Project I.M.P.A.C.T.

Sponsors

Project I.M.P.A.C.T. is a program of the National Medical Association to increase the numbers of African American clinical trial investigators and subjects. I.M.P.A.C.T. maintains a database of physicians interested in conducting clinical trials and offers investigator training programs for physicians who want to conduct clinical trials.

Use the form below to tell us about your study or to request more information on our programs and database. Required items are marked with with an asterisk and are pink.

*Study Abstract:

Begin with a brief one or two sentence title, which is the first thing a patient will see before viewing the entire listing. The abstract should provide an overview of the study, including but not limited to, the following information:

  • Study Phase
  • Type of Study
  • Illness/Indication Targeted
  • Type of Treatment
  • If Possible, One Major Inclusion/Exclusion Criteria

 Official Study Title:

*Condition:

Please use the NLM Headings Browser [MeSH] if unsure of the condition's proper name.

 Study Phase:

Phase I Phase II
Phase III Phase IIIb/IV

 Overall Recruiting Status:

Not yet recruiting: participants are not yet being recruited or enrolled

Recruiting: participants are currently being recruited and enrolled

Suspended: recruiting or enrolling participants has halted but potentially will resume

*IRB Status:

Yes, the study listing is IRB approved. I do have documentation of this approval, and upon request, I agree to provide a copy of this documentation to Project I.M.P.A.C.T.

No, this study listing is not yet IRB approved

No, the listing isn't IRB approved, but it does meet the FDA information sheet #29 guidelines for posting a trial online

*Detailed Study Description:

*Inclusion Criteria:

*Exclusion Criteria:

 Primary Outcomes:

The specific measure that will be used to determine the effect of the intervention(s).

 Key Secondary Outcomes:

Other measures that will be used to evaluate the intervention(s).

 Intervention Type:

Drug
Behavior
Gene Transfer
Device
Vaccine
Procedure

 Intervention Name:

*Primary Sponsor / CRO:

*Secondary Sponsor
(if applicable):

*Funding Source:

 Collaborators:

 Identification #s:

Identification numbers assigned to the protocol, including any applicable NIH grant numbers. Provide up to 5 secondary ID numbers. Example: NCI-123-45678

 Overall Study Officials:

Person(s) responsible for overall scientific leadership of the protocol

 Study Type:

Interventional
Observational

 Study Start Date:

Include Month and Year

 Target Number of Subjects:

Center Contact Information

*Center Name:

 Contact Name:

 Title:

*Address:

*City:

*State:

*ZIP Code:

*Country:

*Phone:

 Fax:

 Email:

Trial Submission Information:

Person submitting the trial if different from above contact information.

 Company Name:

*Contact Name:

 Title:

 Address:

*Phone:

 Fax:

 Email:

 Security:

Enter the code as it is shown below (required):

 
 
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