Validation of the Use of Electronic Medical Records for Identification of Post-gastric Bypass Hypoglycemia Cases

Use of statistical process control in quality improvement projects in abdominal surgery: a PRISMA systematic review

BACKGROUND

The use of quality improvement methodology has increased in recent years due to a perceived benefit in effectively reducing morbidity, mortality and length of stay. Statistical process control (SPC) is an important tool to evaluate these actions, but its use has been limited in abdominal surgery. Previous systematic reviews have examined the use of SPC in healthcare, but relatively few surgery-related articles were found at that time.

OBJECTIVE

To perform a systematic review (SR) to evaluate the application of SPC on abdominal surgery specialties between 2004 and 2019.

METHODS

An SR following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram was completed using Embase and Ovid Medline with terms related to abdominal surgery and SPC.

RESULTS

A total of 20 articles were selected after applying the exclusion criteria. Most of the articles came from North America, Europe and Australia, and half have been published in the last 5 years. The most common outcome studied was surgical complications. Urology, colorectal and paediatric surgery made up most of the articles. Articles show the application of SPC in various outcomes and the use of different types of graphs, demonstrating flexibility in using SPC. However, some studies did not use SPC in a robust way and these studies were of variable quality.

CONCLUSION

This study shows that SPCs are being applied increasingly for most surgical specialties; however, it is still less used than in other fields, such as anaesthesia. We identified conceptual errors in several studies, such as issues with the design or incorrect data analysis. SPCs can be used to increase the quality of surgical care; the use should increase, but critically, the analysis needs to improve to prevent erroneous conclusions being drawn.

Sensitivity and Specificity of Non-Invasive Blood Glucose Level Measurement Optical Device to Detect Hypoglycaemia

Hypoglycemia is related to lethargy, psychiatric disorders, and impaired brain metabolism. Hypoglycemia is one of the leading factors of death in blood glucose level (BGL) metabolism disorders. Optical methods have been heavily researched due to its potential to eliminate drawbacks of conventional hypoglycemia detection; however, clinical data are still scarce. This study objective was to measure the sensitivity and specificity of non-invasive BGL Measurement Optical Device (NI-BGL-MOD) to detect hypoglycemia. The reference standard is venipuncture spectrophotometry. Researcher has developed NI-BGL-MOD, which we have used in a clinical trial in December 2015. The researchers have used spectral data collected from the device to measure the BGL of randomly selected 110 participants who were older than 17 y old. Each participant was measured five times. There are a total of 550 data sets that were then compared to BGL measurement using the reference standard. The spectral data were optimized using Discrete Fourier Transform and inferred to BGL prediction using the Fast Artificial Neural Network. Researchers have defined hypoglycemia case with BGL level at 75 mg/dL or lower. The researchers have calculated sensitivity and specificity using epiR in Rstudio. Respondents' BGL values were between 67 to 96 mg/dL. Researchers have classified eighty-nine cases as hypoglycemia. There are 461 cases classified as not hypoglycemia. The sensitivity was 54%, and the specificity was 97%. Diagnostic accuracy was 86%, and the number to diagnose was 1.96. The newly developed method NI-BGL-MOD could be used to detect hypoglycemia.