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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
Attitude and Practice of Dental Practitioners Towards the Oral Biopsy Procedure: A Questionnaire-based Cross-sectional Study
Correspondence Address :
Mitulkumar Rameshbhai Prajapati,
12, Goverdhannagar-2, Bhuravav, Sapa Road, Godhra-389001, Gujarat, India.
E-mail: opadc08@gmail.com
Introduction: Dentists, the first medical professionals to be consulted for conditions involving the oral cavity, have the distinct advantage of being in a position to screen patients for oral cancer. To effectively manage patients, dentists must be familiar not only with where, when, how and why to perform biopsies, but also with when to refer them to specialised institutions.
Aim: To assess the attitude and practice of dental practitioners towards the oral biopsy procedure.
Materials and Methods: The present questionnaire-based cross-sectional study was conducted in the city of Jamnagar, Gujarat, India, from July 2023 to August 2023. Fifty dental practitioners with a minimum academic qualification of Bachelor of Dental Surgery (BDS) participated in the study, which was designed to collect information regarding the importance of oral biopsy, methods used to obtain biopsies, tissue preservation, diagnosis, referral to higher centers and the attitudes and practices of dental practitioners in examining oral mucosal lesions. The questionnaire was prepared using the Google Forms app. The received responses were compiled and statistical data (percentage) was calculated using Microsoft Excel 2020.
Results: Out of total, 42 (84%) dentists encounter up to 10 oral mucosal lesions, such as potentially malignant disorders, in a month. Despite this, only 22% (n=11) of them performed biopsies themselves. Furthermore, 6 (12%) dentists did not know the proper medium for preserving biopsies. Of all, 24 (48%) dentists felt the need for proper training in biopsy techniques to be included in the undergraduate curriculum.
Conclusion: Despite being aware of the importance of biopsy as a crucial diagnostic procedure, not many dentists perform it routinely due to reasons such as lack of training, patient non compliance and medicolegal implications. Hence, dentists should be educated in performing the oral biopsy procedure, including handling of specimens and referral to specialists.
Oral cancer, Oral pathology, Precancerous condition
Biopsy is defined as the removal of tissue from a living organism for microscopic examination. It is a Greek word (bio- life, opsia- to see), which means view of the living (1). When any abnormal tissue is biopsied from the oral and maxillofacial region, it is recommended by the American Academy of Oral and Maxillofacial Pathology to submit it to an oral and maxillofacial pathologist (2).
Performing a biopsy is generally done for reasons such as establishing a definitive diagnosis, providing a prognosis for malignant or premalignant lesions and serving as a record with legal significance in the medical field (3). Diamanti N et al., reported that both specialists and general dental practitioners hold the view that additional expertise in the biopsy procedure is of utmost importance (4). General dentists rarely find oral lesions that require biopsying, as reported by Schnetler JF and Leonard MS [5,6]. Hence, despite dentists having an advantage in screening patients for oral cancer, due to inexperience and lack of familiarity with the clinical patterns of oral cancer, it becomes more likely that these patients are referred (7). Therefore, dentists must be well acquainted with the when and how of biopsies and understand that not only tumours, but also oral lesions like premalignant lesions, non healing ulcers and swellings need to be biopsied (8),(9).
A biopsy is typically performed to obtain a specimen for the purpose of histopathologic diagnosis. The procedure needs to be followed precisely and meticulously in order to produce a suitable specimen for pathological analysis, as an inaccuracy in the procedure may cause a misdiagnosis of the lesion (10). Instead of being sent for analysis and histological reporting, most of the specimens that are obtained might be discarded, subsequently losing the possibility of obtaining more supportive data from the surgery and transforming the diagnostic procedure into a therapeutic one (11).
In order to ensure that the patient is managed effectively, dentists who refer patients to other healthcare professionals for biopsies nevertheless need to be acquainted with the technique and the outcomes (12). Though clinician’s expertise may eliminate the need for a biopsy in a few obvious cases, it is always a prudent choice to perform a biopsy when in doubt, as the gold standard for diagnosis is the microscopic analysis (13).
Previous studies have been conducted to explore the practices and attitudes of general dentists towards oral biopsy in different parts of the world and in India (4),(9),(11),(14),(15),(16),(17),(18),(19),(20),(21),(22). But no such study has been carried out in the Jamnagar city of Gujarat, India. Therefore, the aim of the present study was to investigate the attitude and practice of general dentists towards the oral biopsy technique in Jamnagar city of Gujarat, India and compare studies performed in other regions of India and the world, aiming to obtain a comprehensive outlook at the scenario regarding oral biopsies on a larger scale.
The present questionnaire-based cross-sectional study was conducted in the city of Jamnagar, Gujarat, India, from July 2023 to August 2023. Study was approved by the Institutional Ethics Committee (ADC/IHEC/31).
Inclusion criteria: Dentists performing clinical practice and having a minimum qualification of BDS degree were included in the study.
Exclusion criteria: Undergraduate dental students and interns were not included in the study.
Sample size: A convenient sample size of 50 was considered after obtaining contact details through the Dental Association of Jamnagar.
Study Procedure
Questionnaire details: The questionnaire was prepared in Google Forms from similar studies on the attitude and practice of dental practitioners towards the oral biopsy procedure and pretested by senior professionals (14),(15),(16),(17),(18),(19),(20),(21),(22). The questionnaire comprised 18 questions, including demographic details, practices, attitude and an evaluation of patient compliance.
The questionnaire’s reliability was evaluated using the test-retest method and the results showed a good agreement of 0.8. The questionnaire’s validity was evaluated using the Content Validity Ratio (CVR), which yielded a result of 0.95. None of the questions needed to be skipped because they were all crucial. The questionnaire was electronically sent to 70 dentists and out of them, 50 responded, giving a response rate of 71.43%.
Statistical Analysis
Microsoft Excel software 2020 was employed to tabulate and analyse the obtained data.
Fifty (71.43%) dental practitioners responded out of 70 practitioners. Among them, 17 (31%) Master of Dental Surgery (MDS) and 33 (66%) were BDS. Thirty three (66%) participants had an experience of less than five years, 35 (70%) participants were associated with private practice and 15 (30%) were in institutional practice (Table/Fig 1).
Out of all, 42 (84%) participants stated that they encountered less than 10 potentially malignant disorders in the oral cavity in a month and 8 (16%) encountered 10 to 20 potentially malignant lesions in a month. It was found that 8 (16%) participants encountered more than 20 other lesions like swellings, ulcerations, etc., in a month. Out of 50, 44 (88%) participants recommended only less than five biopsies in a month, while 4 (8%) of them recommended >10 biopsies a month. Fourty three (86%) participants recommended biopsy for red and white lesions, 18 (36%) for submucous fibrosis and 23 (46%) for pigmented lesions (Table/Fig 2).
It was found that 11 (22) participants performed the biopsy themselves, while 38 (76) referred them to an oral surgeon. Fourty four (88%) participants agreed that they used formalin for tissue preservation, while 4 (8%) used saline for tissue preservation (Table/Fig 3). Out of the total participants, 42 (84%) agreed that only a few patients complied with the biopsy procedure readily. Of all, 30 (60%) stated that non compliance of patients was the main reason for not performing biopsies routinely, while 16 (32%) dentists felt that the lack of trained professionals was the main reason for not performing biopsies in routine practice. Regarding methods to increase the knowledge of biopsy procedures, 24 (48%) felt the need for its inclusion in the undergraduate curriculum, while 16 (32%) and 6 (12%) were of the opinion that hands-on workshops and training centers, respectively, can help (Table/Fig 4).
The present study was undertaken to evaluate the practice and attitude of dentists regarding the biopsy procedures, the medium of specimen preservation, referral to a specialist when in doubt and the choice of referral to a general pathologist or an oral pathologist, as all these factors do have an impact on a patient’s diagnosis and treatment plan. The biopsy technique is a competence skill that is easily earned. Research showed that only 22% of dentists would perform a biopsy on their patients (3). Similar studies have been conducted in different parts of the country (14),(15),(16),(17),(18),(19),(20),(21),(22). The present study also attempts to review the Indian scenario by comparing the results with similar studies undertaken in other regions of India and other countries (Table/Fig 5) (4),(9),(11),(14),(15),(16),(17),(18),(19),(20),(21),(22).
The present study found that only 11 (22%) of dentists preferred performing biopsies on their own. Similar studies were undertaken by Tyagi KK et al., in Uttar Pradesh, Arunachalam M et al., in Chennai and Aishwariya S in Tamil Nadu, which showed that 17.2%, 26% and 26% of dentists performed the biopsy on their own, respectively (14),(17),(18). While Khajuria N and Anjum R reported a much lower percentage (7%) in Jammu (15). This suggests that though the biopsy is a routine diagnostically important procedure, which can help to detect malignancy in the early stages, general dental practitioners are not very confident in performing it.
In the present study, regarding the preservation of the biopsy specimen, 44 (88%) dental practitioners preferred formalin as the ideal medium, while 4 (8%) dentists still thought of saline as the ideal medium. In the study done by Arunachalam M et al., in Chennai, 80% and 10% of dentists preferred formalin and saline, respectively (17).
Thete SG et al., found 82% and 18% preference for formalin and saline, respectively, in Maharashtra (19). While the studies performed by Tyagi KK et al., in Uttar Pradesh, Phulari RG et al., in Vadodara and Aishwariya S in Tamil Nadu showed that only 60%, 67.5% and 62% of practitioners preferred formalin as the ideal preserving medium, respectively (14),(16),(18). Keshwar S et al., reported that dentists were little aware of the importance of preservation and fixation of the tissue specimen in their study (21). It is indeed known that fixation plays a crucial role in arriving at a diagnosis. All studies undertaken in various parts of India show a significant lack of awareness regarding the ideal fixative, which can have a deleterious effect on the tissue and ultimately lead to inconclusive results. This would compel a repeated procedure, which is traumatising to the patient, both physically and mentally, due to the delay in diagnosis.
When asked about the reason for not performing the biopsy procedure routinely, 30 (60%) of practitioners in the present study answered non compliance of patients as the main reason, while 16 (32) dentists answered lack of trained professionals as the reason. Noncompliance of patients was stated as the main reason for not performing the biopsy by 31.4% of dental practitioners in Vadodara and 38% of dental practitioners in Tamil Nadu, in studies conducted by Phulari RG et al., and Aishwariya S, respectively (16),(18). While 46.8%, 46.7%, 74%, 22% of dentists in Jammu, Uttar Pradesh, Maharashtra and Puducherry found a lack of knowledge as the main reason for not performing the biopsy in studies conducted by Tyagi KK et al., Khajuria N and Anjum R, Thete SG et al., and Balan N et al., respectively (14),(15),(19),(20).
When asked about methods to increase knowledge regarding the same, 24 (48%) dentists in the present study felt the need for its inclusion in the undergraduate curriculum. In the study by Tyagi KK et al., 52% of dentists in Uttar Pradesh felt the need for inclusion in the undergraduate curriculum (14). In the study by Aishwariya S in Tamil Nadu, it was found that 59% of dentists preferred Continuing Dental Education (CDE) programmes to increase their knowledge (18). These results reflect how the dentists consider it important to learn biopsy techniques early by its inclusion in the undergraduate curriculum itself. A comparison of the present study with similar studies conducted in India and internationally has been done in (Table/Fig 5) (4),(9),(11),(14),(15),(16),(17),(18),(19),(20),(21),(22). A review of studies conducted in other regions of India showed significant similarity to the present study (14),(15),(16),(17),(18),(19),(20),(21),(22).
The present study found that despite their knowledge of biopsies as a diagnostic tool, dentists did not commonly perform biopsies because of a variety of reasons, including lack of knowledge, patient non compliance and inadequate training. Additionally, many dentists are unfamiliar with the fundamentals of oral biopsies, such as the best preservation medium for biopsy samples. Incorrect approaches can lead to a delay in diagnosis, which may negatively affect patient care. Therefore, it is important to familiarise general practitioners with this procedure enough so that they feel competent enough to carry it out.
Limitation(s)
The present study had some limitations, such as being limited to a small region and a small sample size, so the responses may not be the actual reflection of the entire population.
In the present study, it was found that general dentists struggle when it comes to performing an oral biopsy. Although dentists are aware of the use of biopsies, this knowledge is not reflected in their practice. However, practitioners have expressed their readiness to receive training on the oral biopsy procedure, which shows their positive attitude towards it. Hence, it is essential to incorporate the theory and practice of an oral biopsy in the undergraduate curriculum and offer continuing dental education programs for the same. Moreover, non compliance of patients is also a factor that demotivates practitioners from recommending biopsies in some cases. Hence, programs promoting oral health should also incorporate sessions to increase awareness of oral biopsies as a diagnostic procedure, so as to decrease patients’ anxiety and promote early diagnosis.
DOI: 10.7860/JCDR/2024/67911.19011
Date of Submission: Oct 06, 2023
Date of Peer Review: Nov 04, 2023
Date of Acceptance: Dec 23, 2023
Date of Publishing: Feb 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. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Oct 07, 2023
• Manual Googling: Nov 18, 2023
• iThenticate Software: Dec 23, 2023 (7%)
ETYMOLOGY: Author Origin
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