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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Clinical Case Studies: Novel Tools For Training Medical Students In Rational Prescribing Skills.
Correspondence Address :
Dr Sharma R,MD,DMCH.Ex.Senior Demonstrator Post-graduateDept of Pharmacology and Therapeutics,Govt Medical College,Jammu-J&K(India).Add:216-A GandhiNagar,Jammu (Tawi)-180004.E-mail: rashmichams@yahoo.com
Inclusion of clinical case studies in pharmacology curriculum of Medical students is a novel way to inculcate rational prescribing skills in ‘the future prescribing physicians’. The present prospective randomized cross-sectional study was conducted in the Postgraduate Department of Pharmacology and Therapeutics of a medical college as practical training of 98 fifth semester medical students to study prescribing practices in the teaching hospital and to make them aware of existing irrational practices. At the end of study 100% of students advocated conducting such exercises more frequently and 69.38% students said that rational prescribing is being practiced in our institution; however, 81.63% of students still advocated to improve rational prescribing in institute. 100% students suggested to give exposures of clinical case studies to undergraduate students, 61.22% proposed to conduct periodic seminars and CME (continue medical education) programs on rational prescribing, 40.81% suggested to conduct classes regarding rational prescribing of postgraduate students from different departments of the institute and 93.81% recommended to encourage frequent interactions between pharmacologists and practitioners to improve rational prescribing program. The present study could serve as a model for training students in various aspects of pharmacology with an aim to produce rational prescribers instead of confused practitioners.
Rational prescribing, training medical students, clinical case studies
Introduction
Drug prescriptions form an important point of contact between health care providers and patients. Rational prescribing of drugs requires that patients receive medication appropriate to their clinical needs in right dose for an adequate period of time and at the lowest cost to them and their community. Bad prescribing habits lead to ineffective and unsafe treatment, exacerbation or prolongation of illness, distress and harm to patient and higher costs. Physician-industry interactions appears to affect prescribing and professional behavior of doctors, which may result into irrational prescribing in-terms of inability to identify wrong claims about medication, positive attitude toward pharmaceutical representatives, increasing prescription rate, prescribing fewer generic but more expensive, newer medications at no demonstrated advantage(1),(2). Later on, new graduates copy them and the vicious circle goes on. It is not only difficult to change existing prescribing habits; but also requires lot of money and time. So good training needs to be provided, before poor habits can get a chance to develop. Keeping this in view a practical exercise on analysis of clinical cases regarding rational prescribing is introduced in pharmacology curriculum of Medical students.
Hence, the present prospective randomized cross-sectional study was conducted in the Postgraduate Department of Pharmacology and Therapeutics of a medical college as practical training of fifth semester medical students to study prescribing practices in the teaching hospital and to make them aware of existing irrational practices. Before starting the study, ninety eight students of fifth semester were trained in rational prescribing by using audio-visual aids and giving therapeutic exercises (Annexure 1)(Table/Fig 1) regarding P-drug and P-treatment concept (3). Students were divided into twenty groups; each group was composed of five students except the last group (three students). Two groups were allotted to each teacher (senior or junior residents) and written proformas were distributed to students (Annexure 2)(Table/Fig 2). Each student had to fill five proformas after examining the case sheets of indoor patients (after taking patient’s consent), in Medicine department of the institution. No overlapping of patients was allowed and study was carried over a span of three months. At the end of study all proformas were collected and analysed for various WHO parameters of rational drug prescribing in order to make students aware of existing rational/irrational practices and to have a feedback from them regarding ways to improve existing prescribing practices. Out of total 490 Proformas only 442 were analysed and rest were discarded because of either being incomplete or were wrongly filled. Moreover, students had to appear for viva-voce of their cases before the respective teachers to assess their understanding regarding rational and irrational prescribing practices (Annexure 3)(Table/Fig 3). Any drug prescribed in wrong dose or wrong dosage form or for wrong duration or for wrong indications or for wrong patient or an irrational combination was considered as irrationally prescribed.
Total 1744 drugs were prescribed in prescriptions with an average of 3.94 drugs per prescription (Table/Fig 4). Topical, injectables and oral preparations constituted 6.88%, 16.86% and 76.26% of drugs respectively. Average drug prescribing of 3.94/ prescription in this study is more than that reported from outpatient prescriptions study of the same institute and from other hospitals of the country (4), (5), (6), (7). Although poly-pharmacy is in itself associated with risk of drug interaction and adverse drug reactions along with added cost; multiple drugs prescribed per prescription in the present study could be because of patients with serious conditions or complex pathology. Prescribing under generic name is considered rational and economic, but only 24.77% generic drugs were prescribed in this study, which is less than that reported earlier (74.38%) from a tertiary care hospital of India (7). The Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 states that every physician should, as far as possible, prescribe drugs with generic names and he/ she shall ensure that there is a rational prescription and use of drugs (8). It also goes on to state that it is not unethical for a physician to prescribe drugs as long as there is no exploitation of patient and this should explicitly state the proprietary as well as generic name of drug(8). Hence, there is need to encourage prescribers to prescribe more by generics either by enforcing laws or by discouraging entertainment of medical representatives in the hospital premises.
Abbreviations, dose, dosage form, route and duration of therapy were found in 78.28%, 73.30%, 84.16%, 80.99% and 31.67% of the prescriptions respectively. However, proper written instructions to patients were mentioned in only 15.38% of prescriptions. Antibiotics were the most commonly prescribed drugs followed by NSAIDs (nonsteroidal anti-inflammatory drugs), antihypertensive drugs, PPIs (proton pump inhibitors)/H2-blockers and others (Table/Fig 5)
Cephalosporins, penicillins, quinolones, aminoglycosides and macrolides constituted 31.76%, 25.29%, 20.58%, 18.82% and 3.53% of antibiotics prescribed respectively. Among antibiotics, cephalosporins were the most frequently prescribed drugs as reported earlier (9). Among NSAIDs, diclofenac sodium and paracetamol constituted 47.45% and 38.13% of NSAIDs prescribed respectively. Earlier studies have reported higher rate of prescription of Cox-2(cyclo-oxygenase) selective drugs than NSAIDs (6). However, in the present scenario of controversy (recent evidences of cardiovascular and renal complications) with Cox-2 inhibitors, prescribers of this institution were rational in preferentially prescribing diclofenac (NSAIDs) (10). Calcium channel blockers (CCBs) , beta-blockers, angiotensin converting enzyme inhibitors / angiotensin receptor blockers, alpha-Methyl DOPA and others constituted 27.08%, 21.87%, 27.08% , 8.33% and 15.62% of antihypertensive drugs prescribed respectively.
Vitamins/Iron/Calcium/Nutritional supplements were the most irrationally prescribed drugs; where as 84.70% of antibiotics were prescribed rationally and rest included irrational combinations like ampicillin-cloxacillin, ampicillin-cephalosporin combination etc (Table/Fig 5). 71.83% of PPIs/H2-blockers, 88.54% of antihypertensives, 88.46% of antiprotozoles, 95.76% of NSAIDs were rationally prescribed (Table/Fig 5). This indicates that in this institution most of the drugs are rationally prescribed than earlier reports of only 60% of antimicrobials being rationally prescribed in teaching institutes (9). However, in the present study rationality of drug prescribed in relation to the P-drug / P-treatment concept was analysed considering ideal prescribing conditions and confounding factors like resistance pattern, prescriber’s personal choice, financial constrains etc were not taken into account, which could be considered as a lacuna of the study.
WHO -Indian Program on rational use of drugs aims at promoting rational drug prescribing through various interventions to correct drug use problems, adoption of essential drug list, development of standard treatment guidelines, determining and restricting irrational drug prescribing(4). In the present study 94.72% of the drugs were prescribed from institutional essential drug list, which is similar to that reported earlier from a tertiary care hospital(7). The need for promoting appropriate use of drugs in health care system is not only because of the financial reasons with which policy makers and manager are usually most concerned, but also for health and medical cares of patients and the community. At the end of the study when students were asked regarding their suggestions, 100%(98) of the students advocated to conduct such exercises more frequently and 69.38%(68) student said that rational prescribing is being practiced in our institution; however, 81.63%(80) students still advocated to improve the rational prescribing in the institute. 100%(98) students suggested to give exposures of clinical case studies to the undergraduate students, 61.22%(60) proposed to conduct periodic seminars and CME (continue medical education) programs on rational prescribing, 40.81%(40) suggested to conduct classes regarding rational prescribing of postgraduate students from different departments of the institute and 93.81%(92) recommended to encourage frequent interactions between pharmacologists and practitioners.
Summary
Inclusion of clinical case studies in pharmacology curriculum of Medical students is a novel way to inculcate rational prescribing skills in the future prescribing physicians. In the present scenario when the academicians and researchers are much worried about development of new molecules and technologies to target various pathologies at molecular level, it is really vital to emphasize on rational drug therapy in order to pass the benefits of new researches to the consumers (patients).Student’s participation studies are not only important in rational prescribing, but also in other field like pharmaco- vigilance, pharmaco-economics, community pharmacology, etc. Hence, the present study could serve as a model for training students in various aspects of pharmacology with the aim to produce rational prescribers instead of confused practitioners.
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