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Trial registered on ANZCTR
Registration number
ACTRN12624001117505
Ethics application status
Approved
Date submitted
28/08/2024
Date registered
17/09/2024
Date last updated
17/09/2024
Date data sharing statement initially provided
17/09/2024
Type of registration
Prospectively registered
Titles & IDs
Public title
Penthrox vs nitrous oxide for painful emergency medicine procedures
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Scientific title
A randomised controlled trial comparing Penthrox (methoxyflurane) with nitrous oxide for analgesia during painful emergency medicine procedures in patients aged eight years and over
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Secondary ID [1]
312805
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Nil known
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Universal Trial Number (UTN)
U1111-1312-3668
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Trial acronym
N/A
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Linked study record
N/A
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Health condition
Health condition(s) or problem(s) studied:
Painful emergency medicine procedures
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Condition category
Condition code
Emergency medicine
331423
331423
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0
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Other emergency care
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Anaesthesiology
331543
331543
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0
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Pain management
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
This trial will examine the effectiveness of Penthrox (methoxyflurane; intervention) versus nitrous oxide (comparator) in emergency department patients undergoing painful procedures. Participants randomised to the Penthrox arm will be asked to inhale and exhale into the mouthpiece of a 3mL Penthrox device for 6–8 breaths, beginning inhalation thirty seconds before commencement of the procedure, after which they can continue to inhale continuously or intermittently as required for the duration of the procedure while under observation by the clinician researcher. A second 3mL bottle may be used for continued analgesia if deemed necessary by the clinician researcher.
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Intervention code [1]
329342
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Treatment: Drugs
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Comparator / control treatment
Nitrous oxide is a staple of pain relief in the emergency department, administered via a disposable plastic circuit connected to a gas supply outlet in dedicated treatment rooms. Participants randomised to the nitrous oxide arm will begin receiving treatment thirty seconds before commencement of the procedure, during which time nitrous oxide will be titrated up to a maximum concentration of 70%, delivered via a facemask or mouthpiece. The concentration may be adjusted for analgesic effect as required throughout the duration of the procedure, after which it will be discontinued and the participant will be administered 100% oxygen for a brief (~30 second) period before they return to breathing room air.
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Control group
Active
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Outcomes
Primary outcome [1]
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Patient-reported average pain intensity during the procedure (based on individual measurements taken at the timepoints specified below)
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Assessment method [1]
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Numeric Rating Scale (NRS)
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Timepoint [1]
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1. Immediately pre-procedure
2. Immediately post-procedure
3. 5 minutes post-procedure
4. 10 minutes post-procedure.
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Secondary outcome [1]
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Patient-reported worst pain intensity during the procedure (based on individual measurements taken at the timepoints specified below)
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Assessment method [1]
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Numeric Rating Scale (NRS)
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Timepoint [1]
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1. Immediately pre-procedure
2. Immediately post-procedure
3. 5 minutes post-procedure
4. 10 minutes post-procedure.
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Secondary outcome [2]
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Patient reported current pain intensity before and after the procedure
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Assessment method [2]
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Numeric Rating Scale (NRS)
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Timepoint [2]
438947
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1. Immediately pre-procedure
2. Immediately post-procedure
3. 5 minutes post-procedure
4. 10 minutes post-procedure.
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Secondary outcome [3]
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Patient-reported procedure satisfaction
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Assessment method [3]
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Five-point Likert scale from 'very dissatisfied' to 'very satisfied'
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Timepoint [3]
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Ten minutes after procedure
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Secondary outcome [4]
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Clinician-reported patient pain intensity during the procedure
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Assessment method [4]
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Critical-Care Pain Observation Tool (CPOT)
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Timepoint [4]
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Immediately after procedure
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Secondary outcome [5]
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Clinician-reported procedure satisfaction
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Assessment method [5]
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Five-point Likert scale
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Timepoint [5]
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Immediately after procedure
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Secondary outcome [6]
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Time to procedure
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Assessment method [6]
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Electronic Medical Record lookup
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Timepoint [6]
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Assessed following discharge
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Secondary outcome [7]
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Time to discharge
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Assessment method [7]
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Electronic Medical Record lookup
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Timepoint [7]
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Assessed following discharge
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Secondary outcome [8]
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Use of adjunct analgesia
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Assessment method [8]
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Electronic Medical Record lookup
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Timepoint [8]
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Following discharge
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Secondary outcome [9]
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Adverse events (e.g. for Penthrox: dizziness, feeling sick or nauseous, drowsiness, headache, feeling drunk; for nitrous oxide: feeling dizzy or light-headed, feeling or being sick, euphoria, feeling sleepy, feeling bloated).
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Assessment method [9]
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1. Clinician investigators to record in REDCap during/after procedure
2. Electronic Medical Record lookup
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Timepoint [9]
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Following discharge
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Eligibility
Key inclusion criteria
• Age of eight years or older
• Attending Box Hill Hospital’s Emergency Department Fast Track area
• Requiring a potentially painful procedure that would normally involve the use of nitrous oxide
• Trained clinician researcher available to enrol patient, administer either medication, and instruct/assist participants with self-administration of Penthrox where necessary.
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Minimum age
8
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
• Inability to self-administer Penthrox
• Inability to give verbal or written consent.
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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)
Allocation will be concealed through the use of computerised randomisation, the schedule for which is described in detail below. A team member without contact with patients will obtain and employ the randomisation schedule (creating sequentially numbered, opaque, sealed envelopes).
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Patients will be randomly assigned (1:1) using block randomisation with random block lengths (between 2 and 6 per block) to either intervention or comparator. The randomisation schedule will be developed using the ‘blockrand’ package in R (v4.3.3; R Core Team, Vienna, Austria).
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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
Phase 3
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
For patient-reported pain intensity (numerical rating scale), if there is truly no difference between Penthrox and nitrous oxide, 198 patients (99 per group) are required to be 80% sure that the lower limit of a one-sided 97.5% confidence interval (or equivalently a 95% two-sided confidence interval) will be above the non-inferiority limit of -1.4 points assuming a conservative SD of 3.5 points. There is no plan to achieve an equal balance of adult and child participants in the sample; our aim is for a broad enrolment pool that represents real-world use of procedural sedation.
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
18/09/2024
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Actual
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Date of last participant enrolment
Anticipated
9/09/2026
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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
198
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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]
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Box Hill Hospital - Box Hill
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Recruitment postcode(s) [1]
43050
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3128 - Box Hill
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Funding & Sponsors
Funding source category [1]
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Charities/Societies/Foundations
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Name [1]
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Eastern Health Foundation
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Address [1]
317239
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Country [1]
317239
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Australia
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Primary sponsor type
Other
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Name
Eastern Health
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Address
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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]
319520
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Country [1]
319520
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
315977
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Eastern Health Human Research Ethics Committee
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Ethics committee address [1]
315977
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https://www.easternhealth.org.au/site/item/34-research-ethics
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Ethics committee country [1]
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Australia
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Date submitted for ethics approval [1]
315977
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03/04/2024
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Approval date [1]
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31/07/2024
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Ethics approval number [1]
315977
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E24-007-106072
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Summary
Brief summary
Timely provision of analgesia in the emergency department is often challenging, especially during periods of high patient demand. This has been exacerbated by ongoing staff shortages since the COVID-19 pandemic. Although several analgesic options already exist in the emergency department setting, not all clinical scenarios are well catered for. In particular, patients who are required to undergo a painful procedure in the emergency department, such as suturing, wound debridement or reduction of a fracture, often have to wait for a considerable length of time due to lack of an available treatment space with a nitrous oxide wall outlet, inadequate staffing to provide a second clinician or inadequate fasting. Penthrox provides an alternative that may alleviate some of these issues, allowing for more timely administration than nitrous oxide and subsequently a shorter length of stay. Although a number of studies have been published comparing Penthrox with placebo, there are no good quality head-to-head studies that directly compare Penthrox with nitrous oxide.
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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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A/Prof Paul Buntine
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Address
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Eastern Health – Box Hill Hospital, Emergency Department, 5 Arnold St, Box Hill VIC 3128.
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Country
136402
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Australia
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Phone
136402
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+61 425 749 936
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Fax
136402
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Email
136402
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[email protected]
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Contact person for public queries
Name
136403
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Paul Buntine
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Address
136403
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Eastern Health – Box Hill Hospital, Emergency Department, 5 Arnold St, Box Hill VIC 3128.
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Country
136403
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Australia
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Phone
136403
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+61 425 749 936
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Fax
136403
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Email
136403
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[email protected]
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Contact person for scientific queries
Name
136404
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Paul Buntine
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Address
136404
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Eastern Health – Box Hill Hospital, Emergency Department, 5 Arnold St, Box Hill VIC 3128.
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Country
136404
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Australia
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Phone
136404
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+61 425 749 936
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Fax
136404
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Email
136404
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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
Doc. No.
Type
Citation
Link
Email
Other Details
Attachment
24136
Ethical approval
388336-(Uploaded-23-08-2024-13-03-47)-HREC E24-007-106072 Final Approval Jul2024.pdf
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.
Download to PDF