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

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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




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Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




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I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




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Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
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Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



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




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
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".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
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.
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

Important Notice

Original article / research
Year : 2012 | Month : May | Volume : 6 | Issue : 4 | Page : 612 - 614

The Use of Metered Dose Inhalers: Where are we?

Naren S Dudyala , Marina Amarendra , Subbarao PV

1. Corresponding author, 2. Asst. Professor Dept of Paediatrics 3 Prof and HOD Dept of Pediatrics Pediatrics, Konaseema Institute Of Medical Sciences, Amalapuram Andhra Pradesh 533201, India.

Correspondence Address :
Naren S Dudyala,
Asst Prof, Pediatrics,
Konaseema Institute of Medical Sciences,
Amalapuram Andhra Pradesh 533201, India.
Phone: 09491130738
E-mail: dudyalanaren@gmail.com
dudyalanaren@rediffmail.com

Abstract

The use of inhaled drugs is a basic aspect of the treatment of patients with asthma, in acute episodes as well as in maintenance therapy. For years, conventional nebulizers were the only inhalers available. With the advent of pressurized metered-dose inhalers, the delivery of drugs such as bronchodilators and corticosteroids into the respiratory tract is optimized. Treatment failure in individuals with asthma frequently results from the incorrect use of metered-dose inhalers, which is typically a consequence of a lack of counseling by health professionals, many of whom are unfamiliar with the technique. The Konaseema Institute of Medical sciences, Institute for Children is a tertiary hospital where patients with pulmonary disease states are treated in the emergency room, intensive care unit, outpatient clinic and nurseries. The present prospective study was aimed to evaluate the knowledge regarding the use of pressurized metered-dose inhalers among the professionals working in the hospital,. Statistical analysis by chi-square test and p values, observes a significant difference between the correct usage and the prescribing health care professionals of the hospital which was done as per an evaluation chart. Hence the need for periodic training and evaluation.

Keywords

Metered dose inhalers, Health care professionals, Periodic training and Evaluation

How to cite this article :

Naren S Dudyala , Marina Amarendra , Subbarao PV. THE USE OF METERED DOSE INHALERS: WHERE ARE WE?. Journal of Clinical and Diagnostic Research [serial online] 2012 May [cited: 2019 Nov 13 ]; 6:612-614. Available from
http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2012&month=May&volume=6&issue=4&page=612-614&id=2109

INTRODUCTION
Asthma is a significant public health problem worldwide and it ranges in its prevalence from 1 to 18% (1). In India, asthma is the one of the leading causes of hospitalization among children and young adults and it greatly increases the costs of the health care system. It results in school absenteeism/inability to perform physical activities and it can interfere with the psychosocial development of children (2). Drug therapy forms the cornerstone of the treatment in asthma. Various devices are popular among the general public like spacers, nebulizers, metered dose inhalers, drugs and combinations of these. The apt use of the medication which is prescribed, the technique and the compliance to the medication is important for a healthy tomorrow. The use of inhaled drugs is a basic aspect in the treatment of patients with asthma, in acute episodes as well as in maintenance therapy. Currently, there is a near-unanimous consensus that the use of anti-inflammatory drugs is indicated for the treatment of persistent asthma, since the role of inflammation in the patho physiology of the disease has been well recognized (3). For years, conventional nebulizers were the only inhalers which were available. With the advent of pressurized metered-dose inhalers, the delivery of drugs such as bronchodilators and corticosteroids into the respira¬tory tract was optimized, thereby decreasing the local and the systemic side effects (4),(5).

Various studies have demonstrated that the metered-dose inhaler is safe and efficacious, which produces particles of 1 to 50 μm in diameter (particles which are 1- to 5-μm in diameter reach the distal portions of the tracheobronchial tree). In addition, it is port¬able, it does not depend on an air compressor and it uses a standardized dose (6),(7). The treatment failure in individuals with asthma frequently results from the incorrect use of metered-dose inhalers, which is typically Original Article Pediatrics Sectiona consequence of a lack of counseling by the health professionals, many of whom are unfamiliar with the technique (8). The Konaseema Institute of Medical sciences, Institute for Children, is a tertiary hospital where patients with pulmonary disease states are treated in the emergency room, intensive care unit, infirmary, outpatient clinic and the nurseries. Therefore, in order to determine the difficulties that might interfere with the appropriate counselling of the patients, we decided to determine the theoretical and the practical knowledge of the health care professionals with respect to the use of metered-dose inhalers, which formed the aim of our study.

Material and Methods

Sample size: The prescribing doctors of the hospital (30) and the junior doctors who were involved in the paediatric patient care (80), a total of 110 subjects were included in the study as per the hospital data which was available.

Type of studY: Prospective study

Period of study: August 2011 to September 2011. A prospective study was carried out, which included the junior doctors (interns and post graduates) and the prescribing doctors (practising physicians) of the hospital. An ‘MDI use evaluation score chart’ (Table/Fig 1) was prepared as per the National Asthma Education and Prevention Program (NAEPP) criteria (9) and it was used in the study. For every correctly carried out step, a score of ‘1’ was given, and for every incorrect step, a score of ‘0’ was given. The healthcare professionals were asked, after obtaining their verbal consent, to demonstrate the use of the placebo inhaler to the care givers of the patients, and the steps were graded as per the NAEPP criteria.

STATISTICAL ANALYSIS
The statistical analysis was performed by using the SAS 9.1 version and the Chi-Square test and the Fisher’s extract test was used to calculate the p-value. The test was done at a 5% significance level and a P value of <=0.05 indicated significance.

Results

The results are depicted in (Table/Fig 2), which shows that both thepractising doctors and the junior doctors had an incorrect method of demonstrating the usage of the metered dose inhaler. Steps 1, 2, 8 and 10 were demonstrated correctly, both by the prescribing doctors and the junior doctors. Step 7 was incorrectly demonstrated by a majority of the junior doctors and step 4 was demonstrated incorrectly by a majority of the practising doctors. Also,there was a significant difference between the prescribing doctors and the junior doctors, a majority of the latter were incorrect. Only 12 of the 110 professionals could actually get all the steps correct.

Discussion

In a study which was conducted by Hira HS, at the Maulana AzadMedical College, New Delhi, India, a questionnaire regarding the use of metered dose inhalers (MDI) was administered to 38 physicians, (9) faculty members and 29 residents. Fifty-five percent of the faculty members answered at least three or more of the seven steps of the inhalation technique correctly, as compared to 86% of the residents and this was statistically significant (p value < 0.01). All the participants used to prescribe MDI to their patients. 80% of them responded that they followed the package insert instructions to educate their patients. It was concluded that the doctors who are involved with the MDI use, should learn and become familiar with the proper recommendations for its optimal aerosol delivery (10). Our present study showed that only 10.9 % of the health care professionals were correct, which was of serious concern. In a study from Iran, which included physicians and nurses, only 6.93% could demonstrate MDIs correctly (11). In another study from Oman, only 15% of the respondents performed all the steps correctly (12).

The training and the evaluation of the health care professionals is absolutely essential for the effective management of childhood asthma. The morbidity and the mortality could thus be reduced. The limitations of the present study were, that it was not carried among the nursing personnel who form a vital link and that few healthcare personnel were on leave during the period of the study.

Acknowledgement

Dr Subbarao, Dr Amarendra, The MD, The Medical Superintendent, The Dean, Dr Acharya , Dr Soren, Dr Pujari, Dr Sudhanshu, Dr Vishnumurthy, The Nursing staff, for their guidance. Miss Josna statistician for the analysis.

References

1.
Global Initiative for Asthma [homepage on the Internet]. Ontario: Global Initiative for Asthma [cited 2007 February 12]. Global Initiative for Asthma - global strategy for asthma management and prevention. Available from: http://www.ginasthma.org/Guidelineitem. asp?l1=2&l2=1&intId=60
2.
Sociedade Brasileira de Pneumologia e Tisiologia. IV Diretrizes Brasileiras para o Manejo da Asma. J Bras Pneumol. 2006; 32 Supl 7: S447-S74.
3.
O’Byrne PM, Pedersen S. Measuring the efficacy and the safety of different inhaled corticosteroid preparations. J Allergy Clin Immunol. 1998;102(6 Pt 1):879-86.
4.
Duerden M, Price D. Training issues in the use of inhalers. Dis Manage Health Outcomes. 2001;9(2):75-87.
5.
Laube BL. In vivo measurements of aerosol dose and distribution: clinical relevance. J Aerosol Med. 1996;9(Suppl 1):S77-S91.
6.
Brand PL, Roorda RJ. Drug delivery in pediatric patients with asthma: spacer devices vs nebulizers for the [beta]2 agonists. Am J Drug Delivery. 2003;1(1):61-70.
7.
Biggart E, Bush A. Antiasthmatic drug delivery in children. Paediatr Drugs. 2002;4(2):85-93.
8.
Plaza V, Sanchis J. Skills of medical personnel and patients in the use of metered dose inhalers: a multicentric study. CESEA Group. Respiration. 1998;65(3):195-8.
9.
NAEPP. Expert panel report 2. Guidelines for the diagnosis and management of asthma: NIH publication, 1997.
10.
Hira HS. J Assoc Physicians India. 1994 Jul;42(7):524-5.
11.
Nadi E, Zeraati F. Evaluation of the metered-dose inhaler technique among healthcare providers. Acta Medica Iranica 2005; 43: 268-72.
12.
Baddar SA, Al-Rawas OA, Al-Riyami KA et al. The metered-dose inhaler technique among the healthcare providers who are practising in Oman. SQU Journal for Scientific Research: Medical Sciences 2001; 1: 39-43.

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