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Year 5 Medical & Personal History Cardiovascular Health Study (CHS)

- 03.09.16 - 1 Formular, 9 Itemgruppen, 229 Datenelemente, 1 Sprache

Itemgruppen: Medical History, Medical History: Myocardical Infarction, Medical History: Angina, Date of interview, Medical History: Congestive heart failure, Medical History: Intermittent claudication, Medical History: Cerebrovascular accident, Medical History: Transient ischemic attack, Medical History: Other conditions

Documentation part: Record 29 Year 5 Medical & Personal History The Cardiovascular Health Study (CHS) was initiated by the National Heart, Lung and Blood Institute (NHLBI) in 1987 to determine the risk factors for development and progression of cardiovascular disease (CVD) in older adults, with an emphasis on subclinical measures. The study recruited 5,888 adults aged 65 or older at entry in four U.S. communities and conducted extensive annual clinical exams between 1989-1999 along with semi-annual phone calls, events adjudication, and subsequent data analyses and publications. Additional data were collected by studies ancillary to CHS. With the exception of annual clinic visits, these activities are still ongoing. Data obtained from: https://chs-nhlbi.org/ Permission granted by: Erika Enright.

Medical History II: CRF QMCR University of Alberta

- 17.08.16 - 1 Formular, 2 Itemgruppen, 45 Datenelemente, 1 Sprache

Itemgruppen: General Information, Medical History (See Description)

ODM derived from: http://www.qmcr.ualberta.ca/en/ToolsandTemplates/CaseReportFormCRFTemplates.aspx. Template Name: Medical History II. University of Alberta, Quality Management in Clinical Research. Copyright: 2002-2016 University of Alberta.

Medical History I: CRF QMCR University of Alberta

- 17.08.16 - 1 Formular, 2 Itemgruppen, 9 Datenelemente, 1 Sprache

Itemgruppen: General Information, Medical History (See Description)

ODM derived from: http://www.qmcr.ualberta.ca/en/ToolsandTemplates/CaseReportFormCRFTemplates.aspx. Template Name: Medical History I. University of Alberta, Quality Management in Clinical Research. Copyright: 2002-2016 University of Alberta.

Prior and Concomitant Medications: UIC Quality Improvement CRF

- 17.08.16 - 1 Formular, 2 Itemgruppen, 18 Datenelemente, 1 Sprache

Itemgruppen: General Information, Medications

ODM derived from: http://research.uic.edu/qip/toolbox/case-report-forms-crf. Template Name: Prior and Concomitant Medications. QIP Case Report Forms, UIC Quality Improvement CRF, Office of the Vice Chancellor for Research. Center for Clinical and Translational Science, UIC University of Illinois at Chicago.

Medical History Psoriasis MIPSO EudraCT 2014-003022-40 DRKS00007147 - Medical History Psoriasis MIPSO EudraCT 2014-003022-40

- 23.07.16 - 1 Formular, 2 Itemgruppen, 6 Datenelemente, 1 Sprache

Itemgruppen: Prior diseases, Prior diseases

MIPSO Vergleichende Untersuchung der bakteriellen Mikrobiota in der Haut sowie dem Darm von Psoriasis-Patienten vor und nach systemischer Behandlung mit Adalimumab bzw. Ustekinumab oder Ciclosporin (EudraCT 2014-003022-40) Principal Investigator: Prof. Dr. Dr. h.c. Thomas A. Luger

Basic Documentation, Medical History 1/2, Melanoma NCT00000000 - Basis Doku, Anamnese 1/2, Melanom NCT00000000

- 16.07.16 - 1 Formular, 4 Itemgruppen, 27 Datenelemente, 2 Sprachen

Itemgruppen: Patient identification, Classification of Anamnesis, Consent, Anamnesis and risk factors Part A

Klinik und Poliklinik für Hautkrankheiten - Allgemeine Dermatologie und Venerologie - Direktor: Univ.-Prof. Dr. med. Th. A. Luger

Basic Documentation, Medical History 2/2, Melanoma NCT00000000 - Basis Doku, Anamese 2/2 NCT00000000 Melanom

- 16.07.16 - 1 Formular, 1 Itemgruppe, 9 Datenelemente, 2 Sprachen

Itemgruppe: Medical history and risk factors

Anamnese Melanom Teil 2 NCT00000000 Part: Vervollständigung Anamnese

Baseline Personal History Cardiovascular Health Study (CHS)

- 04.07.16 - 1 Formular, 5 Itemgruppen, 50 Datenelemente, 1 Sprache

Itemgruppen: Personal History, Family History, Questions for female participants, Medication, Date of interview

Documentation part: Record 8 Baseline Personal History The Cardiovascular Health Study (CHS) was initiated by the National Heart, Lung and Blood Institute (NHLBI) in 1987 to determine the risk factors for development and progression of cardiovascular disease (CVD) in older adults, with an emphasis on subclinical measures. The study recruited 5,888 adults aged 65 or older at entry in four U.S. communities and conducted extensive annual clinical exams between 1989-1999 along with semi-annual phone calls, events adjudication, and subsequent data analyses and publications. Additional data were collected by studies ancillary to CHS. With the exception of annual clinic visits, these activities are still ongoing. Data obtained from: https://chs-nhlbi.org/ Permission granted by: Erika Enright.

Baseline Medical History Cardiovascular Health Study (CHS)

- 03.07.16 - 1 Formular, 6 Itemgruppen, 157 Datenelemente, 1 Sprache

Itemgruppen: Medical History: Myocardical Infarction, Medical History: Congestive heart failure, Medical History: Intermittent claudication, Medical History: Angina, Medical History: Other conditions, Date of interview

Documentation part: Record 7 Baseline Medical History The Cardiovascular Health Study (CHS) was initiated by the National Heart, Lung and Blood Institute (NHLBI) in 1987 to determine the risk factors for development and progression of cardiovascular disease (CVD) in older adults, with an emphasis on subclinical measures. The study recruited 5,888 adults aged 65 or older at entry in four U.S. communities and conducted extensive annual clinical exams between 1989-1999 along with semi-annual phone calls, events adjudication, and subsequent data analyses and publications. Additional data were collected by studies ancillary to CHS. With the exception of annual clinic visits, these activities are still ongoing. Data obtained from: https://chs-nhlbi.org/ Permission granted by: Erika Enright.

Baseline Visit (Day 1): Medical History BG00012 Monotherapy Safety and Efficacy Extension Study in Multiple Sclerosis (MS) (ENDORSE) NCT00835770

- 08.06.16 - 1 Formular, 3 Itemgruppen, 7 Datenelemente, 1 Sprache

Itemgruppen: Subject Identification, Medical history Update, Medical history List

The primary objective of this study is to evaluate the long-term safety profile of BG00012 (dimethyl fumarate). Secondary objectives of this study are to evaluate the long-term efficacy of BG00012 using clinical endpoints and disability progression, to evaluate further the long-term effects of BG00012 on multiple sclerosis (MS) brain lesions on magnetic resonance imaging (MRI) scans in participants who had MRI scans as part of Studies 109MS301 (NCT00420212) and 109MS302 (NCT00451451) and to evaluate the long-term effects of BG00012 on health economics assessments and the visual function test. NCT00835770 Part: Baseline Visit (Day 1)

Screening: Medical History Multiple Sclerosis ALAIN01 NCT02419378

- 31.05.16 - 1 Formular, 2 Itemgruppen, 5 Datenelemente, 1 Sprache

Itemgruppen: Medical History, Medical history List

Alemtuzumab in Autoimmune Inflammatory Neurodegeneration: Mechanisms of Action and Neuroprotective Potential (ALAIN01) https://clinicaltrials.gov/ct2/show/NCT02419378 Principal Investigator Prof. Dr. Dr. Sven Meuth, University Hospital Muenster, Germany Part: Screening

Initial survey AIEOP-BFM ALL 2009 DRKS00003772 NCT01117441 - Initial survey AIEOP-BFM ALL 2009 NCT01117441

- 15.05.16 - 1 Formular, 9 Itemgruppen, 103 Datenelemente, 1 Sprache

Itemgruppen: Patient Information, Anamnesis, Diagnosis, Blood analysis, Initial CNS status, Multi-organ involvement, Prednisone response, Comments, Identification and Signature

International Collaborative Treatment Protocol For Children And Adolescents With Acute Lymphoblastic Leukemia. Phase 3 Study. Initial survey. Please send this document within one month after diagnosis to the study centre. Clinical Trial Number: NCT01117441.

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