Physician Clinical Trial Application

The PARITY trial is a multi-center randomized controlled study comparing alternative antibiotics regimens in patients undergoing tumor resections with endoprosthetic replacements.

To be considered as a potential investigator for this clinical trial, please indicate your preference by checking one of the boxes below and returning this form to Paula McKay either by email (mckayp@mcmaster.ca) or fax (905-523-8781)

CONTACT INFORMATION

Physician Name

Address

Phone #

Fax #

Preferred method of contact

Affiliated Hospital

Affiliated University

PRACTICE INFORMATION

1. What is your specialty area of practice?

2. In what specialty area(s) do you have board certification?

3. Are you familiar with Good Clinical Practice Guidelines for conducting clinical trials?

Yes No

4. Have you previously participated in any clinical trials?

Yes No

If yes, how many?

5. Are you currently participating in an industry sponsored clinical trial?

Yes No

6. Are you aware of your site having been audited during a clinical trial?

Yes No

7. Are you experienced in obtaining Institutional Review Board/Research Ethics Board approval?

Yes No

8. Approximately how many long bone endoprosthetic reconstructions of the lower extremity do you do each year for primary bone tumors?

9. What is your local standard of care prophylactic intravenous antibiotic for long bone endoprosthetic reconstructions of the lower extremity?

10. Do you have a dedicated research coordinator?

Yes No

If yes, please provide their contact information below:

Name:

Email:

Phone #:

11. Do you have a study nurse (other than the coordinator) available to help with patient follow-up?

Yes No

If yes, please provide their contact information below:

Name:

Email:

Phone #:

12. If you do not have a study co-ordinator or research nurse, do you have administrative support for being a local principal investigator for clinical trials?

Yes No

If yes, please provide their contact information below:

Name:

Email:

Phone #:

13. Do you plan to utilize sub-investigators in this clinical trial?

Yes No

If yes, please list below:

Physician Clinical Trial Application

Study Title: Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY)