ABSTRACT
Background: One of the work patterns which affects the supply of specialists is the phenomenon of dual practice [DP], i.e., working simultaneously in the public and private sectors. Uncontrolled DP in the surgery health workforce can have adverse effects on access to surgeons, efficiency, effectiveness and quality of surgery services.
Aims: The aim of this article is to examine the impact of DP on service delivery time by surgeons.
Methods: We used a prestructured form to collect data on surgery specialists in all 925 Iranian hospitals. National medical ID codes, council ID codes, first name, surname and father's name were used for data matching. Multilevel linear regression was used to assess the association between DP and study variables, which were recruitment type, faculty status, experience, sex and age.
Results: The 4642 surgery specialists in this study, representing 31.08% of the total number of surgeons identified, spent mean 1.09 [standard deviation 0.33] hours full-time equivalent [FTE] on health care service delivery. Specialists with DP had long service delivery time [beta = 0.427]. Female specialists [beta = 0.049] and full-time specialists [beta = 0.082] spent less time on health care service delivery. Permanent specialists had higher FTE [P < 0.001] and as the population increases, FTE increases [P < 0.05].
Conclusions: Although DP had a direct impact on surgeons' working hours, it seems that a greater share of the difference in working time was used in the private sector services, leading to poor access to surgery services in the public sector. Therefore, it is necessary to develop a systems approach to regulate DP.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Surgeons , Hospitals , Professional PracticeABSTRACT
Background: Dual practice [DP] is performing several different jobs at the same time and has effects on healthcare services delivery.
Aims: To identify the causes of medical specialists' tendency towards DP in the Islamic Republic of Iran.
Methods: We used a qualitative approach to identify the factors affecting DP in medical specialists in 2016. We used a purposive and outlier sampling method to conduct semistructured deep interviews with 14 key informants. The data analysis was performed simultaneously with data collection using thematic content analysis by MAXQDA [version 10.0]. Interviews continued up to data saturation. The quality of the study was ensured by addressing the criteria of Guba and Lincoln.
Results: The results of the interviews showed six themes and 16 subthemes for specialists' propensity to DP. Major themes included financial incentives, cultural attitudes about professional identity of physicians, experience and academic level of specialists, controlling approaches in the public sector, available infrastructure for responding to the population needs in the public sector, and regional characteristics of health service locations.
Conclusions: Medical specialists' DP is a multidimensional issue, influenced by different factors such as financial incentives, cultural attitudes and available infrastructure. Considering the capacities and conditions of each country, control and management of this phenomenon require regulatory and incentive mechanisms, which in the long term can modify private and public sector differences and increase the willingness of doctors to work in the public sector.
Subject(s)
Humans , Male , Female , Middle Aged , Medicine , Professional Practice , Private Practice , Public SectorABSTRACT
Background: The Cancer Institute of Iran, located in Tehran [Iran's capital city], is a national specialized center for cancer. Cancer patients from all over the country refer to it. This study compared the out-of-pocket [OOP] expenditures of patients from Tehran and patients from other parts of Iran who were hospitalized in this center
Methods: This cross-sectional study included all patients over 18 years of age with head and neck or digestive system cancer who were actively undergoing primary treatment in the Cancer Institute of Iran located in Tehran [the capital city]. Data was collected through a structured interview with the patients themselves and/or their companions and then analyzed using SPSS[16] software
Results: Direct medical costs of patients from Tehran were much higher than those of patients from other provinces. In contrast, the average direct non-medical costs including transportation, accommodation, food, etc. of patients from other provinces were significantly higher than those of patients from Tehran, and 53% of patients borrowed money for their treatments
Conclusion: It seems necessary to develop new supportive policies to alleviate financial costs for cancer patients and help them manage their cancers effectively. Patients from the provinces faced additional costs for travel, food, and accommodations which complicated their access to special services. Establishing and improving specialized cancer centers in other cities can reduce the burden of out-of-pocket expenditures for patients from remote areas
ABSTRACT
There is some evidence to suggest that a benefit might be derived from a program that incorporated both annual physical examination of the breast [BPx] and the teaching of breast selfexamination [BSE]. Current investigation presents the profile of a multicenter community based intervention for evaluating the effect of BSE+BPx on the reduction of morbidity and mortality due to breast cancer amongst women residing in urban areas of Yazd [Iran] from 2008 to 2018. There were three distinctive phases in this trial with 10 years duration: pilot phase with the duration of 1 year, active intervention phase with 4 rounds of annual screening of BPx+BSE and follow up phase with 5 years duration. Tools of enquiry included a pretested questionnaire, repeated annual physical examination of the breast and more importantly mammography, sonography, and fine needle aspiration [FNA]. Data were analyzed using descriptive statistics such as frequencies, percent, mean [SD], tests of chi-square and student t-test with 95% confidence level. Comparison of socio-demographic and socio-economic factors such as age, age at marriage, family size, number of live births, occupation, education level, total family income and marital status showed that no significant difference was seen between the groups [P>0.05]. A response rate of 84.5% was seen by participants of the experiment group visiting the health centers for the first BPx. Our results showed that except for the education and marital status, the difference in other main demographic and socio-economic factors between the groups were not significant, and the response rate of individuals in the experiment group was at an acceptable level
ABSTRACT
Concomitant papillary thyroid cancer and parathyroid adenoma is rare. We report a 55 years old female with papillary cancer admitted for surgery. Preoperative laboratory findings revealed hypercalcemia and then primary hyperparathyroidism. Thyroidectomy, neck dissection and excision of parathyroid adenoma were performed. Histological examination revealed parathyroid adenoma. Serum calcium returned to normal range after surgery. We recommend preoperative check of calcium in patients with thyroid cancer
Subject(s)
Humans , Female , Parathyroid Neoplasms , Adenoma , Carcinoma, Papillary , Hypercalcemia , Hyperparathyroidism, Primary , ThyroidectomyABSTRACT
Tubo-ovarian abscess as a serious complication of pelvic inflammatory disease is very uncommon in sexually inactive girls. We report a case of tubo-ovarian abscess in a 24-year-old sexually inactive girl with transverse vaginal septum who was presented with abdominal pain and a pelvic mass and without prior surgical history and no evidences of appendicitis, inflammatory bowel disease, or cancer. A huge unilateral tubo-ovarian abscess was recognized at laparotomy. Unilateral salpingoophorectomy, hysterectomy and postoperative antibiotic therapy cured the patient. Early diagnosis and treatment are essential to prevent further sequel including infertility, ectopic pregnancy, and chronic pelvic pain which cause morbidity