d1 dr ahmed nasr caps ebr presentation april 11 2016, 1015 to 1145 am
TRANSCRIPT
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 EBPBarriers
• 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/
MethodsDefine 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 abstract2) 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 stenosisIs 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?