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759HxTahZXEBZUgdEuao8o2Ei48sAvnSQQeECH4I9CwdEtwqestzsVqxsjsaKUzgjMpDswP8JYTwZKeZfdR95d2c3qaGsZ5HbXNHaeskR3yR

CRC Survey

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The purpose of the Clinical Research Committee (CRC) is to support clinical research and to facilitate research collaborations which involve clinical space, equipment, personnel, or clients from the Northwestern University Center for Audiology, Speech, Language and Learning (NUCASLL). CRC welcomes requests for clinical research involvement that encompass one or more of the following criteria: contribute to the overall mission of the department of Communication Sciences and Disorders and NUCASLL; contribute to clinical growth; and enhance student learning. CRC will review requests according to available resources, including clinical staff time and available space and equipment. CRC will also monitor adherence to clinic procedures and responsible research conduct throughout the study.

Please complete this survey to let us know about your clinical research needs. All fields are required for submission.

Submission Date

* must provide value

M-D-Y

Title of the project

* must provide value

Expand

Name of contact person for project

* must provide value

Email address for contact person of the project

* must provide value

Who is the PI (person responsible for the study and/or faculty mentor) of the project?

* must provide value

Email address of the PI.

* must provide value

Email addresses for other personnel involved in this project (including students)

Who is the other PI of the project?

* must provide value

What is the primary contact person's relationship to the clinic?

* must provide value

Please describe the primary contact person's relationship with the clinic?

* must provide value

What type of project is this?

* must provide value

externally funded faculty project

internally funded faculty project

AuD capstone project

MS-SLL thesis

PhD project (QRP, dissertation)

Pilot (just trying out equipment, not seeing participants)

reset

Please describe the study goals and why this research is best conducted with NUCASLL

* must provide value

Expand

How many participants will be included in this study?

* must provide value

When will you first need access to the clinic?

* must provide value

M-D-Y

When will your need for access to the clinic end?

* must provide value

M-D-Y

What is the expected start date of the study?

* must provide value

M-D-Y

What is the expected end date of the study? (the end date of activities to occur in the clinic)

* must provide value

M-D-Y

Does this study measure the outcomes of a NUCASLL diagnostic and/or treatment clinical program or procedures (e.g., pre-post data, adding research measure to a diagnostic process, presenting clinical data outside of NUCASLL)? These types of projects evaluate existing or new clinical programs that are implemented by clinicical faculty. This does NOT include testing a clinical tool by researchers only.

* must provide value

Yes

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Please describe the outcome measures.

* must provide value

Expand

Please describe the diagnostic and/or treatment clinical procedures involved.

* must provide value

Expand

Does this study involve clinical procedures for clinic patients as part of regular clinical service delivery (administering measures, administering treatment, sending out surveys)? This excludes recruitment efforts only. This excludes research that will eventually be implemented in the clinic.

* must provide value

Yes

reset

This project requires a clinical faculty partner (who has reviewed and approved this proposal). Who is/are the clinical partner(s) for this project?

Carolyn Chiu

Catherine Fabian

Belma Hadziselimovic

Stacy Kaplan

Karen Kinderman

Kristen Larsen

Diane Novak

Sarah Penzell

Judy Roman

Amy Sindelar

Sharon Veis

Nathan Waller

Aaron Wilkins

Tracy Winn

Elizabeth Gardner -Meyer

Katherine Swem

Elisha Magnifico

Rylie Young

Debbie Lee

Stephanie Boron

Please describe the procedures to be implemented by the clinic. What will clinic staff do? What will clinical faculty do?

* must provide value

Expand

Who will be conducting these study procedures?

* must provide value

Which clinical faculty members and/or staff are involved in helping with the research tasks or in implementing the clinical program or procedure to be studied.

* must provide value

Carolyn Chiu

Catherine Fabian

Belma Hadziselimovic

Stacy Kaplan

Karen Kinderman

Kristen Larsen

Diane Novak

Sarah Penzell

Judy Roman

Amy Sindelar

Sharon Veis

Nathan Waller

Aaron Wilkins

Tracy Winn

Elizabeth Gardner -Meyer

Katherine Swem

Elisha Magnifico

Rylie Young

Debbie Lee

Stephanie Boron

Front desk staff

What resources do you anticipate needing?

* must provide value

new card access to clinic (don't have card access but need card access)

clinic space (clinic rooms)

access to video observation system

equipment

specialized clinic software

clinical personnel time (front desk or clinical faculty)

recruiting research participants from the clinic

access to medical records/clinical data for a chart review

"The Communication Research Registry (CRR) offers a ready source of ongoing recruitment. All recruitment requests go through this registry. https://commresearchregistry.northwestern.edu/

This project does not require CRC approval, please contact the CRR directly.

A chart review requires a data review IRB protocol. For an example, please see the attached protocol.

Attachment:

Data Review Protocol - example.doc

To which clinical spaces do you need access?

* must provide value

Virtual Sound Room (ViSoR)

Small clinical speech-language treatment room

Large clinical speech-language treatment room

Audiology diagnostic booth

Hearing aid fitting booth

ABR room

Please list the: (1) names, (2) net IDs, (3) student or employee number (found on the front of the wildcard), and (4) wild card expiration for research personnel who will need NEW card access to clinic.

NOTE: Access is granted for a maximum of 12months and can be renewed after 12 months

* must provide value

Expand

Please list all research personnel who will access to clinic rooms.

* must provide value

Expand

Please list all research personnel who will use clinical equipment.

* must provide value

Expand

Please list all research personnel who will access observation system.

* must provide value

Expand

Please list all research personnel who will access medical records for the chart review.

* must provide value

Expand

Early morning (before 8:30am)

Mornings (8:30am-12pm)

Afternoons (12pm-5:50pm)

Evening (after 5:30pm)

n/a

Monday

* must provide value

Tuesday

* must provide value

Wednesday

* must provide value

Thursday

* must provide value

Friday

* must provide value

Weekends

* must provide value

Please describe your NUCASLL video observation needs.

* must provide value

Expand

Please describe your NUCASLL equipment needs.

* must provide value

Expand

Please describe your NUCASLL software needs.

* must provide value

Expand

Please describe your NUCASLL personnel needs.

* must provide value

Expand

Please describe your NUCASLL recruitment plan. If you plan to have clinical faculty or clinic staff help with recruitment, please describe in detail when and how they will provide potential research participants study information.

* must provide value

Expand

Please attach a copy of your proposed recruitment flyer here and/or a copy of the criteria for recruitment and template for sharing contact information.

* must provide value

Upload file

Please describe the IRB status of this project.

* must provide value

completing the IRB now and would like CRC guidance with IRB protocol

Submitted to IRB and waiting for approval

yes, I have IRB approval

reset

What is your IRB study number?

* must provide value

Please attach your approved or draft IRB protocol.

Upload file

All personnel involved in research projects with NUCASLL require NUCASLL HIPAA training (not CITI HIPAA training).

Have all people participating in this research project completed HIPAA training?

* must provide value

Yes

reset

All personnel involved in research projects with NUCASLL require NUCASLL pandemic training.

Have all people participating in this research project completed NUCASLL pandemic plan training?

* must provide value

Yes

reset

Please list research personnel that have completed HIPAA training.

* must provide value

Expand

Please list research personnel that have completed the NUCASLL pandemic plan training.

* must provide value

Expand

Please list the email addresses for all people who require HIPAA training.

* must provide value

Expand

Please list the email addresses for all people who require NCUASLL pandemic plan training.

* must provide value

Expand

Please provide us with any additional information that may help us support you with your project.

Expand

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