New Research Study For Adults With Alcohol-Induced Hepatitis
The pre-screening questionnaire asks questions about your health and drinking habits to see if you may be a good candidate for an alcoholic hepatitis clinical trial.
For the purposes of this questionnaire, one (1) alcoholic drink is equal to a 12-oz can of beer or seltzer, a 5-oz glass of wine, or a 1.5 oz shot of liquor.
If you pass the prescreening questionnaire, you will be connected to a trial doctor and a dedicated research team.
The questionnaire takes about 5 to 8 minutes to complete.
1. How old are you?
2. How often do you have a drink containing alcohol?
3. When was your last drink?
4. In total, how many years have you been drinking alcohol?
5. On average, how many alcoholic drinks do you have in a week?
6. How often do you consume 3 or more alcoholic drinks in one day?
7. How many alcoholic drinks do you have on a typical day when you are drinking?
8. Have you experienced any of the following symptoms or issues in the last 6 months?
9. Do you have viral hepatitis (hep B or hep C) or HIV?
10. In the last 3 years, have you been diagnosed with cancer (except for skin cancer)?
11. Have you had a liver transplant?
12. Have you had bariatric or weight loss surgery?
13. Are you willing to abstain from drinking for 2 months?
14. Are you able and willing to attend weekly in-person clinic visits for a month?
15. Are you currently pregnant, breastfeeding, or planning to become pregnant?
16. Are you currently prescribed any of the following anti-psychotic, anti-convulsant, and/or anti-depressant medications?*
17. Are you currently taking any of the following immunosuppressant medications?*
18. How far are you willing to travel to a trial site for study visits?
19. How do you prefer to be contacted?
20. What days of the week are best to reach you?
21. What times are best to reach you?
Unfortunately, you have not met the pre-screening requirements for this study.
Based on your answers, this clinical study may not be suitable for you. Each study has specific requirements to ensure participant safety.
Don’t lose hope! Each clinical study is different, and not qualifying for this one doesn’t mean you won’t qualify for another. Your doctor and care team may help you find a more suitable study.
Thank you for your time and interest.
You may contact us via email at clinicaltrials@responsumhealth.com.
Congratulations, you’ve met the pre-screening requirements!
Based on your answers, you may qualify for this clinical study.
A representative from Responsum Health will contact you within the next 1-3 days to connect you with a nearby trial site.
The trial doctor and site coordinator will provide more information about the study and can answer any questions you may have. If the trial doctor believes you may be a good candidate for the study, you will be invited to their clinic for a screening visit.
Participation is completely voluntary, and you can opt-out at any time. If you no longer wish to be connected with a study doctor, please inform Responsum by replying to this email.