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Trial registered on ANZCTR
Registration number
ACTRN12624001038583
Ethics application status
Approved
Date submitted
31/07/2024
Date registered
28/08/2024
Date last updated
28/08/2024
Date data sharing statement initially provided
28/08/2024
Type of registration
Retrospectively registered
Titles & IDs
Public title
Post-intensive care allied health clinic for Intensive Care Survivors.
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Scientific title
Evaluate the feasibility of an allied health-led follow-up service to enhance recovery for intensive care survivors.
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Secondary ID [1]
312636
0
Nil known
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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:
Critical Illness
334594
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Post Intensive Care Syndrome
334595
0
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Condition category
Condition code
Physical Medicine / Rehabilitation
331188
331188
0
0
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Other physical medicine / rehabilitation
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Public Health
331189
331189
0
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
The intervention to be provided is an allied health (AH)-led follow-up service. Participants randomised to the intervention will be triaged based on discipline-specific screening tools for follow-up care from one (or more) of three AH disciplines: Dietetics, Physiotherapy and Psychology, as above. All patients will be contacted via telephone within one month of hospital discharge and baseline health related quality of life will be assessed using the EQ-5D-5L. Additionally the discipline specific screening tools will be done: Mini-Nutritional Assessment-Short Form for dietetics, Barthel Index for Activities of Daily Living for physiotherapy and Hospital Anxiety and Depression Scale and the Impact of event scale-revised tool will be used for psychology.
The intervention will be provided from one-month post-hospital discharge, to up to six months post-hospital discharge. The intervention will be delivered face-to-face where possible (particularly the initial appointment with each discipline), with the option to receive the service via telehealth where required/preferred. The frequency and duration of the sessions will vary between 30 minute and one-hour sessions at clinician discretion with a maximum of 3 sessions per discipline overall.
In each session, personalised strategies to address Post Intensive Care Syndrome (PICS) symptoms will be devised with patients and their families (as appropriate). Dieticians will discuss nutritional plans with participants and may prescribe meal plans, meal supports and supplements. Physiotherapists will discuss training goals with participants and may prescribe an aerobic and strength training program based on this. Psychologists will assess specific patient goals and may use brief skills-based interventions to support patients in self-management techniques to address their goals. Adherence to intervention (% attendance, % completed inter-session work) will be collected and number of intervention sessions attended by mode of delivery (face to face versus telehealth.
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Intervention code [1]
329155
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Rehabilitation
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Comparator / control treatment
Usual Care
Participants will receive follow-up at the discretion of the treating medical team and the participants GP as per usual care.
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Control group
Active
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Outcomes
Primary outcome [1]
338952
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Feasibility of an AH-led model of care. (Composite primary outcome).
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Assessment method [1]
338952
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Eligibility rates and recruitment rates by an audit of study screening, number and reasons of dropouts of randomised patients by audit of study logs, adherence to intervention by review of case reporting forms and completeness of secondary outcome measure assessments.
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Timepoint [1]
338952
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6 months post intervention commencement.
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Secondary outcome [1]
438020
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Secondary outcome measures to be evaluated at 6 months post intervention commencement include healthcare utilisation (ED presentations and unplanned hospital admissions).
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Assessment method [1]
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At 6-months, in both the intervention and usual care group, data will be collected on:
• Healthcare utilisation: ED presentations to 6-months. Data will be collected from the local health service EMR at 6-months from hospital discharge. In order to capture ED admissions outside of the administering health service, participants will be asked to report the number of ED admissions they have had outside of Central Adelaide Local Health Network via telephone call using a study-specific patient diary provided following enrolment into the study.
• Healthcare utilisation: Unplanned hospital admissions to 6-months. Data will be collected from the local health service EMR at 6-months from hospital discharge. In order to capture hospital admissions outside of the administering health service, participants will be asked to report the number of hospital admissions they have had outside of CALHN.
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Timepoint [1]
438020
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6 months post intervention commencement.
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Secondary outcome [2]
438116
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Physical function
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Assessment method [2]
438116
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Barthels Index
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Timepoint [2]
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Baseline and 6 months post intervention commencement.
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Secondary outcome [3]
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Malnutrition status
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Assessment method [3]
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Patient Generated-Subjective Global Assessment (PG-SGA)
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Timepoint [3]
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6 months post intervention commencement.
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Secondary outcome [4]
438118
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Malnutrition Risk
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Assessment method [4]
438118
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Mini Nutritional Assessment - short-form (MNA-SF) questionnaire.
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Timepoint [4]
438118
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Baseline and 6 months post intervention commencement.
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Secondary outcome [5]
438119
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Psychological distress
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Assessment method [5]
438119
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Hospital Anxiety and Depression Scale (HADS) questionnaire.
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Timepoint [5]
438119
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Baseline and 6 months post intervention commencement.
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Secondary outcome [6]
438120
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Post-traumatic stress
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Assessment method [6]
438120
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The Impact of Event Scale-Revised (IES-R) questionnaire.
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Timepoint [6]
438120
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Baseline and 6 months post intervention commencement.
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Secondary outcome [7]
438121
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Health-related quality of life
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Assessment method [7]
438121
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EuroQol-5 Dimension-5 Level (EQ-5D-5L) Quality of Life Tool.
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Timepoint [7]
438121
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Baseline and 6 months post intervention commencement.
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Secondary outcome [8]
438122
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Allied health services received from hospital discharge to 6-months.
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Assessment method [8]
438122
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Allied health services within CALHN with be extracted from EMR at 6 months. Participants receiving services outside CALHN (including private services) will be asked to report the type and number of allied health services received.
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Timepoint [8]
438122
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6 months post intervention commencement.
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Eligibility
Key inclusion criteria
Inclusion criteria:
- Aged equal to or greater than 18 years of age
- Greater than or equal to 7 day RAH ICU admission
- Discharged to the hospital ward for active care
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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:
- Not for discharge home
- Non-English speaking persons requiring an interpreter
- Unable to complete questionnaires or attend face to face or telehealth clinic
- Unlikely to survive 6-months as per treating medical team
- For discharge overseas or interstate, and not receiving ongoing healthcare management within the SA Health network.
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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)
Following informed consent, participants will be randomised to either: 1) usual care or 2) intervention. Allocation will be in a 1:1 fashion via a randomisation schedule developed by a research staff member not involved in patient recruitment, data collection, or data analysis using random.org online random number generator. The schedule will be saved as a password-protected file on the shared hospital server.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Simple randomisation using a randomisation table created by computer software (i.e. computerised 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
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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
A total sample size of 120 (60 per group) meets pilot study recommendations to determine feasibility by estimating outcome variability and event rates with minimal bias and an appropriate level of precision. Initial estimates of group differences in outcomes will be used to inform selection of outcomes for an efficacy trial. Summary statistics will be presented as mean (standard deviation), median [interquartile range] or counts
(percentages). Descriptive statistics will be used to analyse feasibility outcomes of recruitment, attrition and completeness of outcome measure assessment at 6-months (number (%)). Variability of outcomes will be summarised with standard deviations and CIs.
Differences between groups in secondary outcomes including emergency department presentations, unplanned hospital admissions, screening tools (MNA-SF, Barthel Index, HADS, IES-R) and quality of life (EQ-5D-5L) will be assessed using Student’s t-test and Mann-Whitney as appropriate.
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Recruitment
Recruitment status
Recruiting
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Date of first participant enrolment
Anticipated
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Actual
1/08/2024
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Date of last participant enrolment
Anticipated
30/06/2025
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Actual
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Date of last data collection
Anticipated
30/12/2025
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Actual
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Sample size
Target
120
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Accrual to date
4
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Final
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Recruitment in Australia
Recruitment state(s)
SA
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Recruitment hospital [1]
26878
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The Royal Adelaide Hospital - Adelaide
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Recruitment postcode(s) [1]
42940
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5000 - Adelaide
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Funding & Sponsors
Funding source category [1]
317071
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Hospital
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Name [1]
317071
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Intensive Care Unit, Royal Adelaide Hospital
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Address [1]
317071
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Country [1]
317071
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Australia
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Primary sponsor type
Hospital
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Name
Royal Adelaide Hospital
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Address
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Country
Australia
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Secondary sponsor category [1]
319320
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None
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Name [1]
319320
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Address [1]
319320
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Country [1]
319320
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
315819
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Central Adelaide Local Health Network Health Research Ethics Committee
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Ethics committee address [1]
315819
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https://www.rah.sa.gov.au/research/for-researchers/central-adelaide-local-health-network-human-research-ethics-committee
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Ethics committee country [1]
315819
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Australia
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Date submitted for ethics approval [1]
315819
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24/04/2024
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Approval date [1]
315819
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03/07/2024
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Ethics approval number [1]
315819
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Summary
Brief summary
Survivors of critical illness are burdened by persistent disability, termed post intensive care syndrome (PICS), encompassing cognitive, physical and psychological impairments that lead to loss of independence and increased healthcare utilisation. To address this post-ICU disability, critical care follow-up clinics have been implemented and tested internationally although are limited in availability and efficacy. Most of these clinics are medical or nurse-led. Allied health professionals may be another workforce capable of leading post-ICU interventions. We propose AH-led interventions targeting PICS recovery and delivered via a centralised and integrated approach early after hospital discharge, may improve patient and health-system outcomes.
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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
135906
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A/Prof Lee-anne Chapple
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Address
135906
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Intensive Care Unit, Royal Adelaide Hospital, Port Road, Adelaide, SA 5000
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Country
135906
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Australia
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Phone
135906
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+61 8 70741763
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Fax
135906
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Email
135906
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[email protected]
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Contact person for public queries
Name
135907
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A/Prof Lee-anne Chapple
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Address
135907
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Intensive Care Unit, Royal Adelaide Hospital, Port Road, Adelaide, SA 5000
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Country
135907
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Australia
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Phone
135907
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+61 8 70741763
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Fax
135907
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Email
135907
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[email protected]
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Contact person for scientific queries
Name
135908
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Lee-anne Chapple
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Address
135908
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Intensive Care Unit, Royal Adelaide Hospital, Port Road, Adelaide, SA 5000
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Country
135908
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Australia
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Phone
135908
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+61 8 70741763
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Fax
135908
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Email
135908
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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?
De-identified data will be made available upon direct request to the primary investigator and reviewed case-by-case by the management committee.
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When will data be available (start and end dates)?
Data will be made available from the time of publication up until 15 years post study commencement in-keeping with data management outlined in the ethics application.
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Available to whom?
Anyone will be eligible to apply
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Available for what types of analyses?
Scientific analyses
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How or where can data be obtained?
Data will not be placed in a public repository but will be directly sent to approved individuals or institutions after consideration of their application to PI Associate Professor Lee-anne Chapple (
[email protected]
).
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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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