Elimination of Post-Operative Complications in Penetrating Keratoplasty by Deploying Six Sigma

This paper shows how a public eye and research hospital in Turkey initiated Six Sigma principles to reduce the number of complications occurring after penetrating keratoplasty surgeries. Data were collected for nine years. To analyse the complications among 55 patients (59 eyes) underwent penetrative keratoplasty, main tools of Six Sigma’s Define-Measure-Analyze-Improve-Control (DMAIC) improvement cycle such as SIPOC table and Failure, Mode and Effect Analysis (FMEA) were implemented. Sources and root causes of eleven types of complications were identified and reported. For a successful penetrating keratoplasty surgery patient’s anatomy, suitability of donor cornea, experience of ophthalmic surgeon, sterilization and hygiene, and performance of the equipment were determined to be the “critical-to-quality” factors. The complication with the highest hazard score was found to be the glaucoma. The process sigma level of the process was measured to be 3.1418. The surgical team concluded that all types of post-operative complications should be significantly reduced by taking the necessary preventive measures

Integration of Six Sigma Methodology to Reduce Complications in a Private Hemodialysis Center

This paper aims to evaluate the complications occurred during and after the hemodialysis sessions made in a private hemodialysis center in terms of their sigma levels and severity. Complications with sigma levels under 4.00 indicate that the sessions need improvement and corrective actions. Vital few and trivial many critical to quality (CTQ) factors are determined and some improvement suggestions are made for the process based on the vital few CTQ factors. Consequently, it is found that the hemodialysis process operates at a 3.5342 sigma level

Toward Singlet Oxygen Delivery at a Measured Rate: A Self-Reporting Photosensitizer

A Bodipy-based energy transfer cassette with a singlet oxygen reactive linker between the donor and acceptor modules has an interesting emergent property, if the acceptor module is also a photosensitizer. Singlet oxygen produced by the photosensitizer reacts rapidly with the molecule itself to liberate the energy donor, resulting in an enhanced fluorescence emission. The result is a self-reporting photosensitizer providing an assessment of the singlet oxygen production rate under the operational conditions

INTEGRATION OF SIX SIGMA METHODOLOGY TO REDUCE COMPLICATIONS IN A PRIVATE HEMODIALYSIS CENTER

This paper aims to evaluate the complications occurred during and after the hemodialysis sessions made in a private hemodialysis center in terms of their sigma levels and severity. Complications with sigma levels under 4.00 sigma level indicate that the sessions need improvement and corrective actions. Vital few and trivial many critical to quality (CTQ) factors are determined and some improvement suggestions are made for the process based on the vital few CTQ factors

Adoption of Six Sigma’s DMAIC to Reduce Complications in IntraLase Surgeries

Abstract: Purpose: To show how a private eye care center in Turkey initiated Six Sigma principles to reduce the number of complications encountered during and after femtosecond laser-assisted LASIK (IntraLase) surgeries. Method: Data were collected for five years. To analyse the complications among 448 surgeries, main tools of Six Sigma’s Define-Measure-Analyze-Improve-Control (DMAIC) improvement cycle such as SIPOC table, Fishbone Diagram and, Failure, Mode and Effect Analysis were implemented. Sources and root causes of seventeen types of complications were identified and reported. Results: For a successful IntraLase surgery, experience of the refractive surgeon, patient’s anatomy and calibration of laser power were determined to be the “critical few” factors whereas, patient’s psychology, sterilization and hygiene, and suction-ring’s pressure were found to be the “trivial many” factors. The most frequently occurring complication was found to be subconjunctival haemorrhage. Conclusion: The process sigma level of the process was measured to be 3.3547. The surgical team concluded that sixteen complications (out of seventeen) should be significantly reduced by taking the necessary preventive measures

Development of Six Sigma Infrastructure for Strabismus Surgeries

The purpose of this study is to show how a private eye care center in Turkey developed a Six Sigma infrastructure to investigate the root causes of complications occuring during strabismus surgeries. To analyze the collected data, main tools of Six Sigma’s Define-Measure-Analyze-Improve- Control (DMAIC) improvement cycle such as SIPOC table, Fishbone Diagram and, Failure, Mode and Effect Analysis were implemented. Patient’s eye anatomy, experience of the anesthesiologist, experience/attention of the strabismus surgeon was identified to be Critical-to-Quality (CTQ) factors for a successful strabismus surgery. The most frequent complications of strabismus surgeries were found to be X, Y and Z. The process sigma level was found to be 3.2025

Formation of Six Sigma Infrastructure for the Coronary Stenting Process

The purpose of this study is to show how a tertiary care center in Turkey operating mainly in cardiology initiated Six Sigma principles to reduce the number of complications occuring during coronary stent insertion process. A Six Sigma’s Define-Measure-Analyze-Improve-Control (DMAIC) model for coronary stent insertion is suggested. Data were collected for 24-months. Twenty-two Critical-to-Quality (CTQ) factors were identified for successful coronary stent insertion. The most frequent causes of complications in the process were found to be patients with previous bypass surgery or PCI, inexperience of staff members, highly damaged vessel structure, thin and/or long vessel diameter, inappropriate selection of stent type, inappropriate selection of balloon type and poor image quality

Deployment of Six Sigma Methodology to Reduce Complications in Intravitreal Injections

The purpose of this study is to show how a private eye care center in Turkey initiated Six Sigma principles to reduce the number of complications encountered during and after intravitreal injections. Data were collected for 30-months. To analyse the complications among 229 injections administered on 106 patients, main tools of Six Sigma’s Define-Measure-Analyze-Improve-Control (DMAIC) improvement cycle such as SIPOC table, Fishbone Diagram and, Failure, Mode and Effect Analysis were implemented. Sources and root causes of seven types of complications were identified and reported. For a successful intravitreal injection, experience of the retina specialist, attention of the retina specialist and patient’s ocular pathology were determined to be the “critical few” factors whereas, sterilization and hygiene, dosage of drug/agent and chemical properties of drug/agent were found to be the “trivial many”factors. The most frequently occuring and the complication with the highest hazard score was found to be subconjunctival haemorrhage. The process sigma level of the process was measured to be 3.2657. The surgical team concluded that six of the complications (out of seven) should be significantly reduced by taking the necessary preventative measures

Sermaye yapısının belirlenmesinde finansman hiyerarşisi teorisi: Türkiye’deki işletmeler üzerine panel veri analizi [Pecking order theory in determining the capital structure: a panel data analysis of companies in Turkey]

Sermaye yapısı kararları, işletmelerin faaliyetlerini devam ettirebilmeleri ve sağlıklı bir biçimde büyüyebilmeleri açısından üzerinde durulması gereken önemli bir konudur. Bu çalışmanın amacı işletmelerin sermaye yapısı belirleyicilerini tespit etmek ve gerçek hayatta işletmelerin hangi sermaye yapısı teorisine uygun davranış sergilediklerini ortaya koymaktır. Sermaye yapısını belirleyici unsurların özelliklerini ve bu unsurların sermaye yapısını ne yönde etkilediklerini bilmek sermaye yapısı kararlarının daha etkin bir şekilde alınmasını sağlayacaktır. Bu amaç doğrultusunda, hisseleri Borsa İstanbul’da işlem gören 186 imalat sanayi işletmesinin 2009-2016 yılları arasındaki bilanço ve gelir tablosu verilerinden yararlanılarak panel veri analizi yapılmıştır. Analiz sonuçları söz konusu işletmelerin finansman hiyerarşisi teorisine uygun davrandıklarını fon kaynağı ihtiyacında öncelikli olarak iç fon kaynaklarını tercih ettiklerini, iç fon kaynaklarının yetersiz olması durumunda dış fon kaynaklarını kullanma yoluna gittiklerini göstermiştir. Capital structure decisions are an important issue that should be emphasized in order to enable enterprises to continue their activities and grow in a healthy manner. The purpose of this study is determining the capital structure and evaluating which capital structure theory fits the firms' attitude. Knowing the characteristics of the determinants of capital structure and how they affect the capital structure will enable capital structure decisions to be taken more effectively. For this purpose, panel data analysis was carried out by using the balance sheets and income statements data of 186 manufacturing companies, whose shares are traded in İstanbul Stock Exchange between the years 2009-2016. The results of the analysis indicate that firms firstly use internal funds. External funds are used only when internal funds are insufficient. The results of the analysis show that these firms’ attitudes are fit with the pecking order theory.</p

Psödoeksfoliasyonlu Hastaların Katarakt Ameliyatlarında Alti Sigma Altyapısının Geliştirilmesi

Amaç: Psödoeksfoliasyon (PSX) sendromlu hastalarda katarakt ameliyatları sırasında ve sonrasında karşılaşılan komplikasyonların sayısını azaltmak için bir Türk kamu hastanesinin göz kliniğinde başlatılan Altı Sigma çalışmalarını göstermek. Metod: Veriler üç yıl boyunca toplanmıştır. Sürecin analizinde, Altı Sigma'nın Tanımlama-Ölçü-Analiz-Geliştirme-Kontrol (DMAIC) iyileştirme döngüsünün temel araçları olan SIPOC tablosu, Balık Kılçığı Diyagramı ile Başarısızlık, Süreç Hata Modu ve Etki Analizi uygulanmıştır. On tip komplikasyon, kaynak ve kök sebepleri ile tespit ve rapor edilmiştir. Sebep: Göz cerrahın deneyimi, hastanın anatomisi, ameliyat sırasında hastanın işbirliği, sterilizasyon ve hijyen, asistan cerrahın dikkati, ekipman kalibrasyonu ve göz içi malzemenin kalite / kimyasal bileşiminin başarılı bir ameliyat için Kritik Kalite faktörleri olduğu tespit edilmiştir. En sık görülen komplikasyonun ise arka kapsül yırtığı olduğu saptanmıştır. Sonuç: Tüm üç yıllık sürecin sigma seviyesinin 3,703 olduğu ölçülmüştür. Cerrahi ekip, tüm komplikasyonlarda önemli ölçüde gerekli önlemlerin alınarak, seviyelerinin azaltılması gerektiği sonucuna varmıştır