GE55 TRW (Teaching, Research & Wellness) Bldg.
3280 Hospital Dr NW
Calgary, Alberta T2N 4Z6
Phone: (403) 210-7445
General Instructions:
This document is designed as a form into which information can be typed directly. Use as much space as necessary to thoroughly describe your data request or research proposal. If your request is for research purposes, please provide attachments as indicated below and on the form.
All requests should be submitted to:
Diane Galbraith dgalbrai@ucalgary.ca
Fax: (403) 210-7445
Research requests will be reviewed by the research team and clinical steering committee for feasibility and scientific merit.
Page 1-2 (Contact Information/Project Description);

Provide detailed contact information.

Provide a project title.

If submitting the form electronically, check the appropriate box on the signature line. A signature is not necessary if submitting form electronically.
Page 2 (QI/QA and Other Administrative Data Requests)

Please list variables needed if known. If not known, list variables desired. You will be contacted to discuss what variables are available.

Specify the timeframe of APPROACH data from which you would like the population to be drawn.
The registry began January 1995.

Explicitly state the inclusion/exclusion criteria for your study population of interest.

If you have a preferred format in which you would like to receive the data, check one format. If you have no preference, check all acceptable formats.
Page 2 (Abstracts, Manuscripts, and Other Research Requests)
This section describes the materials that must be submitted to help the research team and clinical steering committee consider the feasibility and scientific merit of the project.

Submit a detailed, formal description of the research project, either in a prepared proposal or an attachment describing the background, research question, and outcome variables.

If possible, attach example or sample tables as you plan to present the outcome data.

Some institutions require ethics approval for use of registry data. You will be responsible for determining whether your research topic requires ethics approval, and for gaining such approval.

If you are interested in statistical analysis support, you will be contacted to discuss your specific needs, feasibility, and timelines.
Once you have submitted your request, you may be contacted for additional information with regard to your specific data needs.

GE55 TRW (Teaching, Research & Wellness) Bldg.
3280 Hospital Dr NW
Calgary, Alberta T2N 4Z6
Phone: (403) 210-7445
This entire form must be submitted to be reviewed by the Research Team and Clinical Steering
Committee. All forms can be su b mitted to dgalbrai@ucalgary.ca
or FAXED to the attention of
Diane Galbraith at : (403) 210-9837.
Date of Request:
Name of Person Requesting:
Requester’s Phone/Email:
Occupation or Job Title:
Affiliation/Site:
Contact Person/Phone/Email
(If different from above):
Title of Project:
Purpose of Request:
Department/Unit:
Brief Project Overview:
How do you intend to use this data? Check all that apply:
Quality Improvement/Quality Assurance
Other Administrative Data Request
Abstract Name of Scientific Meeting
Deadline for Submission:
Manuscript
Date of Presentation:
Other Research Request

APPROACH Request for Data
Page 3 of 3
Date Data Required:
Signature of Person Requesting:
For QI/QA and Other Administrative Data Requests:
List of Variables Required:
Check if submitting electronically
Timeframe: From:
(check one) Entire registry
To:
(Cathlab registry began in 1995.)
Module:
(check all
that apply)
Admissions
Catheterization
PCI
All cardiac surgery
CABG only
Nuclear
Referral/booking
Follow-up survey
Population: Entire patient population
(check one) Subpopulation: Please specify any inclusion/exclusion criteria:
Inclusion:
Exclusion:
In what format would you like to receive the data? Excel SPSS SAS CSV
For Abstracts, Manuscripts and Other Research Requests:
Please provide enough information for the committees to consider the feasibility and scientific merit. Attach proposal , or describe the following in an attachment:

Background

Research Question

Outcome Variables
Please attach sample tables, if possible, to help the team evaluate and complete the analysis.
Will you be or are you in the process of applying for ethics approval? Yes Not required
If ethics approval has been granted, please attach approval statement.
Will you be requiring statistical analysis support? Yes No
APPROACH Use Only:
Received:
Reviewed by Research Committee:
Reviewed by Clinical Steering Committee:
Data Request Completed:
Assigned to Statistician (if applicable):
Publication/Presentation (if applicable):