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Research Article | DOI: https://doi.org/10.31579/2639-4162/332
1Professor of Maternal and Newborn Health Nursing, Faculty of Nursing, Beni-Suef University, Egypt.
2Professor of Obstetrics & gynecological Nursing, Faculty of Nursing, Benha University, Egypt.
3Assistant Lecturer of Maternity & Newborn Health Nursing, Faculty of Nursing, Beni-Suef University, Egypt.
4Assistant Professor of Obstetrics & Gynecological Nursing, Faculty of Nursing, Benha University, Egypt.
*Corresponding Author: Hanan Elzeblawy Hassan, Professor of Maternal and Newborn Health Nursing, Faculty of Nursing, Beni-Suef University, Egypt.
Citation: Hassan HE, Omran AA, Saad HE, Gaafr HA., (2026), Maternity Nurses Practices Abdominal Examination, Palpation, and Auscultation at First Stage of Normal Labor: An Instructional Package, J. General Medicine and Clinical Practice, 9(3); DOI:10.31579/2639-4162/332
Copyright: © 2026, Hanan Elzeblawy Hassan. 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: 14 January 2026 | Accepted: 06 February 2026 | Published: 16 February 2026
Keywords: maternity nurses' practices; first stage of normal labor; abdominal examination; palpation; auscultation, instructional package
Background: Abdominal examination is crucial in the initial assessment of labor, helping to confirm its onset and assess fetal condition, including lie, presentation, and position. The Leopold maneuvers comprise four steps: identifying fetal lie and presentation, locating the fetal spine, assessing engagement of the presenting part, and confirming fetal position by locating the forehead and occiput in the lower abdomen. Aim: evaluate how an instructional package influenced nursing practices in general procedures, abdominal examination, palpation, and auscultation of fetal heart rate during the first stage of normal labor. Subjects and Methods: Design: A quasi-experimental design with a one group pre-posttest. Setting: labor unit at Beni-Suef University and Beni-Suef Specialist Hospitals.
Sample: A convenience sample consisting of 50 maternity nurses.
Tools: Observational checklist: Part I: checklist used to assess the general practices. Part II: checklist of performing abdominal examination. Part III: The checklist of performing Leopold's maneuvers. Part IV: The checklist of performing auscultation fetal heart rate. Results: 30% of nurses filled out admission card information pre-instruction compared to 80 post-one. Also, 40% of the nurses had position women in a dorso-recumbent position pre-instruction while 80% were done post-one, p value ≤0.001 for all sub item of abdominal examination. Moreover, 68.0% of nurses did not auscultate fetal heart rate pre-instruction compared to 12.96% post-one. Moreover, it shows that there were highly statistically significant differences for all items of the studied maternity nurses’ reported practices regarding performing Leopold's maneuver items at p-value ≤0.001 between pre- and post-instructional package implementation.
Conclusion: There was a significant improvement in maternity nurses' practices concerning nursing care in the first stage of normal labor, covering general practices, fetal heart rate auscultation, abdominal palpation, and post-instruction examination. Recommendations: Implementing a periodic in-service training program aims to enhance maternity nurses' practices for abdominal and vaginal examination, and auscultation of fetal heart rate
Labor is characterized by the rhythmic contraction and relaxation of uterine muscles, leading to cervical effacement and dilatation, and the expulsion of the fetus and placenta [1-5]. This process can cause physical and mental trauma to both the mother and baby during the intrapartum period [6-10]. Healthcare workers are responsible for managing labor, providing emotional support, and ensuring the health of both mother and child [11-16]. Five factors influencing labor and birth, known as the five Ps, include powers (contractions), passageway (birth canal), passenger (fetus and placenta), position of the mother, and psychological response. The passenger's characteristics are shaped by the fetal head size, presentation, lie, attitude, and position. Notably, the placenta is also considered a passenger in this process [17]. Upon admission for labor, parturient typically undergo a complete blood count, blood type determination, urine analysis, and RH factor testing. High-risk individuals are tested for sexually transmitted infections, such as HIV, hepatitis B and C, syphilis, and group B streptococcus, with some areas requiring these tests for all parturient. A bedside ultrasound may be conducted to confirm fetal position and assess amniotic fluid volume, although this is often unnecessary for low-risk cases evaluated by trained clinicians [18]. Abdominal examination is essential during the initial assessment to confirm labor, evaluate fetal condition, and determine fetal lie, presentation, position, and estimated fetal size for maternal-fetal compatibility. Presentations include cephalic (vertex, brow, face, mentum) and breech (frank, complete, footling). The position may be designated as "right occiput anterior" (ROA) if the fetal occiput is in the right anterior quadrant of the birth canal [18].
The Leopold maneuvers are a set of four systematic palpation steps of the gravid uterus. The 1st maneuver identifies the fetal lie and presentation by palpating the uterine fundus. The 2nd maneuver locates the fetal spine by palpating the lateral surfaces of the uterus. The 3rd maneuver assesses the engagement of the presenting part through gentle upward pressure above the pubic symphysis. Finally, the 4th maneuver confirms the fetal position by locating the fetal forehead and occiput in the lower abdomen [19].
Figure 1: abdominal examination [20].
The FHTs are recorded upon admission and monitored at specified intervals during labor: every 15 minutes in the first stage, 5 minutes during the second stage, and immediately after membrane rupture to detect a prolapsed cord. Intermittent auscultation tracks FHR at least every 30 minutes in active first stage labor and every 15 minutes in the second stage for low-risk pregnancies. [21].
Nursing roles in the health care system are very important; nurses make up the greatest percentage of health care providers assessment of cultural differences is crucial for understanding the diverse attitudes toward childbirth among women from various backgrounds [22-32]. These attitudes, shaped by cultural upbringing, significantly influence childbearing behaviors. Conducting a culture assessment at admission is essential for planning culturally competent care during labor [33].
Aim Of the Study
The current study aimed to evaluate the effect of the instructional package on nursing practices regarding general practices, abdominal examination, palpation, and auscultation of fetal heart rate during the first stage of normal labor.
Research Hypothesis
Following the implementation of the instructional package, nursing practices regarding general practices, abdominal examination, palpation, and
auscultation of fetal heart rate during the first stage of normal labor will be competent.
Subject And Method
Research design:
A quasi-experimental study design (one-group pre-posttest) was utilized to evaluate the effect of an instructional package on maternity nurses’ general practices, abdominal examination, palpation, and auscultation of fetal heart rate during the first stage of normal labor
Settings:
The labor unit at Beni-Suef University Hospital and Beni-Suef Specialist Hospital.
Subjects:
A convenience sample of 50 maternity nurses was utilized in the study, comprising 23 nurses from Beni-Suef University Hospital and 27 nurses from Beni-Suef Specialist Hospital.
Tools of data collection:
Observational checklist: This tool was applied before and after the instructional package sessions to assess the effect of the instructional package on the nurses' competency of practices. This tool was designed by a researcher, after reviewing the related current and previous literatures to assess the maternity nurses' practices regarding nursing care of the first stage of normal labor.
Part I: The checklist consisted of 7 steps, which was used to assess the general practices of maternity nurses regarding nursing care of the first stage of normal labor, such as welcoming and greeting the mother, filling out the admission card information, ensuring privacy, practicing hand hygiene before each procedure, obtaining the history, differentiating between true and false labor pain, and measuring vital signs.
Part II: The checklist ofperforming abdominal examination consisted of 9 steps, which was used to assess the practices of maternity nurses regarding nursing care of the first stage of normal labor (explain procedure, ensure woman empties bladder, provide privacy, position of woman, expose abdomen fully, inspection, Observe abdomen, note shape and contour of abdomen, and note scars & steriae gravidarum).
Part III: The checklist ofperforming abdominal palpation (Leopold's maneuver) consisted of 5 maneuvers: Fundal Level, First maneuver (Fundal palpation), Second maneuver (Lateral palpation), Third maneuver (First pelvic Grib), and Fourth maneuver (Second pelvic Grib)
Part IV: The checklist ofperforming auscultation fetal heart rate and finishing examination by return mother to comfortable position, return equipment, and record findings.
Practice scoring system:
The scoring for maternity nurses' practice was determined by assigning (1) for completed practices and (0) for those not completed. The total was calculated by summing these scores and dividing by the number of items to obtain a mean score, which was then converted into percentages: competent practice is defined as a total score of 60% or higher, while incompetent practice is below 60%.
Tools validity:
Revision of the tools for clarity, relevance, comprehensiveness, understanding, and applicability was done by a panel of expertise composed of five professors of obstetrics and gynecological nursing to measure the content validity of the tools.
Reliability of the tools:
The study tools showed strong internal consistency, indicated by Cronbach’s Alpha values of 0.926 for practice.
Ethical considerations:
Ethical approval for the study was obtained from Benha University's Research Ethics Committee, ensuring privacy and confidentiality, with informed consent provided by participating nurses who were made aware of their right to withdraw at any time.
Pilot study:
A pilot study involving 5 nurses, representing 10% of the total sample, was conducted to evaluate the structured questionnaire's clarity, feasibility, applicability, and required time. Data analysis results indicated that some questions needed modifications regarding rewarding correction, omission, and addition in the knowledge section.
Field work:
Assessment and planning:
The study, conducted from October 2024 to June 2025, involved the researcher attending the study site twice weekly to interview maternity nurses in a private setting. The researcher explained the study's purpose and details to the nurses and assessed their practices related to general care, abdominal examination, and fetal heart rate auscultation during the first stage of normal labor. An instructional package in Arabic, featuring figures and practical skills, was designed based on predetermined educational content and methodologies.
Implementation:
General and specific objectives of an instructional package were developed and implemented to meet the needs of a sample of nurses. The package was executed over two practical sessions, each lasting 45-60 minutes, with five groups of approximately ten nurses each. The first session included an orientation on the package, followed by feedback and discussion on the previous session's content. Motivation techniques were employed to encourage engagement, allowing nurses to ask questions and share insights. The first session focused on practical demonstrations such as abdominal examinations, abdominal palpation, and auscultation of fetal heart rate, while the second session involved feedback, re-demonstration of these procedures. Various teaching methods were utilized, including lectures, discussions, multimedia, and hands-on demonstrations, and an instructional booklet was distributed to summarize nursing care methods for the first stage of normal labor.
Evaluation
The evaluation phase acts as a post-test, utilizing the same tool as the pretest to assess the impact of an instructional package on maternity nurses' practices during the first stage of normal labor. The researcher used the same tool to compare nurses' practices pre- and post-implementation of the instructional package.
III. Administrative approval:
Approval for the study was secured from the Dean of the Faculty of Nursing at Benha University, along with an official letter to the directors of Beni-Suef University Hospital and Beni-Suef Specialist Hospital to obtain informed consent prior to data collection.
I- Statistical item:
The data were analyzed using SPSS version 26 with descriptive statistics and significance assessments via chi-square, paired sample t-test, and Pearson correlation coefficient. Significance thresholds were set at P-value >0.05 (not significant), P-value ≤0.05 (statistically significant), and P-value ≤0.01 (highly statistically significant).
Table (1): Clarifies that there was highly statistically significant improvement for all items of the studied maternity nurses’ practices regarding nursing care at the first stage of normal labor in relation to initial assessment at admission (p value ≤0.001) between pre- and post-instruction. In addition, regarding filling out admission card information, a minority of the studied nurses (30%) had done pre- instruction compared to more than three-quarters of the studied nurses (80%) who had done practice at post- instruction. Regarding differentiating between true and false labor pain, it was revealed that more than three-quarters of the studied nurses (76%) practiced at post- instruction.
Table (2): Proves that there were improvements in the studied maternity nurses’ practices regarding abdominal examination pre- and post- instruction. Regarding scars and striae gravidarum, position her in a dorso-recumbent position as her comfort permits. It was reported that 28% and 40% of the studied nurses had done pre- instruction. While 80% & 80% were done post- instruction, p value ≤0.001 for all sub item of abdominal examination.
Table (3): Proves that there were improvements in the studied maternity nurses’ practices regarding abdominal examination pre- and post- instruction. It shows that there was a first maneuver and first pelvic grip (32% & 32%) of studied nurses done at pre- instruction. While 72% & 70% of the studied sample were done at post- instruction. Also, this table illustrates that there were highly statistically significant differences for all items of the studied maternity nurses’ reported practices regarding performing Leopold's maneuver items at a p-value ≤0.001 between pre- and post- instruction.
Table (4): Presents that 68.0% of nurses did not auscultate fetal heart rate pre-instruction compared to 12.96% post-instruction. Moreover, it shows that there were highly statistically significant differences for all items of the studied maternity nurses’ reported practices regarding performing Leopold's maneuver items at p-value ≤ 0.001 between pre- and post-instructional package implementation.
| Items | Pre- instructional package | Post- instructional package | χ2 | P-value | ||||||
| Done | Not done | Done | Not done | |||||||
| No. | % | No. | % | No. | % | No. | % | |||
| 1- Welcome & greet mother | 20 | 40.0 | 30 | 60.0 | 36 | 72.0 | 14 | 28.0 | 10.390 | 0.001** |
| 2- Fill admission card information | 15 | 30.0 | 35 | 70.0 | 40 | 80.0 | 10 | 20.0 | 25.253 | 0.000** |
| 3- Ensure privacy | 20 | 40.0 | 30 | 60.0 | 38 | 76.0 | 12 | 24.0 | 13.300 | 0.001** |
| 4- Hand hygiene before each procedure | 19 | 38.0 | 31 | 62.0 | 40 | 80.0 | 10 | 20.0 | 18.231 | 0.000** |
| 5- Obtain history | 23 | 46.0 | 27 | 54.0 | 38 | 76.0 | 12 | 24.0 | 9.458 | 0.002* |
| 6- Differentiate between true & false labor pain | 20 | 40.0 | 30 | 60.0 | 38 | 76.0 | 12 | 24.0 | 13.300 | 0.001** |
| 7- Measure vital signs | 16 | 32.0 | 34 | 68.0 | 40 | 80.0 | 10 | 20.0 | 23.377 | 0.000** |
** A highly statistically significant difference P ≤ 0. 001
Table 1: Frequency and percentage distribution of the studied maternity nurses’ general practices regarding nursing care of first stage of normal labor at pre and post-instructional package (n=50)
| Items | Pre- instructional package | Post- instructional package | χ2 | P-value | ||||||
| Done | Not done | Done | Not done | |||||||
| No. | % | No. | % | No. | % | No. | % | |||
| 22 | 44.0 | 28 | 56.0 | 40 | 80.0 | 10 | 20.0 | 13.752 | 0.000** |
| 19 | 38.0 | 31 | 62.0 | 40 | 80.0 | 10 | 20.0 | 18.231 | 0.000** |
| 16 | 32.0 | 34 | 68.0 | 36 | 72.0 | 14 | 28.0 | 16.026 | 0.000** |
| 20 | 40.0 | 30 | 60.0 | 40 | 80.0 | 10 | 20.0 | 16.667 | 0.000** |
| 16 | 32.0 | 34 | 68.0 | 38 | 76.0 | 12 | 24.0 | 19.485 | 0.000** |
| 21 | 42.0 | 29 | 58.0 | 40 | 80.0 | 10 | 20.0 | 15.174 | 0.000** |
| 18 | 36.0 | 32 | 64.0 | 37 | 74.0 | 13 | 26.0 | 14.586 | 0.000** |
| 19 | 38.0 | 31 | 62.0 | 38 | 76.0 | 12 | 24.0 | 14.729 | 0.000** |
| 14 | 28.0 | 36 | 72.0 | 40 | 80.0 | 10 | 20.0 | 27.214 | 0.000** |
** A highly statistically significant difference P ≤ 0. 001
Table 2: Frequency and percentage distribution of the studied maternity nurses’ practices regarding performing abdominal examination at pre and post-instructional package (n=50)
| Items | Pre- instructional package | Post- instructional package | χ2 | P-value | ||||||
| Done | Not done | Done | Not done | |||||||
| No. | % | No. | % | No. | % | No. | % | |||
| Fundal Level | 18 | 36.0 | 32 | 64.0 | 39 | 78.0 | 11 | 22.0 | 17.21 | 0.000** |
| First maneuver (Fundal palpation) | 16 | 32.0 | 34 | 68.0 | 36 | 72.0 | 14 | 28.0 | 16.02 | 0.000** |
| Second maneuver (Lateral palpation) | 17 | 34.0 | 33 | 66.0 | 39 | 78.0 | 11 | 22.0 | 19.64 | 0.000** |
| Third maneuver (First pelvic grib) | 16 | 32.0 | 34 | 68.0 | 35 | 70.0 | 15 | 30.0 | 14.44 | 0.000** |
| Fourth maneuver (Second pelvic grib) | 20 | 40.0 | 30 | 60.0 | 35 | 70.0 | 15 | 30.0 | 9.091 | 0.003* |
** A highly statistically significant difference P ≤ 0. 001
Table 3: Frequency and percentage distribution of the studied maternity nurses’ practices regarding Palpation during pregnancy at pre and post-instructional package (n=50)
| Items | Pre- instructional package | Post- instructional package | χ2 | P-value | ||||||
| Done | Not done | Done | Not done | |||||||
| No. | % | No. | % | No. | % | No. | % | |||
| Auscultation: Listen carefully and count for 30- 60 second | 16 | 32.0 | 34 | 68.0 | 34 | 68.0 | 16 | 32.0 | 12.96 | 0.000** |
| Return mother to comfortable position | 20 | 40.0 | 30 | 60.0 | 38 | 76.0 | 12 | 24.0 | 13.30 | 0.000** |
| Return equipment | 22 | 44.0 | 28 | 56.0 | 39 | 78.0 | 11 | 22.0 | 12.14 | 0.001** |
| Record findings | 25 | 50.0 | 25 | 50.0 | 41 | 82.0 | 9 | 18.0 | 11.40 | 0.001** |
** A highly statistically significant difference P ≤ 0. 001
Table 4: Frequency and percentage distribution of the studied maternity nurses’ practices regarding Auscultation, and finishing examination at pre and post-instructional package (n=50)
Respectful maternity care (RMC) is defined as the provision of care that maintains privacy, confidentiality, and dignity that is free from harm or mistreatment while supporting informed choice during labor and birth [34-40]. RMC is a universal human right to be free from harm and mistreatment during the labor and birth process, and providing RMC may help ensure that all women receive equitable maternity care [41]. The current study was conducted to evaluate the effect of the instructional package on nursing practices regarding general practices, abdominal examination, palpation, and auscultation of fetal heart rate during the first stage of normal labor.
Parmar (2021) mentioned that abdominal examination is vital for evaluating fetal status during labor, focusing on fetal lie, presentation, position, and size [18]. Regarding studied maternity nurses’ practices abdominal examination at pre and post-instructional package, the present study showed that more than three-quarters of the studied nurses had improvement of practice, such as welcoming and greeting the mother, filling out the admission card information, maintaining privacy, practicing hand hygiene before each procedure, explaining the procedure to the women, ensuring the woman's bladder is empty and putting the mother in a dorso-recumbent position at the post-instructional package.
This finding was agreed with by Ibrahim & Hassan (2022), who studied the "Effect of educational program on maternity nurses' knowledge and practices regarding oxytocin drug administration during labor" and reported that the majority of studied nurses had improvement in practice, such as checking women's names, maintaining privacy, asking women to empty their bladders, explaining procedures to women, hand washing, wearing gloves, and assisting women to lie in suitable positions post educational program [42]. Also, this study is on the same line with Murn (2019), who conducted a study entitled "Mothering the mother: An Educational Program for Nurse-Provided Continuous Labor Support" and found that the majority of the studied nurses had good practice regarding assessment of the mother and labor process during the first stage of labor at posttest [43].
Moreover, Lipsett et al (2023) reported that examination utilizes Leopold maneuvers, involving four steps: assessing lie and presentation, locating the fetal spine, checking engagement of the presenting part, and confirming position through identification of the fetal forehead and occiput [19]. Furthermore, maternity nurses' practices about abdominal examination during nursing care of the first stage of normal labor showed that there was a highly statistically significant difference (p<0>
Concerning maternity nurses’ practices regarding auscultation of fatal heart rate at pre and post-instructional package, the results of the present study declare highly statistically improvement in maternity nurses’ practices after the instructional package. This in line with American College of Obstetricians and Gynecologists (2020) emphasized that the fetal heart tones should be recorded upon admission and monitored at specified intervals: every 15 minutes during the first stage of labor, every 5 minutes in the second stage, and immediately after membrane rupture. Intermittent auscultation checks fetal heart rate (FHR) every 30 minutes during active first stage labor [21].
Generally, regarding items of practices of nursing care of the first stage of normal labor, the current study shows that the percentages of the studied nurses' post-instructional package implementation and the highly statistically significant improvement of their practices post-implementation of the instructional package. This result of the present study was agreed with by Ahmed et al. (2019), who conducted a study entitled “The impact of a nurse mentoring program on the quality of labor and delivery care at primary health care facilities in Bihar, India” and revealed that there was an improvement in nurses’ performance regarding four stages of labor and delivery care [45]. This improvement could be attributed to attending the instructional package; the results indicated that there is progression in nurses’ competent practices as well as a wide variety of educational methods used [46-58]. Additionally, the distributed Arabic booklets also played a crucial role in attaining and retaining knowledge. Booklets are best used when they are brief, written in plain language, and full of good pictures and when they are used to back up other forms of education. This is in accordance with Edgar Dale’s or the NTL’s Pyramid of Learning as cited by Masters, as the pyramid illustrated that individuals can retain 10.0% of what they read and 20.0% of what they see and hear (audiovisual). The same author added that one can retain 50.0% of what he learned by a discussion [59-75].
Occasionally, this result is supported by Abd-Elrazek et al. (2022) in their titled "Maternity nurses' knowledge and practices regarding evidence-based practice during the care of mothers in the intrapartum period," which reported that there was improvement in maternity nurses' practice of the first stage of labor in the post-test [76]. Also, this finding was in agreement with Murn (2019), who conducted a study entitled “Mothering the Mother: An Educational Program for Nurse-Provided Continuous Labor Support” and found that there was a statistically significant enhancement in nurses’ performance during the first stage of normal labor post instructional package [43].
Based on the findings of the present study, it can be concluded there was highly statistically significant improvement for all items of the studied maternity nurses’ practices regarding nursing care at the first stage of normal labor. There were improvements in the studied maternity nurses’ practices regarding general, auscultation of fetal heart rate, abdominal palpation, and examination post instructional package.
Recommendation
Implementing a periodic in-service training program aims to enhance maternity nurses' practices for abdominal and vaginal examination, and auscultation of fetal heart rate
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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.
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.
Dear Ms. Mayra Duenas, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. “The International Journal of Clinical Case Reports and Reviews represented the “ideal house” to share with the research community a first experience with the use of the Simeox device for speech rehabilitation. High scientific reputation and attractive website communication were first determinants for the selection of this Journal, and the following submission process exceeded expectations: fast but highly professional peer review, great support by the editorial office, elegant graphic layout. Exactly what a dynamic research team - also composed by allied professionals - needs!" From, Chiara Beccaluva, PT - Italy.
Dear Maria Emerson, Editorial Coordinator, we have deeply appreciated the professionalism demonstrated by the International Journal of Clinical Case Reports and Reviews. The reviewers have extensive knowledge of our field and have been very efficient and fast in supporting the process. I am really looking forward to further collaboration. Thanks. Best regards, Dr. Claudio Ligresti
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation. “The peer review process was efficient and constructive, and the editorial office provided excellent communication and support throughout. The journal ensures scientific rigor and high editorial standards, while also offering a smooth and timely publication process. We sincerely appreciate the work of the editorial team in facilitating the dissemination of innovative approaches such as the Bonori Method.” Best regards, Dr. Matteo Bonori.
I recommend without hesitation submitting relevant papers on medical decision making to the International Journal of Clinical Case Reports and Reviews. I am very grateful to the editorial staff. Maria Emerson was a pleasure to communicate with. The time from submission to publication was an extremely short 3 weeks. The editorial staff submitted the paper to three reviewers. Two of the reviewers commented positively on the value of publishing the paper. The editorial staff quickly recognized the third reviewer’s comments as an unjust attempt to reject the paper. I revised the paper as recommended by the first two reviewers.
Dear Maria Emerson, Editorial Coordinator, Journal of Clinical Research and Reports. Thank you for publishing our case report: "Clinical Case of Effective Fetal Stem Cells Treatment in a Patient with Autism Spectrum Disorder" within the "Journal of Clinical Research and Reports" being submitted by the team of EmCell doctors from Kyiv, Ukraine. We much appreciate a professional and transparent peer-review process from Auctores. All research Doctors are so grateful to your Editorial Office and Auctores Publishing support! I amiably wish our article publication maintained a top quality of your International Scientific Journal. My best wishes for a prosperity of the Journal of Clinical Research and Reports. Hope our scientific relationship and cooperation will remain long lasting. Thank you very much indeed. Kind regards, Dr. Andriy Sinelnyk Cell Therapy Center EmCell
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. It was truly a rewarding experience to work with the journal “Clinical Cardiology and Cardiovascular Interventions”. The peer review process was insightful and encouraging, helping us refine our work to a higher standard. The editorial office offered exceptional support with prompt and thoughtful communication. I highly value the journal’s role in promoting scientific advancement and am honored to be part of it. Best regards, Meng-Jou Lee, MD, Department of Anesthesiology, National Taiwan University Hospital.
Dear Editorial Team, Journal-Clinical Cardiology and Cardiovascular Interventions, “Publishing my article with Clinical Cardiology and Cardiovascular Interventions has been a highly positive experience. The peer-review process was rigorous yet supportive, offering valuable feedback that strengthened my work. The editorial team demonstrated exceptional professionalism, prompt communication, and a genuine commitment to maintaining the highest scientific standards. I am very pleased with the publication quality and proud to be associated with such a reputable journal.” Warm regards, Dr. Mahmoud Kamal Moustafa Ahmed
Dear Maria Emerson, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews’, I appreciate the opportunity to publish my article with your journal. The editorial office provided clear communication during the submission and review process, and I found the overall experience professional and constructive. Best regards, Elena Salvatore.
Dear Mayra Duenas, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews Herewith I confirm an optimal peer review process and a great support of the editorial office of the present journal
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. I am really grateful for the peers review; their feedback gave me the opportunity to reflect on the message and impact of my work and to ameliorate the article. The editors did a great job in addition by encouraging me to continue with the process of publishing.
Dear Cecilia Lilly, Editorial Coordinator, Endocrinology and Disorders, Thank you so much for your quick response regarding reviewing and all process till publishing our manuscript entitled: Prevalence of Pre-Diabetes and its Associated Risk Factors Among Nile College Students, Sudan. Best regards, Dr Mamoun Magzoub.
International Journal of Clinical Case Reports and Reviews is a high quality journal that has a clear and concise submission process. The peer review process was comprehensive and constructive. Support from the editorial office was excellent, since the administrative staff were responsive. The journal provides a fast and timely publication timeline.
Dear Maria Emerson, Editorial Coordinator of International Journal of Clinical Case Reports and Reviews, What distinguishes International Journal of Clinical Case Report and Review is not only the scientific rigor of its publications, but the intellectual climate in which research is evaluated. The submission process is refreshingly free of unnecessary formal barriers and bureaucratic rituals that often complicate academic publishing without adding real value. The peer-review system is demanding yet constructive, guided by genuine scientific dialogue rather than hierarchical or authoritarian attitudes. Reviewers act as collaborators in improving the manuscript, not as gatekeepers imposing arbitrary standards. This journal offers a rare balance: high methodological standards combined with a respectful, transparent, and supportive editorial approach. In an era where publishing can feel more burdensome than research itself, this platform restores the original purpose of peer review — to refine ideas, not to obstruct them Prof. Perlat Kapisyzi, FCCP PULMONOLOGIST AND THORACIC IMAGING.
Dear Mayra Duenas, Editorial Coordinator of the journal IJCCR, I write here a little on my experience as an author submitting to the International Journal of Clinical Case Reports and Reviews (IJCCR). This was my first submission to IJCCR and my manuscript was inherently an outsider’s effort. It attempted to broadly identify and then make some sense of life’s under-appreciated mysteries. I initially had responded to a request for possible submissions. I then contacted IJCCR with a tentative topic for a manuscript. They quickly got back with an approval for the submission, but with a particular requirement that it be medically relevant. I then put together a manuscript and submitted it. After the usual back-and-forth over forms and formality, the manuscript was sent off for reviews. Within 2 weeks I got back 4 reviews which were both helpful and also surprising. Surprising in that the topic was somewhat foreign to medical literature. My subsequent updates in response to the reviewer comments went smoothly and in short order I had a series of proofs to evaluate. All in all, the whole publication process seemed outstanding. It was both helpful in terms of the paper’s content and also in terms of its efficient and friendly communications. Thank you all very much. Sincerely, Ted Christopher, Rochester, NY.
Dear Grace Pierce, Editorial Coordinator of the journal IJCCR, I had a very positive experience with Auctores - Journal throughout the publication process. The Editorial Team was highly responsive, professional, and supportive at every stage. I would like to extend my sincere thanks to the Editor: Grace Pierce, for her guidance and assistance. The peer-review process was smooth and constructive, helping improve the quality of my work. I would gladly recommend Auctores Journal to fellow researchers and authors. Dr. SABITA SINHA, Medical Oncologist, MD (Electro Homeopathy).
Dear Maria Emerson, Editorial Coordinator of - Journal of Clinical Research and Reports. ''I am pleased to provide this testimonial following the publication of our recent case report in this journal. The peer review process was rigorous, constructive, thorough, and conducted in a timely manner. The reviewers’ comments were thoughtful, detailed, and highly constructive, contributing substantially to the refinement, clarity, and scientific robustness of our manuscript. The process was conducted with professionalism and academic integrity throughout. The support provided by the editorial office was exemplary. Communication was consistently prompt, clear, and courteous at all stages of the submission and publication process. The editorial team demonstrated a high level of organization and responsiveness, ensuring that all queries were addressed efficiently and that the process remained transparent and well-coordinated. The overall quality of the journal is reflected in its strong editorial standards, commitment to scientific excellence, and dedication to publishing clinically meaningful research. It has been a privilege to publish our work in this journal, and we would welcome the opportunity to contribute further in the future.'' Best wishes from, Dr. Trogkanis Efstratios, Cardiologist.
