Journal of Medical Council of Iran
Year:2013 | Volume:31 | Issue:1|Papers Count:10

Introduction: family physician plan is one of the most important methods of improving access and equitable utilization of the health services for public. Therefore, this study, investigated the rate of customer load before and after implementation of the family physician program.Methods: in this cross-sectional study, existing data have been described and analyzed. Data were collected and entered into excel spreadsheet. To evaluate trend of customer load during the study period and to compare customer load before and after implementation of family physician, linear and column chart were used respectively. Absence of error bar line overlap, was considered as significant criterion.Results: Mean of customer load for physician, midwife, laboratory and pharmacy before and after implementation of family physician program were 0.3, 0.06, 0.2, 0.03 and 1.3, 0.4, 0.58 and 0.08, respectively.Conclusion: findings showed that rate of customers reference load to family physician team were very impressive and remarkable. Maximum increase of customer load after implementation of family physician was attributable to midwifery services, physician visits, laboratory and pharmacy respectively. Therefore, it is expected that this increase of customer load create positive impact on health sector indicators. Thus, it is suggested to investigate the components of this program systematically.

Introduction: Activity Based Costing (ABC) is a method to illustrate cost of products and is capable to provide non-financial information to improve efficiency of organizations. The Aim of this study is to determine cost of radiology and sonography services and to demonstrate difference between fees and cost in public sector.Methods: We analyzed more than 100 different radiology and sonography services using work and time study to determine dedicate time and resource for each service in radiology ward of Hafez hospital. Total cost of overhead centers was allotted to services using concurrent equation method after calculation.Monte Carlo simulation method has been used to calculate confidence interval of each cost price. Estimated cost price has been showed in details that included activities description, kind, amount and cost of material, equipment and energy consumed by each service. Also we calculated building depreciation and amount of total cost allotted to each service from overhead centers such as management, accounting and so on.Results: fees 36678 and 42038 respectively for radiology and sonography services. Our results indicated that main components of cost were human resource (48%), overhead cost (27%), equipment depreciation cost (14%) and material cost (11%).Conclusion: Due to low productivity, cost of service was higher then received fees. So, for overhead cutting, the best was is increasing service volume. Finally we must mention that for making fees move realistic and imporoving service level use of ABC system is a necessity.

Introduction: Social security organization offers indireet and direct models of health services to the society. Because dircet services are free, there is a high volume of demand by society for that. On the other hand, health centres and societies ore interested in indirect ones. This study is done for evaluation of both dircect and indircet health facilition around the country and the balance between people needs and facility listrulations.Methods: This is an analytical and retrospective study. Information gatheting was by a data shat form, and then data were analyed by spss software. correlation was evalaated by pearson regression test.Results: Centers and doctors accessibitity ware 14.7 centers for every 10000 and 10.2 doctor for 10000 persons, respectively. Of 10.2 for 10000 doctor to person ratio, 4.8 were gor general physicians, 4.4 for specialists and 1 for dentist.Conclusion: In regand to contract with health care centres and also constructig and creating new social security organiation related hospitals, the most inportant issue is paying atteation to justice in country based distribution. first priority must be given to physio therapy, radiology, and dentistry offices, second priority is signing contrect with clinical labratoies pharmacies, and general physicion offices.

Introduction: New and effective health care needs a cooperation between doctor and patient. patients’ satisfaction is necessany for a good Doctor-patient relationship. this study evaluate factors affecting patients content.Methods: A descriptive- analytical survey was performed from November to December 2010. The study sample consisted of 100 patients hospitalized in the emergency wards of Imam Khomeini and Mustafa Hospitals in Ilam- Iran. Subjects were selected by simple random sampling method. Data were collected by questionnaire and it’s reliability was checked using Cronbach α coefficient. Factorial analysis technique was used to find the most important factors affecting patients’ satisfaction. Normal distribution for factor scores was assessed using the Kolmogorov-Smirnov test. Data were analyzed using the Mann-Whitney test and Spearman correlation coefficient. P<0.05 was considered significant.Results: Explanatory factor analysis showed that the patient’s satisfaction is affected by six factors including: satisfaction of physician, nursing staff, presence of students, method of reception and discharge, deciding for cure and knowing the position of therapist. According to the results of factorial analysis, roleand patient’s satisfaction of physician was the most important issue. There was an statistically significant relationship between occurrence time with patients’ satisfaction (r=0.23, P=0.027), number of visit and satisfaction (r=0.27, P=0.00), and occurrence time with number of visit (r=0.36, P=0.000), and time of visits and satisfaction of physician (X2=10.3, P=0.016).Conclusion: since there is a direct relationship between number and time of physician visit with patient’s satisfaction, therefore it recommended to aware physician about this issue.

Introduction: One way to promote quality of medical service and decreased rate of physician faults is to investigate complains that lead to physician convictions. This study evaluated frequency of complaints in different surgical specialies for Laparoscopy surgery.Methods: a descriptive cross sectional survey including review of all files containing complaints against, laparoscopic surgeries considered in forensic medicine sessions during 4 years (2003-2007) in Forensic Medicine Organization committees.Results: 37 (%4.5) out of all files (822) submitted during 4 years were about laparoscopic surgeries. The mean age of patients with complain was 36.34 ±9.21 years, among them 91.2% were females and 8.8% were males. Most frequent complaints were from Ob-Gyn specialists (50%) and the majority of complaints were happened in private system (66.7%) in comparison to public hospitals (27.1%). Filing a lawsuit most frequently happened after demise of patients (36.1%) with general surgery with 61.57% of all cases.Conclusion: patients with complaints were mostly under 50 years old and 91.2% were females, showing that females and young age patients have more desire to bring the case to the court. The majority of complaints happened in private Hospitals. Most of complaints were in private-system which may be due to high medical costs that were paid to physicians which lead to more expectations.

Introduction: Tracheostomy, is one of the ways to manage majo problems in the upper airways, in which a hole is performed in the anterior tracheal wall to establish a temporary airway. in the past tracheostomy was performed because of upper airway obstruction due to infectious disease. Now the reasons have changed. This study was conducted to assess indications and early complications of tracheostomy in patients hospitalized in Imam Khomeini Hospital, Ahvaz, for a 5 years period.Methods: This cross sectional and retrospective study was performed on 151 patients in Ahvaz Imam Khomeini Hospital during 2001- 2006. Patients were assessed for indication, timeing and early complication of the procedure. Factors such as age, sex, causes and complications of tracheostomy and mortality has been analysis.Results: 104 males (68.9%) and 47 females (31.1%) with a sex ratio of 2.26 to 1, males to famales and mean age of 47.8 mean assessed. The youngeot one was 1.5 and oldest one 85 years old. The commonest indications for tracheostomy were laryngeal cancer in 69 cases (45.7%) and then prolonged intubation in 53 patients (35.1%). 49 patients had carly complications with the most common one subcutaneous emphysema in 20 patients (13.5%). Death occurred in 11 cases which were related to underlying disease without any relation to tracheostomy itself.Conclusion: Tracheostomy is a procedure that can be life-saving and when necessary, surgeon skill and knowledge can decrease it’s side-effects.

Medical Laboratory as a basis for disease diagnosis has significant role in the care, control and prevention of communicable and uncommunicable diseases. With recent labratory science progress, the importance of this knowledge becomes clearer for both patients and physicians. Precision, speed, and ethics along with using updated standard scientific methods, are desirable characteristics of a clinical laboratory. Active employees in the medical laboratory are committed to the principles and ethical behavior. Due to the importance of ethics in the laboratory, the World Health Organization and International standard Organization have provided guidelines. Data collection, patient consent, confidentiality, testing, reporting results, archiving documents, access to documents, organized financial arrangement, some specific requests such as autopsy and testing of AIDS are some of the important issues in ethical behavior in medical laboratories discussed in this paper. Laboratory experts and technicians can improve their services using such information.

Using the long implant Fixtures in maxilla for reasons link low bone density, post menopausal osteoporosis or bone defect of the jaws because of accidents or trauma, started in late 1980s and early 1990s in Europe and U.S.A. In this method the long fixtures (more than 30 mm long) are fixed to the bones other than maxilla and normally to the Zygoma-check or Zygoma-orbital process. This report has been published to show that one of the first attempts of using this method has been made in Iran in late 1980s and by sure this is the first surgery of this kind in Iran and perhaps is the first in th word with a record of more than 23 years of success. The implants are well in place working properly. In face due to splinting of two implants to four natural teeth the imptants persisted in spite of total destraction of the rest of patients teeth.The author believes this case report is the only zygomatic implant carrying a full arch bridge which remained in place for 25 years until now.