نشریه سازمان نظام پزشکی مشهد (سیمرغ سپید)
سال هفدهم شماره 2 (پیاپی 63، پاییز 1392)

Considerable number of medical claims is annually submitted to the disciplinary court of Mashhad Medical Council (MMC) which a part of them are dental malpractice claims. The objective of this study was to analyze these dental claims. This was a retrospective descriptive-analytical study on dental claims submitted to disciplinary court of MMC during 2006 to 2012. Data including gender of plaintiff, subject of claim, gender of defendant(s), defendants’ field of expertise, the judgment of board of experts and the final verdict were entered into a predesigned checklist. During 7 years, 243 claims were submitted. Plaintiffs were women in 51% of cases, men in 41% of cases and legal entities in 8% of cases. Defendants were men in 81% cases and women in 19% of cases. Eighty-three percent of defendants were general practitioners, 15% were specialists and 2% were denture makers. According to the subject of claims, most were related to endodontic therapy (28%), complications of dental extraction (17%), restorative treatments (13 %) and prosthodontics (11 %). In 10% of cases, claims were about non-clinical issues including advertisement violations and occupational misbehavior. According to the judgment of board of experts, 52% of defendants were acquitted, 22% were sentenced of malpractice and in 12% of cases the plaintiff(s) acquiesced while 11% of cases were archived due to forbearance of the plaintiff. Among the 203 claims against general dentists, 48 cases (24%) and among the 36 claims against specialist dentists, 7 cases (19%) were sentenced of malpractice which were not significantly different (P = 0.4). Among the confirmed dental malpractices, most were related to endodontic therapy (30%). Dentists should consider the possibility of occurring malpractices and to reduce its rate, they should update their professional knowledge and increase their information about legal and criminal issues of their job. Training about legal issues and ethics should be included in the curriculum of dentistry students.

Identification of common diseases among villagers according to disease class, age and gender can be an effective aid in training programs and higher level of decision making. The current study was aimed to assess the pattern of frequency of diseases according to international classification of diseases (ICD 10) in an adjutant rural health insurance center of Mashhad University of Medical Sciences. In this descriptive cross-sectional study, all insured villagers visiting an adjutant rural health insurance center in Razavi Khorasan province during 2009 to 2010 who could not access their family physician and need a specialist visit were studied. The patients’ demographic data and initial diagnosis based on ICD10 classification were entered into predesigned software. In this study, 26,999 patients visited the center, of which, 15,671 (58%) were female. According to age groups, lowest number of visits was attributed to patients with 6-12 years of age (n = 835; 3%) and the highest number of visits were related patients with 60 years of age and above (6,015; 22.3%). According to ICD 10, the most frequent diseases were gastrointestinal diseases (13.7 %), musculoskeletal diseases (13.7%) and cardiovascular diseases (11.4%) and the lowest number of disease were genetic and hematologic disorders (1.2%). Among men, musculoskeletal diseases (14.4%) were the most common and gynecological disorders (0.2%) were rare. In women, gynecological diseases (18.6%) were the most frequent and accidents were the lowest number of diseases (0.9%). The findings of this study indicated the need for implementation of surveillance program of non-communicable diseases, identification of risk factors of the diseases, the need for education about lifestyle and maintaining a healthy lifestyle in the rural population and reform of educational curriculum of medical students according to more common diseases.

To establish an integrated health system and balanced urban system in a city, controlling the geographical distribution of medical offices is one of the necessities. The objective of this study was to evaluate the frequency and distribution of offices of general physicians and specialists in the city of Mashhad. In this this study, distribution of physician's offices in the municipality zones of Mashhad was evaluated. Geographical location of physician's offices and demographic characteristics of physicians including gender, general practitioner or specialist, and their specialty were extracted from the databank of Mashhad Medical Council (MMC). The data included physicians registered to the databank up to the beginning of October 2013. In Mashhad, 2,915 physicians (i.e. 45% of registered physicians in MMC) had instituted their private offices. Of these, 1,512 physicians (51.9%) were general practitioners and 1,403 physicians (48.1%) were specialists or subspecialists. Among specialists and subspecialists, gynecologists (15.3%), pediatrics (11.8%) and internists (11.0%) were the most frequent and oncologists (0.2%), occupational medicine specialists (0.2%) and forensics specialists (0.1%) were the lowest in number. Considering the zoning of Mashhad (13 municipality zone), the highest number of private clinics was located in zone#1 (34.9%) and zone#8 (15.6%) and the lowest number was located in zone#12 (0.2 %) and the Samen zone (0.9%) which showed a significant difference among them (P<0.001). Data analysis showed the highest concentration of private clinics in two relatively higher-income zones of Mashhad, particularly around the two main public hospitals (Imam Reza and Ghaem). Up to 8 years ago, vice chancellery for treatment affairs of Mashhad University of Medical Sciences has been controlling the location of private medical offices and has been limiting the licensing in highly crowded zones. Restoring the previous process in collaboration with the MMC and Municipality of Mashhad can help to equilibrate the medical office aggregation, reduce traffic in highly crowded zones and improve citizen's access to physicians.

One of the main tasks of the hospital medical staff is training of patients and their family about the disease, essential tips on how to use drugs and how to prevent recurrence and chronicity of the disease. The objective of this study was to assess patients’ satisfaction about the educational programs provided by nurses and physicians in hospitals of Mashhad. This was a descriptive analytical study which was conducted in five general hospitals in Mashhad during 2011 o 2012. Subjects were randomly selected from hospitalized patients in internal medicine, surgery, obstetrics and gynecology, pediatrics, cardiology and emergency departments. Data were collected with a researcher-made questionnaire that includes demographic features of patients and questions about patients’ satisfaction with the trainings received during hospital stay and also a standardized patient satisfaction questionnaire (PSQ-18). In this study, 62.2% of patients were women and mean age of all patients was 42.3 ± 16.5. The highest level of satisfaction with the trainings was related to diagnosis (68.6%) and lowest rate of satisfaction with trainings was about the impact of illness on family members (8.1%). Statistical analysis showed an inverse significant relationship between age and degree of satisfaction (P = 0.007). The relationship between patients’ educational level and degree of satisfaction was also inversely significant (P = 0.009). In addition, there was a direct significant correlation between the number of admissions and degree of satisfaction (P = 0.007). The highest level of satisfaction (very high and high) of trainings was found from patients hospitalized in the cardiology (78.4%) and obstetrics and gynecology (57.5%) departments and the lowest level of satisfaction was found from the department of internal medicine (9.2%). The findings of this study ascertain the need for improving the trainings provided to patients. Hence, the hospital authorities with the help of experts in education should provide systematic and complete educational programs for patients to increase patients’ satisfaction and reduce medical costs by reducing the length of hospital stay and preventing frequent hospital admissions.

Internal Medicine is one of the earliest medical specialties in Iran and thousands of internists have been graduated in this field of medicine from Iranian universities since 1951. In this study, the characteristics of the training program in this field, job duties and income were evaluated and compared with other countries. Using the Iranian Ministry of Health and Medical Education directive for internal medicine residency training program, the features program, compulsory work hours, income and residency training period were extracted and compared with the rest of the world. Selection of other countries was depended upon data availability. In Iran, the annual capacity for resident admission in internal medicine is about 280 people at 34 universities in the country. Medical doctors can apply for this residency after achieving adequate scores in the Iranian central exam for residency. The training curriculum of internal medicine is devised uniformly for all universities by Iranian Ministry of Health and Medical Education and is consisted of a 4 year training of gastroenterology, endocrinology, nephrology, pulmonary, hematology and rheumatology plus cardiology, neurology, intensive care, poisonings, emergency medicine, radiology and dermatology in hospital departments and continuity clinics. Residency training period in Iran is similar to Turkey and Canada and is lower than most European countries. Weekly working hours in an average has been determined to be 83.75 h that is higher than European countries, Canada and the USA. Four to eight years of medical service in underserved areas have been assigned for Iranian graduates before receiving certification for working in larger cities. Residency training in in each country is affected by different factors such as economic status, work force and distribution of facilities. Training of residents with more knowledge and skills that did not bear remarkable pressure during their study period and thus do not feel emotional exhaustion is a challenging goal for policy makers in medical education.

Senior hospital managers needs to accurate information on the financial resources and facilities to effectively manage their organization. The objective of this study was to investigate the annual statistical characteristics of patients admitted to a referral hospital in Iran. In this study, all patients admitted to Mashhad Imam Reza Hospital in 2012 were studied. Data including age, gender and length of stay obtained from the informatics unit and daily cost of stay calculated by the accounting unit were entered into a statistical software. The daily cost of hospital stay in each department was calculated based on daily bed charge, the average cost of drugs and ancillary medical services (such as radiography or physiotherapy). During 2012, 54,181 patient/admissions (50.3% female) were reported from Mashhad Imam Reza Hospital. The mean (SD) age of the patients was 40.6 (22.8) years. The highest number of patient/admissions was reported from medical toxicology (7488, 13.8%) and urology (6259; 11.6%) departments. Mean age of patients admitted to internal medicine emergency section and (64.3) and CCU#1 (62) was the highest. The longest duration of hospital stay was found in Infectious disease intensive care unit (ICU) with average of 493.9 hours and the shortest length of stay was noted in medical toxicology department (53.6 hours). The highest cost of hospital stay was related to cardiac surgery ICU ($1,664) followed by cardiac surgery department ($952) and the lowest cost was related to psychosomatic ($41) and medical toxicology ($84) departments. There was a significant correlation between length of stay and hospital costs (P < 0.001). There was also a significant direct correlation between patient's age and length of stay (P < 0.001). Providing equitable health services can be achievable by using precise reliable statistical information. By devising hospital protocols for various diseases (rational drug administration and definition of time to discharge), healthcare maximization and reduction in unnecessary healthcare costs can be achieved.

Precise planning and providing appropriate career field for pharmacists is depended on recognition of their interests and their educational and career goals. This study was designed to identify career and educational goals and preferences of pharmacy students and the effective factors on them. The study was performed on students of 3rd, 4th and 5th year of pharmacy school, Mashhad University of Medical Sciences, Mashhad, Iran. Subjects were answered to predesigned questionnaire containing questions about their demographic characteristics and their educational and career goals and preferences. Impact of demographic characteristics on the responses was also statistically analyzed. Of the 150 pharmacy students as the target, 65 (43%) subjects responded to the questionnaires. Of these, 36 respondents (55.4%) were men. Mean (SD) age of the respondents was 22.0 (1.1). Most of the respondents (n = 44, 67.7%) stated that after achieving PharmD degree, they are not intended to study in postgraduate levels. Among the group who intended to study in pharmacy residencies, pharmaceutical sciences was the most popular field. Twenty-eight respondents (43 %) stated that research after graduation is one of their preferences. In terms of employment, most respondents (87.7%) preferred to work in the private sector and most of them (80%) predicted a monthly income of between 400 and 4000 dollars for themselves. There was no relationship between age and gender with intention for study in pharmacy residency and work in public sector. However, there was a significant relationship between gender and predicted income as men predicted higher incomes for themselves (P=0.03). Policy makers of medical education need to identify students’ interests and goals in order to appropriately guide them during academic years. Exploring pharmacy students’ educational and career interests in other parts of the country and with a larger sample size, and developing the essential infrastructures for pharmacists to provide more specialized services seem inevitable.