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Trial registered on ANZCTR
Registration number
ACTRN12620000603910p
Ethics application status
Not yet submitted
Date submitted
11/02/2020
Date registered
25/05/2020
Date last updated
25/05/2020
Date data sharing statement initially provided
25/05/2020
Type of registration
Prospectively registered
Titles & IDs
Public title
Development of customised distraction techniques for managing acute behavioural disturbance in patients aged 65 years or older in the emergency department
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Scientific title
development of customised distraction techniques for managing acute behavioural disturbance in patients aged 65 years or older in the emergency department
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Secondary ID [1]
300518
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None
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
dementia
316212
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delirium
316213
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Condition category
Condition code
Neurological
314503
314503
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0
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Dementias
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Neurological
314646
314646
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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
We will test various technologies to provide multimedia distraction, including immersive Virtual Reality (VR) headsets with and without audio; close-proximity screens, with and without audio, and other relevant devices such as audio devices alone. Devices included will be a VR headset: Oculus Quest 64GB, and an immersive multimedia screen to fill patients field of view without the need for a headset. This consists of a curved monitor display (such as LG 38WK95C-W) mounted to a cart with an articulating arm (enabling it to be positioned directly in front of the patient) such as the PDI MedTV Cart. Therefore there are two devices being used, however these may be modified in an iterative fashion as the project progresses.
The actual imagery we will test may include, but is not limited to, nature scenes (eg walking in a forest), underwater scenery, geometric patterns, imagery of different world cities etc.
The intervention will be delivered by a research assistant, who will guide the user through and collect data.
Each participant will use more than one device, with a maximum of three devices, but will only be allocated to a single sitting. Total participation time will be limited to 1 hour. The location will be either in a residential aged care facility, or in the emergency department of Cabrini Hospital. The number of devices used will be determined by the maximum time frame of 1 hour as well as patient discretion.
The three (stepwise) stages are:
1. Healthy volunteers
2. Residents with known cognitive impairment
3. ED patients with acute behavioural disturbance
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Intervention code [1]
316825
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Treatment: Other
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Comparator / control treatment
No control group
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Control group
Uncontrolled
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Outcomes
Primary outcome [1]
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This is primarily an early-phase feasibility study of a novel intervention.
The primary outcome is acceptability of the intervention to the patient and caregivers as determined by a study-specific questionnaire.
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Assessment method [1]
322830
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Timepoint [1]
322830
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At the completion of the session.
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Secondary outcome [1]
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Frequency and dose of medications used to control acute behavioural disturbance
This will be assessed by querying the electronic medication record of hospital patients
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Assessment method [1]
380843
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Timepoint [1]
380843
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At completion of ED visit
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Eligibility
Key inclusion criteria
Stage 1 Healthy volunteers
Stage 2 Residents with known cognitive impairment
Stage 3 ED patients with Acute Behavioural Disturbance (ABD)
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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?
Yes
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Key exclusion criteria
Stage 1
Cognitive impairment
Hearing or sight impaired
Significant limitations in manual dexterity, e.g. inability to operate simple controls
Insufficient English to understand an explanation of the study and provide consent
Stage 2
? Hearing or sight impaired
? Acutely behaviourally disturbed
Stage 3
? Patients meeting “Code Grey” criteria i.e. violence or severe agitation
? Patients previously enrolled in the ED setting
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Non-randomised trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
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Who is / are masked / blinded?
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Intervention assignment
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
1/09/2020
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Actual
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
20
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
VIC
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Recruitment hospital [1]
15866
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Cabrini Hospital - Malvern - Malvern
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Recruitment postcode(s) [1]
29315
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3144 - Malvern
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Funding & Sponsors
Funding source category [1]
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Hospital
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Name [1]
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Cabrini Health
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Address [1]
304931
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183 Wattletree Road
Malvern VIC 3144
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Country [1]
304931
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Australia
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Primary sponsor type
Hospital
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Name
Cabrini Health
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Address
183 Wattletree Road
Malvern VIC 3144
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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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Address [1]
305284
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Country [1]
305284
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Ethics approval
Ethics application status
Not yet submitted
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Ethics committee name [1]
305340
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Monash Health Human Research Ethics Committee
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Ethics committee address [1]
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Locked Bag 29 Clayton VIC 3168
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Ethics committee country [1]
305340
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Australia
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Date submitted for ethics approval [1]
305340
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30/06/2020
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Approval date [1]
305340
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Ethics approval number [1]
305340
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Summary
Brief summary
This is a pilot study using technologically advanced customised distraction techniques to prevent and manage acute behavioural disturbance (ABD) in elderly patients in the emergency department (ED). Acute behavioural disturbance is a common problem in EDs, particularly in elderly patients and even more so in those with cognitive impairment, for example people with delirium or dementia. This behaviour endangers the patients themselves, their companions, other patients and ED staff, and hampers timely delivery of their care. Current treatment options, including psychotropic medication and mechanical restraint remain of limited benefit, confer risk and are of limited efficacy. Despite recognition that they are preferred practice, distraction techniques are rarely used in the management of patients with ABD in the ED setting; with the vast majority of cases managed using psychotropic medications, often administered parenterally, and often without patient consent under the Principle of Necessity. These medications have significant adverse effect profiles; complications can include over-sedation with hypoxia or hypotension, falls and subsequent injuries as well as prolonged lengths of stay and increased mortality. In the ED, available non-pharmacological options are limited, rendering the investigation of distraction techniques such as the use of virtual reality (VR) and other multimedia approaches in this setting an important initiative. We aim to perform an iterative process of testing, adaptation and refinement of devices and media to develop customised distraction techniques for elderly patients who exhibit ABD in Cabrini ED.
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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
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Dr Gabriel Blecher
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Address
100054
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Cabrini Health
Emergency Department
183 Wattletree Road
Malvern VIC 3144
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Country
100054
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Australia
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Phone
100054
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+61395081550
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Fax
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Email
100054
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[email protected]
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Contact person for public queries
Name
100055
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Gabriel Blecher
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Address
100055
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Cabrini Health
Emergency Department
183 Wattletree Road
Malvern VIC 3144
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Country
100055
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Australia
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Phone
100055
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+61395081550
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Fax
100055
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Email
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[email protected]
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Contact person for scientific queries
Name
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Gabriel Blecher
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Address
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Cabrini Health
Emergency Department
183 Wattletree Road
Malvern VIC 3144
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Country
100056
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Australia
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Phone
100056
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+61395081550
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Fax
100056
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Email
100056
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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
Privacy, ethics
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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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