Tissue Donations Forms
In 2005, the NLMSF gamve a $30,000 research grant to Dr. Brooks at the Pennsylvania Hospital to create the LMS Tissue Repository Bank. This is the only Repository/Library in the world and allows researchers around the world to have access to this great resource.
How can you be a part of this research? After surgery (or even before) you can help researchers all over the world by participating following the step below:
1. Inform yourself and read about how your tissue will be used and your rights to privacy. Print and read the HIPAA Notice of Privacy and the letter from Dr. Brooks below.
2. Print and fill out the Informed Consent and Confidentiality & Privacy Rights forms below.
3. Fax or Mail both forms to:
LMS Sarcoma Repository Tissue Bank
c/o Dr. John S. J. Brooks, Chair of Pathology
Pennsylvania Hospital, 800 Spruce St, Philadelphia, PA 19107
Fax (215) 829-7564
Phone (215) 829-3541 (Ms. Diane Flynn)
Donating is simple and easy- and now you're done!
The NLMSF takes privacy very seriously and has measures in place to protect the privacy of those who participate in this project.
In 2005, the NLMSF donated $100,000 (with over $200,000 in future research grants to follow) to Dr. Matt van de Rijn at Standford University to begin extensive DNA and Tissue Microarray analysis. This research was made possible by the LMS patients who donated over 300 tissue samples. Unique research that has never before been done by any researcher for LeioMyoSarcome was done through this collective effort. While Dr. van de Reijn no longer needs additional tissues, he supports this very important next step started by Dr. Brooks.
Donate your tissues and help researchers find treatments and cures of LMS through the use of this tissue repository. Your tissues can help find a cure!
How can you be a part of this research? After surgery (or even before) you can help researchers all over the world by participating following the step below:
1. Inform yourself and read about how your tissue will be used and your rights to privacy. Print and read the HIPAA Notice of Privacy and the letter from Dr. Brooks below.
2. Print and fill out the Informed Consent and Confidentiality & Privacy Rights forms below.
3. Fax or Mail both forms to:
LMS Sarcoma Repository Tissue Bank
c/o Dr. John S. J. Brooks, Chair of Pathology
Pennsylvania Hospital, 800 Spruce St, Philadelphia, PA 19107
Fax (215) 829-7564
Phone (215) 829-3541 (Ms. Diane Flynn)
Donating is simple and easy- and now you're done!
The NLMSF takes privacy very seriously and has measures in place to protect the privacy of those who participate in this project.
In 2005, the NLMSF donated $100,000 (with over $200,000 in future research grants to follow) to Dr. Matt van de Rijn at Standford University to begin extensive DNA and Tissue Microarray analysis. This research was made possible by the LMS patients who donated over 300 tissue samples. Unique research that has never before been done by any researcher for LeioMyoSarcome was done through this collective effort. While Dr. van de Reijn no longer needs additional tissues, he supports this very important next step started by Dr. Brooks.
Donate your tissues and help researchers find treatments and cures of LMS through the use of this tissue repository. Your tissues can help find a cure!
A letter from Dr. John Brooks
Founder and Director of the LMS Sarcoma Repository Tissue Bank (February 2006)
Dr. John Brooks, a pathologist in Philadelphia, has been awarded a grant from the LMS Foundation to set up a LMS Repository Tissue Bank, to house tumor tissue blocks from LMS patients.
He is now asking if you would like to participate in this collection process, which will provide the needed infrastructure for future research. Basically, the Bank serves as a resource of material for investigators. No research can be accomplished easily without such a resource. Research projects on the block will be approved by a Scientific Advisory Committee, according to NIH guidelines.
Some of you have participated in the LMS Microarray Study by Dr. Matt Van de Rijn at Stanford and had your blocks donated there. Dr. Brooks will need to have a consent form signed by you to hopefully allow your blocks to be sent to him by Dr Van de Rijn (rather than be sent back to the original hospital). Thus, if you were involved, please look at the U of Penn Consent form, print it out, and fill it out; be sure to check yes in two places - yes to participate in the study, and yes in the spot asking for your material to be sent to Dr Brooks from Dr Van de Rijn. When completed, please either fax the last page of the form to Dr Brooks (fax number is on it) or send/mail to the address on the Consent Form itself.
Others who may not have participated in the LMS Microarray Study may hopefully be willing to do so now. All work of contacting the original hospital will be done by Dr. Brooks, once he has the information, so be sure to fill out the hospital's address. We are trying to collect as many LMS tumor blocks as possible.
If you agree to participate, you can also fill out the last page of the informed consent forms, being sure to include the Hospital where the tumor was removed (as opposed to a small biopsy); this would be valuable information even if your block was sent to Dr Van de Rijn, as the hospital needs to be told your block is being forwarded to the bank. If you would like, you could be sent an informed consent document by mail, for you to sign. No one can participate without a signed consent form, as required by the IRB (Institutional Review Board).
Your information will be kept confidentially, including in the future when your tissue block is sent to a researcher, who will only know tumor characteristics like location, size, etc..
If you need a paper copy of the Consent form, please call (215) 829-3541. Identify yourself as an LMS patient or family member and my secretary Diane Flynn will assist you.
Thank you for considering participation in the new LMS Sarcoma Repository Tissue Bank.
John S. J. Brooks, M.D., Pathology Department, Pennsylvania Hospital
Dr. John Brooks, a pathologist in Philadelphia, has been awarded a grant from the LMS Foundation to set up a LMS Repository Tissue Bank, to house tumor tissue blocks from LMS patients.
He is now asking if you would like to participate in this collection process, which will provide the needed infrastructure for future research. Basically, the Bank serves as a resource of material for investigators. No research can be accomplished easily without such a resource. Research projects on the block will be approved by a Scientific Advisory Committee, according to NIH guidelines.
Some of you have participated in the LMS Microarray Study by Dr. Matt Van de Rijn at Stanford and had your blocks donated there. Dr. Brooks will need to have a consent form signed by you to hopefully allow your blocks to be sent to him by Dr Van de Rijn (rather than be sent back to the original hospital). Thus, if you were involved, please look at the U of Penn Consent form, print it out, and fill it out; be sure to check yes in two places - yes to participate in the study, and yes in the spot asking for your material to be sent to Dr Brooks from Dr Van de Rijn. When completed, please either fax the last page of the form to Dr Brooks (fax number is on it) or send/mail to the address on the Consent Form itself.
Others who may not have participated in the LMS Microarray Study may hopefully be willing to do so now. All work of contacting the original hospital will be done by Dr. Brooks, once he has the information, so be sure to fill out the hospital's address. We are trying to collect as many LMS tumor blocks as possible.
If you agree to participate, you can also fill out the last page of the informed consent forms, being sure to include the Hospital where the tumor was removed (as opposed to a small biopsy); this would be valuable information even if your block was sent to Dr Van de Rijn, as the hospital needs to be told your block is being forwarded to the bank. If you would like, you could be sent an informed consent document by mail, for you to sign. No one can participate without a signed consent form, as required by the IRB (Institutional Review Board).
Your information will be kept confidentially, including in the future when your tissue block is sent to a researcher, who will only know tumor characteristics like location, size, etc..
If you need a paper copy of the Consent form, please call (215) 829-3541. Identify yourself as an LMS patient or family member and my secretary Diane Flynn will assist you.
Thank you for considering participation in the new LMS Sarcoma Repository Tissue Bank.
John S. J. Brooks, M.D., Pathology Department, Pennsylvania Hospital
Forms
| Hippa Notice |
| Informed Consent Form |
| Confidentiality and Privacy Rights |