Quality improvement is necessary to overcome the occurrence of defective products during the production cycle. The occurrence of defective products is difficult to avoid. Therefore, the Sugar Factory (SG) business unit at PT XYZ began to implement quality control for sugar production. Based on these events, an analysis of quality measurement is carried out through this research. The methods used in this research are control chart, fishbone diagrams, and failure mode and effect analysis (FMEA). The results of the control map measurement using the p-chart and u-chart show that there is no sugar production process that is out of control. Although nothing is out of control, it is also necessary to analyze it using a fishbone diagram to determine the cause of the defects that occur. The results of the measurements with FMEA can be known sub-factors that have the highest RPN, namely negligence of operations, poor sugar cane sorting, changes in production schedules, incomplete repair areas, and poorly organized layouts. From the results of data processing, it can be seen that quality control needs to be carried out by the company. One of them is by making standard operating procedures (SOP) related to the sugar processing process. In addition, the raw materials for making sugar also need to be considered, so that the process will produce sugar with better quality
Based on our previous pilot study, systemic inflammatory response syndrome is more common in off-pump compared to on-pump coronary artery bypass. Therefore, we conducted a clinical trial of dexamethasone in patients undergoing off-pump coronary artery bypass.Sixty consecutive patients undergoing off-pump coronary artery bypass were enrolled from August 2018 to January 2019 and randomized to a dexamethasone or placebo group of 30 each. Clinical outcomes were analyzed.There was a lower incidence of major adverse cardiac events in the dexamethasone group compared to the placebo group (17% versus 43%, p = 0.024). Clinical outcomes in the dexamethasone group were better than those in the placebo group, in terms of duration of mechanical ventilation (p = 0.029), intensive care unit stay (p = 0.028), hospital stay (p = 0.04), and vasoactive-inotropic score (p = 0.045). There were significant differences in inflammatory markers between the two groups: interleukin-6 (p = 0.0001), procalcitonin (p = 0.0001), and C-reactive protein (p = 0.0001) were lower in the dexamethasone group. There was a significant association between the incidence of major adverse cardiac events and both interleukin-6 (p = 0.005) and procalcitonin (p = 0.007).Preoperative dexamethasone in patients undergoing off-pump coronary artery bypass is effective in improving clinical outcomes and controlling the postoperative inflammatory reaction.
Abstract
Background: A prominent increase of overall global death rate of aortic disease is seen on developing country, with South-east Asia having the highest increase of 41%. Lack of identification and prompt management of the diseases in conjunction with lack of facilities in third world countries that could perform aortic surgery made the procedure more complex when the patients admitted to tertiary hospitals
Methods: The data was obtained through medical record of patients underwent thoracic aortic surgery from 2018 to 2021 in National Cardiovascular Center Harapan Kita (NCCHK). One-year and 3-year survival analysis was obtained through phone calls and digital messages. Statistical analysis was done to investigate the impact of surgical complexity as the main predictor and other variables on primary (in-hospital mortality) and secondary (mid-term survival) outcome.
Results: A total of 208 patients were included in the analysis; 157 (75,5%) underwent complex surgery, and 51 (24,5%) underwent non-complex surgery. In-hospital mortality was similar across 2 groups (23,6% vs 13,7%; p = 0,1240). On multivariable analysis, malperfusion syndrome (OR 3,560; p = 0,002), CPB duration > 180 minutes (OR 4,331; p = 0,001), and surgical priority (urgent OR 4,196; p = 0,003; emergency OR 10,879; p = 0,001) were identified as independent predictor of in-hospital mortality. Cox regression identified diabetes (HR 4,539; p = 0,025) and emergency procedure (HR 9,561; p = 0,015) as independent predictors for 1-year mortality, and diabetes (HR 3,609; p = 0,004), aortic dissection (HR 2,795; p = 0,029), and maximum aortic diameter (HR 1,034; p = 0,003) for 3-year mortality. Surgical complexity was not associated with early and mid-term mortality.
Conclusions: In patients undergoing thoracic aortic surgery, surgical complexity was not associated with early and mid-term survival. Early and mid-term survival was largely determined by patient comorbidities and intra-surgery factors.
The research deals with blending and segmenting of reading acquisition skills given to the Early Literacy of K-1 and K-2 Children in I Can Read English Course in Bandung City. The research aims at identifying (1) which skill should be taught first to the students of bilingual school (K1 and K2), blending or segmenting and (2) in using the blending and segmenting, which word divisions (CVC, VCC, CCV) should be taught first to the students of bilingual school (K1-K2). The main data source in this descriptive quantitative research is taken mainly from 38 students of I Can Read English Course studying in bilingual school of K1 and K2. The research stage consists of following steps: Dividing students into two groups, which will be taught Segmenting-Blending and Blending-Segmenting for ten (10) meetings, providing a list of three word division groups which will be used by the instructor later to test the student
Body temperature maintained during open distal anastomosis in patients who undergo aortic surgery has been showing an upward trend; however, a higher temperature may increase visceral organ and spinal cord injury. Distal perfusion may reduce abdominal organ injury, especially acute kidney injury (AKI).From 2009 to 2016, 56 patients who underwent ascending aortic and/or aortic arch surgery were enrolled. Open distal anastomosis was performed using one of three protection strategies: 1) systemic temperature of 25°C followed by selective cerebral perfusion (SCP) with lower body circulatory arrest (Group CA25, n=27); 2) systemic temperature of 28°C followed by SCP with lower body circulatory arrest (Group CA28, n=4); and 3) systemic temperature of 28°C followed by SCP with distal aortic perfusion (Group DP, n=25).During the postoperative course, levels of blood urea nitrogen, creatinine, liver enzymes, lactate dehydrogenase and lactate in Groups CA28 and CA25 were significantly higher than those in Group DP. AKI defined by the AKI Network occurred in 28 cases (50%) and 3 cases required permanent hemodialysis. AKI was significantly higher in Groups CA25 and CA28 than in Group DP (p=0.026). Mid-term follow-up showed that patients who developed postoperative AKI were more likely to suffer from cardiovascular events.Distal perfusion during open distal anastomosis reduced kidney and liver injury after thoracic aortic surgery despite an increased body temperature of up to 28°C. This strategy may be useful to prevent AKI, liver dysfunction, the need for hemodialysis and multiple organ failure and could improve mid-term results.
Isolated saccular compared to fusiform aneurysm is considered to be a rare entity with challenges of its own. A 62-year-old female was diagnosed with a case of saccular aneurysm and penetrating atherosclerotic ulcer of the aortic arch. Additionally, she also had one vessel coronary artery disease and type B abdominal aortic dissection. She was then managed with open aortic arch repair and coronary artery bypass grafting. If required, elective endovascular repair will be done for the abdominal aorta on a later date.
Pendahuluan: Teknik bedah pintas arteri koroner (BPAK) off pump diharapkan mampu menghilangkan efek samping dan komplikasi yang ditimbulkan akibat penggunaan mesin pintas jantung paru (PJP). Namun teknik ini tidak sepenuhnya bebas dari efek samping atau komplikasi. Salah satu efek yang dapat ditimbulkan adalah peningkatan respons inflamasi sistemik, sehingga durasi rawat menjadi lebih lama. Hal tersebut menjadi dasar penelitian ini untuk melakukan studi pemberian deksametason dalam memengaruhi durasi rawat inap pada pasien yang menjalani operasi BPAK off pump. Metode: Penelitian ini merupakan studi observasional analitik dengan enam puluh pasien yang menjalani operasi BPAK off-pump dan dibagi dalam kelompok deksametason atau plasebo masing-masing 30 orang. Hasil klinis dianalisis. Hasil: Lama rawat inap kelompok deksametason berbeda bermakna dibandingkan kelompok plasebo berturut-turut 5 (5-8) hari vs 6,5 (5-30) hari; p=0,04). Keluaran klinis lain pada kelompok deksametason lebih baik daripada kelompok plasebo, dalam hal durasi ventilasi mekanis (p=0,03) dan perawatan di unit perawatan intensif (p=0,03). Terdapat perbedaan penanda inflamasi yang signifikan antara kedua kelompok: interleukin-6 (p=0,0001), prokalsitonin (p=0,0001), dan C-reaktif protein (p=0,0001) lebih rendah pada kelompok deksametason. Kesimpulan: Deksametason praoperasi pada pasien yang menjalani operasi BPAK off pump efektif dalam mengurangi lama rawat pasien di rumah sakit dan mengendalikan reaksi inflamasi pascaoperasi.
