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Trial registered on ANZCTR
Registration number
ACTRN12624001323516p
Ethics application status
Submitted, not yet approved
Date submitted
16/10/2024
Date registered
31/10/2024
Date last updated
31/10/2024
Date data sharing statement initially provided
31/10/2024
Type of registration
Prospectively registered
Titles & IDs
Public title
Measuring effect of chest physiotherapy in ventilated infants using lung ultrasound (LUS)
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Scientific title
Investigating the effect of targeted chest physiotherapy on acute lung collapse in mechanically ventilated neonates using LUS
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Secondary ID [1]
313193
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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:
Preterm birth
335485
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Lung collapse and consolidation
335486
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Condition category
Condition code
Respiratory
332045
332045
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0
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Other respiratory disorders / diseases
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Reproductive Health and Childbirth
332133
332133
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0
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Complications of newborn
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Chest physiotherapy (CPT) will form the intervention that will be measured in this study. CPT will consist of a combination of techniques including positioning, cupping, expiratory flow increase techniques such as expiratory vibes and sustained expiratory manoeuvres, and endotracheal suction. Treatments will not be standardised. Instead, they will be individualised to each infant’s assessment findings and presentation to reflect clinical reality. All CPT interventions in the study will be performed by a paediatric physiotherapist trained to work in the NCCU. CPT will occur in the NCCU at the infant's bedside as per usual practice in our unit. The techniques, dosing and position utilised during the CPT intervention will be determined by the physiotherapist based on the presence/ type of pathology seen on chest radiograph (CXR), auscultation findings and LUS findings. This is based on current practice in the NCCU where the research project will take place. No published guidelines or practice recommendations are available in the literature due to the lack of previous research undertaken regarding CPT in the neonatal population. A single episode of CPT intervention will be measured, however infant's may be eligible to be measured on more than one occasion, ie. on multiple consecutive days, providing they meet the inclusion criteria. CPT will continue for as many days as indicated (no maximum time frame), based on the physiotherapist's clinical interpretation of assessment findings (CXR, auscultation and LUS). There is no limit on the age of infants being eligible for this research study if they meet inclusion criteria and are receiving care in the NCCU. CPT effects will be measured using Lung Ultrasound (LUS), auscultation, physiological measurements and where available CXR by comparing baseline/ pre-CPT measurements with immediately post, and 4 hours post, CPT measurements. CPT will be undertaken by the physiotherapist and documented in the infant's medical notes and details of the treatment will be documented as part of the study report form. As CPT will be undertaken only by the physiotherapist, not by any other staff members, no adherence strategies will be required.
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Intervention code [1]
329765
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Treatment: Other
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Comparator / control treatment
No control group.
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Control group
Uncontrolled
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Outcomes
Primary outcome [1]
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Change in lung collapse on Lung Ultrasound (LUS)
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Assessment method [1]
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A standardised LUS score (as previously described by Brat et al, 2015) will be quantified immediately after undertaking a bedside LUS using a linear 8-18i-RS hockey stick transducer and a LOGIQ e ultrasound machine. LUS will be performed in a standardised manner as per previous studies (Brat et al, 2015).
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Timepoint [1]
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LUS and LUS score will be completed immediately prior to undertaking CPT intervention, again immediately after completion of CPT intervention, and again at 4 hours after completion of CPT intervention.
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Secondary outcome [1]
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Change in auscultation score
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Assessment method [1]
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Infants will undergo auscultation using a neonatal stethoscope and the findings will be coded as binary scores as previously described by Hansell et al, 2023. Scores will be documented as 0 = normal breath sounds and 1 = added sounds or absent breath sounds
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Timepoint [1]
440763
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Auscultation, and auscultation scores, will be collected immediately prior to CPT, immediately after CPT and again at 4 hours post CPT.
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Secondary outcome [2]
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Change in CXR score (if available as part of medical care) with CXR score being a measure of the extent of lung collapse/ how much lung is collapsed, as per the categorization below in Assessment method
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Assessment method [2]
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CXR formal reports will be coded based on previous studies (Hansell et al, 2023), where 0 = No collapse, 1 = plate or minor collapse, 2 = moderate collapse and 3 = total collapse
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Timepoint [2]
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CXR scores will be made using the most recent formally reported CXR prior to these time points and the details of these CXR will be documented.
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Secondary outcome [3]
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Changes in set Tidal volume or Inspiratory pressure (depending on whether infant is ventilated on a volume mode or a pressure mode)
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Assessment method [3]
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Tidal volume/ set inspiratory pressure will be collected immediately prior to CPT, immediately after, and at 4 hours post CPT
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Timepoint [3]
440971
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Tidal volume/ set inspiratory pressure be collected immediately prior to CPT, immediately after, and at 4 hours post CPT
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Secondary outcome [4]
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Changes in Fraction of inspired oxygen (FiO2)
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Assessment method [4]
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FiO2 will be recorded directly from the ventilator
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Timepoint [4]
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FiO2 will be recorded immediately prior to CPT, immediately after CPT and at 4 hours after the completion of CPT
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Secondary outcome [5]
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Changes in oxygen saturations (SpO2)
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Assessment method [5]
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SpO2 will be recorded directly from the infant's observations monitor
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Timepoint [5]
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SpO2 will be recorded immediately prior to CPT, immediately after CPT and at 4 hours after the completion of CPT
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Secondary outcome [6]
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Changes in transcutaneous carbon dioxide level (TCO2) where available (if being used with infant at the time of CPT)
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Assessment method [6]
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TCO2 will be documented directly from the TCO2 monitor where available
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Timepoint [6]
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TCO2 will be recorded immediately prior to CPT, immediately after CPT and at 4 hours after the completion of CPT
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Eligibility
Key inclusion criteria
i. Neonates < 39 weeks gestational age
ii. Invasively ventilated, receiving care in Mater NCCU
iii. Chest radiograph in previous 24 hours of undertaking CPT and evidence of lung collapse/ consolidation diagnosed by radiographer.
iv. Parent/ guardian written consent.
v. Infant deemed medically safe to undergo CPT interventions.
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Minimum age
23
Weeks
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Maximum age
39
Weeks
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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
i. Contraindication to CPT
ii. Absence of CXR within 24 hours from time of CPT assessment and treatment
iii. LUS not possible (e.g. Poor skin integrity, dressings, drains etc)
iv. Pending or active redirection of care
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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
Single group
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
1/01/2025
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Actual
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Date of last participant enrolment
Anticipated
31/12/2025
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Actual
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Date of last data collection
Anticipated
31/12/2025
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Actual
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Sample size
Target
30
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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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Funding & Sponsors
Funding source category [1]
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Other
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Name [1]
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Mater Research
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Address [1]
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Country [1]
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Australia
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Primary sponsor type
Individual
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Name
Bronagh McAlinden - Mater Hospital Brisbane
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Address
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Country
Australia
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Secondary sponsor category [1]
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Individual
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Name [1]
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Judith Hough - Mater Hospital Brisbane
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Address [1]
319954
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Country [1]
319954
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Australia
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Ethics approval
Ethics application status
Submitted, not yet approved
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Ethics committee name [1]
316338
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Mater Misericordiae Ltd Human Research Ethics Committee
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Ethics committee address [1]
316338
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http://www.materresearch.org.au/about-us/human-research-ethics-and-governance/human-research-ethics
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Ethics committee country [1]
316338
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Australia
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Date submitted for ethics approval [1]
316338
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24/10/2024
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Approval date [1]
316338
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Ethics approval number [1]
316338
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Summary
Brief summary
Chest physiotherapy (CPT) is regarded as an important contributor to the management, and potentially long-term outcomes, of preterm infants with lung disease. Delivering CPT in this population is not without risk, however, and the decision to undertake CPT interventions rely on effective assessment (Hough, 2008). Preterm infants present with multiple lung pathologies, (Gallacher et al, 2016) however not all of these are best treated using CPT. In preterm infants, CPT is thought to be most efficacious in treating alveolar collapse and consolidation, and not useful, or potentially harmful, in the management of interstitial lung disease (Hough, 2008). Differentiating between pathological processes using existing assessment tools such as auscultation and chest radiograph is challenging as these tools only provide subjective, non-specific and surrogate measurements of lung aeration and pathology (McAlinden et al, 2020). Physiotherapy- led lung ultrasound (LUS) has been recently proposed as a more accurate and objective way to image both regional lung aeration and lung pathology by the bedside without the potentially harmful radiation associated with other imaging techniques (Hansell et al, 2023; Hayward et al, 2021). Such imaging makes it theoretically possible to deliver individualised and targeted CPT, thereby improving effectiveness and minimising physiological burden. (Le Neindre et al, 2023) Despite its promise, physiotherapist-led LUS is considered an extended scope skill in Australia and further training and knowledge is required before it can be used safely and effectively. To date, physiotherapist-led LUS has been investigated in paediatric (Myszkowski, 2019; Shkurka & Nolann 2023) and adult cohorts (Hansell et al, 2023; Le Neindre et al, 2023) but similar research has yet to be undertaken in preterm infants. This study aims to investigate the use of LUS as a neonatal physiotherapy assessment tool to measure the effect of CPT in premature infants with lung collapse.
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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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Ms Bronagh McAlinden
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Address
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Physiotherapy Department, Mater Hospital Brisbane, Raymond Terrace, South Brisbane QLD 4101
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Country
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Australia
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Phone
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+61 0403652991
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Fax
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Email
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[email protected]
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Contact person for public queries
Name
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Bronagh McAlinden
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Address
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Physiotherapy Department, Mater Hospital Brisbane, Raymond Terrace, South Brisbane QLD 4101
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Country
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Australia
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Phone
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+61 0403652991
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Fax
137579
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Email
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[email protected]
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Contact person for scientific queries
Name
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Bronagh McAlinden
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Address
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Physiotherapy Department, Mater Hospital Brisbane, Raymond Terrace, South Brisbane, QLD 4101
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Country
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Australia
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Phone
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+61 0403652991
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Fax
137580
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Email
137580
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[email protected]
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Data sharing statement
Will the study consider sharing individual participant data?
Yes
Will there be any conditions when requesting access to individual participant data?
Persons/groups eligible to request access:
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Researchers who provide a sound proposal
Conditions for requesting access:
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-
What individual participant data might be shared?
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All de-identified data line by line
What types of analyses could be done with individual participant data?
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IPD meta-analyses
When can requests for individual participant data be made (start and end dates)?
From:
Immediately following publication and with no end date
To:
-
Where can requests to access individual participant data be made, or data be obtained directly?
•
Contact PI Bronagh McAlinden through email:
[email protected]
Are there extra considerations when requesting access to individual participant data?
No
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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