Cardiovascular Nursing Journal

Review of recommendations to prevent and reduce catheter-related bloodstream infections

Shiva Khaleghparast

ABSTRACT
Aim. We sought to review studies regarding interventions to prevent or reduce catheter-related bloodstream infections (CRBSIs).
Background. CRBSIs are associated with peripheral and central intravenous catheters, including nontunneled central catheters, tunneled central catheters, peripherally inserted central venous catheters (PICC), totally implanted intravascular access devices (ports), pulmonary artery catheters, and arterial lines. CRBSIs constitute one of the most frequent complications of intravenous catheters. Infections can be reduced by applying recommendations concerning CRBSIs prevention.
Method. Articles published between 2010 and 2022 were searched out in databases PubMed, Cochrane, Medline, SID, Scopus, IRANDOC, and Magiran using the keywords “prevention”, “bacteremia”, and “catheter-related bloodstream infection” and their Persian equivalents. Original articles and systematic reviews in Persian and English on CRBSI prevention that were published in reliable scientific databases from 2010 to 2022 and had available full texts were selected. The primary research yielded 324 articles via title and abstract reviews and in some cases, full-text perusal. Ultimately, 10 articles fulfilling the research purpose of the present study were reviewed.
Findings. According to the articles reviewed herein, medical centers should lessen CRBSIs incidence by educating healthcare personnel regarding intravascular catheter-use indications, proper intravascular catheter insertion procedures, and appropriate infection-control measures. Additionally, they should periodically assess healthcare personnel’s knowledge of and adherence to guidelines vis-à-vis intravascular catheter insertion and maintenance.
Conclusions. It is advisable that healthcare personnel’s knowledge of and adherence to the latest guidelines concerning CRBSIs prevention be continually monitored and enhanced.

The effect of eye movement desensitization and reprocessing (EMDR) on death anxiety in patients with myocardial infarction: A Randomized clinical trial study

Armin Mahmoodi

Abstract
Aim. The aim of this study was to determine the effect of desensitization with eye movements and reprocessing on death anxiety in patients with myocardial infarction.
Background. Patients with myocardial infarction experience death anxiety and cognitive deficits, which delay return to work, reduce quality of life, and increase the risk of mortality.
Method. This randomized clinical trial study was conducted to investigate the effect of desensitization with eye movements and reprocessing on death anxiety in patients with myocardial infarction in 2021. A total of 60 patients were selected from medical centers of Yasuj city, Iran, by convenience sampling and randomly divided into intervention and control group based on blocking randomization. To collect the data, personal information questionnaire and Templer's death anxiety questionnaire were used. A pre-test was conducted for both groups, then six treatment sessions with EMDR method were implemented for the experimental group, and at the end, a post-test was conducted for both groups. The control group did not receive any intervention. The collected data were analyzed using descriptive and inferential statistics in SPSS version 18 software.
Findings. After adjusting the post-test scores by removing the pre-test effect, the intervention had a statistically significant effect on death anxiety (F=214.11, P≤0.0001, Partial η²=0.796). Also, to analyze the components of death anxiety, the results of the independent t-test showed that the mean pre-test-post-test difference scores of the variables, fear of death (P≤0.0001), fear of illness (P≤0.0001), thoughts related to death (P<0.05), and short life (P≤0.0001) in experimental group was significantly higher than the control group, and control group had no statistically significant difference in this regard.
Conclusion. The method of desensitization with eye movements and reprocessing can be used as a standard and effective treatment method in treating or reducing death anxiety in patients with myocardial infarction.

The effect of cardiac rehabilitation programs on people with Covid-19: A review Study

Ali Karimi Rozveh

Abstract
Aim. This review discusses the studies that have investigated the effect of cardiac rehabilitation programs on people with Covid-19.
Background. It has been previously revealed the profits of cardiac rehabilitation for patients who suffer from cardiovascular diseases. With the occurrence of the covid-19 pandemic, many have suffered from cardiovascular complications due to the coronavirus infection. Despite the application of many medications and therapeutic interventions to control the side effects, many are still experiencing the secondary complications of the disease, specifically the cardiovascular complications, and the search for an effective solution continues. The use of cardiac rehabilitation for these patients may be effective.
Method. A broad search was conducted in scientific databases and search engines such as Science Direct, PubMed, Cochrane, Medline, SID, Scopus, CINAHL, OVID, Iran Doc, and Magiran with the keyboards “Covid-19”, “post covid-19 period”, “cardiac rehabilitation” and “rehabilitation” in both English and Persian language journals published between 2000 and 2022. After a comprehensive review, nine studies that met the purpose of this study were selected.
Findings. Cardiac rehabilitation programs decrease complications, mortality, and readmission of people with Covid-19, and modify the signs, physical and cardiovascular functions, and the quality of life in these patients.
Conclusion. For finer efficacy of cardiac rehabilitation programs, designating a program suited for the patient's condition, schedule adherence, and evaluation of the findings should be considered. It seems that cardiac rehabilitation programs can be beneficial for people with Covid-19 in reducing complications and mortality rates. More studies are needed for more information.

Comparison of Adaptive Support Ventilation (ASV) and Synchronized Intermittent Mandatory Ventilation-Pressure Support (SIMV-PS) modes on consequence of weaning off patients from mechanical ventilator after coronary artery bypass surgery

Mehdi Heidari

Abstract
Aim. This study aimed to compare the effect of Adaptive Support Ventilation (ASV) and Synchronized Intermittent Mandatory Ventilation-Pressure Support (SIMV-PS) modes on consequence of weaning off patients from mechanical ventilator after coronary artery bypass surgery
Background. The ventilation mode used for respiratory support in patients after coronary artery bypass graft surgery is very important. In addition to avoiding pressure on patient's sternotomy incision, the ventilation mode should also provide the possibility of rapid weaning of patient to avoid complications caused by long-term ventilation.
Method. In a semi-experimental study, 26 patients were ventilated with ASV as the experimental group and 26 patients were ventilated with SIMV-PS mode as the control group after coronary artery bypass graft surgery in Rajaie Cardiovascular Medical and Research Center, Tehran, Iran. Mechanical ventilation time and endotracheal tube removal time, hemodynamic variables, and arterial blood gas analysis were compared between the two groups. Data were analyzed using an independent t-test, repeated measures ANOVA and chi-square.
Findings. Out of 52 patients, 36 (69.2 percent) were male and 16 (30.8 percent) were female. The mean time for the endotracheal tube removal was 89.42±33.83 minutes in the experimental group and 101.53±44.91 minutes in control group, which did not have a statistically significant difference (p=0.843). The mean duration of mechanical ventilation of patients in the experimental group was 483.84±158.153 minutes and in the control group, it was 541.92±257.81 minutes, which were not statistically different (p=0.332).
Conclusion. The use of ASV mode for mechanical ventilation after coronary artery bypass graft did not affect reducing the duration of mechanical ventilation and the time of endotracheal tube removal compared to SIMV-PS mode. Therefore, the use of ASV mode for respiratory support of patients undergoing coronary artery bypass surgery should be considered according to the patient's condition and the nurses' expertise.

Virtual visiting in intensive care unit during covid-19 pandemic: A window to the patient/family centered care

Maryam Ehsani

Abstract
Aim. This paper aims to investigate barriers and opportunities of the virtual visiting in intensive care unit during Covid-19 pandemic.
Background. Face-to-face visits of hospitalized patients in intensive care units reduce separation anxiety and stress caused by hospitalization, as well as increase the feeling of comfort and safety in patients. In addition, it is the key to patient/family-centered care. However, the Covid-19 pandemic and its related restrictions ruled out the possibility of using the family's potential and providing patient/family-centered care. Virtual visiting has been proposed as a solution to remove the family's distance from the patient.
Method. This review was conducted by searching out databases, Web of Science, Scopus, PubMed, Magiran, SID and Cochrane with the keywords, Covid-19, Video calls, Family-patient center care, Intensive care unit, and Virtual visiting without time limitation. The inclusion criteria were the publication of the article in Persian or English language and the availability of the full text of the articles. In total, 45 articles were found, most of which focused on virtual appointments and virtual patient visits by physicians. After removing irrelevant papers, and the cases without full text, 29 articles were evaluated in terms of quality. Finally, 10 articles were evaluated in terms of subject, and the purpose related to the present study.
Findings. During Covid-91 pandemic, virtual visits were done in intensive care units in most medical centers using cell phones and tablets through social networks facilities. In all cases, families and health care providers were satisfied with this communication method, but they considered it was not a suitable substitute for face-to-face meetings. They believed that this method combined with face-to-face meetings would be more effective. Lack of regular and systematic planning, ambiguities in the duties of health care providers in the field of holding virtual visiting, lack of access to the internet at a suitable speed, and the complexity of working with smartphones for some families, were barriers of this method.
Conclusion. Virtual visiting provides a form of presence for families who are far away from their patients. Via this method, not only one but also all the family members can visit the patient. Although this method did not affect the stress and anxiety of the family and patients, but it was able to create a positive experience for them during hospitalization in intensive care units. Moreover, by involving the family in treatment process and informing them opens the ways to reach the patient/family-centered care in intensive care units.

The effect of family-centered self-care program based on home visits on adherence to physical activity of patients with acute coronary syndrome

Zahra Salehi

Abstract
Aim. This study was conducted with the aim of investigating the effect of family-centered self-care program based on home visits on adherence to physical activity of patients with acute coronary syndrome
Background. Coronary artery disease is one of the most common cardiovascular diseases. The importance of physical activity as an important factor in controlling and preventing the recurrence of the disease in these patients. Adherence to physical activity in patients with acute coronary syndrome (ACS) has a significant effect on preventing re-hospitalization and reducing complications.
Method. In this semi-experimental study conducted in 2021-2002, 72 people with ACS were randomly divided into experimental and control groups (32 people in each group). For the control group, routine interventions, and for the experimental group, family-centered self-care was delivered. Data collection tools were demographic questionnaire and Beck's physical activity level questionnaire.
Findings. Before intervention, there was no statistically significant difference between groups in the mean score of adherence to physical activity. Immediately after the intervention, the mean score in the experimental and control group was 6.31±2.01 and 5.98±1.21, respectively, indicating a statistical significant difference between groups. One and half month after the intervention, the mean score in the experimental and control group was 9.14±1.44 and 78±0.9, respectively, showing a statistical significant difference between groups.
Conclusion. Family-centered self-care in patients with acute coronary syndrome is effective on adherence to physical activity of these patients. Therefore, it is recommended to use this educational method as one of the effective and non-pharmacological methods for people with ACS in medical centers and at home to improve the quality of life among these patients.

The effect of individual and group self-care training on self-care behaviors and readmission of patients with heart failure

Fatemeh Gheiasi

Abstract
Aim. This study aimed to investigate the effect of individual and group self-care training on self-care behaviors and readmission in patients with heart failure.
Background. Teaching patients with heart failure plays an important role in achieving favorable treatment outcome, management of disease complications and reduction in readmission.
Method. This semi-experimental study was conducted with a pre-test post-test design with a control group and follow-up on 75 patients with heart failure. In individual education group, educational intervention was done individually and in another experimental group, it was done in groups of 3-5 people in two sessions. In control group, routine training was delivered. Self-care behaviors were evaluated using the European Heart Failure Self-care Behavior Scale (EHFScBs) at the beginning, and 30 and 90 days after discharge. The frequency of readmission was evaluated 30, 60 and 90 days after discharge. Data analysis was done in SPSS version 21 using Chi-square and Kruskal-Wallis statistical tests.
Findings. Self-care behaviors in 30 and 90 days after the intervention showed a statistically significant difference between experimental and control groups (p=0.002 and p=0.027, respectively). Regarding the frequency of readmission, at the end of 30, 60 and 90 days after discharge, there was no statistically significant difference between groups.
Conclusion. Providing educational intervention (in individual and group forms) is recommended to improve self-care behaviors in patients with heart failure. The effect of these educational interventions on the frequency of readmission was not significant; therefore, it is suggested to conduct future studies with more samples and in a longer period of time.

Effective interventions in prevention of mediastinitis following cardio- thoracic surgeries: A literature review

Pardis Moradnejad

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.

The effect of early mobilization protocol after open heart surgery on diaphragmatic muscle strength

Pardis Moradnejad

ABSTRACT
Aim. The aim of the present study was to examine the effect of early mobilization protocol on the strength of diaphragmatic muscle and other inspiratory muscles after open heart surgery.
Background. Early mobilization is recommended as a safe protocol after open heart surgery to decrease hospital stay and post-op respiratory complications; however, our knowledge about its effect on improving respiratory muscles strength is limited.
Methods. This is a randomized single-blinded clinical trial conducted on 80 consecutive patients who underwent coronary artery bypass surgery and/or valvular surgery that were randomly assigned to experimental group (postoperative early mobilization) and control group (routine physiotherapy). On the day before surgery and the day before leaving intensive care unit (ICU), two scores were measured for assessing diaphragmatic muscle strength: maximum inspiratory pressure (PI max) and Strength index (S index). Hemodynamic parameters were also measured and compared.
Findings. According to both PI max and S index, diaphragmatic muscle strength decreased from 77.28 to 59.53 cmH₂O in patients after surgery, but the changes in the experimental group was less than the control group, which indicates a significant improvement in the strength of the diaphragm muscle in the experimental group (p≤0.0001). Hemodynamic changes after surgery (lower blood pressure and increased heart rate) occurred in both groups without any significant clinical effect.
Conclusion. Early mobilization after cardiac surgery has positive effect on the strength of diaphragmatic muscle and is also safe as shown to have no adverse effect on hemodynamic parameters.

Obstacles to implementation of evidence-based protocols from the perspective of the staff nurses in Rajaie Cardiovascular Medical and Research Center, Tehran, Iran

Mahnaz Mayel Afshar

Abstract
Aim. This study aimed at investigating the obstacles to the implementation of evidence-based care from the perspective of the staff nurses in Rajaie Cardiovascular Medical and Research Center, Tehran, Iran
Background. Evidence-based care plays a crucial role in enhancing the nursing care quality due to the up-to-date care measures and procedures, and the cost-effectiveness for patients. However, there are some obstacle to implement it that should be addressed.
Method. This is a descriptive cross-sectional study conducted on 215 nurses from different departments of Rajaie Cardiovascular Medical and Research Center, Tehran, Iran. They were selected using simple random sampling method. The data collection tool was a questionnaire measuring the obstacles to the implementation of evidence-based care. The collected data were analyzed using descriptive and inferential statistics in SPSS version 20.
Findings. According to the nursing staff, the obstacles to the implementation of evidence-based care in the management dimension were the insufficient number of staff (80 percent), the large number of patients (71 percent), and the lack of motivation in the staff (68 percent) and in the individual-care dimension the obstacles were the lack of enough time for nurses to study the conducted research (72 percent).
Conclusion. The obstacles to the implementation of evidence-based care are in both individual and managerial areas, so it is suggested to correct arrangement of human resources, holding training workshops and meetings, creating interaction with the centers implementing evidence-based care, and using their life experiences considering the available facilities.

Comparison of the effect of acceptance and commitment-based therapy and emotion regulation educatiopn on chronic pain and self-care in women with coronary artery disease

Vida Mohamdiheris

Abstract
Aim. The aim of this study was to compare the effect of acceptance and commitment-based therapy and emotion regulation education on chronic pain and self-care in women with coronary artery disease.
Background. Research shows that coronary heart disease is one of the leading causes of death and disability in the world, which reduces the useful efficiency of people. Psychological factors can change many aspects of patients' lives and relationships.
Method. The research design was quasi-experimental pre-test-post-test with control group. The statistical population in this study included all women with coronary artery disease referred to Tabriz Heart Hospital in 2020. Women who had inclusion criteria were selected and randomly assigned to the first experimental group (n=15), the second experimental group (n=15) and the control group (n=15). The first experimental group (emotion regulation education) was subjected to 12 sessions of 90-minute duration (three sessions per week), The second experimental group (acceptance and commitment-based therapy) received 8 sessions of 90-minute duration, and the control group did not receive any intervention. The chronic pain scale of Von Korff et al. and the self-care scale of Rigel et al. were used to collect the data. Data were analyzed by multivariate analysis of covariance and LSD post hoc test in SPSS Version 21.
Findings. The results showed that treatment based on acceptance and commitment and emotion regulation education have an effect on chronic pain and self-care of patients with coronary artery occlusion (P ≤0.0001), as they reduced chronic pain and improve patients' self-care. The results also showed that acceptance and commitment therapy has a greater effect on chronic pain and patients' self-care than emotion regulation education.
Conclusion. Attention to acceptance and commitment therapy and emotion regulation education can play a role in reducing the psychological problems of women with coronary artery disease.

Comparison of the effect of narrative couple therapy, couple schema therapy and integrative behavioral couple therapy on hope and perceived stress among patients with coronary artery disease and their spouses

Mohsen Golparvar

Abstract
Aim. The aim of this study was to compare the effect of narrative couple therapy, couple schema therapy and integrative behavioral couple therapy on hope and perceived stress among patients with coronary artery disease and their spouses.
Background. Coronary artery disease is one of the heart diseases that can make couples face problems and need help.
Methods. This research was a semi-experimental study with a pretest and posttest design and with a control group. The statistical population was people with coronary artery disease and their spouses in the winter of 2021. Sixty four couples were selected by purposive sampling method and randomly assigned to three experimental groups and a control group (16 couples for each group). Hope scale of Snyder and perceived stress of Leung et al. were used to assess dependent variables in two stages. The three intervention groups were each treated for 8 sessions of 90 minutes and the control group did not receive any intervention. The data were analyzed by analysis of covariance and post-hoc Bonferroni test.
Findings. The results showed that there was a statistically significant difference of integrative behavioral couple therapy and couple schema therapy with the control group in terms of hope (P≤0.0001), but there was no statistically significant difference between the narrative couple therapy and control group and between three interventions. About the perceived stress, the results showed that there was a statistically significant difference of integrative behavioral couple therapy, narrative couple therapy and couple schema therapy with the control group (p≥0.05).
Conclusion. Considering the effect of integrative behavioral couple therapy and couple schema therapy in increasing hope and effect of the mentioned two interventions and narrative couple therapy in reducing perceived stress among people with coronary artery disease and their spouses. It is recommended to use these interventions in cardiovascular treatment centers.

The effect of multimedia education with Leventhal model approach based on telephone follow-up on understanding of patients with atrial fibrillation

Shirin Madadkar Dehkordi

Abstract
Aim. The present study was conducted with the aim of examining the effect of multimedia education with the Leventhal model approach based on follow-up on understanding of patients with atrial fibrillation.
Background. One of the basic tools in changing the patient's perception of the disease is the existence of an educational program using modern teaching methods.
Methods. In this semi-experimental study, 48 patients with atrial fibrillation were randomly divided into intervention (24 people) and control (24 people) group in Kashani Shahrekord Hospital in 2022. In the intervention group, two virtual training sessions were held for patients through multimedia software (sound, video, image and animation) under the title of 4-hour training workshop on the date and time coordinated with the help of Adobe Connect program. There was no intervention in the control group. After the workshop, disease perception were measured using disease perception questionnaire. Data analysis was done using independent t and paired t tests in SPSS version 21.
Findings. There was no statistically significant difference in the mean score of disease perception between the two intervention and control group before the study, and the two groups were homogeneous. However, after implementation of the intervention, the mean score of disease perception was significantly difference between the groups (p≤0.0001).
Conclusion. Based on the results of the present study, patients with atrial fibrillation gained a better understanding of their disease after the educational intervention. Therefore, it is recommended to carry out educational interventions to improve the understanding of patients with atrial fibrillation.

The effect of the cognitive behavioral group therapy based on mindful walking with the dialectical behavior therapy on psychological symptoms, quality of life and blood pressure in people with hypertension

Abdolmajid Bahranian

Abstract
Aim. The present study was conducted with the aim of comparing the effect of the cognitive behavioral group therapy based on mindful walking with the dialectical behavior therapy on psychological symptoms, quality of life and blood pressure in people with hypertension.
Background. High blood pressure can cause kidney failure and eye problems. High blood pressure is a health problem in industrialized and developing countries due to its high prevalence and association with cardiovascular diseases.
Method. The present study was conducted based on a semi-experimental pre-test post-test design with two experimental groups and one control group. Out of 87 volunteers, 45 patients were allocated to three groups based on random sampling. Data collection tools were the Beck Depression Questionnaires (1960), the Beck Anxiety Questionnaire (1990), and the World Health Organization Quality of Life Questionnaire. Cognitive-behavioral group therapy based on the Leahy Group Conscious Mind Walk (2011) and Dialectical Behavior therapy (Linehan, 1993) were implemented as interventions. Data were collected and analyzed in SPSS version 22 using descriptive and inferential statistics.
Findings. The results indicated a statistically significant difference of the effects of the two interventions with control group in terms of depression, anxiety, quality of life, and blood pressure (P≤0.0001). Also, the cognitive behavioral group therapy based on mindful walking had a greater effect on the quality of life and blood pressure of hypertensive patients compared with the dialectical behavior therapy.
Conclusion. To improve the quality of life and reduce the blood pressure of hypertensive patients, it is better to benefit from the cognitive behavioral group therapy based on mindful walking and to reduce the cognitive symptoms (depression and anxiety) of hypertensive patients, dialectical behavior therapy is beneficial.

Pre-rehabilitation in patients undergoing coronary artery bypass surgery: A literature review

Elham Navab

Abstract
Aim. This review study was conducted with the aim of highlighting the importance of a preoperative preventive approach in the recovery of patients undergoing coronary artery bypass surgery.
Background. With the increase in the number of patients who are candidated for heart surgery, improving the health status before the operation is of great importance to optimize the results after the operation. This review has been conducted with the aim of evaluating the evidence related to the pre-rehabilitation of patients undergoing coronary artery bypass surgery.
Method. The present literature review was conducted by searching out library resources and databases, Scopus, Chochrane Library, Magiran, SID, PubMed, Up-to-date, OVID, CINAHL, and Web of Science with the keywords, coronary artery bypass surgery, pre-rehabilitation, cardiovascular disease and their Persian equivalents without time limit. From a total of 104 articles, 63 full texts articles entered the review stage, of which 17 articles entered the literature review.
Findings. The findings indicate the favorable effects of pre-rehabilitation on improving the quality of life and preventing complications in the early postoperative period. Pre-rehabilitation programs should adopt multifaceted approaches including nutrition, exercise, and anxiety reduction to improve patient resilience in the preoperative period. The pre-operative period is a critical opportunity to implement pre-rehabilitation interventions for vulnerable patients awaiting cardiac surgery.
Conclusion. Cardiac pre-rehabilitation includes a wide range of preventive interventions that can be taught by nurses to patients undergoing cardiac surgery. Pre-rehabilitation requires an interdisciplinary approach, because it suggests a change from the current model of health care and transformation from one-dimensional care to interdisciplinary care, which can be an effective tool for the medical and nursing system in timely identification of physical and mental disorders in initial preoperative assessment, preoperative education and management, as well as prevention of postoperative complications.

Relationship of health literacy, heart failure knowledge and social support with adherence to medical treatment in patients with heart failure

Yasaman Khalili

Abstract
Aim. The aim of this study was to investigate the relationship of health literacy, knowledge of heart failure and social support with adherence to medical treatment in patients with heart failure.
Background. Despite significant advances in the treatment of heart failure, the prognosis in these patients is poor. Factors influencing the prognosis include comorbidities, disease severity, age and sex differences, inadequate health literacy, poor adherence to medication, poor knowledge, and poor social support.
Method. The present study was a cross-sectional descriptive correlational study that was performed on 300 patients referred to the clinic of Rajaie Cardiovascular Medical and Research Center. Sampling method was convenience. The study tools included questionnaires completed by the researcher or patient: demographic form (personal, economic and social information), Health Literacy Questionnaire, Dutch Heart Failure Knowledge Scale, Multidimensial Scale of Perceived Social Support and Morisky Medication Adherence Scale. Data were analyzed in SPSS software version 22 using descriptive and inferential statistics.
Findings. Median (interquartile range) age of the samples was 55 (41-65) years, and 172 (57.33%) were male and 128 (42.66%) were female. In this study, there was a statistically significant relationship of health literacy (P=0.029, r=0.13) and knowledge of heart failure (P=0.02, r=0.13) with adherence to medical treatment. But there was no significant correlation between social support and adherence to medical treatment.
Conclusion. The results of this study showed the relationship of health literacy and knowledge of heart failure with adherence to medical treatment. We can improve patient’s adherence to treatment by increasing the level of their knowledge related to heart failure and health literacy toward the disease

The effect of reality therapy on self-efficacy in people with hypertension

Tahereh Dehghani Firouzabadi

Abstract
Aim. The aim of this study was to examine the effect of treatment based on choice theory (reality therapy) on self-efficacy of people with hypertension.
Background. Hypertension and its complications leads to high mortality and therefore, is considered as a major health problem affecting individual self-efficacy. In addition to drug therapy, psychological treatments can be a significant and important prerequisite for behavior change and self-care promotion in people with hypertension.
Method. The present study was quasi-experimental with a pretest-posttest design and control group. The statistical population of the study included all people with high blood pressure under coverage of the health centers of Meybod city Yazd province) in the fall-winter 2018, who were recruited in the study based on convenience sampling (n=30) and were randomly allocated to experimental and control group. The samples responded to the self-efficacy questionnaire of hypertensive patients (DMSES) before and after intervention. The treatment program based on choice theory was carried out in 8 sessions. The data were analyzed by covariance analysis according to the research hypothesis.
Findings. The results showed that after controlling for the pre-test effect, there was a statistically significant difference between the post-test self-efficacy scores of the group. After the treatment based on the selection theory, the scores of the dimensions of diet, physical activity, drug consumption and blood pressure control of patients with hypertension increased significantly in experimental group compared with the control group.
Conclusion. Implementation of treatment based on choice theory can be a suitable method for increasing self-efficacy in people with hypertension. It's suggested that by applying the theory-based treatment of choice for people with hypertension, an effective step can be taken to improve their self-efficacy.

Disposable suction bottle: Is cost-effective in Iran or not?

Esmaeil Mohammadnejad

Abstract
Aim. In this review article, the cost-effectiveness of disposable suction bottles in Iran was discussed.
Background. Healthcare-associated infections (HAIs) cause mortality and morbidity in patients, especially in the intensive care unit. There are different methods and instructions to control HAI, which is an important and fundamental problem related to suction.
Method. Searching out for articles through databases including Science Direct, PubMed, Cochrane, Medline, SID, Scopus, CINAHL, OVID, Iran Doc and Magiran using the keywords "disposable suction", "hospital infection", "waste management" and their English equivalent were conducted. Articles that were published between 2000 and 2022 and were more related to the main focus of the research topic were selected. The inclusion criteria included their publication in reputable scientific journals, publication in Farsi or English, and access to the full text of the article. Exclusion criteria included publishing articles in weak and invalid journals.
Findings. Disposable suction bottles was evaluated in five domain including hospital infection control and prevention, water consumption management, ease of use, waste management, and cost effectiveness.
Conclusion. Considering the lack of manpower for disinfecting disposable suction bottles, the costs of disinfectant solutions and their improper use in diluting them, and the management of waste water from used solutions and emptying suction cups; disposable suction bottles have priority over reusable suction bottles in Iran.

Assessment of knowledge and skill of pre-hospital emergency technicians in the management of patients with Acute Coronary Syndrome (ACS) in Neyshabour, Iran, in 2021

Neda Sanaie

Abstract
Aim. The present descriptive study was conducted with the aim of evaluating the knowledge and skill of pre-hospital emergency technicians in Neyshabour, Iran, in the management of patients with acute coronary syndrome.
Background. Pre-hospital emergency personnel who have sufficient knowledge and skill to diagnose, giving care and transfer of patients can increase the chance of survival and decrease the possibility of acute and chronic complications of the disease.
Method. In this descriptive cross-sectional study, 126 operational personnel working in the emergency medical center of Neyshabour City, Iran, were recruited by census sampling and participated in the study during a one year period in 2021. The data was collected using a researcher-made questionnaire including demographic information, knowledge level questionnaire, and a pre-hospital emergency personnel skill checklist measuring the management of patients with acute coronary syndrome. The data were analyzed in SPSS version 19 through descriptive statistics.
Findings. The overall knowledge score of the majority of participants in the management of patients with acute coronary syndrome was at a good level (58.7 percent); the highest knowledge score was reported in the interpretation of electrocardiography and the lowest knowledge score was in diagnosing the symptoms of acute coronary syndrome. Finally, the overall skill score of the majority of pre-hospital emergency technicians was at a good level (79.4 percent); the highest skill score was reported in the principles of cardiopulmonary resuscitation and the lowest skill score was in performing cardiac monitoring and detecting arrhythmias.
Conclusion. The majority of pre-hospital emergency technicians had an acceptable level of knowledge and skill in the field of managing patients with acute coronary syndrome, but some skills were far from the desired level. Therefore, due to the importance of strengthening the knowledge and skills of pre-hospital emergency personnel, as the first members of the emergency team dealing with cardiac patients, in the management of patients with acute coronary syndrome, regular training and awareness of updated guidelines are recommended.

Comparison of the effect of Mindfulness-Based Cognitive Therapy and Acceptance and Commitment Therapy on fatigue and quality of life in men with heart failure: A semi-experimental study

Atefeh Nezhad Mohammad Nameghi

Abstract
Aim. This study was conducted to compare the effect of “mindfulness-based cognitive therapy” and “acceptance and commitment therapy” on fatigue and quality of life in men with heart failure.
Background. Fatigue, as one of the important symptoms and complications of heart failure, affects the quality of life of the patients, their self-care and daily task performance. Mindfulness-based cognitive therapy and acceptance and commitment therapy may have an effect on these problems.

Method. This research was semi-experimental with a pre-test post-test design and control group within a three-month follow-up period. Forty five men with heart failure were purposefully selected and randomly allocated to two experimental groups and one control group (15 people in each group). Data were collected in three stages using the Iowa Fatigue Scale, and Minnesota Living with Heart Failure Questionnaire. Data analysis was done in SPSS-25 software with mixed analysis of variance test.

Findings. After intervention and in follow-up stages, both mindfulness-based cognitive therapy and acceptance and commitment therapy were effective on fatigue and quality of life in men with heart failure. The follow-up test showed a greater effect of acceptance and commitment therapy on quality of life and no statistically significant difference was found between the experimental groups in terms of effect on fatigue.

Conclusion. Both interventions, especially acceptance and commitment therapy, can be used as effective interventions on fatigue and quality of life along with medical treatments for men with heart failure in medical centers.

Quality of life and spiritual health among parents of children after heart transplant in Iran

Helia Saremi

Abstract
Aim. The present study was conducted with the aim of determining the quality of life (QoL) and spiritual health of parents of children after heart transplant in Iran.
Background. The child and his family enter a new phase of life after a heart transplant. Assessing the QoL and spiritual health of parents can determine the psychological and health consequences for children and their families.
Method. This was a descriptive cross-sectional study on 102 pairs of parents of children after heart transplantation in the hospitals Rajaie Cardiovascular Medical and Research Center in Tehran, Imam Khomeini Hospital in Tehran, and Razavi Hospital in Mashhad, using the consensus sampling method from November 2020 to June 2021. The questionnaires used in this study included the World Health Organization Quality of Life– BREF (WHOQOL-BREF) and Spiritual Well-being Scale. Data were collected in the forms of face-to-face and network communication (WhatsApp and Telegram). Data were analyzed using SPSS version 22 using descriptive and inferential statistics.
Findings. The mean score of QoL for mothers and fathers was 57.35±12.42 and 57.93±12.22, respectively. Also, the mean score of spiritual health for mothers and fathers was 90.68 ± 07.13 and 88.76 ± 12.78, respectively, which were considered as the average level. In general, these results may have been affected by the Covid-19 pandemic. Parents' QoL had no statistically significant relationship with demographic variables of them and their children. Mothers' spiritual health had a statistically significant relationship with their education (P=0.034), employment status (P=0.002) and age (P=0.024). Regarding fathers, the spiritual health showed a statistically significant relationship with the child's gender (P=0.016) and the waiting time for transplantation (P=0.023).
Conclusion. No difference was observed between fathers and mothers of the children after heart transplant in terms of the variables of QoL and spiritual health. This can indicate the same pressure on both mother and father to take care of the child, especially in critical situations such as the Covid-19 pandemic. In this situation, the support of these families by nurses and health workers to follow up their child's treatment, making an appointment to visit or to better understand their conditions in case of problems is of particular importance. More studies are needed to clarify the situation of these children and their families.

Investigating the compliance of Carbapenem antibiotics (Meropenem and Imipenem) administration in patients undergoing open heart surgery with the standard guidelines of antibiotic stewardship

Monireh Kamali

Abstract
Aim. This study was conducted to examine the compliance of the administration of Carbapenems in patients undergoing open heart surgery with antibiotic monitoring guidelines of the Ministry of Health and Medical Education in Iran.
Background. Antibiotic resistance is a significant challenge for healthcare systems and can lead to increased costs, prolonged treatment duration, and higher mortality rates among hospitalized patients.
Methods. This cross-sectional descriptive study included 70 patients (35 women and 35 men) who underwent heart surgery between March 2021 and the end of August 2021 at Shahid Rajaei Heart Hospital in Tehran, Iran. Data were collected through direct patient interactions and reviewing patients' medical records and were analyzed using SPSS software version 26.
Findings. The data revealed that 81 percent of patients received appropriate Carbapenem prescriptions, while 19 percent received an incorrect prescription. The most prescribed antibiotic, with a frequency of 92.9 percent, was Meropenem, and the average number of antibiotics prescribed for each patient was 1.87. The highest rate of Carbapenem prescription was observed in patients with ventilator-induced pneumonia (55.7 percent) and those undergoing coronary artery bypass graft (CABG) surgery (45.7 percent). Approximately 55.7 percent of patients required dose adjustments 72 hours after receiving Carbapenem due to increased creatinine clearance, and 15.7 percent needed to discontinue the drug. The most common causative infection agents were Candida Albicans, Klebsiella Pneumoniae, and Staphylococcus Aureus, respectively.
Conclusion. Antibiotic management programs can limit the irrational use of antibiotics such as Carbapenems and help improve the treatment of infections by preventing the development of antibiotic resistance.

Readmission determinants in Iranian people with heart failure: A literature review

Mohammad Sadegh Sargolzaei

Abstract
Aim. This literature review was conducted to investigate determinants of readmission among Iranian people with heart failure.
Background. Heart failure (HF) as a chronic progressive syndrome may reduce the quality of life and increase their treatment costs. The rate of readmission is relatively high in these patients, presenting a major health problem.
Method. In the present literature review, the literature on the topic were searched out in databases PubMed, Google Scholar, Web of Science, ProQuest, Magiran, SID, and IranMedex. The terms heart failure, congestive heart failure, readmission, rehospitalization, and Iran were searched without time limit. Literature search and evaluating the articles were independently conducted by two researchers, and all eligible studies were included in the review process.
Findings. Out of 601 studies found in the initial search, seven articles meeting the inclusion criteria entered the final phase of the study and were reviewed. According to these studies, the readmission rate varied from 10.9 to 40 percent. Some of the important factors affecting the readmission rate in patients with heart failure included age, gender, education, job status, underlying disease, disease stage, poor adherence to the therapeutic regimen, insurance coverage status, and place of residence.
Conclusion. Based on the results of the present study, the rate of readmission was high among Iranian patients with heart failure. It is recommended to consider interventions such as educational programs to improve patients’ awareness about this condition and their adherence to self-care activities.

The effect of lifestyle training based on mobile application on adherence to the therapeutic regimen in patients with hypertension

Beheshteh Tabarsi

Abstract
Aim. The aim of the study was to examine the effect of lifestyle education using a mobile phone application on adherence to the treatment regimen in patients with hypertension.
Background. High blood pressure is the most important risk factor for cardiovascular diseases and mortality. Educational applications have provided an effective method for self-care and blood pressure control of patients.
Method. This research is a clinical trial study. The number of samples in control and experimental group was 60 people. In the experimental group, the training was conducted using the mobile application at least three times a week for two months and was followed up during the course through phone calls and virtual networks. In the control group, the usual training of the health center was provided. The degree of adherence to the treatment plan of the patients was measured by a researcher-made questionnaire, before and two weeks after the end of the intervention. Data analysis was done in SPSS version 21 using t-test, multivariate covariance analysis and post-hoc test.
Findings. Comparing the adherence to the treatment program between the two groups after the educational intervention, the mean and standard deviation of the scores of the control and experimental group was 337±22 and 441±20, respectively. There was a statistically significant difference between groups after the intervention in all variables including blood pressure, diet, physical activity, drug regimen, and other domains of compliance with the treatment program (p≤0.0001), which indicated the effectiveness of lifestyle training using a mobile phone application on blood pressure and adherence to the treatment plan.
Conclusion. The use of mobile phone application can be effective and useful for improving and controlling blood pressure among patients with hypertension. Nurses, as one of the most important members of the health care team, can have a direct impact on patients’ quality of life through educational interventions

Design and psychometrics of post-traumatic stress disorder tool for children undergoing heart surgery

Faezeh Sahbaeiroy

Abstract
Aim. The aim of this study was to design and examine the psychometrics of post-traumatic stress disorder tool for children undergoing heart surgery
Background. Heart disease is one of the most important health issues and traumatic events that cause great harm to children, one of which is the experience of surgery. Therefore, we need a standard tool to assess post-traumatic stress disorder in children.
Method. In this methodological study, researchers compiled a questionnaire for measuring post-traumatic stress disorder in children undergoing heart surgery. The questionnaire was provided to 10 experts to examine the validity. In the next step, 40 items, revised by experts, were examined for construct validity and reliability based on the responses of 200 children 12-18 years old to questionnaire. The data were analyzed in SPSS version 24 and LISREL version 10.
Findings. After preparing the draft, the questionnaire was given to 10 experts to determine face and content validity. For face validity, the impact score of the items was computed and due to similar meaning of some items they were merged. In order to determine the content validity, two indexes of content validity ratio (CVR) and content validity index (CVI) were considered. According to Lauche's table, items with a content validity ratio less than 0.62 were excluded (7 items), items with a content validity ratio greater than 0.79 were accepted, and items with a content validity ratio between 0.70 and 0.79 were revised. In the construct validity stage, to ensure the sufficient sample size, the Kaiser-Meier-Elkin (KMO) test was performed and the results of Bartlett's Sphericity test were significant (P≤0.0001). Finally, exploratory factor analysis was performed with Varimax rotation on 40 items, and 7 items with a factor loading of less than 0.4 were removed, and in the end, 33 items remained. To determine the reliability of the questionnaire using the internal consistency method, Cronbach's alpha of the questions were computed and it was above 0.80 for all items. The test-retest results confirmed the significant relationship between the pre-test and post-test scores in 7 factors of the questionnaire (P≤0.0001).
Conclusion. In order to achieve more accurate results in research, it is necessary to use valid and reliable tools. The results of this study showed the strength of the factor structure and acceptable reliability of the post-traumatic stress tool for children undergoing heart surgery. The tool designed in this study is valid and reliable and can be used to determine post-traumatic stress in children undergoing heart surgery.