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Trial registered on ANZCTR
Registration number
ACTRN12611001040954
Ethics application status
Approved
Date submitted
29/09/2011
Date registered
4/10/2011
Date last updated
25/06/2014
Type of registration
Retrospectively registered
Titles & IDs
Public title
A randomised, parallel controlled trial on the effect of heated humidification on patient comfort and facial temperature in patients on non-invasive ventilation, using an oro-nasal facemask.
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Scientific title
Effects of heated humidification during non-invasive ventilation on patient comfort with acute exacerbations of Chronic Obstructive Pulmonary Disease (COPD) and Obesity Hypoventilation Syndrome (OHS).
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Secondary ID [1]
273124
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Nil
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Universal Trial Number (UTN)
U1111-1124-8817
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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:
Chronic Obstructive Pulmonary Disease (COPD)
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Obesity Hypoventilation Syndrome (OHS)
270876
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Condition category
Condition code
Respiratory
279053
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0
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Chronic obstructive pulmonary disease
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Respiratory
279054
279054
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0
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Other respiratory disorders / diseases
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Treatment: Heated humidifier and heated respiratory circuit
A controlled, parallel study.
Patients already prescribed non-invasive ventilation (NIV) are randomised to 2 arms; humidified and non-humidified NIV. Patients are given up to 24 hours to stabilise on NIV, once they are stable on NIV they are asked if they want to take part in the study.
Patients in the humidified arm receive 4 hours of NIV, delivered from a standard hospital NIV ventilator, using the study heated humidifier, heated circuit and mask. The humidifier is turned off and does not contain any water as a washout, to establish a baseline. After 4 hours water is added to the heated humidifier and it is switched on and remains on for the following 8 hour treatment. In this intervention group the gas is heated and humidified to 31 degrees C, 32mg/L water.
Patients in the non-humidified arm receive 4 hours of NIV, delivered from a standard hospital NIV ventilator, using the study heated humidifier, heated circuit and mask. The humidifier is turned off and does not contain any water as a washout, to establish a baseline. The humidifier remains switched off with no water in it for the 12 hours of the study, 4 hour washout and 8 hours treatment.
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Intervention code [1]
269466
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Treatment: Devices
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Comparator / control treatment
The placebo is 8 hours of non-invasive ventilation delivered by the same equipment but without adding water to it to provide humidity or turning the heater on.
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Control group
Placebo
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Outcomes
Primary outcome [1]
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Primary Outcome 1: Change in patient comfort score on a visual analogue scale of 1-10 after the treatment, compared to the baseline reading prior to the treatment.
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Assessment method [1]
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Timepoint [1]
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Timepoint: At 8 hours of treatment
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Secondary outcome [1]
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Secondary Outcome 1: Change in patient comfort score on a visual analogue scale of 1-10 during the treatment, compared to the baseline reading prior to the treatment.
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Assessment method [1]
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Timepoint [1]
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Timepoint: At 4 hours of treatment.
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Secondary outcome [2]
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Secondary Outcome 2: Change in NIV side effects, as determined by a patient questionnaire, compared to the baseline reading prior to the treatment.
Patients are asked on a 0-4 scale (0= not a problem, 1=slight problem, 2=moderate problem, 3= major problem, 4=NIV use suspended because of it).
The side effects assessed are: 1. pressure from mask or straps, 2. airleaks, 3. air pressure too high, 4. machine noise, 5. claustrophobia, 6. dry mouth or throat, 7. mouth or throat too hot, 8. runny nose, 9. congested nose, 10. nose bleeds, 11. head ache, 12. chest discomfort, 13. mask coming off face, 14. skin irritation under mask, 15. skin too hot under mask, 16. too hot generally.
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Assessment method [2]
294263
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Timepoint [2]
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Timepoint: At 4 hours and 8 hours of treatment.
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Secondary outcome [3]
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Secondary Outcome 3: Number and timing of breaks from NIV over the 8 hours of treatment, and the reason.
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Assessment method [3]
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Timepoint [3]
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Timepoint: Throughout the 8 hours of treatment
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Secondary outcome [4]
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Secondary Outcome 4: Change in patient skin facial temperature on the cheek, outside of the mask, compared to the baseline reading prior to the treatment.
A temperature probe (thermocouple) will be temporarily taped to the patient's face using hypoallergenic tape and a reading taken, using a Fisher and Paykel Healthcare Thermister reader (TM101)
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Assessment method [4]
294265
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Timepoint [4]
294265
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Timepoint: At 4 hours and 8 hours of treatment.
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Secondary outcome [5]
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Secondary Outcome 5: Change in patient skin facial temperature on the chin, inside of the mask, compared to the baseline reading prior to the treatment.
A temperature probe (thermocouple) will be temporarily taped to the patient's face using hypoallergenic tape and a reading taken, using a Fisher and Paykel Healthcare Thermister reader (TM101)
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Assessment method [5]
294266
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Timepoint [5]
294266
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Timepoint: At 4 hours and 8 hours of treatment.
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Secondary outcome [6]
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Secondary Outcome 6: Change in patient core temperature, as determined by an ear thermometer, compared to the baseline reading prior to the treatment.
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Assessment method [6]
294267
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Timepoint [6]
294267
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Timepoint: At 4 hours and 8 hours of treatment.
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Eligibility
Key inclusion criteria
1. Acute ventilatory failure in patients with Chronic Obstructive Pulmonary Disease (COPD) or Obesity Hypoventilation Syndrome (OHS), or overlap syndrome (COPD and OHS)
2. NIV has been commenced on clinical grounds, in consultation with a Respiratory Physician
3. The patient has shown an initial positive clinical response to NIV
4. Patient has a good understanding of English
5. Patient is capable of giving informed consent
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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
1. NIV is medically contraindicated
2. Delirium, dementia or confusion due to any cause
3. Patients considered as palliative
4. Kyphoscoliosis
5. Neuromuscular disease
6. Motor neuron disease
7. Cardiogenic pulmonary oedema
8. Unstable coronary disease
9. Facial deformity
10. Pneumothorax
11. NIV failure in the first hour (either intolerance or requirement for intubation)
12. Patient previously enrolled in the study
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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)
Patients who fit the inclusion criteria and are stabilised on NIV within 24 hours of being in the respiratory ward are asked whether they would like to take part in the study. Allocation is according to a table of randomised treatments; Treatment A or Treatment B.
Allocation is not concealed.
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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.
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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
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
22/08/2011
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Actual
22/08/2011
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Date of last participant enrolment
Anticipated
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Actual
20/07/2012
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
42
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Accrual to date
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Final
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Recruitment outside Australia
Country [1]
3871
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New Zealand
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State/province [1]
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Auckland
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Funding & Sponsors
Funding source category [1]
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Commercial sector/Industry
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Name [1]
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Fisher and Paykel Healthcare
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Address [1]
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15, Maurice Paykel Place,
East Tamaki,
Auckland 2013
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Country [1]
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New Zealand
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Primary sponsor type
Hospital
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Name
Counties Manukau District Health Board
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Address
Middlemore Hospital,
Hospital Road,
Otahuhu,
Auckland,1640
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Country
New Zealand
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Secondary sponsor category [1]
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Individual
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Name [1]
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Diana Hart
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Address [1]
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Middlemore Hospital,
Hospital Road,
Otahuhu,
Auckland,1640
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Country [1]
268943
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New Zealand
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Other collaborator category [1]
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Commercial sector/Industry
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Name [1]
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Fisher and Paykel Healthcare
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Address [1]
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15, Maurice Paykel Place,
East Tamaki,
Auckland 2013
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Country [1]
252269
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New Zealand
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
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Upper South A Regional Ethics Committee
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Ethics committee address [1]
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Montgomery Watson Building, 6 Hazeldean Road, Christchurch, 8023
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Ethics committee country [1]
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New Zealand
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Date submitted for ethics approval [1]
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28/06/2011
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Approval date [1]
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18/07/2011
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Ethics approval number [1]
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URA/11/07/028
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Summary
Brief summary
Non-invasive ventilation (NIV) provides respiratory support through the patient’s upper airway using a facemask. NIV is beneficial for some patients, such as those with an exacerbation of chronic obstructive pulmonary disease (COPD), or obesity hyperventilation syndrome (OHS). Many patients find NIV therapy uncomfortable and difficult to tolerate due to the high pressures and flows of cold gas. Consequently, the success of NIV, and ultimately patient outcome, can be influenced by how much a patient uses it. To improve patient tolerance the gas supplied during NIV may be heated and humidified to 31degrees C/ 32mg/L water, although there is little clinical data to support this for this therapy. Patient tolerance is improved because heating and humidifying the gas minimises airway drying and improves secretion clearance from the patient’s airways, stopping them from becoming dry and sore and making it easier for them to cough up secretions. However, some patients complain of being too hot on NIV and using heated humidification may contribute to this. We will test patient comfort, perception of heat, and facial temperature, related to core body temperature, during NIV with and without heated humidification. We will assess the benefits to patients of supplying heated humidification with this therapy. This study will take place exclusively in the respiratory ward (ward 7) of Middlemore Hospital. Only patients already prescribed NIV by a respiratory physician will be eligible for the study. Patients are given up to 24 hours to stabilise on NIV, once they are stable on NIV they are asked if they want to take part in the study. After the study patients will continue on NIV as prescribed by the respiratory physician. They may stay on the study equipment or use the standard hospital NIV equipment, which they will have been on prior to being recruited on to the study.
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Trial website
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Trial related presentations / publications
Hart D, O'Dochartaigh C, Beaumont-Orr S, Lorimer J. The effects of heated humidification on patients on noninvasive ventilation (NIV) for acute ventilatory failure. European Respiratory Society Meeting, Barcelona. P2483. Sept 2013.
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Public notes
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Contacts
Principal investigator
Name
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Mrs Mrs Diana Hart
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Address
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Third Floor, Support Building, Middlemore Hospital, Hospital Road, Otahuhu, Auckland, 1640
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Country
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New Zealand
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Phone
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+64 9 276 0044 ext 2036
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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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Diana Hart
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Address
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Third Floor, Support Building,
Middlemore Hospital,
Hospital Road,
Otahuhu,
Auckland, 1640
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Country
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New Zealand
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Phone
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+64 9 276 0044 ext 2036
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Fax
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+64 9 276 0249
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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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Diana Hart
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Address
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Third Floor, Support Building,
Middlemore Hospital,
Hospital Road,
Otahuhu,
Auckland, 1640
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Country
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New Zealand
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Phone
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+64 9 276 0044 ext 2036
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Fax
7385
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+64 9 276 0249
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Email
7385
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[email protected]
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No information has been provided regarding IPD availability
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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