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Trial registered on ANZCTR
Registration number
ACTRN12624000853549
Ethics application status
Approved
Date submitted
28/05/2024
Date registered
10/07/2024
Date last updated
10/07/2024
Date data sharing statement initially provided
10/07/2024
Type of registration
Prospectively registered
Titles & IDs
Public title
A randomised controlled trial of pre-procedural chewables to help children fasting for surgery (JELLYFISH - Phase Two)
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Scientific title
A randomised controlled trial of pre-procedural chewables to help children fasting for surgery (JELLYFISH - Phase Two)
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Secondary ID [1]
312189
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NIL
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Universal Trial Number (UTN)
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Trial acronym
JELLYFISH
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Pre-operative fasting
333854
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Condition category
Condition code
Anaesthesiology
330530
330530
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0
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Anaesthetics
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Alternative and Complementary Medicine
330531
330531
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0
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Other alternative and complementary medicine
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
This is a single-centre, open-label, clinical trial at Perth Children’s Hospital to evaluate efficacy of pre-procedural chewables for use in pre-procedural fasting.
In this trial we will investigate pre-procedural carbohydrate-based chewables, which come in two flavours. One chewable is prepared using a blueberry-flavoured simple syrup and the other uses a vanilla-flavoured maple syrup.
The pre-procedural chewables are carbohydrate-rich solid chewables (1 x 1 x 0.5cm) which dissolve quickly and completely. The design principle was that of a “solid to clear liquid formulation in vivo” to comply with the anaesthetic fasting guidelines. The chewables are formulated to have the following properties:
- Rapid and complete dissolution in the mouth to become a clear liquid within 3 minutes
- Does not precipitate into particulate material in the acidic content of the stomach
- Safe to administer to young children
- Taste and texture that is acceptable to young children.
- Physically stable for transport and storage at ambient conditions
The ingredients in the pre-procedural chewables are food ingredients purchased from registered Australian suppliers. Further information cannot be supplied at this stage for confidentiality reasons.
The chewables are packaged in a sealed plastic bag.
The chewables will be manufactured in the WA Hospitals Central Pharmaceutical Manufacturing Facility (Auspman). The chewables will adhere to acceptable pharmaceutical standards and the quality of the chewables will be confirmed through various tests, including batch reproducibility, dissolution time in simulated saliva, precipitation in simulated gastric, mechanical integrity during storage and transport, texture and appearance. Auspman is located in Balcatta, WA and is the manufacturing arm of the Pharmacy Department at Perth Children’s Hospital.
This is the second phase of a two-phase trial. This phase will evaluate the effectiveness of the chewables at relieving fasting discomfort. 300 children undergoing elective, surgical procedures will be recruited at Perth Children’s Hospital. These children will be randomised to receive either the pre-procedural chewables (interventional group), DEX(TM) (comparator group) or standard clinical care (no fasting intervention - control group).
Children in the interventional group will be given 20 chewables to consume during the pre-operative fasting period from admission to hospital (after consent) until 1 hour prior to the procedure time. Children can consume as many of the 20 chewables as they wish. Any remaining chewables will be removed one hour prior to the scheduled procedure time. Research staff will note how many chewables the patient consumes during this time.
The comparator group will be 100 children randomised to receive DEX complex carbohydrate drink prior to their procedure. DEX contains water, maltodextrin, natural peach flavour and sodium citrate. Participants in this group will be given the DEX when they arrive in the pre-operative holding area. These chlidren will be allowed 3ml/kg to consume as they wish up until one hour prior to the procedure time. The volume of DEX consumed will be monitored by the research team.
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Intervention code [1]
328638
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Treatment: Other
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Comparator / control treatment
The control group will be 100 children randomised to receive standard fasting care. These participants will be allowed up to 3ml/kg clear fluid until 1 hour prior to the scheduled procedure time. The volume of fluid consumed will be monitored by the research team.
Children's fasting will be monitored by the preoperative nursing team and research staff.
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Control group
Active
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Outcomes
Primary outcome [1]
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Assess the acceptance of the fasting chewables to parents of fasting children scheduled for surgery.
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Assessment method [1]
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Five point Likert scale from 1 (very dissatisfied) to 5 (very satisfied) with pre-operative fasting.
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Timepoint [1]
338296
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Parents will be asked post-operatively on the day of surgery.
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Primary outcome [2]
338297
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Effectiveness of the pre-procedural fasting chewables at alleviating fasting discomfort in children scheduled for surgery at Perth Children's Hospital
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Assessment method [2]
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Five point Likert scale from 1 to 5.
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Timepoint [2]
338297
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Children will be asked post-operatively on the day of surgery.
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Secondary outcome [1]
435321
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Acceptance of the fasting chewables to fasting children
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Assessment method [1]
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Five point Likert scale from 1 (very dissatisfied) to 5 (very satisfied) with pre-operative fasting.
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Timepoint [1]
435321
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Children will be asked post-operatively on the day of surgery.
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Secondary outcome [2]
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Assessment of post-operative nausea and vomiting (PONV) in children undergoing surgery who are given pre-procedural chewables pre-operatively.
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Assessment method [2]
435322
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Any incidence of nausea, vomitting and/or retching will be recorded on a binary scale (yes if it occurred, no if it did not occur).
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Timepoint [2]
435322
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Assessed in the first 6 hours after their procedure or until discharge from hospital.
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Secondary outcome [3]
435323
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Assessment of post-operative nausea and vomiting (PONV) in children undergoing surgery who are given standard treatment
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Assessment method [3]
435323
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Any incidence of nausea, vomitting and/or retching will be recorded on a binary scale (yes if it occurred, no if it did not occur).
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Timepoint [3]
435323
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Assessed in the first 6 hours after their procedure or until discharge from hospital.
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Secondary outcome [4]
435324
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Assessment of post-operative nausea and vomiting (PONV) in children undergoing surgery who are given DEX preoperative fasting drink preoperatively.
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Assessment method [4]
435324
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Any incidence of nausea, vomitting and/or retching will be recorded on a binary scale (yes if it occurred, no if it did not occur).
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Timepoint [4]
435324
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Assessed in the first 6 hours after their procedure or until discharge from hospital.
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Secondary outcome [5]
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Assessment of the ease of fasting in participants.
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Assessment method [5]
435947
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Participants will be asked to assess ease of fasting using a five-point scale (very easy, easy, neither easy nor hard, hard, very hard)
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Timepoint [5]
435947
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Participants will be emailled a survey to be completed 24-48 hours post-procedure.
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Secondary outcome [6]
435948
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Assessment of the ease of fasting in parents of participants.
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Assessment method [6]
435948
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Participants will be asked to assess ease of fasting using a five-point scale (very easy, easy, neither easy nor hard, hard, very hard)
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Timepoint [6]
435948
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Participants will be emailled a survey to be completed 24-48 hours post-procedure.
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Secondary outcome [7]
435949
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Child's assessment of how much the chewables helped with fasting
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Assessment method [7]
435949
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Children in the interventional group will be asked to answer on a five point likert scale from "not at all" to "very much".
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Timepoint [7]
435949
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Participants will be asked post-operatively on the day of surgery.
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Secondary outcome [8]
435950
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Assessment of anxiety and behaviour in children undergoing surgery.
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Assessment method [8]
435950
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Modified Yale peroperative anxiety scale (mYPAS-Short form)
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Timepoint [8]
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Behaviour will be assessed just before checkout from ward to theatre and again at induction.
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Secondary outcome [9]
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Blood glucose levels in children undergoing surgery
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Assessment method [9]
436186
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Gluometer assessment using blood from the intravenous catheter that is routinely inserted during anaesthetic induction.
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Timepoint [9]
436186
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Measured immediately following the induction of anaesthesia.
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Secondary outcome [10]
436187
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Ketone levels in children undergoing surgery
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Assessment method [10]
436187
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Blood ketone measurement using blood from the intravenous catheter that is routinely inserted during anaesthetic induction.
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Timepoint [10]
436187
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Measured immediately following the induction of anaesthesia.
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Secondary outcome [11]
436188
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Number of chewables consumed by patients allocated to recieve the chewables pre-operatively.
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Assessment method [11]
436188
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Parents will be asked to record how many chewables their child consumed (0-20)
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Timepoint [11]
436188
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Parents will be asked 1 hour before the scheduled procedure time, when the chewables will be removed from the child.
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Eligibility
Key inclusion criteria
Children aged 3 to 16 years scheduled for elective day-stay surgery under general anaesthesia at Perth Children’s Hospital who are ASA (American Society of Anaesthesiologists) physical scale 1 or 2
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Minimum age
3
Years
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Maximum age
16
Years
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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
• Known allergy to ingredients of pre-procedural chewables
• Children with diabetes
• Children with pre-existing gastro-oesophageal refl ux
• Children with suspected/delayed gastric emptying or oesphageal pathologies associated with gastroesophageal reflux or known recurrent aspiration
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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)
Centralised computer generated block randomisation
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Computer generated block randomisation
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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
Safety/efficacy
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Statistical methods / analysis
Data will be monitored for fidelity as the trial progresses. Statistical analysis will be performed in the R statistical environment (http://www.Rproject.org). Continuous data will be summarized using the mean (SD), or median (interquartile range) if skewed, and categorical data using counts (%). Significance will be assessed at p<0.05.
The primary outcome is parent satisfaction with preoperative fasting, answered on a Likert scale with values from 1 (very dissatisfied) to 5 (very satisfied). The data will be explored by examining proportions in each level, cross-tables with other categorical variables (such as sex) and plots against continuous covariates (such as BMI). A linear statistical model will be fitted to patient satisfaction against the treatment (chewables, DEX and standard care). to examine any differences in mean satisfaction score. Available demographics will be included in the model. Similarly, comfort score will be modelled to determine any differences in mean comfort between the chewables, DEX and standard care.
Secondary outcomes for this phase will be compared between groups using appropriate models (a Poisson regression of logistic regression) based on the type of outcome data (a count or presence/absence) will be fitted to each outcome, with treatment (standard care, DEX and the pre-procedural chewables) entered as an explanatory variable, and clinically relevant patient and medical characteristics entered as covariates.
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
19/08/2024
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Actual
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Date of last participant enrolment
Anticipated
29/11/2024
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Actual
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Date of last data collection
Anticipated
6/12/2024
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Actual
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Sample size
Target
300
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
WA
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Recruitment hospital [1]
26561
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Perth Children's Hospital - Nedlands
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Recruitment postcode(s) [1]
42603
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6009 - Nedlands
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Funding & Sponsors
Funding source category [1]
316561
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Hospital
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Name [1]
316561
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Perth Children's Hospital
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Address [1]
316561
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Country [1]
316561
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Australia
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Funding source category [2]
316562
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Charities/Societies/Foundations
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Name [2]
316562
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Telethon Trust
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Address [2]
316562
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Country [2]
316562
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Australia
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Funding source category [3]
316563
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Government body
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Name [3]
316563
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WA Department of Health
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Address [3]
316563
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Country [3]
316563
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Australia
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Primary sponsor type
Charities/Societies/Foundations
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Name
Telethon Kids Institute
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Address
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Country
Australia
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Secondary sponsor category [1]
318741
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None
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Name [1]
318741
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Address [1]
318741
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Country [1]
318741
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
315351
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Child and Adolescent Health Service Human Research Ethics Committee
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Ethics committee address [1]
315351
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https://cahs.health.wa.gov.au/Research/For-researchers/Ethics-and-governance-approval
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Ethics committee country [1]
315351
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Australia
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Date submitted for ethics approval [1]
315351
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26/02/2024
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Approval date [1]
315351
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03/05/2024
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Ethics approval number [1]
315351
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RGS0000006727
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Summary
Brief summary
Pre-operative fasting is an important part of preparing for anaesthesia. Fasting reduces the volume andacidity of the stomach contents, which serves to reduce the risk of regurgitation and pulmonary aspiration. Fasting can be particularly stressful for young children, which can in turn lead to negative psychosocial and physiological outcomes. In this study, we wish to investigate if a pre-procedural carbohydrate-based chewables can help children to reduce the negative effects of pre-operative fasting. We hope to provide evidence that these chewables are able to help kids tolerate fasting by improving their fasting discomfort, and reduce their post-operative nausea and vomitting.
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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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Prof Britta von Ungern-Sternberg
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Address
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Perth Children's Hospital 15 Hospital Avenue Nedlands WA 6009
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Country
134426
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Australia
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Phone
134426
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+61 420790101
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Fax
134426
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Email
134426
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[email protected]
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Contact person for public queries
Name
134427
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Britta von Ungern-Sternberg
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Address
134427
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Perth Children's Hospital 15 Hospital Avenue Nedlands WA 6009
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Country
134427
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Australia
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Phone
134427
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+61 420790101
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Fax
134427
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Email
134427
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[email protected]
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Contact person for scientific queries
Name
134428
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Britta von Ungern-Sternberg
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Address
134428
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Perth Children's Hospital 15 Hospital Avenue Nedlands WA 6009
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Country
134428
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Australia
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Phone
134428
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+61 420790101
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Fax
134428
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Email
134428
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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
Investigators for the study are still deciding upon how to proceed with this.
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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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