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Trial registered on ANZCTR
Registration number
ACTRN12624000201572
Ethics application status
Approved
Date submitted
28/01/2024
Date registered
29/02/2024
Date last updated
29/02/2024
Date data sharing statement initially provided
29/02/2024
Type of registration
Retrospectively registered
Titles & IDs
Public title
Nutrition practices in long-stay critically ill patients
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Scientific title
Nutrition practices in long-stay critically ill patients
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Secondary ID [1]
311385
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None
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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:
Critical illness
332658
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Condition category
Condition code
Diet and Nutrition
329363
329363
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0
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Other diet and nutrition disorders
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Public Health
329612
329612
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0
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Health service research
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Intervention/exposure
Study type
Observational
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Patient registry
False
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Target follow-up duration
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Target follow-up type
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Description of intervention(s) / exposure
The exposure observed is nutritional intake. Nutrition data will be collected daily for the first 14 days, and then every seven days thereafter (day 21, day 28), censored at day 28, death, or ICU discharge. All data is collected based on routine clinical practice, such that participants will receive nutrition intake regardless of their involvement in the study. Data will predominantly be collected from electronic medical records that is collected routinely in clinical practice. However if a patient is orally fed, a 24-hour recall of their food intake. and nutrition symptoms will be collected directly from the patient.. At 90 days post study inclusion, the participant or next of kin will be contacted to obtain data on route of nutrition, nutrition intake from the previous 24 hours, presence of nutrition problems that impact nutrition intake or delivery, and an EQ-5D-5L health-related quality of life questionnaire.
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Intervention code [1]
327828
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Not applicable
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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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Energy delivery
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Assessment method [1]
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Energy delivery will be quantified from all sources, including enteral nutrition (EN), parenteral nutrition (PN), oral intake, and non-nutritional energy sources. To quantify daily energy delivery from enteral and parenteral nutrition, data on formula brand and volume delivered will be collected. Energy delivery from non-nutritional energy sources (propofol/ IV dextrose =10%) will be collected. A combination of methods will be used to quantify dietary intake via the oral route. Food record charts will be primarily used in combination with a 24-hour recall for assessing dietary intake for patients on oral intake, and energy intake will be determined using FoodWorks dietary analysis software (Xyris, Brisbane, Australia).
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Timepoint [1]
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Daily for the first 14 days, and then every seven days thereafter (day 21, day 28), censored at day 28, death, or intensive care unit (ICU) discharge.
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Primary outcome [2]
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Protein delivery
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Assessment method [2]
337197
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Protein delivery will be quantified from all sources, including EN, PN and oral intake. To quantify daily protein delivery from enteral and parenteral nutrition, data on formula brand and volume delivered will be collected. A combination of methods will be used to quantify protein intake via the oral route. Food record charts will be primarily used in combination with a 24-hour recall for assessing dietary intake for patients on oral intake and protein intake will be determined using FoodWorks dietary analysis software (Xyris, Brisbane, Australia).
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Timepoint [2]
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Daily for the first 14 days, and then every seven days thereafter (day 21, day 28), censored at day 28, death, or ICU discharge.
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Secondary outcome [1]
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Energy adequacy
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Assessment method [1]
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Energy adequacy will be quantified from all sources, including EN, PN oral intake, and non-nutritional energy sources. This data will be used to calculate prescribed and delivered energy (kJ) and protein (grams). Energy adequacy will be calculated as the proportion of prescribed nutrition that was delivered, presented as a percentage, with requirements as calculated by the treating clinician or where unavailable - calculated using international guidelines for critical care; 25kcal/kg/day and 1.3g protein/kg/day.
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Timepoint [1]
430985
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Daily for the first 14 days, and then every seven days thereafter (day 21, day 28), censored at day 28, death, or ICU discharge.
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Secondary outcome [2]
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Route of feeding
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Assessment method [2]
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Data will be collected from the patient electronic medical record (EMR), bedside nursing staff, or the patient themselves.
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Timepoint [2]
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Daily for the first 14 days, and then every seven days thereafter (day 21, day 28), censored at day 28, death, or ICU discharge.
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Secondary outcome [3]
430988
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Barriers to nutrition delivery
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Assessment method [3]
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Barriers to artificial nutrition delivery will be collected from EMR daily over the first 14 days and then every seven days thereafter (day 21, day 28), censored at day 28, death, or ICU discharge.
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Timepoint [3]
430988
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Daily for the first 14 days, and then every seven days thereafter (day 21, day 28), censored at day 28, death, or ICU discharge.
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Secondary outcome [4]
430989
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Dietetic service delivery
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Assessment method [4]
430989
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Data on dietetic service provision (occasions and frequency of service and interventions provided) across the ICU admission will be collected. At each occasion of service, documented estimated energy and protein requirements will be extracted.
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Timepoint [4]
430989
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Daily for the first 14 days, and then every seven days thereafter (day 21, day 28), censored at day 28, death, or ICU discharge.
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Secondary outcome [5]
430991
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Health-related quality of life
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Assessment method [5]
430991
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EuroQol-five dimension-five level (EQ-5D-5L) health related quality of life questionnaire.
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Timepoint [5]
430991
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Day 90 post-study follow-up.
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Secondary outcome [6]
431064
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Protein adequacy
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Assessment method [6]
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Protein adequacy will be quantified from all sources, including EN, PN, oral intake, and non-nutritional energy sources. This data will be used to calculate prescribed and delivered energy (kJ) and protein (grams). Protein adequacy will be calculated as the proportion of prescribed nutrition that was delivered, presented as a percentage, with requirements as calculated by the treating clinician or where unavailable - calculated using international guidelines for critical care; 25kcal/kg/day and 1.3g protein/kg/day.
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Timepoint [6]
431064
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Daily for the first 14 days, and then every seven days thereafter (day 21, day 28), censored at day 28, death, or ICU discharge.
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Eligibility
Key inclusion criteria
1. Are admitted to the Royal Adelaide Hospital (RAH) ICU;
2. Are aged greater than or equal to 18 years;
3. Have an ICU length of stay of at least 5 days at time of screening and are anticipated to have a total ICU length of stay of at least 7 days as per the treating medical team.
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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. Readmitted to ICU within the current index hospital admission
2. Unable to obtain informed consent (no next of kin (NOK)/NOK unavailable/uncontactable).
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Study design
Purpose
Natural history
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Duration
Longitudinal
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Selection
Defined population
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Timing
Prospective
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Statistical methods / analysis
Given this is an exploratory descriptive study on nutrition practice, no power calculation will be conducted, with all eligible patients included.
Categorical data will be presented as counts (n) and percentages (%), and continuous data will be reported as mean ± standard deviation (SD) for normally distributed data or median [interquartile range (IQR)] for non-normally distributed data as appropriate. No adjustments will be made for partial days of feeding that occur on ICU admission or ICU discharge days.
Paired samples t-tests will be conducted to assess differences between days 1-7 and 8-14 in the sub-group analysis. A two-sided P-value of less than 0.05 will be considered statistically significant. No corrections for multiple comparisons will be made.
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Recruitment
Recruitment status
Recruiting
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Date of first participant enrolment
Anticipated
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Actual
28/02/2024
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Date of last participant enrolment
Anticipated
21/08/2024
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Actual
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Date of last data collection
Anticipated
21/11/2024
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Actual
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Sample size
Target
200
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Accrual to date
1
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Final
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Recruitment in Australia
Recruitment state(s)
SA
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Recruitment hospital [1]
26072
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The Royal Adelaide Hospital - Adelaide
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Recruitment postcode(s) [1]
41926
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5000 - Adelaide
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Funding & Sponsors
Funding source category [1]
315644
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Hospital
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Name [1]
315644
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RAH Research Committee - Allied Health, Nursing, and Pharmacy Grant
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Address [1]
315644
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1 Port Road, Adelaide SA 5000
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Country [1]
315644
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Australia
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Primary sponsor type
Hospital
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Name
Central Adelaide Local Health Network
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Address
1 Port Road, Adelaide SA 5000
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Country
Australia
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Secondary sponsor category [1]
317746
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None
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Name [1]
317746
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Address [1]
317746
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Country [1]
317746
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
314529
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Central Adelaide Local Health Network HREC
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Ethics committee address [1]
314529
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https://www.rah.sa.gov.au/research/for-researchers/central-adelaide-local-health-network-human-research-ethics-committee
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Ethics committee country [1]
314529
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Australia
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Date submitted for ethics approval [1]
314529
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20/12/2023
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Approval date [1]
314529
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25/01/2024
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Ethics approval number [1]
314529
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18800
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Summary
Brief summary
Trials of calorie and protein delivery in critically ill patients have failed to show positive outcomes. However, these trials predominately intervene during the acute phase (first 7 days) of an Intensive Care Unit (ICU) admission only, where metabolic responses to critical illness are likely to impair nutrient utilisation. Furthermore, there is an increasing recognition that nutrition is not a short-term intervention, and extended nutrient provision is required to demonstrate benefit. Little is currently known about nutrition practices in patients that have a longer (>7 day) ICU stay. The purpose of the study is to describe nutrition practices in long-stay critically ill adult patients. 200 patients will be recruited at the Royal Adelaide Hospital. Data for all eligible patients will be extracted from the Australian New Zealand Intensive Care Society Adult Patient Database (ANZICS APD) where applicable, and additional data collected from the patient electronic medical record (EMR), bedside nursing staff, or the patient themselves. Data analysis will be conducted in SPSS Statistics software in consultation with qualified biostatistician Ms Kylie Lange from the National Health and medical Research Council (NHMRC) Centre for Research Excellence at The University of Adelaide. This prospective observational study is an integral step in defining key gaps in nutrition delivery to inform a program of research on improving patient recovery through optimal nutrition.
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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 Cait Davis
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Address
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Royal Adelaide Hospital, 1 Port Road, Adelaide SA 5000
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Country
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Australia
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Phone
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+61 8 7074 1763
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Fax
131902
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Email
131902
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[email protected]
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Contact person for public queries
Name
131903
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Lee-anne Chapple
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Address
131903
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Royal Adelaide Hospital, 1 Port Road, Adelaide SA 5000
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Country
131903
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Australia
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Phone
131903
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+61 8 7074 1763
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Fax
131903
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Email
131903
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[email protected]
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Contact person for scientific queries
Name
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Lee-anne Chapple
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Address
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Royal Adelaide Hospital, 1 Port Road, Adelaide SA 5000
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Country
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Australia
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Phone
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+61 8 7074 1763
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Fax
131904
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Email
131904
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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
This observational study will provide data on energy and protein delivery practices in Australian and New Zealand intensive care units for the sole purpose of advising further study designs on nutrition practices and clinical outcomes. Hence, the data will not be provided publicly.
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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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