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Should the PIs need an extension beyond the proposed duration, they canapply by completing the Continuance Request Form.2)If this research will result in a thesis or dissertation, please check the appropriate box.Undergraduate Level Project Masters Level Project Doctoral Level Project (Thesis, Capstone)(Thesis, Capstone)(Dissertation, Capstone)3)Conflict of Interest Is there any potential or perceived conflict of interest between the researcher, sponsor and/or South University associated with this study? No Yes ***If yes, please explain, including any and all possible conflicts:4)Study populationa.Maximum Number of Participants Proposed: 60b.Age Range: 35 to65 (include low/high age range)c.Gender: Males Femalesd.Site of Subject Recruitment: Cardiology office in the state of Florida***Please note that if recruitment will be conducted at any physical site other than South University, you will need to include a letter from management of the proposed site indicating their approval of your use of the facility.e.Will medical clearance or medical screening be necessary for participants toparticipate because of tissue or blood sampling, administration of substances such asfood or drugs, or physical exercise conditioning? No Yes ***If yes, explain how clearance will be obtained. If a screening instrument will be used, please attach a copy to the application. Page 6 of 16
THIS IS AN EXAMPLE OF SOUTH UNIVERSITY’S IRB APPLICATION AND IS ONLY TO BE COMPLETED AND SUBMITTED AS AN ASSIGNMENT FOR NSG6101.5)Potentially Vulnerable Populations. Please check any groups included in the study.Children (under 18 years of age)Pregnant Women Elderly (65 & older) Psychologically ImpairedCognitively ImpairedPrisonersNative American Tribes and/or Tribal OrganizationsStudents currently enrolled in a class instructed by the investigator*** If you checked any of the above groups, your proposal will require full board review.6)Study Site: Cardiology offices involved***Please note that if research will be conducted at any physical site other than South University, youwill need to include a letter from management of the proposed site indicating their approval of your use of the facility.PART VI – SUMMARY OF STUDY ACTIVITIES***Submission of a copy of a grant application or project proposal does not replace completion of this form. If additional space is required, you may attach a separate document, but please respond to each item in this section and label your responses accordingly. Incomplete proposals will be returned to you. 1)Provide background information for the study including the objective of the proposedresearch, purpose, research question, hypothesis and other information deemed relevant. Myocardial infarctions and other cardiovascular related events are the leading cause of death in the United States (Van Dyke, 2018). The purpose of this study is to determine if patients who receive continued communication with the nurse practitioner about their cardiac rehab treatment plan exhibit a decrease in risk of a subsequent MI within the first year of the initial MI.