Prof. Daniel F. Hanley (VISTA-ICH Chair)Director, Division of Brain Injury OutcomesThe Johns Hopkins Medical InstitutionsDr. Myzoon Ali (VISTA Coordinator)University of Glasgowwww.email@example.com
Data Contribution FormClinical datasets will be lodged with the Robertson Centre for Biostatistics, University of Glasgow on behalf of VISTA. Please complete all applicable sections
Section 1.0 Clinical Dataset InformationSection 1.1Using the checklist below, please ensure that your clinical datasets meet the eligibility criteria for VISTA-ICH.
Minimum dataset of 50 randomised patients with a clinical diagnosis of intracerebral haemorrhage
Documented entry criteria
Documented consent or waiver of consent following local IRB-approved procedure
Confirmation of intracerebral haemorrhage by cerebral imaging within 7 days
Outcome assessed between 1 and 6 months after stroke onset includes NIHSS, SSS, Rankin, Barthel, GOS or similar.
Monitoring procedures existed to validate data
Please check the boxes corresponding to the format of your data.
SAS data sets
Microsoft Excel spreadsheets
Microsoft Access Database
Other (please state)
Section 2.0 Contribution Procedure Please provide contact details for the Principal Investigator(s) who will represent the trial on the VISTA-ICH Steering Committee:
Please detail the inclusion of relevant documents for your clinical dataset in the check-box below and attach these documents using the file transfer link that will be emailed separately.
All fields marked with * are essential
Please tick all files that are attached electronically
Raw Data* 1
Data Dictionary 2
Annotated CRF* 3
Ethics Approval* 5
Consent to hold/ collect original data 5
Section 3.0 Memorandum of Understanding Summary
I hereby acknowledge that I have read and understood the terms and conditions and consent to the contribution of the proposed trial/ registry to VISTA-ICH.
The raw datasets can be transferred using the University of Glasgow’s file transfer system. A separate link will be emailed to you following submission of this form.
Agree to Terms and Conditions
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