Main investigator |
Name |
Address |
Phone/fax |
E-mail |
Number of involved centers (for multi-centric studies) |
Indicate the reference center |
Title of the study |
Protocol ID (acronym) |
Keywords (up to 7 specific keywords) |
Rationale of the study (describe current scientific evidence in support of the research with a possible sub-section for the references) |
Study design |
Monocentric/multicentric |
Perspective/retrospective |
Controlled/uncontrolled |
Open-label/single-blinded or double-blinded |
Randomized/nonrandomized |
n parallel branches/n overlapped branches |
Experimental/observational |
Others |
Primary objective |
Endpoints (main primary and secondary endpoints to be listed) |
Expected results |
Analyzed criteria |
Main variables/endpoints of the primary analysis |
Main variables/endpoints of the secondary analysis |
Safety variables |
Quality of life (if applicable) |
Health economy (if applicable) |
Visits and examinations |
Therapeutic plan and goals |
Visits/controls schedule (also with graphics) |
Comparison to treatment products (if applicable) |
Dose and dosage for the whole time period |
Formulation and power of the studied drugs |
Method of administration of the studied drugs |
Informed consent |
Study population |
Short description of the main inclusion and exclusion criteria |
Sample size |
Estimate of the duration of the study |
Best supposed perspective |
Safety advisory |
Classification needed |
Requested funds |
Additional features |
On the main concept of the study |