENTER - General Health Questionnaire

- 01/02/2017 - 1 Formulário, 16 Grupos de itens, 178 Elementos de dados, 1 Idioma
Grupos de itens: 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

Drug Safety Patient-Reported Adverse Drug Event Questionnaire Part A

- 20/09/2021 - 1 Formulário, 19 Grupos de itens, 306 Elementos de dados, 1 Idioma
Grupos de itens: General Information, Drug use, Symptoms, Symptoms Eyes eyelids, Symptoms Ear, nose and throat swallowing, Symptoms Sweating blushing temperature flu, Symptoms Mouth lips speech, Symptoms Tongue teeth taste, Symptoms chest sleep apnea blood, Symptoms Bladder urination, Symptoms Intestines stomach vomiting, Symptoms Skin hair nails, Symptoms Genitals menopause menstruation, Symptoms Muscles bones joints, Symptoms Dizziness falling balance, Symptoms Head brain moods, Symptoms Sleep fatigue, Symptoms Eating drinking weight, Symptoms Infection edema fungal infection
Study description: Patient-Reported Adverse Drug Event Questionnaire for the evaluation of drug safety, Part A. 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

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