---

Aim. The aim of this study was to determine the effect of first phase cardiac rehabilitation

programs on anxiety and depression in acute coronary syndrome (ACS) patients.

Background. Anxiety and depression are psychological factors influencing the prognosis,

recovery, and adherence to treatment in patients with ACS. Cardiac rehabilitation programs are

an important part of the care plan is arranged for the majority of heart patients.

Method. This clinical trial study was conducted on 88 ACS patients with regard to the inclusion

criteria. The subjects were randomly divided to experimental (n=44) and control (n=44) groups.

The experimental group participated in four educational sessions of cardiac rehabilitation

program, which included familiarity with risk factors of heart disease, nutrition and drugs

recommendations, stress and depression reduction methods and exercises training. Information

booklet was given at the end of the sessions. Data were collected by demographic and diseaserelated

questionnaires and Persian version of Hospital Anxiety Depression Score (HADS).The

data were analyzed by SPSS software version 16.0 and descriptive and analytic statistical tests

(Independent t-test and Chi-square and Fisher's exact test).

Finding. The findings showed that there was no statistically significant relationship of

demographic and disease-related information with anxiety and depression scores before study.

There was significant statistical difference between two groups in the mean of anxiety and

depression score after intervention (P_0.0001).

Conclusion. According to the finding, the first phase cardiac rehabilitation programs is effective

in reducing anxiety and depression in ACS patients Therefore, it can be an effective way to plan

nursing care of patients with ACS.

---

Abstract

Aim. The aim of this study was to examine the effect of muscle relaxation and music therapy on anxiety level in patients waiting for cardiac catheterization.

Background. Anxiety is one of the most common human emotions from positive or negative experiences of life. High levels of anxiety have many unwanted effects on the body systems. In stressful situations such as invasive diagnostic techniques, the person experiences high level of anxiety. One of the main responsibilities of nurses is to control anxiety in patients with pharmacological and non-pharmacological methods.

Method. This quasi-experimental study was conducted in one hospital affiliated to Tehran University of Medical Science. After obtaining approval and written consent, 150 patients, waiting for cardiac catheterization, were randomly divided into three groups of muscle relaxation, music therapy and control. Data were collected by demographic form and self-report form of anxiety through interview. One hour before cardiac catheterization, the level of anxiety was measured in all groups, then, muscle relaxation group was asked to perform Benson muscle relaxation for 20 minutes based on listening to a recorded tape of guidance by headphone. At the same time, the music therapy group listened to music tape by headphone. Control group received no intervention but standard nursing care. Immediately before cardiac catheterization, the level of anxiety was measured again in all groups. Data were analyzed by SPSS using Fisher exact test, Mann-Whitney and Kruskal-Wallis tests.

Findings. Immediately before catheterization, patients' anxiety level was significantly reduced (p<0.001) in muscle relaxation and music therapy groups, while it increased in the control group. Immediately before catheterization, a statistical significant difference was found between levels of anxiety in groups (p<0.001).

Conclusion. Both Benson muscle relaxation and music therapy significantly reduced anxiety level of patients and music therapy had more effect on the anxiety level of patients waiting for cardiac catheterization.

---

Abstract

Aim. The purpose of this study was to determine the effect of comprehensive-care program on patient satisfaction in patients with minor and moderate trauma (accident, fall and other types of trauma) in emergency department.

Background. Assessment of patient satisfaction is one of the most important indicators of measuring quality of care. Patient satisfaction of nursing services is declining it can be caused by increased awareness of patients about their rights and health care services which leads to an increase in patient expectations of health care services. Comprehensive care program is one of the ways to increase patient satisfaction.

Method. This clinical trial study was conducted with 104 patients, 52 in each control and experimental groups. The experimental group received comprehensive-care program from the moment of entering emergency department to the discharge of emergency department and the control group received the usual nursing care. After implementing comprehensive-care program and at the end of the patient stay, the patient satisfaction in two groups was measured using a modified form of satisfaction questionnaire. The data analysis was done by SPSS software, version 22 using descriptive and inferential statistics.

Findings. The mean score of the total satisfaction was 32.02 (relatively appropriate) and 45.6 (appropriate) after intervention in control and experimental groups, respectively. There was a statistical significant difference between the mean score of total satisfaction of the groups after intervention (p<0.001).

Conclusion. Implementing comprehensive-care program increases the rate of the patient satisfaction. Therefore, it is recommended to managers and staff of the health care centers and educational centers to apply comprehensive care program.

---

Abstract

Aim. This study was conducted to examine the effect of supportive nursing program on depression, anxiety and stress of family members of patients during coronary artery bypass graft surgery.

Background. patient’s family members experience high levels of depression, anxiety and stress during coronary artery bypass graft surgery. Informational and emotional support of family members during surgery may have significant effect on reducing their psychological distress and enabling them to better support of the patient.

Method. This semi-experimental study was conducted on 104 relatives of patients. They were recruited in the study with regard to the inclusion criteria and assigned to either experimental (n=52) or control (n=52) group. The experimental group received supportive nursing program including informational and emotional support. The control group only received routine interventions. Data were collected by demographic form and modified Depression Anxiety and Stress Scale (DASS). The data were analyzed by Chi-squire and T-test using SPSS software, version 21.   

Findings. There were no statistically significant differences between control and intervention group regarding the mean scores of depression, anxiety and stress before surgery. After intervention (at the end of surgery) experimental group reported significantly lower levels of depression, anxiety and stress (P<0.0001).

Conclusion. According to the finding, supportive nursing program could reduce depression, anxiety and stress of family members of patients during coronary artery bypass graft surgery so, we suggest this program as an effective intervention to support family members during coronary artery bypass graft surgery.

---

Aim. The aim of this study was to examine the effect of preferred music on sleep quality of patients after coronary artery bypass surgery (CABG). Background. Sleep disorder is common among patients undergoing coronary artery bypass surgery that can also affect other postoperative outcomes. Method. This study was a quasi-experimental trial in which 70 patients who were undergoing coronary artery bypass surgery were recruited using convenience sampling method and assigned into the experimental and control group. Patients in experimental group listened to their preferred music by MP3 player for 20 minutes during 4 consecutive days, while patients in control group received only routine care. The patients’ sleep quality was measured before and after the intervention by means of Pittsburgh sleep quality inventory. Data were analyzed by SPSS, version 16, and descriptive and inferential statistical were used to report the findings. Findings. There was no statistically significant difference in sleep quality, before and after intervention in experimental and control groups. Conclusion. Music did not have effect on sleep quality among patients undergoing coronary artery bypass surgery, but the study can be reproduced with some modifications (change in intervention time and period and targeted selection of patients) in future studies.

---

Aim. The aim of this study was to examine the role of liaison nurse on vital signs of patients in the process of transition from cardiac surgery intensive care unit to general ward. Background. Patients' transfer from intensive care unit to a general ward is accompanied by anxiety, stress and changes in patients' vital signs. It is said that the role of liaison nurse solve the problems between intensive care unit and the general ward and prevent adverse events during transfer of patients. Method. This was a quasi-experimental study in which 68 patients were recruited and allocated to experimental and control group. In both control and experimental group, demographic and disease characteristics were collected in the beginning of the study .The experimental group received liaison nurse services during transfer process. Vital signs of the patients were measured and recorded at the beginning of transfer and two hours after admission of patient in the general ward. The data were analyzed by SPSS version 19 and using statistical tests. Findings. Before intervention, the experimental and control group were homogeneous in terms of demographics and vital signs except for systolic blood pressure. After intervention, significant reductions were found in vital signs in the experimental group. Conclusion. Liaison nurse services affect the vital signs of patients in the process of transition from cardiac surgery intensive care unit to general ward.

---

Aim. The aim of this study was to evaluate the current and expected status of comfort from the point of view of hospitalized cardiac surgery patients. Background. Providing comfort for the patient is one of the most important aspects of nursing that should be considered in all aspects of care as the top nursing care priority. Method. This was a descriptive comparative cross-sectional study in which 292 patients undergoing cardiac surgery were recruited as study sample. Data collection tool was a demographic form and modified form of Kolcaba's comfort questionnaire evaluating the current and expected status of comfort. After that the reliability and validity of the questionnaire was confirmed, it was completed by interview, the second day after surgery. Data analysis was performed by SPSS, version 16. Findings. The participants reported the best current status of comfort in psychospiritual (63.57 percent) and sociocultural (62.71 percent) domains of comfort, and rated physical domain of comfort as the lowest one(36.64 percent). Patients reported the comfort status in the environmental domain as moderate (54.78 percent). The most expectation of the patients were to be provided with comfort in psychospiritual (92.02 percent), environmental (91.14 percent) and physical (90.96 percent) domains, respectively, and the provision of comfort in sociocultural domain were least expected (88.16 percent). There was a statistically significant relationship of comfort with gender, age, education, occupation, place of residence, income, number of family members, physical activity and history of heart surgery, hypertension and hyperlipidemia. Conclusion. Patients reported less comfort in the physical domain and the most expected domain of comfort was psycho-spiritual. It is recommended that nurses pay more attention to providing comfort in physical and psychospiritual domains.

---

Background. Cardiovascular disease is one of the most common causes of morbidity and mortality around the world. The number of people with cardiovascular disease is increasing. This review article discusses the role of Vitamin D and Vitamin D deficiency complications in cardiovascular system.

Methods. This review article was conducted by searching out electronic databases as Google scholar, Elsevier, PupMed, PMC, and Springer to find articles published between 2007 and 2015. The keywords searched out were: “Cardiovascular disease AND Vit D”, “Vit D AND Hypertension”, “Vit D AND Heart”, “Vit D AND Atherosclerosis”,  and “Vit D deficiency”.

Findings. The response of Vitamin D receptors in all tissues including cardiovascular system (in presence of sufficient amount of Vitamin D) can prevent from uncontrolled growth and proliferation of cells in cardiomyocytes and smooth muscle of vessels wall. This is done by specific gene control through 1/25 Dihydroxyvitamin D (active form of Vitamin D). These genes control proliferation and differentiation of cells resulting in prevention of cardiovascular tissue hypertrophy and vessel thickness. Studies revealed that Vitamin D deficiency can cause inadvertent complications in cardiovascular system but it isn’t completely clear that administration of vitamin D can be beneficial in treatment of cardiovascular disease.

Conclusion. It is essential that adequate levels of Vitamin D is provided and replaced in the body before complications happen.

 

---

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.

---

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.

---

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.

---

Aim. The aim of this study was to evaluate the effect of early mobility on respiratory parameters in patients after open heart surgery. Background. Post-operative phase of open heart surgery is the most critical period during which many serious and fatal complication can occur. Early mobility can prevent such complications. The role of the critical care nurse is crucial in this regard. Method. In a randomized clinical trial, 104 patients who were candidate for open heart surgery were randomly assigned to experimental (n=52) and control (n=52) group. Patients in control group received hospital routine treatments. Patients in experimental group were mobilized from the bed in the first, second and third day after surgery. Early mobility included change position, siting on the bed, legs dangling off the bed, sitting in the chair next to the bed, and walking). The effect of early mobilization on respiratory indices was examined. Data were analyzed in SPSS version 18 using independent t-test, Chi-square and one way ANOVA statistical testes. Findings. There was no statistically significant difference between groups regarding demographic variables and underlying disease. Better lung function and arterial blood gases suitable changes were seen in the experimental group. Inspiratory capacity and arterial oxygen saturation was greater in the experimental than control group. Conclusion. Early mobility after open heart surgery is a safe and effective intervention and can have a positive effect on the patient's respiratory indices reducing pulmonary complications following surgery.

---

Abstract

Aim. The purpose of the present study was to examine the effect of supportive educational intervention on quality of sleep before coronary artery bypass grafting surgery.

Background. Patients who are waiting for surgery, experience high levels of stress and anxiety due to invasive nature of the procedure. This experience may influence their sleep quality. Disturbed sleep could lead to worsening the disease condition and reduces the process of recovery. Using non-pharmacological methods such as Benson muscle relaxation, deep breathing and guided imagery could be safe and useful for solving patients’ sleep problems before surgery.

Method. The present study was a quasi-experimental clinical trial in which 160 patients undergoing coronary artery bypass grafting surgery who hospitalized in cardiac surgery wards and cardiac intensive care units of selected hospitals of Tehran University of Medical Science were recruited and divided into two experimental (n=80) and control (n=80) group. Demographic data questionnaire was given to the patients at the first day of hospital admission. The control group received routine care. The intervention group received routine care and supportive educational intervention for at least two days between 4 and 6 p.m. All of the patients filled Groningen sleep quality scale in the day of surgery. Data analyzed by SPSS version 16.

Findings. Before surgery, the mean score of sleep quality was 4.6±5.50 in intervention group and 10.76±1.27 in control group.  There was a statistically significant difference between the experimental and control group in terms of sleep quality as the experimental group reported higher quality sleep than control group (P<0.0001).

Conclusion. Implementation of non-pharmacological methods such as relaxation, deep breathing, and guided imagery could be a good alternative method for hypnotic and sedative drugs. This could be one of the nursing interventions before coronary artery bypass grafting surgery as a safe, available and useful method.

---

---

Abstract

Aim. The aim of this study was to examine the effect of music therapy on ventilation criteria in mechanically ventilated patients in the intensive care unit.

Background. Complications made by mechanical ventilation are so much and considerable. Improvement of ventilation criteria is one of the factors that facilitatesweaning from mechanical ventilation.

Method. This randomized controlled trial was conducted in intensive care units of a teaching hospital affiliated to Iran University of Medical Sciences, Tehran, Iran. Seventy patients were recruited based on inclusion criteria and randomly allocated to experimental (n=35) and control (n=35) groups. For experimental group, relaxing music therapy was played with headphone for 30 minutes, once in the morning and once in the afternoon for one day. For control group, headphone was used without music for 30 minutes, once in the morning and once in the afternoon for one day. In both groups, ventilation criteria of respiratory rate, peak airway pressure and arterial saturation of oxygen (SaO2) were recorded in four intervals. Data analysis was performed in SPSS version 18 using statistical test.

Findings. Comparing of trends of ventilation criteria in experimental group showed that music therapy significantly reduced the mean respiratory rate (p= 0.0001), while in the control group, the mean respiratory rate slightly increased with time. In experimental group, the mean airway pressure reduced significantly within 30 minutes (17.30±3.65) compared with the time zero (19.68±3.64) (p=0.001). In the control group, the mean airway pressure increased slightly. The amount of spo2 did not differ significantly between experimental and control group (P=0.051).

Conclusion. Implementing music therapy in mechanically ventilated patients admitted to intensive care unit can reduce respiratory rate and maximum airway pressure. These could reduce the work of breathing and facilitate weaning the patient from ventilators.

---

Abstract
Aim. This literature review investigates the role of ECMO in the management of pulmonary barotrauma in people with decompression sickness (DCS).
Background. As a result of change in the atmospheric pressure in sea depth, divers may experience life threatening conditions such as barotrauma in vital organs including the lungs. Delivering 100% oxygen is the immediate treatment in these situations. A modern technology for oxygen therapy and supporting vital organs in heart and lung failure is extracorporeal membrane oxygenation (ECMO).
Method. This review was conducted by searching out databases UpToDate, Google scholar, Elsevier, SID and Magiran between 1995-2016 by the following keywords: diver, diving, decompression sickness, decompression syndrome, lung injuries, respiratory disorders, pulmonary barotrauma, treatment, and ECMO, and their Persian equivalents.
Findings. Oxygen administration and prevention of severe complications caused by accumulation of nitrogen bubbles in the body is an important treatment in this DCS. Oxygenation by nasal cannula in early stage and hyperbaric oxygenation in sever conditions are common treatments. ECMO can remove nitrogen bubbles of the blood and body and decrease concentration of nitrogen in the blood, and furthermore, improves oxygenation.
Conclusion. To rescue and prevent death in DCS victims, it is required to consider appropriate measures by minimum side effects. To do so, veno-venous ECMO can be a safe technique. The studies conducted in this field are limited; therefore more studies about ECMO usage in DCS must be conducted.

---

Abstract
Aim. The aim of this literature review was to investigate the effect of self-monitoring program on outcomes of heart failure (HF).  
Background. Heart Failure is a chronic and progressive disease with an increasing prevalence. Self-monitoring program may help to recognize decompensated HF symptoms and taking proper and early action. However, its potential for improvement of HF outcomes has remained unknown.
Method. In this narrative review, databases such as PubMed, Scopus, Web of science, Embase, and Cochrane library was used for data collection. Searching out was conducted on 27 Feb, 2017 for published articles between 1961- 2017 by the keywords "self-monitoring", "heart failure", "outcome", and their English synonyms without language limitation. Inclusion criteria were content similarity to subject under study, clinical trial study design, and self-monitoring of weight and recording it in a diary by patient with HF.
Findings. Out of 13924 retrieved articles, titles and abstracts of 8384 papers were screened for inclusion criteria. Full- text of 20 related paper were downloaded. Finally, data related to 12 papers published between 1998 to 2014 were reviewed. Outcomes of self-monitoring program included HF- related hospitalization and Emergency Department (ED) visit, mortality, self-care, quality of life and other outcomes such as disease knowledge, phone call to health care provider, Ejection Fraction (EF), HF NYHA function class, Brain Natriuretic Peptide (BNP), and care cost.   
Conclusion. Self-monitoring program has led to improve in HF outcomes. Therefore, giving weight and other symptoms self-monitoring diary beside self-care education will be recommended in order to increase patient’s engagement in his/her care.

---

---

---