program development

Follow-up care for discharged preterm infants is crucial to improving neonatal health, but it has faced challenges in the healthcare system of Iran. This study aimed to develop a post-discharge follow-up program for preterm infants. 

This strategic study was conducted at Isfahan University of Medical Sciences from April 2022 to February 2024 in five main stages: (1) Interviews with 42 neonatal care experts (including neonatologists, nurses, and developmental care specialists) to assess the needs and problems in following-up of preterm infants after discharge, (2) Using the Delphi technique for the prioritization of problems identified in the previous stage using expert opinions, (3) Using the SWOT analysis to identify the strengths, weaknesses, opportunities, and threats to the current post-discharge follow-up plans, (4) Using the root cause analysis (RCA) tree diagram for a deeper analysis of the components identified in the previous stages, and drafting the follow-up program, and (5) Validation of the program based on the opinions of a panel of experts. 

Four main themes were identified: Mothers’ poor caregiving empowerment, ineffective post-discharge follow-up planning, lack of psychological support for mothers, and insufficient maternal education. Based on the Delphi technique, the first two themes had the highest priority. The SWOT analysis showed weaknesses in two categories: Mothers’ caregiving and the follow-up care providing system. Using the RCA tree diagram, the weaknesses in mothers’ caregiving had four main categories: Weakness in learning about breastfeeding, post-discharge complications, factors disrupting maternal education, and mothers’ physical and mental stress. Regarding the weakness in the follow-up care providing system, there were two categories of “insufficient access to post-discharge services for infants” and “frequent visits to medical centers”. Based on the opinions of an expert panel, the use of telemedicine for program implementation was recommended.

The post-discharge follow-up program for preterm infants can be used by policymakers in the Iranian Ministry of Health to improve the follow-up care of infants after discharge.

The appointment of managers is one of the most critical decisions in any organization, and it should be based on the competencies of the managers. Managerial competencies at different levels in hospitals offer numerous benefits, including gaining a competitive advantage, strengthening teamwork behavior, and improving financial performance. This study aimed to investigate the role of managerial competencies in enhancing the financial performance of public hospitals in Yazd Province.

This study was applied-developmental in terms of purpose and deductive in terms of approach. In terms of strategy, it was a descriptive-analytical study of the exploratory type, situated within the positivist paradigm. Data were collected using a questionnaire, and the study population comprised managers and supervisors of public hospitals in Yazd Province. Given the limited number of participants, the questionnaire was distributed to all members of the population. Out of 180 distributed questionnaires, 152 valid responses were collected. Data analysis was conducted using Smart PLS3 and SPSS 25 software.

The results indicated that managerial competencies, specifically in the individual, technical, and interactive dimensions, had a direct and significant effect on the financial performance of hospitals.

Selecting competent managers for decision-making related to resource allocation, control, and the efficient utilization of resources can enhance the financial performance of hospitals. Furthermore, it could improve managerial accountability in performance evaluation and help achieve objectives in line with the accreditation standards of public hospitals in Yazd Province.

Development of Fellowship Education is constantly one of the strategies of medical education policy makers because of the key role of graduated fellowships in advanced health care. This study aimed to comprehensively analyzes the current status for Ophthalmic Fellowship Education in Iran.

In this applied qualitative foresight study, using purposive sampling, eleven experts and key informants of Iran’s Ophthalmic Fellowship Education, selected, and invited to participate in a panel of experts. A panel meeting for focused discussion was held on February2023. The data analyzed by thematic approach.

The identified strength points and challenges are presented in 23 main themes, and 65 subthemes. The seven main themes for strengths included, systematic management, successful policies in ophthalmology education, effectiveness of fellowship programs, increasing motivation for academic growth, faculty empowerment, improving access to advanced services, avoiding procedures with questionable indications.
Sixteen themes for challenges included: low educational quality in some centers, lack of community based education, weak professional ethics, low quality of research, lack of comprehensiveness, lack of futuristic approach in developing fellowships, lack of workforce planning, ineffective evaluation system , ineffective centralized admission system, unbalanced admission capacity, receiving fellowship degree to make extra income, performing ophthalmic procedures not related to their fellowship fields , refuse to operate high risk ophthalmic procedures, unattractive Tariffs, regional disparity of medical resources, shortage of advanced technological infrastructures.

Based on experts’ consensus, forward-looking planning is effective in order to maintain the achievements, solve the challenges and improve these courses in line with the desired perspective.

Common Variable Immune Deficiency Disease (CVID) is a group of primary immunodeficiency diseases that is defined as a defect in the functioning of the immune system and is characterized by low levels of immunoglobulin in the blood and an increased incidence of infections. It is a chronic disorder that has no definitive cure and can only be controlled with a blood factor (IVIG) injection. Because of these conditions, patients are affected by a variety of symptoms that limit them. These patients are affected by severe stress and anxiety. This reduces the quality of life and psychological resilience in them. Because this chronic disease affects a person for a long time, its consequences are uncertain, it has high levels of ambiguity in prognosis, and there is no definitive cure. Although medical science has made significant advances in the development of therapies that affect the physical consequences of the disease, facing the consequences of the disease, mental health and emotional adjustment of these patients are the main challenges for the patient and the medical team (9). The important point is that; When suffering from chronic diseases, the psychological factors associated with adaptation in individuals are greatly reduced. Therefore; Positive factors such as resilience, acceptance, life expectancy decrease and also negative factors such as; depression, anxiety and stress increase (10, 11). For this purpose, Logo Therapy was selected as a psychological intervention method and was performed in ten group sessions. The aim of this study was to investigate the effect of group Logo Therapy on increasing resilience and quality of life in CVID patients.

In this study, psychotherapy based on Logo Therapy was developed in 10 group sessions. This online psychotherapy was performed on the experimental group to increase resilience and quality of life of CVID patients and the control group did not receive any intervention and were in contact with the researcher to the extent of informing about the CVID. The statistical population included 32 patients referred to the "Immunodeficiency Research Center of Isfahan University of Medical Sciences" who were randomly divided into experimental and control groups. Logo Therapy helps these patients find meaning and purpose in their suffering and is trained through Logo Therapy techniques to maintain their spirits in the face of difficult and unchangeable conditions and lead a better life. Have. The research protocol is based on the concepts introduced by Victor Frankl and the interpretation of previous protocols. Schulenberg and Hutzel intervention plan was also considered as a research premise (32). In the process of this Logo Therapy, group exercises and homework were developed and presented in order to achieve the following goals:* Helping people to clarify values that have a special meaning to them. Set reasonable goals for individuals. Ensuring that people's goals achieve their meaningful personal values.Practical planning to achieve people's goals and teaching the concept of time in goals.Identify the strengths and weaknesses of people that affect the achievement of their goals. Consider the strengths and weaknesses in planning to achieve goals that are in line with people's values. Teaching Logo Therapy techniques to reduce stress and psychological pressure.The Connor & Davison Resilience Questionnaire (CD_RSC) and the Common Variable Immune Deficiency Quality of Life Questionnaire (CVID_QoL) were used in the pre-test, post-test and one-month follow-up stages of intervention.

The data of this study were analyzed by repeated measures analysis of variance using SPSS23 software. The findings showed; Research stages include; Post-test and follow-up in resilience are not generally different from each other, but in the minimum stages of research i.e. post-test and follow-up or the effect of time on resilience in the two groups, the data are different. The difference between the groups in the stages of research on resilience is equal to 27.1%. Logo Therapy in the post-test phase increased the mean resilience scores in the experimental group and the effect of intervention continued in the follow-up phase. According to the results, it can be concluded that the first hypothesis of the research has been confirmed. In other words, Logo Therapy has been effective in increasing resilience in people with CVID. Post-test and follow-up results on quality of life are generally not different from each other, but at least the process of research stages, i.e. post-test and follow-up or the effect of time on quality of life are different in the two groups. The difference between the groups in the stages of research on quality of life is 12.9%, which shows that Logo Therapy in the post-test phase has increased the average scores of quality of life in the experimental group and the effect of intervention in the follow-up phase has continued. According to the mentioned results, the scores of quality of life and resilience in the post-test stage were associated with a significant increase and in the follow-up stage of intervention was relatively stable. (P <0.05).

From the findings of this study, it is concluded that Logo Therapy has been effective in increasing resilience and the quality of life of CVID patients.The concepts of Logo Therapy taught to these patients have improved their psychological state. Logotherapy has helped these patients become more resilient in the face of illness by teaching concepts such as finding meaning in suffering and accepting it as part of life. Also, the meaning of life has helped these people to accept the existing problems and experience less stress. This acceptance has increased their quality of life. According to the findings of this study, it is suggested that in addition to medical interventions, Logo Therapy should be used as a psychological intervention to improve the quality of life and resilience of these patients. The goal and mission of medicine and psychology is to increase the quality of life of patients. Coherence of these interventions will have significant effects on improving the condition of CVID patients.