UK Dermatology Clinical Trials Network
Themed Research Call Application Form and Request for Funds
(£10,000 max)
1. Title of Project:
What is the research question?
Condition of interest (Include patient group, type of lesion, location etc.)
What treatments do you propose to include or compare?
What outcome measures will you use? (a primary outcome measure is not
applicable if your intended application is for feasibility work only)
What group of patients do you propose to study? (Include main inclusion/exclusion
criteria and estimated patient numbers required. If you are able to provide the rationale for
this study sample size please do so.)
What existing evidence is there? (Supporting evidence is crucial to the marking system
we use. Please provide references to 2-3 papers.)
Has a systematic review been completed (or is ongoing) on your subject? If none,
state ‘none’.
UKDCTN Themed Call Application and Vignette for UK DCTN funds
FINAL Version 1 Jan 2015
Do you have a research team in place? Please provide brief details here and expand on this
information in section 2 below. If ‘no’, the UKDCTN can help you to find suitable collaborators.
Please tell us what experience you have in developing and/or participating in clinical
trials.
Have you considered patient involvement to develop your idea? Please provide brief
details.
Why is this suggestion particularly suitable for study through the UKDCTN Network?
Which funding bodies do you suggest should be approached if your preliminary
pilot/feasibility work is successful?
Are you, or someone else from your team, be prepared to be Principal Investigator on
the potential clinical trial?
If ‘no’, please involve someone else in the development of your vignette who will act as PI,
before you submit the vignette.
If you need assistance in finding a suitable PI with adequate clinical trial experience, please
contact the UKDCTN, as we may be able to find someone suitable.
Why is this research needed now?
Please add here any further information or comments that would help with the
discussion of this vignette.
It is important that our Panel reviewer feedback and other UK DCTN support in the
development of grant applications is acknowledged. Please tick here that you
agree to add an acknowledgement of UK DCTN feedback and support on future
funding applications/publications.
If you would like us to submit this idea to the HTA through their affiliate members’ scheme,
please also include the following:
Why is this research important to the NHS?
(For advice on this question please refer to the HTA website (http://www.ncchta.org/)
If this proposal has been submitted elsewhere, please give details.
UKDCTN Themed Call Application and Vignette for UK DCTN funds
FINAL Version 1 Jan 2015
2. Contact details
Lead Applicant:
Name
Address
Postcode
Tel No
Email
Chief Investigator:
(if different from above)
Name
Address
Postcode
Tel No
Email
Co-applicant 1:
Name
Address
Postcode
Tel No
Email
Co-applicant 2:
Name
UKDCTN Themed Call Application and Vignette for UK DCTN funds
FINAL Version 1 Jan 2015
Address
Postcode
Tel No
Email
Co-applicant 3:
Name
Address
Postcode
Tel No
Email
Co-applicant4:
Name
Address
Postcode
Tel No
Email
UKDCTN Themed Call Application and Vignette for UK DCTN funds
FINAL Version 1 Jan 2015
3. Purpose of Application for Funds
Is your application for:
Pilot/feasibility study
Other
4. Brief summary of the Research Proposal
please include how your feasibility or pilot work may contribute to inform the main
intended trial including a brief outline of your future intended research
(where applicable)
(max 300 words):
UKDCTN Themed Call Application and Vignette for UK DCTN funds
FINAL Version 1 Jan 2015
5. Please explain the reason for your application to the UK DCTN for these funds
and why the UK DCTN should award this money
6. Length of Project
7. Amount of funding requested:
£
Please attach a breakdown of finances by item and amount below.
UKDCTN Themed Call Application and Vignette for UK DCTN funds
FINAL Version 1 Jan 2015
*NB* Item headings used in the table below are used purely for illustrative purposes and
should be tailored and detailed to the activities proposed.
Item
Patient involvement
Statistical input
Research Team and Study
Development-
Equipment
Consumables
Other Direct Costs
Unexpected costs
Details
Estimated Costs (£)
e.g. travel,
subsistence,
Payment for time
commitments and
associated
expenses
e.g. any
anticipated fees
for expert
member of team
to be consulted
e.g. Printing /
photocopying
Posting
/Packaging
e.g. MHRA or
Ethics application
fees
e.g. travel,
subsistence,
Course and
Conference fee
attendance
Additional costs
TOTALS:
8. Signature and date of lead applicant:
UKDCTN Themed Call Application and Vignette for UK DCTN funds
FINAL Version 1 Jan 2015
PLEASE RETURN THIS FORM:
By email to: ukdctn@nottingham.ac.uk
or
By post:
F.A.O Margaret McPhee,
UK Dermatology Clinical Trials Network,
Room A103, King’s Meadow Campus
Lenton Lane, Nottingham, NG7 2NR
Email: ukdctn@nottingham.ac.uk
UKDCTN Themed Call Application and Vignette for UK DCTN funds
FINAL Version 1 Jan 2015