Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Reviews
Year : 2009 | Month : August | Volume : 3 | Issue : 4 | Page : 1697 - 1703

Academic Detailing as a Possible Source of Drug Information in the Context of Nepal: A short review

SAVAL KHANAL*, SUBISH PALAIAN**, P. RAVI SHANKAR***, PRANAYA MISHRA**, MOHAMED IZHAM MOHAMED IBRAHIM****

*Dept. of Pharmacology, Nepalgunj Medical College, Chisapani, Banke, Nepal and Dept. of Social and Administrative Pharmacy, School of Pharmaceutical sciences, University Sains Malaysia, Penang, Malaysia, **Dept. of Hospital and Clinical Pharmacy, Manipal College of Medical Sciences, Pokhara,*** Department of Clinical Pharmacology & Therapeutics, KIST Medical College, Imadol, Lalitpur, [Nepal], **** Dept. of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Malaysia

Correspondence Address :
Saval Khanal, B. Pharm,
Dept. of Pharmacology, Nepalgunj
Medical College, Chisapani, Banke, Nepal
Email:khanalsaval@gmail.com.
Ph:+977 9848063354

Abstract

The source of unbiased drug information is an integral part of evidence based practice. The status of evidence based practice in Nepal is very poor. One of the major factors associated with it, is the limited availability of new literature, and poor documentation and dissemination of the little available information. Academic detailing is an educational outreach program in which a trained health professional visits clinicians in their offices to provide evidence based information. So, there is a huge scope for academic detailing as a means to disseminate the available information in the context of Nepal. Research done worldwide has already shown improvement in the clinicians’ knowledge, their attitude and practice, improvement in their prescribing patterns and an increase in their adherence to clinical guidelines, following academic detailing. In Nepal, there are many topics which can be selected for academic detailing. Topics covering the information regarding newer drugs, diarrhoea treatment guidelines, the rational use of antimicrobials, the rationality of fixed dose combinations, nonsteroidal antinflammatory drugs (NSAIDs) and specialized devices for the administration of drugs, will be more relevant. Lack of local health statistics, lack of awareness about evidence based practice, challenges from pharmaceutical representatives and a lack of financing capability may be the major limitations for academic detailing in Nepal.

Keywords

academic detailing, drug information, evidence based practice

Availability of a wide range of treatment options for the same condition may cause difficulty in clinical decision making. In such circumstances, sometimes clinicians may select the treatment option based on their opinion and experience without adequate information about the advantages and disadvantages of different options. However, the modern world cannot rely on the treatment based on the clinicians’ individual opinions and experience alone; instead, there is demand for scientific evidence and this has given rise to the concept of evidence based practice. Evidence based practice means the practice of using the most current research information to guide clinical decisions, while also fully taking into consideration the patient’s values and circumstances (1). Evidence based practice promotes the rational use of medicines. One of the major problems associated with practicing rational use of medicines is the lack of reliable and unbiased scientific information available for patient care in the context of Nepal (2). Sources of reliable and unbiased drug information thus, become an important element of evidence based practice. In circumstances where clinicians do not have reliable and unbiased sources of drug information, academic detailing may play a vital role to update clinicians with evidence based information.

Academic detailing is an educational outreach program in which a trained health professional visits clinicians in their offices to provide evidence based information (3). It is like a pharmaceutical representative visiting a physician, except that the information provided is evidence-based. Usually, it is given on a one-to-one basis; however, in some cases, it can be given to a small group of clinicians (4). It is also known as an educational outreach or an outreach visit.

Nepal is a developing country with inadequately developed drug information services. In this article, the authors provide an overview of academic detailing as a source of drug information and its scope in Nepal. The authors have also tried to discuss here, possible strategies to run an academic detailing program in Nepal, and its limitations.

Status of drug Information in Nepal
Historically, in the year 1995, the National Drug Policy of Nepal for the first time, emphasized the dissemination of accurate and unbiased drug information within the country. To fulfill this objective, the Drug Information Network of Nepal (DINoN) was established on November 23, 1996. The mission of DINoN was to develop and disseminate drug information among the members. At present, there are nine members of DINoN. Though more than one and a half decade has been already been spent, there has been no increase in the number of members of DINoN (5).

The activity of a drug information center in one of the teaching hospitals in Nepal is commendable. It has gone just beyond providing drug information. It provides drug information services to clinicians and other healthcare professionals, provides medication counseling to patients and their parties, runs a pharmacovigilance center, running continuing education programs and promoting the rational use of medicines inside the hospital (6). Similarly, an article from Nepal has suggested that one of the teaching hospitals in Nepal is running DIC as a pilot project (7).

Though the scenario of drug information services is improving, it is doing so in a very slow manner. Within the last five years, there has not been an appreciable increase in the number of drug information centers associated with DINoN. Limited availability of new literature and poor documentation and dissemination of the little available information, are the main limitations for drug information services in Nepal (8).

Justification for academic detailing
The advantages of the academic detailing and the associated advantages are discussed below under different subheadings.

1. Academic detailing improves the knowledge, attitude and practice of healthcare professionals
The thorough discussion of a topic during academic detailing can improve the knowledge, attitude and practice of the healthcare professionals on that topic. Studies conducted in Kenya and Indonesia had found a significant improvement in the knowledge and performance of pharmacists with respect to the treatment of diarrhoea (9). Similarly, other studies from Australia have suggested that academic detailing may have an impact on the physicians’ knowledge and self-perceived understanding of evidence based medicine (10).

2.Academic detailing improves the prescribing pattern of clinicians
Certain studies done worldwide, have demonstrated improvement in the prescribing pattern of clinicians following academic detailing. Meperidine, an opioid analgesic, is not recommended as the first line drug for pain management because of safety and efficacy concerns. In a hospital in the United States, it was found that there was an increased use of Meperidine. However, academic detailing reduced the use of Meperidine in the hospital (11). A study conducted in Sweden has concluded that there was a marked improvement in the prescription pattern of antipsychotics and benzodiazepines after academic detailing (12). Another study from Spain has demonstrated the positive impact of academic detailing on the prescribing pattern of Nonsteroidal Anti-inflammatory Drugs (NSAIDs) (13). All the studies suggest that academic detailing can improve the prescribing pattern of clinicians.

3. Academic detailing increases adherence to the clinical guidelines
Translating guidelines into practice has been the main problem in health sciences. Academic detailing can be used as one of the interventional programs to increase the clinicians’ adherence to the guidelines (14). Academic detailing has been successful in increasing the clinicians’ adherence to the guidelines. A study conducted in Australia states that the clinician’s adherence to the antibiotic guidelines was increased after academic detailing. They found that academic detailing remarkably decreased the number of antibiotic prescriptions and the total treatment costs (15). Similarly, in another study conducted in a hospital in the United States, academic detailing was useful in implementing new guidelines for treating hypertension (16). Therefore, academic detailing can be used as an informational or educational intervention to facilitate the implementation of clinical guidelines.

4.The perception of clinicians about academic detailing.
Evidence based educational outreach visits are incrementally more effective than conventional educational sessions (14). The clinicians’ perception about academic detailing can be vital to bring behavioural changes in them. Some of the studies carried out on the perception of the clinicians towards academic detailing suggest that the clinicians appreciated academic detailing as a good means to update their knowledge. In a research conducted in Belgium, physicians rated academic detailing visits highly and approximately 90% of those who used academic detailing wished to use it again (17). Similarly, clinicians valued academic detailing as an important source to get evidence based information and a study from Canada reported that despite being a source of valuable information, it is time- consuming (18).

5.The sustainability of academic detailing
To start a program is somehow easier than to sustain it. One article has reported that after a 10 year practice, academic detailing has become a sustainable source of drug information in Sweden. It has been transformed from project to practice (19). However, another article from Canada suggested that one academic detailing center was closed and some are in the way of closure because expected outcomes were not comparable to the investment in those academic detailing centers (20), suggesting that lack of economic strength can be one of the major limitations for academic detailing centers.

Need of academic detailing in Nepal
Academic detailing is known to improve the understanding of evidence based medicine (10). There is very limited data on evidence based practice in Nepal. On observation, one can find that the practice of managing a particular condition in almost the same type of individuals greatly varies between clinicians, suggesting that the status of evidence based practice is very poor in Nepal. An unbiased source of drug information is the heart of evidence based practice. But contrary to this, upon observation, one can hardly find good reference books and other unbiased sources of drug information for the clinicians and healthcare professionals in Nepal (21), (22). In such a scenario, the information which the clinicians or other healthcare professionals had obtained from their academic studies becomes the means of drug information for them. On other hand, due to the emergence of many pharmaceutical companies, clinicians are at a high risk of receiving biased information from their pharmaceutical representatives in Nepal (23). Therefore, in the case where there is a lack of unbiased sources of drug information, academic detailing can serve as a means of unbiased scientifically proven drug information. For such healthcare professionals, the academic detailing program becomes more suitable. By this way, the educational intervention in the form of academic detailing may promote the concept of evidence based practice in Nepal.

There are so many areas where academic detailing can contribute in Nepal. With the help of some health statistics, drug utilization studies and some pharmacoepidemiological studies, the authors try to postulate some of the important topics which can be focused during academic detailing. Those topics are mentioned in (Table/Fig 1).

How academic detailing can be conducted in Nepal?
Ros- Degnan et al has suggested four steps to the healthcare professional to carry out an educational intervention. These four steps are (1) Assess knowledge and actual treatment practices (2) Identify underlying motivations and constraints to changing practices (3) Design a persuasive educational intervention and (4) Carry out and evaluate the intervention (39). The authors of this article have proposed a model method for conducting academic detailing in Nepal, based on the method of Ros-Degnan et al as discussed above. The proposed method is diagrammatically illustrated in (Table/Fig 2).

Expected limitations in conducting academic detailing in Nepal.
In a study conducted in the Netherlands, clinicians identified some barriers in the way of the participation in academic detailing. The barriers identified by them were –the information in academic detailing was not new and could be obtained in other ways, the information was politically coloured and was designed to cut expenses and the educational visits were time-consuming (40). These types of limitations can also be expected in Nepal: however, the barrier of academic detailing to cut expenses may not be relevant to Nepal as there is no third party payment system in Nepal. In addition to the above limitations, some other expected limitations in Nepal are as follows:

1.Lack of local health statistics
This may cause a difficulty in selecting the medicines for which academic detailing should be prioritized. This may also cause problems in getting the information regarding the therapeutic efficacy and safety profile of the medicines in the local population.

2.Lack of awareness about evidence based practice
Since clinicians in Nepal are less aware about evidence based practice and rely mostly on their personal judgment and experience for clinical decision-making, they may not take academic detailing to be an important means of drug information.

3.Challenge from pharmaceutical representatives
Since the aim of both pharmaceutical representatives and academic detailers are to bring changes in the prescribing pattern of clinicians, it may be difficult for academic detailers to compete with the financial strength of pharmaceutical companies.

4.Lack of financing capability
More resource persons need to be appointed and bulletins and information leaflets may be needed. In such cases, economic problems may limit academic detailing. Sometimes, clinicians may also demand some bursaries to spend time on academic detailing. Apart from this, travel and other allowances are also required for academic detailers. So, there will be a demand for a budget to conduct academic detailing.

Conclusion

Though the scenario of the drug information services in Nepal is changing, it is not progressing in an expected manner. The status of evidence based practice is poor in this country. In this article, we have discussed the scope of academic detailing as the source of drug information in the Nepalese perspective. Academic detailing has already been practiced in other countries and has been shown to have a positive impact on promoting evidence based practice. The authors of this article have proposed a model to conduct academic detailing programs in Nepal. More research on the impact of academic detailing in the context of Nepal is required.

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