AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/2639-4162/001
1 Department of Applied Nutrition, Faculty of Livestock, Fisheries and Nutrition, Wayamba University of Sri Lanka, Makandura, Gonawila (NWP), Sri Lanka.
2 Dr. Neville Fernando Teaching Hospital, Sri Lanka.
*Corresponding Author: AMNT Adikari, Department of Applied Nutrition, Faculty of Livestock, Fisheries and Nutrition, Wayamba University of Sri Lanka, Makandura, Gonawila (NWP), Sri Lanka.
Citation: Adikari AMNT, Madumali KAC, Perera ULDS, Improving Nutritional Status of Malnourished Bedridden Patient Diagnosed with Deep Vein Thrombosis and Pulmonary Embolism: A Case Study Approach. J General Medicine and Clinical Practice, Doi: 10.31579/2639-4162/001
Copyright: © 2018. Adikari AMNT. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 05 July 2018 | Accepted: 27 July 2018 | Published: 20 August 2018
Keywords: Bed ridden patients; Malnutrition; Nutritional management; Nutrition supplements
Malnutrition is common among hospitalized bed ridden patients. Nutritional management of hospitalized patients is a necessity in order to improve their nutritional status and disease conditions. The objectives of nutritional management of malnourished bedridden patient diagnosed with deep vein thrombosis and pulmonary embolism were to improve nutritional status of the patient through gradual provision of calorie and protein intake, to improve body protein status and control muscle wasting. Nutritional status was assessed by anthropometric, biochemical, clinical and dietary information. SGA was used to assess the malnutrition status of the patient. Since the patient was severely malnourished, she was fed with NG feeds followed by PEG feeds by gradually increasing calorie and protein up to the target level mainly through nutritional supplements for the one and half months of hospital stay. Patient’s serum protein, albumin levels and muscle mass were improved. According to the SGA, the patient was at normal/ well-nourished condition after nutrition management. Dietary management incorporating nutrition supplements indicated improvement of nutritional status of severely malnourished bedridden patient.
ASPEN: American Society for Parenteral and Enteral Nutrition
CRP: C - Reactive Protein
DRM: Disease Related Malnutriiton
DVT: Deep Vein Thrombosis
GI: Gastrointestinal
MNT: Medical Nutrition Therapy
MUAC: Mid Upper Arm Circumference
NG: Nasogastric
PE: Pulmonary Embolism
PEG: Percutaneous Endoscopic Gastrostomy
RFS: Refeeding Syndrome
SGA: Subjective Global Assessment
Disease-related malnutrition (DRM) is a highly prevalent disease within the hospital environment (Morán López et al., 2016). It is associated with a worse clinical outcome, longer hospital stay and higher costs (Bonilla-Palomas et al., 2016). Malnutrition leads to a range of poor clinical outcomes (Charlton et al., 2012). Malnourished patients who did not receive any nutritional intervention experienced further deterioration in nutritional status in the seven days following admission (McWhirter & Pennington, 1994). Malnutrition increases the risk of developing infection and pressure ulcers (Banks et al., 2010a). Improving nutritional status of these patients is essential for rapid cure, reduce hospital stay and reduce the cost.
Deep vein thrombosis (DVT) is the formation of blood clots (thrombi) in the deep veins. It commonly affects the deep leg veins (such as the calf veins, femoral vein, or popliteal vein) or the deep veins of the pelvis (Emeka et al., 2011). Despite adequate therapy, 1% to 8% of patients in whom pulmonary embolism develops will die, whereas others will experience long-term complications such as postphlebitic syndrome (40%) and chronic thromboembolic pulmonary hypertension (4%) (Scarvelis and Wells, 2006). Compared with DVT, pulmonary embolism is more often fatal, has a higher recurrence rate, and presents with less specific symptoms. Pulmonary embolism is usually a consequence of DVT (Wilbur and Shizan, 2012).
This case study focuses on nutritional management of hospitalized malnourished bed ridden patient with DVT and PE.
Materials and Methods
Case details: A 59 years old woman was diagnosed with deep vein thrombosis in left calf and bilateral pulmonary embolism. She had past history of right side arterio-venous malfunction, bronchial asthma, ischemic heart disease. She was unconscious at the time of admission. Before admission to the hospital, she had been admitted to another hospital and on NG feeds for two months.
Nutrition assessments
Anthropometric Assessments
Estimated body weight and height were 50 kg and 153 cm, respectively and mid upper arm circumference (MUAC) was 23.0 cm. Changes of MUAC throughout the hospital stay is shown in table 1.
Biochemical Assessments
Biochemical parameters of the patient were taken before and during the nutritional management is shown in table 2.
Clinical Assessments
The patient was unconscious. Edema was not present throughout the hospitalized period. Clavicle and Acromion bone region muscles and interosseous muscles of dorsal hand were wasted.
Dietary Assessments
She could not take food orally. She was on NG feeds at the time of hospitalization. She had recurrent vomiting and less food intake since two months.
Medical management (Drugs):
Omeprazole, FeSO4, Warfarin, Meropenem, Metoclopramide
Nutrition diagnosis
This patient was severely malnourished related to poor food intake for about two months as evidence by SGA nutrition assessment (annexure 1),
reduced serum albumin and protein levels and reduced mid upper arm circumference which was closer to margins of cut off value (<22.0 cm). The patient is slightly anemic as seen by her hemoglobin levels.
Goals of MNT
Dietary management during the hospital stay
The patient was at risk of refeeding syndrome since she was in malnourished category and did not have adequate food intake for a long time. The targeted calorie and protein requirement was 2000kcal and 100g (2g per kilo gram of body weight), respectively. But, enteral nutrition was recommended starting with low amount of calorie and protein in order to prevent from refeeding syndrome. Gradually, energy and protein levels were increased up to the target. On the day of admission usual hospital NG feeds were given and patient specific NG feeds were started from second day. After one week of NG feed PEG feeds were started and continued by gradually increasing energy and macro nutrients as show in table 2.
Initially, the patient was fed with patient specific NG feeds with follow up supervision of the dietitian. Since she had tolerated usual hospital NG feed with 1000 kcal energy, 1g/kg of body weight protein, and 200 ml volume per feed, her NG feed contained 1500 kcal per day and volume per feed was 150-200ml. Energy density was maintained as 1 kcal /ml and protein given as 1.2 g/kg of body weight. Her normal energy requirement was given with higher protein content with this NG feed. Energy and protein intake was increased gradually, since she needs high energy and protein to recover from malnutrition.
She was fed with two hourly from 6.00 am to 12.00 pm with ten feeds. Fluid intake was decided by discussing with physician and observing her urine output. Around 2000 ml of fluid could be given to her from feeds and part of that fluid was given with the feeds and remaining was given as water.
After one week of admission, PEG feeding was started. 1st PEG plan was started with very low feed volume and energy level. Since PEG tube was inserted at around 12.00 pm, feeding was started after about 4 hours of insertion and only five feeds could be given on that day. Initial feeding volume was 50 ml and the patient was closely monitored to check the tolerability of the feed. From the 2nd day onwards of the PEG insertion, ten feeds were given for a day. Fluid volume was increased as 50ml, 100 ml, 150 ml, 175 ml and finally 200 ml. Along with increased fluid volume, calorie level was gradually increased as 200 kcal, 1000 kcal, 1500 kcal, 1750 kcal and finally 2000 kcal was continued until patient gets complete recovery. Energy density was maintained as 1kcal/ ml or less in initial feeds and it was 1-1.2 kcal/ml in last feeds. Initially protein was given as 1.2 g/kg of body weight with NG feed and 2nd PEG feed. Thereafter, it was increased gradually as 1.4 g/kg, 1.7 g/kg and finally 2g/kg was continued until the recovery.
Nutrition supplements were suggested as main food item in all the meal plans. Only two or three kitchen feeds were given for a day and rest were given by nutrition supplements. High energy formula (Pentasure (2.0) and sustacal) were suggested as nutrition supplements for the patient since they are specially produced for the patients who need high calorie amounts.
There was a negative nitrogen balance due to high protein catabolism than protein synthesis. Her CRP level was not much high (~13.6). Therefore serum albumin level was taken as an indicator of body protein status. Her serum albumin and total protein levels were lower than normal values on admission. Gradual increase of dietary protein level was effective to reach the target protein intake (2 g/kg). Her improvement could be observed by increased serum albumin levels and mid upper arm circumference in 15 days period (See 2). Serum albumin level was increased from 2.31 to 3.08 after one month and to 3.35 after 1 ½ months of admission as shown in figure 1.
Improvement of serum total protein level is shown in figure 2.
The mid upper arm circumference was increased from 23 cm to 25.5 cm after one month of admission through nutrition care process ( see table 1). This indicates that the patient’s body protein level has been increased to normal range and muscle mass has been increased by provision of high protein and high calorie diet. Patient was in normal/ well-nourished category according to the SGA after nutrition management (annexure). Patient was conscious and started to take foods orally after one and half months nutritional care process.
Many studies have shown that patient outcomes can be improved with adequate nutrition support (Smedley et al., 2004). There is a large and growing body of evidence to show that nutrition support is effective and leads to improved nutritional status and clinical outcomes in malnourished patients. Adequate nutrition is essential to the bed ridden malnourished patients to help anabolism and control catabolism to maintain proper immune system and speed up disease recovery. If dietary intake is not able to meet requirements, oral supplementation is the next line of treatment, followed by tube feeding and finally, if the gut is not working and there is contraindication to feed enterally, parenteral nutrition can be explored (Thomas, 2001). The patient was hemodynamically stable and had a functioning gastrointestinal tract. Thus enteral nutrition was best to provide adequate nutrition to her.
Subjective Global Assessment (SGA) is well accepted as an assessment tool in clinical practice (Lochs et al., 2006). It has been regarded by ASPEN as the best nutrition assessment tool and one of the only two tools (the other one being MNA) recognised as an assessment tool (A.S.P.E.N. Board of Directors and the Clinical Guidelines Taskforce, 2002). It is an easy, non-invasive and inexpensive tool for widespread use by trained clinicians or dietitians (Keith, 2008). Subjective Global Assessment has been widely accepted and used as a diagnostic tool for malnutrition, to track clinical outcomes and as a reference standard to validate nutrition screening tools (Steenson et al., 2013). Hence SGA was the tool that used to assess malnutrition of the patient. This patient did not have any chronic disease condition related to the diet but she was severely malnourished as assessed by subjective global assessment (SGA). Hence nutrition management was focused towards improvement of her nutrition to correct malnutrition condition, micronutrient deficiencies with improved immune system and improve body protein status.
Diet plans were prepared to avoid over feeding, provide adequate energy, protein, carbohydrates, vitamin, mineral and fluids as her requirements. All nutrients were provided gradually by observing her improvements of conditions and clinical features. She requires high amount of energy, protein and other macro and micronutrients. But, they cannot be given suddenly because of refeeding syndrome (RFS). RFS may occur usually in malnourished patients undergoing re-feeding after a period of under nutrition (Rio et al., 2013). Hospitalized patients with risk of malnutrition demonstrate significant risk of RFS (Pourhassan et al., 2017). As malnutrition is the main risk factor for RFS, routine malnutrition screening should also screen for risk of RFS (Boland et al., 2013). The syndrome is complex and may feature hypophosphatemia, abnormal sodium and fluid balance; changes in glucose, protein and fat metabolism’ thiamine deficiency; hypokalemia and hypomagnesaemia (Mehanna et al., 2008). Therefore it was suggested that this patient is at risk of RFS anf energy and all the nutrients were provided gradually.
During feeding tolerance was determined by physical examination, passage of stool and vomiting conditions. GI intolerance is usually defined by vomiting, abdominal distention, complaints of discomfort, high NG output, high GRV, diarrhea, reduced passage of flatus and stool, or abnormal abdominal radiographs (ASPEN, 2016). If the patient do not tolerate the feed, diarrhea and vomiting can be occurred. Initially she had diarrhea, but after one- two days she tolerated the feed since she was given metoclopramide drug. Metoclopramide drug was very much important to tolerate the feed for the patient. Metoclopramide increases the lower oesophageal sphincter pressure, gastric tone, forward peristalsis of the stomach and the duodenum, while simultaneously decreasing pyloric sphincter pressure. These mechanisms accelerate gastric emptying, reduce gastric stasis and residual volume, and thus decrease gastroesophageal reflux (Warusevitane et al., 2014). This reduced the vomiting condition of the patient and helped to patient to tolerate the feed.
Protein is very important to increase the response of immune system, increase muscle mass which loss during illness and prevent from protein energy malnutrition. If patient do not receive adequate protein, she may be at risk of getting infections, increased synthesis of acute phase proteins (CRP, Fibrinogen), reduced gut functions muscle wasting and decreased functions of respiratory muscles (Hoffer & Bistrian, 2014). In the final meal plan she was given 2 g/kg of protein and was continued without further increment. Protein requirements are expected to be in the range of 1.2–2.0 g/kg actual body weight per day in critically ill patients except in burn or multitrauma patients. Providing proteins higher than 2 g/kg per day do not give additional benefits unless in burn or multitrauma patients (ASPEN, 2016). Therefore final protein level was 2 g/kg/ day and continued until complete recovery by observing renal function. Serum creatinine, blood urea nitrogen, uric acid levels were assessed to know the protein metabolism in the body and to measure whether the protein intake is excessive for the patient. Carbohydrates and fat was given as normal requirements in initial meal plans. After that fat content was little increased with reduced carbohydrate level. Fat is a good source of energy dense foods. Energy dense foods are very important to patients who are fed with enteral nutrition in order to provide adequate nutrition along with given fluid amount.
Studies have shown that judicious use of nutrition supplements can improve weight, protein and energy intake, nutritional status, physical function, quality of life and length of stay in acute care (Dietitians Association of Australia, 2009)
Nutrition supplements are the best sources to provide adequate nutrition for tube feeding patients. Supplements contain almost all the macronutrients and micronutrients in correct proportions. The osmolality of supplements are similar to the blood osmolality value which is around 300 mOsm /kg and 300-350 mOsm /kg in supplements are considered to be iso-osmolar. As well as these products have been produced under hygienic conditions and it requires less contribution to be prepared and give to the patient. Then the risk of contamination is less when compared to kitchen feeds. The risk of getting infection is high with kitchen feeds since they are prepared under less hygienic conditions. Further the osmolality cannot be controlled and measured in those kitchen feeds and normally osmolality value is high in them. All the nutrients in the food cannot be extracted to the feed though it is blended and filtered. Hence the energy density and nutrient content is low in kitchen feeds and unable to provide required nutrition with given feed volume. With the consideration of all these reasons, supplements are the best source to provide adequate nutrition for patients.
This is one of the few cases that reports the applying the nutrition care process for malnourished bed ridden patient. Energy, protein, feeding mode, feeding volume, tolerability, refeeding syndrome, type of food sources were several factors to be considered when planning nutrition care process for these people. Nutritional status of malnourished patient of this case was improved along with high energy and high protein diets provided mainly by commercial nutrition supplements through enteral feeding.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
