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Trial registered on ANZCTR
Registration number
ACTRN12619000034134
Ethics application status
Approved
Date submitted
8/01/2019
Date registered
11/01/2019
Date last updated
21/04/2022
Date data sharing statement initially provided
11/01/2019
Type of registration
Prospectively registered
Titles & IDs
Public title
Melatonin for Delirium Reduction, Resolution And Mitigation of Abnormal Arousal (MelaDRRAMAA)
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Scientific title
Melatonin for Delirium Reduction, Resolution And Mitigation of Abnormal Arousal (MelaDRRAMAA): a double blinded placebo-controlled randomised trial of Melatonin 5mg nightly for 5 nights for the reduction of severity of delirium in older adult medical inpatients
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Secondary ID [1]
296082
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nil
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Universal Trial Number (UTN)
U1111-1226-3728
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Trial acronym
MelaDRRAMAA
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Linked study record
Definitive trial following pilot trial: ACTRN12614000101684
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Health condition
Health condition(s) or problem(s) studied:
Delirium
310970
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Condition category
Condition code
Neurological
309633
309633
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0
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Other neurological disorders
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Melatonin 5mg oral capsule nightly for 5 days administered directly by hospital nursing staff.
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Intervention code [1]
313274
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Treatment: Drugs
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Comparator / control treatment
Placebo - identical capsule but for active ingredient.
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Control group
Placebo
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Outcomes
Primary outcome [1]
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Symptoms of Delirium - Memorial Delirium Assessment Scale (MDAS) - during treatment phase
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Assessment method [1]
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Timepoint [1]
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Change from baseline to mean MDAS over days 1-5
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Secondary outcome [1]
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Symptoms of Delirium - Memorial Delirium Assessment Scale (MDAS) - Post treatment phase
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Assessment method [1]
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Timepoint [1]
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Following treatment cessation on days 6 and 7 of the trial (medication on days 1-5)
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Secondary outcome [2]
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Normal level of arousal - proportion of time with a Richmond Agitation and Sedation Scale of zero.
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Assessment method [2]
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Timepoint [2]
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Days 1-5 - daily - during treatment phase
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Secondary outcome [3]
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Duration of delirium - number of days Confusion Assessment Method (CAM) positive
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Assessment method [3]
365453
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Timepoint [3]
365453
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Days 1-5 - daily - during treatment phase
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Secondary outcome [4]
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Number of uses of medications for delirium- Number of uses of rescue medications (Benzodiazepines, Antipsychotics) - assessed by chart review
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Assessment method [4]
365454
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Timepoint [4]
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Days 1-5 - daily - during treatment phase
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Secondary outcome [5]
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Number of uses of physical restraint as assessed by inspection and chart review
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Assessment method [5]
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Timepoint [5]
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Days 1-5 - daily - during treatment phase
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Secondary outcome [6]
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Proportion of participants with a new clinical diagnosis of dementia by clinical assessment by geriatrician at 6 month follow-up visit
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Assessment method [6]
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Timepoint [6]
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6 month follow-up
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Secondary outcome [7]
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Sleep quality - MDAS item 10 score
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Assessment method [7]
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Timepoint [7]
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Days 1-5 - daily - during treatment phase
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Secondary outcome [8]
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Cognition at 6 month follow up (standardised MMSE)
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Assessment method [8]
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Timepoint [8]
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6 months follow-up
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Secondary outcome [9]
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Neurofilament light levels in serum at baseline, 5-7 days and at 6 month follow-up.
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Assessment method [9]
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Timepoint [9]
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Baseline vs. 6 months
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Secondary outcome [10]
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Cost effectiveness (Cost to healthcare system (Australian dollars)) evaluated by linkage to hospital clinical coding data, medicare utilisation data and Pharmaceutical Benefit Scheme Records.
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Assessment method [10]
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Timepoint [10]
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6 months follow-up
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Eligibility
Key inclusion criteria
Diagnosis of delirium (regardless of cause)
Inpatient of the Royal Melbourne Hospital
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Minimum age
65
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
- exclusively hypoactive delirium,
- recent stroke (<14 days),
- sensory impairment or dysphasia or language such that not evaluable,
- planned for surgery,
- prognosis <7days,
- severe hepatic failure
- allergy or intolerance to melatonin or excipients.
- Treated with Melatonin or melatonin agonists within 24 hours prior to enrolment
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Study design
Purpose of the study
Treatment
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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)
Permuted block opaque envelopes with random allocation by trial pharmacist
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Permuted block stratified according to diagnosis with cognitive impairment
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people receiving the treatment/s
The people administering the treatment/s
The people assessing the outcomes
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Intervention assignment
Parallel
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Other design features
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Phase
Phase 2 / Phase 3
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
The primary and secondary outcome measures will be compared using a Students’ t-test for normally distributed data or Mann-Whitney for non-normally distributed continuous variables. For discrete outcomes, results will be tested using a Chi-square test. Missing data will be handled for the analysis using the last observation carried forward method as per protocol. A p value of less than 0.05 will be considered significant, two sided where appropriate.
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Recruitment
Recruitment status
Active, not recruiting
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Date of first participant enrolment
Anticipated
1/06/2019
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Actual
11/03/2021
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Date of last participant enrolment
Anticipated
1/12/2019
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Actual
7/03/2022
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Date of last data collection
Anticipated
14/09/2022
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Actual
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Sample size
Target
120
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Accrual to date
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Final
120
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Recruitment in Australia
Recruitment state(s)
VIC
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Recruitment hospital [1]
12838
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Royal Melbourne Hospital - City campus - Parkville
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Recruitment postcode(s) [1]
25308
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3050 - Royal Melbourne Hospital
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Recruitment postcode(s) [2]
25309
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3050 - Parkville
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Funding & Sponsors
Funding source category [1]
300673
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Hospital
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Name [1]
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Royal Melbourne Hospital
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Address [1]
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Grattan street,
Parkville, VIC 3050.
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Country [1]
300673
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Australia
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Primary sponsor type
Hospital
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Name
Royal Melbourne Hospital
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Address
Grattan street,
Parkville, VIC 3050
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Country
Australia
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Secondary sponsor category [1]
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None
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Name [1]
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None
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Address [1]
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n/a
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Country [1]
301269
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
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Melbourne Health Human Research Ethics Committee
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Ethics committee address [1]
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Grattan street, Parkville, VIC 3050
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Ethics committee country [1]
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Australia
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Date submitted for ethics approval [1]
301455
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07/03/2019
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Approval date [1]
301455
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15/07/2020
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Ethics approval number [1]
301455
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Summary
Brief summary
Delirium is the sudden onset of confusion or hallucinations, due to an illness or medication. It affects the elderly particularly, and is both distressing to the sufferer and their carers, as well as causing death, disability and institutionalisation. Melatonin is a naturally occurring hormone in the human brain important in sleep. Sleep is disturbed in delirium, and studies have shown melatonin can prevent delirium. This study aims to determine whether Melatonin 5mg in oral capsules given nightly for 5 nights can treat and cure delirium that has developed in older patients in hospital.
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Trial website
None.
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Trial related presentations / publications
None.
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Public notes
Delirium is the sudden onset of confusion or hallucinations, due to an illness or medication. It affects the elderly particularly, and is both distressing to the sufferer and their carers, as well as causing death, disability and institutionalisation. Melatonin is a naturally occurring hormone in the human brain important in sleep. Sleep is disturbed in delirium, and studies have shown melatonin can prevent delirium. Low dose melatonin prevented most delirium, but did not reduce the severity of delirium when it occurred. Moderate dose melatonin also prevented most delirium, and was reported to reduce the severity of delirium when it occurred, but this was not demonstrated using a validated scoring scale, or evaluated statistically, ie not properly demonstrated. There is no easily used marker of delirium other than observation – cure from delirium is observed when symptoms resolve. A treatment that causes symptomatic improvement that continues once the treatment has stopped can be said to cure, or at least abate delirium. No treatment has been shown to cure or abate delirium once developed. The group conducted a pilot trial that demonstrated that Melatonin 5mg was safe in this group of patients, and that 120 patients would be required to show that Melatonin 5mg had a clinically and statistically significant effect on delirium severity. This subsequent study aims to determine whether moderate dose Melatonin is effective in treating the symptoms of delirium, and shortening the overall duration of delirium after treatment ceases (abates or cures delirium). To study this, elderly patients admitted to the Royal Melbourne Hospital with delirium, and not requiring surgery, will be recruited with suitable consent to receive either 5mg melatonin oral capsule (60 patients) or inactive placebo (60 patients) nightly for 5 nights (or until discharged). All patients will receive all standard treatment for delirium as well. During treatment and for two further days, participants will be assessed using a validated scale of delirium severity (the Memorial Delirium Assessment Scale), and a validated measure of delirium state (Confusion Assessment Method) to determine if Melatonin decreases the severity and/or the duration of delirium, and abates delirium. Arousal (the level of alertness) can also be altered in delirium, this will be measured, as will sleep, and the number of uses of restraints, medications, falls and pressure areas (bed sores), with the hypothesis that melatonin will reduce the use of restraints and medications for delirium and not increase falls and pressure areas. Should Melatonin be successful in treating the symptoms of delirium, it would be one of only a few treatments that do so, and likely to be a safe and relatively side-effect free compared to other established treatments, substantially improving treatment of delirium. Should Melatonin abate delirium that has developed, it would be the only treatment shown to do so.
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Contacts
Principal investigator
Name
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A/Prof Peter W Lange
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Address
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The Royal Melbourne Hospital
Grattan Street,
Parkville, VIC 3050
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Country
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Australia
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Phone
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+61 0393427000
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Fax
87062
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Email
87062
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[email protected]
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Contact person for public queries
Name
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Peter W Lange
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Address
87063
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The Royal Melbourne Hospital
Grattan Street,
Parkville, VIC 3050
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Country
87063
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Australia
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Phone
87063
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+61 0393427000
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Fax
87063
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Email
87063
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[email protected]
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Contact person for scientific queries
Name
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Peter W Lange
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Address
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The Royal Melbourne Hospital
Grattan Street,
Parkville, VIC 3050
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Country
87064
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Australia
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Phone
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+61 0393427000
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Fax
87064
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Email
87064
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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)?
Yes
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What data in particular will be shared?
All of the individual participant data collected during the trial, after de-identification
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When will data be available (start and end dates)?
After trial completion and analysis. - 10/08/2020. Records will be held for 7 years and therefore available until 10/08/2027.
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Available to whom?
Researchers who provide a methodologically sound proposal and comply with relevant Australian laws, pursuant to HREC approval.
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Available for what types of analyses?
Analyses proposed by researchers who provide a methodologically sound proposal and comply with relevant Australian laws, pursuant to HREC approval.
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How or where can data be obtained?
Access subject to individual approval by Principal Investigator, compliant with relevant Australian laws, pursuant to HREC approval.
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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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