SEA-ORCHID: Collection of secondary outcomes data - DOC

							SEA-ORCHID: Collection of secondary outcomes data


Please complete a separate page for each clinical                      trial and research project
currently underway at each intervention site.

For clinical trials only, please complete the extra questions at the bottom. Please delete the
options that do not apply for a particular question.

ORCHID Site                      RSS    Dr Sardjito Hospital                   PGH Philippine General Hospital
[delete those not applicable]    SLM    Sleman District Hospital               JFH    Jose Fabella Memorial Hospital


                                 KKU    Khon Kaen University Hospital          IPH    Ipoh Hospital
                                 KKH    Khon Kaen Hospital                     USM Kelantan Hospital
                                 KLS    Kalasin Hospital


Trial/Project Description

Title

Clinical area                                 pregnancy & childbirth care            neonatal care

Objectives/Aims

Trial design/
Research methodology

Sample group description

Sample size

Inclusion criteria

Exclusion criteria

Outcome measure description

Follow up of participants

Results available                             yes / no     (if yes, please specify publication and/or author)



Organisation

Start date

End date

Type                                          Single centre                          Multi centre

If multicentre:
     is the intervention site a               Coordinating Centre                    Collaborating or Participating Centre

     list other participating centres

Contact person

Address

Phone

Email



Funding Information

Trial sponsor(s)/Granting body

Sponsor/Granting body ref. no.

Funding amount


Clinical Trial Organisation

ISRCTN1 Registration?                         yes           no

If yes, ISCRTN




1
    International Standard Randomised Controlled Trial Number, http://www.controlled-trials.com/isrctn/
0b0d9276-55c6-4f3f-ade1-d7ac23936288.doc
0b0d9276-55c6-4f3f-ade1-d7ac23936288.doc