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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
Clinical Care Pathways in Paediatric Nursing: A Narrative Review
Correspondence Address :
Dr. Archana Taksande (Lohave),
Assistant Professor, Department of Child Health Nursing, Smt. Radhikabai Meghe Memorial College of Nursing, Datta Meghe Institute of Higher Education and Research, (Deemed to be University), Sawangi (M), Wardha-442004, Maharashtra, India.
E-mail: aptaksande@rediffmail.com
Paediatric Clinical Care Pathways (CCPs) are developed for specific health conditions or patient populations and are designed to standardise care across different healthcare settings, including hospitals, clinics, and outpatient settings. These care pathways outline the clinical guidelines for diagnosis, treatment, and follow-up of specific medical conditions. They provide a framework for the delivery of care based on the best available evidence and tailored to each patient’s individual needs. This overview is aimed at identifying the available evidence for the effective use of CCPs in paediatric patients with Lower Respiratory Tract Infection (LRTI). It reviews the nature of CCPs of LRTI, their benefits, strategies to implement them, steps involved in development of CCPs and the disease condition in paediatric population for whom the CCPs are used so far. The article also gives an account of limitations of using CCPs.
Disease condition, Paediatric population, Standardise care, Treatment
Clinical Care Pathways (CCPs), also known as clinical pathways or care maps, are standardised, evidence-based plans of care that guide healthcare providers in the delivery of high-quality, efficient, and cost-effective care to patients (1). In paediatric nursing, CCPs are essential tools that enable nurses and other healthcare professionals to provide safe, effective, and family-centered care to children and their families (1).
Paediatric care pathway typically includes a sequence of interventions and expected outcomes that are based on the best available evidence and clinical expertise, and they are often supported by decision-making algorithms, clinical practice guidelines, and other resources (1). CCPs are evidence-based care plans that help nurses deliver the best possible care to young patients, while optimising clinical outcomes (2).
CCPs are designed to improve patient outcomes, reduce variations in care, and enhance communication and collaboration among healthcare professionals. These pathways help healthcare providers to standardise care, improve outcomes, and reduce healthcare costs by streamlining care processes (2),(3).
In this article, the authors reviewed [3-6] some of the recent studies and articles that explore the role of care pathways in paediatric nursing.
A cluster randomised control trial was carried out to evaluate the effect of a clinical pathway to reduce hospitalisation in nursing home residents with pneumonia in 2006. A total of 680 residents were evaluated in a nursing home of Hamilton, Ontario, Canada. Clinical pathway treatment in nursing homes includes oral antimicrobial, portable chest X-ray, SpO2 monitoring rehydration and close monitoring by research nurse. A 34 out of 327 residents were hospitalised compared with 76 of 353 residents of the usual care group. The mortality rate was 8% in the clinical pathway group vs 9% in the usual care group. Hence, it reveals treating residents in nursing homes with pneumonia and Lower Respiratory Tract Infection (LRTI), with clinical pathways results in positive outcomes by reducing hospitalisation and cost of healthcare (4).
In the previous studies (3),(4),(5),(6), there was improvement found in outcome, hospitalisation requirement, patients suffering and cost of treatment. And in paediatric patients also, similar previous studies found clinical pathways to be effective. However, very less is known regarding strategies to implement them, and the steps involved in development of CCPs and their limitations of using in paediatric population. Hence, the present review was planned with the objective to improve patient outcomes, reduce variations in care, and enhance communication and collaboration among healthcare professionals. These pathways help healthcare providers to standardise care, improve outcomes, and reduce healthcare costs by streamlining care processes.
Definition of Clinical Care Pathways
CCPs are standardised, evidence-based plans of care that guide healthcare providers in the delivery of patient care. These pathways are multidisciplinary, involving healthcare providers from different disciplines, such as nursing, medicine, and pharmacy. They provide a framework for the delivery of care that is based on the best available evidence and tailored to the individual needs of each patient. CCPs are designed to improve the quality of care, reduce healthcare costs, and enhance patient outcomes (3),(4).
History of Clinical Care Pathways
The development of CCPs can be traced back to the 1980s when they were first introduced as a tool to standardise care delivery in the United States. Since then, CCPs have gained popularity and have been widely used in various healthcare settings. The implementation of CCPs in paediatric nursing has been particularly successful, with numerous studies demonstrating their positive impact on patient outcomes (4).
Why are Clinical Care Pathways Important in Paediatric Nursing?
Paediatric nursing requires a specialised approach to care due to the unique needs of paediatric patients, including their developmental stages, social and emotional needs, and dependence on caregivers. CCPs provide a framework for the delivery of high-quality, patient-centered care to children and adolescents, and help to ensure that all aspects of care are addressed in a coordinated and efficient manner (2).
CCPs in paediatric nursing can be used to manage a wide range of health conditions, from acute illnesses to chronic diseases. For example, care pathways may be developed for the management of asthma, diabetes, or cancer, among others. These pathways provide healthcare professionals with evidence-based guidelines for the management of each LRTI and related conditions, including appropriate assessments with knowledge of staff related to clinical pathway, providing interventions using module and clinical care pathway along with follow-up care using parental satisfaction scale based on the provided care (3).
Benefits of Clinical Care Pathways in Paediatric Nursing
Improved patient outcomes: CCPs have been shown to improve patient outcomes by reducing the Length of Hospital Stay (LOHS), decreasing the incidence of adverse events, and improving patient satisfaction. CCPs can improve the efficiency of care delivery by reducing unnecessary tests, procedures, and hospital stays (5).
Reduced variations in care: CCPs can reduce variations in care by providing a standardised approach to patient care. This can improve the consistency and quality of care delivered to paediatric patients (4),(5).
Enhanced communication and collaboration: CCPs promote communication and collaboration among healthcare professionals by providing a shared understanding of the patient’s care plan. This can lead to more efficient and effective care delivery (5).
Cost-effective: The CCP in paediatric care among children with LRTI is cost-effective as utilisation is easy. It produced good results without costing a lot of money.
Integrate evidence based care: CCPs promote the Evidence Based Practice (EBP) that integrates the clinical expertise, the latest and best available research evidence, as well as the patient’s unique values and circumstances.
Limitations of Clinical Care Pathways in Paediatric Nursing
Despite their benefits, CCPs also face several challenges in paediatric nursing practice:
Child’s physiology and development: One challenge is the difficulty of developing and implementing pathways that are relevant to the specific needs of paediatric patients. Children have unique physiological and developmental needs that must be considered when designing care pathways. Furthermore, paediatric patients may have complex medical conditions that require individualised care plans (4).
Lack of resources: Another challenge is the lack of resources and time for healthcare providers to follow CCPs. Nurses may face competing demands, including the need to provide personalised care, which can make it challenging to adhere to standardised care protocols (4).
Limited applicability: CCPs may not be applicable to all paediatric patients, particularly those with complex medical conditions such as acute bronchitis, bronchial asthma, bronchial pneumonia and Chronic Obstructve Pulmonary Disease (COPD) or co-morbidities such as diabetes mellitus and hypertension. CCPs are to be flexible enough to accommodate individual patient needs and preferences. CCPs must be tailored to the unique needs of each patient, and healthcare providers must have the flexibility to adapt the CCP as needed to meet the changing needs of the patient (5).
Resistance to change: The successful implementation of CCPs in paediatric nursing requires a commitment from healthcare providers to follow the CCP and a willingness to change practice patterns. Implementation of CCPs may face resistance from healthcare professionals who are accustomed to traditional care delivery methods (5).
Risk of oversimplification: CCPs may oversimplify patient care and fail to account for individual patient needs and preferences (5).
Non compliance: Failure to comply is a limitation that can arise due to failure to follow the CCP. That may further result in poor patient outcomes.
Implementation Strategies for Clinical Care Pathways in Paediatric Nursing
The implementation of CCPs in paediatric nursing requires a multidisciplinary team approach. The development process involves a review of the existing evidence, the identification of best practices, and the customisation of the pathway to meet the unique needs of the patient population (7).
Multidisciplinary approach: Implementation of CCPs should involve a multidisciplinary team, including nurses, physicians, and other healthcare professionals (8).
Education and training: Healthcare professionals should receive education and training on the use of CCPs, including their benefits and limitations (9),(10).
Continuous evaluation and improvement: CCPs should be continuously evaluated and improved to ensure their effectiveness and applicability to paediatric patients (8).
Steps in Developing Clinical Care Pathways
The development process typically involves the following steps:
Identification of the clinical problem or patient population: The first step in developing a care pathway is to identify the health condition or patient population for which the pathway will be developed. The first step in implementing a CCP is to identify the patient population that will benefit from the pathway. This may involve reviewing patient data to identify common diagnoses, procedures, or treatments. Once the patient population has been identified, the team can begin developing the pathway. This may involve a review of relevant literature, analysis of clinical data, and consultation with healthcare providers, patients, and families (9).
Conduct a literature review: The team should conduct a thorough review of the existing literature to identify best practices and evidence-based interventions for the patient population (9).
Develop the pathway: Using the information gathered from the literature review, the team should develop a pathway that includes specific interventions, timelines, and outcomes (9).
Obtain stakeholder buy-in: It is important to obtain buy-in from all stakeholders, including nurses, physicians, and other healthcare providers, to ensure that the pathway is accepted and implemented effectively (9).
Pilot test the pathway: Before implementing the pathway hospital-wide, it is important to pilot test it with a small group of patients to identify any potential issues or challenges (10).
Monitor and evaluate the pathway: Once the pathway has been implemented, it is important to monitor its effectiveness and evaluate its impact on patient outcomes and healthcare costs (10).
Evidence of Clinical Care Pathways in Paediatric Nursing
Paediatric CCPs have been developed for a wide range of health conditions and patient populations, including asthma, diabetes, cystic fibrosis, and oncology. Several studies have evaluated the effectiveness of CCPs in paediatric nursing (Table/Fig 1) (10),(11),(12),(13),(14),(15),(16),(17),(18),(19),(20),(21),(22),(23).
The use of CCPs in paediatric nursing has shown promising results in improving patient outcomes and reducing healthcare costs. These pathways help in standardising care practices, reducing variability in care delivery, and promoting evidence-based care. Evidence supporting the use of CCPs in paediatric nursing is growing, with studies demonstrating improvements in outcomes for children in various healthcare settings and populations. As such, CCPs should be considered as a tool to improve the care of children in the healthcare system. However, care pathways may not be appropriate for all patients and can be time-consuming to develop and implement. Further research is needed to evaluate the long-term impact of care pathways on patient outcomes. The future of CCPs in paediatric nursing is promising, with increasing use of technology, patient and family engagement, and data analytics to support care delivery and quality improvement.
DOI: 10.7860/JCDR/2024/66055.19268
Date of Submission: Jun 16, 2023
Date of Peer Review: Sep 27, 2023
Date of Acceptance: Jan 23, 2024
Date of Publishing: Apr 01, 2024
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? NA
• For any images presented appropriate consent has been obtained from the subjects. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jun 17, 2023
• Manual Googling: Sep 25, 2023
• iThenticate Software: Jan 22, 2024 (8%)
ETYMOLOGY: Author Origin
EMENDATIONS: 7
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
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- www.omnimedicalsearch.com