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.

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

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.

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.

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.

Abstract
Aim. The aim of the present study was to investigate the relationship of sleep quality and perceived stress with depression in women with acute myocardial infarction and anxiety symptoms.
Background. Depression is a common disorder with a lifetime prevalence of about 15 percent, and today it is considered the main cause of disability worldwide and ranks fourth among the ten main causes of the global burden of disease, which is characterized by long-term periods, a variety of symptoms. It is accompanied by a high rate of recurrence and many physical and mental disorders.
Method. Descriptive-correlational research design was selected for conducting the study. Statistical population included the women with acute heart attack living in Tehran in year 2022. Seventy people who scored higher than average in the anxiety questionnaire were selected as the research sample. The tools of data collection in this research were anxiety, depression, sleep quality and perceived stress questionnaires.
Findings. The results showed that there was a positive and statistically significant relationship between sleep quality and negative perceived stress and depression, and also a negative and statistically significant relationship was found between positive perceived stress and depression. Sleep quality, negative perceived stress, and positive perceived stress could predict respectively 0.18, 0.20, and 0.08 of changes in depression score.
Conclusions. Sleep problems can cause psychological distress and decrease concentration in people, so it can be expected that an increase in sleep problems can reduce a person's energy, and by increasing anxiety, it can cause an increase in psychological problems such as depression. Therefore, people who suffer from heart disease often endure a high level of anxiety due to the risk of the disease, which can be associated with increased sleep problems, thus leading to depression in them.

Abstract
Aim. The purpose of this study was to investigate the effect of mindfulness training on Corona anxiety in patients with Covid-19 and underlying cardiovascular disease in Imam Ali Hospital, Amol, Iran.
Background. Since its outbreak, the corona virus has shown that it defeats more people with underlying diseases and puts them at risk of death than those who have a healthy body.
Method. This was a quasi-experimental study with control group. The accecible population of this research was all corona patients with a history of cardiovascular disease in Imam Ali Hospital, Amol, Iran, in 2021-2022. Sampling was done from the patients admitted to the hospital based on convenience sampling method. To collect information, the Corona Virus Anxiety Questionnaire developed by Alipour et al. (2018) was used. Mindfulness training based on Kabat-Zinn (2005) educational plan was implemented in experimental group in 8 sessions of 2-hour duration per week.
Findings. The results of multivariate covariance analysis showed that mindfulness training has an effect on reducing anxiety of Corona in patients with Covid-19 and underlying cardiovascular disease to the extent of 0.87 (p≤0.001). Univariate covariance analysis showed that mindfulness training has an effect on reducing the mental symptoms of Corona anxiety in patients with Covid-19 and underlying cardiovascular disease to the extent of 0.83 (p≤0.001). Also, mindfulness training has an effect on reducing physical symptoms of Corona anxiety in patients with Covid-19 and underlying cardiovascular disease by 0.79 (p≤0.001).
Conclusion. Mindfulness exercises can enable patients with Covid-19 and underlying cardiovascular disease to pause and reflect a little before responding, and these pauses provide them with an opportunity. It allows them to get rid of judgment in many situations that can lead to anger, fear and anxiety. This will provide conditions that patients, even in the worst and acute state of their illness, are more likely to be able to maintain their mental peace and thereby, reduce the physical signs and symptoms of anxiety.

Aim. The present study was conducted with the aim of reviewing the role of serum albumin in heart failure.
Background. Heart failure is a complex clinical syndrome that affects a large population worldwide yearly, and its mortality is even higher than that of many cancers. Although the identification of traditional risk factors has helped in primary prevention, the death rate due to this disease is still increasing. Identifying potential and modifiable risk factors that are not known yet seems necessary in this situation. Serum albumin has been known for many years as a strong prognostic biomarker in many pathological conditions. In recent years, studies have been conducted regarding the role of serum albumin in the prediction, prognosis and treatment of heart failure symptoms.
Method. This narrative study was conducted in 2023. For this purpose, the data bases, PubMed, Scopus, Web of Sciences, SID, MagIran were searched out with the keywords albumin, heart failure, diastolic failure, systolic failure, and a total of 30 articles were included in the study.
Findings. Hypoalbuminemia is a common finding in patients with heart failure, and among its main causes in heart failure are malnutrition, inflammation, lack of intestinal function, lack of kidney function, and liver disease. According to clinical and experimental evidence, hypoalbuminemia is related to fluid retention and exacerbation of pulmonary edema in these patients. Also, hypoalbuminemia can independently predict the onset of a new heart failure and can be measured as a prognostic factor of heart failure outcomes. However, there is still no evidence that directly shows the benefit of albumin injection in patients with heart failure.
Conclusion. Serum albumin can be measured as a modifiable risk factor and a prognostic factor in heart failure, but it is necessary to limit its use to cases where its effectiveness has been confirmed.

Abstract
Aim. This study aimed at examining the convergence of calculated HEART pathway by physician and nurse along its utility to predict the 3-month occurrence of major adverse cardiac even (MACE) in patients with chest pain admitted to emergency department (ED).
Background. The HEART pathway is a tool to predict MACE in patients with chest pain admitted to ED, to help risk stratification for early discharge and reduce unnecessary cardiac tests.
Method. In the present study, a diagnostic tool was evaluated. Ninety-seven ED patients with acute chest pain, hospitalized in Rajaie Cardiovascular Medical and Research Center, were recruited prospectively. Risk stratification was performed by an ED nurse, a cardiology resident, and a cardiology attending physician. The correlation and the 3-month MACE outcomes were analyzed. 
Findings. Pairwise agreements were excellent between the raters. The Intraclass Correlation Coefficient (ICC) among raters were 0.84 (95% CI: 0.73–0.97) and thus, overall agreement was excellent. The HEART pathway score showed a high predictive power (AUC: 0.85 for 3-month MACE). For a cut-off score of 4, sensitivity, specificity, and negative predictive values were 87.5, 58.9, and 95.8 percent, respectively.
Conclusion. The HEART pathway score predicted effectively 3-month MACE in patients with acute non-traumatic chest pain. The high agreement among the three different raters suggests that nurses might use efficiently the score.

Abstract
Aim. This study was conducted with the aim of determining the effect of emotion-focused couple therapy on marital life quality, covert relational aggression and psychological health of couples with cardiovascular disease.
Background. Patients with cardiovascular disease face many problems in their marital life and psychological health, and the use of couple therapy methods is necessary to improve them.
Method. This study was a semi-experimental pretest-posttest design with control group. The study population was patients with cardiovascular disease (including hypertension, acute coronary syndrome, infarction, angina pectoris and constrictive pericarditis) referred to Razi Hospital in Ahvaz city, Iran in 2023. The sample size for each group was considered to be 13 couples, and these couples were selected by purposive sampling method based on inclusion criteria. The experimental group received 8 sessions of 90 minutes duration (two sessions per week) in the form of emotion-focused couple therapy and during this time, the control group did not receive any intervention. Data were collected with the scales marital life quality (Zhang et al., 2013), covert relational aggression (Nelsno & Carroll, 2006) and psychological health (Najarian & Davoodi, 2001) and were analyzed with Chi-square test, independent t-test and multivariate analysis of covariance in SPSS-26 software.
Findings. There was no statistically significant difference between the experimental and control groups in terms of age, education, illness duration and type of couple illness. In the pre-test stage, the groups did not differ significantly in terms of the mean score of marital life quality, covert relational aggression and psychological health, but in the post-test stage, there was a statistically significant difference in the mean score of all three variables (P≤0.0001). In this way, the emotion-focused couple therapy improved married life quality (F=125.366, P≤0.0001), reduced covert relational aggression (F=206.601, P≤0.0001) and improved psychological health (F=175.052, P≤0.0001) in couples with cardiovascular disease.
Conclusion. The results of this study showed the effect of emotion-focused couple therapy on improving the marital life quality, reducing the covert relational aggression, and improving the psychological health of couples with cardiovascular disease. Therefore, counselors and therapists can use emotion-focused couple therapy along with other effective treatment methods to improve variables related to marital life and psychological health.
 

Abstract
Aim. In this review article، the role of nurses in managing patients with STEMI who are undergoing primary PCI will be reviewed.
Background. Acute myocardial infarction is the most severe type of coronary artery disease that occurs due to the blockage of the coronary arteries of the heart. Considering the priority of treating patients with STEMI with primary PCI procedure is a priority.
Method. In this review study، literature search with the keywords Primary PCI، Nursing process، CAD، and STEMI was searched out in the electronic databases Google Scholar، Scopus، Cochrane library، PubMed، IranDoc، Magiran، and SID، from 2018 to 2024، in English and Persian language. In total، out of 120 retrieved articles، 21 were reviewed and analyzed.
Findings. ST segment elevation acute myocardial infarction (STEMI) is one of the critical and acute manifestations of CVD. The main treatment of the disease is reestablishing myocardial perfusion with percutaneous coronary intervention or thrombolytic therapy; and coronary angioplasty (PCI) is the preferred method of reperfusion. In line with the successful implementation of the treatment protocol، the cooperation of the medical staff is necessary and the empowerment of nurses regarding emergency nursing and triage of cardiac patients، nursing care before، during and after PCI، the correct implementation of the treatment protocol، prevention of complications، and also the training of patients in the field self-care methods and lifestyle modification، secondary prevention and medication adherence are important.
Conclusion. Nursing measures are very important in managing the treatment of patients with myocardial infarction and reducing complications and mortality، and the knowledge and practice of nurses should be updated to improve the quality of nursing care and increasing patient safety.
 

Abstract
Aim. The present study was conducted with the aim of reviewing the effect of telenursing in the care of patients with heart failure.
Background. Heart failure is one of the most common cardiovascular diseases, which is presented as a progressive and debilitating disorder. The prevalence of this disease is increasing due to the increasing age of the population, recent advances in the treatment of myocardial infarction, congenital diseases and the decline in mortality. In Iran, approximately one percent of all people over 40 years old have heart failure. The prevalence of this disease doubles with every decade of life and reaches about 10 percent in people over 70 years old. Studies have shown that specialized disease management programs for chronic heart failure (CHF) improve survival and quality of life and reduce health care utilization. Telenursing is one of the existing models.
Method. The present study is a narrative review. The researchers searched out the databases and search engines PubMed, Scopus, Web of Science, SID, Magiran, and Google Scholar using the keywords, care, chronic heart failure, nurse, telenursing and their Persian equivalent. After checking out the title and abstract of the articles found using the Joanna Briggs Institute (JBI) tool, the researchers reviewed 10 articles in this study.
Findings. Telenursing reduces hospitalization due to heart failure, reduces mortality and improves quality of life in patients with heart failure and improves education and follow-up after discharge. It also improves disease outcomes and reduces health costs.
Conclusion. The importance of paying attention to telenursing is recommended to policy makers and decision makers in the health system. 

Method. This literature review was conducted through a systematic and targeted search of articles and texts published from 2008 to 2024 in PubMed/, Web of Science, Google Scholar, and Scopus using the keywords Patent ductus arteriosus, Infant, Nursing care, Treatment, and their Persian equivalents.

Findings. Twelve articles and one book were found and the findings were organized as definition and pathophysiology of patent ductus arteriosus, diagnoses. treatment options, and nursing care.
Conclusion. The transition of the fetus from the womb to extrauterine life is one of the dynamic and vital adaptations in the life of neonates, especially premature neonates. With comprehensive monitoring and skillful clinical assessment, patent ductus arteriosus in neonates can be better managed.
 

Abstract
Aim. The aim of the present study was to predict adjustment to the disease in patients with cardiovascular disease based on psychological well-being with the moderating role of health beliefs.
Introduction. Health beliefs are directly related to an individual's adaptation and behavior, and the outcome of this adaptation affects the patient's perception of disability and quality of life. Effective assessment and understanding of illness involves understanding the individual's ability to demonstrate adaptive behaviors and estimating their success in regulating symptoms of the disease, and subsequently, seeking psychological well-being.
Method. This was a descriptive correlational study. Three hundred patients with cardiovascular disease referring to Martyr Dr. Qolipour Medical Center in Bukan, Iran were recruited by purposive sampling. To collect the data, Health Beliefs Questionnaire, Psychosocial Adjustment to Illness Scale, and Psychological Well-being scale were used. Inclusion criteria included cardiovascular disease, having at least a high school education, no acute physical illness other than cardiovascular disease, no acute mental illness, and willingness to participate in the study.
Findings. According to the results, in patients with cardiovascular disease, adjustment to the disease had a statistically significant positive relationship with psychological well-being and health beliefs (P≤0.01). Psychological well-being and health beliefs had the ability to predict adaptation to the disease, and health beliefs had a moderating role in the relationship between psychological well-being and adjustment to the disease.
Conclusion. In general, it can be concluded that in patients with cardiovascular disease, psychological well-being and health beliefs predict adjustment to the disease, and health beliefs can moderate the relationship between psychological well-being and adjustment to the disease.
 

Background. Satisfaction with nursing care and readiness for hospital discharge are essential indicators of healthcare quality. With the growing elderly population and increasing prevalence of cardiovascular diseases, assessing these variables in cardiac surgery patients is of great importance.
Method. In this descriptive-correlational cross-sectional study, 300 elderly patients undergoing cardiac surgery were enrolled using convenience sampling. Data were collected using a demographic questionnaire, the Newcastle Satisfaction with Nursing Scale (NSNS), and the Readiness for Hospital Discharge Scale (RHDS). Data were analyzed using SPSS version 26 with descriptive statistics, Pearson correlation, and multiple regression analysis.
Findings. The mean satisfaction score was 53.22±8.4, and the mean discharge readiness score was 6.1±1.7. There was a statistically significant positive correlation between satisfaction with nursing care and discharge readiness (r=0.46, p≤0.0001). Gender and education level were associated with satisfaction, while income level was associated with discharge readiness.
Conclusion. The findings indicated that patient satisfaction with nursing care is positively related to discharge readiness. Enhancing discharge education, nurse–patient communication, and nursing care quality can improve readiness for discharge among elderly cardiac surgery patients.

Abstract
Aim. This research aimed to identify and analyze the factors affecting resilience in nurses working in Intensive Care Units (ICUs) in Iran.
Background. Resilience is defined as the ability of individuals to resist, adapt, and recover from shocks and stresses while maintaining their functions. This concept is influenced by individual characteristics such as hope, optimism, and coping strategies, as well as social and environmental factors like social support, community cohesion, and effective governance, which play a key role in shaping resilience.
Methodology. In this review study, the keywords resilience, nurses, and intensive care unit, along with their English equivalents, were used. The Persian databases utilized included SID, MagIran, IranMedex, and the database of scientific journals of medical universities in the country. International databases included PubMed, Scopus, and Web of Science, and the Google Scholar search engine was also used. Ultimately, 20 articles were evaluated in the study.
Findings. Resilience in ICU nurses is a vital construction influenced by various factors. To improve nurses' resilience, interventions should be comprehensive, targeting both individual and organizational factors.
Conclusion. Regular assessment of nurses' resilience levels and monitoring the effectiveness of interventions through continuous qualitative and quantitative research are essential to ensure that strategies adapt to the changing needs of this critical group of healthcare personnel. This approach will not only improve the mental health of nurses but also directly lead to an enhancement in the quality of healthcare and the sustainability of the nursing workforce in the future.

Abstract
Aim. This review aimed to identify and analyze lifestyle factors influencing the prevention of cardiovascular diseases (CVD) in older adults, and to evaluate the combined effects of diet, physical activity, smoking avoidance, and body mass index (BMI) control.
Background. Cardiovascular diseases are a leading cause of morbidity and mortality in older adults. Lifestyle modifications, including dietary habits, exercise, and smoking cessation, are effective and low-cost preventive interventions. Understanding the impact of these factors individually and synergistically can guide public health and clinical strategies.
Methodology. A systematic review was conducted based on PRISMA 2020 guidelines. Studies published between 2015 and 2025 on CVD prevention in adults aged ≥60 were searched out from Persian and international databases (SID, MagIran, IranMedex, PubMed, Scopus, Web of Science). Eligible studies included original research (cross-sectional, cohort, and clinical trials) in Persian or English. Data extraction and quality assessment were performed systematically, and 22 studies met the inclusion criteria for final analysis.
Findings. Evidence indicates that a healthy diet, including Mediterranean or plant-based patterns, regular physical activity ≥150 minutes per week, smoking avoidance, and BMI control, collectively reduce cardiovascular risk factors and the incidence of CVD. Adherence to healthy dietary patterns decreased BMI, LDL-C, triglycerides, and HbA1c. Regular exercise demonstrated synergistic benefits with diet and smoking cessation, lowering the risk of myocardial infarction, stroke, and other cardiovascular events. Lifestyle interventions in pre-diabetic or metabolically at-risk populations slowed the progression of metabolic disorders and reduced the incidence of type 2 diabetes.
Conclusion. Promoting and adhering to a healthy lifestyle in older adults is an effective strategy for both primary and secondary prevention of cardiovascular diseases. Comprehensive, multidimensional lifestyle programs not only improve individual health but also reduce the societal and economic burden of CVD and enhance quality of life in the aging population.