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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
Awareness of the Role of Anaesthetists and Importance of Preanaesthetic Check-up among Patients: A Cross-sectional Study
Correspondence Address :
Dr. Lata D Shetty,
MSK Mill Road Dr R R Shah Hospital, Kalaburgi-585102, Karnataka, India.
E-mail: latads@yahoo.co.in
Introduction: Patients scheduled to undergo elective surgeries should be assessed, well in advance, by anaesthetists with a view to plan optimal preparations and perioperative management regarding their anaesthetic requirements.
Aim: To assess the knowledge of the role of anaesthetists during the perioperative period and the importance of preanesthetic check-up among patients undergoing elective surgery.
Materials and Methods: A cross-sectional study was conducted in Khaja Bandanawaz Institute of Medical Sciences, Kalaburgi, Karnataka, India, from August 2019 to February 2020. The study involved 300 patients posted to the preanesthetic check-up clinic, over a span of six months for elective surgeries. Patients were asked to complete a questionnaire consisting of 17 questions. Statistical analysis was carried out using Statistical Social Science Packages (SPSS) version 16.0 for Microsoft Windows and Excel.
Results: A total of 66% (198) patients were males. The mean age of participants was 38.68±10.35 years. Graduates made up 28.6% of the participants, and 44.3% of them either had some schooling (primary or secondary) and the rest 27% did not have any education. Overall, 23% (69) participants had a history of surgery and except one, all received both Preanaesthetic Check-up (PAC) and anaesthesia during their previous surgery. The mean percentage (89.3%) of awareness was highest among the participants with a history of previous surgery (p-value <0.001).
Conclusion: The present study concluded that demographic characteristics such as age, sex, occupation, education and residence do not influence the awareness and importance of preanesthetic check-up clinic however, history of previous surgery was statistically significant.
Perioperative morbidity, Previous surgery, Rural patients, Surgeon
Perioperative care encompasses total care from the time a patient is recommended that a surgical procedure may be appropriate or necessary until specialist medical management is no longer needed. It includes preoperative assessment, planning and provision of anaesthesia, and postoperative care including pain management, fluid and electrolyte management, resuscitation and relevant medical management (1).
Patients scheduled to undergo elective surgeries should be assessed, well in advance, by anaesthetists with a view to plan optimal preparations and perioperative management regarding their anaesthetic requirements. The main objectives of the Preanaesthetic Check-up (PAC) is to identify the correct anaesthetic techniques to be used during the surgical procedure; to provide the best perioperative care; and to ensure that an informed consent for anaesthesia is also obtained (2),(3). During PAC it is also important to identify individual risk factors concerned to the planned surgery. A thorough PAC with an additional advantage of patient satisfaction is more likely to result in better results for the patient (3).
A partial or rushed PAC could place patients at increased risk of perioperative morbidity and mortality. Patients are more likely to comply with anaesthetists (provide full medical, personal and family history, disclose any identified allergies, undergo blood checks, and physical examination) if they are aware of the need of a PAC in their perioperative treatment. If a patient shows a lack of interest in PAC or is unaware of its meaning or does not understand it, then this can undermine overall patient care.
Studies regarding the level of awareness of the role of anaesthetists and PAC among rural patients and general population in Northern parts of India have been conducted (4),(5) .They have shown that the patients attending PAC clinics have insufficient knowledge of preanaesthesia assessment and its role in improving surgical outcome (4).
However, in Karnataka (a Southern State in India), such studies have not been performed. The aim of the present study was to fill the gap in information and try to compare the results with previous studies. The study aimed to assess the awareness of the role of anaesthetists during perioperative period and the importance of PAC among the patients undergoing elective surgery.
A cross-sectional study was conducted in Khaja Bandanawaz Institute of medical sciences, Kalaburgi. This research ran over a span of 6 months (August 2019-February 2020) and involved 300 patients (or participants) who were referred to PAC clinic for elective surgery. Written or verbal consent was obtained from all of the participants in the study. Ethics approval for the study was granted by the Khaja Bandanawaz Institute of Medical Sciences Ethical Committee (Ref.No. KBNIMS/I.E.C/2020-21 dated 24th March 2021).
Inclusion and Exclusion criteria: Patients posted for elective surgery, aged between 18 years to 60 years were included in the study. Patients posted for emergency surgeries and who were unable to consent (due to mental conditions, medications, disabilities-hearing and speech) were excluded from the study.
The participants were invited to complete a questionnaire consisting of 17 questions [Annexure 1]. The representation of the questions were as follows:
• 1-6 questions was demographical,
• 7-10 questions were factual questions,
• 11-16 attitude based questions.
The questionnaire was developed by the researcher. Validation process was done in the Department of Anaesthesia of the study institution. This was to ensure that the questionnaire effectively captures the topic under investigation. Each question was validated with four experts with regards to relevance and clarity content using liberty scale form. And Scale-level Content Validity Index based on the Universal Agreement method (S-CVI/UA) index was 1. The questionnaire was also pilot tested among 20 patients by the researcher to understand whether the questions would be correctly interpreted by the participants.
The questionnaire was available in both English and Kannada (a local language). Instructions on how to answer the questionnaire were given to the patients. For the patients who could not read and/or write, the researcher read out and interpreted the questions and recorded their responses.
Statistical Analysis
Statistical analysis was carried out using Statistical Social Science Packages (SPSS) version 16.0 for Windows and Excel (2013; Microsoft Corporation, Redmond, WA, USA). Demographic characteristics were expressed in terms of frequencies and percentages. Unpaired t-test and one-way variance analysis were used to assess the impact of demographic variables on the awareness of PAC clinics and the role of anesthetists. A p-value<0.05 has been recognised as statistically significant.
In total 300 patients completed the questionnaire and among them 66% (198/300) were males (Table/Fig 1). In terms of occupation of the participants, a majority (34.6%) were unskilled labourers. Graduates made up 28.6% of the participants, and 44.3% of them either had some schooling (primary or secondary) and the rest 27% did not have any education. The urban-rural distribution of the study participants was almost similar, 50.6% and 49.3%.
The participants were asked whether they had previous surgery and if yes, whether they had received any anaesthesia (Table/Fig 2). Out of the total, 69 (23%) of the study participants had a history of surgery and except one, all received both PAC and anaesthesia during their previous surgery. When asked about the main reason/s for them to attend PAC clinic, all of them said that their surgeon had advised them to do so (Table/Fig 2). 24 patients (8%) indicated that they were attending PAC to get investigations; 182 patients (60.6%) felt that the reason was to get a date for their surgery; 180 patients (60%) said that the reason for attending PAC was to understand about anaesthesia (Table/Fig 2).
Total 85.6% of the participants felt that PAC was necessary before a surgery (Table/Fig 3). Total 78.3% of the participants said that anaesthetists were present at PAC clinic. All participants felt that either it was very or moderately important to give accurate medical and personal habit histories at PAC clinic. All of them also indicated that they were either likely or very likely to follow presurgical instructions given at PAC clinic. Total 78.3% of the participants indicated that anaesthetists would give anaesthesia for their planned surgery.
When asked about the role of the anaesthetist during their surgery, all of them said that anaesthetists would put them to sleep and 78% felt that anaesthetists control pain during the surgery (Table/Fig 4). 27% indicated that anaesthetists manage pain postsurgery and 11% said that they also manage patients in the Intensive Care Units. Overall mean scores of awareness of importance of PAC among patients was 0.73±0.45, the percentage score was 73.2%. Awareness regarding PAC before surgery was 85.7% of patients, followed importance to disclose personal habits and medications in PAC clinic was 80.3%. The lowest score of awareness was 59.3%, for presurgical instructions given to be followed PAC given in clinics. Awareness score in the field of role of anaesthetist during surgery was 60.3% (Table/Fig 4).
The scores of awareness of PAC among the participants were analysed by demographics. It showed that the mean percentage of awareness was highest among the participants with a history of previous surgery (89%) (Table/Fig 5). This was also statistically significant (p-value<0.001).
As a discipline, anaesthesia has grown from being simply a supportive specialty to surgery to one engaged in safe and full patient care, not just in operation theatres, but also in intensive care units and pain clinics. Despite this, there is varying degree of awareness among general population, patients, paramedical personnel and even surgeons on different aspects of anaesthesia [4, 6-10]. In low-income countries, where just 50% to 60% of patients consider anaesthesiologists to be doctors, compared to 90-99% of patients in high-income countries [11-13]. This hinders the growth of anaesthesiology as a speciality (14). While this can be ascribed to several reasons, one of the main reasons for this is that patients first consult surgeons for their illness and are later referred to anaesthesiologists (15). However, it was encouraging to see that all participants in the study were advised by surgeon/s to attend the PAC.
Preanaesthetic assessment involves taking of history, adequate physical examination and laboratory investigations. Although, only 24 (8%) of the participants indicated that they were attending PAC for investigations however, this difference was not statistically significant from other reasons for their visit to PAC.
The purpose of the PAC is to optimise the patient care before the surgery such that the risk of anaesthesia and surgery are minimised as much as possible and results in enhanced outcomes for the patients (3). Most of the study participants (85.6%) felt that PAC before their surgery was necessary and 70-80% of them said that it is important to provide accurate medical and personal history at PAC.
In addition, PAC provides the patient with the opportunity to address any anaesthesia questions or concerns. Therefore, the role of an anaesthesiologists becomes more difficult if a patient displays a lack of interest during PAC or attempts to hurry through it. This could result in insufficient optimisation of the patient prior to surgery. It is a well-established fact that morbidity and mortality during surgery are affected by both the preoperative physical state of the patient and the surgical procedure (16). It is encouraging to see that all study participants completed their PAC visits as advised by their surgeons.
Although demographic characteristics such as age, sex, occupation, education and residence did not influence the awareness and importance of PAC however, prior history of surgery did, and this difference was statistically significant.
Limitation(s)
The relationship between lack of information related to PAC and insufficient optimisation of preanaesthesia was not studied. In addition, this research does not propose potential steps that can be taken to enhance information about preanaesthesia check-up for patients. Therefore, further research may be needed to address this issue in full to improve patient care.
Patients have limited information about the evaluation of preanaesthesia and its role in enhancing the outcome of the procedure. Therefore, not only anaesthesiologists, but also surgeons involved in patient care should make efforts to stress the importance of the PAC clinic to reduce perioperative morbidity and mortality.
DOI: 10.7860/JCDR/2022/55846.16816
Date of Submission: Feb 23, 2022
Date of Peer Review: Mar 10, 2022
Date of Acceptance: Aug 03, 2022
Date of Publishing: Sep 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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