Cultural CompetencyNCT04280172
Effectiveness of Cultural Competence Education for Nurse Mentors
A study testing Cultural Competence Education and Standard Mentoring Education in people with Cultural Competency and Mentoring, run by University of Oulu at 2 sites in Finland.
Trial summary
Clinical placements are an integral part of nursing education and have significant impact on nursing students' professional development. According to standards set by the European Union, the duration of clinical placements should account for at least one half of the minimum duration of nursing programs. Read more about this study
- Who is it for?
- Ages 18 years and olderHealthy volunteers can take part
- Conditions the study is for
- Cultural Competency, Mentoring
- What is being tested?
- Cultural Competence Education and Standard Mentoring Education
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 111 participants
- Where
- 2 sitesFinland
- Study dates
- 1 Jun 2020to 1 Dec 2021
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- Healthy volunteers accepted
- Adult, Older adult
Who may be able to join
- be currently employed in any professional nursing role on any unit; have the skills to read and understand the Finnish language; and consent to participate in the study
Who cannot join
- be on long-term leave of absence or maternity leave; lack of skills to read and understand the Finnish language, decline to consent to participate in the study.
Trial locations and contacts
2 sites in 1 country.
Finland2 sites
Healthcare organization in eastern Finland
Kuopio
Healthcare organizations in Nordic Finland
Oulu
About this study
Official title: Educational Intervention to Support Development of Mentors' Cultural Competence and Competence in Mentoring Culturally and Linguistically Diverse Nursing Students
Clinical placements are an integral part of nursing education and have significant impact on nursing students' professional development. According to standards set by the European Union, the duration of clinical placements should account for at least one half of the minimum duration of nursing programs. Also, students must complete training under the supervision of qualified nursing staff (Directive 2013/55/EU of the European Parliament and of the Council).
Nursing staff are responsible for the mentoring of students during completion of their clinical placements. The role of the mentor can be challenging and several studies prove that providing continuing education to mentors can be effective in developing mentors' competence in mentoring. There is an urgent need to add issues related to the development of mentors' cultural competence into mentoring education. This is due to the rapid increase of cultural and linguistic diversity within the nursing workforce and the increase in the numbers of students from international backgrounds.
This study is designed to assess the effectiveness of an educational intervention to develop mentors' cultural competence and their competence in mentoring nursing students from diverse cultural and linguistic backgrounds.
Read the detailed description
METHODOLOGY
Study setting:
The study will be conducted in two hospitals, which are located in two different major cities in Finland.
Study design:
This is a nonrandomized, pre-post quasi-experimental study. Participants in this study will participate in cultural competence education. Participants will self-assess their level of competence in mentoring in general along with their cultural competence in mentoring. There will be three assessment time points: at baseline (before education, T0), immediately after the education (T1), and 6 months after the education (T2). The control group will receive standard mentoring education that does not contain topics specific to cultural competence or the mentoring of students from diverse backgrounds. The same self-assessment instrument and assessment time points will be used for both the intervention and control groups.
Study size:
A total of 60 mentors will be allocated to the intervention group and 60 mentors to the control group.
Study duration:
The educational intervention (cultural competence education) will be conducted for a duration of 9 months (T0, T1, T2). The education will be offered twice (fall 2020, spring 2021), thus the total duration of the study (from date study open for recruitment to final data collection) will be a total of 16 months.
Sampling of participants
Recruitment:
Participants in the intervention group who attend cultural competence education and participants who belong to the control group will be recruited into this study via internal recruitment methods implemented by clinical coordinators employed at the participating hospitals.
Intervention:
Cultural competence education for participants in the intervention group comprises of completion of an online learning module and participation in an eight-hour training day. The educational content includes various topics related to cultural and linguistic diversity and cultural competence in mentoring.
Control:
Participants in the control group will not receive the educational intervention but will participate in standard mentoring education offered at the participating university hospital. This education is offered in an online learning environment and participants can complete the education at their own pace. The educational content focuses on general issues related to mentoring and does not contain topics specific to cultural competence in mentoring.
Sample size
A power analysis has been calculated for an effect size according to Cohen's d, two tail-test, significance at p<0.05, power of 80% (1- Beta err prob). The estimated sample size was 60 participants per group after accounting for significance level of 0.05%, power of 80% and 50% attrition.
INSTRUMENTS AND DATA COLLECTION
Intervention: Cultural competence education
Questionnaire: Mentors' competence in mentoring will be measured using the psychometrically validated self-assessment Mentors' Competence Instrument (MCI). A newly developed Mentors' Cultural Competence Instrument (MCCI) will be used to measure mentors' cultural competence. This instrument has been administered and pilot tested by 12 mentors prior to implementation of the intervention.
Finnish language versions of the questionnaire will be administered containing the following sections:
- Sociodemographic data:
- Sex
- Age
- Educational background
- Place of work
- Current position
- Work experience
- Name of work organization
- Current work unit
- Time when last mentored a student
- Time used for reflective discussion with student
- Previous participation in mentoring education
- Experience mentoring international students
- How often international students are mentored
- Competence in mentoring using Mentors' Competence Instrument which contains 43 items divided into 7 sections
- Mentoring practices between the student and mentor
- Mentor's characteristics
- Mentor's motivation
- Goal-oriented mentoring
- Reflection during mentoring
- Student-centered evaluation
- Constructive feedback
- Mentors' cultural competence using Mentors' Cultural Competence Instrument which contains 21 items covering the following topics
- Cultural sensitivity and awareness
- Cultural knowledge
- Intercultural communication and interaction
- Cultural skills and safety
DATA COLLECTION
Intervention group
- Baseline questionnaire (T0): Paper-based questionnaires will be administered to participants in the intervention group on the day of study recruitment before being given details on how to complete the cultural competence education.
- Post course questionnaire (T1): Paper-based questionnaires will be administered to participants in the intervention group immediately following completion of the cultural competence education.
- Participants will be asked to provide their evaluation of the education in addition to the questionnaire described above. The evaluation contains the following questions:
- How satisfied were you with the mentoring education?
- Did the mentoring education have an impact on your ability to mentor students?
- Did the mentoring education have an impact on your willingness to mentor students?
- Open comment section for comments or concerns regarding the mentoring education
- 6-month follow up questionnaire (T2): Paper-based questionnaires including will be sent to participants via post to participants' home addresses.
Control group
- Baseline questionnaire (T0): Web-based questionnaires will be administered to participants in the control group on the first day of standard online mentoring education.
- Post course questionnaire (T1): Web-based questionnaires will be administered to participants in the control group on the last day of standard online mentoring education.
- 6-month follow up questionnaire (T2): Web-based questionnaires will be sent to participants via email six months following completion of the standard online mentoring education.
ETHICAL CONSIDERATIONS This study complies with the standards and guidelines of the responsible conduct of research. The necessary research permissions from the participating hospitals have been obtained prior to data collection and implementation of the intervention. In this study, formal approval from an ethics committee is not required. Participation is voluntary and participants will be informed of the purpose of the study and their right to withdraw from the study. Participants' confidentiality and anonymity will be protected and research data will be secured according to current standards.
Data analysis Data will be analyzed using IBM Social Package for Social Science (SPSS, version 26). Data will be analyzed using descriptive statistics, a Wilcoxon Signed-Rank Test and a two-way ANOVA test. In this study, two-tailed testing will be used and the significance level will be set at a p-value <0.05.
- Conditions
- Cultural Competency, Mentoring
- Being tested
- Cultural Competence Education, Standard Mentoring Education
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Cultural Competence EducationOther
Cultural competence education for participants in the intervention group comprises of completion of an online learning module and participation in an eight-hour training day. The educational content includes various topics related to cultural and linguistic diversity and cultural competence in mentoring.
Standard Mentoring EducationOther
Participants in the control group will not receive the educational intervention but will participate in standard mentoring education. This education is offered in an online learning environment and participants can complete the education at their own pace. The educational content focuses on general issues related to mentoring and does not contain topics specific to cultural competence in mentoring.
| Study group | Role | What they receive |
|---|---|---|
| Cultural Competence Education | Experimental | Participants in the intervention group will attend cultural competence education Receives: Other: Cultural Competence Education |
| Standard Mentoring Education | Active comparator | Participants in the control group will complete standard mentoring education that does not include a cultural competence component Receives: Other: Standard Mentoring Education |
What is being measured
The primary outcome is the main question the study is designed to answer.
Changes in mentors' cultural competence
Mentors' cultural competence will be measured using the newly developed Mentors' Cultural Competence Instrument. The instrument contains 21 items using a four-level Likert scale. A higher score on the likert scale indicates a higher level of competence.
Measured: Pre intervention, immediately after intervention and 6 months after intervention
Changes in competence in mentoring
Mentors' competence in mentoring will be measured using the psychometrically validated self-assessment Mentors' Competence Instrument (MCI), which contains 43 items divided into 7 sections using a four-level Likert scale. A higher score on the Likert scale indicates a higher level of competence.
Measured: Pre intervention, immediately after intervention and 6 months after intervention
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted21 Feb 2020
- Study start1 Jun 2020
- Primary completion1 Dec 2021
- Study completion1 Dec 2021
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (3)Papers the sponsor has linked to this study.
- Other trials for Cultural CompetencyStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Health services research
- Allocation
- Non-randomised
- Intervention model
- Parallel groups
- Masking
- Double blind
- Who is masked
- Investigator, Outcomes assessor
- Enrolment
- 111 participants (actual)
Sponsor and investigators
- Lead sponsor
- University of Oulu
- Sponsor type
- University, hospital or other
- Collaborators
- The Finnish Association of Nursing Research, Finnish Nurses Association
- Responsible party
- Principal investigator, Ashlee Oikarainen, University of Oulu
- Investigators
- Kristina Mikkonen, PhD, Study chair, University of OuluAshlee I Oikarainen, MHSc, Principal investigator, University of Oulu
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT04280172
- Sponsor's protocol ID
- CulturalCompetence
- Status last verified
- May 2022
- First submitted
- 13 Feb 2020
- Last updated
- 13 May 2022
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Oikarainen A, Mikkonen K, Tuomikoski AM, Elo S, Pitkanen S, Ruotsalainen H, Kaariainen M. Mentors' competence in mentoring culturally and linguistically diverse nursing students during clinical placement. J Adv Nurs. 2018 Jan;74(1):148-159. doi: 10.1111/jan.13388. Epub 2017 Aug 1.
PubMed 28702955Oikarainen A, Mikkonen K, Kenny A, Tomietto M, Tuomikoski AM, Merilainen M, Miettunen J, Kaariainen M. Educational interventions designed to develop nurses' cultural competence: A systematic review. Int J Nurs Stud. 2019 Oct;98:75-86. doi: 10.1016/j.ijnurstu.2019.06.005. Epub 2019 Jun 21.
PubMed 31319338Oikarainen A, Kaarlela V, Heiskanen M, Taam-Ukkonen M, Lehtimaja I, Karsamanoja T, Tuomikoski AM, Kaariainen M, Tomietto M, Mikkonen K. Educational intervention to support development of mentors' competence in mentoring culturally and linguistically diverse nursing students: A quasi-experimental study. Nurse Educ Today. 2022 Sep;116:105424. doi: 10.1016/j.nedt.2022.105424. Epub 2022 May 29.
PubMed 35714426
Study at a glance
From the registry record, last updated by the sponsor on 13 May 2022. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Educational Intervention to Support Development of Mentors' Cultural Competence and Competence in Mentoring Culturally and Linguistically Diverse Nursing Students
- ClinicalTrials.gov ID
- NCT04280172
- Acronym / sponsor ID
- CulturalCompetence
- Conditions
- Cultural Competency, Mentoring
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 111 participants (actual)
- Lead sponsor
- University of OuluUniversity, hospital or other
- Collaborators
- The Finnish Association of Nursing Research, Finnish Nurses Association
- Study start
- 1 Jun 2020 (actual)
- Primary completion
- 1 Dec 2021 (actual)
- Study completion
- 1 Dec 2021 (actual)
- First posted
- 21 Feb 2020 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Clinical placements are an integral part of nursing education and have significant impact on nursing students' professional development. According to standards set by the European Union, the duration of clinical placements should account for at least one half of the minimum duration of nursing programs. Also, students must complete training under the supervision of qualified nursing staff (Directive 2013/55/EU of the European Parliament and of the Council).
Nursing staff are responsible for the mentoring of students during completion of their clinical placements. The role of the mentor can be challenging and several studies prove that providing continuing education to mentors can be effective in developing mentors' competence in mentoring. There is an urgent need to add issues related to the development of mentors' cultural competence into mentoring education. This is due to the rapid increase of cultural and linguistic diversity within the nursing workforce and the increase in the numbers of students from international backgrounds.
This study is designed to assess the effectiveness of an educational intervention to develop mentors' cultural competence and their competence in mentoring nursing students from diverse cultural and linguistic backgrounds.
Detailed description
METHODOLOGY
Study setting:
The study will be conducted in two hospitals, which are located in two different major cities in Finland.
Study design:
This is a nonrandomized, pre-post quasi-experimental study. Participants in this study will participate in cultural competence education. Participants will self-assess their level of competence in mentoring in general along with their cultural competence in mentoring. There will be three assessment time points: at baseline (before education, T0), immediately after the education (T1), and 6 months after the education (T2). The control group will receive standard mentoring education that does not contain topics specific to cultural competence or the mentoring of students from diverse backgrounds. The same self-assessment instrument and assessment time points will be used for both the intervention and control groups.
Study size:
A total of 60 mentors will be allocated to the intervention group and 60 mentors to the control group.
Study duration:
The educational intervention (cultural competence education) will be conducted for a duration of 9 months (T0, T1, T2). The education will be offered twice (fall 2020, spring 2021), thus the total duration of the study (from date study open for recruitment to final data collection) will be a total of 16 months.
Sampling of participants
Recruitment:
Participants in the intervention group who attend cultural competence education and participants who belong to the control group will be recruited into this study via internal recruitment methods implemented by clinical coordinators employed at the participating hospitals.
Intervention:
Cultural competence education for participants in the intervention group comprises of completion of an online learning module and participation in an eight-hour training day. The educational content includes various topics related to cultural and linguistic diversity and cultural competence in mentoring.
Control:
Participants in the control group will not receive the educational intervention but will participate in standard mentoring education offered at the participating university hospital. This education is offered in an online learning environment and participants can complete the education at their own pace. The educational content focuses on general issues related to mentoring and does not contain topics specific to cultural competence in mentoring.
Sample size
A power analysis has been calculated for an effect size according to Cohen's d, two tail-test, significance at p<0.05, power of 80% (1- Beta err prob). The estimated sample size was 60 participants per group after accounting for significance level of 0.05%, power of 80% and 50% attrition.
INSTRUMENTS AND DATA COLLECTION
Intervention: Cultural competence education
Questionnaire: Mentors' competence in mentoring will be measured using the psychometrically validated self-assessment Mentors' Competence Instrument (MCI). A newly developed Mentors' Cultural Competence Instrument (MCCI) will be used to measure mentors' cultural competence. This instrument has been administered and pilot tested by 12 mentors prior to implementation of the intervention.
Finnish language versions of the questionnaire will be administered containing the following sections:
- Sociodemographic data:
- Sex
- Age
- Educational background
- Place of work
- Current position
- Work experience
- Name of work organization
- Current work unit
- Time when last mentored a student
- Time used for reflective discussion with student
- Previous participation in mentoring education
- Experience mentoring international students
- How often international students are mentored
- Competence in mentoring using Mentors' Competence Instrument which contains 43 items divided into 7 sections
- Mentoring practices between the student and mentor
- Mentor's characteristics
- Mentor's motivation
- Goal-oriented mentoring
- Reflection during mentoring
- Student-centered evaluation
- Constructive feedback
- Mentors' cultural competence using Mentors' Cultural Competence Instrument which contains 21 items covering the following topics
- Cultural sensitivity and awareness
- Cultural knowledge
- Intercultural communication and interaction
- Cultural skills and safety
DATA COLLECTION
Intervention group
- Baseline questionnaire (T0): Paper-based questionnaires will be administered to participants in the intervention group on the day of study recruitment before being given details on how to complete the cultural competence education.
- Post course questionnaire (T1): Paper-based questionnaires will be administered to participants in the intervention group immediately following completion of the cultural competence education.
- Participants will be asked to provide their evaluation of the education in addition to the questionnaire described above. The evaluation contains the following questions:
- How satisfied were you with the mentoring education?
- Did the mentoring education have an impact on your ability to mentor students?
- Did the mentoring education have an impact on your willingness to mentor students?
- Open comment section for comments or concerns regarding the mentoring education
- 6-month follow up questionnaire (T2): Paper-based questionnaires including will be sent to participants via post to participants' home addresses.
Control group
- Baseline questionnaire (T0): Web-based questionnaires will be administered to participants in the control group on the first day of standard online mentoring education.
- Post course questionnaire (T1): Web-based questionnaires will be administered to participants in the control group on the last day of standard online mentoring education.
- 6-month follow up questionnaire (T2): Web-based questionnaires will be sent to participants via email six months following completion of the standard online mentoring education.
ETHICAL CONSIDERATIONS This study complies with the standards and guidelines of the responsible conduct of research. The necessary research permissions from the participating hospitals have been obtained prior to data collection and implementation of the intervention. In this study, formal approval from an ethics committee is not required. Participation is voluntary and participants will be informed of the purpose of the study and their right to withdraw from the study. Participants' confidentiality and anonymity will be protected and research data will be secured according to current standards.
Data analysis Data will be analyzed using IBM Social Package for Social Science (SPSS, version 26). Data will be analyzed using descriptive statistics, a Wilcoxon Signed-Rank Test and a two-way ANOVA test. In this study, two-tailed testing will be used and the significance level will be set at a p-value <0.05.
Study design
- Primary purpose
- Health services research
- Allocation
- Non-randomised
- Intervention model
- Parallel groups
- Masking
- Double blind (investigator, outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Cultural Competence Education | Experimental | Other: Cultural Competence EducationParticipants in the intervention group will attend cultural competence education |
| Standard Mentoring Education | Active comparator | Other: Standard Mentoring EducationParticipants in the control group will complete standard mentoring education that does not include a cultural competence component |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (1 listed)
- be currently employed in any professional nursing role on any unit; have the skills to read and understand the Finnish language; and consent to participate in the study
Key exclusion criteria (1 listed)
- be on long-term leave of absence or maternity leave; lack of skills to read and understand the Finnish language, decline to consent to participate in the study.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Cultural Competence EducationCultural competence education for participants in the intervention group comprises of completion of an online learning module and participation in an eight-hour training day. The educational content includes various topics related to cultural and linguistic diversity and cultural competence in mentoring. | Other | Cultural Competence Education |
| Standard Mentoring EducationParticipants in the control group will not receive the educational intervention but will participate in standard mentoring education. This education is offered in an online learning environment and participants can complete the education at their own pace. The educational content focuses on general issues related to mentoring and does not contain topics specific to cultural competence in mentoring. | Other | Standard Mentoring Education |
Primary outcome
Changes in mentors' cultural competence
Time frame: Pre intervention, immediately after intervention and 6 months after intervention
Mentors' cultural competence will be measured using the newly developed Mentors' Cultural Competence Instrument. The instrument contains 21 items using a four-level Likert scale. A higher score on the likert scale indicates a higher level of competence.
Changes in competence in mentoring
Time frame: Pre intervention, immediately after intervention and 6 months after intervention
Mentors' competence in mentoring will be measured using the psychometrically validated self-assessment Mentors' Competence Instrument (MCI), which contains 43 items divided into 7 sections using a four-level Likert scale. A higher score on the Likert scale indicates a higher level of competence.
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 13 May 2022.
- Background: PubMed 28702955Oikarainen A, Mikkonen K, Tuomikoski AM, Elo S, Pitkanen S, Ruotsalainen H, Kaariainen M. Mentors' competence in mentoring culturally and linguistically diverse nursing students during clinical placement. J Adv Nurs. 2018 Jan;74(1):148-159. doi: 10.1111/jan.13388. Epub 2017 Aug 1.
- Background: PubMed 31319338Oikarainen A, Mikkonen K, Kenny A, Tomietto M, Tuomikoski AM, Merilainen M, Miettunen J, Kaariainen M. Educational interventions designed to develop nurses' cultural competence: A systematic review. Int J Nurs Stud. 2019 Oct;98:75-86. doi: 10.1016/j.ijnurstu.2019.06.005. Epub 2019 Jun 21.
- Derived from this study: PubMed 35714426Oikarainen A, Kaarlela V, Heiskanen M, Taam-Ukkonen M, Lehtimaja I, Karsamanoja T, Tuomikoski AM, Kaariainen M, Tomietto M, Mikkonen K. Educational intervention to support development of mentors' competence in mentoring culturally and linguistically diverse nursing students: A quasi-experimental study. Nurse Educ Today. 2022 Sep;116:105424. doi: 10.1016/j.nedt.2022.105424. Epub 2022 May 29.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Kristina Mikkonen, PhD study chair
University of Oulu
Ashlee I Oikarainen, MHSc principal investigator
University of Oulu
2 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Cultural Competence Education and Standard Mentoring Education in people with Cultural Competency and Mentoring, run by University of Oulu at 2 sites in Finland.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 1 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 13 May 2022. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 2 sites in Finland. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Changes in mentors' cultural competence (time frame: Pre intervention, immediately after intervention and 6 months after intervention). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT04280172, which also lists 3 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 13 May 2022.