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*Corresponding Author: Marcia Magnus, Department of Dietetics and Nutrition, Florida International University, Miami, USA.
Citation: Marcia Magnus, Tabe Besong RN. An Evaluation of the Therapeutic Nutrition Knowledge of Belizean Nurses, J. New Medical Innovations and Research, 2(1): DOI: 10.31579/jnmir.2021/004.
Copyright: © 2021 Marcia Magnus and Tabe Besong RN. 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: 06 February 2021 | Accepted: 12 February 2021 | Published: 16 February 2021
Keywords: nurses; therapeutic nutritional knowledge; utritional guidance; questionnaire; Belize
In Belize, patients rely on nurses for nutritional guidance on non-communicable diseases in the Caribbean. The objectives of this study were to quantify the therapeutic nutritional knowledge of 198 Belizean nurses using the Al-Shwaiyat questionnaire. The mean correct response rate for the therapeutic nutritional knowledge was suboptimal (53.30%±17.20). Nurses in the West region of the country had the highest mean knowledge scores on nutrition and diabetes 75.41±20.10, p=0.003; on nutrition and cardiovascular diseases 57.23±10.90, p=0.000; and in overall knowledge 62.34±9.76 p=0.000. Nurses without a diagnosis of diabetes had higher mean knowledge scores on a) nutrition and diabetes 63.86±26.07, p=0.001; b) nutrition and obesity questions 49.55±20.80, p=0.004; c) nutrition and cardiovascular disease 53.30±15.70, p=0.007 and d), overall mean 55.24±16.67, p=0.000. There is a need to address the low levels of knowledge of Belizean nurses.
Belize is the only English-speaking country in Central America. In 2019, Belize had a population of 383,000 [1]. Belize is a developing upper-middle-income country, with a GDP per capita of US$ 4,829 in 2016. The 2009 Country Poverty Assessment revealed a poverty rate of 68% for the indigenous Maya, a child poverty rate of 50%, and a national average poverty rate of 41.3% [2]. Belize, like other English-speaking Caribbean countries and Central American countries, has been experiencing an increased prevalence of non-communicable chronic diseases, many of which respond to dietary management. In 2015, the crude diabetes prevalence rate was 14.2%, the highest of all counties in North America and the Caribbean region [3]. Between 2000 and 2016, adult male obesity increased from 9.7% to 16 %, in adult females from 23.0% to 31.5% [1]. Although diabetes prevalence increased from 11.3% to 15.2% among females, and from 7.8% to 10.0% among males, high blood pressure in adult males decreased from 27.5% to 24.4%, and among females from 23.4% to 21.0% [1]. Between 2002 and 2014, the prevalence of female adult diabetes increased from 11.3% to 15.2%, with male adult diabetes increasing from 7.8% to 10.0% [1]. The leading cause of death in people aged 50 and over was diabetes and its complications, followed by ischemic heart disease, hypertension, advanced HIV infection, and chronic liver disease and cirrhosis [2]. In 2019, progress against global nutrition targets for adult female and male obesity, adult female and male diabetes were described as “no progress or worsening” in Belize [1].
In 2015, the over 60-year old population accounted for 5.9% of the total population, and this segment of the population had a higher hospital utilization rate than the rest of the population [2]. Research from twelve countries demonstrated that 50.5% of older people in rehabilitation were malnourished, closely followed by older people in hospital (38.7%) and then those in aged care facilities (13.8%) [4]. Nurses’ role in initial nutrition screening has been described as “crucial” in the identification of patients who are already malnourished and those who are at risk of becoming malnourished, with the goal of developing nutritional care strategies which prevent severe malnutrition [5].
Although between 2010 and 2015, the population density of physicians and dentists increased, the population density of nurses decreased from 14.5 in 2010 to 12.3 per 10,000, largely due to migration [2]. In 2020, eight nutritionists/dietitians were employed in seven public and three private hospitals, and 54 health clinics, serving a population of 383,000 persons [1].
US data indicate that nurses are 40 times more than dietitians, and 100 times more than certified diabetes educators to meet hospitalized diabetes patients on a daily basis [6]. Nurses play an important role in patients’ nutritional care. Nurses often fill the role of nutrition counsellors by providing nutrition screening and/or nutrition advice to patients [7]. Because they have the most contact with patients, nurses play a key multidisciplinary role and often provide nutrition screening, referral, facilitation of recommendations to adjust a diet plan, and implementation of a special diet modification with patients, and family members [7]. Nurses play equally important roles which complement the role of the dietitian to ensure adequate nutrition for patients [8, 9].
Nurses’ roles in nutritional support have been mandated by governmental regulations internationally. The Australia Ministry of Health states that nurses are responsible for monitoring and documenting nutritional intake [10]. The UK Ministry of Health decrees that nurses are expected to a) promote healthier lifestyle choices from the point of admission through to discharge, to conduct nutritional assessment, and b) offer appropriate lifestyle advice and an effective referral system which supports positive long-term behavioural change [11]. In the USA, nutrition has been described as the second most important area for nursing care. Nutrition topics such as nutritional assessment and monitoring, diet therapy, and enteral and parenteral nutrition have been included in the National Council Licensure Examination for Registered Nurses [12]. In Belize, there is no official Ministry of Health document which specifies the role of nurses in nutrition care. Based on a conversation with a L Castillo, RN, NP, (August, 2020), nurses are responsible for feeding patients via the oral, enteral and parenteral routes; breastfeeding education, and to provide holistic care.
Despite widespread calls for nurses’ role in nutritional care, the Academy of Nutrition and Dietetics, the world’s largest association of nutrition professionals, has identified patient risks which derive from “scope creep”—health care professionals who go beyond their scope of practice and engage in activity for which they are not qualified [13]. Although RDNs, nurses and pharmacists all deliver Diabetes Self-Management training to patients, when professionals who provide care for which they were not trained, scope creep can be dangerous and put patients and clients at risk of harm. The Academy believes that the provision of medical nutrition therapy and other complex dietetics and nutrition services should only be provided by individuals who have at minimum the specialized training and competencies of RDNs.
Because there are no published studies on the therapeutic nutrition knowledge of nurses in Belize, this study was undertaken. The objective of this study was to determine the extent to which the nurses have the nutrition knowledge needed to educate and improve the lives of persons living with obesity, diabetes and hypertension.
Research questions
1. What is the level of therapeutic nutrition knowledge among Belizean nurses?
2. How is nurses’ knowledge affected by health region, gender, age group, education level, years of service; self–reported weight status, and diagnosed diabetes mellitus and hypertension?
Therapeutic nutrition knowledge was defined as the latest theories and research in nutrition and health sciences to individuals seeking to manage chronic disease or promote optimum health. Nurses’ therapeutic nutrition knowledge has been reported as 35%±3.8 in South Africa [14], 60%±8.4 in Australia [15], 56.75%±10.84 in Turkey [16], 58.8% ±13.2 in Jordan [17], 58.4% in Korea [18], 44.9% ± 3.17 in Ghana [19], 65%±11 in the United States of America [20]. Given the low levels of nurses’ nutrition knowledge, all authors have recommended better educational preparation in nutrition and specific treatment guidelines for nurses.
Research design and setting
Of the 635 nurses in Belize, 198 were randomly recruited to respond to the therapeutic nutrition knowledge questionnaire which included items on diabetes (5 items), obesity (9 items) and cardiovascular diseases (17 items). The correct response for each question was scored as [1]. Incorrect and “don’t know” answers were scored as (0). Demographic factors (health region, gender, age, level of education, years of work experience), and self-reported weight status, diabetes, and hypertension diagnosis) were conceptualized based on the work of Al-Shwaiyat, 2013 [17].
Sample Size and sample selection
G-Power version 3.0.10 was used to determine the appropriate sample size of 198. This was considered sufficient to yield 0.80 power using F-test with a significant level of 0.05 and effect size 0.13. A convenience sample was derived. Inclusion criteria were registered nurses, practical nurses, nurses working in both clinics and hospitals. Excluded from the study were nurse specialists, nurse supervisors and nurses working at the private sector.
Instrumentation
The Al-Shwaiyat et al., 2013 instrument [17] was used. The first section of the instrument included demographic characteristics, and the second section had therapeutic nutrition knowledge questions--five diabetes questions, nine obesity questions, and 17 questions on cardiovascular diseases. It had a Cronbach’s Alpha reliability coefficient of 0.709. To assess the face validity of the instrument, a focus group of Belizean nurses was conducted to assess their understanding of questions and perception of the cultural appropriateness of the instrument. A pilot study was undertaken among five nurses to evaluate the time, quality and structure of the questions; and to also determine if there were any problems or misinterpretation of the questionnaire.
Data collection
Permission to conduct this study was granted by the Institution Review Board of Belize, and by hospital managers. The questionnaires were administered to nurses three hours before the end of their shifts. Nurses were advised of their right to refuse to participate even after giving consent. Privacy of nurses’ information was maintained to prevent access by others who are not directly involved in the research. Questionnaires were coded to maximize respondents’ confidentiality and anonymity.
Data analysis
Questionnaires were coded and analyzed with SPSS version 25.0 [21]. Analysis of Variance (ANOVA), t-test and Pearson correlation, and regression analysis were used to test the relationships between variables.
Among 198 nurses, the majority were female (82.9%), and 67.9% were registered nurses (Table 1). Nurses were almost evenly distributed among the four health regions of Belize. The largest percentage (29.4%) had 6-10 years of work experience. For self-reported weight status, 44.1% described themselves as being at recommended weight, and 48.7% as overweight. Only 10.2% reported a diagnosis of diabetes mellitus status, and 16.8% reported having hypertension.
Demographic characteristic | N | % |
Health region: North South West Central |
47 48 48 55 |
23.7 24.2 24.2 27.8 |
Gender: Male Female |
33 160 |
17.1 82.9 |
Age group (years): ≤25 31-35 ≥36 |
36 92 69 |
18.3 46.7 35.0 |
Educational level: LPN RN |
63 133 |
32.1 67.9 |
Years of work experience: ≤5 6-10 11-15 ≥16 |
55 58 33 51 |
27.9 29.4 16.8 25.9 |
Nurses’ self-reported weight status: At Recommended Weight Overweight Underweight |
86 95 14 |
44.1 48.7 7.2 |
Self-reported diabetes diagnosis: No DM diagnosis DM diagnosis |
176 20 |
89.8 10.2 |
Self-reported hypertension diagnosis: No HBP diagnosis HBP diagnosis |
164 33 |
83.2 16.8 |
Table 1: Demographic characteristics of Belizean nurses (N=198)
The mean therapeutic nutrition knowledge score of 198 Belizean nurses was 53.31%±17.20 (Table 2). The mean knowledge score for diabetes mellitus questions was 62.90%±26.70, 51.0%±16.50 for questions on cardiovascular diseases, and 47.00%±20.90 for obesity questions. Nurses in Belize’s West region had a significantly higher overall mean knowledge score 62.34±9.76 p=0.000; and higher mean knowledge scores for nutrition and diabetes 75.41±20.10, p=0.003; nutrition and cardiovascular diseases 57.23±10.90, p=0.000; compared to nurses in other regions. Female nurses had a mean score of 54.58%±16.76, while males had a mean score of 53.50%±16.59. Nurses who were >36 years of age had the highest mean score of 57.80%±14.45, followed by those ≤25 years (54.28%±17.84) and lastly, those >31-35 years (50.57%±18.11). Registered nurses had a higher score of 55.40%±17.61, while practical nurses had a score of 49.50%±15.44. Nurses with less than 5 years of work experience had the highest score 61.25%±14.24, followed by those with ≥ 16 years (56.05%±15.50), those with 6-10 years (49.92%±17.63) and lastly, those with 11-15 years of work experience (44.57%±17.36).
Variables | Nurses N (%) | Nutrition and diabetes knowledge Mean±SD | Nutrition and obesity knowledge Mean±SD | Nutrition and cardiovascular diseases Mean±SD | Overall Mean ±SD |
All nurses | 198(100%) | 62.90±26.70 | 47.0±20.90 | 51.0±16.50 | 53.31±7.20 |
Health region: North South West Central p-value |
47(23.7%) 48(24.2%) 48(24.2%) 55(27.8%)
|
56.52±7.44 49.16±27.40 75.41±20.10 65.09±25.00 0.003* |
48.92±0.15 38.19±25.10 54.39±16.80 50.10±18.70 0.136 |
45.18±15.99 44.61±20.19 57.23±10.90 56.57±13.88 0.000* |
50.23±17.31 43.98±20.48 62.34±9.76 57.25±14.29 0.000* |
Gender Men Women p value |
33(17.1%) 160(82.9) |
63.63±19.50 62.75±27.50 0.857 |
46.80±22.50 49.16±20.90 0.547 |
50.08±18.19 51.83±16.13 0.580 |
53.50±16.59 54.58±16.76 0.737 |
Age Group: ≤25 years >31-35 >36 years p value |
36(18.3%) 92(46.7%) 69(35.2%) |
62.27±25.10 57.82±28.40 66.95±24.40 0.463 |
48.45±21.40 44.93±21.40 52.33±18.40 0.381 |
51.47±15.99 48.97±17.20 54.13±15.65 0.449 |
54.28±17.84 50.57±18.11 57.80±14.45 0.327 |
Education: Practical nurse Registered nurse p value |
63(32.1%)
133(67.9)
|
58.09±25.33
63.90±27.13
0.154 |
45.50±17.48
49.71±21.99
0.185 |
48.64±15.17
52.59± 17.65
0.119 |
49.50±15.44
55.40±17.61
0.074 |
Years of experience: ≤5 6-10 11-15 ≥16 p-value |
55(27.9%) 58(29.4%) 33(16.8%) 51(25.9%) |
73.81±18.8 55.86±27.47 49.09±30.45 64.70±24.19 0.059 |
54.74±21.15 45.02±20.33 37.37±17.96 51.42±20.12 0.257 |
55.18±16.65 48.88±16.46 47.24±14.21 52.02±17.50 0.323 |
61.25±14.24 49.92±17.63 44.57±17.36 56.05±15.50 0.080 |
Table 2: Nurses’ therapeutic nutrition knowledge and demographic characteristics (N=198).
*Means are significantly different at p value < 0.05 by students’-test.
Overweight nurses had the highest knowledge score 57.87%±15.94, followed by those at recommended weight (52.08%±17.19) and lastly, by those who are underweight (33.0%±10.41).
Nurses who had no prior diabetes diagnosis had significantly higher overall knowledge scores, higher nutrition and diabetes scores, higher nutrition and obesity scores than nurses who reported diabetes diagnoses (Table 3). Nurses who did not report a diagnosis of diabetes had a significantly higher overall mean knowledge scores (55.24%±16.67) than those who were living with diabetes (40.10%±16.74) p=.000. Nurses with no self-reported diagnosis had significantly higher nutrition and diabetes scores 63.86±26.07 than nurses who had diabetes 43.00±26.96 p=0.001. Nurses with no self-reported diabetes diagnosis had significantly higher nutrition and obesity knowledge scores 49.55±20.80 than those who did not have diabetes 35.50±18.24 p=0.004. Nurses with no self-reported diabetes diagnosis had significantly higher nutrition and cardiovascular disease knowledge scores 53.30±15.70 than those who did not have diabetes 47.76±20.63 p=0.007.
Self-reported weight status and diagnoses | Nurses N (%) | Nutrition and diabetes knowledge Mean±SD | Nutrition and obesity knowledge Mean±SD | Nutrition and cardiovascular disease knowledge Mean±SD
| Overall Mean (SD) |
Weight status: Recommended weight Overweight Underweight p-value |
86(44.1%) 95(48.7%) 14(7.2%) |
57.90±27.09 70.10±22.76 25.17±14.52 0.059 |
47.93±21.68 50.50±20.74 32.53±16.57 0.257 |
50.41±15.27 53.00±16.57 40.75±13.54 0.510 |
52.08±17.19 57.87±15.94 33.00±10.41 0.275 |
Diabetes diagnosis: No diabetes Diabetes p-value |
176(89.8%) 20(10.2%) |
63.86±26.07 43.00±26.96 0.001* |
49.55±20.80 35.50±18.24 0.004* |
53.30±15.70 47.76±20.63 0.007* |
55.24±16.67 40.10±16.74 0.000* |
Hypertension diagnosis: No hypertension Hypertension p-value |
164(83.2%) 33(16.8%) |
63.17±26.30 54.54±28.40 0.091 |
48.70±20.83 44.78±21.24 0.317 |
51.50±16.84 50.08±18.78 0.653 |
54.48±16.99 49.80±18.61 0.155 |
Table 3: Nurses’ therapeutic nutrition knowledge and self- reported diagnosis (N=198).
*Means are significantly different at p value < 0.05 by students’t-test.
Nurses who reported no previous hypertension diagnosis had higher overall knowledge scores, higher scores on nutrition and diabetes, nutrition and obesity, or nutrition and cardiovascular diseases than nurses who had been diagnosed with hypertension. However, none of these scores were significantly different.
Overall, the item with the highest correct response rate (80%) was that high blood cholesterol increases the incidence of heart disease (Table 4). This was also the item with the highest correct response rate among cardiovascular disease related questions. The item with the highest mean score among diabetes mellitus related questions was that fruits should be consumed by persons living with diabetes (77.3% response rate). The item with the highest mean score among obesity related questions was that nurses agreed a high fiber diet is recommended for obesity (62.9% response rate).
Question | Answer Options | N | % |
High blood cholesterol increases the incidence of heart disease. | A. Agree* B. Disagree C. Don’t know | 156 33 6 | 80.0 16.9 3.1 |
Fruits should not be consumed by the diabetic patients. | A. Agree B. Disagree* C. Don’t Know | 35 153 10 | 17.7 77.3 5.1 |
For the treatment of hypertension, a low sodium diet is routinely recommended. | A. Agree* B. Disagree C. Don’t know | 152 39 6 | 77.2 19.8 3.0 |
Omega-3 fatty acids such as fish oil help to reduce hyperlipidaemia | A. Agree* B. Disagree C. Don’t know | 128 42 25 | 65.6 21.5 12.8 |
A lower intake of saturated fat decreases the risk of coronary artery disease. | A. Agree* B. Disagree C. Don’t know | 127 48 20 | 65.1 24.6 10.3 |
Table 4: Top 5 Most frequently correct responses (N=198).
The five most frequently incorrect statements are presented in Table 5. Only 8.1% of nurses knew that decreased total fat intake is recommended for an obese 45-year-old adult who had a blood cholesterol level of 239 mg/dl. This was the item with the lowest correct response rate among all questions. This was also the item with the highest correct response rate among obesity related questions. Among cardiovascular disease related questions, 19.2% of nurses agreed that intake of <300mg of cholesterol is recommended for a low cholesterol diet—the lowest correct response rate among cardiovascular disease related questions. Among diabetes related questions, 47.7% (the lowest correct response rate) of nurses knew that sugar-free carbonated beverages should not be used for patients with hypoglycemia.
Question | Responses | N | % correct |
An obese 45-year-old adult has a blood cholesterol level of 239 mg/dl. Which of the following dietary therapies is the first recommended? | A. Decrease monounsaturated fat intake B. Decrease polyunsaturated fat intake C. Decrease total fat intake* D. Decrease total cholesterol intake E. Decrease carbohydrate intake F. Don’t know | 23
55
37
| 11.6
27.8
18.7
|
Intake of less than __mg of cholesterol is recommended for a low-cholesterol diet. | A. 100 B. 200 C. 300* D. 400 E. 500 F. Don’t know | 49 62 38 3 4 41 | 24.9 31.5 19.2 1.5 2.2 20.7 |
The dietary therapy which is not recommended for preventing coronary artery disease is: | A. Replace iso-calories of unsaturated by saturated fatty acids* B. Consume complex carbohydrates as the majority of daily caloric intake C. Reduce food high in cholesterol D. Decrease total fat intake E. Increase fruits and non-starch vegetables F. Don’t know | 58
45
52
10 10 18 | 30.1
23.3
26.9
5.2 5.2
|
Table 5: The five most frequently incorrect statements.
The profile of a knowledgeable nurse was a female registered nurse from the Western region who had less than five years’ experience, who was more than 36 years old, who was overweight but had been diagnosed with neither diabetes nor hypertension. The profile of a less than knowledgeable nurse was a male licensed practical nurse from the South region, who had 11-15 years’ experience, who was more than 35 years old, who had been diagnosed with diabetes mellitus and hypertension, and who was underweight.
As has been demonstrated in earlier studies, Belizean nurses have low levels of therapeutic nutrition knowledge (mean score=53.30%±17.20). The two most recently reported mean knowledge scores were for Jordanian nurses 58.8% ±13.2 in 2013 [17], and for Ghanaian nurses 44.9% ± 3.17 in 2015 [19]. The only published studies which have shown higher levels of nurses’ nutrition knowledge were from Australia 60%±8.4 in 2005 [15], and the United States of America 65%±11 in 2001 [20]. Nurses in Belize’s West region had a significantly higher overall mean, higher mean knowledge scores for nutrition and diabetes; and for nutrition and cardiovascular diseases; compared to nurses in other regions. The West region of Belize is the site of the capital city, Belmopan.
No other published studies have assessed the relationship between nurses’ nutrition knowledge scores and their weight status and previous diagnosis of diabetes and hypertension. Nurses who had not been diagnosed with diabetes had significantly higher knowledge scores overall, in nutrition and diabetes, nutrition and cardiovascular diseases, and in nutrition and obesity. This was a surprising, if not troubling, discovery. Ideally, nurses who have been diagnosed with a non-communicable disease should not only be knowledgeable about disease management but they should have achieved success in managing the condition. Since Afro-Trinidadian adolescents and Jamaica, adults have been shown to view overweight and obesity are viewed favorably as signs of happiness or wealth [22-24], it would be important for future research to compare Caribbean nurses’ actual and perceived weight status to nutrition knowledge. Future research could address the extent to which nurses’ nutrition knowledge is related to glycemic control and blood pressure levels.
These data did not confirm the data from one earlier study which showed a direct relationship between knowledge scores and age, and years of nursing experience. Using a different 48-item instrument, Australian nurses who were more than 36 years of age had statistically significant higher nutrition knowledge scores 65.2% than nurses who were 35 years or younger 52.5% p = 0.004 [15]. Similarly, Australian nurses with more than 10 years of experience had a statistically significant higher knowledge score than nurses with 10 years or less experience p = 0.024, although actual scores were not stated.
Earlier studies have reported inconsistencies in the relationship between nurses’ knowledge and educational preparation. In Australia, nurses with a Diploma or General Nurse Training (less than four years of preparation) had a statistically significantly higher knowledge score 63.5%, than nurses with a four-year degree 54.6% p = 0.029 [15]. However, among Turkish nurses, knowledge scores were significantly higher as educational preparation increased p<0.001 (16). Approximately 45.2% graduate nurses had “good” (13-16 points) mean scores, 39.3% undergraduate nurses had “adequate” (9-12 points) mean scores, and 15.2% of secondary education nurses had “inadequate” (≤ 8 points) mean scores.
Earlier studies have also identified statistically significant but an inconsistent relationship between nurses’ nutrition knowledge and gender. In Jordan, nutrition knowledge on cardiovascular diseases was significantly higher for female nurses 56.6%, compared to male nurses 51.9% p=0.04 [17]. However, in Ghana, male nurses had a significantly higher nutrition knowledge score 12.93±3.10 than females 11.34±3.05 p=0.003 using a 21-item instrument [19]. The variation in results from different studies may be related to the different types of questionnaires used in the studies, the size of the sample, differences in the scope of practice of the nurses among countries, and variation in the nursing school curriculum among different countries.
The low level of therapeutic nutrition knowledge of Belizean nurses 53.30%±17.20 is similar to levels described in Jordan and Turkey, but lower than studies in the USA 65%±11.0 [20], and Australia 60%±8.4 [15].
One study limitation is that completing questionnaires during work hours may have influenced nurses’ interpretation and responses to questions. These data were derived from a convenience sample and should therefore not be generalized to all Belizean nurses. Future research may need to quantify the extent to which nurses provide nutrition services—screening, counseling, and monitoring--to hospitalized patients.
This study showed that nurses in Belize have suboptimal level of therapeutic nutrition knowledge (53.30%±17.20). In small countries such as Belize where nutrition professionals are uncommon, and there is no national plan to increase the number of trained dietitians and nutritionists, it is even more important to ensure that nurses have adequate therapeutic nutrition knowledge. Nurses need to have access and to be rewarded for continuing education in therapeutic nutrition as part of their licensing requirements. Mandatory continuing education in nutrition could be part of nurses’ licensing requirements. To improve compliance, nurses need to be consulted on their preferences for learning modalities such as e-learning and Medscape [25].
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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.
