ࡱ> =?:;< (lbjbj ?tcQz z HHH\\\8,\f$"<$<$<$&.0Loqqqqqq$$ֆH 6%@& 6 6<$<$(>>> 6&R<$H<$o> 6o>>ٳ&"<$AY38sw2[ҁ<w99d_z_z\Hz13>34111K=f111 6 6 6 6111111111z : 91Ů Institutional Review Board INSTRUCTIONS FOR COMPLETING THE CONTINUING REVIEW REQUEST / NOTICE OF STUDY COMPLETION DO NOT COMPLETE THIS FORM IF YOUR STUDY WAS APPROVED FOR EXEMPT REVIEW To notify the IRB of an exempt study closure, e-mail  HYPERLINK "mailto:irb@slu.edu" irb@slu.edu. If you have questions regarding this form, please contact the IRB at 314-977-7744 or email  HYPERLINK "mailto:irb@slu.edu" irb@slu.edu. A. DETERMINATION OF WHETHER A CONTINUING REVIEW OR NOTICE OF STUDY COMPLETION IS NEEDED Investigators are considered to be conducting human research if they are (i) obtaining data through intervention or interaction with living individuals or (ii) collecting information about individuals or conducting ongoing data analysis of previously approved full board or expedited projects. When all such activities are completed at 91Ů, the research no longer requires a continuing review by 91Ů IRB and a Notice of Study Completion should be submitted. B. FREQUENCY OF REVIEW FOR STUDY CONTINUATION In accordance with federal regulations, the IRB must review human research protocols at least annually, or more frequently at intervals appropriate to the degree of risk and degree of vulnerability of the subject population. In order to determine whether continuance of IRB approval is warranted, it is the investigators responsibility to submit the Continuing Review Request form. Materials not received by the due date or incomplete submissions may not be reviewed by the IRB in time to obtain approval. NOTE: The continuation of research after expiration of IRB approval is a violation of federal regulations. If the IRB has not reviewed and approved a research study by the studys current expiration date, i.e., IRB approval has expired, research activities should stop. No new subjects may be accrued. If the investigator is actively pursuing renewal with the IRB and believes that an over-riding safety concern exists or ethical issue is involved, the investigator must seek IRB permission to continue study procedures for the brief time required to complete the review process. WHAT TO SUBMIT WITH YOUR CONTINUING REVIEW APPLICATION For studies that are open to accrual and those that are closed to accrual but data collection is ongoing or research related interventions remain active, submit an original and two (2) sets of the following materials with your request for continuing review (For expedited studies, submit an original set of applicable documents): Current 91Ů IRB application and protocol with all current applicable supplemental materials (e.g., recruitment materials, questionnaires) Current sponsors protocol (for sponsored studies) For studies that have an Investigators Brochure (IB): Please submit the section of the IB that summarizes risks OR the current full IB. (The summary section may be titled Summary of Data and Guidance for the Investigator) Last approved (stamped) consent/assent form(s) and HIPAA Authorization Form if applicable For studies that are open to accrual, submit one clean (unstamped) copy of consent/assent document(s) to be stamped upon IRB approval. For studies that are closed to accrual, submit one clean (unstamped) copy of consent/addendum consent only if subjects need to be re-consented. Any changes, updated and/or new study materials should be submitted along with a HYPERLINK "/research/faculty-resources/research-integrity-safety/institutional-review-board-irb/irb_assets/form_change-in-protocol_for_information_only.doc"change-in-protocol form to accompany the continuing review request form Subject Safety information including the most current Serious Adverse Event (SAE) cumulative table and Data safety monitoring reports since the last IRB approval Publications (e.g., manuscripts, abstracts) since the last IRB approval For studies that are permanently closed to accrual and/or research activities are limited to data analysis, submit an original and one (1) set of the following materials with your request for continuing review: Current 91Ů IRB application/protocol Any changes, updated and/or new study materials should be submitted along with a HYPERLINK "/research/faculty-resources/research-integrity-safety/institutional-review-board-irb/irb_assets/form_change-in-protocol_for_information_only.doc"change-in-protocol form to accompany the continuing review request form. Publications (e.g., manuscripts, abstracts) since the last IRB approval Subject Safety information WHAT TO SUBMIT WITH YOUR NOTICE OF STUDY COMPLETION For studies for which human research activities are completed, submit the notice of study completion form as a final report. Please do not submit these instructions with the form SAINT LOUIS UNIVERSITYIRB #:Institutional Review Board (IRB) Caroline Bldg, Room C110 (314) 977-7744 (314) 977-7730 (fax) CONTINUING REVIEW REQUEST / NOTICE OF STUDY COMPLETION DATE:IRB Approval Expiration Date:Principal Investigator: Phone/Pager: Department: Address: E-Mail: Degree: Contact Person: Phone/Email: Study Title: (If applicable, use the exact title listed in the grant/contract application.)  FOR SPONSORED STUDIES ONLY (IRB Fees):  FORMCHECKBOX  Bill Sponsor - OR -  FORMCHECKBOX  Bill 91Ů DepartmentSponsor/CRO Name: Protocol Number: Sponsor/CRO Contact: Address: E-Mail: Phone: 91Ů Contact Name: 91Ů Billing Address: E-Mail: Phone:   FORMCHECKBOX  REQUEST FOR STUDY RE-INITIATION This box is to be checked if IRB approval has expired, and the investigator is requesting re-initiation of the study to resume research activities. Complete all sections for continuing review.  FORMCHECKBOX  CONTINUING REVIEW REQUEST, Check here if you are requesting continuing review. The following boxes need to be completed for both re-initiation and continuing review requests.  FORMCHECKBOX  Study has not started but will become active. (Please complete sections A, B, F, G, H)  FORMCHECKBOX  Study is ACTIVE, Please check the appropriate box below.  FORMCHECKBOX  Study is open to accrual. Complete all sections for continuing review.  FORMCHECKBOX  Study is on hold or halted. Complete all sections for continuing review.  FORMCHECKBOX  Study is permanently closed to accrual. If you checked this box, please answer the questions below and complete all sections for Continuing Review. Have all subjects completed all research related activities/interventions? No FORMCHECKBOX  Yes*  FORMCHECKBOX  Will the research only remain active for long-term follow-up of subjects? No FORMCHECKBOX  Yes*  FORMCHECKBOX  N/A  FORMCHECKBOX  Are remaining research activities limited to data analysis only? No FORMCHECKBOX  Yes*  FORMCHECKBOX  For IRB office use: * May qualify for expedited review  FORMCHECKBOX  NOTICE OF STUDY COMPLETION, Check here if your study should be closed.  FORMCHECKBOX Research activities are complete. (Complete sections A, B, C, F, H) When all human research procedures (including data analysis) are completed at 91Ů, the research no longer requires continuing review by the 91Ů IRB. For multi-center studies, continuing review of the research by the 91Ů IRB is not required after all human research activities have been completed at 91Ů even if (i) interactions or interventions with subjects may be occurring at other study sites, or (ii) data analysis of identifiable private information is ongoing at another central site that collects and analyzes data from all study sites. For multi-center investigator-initiated studies (e.g., 91Ů Investigator is the head of this multi-center trial and is responsible for reporting to IRB, FDA, and/or other sites), the 91Ů IRB would require the study to remain open until all sites have completed the research project and data analysis.  FORMCHECKBOX Study can be terminated because research activities never started. (Complete section A and section H ONLY)  DOCUMENT CHECKLIST FOR ITEMS SUBMITTED Please refer to the Instructions on Page 1 for a list of materials to be submitted with your Request for Continuing review or Notice of Study Completion. Submit all materials to the same IRB office that initially reviewed the study. Submit 1 original plus 2 complete sets for Full Board Studies, or submit 1 original set for Expedited Studies of the continuing review request form (including current supplemental documents):  FORMCHECKBOX Current version of IRB Application and Protocol (version date: _____________ )**  FORMCHECKBOX Current version of Sponsors Protocol, if applicable (version date: _____________ )  FORMCHECKBOX Last approved (stamped) consent/assent form(s) if applicable (version date _____________ )  FORMCHECKBOX Clean (unstamped) copy of consent/assent form(s) if applicable, and indicate # of consent/assent forms below:  FORMCHECKBOX  Assent Document(s) _____ Number of assent documents submitted  FORMCHECKBOX  Standard Consent Document(s) _____ Number of consent documents submitted  FORMCHECKBOX  Addendum Consent Document(s), if applicable (if study is closed to accrual, but subjects are being re-consented) Submit any documents used in lieu of a standard consent document:  FORMCHECKBOX  Request for Waiver or Alteration of Informed Consent or Written Consent form  FORMCHECKBOX  HYPERLINK "/research/faculty-resources/research-integrity-safety/institutional-review-board-irb/irb_assets/consent_recruitment_statement_template.doc"Recruitment statement or letter  FORMCHECKBOX  HYPERLINK "http://www.hhs.gov/ohrp/humansubjects/guidance/45cfr46.html" \l "46.117"Short form (45CFR46.117(b)2)  FORMCHECKBOX  Translated consent documents if the study involves subjects whose first language is not English Submit appropriate HIPAA documents, if applicable:  FORMCHECKBOX  Last approved (stamped) HYPERLINK "/research/faculty-resources/research-integrity-safety/institutional-review-board-irb/irb_assets/hipaa_authorization_form.doc"HIPAA Authorization Form (if HIPAA section is not incorporated into consent form)  FORMCHECKBOX  HYPERLINK "/research/faculty-resources/research-integrity-safety/institutional-review-board-irb/irb_assets/hipaa_waiver_alteration.doc"HIPAA Waiver or Alteration of Authorization Form  FORMCHECKBOX  HYPERLINK "/research/faculty-resources/research-integrity-safety/institutional-review-board-irb/irb_assets/hipaa_deidentification_certification_form.doc"HIPAA De-Identification Certification Form If submitting revisions for review with this continuing review request, please submit all revised materials.  FORMCHECKBOX HYPERLINK "/research/faculty-resources/research-integrity-safety/institutional-review-board-irb/irb_assets/form_change-in-protocol_for_information_only.doc"Change-in-protocol form  FORMCHECKBOX Revised Consent and/or Assent with changes highlighted*  FORMCHECKBOX Revised IRB Protocol with changes highlighted**  FORMCHECKBOX Supporting documentation (e.g., Sponsors amended materials, etc.) *Note: If you are submitting changes to the consent/assent documents, please include the following with your submission: the old IRB approved (stamped) version, the new version with changes highlighted, and 1 original clean new version copy to be stamped. **Note: If you are submitting changes to the protocol, only the new version of the protocol with changes highlighted should be submitted. DO NOT submit the previously approved version. If safety information exists, please submit any new documents since the last continuing review  FORMCHECKBOX  Serious Adverse Event (SAE) cumulative form submit the most recent IRB approved copy of the SAE cumulative table. All new SAE submissions should be submitted separately to the IRB.  FORMCHECKBOX  Data Safety Monitoring Board (DSMB) or medical monitor report- submit copies of Data Safety Monitoring reports received during the last IRB approval period, including copies that may have previously been submitted to the IRB.  FORMCHECKBOX  Package insert dated: _____________ (Indicate version number or date if available)  FORMCHECKBOX  Current Investigators Brochure (IB) (Submit the section of the IB that summarizes risks OR the current full IB. The summary section may be titled Summary of Data and Guidance for the Investigator) Additional information, if appropriate:  FORMCHECKBOX  Publications/presentations: Attach citations of any presentations or publications that were derived from the study. Cite all authors (do not use et al). If there have been publications (e.g., manuscripts, abstracts) in the past approval period, please provide a copy of the entire publication.  FORMCHECKBOX  Provide documentation of IRB approvals from additional institutions if attaining approval from another IRB. (Does not include approval from sites for multi- centered trials)  FORMCHECKBOX  Attach a copy of any study external audit findings since the last continuing review HYPERLINK "http://www.slu.edu/research/irb/documents/postirbapprovalreporting.doc"(see post approval information sheet)  FORMCHECKBOX  Other (please describe):  A. STUDY STATUS 1. When was the study initially approved by the IRB? (should match date provided in IRB approval letter)  2. What was the last approval date for continuing review? (if this is first continuing review, state N/A) 3. If requesting re-initiation of a study, explain any research activities occurring during lapse in IRB approval. Otherwise, state Not applicable.  4. Have research activities started?  FORMCHECKBOX  No  FORMCHECKBOX  Yes If no, please explain in the box below (e.g., awaiting funding, lag in subject accrual with reasons for lag included). Also if this study is on hold, please explain what needs to occur before accrual can resume.  NOTE: If there is a change in the anticipated completion date (as stated in the approved protocol), submit a revised protocol and  HYPERLINK "http://www.slu.edu/research/irb/irb_instruc.html" change-in-protocol form. 5. Have there been any significant amendments or revisions to the protocol during the past approval period? Significant changes include changes in study design or risk level including those that resulted in a change in consent  FORMCHECKBOX  No  FORMCHECKBOX  Yes If yes, please briefly summarize the changes below.  B. SUBJECT STATUS Does this study only involve research limited to the review of data, documents, records, or specimens (i.e., there are never any interactions with human subjects)?  FORMCHECKBOX No (Proceed to question 2)  FORMCHECKBOX Yes (Answer questions in the records/specimens accrual table, below) RECORDS/SPECIMENS ACCRUAL TABLE Number of records/specimens approved by the IRB for the study as stated in the current protocol (Section E: Study Design on 91Ů IRB Application)Total number of items (records or specimens) that have been collected/reviewed to date (total) (Proceed to Question #4) Please refer to the 91Ů IRB HYPERLINK "/research/faculty-resources/research-integrity-safety/institutional-review-board-irb/irb_assets/guidelines_subject_accrual.doc"Policy on Subject Accrual for assistance in answering the following: SUBJECTS ACCRUAL TABLE Number of subjects currently approved by the IRB for the study as stated in current protocol (Section E: Study Design on 91Ů IRB Application)Subject Accrual Totals  B1. Total number of subjects that have given consent (verbal or written) to date B2. Total number of subjects that failed screening* (if not applicable, state N/A) B3. Total number of subjects accrued** to dateNumber of Accrued Subjects Withdrawn or Discontinued (If any subjects have withdrawn or discontinued, see question #3, below)* Subjects are screen failures if they signed a consent form and underwent study screening procedures, but participation did not yield evaluable data. **Accrued subjects are those who have given consent and whose participation yields evaluable data. Evaluable data are data that are intended to contribute to generalizable knowledge (i.e., the study goals). FOR MULTI-CENTER STUDIES ONLY TOTAL STUDY SUBJECT ACCRUAL TABLE Number of subjects approved for accrual in the total study (91Ů site plus all other study sites) Total Study Subject Accrual (according to study sponsor)  If any of the subjects in 2C (above) were withdrawn or discontinued due to safety or increased risk, please explain. If withdrawn for any other reason than safety or risk issues, state Not applicable.  To your knowledge, were there any subject complaints about the research?  FORMCHECKBOX  No  FORMCHECKBOX  Yes. If yes, please explain below:  5. For studies that are closed to subject accrual, do any subjects need to be re-consented (to inform them about changes to study procedures, study risks, study personnel, etc.)?  FORMCHECKBOX  No  FORMCHECKBOX  Yes. If yes, please submit clean copy of consent/addendum consent for IRB review.  FORMCHECKBOX  Not applicable. This study is open to accrual. C. SUMMARY OF PROGRESS OR FINDINGS: Briefly describe (1 page maximum) the progress of the study to date. If possible, include any observations, results, or findings. For multi-center studies, include progress for the total study (all sites) if available.  2. Publications, Presentations, and Recent Findings: Have there been any submissions for presentation or publications resulting from this study during the last approval period? Please include only copies published/presented from 91Ů researcher(s).  FORMCHECKBOX  No  FORMCHECKBOX  Yes. If yes, please provide a copy of the abstract or manuscript submitted or published. Have there been any recent findings either from this study, or a related study, which would have an effect on subject safety or the risk/benefit sections of the protocol and/or consent document(s)?  FORMCHECKBOX  No  FORMCHECKBOX  Yes. If yes, (and the study is ongoing) and a change in protocol form has not been submitted, please update the protocol and/or consent and submit a HYPERLINK "/research/faculty-resources/research-integrity-safety/institutional-review-board-irb/irb_assets/form_change-in-protocol_for_information_only.doc"change in protocol form with explanation and references. SECTIONS D and E APPLY TO BIOMEDICAL AND BEHAVIORAL & SOCIAL SCIENCES STUDIES D. SERIOUS ADVERSE EVENT (SAE) AND UNANTICIPATED PROBLEM (UP) REPORTING Please refer to the 91Ů IRB HYPERLINK "/research/faculty-resources/research-integrity-safety/institutional-review-board-irb/irb_assets/guidelines_reportable_events.doc"Requirements for Reporting Events Relating to Subject Safety for assistance in answering the following. REPORT FOR THIS SPECIFIC STUDY: Number of unanticipated problems (UP) at 91Ů sites since last continuing review (for first year studies, since the initial IRB review):Number of SAE reports at 91Ů sites (sites under direct guidance of 91Ů investigators) since last continuing review (for first year studies, since the initial IRB review):** **NOTE: The number reported should match the table on any SAE report already submitted to the IRB. If any SAEs have been reported to the IRB since the last continuing review, please attach a current cumulative SAE report to this submission. All new SAEs should be submitted separately to the IRB. E. SAFETY MONITORING 1. Is there a Data Safety Monitoring (DSM) plan for this study?  FORMCHECKBOX  No  FORMCHECKBOX  Yes, a copy of the DSM report(s) for the last approval period is attached.  FORMCHECKBOX  Yes, but a copy of the DSM report(s) for the last approval period is not attached. Please explain:  SECTION F APPLIES TO BIOMEDICAL STUDIES ONLY F. FDA REGULATED STUDIES If this is a FOOD and DRUG ADMINISTRATION (FDA) REGULATED STUDY, (e.g., involves DRUGS, DEVICES, BIOLOGICS), answer the following questions. Otherwise skip to section G YESNOHave there been any changes in the FDA status of any drug or device used in the study?Have any of the investigational drugs or devices used in this study received FDA approval?Have any new alternative drugs or devices been approved for treatment of the study condition that may affect subjects willingness to participate? Has there been a change in the standard care that may be considered as an alternative to the investigational drug or device or that would affect the original study design?Is there any new information that might affect the risk/benefit ratio and the willingness of current study subjects to participate or to continue to participate in the research? Does the study include an investigators brochure? If yes, what is the current version date:___/___/____ If yes to any of the above questions 1-5, please explain: If yes to any of the above questions 3-5, have current study subjects been notified? Please explain: CONFLICT OF INTEREST Indicate whether you, your spouse or dependent children, or any investigator participating in the study have, or anticipate having, any income from or financial interest in the sponsor of this protocol, the supporting organization, or a company that owns/licenses the technology being studied that may reasonably affect the outcome of the research. Financial Interest includes but is not limited to consulting, speaking or other fees; honoraria; gifts; licensing revenues; other research agreements; equity interests (including stock, stock options, warrants, partnership and other equitable ownership interests). Is the information you previously reported to the Institutional Review Board (IRB) and the Conflict of Interest Committee (COIC) still accurate and complete?  FORMCHECKBOX Yes  FORMCHECKBOX No For studies where the investigator(s) indicated a potential conflict of interest, does the consent document still provide adequate disclosure?  FORMCHECKBOX Yes  FORMCHECKBOX No  FORMCHECKBOX N/A NOTE: If you responded NO to either of the questions above, please provide the following revised materials to the COIC and/or the IRB. Investigator(s) must have: Current, up-to-date HYPERLINK "/research/faculty-resources/research-integrity-safety/conflict-of-interest-coirc.php"Conflict of Interest Disclosure Form on file with the 91Ů Conflict of Interest Committee (COIC) that describes any financial relationship indicated. This information must be disclosed on the 91Ů confidential Conflict of Interest Disclosure Form for review by the COIC before accruing research subjects in this study. If your current Disclosure Form does not contain this information, you are required to submit an updated Disclosure Form to the COIC. Financial disclosure statement incorporated into the consent document. Please see Model Consent for suggested language. In signing this form, the INVESTIGATOR certifies that he/she has read the Universitys Conflict of Interest Research Policy and has checked the appropriate box above. In addition, the INVESTIGATOR certifies that, to the best of his/her knowledge, no person working on this project at 91Ů has a conflict of interest or if a conflict of interest does exist, that an appropriate management plan is in place. For questions regarding Conflicts of Interest, consult the HYPERLINK "/general-counsel/compliance/conflict-of-interest.php"Conflict of Interest in Research Policy.  H. INVESTIGATOR ASSURANCE AND SIGNATURE Investigators Assurance: I certify that the information provided is complete and accurate. As Principal Investigator, I have ultimate responsibility for the conduct of this study, the ethical performance of the project, the protection of the rights and welfare of human subjects and strict adherence to any stipulations designated by the 91Ů IRB. I agree to comply with all 91Ů policies and procedures, as well as with all applicable Federal, State and local laws regarding the protection of human subjects in research. ________________________________________________ ______________ Principal Investigators Signature Date For IRB Use OnlyContinuing Review_ ____ Approved on an expedited basis under category (ies) __________ IRB#___________________ ____ Approved at the IRB meeting of:_____________ Board #:_____ ____ Continuing Review of Consent Form(s) approved; use only the attached consent form(s) with the updated IRB approval stamp. ____ Re-initiation/Expedited Approval ____ Re-initiation/Full Review/Full Approval at the IRB meeting of:_____________ Period of approval: One year____ or specify period:__________ Study Closure ____IRB Notified of studys discontinuance/completion Signature of IRB Chairperson or IRB Designee________________________________________________________________ Date:_____/_____/_____      IRB Template Date: 8/1/11 PAGE   PAGE 6 Version: 2lmn  ( ) * 5 6 7 9 : °~qdZMZ@hw(bhzpOJQJ^Jhw(bh`:OJQJ^JhI6OJQJ^Jhw(bhw(bOJQJ^Jhy'hw(b0JCJaJ'jhy'hw(bOJQJU^J!jhy'hw(bOJQJU^Jhy'hw(bOJQJ^J"h'ahW5CJOJQJ\^JhW5CJOJQJ\^J hZ5CJOJQJ\^JaJ hW5CJOJQJ\^JaJhW5OJQJ\^J23S: ! / 0 -.uv & F ^gdA & Fgdh^hh^hgd=.$a$gd=.$a$  !  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