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- Ensaio Clínico NCT04995263
A Multicomponent Intervention for Prevention and Treatment of Sleep Disturbances in a Psychiatric Intensive Care Unit (SUEÑA-SM)
A Multicomponent Intervention for Prevention and Treatment of Sleep Disturbances in a Psychiatric Intensive Care Unit: A Before-After, Randomized, Controlled Trial
Visão geral do estudo
Status
Condições
Intervenção / Tratamento
- Comportamental: Sueña component 1: Sleep Hygiene Promotion
- Comportamental: Sueña component 2: Periodic Anxiety and Pain Screening
- Comportamental: Sueña component 3: Hypnotics and Caffeine Regulation
- Comportamental: Sueña component 4: Sleep Masks and Ear Plugs
- Outro: Sueña component 5: Personalized Psychoeducation
- Dispositivo: Sueña component 6: Sleep Reports
Tipo de estudo
Inscrição (Antecipado)
Estágio
- Não aplicável
Contactos e Locais
Contato de estudo
- Nome: Constanza Caneo Robles, MD
- Número de telefone: +56 9 4290 9250
- E-mail: cmcaneo@uc.cl
Estude backup de contato
- Nome: Juan C Rodríguez, MD
- Número de telefone: +56 9 4448 9732
- E-mail: jcrtjcrt@gmail.com
Locais de estudo
-
-
Región Metropolitana
-
Santiago de Chile, Región Metropolitana, Chile, 7550000
- Recrutamento
- Clínica San Carlos de Apoquindo UC
-
Subinvestigador:
- Pedro Letelier Camus, MD
-
Subinvestigador:
- Simón Medina, MD
-
Subinvestigador:
- Matías Paredes Gálvez, BE
-
-
Critérios de participação
Critérios de elegibilidade
Idades elegíveis para estudo
Aceita Voluntários Saudáveis
Gêneros Elegíveis para o Estudo
Descrição
Inclusion Criteria:
- Hospitalized in the last 72 hours.
- Capacity to consent
- Approval by treating physician
Exclusion Criteria:
- Active psychosis
- Active eating disorder
- Delirium
- Major cognitive disorder
Plano de estudo
Como o estudo é projetado?
Detalhes do projeto
- Finalidade Principal: Prevenção
- Alocação: Randomizado
- Modelo Intervencional: Atribuição sequencial
- Mascaramento: Solteiro
Armas e Intervenções
Grupo de Participantes / Braço |
Intervenção / Tratamento |
|---|---|
|
Sem intervenção: Pre-intervention, control group
A basal measurement of primary and secondary outcomes of the target population, prior to the implementation the intervention.
Estimated duration 3 months, n = 30.
|
|
|
Experimental: Post-intervention, SUEÑA half bundle, active group 1
Post-intervention, environmental and behavioral modifications in patient care interventions. Implementation of components 1 through 4 of SUEÑA intervention in the entire PICU unit. All participants will be exposed to the intervention. Estimated duration: 3 months, n = 30. |
The nursery staff will be instructed to promote sleep hygiene.
Nurse technicians will: inform patients of the efforts to ensure a healthy sleep environment, verify the minimization of light and noise after 23:00 PM, favour natural light after 07:00 AM, and foment patient's activities and participation in group therapy.
Nurses will: reduce sleep interruptions to a minimum, to only perform actions (i.e.
blood testing, clinical controls, medicine administration) deemed strictly necessary between 23:00 PM and 07:00 AM.
A list of commonly used medications with their pharmacodynamic and pharmacokinetic properties tailored by a pharmaceutical chemist will be provided, to ensure optimal medication administration while protecting the guaranteed sleep hours, to be coordinated with the treating physician.
Every night, nursery staff will include anxiety and pain screenings as part of vital signs assessments, using visual analog scales for each one.
If any screening is altered, clinical actions will be performed to alleviate symptomatology if deemed necessary, using clinical judgement.
The use of hypnotics will be standardized to be administered no later than at 22:00 PM; in the case of melatonin, its administration will be suggested at sundown, at 20:00 PM.
Caffeinated drinks will be prohibited after 15:00 PM.
Sleep masks and ear plugs will be available to all patients if they wish to use them.
The nursery team will reinforce its use between 23:00 PM and 07:00 AM.
|
|
Experimental: Post-intervention, randomization for SUEÑA half bundle plus, active group 2
Randomization for full SUEÑA bundle: environmental and behavioral modifications in patient care interventions plus sleep informed treatment. Participants will be randomized to receive SUEÑA components 1 through 5 Estimated duration: 6 months, n = 30 |
The nursery staff will be instructed to promote sleep hygiene.
Nurse technicians will: inform patients of the efforts to ensure a healthy sleep environment, verify the minimization of light and noise after 23:00 PM, favour natural light after 07:00 AM, and foment patient's activities and participation in group therapy.
Nurses will: reduce sleep interruptions to a minimum, to only perform actions (i.e.
blood testing, clinical controls, medicine administration) deemed strictly necessary between 23:00 PM and 07:00 AM.
A list of commonly used medications with their pharmacodynamic and pharmacokinetic properties tailored by a pharmaceutical chemist will be provided, to ensure optimal medication administration while protecting the guaranteed sleep hours, to be coordinated with the treating physician.
Every night, nursery staff will include anxiety and pain screenings as part of vital signs assessments, using visual analog scales for each one.
If any screening is altered, clinical actions will be performed to alleviate symptomatology if deemed necessary, using clinical judgement.
The use of hypnotics will be standardized to be administered no later than at 22:00 PM; in the case of melatonin, its administration will be suggested at sundown, at 20:00 PM.
Caffeinated drinks will be prohibited after 15:00 PM.
Sleep masks and ear plugs will be available to all patients if they wish to use them.
The nursery team will reinforce its use between 23:00 PM and 07:00 AM.
Two individualized, nurse-led psychoeducation PowerPoint presentations on sleep hygiene will be presented to patients, supported by educational material aimed at the patient and their families.
|
|
Experimental: Post-intervention, randomization for SUEÑA full bundle, active group 3
Randomization for full SUEÑA bundle: environmental and behavioral modifications in patient care interventions plus sleep informed treatment and personalized psychoeducation. . Participants will be randomized to receive SUEÑA components 1 through 6. Estimated duration: 6 months, n = 30 |
The nursery staff will be instructed to promote sleep hygiene.
Nurse technicians will: inform patients of the efforts to ensure a healthy sleep environment, verify the minimization of light and noise after 23:00 PM, favour natural light after 07:00 AM, and foment patient's activities and participation in group therapy.
Nurses will: reduce sleep interruptions to a minimum, to only perform actions (i.e.
blood testing, clinical controls, medicine administration) deemed strictly necessary between 23:00 PM and 07:00 AM.
A list of commonly used medications with their pharmacodynamic and pharmacokinetic properties tailored by a pharmaceutical chemist will be provided, to ensure optimal medication administration while protecting the guaranteed sleep hours, to be coordinated with the treating physician.
Every night, nursery staff will include anxiety and pain screenings as part of vital signs assessments, using visual analog scales for each one.
If any screening is altered, clinical actions will be performed to alleviate symptomatology if deemed necessary, using clinical judgement.
The use of hypnotics will be standardized to be administered no later than at 22:00 PM; in the case of melatonin, its administration will be suggested at sundown, at 20:00 PM.
Caffeinated drinks will be prohibited after 15:00 PM.
Sleep masks and ear plugs will be available to all patients if they wish to use them.
The nursery team will reinforce its use between 23:00 PM and 07:00 AM.
Two individualized, nurse-led psychoeducation PowerPoint presentations on sleep hygiene will be presented to patients, supported by educational material aimed at the patient and their families.
Objective and subjective reports of sleep quality will be handed to attending psychiatrist, using data gathered with wearable devices (Fitbit Charge 4) and self-report questionnaires regarding perceived sleepiness and overall sleep.
The psychiatrist in charge uses said information in the routine case management
|
O que o estudo está medindo?
Medidas de resultados primários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
|
Change in Total Sleep Time
Prazo: From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
|
Measured in hours and minutes, using objective data obtained via Fitbit Charge 4 devices, and subjective data obtained directly from the patient using the Sleep Diary, a consensus tool for the self report of different standardized sleep variables.
|
From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
|
Medidas de resultados secundários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
|
Change in Mean Number and Total Duration of Nocturnal Awakenings
Prazo: From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
|
Measured in integer numbers for mean number and minutes for duration, using subjective data obtained directly from the patient using the Sleep Diary, and objective data obtained via Fitbit Charge 4 devices.
|
From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
|
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Change in Mean Number and Total Duration of Naps During the Day
Prazo: From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
|
Measured in integer numbers for mean number and minutes for duration, using subjective data obtained directly from the patient using the Sleep Diary, and objective data obtained via Fitbit Charge 4 devices.
|
From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
|
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Change in Average Time of Falling Sleep and Awakening
Prazo: From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
|
Measured in time of day in 24-hour notation, using subjective data obtained directly from the patient using the Sleep Diary, and objective data obtained via Fitbit Charge 4 devices.
|
From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
|
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Change in Sleep Architecture
Prazo: From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
|
Measured in minutes of total duration for each sleep phase (awake, light sleep, deep sleep and REM) and as a relative value of the total sleep time, using objective data measured by Fitbit Charge 4 devices.
|
From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
|
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Change in Sleep Onset Latency Mean Duration
Prazo: From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
|
Measured in minutes of total time spent awake from the time of going to bed with the intention of falling asleep to the time of the first registered sleep phase, using subjective data from the Sleep Diary and objective data measured by Fitbit Charge 4 devices.
|
From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
|
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Change in REM Onset Latency Mean Duration
Prazo: From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
|
Measured in minutes of total time spent awake from the time of going to bed with the intention of falling asleep to the time of the first registered REM phase, using subjective data from the Sleep Diary and objective data measured by Fitbit Charge 4 devices.
|
From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
|
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Change in Wake After Sleep Onset Mean Duration
Prazo: From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
|
Measured in minutes of total time spent awake from the time of the first registered sleep phase to the time of the last registered awakening, using objective data measured by Fitbit Charge 4 devices.
|
From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
|
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Change in Sleep Efficiency
Prazo: From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
|
Measured in percentage of total time spent sleeping at night, calculated as total sleep time divided by total time spent in bed, using subjective data from the Sleep Diary and objective data measured by Fitbit Charge 4 devices.
|
From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
|
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Change in Mean Heart Rate
Prazo: From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
|
Measured in integer numbers, using objective data measured by Fitbit Charge 4 devices, considering the heart rate during the day and while in bed.
|
From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
|
|
Change in Mean Number of Steps
Prazo: From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
|
Measured in integer numbers, using objective data measured by Fitbit Charge 4 devices.
|
From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
|
|
Change in Mean Level of Sound
Prazo: From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
|
Measured in decibels, using objective data registered by a decibel meter placed in the participant's rooms.
|
From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
|
|
Change in Mean Level of Light
Prazo: From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
|
Measured in lux, using objective data registered by a lux meter placed in the participant's rooms.
|
From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
|
|
Changes in Sleep Quality Perception
Prazo: From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
|
Measured using the Richard Campbell Sleep Questionnaire (RCSQ), which considers 5 domains in Likert scales, and registers a mean score of all domains.
|
From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
|
|
Changes in Daytime Sleepiness
Prazo: From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
|
Measured using the Epworth Sleepiness Scale (ESS), which considers 8 hypothetical situations and scores the likelihood of falling asleep from 0 to 3, and registers a total aggregated score (with a maximum total score of 24).
|
From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
|
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Changes in Subjective Perception of Sleep-Disturbing Factors
Prazo: From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
|
Measured using complementary questions regarding the presence/absence of factors (either environmental, symptomatological, or other) and their identification using predefined options: excessive light, excessive noise, interactions with health personnel, pain, anxiety, or others.
In case of selecting "others", a text field will be available for its description.
|
From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
|
|
Changes in Pharmacological Indications and Need of SOS Medication
Prazo: From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
|
Registered using extensive charts of common use medications during hospitalization, obtaining data registered in the participant's daily medical chart.
|
From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
|
|
Changes in Systolic and Diastolic Blood Pressure
Prazo: From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
|
Measured in millimetres of mercury (mmHg), using morning data registered in the participant's daily medical chart.
|
From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
|
|
Level of Pain
Prazo: From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge. To be measured from the second branch onward, after the environmental interventions implementation.
|
Measured with a Visual Analog Scale for Pain (scores ranging from 0 - 10 points), using data registered at 20:00 PM, in the participant's daily medical chart.
|
From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge. To be measured from the second branch onward, after the environmental interventions implementation.
|
|
Level of Anxiety
Prazo: From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge. To be measured from the second branch onward, after the environmental interventions implementation.
|
Measured with a Visual Analog Scale for Anxiety (scores ranging from 0 - 10 points), using data registered at 20:00 PM, in the participant's daily medical chart.
|
From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge. To be measured from the second branch onward, after the environmental interventions implementation.
|
|
Change in Mean Length of Stay
Prazo: From day 1 of hospitalization until discharge
|
Measured in days, using data from the participant's medical record.
|
From day 1 of hospitalization until discharge
|
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Change in 30-day Readmission Rate
Prazo: 30 days after the participant's discharge.
|
Measured as a proportion, using data from the participant's medical record and telephonic follow-up.
|
30 days after the participant's discharge.
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Change in Participant Satisfaction Regarding Sleep During Hospitalization
Prazo: 7 days after the participant's discharge.
|
Measurement of the subjective experience of the participant, using telephone surveys.
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7 days after the participant's discharge.
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Participant Satisfaction Regarding the Intervention
Prazo: 7 days after the participant's discharge.
|
Measurement of the subjective experience of participants, using telephone surveys.
|
7 days after the participant's discharge.
|
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Health Personnel Satisfaction and Agreeability Regarding the Intervention
Prazo: Every 3 months through study completion, an average of 1.5 years
|
Measurement of the subjective experience of treating physicians and nursery team, using web-based surveys.
|
Every 3 months through study completion, an average of 1.5 years
|
Colaboradores e Investigadores
Patrocinador
Colaboradores
Investigadores
- Diretor de estudo: Constanza Caneo Robles, MD, Pontifica Universidad Catolica de Chile
- Diretor de estudo: Juan C Rodríguez, MD, Pontifica Universidad Catolica de Chile
- Cadeira de estudo: María Rodríguez Fernández, PhD, Pontifica Universidad Catolica de Chile
- Cadeira de estudo: Marcela Babul, MD, Pontifica Universidad Catolica de Chile
Publicações e links úteis
Publicações Gerais
- Kanji S, Mera A, Hutton B, Burry L, Rosenberg E, MacDonald E, Luks V. Pharmacological interventions to improve sleep in hospitalised adults: a systematic review. BMJ Open. 2016 Jul 29;6(7):e012108. doi: 10.1136/bmjopen-2016-012108.
- Tembo AC, Parker V. Factors that impact on sleep in intensive care patients. Intensive Crit Care Nurs. 2009 Dec;25(6):314-22. doi: 10.1016/j.iccn.2009.07.002. Epub 2009 Oct 31.
- Hu RF, Jiang XY, Chen J, Zeng Z, Chen XY, Li Y, Huining X, Evans DJ. Non-pharmacological interventions for sleep promotion in the intensive care unit. Cochrane Database Syst Rev. 2015 Oct 6;2015(10):CD008808. doi: 10.1002/14651858.CD008808.pub2.
- Bano M, Chiaromanni F, Corrias M, Turco M, De Rui M, Amodio P, Merkel C, Gatta A, Mazzotta G, Costa R, Montagnese S. The influence of environmental factors on sleep quality in hospitalized medical patients. Front Neurol. 2014 Dec 11;5:267. doi: 10.3389/fneur.2014.00267. eCollection 2014.
- Bernhofer EI, Higgins PA, Daly BJ, Burant CJ, Hornick TR. Hospital lighting and its association with sleep, mood and pain in medical inpatients. J Adv Nurs. 2014 May;70(5):1164-73. doi: 10.1111/jan.12282. Epub 2013 Oct 27.
- Bourne RS, Mills GH. Sleep disruption in critically ill patients--pharmacological considerations. Anaesthesia. 2004 Apr;59(4):374-84. Review.
- Denkinger MD, Lindemann U, Nicolai S, Igl W, Jamour M, Nikolaus T. Assessing Physical Activity in Inpatient Rehabilitation: validity, practicality, and sensitivity to change in the physical activity in inpatient rehabilitation assessment. Arch Phys Med Rehabil. 2011 Dec;92(12):2012-7. doi: 10.1016/j.apmr.2011.06.032.
- Horne S, Hay K, Watson S, Anderson KN. An evaluation of sleep disturbance on in-patient psychiatric units in the UK. BJPsych Bull. 2018 Oct;42(5):193-197. doi: 10.1192/bjb.2018.42.
- Lawrence G, Muza R. Assessing the sleeping habits of patients in a sleep disorder centre: a review of sleep diary accuracy. J Thorac Dis. 2018 Jan;10(Suppl 1):S177-S183. doi: 10.21037/jtd.2017.12.127.
- Milani RV, Bober RM, Lavie CJ, Wilt JK, Milani AR, White CJ. Reducing Hospital Toxicity: Impact on Patient Outcomes. Am J Med. 2018 Aug;131(8):961-966. doi: 10.1016/j.amjmed.2018.04.013. Epub 2018 May 3.
- Pilkington S. Causes and consequences of sleep deprivation in hospitalised patients. Nurs Stand. 2013 Aug 7-13;27(49):35-42. Review.
- Rodriguez JC, Dzierzewski JM, Alessi CA. Sleep problems in the elderly. Med Clin North Am. 2015 Mar;99(2):431-9. doi: 10.1016/j.mcna.2014.11.013. Epub 2014 Dec 30. Review.
- Sandoval-Rincón M, Alcalá-Lozano R, Herrera-Jiménez I, Jiménez-Genchi A. [Validation of the Epworth sleepiness scale in Mexican population]. Gac Med Mex. 2013 Jul-Aug;149(4):409-16. Spanish.
- Stewart NH, Arora VM. Sleep in Hospitalized Older Adults. Sleep Med Clin. 2018 Mar;13(1):127-135. doi: 10.1016/j.jsmc.2017.09.012. Epub 2017 Nov 10. Review.
- Tamrat R, Huynh-Le MP, Goyal M. Non-pharmacologic interventions to improve the sleep of hospitalized patients: a systematic review. J Gen Intern Med. 2014 May;29(5):788-95. doi: 10.1007/s11606-013-2640-9. Epub 2013 Oct 10.
- Tullmann DF, Dracup K. Creating a healing environment for elders. AACN Clin Issues. 2000 Feb;11(1):34-50; quiz 153-4. Review.
- Wesselius HM, van den Ende ES, Alsma J, Ter Maaten JC, Schuit SCE, Stassen PM, de Vries OJ, Kaasjager KHAH, Haak HR, van Doormaal FF, Hoogerwerf JJ, Terwee CB, van de Ven PM, Bosch FH, van Someren EJW, Nanayakkara PWB; "Onderzoeks Consortium Acute Geneeskunde" Acute Medicine Research Consortium. Quality and Quantity of Sleep and Factors Associated With Sleep Disturbance in Hospitalized Patients. JAMA Intern Med. 2018 Sep 1;178(9):1201-1208. doi: 10.1001/jamainternmed.2018.2669.
- Novak C, Packer E, Paterson A, Roshi A, Locke R, Keown P, Watson S, Anderson KN. Feasibility and utility of enhanced sleep management on in-patient psychiatry wards. BJPsych Bull. 2020 Dec;44(6):255-260. doi: 10.1192/bjb.2020.30.
Datas de registro do estudo
Datas Principais do Estudo
Início do estudo (Real)
Conclusão Primária (Antecipado)
Conclusão do estudo (Antecipado)
Datas de inscrição no estudo
Enviado pela primeira vez
Enviado pela primeira vez que atendeu aos critérios de CQ
Primeira postagem (Real)
Atualizações de registro de estudo
Última Atualização Postada (Real)
Última atualização enviada que atendeu aos critérios de controle de qualidade
Última verificação
Mais Informações
Termos relacionados a este estudo
Palavras-chave
Termos MeSH relevantes adicionais
- Transtornos Mentais, Desordem Mental
- Doenças do Sistema Nervoso
- Distúrbios do Sono Vigília
- Dissônias
- Parassonias
- Efeitos Fisiológicos das Drogas
- Agentes Neurotransmissores
- Mecanismos Moleculares de Ação Farmacológica
- Depressores do Sistema Nervoso Central
- Inibidores Enzimáticos
- Antagonistas purinérgicos
- Agentes Purinérgicos
- Inibidores da fosfodiesterase
- Antagonistas dos Receptores P1 Purinérgicos
- Estimulantes do Sistema Nervoso Central
- Cafeína
- Hipnóticos e Sedativos
Outros números de identificação do estudo
- Número de outro subsídio/financiamento: Community Foundation of Greater Birmingham Women's Breast Health Fund
Plano para dados de participantes individuais (IPD)
Planeja compartilhar dados de participantes individuais (IPD)?
Descrição do plano IPD
Prazo de Compartilhamento de IPD
Critérios de acesso de compartilhamento IPD
Tipo de informação de suporte de compartilhamento de IPD
- Protocolo de estudo
- Plano de Análise Estatística (SAP)
- Termo de Consentimento Livre e Esclarecido (TCLE)
- Relatório de Estudo Clínico (CSR)
Informações sobre medicamentos e dispositivos, documentos de estudo
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