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Trial registered on ANZCTR
Registration number
ACTRN12615001120561
Ethics application status
Approved
Date submitted
7/07/2015
Date registered
23/10/2015
Date last updated
7/07/2020
Date data sharing statement initially provided
18/12/2018
Type of registration
Prospectively registered
Titles & IDs
Public title
Evaluating methods for effective decontamination of needleless connectors in adult patients: A pilot randomised control trial
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Scientific title
Can a chlorhexidine in a 70% alcohol swab, a 70% alcohol impregnated cap, or the standard treatment of a 70% alcohol swab, be used for effective decontamination of needleless connectors in an adult patient population: A pilot randomised control trial?
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Secondary ID [1]
287049
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Nil
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Universal Trial Number (UTN)
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Trial acronym
DINAMIC
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Needleless connector care and maintenance
295530
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Bloodstream infection
295653
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Condition category
Condition code
Infection
295803
295803
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0
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Other infectious diseases
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Public Health
295805
295805
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0
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Health service research
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Intervention 1: Decontamination of the needleless connector using a 2% chlorhexidine and 70% alcohol swab
Intervention 2: Decontamination of the needleless connector with the use of a 70% alcohol impregnated cap that is screwed into place on the needleless connector, and remains in place until nursing staff are required to inject medications into the connector. The cap is discarded, and a new one applied once treatment has been completed. The cap can stay in position for up to one week, and is required to be in position for at least 5 minutes prior to decontamination taking effect.
Overall duration of the intervention will be from device insertion through to device removal, or up to 4 weeks from time of recruitment (whichever comes first).
The frequency of decontamination will be each time the connector is accessed.
Ward nursing staff will be administering the intervention.
Adherence to the intervention will be monitored by a Research nurse twice weekly to assess compliance.
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Intervention code [1]
292272
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Prevention
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Intervention code [2]
292273
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Treatment: Devices
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Comparator / control treatment
The control: Decontamination of the needleless connector using a 70% alcohol swab (current practice).
This treatment is current standard practice.
Overall duration of the intervention will be from device insertion to device removal, or up to 4 weeks from time of recruitment (whichever comes first).
The frequency of decontamination will be each time the connector is accessed.
Ward nursing staff will be administering the intervention.
Adherence to the intervention will be monitored by a Research nurse twice weekly to assess compliance.
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Control group
Active
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Outcomes
Primary outcome [1]
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The composite primary outcome of this pilot trial is to assess: feasibility (eligibility (proportion of screened patients eligible >80%), recruitment (proportion of eligible patients recruited >80%), retention and attrition (<5%), protocol adherence (>90%), missing data, staff satisfaction); data collection strategies; proposed methods; and to test the interventions with the control to determine an appropriate size for a future larger clinical trial.
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Assessment method [1]
295502
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Timepoint [1]
295502
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At the completion of the research study
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Secondary outcome [1]
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Central line-associated bloodstream infection: as defined by CDC/NHSN criteria.
This will be confirmed by a blinded infectious diseases specialist using de-identified clinical and microbiological data.
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Assessment method [1]
315714
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Timepoint [1]
315714
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Between the time of device insertion and 48 hours after device removal, or patient removal from study, whichever comes first.
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Secondary outcome [2]
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Mortality
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Assessment method [2]
315716
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Timepoint [2]
315716
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Patients will be assessed for outcomes 48 hours after device removal, or patient removal from study, whichever comes first.
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Secondary outcome [3]
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Primary bloodstream infection (laboratory confirmed bloodstream infection): as defined by CDC/NHSN criteria.
This will be confirmed by a blinded infectious diseases specialist using de-identified clinical and microbiological data.
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Assessment method [3]
374450
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Timepoint [3]
374450
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Between the time of device insertion and 48 hours after device removal, or patient removal from study, whichever comes first.
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Secondary outcome [4]
374451
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Device (tip) colonisation: defined as a positive tip culture (equal to or more than 15 colony forming units). (Note. device tips will be removed upon suspicion of infection by the treating clinical team, not research staff).
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Assessment method [4]
374451
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Timepoint [4]
374451
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Upon removal of the central line.
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Eligibility
Key inclusion criteria
Patients greater than or equal to 18 years of age
Requiring a CVAD to be inserted for greater than or equal to seven days
Able to provide informed consent
CVAD inserted within 24 hours of recruitment
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Non-English speaking without an interpreter
Current bloodstream infection
Previous enrolment in the study in current hospital admission
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Study design
Purpose of the study
Prevention
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Computer generated allocation.
Allocation is concealed by a central randomisation computer service.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Computer generated
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
31/07/2017
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Actual
31/07/2017
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Date of last participant enrolment
Anticipated
28/06/2019
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Actual
5/04/2019
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Date of last data collection
Anticipated
26/07/2019
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Actual
11/04/2019
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Sample size
Target
200
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Accrual to date
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Final
180
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Recruitment in Australia
Recruitment state(s)
QLD
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Recruitment hospital [1]
4017
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Royal Brisbane & Womens Hospital - Herston
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Recruitment hospital [2]
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Gold Coast University Hospital - Southport
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Recruitment postcode(s) [1]
9941
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4029 - Royal Brisbane Hospital
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Recruitment postcode(s) [2]
24196
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4215 - Southport
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Funding & Sponsors
Funding source category [1]
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University
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Name [1]
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Griffith University
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Address [1]
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Nathan Campus
170 Kessels Road
Nathan
Queensland, 4111
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Country [1]
291611
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Australia
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Funding source category [2]
300822
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Charities/Societies/Foundations
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Name [2]
300822
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Cancer Council Queensland
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Address [2]
300822
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553 Gregory Terrace, Fortitude Valley QLD 4006
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Country [2]
300822
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Australia
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Funding source category [3]
300823
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Government body
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Name [3]
300823
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Nursing and Midwifery Research Fellowship
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Address [3]
300823
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Health and Medical Research Unit,
Queensland Health,
GPO Box 48,
Brisbane QLD 4001,
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Country [3]
300823
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Australia
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Primary sponsor type
University
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Name
Griffith University
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Address
Nathan Campus
170 Kessels Road
Nathan
Queensland, 4111
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Country
Australia
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Secondary sponsor category [1]
290282
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Hospital
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Name [1]
290282
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Royal Brisbane and Women's Hospital
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Address [1]
290282
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Butterfield Street
Herston
Queensland, 4029
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Country [1]
290282
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Australia
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
293144
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Royal Brisbane and Women's Hospital
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Ethics committee address [1]
293144
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Butterfield Street Herston Queensland, 4029
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Ethics committee country [1]
293144
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Australia
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Date submitted for ethics approval [1]
293144
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16/11/2015
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Approval date [1]
293144
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11/12/2015
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Ethics approval number [1]
293144
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Ethics committee name [2]
304233
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Griffith University Human Research Ethics Committee
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Ethics committee address [2]
304233
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Office for Research Bray Centre, Nathan Campus Griffith University 170 Kessels Road Nathan, QLD, 4111
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Ethics committee country [2]
304233
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Australia
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Date submitted for ethics approval [2]
304233
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02/06/2016
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Approval date [2]
304233
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03/06/2016
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Ethics approval number [2]
304233
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2016/410
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Summary
Brief summary
The large number of patients require a central venous access device (CVAD) for the administration of intravenous fluids, medications, blood products and specialised treatments. These intravenous fluid lines will be accessed by nurses via a needleless connector (NC) multiple times every shift; however these connectors have also been linked with the development of CVAD associated bloodstream infection (CLABSI). The two most common causes of CLABSI are: the colonisation of the outer surface of the catheter during insertion from bacteria originating from the skin; and colonisation of the inner surface of the catheter through contamination of the hub or NC, often from poor non-touch technique practices from healthcare workers. These complications can be minimised, however while practice is variable, with little evidence to guide clinicians, research is required to reduce the gaps in this area. The importance of decontaminating the needleless connectors (NC) has been highlighted prior to accessing the central venous access device (CVAD) by many of the current CVAD guidelines. However, the standard for the scrub time and the decontamination solution is still lacking, with some studies showing the time required for decontamination to be from 10 to 30 seconds using friction and 70% isopropyl alcohol swab. The Centre for Disease Control and Prevention (CDC) guidelines for the prevention of intravascular catheter-related infections suggest decontamination with a chlorhexidine/alcohol preparation. However, they do not mention a specific time for this procedure, other than stating that using a 70% alcohol solution for 3 to 5 seconds is not adequate (O'Grady, 2011). The national evidence based guidelines for preventing healthcare associated infections in National Health Service hospitals in England (Epic3) recommend disinfecting the connector for a minimum of 15 seconds with chlorhexidine gluconate in 70% isopropyl alcohol, then allowing it to dry prior to accessing the system. The Queensland Health I-Care Guideline for Tunnelled Central Venous Catheters recommends a 5 second scrub with a 70% alcohol solution and allowing the connector to dry before accessing the CVAD system. With each guideline having differing recommendations, clinicians may have difficulty deciding which method will reduce the risk of CLABSI.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
58634
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Prof Claire Rickard
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Address
58634
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Level 2, Building 48
Griffith University, Nathan Campus
170 Kessels Road
Nathan, QLD, 4111
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Country
58634
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Australia
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Phone
58634
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+61 7 36468725
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Fax
58634
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Email
58634
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[email protected]
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Contact person for public queries
Name
58635
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Claire Rickard
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Address
58635
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Level 2, Building 48
Griffith University, Nathan Campus
170 Kessels Road
Nathan, QLD, 4111
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Country
58635
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Australia
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Phone
58635
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+61 7 36468725
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Fax
58635
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Email
58635
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[email protected]
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Contact person for scientific queries
Name
58636
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Claire Rickard
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Address
58636
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Level 2, Building 48
Griffith University, Nathan Campus
170 Kessels Road
Nathan, QLD, 4111
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Country
58636
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Australia
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Phone
58636
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+61 7 36468725
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Fax
58636
0
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Email
58636
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[email protected]
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Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
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No/undecided IPD sharing reason/comment
No data will be shared to other parties other than investigators for this study
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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