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Trial registered on ANZCTR
Registration number
ACTRN12624000076572
Ethics application status
Approved
Date submitted
18/12/2023
Date registered
30/01/2024
Date last updated
23/09/2024
Date data sharing statement initially provided
30/01/2024
Type of registration
Prospectively registered
Titles & IDs
Public title
Clindamycin and bacterial load reduction as prophylaxis for surgical site infection after below-knee flap and graft procedures: a trial protocol.
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Scientific title
Clindamycin and bacterial load reduction as prophylaxis for surgical site infection after below-knee flap and graft procedures in patients requiring surgical management of skin cancer below the knee: a trial protocol.
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Secondary ID [1]
311202
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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:
Skin Cancer
332379
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Surgical site infection
332380
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Condition category
Condition code
Skin
329091
329091
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0
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Dermatological conditions
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Cancer
329259
329259
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0
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Non melanoma skin cancer
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Cancer
329260
329260
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0
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Malignant melanoma
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Treatment arms will be:
• Arm 1 – All patients will use an all-over chlorhexidine body wash (minimum 50ml of Chlorhexidine gluconate 4% w/v solution) the night before and morning of the surgery and receive placebo antibiotics as per those is arm 3 – Control.
• Arm 2 – Clindamycin: Patients will be administered 450mg of oral clindamycin 30-60 mins before surgery in the waiting room to enable monitoring for adverse reactions and an equal second dose at home 6hrs post-surgery Participants will perform a placebo bacterial load reduction following the same protocol as in Arm 1.
Participants will be asked to complete a treatment diary to monitor adherence to the intervention.
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Intervention code [1]
327652
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Prevention
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Intervention code [2]
327653
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Treatment: Drugs
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Comparator / control treatment
Arm 3 – Control: This group represents normal standard of care in which no active bacterial load reduction or active clindamycin will be administered. Patients will receive placebo oral capsules containing an inert vehicle powder for clindamycin (in lieu of clindamycin), placebo saline wash (in lieu of chlorhexidine) and placebo soft white paraffin ointment (in lieu of nasal mupirocin). Placebo treatments will follow the same time schedule as their active counterparts in arms 1 and 2.
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Control group
Placebo
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Outcomes
Primary outcome [1]
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Incidence of postoperative surgical site infection
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Assessment method [1]
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Surgical site infection will be determined in accordance with a modified version of the CDC definition for superficial surgical site infection:
• Infection occurs within 30 days after excision, AND
• Infection involves ONLY skin or subcutaneous tissue of the incision, AND
• At least ONE of the following:
o Purulent drainage with or without laboratory confirmation from the superficial incision
o At least one of the following signs or symptoms: pain or tenderness, localised swelling, redness or heat
o Diagnosis of superficial surgical site infection by the GP
• Stitch abscesses, characterised by minimal inflammation and discharge confined to points of suture penetration, will not be included as surgical site infection.
These data will be collected at follow-up clinical appointments (for suture removal or at any time the participant presents to the clinic), if indicated by the participant at any time during their involvement in the trial, or if reported at the 28 day post surgery phone call follow-up.
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Timepoint [1]
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Day 14 post surgery. Day 28 post surgery to assess for delayed infection.
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Secondary outcome [1]
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Adverse reactions to clindamycin
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Assessment method [1]
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Presence of:
a. Anaphylaxis
b. Nausea, diarrhoea, vomiting
c. skin irritation or contact dermatitis
d. rash
These data will be collected at follow-up clinical appointments (for suture removal or at any time the participant presents to the clinic), if indicated by the participant at any time during their involvement in the trial, or if reported at the 28 day post surgery phone call follow-up.
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Timepoint [1]
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Within 30 days of surgery
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Secondary outcome [2]
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Microbiology of infected wounds
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Assessment method [2]
430139
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All wounds with purulent discharge will be swabbed and sent to a pathology lab for testing
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Timepoint [2]
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Within first 30 days post surgery
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Secondary outcome [3]
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Cost analysis
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Assessment method [3]
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Based on number needed to treat to prevent infection (difference in numbers of infection in intervention and control arms- the number of infections prevented will be divided by the number os infections treated). Costs will then be calculated based on the difference between resource use and associated costs of infection/no infection. Costs will be sourced from Medicare item numbers and out-of-pocket costs to the participants which can be collected from the treating clinics.
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Timepoint [3]
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Within 30 days from time of surgery
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Secondary outcome [4]
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Adverse reactions to chlorhexidine wash
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Assessment method [4]
430632
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Presence of:
a. Anaphylaxis
b. Nausea, diarrhoea, vomiting
c. skin irritation or contact dermatitis
d. rash
These data will be collected at follow-up clinical appointments (for suture removal or at any time the participant presents to the clinic), if indicated by the participant at any time during their involvement in the trial, or if reported at the 28 day post surgery phone call follow-up.
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Timepoint [4]
430632
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Within 30 days of surgery
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Secondary outcome [5]
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Patterns of antibiotic resistance
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Assessment method [5]
430634
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Based on microbiology reports of any surgical site infection (SSI)
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Timepoint [5]
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At 30 days post surgery
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Eligibility
Key inclusion criteria
Patients presenting to recruiting skin cancer clinics for surgical management of skin cancer below the knee which requires a complex surgical technique (flap or graft repair).
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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
Allergy to clindamycin, chlorhexidine or mupirocin; existing skin infection; unable to provide informed consent; peripheral vascular disease; diabetes; current use of antibiotics; clinical indication for antibiotic treatment following excision (e.g. valvular heart disease).
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Study design
Purpose of the study
Prevention
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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)
Numbered containers
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
sequence generated by a computer-generated random number table
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people receiving the treatment/s
The people administering the treatment/s
The people assessing the outcomes
The people analysing the results/data
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Intervention assignment
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Other design features
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Phase
Phase 1
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Recruiting
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Date of first participant enrolment
Anticipated
1/05/2024
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Actual
10/04/2024
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Date of last participant enrolment
Anticipated
1/02/2025
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Actual
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Date of last data collection
Anticipated
1/03/2025
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Actual
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Sample size
Target
155
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Accrual to date
31
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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]
315462
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University
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Name [1]
315462
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James Cook University
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Address [1]
315462
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1 James Cook Drive James Cook University QLD 4811
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Country [1]
315462
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Australia
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Primary sponsor type
University
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Name
James Cook University
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Address
1 James Cook Drive James Cook University QLD 4811
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Country
Australia
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Secondary sponsor category [1]
317531
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None
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Name [1]
317531
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Address [1]
317531
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Country [1]
317531
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
314371
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Townsville Hospital and Health Service Human Research Ethics Committee
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Ethics committee address [1]
314371
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100 Angus Smith Drive Douglas QLD 4814
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Ethics committee country [1]
314371
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Australia
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Date submitted for ethics approval [1]
314371
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22/09/2023
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Approval date [1]
314371
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12/12/2023
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Ethics approval number [1]
314371
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90257
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Summary
Brief summary
This study will investigate the effectiveness of two interventions to prevent surgical site infection after below-knee surgery for skin cancer in adults. Who is it for? You may be eligible for this study if you are aged 18 years or older, you have been diagnosed with a skin cancer below the knee which requires a complex surgical technique (flap or graft repair), and you are a patient at one of the participating centres in Queensland. Study details Participants who choose to enrol in this study will be randomly allocated by chance (similar to flipping a coin) to one of three groups. Participants allocated to the first group will be asked to take an oral tablet pre- and post-surgery, and use an antibacterial body wash prior to their surgery. Participants allocated to the second group will also be asked to take a pre- and post-surgery antibiotic dose and use a provided body wash prior to their surgery. Participants allocated to the third group will be asked to take an oral tablet pre- and post-surgery and use a provided body wash prior to their surgery. It is hoped this research will determine whether use of oral antibiotics with or without antibacterial body wash has any impact on the incidence of post-surgical skin infections in patients undergoing surgical removal of below the knee skin cancers. If one or both of these measures is found to be effective, a larger trial enrolling a greater number of participants may be undertaken.
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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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Dr Helena Rosengren
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Address
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Skin Repair Skin Cancer Clinic Townsville, 66 Mooney Street, Gulliver, Townsville, QLD, 4812
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Country
131338
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Australia
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Phone
131338
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+61 07 4779 0099
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Fax
131338
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Email
131338
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[email protected]
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Contact person for public queries
Name
131339
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Helena Rosengren
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Address
131339
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Skin Repair Skin Cancer Clinic Townsville, 66 Mooney Street, Gulliver, Townsville, QLD, 4812
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Country
131339
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Australia
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Phone
131339
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+61 07 4779 0099
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Fax
131339
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Email
131339
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[email protected]
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Contact person for scientific queries
Name
131340
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Helena Rosengren
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Address
131340
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Skin Repair Skin Cancer Clinic Townsville, 66 Mooney Street, Gulliver, Townsville, QLD, 4812
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Country
131340
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Australia
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Phone
131340
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+61 07 4779 0099
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Fax
131340
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Email
131340
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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
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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