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Trial registered on ANZCTR
Registration number
ACTRN12619000223134
Ethics application status
Approved
Date submitted
9/02/2019
Date registered
14/02/2019
Date last updated
21/02/2019
Date data sharing statement initially provided
14/02/2019
Date results provided
14/02/2019
Type of registration
Retrospectively registered
Titles & IDs
Public title
Feasibility of acupressure for post-operative nausea and vomiting
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Scientific title
Feasibility of acupressure for post-operative nausea and vomiting: A pilot study utilising the FAME approach
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Secondary ID [1]
297345
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N/A
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Universal Trial Number (UTN)
N/A
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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:
Post-operative nasuea
311461
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Postoperative vomiting
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Post-operative pain
311555
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Condition category
Condition code
Anaesthesiology
310100
310100
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0
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Other anaesthesiology
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Alternative and Complementary Medicine
310101
310101
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0
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Other alternative and complementary medicine
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Anaesthesiology
310102
310102
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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
A combined acupressure interventions consisting of Wristband and auricular acupressure
Wristband (Sea-Band Limited, Leicestershire, England). An elasticised fabric band with a protruding button applies pressure to Nei Guan PC6; an acupuncture point known to reduce nausea and vomiting. This is applied to both wrists prior to surgery and retained in place for 24 hours.
Auricular acupressure using seeds (Earseeds com Inc. NJ, 07666 USA). 4 ear seeds are taped to ear acupuncture points related to the reduction of nausea, vomiting, pain and anxiety on one ear, prior to surgery, and retained in place for 72 hours, with the patient applying manual pressure to the seeds 3 times daily. The points are Shen men, Point Zero, Lung and Subcortex. The choice of those points was based on published clinical trials.
All participants will receive the same standardised acupressure intervention in conjunction with usual anaesthetic and perisurgical care.
Compliance was monitored by the researchers who followed up with patients in person while patients were in the hospital and with phone calls after patients being discharged.
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Intervention code [1]
313593
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Treatment: Devices
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Intervention code [2]
313621
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Treatment: Other
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Comparator / control treatment
Standard postoperative nausea and vomiting (PONV ) management of a previous cohort of elective surgery patients from 12/05/2016 to 31/08/2016.
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Control group
Historical
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Outcomes
Primary outcome [1]
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FAME framework is used
Feasibility: What is the time commitment required to deliver acupressure within the peri-surgical environment
This is assessed by the trial acupuncturists who recoded the time needed for the procesure
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Assessment method [1]
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Timepoint [1]
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During the preoperative period between admission and surgery, assessed by measuring the time taken to deliver acupressure to patients.
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Primary outcome [2]
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Appropriateness:
Of those patients who had acupressure applied preoperatively, the percentage who used acupressure for 24 hours after surgery.
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Assessment method [2]
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Timepoint [2]
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24 hours after surgery, assessed by direct observation and questions to the patient.
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Primary outcome [3]
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Meaningfulness: Patient satisfaction with the use of acupressure, assessed by level of agreement with the statement "I am satisfied with the use of acupressure for my recovery" (Strongly agree / agree / neutral / disagree / strongly disagree).
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Assessment method [3]
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Timepoint [3]
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24 hours after surgery
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Secondary outcome [1]
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Effectiveness: Incidence of postoperative nausea and vomiting
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Assessment method [1]
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Timepoint [1]
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6, 24, 48 and 72 hours after surgery, Assessed by direct questioning of the patient.
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Secondary outcome [2]
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Requirement for rescue antiemetics
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Assessment method [2]
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Timepoint [2]
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6, 24, 48 and 72 hours after surgery, assessed by antiemetic medications recorded in the patient medication chart.
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Secondary outcome [3]
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Adverse events occurring during acupressure, including tightness, discomfort, pain, swelling and numbness.
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Assessment method [3]
366692
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Timepoint [3]
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24 hours after the operation, direct questioning of the patient.,
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Secondary outcome [4]
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Quality of recovery: QoR-15 questionnaire
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Assessment method [4]
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Timepoint [4]
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24 hours after minor surgery or 72 hours after major surgery
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Eligibility
Key inclusion criteria
1. Adults 18-90 undergoing elective surgery
2. PONV risk factor at 2 or over,
3. Able to give informed consent
4. For patients whose English is not sufficient for daily communication, interpreting service is required. Only those for whom we can locate an interpreter for the consent will be included.
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Minimum age
18
Years
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Maximum age
90
Years
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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. PC6 wrist area, or the auricle of the ear, not accessible for any reason including previous trauma, local infection or inflammation, or the need for medical/surgical access.
2. Active carpel tunnel syndrome
3. Participants who find the wristbands painful when wearing them, or if the wristbands constrict their circulation, will be excluded.
4. Participants who develop emergency surgical complications may be discontinued. Standard medical care will take precedence.
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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)
N/A
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
N/A
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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
This is a feasibility study. The primary outcome is not the clinical outcome, but the data related to the possibility of acupressure being used in the peri-operative setting.
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Phase
Not Applicable
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Type of endpoint/s
Safety/efficacy
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Statistical methods / analysis
The end points are feasibility and safety.
For feasibility, appropriateness, meaningfulness and safety: descriptive methods will be used.
For effectiveness: Chi square analysis is used to compare the incidence of PONV between the acupressure cohort with the historical cohort. T-tests are used to compare parametric data, including dose of anti-emetics, opioid medication, severity of pain and QR-15.
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
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Actual
10/10/2016
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Date of last participant enrolment
Anticipated
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Actual
5/04/2017
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Date of last data collection
Anticipated
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Actual
31/12/2017
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Sample size
Target
80
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Accrual to date
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Final
55
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Recruitment in Australia
Recruitment state(s)
VIC
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Recruitment hospital [1]
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The Northern Hospital - Epping
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Recruitment postcode(s) [1]
25586
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3076 - Epping
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Funding & Sponsors
Funding source category [1]
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Government body
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Name [1]
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NHMRC
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Address [1]
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National Health and Medical Research Council
GPO Box 1421
Canberra ACT 2601
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Country [1]
301908
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Australia
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Funding source category [2]
301909
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University
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Name [2]
301909
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RMIT University
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Address [2]
301909
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RMIT University, School of Health and Biomedical Sciences
Address PO BOX 71,
Bundoora, Vic 3083
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Country [2]
301909
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Australia
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Primary sponsor type
Hospital
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Name
Northern Hospital
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Address
: 185 Cooper St, Epping VIC 3076
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Country
Australia
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Secondary sponsor category [1]
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Commercial sector/Industry
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Name [1]
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Sea-Band Limited, Leicestershire, England
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Address [1]
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Sea-Band Ltd, Lancaster Road, Hinckley,
Leicestershire, LE10 0AW England
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Country [1]
301663
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United Kingdom
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
302596
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Northern Health
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Ethics committee address [1]
302596
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185 Cooper St, Epping VIC 3076
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Ethics committee country [1]
302596
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Australia
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Date submitted for ethics approval [1]
302596
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16/05/2016
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Approval date [1]
302596
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08/09/2016
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Ethics approval number [1]
302596
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HREC/15/NH/71
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Ethics committee name [2]
302597
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Austin Health
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Ethics committee address [2]
302597
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145 Studley Road PO BOX 55555 Heidelberg Vic 3084
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Ethics committee country [2]
302597
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Australia
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Date submitted for ethics approval [2]
302597
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06/12/2016
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Approval date [2]
302597
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06/12/2016
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Ethics approval number [2]
302597
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HREC/16/Austin/517
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Summary
Brief summary
Post-operative nausea and vomiting (PONV) occurs in 30-50% of patients, and can prolong the hospital stay. Acupressure can safely and effectively reduce the incidence of PONV by up to 30%. Over 80% of surgical patients would be willing to try acupressure for PONV, however this intervention has not been incorporated into routine peri-operative care. This study is embedded in a large project that aims to systematically examine the barriers and enablers in the implementation of acupressure for PONV, and to develop and implement strategies for successful application of acupressure. The specific aim of this feasibility study was to identify the suitable form(s) of acupressure to be used in a peri-operative setting. We used FAME approach to study its feasibility, appropriateness, meaningfulness and effectiveness and safety. Our initial FAME analysis of the existing literature indicates moderate to strong support to the feasibility of per-operative acupressure for preventing and treating PONV. The two forms of acupressure identified from the literature were wristband and auricular acupressure. In this study, we trialled out these two forms of acupressure and to identify if, when and how acupressure could be implemented. We hypothesised that this simple, non-drug intervention would be well-accepted by patients and staff, and with modification could be integrated into the per-operative setting without any difficulties. Acupressure could reduce PONV incidents and / or medication use. Data from the study also helped us identify barriers and enablers for later implementation. This study was conducted among patients undergoing elective surgery at Northern Hospital.
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Trial website
N/A
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Trial related presentations / publications
• Layton, J; Briedis, J ; Stelmach, WS; Ma, J; Atme, J; Howat, P; Hau, R; Xue, CCL; Zheng, Z. (2016) Mechanisms underlying the effects of acupuncture on post-operative nausea and vomiting: a narrative review. Northern Health Research Week, July 206, Melbourne. • Zheng, Z; Briedis, J; Stelmach, WS; Ma, J; Atme, J; Layton, J; Xue, C (2016) Implementing acupressure to improve post-operative nausea and vomiting- Protocol development. November 2016, The 5th NHMRC Symposium on Research Translation. Melbourne • Zheng, Z; Stelmach, WS; Briedis, J; Ma, J; Atme, J; Bourne, D; Crabbe, J; Fletcher, C; Reynolds, D; Howat, P; Hau, R; Layton, J; Xue, CCL (2017) Health professionals’ attitudes towards incorporating acupuncture / acupressure into the management of post-operative nausea and vomiting: a hospital survey Northern Health Research Week, October 2017, Melbourne. • Zheng, Z; Stelmach, WS; Briedis, J; Ma, J; Atme, J; Bourne, D; Crabbe, J; Fletcher, C; Reynolds, D; Howat, P; Layton, J; Xue, CCL; Duong, J; Maduri, M; Nguyen, A; Wijesinghe, P (2017) Acupressure: preventative measure for post-operative nausea and vomiting. Northern Health Research Week, October 2017, Melbourne. • Zheng, Z. (2017) How to integrate acupuncture into routine management of post-operative nausea and vomiting? – a model based on implementation science. Australasian Acupuncture & Chinese Medicine Annual Conference (AACMAC), May 2017, Brisbane . • Zheng, Z; Layton, J; Stelmach, W; Briedis, J; Ma, J; Atme, J; Bourne, D; Crabbe, J; Fletcher, C; Reynolds, D; Howat, P; Cleary, S; Xue, CCL (2018) Implementing acupressure as an preventative measure for post-operative nausea and vomiting: preliminary results. Presented at 2018 ACORN & ASIORNA International Conference, May 2018, Adelaide. • Layton, J; Stelmach, WS; Crabbe, J; Briedis, J; Ma, J; Atme, J; Bourne, D; Cleary, S; Xue, CCL; Zheng, Z (2018) Patterns of uptake of acupressure for reducing postoperative nausea and vomiting Northern Health Research Week, October 2018, Melbourne. • Zheng, Z; Layton, J; Stelmach, WS; Crabbe, J; Briedis, J; Ma, J; Atme, J; Bourne, D; Reynolds, D; Cleary, S; Xue, CCL (2018) Implementing a self-checklist to improve identification of the risk of post-operative nausea and vomiting among surgical patients. Northern Health Research Week, October 2018, Melbourne
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Public notes
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Contacts
Principal investigator
Name
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Ms Wanda Stelmach
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Address
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Divisional Director, Surgery
Northern Health
185 Cooper Street
EPPING VIC 3076
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Country
90766
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Australia
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Phone
90766
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+61 3 8405 8814
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Fax
90766
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+61 3 8405 8038
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Email
90766
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[email protected]
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Contact person for public queries
Name
90767
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Zhen Zheng
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Address
90767
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School of Health and Biomedical Sciences
RMIT University
PO BOX 71, Bundoora, Vic 3083, Australia
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Country
90767
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Australia
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Phone
90767
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+61 3 9925 7167
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Fax
90767
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+61 39925 7178
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Email
90767
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[email protected]
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Contact person for scientific queries
Name
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Zhen Zheng
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Address
90768
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School of Health and Biomedical Sciences
RMIT University
PO BOX 71, Bundoora, Vic 3083, Australia
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Country
90768
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Australia
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Phone
90768
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+61 3 9925 7167
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Fax
90768
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+61 3 9925 7178
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Email
90768
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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 of the clinical outcomes: incidence of postoperative nausea and vomiting, postoperative pain, use of antiemetics and use of opioids and other surgical related outcomes: duration of the anaesthetise, category of surgery, length of hospital stay
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When will data be available (start and end dates)?
Immediately following publication
ending 5 years following main results publication
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Available to whom?
To researchers who provide a methodologically sound proposal, case-by-case basis at the discretion of Primary Sponsor.
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Available for what types of analyses?
IPD meta-analysis
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How or where can data be obtained?
Access subject to approvals by Principal Investigator
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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.
Download to PDF