AUCTORES
Globalize your Research
Research Article
*Corresponding Author: kalpana Madikattu, Department of Psychological Medicine, st.Peters institure of pharmaceutical sciences, India.
Citation: kalpana Madikattu , vamshikrishna M . Analytical aspects of depression among elderly. J Psychology and Mental Health Care. 1(2); DOI; 10.31579/2637-8892/010
Copyright: © 2017 kalpana Madikattu. 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: 03 April 2017 | Accepted: 11 April 2017 | Published: 20 April 2017
Keywords: depressive states; diagnose; clinical heterogeneity
The depressive states of the elderly are frequent and difficult to diagnose due mainly to their clinical heterogeneity. One of the reasons for the increase in the rate of suicide in the over 80 years is probably the non-recognition of depressive states. Thymicand affective complaints frequently occur with advancing age and are too often attributed to the consequences of normal aging, which is accompanied by the successive losses that characterize old age.
Introduction
The depressive states of the elderly are frequent and difficult to diagnose due mainly to their clinical heterogeneity. One of the reasons for the increase in the rate of suicide in the over 80 years is probably the non-recognition of depressive states. Thymicand affective complaints frequently occur with advancing age and are too often attributed to the consequences of normal aging, which is accompanied by the successive losses that characterize old age. However, we must insist on the need to recognize the existence of a thymic disorder that we can treat because the latter will cause, in addition to excessive suffering but also a signifi cant handicap in the daily operation from subject. We will try in this article to highlight the specifi cities of this pathology in the elderly and its management.
Epidemiology
The results of the epidemiological studies on depression vary according to the defi nitions of depression and methods of identification and evaluation [1]. It seems that the main problem lies in the choice of diagnostic criteria and arguments exist for the hypothesis that the depression of the elderly person may have symptomatic profi les different from those observed in young adults. It is not a different disease but rather a clinical form where symptomatic differences may represent subtypes of aging-related brain disorders. It is also known that the health status of the elderly has improved overall in recent years. It must be emphasized, however, that this observation covers highly heterogeneous situations. In fact, the state of health of an institutionalized person has nothing in common with that of an autonomous person living at home. This heterogeneity is also found when one looks at the prevalence of depression. Thus the authors agree to describe this prevalence according to the situation of the subjects. There are studies in general population, studies in care structure and accommodation and the results are very different.
In general population, the prevalence rate is estimated between 2 and 3% for a major depressive episode defi ned according to the DSM V after 65 years [2]. If one is interested in dysphoria, that is to say the less well-characterized depressive episodes, the rates can be as high as 10 to 15% [3, 4]. The studies carried out in general medicine are worthy of interest because it is the general practitioners who see, more than the psychiatrists, old depressed subjects, because of their availability and especially of the look often pejorative that the elderly subjects are on the psychiatry. About 15 to 30% of seniors who visit general practice have signifi cant depressive symptoms. It is often a somatic disorder that causes the subject to consult, which makes the diagnosis more diffi cult [5].
In institutionalized subjects, the authors manage to identify a prevalence rate of up to 40%. Some of these subjects present with chronic and severe forms of depression (10%) that persist for a long time and may prevent the resolution of concomitant somatic problems [6]. Overall, major depression and depressive symptoms are more common in women but the frequency of suicide is higher in men. The prevalence of suicide in the depression of the elderly seems to be 4 times higher than in young people [7]. In fact, elderly people “succeed” in 54- 79% of cases. Depression is an important factor of mortality in institutionalized elderly populations and constitutes a very negative prognostic risk factor for associated pathologies (infarction, stroke, hip fracture, etc.) [8].
Risk factors
The causes or risk factors of depression are schematically of 3 major types: biological, psychological and social [9]. Depression is more common in patients with severe or chronic somatic conditions, loss of autonomy or disabling sensory defi cits. Lifestyle changes, separations, bereavement, loss of social and family ties and roles, or a new role (such as caring for a sick spouse) are all factors that contribute to dep Epidemiological studies also show that low-income and low- cultural subjects are at greater risk of depression than others. Family and biological studies suggest the possible involvement of genetic factors in major depression. However, the family terrain plays a much less important role for the elderly than for the young adult. Changes in neurotransmitter activity and metabolism with advancing age are also risk factors for developing depression [10]. Some treatments can trigger or aggravate a depressive state. These “iatrogenic” forms are sometimes diffi cult to recognize, the symptomatology may develop a few days after initiation as weeks later. Corticosteroids are one example. Neuroendocrine changes also appear to affect mood. Indeed, some studies show a positive association between increased secretion of cortisol and the presence of depressive episodes. Dysregulations of the thyrotrophic axis can also be associated with depressive episodes [11]. Finally, the high frequency of depressive states in peri-menopause emphasizing the role of estrogen defi ciency in the onset of this type of symptoms [12]. In summary, there are many risk factors, but experience shows that in the elderly, depression is particularly prevalent among women, single or widowed individuals, those with recent bereavement or stressful events. So there are risk factors that are easy to spot if we take the trouble to consider them at their fair value.
Semiological aspects
Depression is more difficult to recognize in the elderly because of the somatic changes that accompany aging, the frequent entanglement with somatic conditions with the idea that anhedonia or lack of pleasure inevitably accompanies old age. As a result, the depression of the elderly will be under diagnosed in about 40% of cases. Any sadness is not a sign of depression either. Emotional changes are frequent in the elderly and may be the consequence of physiological aging or symptoms induced by a somatic or iatrogenic condition common at this age. Sadness becomes pathological only when it is associated with a loss of interest and a slowdown, and there are circumstances such as grief, for example, where it must be respected. The loss of interest experienced as unpleasant must attract attention, especially when it is disproportionate to the subject’s physical and cognitive abilities [13]. The set of signs encountered in the depression of the adult subject can be found in the clinic of the depression of the elderly subject. However, it must be emphasized that the elderly person has a hard time being depressed and complaining about it. We must therefore identify, in addition to the central symptoms of depression that will not be expressed, signs such as loss of interest, asthenia and loss of energy, decreased appetite, changes observed during the waking sleep cycle, psychomotor slowing and diffi culty in focusing, which will need to alert the doctor [14]. In conclusion, depressive presentations are often atypical: - Somatic complaints are considered as a means of expressing the painful experience of depression. These complaints are generally more frequent in the elderly patient compared to the young adult. - Cognitive complaints, because of idiopathic slowdown sign of depression, are often put forward by the patient. They constitute a double trap because they can mask the depression and deprive the patient of a therapeutic management. Moreover, these complaints may be the fi rst manifestation of a degenerative pathology beginner. Depression can also be expressed by anxiety disorders, temper or irritability, or impulsivity. Recent compulsive alcoholism may also refl ect a debilitating depression.
Evaluation of the elderly depressed patient At present, there is no consensus on the procedures to be used to detect depression in the elderly. There is a very often used instrument that is a 30-item scale for self-evaluation and can be reduced to 15 items without losing any of its sensitivity [15]. This is the Geriatric Depression Scale (GDS). Some authors have suggested the use of 4 items of this scale so that general practitioners or nurses, at home, can detect a depressive syndrome.
These 4 items are:
- are you basically satisfi ed with your life?
- do you consider that your life is empty?
- do you fear that something bad is happening to you?
- do you feel happy most of the time?
This 4-item scale is a good starting point and can be complemented by a list of predisposing factors: Does the patient have a history of depression, is he / she socially isolated, has chronic health problems, or has recently been mourned? Clinical history is the most important aspect of evaluation. There are 7 main points that he should be considered in all cases: -
family history: family history of depression or other psychiatric illnesses, - personal psychiatric history: does the patient have a documented history.
- personality: how does the patient function in terms of personality when he is not depressed? Information on this aspect should be collected from a person close to the patient.
- social antecedents: what is the optimal level of functioning of the patient, does he live alone, he goes on, does he receive home help.
- Suicide: Is the patient at risk of suicide. Has he made several suicide attempts?
- Somatic disorders: Does the patient have somatic disorders.
What medications do he / she take at the time daily?
- Evolution of the depressive symptom: since when does the symptomatology evolve, what was its speed of installation.
The cognitive evaluation, even if it will be strongly disturbed by the depressive symptomatology, must be done with simple instruments [16]. For this purpose, the “Mini-Mental” can be used State Examination “(MMSE) that will provide a benchmark before starting antidepressant treatment. If cognitive impairment exists, it should improve with treatment if the subject does not present neurodegenerative pathology. In addition, it is important to know that an elderly person with signs of cognitive impairment will have 4 times more of risk of presenting Alzheimer’s disease a few years later compared to a depressed elderly in whom the cognitive functions are preserved.
Evolution
The frailty of the depressed elderly subject is without question. Even after the resolution of the depressive episode, these subjects remain at risk of either relapse or somatic complications. The mortality rate has been estimated at 15%. Mortality can relieve immediate complications of depressive episodes (decubitus, malnutrition) but also occurs several years later because of the bad state subject physics. The prognosis of depression depends on the severity of the disorder. Evolution can be done towards complete cure without relapse, but a signifi cant rate of patients presents relapses of during the fi rst year. A signifi cant proportion of depressed (approximately 10 %), will present a chronic course with persistence of depressive symptomatology disabling. Finally, it should be emphasized that the depression of the elderly subject in itself remains a risk factor for dementia is not insignifi cant [17].
Treatments
The care of the depressed elderly subject is in the fi rst place a comprehensive care. It must focus on the environmental factors that have favored the depressive syndrome but also associated somatic pathologies as well as the subject’s prior personality. In addition to the pharmacological therapeutics represented by the prescription of psychotropic drugs, antidepressant drugs, we must not forget that elderly people respond to psychotherapy and that age is not in itself a contraindication.
Pharmacological treatments
Elderly people are heavy users of psychotropic drugs. Average consumption in institution is higher than at home. Benzodiazepines will be more prescribed outpatient then that it is the neuroleptic that arrives at the top of prescriptions in medical structures [18], but unfortunately there are not adapted in elderly patients depressed. Aging is accompanied by a change in the pharmacokinetics of drugs by digestive resorption sometimes reduced, by a fi rst-pass effect, by a reduction in hepatic excretion, renal excretion or protein fi xation. These general remarks prescribing behavior and should be remembered: In most cases, dosages should be decreased as well as fractionated in the intake. Polypathology resulting in polymedication is a limiting factor in the prescription of psychotropic drugs and the patient is often at risk for drug interactions. The rate of side effects would also be higher in the elderly. The most iatrogenic often encountered are:
- confusion
-cognitive decline due to the effects of psychotropic drugs on cognitive functions, Parkinson’s syndrome found with the prescription of neuroleptics but also with serotonin reuptake inhibitors that may cause an extrapyramidal syndrome,
-falls,
-hypotension
-cardiovascular effects with disorders of conduction, and finally,
-hyponatremia, because there is a risk of occurrence of a syndrome of inappropriate secretion of the anti-diuretic hormone when taking a serotonin reuptake inhibitor.
Any prescription of a pharmacological treatment obviously depends on the establishment of a reliable clinical diagnosis. In addition, the drug compliance of older people is a very common problem. This requires medical information of the patient and his entourage depression and treatment that remains a prerequisite for successful treatment [18]. Once the antidepressant treatment is prescribed, the duration of the treatment is in fact linked to the prevention of recurrence when it has been effective on acute episodes. It has been shown that the prosecution antidepressants would provide signifi cantly greater prevention against recurrences than the placebo. As a rule, the treatment should be maintained 6 months after healing the fi rst episode and 12 months to 2 years after the second. It should be emphasized that the adage “start low, go slow” “start at a small dose, increase slowly” is particularly suitable for the conduct of antidepressant treatment in the elderly. These precautions allow, starting at low dosages, to avoid the side effects encountered at the beginning of treatment and increasing in small increments, avoids abrupt modifi cations of serum levels very often responsible for iatrogenies. SSRIs are commonly used to treat depression in the elderly without dual-blind placebo-controlled trials demonstrating effi cacy in patients over 75 years of age [19].
Given the existence of signifi cant changes in pharmacokinetics, as well as the existence of a polymedication another rule is that of monitoring the serum level of antidepressants that should be more common practice in the elderly. Faced with the ineffi ciency of a well conducted treatment, this practice will explain most situations by the discovery of too much serum low, but it will also explain the occurrence of unexpected side effects in cases accumulation of the product. Therapeutic strategies are guided by the tolerance of available products. First, he will be to prescribe serotonin reuptake inhibitors that are generally well tolerated and often effective on depressive symptoms. The effect will not be immediate and is often delayed by compared to the deadlines found in adults. So you should know to wait at least a month before judge an ineffective treatment and increase the dosage. Molecule changes for ineffi ciency should be guided by consistent and careful clinical reasoning in trying to eliminate all causes of ineffi ciency such as non-compliance before declaring the disorder resistant to molecule. Imipraminic antidepressants are prescribed as second-line signifi cant side effects. For some authors, they would be more effective in elderly depression than serotonergic antidepressants [20]. Given the lack of response of conventional antidepressants in the subject of some authors have proposed the use of ketamine [21].
Electroconvulsotherapy (ECT)
ECT is a treatment that must be used in the depression of the elderly resistant patient. The trends action remains unknown but their effectiveness remains unquestionably [22]. The indications in the elderly are the depressive syndrome with delusional disorders, pseudo dementia and the presence of contraindications to antidepressants or poor tolerance to these last. The side effects are very moderate and the contraindications would be limited to those of anesthesia. This technique still supports a very negative image of both public opinion and among physicians; however, the mortality rate would be between 1 in 10,000 or 50,000 cases, which would make it one of the safest medical treatments under anesthesia
Psychological approaches
The solicitation of the patient to greater family and social participation is not to neglect (physical activity, senior club ...). Psychotherapy (supportive therapy, cognitive therapy) can play an important role in taking in charge of depression [23]. However, experience shows that this approach is rarely implemented in the elderly.
Conclusion
Depression of the elderly is a major public health problem, both in terms of frequency and impact on quality of life, general health, and loss of autonomy and increased risk of suicide. In general or primary care, the screening and treatment of depression in the elderly remains extremely diffi cult, due in particular to an often atypical symptomatology, with the particularly frequent presence of somatic complaints, pain and / or hypochondriacally symptomatology. The “traditional” diagnostic criteria as presented by the DSM-IV and ICD-10 are often diffi cult to use in depressed elderly subjects. Depending on the antecedents, the clinical picture and the evolution, the association with other psychiatric disorders or degenerative neurological diseases of the central nervous system must be taken into account. The diffi culty of making a diagnosis of certainty remains the main reason why the depression of the elderly is insuffi ciently diagnosed, whereas its frequency is high [24]. Major depression in older adults is common and can be effectively treated with antidepressants and electroconvulsive therapy. Psychological therapies and exercise may also be effective for mild-moderate depression, for patients who prefer nonpharmacological treatment, or for patients who are too frail for drug treatments [18].
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
