The Prevalence of Comorbidities and Associated Factors among Patients with Dementia in the Indian Setting: Meta-analysis of Observational Studies.

Background: Patients with dementia usually have multiple comorbidities. The presence of comorbidities may exacerbate the progression of dementia and decreases the patient's ability to participate in health maintenance activities. However, there is hardly any meta-analysis estimating the magnitude of comorbidities among patients with dementia in the Indian context. Methods: We searched PubMed, Scopus, and Google Scholar, and relevant studies conducted in India were included. The risk of bias was assessed and a random-effects meta-analysis model was used in which I2 statistics were calculated to measure heterogeneity among studies. Results: Fourteen studies were included in the meta-analysis based on the inclusion and exclusion criteria. Altogether, we found the coexistence of comorbid conditions such as hypertension (51.10%), diabetes (27.58%), stroke (15.99%), and factors like tobacco use (26.81 %) and alcohol use (9.19%) among patients with dementia in this setting. The level of heterogeneity was high due to differences in the methodologies in the included studies. Conclusions: Our study found hypertension as the most common comorbid condition among patients with dementia in India. The observed lacuna of methodological limitations in the studies included in the current meta-analysis provides the urgent need for good quality research to successfully meet the challenges ahead while devising appropriate strategies to treat the comorbidities among patients with dementia.

Why Do Manuscripts Get Rejected? A Content Analysis of Rejection Reports from the Indian Journal of Psychological Medicine.

Background: A proportion of manuscripts submitted to scientific journals get rejected, for varied reasons. A systematic analysis of the reasons for rejection will be relevant to editors, reviewers, and prospective authors. We aimed to analyze the reasons for rejection of manuscripts submitted to the Indian Journal of Psychological Medicine, the flagship journal of Indian Psychiatric Society South Zonal Branch. Methods: We performed a content analysis of the rejection reports of all the articles submitted to the journal between January 1, 2018, and May 15, 2020. Rejection reports were extracted from the manuscript management website and divided into three types: desk rejections, post-peer-review rejections, and post-editorial-re-review rejections. They were analyzed separately for the rejection reasons, using a predefined coding frame. Results: A total of 898 rejection reports were available for content analysis. Rejection was a common fate for manuscripts across the types of submission; figures ranged from 26.7% for viewpoint articles to 72.1% for review articles. The median time to desk rejection was 3 days, while the median time to post-peer-review rejection and post-editorial-re-review rejection was 42 days and 96 days, respectively. The most common reasons for desk rejection were lack of novelty or being out of the journal's scope. Inappropriate study designs, poor methodological descriptions, poor quality of writing, and weak study rationale were the most common rejection reasons mentioned by both peer reviewers and editorial re-reviewers. Conclusions: Common reasons for rejection included poor methodology and poorly written manuscripts. Prospective authors should pay adequate attention to conceptualization, design, and presentation of their study, apart from selecting an appropriate journal, to avoid rejection and enhance their manuscript's chances of publication.

Trust but verify: An analysis of redundant publications from two major psychiatry journals in India.

Background: No analysis of redundant or duplicate publications, deemed unethical and unscientific, has been undertaken in psychiatric literature. Aim: To analyze the proportion and patterns of redundant publications associated with index articles published in two major Indian psychiatry journals. Methods: Index articles were original papers published in the Indian Journal of Psychiatry and the Indian Journal of Psychological Medicine between 2015 and 2017. Using a systematic search strategy that combined author names and article keywords, we combed the literature to identify and characterize redundant publications related to these index articles. Redundant publications were classified into one of the following categories using a priori definitions: dual, suspected dual, salami slicing, meat extender, and extended sample publication. Results: From 324 index articles screened, a total of 27 articles (8.4%) were identified to have 32 associated redundant publications of the following types: dual (n = 3), suspected dual (n = 2), salami slicing (n = 22), meat extender (n = 3), and extended sample publication (n = 2). A majority of the redundant articles (n = 23, 71.9%) failed to clearly cross-reference the prior publication(s). We also identified nine non-redundant but related publications with no proper cross-referencing in five of them. Conclusion: Redundant publications are a common practice in the psychiatry journals screened. Salami slicing is the most common form of redundancy, with no proper cross-referencing in most cases. Concerted efforts are needed to detect and deal with this concerning practice that undermines both science and ethics.

Fate of Manuscripts Rejected by a Specialty Psychiatry Journal: A Retrospective Cohort Study.

Background: Little is known about the publication outcomes of submissions rejected by specialty psychiatry journals. We aimed to investigate the publication fate of original research manuscripts previously rejected by the Indian Journal of Psychological Medicine (IJPM). Methods: A random sampling of manuscripts was drawn from all submissions rejected between January 1, 2018, and December 31, 2019. Using the titles of these papers and the author names, a systematic search of electronic databases was carried out to examine if these manuscripts have been published elsewhere or not. We extracted data on a range of scientific and nonscientific parameters from the journal's manuscript management portal for every rejected manuscript. Multivariable analysis was used to detect factors associated with eventual publication. Results: Out of 302 manuscripts analyzed, 139 (46.0%) were published elsewhere; of these, only 18 articles (13.0%) were published in a journal with higher standing than IJPM. Manuscripts of foreign origin (odds ratio [OR] 1.77, 95% confidence interval [CI] = 1.06-2.97) and rejection following peer review or editorial re-review (OR 2.41, 95% CI = 1.22-4.74) were significantly associated with publication. Conclusion: Nearly half of the papers rejected by IJPM were eventually published in other journals, though such papers are more often published in journals with lower standing. Manuscripts rejected following peer review were more likely to reach full publication status compared to those which were desk rejected.

Quality of peer review reports submitted to a specialty psychiatry journal.

BACKGROUND: Though peer review is at the heart of scholarly publishing, peer review reports are not commonly investigated. We aimed to analyse the quality and structure of review reports submitted to the Indian Journal of Psychological Medicine (IJPM). METHODS: We systematically analysed the structure, tone, and quality of peer review reports of all original articles submitted to the journal between January 1, 2018 to May 15, 2020. Quality assessment was done using the 8-item Review Quality Instrument (RQI). RESULTS: A total of 527 review reports from 291 original articles were analysed. More than two-thirds of review reports were provided as inline comments (n = 368, 69.8 %). Most of the review reports were not well-structured; only a few provided a summary (n = 64, 13.2 %) or divided the comments into major and minor ones (n = 12, 2.5 %). Nearly a quarter had negative wordings (n = 117, 24.1 %) and a minority had a frankly unprofessional tone (n = 43, 8.8 %). The global rating was "poor" (n = 266, 50.5 %) or "below average" (n = 203, 38.5 %) for most reports. CONCLUSION: Most of the peer reviews submitted to the IJPM were not structured and obtained low scores on the RQI domains. Concerted efforts are needed to improve the quality of peer reviews and to provide training for reviewers.

The Relevance of Telemedicine in Continuing Medical Education.

Continuing medical education (CME) is essential for medical practitioners to update their knowledge and skills periodically to provide clinical care in keeping with the evidence available. Traditional methods of CME such as workshops, conferences, and seminars are helpful to bridge the gaps in practice. With advancing technologies, online format is used to deliver CME with appropriate modifications. Although there are distinct advantages of online CME in regards to wider reach and flexibility, there are certain drawbacks beyond just technological limitations. Interactivity using ingenious ideas may be required to motivate and engage learners during online CME.

Designing and Conducting Knowledge, Attitude, and Practice Surveys in Psychiatry: Practical Guidance.

Knowledge, attitude, and practice (KAP) surveys are popular in health care because they provide useful information and appear easy to design and execute. There are subtleties, however, in such surveys that early career researchers need to be aware of. This article does not provide a detailed review of the subject, nor does it address theory; rather, it provides practical guidance on matters such as identifying the need for the survey; defining the target population; preparing the questions that address knowledge, attitudes, and practice; preparing options for the answers to the items in the questionnaire; deciding how to score the instrument and analyze the results; and validating the instrument. Specific examples are presented to help readers understand and apply the guidance in various contexts.

Discharge planning and Mental Healthcare Act 2017.

Mental Healthcare Act 2017 mandates that proper discharge planning should be done and documented before any discharge is done from MHEs. Discharge planning should be based on a thorough assessment of the needs of the patient. Family should be actively involved in the planning process. Necessary steps should be taken for referral to other services, especially those in the community. Discharge planning helps us to balance the goals of the treatment at admission, to reality check at the time of discharge. Adequacy of discharge planning can be ensured by using various published checklists.

Newer documentary practices as per Mental Healthcare Act 2017.

Medical records form an integral part of patient care. Proper documentation and its maintenance are mandatory as part of the law. It is essential for a treating doctor to document the required details to avoid allegations of negligence. Proper documentation will not only help us to prove that particular services were provided but can also serve as a tool for communication with other professionals. This article draws together the standards and suggests some good clinical practices as per the Mental Healthcare Act 2017.

Metabolic syndrome in first episode schizophrenia - a randomized double-blind controlled, short-term prospective study.

BACKGROUND: Although the treatment of schizophrenia, arguably one of the most devastating diseases today, has been immensely helped by the advent of second-generation antipsychotics, they have come at a considerable cost - the metabolic syndrome (MetS). This adverse effect has been described with several antipsychotics to range between 20%-60%, at least double the prevalence in the general population. METHODS: All consecutive patients with first episode schizophrenia at our referral psychiatric hospital were recruited in an extensive prospective randomized, double-blind controlled study including measures of waist circumference (WC), blood pressure (SBP/DBP), triglyceride (TGL), high-density lipoproteins (HDL) and fasting blood sugar (FBS) levels and randomized to receive either, haloperidol, olanzapine or risperidone. The prevalence of MetS was assessed based on two criteria- ATP IIIA and criteria of International Diabetes Federation (IDF). This was compared with a gender, age, exercise and diet matched healthy control group. RESULTS: The analysis of 99 patients showed a prevalence of MetS as 10.1% and 18.2% as assessed by ATP IIIA and IDF criteria respectively. The prevalence of MetS in our sample of patients with schizophrenia is at least five times as high when compared to the matched healthy control group. Olanzapine had maximum prevalence of MetS at 20-25% followed by risperidone at 9-24% and haloperidol at 0-3%. DISCUSSION: Metabolic syndrome is highly prevalent among treated patients with first episode schizophrenia. Early monitoring of patients on atypical antipsychotics can possibly play an important role in early detection and hence prevention of the metabolic syndrome.

Quality of the Reviews Submitted by Attendees of a Workshop on Peer Review.

OBJECTIVE: The objective of the study was to study the methodological quality and error detection of the review by the participants of a peer review workshop. METHODS: All participants of the workshop were invited to peer review a randomized controlled trial. The manuscript was E-mailed to them after introducing eight deliberate errors to it. Specific instructions and a deadline were provided. All the reviews were analyzed using review quality instrument (RQI). Furthermore, the rate and the type of errors identified were recorded. RESULTS: Of 25 participants, 16 (64%) returned the reviews. The mean total score on RQI was 4.12 (standard deviation 0.70, 95% confidence interval 3.74-4.50); the items which most reviewers did not discuss where the importance of research question and originality of the paper. The number of errors correctly identified varied from 0 to 6 (median 3), the most common being a wrong conclusion (87.5%), randomization procedure (50%), written informed consent (50%), ethics committee approval (42.8%), and masking (31.2%). Only 5 (31.2%) gave an overall recommendation on whether the manuscript should be accepted or not. CONCLUSIONS: Major errors were readily identified by the reviewers; however, the need for training was felt in some areas in which the review quality was modest.