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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
Recent Strategies for Cardiac Rehabilitation in Post-Myocardial Infarction Patients: A Narrative Review
Correspondence Address :
Dr. Vishnu Vardhan,
Professor and Head, Department of Cardiovascular Respiratory Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences, Wardha-442004, Maharashtra, India.
E-mail: vishnudiwakarpt@gmail.com
Myocardial Infarction (MI) is a severe cardiac crisis that can result in significant morbidity and death. ST segment Elevated Myocardial Infarction (STEMI) is irreparable myocardial damage caused by persistent ischaemia, and while the adage “time is muscle” remains true, rapid and prompt detection of MI continues to be a key concern. Cardiac Rehabilitation (CR) is the most significant evidence-based intervention for secondary prevention following STEMI. However, only a small proportion of patients have access to a cardiovascular recovery programme. Recent research implies that exercise-based CR provides significant benefits to patients with cardiovascular disease, including a lower risk of MI, a likely slight decline in all causes of mortality, a massive reduction in all-cause hospitalisation, along with associated medical costs, and enhanced Health-Related Quality of Life (HRQoL) upto a year of follow-up. Adapting rehabilitation programmes to existing abilities based on experience in the field of activity is becoming a major solution in the current CR training programme selection. The effectiveness of both centre-based and home-based therapy is proven. Telerehabilitation and home-based rehabilitation strategies have gained much importance during the Coronavirus Disease-2019 (COVID-19) pandemic. Further research is needed to standardise the treatment quality for patients with home-based CR.
Coronavirus disease-2019, Mobile application, Myocardial infarction, Physiotherapy, Telerehabilitation
The MI is a severe cardiac crisis that can result in significant morbidity and death. STEMI is irreparable myocardial damage caused by persistent ischaemia, and while the adage “time is muscle” remains true, rapid and prompt detection of MI continues to be a key concern (1). This illness is characterised by acute coronary syndrome induced by bouts of plaque ulceration, fissuration, or rupture, which results in the generation of thrombogenic material and the development of intravascular thrombus. Acute coronary syndrome, sometimes referred to as Type 1 MI, is characterised by unstable angina, STEMI, and Non-ST segment Elevated Myocardial Infarction (NSTEMI) (2). The exclusion and inclusion of elevated ST-segment on the Electrocardiogram (ECG) distinguish two primary clinical spectrums of STEMI and NSTEMI (3). Acute Myocardial Infarction (AMI) is a devastating condition, especially when it affects children. Despite significant advancements in prognosis over the past 10 years, AMI continues to be the most common cause of morbidity and death globally (4). It is linked to a high psychological impact and financial constraints for the sufferer and their family (5). Familial hypercholesterolemia, cigarette smoking, arterial hypertension, diabetes mellitus, or chronic renal disease are also risk factors for AMI, particularly in younger individuals. STEMI is more common in young individuals with AMI in clinical studies.
Severe coronary artery narrowing is more common in the Left Anterior Descending artery (LAD) compared to other arteries in AMI. The majority of patients with AMI experience coronary atherosclerotic plaque rupture, thrombosis, myocardial ischaemia necrosis, arrhythmia, heart failure, and even shock, all of which represent a significant risk to the patient’s life and safety (6). Type 1 MI occurs as a result of an acute plaque rupture/erosion event, which has also been seen in the context of other viral infections, whereas, type 2 MI occurs as a result of “demand ischaemia” caused by an oxygen demand/supply mismatch caused by stress factors such as hypoxia, hypoperfusion, and tachycardia (7).
Many attempts are made to avoid coronary artery disease in the first place, and quick diagnostic tools are employed. A network of invasive cardiology centres is being established to provide the best screening and therapeutic choices for the entire community (5). In 2020, COVID-19 was the third leading cause of death with an estimated 345,323 deaths in the USA. Perhaps more than any other communicable disease, COVID-19 has captivated the cardiology community due to its apparent links with cardiovascular disease. Both types of MIs have been reported in COVID-19 (7).
Cardiac Rehabilitation (CR)
CR is the most significant evidence-based intervention for secondary prevention following STEMI; however, only a small proportion of patients have access to a cardiovascular recovery programme. It is critical to emphasise the necessity of CR involvement for all post-MI individuals, especially those from low-income families (8). Rehabilitation is an interdisciplinary, systematic, and customised method of delivering appropriate medical, lifestyle, and psychological therapy to individuals suffering from a range of cardiovascular conditions (9).
CR exercises are an important part of the secondary prevention of Coronary Artery Disease (CAD). Scientific and reasonable CR exercise can improve vascular endothelial function, maintain the stability of coronary artery plaque, and promote the establishment of collateral circulation, thus reducing mortality and improving cardiac function and the Quality of Life (QoL) of patients (6). CR is often performed as a three to four-week multimodal intensive course to positively influence the disease’s medical, physical, mental, and socioeconomic components (10). Anderson L et al.,conducted a research, that concluded exercise-based CR provides significant benefits to patients with cardiovascular disease, including a lower risk of MI, a likely slight decline in all causes of mortality, a massive reduction in all-cause hospitalisation, along with associated medical costs, and enhanced HRQoL upto a year of follow-up (11). The outcomes may include a lower risk of cardiovascular events and MI over a prolonged period (12).
Cardiac Rehabilitation (CR) Strategies
Centre and community based rehabilitation: Adapting rehabilitation programmes to existing abilities based on experience in the field of activity is becoming a major solution in the current CR training programme selection. Indoor cycling is a type of aerobic interval training that is comparable to the typical exercise prescribed in the second stage of recovery but with a slightly altered course. Indoor cycling training, which is employed in fitness Centres, and standard endurance training, which is employed from the second stage of CR, have many similarities. In individuals who have had an MI, both indoor cycling training and standard training (aerobic, resistive, flexibility exercises) have a comparable impact on improving exercise tolerance, changing hemodynamic markers of the left ventricle, and improving lipid metabolism. In CR, indoor cycling exercise can be used instead of traditional endurance training (13). For patients with coronary heart disease, Centre-based CR lowers recurrent ischemic episodes, improves HRQoL, and improves long-term outcomes as mentioned in a study (14). Only about a quarter of outpatients participate in community-based physical therapy programmes and services; 30% to 40% quit after six months, and upto 50% quit after a year. Xiao M et al., found that, community-based physical therapy lowered Major Adverse Cardiovascular Events (MACE) risk and increased cardiovascular function and physical endurance in individuals who had Percutaneous Coronary Intervention (PCI) after an AMI (15). However, most patients receive rehabilitation while in the facility, and only for a brief period. Patients may benefit from community-based strategies to help them retain the benefits of in-hospital rehabilitation (15).
Home-based approaches:
A. Exercise intervention: Given the paucity of CR programmes in India and the low acceptance globally, there is an urgent need for developing alternative CR approaches that are economical and may provide options to underprivileged populations (16). Hence, a study was conducted to evaluate how yoga-based CR impacts major cardiovascular events and self-perceived health. Yoga is a famous Indian mind-body exercise that has spread across the globe. It is a combination of physical functioning and psychological functioning. Physical functioning includes physical exercise with breathing. Psychological functioning includes meditation. Yoga-CaRe enhanced self-reported health and return to pre-infarct activities after AMI. When traditional CR is unavailable or unsuitable for specific individuals, Yoga-CaRe could be an alternative. The possible advantages of the Yoga-CaRe programme could be mainly attributed to meeting the primary objectives of traditional CR: providing a structured programme of exercise and support to maximise physical and psychosocial functioning, as well as improving health behaviors to slow the progression of the disease (16).
B. Web-based application and telerehabilitation: Many parts of healthcare have been transformed through the use of mobile and wearable technology for pulse rate and activity tracking, and CR is a potential area for utilising real-time monitoring to enhance cardiovascular outcomes. The use of Home-Based Cardiac Rehabilitation (HBCR) is undoubtedly one of the most urgently required innovative approaches for increasing active involvement. HBCR programmes have been improved due to the latest developments in information and communication technology. Vital signs and physical activity can be effectively controlled with the use of wearable technology and portable medical sensors (17). Chaari M et al., conducted research that has provided a multi-platform Human Activity Recognition (HAR) based smartphone app for HBCR using an application that enables clinicians to track specific individuals at their homes using the Hexoskin intelligent-textile shirt (17). Walking, jogging, falling right, left, backward and forward, climbing stairs, descending stairs, sitting, and lying all generate acceleration signals that are recorded by the shirt. After that, this data is delivered to the application for analysis. This can be used for monitoring during home-based rehabilitation and can help doctors monitor patients’ activity by creating an interactive dashboard that provides feedback (17).
The feasibility of providing cardiac telerehabilitation at home to AMI survivors via a health watch-based programme and telephone counseling sessions was demonstrated in one study. The usability 2and adherence to the usage of health watches, exercise advice, and counseling sessions were found to be excellent. Delivery of CR using contemporary telecommunication and smart device technologies may reduce logistical and financial barriers associated with CR by facilitating CR in the home. The ability to perform CR at home may increase participation while providing comparable outcomes for patient HRQoL, exercise capacity, and mortality (18).
The impact of initial home-based CR exercise on the prognosis of patients with AMI following PCI is investigated by a group of researchers. They selected a group of patients that underwent PCI after AMI and divided them into two groups: “Group A and Group B”. Standard exercise rehabilitation training was given to Group A, whereas early home-based CR instruction was given to Group B. Early home-based CR in patients with AMI following PCI can improve functional recovery, lower the risk of postoperative complications, and increase cardiac antioxidant capacity, exercise tolerance, and QoL (6). A 24-week dual-phase Smartphone CR, Assisted self-Management (SCRAM) strategy had been adopted in a study. If the SCRAM programme is found to be cost-effective, it can be advocated on a national or even worldwide level as a complementing alternative CR delivery model that may satisfy the requirements of many imdividuals, who are unwilling or unable to engage in typical Centre-based CR programmes. The findings will help policymakers, healthcare administrators, and other providers of health services make informed judgments about the SCRAM programme’s continued usage or potential future deployment (14).
Artificial Intelligence (AI) is a branch of computer science that aims to replicate human cognitive processes, learning ability, and information storage. AI is divided into two major subfields: Machine Learning (ML) and cognitive computing. Incorporating AI may improve the uptake and delivery of cardiac telerehabilitation (19). The use of digital health treatments, such as telemedicine, web-based techniques, mobile applications, and monitoring devices, has the potential to encourage autonomy and self-management. With the introduction of modern ML tools and algorithms, a new class of smart digital health treatments can be created. ML has been widely used in various medical fields, including diabetes, cancer, cardiology, and mental health are a few of the medical fields, whereit has been used (20).
Paruchuri K et al., designed an application to handle the inpatient-outpatient transition following PCI to increase CR enrollment (21). Their objectives were to determine the feasibility of deploying a smartphone application during inpatient hospitalisation and to examine the application’s performance in increasing CR participation, as well as, the short-term safety of engaging with third-party healthcare consultants compared to historical controls. Mobile health platforms were previously considered revolutionary care solutions and have recently been proposed to minimise transmission of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Virtual techniques can enhance access to care and make lifestyle changes easier (21). Among post-MI patients receiving treatment in an organised CR programme, text message reminders significantly improved adherence to medication and exercise. This system is a simple and scalable way to ensure the consistent use of evidence-based cardiovascular medicines (22). Research on the cardiac telerehabilitation platform includes an Android-based application for patients and web-based monitoring for rehabilitation instructors. A cardiac telerehabilitation system is a useful tool for post-MI individuals who are unable to visit outpatient CR facilities due to various factors (23). Using mobile technologies is a practical method to expand accessibility and personalise CR (24).
During the COVID-19 pandemic, hospitalisations for AMI significantly decreased, but death and complication rates increased. As a result, CR Institutions have been obligated to emphasise more on distant or virtual CR services (25). A study has revealed that cardiac telerehabilitation sessions are associated with improvements in cardiac patients’ fitness levels, enhancements in their QoL, and a decrease in rehabilitation administrative costs (26). COVID-19 has posed significant challenges in the implementation of CR, hindering patients’ access to CR and creating difficulties for hospitals. However, it has also highlighted the role of CR in encouraging positive lifestyle changes that reduce the risk of atherosclerotic CVD and COVID-19-related illness and death. This has led to an increased acceptance of new technologies into routine clinical practice, as they may increase access to and engagement in exercise-based CR after the COVID-19 era. Several innovations have been introduced to ensure that patients can continue to benefit from CR even during the pandemic period, with telerehabilitation and mobile phone applications becoming mainstream practices. Telerehabilitation utilises information and communication technologies, such as smartphones or teleconferencing, to provide feedback, training, and consultation. It has transformed telerehabilitation from a rarely used intervention to the most useful intervention in the last two years (26).
Cardiac rehabilitation is a technique that can help patients improve their cardiovascular health, provide a secondary intervention to patients diagnosed with myocardial infarction, and improve their QoL. The effectiveness of both centre-based and home-based therapy has been proven. Telerehabilitation and home-based rehabilitation strategies have gained much importance during the COVID-19 pandemic. Further research is needed to standardise the treatment quality for patients with home-based CR.
DOI: 10.7860/JCDR/2023/61800.18278
Date of Submission: Nov 25, 2022
Date of Peer Review: Dec 23, 2022
Date of Acceptance: Jan 13, 2023
Date of Publishing: Aug 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: Nov 26, 2022
• Manual Googling: Dec 09, 2022
• iThenticate Software: Jan 04, 2023 (14%)
ETYMOLOGY: Author Origin
EMENDATIONS: 6
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