Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018




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MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
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An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



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Aug 2018




Dr. Rajendra Kumar Ghritlaharey

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Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


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.
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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.
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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

Important Notice

Original article / research
Year : 2007 | Month : December | Volume : 1 | Issue : 6 | Page : 488 - 493

Hassles and Quality of Life in Myocardial Infarct Patients

KOHLI A,* GROVER A,** GROVER K,** KAUR M*

*Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India.**Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Correspondence Address :
Dr Adarsh Kohli.Tel.: 2756805, 2747585; e-mail: doc_adarsh@hotmail.com

Abstract

Acute myocardial infarction (AMI or MI), commonly known as a heart attack, is a serious, sudden heart condition, usually characterised by varying degrees of chest pain or discomfort, weakness, sweating, nausea, vomiting, and arrhythmias, sometimes causing loss of consciousness. Psychological factors preceding and consequent to MI need attention.

Aim: The aim of the study was to assess the quality of life (QOL) and daily hassles in myocardial infarct patients.

Method: Thirty consecutive outpatients with diagnosis of myocardial infarction, both males and females, in the age range of 28–70 years, belonging to all educational groups, were recruited from the In-patient Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh. Thirty normal controls were recruited for comparative purposes. Both the groups were administered Daily Hassles Scale and WHOQOL Bref version.

Results: Analysis of Hassles Scale and WHOQOL Scale assessing various areas (general, physical, psychological, environmental, and social) was done to find out the impact of daily hassles on the QOL of cardiac patients. Results show that QOL is affected after MI, compromising in the areas of general well-being, physical health, psychological functioning, and environmental dimensions. No significant differences were found on hassles experienced by MI patients as compared to the normal controls.

Keywords

Myocardial infarction, quality of life, hassles

How to cite this article :

KOHLI A,GROVER A,GROVER K,KAUR M. HASSLES AND QUALITY OF LIFE IN MYOCARDIAL INFARCT PATIENTS . Journal of Clinical and Diagnostic Research [serial online] 2007 December [cited: 2019 Aug 25 ]; 1:488-493. Available from
http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2007&month=December&volume=1&issue=6&page=488-493&id=157

Introduction
Acute myocardial infarction (AMI or MI), commonly known as a heart attack, is a serious, sudden heart condition usually characterised by varying degrees of chest pain or discomfort, weakness, sweating, nausea, vomiting, and arrhythmias, sometimes causing loss of consciousness. It occurs when a part of the heart muscle is injured, and this part may die because of sudden total interruption of blood flow to the area. It is a life-threatening medical emergency, which demands both immediate attention and activation of the emergency medical services. One of the contributory causes is researched to be stress, both physical and psychological.

Much of the stress in our lives results from having to deal with daily hassles pertaining to our jobs, personal relationships, and everyday living circumstances. Hassles are irritants that range from minor annoyance to major family pressures, problems, or difficulties. Many people experience the same hassles every day. When taken individually, these hassles may feel like only minor irritants, but cumulatively, over time, they can cause significant stress. Studies have found that one’s exposure to daily hassles is actually more predictive of illness than is exposure to major life events. Cardiac mortality rises sharply within a small time-frame after a catastrophic event, but even common daily hassles, anxiety, depression, or personality traits can impair cardiac health (1). Positive associations between the frequency of job hassles and psycho-physiological reactions have been reported in some studies (2). It is also reported that predictive psychosocial risk factors for women with respect to coronary heart disease (CHD) were physical stress reactions, emotional stress reactions, burnout, family relationships, and daily hassles/satisfactions, and they were at approximately the same level as biomedical risk factors (3). Twisk et al. (4) investigated the influence of positive and negative life events (including daily uplifts and daily hassles) on several biological and lifestyle CHD risk factors. Their study could not fully determine whether or not different mechanisms play a role in the health benefits of positive life events compared to the health burdens of negative life events. However, the fact that those life events do affect the mental and physical constituents of the body is beyond doubt. Consequently, post MI, patients may have debilitating effect on the otherwise active life. The quality and quantity of impact may be of interest psychologically and functionally.

Quality of life (QOL) is increasingly being used as an outcome measure in clinical trials and observational studies designed to evaluate the quality of care for patients with AMI (5),(6),(7). QOL is the concept that includes a large set of physical and psychological characteristics. QOL has been defined as “the extent to which one’s usual or expected physical, emotional, and social well being is affected by a medical condition or its treatment” (8). Interest in QOL has developed in the wake of growing recognition of the importance of a patient’s perspective of his or her health status after medical treatment. Such perceptions have become particularly important, given that recent advances in AMI treatment have left practitioners with numerous treatment alternatives that offer no clear survival benefits at substantial cost (9),(10). In the absence of such benefits, QOL measurements can provide an additional measure of the effectiveness of post-AMI care. Health-related QOL was low, studied 7 months after a myocardial infarction (11).

Psychological factors preceding and consequent to MI need attention. It is also seen tha

Material and Methods

Sample
Thirty consecutive patients with diagnosis of myocardial infarctions, both males and females, in the age range of 28–70 years, belonging to all educational groups, fulfilling the exclusion and inclusion criteria, were recruited from the In-patient Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh. Thirty normal controls were recruited for comparative purposes.

Inclusion criteria
1. Patients with first episode of MI attack were recruited for this study.
2. Only stable patients were included in the sample (survived the attack and expected to live for another year and had stable vital parameters like normal BP, near-normal pulse, and no respiratory distress).
3. Those who were able to speak and understand Hindi.

Exclusion criteria
1. Patients with abnormally higher mental functions/psychiatric illness were clinically assessed with the help of a psychiatrist and excluded.
2. Physical limitation or illness severity needed to be sufficient to preclude participation.

Ethical clearance
1. The comfort level of the patient was ensured.
2. Implicit and explicit consents were taken.
3. Non-cooperation should not in any way hamper the treatment given.

Tools
1. Hassles Scale (12): Hassles are simply obstructions in daily life of a person. The participants rate each hassle occurring during the previous month for both severity and persistence on a three-point scale. Frequency, cumulative severity and intensity of hassles were calculated for each subject. The scale has 119 items and has been shown to have good reliability.
2. WHOQOL Bref version (13): It is a self-administered instrument. It pays emphasis on subjective evaluation of respondent’s health and living condition. It measures five domains of QOL: general, physical, psychological, environmental, and social. This scale has 26 items scored 1–5, with total score range of 26–130. Its psychometric properties have been found to be comparable to those of the full version (WHOQOL-100).
3. Socio-demographic profile sheet: It was used to collect the socio-demographic information, i.e. name, age, sex, education, locality, etc. of the patients and the caregivers.

Procedure
Patients clinically diagnosed as having MI were identified, and the purpose of the study was explained to them. Patient who were in CCU and have survived the MI attack were assessed on the third or fourth day. Written informed consent was obtained from those who agreed to participate in the study. They were assured that information given by them would be kept strictly confidential. Control group consisted of relatives and attendants of patients in the same age group. Patient group as well as control group was administered Hassles Scale and WHOQOL Bref version. It took about 30–45 minutes to complete the tests.

Results

The patient group consisted of 26 males (86.67%) and four females (13.3%). The age range was from 28 to 70 years, with a mean of 45.60 years (SD = 11.47 years). Almost one-third of the patient group was working as skilled or unskilled workers (36.67%) and had a monthly income between Rs. 5000 and Rs. 10,000 per month (30%). Majority of the subjects (93.3%) in the patient group were married and living in a nuclear set-up (60%). Almost two-thirds of the patients (66.67%) were Hindus. In the present study, an equal number of normal subjects were recruited as the control group for comparative purposes.

(Table/Fig 1) shows means, SDs, and t ratios of dimensions of QOL of MI and control group. MI group has lower general well-being (mean 5.83, SD 1.53) than the control group (mean 6.80, SD 1.03), and the t ratio (2.87, p < 0.01) reached the level of significance. On physical health, the MI group (mean 18.37, SD 4.24) has lower score than the control group (mean 25.47, SD 2.85), and the t ratio (7.61, p < 0.01) reached the level of significance. Similarly, control group has higher score on general psychological functioning (mean 19.97, SD 2.41) than the MI group (mean 17.07, SD 3.42) and the difference is statistically significant (3.79, p < 0.01). Control group also reported higher score on environment (mean 24.43, SD 2.54) than the MI group (mean 22.33, SD 4.19), and the difference is statistically significant (2.35, p < 0.05). However, no significant difference between the mean scores is found on social dimensions of QOL.

(Table/Fig 2) and (Table/Fig 3) show the comparison of MI and control group on various dimensions of hassles scale. It is evident that MI and control group have no significant differences on subscales of hassles scale, neither do the two groups differ on severity, frequency, and intensity of hassles.

(Table/Fig 4) shows the correlation of hassles and dimensions of QOL. It is clear from the table that the correlation values do not reach the level of significance.

Discussion

Aim of the present study was to assess the QOL and hassles in myocardial infarct patients in the wake of growing recognition of the importance of a patient’s perspective of his or her health status after medical treatment.

The QOL provides information pertaining to the effect of the vent and/or intervention on the patient’s life. Present study provides same insight into the different dimensions of QOL of patients with myocardial infarction. A glance at (Table/Fig 1) reveals that MI and control groups differ significantly on general well-being, physical health, psychological functioning, and environmental dimensions of QOL. The patients suffering from MI have lower scores on four of the five areas of QOL, as measured by WHOQOL Bref version, except for social relationships. Results clearly indicate that QOL is affected after MI; there are compromises in the areas of general well-being, physical health, psychological functioning, and environmental dimensions. These findings are consistent with a number of previous studies. It has been reported that patients with MI have lower scores on all the sub-dimensions of QOL except for social functioning (14). In another study, health-related QOL was investigated in Japanese patients. As compared to the rest of the Japanese national norms, physical functioning, role-physical, general health, and role-emotional were lower (15). It is possible that after myocardial infarction patients often experience physical and emotional effects related to the events that impair functioning to the point of interfering with house work, work for pay, social life, and other important activities. The younger the MI, the more the QOL would be affected, because the older people would have fulfilled their life obligations. They may experience anxiety and depression that were not present before the event, which may exacerbate the existing conditions [16–19].

Daily life is filled with countless minor annoying sources of stress termed hassles. Much of the stress in our lives results from having to live with daily hassles and can interfere with our immune systems (20),(21), and it is believed that exposure to everyday hassles is more predictive of illness than major life events. The present study tried to investigate the role of daily hassles in patients with MI with the help of Hassles Scale. A glance at (Table/Fig 2) and (Table/Fig 3) reveals that the two groups do not differ significantly on any of the subscales of hassles, neither are there any difference on the severity, frequency, and intensity of the hassles. It can be concluded from the results that patients suffering from MI experience the same amount of hassles as the normal population. These results are in line with an earlier study that also has reported hardly any association between positive and negative life events and biological CHD risk factors (4). The plausible reason could be the way in which the individual perceives that non-life-threatening stressors (hassles) can influence his/her physiological reaction and subsequent development of real physical illness. Type A personality, perceived control, social relationships, and coping styles can be the main mediating variables. Twisk et al. (22) stated that the subjective appraisal of life events should always be taken into account and that the relationship between daily hassles and CHD risk factor seemed to be mediated by different coping styles and type A behaviour. Some evidence also indicates that optimistic people are much more stress resistant than pessimists (23). Cognitive appraisal

Key Message

1. AMI is one of the leading life-threatening diseases.
2. MI is characterised by physical and psychological concomitants.
3. MI affects the functional ability of the subject and subsequent quality of life.
4. Stress is a common psychological cause leading to MI.
5. Individual’s personality characteristics and perception of stress are crucial confounding variables.
6. Need to focus on antecedent and consequent factors of MI.

References

1.
Csef H, Hefner J. Psychosocial stress as a risk and prognostic factor in coronary artery disease and myocardial infarction. Versicherungsmedizin 2006;58(1):3–8.
2.
Johansson G, Evans GW, Rydstedt LW, Carrere S. Job hassles and cardiovascular reaction patterns among urban bus drivers. Int J Behav Med 1998;5(4):267–80.
3.
Hallman T, Burell G, Setterlind S, Oden A, Lisspers J. Psychosocial risk factors for coronary heart disease, their importance compared with other risk factors and gender differences in sensitivity. J Cardiovasc Risk 2001;8(1):39–49.
4.
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