Abstract
Aim. The aim of this study was to determine the effect of the implementation of clinical surveillance model on the amount of education provided to cardiac patients.
Background. Clinical supervision is a relationship between nurse and observer that promotes the development of nursing professional skills.
Method. This is a quasi-experimental before-after study without control group. The stratified sampling method was used to recruit 300 patients based on inclusion and exclusion criteria. The researcher used the data-gathering form to record teachings provided to patients by nurses and also, the rate of their registration in the medical record. Clinical surveillance model included planning, monthly meetings with health education volunteers, classified teaching, daily clinical supervision, follow-up, identifying the weaknesses of nurses in providing training to cardiac patients and corrective actions in a regular and continuous basis for one year. After the intervention, teachings provided to patients by nurses and also, the rate of their registration in the medical record were re-evaluated. Data were analyzed using descriptive and inferential statistics in SPSS version 19.
Findings. After intervention, the amount of teaching provided by nurses at the time of admission, during hospitalization and at the time of discharge was significantly increased (P<0.001). The findings also showed that the patients were more satisfied with the received teaching after intervention (P<0.001).
Conclusion. Continuous and regular monitoring has a significant role in the amount of education provided to patients by nurses. It is recommended to plan management and supervisory programs to be implemented for nurses involved in patient education.

Abstract
Aim.  This study aimed to determine barriers to patient education from the perspective of patients, nurses and doctors.
Background. Patient education is one of the indicators of quality of heath care services. Patient education could lead to a reduction in the cost of health care and increase the quality of care and ultimately, help the patient to become independent and self-sufficient.
Method. A cross-sectional descriptive study was carried out. The research population included physicians, nurses and patients admitted to different wards of the Rajaee cardiovascular medical and research center. The sampling method was stratified random sampling for each population of the participants (patients, nurses and doctors). Data collection tool was a researcher-made questionnaire that measured the obstacles to patient education. The collected data were analyzed by SPSS software.
Findings. According to physicians, the most important barriers to education for patients was related to patients, and then related to physicians. From the viewpoint of nurses, the most important barriers to patient education were related to nurses. Patients evaluated themselves as the most important barrier to patient education, and then, the most important barriers were  related to nurses from patients’ perspectives.
Conclusion. Regarding the importance of teaching to the patient, it is suggested that the managers take actions to increase the number of nursing staff, provide patients with educational brochures, allocate sufficient funds for patient education, supervise and encourage nurses and doctors, and prioritize training in daily tasks.

Abstract
Aim. The purpose of this study was to examine the effect of peer education on the anxiety - of post Coronary Artery Bypass Graft patients and caregivers
Background. Patients undergoing coronary artery bypass surgery experience moderate to high anxiety, which has also been reported among their family members. Studies have shown that educating patients and their family caregivers has in many cases reduced their anxiety. Peer education and research on the effect of peers is of great importance in promoting therapeutic and caring goals.
Method. This randomized clinical trial study was performed in year 2018 in surgery wards of Rajaee Cardiovascular Medical and Research center. In this study, 60 family caregivers of patients undergoing coronary artery bypass graft surgery and their respective patients were recruited at the time of discharge from intensive care unit and entering into the surgical ward. The subjects were randomly assigned to experimental and control group. Data collection tools included demographic information questionnaire and Spielberger's "State and trait anxiety" form. Initially, patients' family caregivers who were selected as peers were trained by the researcher in three stages. Before visiting the patients by family caregivers, their anxiety and also, patients' anxiety was measured in both groups. Thereafter, the patients’ family caregivers in the control group received routine training, and the patients' family caregivers in the experimental group received peer training in two sessions by their peers. In the third step, the anxiety of patients and their family caregivers in both groups were measured on the second and fifth days after intervention. The data were analyzed in SPSS 20 software.
Findings. Before intervention, the mean scores of anxiety in the experimental and control groups were not statistically different in both patients and their family caregivers, and the mean anxiety scores in both groups were moderate to high. After intervention, the mean score of anxiety in the experimental group was significantly lower than the control group (P≤0.0001). Also, in the second and fifth days after the intervention, there was a significant difference between the experimental and control groups in the mean score of anxiety of the patients and their family caregivers (P≤0.0001).
Conclusion. Peer education seems to reduce anxiety in patients and their family caregivers after discharge from ICU. It is suggested that peer education be used as effective and low cost education to reduce patient and family caregiver anxiety.

Abstract
Aim. This study aimed to examine the effect of open visiting hours on sleep quality, anxiety, and satisfaction of patients undergoing coronary artery bypass graft surgery (CABG).
Background. The importance of visiting patients after CABG has been emphasized in various studies, but there is insufficient evidence to confirm whether restricted /open visits may have more positive or negative effects than each other.
Method. In this clinical trial study, 60 post-CABG patients, admitted to Shahid Rajaei Cardiovascular, Medical and Research center, were randomly selected and divided into experimental (n=30) and control group (n=30). Patients in experimental group received an open visiting schedule (free visiting) and those in control group experienced a regular visiting schedule (restricted visiting). Anxiety was measured on the second and fourth days of hospitalization by the Spielberger Anxiety Inventory (STAI), sleep quality was measured by Richard Campbell and satisfaction was assessed through researcher-made questionnaire on the fourth day of hospitalization. Data were analyzed using independent t-test in SPSS-20 software.
Findings. There was a statistically significant difference between control and experimental groups in terms of anxiety mean score (43.97±6.76 against 35.90±4.31, respectively) (p≤0.0001). There was also a statistically significant difference between control and experimental groups in terms of mean score of patient satisfaction (46.13±7.15 vs 32.23±4.67, respectively) (p≤0.0001). A statistically significant difference was found between control and experimental groups in terms of sleep quality mean score (2.33±0.8 vs 3.33±0.75, respectively) (p≤0.0001).
Conclusion. Open visiting can reduces anxiety, and improves sleep quality and patients' satisfaction after CABG.

Abstract
Aim. This study aimed at examining the effect of preoperative fluid therapy on kidney function in patients undergoing heart surgery.
Background. As one of surgery complications, kidney failure occurs with oliguria and rise in creatinine. Decreased heart output leads to reduction in renal perfusion. Acute renal failure is associated with increase in morbidity, mortality and high medical treatment cost. Various studies has indicated an increase in postoperative mortality rate when complications of acute renal failure superimpose the situation. One of the best strategies for kidney protection is optimizing preoperative hemodynamics and fluid therapy.
Method. In this clinical trial study, 107 patients were recruited based on inclusion criteria and randomly allocated to experimental (n=54) and control (n=53) group. Patients in experimental group received Half- Saline, 1cc/kg/hr, during 12 hours before surgery. Patients in control group started as being NPO, 8 hours before the surgery. Creatinine level, BUN, and 24-hours urine output were measured and recorded during two days after surgery. Data were analyzed in SPSS V.22 using descriptive and inferential statistics.
Findings. The groups didn't differ in terms of age, gender, weight, and ejection fraction. There was no statistically significant difference between experimental and control group in terms of creatinine changes during the preoperative day and the first and the second day after surgery. Also, there was no statistically significant difference between groups in BUN on the first and second days after surgery. The urine output of the experimental group was greater than control group on first and second days after operation, but the difference was not significant. The duration of ICU stay were similar in both groups. There were recorded two deaths in control group while there was no death in experimental group.
Conclusion. It was concluded that preoperative fluid therapy has no short-term effect on kidney function. It is recommended to examine the effect of fluid therapy on kidney function in longer periods.

Abstract
Aim. The present article aimed at reviewing the literature regarding factors causing arteriosclerosis.
Background. The origin of arteriosclerosis, which leads to the development of cardiovascular diseases, is quite complicated. The pathogens involved in arteriosclerosis include hemodynamic, thrombotic, carbohydrates, lipid, metabolic changes, and the inherent properties of the arterial wall. These physiological and biochemical properties finally give rise to the clinical symptoms in patients. Furthermore, environmental factors such as smoking, and changing lifestyle can aggravate these symptoms. The progression of arteriosclerosis and the increase in its severity depends on these risk factors as well as their continuation over time.
Method. The present research reviewed the literature published within the last 20 years concerning the factors causing arteriosclerosis. The articles were searched out using databases Science Direct, PubMed, Cochrane, Medline, SID, Scopus, Iran Doc, OVID, CINAHL, and Magiran and the keywords were Atherosclerosis, atherosclerosis, cardiovascular disease and their Persian equivalents.
Findings. The findings indicated that there have been considerable developments in identifying the factors causing Atherosclerosis, factors such as age, sex, hypertension, smoking, increase in the LDL level, decrease in the HDL and cholesterol level, which are effective in the development of atherosclerosis, and the metabolic factors (disorder of glucose metabolism), thrombogenic and homeostatic factors such as fibrinogen and inflammatory factors that can lead to cardiovascular diseases. Despite the various studies carried out in this regard, cardiovascular diseases are still the leading cause of death as reported by the World Health Organization and the methods for controlling and preventing these diseases have not yet been completely developed.
Conclusion. Taking into account the high mortality rate of cardiovascular diseases, besides identifying the risk factors leading to arteriosclerosis, there must be public education at every level in order to increase awareness, cause fundamental changes in people’s lifestyles, and increase patient self-care education.

Abstract
Aim. This study was conducted to examine the effect of using Burn weaning checklist on the duration of mechanical ventilation and hemodynamic criteria in patients undergoing adult open heart surgery.
Background. Mechanical ventilation is an adjunct or alternative to spontaneous breathing. Due to the proximity of the circulatory and pulmonary systems, the balance of the mechanical ventilation system and the human cardiovascular system is complex, and its weaning must be planned.
Method. This randomized clinical trial study was performed on 80 patients admitted for open heart cardiopulmonary bypass surgery. After random assignment, in the control group, the weaning process was performed according to the routines by a physician, and in the experimental group, the weaning was performed by a Burn checklist by a physician and a nurse. Hemodynamic criteria (first and second hours upon arrival, first and second hours during weaning, first and second hours after weaning) and duration of mechanical ventilation were recorded and compared between experimental and control group. Data were analyzed in SPSS software version 22 using two-way repeated measures ANOVA.
Findings. The mean intubation duration in the experimental group (7.50±1.86 hours) was significantly less than the control group (11.30±3.39 hours) (P≤0.0001). The interaction between group and time for variables diastolic blood pressure (P=0.002), pulse pressure (P=0.003) and heart rate (P≤0.0001) was statistically significant.
Conclusion. The use of the Burn assessment checklist reduces the duration of weaning process in patients after adult open heart surgery. It also helps balancing hemodynamic criteria.

Abstract
Aim. This Study aimed to examine the effect of social networking education on blood glucose control and post-surgical infections after open heart surgery in diabetic patients.
Background. Cardiovascular surgery is one of the most common surgeries that is performed with the aim of increasing survival and improving the quality of life in diabetic patients.
Method. This randomized clinical trial study was conducted on 120 diabetic patients (age range 18-60 years) who underwent open heart surgery at Shahid Rajaei Cardiovascular Research and Research Center. The participants were randomly divided into experimental (n=60) and control group (n=60). In the experimental group, posts were delivered to patients with educational content (such as nutrition education, blood sugar self-monitoring, and ...) on a daily basis for three months on the WhatsApp social network. Data were collected by a checklist consisting of three parts: demographic characteristics, fasting blood sugar (FBS) and glycosylated hemoglobin (HbA1c) of patients before and 3 months after the intervention.
Findings. In both experimental and control group, 55 percent were male and 45percent were female. The percent of patients with postoperative wound infection in the experimental and control groups was 5.0 and 3.3, respectively. After intervention, in the experimental group, the FBS and Hb1Ac median was significantly reduced compared to before the intervention (p<0.001). The levels of FBS and Hb1Ac before and after the intervention did not differ significantly between the experimental and control group.
Conclusion. There was no different between groups in terms of blood sugar control and wound infections after open heart surgery. Due to the easy access, lack of time and space limitations of using social networks, further studies with longer follow-up are recommended.

Abstract
Aim. The aim of this study was to review studies that investigate the factors affecting adherence to treatment in people with cardiovascular disease.
Background. Adherence to treatment is a comprehensive term that is used to convey acceptance of treatment process and following professional advice by the patient to increase the quality of life. Given the importance of adhering to treatment plans and being aware that many people do not follow treatment plans, understanding the factors that lead to patients' effective adherence to the treatment regimen can lead to the development of strategies to increase patients' adherence to the therapeutic regimen.
Method. Articles published between years 2010-2020 were searched out in databases Science Direct, PubMed, Cochrane, Medline, SID, Scopus, CINAHL, OVID, Iran Doc and Magiran using the keywords adherence to treatment, cardiovascular diseases and their Persian Equivalents. Research articles in Persian and English focusing on the factors affecting the adherence to treatment in cardiovascular patients were selected for the study. In total, 167 articles were found in primary search by reviewing the title and abstract and in some cases after studying the full text of the articles; out of them, 11 were selected that were in accordance with the research purpose of this study.
Findings. The most effective methods for improving adherence to treatment were tele-nursing and educating colleagues on how to follow up patients. Also, recognizing differences between personal and psychological aspects of patients and adopting an appropriate method for each person to pursue treatment and increase adherence to the treatment regimen are very important known factors in the care of cardiovascular patients.
Conclusion. In general, the care and training provided and continuous follow-up by the health care professionals have the greatest impact on increasing adherence to the treatment regimen among patients.

Abstract
Aim. This study aimed to examine the effect of education about anti-platelet drugs consumption through telephone follow-up on medication adherence in patients with coronary angioplasty.
Background. Regarding the necessity of proper use of antiplatelet drugs after coronary angioplasty, adherence to treatment is of great importance, and it is considered as one of the major concerns.
Method. This quasi-experimental study was conducted on 392 patients with percutaneous coronary intervention. The patients were divided into two experimental (telephone fallow-up) and control (without telephone fallow-up) group for one year. Adherence to treatment was assessed using the Morisky Medication Adherence Scale before and after percutaneous coronary intervention. Data were analyzed using t-test, chi-square and linear regression model in SPSS software.
Findings. The mean age of patients was 61.71±10.28 years in the experimental group and 60.72±11.14 years in the control group. Changes in the mean score of medication adherence was 53.09±1.37 in the experimental group and 18.09±1.30 in the control group, indicating a statistically significant increase in medication adherence in the experimental group compared with the control group (P=0.001). Non-use of anticoagulants in the experimental group increased until the end of the sixth month of telephone follow-up and then, decreased until the end of the twelfth month of follow-up.
Conclusion. Since changes in the mean score of adherence to medication in the experimental and control groups was significant, it is recommended that follow-up interventions in patients be continued continuously for at least one year.

Abstract:
Aim. The aim of this article is to review studies that have evaluated effective interventions in the prevention of mediastinitis following cardiothoracic surgery.
Background. Mediastinitis and deep surgical wound infections (DSWI) are life-threatening complications of median sternotomy and have a prevalence of 0.4-5 percent. They can produce a significant financial burden on the patient and also the health care system by prolonging the hospitalization period and the need for repeated surgeries or long-term antibiotics. Several risk factors have been identified for mediastinitis following cardiothoracic surgery, many of which are easily preventable by proper diagnosis.
Method. In this literature review, databases including PubMed, Medline, UpToDate, Scopus, Science
Direct, SID, and Magiran were searched out using the keywords Mediastinitis, Prevention, Cardiothoracic
surgery, and their Persian equivalents. Persian and English original articles (including cross-sectional, case- control, cohort studies, and clinical trials) investigating the effective interventions in the prevention of me- diastinitis following cardiothoracic surgeries and were published between 2000 and 2021 and had an available full text, were included in the current study; review articles, letter to editors, and case reports published in non-authoritative journals were excluded from this study. After primary search, 62 relevant articles were found and based on inclusion/exclusion criteria, 16 articles were finally selected and reviewed in the cur- rent study.
Findings. Mediastinitis ca n be prevented before surgery by hand hygiene, weight loss, smoking cessa-tion, proper prophylactic antibiotics, decolonization of nasopharynx and oropharynx from Staph aureus by Mupirocin ointment, and removing hair using depilatory cream (not the blade). Tight blood glucose monitoring before, after, and during the surgery, disinfection of the surgical field by chlorhexidine, using a proper surgical technique for wound closure and stabilizing the sternum, and proper patient training by nurses about red flags of infection can play an important role in the prevention of mediastinitis.
Conclusion. Mediastinitis ca n be easily prevented by identifying its risk factors and controlling them accurately and in a timely manner.