McMaster University

McMaster University

MPSRC Current Research

The MPSRC is currently conducting the following clinical research studies:

  • Quantitative
    Research
  • Systematic/Scoping
    Reviews and Meta-Analyses
  • Qualitative
    Research
  • Educational
    Research
  • Evidence-Based
    Reviews

Quantitative Research


CLASHCLASH

Caudal vs. Local Anesthesia In Hypospadias: The CLASH study

Principle Investigator: Dr. Luis Braga

 

The CLASH study is a pilot study assessing the feasibility of a definitive trial that seeks to understand if caudal anesthesia will result in more postoprative complications when compared to a dorsal penile block. This study is being conducted in the pediatric urology clinic at McMaster Children's Hospital.

Funded by: The Canadian Urological Association Dragon's Den Grant


EXPRESSO

EXPRESSO

Expertise-Based Randomized Control Trial of Scrotal versus Inguinal (Standard) Orchidopexy on Postoperative Pain: EXPRESSO Trial

Principle Investigator: Dr. Luis Braga

The primary objective of the EXPRESSO Trial is to determine the difference in post-operative pain between scrotal orchidopexy and the traditional inguinal approach. This definitive randomized controlled trial is currently being conducted in the 2G Pediatric clinic at McMaster Children's Hospital.

Funded by: McMaster Surgical Associates Grant


SUPP LogoSUPP

Glycerin Suppositories Used Prophylactically in Premature Infants (SUPP): A pilot randomized placebo-controlled trial

Principal Investigator: Dr. Mark Walton

The SUPP Trial is a pilot study to assess the feasibility of a multicenter randomized controlled trial in the neonatal intensive care unit. Unfortunately, all preterm infants have problems with adequate feeding and nutrition. Giving them glycerin suppositories may be one way to help prevent some of these issues. The SUPP Trial is being coordinated by the McMaster Pediatric Surgery Research Collaborative in association with our colleagues in Neonatology and Nursing at McMaster Children’s Hospital.

Funded by: McMaster Surgical Associates Innovation Grant


CARE LogoCARE

Caregiver quAlity of life of pediatric patients Referred for fEeding tube insertion: A repeated measures pilot study

Principal Investigator: Dr. Mark Walton

The focus of this study is to formally quantify the impact of gastrostomy tube feeding on the quality of life of caregivers who care for children with severe feeding problems. This is a prospective cohort study being conducted at the McMaster Children's 2Q Surgical Clinic. With enrollment completed, the CARE feasibility results were tabulated and presented at the Canadian Association of Pediatric Surgeons national conference (Ottawa, 2011).

Funded by: McMaster Surgical Associates Clinical Research Award


Antibiotic prophyLaxis versus Placebo in infants diagnosed with Hydronephrosis Antenatally: A prospective, randomized controlled pilot trial (ALPHA)

ALPHA

Antibiotic prophylaxis versus Placebo in Infants Diagnosed with Hydronephrosis Antenatally: A Prospective, Randomized Controlled Pilot Trial

Principal Investigator: Dr. Luis Braga

The overall objective of this definitive study is to determine the effect of antibiotic prophylaxis compared to placebo on reducing the number of febrile urinary tract infections in infants with antenatally detected hydronephrosis over the first year of life. The trial is currently being conducted in the 2G Pediatric clinic at McMaster Children's Hospital. The Alpha Study has recently expanded to include the Children's Hospital at London Health Sciences Centre in London, Ontario and The Hospital for Sick Children in Toronto, Ontario.

Funded by:

  • Hamilton Health Sciences New Investigator Award
  • McMaster Surgical Associates Clinical Research grant

ACT (Attitudes of Clinicians Treating Children with Obesity Nation Wide: A Choice Based Conjoint National Survey)ACT NOW. (Attitudes of Clinicians Treating Children with Obesity Nation Wide: A Choice Based Conjoint National Survey)

Principal Investigator: Dr. Karen Bailey

This choice based conjoint survey will study a sample of physicians who provide care for children ages 2-18 to understand their attitudes, preferences for knowledge acquisition, knowledge of obesity and treatment options, patient demographics, and treatment referral patterns of morbidly obese children and adolescents in Canada.

Funded by:

  • Hamilton Health Sciences New Investigator Award
  • McMaster Surgical Associates Innovation grant

Seminal Canadian Recommendations for Evidence-Based Examination of Neonates for Retinopathy of Prematurity (SCREEN-ROP) Study

Seminal Canadian Recommendations for Evidence-Based Examination of Neonates for Retinopathy of Prematurity (SCREEN-ROP) Study

Principal Investigator: Dr. Kourosh Sabri

The primary objective of this study is to develop evidence-based recommendations for retinopathy of prematurity (ROP) screening that minimize the number of patients being screened as well as associated costs and morbidities while still capturing all nascent cases of ROP. This study is in partnership with the Canadian Neonatal Network™ and involves all 30 Level-3 Neonatal Intensive Care Units in Canada.

Funded by:

  • CIHR-Partnerships for Health Systems Improvement
  • Ministry of Health and Long-Term Care
  • McMaster University Department of Surgery

HOLD logo

Hypospadias Outcomes Long-Term Database (HOLD)

Principal Investigator: Dr. Luis Braga

The objective of this prospective database is to develop a reliable and quality registry of information on long-term surgical outcomes of hypospadias surgeries performed at McMaster Children's Hospital. The HOLD database will produce consistent high-level evidence needed in hypospadias surgery and inform the future practice of pediatric urologists. This project also provides infrastructure that will facilitate and encourage future collaborative research among pediatric urologists. The future plan is to include participating centres from across Canada, the USA, Brazil, France and Italy to make this an international database connecting pediatric urologists from around the world.

In Septemeber 2013, Dr. Braga and the MPSRC hosted the first ever International Pediatric Urology Task Force on Hypospadias funded by a planning grant from the CIHR. The focus of the meeting was to discuss the state of current knowledge on hypospadias repair and to facilitate international collaboration in hypospadias research.


Preventable Vision Loss in 4 Inner City Hamilton Elementary Schools — An Observational Study of the Prevalence and Causes of Amblyopia

Principal Investigator: Dr. Kourosh Sabri

This study will consist of screening each consented child at Cathy Wever, Bennetto, Dr. J. Edgar Davey and Hess Street elementary schools over the age of seven using a vision chart, a colour vision test and a depth perception test. A preliminary general diagnosis will be made based on these tests and those students identified as requiring a follow-up eye examination with a paediatric ophthalmologist will be given the opportunity to have an appointment. Dr. Sabri will make a final diagnosis and plan treatment for the patient based on a full eye exam.


Evaluating Practice Patterns in the Treatment of Antenatal Hydronephrosis:
A National Survey of Pediatric Urologists & Nephrologists

Principal Investigator: Dr. Luis Braga

The primary objective of this study was to determine whether variability exists between nephrologists and urologists in the management of infants with antenatal hydronephrosis (AHN) based on their practice patterns of prescribing prophylaxis (CAP) and obtaining a voiding cystourethrogram (VCUG). Online surveys were distributed to members of the Canadian pediatric nephrology and urology associations. Results of the surveys indicated that variability indeed exists between both specialty groups. This may be a result of a lack of treatment guidelines and supports efforts to obtain high-level evidence to develop management protocols for this common condition.


Accuracy and Cost of Ultrasound in the Diagnosis of Cryptorchidism

Principal Investigator: Dr. Luis Braga

The focus of this study is to determine the accuracy of the ultrasound as a diagnostic test in detecting undescended testis (UDT) as well as defining the agreement between referring practitioners and pediatric urologists’ diagnosis of UDT. Between March 2011 and January 2014, patients referred with an ultrasound to a tertiary Children’s Hospital for UDT were included in a prospective database. Data was collected on pediatric urologists’ physical examination, referral diagnosis, and ultrasound findings. Results indicated that when ultrasound findings were compared to pediatric urologists’ diagnosis, the performance of ultrasound as a diagnostic test was poor with a high percentage of false-positives.  This inaccuracy creates confusion and anxiety for patients and their families. Thus, the study results demonstrate that ultrasound is an ineffective test for diagnosis of UDT.


A Long Term Follow-up Study of Patients who Underwent Corrective Surgery (Orchidopexy) for Undescended Testicles: A Pilot Study.

Principal Investigator: Dr. Jorge DeMaria

The study aimed to compare the Conventional Laparoscopic Fowler-Stephens Orchidopexy (CLO) procedure and an alternative laparoscopic technique, which involves pulling the testis through the internal inguinal ring (IIR), without dividing the gubernaculum and sparing the cremasteric vessels (GSLO), aiming to reduce testicular atrophy. Data was collected on all patients who had GSLO from 2008-2013 and results were compared with a historical cohort of patients who had undergone CLO from 2005-2008.  The main outcome studied is testicular atrophy rate and testis position in the scrotum.


A Standardized Flow Sheet Improves Pediatric Trauma Documentation

Principal Investigator: Dr. Karen Bailey

The overall objective of this retrospective cohort study is to compare the utilization and documentation rates for pediatric trauma patients before and after implementing a revised pediatric trauma flow sheet within the Emergency Department at McMaster Children’s Hospital. Fifty-One pediatric trauma patients admitted between March 2009 – March 2012 were categorized into two groups based on the flow sheet utilized: pediatric trauma flow sheet (PTF1) and the Emergency Department flow sheet (EDF). Variables such as age, gender, trauma type and ISS scores were analyzed to design a new pediatric trauma flow sheet (PTF2).  PFT2 was implemented and utilized on twenty-one patients between September 1, 2011 and March 25, 2012. Results indicated that patients assessed using PTF1 had a higher documentation of key variables compared to the EDF cohort, although, administration of the newly designed PTF2 increased trauma documentation rate significantly. Thus, standardized pediatric trauma flow sheets should be utilized and audited in the ED setting.


Paediatric Trauma in Situ Simulation Facilitates Identification and Resolution of System Issues

Principal Investigator: Dr. Karen Bailey

The primary objective of this study is to perform and evaluate the administration of serial paediatric trauma in situ simulations at the McMaster Children’s Hospital Emergency Department. Evaluation forms were distributed to participants and observers of ten simulated traumas, asking for what was learned, liked and what should be changed. The comments on the form were analyzed and changes to the system were made in response to the evaluations reviewed. A few of the changes made to the system in response to the feedback included improved communication processes, documentation processes, defining roles and responsibilities, and the relocation and acquisition of equipment in the ER. The in situ simulations were valuable in identifying and resolving system issues as well as providing an opportunity to a multidisciplinary team to rehearse trauma care, and thus, promoting continuous quality improvement.


Assessing the Management of Transesophageal Fistula and Esophageal Atresia:
A Survey of the Canadian Association of Paediatric Surgeons

Principal Investigator: Dr. Helene Flageole


Post-Operative Impact of Nasogastric Tubes on Rates of Emesis in Infants Diagnosed with Pyloric Stenosis: Multicentre Feasibility Survey

Principal Investigator: Dr. Helene Flageole


Laparoscopic Esophagomyotomy for Esophageal Achalasia in Children:
Do all Children Require Fundoplication?

Principal Investigator: Dr. Mark Walton


Achievement of Paediatric National Quality Indicators: An Institutional Report Card

Principal Investigator: Dr. Karen Bailey


Testing the Reliability of Tools for Pediatric Trauma Teamwork Evaluation in A North American High-Resource Simulation Setting

Principal Investigator: Dr. Karen Bailey

Systematic/Scoping Reviews and Meta-Analyses

Pediatric Surgical Outcomes in Africa: A Scoping Review

Principal Investigator: Dr. Dan Poenaru

This project is a scoping review of the outcomes from pediatric surgical procedures in low- and middle-income countries (LMICs), which is a first step in the essential task of identifying and addressing the root causes of pediatric surgical mortality and morbidity in these countries.

Does Antibiotic Prophylaxis Prevent Urinary Tract Infections in Infants with Antenatally Detected Hydronephrosis: A Systematic Review and Meta Analysis

Principal Investigator: Dr. Luis Braga


Androgen Stimulation Prior to Hypospadias Surgery and its Effect on Surgical Complications: A Scoping Review

Principal Investigator: Dr. Luis Braga


Sclerotherapy for Lymphatic Malformations in Children: A Scoping Review

Principal Investigator: Dr. Paige Churchill


Indications for Surgical Intervention in Pectus Excavatum: A Scoping Review

Principal Investigator: Dr. Peter Fitzgerald


The Role of Anti-Reflux Medications in Minimizing the Impact of Gastro-esophageal Reflux in Patients Treated Surgically for Congenital Esophageal Atresia and Tracheo-esophageal Fistula: A Scoping Review

Principal Investigator: Dr. Helene Flageole


How Best to Measure Eye Pressure in Young Children? A Systematic Review of the Effects of Anesthetic Agents on Intraocular Pressure

Principal Investigator: Dr. Kourosh Sabri

Qualitative Research

A Qualitative Approach to Understanding Professionalism in Surgical Clerkship Using Critical Incident Reports

Principal Investigator: Dr. Brian Cameron

The main objective of this descriptive qualitative study is to investigate the major themes concerning professionalism identified in critical incident reports presented by surgical clerks at McMaster University Medical School.


Health-Related Quality of Life after Anorectal Surgery Repair in Children

Principal Investigator: Dr. Brian Cameron

The objective of this descriptive qualitative study is to identify patient and family health related quality of life issues specific to children who have undergone anorectal surgery at the McMaster Children's Hospital.


Understanding the Caregiver Quality of Life Experience Following Gastrostomy Tube Insertion in Pediatric Patients: A Qualitative Phenomenological Approach

Principal Investigator: Dr. Mark Walton

The objective of this phenomenological qualitative study is to identify quality of life issues specific to parents of children who have undergone gastrostomy surgery at the McMaster Children's Hospital.

Educational Research

Neonatal Circumcision: An Educational Surgical Training Website

Principal Investigator: Dr. Jorge DeMaria

The main objective of this project is to create a standardized, accessible, web-based instruction module to help reduce the complication rates of neonatal circumcision.

Web: Neonatal Circumcision Education

TTT Update Project

Principal Investigator: Dr. Brian Cameron

The Trauma Team Training Course is a nationally accredited trauma program in Guyana. The TTT Update course was piloted November 2011 to allow TTT graduates to sharpen skills while focusing on teamwork capacity. Study results will help inform the development of an official TTT Update manual for the Canadian Network for International Surgery. An abstract and a poster for this project were presented at the 2012 Bethune Round Table Conference.


Connect that Bowel! Development of a Hand-sewn Bowel Anastomosis Education Module

Principal Investigator: Dr. Brian Cameron

A pilot study of this project is currently underway. This stage of the study involves asking surgical staff, fellows, and chief residents for feedback on the proposed hand-sewn bowel anastomosis training module, as well as the synthetic bowel model that will be used later in the study.


Evaluation of a New Pediatric Intraoseous Needle Insertion Device for Low Resource Settings

Principal Investigator: Dr. Brian Cameron

Evidence-Based Reviews

Quality of Reporting over 10 years in Randomized Controlled Trial Published in the Journal of Pediatric Surgery

Principal Investigator: Dr. Peter Fitzgerald


Quality of Reporting in Hypospadias Randomized Controlled Trial Published over 5 years

Principal Investigator: Dr. Luis Braga


The Scientific Program at the Canadian Association of Pediatric Surgery National Meetings: Is the Level of Evidence Changing?

Principal Investigator: Dr. Helene Flageole

The MPSRC is currently participating in the following clinical research studies:

CBAR

The Canadian Biliary Atresia Registry (CBAR): Establishing Best Practices for the Assessment, Management, and Outcome of Biliary Atresia in Canada

Local Principal Investigator: Dr. Brian Cameron

Principal Investigator: Dr. Richard Schreiber

Biliary atresia (BA) is a pediatric liver disease that occurs in newborn infants. The aim of this collaborative study is to collect data on the assessment, management and outcome of BA in children across Canada. Fifteen hospitals across the country are currently participating in data collection for this registry, which is coordinated though the University of British Columbia. It is hoped that the creation of the CBAR will aid in standardizing care for patients with BA and promote research and education for these patients and their families.

UBC .


CAPSNet

The Canadian Pediatric Surgery Network (CAPSNet) is a multi-speciality Canadian collaborative established in 2005 to enable systematic study of the two most common structural birth defects encountered by pediatric general surgeons: gastroschisis (GS) and congenital diaphragmatic hernia (CDH).

Local Principal Investigator: Dr. Peter Fitzgerald
Principal Investigator: Dr. Eric Skarsgard, British Columbia's Children's Hospital

Canadian Pediatric Surgery Network (CAPSNet)


STEP Database

The STEP database aims to create a web-based data registry for all patients worldwide who undergo the serial transverse enteroplasty (STEP) procedure, analyze the data from the STEP registry to determine a baseline diagnostic, demographic, anatomical, and nutritional profile for patients who undergo the STEP procedure, and analyze long-term data from the STEP registry to determine and measure long-term clinical outcomes of patients who undergo the STEP procedure.

Local Principal Investigator: Dr. Brian Cameron

Principal Investigator: Children's Hospital Boston

Children's Hospital Boston


The Paediatric EVICEL Soft Tissue and Parenchymal Organ Bleeding Study

A Prospective, Randomized, Controlled Study Evaluating EVICEL Fibrin Sealant as an Adjunct to Haemostasis During Abdominal, Retroperitoneal, Pelvic or Thoracic (Non-Cardiac) Surgery in Paediatric Patients

Local Principal Investigator: Dr. Helene Flageole

Sponsor: ETHICON, a Johnson & Johnson Co.

The objective of this multicenter study is to evaluate the safety and haemostatic effectiveness (ability to stop bleeding) of EVICEL® versus SURGICEL®® in controlling mild to moderate bleeding during non-emergent abdominal, pelvic or thoracic (non-cardiac) surgeries in children.

 

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