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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 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
The Use of Metered Dose Inhalers: Where are we?
Correspondence Address :
Naren S Dudyala,
Asst Prof, Pediatrics,
Konaseema Institute of Medical Sciences,
Amalapuram Andhra Pradesh 533201, India.
Phone: 09491130738
E-mail: dudyalanaren@gmail.com
dudyalanaren@rediffmail.com
The use of inhaled drugs is a basic aspect of the treatment of patients with asthma, in acute episodes as well as in maintenance therapy. For years, conventional nebulizers were the only inhalers available. With the advent of pressurized metered-dose inhalers, the delivery of drugs such as bronchodilators and corticosteroids into the respiratory tract is optimized. Treatment failure in individuals with asthma frequently results from the incorrect use of metered-dose inhalers, which is typically a consequence of a lack of counseling by health professionals, many of whom are unfamiliar with the technique. The Konaseema Institute of Medical sciences, Institute for Children is a tertiary hospital where patients with pulmonary disease states are treated in the emergency room, intensive care unit, outpatient clinic and nurseries. The present prospective study was aimed to evaluate the knowledge regarding the use of pressurized metered-dose inhalers among the professionals working in the hospital,. Statistical analysis by chi-square test and p values, observes a significant difference between the correct usage and the prescribing health care professionals of the hospital which was done as per an evaluation chart. Hence the need for periodic training and evaluation.
Metered dose inhalers, Health care professionals, Periodic training and Evaluation
INTRODUCTION
Asthma is a significant public health problem worldwide and it ranges in its prevalence from 1 to 18% (1). In India, asthma is the one of the leading causes of hospitalization among children and young adults and it greatly increases the costs of the health care system. It results in school absenteeism/inability to perform physical activities and it can interfere with the psychosocial development of children (2). Drug therapy forms the cornerstone of the treatment in asthma. Various devices are popular among the general public like spacers, nebulizers, metered dose inhalers, drugs and combinations of these. The apt use of the medication which is prescribed, the technique and the compliance to the medication is important for a healthy tomorrow. The use of inhaled drugs is a basic aspect in the treatment of patients with asthma, in acute episodes as well as in maintenance therapy. Currently, there is a near-unanimous consensus that the use of anti-inflammatory drugs is indicated for the treatment of persistent asthma, since the role of inflammation in the patho physiology of the disease has been well recognized (3). For years, conventional nebulizers were the only inhalers which were available. With the advent of pressurized metered-dose inhalers, the delivery of drugs such as bronchodilators and corticosteroids into the respira¬tory tract was optimized, thereby decreasing the local and the systemic side effects (4),(5).
Various studies have demonstrated that the metered-dose inhaler is safe and efficacious, which produces particles of 1 to 50 μm in diameter (particles which are 1- to 5-μm in diameter reach the distal portions of the tracheobronchial tree). In addition, it is port¬able, it does not depend on an air compressor and it uses a standardized dose (6),(7). The treatment failure in individuals with asthma frequently results from the incorrect use of metered-dose inhalers, which is typically Original Article Pediatrics Sectiona consequence of a lack of counseling by the health professionals, many of whom are unfamiliar with the technique (8). The Konaseema Institute of Medical sciences, Institute for Children, is a tertiary hospital where patients with pulmonary disease states are treated in the emergency room, intensive care unit, infirmary, outpatient clinic and the nurseries. Therefore, in order to determine the difficulties that might interfere with the appropriate counselling of the patients, we decided to determine the theoretical and the practical knowledge of the health care professionals with respect to the use of metered-dose inhalers, which formed the aim of our study.
Sample size: The prescribing doctors of the hospital (30) and the junior doctors who were involved in the paediatric patient care (80), a total of 110 subjects were included in the study as per the hospital data which was available.
Type of studY: Prospective study
Period of study: August 2011 to September 2011. A prospective study was carried out, which included the junior doctors (interns and post graduates) and the prescribing doctors (practising physicians) of the hospital. An ‘MDI use evaluation score chart’ (Table/Fig 1) was prepared as per the National Asthma Education and Prevention Program (NAEPP) criteria (9) and it was used in the study. For every correctly carried out step, a score of ‘1’ was given, and for every incorrect step, a score of ‘0’ was given. The healthcare professionals were asked, after obtaining their verbal consent, to demonstrate the use of the placebo inhaler to the care givers of the patients, and the steps were graded as per the NAEPP criteria.
STATISTICAL ANALYSIS
The statistical analysis was performed by using the SAS 9.1 version and the Chi-Square test and the Fisher’s extract test was used to calculate the p-value. The test was done at a 5% significance level and a P value of <=0.05 indicated significance.
The results are depicted in (Table/Fig 2), which shows that both thepractising doctors and the junior doctors had an incorrect method of demonstrating the usage of the metered dose inhaler. Steps 1, 2, 8 and 10 were demonstrated correctly, both by the prescribing doctors and the junior doctors. Step 7 was incorrectly demonstrated by a majority of the junior doctors and step 4 was demonstrated incorrectly by a majority of the practising doctors. Also,there was a significant difference between the prescribing doctors and the junior doctors, a majority of the latter were incorrect. Only 12 of the 110 professionals could actually get all the steps correct.
In a study which was conducted by Hira HS, at the Maulana AzadMedical College, New Delhi, India, a questionnaire regarding the use of metered dose inhalers (MDI) was administered to 38 physicians, (9) faculty members and 29 residents. Fifty-five percent of the faculty members answered at least three or more of the seven steps of the inhalation technique correctly, as compared to 86% of the residents and this was statistically significant (p value < 0.01). All the participants used to prescribe MDI to their patients. 80% of them responded that they followed the package insert instructions to educate their patients. It was concluded that the doctors who are involved with the MDI use, should learn and become familiar with the proper recommendations for its optimal aerosol delivery (10). Our present study showed that only 10.9 % of the health care professionals were correct, which was of serious concern. In a study from Iran, which included physicians and nurses, only 6.93% could demonstrate MDIs correctly (11). In another study from Oman, only 15% of the respondents performed all the steps correctly (12).
The training and the evaluation of the health care professionals is absolutely essential for the effective management of childhood asthma. The morbidity and the mortality could thus be reduced. The limitations of the present study were, that it was not carried among the nursing personnel who form a vital link and that few healthcare personnel were on leave during the period of the study.
Dr Subbarao, Dr Amarendra, The MD, The Medical Superintendent, The Dean, Dr Acharya , Dr Soren, Dr Pujari, Dr Sudhanshu, Dr Vishnumurthy, The Nursing staff, for their guidance. Miss Josna statistician for the analysis.
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