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Aim. This study aimed at examining the effect of nursing care training program on outcomes of mechanically- ventilated infants.

Background. Mechanical ventilation in infants is considered as an invasive procedures with complications such as bronchopulmonary dysplasia, lung bleeding, obstruction or removal of the endotracheal tube, which are almost all preventable. Nurse have responsibility to avoid these complications.

Method. This study was a randomized clinical trial (outcome-based). The study included all infants undergoing mechanical ventilation in the neonatal intensive care unit of Comprehensive Women's hospital in Tehran. Nurses were trained over one month at bedside by the clinical instructor. Data on ventilator complications were collected of 120 cases from patients' medical records, before and after intervention. The data were analyzed by SPSS version 21.

Findings: A statistical significant decrease was seen in most outcomes. The incidence of bronchopulmonary dysplasia declined from 35% to 18%, re-intubation decreased from 57% to 33%, pulmonary hemorrhage declined from 32% to 13%, and pneumothorax changed from 55% to 35%. Duration of mechanical ventilation and length of stay also decreased significantly after intervention. No statistically significant decrease was observed in retinopathy of prematurity and death.

Conclusion. Educational program, especially by the coach, is effective on most outcomes of the infants under mechanical ventilation. Taking into account the workload of nurses and problems with attending in educational classes outside of the ward, it is recommended to hold education at bedside for nurses to improve quality of education.

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Aim. This study examined the effect of white noise on depression of patients in the Cardiac Care Unit (CCU).

Background. Many patients with cardiovascular disease are susceptible to experience depression after admission in Cardiac Care Unit (CCU). Depression can influence patients' recovery.

Method. This was a quasi-experimental study conducted in Shaheed Rajaei Cardiovascular Center, Tehran in 2014. Ninety patients admitted to the cardiac care unit were recruited in the study based on convenience sampling and divided into experimental and control group (45 patients in each group). Depression was measured for 3 consecutive days by depression subscale of DASS-21 questionnaire. In the experimental group, white noise with an intensity of 50 to 60 decibels was played for 30 minutes. Data were analyzed by SPSS , version 17, using independent t-test, paired t-test and chi-square test.

Findings. In control group, no statically significant difference was observed between mean scores of depression, before and after intervention (4.12±4.35 and 3.52±3.74, respectively; p=0.05). In the experimental group, the difference between mean scores of depression, before and after intervention was statistically significant (4.81±4.47 and 3.93±4.48, respectively; p=0.02).

Conclusion. According to the findings, white noise can leads to a significant reduction in depression. This intervention can be used as a simple and low-cost non-pharmacological care for these patients.

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Aim. This study was aimed to assess the effect of self-care educational program on quality of life in patients with hypertension.

Background. Hypertension is a major health problem due to complications and high mortality rate. It causes problems in the ability of patients for self-care and affect their quality of life.

Method. This clinical trial study with control group was conducted in Mahmud-Abad Hospital affiliated to Mazandaran University of Medical Sciences. In this study, 70 patients who met the inclusion criteria were selected through convenience sampling and to prevent information contamination, they were allocated to groups according to whether they refer to hospital even or odd days. Before and three months after intervention, data were collected by quality of life questionnaire SF-36 in both groups. Patients in control group received routine education. Patients in intervention group participated in three face to face self-care education sessions (each session lasted 20 minutes) and received educational package including instruction booklet and CD. Data were analyzed by using Independent t-test, Paired t test, Chi-square test, and Fisher’s exact test through SPSS version 21.

Findings. The results showed that before intervention, there was not a statistically significant difference between two groups regarding quality of life, but after 3 months there was a statistically significant difference (P<0.0001). Also, in the intervention group, there were statistically significant differences regarding the total score of quality of life and all related dimensions, before and three months after education (P<0.0001).

Conclusion. Self-care education can improve quality of life among patients with hypertension. It is recommended that health care providers, particularly nurses, implement these educational programs for improving the quality of life of patients with hypertension.

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Aim. The aim of the study is to investigate the need for hospital infection control and prevention.
Background. Nosocomial infections are among the major health problems which increase mortality and hospital costs, especially in intensive care units. Successful control of nosocomial infections depends on recognition of hospital challenges in this issue.

Method. This study is an overview study. The keywords “hospital infection” and “ICU”, alone or together, with Persian equivalents were searched in websites such as Iranmedex, CINAHL, Scopus, Medline, Embase, SID, PubMed, Magiran and Irandoc.

Findings. Based on the findings, the main causes of nosocomial infections included multiple procedures and invasive diagnostic and therapeutic treatments, especially in ICUs. Compromised immune system, duration of hospitalization, absence of hospital surveillance reporting system, inappropriate disinfection and sterilization of equipment, inappropriate physical structure of ICU, non-cooperative managers and departments, and lack of knowledge of medical staff, especially physicians and nurses.

Conclusion. Identifying causes of hospital infections and the use of especial measures to promote safety and enhance quality of care in the treatment and prevention of these infections are necessary for a comprehensive and integrated controlling program.

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Aim. The purpose of this study was to review the effectiveness of new cardiac biomarkers.

Background. Cardiovascular diseases have been a heavy burden on the health system’s shoulders and caused about 30 percent of human's deaths annually. Irreversible myocardial injury occurs within around 15-20 minutes following the coronary artery occlusion. Therefore, early diagnosis of this problem is very important for the health care professionals to save patients’ lives. Nowadays, thanks to recognition of new biomarkers and using their characteristics, evaluating the short-term and long-term prognosis is possible.

Method. In this study, papers published within the time period 1980 to 2014, were considered. The papers  were searched out by the keywords “cardiac biomarker”, “new cardiac markers”, “coronary diseases”, and “cardiovascular diseases” in Elsevier, Google Scholar, JAMA, Science Direct, Wiley, PubMed, and Iran Medex databases.

Findings. The results indicate that characteristic of each biomarker can play an important role to advance the goals of medicine and harm reduction in the cardiovascular patients. However, despite the high efficiency, routine usage of them is still unclear which indicates the need for further research in this field.

Conclusion. New biomarkers provide new insight about recognition of the causes of cardiovascular diseases, also their easy and rapid application with high sensitivity and predictive value will develop a dramatic change in the diagnosis and treatment of patients with cardiovascular diseases.

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Aim. This study aimed at investigating the effect of education based on illness perception on self-care behaviors of patients with heart failure.

Background. Heart failure is the final outcome of most cardiovascular diseases, reducing patients’ self-care behaviors as a chronic condition. Changing illness perception of patients with heart failure about the disease is a way to improve the self-care behaviors in these patients.

Method. An experimental design was used to conduct the study. Seventy and six patients with heart failure who admitted to hospitals affiliated to Tehran University of Medical Sciences and were eligible to participate in the study was recruited in 2014 and were randomly divided into intervention and control group. The intervention group attended in three educational sessions and received cell phone follow-up for 8 weeks. The control group received conventional treatment. The self-care behaviors was compared in both groups before, and eight weeks after the intervention. The data were analyzed by SPSS-16 software.

Findings. There was no statistical significant difference between demographic variables of two groups. Self-care behaviors in the intervention group increased after the intervention when compared with the control group (p<0.0001). In the experimental group, the mean score of self-care behaviors after the intervention was significantly higher than mean score before intervention (p<0.0001).

Conclusion. The results showed that education based on illness perception affects self-care behaviors in patients with heart failure. It is suggested as an effective method to promote the self-care behaviors in these patients.

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Aim. The purpose of the present study was to investigate the effect of cardiac rehabilitation on quality of life and return to work in patients with Acute coronary syndrome (ACS).

Background. ACS is one of the major cardiovascular diseases that can affects the patients’ quality of life and return to work.

Method. This was a clinical trial study conducted on 50 patients with ACS admitted to the coronary care units of the selected hospital of Isfahan University of Medical Sciences in 2013-2014. The participants were randomly assigned to control (n=25) or experimental  group (n=25). The experimental group received phase 1 and 2 cardiac rehabilitation program, however, the control group received usual care. The data was collected via demographic questionnaire and SF-36 quality of life questionnaire, before and one month after intervention. Return to work  was estimated through questions  and then was compared in both groups.

Findings. There was no statistically significant difference between experimental and control groups in terms of demographic variables and cardiovascular risk factors. After intervention, in the experimental group, the mean scores in all domains of quality of life increased significantly (p<0.0001). In the control group, the mean score of quality of life, before and after the intervention was not significantly different. A statistical significant difference was found between the experimental and control groups in all domains of quality of life, except for general health and social function, in favor of the experimental group. No statistically significant difference was found between the groups in terms of the duration of  return to work.

Conclusion. The results of this study showed that cardiac rehabilitation program can improve the quality of life in patients with ACS.

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Heart failure is one of the major causes of mortality in developed countries. Usually before heart failure, remodeling occurs to adapt to myocardial wall stress changes or pressure caused by external stimuli. Cardiac remodeling encompass many of the changes associated with the development of heart failure, like genome expression changes, and cellular, molecular and interstitial changes, that causes a change in size, shape and function of the heart after damage. Cardiac remodeling shows the capacity of heart to response and adaptation to a variety of stimuli. The ultimate goal of cardiac remodeling is adaptation to and properly reducing the increased wall stress, and maintaining or even increasing cardiac function. In general, cardiac remodeling is divided into two categories: physiological and pathological, each have different causes and consequences.

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Aim. This study was conducted to examine the effect of family-centered education on the quality of life patients after coronary artery bypass graft surgery.

Background. Following coronary artery bypass graft surgery, the patients face many physical, mental and social problems, which reduce their quality of life. Teaching the patient's family provides an opportunity for family members to cooperate actively in taking care and supporting patient, thereby, improve patients' quality of life.

Method. This was an experimental study in which 96 patients with their active family members were recruited according to inclusion criteria and randomly allocated to experimental (n=48) and control group (n=48). Before intervention, SF-12 Quality of Life Questionnaire (QOL) was completed by participants in both groups. Then, experimental group received family-centered education in three sessions and control group received only hospital routine educational program. Quality of life was again measured one month later. The data were analyzed by SPSS version 22.

Findings. There were no statistically significant differences between the two groups regarding demographic characteristics. Based on Mann-Whitney test, a statistically significant increase was observed in scores of QOL dimensions after intervention in the experimental group as compared with control group (P<0.0001).

Conclusion: Family-centered education in patients under coronary artery bypass graft can improve quality of life in these patients.

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Aim. The aim of this study was to investigate the role of social capital in healthy lifestyle promotion among people with Coronary Artery Disease (CAD).

Background. Social capital, one of the social determinants of health, plays an important role in promoting healthy lifestyle among people. Due to increasing incidence of CAD, research is needed about social capital and its relationship with healthy lifestyle among people with CAD.

Method. This cross-sectional study was conducted on 412 patients with CAD, including 239 men and 173 women, in 4 different wards (i.e. men and women internal wards, Diplomat and VIP wards) in Shahid Rajaie Cardiovascular, Medical and Research Center from January 2015 to June 2015. Data were collected by demographic characteristic form, Miyamoto et al. social capital questionnaire and researcher-made questionnaire of healthy lifestyle. Validity and reliability were confirmed by content analysis and Cronbach's alpha methods. The data were analyzed using SPSS with appropriate statistical tests. 

Findings. There was a statistically significant difference between social capital in terms of gender (p=0.015). A statistically ssignificant correlation was found between social capital and healthy lifestyle (r=0.418, P<0.01). The highest correlation was observed between social capital and “health responsibility” component (r=0.384, P<0.01) and the lowest correlation was observed between social capital and “abstain from tobacco and alcohol’’ (r=0.107, P<0.01). Among social capital components, “social relationships” had the highest correlation with healthy lifestyle (r=0.511, P<0.01).

Conclusion. Social capital and its components have positive and important effects on healthy lifestyle and its subscales. It is necessary to emphasize community-based programs, such as strengthening social capital in the society to prevent and control chronic diseases, especially heart disease.

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Aim. The aim of current study was to assess post-traumatic growth in patients with myocardial infarction (MI).

Background. Post-traumatic growth is defined as subjective positive psychological changes following the struggle with highly challenging life events.

Method. This was a descriptive cross-sectional study in which 166 patients with MI, referred to the cardiac clinics in Bonab and Maragheh, were recruited by convenience sampling. Post-traumatic Growth Inventory (PTGI) was used for measuring PTG. Descriptive  and inferential statistics were used by SPSS version 22 to analyze the data.

Results. The mean PTGI score of the participants was 68.39±19.40, and the most acquired score was observed in the dimension "spiritual changes". The results showed that women and patients with a history of MI within the previous 6 months acquired more score of post-traumatic growth than men (p=0.029) and patients with a history of MI before the recent 6 months (p=0.008), respectively.

Conclusion. The occurrence of MI leads to positive psychological changes as named posttraumatic growth. Nurses and care policymakers can use these findings to help patients in coping with stressful conditions.

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Aim. The aim of this study was to evaluate the effect of using “Pain Assessment Tool” by nurses on analgesics requirement and patient’s satisfaction after coronary bypass graft surgery.

Background. One of the main duties of caregivers in ICU is relieving patients’ pain. Using "Pain Assessment Tool" may have a positive effect on the choice of analgesics and dosage adjustment with patients’ requirements. More research is still needed.

Method. In a clinical trial, 153 hospitalized patients in the intensive care unit were selected randomly and were divided into two experimental (n=77) and Control group (n=76). The Pain Assessment Tool and pain management for 48 hours were implemented for conscious patients. Routine measures were taken into account for control group and the severity of pain and analgesic injection for experimental group were determined. In both groups, the amount of analgesics administered for pain relief, and patient satisfaction were recorded. Data were analyzed by SPSS version 16.

Findings. The use of Pain Assessment Tool increased the number of recipients of analgesic drugs and reduced their dosage over 48 hours in the experimental group. Also, the satisfaction of pain relief was higher in the experimental group than the control group (p<0.0001).

Conclusion. The findings of this study demonstrate the positive effect of Pain Assessment Tool on pain control, proper use of analgesics, prescribing the proper dose of analgesics based on patients’ pain and satisfaction improvement. The measurement of pain severity using Pain Assessment Tool, before and after analgesics administration is suggested.

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Aim. This study was conducted to determine the effect of Lemon Balm (Melissa Officinalis) on depression in patients after coronary artery bypass graft.

Background. Coronary artery bypass grafting (CABG) is the most common operation among patients with coronary artery disease. Many of these patients are faced with depression after cardiac surgery.

Method. In this randomized clinical trial, 80 patients undergoing coronary artery bypass graft were randomly assigned to treatment and placebo groups. Data collection tools included demographic and clinical sheet and the Hospital Anxiety and Depression Scale (HADS). Each patient randomly received either a capsule containing 500 mg lemon balm or a placebo, 3 times a day. After 7 days, depression in both groups was measured and compared. Data analysis was performed using SPSS (version 16).

Findings. After the intervention, herbal balm decreased depression more in intervention group compared with the placebo group (P=0.008).

Conclusion. According to findings , Lemon balm may reduce depression after coronary artery bypass graft.

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Aim. The aim of this study was to review studies about the cause and development of cardiovascular diseases among people with depression.

Background.  Cardiovascular disease and depression are common and the research have shown the comorbidity of these two disorders.

Method. In this review study, different databases such as Google Scholar, PubMed, Springer, AHA journal, Biomed, Scope med, Elsevier, and WHO webpage were searched out by Persian and English forms of keywords like “depression and cardiovascular diseases”, “depression and endothelial system”, “depression and autonomic system”, “depression and inflammatory-immune system”, “depression and platelet activation”, “depression and hypothalamic-pituitary-adrenal (HPA) axis” and “depression in prenatal period”.

Findings. Suggested mechanisms of developing cardiovascular diseases by depression include dysfunction of hypothalamic-pituitary-adrenal axis, inflammatory-immune system, autonomic system, platelet activity, endothelial system and habit pattern changes (metabolic syndrome) and depression in prenatal period.

Conclusion. Findings show that HPA axis dysfunction provides the situation for autonomic system dysfunction. Forming of atheroma and thrombosis are faster in platelet dysfunction, endothelial system dysfunction and inflammatory-immune system dysfunction than the other destructive ways. On the other hand, as depression can cause inflammatory-immune system dysfunction, the process of endothelial system dysfunction can cause this too. No finding has been found about the relationship between severity of depression and development of cardiovascular diseases.

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Aim. This study was conducted to assess physical activity in elderly people with heart disease, in Ilam, Iran.

Background. Regarding the increasing number of elderly people, paying attention to their health is of great importance. Regular physical activity is being regarded as a way of reinforcing the immune system and preventing non-communicable diseases.

Method. A descriptive cross-sectional study was conducted on 240 elderly patients admitted to post CCU and CCU of hospitals in Ilam, Iran. The sample was recruited by convenience sampling method. The questionnaire “Rapid Assessment of Physical Activity” (RAPA) was used to assess physical activity. SPSS version 17 was used to analyze the data through descriptive statistics (mean and standard deviation) and inferential statistics.

Findings. Of 240 elderly people participated in the study, 108 were male and 122 were female. Only 5% of the subjects had appropriate physical activity according to the World Health Organization classification. Physical activity was found to be statistically related with age, education, income, occupation, and marital status.

Conclusion. Physical activity was at a low level among older adults. It is necessary to take interventions for improving physical activity in elderly people. It is suggested to teach them appropriate life style in terms of physical activity.

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Aim. The aim of this study was to determine the effect of patient education and  nurse-led  telephone follow-up (telenursing) on adherence to treatment in patients with acute coronary syndrome admitted to cardiac care units hospitals affiliated to Alborz University of  Medical Sciences.

Background. Increasing adherence to treatment is essential in patients with acute coronary syndrome to reduce readmissions and improve the recovery, but only patient education does not guarantee the adherence to treatment and it is necessary to follow-up patients after discharge.

Method. This randomized clinical trial study was conducted on patients with acute coronary syndrome admitted to the selected hospitals of Karaj, Iran, in 2014. In this study, 90 patients were selected purposively and randomly allocated  in  three groups of education (n=30), education/ telephone follow-up (n=30), and control (n=30). Data collection instrument was questionnaire. Data were gathered at baseline and 12 weeks after the intervention. Patients in educational groups  (education, and education/ telephone follow-up groups) were trained before discharge using educational pamphlets. Telephone follow-up were implemented for education/ telephone follow-up group for 3 months; twice a week in the first six weeks and weekly in the second six weeks. The data was analyzed by descriptive and inferential statistics in SPSS version16.

Results. After intervention, there was a statistically significant difference between the groups in terms of adherence to treatment (P=0.001). Participants in the education/ telephone follow-up group and education group experienced more improvement in adherence to treatment than the control group.

Conclusion. Both patient education and education/ telephone follow-up have effect on improvement of adherence to treatment, but education/ telephone follow-up results in more improvement in adherence in comparison to education. It is recommended to implement education/ telephone follow-up for patients with acute coronary syndrome.

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Aim. This study was conducted to examine the effect of nursing ethics workshop on patients rights practiced by nurses in the emergency department.

Background. According to the goals of 20 years vision and development plans of Iran, moving toward improving the quality and safety of patients and their rights are of the main priorities of health care system approved by national and international experts and authorities.

Method. This study is quasi-experimental study with control group. To measure dependent variable (patient’s right practice by nurses), before and after intervention, perspectives of 180 patients admitted to emergency department were selected by convenience sampling. Intervention was implemented for emergency department nurses. All emergency department staff nurses working in a governmental hospital in the City Shahriar, Iran, were selected. The data were collected through a questionnaire composed of 2 parts, demographic information and 15 questions designed based on patients rights protocol in 5 domains with Likert scale. In order to ensure reliability, Cronbach’s Alpha was calculated for internal consistency coefficient through interviews with 20 patients (&alpha;=0.84). Validity of the questionnaire was evaluated by 10 experts. The questionnaire were completed before and one month after intervention through interviewing with patients admitted to the emergency department during the data collection time period. Data were analyzed by SPSS version 22.

Findings. Before intervention, the mean score of patient’s right practice was 58.83±16.81 and after intervention, the mean score of patient’s right practice increased to 84±8.12. There was a statistically significant difference between the mean total score of patient’s rights practice based on patients perspectives, before and after intervention (p˂0.0001). The lowest score for patient’s rights practice was reported for the domain information giving (15%) and the highest score was reported for the domain respect for privacy (82.7%).

Conclusions. The intervention (nursing ethics workshop) has a positive effect on patient’s rights practice by nurses in the emergency department.

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Aim. The present study aims to determine the relationship between family performance indices (cohesion, expressiveness, and conflict) and the risk of myocardial infraction.

Background. Cardiovascular diseases, especially myocardial infraction, is the first factor of fatality in the world and also in Iran. The etiology of myocardial infraction is a very complicated. One of the risk factors overlooked in the studies associated with the etiology of cardiovascular disorders is family and performance indices of the family.

Method. The present research was conducted by a case-control cross-sectional design. The data were collected from two groups, a group of 50 patients with myocardial infraction symptoms (case group) referring to Heshmat Specialized Hospital for Cardiology in Rasht and Tehran Specialized Heart Center, and a group of 50 healthy persons (control group) with no symptoms of myocardial infraction. The data gathering tool included Family Relationships Index. The data were analyzed by SPSS version 16 using MANOVA method.

Findings. There was a statistically significant difference between case and control groups in terms of control variables: history of myocardial infarction, education, history of smoking, history of cholesterol and hypertension (p<0.01), and history of diabetes (p<0.05). There was also a statistically significant difference between groups in terms of cohesion, and conflict indices (p<0.01).

Conclusion. Deficiency in family performance indices, including cohesion, and conflict in family relationships, are among the main risk factors of myocardial infarction. Therefore, it is necessary to prepare and implement social, behavioral and educational interventions in order to prevent negative effects of inadequacies in family performance indices.

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Aim. The aim of this review was to determine the clinical outcomes of blood transfusion in patients undergoing coronary artery bypass graft surgery. Background. Despite efforts to reduce the use of blood products in cardiac surgeries, its use is still high. Blood should be considered as a scarce source which can lead to some clinical outcomes. Method. In this paper, a review was conducted on the studies published between 2002-2015. The studies were searched out through scientific databases, including PubMed and Science Direct by the keywords blood transfusion, adverse effects, clinical outcomes, coronary artery bypass graft surgery and their Persian equivalents. Findings. The review of 15 studies revealed that survival rate 30 days and 1 year among patients received blood transfusion were significantly less than patients without blood transfusion. Mortality (short and long term) in patients with blood transfusion was significantly higher than patients without blood transfusion. Also, patients receiving blood transfusion had more complications including atrial fibrillation, infection, pneumonia and cerebral vascular accident as compared with patients without blood transfusion. Conclusion. Blood Transfusion increases mortality, hospital stay and several various complications. It is essential that policy of limited blood transfusion to be considered against free blood transfusion.

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Aim. This study was conducted to examine the effect of deep and slow breathing on pain and pain outcomes during arterial sheath removal after undergoing coronary angioplasty.

Background. During the last 30 years, coronary angioplasty has been the most common method for management of coronary artery stenosis. Lack of control or treatment of the pain caused by arterial sheath removal may have some consequences, most notably increased heart rate and blood pressure in patients.

Method. This is a clinical trial study conducted on 60 patients undergoing coronary angioplasty, hospitalized between April and August 2015 in the catheterization laboratory of Shariati hospital, Tehran, Iran. Patients were divided into two groups using random number table. The intervention was slow, deep breathing techniques by inhale and exhale ratio of 4 to 6. Data were analyzed using SPSS.

Findings. Immediately and 5 minutes after sheath removal, the average pain score in the intervention group  was significantly lower rather than control group (P<0.05). There was no statistically significant difference between groups in terms of blood pressure and heart rate average. The average number of vasovagal attack was significantly different between the groups. The average number of vascular complications was not significantly different between intervention and control group.

Conclusion. The use of slow and deep breathing and relaxation technique is effective on pain management and the incidence of vasovagal attacks after arterial sheath removal, and can be used as an easy and safe method to decrease patients’ discontent caused by pain.