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

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On Sep 2018

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On Sep 2018

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"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."

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"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.
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On Sep 2018

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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,
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
(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)
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.
On April 2011

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
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : October | Volume : 16 | Issue : 10 | Page : LC11 - LC14 Full Version

Development and Validation of Quality of Life Tool among Chemotherapy Patients: A Pilot Trial

Published: October 1, 2022 | DOI:
Virendra Kumar Jain, Anil Sharma

1. PhD Scholar, Department of Medical Surgical Nursing, Manikaka Topawala Institute of Nursing, Changa, Anand, Gujarat, India. 2. Principal, Department of Nursing, Manikaka Topawala Institute of Nursing, Changa, Anand, Gujarat, India.

Correspondence Address :
Mr. Virendra Kumar Jain,
Manikaka Topawala Institute of Nursing, Changa, Anand, Gujarat, India.


Introduction: Quality of Life (QoL) is a main alarm of patients with life-threatening cancer. Symptoms have an effect on their QoL. There are many standardised tools which measure the QoL among cancer patients. But there is no specific questionnaire or tool available to evaluate the chemotherapy patients in Indian context.

Aim: To develop and validate a QoL tool for chemotherapy patients.

Materials and Methods: This mixed method pilot study with sequential exploratory design was led at Outpatient Department (OPD) and Inpatient Department (IPD) of S. N. Shah Cancer Hospital, Nadiad city, Gujarat, India, from April to May 2020. In qualitative stage, the data was gathered by involving in detail interview of 15 chemotherapy patients. Interview data were analysed by utilising conventional content analysis method and themes and subthemes were formed. Based on it, a pool of items for the questionnaire was prepared. In quantitative stage, psychometric properties of the questionnaire were assessed by using face, content and construct validity. The reliability of the tool was evaluated by internal consistency and Cronbach’s alpha. Overall 15 patients participated in qualitative and quantitative phase separately.

Results: At the end of phase I, a draft of 104 questionnaires was formed. In phase 2, a specialist panel reviewed 84 items relevant with the domains and 20 items were erased on the basis of expert opinion, Item Content Validity Index (I-CVI) and Scale Content Validity Index (S-CVI). At this time, 84 item tool were given to 15 chemotherapy patients. In view of the patient’s opinion, researcher drew a screen plot based on eigen value of above 1. These four domains showed 53.846% of the total variance. Last 84 items were scrutinised as per specific domain. The end draft had a Cronbach’s alpha value of 0.932.

Conclusion: The newly develop tool will help the chemotherapy patients and healthcare team to evaluate the QoL. This QoL tool will also impact the cancer treatment and implement strategies accordingly.


Item pool generation, Mix method, Psychometric property, Sequential exploratory, Tool development

There are numerous factors which affect the health status of a person and society. The key components of health include physical, mental, social, emotional and spiritual well-being (1),(2). Cancer is a leading reason of death. People living with cancer experience a diversity of symptoms. QoL cares with “the degree to which an individual enjoys the important possibilities of life”. Health Related Quality of Life (HRQoL) depicts an individual’s view of how wellbeing impacts a person’s life quality and overall well-being. QoL is a significant measurable result of care for conditions that do not threaten life (3). The QoL is an individual observation. It may vary from person to person as per his life goal and expectation. A healthy person is considered to have a good QoL (4). QoL can be dignified with the help of qualitative and quantitative approach. Mixed method is the best approach to collect the detailed information from the participants (5). Mixed method is a way to gather information under various domains. It also recognises the theme and subthemes from subject’s statement (6). Evaluating the QoL tool among the chemotherapy patient it assists with perceiving their neglected necessities, individual issues, physical needs and so forth.

Many tools have been developed to assess the QoL of cancer patient in India and globally and there are few remedial modalities for cancer treatment such as surgery (curative, palliative), radiation therapy and chemotherapy. This tool might be utilised for cancer patients. But the present study revealed that the newly developed tool (84 items) covered all the domains of health (physical, social, psychological and spiritual). This tool also covered various important questions like awareness about disease, lack of knowledge about government health scheme, Non Government Organisation (NGO) for cancer, poor socialisation, social aspects (stigma, non acceptance in family), spiritual aspects, traditional beliefs and superstition etc. Therefore, the newly developed tool (84 items) is a useful tool in measuring QoL among the chemotherapy patients. It can be used to observe the patient’s QoL improving during the chemotherapy cycle. It is simple to use and not cumbersome.

Material and Methods

This mixed method pilot study with sequential exploratory design was led at Outpatient Department (OPD) and Inpatient Department (IPD) of S. N. Shah Cancer Hospital, Nadiad city, Gujarat, India, from April to May 2020. The study was endorsed by the Institutional Ethics Committee board of CHARUSAT (ARIP/IEC/19/08).

Inclusion criteria: Patient diagnosed with cancer (irrespective of site) and those who were receiving chemotherapy, atleast had 2 or more cycles, age above 20 years, free at the time of enrolment were included in the study.

Exclusion criteria: Cancer patient receiving chemotherapy along with radiation and other adjuvant treatment and refusal to give assent were excluded from the study.

Study Procedure

It is sequential exploratory, since first qualitative information and secondly quantitative information has been collected (Table/Fig 1).

In stage I, qualitative data were assembled from the 15 chemotherapy patient’s those were diagnosed with cancer. In stage II, information was gathered from the same 15 chemotherapy patients. Each interview lasted for 15-20 minutes. The responses were noted and analysed using conventional content analysis. Here a researcher extracts contextual category, themes and significant statement. Data were gathered and analysed through Colaizzi method (7). A written informed consent was taken from the patients before their cooperation in two phases. Baseline information including participants age, gender, educational status, religion, occupation, income of the family per month in rupees, financial support for chemotherapy, duration of illness, cancer affected region or organ, total number of cycle, type of care and type of chemotherapy administered.

Statistical Analysis

The statistical analysis was coordinated by using Statistical Package for the Social Sciences (SPSS) programming. Reliability, factor analysis, internal consistency, scree plot, inter item correlation, item total correlation was determined. The reliability was calculated through Cronbach’s alpha.


Schematic representation of research methodology and process of tool development (Table/Fig 2): Total 104 items were developed at the end of primary phase. Many of the items were deleted from the pool, due to item repetition, item domain appropriateness, item vague in nature, correction in language and wording, few grammatical error, irrelevant item to cancer, item addressing same issue. Further, Factor Analysis (FA) was run to reduce the number items. Based on FA, 20 items were removed. The second draft consisted of 84 items which were further administered to the participants. The test retest reliability was found 0.932.

Phase-I (Qualitative)

The process of interview continued till the data saturation. In the interview questions were asked to patients on how the disease was diagnosed, experience of chemotherapy cycle and its affect, impact on day to day life, support from family members and society, financial crisis, employment issue, psychological impact, impact of spiritual activities etc. Patient’s responses were noted. The responses were analysed using conventional content analysis. Result of participant’s interview was discussed among the oncologist and nurse. The oncologist reviewed the interview and developed a questionnaire and suggested fitting the items as per appropriate domain. Nurses suggested including item related to patient behaviour, psychosocial well-being, financial aspect, family aspect and communication. Toward the finish of this phase-1, a pool of 104 items through categories four domains was developed. The back translation of questionnaire in local language (Gujarati) was initiated.

Phase-II (Quantitative Phase)

Validity of Tool: I-CVI (content validity of individual items) and S-CVI (content validity of the overall scale) were calculated for content validity. In this phase, 16 experts were involved (Oncophysician, Onco-surgeon, physician, psychologist, bio-statistician, pharmacologist, Onco-nurse, PhD nursing faculty) for the content validation of tool. The experts were asked to give their perspectives and rate on the very items produced during phase-I. A scale with excellent content validity ought to be made out of I-CVIs of 0.78 or higher and S-CVI Average of 0.8 and 0.9 or higher, individually (8). The I-CVI reached the level of acceptance, that is, 0.869. The S-CVI was likewise more than 0.813 which is adequate in range.

Item analysis: According to (Table/Fig 3), each of the 84 items was organise into four domains factors as per factor analysis matrix. These four domains (named physical domain, social domain, psychological domain, spiritual domains) covered 53.846% of variance. The (Table/Fig 4) shows scree plot viewing factors on the based on eigen value for all 84 items, according to statistical analysis.

Item reduction (Principal component analysis): Data from draft of 84 items was statistical assessed. Items were removed on the basis of item total correlation and inter item correlation matrix. The (Table/Fig 5) showing the range of score considered as acceptable.

Reliability analysis: The internal consistency, i.e., Cronbach’s alpha was 0.932.

Inter item correlation: As per inter item correlation, 11 items which had item total correlation coefficient of <0.3 were expelled while nine items were excluded as they showed an inter item correlation of >0.7. So 20 items were deleted.

Reliability-Internal consistency reliability (Cronbach’s alpha): Cronbach alpha value of each component was satisfactory (>0.7). The final draft of the tool had four components (84 items) (Table/Fig 6).

Every item estimated the response in five point Likert scale. Each item can have a minimum score of ‘1’ and a maximum score of ‘5’ (Table/Fig 7).

Factor analysis of the four domains: Component I (physical domain) had 27 items related to routine life style, lack of sleep and activity of daily life. The reliability of this domain was 0.868. The inter item total correlation as per matrix was acceptable, which differed from -0.371 to 1.000. The Cronbach’s alpha of physical endurance was 0.868 and corrected item total correlation varied from -0.022 to 0.692.

Component II (social domain) had 18 items which included relationship with relatives, friends and society. The reliability of this domain was 0.895. The inter item total correlation as per matrix was also satisfactory which range variety from -0.264 to 0.568. The Cronbach’s alpha of this domain was 0.895.

Component III (psychological/mental domain) had 22 items associated to assurance, distrustful life, fears and career prospect. The reliability of this domain was 0.811. The inter item total correlation as per matrix was acceptable and ranged from -0.257 to 0.361. The Cronbach’s alpha of this domain was 0.811 and corrected item total correlation differed from -0.143 to 0.746.

Component IV (spiritual domain) had 17 items associated with spirituality, self-confidence and achievement. The reliability of this domain was 0.902. The inter item total correlation as per matrix was satisfactory and ranged from -0.499 to 0.134. The Cronbach’s alpha of this domain was 0.902 and corrected item total correlation variety from -0.390 to 0.643.


The QoL refers to “global well-being,” including physical, emotional, mental, social and behavioural factors. Prolonged cancer may harm multiple organs for long duration and affecting patients’ health and subjective perceived QoL. There are particular difficulties in patients’ life including the physical impairment, yet in addition change in psychological and social domain. Many QoL assessment tools and questionnaires have come into utilisation throughout the past 10 years. The most commonly tools to measure the QoL in cancer patients are the EORTC QLQ-C30, SF-36, FACT-G, and the Rotterdam Symptom Checklist (RSCL) (9),(10),(11). But due to geographical limitations and cultural differences, a common resolution may not be pertinent and thus there is a need to formed a local based tool and validate (standardise) the similar tool (Table/Fig 8) (9),(10),(11),(12).

A standardised tool with excellent content validity ought to be made out of I-CVIs of 0.78 or higher and S-CVI average of 0.8 and 0.9 or higher, individually. In this way, the current study showed that “I-CVI arrived the level of acceptance, that is, 0.869. The S-CVI was also more than 0.813” which show a newly developed tool is valid and reliable tool which measures the QOL among chemotherapy patients. The present study developed and validated 84 items which cover four domains as per factor analysis which are physical domain (27), social domain (18), psychological/mental domain (22), and spiritual domain (17). All these domains and items had high internal consistency (Cronbach’s alpha 0.932). The QoL assessments are recommended to be used one week after chemotherapy administration when patients are at home. Tool score may help out to optimise preventive, curative and supportive care during chemotherapy.


The study sample was restricted to Charotar region (Kheda-Anand District) of Gujarat, India. Samples were chosen based on non probability sampling technique and age of patients above 20 years and data collected from OPD and IPD of cancer hospital.


This newly developed QoLtool, comprising of 84 items is a reliable and valid instrument for the evaluation of QoL among the chemotherapy patient. More exploration studies are expected to validate the tool for application in other clinical areas, and wider socio-economic community settings. Linguistic validation is also required to manage in various languages with more number of participants.


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DOI and Others

DOI: 10.7860/JCDR/2022/57199.16962

Date of Submission: Jul 03, 2022
Date of Peer Review: Jul 28, 2022
Date of Acceptance: Sep 12, 2022
Date of Publishing: Oct 01, 2022

• 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 X-checker: Jul 04, 2022
• Manual Googling: Sep 10, 2022
• iThenticate Software: Sep 19, 2022 (20%)

ETYMOLOGY: Author Origin

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