Fishbone Diagram Research Articles

Enhancing MAUDE Database Utility by GPT-4 and Cause-Effect Visualization.

The MAUDE database is a valuable public resource for understanding malfunctions and adverse events related to medical devices and health IT. However, its extensive data and complex structure pose challenges. To overcome this, we have developed an automated analytical pipeline using GPT-4, a cutting-edge large language model. This pipeline is intended to efficiently extract, categorize, and visualize safety events with minimal human annotation. In our analysis of 4,459 colonoscopy reports from MAUDE (2011-2021), the events were categorized into operational, human factor, and device-related. Ishikawa diagrams visualized a subset stored in a vector database for easy retrieval and comparison through a similarity search. This innovative approach streamlines access to vital safety insights, reducing the workload on human annotators, and holds promise to enhance the utility of the MAUDE database.

Optimisation of a Microwave Synthesis of Silver Nanoparticles by a Quality by Design Approach to Improve SERS Analytical Performances.

A major limitation preventing the use of surface-enhanced Raman scattering (SERS) in routine analyses is the signal variability due to the heterogeneity of metallic nanoparticles used as SERS substrates. This study aimed to robustly optimise a synthesis process of silver nanoparticles to improve the measured SERS signal repeatability and the protocol synthesis repeatability. The process is inspired by a chemical reduction method associated with microwave irradiation to guarantee better controlled and uniform heating. The innovative Quality by Design strategy was implemented to optimise the different parameters of the process. A preliminary investigation design was firstly carried out to evaluate the influence of four parameters selected by means of an Ishikawa diagram. The critical quality attributes were to maximise the intensity of the SERS response and minimise its variance. The reaction time, temperature and stirring speed are critical process parameters. These were optimised using an I-optimal design. A robust operating zone covering the optimal reaction conditions (3.36 min-130 °C-600 rpm) associated with a probability of success was modelled. Validation of this point confirmed the prediction with intra- and inter-batch variabilities of less than 15%. In conclusion, this study successfully optimised silver nanoparticles by a rapid, low cost and simple technique enhancing the quantitative perspectives of SERS.

Pengendalian Kualitas Produk Arummanis dengan Peta Kendali P dan Diagram Fishbone di UMKM Arummanis AT

UMKM arummanis AT is an UMKM that produces traditional food, namely arummanis or what is often called grandmother's hair. UMKM arummanis AT often experience defects during arummanis production, which has an impact on sales of the arummanis. The defect in AT's arummanis product is that the arummanis often clumps which makes it difficult to package and results in the arummanis being unfit for sale. The method used is a P control chart and also a fishbone diagram. The results of the research show that the highest proportion of defects is 0.00134 and the lowest proportion of defects is 0.00067 with a center line (CL) of 0.000912. The fishbone diagram shows the factors that cause defects in Arummanis products which are influenced by machine, method, human, environmental and material factors. The conclusion obtained in this research is that according to the P control line analysis, the research results show that 1 point of Arummanis error exceeds the control limit, which is then corrected. The solution to minimize the occurrence of defective products in Arummanis is by creating work SOPs, carrying out routine maintenance, maintaining cleanliness by creating a cleaning schedule, and also providing job training to workers. Keywords : Defective Products, Fishbone Diagram, P Control Chart, Quality.

Identifikasi dan Usulan Menangani Waste pada Proyek Mesin Selectifier dengan Pendekatan Lean Project Management Di PT. Z

The delay of a project can occur due to poor planning of its necessary resources, causing waste or waste. The purpose of this research is to find out the waste and its factors that can potentially occur in the selectifier machine project and know the viable solution to choose to deal with the waste. Then careful planning is required by applying the Lean Project Management methodology, where waste and harm can be found using scoring matrices and fishbone diagramming tools. Based on the analysis results in the selectifier machine project at PT. Z, the potential waste appears, namely waste waiting, defects and overprocessing. Waste and its potential causes are materials or components that are late dating, workers waiting for certain information, machines or tools supporting machine manufacturing are damaged, manufacturing process is not suitable for SOP, materials or components of poor quality, less scrupulous workers, poor working techniques. And according to the evaluation matrix, the best solution obtained is to perform other tasks that do not involve doing material work or using components that have not yet arrived on site, and buying back better materials from vendors. Keywords : Evaluation Matrix, Fishbone Diagram, Lean Project Management, Waste

Quality Control to Reduce Appearance Defects at PT. Musical Instrument

This research was conducted at PT. Musical Instruments that aim to analyze quality control to reduce appearance defects in piano products on the assembling production line. The problem faced by the company is the high level of product defects which has an impact on decreasing quality and customer satisfaction. The research method used is Six sigma with a DMAIC (Define, Measure, Analyze, Improve, Control) approach. This type of research is quantitative, with data collected in the form of the number of production defects in pianos. To analyze the causes of defects, a fishbone diagram with 4M + 1E factors is used, namely Man, Machine, Method, Material, and Environment. The results of the analysis show that the main factors causing appearance defects in piano products include incompatibility with work methods, lack of worker training, use of non-standard materials, suboptimal jig conditions, and unsupportive working environment. Based on these findings, improvement proposals are given in the form of improving standard operating procedures, regular training for workers, the use of high-quality materials, regular maintenance and calibration of jigs, and improvement of work environment conditions. The implementation of this improvement proposal is expected to reduce the number of appearance defects in piano products, improve product quality, and meet the quality standards expected by PT. Musical instrument.

Analysis of Carton Packaging Quality Control Using Statistical Quality Control Methods at PT XYZ

This research focuses on analyzing the quality control of cardboard box packaging at PT XYZ using the Seven Tools method. The main problem faced by the company is the high level of defects in the cardboard box products produced, which has a negative impact on production efficiency and customer satisfaction. The aim of this research is to analyze the main causes of defects in cardboard box products and provide suggestions for improvements that can be implemented by companies. The method used in this research is Statistical Quality Control (SQC) which involves the use of Seven Tools, namely check sheets, Pareto charts, fishbone diagrams and control charts. Using these tools, data regarding defects is collected, analyzed, and interpreted to identify the main causal factors of quality problems. The analysis results show that certain factors, such as the quality of raw materials, production processes, and operator skills, have a significant contribution to the occurrence of defects. Based on these findings, this research proposes several improvements that can be implemented by PT XYZ to improve the quality of their cardboard box products. Proposed improvements include increasing control over the quality of raw materials, skills training for operators, and implementing stricter standard operational procedures in the production process. By implementing this proposed improvement, it is hoped that PT XYZ can reduce the level of defects in their products, increase production efficiency, and increase customer satisfaction.

Efficiency Analysis of Die Attach Machines Using Overall Equipment Effectiveness Metrics and Failure Mode and Effects Analysis with an Ishikawa Diagram

Efficiency Analysis of Die Attach Machines Using Overall Equipment Effectiveness Metrics and Failure Mode and Effects Analysis with an Ishikawa Diagram

Practical manual for the implementation of service and process improvement methodologies, quality models and tools

This study seeks to identify the common factors in the methodologies, practices and management models, as well as in the quality tools used by leading national companies through a systematic review in which the city of Guayaquil was taken as a sample reference, investigating the achievement of procedures in institutions that have adopted this simplification model. It responds to a result of the research project carried out by students and teachers of the TES: Practical manual for the implementation of methodologies for the improvement of services and processes, models and quality tools. The authors used instruments such as interviews, SWOT analysis, Ishikawa diagrams, among others, to collect qualitative and quantitative data. The technique used was documentary review, using record cards as an instrument. The results obtained allow us to conclude that the authors' analysis highlights the need to apply specific strategies to improve organizational efficiency. They also seek to reflect the impact that quality management has had on the country's competitiveness. In addition, the importance of adopting proactive approaches to address the challenges identified in other studies is emphasized.

A Quality by Design (QbD) driven gradient high performance liquid chromatography method development for the simultaneous estimation of dasatinib and nilotinib in lipid nanocarriers

Tyrosine kinase inhibitors (TKIs) are effective as a targeted treatment for chronic myeloid leukemia (CML), which can selectively suppress BCR-ABL1 kinase activity. CML therapy with TKIs combination has been supported by in-vitro, in-vivo, and patient-based data where the nilotinib-dasatinib co-administration has exerted superior anticancer efficacy with greater cellular uptake, less resistance to chemotherapy, and no additive adverse events encountered. Therefore, it is essential to develop a suitable analytical method for the simultaneous estimation of these drugs in the developed novel lipid nanocarriers like liposomes. Design of Experiment (DoE) has been implemented as a tool of QbD to systematically investigate the relation between the HPLC method attributes and analytical responses, i.e., chromatographic detection, quantification, and peak properties for dasatinib and nilotinib. An Ishikawa diagram is constructed to delineate possible influencing variables to the analytical performances. Afterward, 4 factors 2 level full factorial design (FFD) was employed to model and identify the main effects and interaction effects between the factors selected after the initial risk assessment. The suggested design space for optimized chromatographic conditions by QbD analysis is linear within the selected range of drug concentrations, accurate and precise, sensitive, and robust according to the ICH guidelines. The optimal method is comprised of a 1 mL/min flow rate of mobile phase (ACN and 20 mM KH2PO4 of pH 7.00) in gradient mode at 25 °C column temperature for 20 μL sample injection volume and detection wavelength fixed at 297 nm. Most importantly, this novel HPLC method is simple and selective enough to evaluate dasatinib and nilotinib content in the lipid nanocarriers.

Use of the DMAIC Lean Six Sigma quality improvement framework to improve beta-lactam antibiotic adequacy in the critically ill.

Beta-lactam antibiotics are widely used in the intensive care unit due to their favorable effectiveness and safety profiles. Beta-lactams given to patients with sepsis must be delivered as soon as possible after infection recognition (early), treat the suspected organism (appropriate), and be administered at a dose that eradicates the infection (adequate). Early and appropriate antibiotic delivery occurs in >90% of patients, but less than half of patients with sepsis achieve adequate antibiotic exposure. This project aimed to address this quality gap and improve beta-lactam adequacy using the Define, Measure, Analyze, Improve, and Control Lean Six Sigma quality improvement framework. A multidisciplinary steering committee was formed, which completed a stakeholder analysis to define the gap in practice. An Ishikawa cause and effect (Fishbone) diagram was used to identify the root causes and an impact/effort grid facilitated prioritization of interventions. An intervention that included bundled education with the use of therapeutic drug monitoring (TDM; i.e. drug-level testing) was projected to have the highest impact relative to the amount of effort and selected to address beta-lactam inadequacy in the critically ill. The education and TDM intervention were deployed through a Plan, Do, Study, Act cycle. In the 3 months after "go-live," 54 episodes of beta-lactam TDM occurred in 41 unique intensive care unit patients. The primary quality metric of beta-lactam adequacy was achieved in 94% of individuals after the intervention. Ninety-four percent of clinicians gauged the education provided as sufficient. The primary counterbalance of antimicrobial days of therapy, a core antimicrobial stewardship metric, was unchanged over time (favorable result; P = .73). Application of the Define, Measure, Analyze, Improve, and Control Lean Six Sigma quality improvement framework effectively improved beta-lactam adequacy in critically ill patients. The approach taken in this quality improvement project is widely generalizable to other drugs, drug classes, or settings to increase the adequacy of drug exposure.

Quality-by-design driven approach in the formulation of an anti-ulcer and gastro-protective oral suspension

Objective This work aims to present a Quality-by-Design (QbD) step-by-step methodology to formulate anti-ulcer and gastro-protective oral suspensions. Methods Sucralfate was used as a drug model. The Quality Target Product Profile was established early during preformulation. Viscosity, resuspendability, pH, and density were assessed through the screening of several suspension platforms based on different prototype compositions. A compatibility study between the active pharmaceutical ingredient and the excipients was performed by thermal analysis and infrared spectroscopy. An Ishikawa fishbone diagram and Failure Mode and Effect Analysis were employed to identify the Critical Material Attributes (CMAs), Critical Process Parameters (CPPs), and Critical Quality Attributes (CQAs). CMAs’ and CPPs’ impact on identified CQAs was further assessed through a 22 full factorial experimental design at normal conditions after manufacture and one month at super-accelerated stress conditions. Results: The lead prototype exhibited no physicochemical incompatibilities. The risk assessment tools revealed that the concentration of the wetting agent and the total concentration of thickening agents represented critical factors for the quality profile of the preparation in terms of viscosity. The optimized formulation comprising 1.125 w/v% total concentration of Natrosol 250 HX and Avicel RC 591 exhibited an enhanced performance according to the established profile. Conclusions The analytical and physicochemical tests showed the robustness and compliance of the final preparation with the quality profile. The proposed step-by-step methodology based on QbD, Design of Experiments, and Quality Risk Management presented in our research holds practical implications for local industries and formulation scientists involved in the development of oral suspensions.

Demonstration of Cough Etiquette As an Effort to Reduce Pulmonary Tuberculosis Cases in Sindang Jaya Using a Community Diagnosis Approach

ABSTRACT Pulmonary Tuberculosis is currently still a serious health problem and is very easily transmitted. Indonesia is the country with the second-highest number of new pulmonary TB cases in the world. The Tangerang District Health Service at the end of 2022 found the number of pulmonary TB cases was 8,941 cases. There was an increase of 60% in new cases of pulmonary TB in Sindang Jaya District within 3 months in 2023. It was necessary to determine which villages had the main problem of pulmonary TB. This study aims to know the causes and carry out interventions to reduce new cases of pulmonary TB. Activities are carried out with a community diagnosis approach. A situation analysis is carried out to determine the problem. Identify the cause of the problem using the Blum Paradigm. Prioritization of problems using the Delphi non-scoring technique. Fishbone diagram to determine the root cause of the problem. Intervention plan with log frame goals and plan of action. Intervention is carried out through a demonstration of cough etiquette. There has been an increase in the ability to practice cough etiquette to help reduce the number of new cases of pulmonary TB. It was proven that 50% of the counseling participants could understand and practice cough etiquette well. After taking a community diagnosis approach, the cause of the problem was found and intervention was carried out, so it is hoped that new cases of tuberculosis in the Sindang Jaya Health Center working area will decrease. Keywords: Tuberculosis, Community Diagnosis, Blum Paradigm, Fishbone Diagram

Fulfilling last wishes: improving the compassionate discharge process

BackgroundCompassionate discharges (ComD), commonly known as rapid discharges, are urgent one-way discharges for critically ill hospitalised patients with death expected within hours or less than 7 days, to die at...

Food Safety Risk Analysis of Songkem Duck Using Failure Mode and Effect Analysis (FMEA) Method

Food safety is an essential aspect of human health. Food processed without paying attention to food safety regulations can harm consumer health. This research aims to 1) identify activities with food safety risks, 2) determine the sequence of food safety risks that will be followed up, and 3) determine appropriate food safety risk mitigation. This research uses the Failure Mode and Effect Analysis (FMEA) method and fishbone diagrams. A case study was conducted on the Songkem pak Soleh Bangkalan duck supply chain. The research results show that activities that pose a food safety risk include receiving raw materials, storing raw material stocks, using raw materials and BTP, sanitizing production facilities, and storing finished products. The priority order of food safety risks in the Songkem duck supply chain is based on the FMEA method: storage of finished products, sanitation of production facilities, and storage of raw material stocks. Risk mitigation can be done to prevent food safety risks in storing raw material stocks and storing finished products, namely by controlling water activity (aw) and acidity factor (pH); and controlling the room's atmosphere. Meanwhile, to prevent risks due to sanitation hygiene, namely holding training to increase awareness of the importance of sanitation hygiene for restaurant employees monitoring and maintaining sanitation hygiene in the production environment.

Quality control of garment product using DMAIC Six Sigma

Quality control is intended to ensure that the products are in accordance with the predefined standards. PT. XYZ is a garment company that manufactures products with global target market. Hence, product quality assurance becomes an important issue for PT. XYZ. This research focuses on the Just Brand-MCJA216142 jacket product at the sewing work station on line-4 of PT. XYZ. Preliminary observations show that the number of reworked-products was experiencing an increasing trend. This study aims to determine whether the company has carried out quality control properly. Specifically, the research objectives are to identify the type and level of product defects, identify the factors causing product defects, and provide proper improvement suggestions to reduce the occurrence of product defects. This study applied DMAIC (Define–Measure–Analyze–Improve–Control) Six Sigma concept. The results showed that the quality of the Just Brand-MCJA216142 jacket product has exceeded the Indonesian industry average and is classified as the USA industry average. However, quality improvement is still needed since the products are targeted for the export market. Based on Pareto diagram at the Analyze stage, it was found that the most dominant defects occurred in the Just Brand-MCJA216142 jacket production process were broken threads and puckering. The frequency of occurrence for these two types of defect reaches 23% of the total 16 types of defects. The defects were caused by human, machine, material, method, and environmental factors. Recommendations for improvement at the Improve stage are based on root cause analysis of each causative factor that is identified using a fishbone diagram. This research results strengthen the previous related researches regarding the effectivity of DMAIC Six Sigma for analyzing quality control of products.

Analysis of Bolt Former Machine Effectiveness Using Overall Equipment Effectiveness (OEE) and Six Big Lossess

XYZ a manufacturer of nuts and bolts, frequently faced bolt former breakdowns that resulted in huge losses and disrupted the company's operational efficiency and reputation. To solve this problem, PT XYZ needs to implement an effective maintenance strategy and closely monitor machine conditions to reduce the risk of breakdowns and ensure smooth production. This can be analyzed using the OEE method that exists in the company to detect early symptoms of damage, and continuous monitoring of machine conditions. Based on the calculation (OEE) before maintenance scheduling is made on the bolt former machine is currently 69.34%, which is below the standard (JIPM) of 85%. Therefore, the machine still needs to increase productivity through the OEE and Six Big Losses methods and then proceed with analyzing the problem using a fishbone diagram. The results of the analysis found that the biggest factor of time loss was reduced speed losses of 23.15%. The value of setup and adjustment losses was 7.82%, idling and minor stoppages losses were 7.44%, equipment failure losses were 3.12%, defect losses were 0.99%, and scrap losses were 0.11%. After the implementation of OEE, it has an impact on the level of productivity with the calculation results increasing to 77.78%. The availability value reached 89.90%, the performance value was 87.75%, and the quality value was 99.57%.

Strategi Peningkatan Volume Muatan Kapal Roro Trayek Makassar-Jakarta di PT Bumi Lintas Tama Kalla Lines

This study aims to determine the factors that affect the low volume of cargo and get the right action strategy to increase the volume of cargo of RollOn–RollOff (RoRo) Makassar-Jakarta route at PT Bumi Lintas Tama Kalla Lines. The type of data used in this research is quantitative data, namely about the main size of the ship (LOA, LBP, B, H and T), the ship's cargo capacity, the size of the ship's loading space, the number of ship decks, determining the internal and external factors that influence the handling of Roro Ferry shiploads with interviews and questionnaires and Questionnaire Forms. Using the method with the results obtained from the calculation of the load factor and the determination of the fishbone diagram factors to get the root cause of the lack of RoRo ship cargo volume. The sample in this study were 50 respondents consisting of practitioners at the Port and AMI Maritime Polytechnic Lecturers in Makassar. The results of this study indicate that the company adopts a conventional system that focuses on one side, namely incoming cargo or the Jakarta-Makassar route. In addition, the use of SWOT analysis found that the situation experienced by PT Bumi Lintas Tama is in quadrant IV, indicating an unfavorable situation with various internal threats and weaknesses. It is recommended to focus on strengthening internal strengths and overcoming weaknesses. As for its operational efficiency and performance, it should adopt a more holistic approach and consider using methods other than the fishbone method.

Pendampingan Perencanaan Implementasi dan Evaluasi Program Kesehatan Bebas Anemia Remaja Berkarya

Health program planning was carried out to develop a mature and well-organized health plan to achieve predetermined health goals within a certain timeframe. Based on a systems approach, a survey through questionnaires, and determining priority problems through USG (Urgency, Seriousness, and Growth), the result obtained was that 84% of teenage girls at SMPN 41 Surabaya did not adhere to consuming Iron Deficiency Anemia tablets (TTD). Following that, a root cause analysis of the issue was conducted utilizing a fishbone diagram, and the main cause related to this problem was found, which was the absence of a routine schedule for TTD assistance. Hence, several alternative solutions were given priority based on the MEER method (Methodology, Effectiveness, Efficiency, and Relevance).. From this method, it was concluded that the selected solution that could be implemented was the provision of the "Bebas Anemia Remaja Berkarya" program with the highest score of 400. The implementation of this program increased the understanding of teenage girls at SMPN 41 Surabaya from pre-test to post-test by at least 70% of those present, as well as increasing the adherence to taking Iron Deficiency Anemia tablets by at least 70% of the teenage girls at SMPN 41 Surabaya who were present

Improving the KYC Onboarding Process Using Business Process Re-Engineering: A Case Study of a Foreign Bank in Indonesia

The Know-Your-Customer (KYC) onboarding component in the customer acquisition process became an issue in an Indonesian branch of a prominent global bank. In 2023, the branch received a significant complaint from one of its major clients, noting the inefficiency of its KYC onboarding process, thus garnering attention from local senior management. From 2019 to 2023, there was a steady increase in client dissatisfaction rate and the number of new clients dropping their requests during the KYC onboarding stage. This research aims to identify the pain points in Magnolia Bank’s KYC onboarding process and propose solutions using the Business Process Re-engineering (BPR) approach. Fifteen respondents, including 10 bank employees and 5 corporate clients, were interviewed. Thematic analysis of interview results was conducted and it revealed three major pain points of the process: difficulty in document submission, challenges in requirements, and communication issues. The root cause of these pain points were then analyzed using the fishbone diagram, from which three root causes were discovered: inadequate technology infrastructure, lack of transparency in the process, and insufficient guidance that clients receive from the bank. The BPR approach was taken to fix the problems, the project focused on improving the guidance to clients, enhancing technology infrastructure, and developing a system for clients to track their onboarding progress. The proposed business solution for this research is for Magnolia Bank to develop a dedicated KYC onboarding platform, allowing prospective clients to submit the requirements directly, experience a one-window communication system, and track their KYC onboarding status.

The Efficacy of Evidence-Based Practice Training in Enhancing Decision-Making Competency Utilizing Fishbone Diagrams Among Nurse Managers at Hospital B Bandung

The Efficacy of Evidence-Based Practice Training in Enhancing Decision-Making Competency Utilizing Fishbone Diagrams Among Nurse Managers at Hospital B Bandung