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The Canadian Association of Paediatric
Surgeons Evidence-Based Resource
(CAPS EBR)
Bridging the Knowledge-to-Action Gap
https://www.caps.ca/evidence-based-resource/
https://www.caps.ca/evidence-based-resource/
I have no actual or potential conflict of interest in relation to this topic or presentation.
Disclosure
• Medicine & all other health care areas are rapidly
changing
• Today >20,000 biomedical journals
• To keep up to date in medicine, we need to read 17
articles a day, 365 days a year
https://www.caps.ca/evidence-based-resource/
Evidence in Medicine
https://www.caps.ca/evidence-based-resource/
https://www.caps.ca/evidence-based-resource/
Evidence Based Practice
• Aims to apply the best available evidence gained
from the scientific method to medical decision making
• It seeks to assess the quality of evidence of the risks
and benefits of treatments (including lack of
treatment)
• Exists
• Does not exist
https://www.caps.ca/evidence-based-resource/
The Evidence
…SO LITTLE TIME
https://www.caps.ca/evidence-based-resource/
SO MANY STUDIES
• Dissemination
• Acceptance
• Application
old routines die hard!
https://www.caps.ca/evidence-based-resource/
The Hurdles
• Exists
• Does not exist
The vicious circle
https://www.caps.ca/evidence-based-resource/
The Evidence
• Surgical practice lags behind its medical
counterpart
• Pediatric surgery in particular has trailed general
surgery
Evidence Based Practice
https://www.caps.ca/evidence-based-resource/
• There is a disturbing lack of evidence based
practice in the pediatric surgery field
• The vicious circle
• Even when evidence exist, there are the three
hurdles
https://www.caps.ca/evidence-based-resource/
Summary of the Problem
https://www.caps.ca/evidence-based-resource/
Barriers and Facilitators to EBP
Barriers
• Time constraints
• Resource limitations
• General poor quality
of evidence
• Lack of required
skills
• Apprenticeship style
of teaching
Facilitators
• An institution that
generates it’s own
research
• Having a champion
for EBP
• Peers that support
EBP implementation
https://www.caps.ca/evidence-based-resource/
CAPS EBR
Goal: To facilitate and promote EBP by providing up-to-
date critically appraised evidence, and to make
recommendations for practice based on evidence
Objective
• To establish a regularly-updated evidence-based
resource on the CAPS website
https://www.caps.ca/evidence-based-resource/
Hypotheses
• We can encourage evidence based practice and
improve patient care by:
• 1. Making summaries of evidence easily accessible
• 2. Directing research efforts
https://www.caps.ca/evidence-based-resource/
https://www.caps.ca/evidence-based-resource/
Methods
Define research
question
Literature search
Screening (two levels)
Summarization
of evidence
Quality assessment
Regularly update
https://www.caps.ca/evidence-based-resource/
Define Research Question
• Two round Delphi survey
• At least 20 experts per topic
“In your practice with the surgical management of
[e.g., undescended testis], what areas do you find to
be controversial and in need of further research
and/or consensus?”
https://www.caps.ca/evidence-based-resource/
Data Collection
• Librarian designed search strategy
• Two-levels screening:
1) Title and abstract
2) Full text
• Quality assessment of included studies
• AMSTAR (systematic reviews)
• Cochrane Risk of Bias (RCT)
• MINORS (non-RCT)
https://www.caps.ca/evidence-based-resource/
Dissemination of Evidence
• On the CAPS EBR website
(https://www.caps.ca/evidence-based-resource/)
• Study level summary with quality assessment
• Overall summary with Oxford Level of Evidence
• Peer-reviewed journal publication
• Media (including social media)
• National organizations
https://www.caps.ca/evidence-based-resource/
Website
• Currently available: 7 research questions within 5 topics
• Hypertrophic pyloric stenosis (2 questions)
• Undescended testes (2 questions)
• Inguinal hernia and hydroceles
• Gastroesophageal reflux
• Cysts of the lung and mediastinum
• In peer review: 2 research questions
• In development: 8 research questions
https://www.caps.ca/evidence-based-resource/
Hypertrophic Pyloric Stenosis
Publication
https://www.caps.ca/evidence-based-resource/
News Article
https://www.caps.ca/evidence-based-resource/
https://www.caps.ca/evidence-based-resource/
Journal Publications
https://www.caps.ca/evidence-based-resource/
Choosing Wisely Canada
https://www.caps.ca/evidence-based-resource/
Social Media
• CAPS EBR twitter: @CAPS_EBR
• Twitter of our collaborators/partners:
• CADTH: @CADTH_ACMTS
• Cochrane Canada: @CochraneCanada
• Cochrane Child Health: @Cochrane_child
• Canadian Association of Paediatric
Surgeons: @CAPSsurgeons
https://www.caps.ca/evidence-based-resource/
Impact
• Facilitate EBP by removing barriers such as:
• Resources (e.g. time, pay wall, etc.)
• Lack of skills
• Quality of the research
• Identify areas in which quantity or quality of evidence
is lacking for future primary research
• Serve as an educational resource for residents,
fellows, and surgeons
https://www.caps.ca/evidence-based-resource/
Web Analytics
~1,200 views since April 2014
1,100+ views since April 2014
1,400+ views since April 2014
https://www.caps.ca/evidence-based-resource/
Visit the CAPS EBR!
https://www.caps.ca/evidence-based-resource/
https://www.caps.ca/evidence-based-resource/
Collaborators/Sponsors
Cochrane Child Health Field
https://www.caps.ca/evidence-based-resource/
Questions?
https://www.caps.ca/evidence-based-resource/
Available Topics
• Hypertrophic pyloric stenosis
Is laparoscopic or open pyloromyotomy the better
method?
What is the ideal post-pyloromyotomy feeding
regimen?
• Undescended testes:
What is the ideal management strategy for intra-
abdominal testes?
What is the ideal timing for orchiopexy?
https://www.caps.ca/evidence-based-resource/
• Inguinal Hernias and Hydroceles:
Should the contralateral side be explored when
repairing a unilateral pediatric inguinal hernia?
• Gastroesophageal reflux:
Complete or partial fundoplication method for
surgical management of medically resistant GERD?
• Cysts of the Lung and Mediastinum:
What is the ideal management of asymptomatic
congenital pulmonary airway malformation
(CPAM)
Available Topics (con’t)
https://www.caps.ca/evidence-based-resource/
Topics Currently Under Peer
Review
• Cysts of the Lung and Mediastinum:
What is the optimal age for elective surgical
resection of asymptomatic CPAM?
• Inguinal Hernia and Hydroceles:
What is the optimal age for surgical treatment of
inguinal hernia?