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

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Dr Mohan Z Mani

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Department of Dermatolgy,
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
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

Important Notice

Original article / research
Year : 2022 | Month : June | Volume : 16 | Issue : 6 | Page : UC43 - UC47 Full Version

Effect of Standardised Virtual Communication on Anxiety in Relatives of Patients with COVID-19 Infection in Central Gujarat: A Prospective Interventional Study


Published: June 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/56802.16499
Komal Makwana, Sangeeta Jain, Balaji Ghugare, Niraj Rathod

1. Assistant Professor, Department of Physiology, Gujarat Medical Education and Research Society Medical College and Hospital, Gotri, Baroda, Gujarat, India. 2. Associate Professor, Department of Physiology, Gujarat Medical Education and Research Society Medical College and Hospital, Gotri, Baroda, Gujarat, India. 3. Associate Professor, Department of Physiology, Gujarat Medical Education and Research Society Medical College and Hospital, Gotri, Baroda, Gujarat, India. 4. Associate Professor, Department of Anesthesia, SBKS Medical Institute and Research Centre, Pipariya, Baroda, Gujarat, India.

Correspondence Address :
Dr. Niraj Rathod,
A-202, Gujarat Medical Education and Research Society Medical College and Hospital, Medical College Quarters, Baroda, Gujarat, India.
E-mail: drnmrathod@gmail.com

Abstract

Introduction: There are various researches for increased anxiety in Coronavirus Disease 2019 (COVID-19) patients and their relatives due to separation, but most of them are observational. Audio-video communication can be employed for communication between patients in rigorous isolation and their relatives. There were few researches available about the effectiveness of video calling on anxiety in COVID-19 patient. Gujarat lags considerably behind, according to bibliometric analysis of the India-based COVID-19 publication. Thus, the authors sought to conduct present study to evaluate that how video conferencing between COVID-19 patients in isolation and their relatives, affects anxiety.

Aim: To determine the effect of standardised virtual communication on anxiety levels in relatives of COVID-19 intubated patient’s.

Materials and Methods: This prospective interventional study was conducted at a tertiary care centre, Gujarat Medical Education and Research Society Medical College and Hospital, Vadodara, Gujarat, India, from April 2021 to July 2021. Total 283 relatives of COVID-19 patient were recruited by purposive sampling. Virtual communication unit was set up, where relatives can communicate audio-visually with their patient and caregiver with help of video calling technology. Inside Intensive Care Unit (ICU), the caregivers (intern, doctors or nurses) wearing Personal Protective Equipment (PPE) kit handled the portable audio-visual screen and answered on behalf of the patient. The Hamilton anxiety scale was used to measure the anxiety of relatives before and after the communication. Paired t-test was used to statistically analyse the data. Level of significant p-value <0.05 was considered.

Results: A total of 283 subjects with 178 males and 105 female relatives were enrolled in the study. As an effect of communication, the mild anxiety prevalence decreased from 69.71% to 46.27%, the moderate anxiety prevalence decreased from 4.93% to 3.81%, and 49.92% of relatives reported being anxiety-free after communication. Statistical analysis of the paired t-test of Hamilton anxiety score showed a drop in anxiety score after communication from 4.77±3.66 to 2.88±2.34 (p-value <0.001).

Conclusion: Audio-visual technology is effective as a mode of communication and counselling during a pandemic to reduce anxiety in COVID-19 victim families.

Keywords

Audio-visual communication, Coronavirus disease 2019, Counselling, Intensive care unit, Stress

A lot of researches are done about the increase in risks of mortality and morbidity due to Coronavirus Disease 2019 (COVID-19) (1),(2),(3). There are foreign studies about increased anxiety in relatives and COVID-19 patients during the acute phase of the disease and its long-term effect on their mental health (4),(5),(6). There are so many factors that can be associated with the adverse mental health of COVID-19 patient’s relatives such as fear of sudden death of a patient, not being able to visit the patient, stress due to separation from the patient, higher perceived overall burden in situation due to finance, increased worries about uncertain diagnosis and infection, not enough contact with the medical team. All these factors are significantly responsible for psychosocial distress (7).

There is a study that suggests the use of video technology for face-to-face communication between junior doctors and relatives of COVID-19 patients for routine medical updates and facilitating relatives to communicate with their patients (8). The ability of relatives to remain active in their caregiving roles virtually and rapport built with medical caregivers through video technology improves the psychological wellbeing of patients and their families (8). Gujarat lags far behind in COVID-19 based publication (9).

This tertiary care centre, where the present study was undertaken, was strictly following the isolation and quarantine norms. Hospital administrator felt an urgent need for innovative methods that serve as the best alternative for routine patient-relative communication. Thus, a virtual communication unit was set near COVID-19 Intensive Care Unit (ICU), where facility of audio-visual communication was set. The communication unit work as a virtual bridge through which the relatives were able to communicate with their patient In COVID-19 ward and ICU with help of video audio technology, without exposure to the virus. On the other hand, patient was able to see and hear relatives on the portable screen handled by a primary caregiver who was trained in Attitude, Ethics and Communication (AETCOM) modules based on need of COVID-19 patients (10),(11),(12).

The relative whose patients were admitted to ICU are found more anxious due to restricted family visiting. The fear of dying, related patient alone in ICU, and the inability of a relative to comfort his patient bedside are major contributing factors to anxiety (13). In this intervention study authors wanted to measure the effect of communication on the anxiety of the relatives whose specific patient was admitted less than seven days and was intubated. To make communication homogenous for all subjects Authors narrowed the broad concept of communication by standardising it. There was no study found about the effect of virtual communication on anxiety which was conducted in Gujarat state. Hence, the present study was conducted to determine the effect of virtual communication on the anxiety of a relative whose specific patient was hospitalized and isolated in a tertiary care centre which is located in Central Gujarat.

Material and Methods

This prospective interventional study was conducted at a tertiary care centre, Gujarat Medical Education and Research Society Medical College and Hospital, Vadodara, Gujarat, India, from April 2021 to July 2021 after the Institutional Ethical Clearance (IEC approval number- BHR/10/2021 which was approved on 19th March 2021).

Inclusion criteria: The immediate relatives of COVID-19 intubated patients, admitted in ICU for less than seven days were included. The status of relative was noted in relation to patient and relatives like mother, father, spouse, children, siblings were included were included in the study.

Exclusion criteria: Relatives aged less than 18 years, with history of any previous mental health disorders and denial of consent were excluded from the study.

Sample size calculation: The sample size was calculated using the following formulae n=Z2p(1-p)/d2

Where,

n is the sample size,

Z is the statistic corresponding to the level of confidence, p is the expected prevalence (that is obtained from previous research), and

d is precision (corresponding to effect size) from earlier research (6),(14).

Thus, in this formula where,

Z=1.96, p=20, 1-p, d=5%

The final calculated sample size was 245. Total of 283 subjects were enrolled in the study.

The sampling method was convenient-purposive sampling where author and team approached the study population who came to use a virtual communication facility to talk with their patient. The author and team informed relatives about this study, asked for consent and screened relatives for inclusion criteria.

Procedure

Data collection was done at a communication and counseling centre. The virtual communication unit was set-up under the administration of this already running communication and counseling centre.

Hamilton Anxiety Scale (HAM-A): The suitable subjects were screened for anxiety using the Hamilton anxiety scale for assessment of anxiety before and after virtual communication which took about 15 to 20 minutes (15),(16),(17). The Hamilton anxiety scale (HAM-A) is one of the first rating scales which were developed to measure the severity of anxiety levels, available in public domain, and is still widely used even today in both clinical and research. It is made of 14 symptom-defined elements- anxious mood, tension, fear, insomnia, intellectual, depressed mood, somatic(muscular), somatic(sensory), cardiovascular symptoms, respiratory symptoms, gastrointestinal symptoms, genitourinary symptoms, autonomic symptoms and behaviour at interview. (psychological and somatic) comprising anxious mood, tension, startle response, fatigability, restlessness, fears of dark/strangers/crowds, insomnia, intellectual problems like poor memory/difficulty concentrating, depressed mood.

• Physical somatic symptoms include aches and pains, stiffness, bruxism.
• Physical sensory symptoms including tinnitus, blurred vision.
• Other domains of somatic system screened like respiratory (chest tightness, choking); cardiovascular (including tachycardia and palpitations); gastrointestinal (including irritable bowel syndrome-type symptoms); genitourinary (including urinary frequency, impotency); autonomic (including dry mouth).

For every question score on scale of

• 0= not present,
• 1=mild,
• 2=moderate,
• 3=severe,
• 4=very severe was given as an answer option.

In Hamilton Anxiety Scale, if total

• Score 0 means no anxiety,
• Score <17 indicates mild anxiety,
• Score 18-24 mild to moderate anxiety,
• Score 25-30 moderate to severe and
• Score 31 to 56 severe anxiety.

[Annexure 1] is showing the Hamilton anxiety scale questionnaire

Standardised Virtual Communication (SVC): After initial screening for anxiety, relative entered the virtual communication unit. A virtual communication centre with help of audio video; input and output technology facilitated the communication between relative and particular patient. The caregiver moved the portable audio-visual unit in front of patient, where relatives and patient both parties could comfortably see each other and listen. After the completion of virtual communication relative exit the out unit and immediately approached by the author and team for post-SVC anxiety assessment.

To overcome the challenges during video calling the caregivers were given training in attitude, ethics and communication modules based on COVID-19 disease. This new curriculum includes attitude, ethical and communication training compulsory for all students (10),(11),(12). Based on those modules, at the counselling and communication centre the intern doctors and paramedical staff were given training.

It was focused on affective domain like:

• What is to be COVID-19 patient?
• What is to be relative of COVID-19 infected patient?
• How to break bad news to patient’s relatives?
• Remodeled and structured according to specific COVID-19 pandemic scenarios. Specific written guidelines of Do’s and Don’t check lists before starting Standardised Virtual Communication (SVC) were given to caregivers (10),(11),(12).

Statistical Analysis

In present study Prism - GraphPad version 8 was used for statistical analysis. Paired t-test was used to statistically analyse the data. Level of significant p-value <0.05 was considered.

Results

The (Table/Fig 1) shows the relation, gender and age distribution in study subjects. A total of 283 subjects were included in this study out of the 178 were males and 105 were females. Further demographic distribution of subjects whose recruitment was based on relation to the specific patient was 130 sons, 32 brothers,12 fathers,4 husbands, 43 daughters,16 sisters, 15 mothers and 31 wives.

There was a significant decrease in the HAM score after audio-visual communication (2.88±2.34) than before the communication (4.77±3.66) (p-value <0.001) (Table/Fig 2).

Analysis of Hamilton anxiety score before and after communication showed that prevalence of anxiety has decreased post communication, the mild to moderate anxiety prevalence decreased from 197 (69.71 %) to 131 (46.27%), moderate to severe anxiety prevalence decreased from 14 (4.93%) to 11 (3.81%) (Table/Fig 3).

Discussion

Since 2019, the globe has been fighting a novel coronavirus, and scientific study and literature about the epidemic are critical to victory. Researchers have published in the areas of causation, clinical characteristics, and vaccine development, resulting in a significant increase in the amount of scholarly literature on COVID-19 (9). The authors during an intensive literature review found that India is far behind the United States of America, China, United Kingdom and Italy (18),(19),(20). A meta-analysis of the global prevalence of anxiety and depression shows publication ratio of China:India is 7:2 indicating ignored mental health aspects of COVID-19 in the Indian background (19).

The researchers stated that the research work done done on the mental health of relatives is less than compared of patients and frontline health workers (21). Recent evidence suggests that individuals who are kept in isolation and quarantine have negative effects on mental health such as stress, anxiety, frustration, anger, fear and confusion (20).

The higher prevalence of anxiety in relatives may be due to the acute phase of disease or hospitalization (4),(5). There are so many factors that can be causing anxiety and stress in relatives such as stress due to isolation measures and separation from the patient, not being able to visit the patient, fear of death of a patient, higher perceived overall burden on the situation, increased worries about uncertain diagnosis and infection, not enough contact with the medical team, missing physical touch (7). The most violated domain and contributing factor in anxiety was the affective domain i.e, the emotional needs of the family. In these studies, video calling was implemented in the COVID-19 unit with some attempts of standardisation, but the training of health care personnel to meet the affection needs of COVID-19 affected families was not done. All of these factors discussed earlier can be removed by virtual communication except physical touch (22),(23),(24),(25). A qualitative study done by a researcher in Italy where he conducted an in-depth interview of respiratory therapists who used video calling for communicating with relatives confirmed the positive impact of video calling on patients and relatives both, but also the need for training to cope with psychological challenges during communication (25). Family dynamics were shattered during the COVID-19 pandemic scenario because of isolation and restricted visits (26). All these factors can lead to Post Traumatic Stress Disorder (PTSD) in the future which is a highly occurring relative of COVID-19 (27). The guilt of not being able to visit, and take care of the patient often is a major contributor to PTSD. The fear of patients dying alone is major stress and grief inducer in relatives (27),(28),(29).

Authors made COVID-19 specific AETCOM training modules with help of institutional experts, scientific discussion and feedback from every healthcare level. In which caregivers were specially trained to cope with challenges during virtual communication which were based on the following list of affective aspects:

• Relative wanted to be near their patient during hospitalization and especially in the patient’s end time.
• Relatives wanted to express their feelings to nursing and medical staff and want to feel accepted by them.
• They want to feel that the staff is concerned about their patient.
• They want to receive the appropriate education or information to help their patient in the hospital.

The most ethically challenging sensitive issue was relatives always wanted to feel that there is hope for the patient’s recovery because in very morbid patients, doctors had to break the bad news of the “probable end time of patient’s life and all relatives should say goodbye”. Thus, providing an on-site (just nearby ICU where loved ones are admitted) standardised virtual communication unit where relatives can sit comfortably see and talk with their patient, where the primary care giver was present by their patient side must be fulfilling their emotional needs. Especially covering the affective domain in communication might be the core of all interrelated factors which decreased post communication anxiety scores. Studies show that the opportunity for meaningful communication prior to death maybe even more important than being all-time present (30). A study suggests that well-maintained updated communication between caregivers and family establishes good rapport and trust (8). Thus, having good communication with patients mediated by the primary caregiver and a sense of having talked before imminent tragedy may be a reason of post communication stress relief in family members (8),(31),(32).

Also, we cannot overlook the advantage of non verbal communication provided by virtual communication where relatives can see the body language, and eye contact of the primary caregiver. The presence of a doctor at the bedside of the patient for a long time is a good attitude and communication factor which might also help reduce the anxiety of relatives (31),(32),(33). This implementation of standardised virtual communication which has to be molded according to the needs of the field and patients can be helpful to Physiotherapists, nursing staff, psychologists and other allied health professionals in their COVID-19 patient care, senior citizen care and patients with mobility issues. The specific guidelines sensitization regarding this should be done in advance (34). In the case of the 3rd wave of COVID-19, structured guidelines and resources should be available for the implementation of virtual communication at the secondary and tertiary care centre level. Standardised communication guidelines for relatives (soft copy via SMS or WhatsApp) that outline protocol in local Gujarati/ Hindi/ English language should be distributed to patient’s relatives on admission. The purpose of this standardised guideline is to help relative to align their expectations, limitation and maintain a structured approach to communication. The specific arrangement for communication unit duty allotment and COVID-19 AETCOM sensitization should be done in advance at secondary and tertiary care centres to prepare in advance. But precaution needs to be taken while using video technology to avoid in house contamination. One major fear is cross-infection to the staff and other patients because of contamination of devices because SARS-CoV-2 is viable for up to 3 days on the surfaces of electronic devices (35). Measures were taken to prevent this was the use of disposable plastic sleeves to cover the device with each use, a specific allotment to one person for communication duty who wears a Personal Protective Equipment (PPE) kit and did not touch any other surfaces and patient except for communication devices and regular alcohol sanitization of all surfaces (36),(37).

Limitation(s)

The scope of the study is limited since the sample is entirely from one institution (single institutional involvement). One major fear was cross-infection to the staff and other patients because of contamination of devices. Patient anxiety scale was not recorded. The self-reported bias as for anxiety the screening was only applied (not diagnosed by the clinician).

Conclusion

The positive effect of standardised virtual communication which is measurable in terms of anxiety scale and prevalence. The actual implementation of theoretical aspects of attitude, ethics and communication principles in COVID-19 pandemic scenario. First kind of interventional study COVID-19 mental health aspects in central Gujarat. The universal implication of this both tools can be effective in reducing anxiety, depression and PTSD in COVID-19 victim families, reducing the community and national health burdens. Further studies could be aimed to implement and study its effect on various need-specific AETCOM modules in scenarios where the doctor-patient relationship is most challenged and planning for a cohort where we can measure its implication in the longer run.

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DOI and Others

DOI: 10.7860/JCDR/2022/56802.16499

Date of Submission: Apr 01, 2022
Date of Peer Review: Apr 13, 2022
Date of Acceptance: May 25, 2022
Date of Publishing: Jun 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Apr 05, 2022
• Manual Googling: Apr 08, 2022
• iThenticate Software: May 23, 2022 (7%)

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