Effect of Monazite Sands in Patients With Osteoarthritis of the Knee
Phase: NA
Conditions: Osteo Arthritis Knee
Sponsor: University Vila Velha

 
 
Document date: May 2nd , 2019
Official Title: 
Effect of Monazite Sands in Patients With Osteoarthritis of the Knee   
Ethical committee Protocol No: 3.160.891     
Enrolment Log 

        
 
SUBJECT ENROLMENT LOG 
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This template has been freely provided by The Global Health Network and was 
adapted to our. Reference: The Global Health Network when possible when using this 
template. www.theglobalhealthnetwork.org.  
 
Study brief Title: 
Effects of Sand Treatment on Osteoarthritis   
Official Title: Effect of Monazite Sands in Patients with Osteoarthritis of the Knee   
Ethical committee Protocol No: 3.160.891    
                         
Unique Protocol ID:   T015-M02-2019AF002                                         
1Exclusion Criteria: A) History of previous knee surgery. B) History of fracture in the knee region. C) History of any secondary OA associated with any cystic arthropathy. D) Any 
treatment for the knee with methotrexate. E) History of hemorrhagic disorders. F) History of any infiltration of the knee during the previous 6 months (eg corticosteroids and 
hyaluronic acid). G) Morbid obesity. H) History of severe psychiatric disorders. I) History of skin cancer. 
Signature of the Principal Investigator: 
 
 
 
 
 
 
 
 
 Date:  
 
 
 
S.No. 
Identifier/initials
if applicable 
Screening Date 
(dd/mm/yyyy) 
Exclusion 
met?1  
If ineligible, 
specify reason 
for ineligibility 
Signed the 
inform 
consent? 
Enrolment 
date 
(dd/mm/yyyy) 
Subject ID 
If No, 
reasons 
Investigato
r Initials 
and Date 
 
 
 
Yes Ο  No Ο 
 
Yes Ο  No Ο 
 
 
 
 
 
 
 
Yes Ο  No Ο 
 
Yes Ο  No Ο 
 
 
 
 
 
 
 
Yes Ο  No Ο 
 
Yes Ο  No Ο 
 
 
 
 
 
 
 
Yes Ο  No Ο 
 
Yes Ο  No Ο 
 
 
 
 
 
 
 
Yes Ο  No Ο 
 
Yes Ο  No Ο 
 
 
 
 
 
 
 
Yes Ο  No Ο 
 
Yes Ο  No Ο