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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
Awareness on Recent Guidelines for Rabies Prophylaxis among Healthcare Professionals in Rewa District, Madhya Pradesh, India: A Questionnaire-based Cross-sectional Study
Correspondence Address :
Dr. Neera Marathe,
Professor and Head, Department of Community Medicine, Shyam Shah Medical College, Rewa-486001, Madhya Pradesh, India.
E-mail: neeramarathe79@gmail.com
Introduction: Rabies is a zoonotic disease that can be fatal and continues to impose a significant financial burden on developing countries. Recently, there have been advancements in the introduction of cell culture vaccines and immunoglobulin, as well as the approval of Intradermal (ID) schedules for vaccine administration.
Aim: To assess the knowledge of doctors in Rewa District regarding the National Guidelines for Rabies Prophylaxis in 2019.
Materials and Methods: A cross-sectional study was conducted, involving doctors from tertiary healthcare centres, district hospitals, and private practices. Data were collected over a period of one month from 206 doctors using a Google form, which included information about their field of practice and their knowledge of recent guidelines on Rabies prophylaxis. Data analysis was performed using the Chi-square test.
Results: Out of the 206 doctors surveyed, 92 (44.7%) were male. A 56.7% of the doctors were aware of the regimen and dosage for ID administration of the Anti Rabies Vaccine, (ARV) and 44.6% were knowledgeable about the modification of Post-Exposure Prophylaxis (PEP) to Pre-Exposure Prophylaxis (PrEP) in the Essen regimen. Furthermore, 70.9% of the doctors were familiar with the dosage of Human Rabies Immunoglobulin (HRIG), while 42.7% knew how to manage animal bites in immunocompromised patients.
Conclusion: The study revealed a lack of sufficient knowledge on various aspects of rabies management among the doctors surveyed. This underscores the need for reorientation programs and Continuing Medical Education (CMEs) training to be provided to doctors to enhance their knowledge of rabies and improve the effective management of animal bites.
Animal bites, Doctors, Intradermal, Knowledge, Regimen
Rabies remains an endemic disease affecting more than 150 nations and territories worldwide, resulting in approximately 59,000 annual fatalities and 8.6 billion USD in economic losses (with 96% of cases concentrated in Asia and Africa) (1),(2). In countries like India, where rabies is endemic, every animal bite is considered a potential rabies exposure (3). The disease is caused by Lyssavirus type 1, a lethal condition that impacts the central nervous system. Dogs and cats, among other warm-blooded animals, serve as the primary hosts for this zoonotic disease (4).
The National Centre for Disease Control in Delhi, along with the World Health Organisation (WHO) collaborating centre for rabies epidemiology, developed national guidelines for rabies prophylaxis in 2002 to standardise PEP practices and animal bite management practices (5). The prompt use of ARVs following an exposure, coupled with proper wound care and the administration of RIG, is nearly 100% effective in preventing the disease (6). WHO recommends the use of an ID regimen over an intramuscular one in situations where vaccines or resources are limited (7). Since 2005, the Indian government has endorsed and promoted ID rabies vaccination in all public healthcare facilities in alignment with these guidelines.
The WHO Technical Report Series (TRS) 1012 report, published in 2018, shed light on potential revisions to rabies guidelines (7). Subsequently, national guidelines for rabies prophylaxis were reviewed and published in 2019, incorporating new recommendations for ID vaccination and the management of immunocompromised individuals (8).
Timely and appropriate management of animal bites is crucial in preventing infections and reducing mortality from rabies. It is essential for doctors to possess the requisite skills and knowledge to effectively handle animal bite cases. Few studies have focused on the knowledge of healthcare professionals regarding animal bite management in compliance with recent guidelines (9),(10),(11),(12),(13),(14). Taking these factors into consideration, this study was conducted to evaluate doctors’ knowledge and to identify potential training needs for clinical practice.
A cross-sectional study was conducted in October 2023 among doctors working in the Rewa district of Madhya Pradesh, India for a period of one month. The study received ethical clearance from the Institutional Ethics Committee (IEC) at SS Medical College, Rewa (MP). Reference Number: S No./IEC/M.C./2023/31114.
Inclusion criteria: All doctors working in Rewa district, including both those in government and private sectors, who provided consent and were willing to participate, were included in the study.
Exclusion criteria: Doctors practicing homeopathy and ayurveda, as well as those not engaged in clinical practice, were excluded from the study.
Sample size (n) calculation:
n=Nz2pq/d2 (N-1)+z2pq,
Where, N is the population size (N=900), p is the prevalence of knowledge about post-exposure treatment in healthcare professionals (p=47.4%), (q=1-p). The sample size estimated with a 95% confidence interval and absolute precision(d) of 6 was found to be around 206 (15).
The sample size estimated with a 95% confidence interval and a 6% allowable error was 206 (based on a study by Digafe RT et al., showing a 47.4% prevalence of knowledge about post-exposure treatment in healthcare professionals) (16). Data were collected using a Google form distributed in various WhatsApp groups and email IDs. A total of 269 doctors were approached to achieve the required sample size of 206.
Questionnaire details: The questionnaire, consisting of a total of 22 questions in the knowledge section, was developed by the principal investigator. It encompassed inquiries regarding knowledge and practices related to the recent guidelines on Rabies prophylaxis. The questionnaire was crafted by the investigator based on the 2019 guidelines for rabies prophylaxis, a literature review on the topic under study, and input gathered through interviews with respondents (9),(17),(18),(19). Variables included in the questionnaire covered aspects such as age, gender, doctors’ qualifications, years of work experience, training/CME related to animal bite management, knowledge of rabies, classification, and management of animal bite wounds, different vaccination schedules, site of administration, and dosage. Validity and reliability were established before data collection. Content validity was ensured by a panel of experts, and the content validity index was calculated, yielding an appropriate value (S-CVI=0.84). The Cronbach’s alpha value for the questionnaire assessing knowledge was calculated as α=0.92. A pilot study involving 10 subjects was conducted, and they were not included in the final study sample.
The study’s purpose was clearly explained to the doctors, ensuring confidentiality regarding their participation, and informed consent was obtained. A total of 206 doctors from various clinical fields (medical officers, faculty, private practitioners, and resident doctors) provided consent and took part in the study. The response rate achieved was 76.58%.
Statistical Analysis
The data were entered into an Excel sheet and analysed using Jamovi 2.3.21 software. Comparisons were made using Chi-square, and results were obtained. A p-value of <0.05 was considered statistically significant.
(Table/Fig 1) presents the socio-demographic information about the work area of the study participants. Out of the 206 doctors, 92 (44.7%) were males and 114 (55.3%) were females. The teaching faculty comprised 72 (35%), medical officers 12 (5.8%), private practitioners 34 (16.5%), and postgraduates and senior residents 88 (42.7%), respectively.
(Table/Fig 2),(Table/Fig 3) depict knowledge about animal bites and their management. Among the participants, 203 (98.5%) had correct knowledge regarding the causative agent of rabies, while less than one-third of the doctors (55, 26.6%) had the correct knowledge regarding the 10-day observation period for dogs and cats. Residents demonstrated significantly better knowledge regarding the site of rabies vaccine administration in infants and young children (p-value=0.004) compared to teaching faculty and private practitioners. It is noteworthy that the majority of doctors (196, 95.1%) had correct knowledge regarding the administration of ARV in provoked bites, but only half of them (124, 60.2%) had correct knowledge regarding ARV administration in cases of documented animal vaccination. Additionally, 150 (72.8%) of doctors were aware that ARV is not contraindicated in pregnancy and lactation, and 123 (59.7%) knew that corneal donation is contraindicated in suspected or confirmed cases of rabies. Residents also performed significantly better than faculty in categorising wild animal bites (p-value=0.04).
While 164 (79.6%) of the doctors were aware of the categories of animal bites and their management, only 89 (43.2%) were knowledgeable about the cost-effectiveness and current recommendation of the ID route of vaccination. Approximately, 117 (56.7%) of doctors responded correctly regarding the regimen and dose for ID as well as the 5-dose regimen for intramuscular administration of ARV. Only 92 (44.6%) were aware of the modification of PEP to PrEP in the Essen regimen, and 88 (42.7%) knew how to manage animal bites in immunocompromised patients. Although 146 (70.9%) of the doctors were familiar with the dosage of HRIG, only half of them knew when to administer RIG in relation to the vaccine. Furthermore, 104 (50.4%) of the doctors knew that the rabies vaccine vial should be utilised within six hours of reconstitution (Table/Fig 3).
Animal bite management is of utmost importance if we are to achieve zero deaths from rabies by 2030. The results of this study reflect that only half of the doctors had an overall understanding of rabies and PEP for managing animal bites. A similar study conducted in Uganda showed that 41% of doctors had sufficient knowledge about rabies (20). The doctors in this study demonstrated good knowledge of the causative agent of rabies (98%), which was slightly higher compared to a study conducted in Belgaum city (95.23%) (21).
The observation period of 10 days in the case of bites by dogs and cats was known to very few participants, i.e., 26.6% in this study, as compared to 56% in a study conducted in Patiala (19) and 70% in a study by Sudarshan MK (12). In this study, only 44.6% of the doctors were aware that the Essen regimen could be modified from PEP to PrEP. Given that the majority of bites in India are from dogs and cats, the observation period holds significance for these animals. A correct understanding of this concept would enable the modification of PEP to PrEP, leading to lower dosages and increased cost-effectiveness (5).
The categories of animal bites were correctly known to 84.9% of doctors in this study, compared to 50% of doctors in AIIMS Jodhpur (18). Additionally, 56.7% of doctors had correct knowledge regarding the regimen and dosage of the ID route in this study, which was comparatively lower than 66.6% in a study conducted in Gwalior (22) and only 3% in a study by Chuchu VM et al., (23). Implementing the ID route in practice on days 0, 3, 7, and 28, with 0.1 mL in both deltoids, reduce costs and the vaccine dose, subsequently improving its availability to people in countries like India where animal bites are frequently encountered (8).
The safety of the ARV in pregnancy was known to 72.8% of doctors in this study, compared to 66.7% in a study conducted in Mumbai (24) and 63.3% in a study by Sudarshan MK (12). Correct knowledge of the dosage and site of HRIG in this study was found to be 70.9%, compared to 31% in the study conducted in Patiala (19), 45% in AIIMS Jodhpur (18), and 41.3% in a study by Choudhary R et al., (14). HRIG is life-saving in category III bites where an immediate immune response is needed at the site of exposure. This was known to 58.25% of doctors in this study, while 68.75% of doctors were aware of post-exposure management according to the category of bite in a study by Malhotra V et al., (19).
The time limit for the utilisation of reconstituted vaccine vials was known to 50.4% of doctors in this study, which was similar to the study conducted by Sudarshan MK (12). Additionally, 42.7% of them were aware of how to handle animal bites in immunocompromised patients. It is essential that doctors are aware of the immune status and co-morbidities of animal bite victims before administering ARV. Furthermore, 47.57% of doctors in this study knew that a serum titre of anti-rabies neutralising antibody of more than 0.5 IU/ml is considered adequate seroconversion post-vaccination. This was almost similar to a study by Agarwal A et al., where 45.83% of doctors knew the titre of serum considered adequate for protection (22). Similar studies from the literature have been tabulated in (Table/Fig 4) (19),(23),(24),(25).
There was a significant difference in knowledge between faculty and residents regarding the site of administration of the rabies vaccine in infants and young children, which could lead to adverse reactions following immunisation. Additionally, a significant knowledge gap was found among faculty and residents in the categorisation of wild animal bites. Resident doctors appear to be more updated with the recent guidelines for rabies prophylaxis. Due to the fact that only 16.5% of doctors have undergone training in the previous year, most clinicians are not well-versed in the new additions to the rabies guidelines.
Limitation(s)
A Google form was used for collecting data with a limited sample size, making it not possible to observe the study subjects’ attitudes or practices.
The study highlighted the need to upgrade the knowledge of doctors in Rewa district for PEP management of animal bites according to the recommended guidelines. More emphasis should be placed on the ID route, its cost-effectiveness, dosage, and regimen; PEP modification to PrEP; management according to the category of animal bite; animal bite management in immunocompromised individuals; and the duration needed to use vaccination vials upon reconstitution. These are some of the points to be considered while planning reorientation programs and CMEs for doctors. Therefore, by adhering to standard guidelines for rabies prophylaxis, collective efforts will work towards the elimination of Dog-Mediated Rabies by 2030, i.e., ‘Zero by Thirty’.
DOI: 10.7860/JCDR/2024/69153.19132
Date of Submission: Dec 18, 2023
Date of Peer Review: Jan 12, 2024
Date of Acceptance: Feb 12, 2024
Date of Publishing: Mar 01, 2024
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. No
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Dec 18, 2023
• Manual Googling: Jan 09, 2024
• iThenticate Software: Feb 09, 2024 (7%)
ETYMOLOGY: Author Origin
EMENDATIONS: 7
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