Bir kamu hastanesinde yemekhane hizmet sürecinin iyileştirilmesi

Neredeyse tüm hastanelerin bilinen problemlerinden birisi, farklı düzeylerde de olsa, yemeklerin hastalara soğuk ulaşmasıdır. Problemin çözümü süreç iyileştirme kapsamında ele alınabilmektedir. Bu çalışmada, bir kamu hastanesinde daha önceden yapılmış bir anket sonucu ortaya çıkan bu sorun, süreç iyileştirme analizi yapılarak çözülmeye çalışılmakta, iyileştirme önerileri ortaya konmaktadır. Araştırmada, tanımlayıcı ve açıklayıcı bilgileri elde etmek için tarama modeli kullanılmıştır. DMAIC metodolojisi takip edilerek etki-neden analizleri yapılmış, yemek dağıtım süreleri gözlemlenmiştir. Yemek dağıtım sürelerini olumsuz etkileyen darboğazlar üzerinde durularak yemekhane servislerinin daha kısa sürede gerçekleştirilebilmesi için Hizmet Kalite Standartları da gözetilerek öneriler ortaya konmuştur.One of the common problems that exists at different levels in almost all of the hospitals, is serving the meals to patients cold. The problem could be solved by process improvement approach. In this study, the problem, which emerged as an outcome of a previously conducted survey, is to be solved in a public hospital and improvement suggestions are put forward. In the research, a scanning model is used in order to attain descriptive and explanatory information. Following the DEMAIC methodology, cause and effect analyses were conducted; times for meal serving were observed. Focusing on the bottlenecks that affect negatively the meal serving times, improvement suggestions were made to realize the serving time shorter by taking into account the Quality Service Standards

Does asymptomatic/uncomplicated SARS-CoV-2 infection during pregnancy increase the risk of spontaneous preterm birth?

Objectives: The aim of this study was to analyze the perinatal outcomes of asymptomatic/uncomplicated SARS-CoV-2 infection during pregnancy and the relationship between gestational age at the time of infection and spontaneous preterm birth (PTB). Material and methods: This was a retrospective cohort study. The study population included pregnant women who were 19–45 years old and who had been admitted to a Research and Training Hospital for singleton birth delivery. Women who had contracted SARS-CoV-2 during their pregnancy (n = 102) were compared to those who were not infected (n = 378) for the development of spontaneous PTB and other perinatal outcomes. The factors associated with spontaneous PTB were analyzed through univariate and multivariate methods. Results: Spontaneous PTB developed in 22.5% of the pregnant women with a history of SARS-CoV-2 infection and in 5.3% without a history of the infection (p < 0.001). The multivariate model determined that compared to the non-infected women, the OR of spontaneous PTB among those who had contracted the virus in the first, second, and the third trimesters were 9.13 (p < 0.001), 1.85 (p = 0.292) and 7.09 (p < 0.001), respectively. Pregnancy cholestasis (3.9% vs 0.5%; p = 0.020) and placental abruption (3.9% vs 0.5%; p = 0.040) were significantly higher in cases with a history of SARS-CoV-2 infection compared to the non-infected women. Conclusions: Asymptomatic or uncomplicated SARS-CoV-2 infection during pregnancy increases the risk of spontaneous PTB. This risk is higher particularly among pregnant women who develop the infection in the first and the third trimesters

Expectations of pregnant women for antenatal care services and factors affecting anxiety severity during the COVID-19 pandemic

Objectives: We aimed to evaluate the difficulties pregnant women encountered while receiving health care, their demands for antenatal care, and their mental state during the COVID-19 pandemic. Material and methods: A total of 447 pregnant women were included in this cross-sectional study. The data were collected through a face-to-face questionnaire, which assessed participants’ demographic, individual, and obstetric characteristics, their opinions regarding the COVID-19 pandemic, expectations from their antenatal care services, and their Beck Anxiety Inventory (BAI) scores. Results: During the COVID-19 pandemic, it was determined that 17.2% of the pregnant women participating in our study could not go to antenatal follow-ups and almost half (45.9%) demanded that their follow-ups be reduced due to the risk of coronavirus transmission. The BAI scores were found to be significantly higher in participants with low-income levels, chronic diseases, those in the third trimester, those with high-risk pregnancy either previous or current, and those who got pregnant unintentionally. Young age, unintentional conception, advanced pregnancy week, previous high-risk pregnancy, and failure to receive regular antenatal care were independent variables that predicted moderate-severe anxiety in logistic regression analysis. Conclusions: In order to minimize the adverse effects of the COVID-19 pandemic on the mental health of pregnant women, it is important to develop support programs that contribute to the well-being of the mother and fetus by recognizing the pregnant women at risk in the antenatal period

The comparison of the perinatal outcomes in monochorionic twin pregnancies with and without selective intrauterine growth restriction

Objective Both fetuses may be affected negatively as a result of the non-equal share of the placenta and vascular anastomoses in monochorionic pregnancies with selective intrauterine growth restriction (sIUGR). In our study, we aimed to investigate the perinatal outcomes of both larger and smaller fetuses in monochorionic pregnancies with and without sIUGR (non-sIUGR) separately. Methods A total of 196 monochorionic twin pregnancies were evaluated retrospectively between January 2013 and January 2019. The cases were grouped as sIUGR and non-sIUGR pregnancies. The pregnancies with sIUGR were also separated into sub-groups as the cases with normal umbilical flow pattern and the cases with abnormal umbilical flow pattern. The perinatal outcomes were investigated separately between the groups for larger and smaller fetuses. Results Of 153 monochorionic pregnancies included in the study, 17.6% (n=27) were sIUGR cases and 82.4% (n=126) were non-sIUGR cases. While the umbilical artery flow pattern was normal in 59.3% (n=16) of the pregnancies which developed sIUGR, 40.7% (n=11) of them had abnormal umbilical artery flow pattern. The preeclampsia rate was found significantly higher in sIUGR pregnancies than non-sIUGR pregnancies (25.9% vs. 11.1%, p=0.042). The need for intensive care for both larger and smaller newborns was significantly higher in sIUGR pregnancies compared to non-sIUGR pregnancies (p<0.001). Three (11.1%) of newborns in sIUGR pregnancies passed away during neonatal period. All of the newborns that passed away were the smaller newborns from sIUGR pregnancies with abnormal umbilical artery flow pattern. Conclusion The pregnancies with selective intrauterine growth restriction (sIUGR) are more associated with high risks in terms of perinatal outcomes compared to the pregnancies with non-sIUGR. In pregnancies developing sIUGR, the risk increases for larger fetus as well as smaller fetus. More prospective studies are needed to investigate whether this increased risk in the pregnancies with sIUGR is associated with prematurity which is more common or is a result of sIUGR

Analytic hierarchy process application in selecting the mode of transport for a logistics company

SUMMARY As a multi-criteria decision-making (MCDM) method, the analytic hierarchy process (AHP) has been used considerably to solve hierarchical or network-based decision problems in socio-economic fields. Following an in-depth explanation of the transport function in logistics and an overview of the MCDM methods, the AHP model is employed in the paper for a logistics company in selecting the most suitable way of transportation between two given locations in Turkey. The criteria used in the selection of transportation modes are identified as the cost, speed, safety, accessibility, reliability, environmental friendliness, and flexibility. Several cost parameters (transportation, storage, handling, bosphorus crossover) are incorporated into the decision-making process. The application is carried out in instructional character. The results of the study indicate that the railway transportation, which is not widely used in Turkey, is also an alternative and suitable means of transportation. Copyright © 2013 John Wiley & Sons, Ltd

Gebelikteki kilo artışının perinatal ve neonatal sonuçlarla olan ilişkisinin değerlendirilmesi

GEBELİKTEKİ KİLO ARTIŞININ PERİNATAL VE NEONATAL SONUÇLARLA OLAN İLİŞKİSİNİN DEĞERLENDİRİLMESİÖZETGebelik, vücut ağırlığı değişikliklerinin hızlı yaşandığı bir süreçtir ve bu dönemdeki aşırı ağırlık artışı ya da azalışı, yenidoğan açısından önemli sağlık sorunlarına yol açabilir. Kilo alımının gebelik süresince yakından kontrolü hem annenin sağlığı için hem de doğacak olan bebeğin sağlığı için odukça önemlidir. Bu araştırmada, gebelik sırasında kilo alım miktarının, doğum öncesinde, doğum sırasında ve doğum sonrasında annede oluşacak komplikasyonlar ve neonatal dönemde yenidoğanda oluşabilecek komplikasyonlar ile ilişkisi incelenmiştir.15 Şubat 2017 ile 15 Mart 2018 tarihleri arasında Sağlık Bilimleri Üniversitesi Zeynep Kamil Kadın ve Çocuk Hastalıkları Eğitim ve Araştırma Hastanesi’nde Kadın Hastalıkları ve Doğum Kliniği’nde doğum yapan ve aynı hastnaden izlenmiş olan 1081 gebe ile gerçekleştirilmiştir. Araştırmada değerlendirilen tüm değişkenler hasta dosyalarından alınan ve/veya gebelere uygulanan anketlerden elde edilen veriler aracılığı ile elde edilmiştir. Gebelikte uygun kilo artışı tanımı gebelik öncesi ağırlığı dikkate alan Amerika Tıp Enstitüsü (IOM) 2010 rehberine göre yapılmıştır. Verilerin analizinde tekli analizler ve lojistik regresyon analizi kullanılmıştırÇalışmanın sonuçlarına göre gebelerin %36’sı önerilene uygun, %35’i önerilenden fazla ve %26’sı önerilenden az kilo almıştır. Lojistik regresyon analizleri sonuçlarına göre, gebelik döneminde önerilenden fazla kilo artışı olan gebelerde, önerildiği kadar kilo alan gebelere göre gestasyonel yaşa göre büyük olan (LGA) bebek doğumu 6,79 kat (%95 GA 3,36-13,72); gestasyonel hipertansiyon 1,76 kat (%95 GA 1,11-2,79); gestasyonel diyabet 2,00 kat (%95 GA 1,23-3,25) fazla gözlenirken, özerilenden az kilo artışı olanlarda fetal gelişim kısıtlılığı 2,24 kat (%95 GA 1,39-3,62); gestasyonel yaşa göre küçük (SGA) bebek doğumu 2,94 kat (%95 GA 1,86-4,65) ve prematürite 2,96 kat (%95 GA 1,80-4,87) daha fazladır.Gebelikte kilo artışının önerilenden az veya çok olması maternal ve neonatal komplikasyonlarla ilişkilidir. Kilo artışının düzenli izlemi doğum öncesi bakımın önemli bileşenlerinden biri olarak ele alınmalıdır. --------------------EVALUATION OF THE RELATIONSHIP BETWEEN PERINATAL AND NEONATAL RESULTS AND WEIGHT GAIN IN PREGNANCYABSTRACT Pregnancy is a process in which body weight changes are experiencing fast, and excessive weight gain or decrease in this period can lead to significant health problems in terms of newborns. Closer control of weight gain during pregnancy is very important both for the health of the mother and for the health of the baby to be born. In this study, the relationship between weight gain during pregnancy, maternal complications during prenatal, intrauterine and postnatal periods, and also neonatal complications were investigated.Between February 15, 2017 and March 15, 2018, 1081 pregnant women who gave birth at the Obstetrics and Gynecology Clinic of Zeynep Kamil Maternity and Children's Diseases Training and Research Hospital of Health Sciences University were enrolled. All variables assessed in the study were obtained via data obtained from patient files and / or obtained from questionnaires. The definition of appropriate weight gain in pregnancy was made according to the American Institute of Medicine (IOM) 2010 guidelines, which considers pre-pregnancy weight. In the analysis of the data, single analyzes and logistic regression analysis were used.According to the results of the study, 36% of the pregnancies gained weight recommended level, 35% gained weight high than recommended and 26% gained weight less than recommended. According to the results of logistic regression analyzes, LGA baby birth is approximately 6.79 times (C.I. %95 3.36-13.72); the presence of gestational hypertension 1.76 times C.I. %95 1.11-2.79); gestational DM 2.00 times (C.I. %95 1.23-3.25) higher in women who have an excess weight gain during the pregnancy period than women who have the recommended weight gain in pregnancies. The fetal growth restriction is 2.24 times (C.I. %95 1.39-3.62); the presence of SGA baby birth is 2.94 times (C.I. %95 1.86-4.65) and prematurity 2.96 times (C.I. %95 1.80-4.87) higher in women who have an less than recommended weight gain in pregnancies.It is associated with maternal and neonatal complications when the weight gain in pregnancy is more or less than recommended. Regular follow-up of weight gain should be considered as one of the important components of prenatal care

A fuzzy ANP model for the selection of 3D coordinate - measuring machine

Kumru, Mesut (Dogus Author)The analytic network process (ANP) method is normally used to determine the relative weights of a set of evaluation criteria when ranking the competing alternatives in terms of their overall performance. It has the ability to deal with interdependent relationships among the criteria. Since the fuzzy logic approach provides more accuracy on judgments, the fuzzy extension of the ANP method enables the decision-maker to use uncertain human preferences as input information in the decision-making process. The fuzzy ANP enhances the potential of the conventional ANP for dealing with imprecise and vague human comparison judgments. In this work, a fuzzy ANP method is introduced to present a performance analysis on a specific machine tool selection problem. Unlike conventional fuzzy ANP applications, the proposed approach here is to be applied comprehensively for a sophisticated machine selection case in a company. Different from the machine tool selection studies so far done, machine hardware and software are to be discussed together in the selection process. It is used for the selection of a 3D coordinate-measuring machine for a die manufacturing company. The results indicate more accurate and reliable decision making in machine tool selection problem

Using artificial neural networks to forecast operation times in metal industry

This study was conducted in an auto spare parts production plant where the biggest bottleneck in managing the enterprise is the lack of fulfilling the requisitions of the customers on time. The main reason for the delay is the absence of operation time data valid for the required parts ordered with different specifications. For preparing effective schedules and for eliminating the bottleneck, the factory needs to use reliable operation time data for each part produced. An artificial neural network (ANN) approach was used for this purpose, and its forecasting performance was compared with that of multiple linear and nonlinear regression models. Based on the statistical analyses, the ANN approach outperformed the regression models and is found to be more reliable in forecasting the operation times

Analysis of employee satisfaction in an automotive spare parts manufacturing company

Kumru, Mesut (Dogus Author) -- Conference full title: 37. Yöneylem araştırması ve Endüstri Mühendisliği Ulusal Kongresi; Yıldız Teknik Üniversitesi, İstanbul, 5-7 Temmuz 2017Otomotiv yan sanayiinin lider firmalarından birisinde çalışan memnuniyeti incelenmiştir. Bu maksatla bir anket düzenlenmiş, bu anketle çalışanların işyerindeki fiziksel çalışma ortamından, yaptıkları işlerden, iş arkadaşlarından, çalıştıkları şirketten, amirlerinden, genel şirket yönetimi ve eğitim programlarından memnun olup olmadıkları konusunda bilgi edinilmeye çalışılmıştır. Sözü edilen organizasyonel faktörlere ilaveten kişisel faktörler olarak yaş, cinsiyet, hizmet süresi, statü ve eğitim durumu incelenmiştir. Söz konusu değişkenlerin çalışan memnuniyeti düzeyine etkileri araştırılmıştır. Çalışanların sözü edilen faktörlerden memnuniyet düzeyleri ile demografik özelliklerinin ilişkisi parametrik olmayan ki-kare testiyle incelenmiştir. Bu çerçevede oluşturulan dokuz hipotez test edilmiştir. Ayrıca, yapılan iş ve çalışılan şirketle ilgili bazı hususlar yedi ana faktörle ilişkilendirilmeye çalışılmış, örnek regresyon bağıntıları ortaya konulmuştur

Gebelikteki kilo artışının perinatal ve neonatal sonuçlarla olan ilişkisinin değerlendirilmesi

GEBELİKTEKİ KİLO ARTIŞININ PERİNATAL VE NEONATAL SONUÇLARLA OLAN İLİŞKİSİNİN DEĞERLENDİRİLMESİ ÖZET Gebelik, vücut ağırlığı değişikliklerinin hızlı yaşandığı bir süreçtir ve bu dönemdeki aşırı ağırlık artışı ya da azalışı, yenidoğan açısından önemli sağ