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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
Performance Of The Medication Counseling Center In Manipal Teaching Hospital: A Follow Up Study
Correspondence Address :
Kadir Alam M.Pharm,Lecturer, Dept of Hospital and Clinical Pharmacy/Pharmacology Manipal Teaching Hospital/ Manipal College of Medical Sciences, Pokhara, (Nepal). E mail: alamkad2050@yahoo.com Phone: 00977-61-526420
Objective: Non-compliance to drug therapy is a common problem worldwide. Providing counseling to the patients regarding their medication is a better means to improve patient compliance. The present study evaluated the performance of the Medication counseling center in Manipal Teaching Hospital, Pokhara, Nepal.
Methods: The filled medication counseling documentation forms during the period of three years (September 2004 to September 2007) were analyzed. The data obtained were entered in a Microsoft Excel spread sheet and were analyzed.
Results: Altogether, 1105 patients were counseled (as per the Omnibus Budget Reconciliation Act -1990 guidelines) by the center from September 2004 till August 2007. Females comprised 51% of the patients who received counseling. Nearly half of the counseled patients were from the Department of Otorhinolaryngology. Nasal spray was the most commonly used counseling aid (44.48 %). A majority of patients were counseled regarding the dosage form of the medication (97.29%), the dosage regimen (96.38%), the description of the medicine (96.02%), the route of administration (95.84%), duration of therapy (90.41%) and storage conditions (80.45%). Nearly 6-10 minutes were spent while counseling one third of the patients. In general, patients with modified drug delivery system, such as the metered dose inhaler and dry powder inhalers, were counseled more frequently.
Conclusion: It can be concluded that the Medication counseling center in the Manipal Teaching Hospital plays an important role in educating the patients regarding safe and effective use of their medications.
Practice Implications: In resource limited countries like Nepal, pharmacists can provide counseling to the patients through medication counseling centers. This may in turn improve patient adherence, which is one of the common causes for therapeutic failures in countries like Nepal.
Nepal, Non-compliance, Patient counseling
Introduction
Non-compliance to drug therapy is a common problem worldwide. The problem of non-compliance is documented even in developed countries. Evidence suggests that non-compliance can lead to adverse drug reactions (ADRs) (1) and therapeutic failures (2). There are several reasons for non-compliance. The most common reasons include ADRs due to medication, poor understanding of instructions, the cost of medications, frequent administration, etc(3),[ 4],[ 5]. Several strategies can be taken to improve patient compliance. One of the best means is the counseling of the patient by the pharmacists. Several studies have acknowledged that counseling by pharmacists can improve the patient’s understanding about medication and lifestyle modifications(6),(7) ,(8). Patient counseling is defined as providing medication related information orally or in written form to the patients or their representatives, on topics like direction of use, advice on side effects, precautions, storage, diet and life style modifications(9). The ultimate goal of counseling is to provide information directed at encouraging safe and appropriate use of medications, thereby enhancing therapeutic outcome[.10]. The concept of patient counseling is very new in South Asia. One study from the neighbouring country, India, evaluated the impact of counseling by pharmacists(11).
In Nepal, due to poor literacy rates, lower economy and various other reasons, there are inadequate resources for patients to get information about their medicine. Moreover, there are no patient information leaflets in the pharmaceutical products manufactured by the Nepalese companies. Even while dispensing the medication, the retail Pharmacists do not provide adequate information to the patients. Even the Doctors and Nurses do not spent adequate time in counseling the patients. Manipal Teaching Hospital (MTH) is the first hospital in Nepal to set up a Medication Counseling Center (MCC) in Nepal. The counseling is done as per the Omnibus Budget Reconciliation Act -1990 (OBRA-90)(12). The preliminary evaluation of the MCC after the initial six months of functioning, concluded that the medication counseling center can play a definite role in enhancing the patient’s understanding about the medications and the disease pattern, which in turn, may improve patient compliance(13). Successively, a number of initiatives have been carried out to improve drug use situations in MTH. A hospital drug and therapeutics committee (DTC) was formed, consisting of staff from the departments of the hospital and the clinical pharmacy, pharmacology, medicine, administration and other clinical departments. The DTC has undertaken a number of initiatives to improve the prescribing of medicines(14). Restricting the number of brands in the hospital pharmacy and creating a hospital drug list, were some of the initiatives carried out(15). The department of pharmacology runs a drug information and pharmacovigilance center (DIPC) in the teaching hospital. The DIPC also introduced a Continuing Pharmacy Education (CPE) program for the pharmacists working in the hospital. The CPE focused mainly on diseases like diabetes, hypertension, asthma etc, where the pharmacists need to know more while counseling the patients in the MCC(16). The impact of these initiatives on the functioning of the MCC was not studied. Hence, the present study was carried out.
The objectives of the present study were
1. To study the demographic details of the patients visiting the medication counseling center
2. To study the therapeutic category of the drugs about which the patients were counseled
3. To study the counseling and compliance aids used by the pharmacists during the counseling process
4. To study the content of counseling provided to the patients
5. To study the time spent by the pharmacists in counseling the patients
Methods
The filled medication counseling forms (Table/Fig 1) during the period of three years (September 2004 to September 2007) were analyzed. The data obtained were entered in a Microsoft Excel spread sheet and analyzed as per the study objectives.
Altogether, 1105 patients were counseled during the study period. Among these patients, a majority [51% (n=566)] were females. Among the total patients, [49.5 % (n=547
)] were married. The age distribution of the patients who received counseling is given below in the (Table/Fig 2).
The departments from where the patients came to the MCC were studied. The details are shown in (Table/Fig 3).
Most of the patients who visited the MCC were directed by the pharmacists (62.3%) and then by the doctors (12.9%). However, 7.2% of the patients visited, based on their own interest. The therapeutic classifications of the drugs counseled by the pharmacists in the MCC are given in (Table/Fig 4).
Most of the drugs about which counseling was given were of oral dosage form (48.1%), followed by inhalation medications (34.14%), topical agents (14.8%) and few (0.41%), which belonged to the parenteral dosage forms. The details of dosage form of the counseled drugs are shown in (Table/Fig 5).
The pharmacists used certain counseling aids while counseling the patients. The details regarding the use of counseling aids are given in (Table/Fig 6).
The pharmacists provided counseling to the patients directly in a private space. Sometimes the counseling was given to the patient parties as well. The details of the receivers of the counseling are given in (Table/Fig 7).
The various points covered while counseling the patients are studied. The details are given in (Table/Fig 8).
While counseling, the pharmacists used ‘compliance aids’ in order to improve the compliance following the counseling. The most commonly provided compliance aids were ‘medication envelops’ (52%), followed by ‘medication calendar’ (0.63 %) and Leaflets (0.09%). However, in 44.71% of the cases, compliance aids were not used. The amount of time spent by the pharmacists to counsel the patients is given in (Table/Fig 9).
The majority of times counseling was given by the ‘pharmacy assistant’ and then by the ‘pharmacist’. The details are given in (Table/Fig 10).
The present study evaluated the performance of the MCC in MTH. Most of the patients visiting the MCC were from the Department of Otorhinolaryngology. This is because a considerable number of patients were prescribed with nasal sprays. In general, patients with nasal sprays required counseling regarding the use of the device. However, the previous study identified placebo MDIs to be the most commonly used counseling aids(13). This finding suggests that many patients who initially received counseling for the MDIs did not need counseling during their follow-up visits. We found hormone and hormone antagonists to be the most commonly counseled class of drugs. This is because these patients were prescribed with corticosteroids to be inhaled, which required counseling.
For better counseling, the pharmacists used ‘counseling aids’. Counseling aids are one of the better means to improve counseling (Appendix 2) Refer: (Table/Fig 1). The most commonly used counseling aids were nasal sprays, metered dose inhalers (MDI) and rotahalers (a form of dry powder inhaler). Counseling patients with MDI is very essential. It has been shown that approximately 75% of the patients using MDIs do not take them properly[ 17].
In cases such as paediatric patients, elderly etc, the pharmacists counseled the patient party. It was understood that it was better to counsel the patient attendants of these patient population, so as to have a better compliance.
In MCC, counseling is provided as per the OBRA recommendations. As per the OBRA recommendations(12), the pharmacist must provide certain information to the patients while dispensing medication in the US. In Nepal, recently the good pharmacy practice (GPP) guidelines has been drafted, which also provides certain guidelines for the pharmacist to counsel the patients(18).
Dedicating adequate time is an important factor while counseling the patients. In our study, the pharmacists spent 6-10 minutes for more than one third of the patients, which is a welcoming effort. Dedicating more time will certainly have a positive impact on counseling.
In order to improve the outcome of the counseling, the pharmacists used ‘compliance aids’ that include medication envelops, medication calendar and leaflets. The use of leaflets and medication calendar were very poor, and needs to be improved. The use of medication envelops is one of the better means while counseling the illiterate patients.
The present study was successful in identifying the performance of the Medication counseling in MTH. Patients from the Otorhinolaryngology were the ones visiting the MCC more often. In general, the patients with modified drug delivery systems such as the MDIs and dry powder inhalers were counseled more frequently. The time spent by the pharmacists is adequate and in some cases, the patient parties were counseled for better outcomes. It can be concluded that, MCC at MTH plays an important role in educating patients towards safe and effective use of medicines.
Practice Implications
In resource limited countries like Nepal, pharmacists can provide counseling to the patients through medication counseling centers. This may in turn improve patient adherence, which is one of the common causes for therapeutic failures in countries like Nepal.
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