協調的、協調的、包括的、家族ベース、統合型、テクノロジー対応の脳卒中ケア (C3FIT)
C3FIT (協調的、共同的、包括的、家族ベース、統合的、テクノロジー対応ケア): 脳卒中の無作為化試験
脳卒中は、アメリカ合衆国 (US) における死因の第 5 位であり、成人の身体障害の主な原因です。 脳卒中は、複数の相互作用する危険因子 (遺伝、高血圧、コレステロール、および喫煙、食事、運動などのライフスタイル要因など) を伴う複雑な疾患であり、脳卒中の初期および再発につながります。 脳卒中生存者の最大 90% は、身体的および精神的健康の両方に影響を与える何らかの機能障害を持っています。
最良の脳卒中ケア提供デザインを特定する科学的証拠は不足しています。 私たちは、統合診療ユニット (IPU) と呼ばれる新しい脳卒中治療デザインをテストする、3 年間のメディケア & メディケイド サービス センター (CMS) ヘルスケア イノベーション アワードを完了しました。 この IPU は、患者、介護者、看護師、脳卒中の専門家、リハビリテーションの専門家、患者擁護団体、支払者、テクノロジー企業からの利害関係者の意見をもとに開発されました。 この IPU 設計は、入院期間の短縮、再入院、脳卒中の再発、および低コストに関連していました。
CMS 研究に基づいて、C3FIT (協調的、共同的、包括的、家族ベース、統合型、およびテクノロジー対応の脳卒中ケア) と呼ばれる、より大規模で実用的な試験が開発されました。 C3FIT は、米国の 18 の病院サイトを無作為に割り当てて、共同委員会認定の包括的/プライマリ (CSC/PSC) 設計を継続するか、脳卒中治療のための新しい統合脳卒中診療ユニット (ISPU) 設計を行います。 C3FIT の ISPU は、チームベースの強化されたコラボレーション (Stroke Central と呼ばれる) を使用し、救急部門 (ED) での診察から退院後 12 か月 (Stroke Mobile と呼ばれる) まで患者を追跡します。 Stroke Mobile には、複数のプロバイダーへのアクセスを容易にする遠隔医療技術を使用して機能と生活の質を評価するために、自宅またはリハビリ施設または熟練した看護施設で患者と介護者を訪問する看護師と一般の健康教育者チームが含まれます。 C3FIT の結果は、患者と介護者の健康を確保する最適な脳卒中治療デザインを決定するための質の高い科学的証拠を提供します。
調査の概要
状態
詳細な説明
Scientific evidence that identifies the best stroke care delivery design is lacking. We completed a three-year, Centers for Medicare & Medicaid Services (CMS) Health Care Innovation Award that tested a new stroke care design called an Integrated Practice Unit (IPU). This IPU was developed through stakeholder input from patients, caregivers, nurses, stroke specialists, rehabilitation specialists, patient advocacy groups, payers, and technology companies. This IPU design was associated with decreased hospital length of stay, readmissions, and stroke recurrence, as well as lower cost.
Based on the CMS study, a larger, pragmatic trial was developed that is called C3FIT (Coordinated, Collaborative, Comprehensive, Family-based, Integrated, and Technology-enabled Stroke Care). C3FIT will randomly assign approximately 22 US hospital sites to continue Joint Commission-certified Comprehensive/Primary (CSC/PSC) design or to the novel Integrated Stroke Practice Unit (ISPU) design for stroke care. C3FIT's ISPU uses team-based, enhanced collaboration (called Stroke Central) and follows patients from presentation at the Emergency Department (ED) through 12-months post-discharge (called Stroke Mobile). Stroke Mobile includes a nurse and lay health educator team who visit patients and caregivers at home or at a rehabilitation or skilled nursing facility to assess function and quality of life using telehealth technology to facilitate access to multiple providers. Results from C3FIT will provide high quality scientific evidence to determine the best stroke care design that ensures positive health for patients and caregivers.
研究の種類
入学 (実際)
段階
- 適用できない
連絡先と場所
研究場所
-
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Alabama
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Birmingham、Alabama、アメリカ、35233
- University of Alabama at Birmingham
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Arizona
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Phoenix、Arizona、アメリカ、85054
- Mayo Clinic Hospital
-
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Connecticut
-
Hartford、Connecticut、アメリカ、06102
- Hartford Hospital
-
-
Florida
-
Jacksonville、Florida、アメリカ、32224
- Mayo Clinic
-
-
Georgia
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Atlanta、Georgia、アメリカ、30303
- Emory University/Grady Health
-
Augusta、Georgia、アメリカ、30912
- Augusta University Medical Center
-
-
Illinois
-
Chicago、Illinois、アメリカ、60611
- Northwestern University
-
-
Kansas
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Kansas City、Kansas、アメリカ、66160
- University of Kansas Medical Center
-
-
Kentucky
-
Louisville、Kentucky、アメリカ、40202
- University of Louisville Hospital
-
-
Nevada
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Las Vegas、Nevada、アメリカ、89128
- Intermountain
-
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New Mexico
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Albuquerque、New Mexico、アメリカ、87131
- University of New Mexico Health Sciences Center
-
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Ohio
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Columbus、Ohio、アメリカ、43214
- Ohio Health Riverside Methodist Hospital
-
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Pennsylvania
-
Pittsburgh、Pennsylvania、アメリカ、15213
- University of Pittsburgh Medical Center
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State College、Pennsylvania、アメリカ、16802
- Penn State
-
-
South Carolina
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Charleston、South Carolina、アメリカ、29425
- Medical University of South Carolina
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Tennessee
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Johnson City、Tennessee、アメリカ、37604
- Johnson City Medical Center at Ballad Health
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Knoxville、Tennessee、アメリカ、37916
- Covenant Health Fort Sanders Regional Medical Center
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Memphis、Tennessee、アメリカ、38120
- Baptist Memorial Hospital
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Nashville、Tennessee、アメリカ、37322
- Vanderbilt University Medical Center
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Texas
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Edinburg、Texas、アメリカ、78539
- Doctors Hospital Renaissance
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Wisconsin
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Madison、Wisconsin、アメリカ、53705
- University of Wisconsin Madison
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参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
説明
包含基準:
- 18歳以上。
- -脳内出血または虚血性脳卒中と互換性のある脳画像による急性脳卒中の臨床診断(通常の脳スキャンを含む);表 4 の ICD 10 コードを参照してください。
- 英語またはスペイン語を話す科目。
- -患者は、インデックス脳卒中イベントから7日以内に入院しました。
- 患者は生きて退院し、ホスピスケアに送られません。
- その C3FIT サイトの募集地域内の退院時に住んでいる患者。
- -0〜1の病的前のmRSランキンスコア。
- 患者および/または代理人は、インフォームド コンセント プロセスの後に参加することに同意します。
- リハビリテーション入院治療またはその他のケア施設に通う患者は、募集対象地域に居住し、ホスピス ケアに行かない限り、資格があります。
除外基準:
- 臨床的一過性脳虚血発作 (TIA) 38-41 は、プレゼンテーション時に臨床症候群に対応するコンピュータ断層撮影 (CT) または磁気共鳴画像 (MRI) 病変がある場合でも除外されます。
- -C3FITへの参加が結果のフォローアップ評価またはC3FITの継続に関して妥協される別の臨床試験にすでに登録されている、または登録が計画されている。
- -同意前にホスピスケアへの入院が計画されている患者。
- -神経学的または他の医学的状態(すなわち、進行がん、ホスピスケア、心臓病など)のために1年間生存することが予想されない患者。
- -サイト調査員の意見では、フォローアップケアに関与できない患者。
- -被験者または法定後見人/代理人が、研究手順を理解して協力する、またはインフォームドコンセントを提供することができない、または望まない。
研究計画
研究はどのように設計されていますか?
デザインの詳細
- 主な目的:ヘルスサービス研究
- 割り当て:ランダム化
- 介入モデル:並列代入
- マスキング:独身
武器と介入
参加者グループ / アーム |
介入・治療 |
|---|---|
|
アクティブコンパレータ:統合脳卒中練習ユニット (ISPU)
ISPU 職員は、退院後 30 日間の通院を含め、合同委員会認定の CSC/PSC 設計に基づいて提供されるケアを継続します。
これは、急性期および入院治療から退院後 12 か月までの脳卒中治療の継続全体にわたるチームベースの取り組みを通じて連携を強化するように設計された、より統合されたモデルによって補完されます。
ケアチームは、回復を評価し、危険因子を管理し、理解を深め、患者と介護者の前向きな行動変容を構築するために、自宅またはリハビリテーション/高度な看護施設で患者を毎月12回追跡します。
主要転帰は、3、6、12 か月後に電話で評価されます。副次的転帰は 3、6、12 か月後に評価されます。
|
ケアチームは、回復を評価し、危険因子を管理し、患者と介護者の理解を深め、前向きな行動の変化を築くために、自宅またはリハビリテーション/高度な看護施設で患者を毎月12回追跡します。
一次および二次転帰は、3、6、および 12 か月後に評価されます。
他の名前:
|
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アクティブコンパレータ:総合または一次脳卒中センター (CSC/PSC)
CSC/PSC 職員は、退院後の 30 日間の通院、外来提供者が推奨するフォローアップの通院、および医師が開始するその他の通院を含む、合同委員会認定の CSC/PSC 設計に基づいて提供されるケアを継続します。問題が起こったときは辛抱強く。
主要転帰は、3、6、12 か月後に電話で評価されます。副次的転帰は 3、6、12 か月後に評価されます。
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一次および二次転帰は、3、6、および 12 か月後に評価されます。
他の名前:
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この研究は何を測定していますか?
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
Stroke Impact Scale (SIS) at 12-months Post-discharge
時間枠:12 months post-stroke
|
59-item questionnaire to assess aspects of patient quality of life following stroke; includes 8 dimensions assessed on a 5-point Likert scale that are summed by domain.
Scores range from 0-100, with higher scores indicating less difficulty.
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12 months post-stroke
|
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Modified Rankin Scale at 12 Months Post-stroke
時間枠:12 months post-stroke
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The Modified Rankin Score (mRS) is a widely used scale to measure the degree of disability or dependence in daily activities of individuals who have suffered a stroke. Scores were categorized as 0-2 or >2. Overview of the Modified Rankin Scale
|
12 months post-stroke
|
二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
Stroke Impact Scale (SIS) at 3-months Post-discharge
時間枠:3-months post-stroke
|
59-item questionnaire to assess aspects of patient quality of life following stroke; includes 8 dimensions assessed on a 5-point Likert scale that are summed by domain.
Scores range from 0-100, with higher scores indicating less difficulty.
|
3-months post-stroke
|
|
Stroke Impact Scale (SIS) at 6-months Post-discharge
時間枠:6-months post-discharge
|
59-item questionnaire to assess aspects of patient quality of life following stroke; includes 8 dimensions assessed on a 5-point Likert scale that are summed by domain.
Scores range from 0-100, with higher scores indicating less difficulty.
|
6-months post-discharge
|
|
Modified Rankin Scale (mRS) at 3-months Post-discharge
時間枠:3-months post-stroke
|
The Modified Rankin Score (mRS) is a widely used scale to measure the degree of disability or dependence in daily activities of individuals who have suffered a stroke. Scores were categorized as 0-2 or >2. Overview of the Modified Rankin Scale
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3-months post-stroke
|
|
Modified Rankin Scale (mRS) at 6-months Post-discharge
時間枠:6-months post-discharge
|
The Modified Rankin Score (mRS) is a widely used scale to measure the degree of disability or dependence in daily activities of individuals who have suffered a stroke. Scores were categorized as 0-2 or >2. Overview of the Modified Rankin Scale
|
6-months post-discharge
|
|
Stroke Risk Factors - Blood Pressure Control (BP) at 3-months Post-discharge
時間枠:3-months post-discharge
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To assess BP control through measurement of a seated patient using a blood pressure cuff; controlled BP is 120-130/80 or below for ischemic stroke patients and 140/80 or below for hemorrhagic stroke patients.
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3-months post-discharge
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Stroke Risk Factors-Blood Pressure (BP) at 6-months Post-discharge
時間枠:6-months post-discharge
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To assess BP control through measurement of a seated patient using a blood pressure cuff; controlled BP is 120-130/80 or below for ischemic stroke patients and 140/80 or below for hemorrhagic stroke patients.
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6-months post-discharge
|
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Stroke Risk Factors-BP at 12-months Post-discharge
時間枠:12-months post-discharge
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To assess BP control through measurement of a seated patient using a blood pressure cuff; controlled BP is 120-130/80 or below for ischemic stroke patients and 140/80 or below for hemorrhagic stroke patients.
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12-months post-discharge
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Stroke Risk Factors - Cholesterol (LDL) at 3-months Post-discharge
時間枠:3-months post-discharge
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To assess LDL/lipids control through a LDL or lipids blood draw (standard of care) for patients with elevated cholesterol at baseline (prior to hospital discharge); controlled LDL is less than/equal to 70 for stroke patients.
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3-months post-discharge
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Stroke Risk Factors - Cholesterol (LDL) at 6-months Post-discharge
時間枠:6-months post-discharge
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To assess LDL/lipids control through a LDL or lipids blood draw (standard of care) for patients with elevated cholesterol at baseline (prior to hospital discharge); controlled LDL is less than/equal to 70 for stroke patients.
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6-months post-discharge
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Stroke Risk Factors - Cholesterol (LDL) at 12-months Post-discharge
時間枠:12-months post-discharge
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To assess LDL/lipids control through a LDL or lipids blood draw (standard of care) for patients with elevated cholesterol at baseline (prior to hospital discharge); controlled LDL is less than/equal to 70 for stroke patients.
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12-months post-discharge
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Stroke Risk Factors - Blood Sugar (HgBA1c) at 3-months Post-discharge
時間枠:3-months post-stroke
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To assess blood sugar control through a HgBA1c blood draw (standard of care) for patients with elevated blood sugar at baseline (prior to hospital discharge); controlled HgBA1c is less than/equal to 7% for stroke patients.
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3-months post-stroke
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Stroke Risk Factors - Blood Sugar (HgBA1c) at 6-months Post-discharge
時間枠:6-months post-discharge
|
To assess blood sugar control through a HgBA1c blood draw (standard of care) for patients with elevated blood sugar at baseline (prior to hospital discharge); controlled HgBA1c is less than/equal to 7% for stroke patients.
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6-months post-discharge
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Stroke Risk Factors - Blood Sugar (HgBA1c) at 12-months Post-discharge
時間枠:12-months post-discharge
|
To assess blood sugar control through a HgBA1c blood draw (standard of care) for patients with elevated blood sugar at baseline (prior to hospital discharge); controlled HgBA1c is less than/equal to 7% for stroke patients.
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12-months post-discharge
|
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Stroke Risk Factors - Body Mass Index (BMI) in kg/m^2 at 3-months Post-discharge
時間枠:3-months post-stroke
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To assess weight status by measuring patients' weight and height and applying a formula; patients with normal weight have BMI kg/m*2=18.5-24.9
(BMI less than 18.5 kg/m^2 is underweight, and BMI 25.0 kg/m^2 or above is overweight (BMI=25.0-29.9
kg/m^2 ) or obese (BMI=30.0
kg/m^2 or above).
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3-months post-stroke
|
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Stroke Risk Factors - Body Mass Index (BMI) in kg/m^2 at 6-months Post-discharge
時間枠:6-months post-stroke
|
To assess weight status by measuring patients' weight and height and applying a formula; patients with normal weight have BMI kg/m*2=18.5-24.9
(BMI less than 18.5 kg/m^2 is underweight, and BMI 25.0 kg/m^2 or above is overweight (BMI=25.0-29.9
kg/m^2) or obese (BMI=30.0
kg/m2 or above).
|
6-months post-stroke
|
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Stroke Risk Factors - Body Mass Index (BMI) in kg/m^2 at 12-months Post-discharge
時間枠:12-months post-stroke
|
To assess weight status by measuring patients' weight and height and applying a formula; patients with normal weight have BMI kg/m*2=18.5-24.9
(BMI less than 18.5 kg/m^2 is underweight, and BMI 25.0 kg/m^2 or above is overweight (BMI=25.0-29.9
kg/m^2) or obese (BMI=30.0
kg/m^2 or above).
All measures are in kg/m*2
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12-months post-stroke
|
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Stroke Risk Factors - Diet at 3-months Post-discharge
時間枠:3-months post-stroke
|
Participants were asked one yes/no question to measure awareness of and adherence to the DASH (Dietary Approaches to Stop Hypertension) eating plan and the Mediterranean Diet.
Total number of yes scores is provided where a yes score indicates better adherence to the dietary pattern and therefore in control and a no answer indicated poorer adherence and not in control.
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3-months post-stroke
|
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Stroke Risk Factors - Diet at 6-months Post-discharge
時間枠:6-months post-stroke
|
Participants were asked one yes/no question to measure awareness of and adherence to the DASH (Dietary Approaches to Stop Hypertension) eating plan and the Mediterranean Diet.
Total number of yes scores is provided where a yes score indicates better adherence to the dietary pattern and therefore in control and a no answer indicated poorer adherence and not in control.
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6-months post-stroke
|
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Stroke Risk Factors - Diet at 12-months Post-discharge
時間枠:12-months post-stroke
|
Participants were asked one yes/no question to measure awareness of and adherence to the DASH (Dietary Approaches to Stop Hypertension) eating plan and the Mediterranean Diet.
Total number of yes scores is provided where a yes score indicates better adherence to the dietary pattern and therefore in control and a no answer indicated poorer adherence and not in control.
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12-months post-stroke
|
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Stroke Risk Factors - Smoking Status/Cessation at 3-months Post-discharge
時間枠:3-months post-stroke
|
Participants who ever smoked were asked one yes/no question "Do you smoke now?" to measure compliance with the smoking cessation recommendation.
Total number of participants answering yes indicates adherence to the smoking cessation recommendation pattern and therefore in-control while a no answer indicates non-adherence and not in control.
|
3-months post-stroke
|
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Stroke Risk Factors - Smoking Status/Cessation at 6-months Post-discharge
時間枠:6-months post-stroke
|
Participants who ever smoked were asked one yes/no question "Do you smoke now?" to measure compliance with the smoking cessation recommendation.
Total number of participants answering yes indicates adherence to the smoking cessation recommendation pattern and therefore in-control while a no answer indicates non-adherence and not in control.
|
6-months post-stroke
|
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Stroke Risk Factors - Smoking Status/Cessation at 12-months Post-discharge
時間枠:12-months post-stroke
|
Participants who ever smoked were asked one yes/no question "Do you smoke now?" to measure compliance with the smoking cessation recommendation.
Total number of participants answering yes indicates adherence to the smoking cessation recommendation pattern and therefore in-control while a no answer indicates non-adherence and not in control.
|
12-months post-stroke
|
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Stroke Risk Factors - Exercise at 3-months Post-discharge
時間枠:3-months post-stroke
|
To assess self-reported adherence to American Stroke Association exercise guidelines (patients with stroke or transient ischemic attack (TIA) who are capable of at least moderate-intensity aerobic activity for a minimum of 10 minutes 4x per week, or vigorous intensity activity for a minimum of 20 minutes 2x per week is indicated) except as modified by the participants physician or physical therapist, Participants were asked one yes/no question to measure awareness of and adherence to the exercise recommendations Total number of participants with a yes score indicates adherence to the exercise recommendation pattern and therefore in-control while a no answer indicates non-adherence to the recommendation and not in control. .
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3-months post-stroke
|
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Stroke Risk Factors - Exercise at 6-months Post-discharge
時間枠:6-months post-stroke
|
To assess self-reported adherence to American Stroke Association exercise guidelines (patients with stroke or transient ischemic attack (TIA) who are capable of at least moderate-intensity aerobic activity for a minimum of 10 minutes 4x per week, or vigorous intensity activity for a minimum of 20 minutes 2x per week is indicated) except as modified by the participants physician or physical therapist, Participants were asked one yes/no question to measure awareness of and adherence to the exercise recommendations Total number of participants with a yes score indicates adherence to the exercise recommendation pattern and therefore in-control while a no answer indicates non-adherence to the recommendation and not in control. .
|
6-months post-stroke
|
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Stroke Risk Factors - Exercise at 12-months Post-discharge
時間枠:12-months post-stroke
|
To assess self-reported adherence to American Stroke Association exercise guidelines (patients with stroke or transient ischemic attack (TIA) who are capable of at least moderate-intensity aerobic activity for a minimum of 10 minutes 4x per week, or vigorous intensity activity for a minimum of 20 minutes 2x per week is indicated) except as modified by the participants physician or physical therapist, Participants were asked one yes/no question to measure awareness of and adherence to the exercise recommendations Total number of participants with a yes score indicates adherence to the exercise recommendation pattern and therefore in-control while a no answer indicates non-adherence to the recommendation and not in control. .
|
12-months post-stroke
|
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Mortality at 12-months Post-discharge
時間枠:12-months post-discharge
|
Mortality following stroke will be assessed with family member, through study personnel, and/or using public sources.
|
12-months post-discharge
|
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Rehospitalization
時間枠:12-months post-stroke
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Rehospitalization following stroke will be assessed/confirmed with study personnel.
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12-months post-stroke
|
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Recurrence
時間枠:12-months post-stroke
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Recurrence of stroke will be assessed/confirmed with study personnel.
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12-months post-stroke
|
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Time at Home
時間枠:12-months post-stroke
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Time spent at home compared to institution assessed/confirmed with study personnel.
Time at home is the proportion of time the participant spent at home out of their time at risk in this study (defined as being alive and with known status).
The time at home is defined by subtracting time during hospitalization/rehabilitation/skilled nursing from the total time at risk and divided by total time at risk to get the proportion of time at home.
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12-months post-stroke
|
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Depression: Patient Health Questionnaire (PHQ-9) at 3-months Post-discharge
時間枠:3-months post-discharge
|
9-item questionnaire to assess presence and/or severity of patient depression (includes an additional question to assess difficulty that doesn't impact scoring); scores range from 0-27, with 0=No depression, 1-4=Minimal depression, 5-9=Mild depression, 10-14=Moderate depression, 15-19=Moderately severe depression; and 20-27=Severe depression.
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3-months post-discharge
|
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Depression: Patient Health Questionnaire (PHQ-9) at 6-months Post-discharge
時間枠:6-months post-discharge
|
Depression: Patient Health Questionnaire (PHQ-9) at 3-months post-discharge 9-item questionnaire to assess presence and/or severity of patient depression (includes an additional question to assess difficulty that doesn't impact scoring); scores range from 0-27, with 0=No depression, 1-4=Minimal depression, 5-9=Mild depression, 10-14=Moderate depression, 15-19=Moderately severe depression; and 20-27=Severe depression.
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6-months post-discharge
|
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Depression: Patient Health Questionnaire (PHQ-9) at 12-months Post-discharge
時間枠:12-months post-discharge
|
9-item questionnaire to assess presence and/or severity of patient depression (includes an additional question to assess difficulty that doesn't impact scoring); scores range from 0-27, with 0=No depression, 1-4=Minimal depression, 5-9=Mild depression, 10-14=Moderate depression, 15-19=Moderately severe depression; and 20-27=Severe depression.
|
12-months post-discharge
|
|
Modified Caregiver Strain Index (mCSI) at 3-months Post-discharge
時間枠:3-months post-stroke
|
13-item questionnaire to assess the level of strain in caregivers.
Scores can range from 0-26, with higher scores indicating increased caregiver strain.
Mean scores for each arm are provided and standard deviation of the mean.
|
3-months post-stroke
|
|
Modified Caregiver Strain Index (mCSI) at 6-months Post-discharge
時間枠:6-months post-discharge
|
13-item questionnaire to assess the level of strain in caregivers, with higher scores indicating increased caregiver strain.
|
6-months post-discharge
|
|
Modified Caregiver Strain Index (mCSI) at 12-months Post-discharge
時間枠:12-months post-discharge
|
13-item questionnaire to assess the level of strain in caregivers.
Scores can range from 0-26, with higher scores indicating increased caregiver strain.
Mean scores for each arm are provided and standard deviation of the mean.
|
12-months post-discharge
|
協力者と研究者
捜査官
- 主任研究者:Kenneth Gaines, MD、Vanderbilt University Medical Center
- 主任研究者:Barry Jackson
- 主任研究者:George Howard, DrPH、University of Alabama at Birmingham
出版物と役立つリンク
研究記録日
主要日程の研究
研究開始 (実際)
一次修了 (実際)
研究の完了 (実際)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (実際)
学習記録の更新
投稿された最後の更新 (実際)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
本研究に関する用語
キーワード
追加の関連 MeSH 用語
その他の研究ID番号
- C3FIT
個々の参加者データ (IPD) の計画
個々の参加者データ (IPD) を共有する予定はありますか?
医薬品およびデバイス情報、研究文書
米国FDA規制医薬品の研究
米国FDA規制機器製品の研究
米国で製造され、米国から輸出された製品。
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