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Leslee J. Shaw Romalisa Miranda-Peats Piotr Slomka John Friedman Sean W. Hayes Daniel S. Berman Gary V. Heller Marcin Dada William E. Boden Paul Casperson Robert A. O’Rourke Ronald Schwartz William S. Weintraub David J. Maron Spencer King Koon Teo Pamela Hartigan 《Journal of nuclear cardiology》2006,13(5):685-698
Background Stress gated myocardial perfusion single photon emission computed tomography (gSPECT) is increasingly used before and after
intercurrent therapeutic intervention and is the basis for ongoing evaluation in the Department of Veterans Affairs clinical
outcomes utilizing revascularization and aggressive drug evaluation (COURAGE) trial.
Methods and Results The COURAGE trial is a North American multicenter randomized clinical trial that enrolled 2287 patients to aggressive medical
therapy vs percutaneous coronary intervention plus aggressive medical therapy. Three COURAGE nuclear substudies have been
designed. The goals of substudy 0 are to examine the diagnostic accuracy of the extent and severity of inducible ischemia
at baseline in COURAGE patients compared with patient symptoms and quantitative coronary angiography and to explore the relationship
between inducible ischemia and the benefit from revascularization when added to medical therapy. Substudy 1 will correlate
the extent and severity of provocative ischemia with the frequency, quality, and instability of recurrent symptoms in postcatheterization
patients. Substudy 2 (n _ 300) will examine the usefulness of sequential gSPECT monitoring 6 to 18 months after therapeutic
intervention. Together, these nuclear substudies will evaluate the role of gSPECT to determine the effectiveness of aggressive
risk-factor modifications, lifestyle interventions, and anti-ischemic medical therapies with or without revascularization
in reducing patients’ ischemic burdens.
Conclusions The unfolding of evidence on the application of gSPECT in trials such as COURAGE defines a new era for nuclear cardiology.
We hope the evidence that emerges from the COURAGE trial will further establish the role of nuclear imaging in the evidence-based
management of patients with stable coronary disease.
The COURAGE trial was supported by the Cooperative Studies Program of the Department of Veterans Affairs Office of Research
and Development in collaboration with the Canadian Institutes of Health Research. Unrestricted research grants were obtained
from Merck & Co; Pfizer Pharmaceuticals; Bristol-Myers Squibb Medical Imaging; Astellas Pharma; Kos Pharmaceuticals; Data
Scope; Astra Zeneca Pharmaceuticals; Astra-Zeneca-Canada; Schering-Plough Coorporation, Ltd; Sanofi-Aventis, Inc; First Horizon;
and GE Healthcare. All industrial funding for this trial was directed through the Department of Veterans Affairs. Additional
funding for this substudy was provided by grants to the Department of Veterans Affairs and Canadian Institutes of Health Research
from Astellas Pharma and Bristol-Myers-Squibb Medical Imaging. 相似文献
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Factors influencing family physicians to enter rural practice: Does rural or urban background make a difference?
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C E Paniak D L Shore B P Rourke 《Journal of clinical and experimental neuropsychology》1989,11(5):631-644
This study examined selective reminding and recognition memory performance of 21 severe closed-head injured patients tested within 6 months of regaining consciousness and then again after at least 1 year. Performances on selective reminding parameters were highly correlated and patients performed significantly worse at both testings than did hospitalized controls matched for age, education, and sex. Patients improved from testing 1 to testing 2 on only four of six memory variables. Average Impairment Rating at testing 1 was a marginally better predictor of memory performance at testing 2 than was length of coma. Results are discussed in terms of (a) utility of selective reminding parameters and predictors of outcome and (b) dissociations in recovery of memory parameters. 相似文献
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J R Zarcone T A Rodgers B A Iwata D A Rourke M F Dorsey 《Research in developmental disabilities》1991,12(4):349-360
The Motivation Assessment Scale (MAS) has been proposed as an efficient questionnaire for identifying the source of reinforcement for an individual's self-injurious behavior (SIB). A previous reliability analysis of the MAS (Durand & Crimmins, 1988) reported interrater correlation coefficients ranging from .66 to .92, based on a comparison of responses provided by classroom teachers. In this study, the reliability of the MAS was reexamined with two independent groups of developmentally disabled individuals who exhibited SIB (N = 55). For the institutional sample (n = 39), the MAS was given to two staff members (a supervisor and therapy aide) who work with the individual daily. For the school sample (n = 16), the MAS was given to the teacher and teacher's aide who taught the student. The correlational analyses completed by Durand and Crimmins (1988) were repeated; in addition, a more precise analysis of interrater reliability was calculated based on the actual number of scoring agreements between the two raters. Results showed that only 16 of the 55 raters agreed on the category of reinforcement maintaining their client's or student's SIB, that only 15% of the correlation coefficients obtained were above .80, and that none of the reliability scores based on percent agreement between raters was above 80%. 相似文献
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