DOC D

GLASGOWDENTALHOSPITALAND SCHOOL

PRELIMINARY STUDY PROPOSAL FORM

E-MAIL formto

In order to aid discussion of this protocol, this form MUST be completed as fully as possible by Project Lead in the Dental School/Hospital. This will ensure logistical/practical concerns have been identified addressed prior to funding/ethics/R&D approval submissionsprior to offers being made to PG students

Investigator:
And Supervisor if relevant: / Email:
Type of project: / Principal Investigator Co-applicant
Postgraduate Research Postgraduate Taught Undergraduate
Research group/theme /
UoG Research Institute? / COH Oral Sciences Education
Scottish Oral Health Research Collaboration
University of Glasgow Research Institute - which:
Protocol title:
Commercialstudy? / Yes No / Sponsor*:
Contact:
Academic Study? / Yes No / Do you require sponsorship from NHS GG&C ?
/ Yes No

*Body legally responsible for management, monitoring and financing clinical research studies. In Glasgow this is likely to be NHS GG&C for studies involving patients, their tissues/data or NHS staff/resources.

Section 1: / Protocol: Final version? Yes No
Version number: / Version Date:

Section 2: Protocol synopsis (confirmation that statistical advice if relevant has been sought Yes No)

Please provide a brief summary of the protocol including study type (maximum 300 words, section will expand)
- include detail on research questions and methods

Section 3: Project funding:

Funding body
Amount requested

Section 4: Study Support:

Please list support departments that will be involved in the study (e.g. Biochemistry, Pharmacy, Radiology, Health Records) and indicate if they are aware of the study.

Support department (complete as required) / Are department aware of study?
Yes No
Yes No
Yes No

Do you require support from any of the following?

Dental Hosp Clinical Research Facility Yes No
General Clinical Research Facility nurses? Yes No / Yes No
Project Management team? Yes No / Yes No
Research Facilitator? Yes No / Yes No

Section 5: NHS Service Impact:

Please list NHS service support that will be involved in the study/ indicate if the service manager(s) are aware of the study.

NHS Resource (complete as required)
Service Manager is aware of study / Yes No
Clinical Waiting Area / Yes No
Dental Nurse/Clinical Support Worker Support / Yes No
NHS Clinician support ( e.g. identification of potential participants) / Yes No
Dental Laboratory / Yes No
New patient clinics / Yes No
NHS equipment / Yes No
Other (please specify)…………………………………. / Yes No

Section 6: Patient recruitment:

Are there any competing studies in the same patient population? / Yes No
Total number of recruits / Recruits per month

Members of the Glasgow Dental Hospital and School Research Management Committee (RMC) will review and provide feedback within 2 weeks of date submitted by email or you will be invited to attend a RMC meeting.