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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
Heart Rate Variability Biofeedback Psychophysiological Rehabilitation in Coronary Artery Disease Patients: State of Heart as the State of Brain
Correspondence Address :
Vishnu Vardhan,
Professor and Head, Department of Cardiorespiratory Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences (DU), Wardha, Maharashtra, India.
E-mail: vishnudiwakarpt@gmail.com
Introduction: Psychological therapies in cardiac rehabilitation programs were found to be effective for patients with Coronary Artery Disease (CAD). Heart Rate Variability Biofeedback (HRV-BF) is a behavioural neuro-cardiac intervention designed as a natural oscillation between the breathing cycle and Heart Rate (HR), also known as refractory sinus rhythm biofeedback.
Aim: To find the potential effects of heart rate variability biofeedback for psychophysiological rehabilitation in CAD patients.
Materials and Methods: In this systematic review included five databases (PubMed, Scopus, web of science, and Google Scholar) were searched for publications between January to December 2021. Randomised control trials published in the English language, done on the effect of HRV-BF on psychophysiological rehabilitation in CAD, were included. High-quality experimental trials were chosen for the study, using Arksey and O’Malley framework. The records were screened against eligibility criteria and methodological quality analysis was done using Downs and Black N checklist.
Results: Overall, 11,048 articles were extracted, from which 56 records were screened, and three randomised control trials were included in the study. All the three studies scored within a range of 20-25, with good methodological quality. They demonstrate practical feasibility of HRV-BF device with both short-term and long-term effect on psychophysiological rehabilitation in CAD patients.
Conclusion: This systematic review showed the potential effects of HRV-BF for psychophysiological rehabilitation in CAD patients. Patients have reported the benefits of HRV-BF therapies by patient reported as well as therapies reported outcome measures.
Cardiovascular morbidity, Outcome, Practical feasibility
Cardiac autonomic dysregulation is a significant predictor anchored to the development of cardiovascular disorders that can be assessed non invasive via Heart Rate Variability (HRV) analysis. It indicates the temporal difference between successive sinus heartbeats induced by the equilibrium of the parasympathetic and sympathetic nervous systems (1). It is most often assessed between QRS complexes at each Normal-to-Normal (NN) interval (2). The ability of the cardiovascular system to adapt to changes in sympathetic influences is reflected in HRV. Thus, increased HRV indicates good heart health, whereas low variability has been linked to poor cardiac health and poor cardiac outcomes, and is an independent predictor for cardiovascular morbidity and mortality, and cardiac event recurrence (3),(4). Furthermore, poor HRV, hyperactivity of the vagus nerve and sensitivity of the pressure sensors (baroreflex system) when combined with depression symptoms were strong predictors of mortality in Coronary Artery Disease (CAD) patients (5).
Reduced cardiovascular morbidity and death are two well-known benefits of multidisciplinary Cardiac Rehabilitation (CR). Psychological therapies in CR programs were found to be effective for patients with CAD during short and long-term follow-ups, primarily in minimising depression and anxiety, symptom recurrence and death (6). Biofeedback is a type of self-regulation therapy in which the patient learns to manage the function of their autonomic nervous system to improve the overall health. Patients with a variety of cardiovascular illnesses, including hypertension, CAD and heart failure, have benefited from biofeedback (5). The Heart Rate Variability Biofeedback (HRV-BF) is a behavioural neuro-cardiac intervention that involves breathing six times per minute to stimulate efferent vagal activity to the Sinoatrial (SA) node, modulate HR and Blood Pressure (BP), increase HRV indices, and achieve a power spectral distribution of Low Frequency (LF) at 0.1 Hz. HRV-BF is a natural oscillation between the breathing cycle and HR, also known as refractory sinus rhythm biofeedback.
The primary aim of this study was to undertake a review of the literature to investigate the effectiveness of psychophysiological interventions using HRV-BF in CAD patients. The secondary aim was to identify the various HRV-BF devices utilised in the psychosocial interventions. The aim of this review was to evaluate the current efficacy of additional, well-defined psycholophysiological interventions using HRV-BF compared with CR alone on depression, anxiety, Quality of Life (QOL), cardiovascular morbidity, cardiovascular mortality and total mortality in CAD patients.
A wide electronic search was performed for trials available from January to December 2021 in the Web of Science, Google Scholar, Scopus, and PubMed databases. The five stage review framework suggested by Arksey H and O’Malley L, which was used to select studies (7). The following MeSH terms were used: CAD, HRV-BF, psychological intervention, cardiac rehabilitation.
Inclusion criteria: The human experimental clinical trials, in the study period for the data collection (January to December 2021) and English language articles were included in the study.
Exclusion criteria: All review articles, meta-analyses, or case series were excluded from the study. Articles with only abstracts, having no control group, and HRV-BF in other conditions were also excluded.
Study Procedure
In the second stage, the relevant studies related to HRV, HRV-BF, and their impact on psychophysiological rehabilitation in CAD was noted down. The selection of studies was done in the third step by one reviewer going over the titles and abstracts (MJJ). The three complete studies were chosen, reviewed, and rated following the eligibility requirements using Downs SH and Black N checklist for methodological quality index score (8). The checklist consists of 27 items that address the following methodological components: reporting, external validity, internal validity (bias and confounding) and power. The scores range from 0-28 with higher scores indicating a better methodological quality of the study. The following cutpoints have been suggested to categorise studies by quality: excellent (26-28), good (20-25), fair (15-19) and poor (<14) (8). Year, research design, participants, HRV-BF intervention, CAD patients, and the major findings of the studies were all retrieved from the final three studies and used to evaluate the entire review. The reviewer (MJJ) completed data extraction independently, and both reviewers agreed to include the articles in the fourth stage. The data was methodically categorised and structured at the survey’s final step, utilising a data charting form created in Microsoft excel. A flow diagram illustrated the process of the research selection, and the findings were presented with a narrative synthesis in table form (Table/Fig 1).
In summary, extensive database and additional hand-search resulted in 11,048 records, after exclusion from which 56 were screened. Only 36 records were excluded and 20 full-text articles were assessed for diseaseeligibility and qualitative analysis and three studies were finally included into the quantitative synthesis (Table/Fig 1).
Study design: There were three Randomised Clinical Trials (RCT) included in the review. The study size ranged from 31 CAD patients to 210 patients in total and follow-up periods ranged from one month to one year and one study with no follow-up.
Populations: All the three studies included mixed CAD populations {either undergone Percutaneous Coronary Intervention (PCI) or Coronary Artery Bypass Grafting (CABG)}.
Study characteristics: The characteristics of the all three included articles are summarised in (Table/Fig 2) (6),(9),(10).
Interventions: Experimental group: There was a considerable heterogeneity with respect to duration and content of the psychological interventions. The duration of intervention range from: Number of session: 6 sessions-10 sessions; Number of session in a week: once a week- twice a week; Each session duration: 45-60 minutes.
The control group received usual medical care and medical care in all the three studies, whereas only one study provided 10 minutes of psychological education after postintervention assessment.
Effectiveness of the intervention: All the three studies reported increase in HRV and positive effect on psychophysiological intervention with short-term and long-term effects in cardiac rehabilitation programs in CAD patients. They also demonstrate practical feasibility of HRV-BF in CAD patients.
Study quality: According to the Downs SH and Black N, checklist, all the three studies ranged from 20-25 with good methodological quality (Table/Fig 3) (6),(9),(10).
Heart rate variability biofeedback has the potential to reduce stress levels while also improving autonomic nervous system function and cardiovascular endpoints. It can be used both as short-term and long-term psychophysiological intervention used in CR programme (10). Psychological stress level monitoring and management has fascinating implications for HRV measurement (11). The results of the study by Amjadian M et al., also revealed a significant inverse relationship between patients’ HRV and depression and anxiety. In fact, breathing strategies with HRV feedback were significantly effective in alleviating depression, as well as increasing the patients’ psychophysiologic coherence (12). Breathing techniques with HRV-BF were found to be very beneficial in improving psychophysiologic coherence, physical and mental health, and decreasing depression and anxiety in patients (13). For patients with CAD, HRV-BF may increase overall HRV, ANS control and baroreflex activation during rage events, and maybe a good program for CR (14).
Psychophysiological rehabilitation programs that aim to increase the provision of psychosocial interventions and prepare and endorse participants to interact outside of the traditional CR setting may reduce inequities in access to services and improve patient outcomes through support and self-management. Through, assistance and self-management, it is possible to eliminate disparities in service delivery and enhance patient outcomes. The review analysis shows the potential effects of HRV-BF for psychophysiological rehabilitation in CAD patients. Patients have reported the benefits of HRV-BF therapies by patient reported as well as therapies reported outcome measures.
Limitation(s)
The inclusion criteria was mainly concentrated on the experimental trials, therefore some relevant other type of studies like observational studies might have been missed. The removal of research publications written in languages other than English during the searching and screening process is one constraint that could have affected the present findings.
The current study was carried out to give a snapshot of research regarding incorporating HRV-BF as an effective psychological intervention in CR. Such observations open a window of opportunity for anchoring psychosocial intervention along with cardiac rehabilitation to gain better outcomes among such patients. HRV-BF increased efferent vagal activity to moderate the SA node, increased baroreflex gain, and overall HRV, and reduced expressive and suppressive hostile behaviour. The report concludes with a broad description of how to manage such individuals from a psychiatrist’s perspective. In the long run, a collaborative strategy is likely to be beneficial to the patient and cost-effective. The research finishes with a basic review of how such patients should be managed from the psychiatrist’s standpoint.
A standard protocol can be made concerning psychophysiological rehabilitation in CAD patients both operative and non operative. More high-quality RCTs should be done in other cardiac patients. Further, more studies can be done on the community level where the lack of educational material is present to spread awareness regarding psychophysiological health in cardiac patients.
DOI: 10.7860/JCDR/2023/57895.17384
Date of Submission: May 22, 2022
Date of Peer Review: Jul 16, 2022
Date of Acceptance: Sep 12, 2022
Date of Publishing: Feb 01, 2023
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? No
• For any images presented appropriate consent has been obtained from the subjects. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: May 23, 2022
• Manual Googling: Sep 09, 2022
• iThenticate Software: Sep 10, 2022 (18%)
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