- ICH GCP
- Yhdysvaltain kliinisten tutkimusten rekisteri
- Kliininen tutkimus NCT01685840
Guiding Evidence Based Therapy Using Biomarker Intensified Treatment (GUIDE-IT)
Guiding Evidence Based Therapy Using Biomarker Intensified Treatment in Heart Failure.
Tutkimuksen yleiskatsaus
Tila
Ehdot
Interventio / Hoito
Yksityiskohtainen kuvaus
Opintotyyppi
Ilmoittautuminen (Todellinen)
Vaihe
- Ei sovellettavissa
Yhteystiedot ja paikat
Opiskelupaikat
-
-
Alberta
-
Calgary, Alberta, Kanada, T2N 4Z6
- Foothills Medical Centre
-
Edmonton, Alberta, Kanada, T6G 2B7
- University of Alberta Hospital
-
-
British Columbia
-
Vancouver, British Columbia, Kanada, V5Z 1M9
- Vancouver General Hospital
-
Vancouver, British Columbia, Kanada, V6Z 1Y6
- Saint Paul's Hospital
-
-
Ontario
-
Hamilton, Ontario, Kanada, L8L 2X2
- Hamilton Health Sciences
-
Toronto, Ontario, Kanada, M5B 1W8
- St. Michaels Hospital
-
-
-
-
Alabama
-
Huntsville, Alabama, Yhdysvallat, 35801
- The Heart Center PC
-
-
California
-
Sacramento, California, Yhdysvallat, 95819
- Sutter Memorial Hospital
-
San Diego, California, Yhdysvallat, 92037
- University of California San Diego Medical Center
-
-
Connecticut
-
New Haven, Connecticut, Yhdysvallat, 06510
- Yale University School of Medicine
-
-
Florida
-
Coral Springs, Florida, Yhdysvallat, 33065
- Holy Cross Medical Group
-
Fort Lauderdale, Florida, Yhdysvallat, 33308
- Holy Cross Hospital
-
-
Georgia
-
Atlanta, Georgia, Yhdysvallat, 30322
- Emory University
-
Augusta, Georgia, Yhdysvallat, 30901
- University Cardiology Associates, LLC
-
-
Illinois
-
Aurora, Illinois, Yhdysvallat, 60504
- Fox Valley Clinical Research Center, LLC
-
-
Indiana
-
Indianapolis, Indiana, Yhdysvallat, 46202
- Krannert Institute of Cardiology
-
-
Maryland
-
Baltimore, Maryland, Yhdysvallat, 21201
- University of Maryland
-
Beltsville, Maryland, Yhdysvallat, 20705
- Metropolitan Cardiovascular Consultants
-
-
Massachusetts
-
Boston, Massachusetts, Yhdysvallat, 02114
- Massachusetts General Hospital
-
Boston, Massachusetts, Yhdysvallat, 02215
- Beth Israel Medical Center
-
Haverhill, Massachusetts, Yhdysvallat, 01830
- Pentucket Medical Associates
-
-
Minnesota
-
Rochester, Minnesota, Yhdysvallat, 55905
- Mayo Clinic
-
-
Missouri
-
San Luis, Missouri, Yhdysvallat, 63112
- Washington University School of Medicine
-
-
New Hampshire
-
Lebanon, New Hampshire, Yhdysvallat, 03756
- Dartmouth Hitchcock Medical Center
-
-
New Jersey
-
Cherry Hill, New Jersey, Yhdysvallat, 08034
- Cardiovascular Associates of the Delaware Valley
-
New Brunswick, New Jersey, Yhdysvallat, 08903
- Robert Wood Johnson University Hospital
-
Sewell, New Jersey, Yhdysvallat, 08080
- Cardiovascular Associates of the Delaware Valley
-
-
New York
-
Bronx, New York, Yhdysvallat, 10461
- Jacobi Medical Center
-
Bronx, New York, Yhdysvallat, 10457
- Bronx-Lebanon Hospital Center
-
Bronx, New York, Yhdysvallat, 10467
- Albert Einstein University Hospital
-
Brooklyn, New York, Yhdysvallat, 11215
- New York Methodist Hospital
-
Saratoga Springs, New York, Yhdysvallat, 12866
- Saratoga Cardiology Associates
-
-
North Carolina
-
Chapel Hill, North Carolina, Yhdysvallat, 27599
- University of North Carolina at Chapel Hill
-
Charlotte, North Carolina, Yhdysvallat, 28204
- Novant Health Heart and Vascular Institute
-
Durham, North Carolina, Yhdysvallat, 27710
- Duke University Medical Center
-
Greensboro, North Carolina, Yhdysvallat, 27401
- LeBauer Cardiovascular Research Foundation
-
-
Ohio
-
Cincinnati, Ohio, Yhdysvallat, 45267
- University of Cincinnati Medical Center
-
Cleveland, Ohio, Yhdysvallat, 44195
- Cleveland Clinic Foundation
-
-
Pennsylvania
-
Camp Hill, Pennsylvania, Yhdysvallat, 17011
- Capitol Area Research, LLC
-
Philadelphia, Pennsylvania, Yhdysvallat, 19102
- Drexel University College of Medicine
-
Philadelphia, Pennsylvania, Yhdysvallat, 19107
- Thomas Jefferson University Hospital
-
Pittsburg, Pennsylvania, Yhdysvallat, 15212
- Allegheny-Singer Research Institute
-
-
South Carolina
-
Anderson, South Carolina, Yhdysvallat, 29621
- AnMed Health Medical Center
-
-
Texas
-
Dallas, Texas, Yhdysvallat, 75390
- University of Texas Southwestern Medical Center Dallas
-
-
Utah
-
Murray, Utah, Yhdysvallat, 84157
- Intermountain Medical Center
-
-
Virginia
-
Chesapeake, Virginia, Yhdysvallat, 23320
- Cardiovascular Associates, Ltd.
-
-
Osallistumiskriteerit
Kelpoisuusvaatimukset
Opintokelpoiset iät
Hyväksyy terveitä vapaaehtoisia
Sukupuolet, jotka voivat opiskella
Kuvaus
Inclusion Criteria:
- Age 18 years or older
- Most recent LVEF to be ≤ 40% by any method within 12 months of randomization.
- High risk heart failure as defined by the following criteria:
A Heart Failure Event in the prior 12 months, defined as any one of the following:
- HF Hospitalization
- Treatment in the Emergency Department (or equivalent) for Heart Failure
- Outpatient treatment for heart failure with intravenous diuretics
AND
- NT-proBNP greater than 2000 pg/mL or BNP greater than 400 pg/mL at any time during the 30 days prior to randomization
- Willing to provide informed consent
Exclusion Criteria:
- Acute coronary syndrome (clinical diagnosis) or cardiac revascularization procedure within 30 days
- Cardiac resynchronization therapy (CRT) within prior 3 months or current plan to implant CRT device
- Active myocarditis, Hypertrophic obstructive cardiomyopathy, pericarditis, or restrictive cardiomyopathy
- Severe stenotic valvular disease
- Anticipated heart transplantation or ventricular assist device within 12 months
- Chronic inotropic therapy
- Complex congenital heart disease
- End stage renal disease with renal replacement therapy
- Non cardiac terminal illness with expected survival less than 12 months
- Women who are pregnant or planning to become pregnant
- Inability to comply with planned study procedures
- Enrollment or planned enrollment in another clinical trial
Opintosuunnitelma
Miten tutkimus on suunniteltu?
Suunnittelun yksityiskohdat
- Ensisijainen käyttötarkoitus: Hoito
- Jako: Satunnaistettu
- Inventiomalli: Rinnakkaistehtävä
- Naamiointi: Ei mitään (avoin tarra)
Aseet ja interventiot
Osallistujaryhmä / Arm |
Interventio / Hoito |
---|---|
Kokeellinen: Usual Care
Usual Care group will receive standard heart failure treatment based on the doctor's best judgment and following the recommendation of current guidelines.
This will typically include the use of medicines such as beta-blockers, ACE-inhibitors, and diuretics, all of which are approved, recommended treatments for heart failure.
|
Tavallinen hoito
|
Kokeellinen: Biomarker-Guided Care
Device: Biomarker-Guided care NT-proBNP The Biomarker Guided Therapy group will receive the standard heart failure treatments.
In addition, the doctor will use the results of a blood test called NT-proBNP to help adjust the treatments and drug doses.
|
Device: NT-proBNP
|
Mitä tutkimuksessa mitataan?
Ensisijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
---|---|---|
CV Death or Heart Failure Hospitalization
Aikaikkuna: 24 Months
|
Composite of First Heart Failure Hospitalization or Cardiovascular Mortality
|
24 Months
|
Toissijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
---|---|---|
All-cause Mortality
Aikaikkuna: 24 months
|
All-cause mortality by treatment arm
|
24 months
|
Cumulative Morbidity
Aikaikkuna: 24 months
|
Days alive and not hospitalized for CV reasons
|
24 months
|
CV Death
Aikaikkuna: 24 months
|
CV death by treatment arm
|
24 months
|
Number of Hospitalizations for First Heart Failure
Aikaikkuna: 24 months
|
First Heart Failure Hospitalization
|
24 months
|
Number of Hospitalizations for Recurrent Heart Failure
Aikaikkuna: 24 months
|
Recurrent Heart Failure Hospitalization
|
24 months
|
Percentage of Patients With Moderate to Severe Depression
Aikaikkuna: Baseline, 3,6, 12 and 24 months
|
Percentage of patients with moderate to severe depression as measured by the Center for Epidemiologic Studies Depression Scale (CES-D). CES-D is a 20-item scale measuring general depression. Scores range from 0-60, with higher scores indicating greater general depression. Moderate to severe depression is indicated by a score of 11 or higher. |
Baseline, 3,6, 12 and 24 months
|
Duke Activity Status Index (DASI)
Aikaikkuna: Baseline, 3, 6, 12 and 24 months
|
The DASI is a self-administered questionnaire that measures a patient's functional capacity.
It can be used to get a rough estimate of a patient's peak oxygen uptake.
The maximum score for the DASI is 58.2 (better functional ability/capacity) and the minimum score is 0 (worse functional ability/capacity).
|
Baseline, 3, 6, 12 and 24 months
|
EQ-5D Health Index
Aikaikkuna: Baseline, 3, 6, 12 and 24 months
|
The EQ-5D measures the subjects health status in 5 categories (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) and totals them into 1 score, from -0.59 (worst) to 1 (best).
|
Baseline, 3, 6, 12 and 24 months
|
EQ-5D Visual Analog Scale
Aikaikkuna: Baseline, 3, 6, 12 and 24 months
|
The EQ-5D VAS records participants self-rated health status on a vertical (0-100) scale with higher scores indicating higher Health-Related Quality of Life, where 0 = worst imaginable health state and 100 = best imaginable health state.
|
Baseline, 3, 6, 12 and 24 months
|
Kansas City Cardiomyopathy Questionnaire (KCCQ) Overall Score
Aikaikkuna: Baseline, 3, 6,12 and 24 months
|
This KCCQ overall score represents the mean of the following 4 scores: Physical Limitation, Total Symptom, Quality of Life, and Social Limitation.
Mean scores are transformed to a 0-100 scale with high scores representing better outcomes.
|
Baseline, 3, 6,12 and 24 months
|
Short Form-36 (SF-36) General Health Subscale
Aikaikkuna: Baseline, 3, 6, 12 and 24 months
|
SF-36 measures perceived Quality of Life.
The following subscales were used: General Health, Mental Health, Social Functioning, Physiological Functioning, and Vitality Each subscale is scored from 0-100 with 0 indicating lowest quality of life.
|
Baseline, 3, 6, 12 and 24 months
|
Short Form-36 (SF-36) Mental Health Subscale
Aikaikkuna: Baseline, 3, 6, 12 and 24 months
|
SF-36 measures perceived Quality of Life.
The following subscales were used: General Health, Mental Health, Social Functioning, Physiological Functioning, and Vitality Each subscale is scored from 0-100 with 0 indicating lowest quality of life.
|
Baseline, 3, 6, 12 and 24 months
|
Short Form-36 (SF-36) Social Functioning Subscale
Aikaikkuna: Baseline, 3, 6, 12 and 24 months
|
SF-36 measures perceived Quality of Life.
The following subscales were used: General Health, Mental Health, Social Functioning, Physiological Functioning, and Vitality Each subscale is scored from 0-100 with 0 indicating lowest quality of life.
|
Baseline, 3, 6, 12 and 24 months
|
Short Form-36 (SF-36) Physiological Functioning Subscale
Aikaikkuna: Baseline, 3, 6, 12 and 24 months
|
SF-36 measures perceived Quality of Life.
The following subscales were used: General Health, Mental Health, Social Functioning, Physiological Functioning, and Vitality Each subscale is scored from 0-100 with 0 indicating lowest quality of life.
|
Baseline, 3, 6, 12 and 24 months
|
Short Form-36 (SF-36) Vitality Subscale
Aikaikkuna: Baseline, 3, 6, 12 and 24 months
|
SF-36 measures perceived Quality of Life.
The following subscales were used: General Health, Mental Health, Social Functioning, Physiological Functioning, and Vitality Each subscale is scored from 0-100 with 0 indicating lowest quality of life.
|
Baseline, 3, 6, 12 and 24 months
|
Resource Utilization
Aikaikkuna: 24 months
|
Observed Resource Use
|
24 months
|
Resource Utilization Cost
Aikaikkuna: 24 months
|
Observed Hospital-Based Cost.
|
24 months
|
Yhteistyökumppanit ja tutkijat
Sponsori
Yhteistyökumppanit
Tutkijat
- Päätutkija: Michael Felker, MD, Duke University
Julkaisuja ja hyödyllisiä linkkejä
Yleiset julkaisut
- Ezekowitz JA, Alemayehu W, Rathwell S, Grant AD, Fiuzat M, Whellan DJ, Ahmad T, Adams K, Pina IL, Cooper LS, Januzzi JL, Leifer ES, Mark D, O'Connor CM, Felker GM. The influence of comorbidities on achieving an N-terminal pro-b-type natriuretic peptide target: a secondary analysis of the GUIDE-IT trial. ESC Heart Fail. 2022 Feb;9(1):77-86. doi: 10.1002/ehf2.13692. Epub 2021 Nov 16.
- Chouairi F, Fuery MA, Mullan CW, Caraballo C, Sen S, Maulion C, Wilkinson ST, Surti T, McCullough M, Miller PE, Pacor J, Leifer ES, Felker GM, Velazquez EJ, Fiuzat M, O'Connor CM, Januzzi JL, Desai NR, Ahmad T. The Impact of Depression on Outcomes in Patients With Heart Failure and Reduced Ejection Fraction Treated in the GUIDE-IT Trial. J Card Fail. 2021 Dec;27(12):1359-1366. doi: 10.1016/j.cardfail.2021.06.008. Epub 2021 Jun 22.
- Fuery MA, Chouairi F, Januzzi JL, Moe GW, Caraballo C, McCullough M, Miller PE, Reinhardt SW, Clark K, Oseran A, Milner A, Pacor J, Kahn PA, Singh A, Ravindra N, Guha A, Vadlamani L, Kulkarni NS, Fiuzat M, Felker GM, O'Connor CM, Ahmad T, Ezekowitz J, Desai NR. Intercountry Differences in Guideline-Directed Medical Therapy and Outcomes Among Patients With Heart Failure. JACC Heart Fail. 2021 Jul;9(7):497-505. doi: 10.1016/j.jchf.2021.02.011. Epub 2021 May 12.
- Daubert MA, Yow E, Barnhart HX, Pina IL, Ahmad T, Leifer E, Cooper L, Desvigne-Nickens P, Fiuzat M, Adams K, Ezekowitz J, Whellan DJ, Januzzi JL, O'Connor CM, Felker GM. Differences in NT-proBNP Response and Prognosis in Men and Women With Heart Failure With Reduced Ejection Fraction. J Am Heart Assoc. 2021 May 18;10(10):e019712. doi: 10.1161/JAHA.120.019712. Epub 2021 May 6.
- Parcha V, Patel N, Kalra R, Suri SS, Arora G, Wang TJ, Arora P. Obesity and Serial NT-proBNP Levels in Guided Medical Therapy for Heart Failure With Reduced Ejection Fraction: Insights From the GUIDE-IT Trial. J Am Heart Assoc. 2021 Apr 6;10(7):e018689. doi: 10.1161/JAHA.120.018689. Epub 2021 Mar 23.
- Fiuzat M, Ezekowitz J, Alemayehu W, Westerhout CM, Sbolli M, Cani D, Whellan DJ, Ahmad T, Adams K, Pina IL, Patel CB, Anstrom KJ, Cooper LS, Mark D, Leifer ES, Felker GM, Januzzi JL, O'Connor CM. Assessment of Limitations to Optimization of Guideline-Directed Medical Therapy in Heart Failure From the GUIDE-IT Trial: A Secondary Analysis of a Randomized Clinical Trial. JAMA Cardiol. 2020 Jul 1;5(7):757-764. doi: 10.1001/jamacardio.2020.0640.
- Januzzi JL Jr, Ahmad T, Mulder H, Coles A, Anstrom KJ, Adams KF, Ezekowitz JA, Fiuzat M, Houston-Miller N, Mark DB, Pina IL, Passmore G, Whellan DJ, Cooper LS, Leifer ES, Desvigne-Nickens P, Felker GM, O'Connor CM. Natriuretic Peptide Response and Outcomes in Chronic Heart Failure With Reduced Ejection Fraction. J Am Coll Cardiol. 2019 Sep 3;74(9):1205-1217. doi: 10.1016/j.jacc.2019.06.055.
- O'Connor C, Fiuzat M, Mulder H, Coles A, Ahmad T, Ezekowitz JA, Adams KF, Pina IL, Anstrom KJ, Cooper LS, Mark DB, Whellan DJ, Januzzi JL Jr, Leifer ES, Felker GM. Clinical factors related to morbidity and mortality in high-risk heart failure patients: the GUIDE-IT predictive model and risk score. Eur J Heart Fail. 2019 Jun;21(6):770-778. doi: 10.1002/ejhf.1450. Epub 2019 Mar 27.
- Daubert MA, Adams K, Yow E, Barnhart HX, Douglas PS, Rimmer S, Norris C, Cooper L, Leifer E, Desvigne-Nickens P, Anstrom K, Fiuzat M, Ezekowitz J, Mark DB, O'Connor CM, Januzzi J, Felker GM. NT-proBNP Goal Achievement Is Associated With Significant Reverse Remodeling and Improved Clinical Outcomes in HFrEF. JACC Heart Fail. 2019 Feb;7(2):158-168. doi: 10.1016/j.jchf.2018.10.014. Epub 2019 Jan 2.
- Mark DB, Cowper PA, Anstrom KJ, Sheng S, Daniels MR, Knight JD, Baloch KN, Davidson-Ray L, Fiuzat M, Januzzi JL Jr, Whellan DJ, Pina IL, Ezekowitz JA, Adams KF, Cooper LS, O'Connor CM, Felker GM. Economic and Quality-of-Life Outcomes of Natriuretic Peptide-Guided Therapy for Heart Failure. J Am Coll Cardiol. 2018 Nov 27;72(21):2551-2562. doi: 10.1016/j.jacc.2018.08.2184.
- Felker GM, Anstrom KJ, Adams KF, Ezekowitz JA, Fiuzat M, Houston-Miller N, Januzzi JL Jr, Mark DB, Pina IL, Passmore G, Whellan DJ, Yang H, Cooper LS, Leifer ES, Desvigne-Nickens P, O'Connor CM. Effect of Natriuretic Peptide-Guided Therapy on Hospitalization or Cardiovascular Mortality in High-Risk Patients With Heart Failure and Reduced Ejection Fraction: A Randomized Clinical Trial. JAMA. 2017 Aug 22;318(8):713-720. doi: 10.1001/jama.2017.10565.
- Felker GM, Ahmad T, Anstrom KJ, Adams KF, Cooper LS, Ezekowitz JA, Fiuzat M, Houston-Miller N, Januzzi JL, Leifer ES, Mark DB, Desvigne-Nickens P, Paynter G, Pina IL, Whellan DJ, O'Connor CM. Rationale and design of the GUIDE-IT study: Guiding Evidence Based Therapy Using Biomarker Intensified Treatment in Heart Failure. JACC Heart Fail. 2014 Oct;2(5):457-65. doi: 10.1016/j.jchf.2014.05.007. Epub 2014 Sep 3.
Opintojen ennätyspäivät
Opi tärkeimmät päivämäärät
Opiskelun aloitus
Ensisijainen valmistuminen (Todellinen)
Opintojen valmistuminen (Todellinen)
Opintoihin ilmoittautumispäivät
Ensimmäinen lähetetty
Ensimmäinen toimitettu, joka täytti QC-kriteerit
Ensimmäinen Lähetetty (Arvio)
Tutkimustietojen päivitykset
Viimeisin päivitys julkaistu (Todellinen)
Viimeisin lähetetty päivitys, joka täytti QC-kriteerit
Viimeksi vahvistettu
Lisää tietoa
Tähän tutkimukseen liittyvät termit
Avainsanat
Muita asiaankuuluvia MeSH-ehtoja
Muut tutkimustunnusnumerot
- Pro00033097
Nämä tiedot haettiin suoraan verkkosivustolta clinicaltrials.gov ilman muutoksia. Jos sinulla on pyyntöjä muuttaa, poistaa tai päivittää tutkimustietojasi, ota yhteyttä register@clinicaltrials.gov. Heti kun muutos on otettu käyttöön osoitteessa clinicaltrials.gov, se päivitetään automaattisesti myös verkkosivustollemme .
Kliiniset tutkimukset Sydämen vajaatoiminta
-
Region SkaneIlmoittautuminen kutsustaSydämen vajaatoiminta New York Heart Associationin (NYHA) luokka II | Sydämen vajaatoiminta New York Heart Associationin (NYHA) luokka IIIRuotsi
-
Medical University of BialystokInstitute of Cardiology, Warsaw, Poland; Medical University of Lodz; Poznan... ja muut yhteistyökumppanitEi vielä rekrytointiaSystolinen sydämen vajaatoiminta | Sydämen vajaatoiminta pienentyneellä ejektiofraktiolla | Sydämen vajaatoiminta New York Heart Associationin luokka IV | Sydämen vajaatoiminta New York Heart Associationin luokka IIIPuola
-
Mathematica Policy Research, Inc.University of Pennsylvania; University of California, San Francisco; Arnold... ja muut yhteistyökumppanitAktiivinen, ei rekrytointiKeuhkokuume | COPD | CHF - Congestive Heart FailureYhdysvallat
-
Novartis PharmaceuticalsValmisPotilaat, jotka päättivät onnistuneesti ydintutkimuksen 12 kuukauden hoitojakson (de Novo Heart Recipipient), jotka olivat kiinnostuneita EC-MPS-hoidosta
-
University of WashingtonAmerican Heart AssociationValmisSydämen vajaatoiminta, kongestiivinen | Mitokondrioiden muutos | Sydämen vajaatoiminta New York Heart Associationin luokka IVYhdysvallat
-
CHX Technologies Inc.The Research Institute of St Joe's Hamilton; St. Joseph's Health System...Ei vielä rekrytointiaDialyysi | COPD (krooninen obstruktiivinen keuhkosairaus) | Krooninen aineenvaihduntahäiriö | Congestive Heart Failure (CHF)
Kliiniset tutkimukset Tavallinen hoito
-
University of Colorado, DenverNational Institute of Mental Health (NIMH); Washington State University; University...RekrytointiItsemurhien ehkäisyYhdysvallat
-
VA Office of Research and DevelopmentValmisPTSD | Posttraumaattinen stressihäiriöYhdysvallat
-
Albert Einstein College of MedicineColumbia University; University of Rochester; Rutgers UniversityValmisLasten liikalihavuus | Varhaislapsuuden kariesYhdysvallat
-
Scripps Whittier Diabetes InstituteMcKesson Foundation; Neighborhood HealthcareValmis
-
Ohio State UniversityEi vielä rekrytointiaSynnytyksen jälkeinen masennus | Synnytyksen jälkeinen ahdistus | Kardiometabolinen oireyhtymäYhdysvallat
-
RANDLouisiana Public Health InstituteValmis
-
Yale UniversityNational Institute of Mental Health (NIMH)RekrytointiItsemurha-ajattelu | Itsemurha | Itsemurhien ehkäisyPakistan
-
Rutgers, The State University of New JerseyNational Cancer Institute (NCI); Georgetown UniversityRekrytointiPerinnöllinen syöpä | Geneettinen testausYhdysvallat
-
University of Colorado, DenverEunice Kennedy Shriver National Institute of Child Health and Human Development... ja muut yhteistyökumppanitValmisFyysinen kuntoutus | Vanhemmat aikuisetYhdysvallat
-
VA Office of Research and DevelopmentValmisItsemurha, yritys | Itsemurha | Sairaalat, psykiatrisetYhdysvallat