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THESIS PROPOSAL
FOR APPROVAL OF SUBJECT OF THESIS TO BE SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SURGERY IN SURGERY OF THE BABA FARID UNIVERSITY OF HEALTH SCIENCES FARIDKOT
June, 2011
Co- Supervisor
This is to certify that facilities for working on the subject of thesis entitled A CLINICOMICROBIOLOGICAL PROFILE OF DIABETIC FOOT
INFECTIONS do exist in Department of Surgery, of Dayanand Medical College & Hospital, Ludhiana and will be provided to the candidate. We will see that the data being included in the thesis is genuine and the work is done by the candidate herself under our supervision and guidance.
Supervisor
Co-Supervisor
Dr. Deepinder Chhina Professor & Head Department of Microbiology DMC&H, Ludhiana
APPROVAL PROFORMA BY RESEARCH & ETHICS COMMITTEE (DAYANAND MEDICAL COLLEGE & HOSPITAL, LUDHIANA)
Name of Candidate Department Topic of Thesis Likely date of appearing in PG examination Date of enrollment Name of Head of Department 1) Supervisor
Dr. Maninder Kaur Surgery A Clinicomicrobiological profile of Diabetic foot infections May 2014 1-2- 2012 Dr. Jaspal Singh Dr. Atul Mishra Associate Professor Dr. Deepinder Chhina Professor & Head Signatures of Members of Ethical Committee with Stamp 1. HOD Physiology 2. HOD Pathology 3. HOD Pharmacology 4. HOD SPM 5. HOD Medicine 6. HOD Surgery 7. HOD Obst. & Gynae 8. Legal Expert 9. Vice Principal 10. Principal Approved: Yes/No
2) Co-Supervisor Signatures of Members of Research Committee with Stamp 1.HOD Pharmacology 2.HOD Surgery 3.HOD Pathology 4.HOD Medicine 5. Dean Academics 6. Vice Principal
Approved: Yes/No
3. 4. 5.
Course of Study and Subject Date of Admission of Course Title of the topic
This is to certify that the plan of thesis entitled A CLINICOMICROBIOLOGICAL PROFILE OF DIABETIC FOOT INFECTIONS has been discussed in the Department of Surgery, Dayanand Medical College and Hospital, Ludhiana and approved by whole of the faculty of the Department. The plan writing is satisfactory.
Supervisor
Co- supervisor
Dr. Deepinder Chhina Professor & Head Department of Microbiology DMC&H, Ludhiana
Dated......................
Certified that the study entitled A CLINICOMICROBIOLOGICAL PROFILE OF DIABETIC FOOT INFECTIONS involves only such investigations and / or treatment, which are relevant in this management of patients and has no extra cost implications to the patient. Name of Candidate Supervisor Co-Supervisor : : : Dr. Maninder Kaur Dr. Atul MIshra Dr. Deepinder Chhina
Dated......................
I shall carry out the study A CLINICOMICROBIOLOGICAL PROFILE OF DIABETIC FOOT INFECTIONS meticulously and shall maintain the
records for 5 years after the submission of thesis and present them to any competent authority as and when required. The following documents will be preserved : 1.List of enrolled subjects with identification details. 2.Consent forms of all the enrolled subjects. 3.Performa of each subject with verifiable details , individually signed by Supervisor. ____________________ PG Registrar Department of Surgery DMC& Hospital, Ludhiana
I..D/o, W/o, S/o. . am willing to participate in the study. The procedure with its complications has been explained to me in local vernacular language. I have fully understood that no special tests and extra expenditure in any form, merely for the purpose of thesis is being carried out. I am free to opt out the study any time without assigning any reason.
Signature of Candidate
CERTIFICATE
This is to certify that we have thoroughly checked the consent form translated in local languages i.e. Punjabi as well as in Hindi.
Supervisor
Co- supervisor