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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
Case report
Full Version
Affirmative Outcome after Modified Cardiopulmonary Rehabilitation in Postpump Syndrome with Reduced Ejection Fraction following Coronary Artery Bypass Graft
Correspondence Address :
Dr. Vaishnavi Dilip Yadav,
Assistant Professor, Department of Cardio-Respiratory Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences (DU), Wardha,
Maharashtra, India.
E-mail: vaishnavi1326@gmail.com
In Coronary Artery Bypass Graft (CABG) patients’ Postoperative Pulmonary Complications (PPCs) like atelectasis, pleural effusion, pneumonia, pulmonary oedema, and pneumothorax are the leading cause of morbidity. Secondary prevention and Cardiac Rehabilitation (CR) are essential aspects of the post revascularisation care approach. Here, authors presents a case of 56-year-old male, diagnosed with triple vessel disease with reduced ejection fraction, underwent CABG surgery and developed Postpump Syndrome (PPS). There was pleural effusion secondary to the cardiopulmonary bypass machine. Postoperatively, the patient complained of pain at the incision site, cough, and difficulty in breathing. He underwent two weeks of a precise, planned early phase I CR protocol with regular vital monitoring. Post rehabilitation, the two-Minute Walk Test (MWT) and Borg’s scale showed improvement in the walking distance sequentially from 7th, 11th, and 14th day postoperatively. There was a decrease in the perception of difficulty in breathing. He showed a tremendous level of recovery in vitals, functional capacity, pain, and quality of life seen postrehabilitation. It can be concluded that exercise-based CR is an important adjunct therapy for secondary complications in post CABG patients.
Borg’s scale, Cardiac rehabilitation, Coronary artery disease, Pleural effusion
A 56-year-old male patient was referred to a Cardiorespiratory physiotherapist in Cardiovascular and Thoracic Surgery (CVTS) Intensive Care Unit (ICU) on the first Postoperative Day (POD 1). He had undergone a pump CABG surgery and an Intra-aortic Balloon Pump (IABP) was inserted. Postoperatively, the patient complained of pain at the incision site, cough, and troubled breathing. The pain was dull aching, diffuse, intermittent, and located in the midline (centrally) of the chest with a Numerical Pain Rating Scale (NPRS) score of 4/10 during rest, and 7/10 during activity (1). The cough was intermittent and dry. There was diminished chest wall movement on the left side. There was dullness over the right 5th intercostal space on percussion. Tactile vocal fremitus was resonant bilateral. On auscultation, there were bilateral crepitations present in lower zones. Postoperative chest X-ray revealed the patient suffers from PPS and developed pleural effusion secondary to Cardiopulmonary Bypass Machine (Table/Fig 1).
Physical therapy rehabilitation: On POD 1 patient education, assessment, and evaluation was done followed by physiotherapy treatment. From POD 1 to 3 the patient was on mechanical ventilator support (pressure support/ continuous positive airway pressure, Fraction of Inspired Oxygen (FIO2) was 50%, positive end-expiratory pressure was 5 cm H2O) along with IABP in CVTS ICU. For the first three days, nebulisation (levosalbutamol) was done followed by draining of lung segments with appropriate and modified postural drainage positions along with in bed active-assisted Range of Motion (ROM) exercise for both upper and lower limbs.
On POD 4 and 5, the patient was weaned off from the ventilator and IABP and put on oxygen support (10L/min via face mask). In a high sitting position; the use of acapella (green) was taught for active drainage of secretions and incentive spirometer was started (Table/Fig 2)a,b. To alleviate incisional pain chest binder was advised and encouraged for splinted coughing. On POD 6 and 7, active cycle of breathing technique to mobilise secretions from the larger airways, breathing retraining with diaphragmatic breathing exercises were given. Buteyko breathing and pursed lip breathing was incorporated with the existed regimen to provide improvement in a respiratory pattern which increases tidal volume and minute ventilation. Supervised graded ambulation around the bed (20 meters) was initiated.
The patient was shifted to the CVTS ward on POD 8 and was maintained on saturation without oxygen support. Walking distance was increased upto 35 meters on POD 9 along with continuation of previous exercises with increased repetitions and Activity of Daly Living (ADL) training. Graded mobilisation with vitals monitoring continued on POD 11 and 12 along with strengthening exercises for extremities and gait training. The patient was able to walk upto 80 meters without any discomfort on POD 13 and 14 (Table/Fig 3) (2),(3),(4).
Before discharge, the patient was given complete instructions for a home exercise programme, energy conservation and pacing strategies, and a patient-tailored exercise training programme. He was followed-up after one month in the CR Outpatient Department.
Postrehabilitation outcome variables such as 2 MWT, showed improvement in the walking distance sequentially from 7th, 11th, and 14th day. There was decrease in the perception of difficulty in breathing, along with improved self-efficacy and psychological well-being. The patient was monitored over a telephonic conversation for appropriate training or assistance and showed improved dyspnoea and fatigue symptoms while performing instrumental activities of daily living.
Cardiac rehabilitation quickens the healing process by preventing or treating postpulmonary problems and bringing the patient back to his premorbid condition. The index patient was diagnosed with triple vessel disease with low ejection fraction, for which he underwent CABG. Postsurgery he suffered from PPS and developed pleural effusion secondary to the cardiopulmonary bypass machine. The systemic and local inflammatory reaction leading to PPS caused a delay in the complete recovery and hence, required a modified CR program (5),(6). The early phase I CR protocol was administered with continuous monitoring of patient haemodynamic status with the main focus on reduced ejection fraction.
A Left Ventricular Ejection Fraction (LVEF) of 35% has been linked to lower long-term survival in patients on medical therapy and higher early mortality in CABG patients (7),(8). In this category of high-risk patients, their inclusion in a rehabilitation program is mandatory for better postoperative results (9). Bjarnason-Wehrens B et al., conducted a systemic review in which they concluded that exercisebased CR was associated with an increase in quality of life and exercise capacity in patients with low ejection fraction (10). Similarly, Robu M et al., stated that continued physical training and activity under supervision quickly reintegrates patient back into socialeconomic life, the idea that exercise could overload cardiac pumps and increase mortality was dropped (11).
In the present case, there was improvement seen in all the outcome measures and perceived level of exertion at the end of the rehabilitation program. The progress was seen in the increasing walking distance motivated the patient to improve his respiratory capacity and stick to the protocol. Therefore, phase 1 CR program that includes supervised graded monitored mobilisation proved beneficial in index patient by reducing skeletal muscle dysfunction secondary to postoperative immobility and apprehension.
The present study concluded that exercise-based CR program is considered an important adjunct therapy for secondary complications in post CABG patients. After rehabilitation, there was a significant improvement in vitals, functional capacity, and quality of life, which can be attributed to the planned intervention in the ICU and ward. The study also emphasises the necessity of encouraging early exercise-based CR in PPS patients with low ejection fraction.
DOI: 10.7860/JCDR/2022/57951.16989
Date of Submission: May 24, 2022
Date of Peer Review: Jul 15, 2022
Date of Acceptance: Aug 05, 2022
Date of Publishing: Oct 01, 2022
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: May 31, 2022
• Manual Googling: Jul 28 2022
• iThenticate Software: Aug 06, 2022 (12%)
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