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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
Role of Telemedicine in Otorhinolaryngology during COVID-19 Pandemic in a Tertiary Care Centre of Tamil Nadu: A Prospective Cohort Study
Correspondence Address :
Dr. RB Namasivaya Navin,
4/172, Nadar Line, Gangaikondan, Neyveli, Chennai-607802, Tamil Nadu, India.
E-mail: navin.rajasekar@gmail.com
Introduction: Telemedicine is the practice of using telecommunication technology to provide healthcare services to patients in remote areas. Teleconsultation is used in various specialties of medicine, especially during the COVID-19 pandemic situation. But in developing countries like India, it is less practicable in surgical specialties like Otorhinolaryngology.
Aim: To determine the eligibility and effectiveness of telemedicine practice in otorhinolaryngology during the COVID-19 pandemic in a tertiary care centre of Chengalpattu district, Tamil Nadu, India.
Materials and Methods: A prospective cohort study was conducted at Chettinad Hospital and Research Institute, Tamil Nadu, India from September 2021 to February 2022 which involved 90 patients who requested a consultation for various ear, nose, and throat complaints. Based on history, a provisional diagnosis was made and treated. Feedback forms contained 11 questions were sent during the revisit and analyses were made. Statistical analysis were done using mean, proportion and Chi-square test.
Results: This study included 49 (54.4%) male and 41 (45.6%) female patients with a mean age of 40.68 years. Only 23 (25.6%) patients had no problem seeing the doctor clearly and 19 (21.1%) had no trouble hearing the doctor. Only 4 (4.4%) patients accepted teleconsultation and will use teleconsultation services again.
Conclusion: This study concluded that teleconsultation practice was not satisfactory for the majority of patients in the field of otorhinolaryngology. The inability to arrive at the definitive diagnosis and subsequent therapeutic procedures by using telemedicine was the limitation.
Coronavirus disease-2019, Ear, nose and throat, Teleconsultation, Video consultation
Telemedicine is defined as a practice that uses telecommunication technology to provide medical care in remote access areas, especially in an underserved regions (1). Telemedicine was used for the first time during the outbreak of contagious disease when smoke signals were sent by ancient civilisations to warn about an outbreak (2). Telemedicine is successfully used in many fields of medicine like ophthalmology, radiology, cardiology, psychiatry, and dermatology (3). As technology improves, the use of telemedicine will continue to expand in all areas of medicine. Otorhinolaryngology is a small subset of surgical specialties and the practice of telemedicine is now accepted slowly. Since most otorhinolaryngologists are located in urban areas, it is difficult to access patients from rural areas to travel for hours (4). Initially telemedicine was established to provide adequate medical care to patients living in underserved areas. Telemedicine aims to reduce the time and cost required to travel to the hospital with improved efficiency and quality of care (5). There are two types of telemedicine: synchronous and asynchronous (6). Because of increased population and shortage of doctors, teleconsultation has gained popularity. In otorhinolaryngology, objective tests including tympanograms, audiograms, and diagnostic images are available, but history taking and examinations like endoscopy are vital for the diagnosis (5).
The novel coronavirus Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) infection emerged as a pandemic from 17th November 2019 (7). The rapid progression of the virus caused a pandemic and became a real challenge for the whole world. Social distancing is very important to control the spread of this communicable disease which makes it difficult access to medical care. The usage of telemedicine during the coronavirus epidemic has been the first line of defence to reduce and slow the spread of disease, keep social distance, and provide services by phone or videoconferencing (7). Some conditions in otorhinolaryngology can be treated through electronic consultations but many may require a traditional face-to-face approach (4). Previous studies have showed the use of telemedicine in otorhinolaryngology was effective, especially in rural areas with significant cost and time savings (4),(5). Telemedicine in Otorhinolaryngology is practiced in developed countries and numerous studies are testing its efficacy (1),(3),(4). There are very few studies testing the feasibility of telemedicine in Otorhinolaryngology in India (8),(9). The application of telemedicine during the COVID-19 pandemic especially in developing countries like India is very challenging and this current study was conducted when access to the healthcare system was difficult in both urban and rural areas due to the rapid spread of infection and social distancing practices. This study aimed to determine the eligibility and effectiveness of telemedicine practice in otorhinolaryngology during the COVID-19 pandemic in a tertiary care centre of Chengalpattu District, Tamil Nadu, India.
This prospective cohort study was done at Chettinad Hospital and Research Institute, Chennai, Tamil Nadu, India, which involved a total of 90 patients who requested teleconsultation over six months during the COVID-19 pandemic from September 2021 to February 2022 in the Otorhinolaryngology Department, Chettinad Hospital, and Research Institute after getting approval from the Ethical Committee (Ref No: IHEC-II/0033 /21).
Sample size calculation: Sample size was calculated with the formula of sample size for observational study, n=Z2 pq/l2 (ppercentage of satisfaction with telemedicine services taken as 87%,- relative error of 7%), P=87% (10), q=13%, Z=1.96 and l=7%. Substituting these values, a sample size of 88 was arrived. Thus sample of 90 were included.
Inclusion criteria: Patients with minor ear, nose, and throat complaints requested telemedicine consultation, all patients >18 years of either sex and postoperative patients after one month of surgery who needed regular follow-up were included in this study.
Exclusion criteria: Patients who presented to the outpatient department of Otorhinolaryngology, all patients <18 years of age, patients requiring emergency/major ear, nose, and throat management (such as foreign bodies, stridor, etc.,), patients with uncontrolled co-morbidities and postoperative patients less than one month of surgery were excluded from this study.
Study Procedure
Patients who attended teleconsultation in the Department of Otorhinolaryngology, at the tertiary care centre were evaluated after obtaining informed and written consent. Demographic details of the patients were collected. Clinical history and symptoms were noted. Based on their history and symptoms provisional diagnosis was made. Then the patients were treated through teleconsultation. Follow-up of the patients was done after two days through teleconsultation. While giving teleconsultation patients were advised to immediately contact their concerned doctor in case of any adverse reactions like vomiting, headache, breathing difficulties, rashes, etc. Feedback form TESQ (TeleENT Satisfaction Questionnaire) was modified according to Indian context and pretesting was done (1). This study was assessed for criteria validity and cronbach’s alpha measurement was done. Pretesting and pilot testing was done in around 10 patients and tool was modified on the basis of this pilot testing. Original version had 14 questions, three questions were removed after the pilot testing. The modified questionnaire contained 11 questions which had five options ranging from strongly disagree to strongly agree [Annexure 1]. All these responses were downloaded, tabulated, stored, and assessed for the effectiveness of telemedicine. A total score of 30 or more was considered a good response and considered that patient was satisfied. The cut-off value of 30 value was arrived by pretesting and pilot testing.
Statistical analysis
Statistical analysis was carried out using Statistical Package for the Social Sciences (SPSS) version 21.0 and Microsoft excel software. The means and proportions were used. The association between two groups were assessed by independent t-test. The statistical significance was considered when p-value <0.05.
Out of 90 patients, 49 (54.4%) males and 41 (45.6%) females were involved (Table/Fig 1). The mean age of the study population was 40.68±12.9 years. Among them, 26 (28.9%) patients had otological complaints like ear pain, ear discharge, hard of hearing, etc., 28 (31.1%) patients had nasal symptoms like nasal block, nasal discharge, headache, etc., 27 (30%) patients had pharyngeal complaints like throat pain, dysphagia, etc., 9 (10%) patients consulted for postoperative follow-up after one month of surgery (Table/Fig 2).
All the patients who needed teleconsultation were evaluated and treated. During follow-up, feedback forms were sent to all these patients and were analysed. Among those, only 23 (25.6%) patients agreed that they can clearly saw the doctor, 19 (21.1%) patients had no trouble hearing the doctor, 20 (22.2%) patients agreed that the doctor seemed to understand the problem, and 17 (18.9%) patients understood clearly what the doctor told during the teleconsultation visit (Table/Fig 3). About 22 (24.4%) patients stated that receiving the medical care was more accessible, 18 (20%) patients agreed that teleconsultation saved their time and only 4 (4.4%) patients found telemedicine was acceptable to receive healthcare services. About 63 (70%) patients disagreed with the concept of telemedicine in receiving healthcare, 53 (58.9%) patients preferred face-to-face visits rather than teleconsultation, 17 (18.9%) patients were satisfied with teleconsultation and only 4 (4.4%) would use the teleconsultation services again in the future. 48 (53.3%) scored <30 and 42 (46.6%) scored >30 in the teleENT satisfaction questionnaire analysis.
Independent t-test was applied to compare the score between age groups and sex. It was found from the analysis that there was no statistical significant difference among the groups (Table/Fig 4).
This prospective cohort study included 90 patients to evaluate the effectiveness of teleconsultation practice in the field of otorhinolaryngology during the COVID-19 pandemic. This study included 49 (54.4%) male and 41 (45.6%) female patients with a mean age of 40.68 years who requested teleconsultation for various otorhinolaryngology symptoms. Only 23 (25.6%) patients had no problem seeing the doctor clearly and 19 (21.1%) had no trouble hearing the doctor), 22 (24.4%) patients stated that receiving the medical care was more accessible. 63 (70%) patients disagreed with the concept of telemedicine in receiving healthcare. Only 17 patients (18.9%) were totally satisfied with teleconsultation 4 (4.4%) patients accepted teleconsultation and will use teleconsultation services again.
During the COVID-19 pandemic, teleconsultation has been satisfactorily used in various non surgical specialties. There was a big gap in the healthcare and resources during these situations and telemedicine was essential to sort out this issue to a greater extent (9). Otorhinolaryngology is relatively a small surgical field that requires advanced equipment for definite diagnosis and management. It can be affected by the quality of information transferred and the skills of examiners (1). Diagnostic procedures like otoscopic examination, diagnostic nasal endoscopy, video laryngoscopy, audiometry, and therapeutic procedures like ear wax removal, aural toilet, foreign body removal, and postoperative nasal cleaning are necessary for definite diagnosis and effective management of patients in otorhinolaryngology (10). In otorhinolaryngology practice, telemedicine was useful for temporary symptomatic relief but definite diagnosis and treatment should be made for complete care of the patient which was not possible with the use of telemedicine and also there was a longer surgical wait list (11). Another limitation was lack of awareness and accepting the new technology by the patients mainly in developing countries like India (12).
This current study showed the patients were less satisfied with telemedicine consultation due to the lack of diagnostic and therapeutic procedures when compared to traditional outpatient practices. Seim N et al., conducted a study on developing synchronous telemedicine clinics in 21 patients and found it to be equivalent to standard otolaryngology clinics with patient-provider satisfaction (1). Philips R et al., concluded that both patients and the peripheral healthcare system benefitted from telemedicine in the otorhinolaryngology field in terms of cost savings, especially in rural areas (2). Comparative evaluation of different studies have been done in (Table/Fig 5) (1),(3),(4),(8),(10),(11). With further improvements in technology and with improved fluency in telecommunication services, telemedicine in Otorhinolaryngology may be feasible in the upcoming years.
Limitation(s)
The previous studies were conducted during non pandemic time with the help of on-site and remote physicians which made diagnosis and treatment easier with more patient satisfaction. But 2019 (COVID-19) pandemic, there was no on-site doctor available. It makes definite diagnosis and treatment for the patient was difficult and the patient needs to come to the hospital for specific diagnostic and therapeutic procedures. the current study was conducted during the Coronavirus Disease 2019 (COVID-19) pandemic, there was no on-site doctor available. It makes definite diagnosis and treatment for the patient was difficult and the patient needs to come to the hospital for specific diagnostic and the rapeutic procedures.
Telemedicine is successfully used in various fields of medicine due to advancements in technology mainly after COVID-19 pandemic. In this study, only 17 patients (18.9%) were totally satisfied with teleconsultation and only 4 (4.4) were willing to use the teleconsultation services again in the future. The current study concluded that teleconsultation practice was less satisfactory for the patients in the field of otorhinolaryngology. This was due to the lack of definitive diagnosis and subsequent therapeutic procedures especially in developing countries like India. Further studies are required to overcome the limitations like the development of fully equipped otorhinolaryngology sub-centers, provision of healthcare at patient’s homes, etc.
DOI: 10.7860/JCDR/2022/56914.16992
Date of Submission: Apr 06, 2022
Date of Peer Review: May 13, 2022
Date of Acceptance: Jun 29, 2022
Date of Publishing: Nov 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
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