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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
Reviews
Full Version
Predictors of Heart Rate Variability: A Systematic Review
Correspondence Address :
Dr. Neetha Kamath,
Kotekar Beeri Road, Paneer, Deralakatte, Mangalore, Karnataka, India.
E-mail: neethakamath@nitte.edu.in
Introduction: The heart has the ability to maintain cardiac output in accordance with the body’s momentarily changing demands by adjusting its rate of contractions and this ability is termed Heart Rate Variability (HRV), which is manifested as a fluctuation of R-R interval in milliseconds on an Electrocardiography (ECG). Maintenance of good HRV levels is significant for the patient population since they influence the prognosis and quality of life.
Aim: To identify the predictors of HRV.
Materials and Methods: The present study was a systematic and literature review which was based on Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines 2020. Randomised Controlled Trials (RCTs) published in English from 2014 to 2021 were identified from Cochrane Library, Science Direct, PubMed, and Google Scholar databases. The keywords with Boolean operators were used as “influencing factors or determinants or predictors and HRV.” The quality assessments of the studies were performed with Cochrane risk-of-bias assessment tool. Narrative syntheses upon the selected studies were done.
Results: The significant findings from the nine selected RCTs were summarised. Physical exercise, breathing exercise, diet, music, and mind-body interventions such as yoga and meditation were identified as the factors enhancing HRV or predictors of HRV.
Conclusion: The findings of this systematic review strive to facilitate healthcare providers to devise the strategies to support the risk group of low HRV by the implementation of enhancing factors of HRV to achieve a better outcome.
Determinants, Exercises, Influencing factors
The heart is a unique organ with a capacity to maintain cardiac output in accordance with the body’s momentarily changing demands by adjusting its rate of contractions. This ability is termed HRV, manifested as a fluctuation of R-R interval in milliseconds on an ECG. A person with high HRV can be considered healthy in terms of physical, social, mental, and spiritual aspects. Measurement and maintenance of good HRV levels are significant for the patient population since they influence the prognosis and quality of life (1). The heart rate is modulated by a balance between the sympathetic and parasympathetic systems. The neurocardiac function reflects the interaction between the heart and brain, measured by the HRV. Hence, researchers and clinicians worldwide use HRV to measure the heart’s autonomic control (2). HRV is an emerging concept in the field of medical treatment, and the available empirical data on the factors affecting HRV are scattered. Many factors can influence HRV. Several studies were conducted to identify, the influence of individual factors on HRV. According to a review, physiological, pathological, neuropsychological, lifestyle, and environmental factors can influence HRV (3). The studies involving a compilation of the factors which can enhance HRV may facilitate the healthcare providers to devise strategies to support the risk group of low HRV. The enhancement of HRV is directly related to Parasympathetic Nervous System (PNS) activation (4). The present systematic review addresses the research question, that what are the factors enhancing HRV. The main objective was to identify the positive predictors of HRV.
Search Strategy
The review followed the guidelines of PRISMA 2020 (5). The Prospero Id for the review was registered as CRD42021270016. The steps for conducting the systematic review comprised locating the sources, selecting the studies, and quality appraisal of studies, followed by the presentation of findings. A systematic review of literature for articles in the English language, published from 2014 to 2021, was conducted using electronic databases such as Cochrane Library, Science Direct, PubMed, and Google Scholar. The keywords used for the search were “influencing factors”, “HRV” combined with Boolean operators “AND” and “OR” with the synonyms “determinants” and “predictors”. In addition to the above, a reference list of all relevant articles and reviews was checked.
Inclusion criteria
• Type of study- RCTs published between 2014-2021
• Language-English
• Study participants-Adults of both gender aged above 18 years
• Full-text article availability.
Exclusion criteria
Articles on-
• Paediatric population,
• Pregnant and lactating mothers.
After identifying the records through databases and reference lists, duplicates were removed manually. Two levels of screening were completed independently by three authors, the first level was the screening of title and abstracts, and the second level was the full-text screening of eligible studies. Disagreements concerning article inclusion were resolved within the group discussion. Three reviewers worked independently to reduce the chance of error, add more scrutiny, and ensure proper conduct.
The literature search in various databases and reference list of other relevant articles yielded 360 studies. After excluding 15 duplicates, there were 345 articles, of which 288 articles that were not relevant based on the selection criteria were excluded, and the remaining 57 records were identified for screening. Another 44 studies were also eliminated as they had multiple outcome measures other than factors influencing HRV. A risk-of-bias assessment screening was done for the remaining 13 records, and four studies were eliminated. Ultimately, nine studies were considered for data synthesis. The study selection process is depicted in PRISMA (Table/Fig 1) (5).
Quality Assessment and Data Extraction
The methodological qualities of the studies were evaluated independently by two authors. An assessment of the ‘risk-of-bias’ was done using the Cochrane risk-of-bias assessment tool for randomised trials (6). The tool categorises the risk as high, low, or uncertain according to the description of the study with reference to the methodology. The researchers compared the scores after they were measured independently by the researchers (Table/Fig 2) (7),(8),(9),(10),(11),(12),(13),(14),(15),(16),(17),(18),(19).
Three reviewers extracted data using a predesigned data extraction sheet to allow standardised reporting of results across studies.
The study characteristics extracted from each review were as follows: Basic information of the study, including the year of publication, author, participants, interventions, and outcome (Table/Fig 3) (7),(10),(11),(13),(14),(15),(16),(18),(19).
As the studies included were heterogeneous in outcome measures, a narrative synthesis of the data was conducted. The significant findings from the nine selected RCTs were summarised. Physical exercise, breathing exercise, diet, music, and mind-body interventions such as yoga and meditation were identified as the factors enhancing HRV or predictors of HRV (Table/Fig 4) [7,(10),(11),(13),(14),(15),(16),(18),(19).
HRV is the outcome of the dynamic interaction of various body systems. It is now used as a standard indicator of health. Understanding the following influencing factors of HRV helps healthcare providers in their daily practice in different clinical contexts (2). Physical exercises such as combined aerobic and resistance training (10), water exercises (11), stretching (13), and interval training (16) enhance HRV. Exercise duration between 6-24 weeks, for atleast three times per week, is sufficient to influence HRV positively (20). A systematic review identified interval training as an efficient method for cardiorespiratory variables. The acute stretching exercise was a helpful therapeutic intervention to improve cardiac autonomic function in different populations (21). Walking is associated with enhanced PNS activity and improved HRV (22),(23).
The frequency and amplitude of respiration modulate the pattern of heart rhythm known as respiratory sinus arrhythmia. So, cognitively directed breathing exercises can highly influence HRV in a positive manner (7),(15),(19). An experimental study identified the influence of metronome breathing upon HRV with age and postural variations. HRV and respiratory sinus arrhythmia were promoted by breathing techniques paralleled by central nervous system activity modifications. A slow breathing technique was indicated by an increase in alpha and a decrease in theta power during EEG monitoring (24). Many sources of stress, such as anxiety, hostility, depression, work stress, and negative emotions, induce low HRV. Mind body interventions such as mindfulness meditation, yoga, qigong/tai chi, etc., improve HRV by increasing parasympathetic tone (3),(15),(25),(26).
The literature also identified the positive influence of compassionate care on HRV (27),(28). In a thesis, it is identified that forgiveness improves HRV, and forgiveness influences physical health through mechanisms of cardiac autonomic control ((29)-unpublished, waiting to be published). A randomised pilot study revealed that, gratitude journaling improves parasympathetic HRV responses (30). As per a review, a moderate-fat diet containing pistachios improves the measures of HRV (18). Another review explains that the mediterranean diet, omega-3 fatty acids, B vitamins, probiotics, and polyphenols enhance HRV. In a cross-sectional study, wine intake was associated 3with increased HRV. On the other hand, the consumption of beer and spirits and the total amount of alcohol consumed did not relate significantly to the HRV parameters (31),(32). Another systematic review identified that music benefits the cardiovascular system (33). Hence, with music therapy, HRV can be increased, and there will be reduced sympathetic activation.
The clinical implementation of this systematic review finding was significant for a holistic approach to patient care. In light of this, it may be suggested that an intervention comprising positive predictors of HRV be developed and an extensive prospective evaluation of the intervention should be conducted.
Limitation(s)
In the present review, a formal meta-analysis was not considered appropriate due to the considerable variations in the analysed HRV parameters and assessment contexts (e.g., short term versus long term recordings of HRV).
Keeping an elevated HRV level plays a significant role in a person’s personal and social life. It contributes much to his/her physical, mental, social, and spiritual well-being. The findings of this systematic review strive to facilitate healthcare providers and devise strategies to support the risk group of low HRV and to achieve a better outcome.
The authors would like to thank Mrs. Leena Sooraj for editing the manuscript.
DOI: 10.7860/JCDR/2023/57454.17270
Date of Submission: Jun 21, 2022
Date of Peer Review: Aug 25, 2022
Date of Acceptance: Nov 26, 2022
Date of Publishing: Jan 01, 2023
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• 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: Jun 22, 2022
• Manual Googling: Nov 21, 2022
• iThenticate Software: Nov 24, 2022 (15%)
ETYMOLOGY: Author Origin
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
- Index Copernicus ICV 2017: 134.54
- Academic Search Complete Database
- Directory of Open Access Journals (DOAJ)
- Embase
- EBSCOhost
- Google Scholar
- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
- Journal seek Database
- Popline (reproductive health literature)
- www.omnimedicalsearch.com