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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
View Point
Roles and Responsibility of the Retriever Renalogist: An Insight
OI01-OI03
Correspondence
Dr. Chandan Bala R Kataria,
No: 1/472, Bazaar Street, Kadambathur, Trivallur District, Chennai, Tamil Nadu, India.
E-mail: chandanbala.cbk@gmail.com
Unequivocally, the term “retriever” is the pertinent description for the dialysis technologists since they consecrate themselves to retrieving the quality of life of the dialysis patients. These professionals commit their lives to their patients; they are so dedicated that even natural disasters can’t derail their work. Apart from just assembling the extracorporeal circuit and terminating the case, technologists play a predominant role during renal replacement therapy.
HAEMODIALYSIS: ROLE AND RESPONSIBILITY
Dialysis Zone Infrastructure
The technologist is accountable for maintaining the facility in an aseptic environment with an ambient temperature of 70-72°F and a humidity of 55-60%. The area must be well-organised to curb patients from converting from negative to positive serology (sero-conversion). As a consequence, the spectrum is divided into negative and positive bays, and patients are dialysed in their respective bays based on their serology. The dialysis facility also features an emergency evacuation tunnel that connects to Intensive Care Unit (ICU) in case of a medical emergency (1).
Dialysis Zone Necessities in an Emergency
The defibrillator and the crash cart are required equipment components for the unit. These are crucial in circumstances where saving lives is vital. The oxygen cylinder or colour-coded oxygen supply pipelines, along with vacuum pump lines next to them, make up the other significant pieces of equipment.
Primitive Medical Care
Technologists render significant contributions to patient care through their knowledge and experience. These professionals supervise patients from the time they arrive at the facility until they depart. When a patient arrives at the department, their weight and vascular access are assessed. Technologists ought to be acquainted with sphygmomanometers, thermometers, and glucometers to evaluate blood pressure, temperature, and plasma glucose. In addition to these, they have the requisite skills to analyse vital indicators, including heart rate, respiration rate, pulse rate, and Electrocardiogram (ECG) waves. Typically, these parameters are detected in monitors with the use of leads positioned on the patient’s skin (2).
Assessment of Vascular Access
The viability of the fistula is assessed by bruit or thrill sound, which benchmarks the patency of the access. The technologist also ensures if there is any lack of sensation to rule out the steal syndrome (ischaemia of the limb bearing a permanent access). The access is intended to be sterile during cannulation to prevent infection, and the ideal techniques are the rope ladder method with sharp needles and the buttonhole approach with blunt needles.
These professionals indeed have the responsibility of guiding and training patients to perform ball exercises for prominent matured veins. The therapist examines for inflammation at the exit site before
scrubbing with a povidone-iodine solution in the case of temporary access. Medical professionals advise patients to take preventative measures and administer catheter antibiotics locks as per the nephrologist’s orders when there is inflammation.
The permanent access is inaccessible for drawing blood and recording blood pressure. These safety measures are educated by the therapist. To improve the longevity of access, patients are recommended to undrape the tourniquet after 4 hours postdialysis. To prevent vascular complications such as stenosis or thrombosis, thrombolytic agents or ice pack application is suggested (3).
Intradialytic Roles
While the patient is on dialysis mode with the extracorporeal circuit intact with the machine circumference, the technologist monitors both the living and non living sectors of the dialysis. The sole purpose of monitoring the patient during dialysis is to avert intradialytic complications. The therapist’s key role is to use sodium modeling and ultrafiltration profiling to reduce predominant complications such as hypotension and muscle cramps. Other vitals that are monitored include venous pressure, transmembrane pressure, and conductivity. These pressures indicate any complications, such as swelling at the cannulation site, dislocation of needles, clotting of the dialyser, and increased sodium and bicarbonate levels due to high conductivity. Air bubbles invading the circuit must be monitored meticulously as they can cause circuit clotting or an air embolism. If not addressed, it can jeopardise the situation and put the patient’s life at stake. The therapist must be proactive during the procedure.
Haemodialysis Equipment
Dialyser-the artificial kidney: The dialyser, or artificial kidney, is the central component of the procedure. Professionals predetermine the dialyser based on the patient’s body surface area. Ethylene trioxide (ETO) or steam is used for sterilising these dialysers. Since this sterilisation technique is perilous, a priming step is performed to prevent complications such as first-use syndrome or activation of the complementing system. After completing the step, a test factor helps in ruling out the presence of residual substances.
Storage and reuse of the dialyser: Dialysers are typically reprocessed and reused before being stored in an aseptic environment. Before storing and priming the dialyser, professionals ensure that the sterilising agents bare atleast 90% full. They also provide specific details on each dialyser, such as the patient’s name, age, and distinctive hospital Identification (ID) number. If the dialyser is stored for an extended period (more than a month), it is not reused.
Blood circuit: These circuits are sterilised using agents similar to those used for dialysers. Therefore, these agents must be removed before the procedure. After the priming process, technologists ensure that the circuit is free of contaminants by performing a litmus paper test. The volume of these circuits varies depending on the group of patients undergoing haemodialysis; adult circuits are typically around 150 mL, while paediatric circuits are 10% less.
Anticoagulant: Low molecular weight heparin is the preferred drug during haemodialysis to prevent blood clotting. The dosage of the drug is determined based on laboratory data of Partial Prothrombin Time (PTT) and clotting time. Technologists find it easy to prevent circuit clots during heparin-free dialysis. They also ensure that anticoagulants are avoided in cases of active bleeding or completed/planned surgery.
Dialysate: The fluid part used during the procedure, known as the dialysate or bath, contains a specific concentration of electrolytes and an acid-base component (Table/Fig 1). It interacts with the blood to aid diffusion. There are two types of buffer systems: acetate-based and bicarbonate-based. Each type has its advantages and disadvantages. Acetate dialysate is not ideal for patients with liver failure because acetate cannot be converted into bicarbonate.
The Reverse Osmosis (RO) standards for dialysate include a requirement of <100 μs/cm3 colony forming units and endotoxin levels should be <0.03 μs/cm3. It is important to remove trace metals as they can lead to toxicity (4).
For patients with hyperkalemia, potassium-free baths are highly recommended. There are several options available, including a zero-potassium bath, 2 K bath and 4 K bath (5).
The volumetric portable device facilitates the precise elimination of ultrafiltration volume from the patient’s body. The ultrafiltration volume is determined by the difference between dry weight and prehaemodialysis weight. This advanced device also allows for online clearance monitoring of urea/sodium, as well as measurements of blood temperature and pressure. It is user-friendly, practical, and offers assistance in case of any issues.
Haemodialysis standards: Professionals adhere to haemodialysis standards to enhance the quality of life and prevent complications in haemodialysis patients. Regulatory bodies provide guidelines for determining the quality of dialysis, with the adequacy cut-off value typically set at 1.4-1.6 (6). To achieve this goal, technologists must consider specific criteria for adequacy, such as dialyser surface area based on body surface area, cannulation technique to prevent recirculation, dialysis duration and frequency, effective blood flow rate, and dialysate flow rate.
Post haemodilaysis role: Technologists assess vital signs and the patency of vascular access. If the blood pressure exceeds 160/90 mmHg, they do not administer erythropoitein (EPO) (7). They also educate the patient on vascular access maintenance and restrictions on salt and water intake. They evaluate the postdialysis weight to ensure accurate removal by the machine. If complications arise during subsequent dialysis sessions, they may reassess the dry weight.
PERITONEAL DIALYSIS: ROLES AND RESPONSIBILITIES
When it comes to peritoneal dialysis, it may seem like the technologist’s role is simple and concise. However, it requires great care as the entire procedure is manual, and there are no pressure pods to monitor inflow and outflow pressure. Technologists follow aseptic procedures throughout the dialysis process to prevent the risk of developing peritonitis. In addition to manually conducting the procedure, technologists play a pivotal role in determining the type of transporter through Peritoneal Equilibration Test (PET). Non compliance with aseptic process increases the risk of peritonitis and may require the patient to transition to chronic haemodialysis. Therefore, the role may sound effortless, but it is not as easy as it may seem. The therapist primarily assesses the effectiveness of the dialysis, which helps improve the therapy. Furthermore, educating patients and caregivers on the aseptic process of manual exchange in peritoneal dialysis is one of the most crucial responsibilities.
CONTINUOUS RENAL REPLACEMENT THERAPY: ROLES AND RESPONSIBILITIES
The technologist plays a crucial role in continuous renal replacement therapy, which is often indicated for patients with haemodynamically unstable renal failure or septic shock. The technologist monitors the Arterial Blood Gas (ABG) report and vital signs to assess pH levels, lactate and bicarbonate levels, potassium, and other electrolytes. When these parameters are altered, the technologist seeks instructions from the nephrologists and executes them. They also provide continuous monitoring of the patients throughout the treatment, being available around the clock.
AdditionalResponsibilities
Vaccinations
Patients with Chronic Kidney Disease (CKD) should receive vaccinations for Hepatitis B, diphtheria, tetanus, influenza A and B, and Pneumococcus. The technician maintains records of the patients’ immunisation status (3).
Renal Diet
The technologist also serves as a nutritionist, being aware of each patient’s eating habits and tailoring their diet to meet their nutritional needs. They calculate the Body Mass Index (BMI) and assess it using nutritional methods such as Subjective Global Assessment (SGA), anthropometry, and bioimpedance. These patients are advised to avoid potassium-rich meals and processed foods (8).
Minor Procedures
The technologist assists the nephrologist in minor procedures such as temporary access catheterisation (Internal Jugular Vein (IJV), subclavian, femoral) and renal biopsy. They also handle catheter removal and control bleeding from the exit site. In cases where doctors are unavailable, the technologists are authorised to approve x-rays taken after catheterisation.
Renal Psychologist
The technologists also address the psychological needs of the patients. Renal psychologists work with all patients who have chronic renal failure or any renal condition. They provide encouragement, support, and strive to build a friendly relationship with the patients.
