AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/2767-7370/024
1 Dilusha Consultant, Norflok & Norwich University Teaching Hospital. UK.
2 Locum SpR, Norflok & Norwich University Teaching Hospital. UK.
3 Clinical Fellow, Norflok & Norwich University Teaching Hospital. UK.
*Corresponding Author: Emmanuel Tigalya, Norflok & Norwich University Teaching Hospital. UK.
Citation: Lamabadusuriya, Emmanuel Tigalya, and Yasmine Karachiwala (2021), Investigation of Anaemia in Geriatric patients Admitted to Norfolk & Norwich University teaching Hospital Old People’s Medicine/Geriatric Department, J. New Medical Innovations and Research, 2(5): DOI: 10.31579/2767-7370/024.
Copyright: © 2021 Emmanuel Tigalya. 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 October 2021 | Accepted: 12 October 2021 | Published: 20 October 2021
Keywords: anaemia; geriatric patients; low HB; iron level check; ferritin
Aims
To assess if anaemia detected in geriatric patients admitted to the Old Peoples Medicine Department at Norfolk and Norwich University Teaching Hospital was investigated with appropriate laboratory tests- haematinics and iron level tests.
Also increase awareness among doctors of the high prevalence of anaemia in geriatric patients and the need to investigate to start treat if indicated.
Target population or scope
All patients aged 80 and above admitted under the care of NNUH OPM department on a given day incidentally found to have anaemia.
Criteria
All over 80 year olds admitted to hospital found incidentally to have low HB (anaemia) should be investigated by having elemental iron level and haematinic checks;
Target population or scope
All patients aged 80 and above admitted under the care of NNUH OPM department on a given day incidentally found to have anaemia.
Aims
To assess if anaemia detected in geriatric patients admitted to the Old Peoples Medicine Department at Norfolk and Norwich University Teaching Hospital was investigated with appropriate laboratory tests- haematinics and iron level tests.
Also increase awareness among doctors of the high prevalence of anaemia in geriatric patients and the need to investigate to start treat if indicated.
Criteria
All over 80 year olds admitted to hospital found incidentally to have low HB (anaemia) should be investigated by having elemental iron level and haematinic checks;
Although the mean corpuscular volume (MCV) and red cell width (RDW) should guide which investigations should be ordered in anaemia +/- macrocytosis, the accepted practice at NNUH is for haematinics to be ordered for all elderly anaemic patients on admission if not recently checked.
Standards
A standard is the proportion of patients who meet the criterion.
98% of all anaemic geriatric patients should have haematinics and iron levels checks when the low Hb is detected. This can be arranged by GPs or during hospital admission.
A 2 % slippage is allowed to account for patient who are anaemic but don’t attend hospital regularly because they are well.
From the OPM PAS list of 247, patient admission FBC- blood tests archived in the ICE database of NNUH hospital laboratory department belonging to anaemic over 80 year old patients were identified and reviewed to check if haematinics and elemental level tests were ordered by doctors after initial FBC tests indicated a low Hb (anaemia).
*OPM PAS list is the list of all admitted patients under the OPM department on a given day.
*Haematinics in this audit included only Vitamin B12, folate and Ferritin
Anaemia was defined based World Health Organization (WHO) – defined anaemia as (haemoglobin < 12>
This is usually stated as the proportion meeting the criteria and compared that against the standard set.
Overall from our evaluation of the laboratory results of the 247 patients on the PAS list, 166 were found to be anaemic as opposed 81 who were not anaemic. Therefore 67% of patients admitted under OPM on a given day could be classed as anaemic.
Of the 166 anaemic patients only 94 patients (56%) were further investigated under any of the 3 criteria, this is much below the standard set (98%). Further analysis of the 94 investigated anaemic patients revealed that 32 (34%) patients met criterion 1 (had iron level checks), 45 (47.9%) patients met criterion 2 (had Vitamin B12& Folate level checks) and 17 (18.1 %) patients met criterion 3 ( had Ferritin level checks).
Total Number of Anaemic Patients | Number of Anaemic Patients investigated further for anaemia | Number of Anaemic Patients not investigated anaemia further |
N | 94 (56.6%) | 72 (43.4%) |
Table. 1. Proportions of Anaemic Patients in the Audit who were further investigated or not further investigated. Total of Anaemic patients (N) was 166.
Criterion | Number of Patient meeting criteria | Percentage |
1- had Iron level checked | 32 | 34.0% |
2- had Vitamin B12 and folate checked | 45 | 47.9% |
3- had Ferritin checked | 17 | 18.1 % |
Table .2. Number of Patients meeting each criterion
Norwich & Norfolk University Teaching Hospital has one of the largest Old People’s Medicine department in UK with a capacity of over 300 inpatients at any given day and so this presented us with an excellent opportunity to audit the detection and management of anaemia in geriatric patients admitted to the hospital.
The elderly is an important demographic population that is growing globally especially in the western world, in this demographic of anaemia is now recognized as a risk factor for a number of adverse outcomes even when the anaemia is mild. Adverse outcomes include decreased physical performance, increased number of falls, increased frailty, decreased cognition, increased dementia, increased hospitalization and increased mortality [1-4].
The prevalence of anaemia is now known to increase with increasing age, in a cross-sectional, retrospective analysis that included all inpatients and outpatients aged ³64 years with complete blood counts treated at Innsbruck Medical University Hospital in Austria between October 1, 2004 and September 29, 2005 (n19,758, median age 73 years), Based on World Health Organization criteria of anaemia, 21.1% of these patients were anaemic, i.e, 30.7% and 37.0% at 80years and 90years, respectively. The prevalence of anaemia was significantly correlated with advanced age (r0.21; P<0>P<0>
Anaemias based on iron, folate, and/or vitamin B12 deficiency form one the three major pathophysiological categories of anaemia. Past studies for example The NHANES III that used fixed laboratory measures determined that about one third of geriatric anaemic patients had anaemia caused by nutritional deficiency primarily that of iron, one third anaemia was associated chronic inflammation or chronic kidney disease (CKD); and one third had unexplained anaemia [1-4] (figure 1).
Lack of iron is by far the most frequent nutritional deficiency anaemia. Similar to folate deficiency, iron depletion is often associated with malnutrition. Age dependent alterations in function of GI tract, polypharmacy, and social isolation may lead to malnutrition and subsequent anaemia. Up to 36% of a general geriatric medical population have absolute iron deficiency as a form nutritional deficiency.
In clinical practice it is important to consider bleeding due to a variety of medications (eg, acetylsalicylic acid, standard or direct oral anticoagulants) or GI diseases, including GI malignancy as a frequent cause of iron deficiency anaemia (IDA) in older patients through chronic blood loss.
Thus, apart from iron re- placement therapy, a careful GI diagnostic workup is mandatory to define a possible site of blood loss in these patients.
Iron-restricted erythropoiesis can cause Iron deficiency anaemia due to an absolute iron deficiency; i.e underlying problems in iron sequestration which is mediated by hepcidin; and/or a functional iron deficiency due to blunted erythropoietin-stimulated erythropoiesis.
Deficiency in Vitamin B12 or folate can also result in deficiency anaemias. The cause may be due to dietary deficiency in malnutrition, malabsorption, or lack of folate supplementation for example in pregnancy. Malnutrition in association with alcohol abuse may result in folate deficiency. Medication such like anticonvulsants and methotrexate can also cause folate deficiency.
Pernicious anaemia is a classic example of vitamin B12 deficiency anaemia which can be accompanied by neurological symptoms that resolve with vitamin B 12 replacement. Helicobacter pylori infection, acid-reducing drugs such as omeprazole and atrophic gastritis may cause hypochlorhydria leading to a food-cobalamin malabsorption syndrome, for this reason including folate and B-12 measurement in basic laboratory screening for elderly anaemic patients is important.
In anaemic patients with chronic inflammation, when serum ferritin and transferrin saturation values are inconclusive and there is a lack of response to iron therapy, a diagnosis of the anaemia of inflammation or unexplained anaemia of the elderly (UAE) can be given. Aging has been associated with increasing levels of IL 6 which in turn correlates with anaemia, this is particularly seen elderly patients with multiple co-morbidities.
Clinical evaluation for inflammatory conditions, measurement of C-reactive protein, fibrinogen, erythrocyte sedimentation rate (ESR), IL6, and hepcidin levels helps in establishing the diagnosis. Management of chronic inflammatory anaemia requires addressing underlying conditions and supplementation with an erythropoiesis stimulating agent (ESA) sometimes [1-4].
Anaemia related to chronic kidney disease (CKD) is due to reduced erythropoeitin production. Serum creatinine and GFR must be determined in order to evaluate for CKD, in which case referral to a nephrologist may be appropriate. The suggested cut-off of glomerular filtration rate (GFR) is < 60>
With unexplained anaemia of the elderly (UAE) also referred to as idiopathic anaemia, diagnosis is usually considered when other causes of anaemia in the elderly have been eliminated. The diagnosis of UAE is based on the findings of a hypoproliferative anaemia: a low reticulocyte index and an inadequate erythropoietin level for the degree of anaemia. The management of these patients is a serious and recurrent issue, since the aetiology is usually not understood, there is no proven efficacious intervention except transfusion therapy when symptomatic [1-4].
It is estimated that UAE occurs in approximately 20-30% of community-dwelling elderly anaemic subjects in cross sectional epidemiologic studies and in up to half of anaemic nursing home residents.
Mechanisms suspected to underly UAE include hypogonadism (79), alterations in haematopoietic stem and erythroid progenitor cell number and/or function, and the presence of “early” or overt myelodysplastic syndrome (MDS).
A percentage of those with otherwise unexplained anaemia are likely to have MDS.
MDS is a disease of the elderly, with the median age of diagnosis in the late 60s to 70s.
In one study 37 of 245 (15%) hospitalised geriatric patients who underwent evaluation based on the French-American-British (FAB) classification for unexplained haematologic abnormalities were diagnosed with MDS, also using the FAB classification [1-4].
The criteria selected in this audit were guided by NICE guidelines on anaemia [5].
NICE recommends that if the diagnosis of iron deficiency anaemia is in doubt despite serum ferritin test results, diagnostic trials of iron treatment in can be considered.
NICE guidelines also recommend Vitamin B12 and folate level checks, and this should be done especially when a person has normocytic anaemia with a low or normal ferritin level.
Serum ferritin is perhaps the most frequently used peripheral blood test for assessing iron deficiency anaemia. Iron stores are reliably depleted when ferritin is less than 12 mg/L. However, whereas a low serum ferritin dependably indicates iron deficiency, a normal level in an elderly patient does not necessarily rule out iron deficiency, as serum ferritin rises with age.
Iron indices may also be influenced by the presence of inflammation, in which the transferrin is normal or low, and the ferritin is normal or elevated.
In one study of the elderly, the sTfR(soluble transferrin receptor)/log ferritin was found to be much more sensitive than standard iron indices in diagnosing iron deficiency anaemia. While the serum ferritin is the most cost-effective diagnostic measurement of iron deficiency, the sTfR/log ferritin may be useful however, the lack of standardised reagents for the sTfR complicates local interpretation of the sTfR/ferritin ratio for many diagnostic laboratories.
It has been suggested that a carefully monitored trial of iron supplementation can be used to confirm the diagnosis IDA if the anaemia resolves following a period of supplementation.
Given the above difficulties, elemental iron level checks are effective and reliable in diagnosing IDA in my opinion.
Good workup of anaemia must also consider unexpected diagnoses including chronic kidney disease (CKD) or occult malignancy. If absolute iron deficiency is diagnosed, in the elderly and post-menopausal population it is mandatory to rule out gastrointestinal pathology, including malignancy (Appendix A, 1).
On the background above, let us scrutinize the results of the audit; our analysis revealed a very high prevalence of anaemia in the patients admitted to the OPM department of NNUH.
166 (67.2 %) of the 246 patients in the audit were anaemic, this is a very significant proportion but it is in agreement available scientific literature and studies, where it is has been observed that the prevalence of anaemia increases with age as reported above [1-4].
Among anaemic patients only 94 (56.6%) received further tests to determine the cause of their anaemia (Table 1). This proportion is short of the expected standard of 98% given the high prevalence of anaemia in the elderly. This indicates that many elderly patients with anaemia are not being properly worked up in the OPM department an NNUH.
Turning to analysis of anaemic patients meeting each criterion (Table 2), 32 (34.0%) patients had their iron level checked (criterion 1), 45 (47.9%) anaemic patients had their vitamin B12 & folate checked (criterion 2), and on 17 (18.1%) received ferritin level checks (criterion 3).
These results indicate that nearly half (44 %) anaemic elderly patients admitted at the NNUH OPM department are not receiving any form of investigation for their anaemia once it is detected on the FBC. Vitamin B 12 & folate was the most ordered test, one reason contributing to this I suggest is the fact that as many elderly patients admitted have delirium in addition to other medical problems, B12 & folate checks are done as part of the delirium screening process and not solely to investigate anaemia.
In summary, from the audit results it is clear that standards are not being met for patients admitted to the OPM department at NNUH, more anaemic patients should receive appropriate subsequent workup for anaemia once identified to have anaemia on admission.
As mentioned above, anaemia even if mild has many serious adverse outcomes, underlying aetiology for the anaemia such as chronic disease, iron deficiency, or myelodysplastic syndromes that can be identified through further investigation.
Changes recommended based on the audit results will include doctors having access to a single anaemia test panel that include haematinics and elemental iron tests as a unit battery of tests.
There is a need for a single anaemia test panel with all haematinics including elemental Iron to be developed by the laboratory/pathology department so that a doctor can order all appropriate tests in a single click when anaemia is detected in the FBC during admission workup.
For example at Nobles Hospital on the Isle of Man the Iron studies panel includes; Iron, Total Iron Binding, Ferritin, Transferrin Saturation. Could NNUH go further and consider adding vitamin B12 and folate to the Nobles Hospital Iron studies panel? I believe this would represent a robust approach to investigating anaemia in the elderly by a single click of a button when a doctor is ordering investigations.
Also guidelines should be strengthened to make it mandatory for any doctor seeing an elderly anaemic patient to investigate the cause of anaemia or document why they have chosen not to investigate.
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.
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
