UNIT LOG (For local use)

Transkript

1 (EUROpean Pain Audit In Neonates) European survey of sedation and analgesia practices for ventilated newborn infants UNIT LOG (For local use) MONITORING OF INCLUSIONS/ EXCLUSIONS Principal Investigators (studieledelse): Carbajal, Ricardo. Emergency Department, Trousseau University Hospital, Paris, France Erikson, Mats. Centre for health care sciences, Örebro University Hospital, S-701. Sweden For any questions, please contact Center (sykehus): Medical Coordinator (studieansvarlig lege): Nurse Coordinator (studiesykepleier): Very important (svært viktig) Please register in this log all the neonates that fulfill the study entry criteria. If for any reason a neonate is not included, the reason for this is to be recorded. This log will allow local staff to identify included patients. The identification () electronic system should be copied on this log to allow communication with the Principal Investigators who do not have the of the patient. Principal Investigators will only have the. Registrer i denne loggen alle nyfødte som oppfyller inklusjonskriteriet for studien. Hvis en nyfødt av en eller annen grunn ikke inkluderes skal årsaken til dette dokumenteres. Loggen lar avdelingen identifisere inkluderte pasienter. Identifikasjonsnummeret () som den elektroniske skal kopieres inn i loggen for å muliggjøre kommunikasjon med som ikke har navnet på pasienten. De har bare Pasient ID en. At the end of the study, a log, WITHOUT THE NAME OF THE PATIENT, will be sent to Principal investigators Ved studieslutt skal en fullstendig logg, UTEN PASIENTNAVN, sendes til. Spesielt for Norge: Nasjonal coordinator skal ha tilsendt en fullstendig logg, MED PASIENTNAVN 1

2 of the start of the study (Dato for studiestart):.. Last and First 2

3 of the start of the study (Dato for studiestart):.. Last and First 3

4 of the start of the study (Dato for studiestart):.. Last and First 4

5 of the start of the study (Dato for studiestart):.. Last and First 5

6 of the start of the study (Dato for studiestart):.. Last and First 6

7 of the start of the study (Dato for studiestart):.. Last and First 7

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