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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
Trends in Hospital Outpatient Department Registrations and Admissions during COVID-19 Pandemic in a Super Speciality Hospital, Delhi, India
Correspondence Address :
Dr. Amit Aggarwal,
AA-292, Shalimar Bagh, Delhi-110088, India.
E-mail: amit.aggarwal.microbiology@gmail.com
Introduction: Delhi, India’s capital, witnessed the first Coronavirus Disease-2019 (COVID-19) case on February 10, 2020, and subsequently three waves of the pandemic due to which the government had to impose lockdown starting March 25. It led to a decrease in patients seeking health care services for non emergency problems. Janakpuri Super Speciality Hospital (JSSH), a three hundred bedded autonomous institute under Delhi Government, also encountered a decrease in patient footfall.
Aim: To identify the changes in trend in Outpatient Department (OPD) registrations and Inpatient Department (IPD) admissions during one year (January 1, 2020 to December 31, 2020) of COVID-19 pandemic in comparison to 2019 and also to analyse the collected data with the publicly available data on daily COVID-19 incidence in Delhi.
Materials and Methods: A retrospective study was done by collecting data from the Janakpuri Super Speciality Hospital, Delhi, India, Medical Record Department from 1st January 2019 to 31st December 2020, for daily OPD visits and IPD admissions. The collected data was analysed with the publicly available data on daily COVID-19 incidence in Delhi. Statistical analysis was performed using Microsoft excel 2017. The non parametric exponential smoothening technique (dampening factor=0.9) was applied over the dot plot graphs.
Results: In 2020, compared to 2019, the daily OPD visits decreased by 37%. After an initial fall with March lockdown, there was a gradual increase in daily load. The OPD load peaked near middle of August 2020, The second big fall in OPD footfall occurred near second wave in September 2020, After that, OPD volume remained low till the 31st December 2020. Similarly, IPD admission volume peaked near the first wave in June 2020. The 2020 IPD admission volume also witnessed a massive decrease of 40.67% compared to 2019 and was maximum in gastroenterology admissions (65.63%).
Conclusion: The study’s findings suggest that temporal associations between COVID-19 pandemic and hospital OPD and IPD admissions during 2020. The possibility of increased morbidity and mortality amongst non COVID-19 patients due to the unavailability of timely health care cannot be ruled out. The government should do capacity building to guide patients to identify the best doctor, clinic and hospital nearest to them in case of future pandemics.
Coronavirus disease-2019, Hospital services, Inpatient department
Coronavirus Disease-2019 (COVID-19) pandemic ravaged havoc all through the year 2020, and the story is not different in the year 2021 as well (1). Delhi, India’s capital, with population density one of the highest globally, recorded its first case on 10th February 2020 (2). The country and the city took initial vital and strict public health measure of the forceful lockdown of 68 days from 25th March to 31st May 2020 (3). All type of public movement, barring certain essential services like health, was restricted. The initial reports suggested that the fear of disease percolated down well in the entire country. This was seen in public behaviour of avoidance to seek health care facilities for non emergency problems and reduce surgeries (4). The country started unlocking lockdown in a phased manner from 1st June 2020, and has witnessed a tremendous increase in daily case incidence since then (5).
Janakpuri Super Speciality Hospital (JSSH) is a 300 bedded super-speciality care hospital in West Delhi and runs four routine speciality clinics for Cardiology, Nephrology, Neurology and Gastroenterology on an Outpatient Department (OPD) basis. Typically, patients who require care and intervention under direct supervision are admitted to Inpatient Department (IPD) of hospital. However, nephrology ward admissions are for only those patients who require dialysis as a day care procedure. The hospital does not have any emergency or allied Surgical Department. The clinics and the admission services were never under lockdown and thus worked unhindered during the COVID-19 pandemic. Thus, the present study identified how the OPD visits and the IPD admissions changed as the COVID-19 pandemic intensified in Delhi city during 2020.
A retrospective study was done by collecting data from the Medical Record Department of JSSH, Delhi, India, from 1st January 2019 until 31st December 2020. The data collection was completely anonymised and no ethical approval was taken from Institutional Ethical Committee of the hospital.
Inclusion criteria: The daily census for OPD registration and admission data for each of the only four specialities running in hospital (Cardiology, Neurology, Gastroenterology and nephrology) was included in the study.
Exclusion criteria: Data from other departments except these four (Cardiology, Neurology, Gastroenterology and Nephrology were excluded from the study.
Study Procedure
The daily census for OPD registration and admission data for each of the only four specialities running in hospital (Cardiology, Neurology, Gastroenterology and Nephrology Department) were collected for a total of 297 Working Days (WD). The collected data was analysed with the publicly available data on daily COVID-19 incidence in Delhi (6).
Statistical Analysis
Statistical analysis was performed using Microsoft excel 2017. The non parametric exponential smoothening technique (dampening factor=0.9) was applied over the dot plot graphs. This method computes a different expected value against each observed value by giving statistical weight to penultimate observed and expected values (7). This, in turn, minimises the effects of outliers and makes dot plot curves visually more interpretable.
The city witnessed its first COVID-19 case on 10th February 2020 (WD-34) and subsequently saw three pandemic waves. Due to this, the 2019 OPD registration volume of approximately 350,000 (before the COVID-19 pandemic) came down drastically to 220,221 in 2020, a massive 37% fall [Table/ Fig-1]. The fall was seen across all the four specialities (Cardiology, Neurology, Gastroenterology and Nephrology Department), but maximum in Gastroenterology OPD (48.8%).
Of the three waves of the pandemic, the crest of the first one occurred on June 23, 2020 (WD-143), with 3,947 cases diagnosed in one single day (Table/Fig 2). The other two peaks came on 16 September (WD-213; 4473 cases) and 11 November 2020 (WD-258; 8593 cases). The city underwent 68 days of continuous lockdown starting from 25 March (WD-71) till 31 May (a day after WD-123). Initially, a massive decline in hospital daily registrations was seen across all the clinics. But later, even before the announcement of the first lockdown unlock in 1st June 2020 (WD-124), all the specialities started showing a gradual increase in daily registrations. This gradual OPD registration increase was slower in nephrology (Table/Fig 3). Rise in OPD 2footfall continued till the onset of the subsequent second wave (Table/Fig 2),(Table/Fig 3),(Table/Fig 4),(Table/Fig 5). The daily registrations remained low after that till the year end. Although registrations witnessed a decline during the last two COVID-19 waves, a more considerable decrease in exponential smoothing curve estimates was seen in the second wave.
Similar to OPD registrations, the 2020 IPD admission volume also witnessed a massive decrease of 2299 (40.67%) compared to 2019 (3875) and was maximum in gastroenterology admissions (65.63%)(Table/Fig 1). The initial decline in IPD daily admissions was due to 25 March 2020 lockdown imposition and was observed across the specialities (Table/Fig 6),(Table/Fig 7),(Table/Fig 8),(Table/Fig 9). After that, the admission volume started showing a gradual increase, albeit less pronounced in neurology and peaked near the onset of the first wave on 23 June 2020 (WD-143). In contrast to Neurology, where admission volume showed an increasing trend near the onset of subsequent COVID-19 waves, the remaining specialitie’s volume remained either stable or decreased till the year-end.
As the COVID-19 pandemic waves appeared with varying intensities in Delhi during the year 2020, the volume of OPD visits and the IPD admissions also fluctuated, albeit less closely for specific periods. Delhi, India’s capital, with population density one of the highest globally, recorded its first case on February 10, 2020 (2). COVID-19 cases did start appearing in Delhi in February and Lockdown was imposed in March, but, India reported the first case much earlier on 27th January 2020. Delhi is a cosmopolitan city wherein people from all states come. Therefore, undercurrent of COVID signs and symptoms must have started in Delhi before February. This could possibly affect OPD and IPD volume in any government setup. This is why data was taken for post COVID-19 from January to December 2020 (COVID-19 first case reporting). The OPD visits decreased by more than 36% in all the specialities. Although, the numbers suddenly plunged from their height in January to the lowest point in March 2020, when the forceful lockdown was imposed, the volume gradually started rising until the onset of second pandemic wave near the beginning of the third week of September 2020. Possible explanations for this temporal association are many. Many of the smaller unaided private city clinics and health care practitioners stopped running their OPD because of a fear of being exposed to COVID-19 and instead shifted to telemedicine (8),(9). Smaller clinics might have also stopped running due to massive financial losses incurred due to lock down, as was reported in a study by Rubin R from Indiana, United States of America (USA) (10).
In the present study, the data shows that the city patients responded well to the national risk mitigation message and the possibility of acquiring an infection. They restricted themselves in presenting to the government run free hospital for the four specialities’ critical clinical problems. With annual OPD load decreasing by more than 36%, the hospital’s OPD load at the end of 2020 year was nowhere close to end of 2019. This was in line with the entire India figures where the fear of getting COVID-19 infection had percolated down and was seen in concerns about the possibility of long wait times and a sense of civic responsibility to avoid using health care services for not so emergency conditions (11). The later rise of OPD volume can be seen as necessary requirement of city patients for only significant and meaningful follow-ups. Similar findings were also reported by Mehrotra A et al., from USA (12) wherein the number of visits to ambulatory practices declined nearly 60% by early April after which a rebound was seen in daily OPD numbers. However, this rebound reported one-third lower visits after the easing of pandemic in 2020 than what was seen before the pandemic.
However, a grim aspect of the above situation emerged in dialysis patients’ inability to undergo the timely procedure. The dialysis procedures were deferred because of the fear of catching more COVID-19 in immunocompromised states (13). Daily IPD admission volume also took a plunge with the March lockdown announcement. After that, barring gastroenterology, where admission always remained low, hospital admission rates from the OPD gradually increased until the disease transmission in the city peaked with the onset of second and third waves. A possible explanation for this temporal association is that there was a sense among physicians for higher admission acuity in low patient volume OPD. Although, the present study did not attempt to identify the reasons for admission in every speciality, it does provide insight into the perception of the medical community and the public during the COVID-19 pandemic. The association between OPD visits and IPD admissions by patients seeking care for reasons unrelated to COVID requires further study.
Limitation(s)
The present study’s findings are not generable outside the present government run JSSH, Delhi, India, where it has been done because the hospital has only four specialities. Findings may be different for a general hospital, which caters to many other specialities. Lack of emergency services in the hospital could also be reflecting on the overall OPD registration and IPD admission census figures.
The present study suggest that as the COVID-19 pandemic intensified from March 2020 to December 2020 and precautionary lockdowns were imposed, temporal associations were observed between COVID-19, OPD visits, and hospital IPD admissions. The possibility of increased morbidity and mortality amongst non COVID-19 patients due to the unavailability of timely health care cannot be ruled out. The Government Health Department and authorities should do capacity building in such a way so that they can provide continued guidance to patients for them to identify the best doctor, clinic and hospital nearest to them in case of pandemics.
DOI: 10.7860/JCDR/2022/53199.16245
Date of Submission: Nov 08, 2021
Date of Peer Review: Jan 02, 2022
Date of Acceptance: Feb 01, 2022
Date of Publishing: Apr 01, 2022
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? No
• Was informed consent obtained from the subjects involved in the study? NA
• For any images presented appropriate consent has been obtained from the subjects. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Nov 11, 2021
• Manual Googling: Jan 11, 2022
• iThenticate Software: Feb 18, 2022 (4%)
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