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Trial registered on ANZCTR
Registration number
ACTRN12624000188538
Ethics application status
Approved
Date submitted
18/01/2024
Date registered
27/02/2024
Date last updated
9/08/2024
Date data sharing statement initially provided
27/02/2024
Type of registration
Prospectively registered
Titles & IDs
Public title
A pilot study of preoperative Roxadustat in patients undergoing major surgery.
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Scientific title
Hypoxic Enhancement Before Major Surgery (HYPE): A pilot randomised controlled trial of preoperative Roxadustat vs placebo in patients undergoing major surgery, assessing safety, effectiveness and feasibility.
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Secondary ID [1]
311365
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None
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Universal Trial Number (UTN)
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Trial acronym
HYPE Pilot Study
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Postoperative Complications
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Surgical site infection
332893
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Condition category
Condition code
Surgery
329338
329338
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0
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Other surgery
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Infection
329609
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0
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Other infectious diseases
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Roxadustat 100mg oral capsules taken on alternate days for four days up to and including the day of surgery i.e. 1st dose 4 days before surgery, 2nd dose 2 days before surgery, final dose on day of surgery. Adherence will be documented by participants in a treatment diary and checked by research team on day of surgery.
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Intervention code [1]
327809
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Treatment: Drugs
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Comparator / control treatment
Placebo capsules identical in appearance with TGA approved StarCap 1500 Starch Excipient (contains maize starch and pre-gelatinised maize starch).
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Control group
Placebo
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Outcomes
Primary outcome [1]
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A composite of any acute preoperative illness prompting participant to discontinue drug or to seek medical assessment AND/OR any hospital acquired complication (HAC) using the Australian Commission on Safety and Quality in Healthcare definitions.
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Assessment method [1]
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Preoperative treatment diary, in-hospital bedside assessment, post-discharge phone call and medical record/ ICD-10 coding review. Known adverse reactions listed in the product information leaflet for patients with chronic kidney disease taking long-term (> 6 months) roxadustat include: DVT; PE; vascular access thrombosis; seizures; sepsis; dermatitis; high potassium; high blood pressure; nausea; diarrhoea; peripheral oedema; insomnia; headache; vomiting; constipation; high bilirubin; decreased thyroid function.
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Timepoint [1]
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Day of surgery, day of discharge, postoperative day 30.
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Secondary outcome [1]
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Cellular glycolysis (circulating immune cells)
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Assessment method [1]
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Gene expression/ RNA analysis
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Timepoint [1]
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Day of surgery (pre-anaesthesia)
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Secondary outcome [2]
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Immune function (circulating immune cells)
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Assessment method [2]
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Flow cytometry
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Timepoint [2]
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Day of surgery (pre-anaesthesia)
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Secondary outcome [3]
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Postoperative C-Reactive Protein
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Assessment method [3]
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Blood tests
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Timepoint [3]
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Postoperative days 1, 2 and 3
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Secondary outcome [4]
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Postoperative Troponin
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Assessment method [4]
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Blood tests
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Timepoint [4]
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Postoperative days 1, 2 and 3
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Secondary outcome [5]
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Surgical Site Infection (CDC Criteria)
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Assessment method [5]
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Phone and medical record assessment
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Timepoint [5]
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Postoperative Day 30
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Secondary outcome [6]
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Length of stay
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Assessment method [6]
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Medical record review
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Timepoint [6]
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Postoperative Day 30
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Secondary outcome [7]
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Readmission within 30 days
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Assessment method [7]
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Medical record review
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Timepoint [7]
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Postoperative Day 30
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Secondary outcome [8]
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Days alive and out of hospital in first 30 days
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Assessment method [8]
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Phone and medical record assessment
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Timepoint [8]
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Postoperative Day 30
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Secondary outcome [9]
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Acute kidney injury
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Assessment method [9]
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Blood tests
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Timepoint [9]
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Postoperative days 1, 2 and 3
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Secondary outcome [10]
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Mortality
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Assessment method [10]
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Medical record review
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Timepoint [10]
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Postoperative Day 30, 1 year after surgery
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Secondary outcome [11]
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Enrolment rate equal to or greater than 50 patients/ centre/ year.
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Assessment method [11]
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Enrolment log
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Timepoint [11]
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Study end
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Secondary outcome [12]
430893
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Treatment compliance
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Assessment method [12]
430893
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Treatment diary
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Timepoint [12]
430893
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Day of surgery
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Eligibility
Key inclusion criteria
1. Age 18 years or over
2. Undergoing elective major surgery including the following procedures: Oesophagectomy; Gastrectomy; Small bowel resection; Large bowel resection; Hepatectomy; Splenectomy; Pancreatectomy; Nephrectomy; Prostatectomy; Cystectomy; Adrenalectomy; Abdominal aneurysm repair (Open); Femoral-Popliteal Bypass; Total hip replacement; Total knee replacement; Spinal surgery (3 levels or more).
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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. Inability to provide informed consent
2. Peanut or soya allergy
3. Current viral or bacterial infection
4. Pregnancy or breast feeding
5. Epilepsy
6. Severe liver disease (Childs Pugh C)
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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)
Central randomisation by computer
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Permuted block randomisation, stratified according to surgery type (open abdominal, laparoscopic abdominal, orthopaedic, other).
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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
Parallel
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Other design features
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Phase
Phase 2
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Type of endpoint/s
Safety/efficacy
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Statistical methods / analysis
A convenience sample was chosen to demonstrate phase 2 safety. Analysis will be predominantly qualitative.
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Recruitment
Recruitment status
Recruiting
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Date of first participant enrolment
Anticipated
15/04/2024
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Actual
14/06/2024
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Date of last participant enrolment
Anticipated
14/12/2025
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Actual
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Date of last data collection
Anticipated
14/12/2026
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Actual
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Sample size
Target
150
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Accrual to date
13
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Final
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Recruitment in Australia
Recruitment state(s)
WA
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Recruitment hospital [1]
26046
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Royal Perth Hospital - Perth
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Recruitment postcode(s) [1]
41893
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6000 - Perth
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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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National Health and Medical Research Council
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Address [1]
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GPO Box 1421, Canberra, ACT 2601
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Country [1]
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Australia
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Primary sponsor type
Hospital
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Name
Royal Perth Hospital
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Address
197 Wellington Street ,Perth, WA 6000
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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]
317719
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Country [1]
317719
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
314508
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South Metropolitan Health Service Human Research Ethics Committee
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Ethics committee address [1]
314508
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Level 2, Education Building, Fiona Stanley Hospital 14 Barry Marshall Parade MURDOCH Western Australia 6150
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Ethics committee country [1]
314508
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Australia
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Date submitted for ethics approval [1]
314508
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01/11/2023
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Approval date [1]
314508
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12/12/2023
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Ethics approval number [1]
314508
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RGS0000006528
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Summary
Brief summary
Complications after major surgery are common and decrease survival in the short and long-term. Tissue hypoxia (low oxygen) is established as a driver of postoperative complications. All complex cells can adapt to low oxygen conditions, over a period of hours to days, by activating the highly conserved hypoxia inducible factor (HIF) pathway. Roxadustat is a first-in-class oral prolyl hydroxylase inhibitor that increases HIF signalling and is currently marketed for the treatment of anaemia in chronic kidney disease. Brief preoperative Roxadustat exposure stands to prime cells to function well under the anticipated hypoxic stress of major surgery, a clinical insult that is unique due to its precise timing. In particular, Roxadustat may enhance immune cell function and healing in the hypoxic microenvironment of the surgical wound, thereby reducing the burden of surgical site infection. Hypothesis: A definitive phase 3 randomised controlled trial of preoperative roxadustat vs placebo in patients undergoing major noncardiac surgery is safe, feasible and justified.
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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 Andrew Toner
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Address
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Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, 197 Wellington Street, Perth, WA 6000
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Country
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Australia
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Phone
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+610892242244
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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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Andrew Toner
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Address
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Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, 197 Wellington Street, Perth, WA 6000
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Country
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Australia
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Phone
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+6189224 2244
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Fax
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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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Andrew Toner
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Address
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Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, 197 Wellington Street, Perth, WA 6000
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Country
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Australia
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Phone
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+610892242244
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Fax
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Email
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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?
Individual participant data underlying published results only
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When will data be available (start and end dates)?
Immediately following publication, no end date
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Available to whom?
Researchers who provide a methodologically sound proposal
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Available for what types of analyses?
For IPD meta-analyses
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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.
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