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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
Knowledge, Attitude and Practice of Pharmacovigilance among Ayurveda Doctors Practicing in Wardha, Maharashtra, India: A Cross-sectional Study
Correspondence Address :
Bharat Rathi,
Professor, Department of Rasashastra and Bhaishajya Kalpana, Mahatma Gandhi Ayurved College, Hospital and Research Centre (MGACHRC), Salod (H), Wardha, Maharashtra, India.
E-mail: bharatrathi174@gmail.com
Introduction: Adverse Drug Reactions (ADRs) significantly, cause morbidity and mortality worldwide. As a result, proper ADR monitoring is required. Considering the consequence of this area, the Ministry of AYUSH has introduced a Pharmacovigilance programme for Ayurveda, Siddha, Unani and Homeopathy (ASU&H) drugs. Every Ayurveda Practitioner’s (AP) immense responsibility is to detect and report ADR.
Aim: To evaluate the knowledge, attitude, and practice of pharmacovigilance among AP in Wardha, Maharashtra, India.
Materials and Methods: A cross-sectional survey was conducted in a Government Hospital, Wardha, Maharashtra, India, during March to May 2022. Total 38 Ayurveda Doctors of Wardha city having Bachelor of Ayurvadic Medicine and Surgery (BAMS), Doctor of Medicine (MD) degree, either working in private clinics and hospitals or as medical officers were enrolled in the study. A validated questionnaire was prepared on Google form, circulated through WhatsApp to the doctors, and asked them to fill and submit it within seven days. The collected data were analysed using Microsoft excel 2007 and expressed in percentages (%).
Results: A 28 (73.67%) male, and 10 (26.31%) female doctors possessing BAMS degrees (68.42%) and postgraduate degrees (37.57%), with practice experience between 5-30 years participated in the study. Present study revealed that 32 (84.21%) of the BAMS doctors from Wardha city believed that Ayurveda drugs cause ADRs, and only 7 (18.4%) have encountered ADRs in their practice, of which only 02 (5.26%) reported an ADR.
Conclusion: The present study revealed that AP are well aware about ADR but lacking in the knowledge of its reporting. There is a strong need to organise sensitisation and awareness programmes to implement the pharmocovigilance effectively.
Adverse drug reactions, Ayurveda medicines, Health, Herbal drugs
Ayurveda, the science of life, is immortalised in the form of elegant Sanskrit stanzas in the Samhitas, which describe diagnosis and therapy and ways to sustain good health (1). India is known for its biodiversity, and as a result, it has its indigenous codified healing systems. Ayurveda is one such healthcare system practiced in India for thousands of years and is a crucial component of the healthcare sector (2). Approximately, 80% of the Indian population is estimated to utilise Ayurvedic medicines for their medical needs (3).
Ayurveda is also becoming more popular in Western countries (4). The growing use of Ayurvedic medications worldwide has raised concerns about their safety. Several recent publications have expressed concern about the safety of Ayurvedic medicines (5),(6). Today, Ayurveda is gaining popularity worldwide, both as a therapeutic option for treating various chronic and noninfectious diseases and because of its potential health risks. Despite the fact that, Ayurveda has been practiced for centuries, there is a lack of systematic documentation concerning ADRs and other issues concerning the safety of Ayurvedic medicines (7),(8).
Furthermore, compared to the practice of Ayurveda in the past, there is a significant difference in many aspects of its application today. As a result, the changes in environmental factors, adulteration of herbs, the ever increasing use of insecticides, modern drug manufacturing techniques, negligence of regulations, and an increase in over-the-counter sales, safety monitoring has become increasingly important (9),(10).
With growing concerns about the safety of Ayurvedic medicines, the Department of Ayurveda, Yoga, and Naturopathy, Unani, Siddha Homeopathy (AYUSH); Ministry of Health and Family Welfare, Government of India has launched a National Pharmacovigilance Programme in Ayurveda, Siddha, and Unani (ASU) drugs (11). “Pharmacovigilance is the science and activities relating to detecting, assessing and preventing adverse events and all other problems related to medicines moreover, it has a vital role in therapeutic decision making, either for an individual, national or global perspective” (12). Nearly, 70% of modern medicines on the global market are derived directly or indirectly from plant products (13). The common misconception about herbal medicines is that, they are entirely safe and can thus be consumed by the patient without a physician’s prescription (13). This belief has resulted in widespread self-medication by people all over the world, which frequently results in disheartening results, health consequences or undesired after-effects (14).
The National Pharmacovigilance Programme was established in India in response to the growing global safety of Ayurvedic drugs (15). The goal of the pharmacovigilance programme is to collect data on the occurrence of ADR and to identify and quantify the risk associated with drug use. Such information is used to recommend informed regulatory interventions and communicate risks to healthcare professionals and the general public. As a result, proper ADR monitoring is required. All healthcare professionals in India, including doctors, nurses and pharmacists, can report an ADR by completing the Central Drugs Standard Control Organisation’s ADR form (16). Healthcare professionals must understand how and where to report an ADR. Pharmacovigilance programme should be conducted to improve the knowledge of healthcare professionals regarding ADR (17).
Ayurveda practitioner’s could be reliable scientific resources in pharmocovigilance reporting mechanism, but, no report is available so far, regarding the knowledge and behaviour on pharmocovigilance among AP of Wardha. Hence, the present study was conducted to identify the healthcare professionals practicing Ayurveda in Wardha, Maharashtra, India, and to evaluate their knowledge, attitude and practice of pharmacovigilance.
A cross-sectional study was conducted between March and May 2022 in Government Hospitals of Wardha, Maharashtra, India. An approval from the Institutional Ethical Committee was taken prior to the commencement of the study (Ref. No.MGACHRC/IEC/June-2021/256). Written informed consent was taken from the participants for inclusion in the study.
Inclusion criteria: All the doctors with BAMS degrees either working in private clinics and hospitals or as medical officers in Government hospitals in Wardha city willing to participate voluntarily were included in the study.
Exclusion criteria: Retired doctors, doctors who were not practicing alternative systems of medicine and unwilling to take part in the survey were excluded from the study.
Sample size calculation: The sample size was calculated as using the formula:
n=Z2×(p×q)/e2
=1.642×0.1657×(1-0.1657)/0.12
=0.3718/0.01
=38
where, n=required sample size, p=prevalence, 16.57 % (18), q=1-p, e=margin of error, 10%, Z=1.64 at 95% confidence interval.
Study Procedure
The demographic data concerning their age, gender, education qualification and practice experience was collected. The study comprised an online survey that assured the confidentiality and anonymity of the participants. A validated questionnaire was prepared by the researchers on Google form and circulated through WhatsApp group of the doctors for assessing their knowledge, attitude and practice of pharmacovigilance and reporting of ADRs. Each of them was asked to download the Google form and answer all the 16 questions by opting for Y (yes) or N (no) or NA (not aware) that were already present opposite to each question through the edit option of the document and submit it within seven days. A total of 48 doctors with BAMS degrees from Wardha city were identified and included in the study and were distributed the questionnaire through WhatsApp. Only 38 doctors responded by submitting the filled Google form after repeated reminders and hence considered for the analysis.
Questionnaire: The questionnaire was prepared based on a few previous studies [19,20]. The questionnaire enclosed a total of 16 close ended questions, of which seven were pertaining to knowledge, five related to attitude and four related to the practice of pharmacovigilance with Y (yes) or N (no) or NA (not aware) options. The questionnaire was validated and approved by faculty from School of Health Professional Education and research (SHPER) of Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe) Wardha, India. At first, a pilot study was done by sending the Google form to 10 first year postgraduate students (pursuing BAMS, MD degree) of the college. On piloting, questionnaire was found to take approximately three to four minutes to answer. In this pilot study, the Cronbach’s alpha value was 0.79, so, the authors proceeded for the data collection from the study population.
Statistical Analysis
The collected data was entered in Microsoft excel sheet, version MS office 2013. The results were calculated in terms of frequency and percentage (%).
The majority, 19 (50%) respondents were in the age group of 25-34 years and 14 (36.84%) respondents were in 35-44 years age group. Among these 38 Ayurveda doctors, 28 (73.67%) were male, and 10 (26.31%) were female, possessing BAMS degrees 26 (68.42%) and postgraduate degrees 12 (37.57%), with most of the doctors, 18 (47.36) having practice experience between 5-15 years (Table/Fig 1).
Total 35 (92.10%) reported to have heard the name pharmacovigilance, while only 14 (36.84%) knew the meaning of pharmacovigilance. A 30 (78.94%) of doctors answered the meaning of ADR, and 32 (84.21%) believe the Ayurveda drug can cause ADRs. Only 1 (2.63%) reported that they were aware of the location of the National Pharmacovigilance Centre and 18 (47.36%) answered correctly about the personnel eligible to report an ADR (Table/Fig 2).
Only 37 (97.36%) thought reporting an ADR with Ayurveda, Siddha and Unani (ASU) drugs is necessary, while 37 (97.36%) believe that healthcare professionals should be trained in depth about pharmacovigilance. Only 19 (50%) were aware of ADRs through the article reading. A 37 (97.36%) thought it necessary to set-up an ADR monitoring centre at every hospital, while all the doctors were of the opinion that reporting ADRs will help enhance patient safety (Table/Fig 3).
A 7 (18.41%) had encountered an ADR with Ayurveda drugs, 18 (47.36%) were familiar with the ADR reporting form, and 2 (5.26%) knew how to report ADRs. In contrast, only 1 (2.63%) of doctors only keep a record of ADR (Table/Fig 4).
In the present study, it was observed that majority of the doctors practicing alternative systems of medicine in Wardha city were aware about the ADRs caused due to Ayurveda medicines but only 2 (5.26%) knew how to report ADRs which is very alarming.
Currently, a large amount of healthcare is given by treating illnesses using traditional, alternative and complementary medicine systems worldwide. AP in India utilise herbal medications, metals and minerals in the form of Kharaliya rasakalpa (herbo mineral formulations), parpati, or kupipakwa Kalpa, and Bhasmas (incinerated mineral formulations). During the initial days, Ayurveda physicians (Vaidyas) used to prepare medicines for their patients themselves, ensuring the safety and efficacy of the drugs. But in recent years, this practice has changed, and most Ayurveda physicians depend on the drug prepared by Ayurvedic drug manufacturing units. This widespread availability of Ayurvedic medicines has helped to bring many serious challenges, such as the quality and purity of drugs, highlighting the need for a pharmacovigilance programme in this field. ADRs can occur when strict procedures for preparing and prescribing specific drugs are not followed (21). It is the common belief that the medications used in traditional treatment systems, such as Ayurveda, are safe and free of ADRs (21),(22).
The present study revealed that 84.21% of the BAMS doctors from Wardha city believed that Ayurveda drugs cause ADRs. Only 21.05% have encountered ADRs in their practice, of which only 5.26% had ever approached the pharmacovigilance centre to report an ADR.
These findings are congruent with the results drawn by Prakash GB et al., in which 80% of the Ayurvedic doctors believed Ayurvedic medicines do not cause ADRs, and only 11% had come across ADRs with Ayurvedic drugs in their practice, of which only one physician reported ADRs (18). In contrast, another study conducted in Orissa has shown high knowledge but poor practice of ADRs among Ayurvedic doctors (23). Desai CK et al., also observed the right attitude toward ADR reporting subsisted among most participants but lacked the actual practice of ADR reporting (24). Some such studies in India show similar results regarding attitude towards ADR reporting (25),(26). Amancharla MK et al., conclude that the major discouraging factors for under reporting were a lack of time and difficulty detecting that the ADR was due to a particular drug (27). Treating drug induced adverse effects is an additional cost of pharmaceutical treatment, so the under-reporting of ADRs should be taken more seriously (28). This can only be avoided if healthcare professionals instill the habit of spontaneously reporting ADRs, which serves as the pharmocovigilance’s primary data generation system (29). Awareness and reporting of ADRs can be encouraged by educating the practitioners by organising Webinars and displaying banners and posters depicting ADRs through digital and print media (30),(31).
Even though the name “pharmocovigilance” does not appear in Ayurvedic literature, the concept is found in all key Samhitas. pharmocovigilance’s key goals are to develop patient care and safety regarding drug usage to encourage rational drug use. Well-known text of Ayurveda medicine, Charaka Samhita, chronicles all adverse reactions to drugs that occur when they are improperly made or utilised. Even a potent toxin can be used as a good remedy if provided appropriately,” Charaka believes. Contrary to this, even the most beneficial medicine might become poisonous if mistreated (32). Ayurveda seers considered the prevalence of ADRs and categorised drug lists as toxic, semi-toxic, or to be taken with caution, among other things, as well as strategies to avoid or negate them (33). In India, where a significant population consumes modern medicine and another system of medicine, it is even more critical to establish an ADR reporting system and maintain a proper ADR database so that any potentially dangerous drug can be removed from the market soon as possible (34).
Limitation(s)
The study had a small and convenience sample size that included AP from a single city only which may affect the generalisability of the study results.
Present study revealed the poor knowledge and practice of pharmocovigilance among the AP of Wardha. Also, despite the positive attitude of AP toward ADR reporting, there was a lack of knowledge on how to report and where to report, and it needs to be addressed through sensitisation and awareness programmes. There is strong need to sensitise the practitioners regarding the concept of pharmocovigilance and how to report and where to report, so that they actively participate in the process of drug monitoring. This study will encourage ADR reporting and help reduce the overall economic burden of healthcare expenditures, morbidity and mortality.
The authors acknowledge the support from the management of the University. Authors also acknowledge the Ayurveda practitioners of Wardha city for their active participation in the study.
DOI: 10.7860/JCDR/2023/59102.17503
Date of Submission: Jul 16, 2022
Date of Peer Review: Sep 21, 2022
Date of Acceptance: Nov 16, 2022
Date of Publishing: Feb 01, 2023
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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• Plagiarism X-checker: Jul 18, 2022
• Manual Googling: Aug 31, 2022
• iThenticate Software: Nov 14, 2022 (20%)
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