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Trial registered on ANZCTR
Registration number
ACTRN12624001009505p
Ethics application status
Not yet submitted
Date submitted
5/07/2024
Date registered
20/08/2024
Date last updated
20/08/2024
Date data sharing statement initially provided
20/08/2024
Type of registration
Prospectively registered
Titles & IDs
Public title
Efficacy of a transition of care service to reduce hospital readmissions for high-risk cardiology patients.
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Scientific title
The efficacy of a transition of care service to REduce hospital readmissions for high-risk CARDiology patients (RECARD): a pre-post interventional trial.
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Secondary ID [1]
312468
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MRFMMIP000044
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Universal Trial Number (UTN)
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Trial acronym
RECARD
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Acute myocardial infarction
334305
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Cardiac surgery
334306
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Condition category
Condition code
Cardiovascular
330961
330961
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0
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Coronary heart disease
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Public Health
331181
331181
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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
Pharmacist-led interdisciplinary transition of care service that will incorporate the following:
The provision of written materials to patients, such as an updated discharge medication list, along with consumer medication information leaflets on newly prescribed medications. A senior pharmacist will lead the service and provide in-patient activities to the patient on discharge that will include medication review and reconciliation, discharge planning and organisation, supply of medications, medication counselling, and communication of any medication changes to primary care providers (i.e., community pharmacist or general practitioner). The pharmacist will also provide an out-patient follow-up consultation, which will also involve medication review and medication counselling after the patient has been discharged. The pharmacist will be supported by a nurse and indigenous healthcare worker who may also provide support in medication review and progress assessments. The pharmacist will be a senior clinician (Queensland Health practitioner level HP4) with a minimum of 3-4 years experience, the nurse will also be a senior practitioner (Grade 6) with a minimum of 3 years experience, and the indigenous healthcare worker will be an identified position to provide culturally safe care where it is needed.
The mode of delivery will be face to face whilst the patient is in hospital. After they are discharged, the mode of delivery will mainly be through telephone or video for follow-up consultations. The option for a home visit to provide a face to face follow-up consultation will be provided on the basis of feasibiltiy and patient preference. The pharmacist will provide the service/intervention at least once during the patient's inpatient stay, and prior to discharge (e.g., 1 x 1 hour face to face consultation), and the follow-up consultation will be provided at least once (e.g., 30 mins to 1 hour for a telephone or video consultation, and up to 2 hours for a home visit) within 1 to 2 weeks post-discharge. The nurse and indigenous health worker will provide support in the inpatient setting where they are needed through 30min to 1 hour in-person consultations with the patient. The location of the intervention will be at the three hospital sites for the study setting (Princess Alexandra Hospital, Royal Brisbane and Womens Hospital, and Townsville Univeristy Hospital) for inpatient care, and over telephone or video for outpatient follow-up consultations post-discharge. Follow-up consultations may be completed in the participant's home if this is appropriate and preferred. If the participant is identified as a First Nation's patient, the indigenous healthcare worker may be required to support the pharmacist consultation as care will need to be adapted to ensure a culturally safe and appropriate transition of care service.
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Intervention code [1]
328983
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Treatment: Other
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Comparator / control treatment
Usual care will include participants that do not receive the pharmacist-led transition of care service, as determined through a historical cohort control group. The data collected for this historical control group will be from June 2024 to June 2025, approximately 1 year before the service (intervention) will be implemented (pre-post trial design). Usual care means that participants may still be provided with a consultation from a general ward pharmacist; however, no consultation with the transition of care pharmacist as described above will be provided.
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Control group
Historical
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Outcomes
Primary outcome [1]
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30-day medication related readmissions
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Assessment method [1]
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Assessed using medical records for hospital readmissions and determination of medication-related readmissions through causality assessment and review of medical records.
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Timepoint [1]
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30 days after discharge
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Secondary outcome [1]
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30-day all cause readmissions
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Assessment method [1]
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Assessed using medical records for hospital readmissions.
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Timepoint [1]
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30 days after hospital discharge.
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Secondary outcome [2]
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60-day all cause readmissions
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Assessment method [2]
437173
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Assessed using medical records for hospital readmissions
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Timepoint [2]
437173
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60-days after hospital discharge
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Secondary outcome [3]
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90-day all cause readmissions.
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Assessment method [3]
437174
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Assessed using medical records for hospital readmissions
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Timepoint [3]
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90 days after hospital discharge.
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Secondary outcome [4]
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Type of harm in terms of severity of medication-related readmissions.
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Assessment method [4]
437178
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Assessed using medical records from readmissions where servity will be assessed using the validated and accepted definitions by Morimoto, which classifies events as fatal, life-threatening, serious, or significant.
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Timepoint [4]
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30-days from discharge.
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Secondary outcome [5]
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Patient satisfaction of the transition of care service.
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Assessment method [5]
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A study-specific survey will be designed to capture patient satisfaction with the transition of care service, using Likert scale questions and free-text questions that will obtain patient feedback.
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Timepoint [5]
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30-days after discharge and after receiving the transition of care service.
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Secondary outcome [6]
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Cost-effectiveness of the transition of care service.
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Assessment method [6]
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Economic evaluation to assess the cost per readmission avoided for the intervention (ToC service) compared to the comparator group from the healthcare system perspective, with a partial societal perspective that includes patient costs. The outcome will be assessed by calculating the cost to the hospital site for the readmission, which might include direct resources, such as staff, physical resources (e.g. bed, medications). The hospital finance departments are able to provide costing information on readmission data. Patient costs will be included as a question in the survey on patient travel for any relevant appointments.
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Timepoint [6]
437187
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30-days after discharge.
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Secondary outcome [7]
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Type of harm in terms of the preventability of medication-related readmissions.
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Assessment method [7]
437990
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Assessed using medical records from readmissions where preventability will be assessed using the modified Schumock and Thornton scale, which is a validated and commonly used tool to assess the preventability of medication related events. The tool includes key considerations for preventability, such as the appropriateness of the medication, history of previous reactions, potential for interactions, or poor compliance.
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Timepoint [7]
437990
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30-days from discharge.
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Eligibility
Key inclusion criteria
Inclusion Criteria
• Greater than or equal to 18 years of age (Adult participants).
• Discharge from Princess Alexandra Hospital (PAH), Royal Brisbane and Womens Hospital (RBWH), or Townsville University Hospital (TUH) for an index diagnosis of acute myocardial infarction (AMI).
• Discharged from PAH, RBWH or TUH for a planned cardiac surgery (CS) admission.
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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
Exclusion Criteria
• Patients who reside in a residential aged care facility (RACF).
• Patients who are palliative or receiving end of life care.
• Patients undergoing chemotherapy, radiation, or dialysis.
• Patients who are inter-hospital transferred to a site other than PAH, RBWH or TUH.
• Patients who discharge against medical advice.
• Patients who died during their admission
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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
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Other
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Other design features
Pre-Post Interventional trial with a historical control group.
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Phase
Not Applicable
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
An intention to treat (ITT) analysis will be conducted. Participants that are lost to follow up (do not complete the intervention, withdrawal of consent, death) will be included in the ITT analysis for the primary outcome. Participant characteristics will be summarised according to the pre- and post- study cohorts. Characteristics will be summarised and presented descriptively using means and standard deviations, medians and interquartile ranges and number and percentages, as required. Independent t-tests and chi-squared tests will be undertaken to determine if there are any differences in baseline characteristics between the pre- and post-study cohorts. The primary outcome is a comparison of 30-day medication related readmissions in the pre- and post-study cohort, with secondary outcomes compared between the pre- and post-study cohort as well. The results for these outcomes will be considered significant at the 5% level, with 95% confidence intervals reported. Subgroup analysis will also be undertaken to assess whether the clinical impact of the intervention varied by location (regional versus metropolitan site), or cohort (acute myocardial infarction and cardiac surgery).
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
1/06/2025
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Actual
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Date of last participant enrolment
Anticipated
31/07/2026
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Actual
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Date of last data collection
Anticipated
31/12/2026
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Actual
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Sample size
Target
775
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
QLD
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Recruitment hospital [1]
26758
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Princess Alexandra Hospital - Woolloongabba
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Recruitment hospital [2]
26759
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Royal Brisbane & Womens Hospital - Herston
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Recruitment hospital [3]
26760
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Townsville University Hospital - Douglas
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Recruitment postcode(s) [1]
42807
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4102 - Woolloongabba
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Recruitment postcode(s) [2]
42808
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4029 - Herston
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Recruitment postcode(s) [3]
42809
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4814 - Douglas
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Funding & Sponsors
Funding source category [1]
316883
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Government body
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Name [1]
316883
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Medical Research Future Fund (MRFF), Department of Health and Aged Care.
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Address [1]
316883
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Country [1]
316883
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Australia
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Primary sponsor type
University
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Name
The University of Queensland
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Address
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Country
Australia
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Secondary sponsor category [1]
319130
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None
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Name [1]
319130
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Address [1]
319130
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Country [1]
319130
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Ethics approval
Ethics application status
Not yet submitted
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Ethics committee name [1]
315647
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Metro North Health Human Research Ethics Committee A
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Ethics committee address [1]
315647
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https://metronorth.health.qld.gov.au/research/ethics-and-governance/human-research-ethics-committee
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Ethics committee country [1]
315647
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Australia
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Date submitted for ethics approval [1]
315647
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31/08/2024
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Approval date [1]
315647
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Ethics approval number [1]
315647
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Summary
Brief summary
The transition from hospital back into the community can be a difficult time for patients to navigate due to the involvement of multiple health professionals, medication changes and complex health care plans. These factors place patients at risk of medication-related harm during the transition of care (ToC) period. This study will use a prospective pre-post interventional study of a locally appropriate pharmacist-led interdisciplinary transition of care service for high-risk cardiology patients across three tertiary Queensland hospitals. We hypothesise that this will help to reduce 30-day medication related readmissions to hospital.
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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 Michael Barras
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Address
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Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba Queensland 4102
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Country
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Australia
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Phone
135362
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+61 7 3176 7048
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Fax
135362
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Email
135362
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[email protected]
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Contact person for public queries
Name
135363
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Michael Barras
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Address
135363
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Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba Queensland 4102
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Country
135363
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Australia
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Phone
135363
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+61 7 3176 7048
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Fax
135363
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Email
135363
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[email protected]
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Contact person for scientific queries
Name
135364
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Dr Keshia De Guzman or Dr Chariclia Paradissis
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Address
135364
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The University of Queensland, School of Pharmacy, 20 Cornwall Street Woolloongabba Queensland 4102
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Country
135364
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Australia
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Phone
135364
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+61 7 3346 1980
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Fax
135364
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Email
135364
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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
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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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