Irritable Bowel Syndrome With DiarrheaNCT05702255
Self- Administered Acupressure for Diarrhea Predominant Irritable Bowel Syndrome
A study testing Active acupressure in people with Irritable Bowel Syndrome With Diarrhea, run by Alexandria University at 1 site in Egypt.
Trial summary
This study aims to assess the effect of active self- administered acupressure compared to sham self- administered acupressure on the health outcome for patient with diarrhea predominant Irritable Bowel Syndrome Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Irritable Bowel Syndrome With Diarrhea
- What is being tested?
- Active acupressure
- Could I receive a placebo?
- Yes, some participants may receive a placebo
- How many people
- 70 participants
- Where
- 1 siteEgypt
- Study dates
- 5 Feb 2023to 28 Aug 2023
- 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
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Diagnosed with diarrhea irritable bowel syndrome symptoms following Rome IV diagnostic criteria
- Agreed to be on a fixed dose of the pharmacological therapy throughout the study
Who cannot join
- Patients with severe lesions in major organs such as the heart, liver, and kidney, hematopoietic diseases, or tumors
- Eating disorders
- History of major abdominal surgery
- History of neurological and mental illness
- Usage of other treatment rather than the medical treatment regularly 2 weeks before randomization and throughout the study
- Previous history of drug or alcohol abuse 6 months before randomization
Show all 10Show fewer
- Pregnant and lactating women.
- Patient reporting of adequate relief of their irritable bowel syndrome symptoms the week preceding the randomization
- Patient has too mild symptoms ( obtaining less than 75 on Irritable bowel syndrome symptoms severity scale at the baseline assessment)
- Currently participating in other clinical trials
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Effect of Self- Administered Acupressure on Diarrhea Predominant Irritable Bowel Syndrome Patients' Health Outcomes: a Double Blind- Sham Controlled Randomized Clinical Trial
This study aims to assess the effect of active self- administered acupressure compared to sham self- administered acupressure on the health outcome for patient with diarrhea predominant Irritable Bowel Syndrome
Read the detailed description
Research suggests promising benefits of acupuncture in terms of symptom control and quality of life improvements in patients with irritable bowel syndrome. but the cost of the needle and the invasive nature of the procedure decreases patient compliance with acupuncture. in this respect, acupressure can be taught to patients to allow them to perform it themselves, instead of being administered by practitioners. Self-administered acupressure is less time-intensive, low-cost, and flexible to perform. Nurses involved in irritable bowel syndrome patient care play an active role in the practitioner-patient relationship By assessing the specific symptoms that are present, determining the severity of symptoms and the impact on the irritable bowel syndrome patient's life, and being knowledgeable of available treatment options, the nurse involved in irritable bowel syndrome care becomes an essential conduit of information and a valuable facilitator of a positive practitioner-patient therapeutic relationship. In this way, nurses can help to limit the negative consequences of this common disorder and improve overall treatment outcomes in this population. . Thus this study will be conducted to assess the effectiveness of active self-administered acupressure on diarrhea-predominant irritable bowel syndrome
- Conditions
- Irritable Bowel Syndrome With Diarrhea
- Being tested
- Active acupressure, Sham acuptressure
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Active acupressureOther
Participants will receive training (2 sessions, 2 days a part) by a training researcher. Patients will be taught on the acupoints location and the acupressure technique. Participants will be verified for the correct location of the acupoints, acupressure technique and strength. Participants will be instructed to use thumb or middle finger to self- press each acupoint using circular movements. The force of pressing must be sufficiently strong but still within a comfortable range. A lubricant will be uses to decrease friction between the acupoints and the finger. Follow up evaluation will be at the end of the week 2 and week 4 .The training researcher will make weekly calls to remind participants to perform acupressure and to answer questions
Sham acuptressureOther
The same protocol as the active acupressure group.
| Study group | Role | What they receive |
|---|---|---|
| Active acupoints group | Experimental | All participants in the active group will be treated with basic acupoints Zhongwan (CV 12), Tianshu (ST25) in alternation with Sanyinjiao (SP 6), Zusanli (ST 36). Moreover according to traditional Chinese medicine diagnosis, additional acupoints will be added. The frequency of acupressure treatment will be twice a day for 4 weeks, in total 56 sets. Receives: Other: Active acupressure |
| Sham acupoints group | Sham comparator | All participants on the sham acupoints group will recieive sham Zhongwan (CV 12), sham Tianshu (ST25), sham Sanyinjiao (SP 6), and sham Zusanli (ST 36) acupressure. All the sham points are 2 cm outside and parallel to the actual points which do not match any recognized acupuncture points and are thought to have no therapeutic effect. The frequency of acupressure treatment will be twice a day for 4 weeks, in total 56 sets. Receives: Other: Sham acuptressure |
What is being measured
The primary outcome is the main question the study is designed to answer.
Baseline mean of irritable Bowel Syndrome Symptom Severity Score
It is five item questionnaire measuring frequency and intensity of abdominal pain, the severity of abdominal distension, dissatisfaction with bowel habits, and the interference of IBS with daily life. Subjects respond to each question on a 100-point visual analogue scale. The total score ranges from 0 to 500. Subjects can be categorized as having mild (75-175), moderate (175-300), or severe (>300) disease
Measured: Immediately before assigning the participants to the study groups
Change from the baseline irritable Bowel Syndrome Symptom Severity Score at 2 weeks
t is five item questionnaire measuring frequency and intensity of abdominal pain, the severity of abdominal distension, dissatisfaction with bowel habits, and the interference of IBS with daily life. Subjects respond to each question on a 100-point visual analogue scale. The total score ranges from 0 to 500. Subjects can be categorized as having mild (75-175), moderate (175-300), or severe (>300) disease
Measured: after 2 weeks from the baseline
Change from the baseline irritable Bowel Syndrome Symptom Severity Score at 4 weeks
t is five item questionnaire measuring frequency and intensity of abdominal pain, the severity of abdominal distension, dissatisfaction with bowel habits, and the interference of IBS with daily life. Subjects respond to each question on a 100-point visual analogue scale. The total score ranges from 0 to 500. Subjects can be categorized as having mild (75-175), moderate (175-300), or severe (>300) disease
Measured: after 4 weeks from the baseline
Irritable Bowel Syndrome Adequate Relief question
It is a dichotomous single item that asks participants "Over the past week have you had adequate relief of your irritable Bowel Syndrome symptoms?" . A responder was defined as a patient who answered this question affirmatively.
Measured: At the baseline
Irritable Bowel Syndrome Adequate Relief question
It is a dichotomous single item that asks participants "Over the past week have you had adequate relief of your irritable Bowel Syndrome symptoms?" . A responder was defined as a patient who answered this question affirmatively.
Measured: After 2 weeks from the baseline
Irritable Bowel Syndrome Adequate Relief question
It is a dichotomous single item that asks participants "Over the past week have you had adequate relief of your irritable Bowel Syndrome symptoms?" . A responder was defined as a patient who answered this question affirmatively.
Measured: After 4 weeks from the baseline
Mean stool frequency after 2 weeks
Defined by the bi-weekly change of frequency of defecation,patient will report the number of defecation per day to calculate it.
Measured: After 2 weeks from the patient endorsement
Mean change of stool frequency after 4 weeks
Defined by the bi-weekly change of frequency of defecation,patient will report the number of defecation per day to calculate it.
Measured: After 4 weeks from the patient endorsement
Stool consistency
Defined by the Bristol Stool Form Scale, It is an ordinal scale of stool types ranging from the hardest (Type 1) to the softest (Type 7). Types 1 and2 are considered to be abnormally hard stools while Types 6 and 7 are considered abnormally loose/liquid stools. Type 3, 4 and 5 are considered to be the most normal stool type
Measured: at the baseline
Change in the frequency of stool consistency at 2 weeks from the baseline
defined by the Bristol Stool Form Scale
Measured: after 2 weeks from baseline
Change in the frequency of stool consistency at 4 weeks from the baseline
Defined by the Bristol Stool Form Scale, It is an ordinal scale of stool types ranging from the hardest (Type 1) to the softest (Type 7). Types 1 and2 are considered to be abnormally hard stools while Types 6 and 7 are considered abnormally loose/liquid stools. Type 3, 4 and 5 are considered to be the most normal stool type
Measured: after 4 weeks
Secondary outcomes (8)
Demographic and clinical data
A questionnaire will be developed to collect data about participants' age, gender, body mass index, physical activity status, diet, smoking status, medication used.
Measured: before assignment of the participants to the study groups
the baseline mean of psychological distress measured by the Hospital Anxiety and Depression Scale
the scale contains 14 items, seven statements on each sub-scale which assess symptoms experienced during the past week on four-point rating scale (0 to 3); a higher score depicts a worse condition. For each sub-scale the maximum score is 21. A score of ≥11 is considered a clinically significant disorder, whereas a score between 8 and 10 suggests a mild disorder
Measured: at the baseline
Change from the baseline mean of the psychological distress measured by the Hospital Anxiety and Depression Scale at 4 weeks
the scale contains 14 items, seven statements on each sub-scale which assess symptoms experienced during the past week on four-point rating scale (0 to 3); a higher score depicts a worse condition. For each sub-scale the maximum score is 21. A score of ≥11 is considered a clinically significant disorder, whereas a score between 8 and 10 suggests a mild disorder
Measured: after 4 weeks from the baseline
Baseline mean of the quality of Life
it will be measured by the irritable bowel syndrome quality of Life questionnaire. It consists of 34 items that assess the degree to which irritable bowel syndrome disturbed quality of life for a subject over the past 30 days through eight sub-scales. Each item is rated on a 5-point scale ranging from 1 to 5 with higher values indicating a lower quality of life.
Measured: at the baseline
Change from the baseline mean of the quality of life at 4 weeks
it will be measured by the irritable bowel syndrome quality of Life questionnaire. It consists of 34 items that assess the degree to which irritable bowel syndrome disturbed quality of life for a subject over the past 30 days through eight sub-scales. Each item is rated on a 5-point scale ranging from 1 to 5 with higher values indicating a lower quality of life.
Measured: Four weeks after the baseline assessment
Related adverse Events
An unfavorable change in the health of a participants that happens during a clinical study or within a week after the study has ended. This change may or may not be caused by the acupressure.
Measured: from the patients endorsement till one week after study completion
Adherence to the to active and sham self-administered acupressure of the study.
The adherence will be calculated as percentage of planned sessions of acupressure, and adherence rate above 80% was set as a minimum requirement to be regarded as acceptable
Measured: throughout study completion, an average of 4 months
use of rescue medicine
participants will be asked to report the use of rescue medicine for diarrhea or gastrointestinal symptoms
Measured: throughout study completion, an average of 4 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted27 Jan 2023
- Study start5 Feb 2023
- Primary completion28 Aug 2023
- Study completion28 Aug 2023
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for Irritable Bowel Syndrome With DiarrheaStudies of the same condition, open and under way.
- More trials run by Alexandria UniversityThe sponsor's other registered studies.
- 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
- Supportive care
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind
- Who is masked
- Participant, Outcomes assessor
- Enrolment
- 70 participants (actual)
Sponsor and investigators
- Lead sponsor
- Alexandria University
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Maha Gamal Ramadan Asal, Alexandria University
- Investigators
- Maha G Asal, Phd, Principal investigator, Alexandria UniversityZahraa H Ramzy, Phd, Principal investigator, Alexandria UniversityRasha F Ahmed, Phd, Principal investigator, Alexandria University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT05702255
- Sponsor's protocol ID
- 2022-9-55
- Status last verified
- Apr 2024
- First submitted
- 7 Jan 2023
- Last updated
- 30 Apr 2024
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
Publications
Asal MGR, El-Sayed AAI, Alsenany SA, Ramzy ZH, Dawood RFA. Self-administered active versus sham acupressure for diarrhea predominant irritable bowel syndrome: a nurse-led randomized clinical trial. BMC Nurs. 2025 Jan 28;24(1):106. doi: 10.1186/s12912-024-02594-5.
PubMed 39875940
Study at a glance
From the registry record, last updated by the sponsor on 30 Apr 2024. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Effect of Self- Administered Acupressure on Diarrhea Predominant Irritable Bowel Syndrome Patients' Health Outcomes: a Double Blind- Sham Controlled Randomized Clinical Trial
- ClinicalTrials.gov ID
- NCT05702255
- Acronym / sponsor ID
- 2022-9-55
- Conditions
- Irritable Bowel Syndrome With Diarrhea
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 70 participants (actual)
- Lead sponsor
- Alexandria UniversityUniversity, hospital or other
- Study start
- 5 Feb 2023 (actual)
- Primary completion
- 28 Aug 2023 (actual)
- Study completion
- 28 Aug 2023 (actual)
- First posted
- 27 Jan 2023 (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.
This study aims to assess the effect of active self- administered acupressure compared to sham self- administered acupressure on the health outcome for patient with diarrhea predominant Irritable Bowel Syndrome
Detailed description
Research suggests promising benefits of acupuncture in terms of symptom control and quality of life improvements in patients with irritable bowel syndrome. but the cost of the needle and the invasive nature of the procedure decreases patient compliance with acupuncture. in this respect, acupressure can be taught to patients to allow them to perform it themselves, instead of being administered by practitioners. Self-administered acupressure is less time-intensive, low-cost, and flexible to perform. Nurses involved in irritable bowel syndrome patient care play an active role in the practitioner-patient relationship By assessing the specific symptoms that are present, determining the severity of symptoms and the impact on the irritable bowel syndrome patient's life, and being knowledgeable of available treatment options, the nurse involved in irritable bowel syndrome care becomes an essential conduit of information and a valuable facilitator of a positive practitioner-patient therapeutic relationship. In this way, nurses can help to limit the negative consequences of this common disorder and improve overall treatment outcomes in this population. . Thus this study will be conducted to assess the effectiveness of active self-administered acupressure on diarrhea-predominant irritable bowel syndrome
Study design
- Primary purpose
- Supportive care
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind (participant, outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Active acupoints group | Experimental | Other: Active acupressureAll participants in the active group will be treated with basic acupoints Zhongwan (CV 12), Tianshu (ST25) in alternation with Sanyinjiao (SP 6), Zusanli (ST 36). Moreover according to traditional Chinese medicine diagnosis, additional acupoints will be added. The frequency of acupressure treatment will be twice a day for 4 weeks, in total 56 sets. |
| Sham acupoints group | Sham comparator | Other: Sham acuptressureAll participants on the sham acupoints group will recieive sham Zhongwan (CV 12), sham Tianshu (ST25), sham Sanyinjiao (SP 6), and sham Zusanli (ST 36) acupressure. All the sham points are 2 cm outside and parallel to the actual points which do not match any recognized acupuncture points and are thought to have no therapeutic effect. The frequency of acupressure treatment will be twice a day for 4 weeks, in total 56 sets. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (2 listed)
- Diagnosed with diarrhea irritable bowel syndrome symptoms following Rome IV diagnostic criteria
- Agreed to be on a fixed dose of the pharmacological therapy throughout the study
Key exclusion criteria (10 listed)
- Patients with severe lesions in major organs such as the heart, liver, and kidney, hematopoietic diseases, or tumors
- Eating disorders
- History of major abdominal surgery
- History of neurological and mental illness
- Usage of other treatment rather than the medical treatment regularly 2 weeks before randomization and throughout 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 |
|---|---|---|
| Active acupressureParticipants will receive training (2 sessions, 2 days a part) by a training researcher. Patients will be taught on the acupoints location and the acupressure technique. Participants will be verified for the correct location of the acupoints, acupressure technique and strength. Participants will be instructed to use thumb or middle finger to self- press each acupoint using circular movements. The force of pressing must be sufficiently strong but still within a comfortable range. A lubricant will be uses to decrease friction between the acupoints and the finger. Follow up evaluation will be at the end of the week 2 and week 4 .The training researcher will make weekly calls to remind participants to perform acupressure and to answer questions | Other | Active acupoints group |
| Sham acuptressureThe same protocol as the active acupressure group. | Other | Sham acupoints group |
Primary outcome
Baseline mean of irritable Bowel Syndrome Symptom Severity Score
Time frame: Immediately before assigning the participants to the study groups
It is five item questionnaire measuring frequency and intensity of abdominal pain, the severity of abdominal distension, dissatisfaction with bowel habits, and the interference of IBS with daily life. Subjects respond to each question on a 100-point visual analogue scale. The total score ranges from 0 to 500. Subjects can be categorized as having mild (75-175), moderate (175-300), or severe (>300) disease
Change from the baseline irritable Bowel Syndrome Symptom Severity Score at 2 weeks
Time frame: after 2 weeks from the baseline
t is five item questionnaire measuring frequency and intensity of abdominal pain, the severity of abdominal distension, dissatisfaction with bowel habits, and the interference of IBS with daily life. Subjects respond to each question on a 100-point visual analogue scale. The total score ranges from 0 to 500. Subjects can be categorized as having mild (75-175), moderate (175-300), or severe (>300) disease
Change from the baseline irritable Bowel Syndrome Symptom Severity Score at 4 weeks
Time frame: after 4 weeks from the baseline
t is five item questionnaire measuring frequency and intensity of abdominal pain, the severity of abdominal distension, dissatisfaction with bowel habits, and the interference of IBS with daily life. Subjects respond to each question on a 100-point visual analogue scale. The total score ranges from 0 to 500. Subjects can be categorized as having mild (75-175), moderate (175-300), or severe (>300) disease
Irritable Bowel Syndrome Adequate Relief question
Time frame: At the baseline
It is a dichotomous single item that asks participants "Over the past week have you had adequate relief of your irritable Bowel Syndrome symptoms?" . A responder was defined as a patient who answered this question affirmatively.
Irritable Bowel Syndrome Adequate Relief question
Time frame: After 2 weeks from the baseline
It is a dichotomous single item that asks participants "Over the past week have you had adequate relief of your irritable Bowel Syndrome symptoms?" . A responder was defined as a patient who answered this question affirmatively.
Irritable Bowel Syndrome Adequate Relief question
Time frame: After 4 weeks from the baseline
It is a dichotomous single item that asks participants "Over the past week have you had adequate relief of your irritable Bowel Syndrome symptoms?" . A responder was defined as a patient who answered this question affirmatively.
Mean stool frequency after 2 weeks
Time frame: After 2 weeks from the patient endorsement
Defined by the bi-weekly change of frequency of defecation,patient will report the number of defecation per day to calculate it.
Mean change of stool frequency after 4 weeks
Time frame: After 4 weeks from the patient endorsement
Defined by the bi-weekly change of frequency of defecation,patient will report the number of defecation per day to calculate it.
Stool consistency
Time frame: at the baseline
Defined by the Bristol Stool Form Scale, It is an ordinal scale of stool types ranging from the hardest (Type 1) to the softest (Type 7). Types 1 and2 are considered to be abnormally hard stools while Types 6 and 7 are considered abnormally loose/liquid stools. Type 3, 4 and 5 are considered to be the most normal stool type
Change in the frequency of stool consistency at 2 weeks from the baseline
Time frame: after 2 weeks from baseline
defined by the Bristol Stool Form Scale
Change in the frequency of stool consistency at 4 weeks from the baseline
Time frame: after 4 weeks
Defined by the Bristol Stool Form Scale, It is an ordinal scale of stool types ranging from the hardest (Type 1) to the softest (Type 7). Types 1 and2 are considered to be abnormally hard stools while Types 6 and 7 are considered abnormally loose/liquid stools. Type 3, 4 and 5 are considered to be the most normal stool type
8 secondary outcomes
Demographic and clinical data
Time frame: before assignment of the participants to the study groups
the baseline mean of psychological distress measured by the Hospital Anxiety and Depression Scale
Time frame: at the baseline
Change from the baseline mean of the psychological distress measured by the Hospital Anxiety and Depression Scale at 4 weeks
Time frame: after 4 weeks from the baseline
Baseline mean of the quality of Life
Time frame: at the baseline
Change from the baseline mean of the quality of life at 4 weeks
Time frame: Four weeks after the baseline assessment
Related adverse Events
Time frame: from the patients endorsement till one week after study completion
Adherence to the to active and sham self-administered acupressure of the study.
Time frame: throughout study completion, an average of 4 months
use of rescue medicine
Time frame: throughout study completion, an average of 4 months
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 30 Apr 2024.
- Derived from this study: PubMed 39875940Asal MGR, El-Sayed AAI, Alsenany SA, Ramzy ZH, Dawood RFA. Self-administered active versus sham acupressure for diarrhea predominant irritable bowel syndrome: a nurse-led randomized clinical trial. BMC Nurs. 2025 Jan 28;24(1):106. doi: 10.1186/s12912-024-02594-5.
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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.
Maha G Asal, Phd principal investigator
Alexandria University
Zahraa H Ramzy, Phd principal investigator
Alexandria University
Rasha F Ahmed, Phd principal investigator
Alexandria University
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Active acupressure in people with Irritable Bowel Syndrome With Diarrhea, run by Alexandria University at 1 site in Egypt.
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 2 inclusion and 10 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 30 Apr 2024. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Egypt. 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. Some participants in this study may receive a placebo. 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?
Baseline mean of irritable Bowel Syndrome Symptom Severity Score (time frame: Immediately before assigning the participants to the study groups). The study lists 11 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 NCT05702255, which also lists 1 linked publication.
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 30 Apr 2024.