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Aim

The aim of this study was to evaluate the effect of planned breathing exercises on oxygenation in patients undergoing coronary artery bypass surgery.

Background

Pulmonary complications and impaired oxygenation are common after coronary artery bypass graft surgery and cause increased hospitalization and health care costs. Breathing exercises are applied commonly in managing coronary artery bypass graft (CABG) patients in many hospitals, but scientific evidence is not sufficient about the efficacy of this treatment.

Method

In a clinical trial , 100 patients undergoing CABG were randomly allocated to planned breathing exercises (n=50) and control group (n=50). The patients in experimental group received breathing exercises protocol (deep breathing, incentive spirometry and directed cough maneuvers) and the patients in control group received daily routine hospital physiotherapy. Other therapies were similar in two groups. Arterial blood gases were compared between groups before operation and the first, second and third postoperative day. The data were analyzed by SPSS Version 17 software using chi square, T test and analysis of variance.

Findings

The study findings showed no statistically significant difference between groups in terms of demographic data, history of chronic diseases, Pao2 and Sao2 before surgery and on the first and second day after surgery. On the third postoperative day, the mean score of SaO2 (95, SD=2.47 vs. 93.24, SD=16.3, p=0.003) and PaO2 (83.19, SD=16.23 vs. 72.66, SD=13.20, P≤0.001) were higher in the experimental group.

Conclusion

The patients receiving planned breathing exercises including deep-breathing exercises, incentive spirometry and directed cough maneuvers have better oxygenation after coronary artery bypass surgery.

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Aim. The aim of this study was to compare the quality of life (QOL) in patients after coronary artery bypass graft surgery (CABG) and percutaneous transluminal coronary angioplasty(PTCA), before surgery and three, six and twelvemonths after surgery.

Background.CABG and PTCA are common treatments in coronary artery disease(CAD). After PTCA the patient is hospitalized only for one day and pays less than CABG,but it is not obviouswhether there is any difference between the quality of life in these two groups.

Method.This prospective cohort study was conducted on 241 patients (115 PTCA and 126 CABG patients) who were hospitalized in Tehran University of Medical Sciences hospitals between 2004-2006. The data were collected by questionnaire including 40 questions regarding demographic data, disease information and quality of life. The data were analyzed by statistical tests including T- test, Fisher's exact test, Wilcoxon and Friedman.

Findings.The findings showed that both groups hadreduction in the quality of life(P≤0.001), but the QOL had statistically significant difference in both groups three, six and twelve months after surgery (P≤0.001).

Conclusion.Patients and their families need to be supported and trained by health care team after performing each of these surgeries and encouraged to follow up their disease status.

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Aim. The aim of this study was to assess the effect of anti-embolism stocking in preventing lower limb edema following saphenous vein harvesting in patients undergoing coronary artery bypass graft surgery (CABG).

Background. Saphenous vein harvesting in the CABG may cause leg edema and compression therapy commonly used for the prevention of this problem.

Method. This prospective cohort study was conducted on 106 patients underwent elective CABG in Tehran Shahid Rajaei cardiovascular center from June 2011 to March 2011. Following the surgery, at the end of the fourth week, the patients were divided into two study groups according to the method of anti-embolism stocking usage. The first group regularly and consistently used the anti-embolism stocking following surgery (anti-embolism stocking group), whereas the second group did not use anti-embolism stocking, or irregularly used it (control group). The severity of the lower limb edema and changes in the circumference of the legs and thigh were analyzed following the surgery between two groups.

Findings. The findings showed that four weeks after the surgery, the incidence and the severity of the lower limb edema were significantly lower in the anti-embolism stocking group (P≤0.001). Also, the postoperative increase in leg circumference was significantly lower in anti-embolism stocking group, but there was no statistically significant difference between two groups in terms of thigh measurements (P≤0.05). The findings showed that weight and daily activity significantly correlated (P = 0.035 and 0.002 respectively) with the occurrence of lower limb edema, but there was no statistically significant correlation of occurrence of lower limb edema with age, gender, height, the use of diuretic, diabetes, low-salt diet, cardiac postoperative complication, donor leg ulcer complication and method of saphenous vein use.

Conclusion. This study showed that the regular use of anti-embolism stocking has a significant effect for the prevention of the lower limb edema and reduction of its grade, following the saphenous vein harvesting in CABG patients.

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Aim. This study aimed to evaluate the effect of cardiac rehabilitation on the quality of life in patients undergoing coronary artery bypass graft surgery (CABG).

Background. Nowadays, CABG is common in many patients to treat complications of the cardiovascular disease.

Method. This quasi-experimental study was conducted on 100 patients after coronary artery bypass graft surgery procedure (CABG). Based on objective and with regard to the inclusion criteria, the subjects were randomly divided into two groups of experimental and control groups. Cardiac rehabilitation program was conducted 24 sessions for the experimental group and the control group followed the usual program. Data were collected by demographic and SF-36 quality of life questionnaires at discharge (at the beginning of rehabilitation), the fourth week (after twelfth session) and the eighth week (after twenty fourth session) of cardiac rehabilitation. The data were analyzed by using Chi-square, independent T and RMANOVA tests.

Findings. The findings showed that the experimental and control groups were not significantly different with each other in terms of demographic variables. Comparison of experimental and control groups by using independent T-test showed that approximately there was statistically significant difference in all quality of life components after 12 sessions of cardiac rehabilitation in experimental group (4 weeks after control group discharge). Also, the comparison of both groups showed that after 24 sessions of cardiac rehabilitation in experimental group (8 weeks after control group discharge), there was statistically significant difference in variables such as physical functioning, general health, vitality, emotional role (emotional limitations), mental health, physical and mental health component and quality of life.

Conclusion. The results indicate a significant improvement on quality of life with cardiac rehabilitation intervention therefore, it is necessary to emphasize and encourage cardiac rehabilitation.

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Aim. The aim of this study was to evaluate the impact of cardiac rehabilitation on hemodynamic parameters

in patients undergoing coronary artery bypass graft surgery (CABG).

Background. Nowadays, CABG is common to treat complications of cardiovascular disease in many

patients.

Method. This clinical trial study was conducted on 50 patients after CABG. The patients were selected

based on objective and with regard to the inclusion criteria. Rehabilitation program was conducted for 24

sessions. Data were collected by demographic questionnaire and hemodynamic parameters checklist at the

beginning of rehabilitation, 12th session and 24th session of cardiac rehabilitation. The data were analyzed

by using Chi-square, RMANOVA tests and SPSS software.

Findings. The groups in terms of demographic variables were not significantly different with each other.

The findings showed statistically significant differences in variables such as systolic blood pressure, pulse

rate and arterial hemoglobin saturation. There were significant differences in these variables between the

first and the last sessions (session 24), also between the first session and during the rehabilitation (session

12). There was a significant difference between the 12th and the end of rehabilitation (session 24) in the

diastolic blood pressure (p=0.045), but no significant differences in other hemodynamic parameters were

seen.

Conclusion. The results indicate a relative improvement in some hemodynamic parameters with cardiac

rehabilitation intervention therefore, it is necessary to pay more attention to the cardiac rehabilitation.

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Abstract

Aim. The aim of this study was to examine the effect of massage therapy on sleep quality of patients after coronary artery bypass surgery (CABG).

Background. Poor sleep quality is common among patients following CABG and has been noticeable for more than 30 years.

Method. In this quasi-experimental study, 72 patients, who had undergone CABG in Isfahan Chamran Hospital were were recruited. The patients were randomly assigned to the two experimental and control groups. The patients of the experimental group received light pressure stroking massage for 20 minutes in four sessions after the surgery. The patients in control group received only the routine care. The patients› sleep quality was measured before and after the intervention with St Mary›s Hospital Sleep Questionnaire. Data were analyzed by SPSS software, version 18 and descriptive and inferential statistical methods were used for data analysis.

Findings. Mean scores for sleep quality before the intervention in the experimental and control groups were 22.5±3.6 and 22±3.8, respectively, and no statistically significant difference seen between them. After the intervention, there was a statistically significant difference between mean scores for sleep quality of the experimental and control groups (11.8±2.8 vs 15.5±4.7) (P<0.001).

Conclusion. The use of massage therapy can promote sleep quality of patients after CABG and due to low cost and simplicity it can be used as a complement to drug therapy and postoperative interventions implemented in these patients.

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Abstract

Aim. This study was conducted with the aim of evaluating the effect of spritual care based on «GHALBE SALIM» model on spritual experiences of the patients who have undergone coronaryartery bypass surgery.

Background. Patients undergoing open heart surgery, experience a crisis in their life. Every crisis is considered as a spiritual crisis and creates a unique experience that is rooted in culture and religion. Spiritual intervention which considers the spiritual mutual experience of the therapist and client is called spiritual care based on «GHALBE SALIM» model.

Method. In this clinical trial, 60 patients, candidated for elective coronary artery bypass graft surgery, were randomly assigned to experimental and control groups. Experimental group received spiritual care based on»GHALBE SALIM» model during hospital stay. The questionnaire Daily Spiritual Experience Scale (DSES) was completed by patients at the time of admission and discharge.

Findings. The level of spritual experiences at the time of hospitalization was not statristically significant between groups. On discharge, after implementing «GHALBE SALIM» model, the level of spritual experiences in experimental group was significantly higher in comparison with control group (P<0.001).

Conclusion. Spiritual care based on «GHALB SALIM» model increases the level of spiritual experiences and could be performed for meeting spiritual needs of patients.

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Abstract  

Background. One of the most important aspects of care and follow-up after coronary artery bypass graft surgery is treatment adherence program. As the long term success of the surgery depends on the treatment of adherence plan.

Aim. The purpose of this study was to evaluate the efficacy of phone and SMS follow-up care on patients' treatment adherence after coronary artery bypass graft.

Method. This clinical trial was performed on patients undergoing coronary artery bypass graft surgery in the heart surgery unit in Tehran hospitals in 2014. In this study, 90 patients were selected purposively and allocated into telephone follow-up group (n=30), SMS follow-up group (n=30) and control group (n=30). Demographic and treatment adherence questionnaire were completed twice (before intervention and two months after the intervention). The telephone follow-up and SMS follow-up groups were given training and booklet before discharge. In telephone follow-up intervention, three calls a week was made for two months and the SMS follow-up group received text messages daily for two months. To analyze the data, Chi-square test, Fisher exact test, t-test and ANOVA, ANCOVA, and Bonferroni test were used.

Findings. There was no statistically significant difference between the telephone follow-up and SMS follow-up groups in terms of treatment adherence scores, before and after intervention. A statistically significant difference was seen between telephone follow-up and control groups (p<0.0001), and SMS follow-up and control groups (p<0.0001) in terms of treatment adherence scores, before and after the intervention.  

Conclusion. Both SMS and telephone follow-up are effective to improve treatment adherence in patients after coronary artery bypass graft. It is suggested to use these interventions for patient following coronary artery bypass graft.

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Abstract

Aim.The purpose of this study was to examine the effect of patient education on postoperative pain perception in patient undergoing Coronary Artery Bypass Graft (CABG).

Background.Pain is a common complication after CABG surgery. Non-pharmacological methods are more favorable than pharmacological agents. 

Method.In this quasi-experimental study, 72 patients who were scheduled for elective CABG surgery  were randomized to experimental (n=36) and control group (n=36). Experimental group received educational intervention about pain control, one day before surgery (20-30 minutes duration), while control group received no intervention. Following transferring to the ICU and 2 hours after extubation, patients’ pain intensity wasmeasured by Johnson’s numerical scale. The measurements wererepeated twice withanintervalof threehours. The type and dosage of pain medication administered during ICU stay were recorded. To analyse the data, descriptive(mean and standard deviation, frequency distribution and percentage) and analytical statistics (Chi-square and Mann-Whitneytest) were used.

Findings.There was no statistically significant difference between two groups in terms of demographic characteristics. Two hours after extubation, there were no statistically significant difference between experimental and control group in the intensity of pain (P=0.313). Pain intensity was significantly lower in experimental group than control group, 5 hours (P=0.015) and 8 hours (P=0.006) after surgery. The results also showedthat the amount ofanalgesics used to relieve post-operativepain was significantly lower in experimental group than control group (P=0.046).

Conclusion.Patient education about pain control may have positive effects on postoperative pain in patients undergoing CABG surgery. This intervention could serve as an effective strategy for nurses to improve pain management among these patients. 

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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.

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

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

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

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

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

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

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

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

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

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

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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.

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Abstract

Aim. The aim of this study was to examine the effect of early mobilization on hemodynamic parameters in patients undergoing coronary artery bypass graft (CABG) surgery.

Background. CABG is one of the most common surgeries that can increase quality of life and reduce mortality in most cases. It seems that early mobilization of patients from bed may reduce complications after surgery. The most important concern regarding early mobilization is the possible effect on hemodynamic parameters based on which this important intervention is neglected.

Method. In a clinical trial with 100 patients who were candidate for CABG. The patients were randomly assigned to experimental and control group. The experimental group were mobilized from bed in the first, second and third day after surgery. The control group received the hospital routine treatments and mobilization was done in the third day after the operation. The effect of early mobilization on hemodynamic parameters were compare between the groups. Other treatment programs were the same for both group. Data were analyzed in SPSS version 18 and using independent t-test, Chi-square and ANOVA statistical testes.

Findings. There was no statistically significant difference between groups regarding demographic variables and underlying diseases. In the experimental group, blood pressure was higher in the second and third days  compared with that control group. Chest tube drainage on the third day were 495±241 ml for experimental group and 556±285 ml for the control group, and no statistically significant difference was found between the groups in terms of chest tube drainage. None of the patients showed any complication during the mobilization.

Conclusion. The experimental group experienced a minimal increase in blood pressure, but it was not clinically significant. The results of this study indicate that early mobilization from bed in patients undergoing coronary artery bypass graft is a safe and applicable intervention, and don’t increase bleeding and acute hemodynamic changes.

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Abstract

Aim. This study aimed to determine the relationship of spiritual experiences with the life expectancy and death anxiety in patients undergoing coronary artery bypass grafting (CABG).

Background. The patients undergoing CABG experience a critical situation that requires taking into account such factors as life expectancy, spiritual experience, and death anxiety. During taking care of these patients, nurses must consider these experiences and their relationship.

Method. In this descriptive-analytic study, 150 patients undergoing coronary artery bypass surgery in hospitals located in Kerman city, Iran, were recruited within an 8 months period in 2015. Data were collected using a questionnaire including demographic data, Templer Death Anxiety Scale, Adult Hope Scale and the Scale of Daily Spiritual Experiences (DSES). Data were analyzed in SPSS version 20 using Pearson correlation test, Independent T-test, ANOVA and multiple linear regression.

Findings. There was a statistically significant negative correlation of daily spiritual experiences with death anxiety (p=0.004) and death anxiety with life expectancy (p≤0.0001). There was also a statistically significant positive correlation between spiritual experiences and life expectancy (p≤0.0001). Multiple linear regression analysis showed that age and life expectancy predicted 61 percent of changes related to spiritual experiences.

Conclusion. The findings suggest that paying attention to spiritual experiences of patients may increase life expectancy and reduce the death anxiety. It is suggested to include supporting, facilitating and attending to the spiritual needs of patients in nursing care plans for these patients.

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Abstract

Aim. The aim of this study was to examine the effect of incentive spirometry and deep breathing exercises on arterial blood gas parameters after coronary artery bypass graft (CABG) surgery.

Background. After CABG, pulmonary complications and oxygenation disorders are common and play an important role in post-operative mortality and morbidity. The different methods are being used for improvement of pulmonary function and oxygenation after CABG.

Method. In this clinical trial study, 75 patients who were candidate for CABG surgery were recruited and randomly allocated to two intervention groups (incentive spirometry group and deep breathing exercise group) and control group. The groups were compared in terms of arterial blood gas parameters (PaO2, PaCO2 and SaO2) before surgery, and on the first day, the second day, and the third day after surgery.

Findings. The study findings showed that in the third postoperative day, there was a statistically significant difference between intervention groups and control group in terms of the mean of arterial blood gas parameters (PaO2, PaCO2 and SaO2). 

Conclusion. Incentive spirometry and deep breathing exercise are both significantly effective on improvement of arterial blood gas parameters (PaO2, PaCO2 and SaO2).

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Abstract
Aim. The aim of this study was to examine the effect of Mindfulness-Based Stress Reduction (MBSR) on depression and anxiety in people with coronary artery disease (CAD) treated with coronary artery bypass graft (CABG) surgery. 
Background. Depression and anxiety are common in people with CAD treated with CABG. Therefore, it is important to investigate if effective therapeutic models can influence the negative emotions of these patients.
Method. The research method was single-subject and the statistical population of this study included all people with coronary artery disease who referred to Shahid Madani Hospital in Tabriz, Iran, during the second six months of the year 2016 for rehabilitation after surgery. The study sample consisted of four available people with CAD who received eight sessions of MBSR training by the researcher. The subjects were assessed before and after receiving the MBSR training by Beck Depression Inventory, and Beck anxiety Inventory. The data were analyzed through recovery percentage, percent of non-overlapping data (PND), standardized mean difference (SMD) and visual analysis of the charts. 
Findings. The findings showed that MBSR training reduced anxiety and depression in people with CAD following treatment with CABG.
Conclusion. Based on these findings, it be can concluded that MBSR is an effective treatment for management of negative emotions of people with CAD treated with CABG.

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Abstract
Background. Self-care behaviors in cardiac patients are one of the essential factors in their treatments. The failure to apply proper self-care behaviors reduces their recovery and imposes high costs on the health care system.
Aim. This study aimed for design and psychometric measurement of the questionnaire on attitude, knowledge and utilization of self-care for patients undergoing coronary artery bypass graft surgery based on Waltz model
Method. In this methodological study, the following four steps were conducted for design and psychometric measurement of the questionnaire: 1) defining the theoretical and practical self-care concept for patients undergoing coronary artery bypass graft surgery in the domains of physical activity, sexual activity, social activity, mental state, and smoking; 2) designing the items of the questionnaire using other instruments which are being used in heart diseases; 3) determining the face validity (the assessment of facility, difficulty, and ambiguity of the items and their importance for patients) and content validity of the questionnaire (the assessment of appropriateness and necessity of items by experts opinions and measuring CVR and CVI; 4) the internal consistency of the questionnaire was evaluated by determining the Cranach's alpha coefficient.
Findings. The first version of this questionnaire was produced with 56 items, of which 15 items were deleted during the process of validity and reliability confirmation. The final version of the questionnaire was provided with 41 items in three domains; knowledge domain with 14 items, attitude domain with 7 items and utilization domain with 20 items. The results of the psychometric procedure for the questionnaire was the content validity index of 0.99, the content validity ratio of 0.96 and the internal consistency of the questionnaire with Cronbach's alpha coefficient of 0.7 representing appropriate validity and reliability of the questionnaire.
Conclusion. This 41-item questionnaire can be utilized in the assessment process of these patients. Measuring construct validity is recommended for the validity of the domains of the present questionnaire.

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