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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
Effectiveness of Abdominal Breathing Exercise on Biological Parameters among Hypertensive Patients at Selected Tertiary Care Hospital, Mangaluru, India
Correspondence Address :
Mr. GR Gireesh,
Yenepoya Nursing College, deralakatte, Mangaluru, Karnataka, India.
E-mail: gireeshgr@yenepoya.edu.in
Introduction: High blood pressure, also known as Hypertension (HTN) is a long-term medical condition in which the blood pressure in the arteries remains consistently high. HTN rates in India are expected to rise. Abdominal breathing exercise activates the parasympathetic nervous system which decreases the heart rate and dilates blood vessels, reducing overall blood pressure.
Aim: To find out the effectiveness of abdominal breathing exercise on biological parameter among hypertensive patients.
Materials and Methods: This quasi-experimental time series design study was conducted at Yenepoya Medical College Hospital, Mangaluru, Karnataka, India, from February 2021 to March 2021. A total of 60 samples were selected, with 30 samples in each of the control and experimental groups. Abdominal breathing exercise was given for 5-10 minutes about 3-4 times a day for seven days after the pretest of biological parameter assessment. Data was collected for three alternative days. The tools used were demographic proforma and clinical assessment proforma. Unpaired t-test and chi-square test were used for statistical analysis.
Results: About 53.3% of the participants in the control group were males as compared to 66.7% in experimental group. The mean value of pretest Systolic Blood Pressure (SBP) and the Diastolic Blood Pressure (DBP) had no significant difference (p>0.05). However, after the abdominal exercises, there was significant difference in the mean SBP (p=0.01), DBP (p=0.01), Pulse Rate (p=0.05), Respiratory Rate (RR) (p=0.01) in experimental group when compared to control group.
Conclusion: The study concluded that abdominal breathing exercise reduced BP, HR and RR among hypertensive patients and it is an effective technique to reduce BP, PR and respiration.
Health, Hypertension, Pulse rate, Respiration rate
Health is the physical, social, psychological and spiritual well-being of individuals. Overall health of the population is determined by the people’s income, education, employment and housing as a combination of preventive and rehabilitative approaches and services (1). The foremost common hereditary diseases which are prevailing in Indian population are diabetes mellitus, HTN, cardiac disease, respiratory disorder, tuberculosis. Among these disease HTN is the most commonly seen (2).
The HTN is also named as silent killer because many people do not know that they are hypertensive. Varieties of safe and effective medications are available for treatment of high BP. These include older molecules like thiazide diuretics, beta-blocking agents, Calcium Channel Blockers (CCB) and newer molecules, such as, Angiotensin Converting Enzyme (ACE) inhibitors, and Angiotensin Receptor Blockers (ARB). In view of the recent clinical trials information, international guideline (World Health Organisation (WHO), International society of hypertension) counseled that CCB, ACE inhibitors or ARB (and not betablockers or diuretics) should be the initial therapy in HTN management. The former however, are much more expensive and beyond the affordability in several poor income countries (3),(4). The side-effects and cost of antihypertensive drugs have stimulated the search for a non pharmacological approach to control BP either as a first line or adjunctive treatment (5). Complementary Therapy is proved to be one of the effective treatments for the most of the disease conditions. Complementary therapies such as yoga exercises, homeopathy, acupuncture, herbs and oils can boost the immune system, it helps to eliminate toxins, relieve pain, improve circulation, improve sleep pattern, increase energy levels, induce deep relaxation, reduce stress and tension and restore balance to body systems (6).
Abdominal breathing exercise activates the parasympathetic nervous system which decreases HR and dilates blood vessels, reducing overall BP. Breathing deeply can help lower blood pressure, it relaxes the body and lowers the HR, reducing the chronic stress and tension that raises the BP. Deep breathing may also help the body to process the salt that contributes to high BP more effectively (3). Diaphragmatic breathing exercise is a type of abdominal breathing exercise that helps strengthen the diaphragm, an important muscle that helps to breathe (7). With regular practice, it helps to breathe from the abdomen most of the time, even while asleep. Breathing deeply can help to lower BP (8). In 2005, 20.6% of Indian men and 20.9% of Indian women were diagnosed with HTN, according to a global study of data. By 2025, the proportion of Indian men and women with HTN is expected to rise to 22.9 and 23.6. Deep breathing exercise is the one of the measures which will overcome these issues in management of HTN. Regular practices of deep breathing exercise increase blood and oxygen flow to the brain to function normally (9).
Various researches on the effect of abdominal breathing exercise on HTN have been undertaken (6),(7) and it has been discovered that exercise results in a significant reduction in BP. It was also discovered that long-term treatment leads to non compliance due to the high cost of treatment. As a result, it is critical to identify and administer a medication that is both cost-effective and successful in treating hypertension (6). As a result, the investigator chose this topic to provide quality of care for management of HTN. The main objectives of the study were to assess the biological parameter among HTN patients, to evaluate the effectiveness of abdominal breathing exercise on biological parameter among hypertensive patients and to find out the association between biological parameter with selected socio-demographic variables.
This quasi-experimental time series design study conducted at Yenepoya Medical College Hospital, Mangaluru, Karnataka, India, for duration of one month from February 2021 to March 2021. Written approval for the study was obtained from the ethical committee of university. (Approval number: YEC2/467 Date 14/01/2021). Consent was obtained from all participants of the study.
Inclusion criteria: Hypertensive patients undergoing treatment, patients who were suffering with co-morbid medical conditions such as diabetes, kidney disease, cancer, cardiovascular disease.
Exclusion criteria: Patients who had severe respiratory problems like pleural effusion, chronic obstructive pulmonary disease, hemodynamically unstable patients, patients who are already practicing abdominal breathing exercise, patients with gastrointestinal disorder were excluded from the study.
Sample size estimation: The sample size was calculated using G* statistical analysis. It was based on the 10% level of attrition α=0.01. Power is 60% (10). Hence, the sample size estimated was 60. The control group and experimental group had 30 samples each.
Procedure
After self-introductions, the investigator explained the purpose of the study and obtained consent from the subjects followed by an interview to obtain the demographic data and pretest biological outcomes (blood pressure by sphygmomanometer, pulse and respiration manually). The experimental group practiced abdominal breathing exercise for seven days, where the subject placed one hand on upper chest and the other hand just below the ribcage. Client breathed slowly through the nose and exhale through pursed lips (11) This exercise was carried out 5-10 minutes about 3-4 times a day with the routine treatment and those in the control group received only routine treatment. The post-test (abdominal breathing exercise) BP, HR and RR was assessed in all 60 samples on 3rd (Post-test 1), 5th (Post-test 2) and 7th day (Post-test 3) during the intervention period.
Statistical Analysis
The data was analysed by using by descriptive and inferential statistics using SPSS version 16.0. Chi-square test, unpaired t-test, Mann-whitney test and Friedman rank test at 5% level of significance was used for statistical analysis. A p-value <0.05 is considered to be statistically significant.
Total 60 participants with age range from ≤30 to >51 years were divided in two groups. Each group had 30 participants, the control group consisted of 16 males and 14 females, while the experimental group had 20 males and 10 females.
Majority of the patients in the control group were above 51 years old, accounting for 9 patients (30%) whereas in the experimental group 9 patients (30%) belonged to ≤30 age group, while 6 (20%) were between the ages of 31 and 40. Males constituted the majority of the subjects in both the control and experimental groups. In the control group, 25 (83.3%) samples had a family history of hypertension, while in the experimental group, 21 (70%) samples had a history of hypertension (Table/Fig 1).
The pretest SBP and DBP between the experimental and control groups were comparable with p>0.05 (Table/Fig 2). There was a significant decrease in the SBP post abdominal exercise in the experimental group when compared to the control group (p=0.01). In experimental group post-test 3 IQR (10.0) was much less than the control group (12.50) and Z value was -5.39 and the obtained p values was<0.05 hence there was a difference in SBP. In experimental group DBP on post-test 3 was 85.0 mmHg and in control group it was 96.0 mmHg with Z value -5.13 and the obtained p value was <0.05 (Table/Fig 3).
The pretest pulse rate between the experimental and control groups were comparable with p>0.05 (Table/Fig 4). In post-test 3, the Z value was -2.78 and the obtained p values was 0.05, hence there was significant difference in PR (Table/Fig 5).
There was no significant difference (p=0.39) in the pretest values of RR between both the groups (Table/Fig 6). In experimental group for post-test3 IQR (4.50) was much less than the control group (6.0), Z value was -4.0 and the obtained p value was< 0.05 hence there was significant difference in RR (Table/Fig 7).
The Friedman Rank test was used to assess the effectiveness of abdominal breathing exercise on biological parameter among hypertensive patients on pre-test and post-test of each group. In the experimental group, the mean post-test value of systolic BP (133.3±11.2) p=0.01 was much less than the control group (150.3±8.89) p=0.112. The mean post-test value of diastolic blood pressure (85.0±6.82) p=0.01 in the experimental group was much less than the control group (96.0±6.21) p=0.641. In experimental group, the mean post-test value of HR (72.8±10.1) p=0.01 was significantly lower than the control group (79.8±8.38) p=0.01 and in experimental group, the mean post-test value of respiration rate (22.3±4.33) p=0.01 was lower than the control group (26.9±4.09) p=0.01. This indicated the effectiveness of abdominal breathing exercise on BP, HR and RR among hypertensive patients (Table/Fig 8).
There was no significant association between the blood pressure, pulse rate, respiration rate and the demographic variables such as age, gender, education, occupation, type of family, diet, family history of HTN, duration of illness in both experimental and control group (p>0.05). However, increased pulse rate was associated with smoking history in experimental group with p=0.03.
Abdominal breathing exercise activates the parasympathetic nervous system which decreases the HR and dilates blood vessels, reducing overall BP (12). The present study showed that post-test mean score of SBP, Sent DBP, PR and RR in the experimental group was significantly lower than that of the control group. This showed that abdominal breathing exercise was effective in reducing BP, PR and RR.
The above findings were supported by a study conducted by Samson, who discovered that abdominal breathing exercise is particularly efficient in lowering blood pressure (12). It was also corroborated by a study by Mourya M. et al, which found that both slow and fast breathing exercises benefit individuals with hypertension, although slow breathing had a stronger effect (13).
In the present study, in experimental group 9 (30%) of the patients were under 30 years old, while in the control group, the majority of the patients were over 51 years old, 9 (30%). Another study conducted by Lovikali K, to assess the effectiveness of abdominal breathing exercise among patients with hypertension revealed that majority of the patients were over age group of 51 years (14). Comparison of similar studies has been done in (Table/Fig 9) (12),(13),(15),(16).
The present study showed that abdominal breathing exercise helped to decrease BP, HR and respiration rate among hypertensive patients.A similar study was conducted in Faridkot, Punjab to assess the abdominal breathing exercise on BP among hypertensive patients found that In experimental group mean value of BP (104.6±3.69) was much less than the control group (116.5±6.3). As per t-test there was a significant difference in BP on post-test 2 (t=2.293 and p=0.02) (16). The experimental group's mean post-test of biological parameter reading (p<0.05) was significantly lower than the control group’s. A similar study was conducted by Saxena T and Rajeev K, revealed that the mean value of the pretest was 116.7±7.57 and mean value of post-test is 111.16±7.41. From this it is inferred that there will be a significant difference in the BP after doing breathing exercise, hence there was an effectiveness of abdominal breathing exercise on BP among hypertensive patients (17).
There was no significant association found between the biological parameter and demographic variables such as gender, education, family history of hypertension, habits and duration of illness in both groups except age,occupation and diet in control group. This was also supported by a study conducted by Kaur A et al., it shows that there was no significant association of BP with gender, education, occupation, duration of hypertension, habits and diet (16).
Limitation(s)
The effectiveness of the interventions was assessed for a shorter duration (one week), and the sample size was minimal (60) which imposed limits to larger generalisation.
Abdominal breathing exercise was helpful in lowering BP, HR, and RR based on the findings of the study. As a result, daily abdominal breathing exercises are recommended to assist maintain a normal BP level. This study found no association between the biological parameter and demographic variables such as gender, diet, family type and family history of hypertension. In hypertensive patients, abdominal breathing exercise is an effective complementary therapy for lowering BP, HR and RR. It can be concluded that similar study can be replicated on a large sample in a different setting to strengthen the findings. A study can be conducted to assess the factors which influence in hypertension.
Authors are thankful to the authorities of Yenepoya Medical College Hospital Deemed to be University for providing all the technical and other support for the completion of this research work.
DOI: 10.7860/JCDR/2022/53194.16572
Date of Submission: Nov 08, 2021
Date of Peer Review: Jan 15, 2022
Date of Acceptance: May 02, 2022
Date of Publishing: Jul 01, 2022
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
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