Download Consent form - St David`s College

Cardiff School of Biosciences
Consent form
Practical name: Recording the electrocardiogram (ECG)
Module number:
Researcher/Supervisor:
Sixth form workshop
Dr Sarah Hall
1.
I confirm that I have read and understand the information sheet dated
2009 for the above study. I have had the opportunity to consider the
information, ask questions and have had these answered satisfactorily.
2.
I understand that my son/daughter’s participation is voluntary and
that he/she is free to withdraw at any time, without giving any
reason, without their medical care or legal rights being affected.
3.
I am unaware of any circumstance or condition that may affect my
son/daughter’s suitability to participate in this study and undertake to
disclose any information that may be relevant.
I agree that my son/daughter may take part in the above study.
Parent/Guardian name
_____________________________________________________
Date
_____________________________________________________
Signature
_____________________________________________________
BI2302: The electrocardiogram (ECG)
Information sheet
12.10.09
You are being invited to take part in a study as part of an outreach workshop. Before
you decide, it is important for you to understand why the study is being done and what
it will involve. Please take time to read the following information carefully and decide
whether or not you wish to take part.
 What is the purpose of the study?
To record, measure and interpret ECG records, to give an understanding of the
electrical activity of the heart
 What will happen if I take part and what do I have to do?
You will work in groups of 3-5 to make ECG records from at least one subject. ECGs will
be recorded via surface electrodes on the wrists and ankles. ECG signals will be recorded
at rest. In some studies, ECG’s will also be recorded under conditions which may alter
heart rate (exercise, stress (mental arithmetic and memory tasks), eating chocolate).
 What are the possible disadvantages and risks of taking part?
ECG recording is a standard, non-invasive method used routinely in clinical settings;
there is negligible risk. Individuals with underlying cardiac, respiratory or endocrine
disorders should not undertake strenuous exercise in this situation.
 What are the possible benefits of taking part?
You will be contributing to a practical class providing experience of experimental
physiology. This study will give you an enhanced understanding of physiological
mechanisms and enhanced awareness of the electrical behaviour of the heart, as well a
practical experience of ECG recording.
 What if there is a problem?
You are free to withdraw from the experiment at any time without needing to give a
reason. Close supervision ensures that if a problem arises it is addressed rapidly; firstaid assistance is available locally.
 Will my taking part in the study be kept confidential?
No, volunteer subject is observed by the class
 What will happen to the results of the research study?
They will be used by members of your group to study and interpret ECG records. Stored
data will be deleted from the computer.
If anything is not clear on this information sheet please discuss it with a
researcher/supervisor (details over).
The supervisory staff involved in this practical are not qualified medical practitioners.
It is important that you realise that these experiments / activities will not provide any
information that may help in the diagnosis of any medical condition, nor should you
regard results obtained from these experiments as a medical screening procedure. If
you do have any health concerns, you should contact a qualified medical practitioner,
such as your GP, in the normal way.
Many thanks for taking the time to read this information. If you wish to participate, you
should keep this information sheet and begin by signing the consent form.
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