Pendekatan Lean Healthcare Untuk Meminimasi Waste Di Rumah Sakit Islam Unisma Malang

Lean adalah suatu upaya terus-menerus untuk menghilangkan pemborosan (waste) dan meningkatkan nilai tambah (value added) produk, baik barang maupun jasa, kepada pelanggan. Lean yang diterapkan dalam industri kesehatan disebut juga lean healthcare. Salah satu Rumah Sakit swasta yang ada di daerah Malang yakni Rumah Sakit Islam Unisma. Penelitian ini akan difokuskan pada waste yang ditemukan di Unit Rawat Jalan dan Rawat Inap, yang mana kondisi saat ini masih terdapat aktivitas yang tergolong waste. Pada penelitian ini Big Picture Mapping digunakan untuk mengidentifikasi proses yang ada di dalam instalasi rawat jalan dan rawat inap. Identifikasi aktivitas sepanjang big picture mapping bertujuan untuk mengetahui dan menghitung presentase aktivitas-aktivitas yang termasuk kategori aktivitas yang memberikan nilai tambah, aktivitas yang penting namun tidak memberikan nilai tambah, dan aktivitas yang tidak memberikan nilai tambah. Fishbone Diagram digunakan untuk menganalisis sebab dan akibat suatu permasalahan sehingga ditemukan akar permasalahan dari waste kritis yang terjadi. FMEA digunakan untuk mengidentifikasi dan memberikan prioritas kegagalan. Hasil dari FMEA menunjukkan penyebab kritis dari waste motion adalah kondisi tata letak dokumen dalam rak pada ruang penyimpanan status rekam medis belum ergonomis, penyebab kritis dari waste transportation adalah petunjuk ruang kurang jelas, penyebab kritis dari waste waiting adalah penulisan keterangan obat di rak kurang jelas dan sudah jelek, penataan kertas resep obat tidak rapi, hanya ada satu loket resep obat, sedangkan penyebab kritis dari waste defect adalah tulisan petunjuk ruang berwarna sama dengan warna pintu dan petunjuk ruang terlalu kecil. Alternatif solusi yang diusulkan yakni peletakan dokumen pada rak ruang penyimpanan status rekam medis pada tempat yang jauh lebih ergonomis, , pembuatan alat kontrol visual, pengkondisian meja pegawai, denah rumah sakit yang dilengkapi dengan detail foto, diagram alir pelayanan, perbaikan papan nama, pembedaan loket resep racikan dan non racikan, pemberian nomer antrian, dan pelabelan pada rak obat

Perancangan Ulang Tata Letak Fasilitas Dengan Pendekatan Cellular Manufacturing System (Studi Kasus Di PT. Malang Indah)

PT. Malang Indah merupakan Perusahaan yang bergerak di industri pembuatan material bangunan seperti Genteng, Batako, dan Paving. PT. Malang Indah memiliki mesin-mesin khusus dalam proses produksi material-material tersebut. Tipe produksi pada Perusahaan ini adalah Make to Order (MTO) dan Make to Stock (MTS). Tetapi PT. Malang Indah lebih menekankan pada tipe Make to Stock (MTS), hal ini bertujuan agar PT. Malang Indah tidak kehilangan pelanggan yang dikarenakan tidak dapat memenuhi kebutuhan pelanggan setiap saat.Dalam pengamatan yang dilakukan di bagian produksi PT. Malang Indah, terdapat fasilitas berupa mesin-mesin produksi yang belum dikelompokkan berdasarkan tipe proses produksi dan jenis produk yang dihasilkan. Tata letak fasilitas seperti ini tentunya akan menghambat kelancaran proses produksi dan mengakibatkan besarnya jarak dan waktu pemindahan bahan atau material handling. Waktu pemindahan bahan untuk proses produksi seluruh produk pada saat ini juga cukup signifikan. Pada penelitian ini, mesin-mesin produksi dikelompokkan berdasarkan proses produksi dan produknya kedalam sel manufaktur atau disebut juga “manufacturing cell” dengan menggunakan Algoritma Genetik. Hasil yang diperoleh dari penelitian ini adalah pengelompokan mesin dengan pendekatan Cellular Manufacturing System berdasarkan Algoritma Genetik, dan menghasilkan 3 buah sel manufaktur. Dari pengelompokan tersebut dihasilkan 3 buah layout alternatif, dan dipilih layout 3 karena secara keseluruhan memiliki total jarak terpendek

Studi Pola Lengkung Kebutuhan Air Untuk Irigasi Pada Daerah Irigasi Tilong

Daerah Irigasi Tilong dengan luas daerah irigasi sebesar 1.484 ha disuplai air dari Bendungan Tilong dengan debit sebesar 2,23 m3/det pada pintu pengambilan. Dengan kapasitas saluran tersebut, air dialirkan ke seluruh bagian kiri dengan luas 233 ha dan bagian kanan dengan luas layanan 1.251 ha. Dengan luas daerah yang demikian penulis ingin mengetahui bagaimana pola lengkung kapasitas saluran dari kapasitas Tilong Untuk menentukan lengkung kapasitas tersebut, digunakan data klimatologi dengan kala ulang 15 tahun serta data sekunder dari irigasi setempat dan mencari berapa besarnya kebutuhan air di sawah per hektar. Dengan demikian digunakan rumus perhitungan kapasitas saluran dengan rumus NFR dan Lengkung Kapasitas Tegal untuk mendapatkan besarnya kapasitas saluran. Dengan metode perhitungan kebutuhan air diperoleh nilai besarnya kebutuhan air maksimum per hektar di Daerah Irigasi Tilong sebesar 2,12 ltr/dt.ha. Analisis kapasitas saluran dengan menggunakan rumus NFR dan Lengkung Kapasitas Tegal menunjukkan kebutuhan air yang berbeda. Pola lengkung yang trend dari rumus NFR membentuk linear artinya terjadi penambahan kapasitas pada saluran jika areal yang dilayani semakin luas sedangkan dengan Lengkung Kapasitas Tegal membentuk garis parabola artinya akan terjadi pengurangan kapasitas saluran ketika areal yang dilayani semakin luas

Solutions to the ultradiscrete Toda molecule equation expressed as minimum weight flows of planar graphs

We define a function by means of the minimum weight flow on a planar graph and prove that this function solves the ultradiscrete Toda molecule equation, its B\"acklund transformation and the two dimensional Toda molecule equation. The method we employ in the proof can be considered as fundamental to the integrability of ultradiscrete soliton equations.Comment: 14 pages, 10 figures Added citations in v

Relationships Between Two Approaches: Rigged Configurations and 10-Eliminations

There are two distinct approaches to the study of initial value problem of the periodic box-ball systems. One way is the rigged configuration approach due to Kuniba--Takagi--Takenouchi and another way is the 10-elimination approach due to Mada--Idzumi--Tokihiro. In this paper, we describe precisely interrelations between these two approaches.Comment: 16 pages, final version, minor revisio

The Implementation of Speech Recognition using Mel-Frequency Cepstrum Coefficients (MFCC) and Support Vector Machine (SVM) method based on Python to Control Robot Arm

In this paper describe an implementation of speech recognition to pick and place an object using Robot Arm. To get the feature extraction of speech signal used Mel-Frequency Cepstrum Coefficients (MFCC) method and to learn the database of speech recognition used Support Vector Machine (SVM) method, the algorithm based on Python 2.7. The data learning which used to SVM process are 12 features, then the system tested using trained and not trained data show the best agreement to identifying the speech recognition. The speech recognition system has been implemented for control the 5 DoF Robot Arm based Arduino microcontroller to doing task pick and place the object

Application of Numerical Newton-Raphson Method in Calculation of Emitter Water Discharge of Drip Irrigation System in “Mutis Cemerlang” Coffee Plantation

Based on the slope class, the shape of the area and the elevation of dry land in Nusa Tenggara, agricultural land in Noepesu Village is suitable for planting coffee plants with an agroforestry scheme. To overcome the problem of limited water, drip irrigation system technology can be applied. The use of drip irrigation as an agricultural technology in Noepesu village has been carried out by many farmer groups. Still, the installation process does not consider the pipe specifications (pipe length and pipe diameter) and the condition of agricultural land. This causes the service life of drip irrigation to be not long. If this continues, of course, it will increase system installation costs. To optimize service life, a hydraulics analysis method is needed for drip irrigation pipe network systems that take into account pipe specifications and agricultural land conditions.The hydraulics analysis of the drip irrigation network system determines the emitter’s water flow rate. The emitter flow rate forms a nonlinear equation known as the closed pipe equation. In the process of solving these equations, numerical methods can be used, specifically the Newton-Raphson method. This study focuses on applying the Newton-Raphson method to calculate the amount of water discharge from each emitter of the drip irrigation network system on the farmland of the Mutis Cemerlang Farmer Group in Noepesu Village. The drip irrigation system is designed with 250 nodes, 275 pipes, 26 loops, and 86 outlets divided into two sides, with the left side containing 84 outlets with one emitter and the right side containing 102 outlets with two emitters. The amount of water discharge for each emitter is 0,0008 ml/second≤Q≤2,6 ml/second for the left side and 0,001 ml/second≤Q≤1,1 ml/second for the right side, as determined by simulation calculations utilizing the Newton-Raphson method and Matlab software. The simulation results show that the amount of water discharge at each emitter is ideal in the first iteration because it has a discharge correction value (∆Q)≈0

Effect of different concentrations of soybean lecithin and virgin coconut oil in Tris-based extender on the quality of chilled and frozen-thawed bull semen

Aim: The objective of this study was to evaluate the effects of different concentrations of soybean lecithin (SL) and virgin coconut oil (VCO) in Tris-based extender on chilled and frozen-thawed bull semen quality parameters. Materials and Methods: A total of 24 ejaculates were collected from four bulls via an electroejaculator. Semen samples were diluted with 2% VCO in Tris-based extender which consists of various concentrations of SL (1, 1.25, 1.5, and 1.75%). A 20% egg yolk in Tris used as a positive control (C+). The diluted semen samples were divided into two fractions; one for chilling which were stored at 4°C for 24, 72, and 144 h before evaluated for semen quality parameters. The second fraction used for freezing was chilled for 3 h at 4°C, packed into 0.25 mL straws and then cryopreserved in liquid nitrogen. The samples were then evaluated after 7 and 14 days. Chilled and frozen semen samples were thawed at 37°C and assessed for general motility using computer-assisted semen analysis, viability, acrosome integrity and morphology (eosin-nigrosin stain), membrane integrity, and lipid peroxidation using thiobarbituric acid reaction test. Results: The results showed that all the quality parameters assessed were significantly (p<0.05) improved at 1.5% SL concentration in chilled semen. Treatment groups of 1, 1.25, 1.5, and 1.75% SL were higher in quality parameters than the control group (C+) in chilled semen. However, all the quality parameters in frozen-thawed semen were significantly higher in the C+ than the treated groups. Conclusion: In conclusion, supplementation of 1.5% SL in 2% VCO Tris-based extender enhanced the chilled bull semen. However, there was no marked improvement in the frozen-thawed quality parameters after treatment

Characterization of 4-HNE Modified L-FABP Reveals Alterations in Structural and Functional Dynamics

4-Hydroxynonenal (4-HNE) is a reactive α,β-unsaturated aldehyde produced during oxidative stress and subsequent lipid peroxidation of polyunsaturated fatty acids. The reactivity of 4-HNE towards DNA and nucleophilic amino acids has been well established. In this report, using proteomic approaches, liver fatty acid-binding protein (L-FABP) is identified as a target for modification by 4-HNE. This lipid binding protein mediates the uptake and trafficking of hydrophobic ligands throughout cellular compartments. Ethanol caused a significant decrease in L-FABP protein (P<0.001) and mRNA (P<0.05), as well as increased poly-ubiquitinated L-FABP (P<0.001). Sites of 4-HNE adduction on mouse recombinant L-FABP were mapped using MALDI-TOF/TOF mass spectrometry on apo (Lys57 and Cys69) and holo (Lys6, Lys31, His43, Lys46, Lys57 and Cys69) L-FABP. The impact of 4-HNE adduction was found to occur in a concentration-dependent manner; affinity for the fluorescent ligand, anilinonaphthalene-8-sulfonic acid, was reduced from 0.347 µM to Kd1 = 0.395 µM and Kd2 = 34.20 µM. Saturation analyses revealed that capacity for ligand is reduced by approximately 50% when adducted by 4-HNE. Thermal stability curves of apo L-FABP was also found to be significantly affected by 4-HNE adduction (ΔTm = 5.44°C, P<0.01). Computational-based molecular modeling simulations of adducted protein revealed minor conformational changes in global protein structure of apo and holo L-FABP while more apparent differences were observed within the internal binding pocket, revealing reduced area and structural integrity. New solvent accessible portals on the periphery of the protein were observed following 4-HNE modification in both the apo and holo state, suggesting an adaptive response to carbonylation. The results from this study detail the dynamic process associated with L-FABP modification by 4-HNE and provide insight as to how alterations in structural integrity and ligand binding may a contributing factor in the pathogenesis of ALD