AUCTORES
Globalize your Research
Research Article
*Corresponding Author: Melba Sheila D'Souza, Department of Adult health and critical care, Sultan Qaboos University and Hospital, Muscat, Sultanate of Oman
Citation: Melba Sheila D'Souza, Eilean Lazarus Rathinasamy, Education and Exercise on the Quality of Life among Adults with Chronic Renal Disease .J. Endocrinology and Disorders, Doi:10.31579/2640-1045/037
Copyright: © 2018 Melba Sheila D'Souza et al. 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: 13 August 2018 | Accepted: 22 August 2018 | Published: 27 August 2018
Keywords: quality of life; kidney disease quality of life; education; exercise; chronic renal disease; end-stage renal disease; hemodialysis
Objective: Evaluate the effectiveness of education and exercise on the quality of life among adults with chronic renal disease (CRD) on hemodialysis post-intervention (4 and 8 weeks).
Methods: An evaluative true intervention approach was used. An ethical approval was obtained from the institutional ethics committee. A random sample of 150 patients (75 in intervention and 75 in control group) with CRD receiving dialysis was selected based on the inclusion criteria. The intervention group received interactive education and supervised exercises. RAND health-related kidney disease QOL (KDQOL) questionnaire was used.
Results: Mean scores for the Kidney Disease and general QOL sub-scales among the intervention group were higher and statistically significant (p<0.01) compared to the control group. Conclusion: Education and exercise was shown to have a positive effect on the physical and mental health among the adults.
Chronic kidney disease (CKD) or chronic renal disease (CRD) is a progressive loss of renal function overtime causing a slow decline in kidney function [29]. CRD may be caused by chronic hypertension, diabetes, congestive heart failure, lupus or sickle cell anemia and initiated by acute disease processes like sepsis (infection), shock, trauma, kidney stones, kidney infection, drug toxicity (aspirin or lithium), poisons or toxins (drug abuse) or after injection with an iodinated contrast dye (adverse effect). CRD may result in a life-threatening metabolic imbalance [3] and leads to end-stage renal disease [1]. In India, the causes of end-stage renal disease (ESRD) are diabetic nephropathy, hypertensive nephropathy, chronic pyelonephritis, autosomal polycystic kidney disease and obstructive uropathy [22]. The approximate prevalence of CKD is 800 per million population (pmp) and the incidence of ESRD is 150-200 pmp. There is no data on the true incidence and prevalence of chronic renal failure in the developing world [1]. Hence, CRD is a distressing medical, social and economic problem for adults and their families.
People with CRD surface with physical and emotional changes related to their disease and its treatments. They can live independently if they are able to function, both physically and mentally [26]. Physical and mental function are inversely correlated with the risk for hospitalization and mortality (15). Health-related quality of life (QOL) refer to the measure of adult's functioning, well-being, and general health perception in each of three domains: physical, psychological, and social among adults with CRD. CRD influences QOL and QOL is predictor of outcome in CRD. Adults with CRD on dialysis have lower level of QOL. QOL of adults with CRD is influenced by the disease and by the type of replacement therapy. QOL is an indicator of the effectiveness of the medical care they receive.
Background
QOL is compromised, by fatigue and encounters in planning meals and limiting fluids. Adults' social and role responsibilities may be altered due to problems with travel, impotence, and changes in body image [13]. Education, social support, and self-care have been shown to raise coping skills among people on dialysis [33]. Emotional adjustment, adherence to treatments, positive attitude, exercise, and engagement in life pose challenges to adults with CRD [16]. Kidney failure, treatment choices, medications, and the renal diet can help adults with CRD on dialysis to maintain a sense of control, a factor linked to improved adherence and life satisfaction [23]. Early education about renal disease, and the potential to live long can aid in overall adjustment and decision making for people on dialysis [37].
Informed adults have reported fewer symptoms as well as more confidence in their ability to manage the symptoms they do have. Supportive social environments have shown a positive impact on adjustment for people with renal disease [10]. Support received from their families and dialysis staff was a major factor in promoting employment; an activity that contributes to emotional health [31]. With education and support, people on dialysis can begin to make careful, informed decisions about their treatment [18]. Renal rehabilitation is an optimal functioning for adults and restoration to productive activities [32] and the “5 E's”- encouragement, education, exercise, employment, and evaluation are used [21]. Energy and activity levels, functional ability, sleeping and eating behaviors, disease symptoms, health status, sex life, well-being, psychological effect, satisfaction with life and health, and happiness was found to affect QOL in young and elderly adults [11]. There is no data to explore the effect of combined education and exercise on the QOL among adults with CRD on hemodialysis [34]. Hence this study was conducted to examine the effects of combined education and exercise on QOL among adults with CRD.
Conceptual model
Adaptive system model (Roy, 1984) was used in this study (Figure 1).
The adaptive system (person) has inputs of stimuli includes variables, outputs as adaptive responses that serves as feedback [28]. Individual is a whole and dysfunction in one component
affects the entire system. The inputs is identified as stimuli are age, gender, educational status, occupation, economic status, co-morbidity, frequency of dialysis, hemoglobin level, serum creatinine and body mass index. Throughput makes use of a person processes and effectors. The processes used for intervention group special intervention like education, exercise, adherence to treatment options, dialysis, diet, drug, exercise, counseling, and encouragement. Effectors refers to the assessment of Kidney Disease QOL which includes physical functioning, role physical, bodily pain, general health, vitality, social functioning, role emotional and mental health. Output
is the outcome of the system. When the system is a person, output refers to the person’s behaviors. In the intervention group the adaptive responses are used when a person demonstrates behaviors that achieved the goals like better physical health, mental health, knowledge and adherence to treatment.
Aim
Effectiveness of education and exercise on the quality of life among adults at base line and post-intervention with chronic renal disease on hemodialysis.
Design
An evaluative true intervention approach using randomized pre-test and post-test control group design was employed to evaluate the effectiveness of education and exercise on the quality of life among adults on hemodialysis. This study instituted two groups, an intervention group exposed to education and exercise and the control group with usual care.
Selection and description of participants:
This study was conducted at a selected multi-specialty hospital with high-tech dialysis center consisting of 12-bedded unit with hemodialysis. The target population was adults with CRD subjected to hemodialysis at the dialysis unit during the period of data collection in 2012.
A sample size of 64 was determined using mean difference for a power of 0.80, a medium effect of 0.80 with p<0.05 (Cohen 1992). A total sample size of 75 adults was estimated for intervention and 75 adults for the control group to reduce the rate of attrition (Figure 2. Consort diagram).
A random probability sampling was used to select the total sample of 150 adults with CRD undergoing hemodialysis. Adults with CRD on hemodialysis who fulfilled the inclusion criteria (elective basis, more than 6 weeks on dialysis, and age group of 20-70 years) during the data collection period were recruited to participate in the study. Adults who were known to have psychiatric disorder, and altered level of consciousness were excluded from the study.
Measurements:
The Kidney Disease Quality of Life- Short form (KDQOL-SF) instrument is a self-report measure developed for individuals with kidney disease and on dialysis [12]. It includes 43 kidney-disease targeted items and 36 items of SF that provide a generic score and an overall health rating item. It focus on particular health-related concerns like Symptoms/Problems (12 items), Effects of kidney disease on daily life (8 items), Burden of kidney disease (4 items), Work status(2 items), Cognitive function (3 items), Quality of social interaction (3 items), Sexual function (2 items), Sleep (4 items), Social support (2 items), Dialysis staff encouragement (2 items), adult satisfaction (1 item) (KDQOL-SF 1997). The KDQOL-SF includes a 36 item health survey (RAND 36-item health survey) as the generic core (12). It consists of 8 multi-item measures of physical and mental health status: physical functioning (10), role-physical (4), bodily pain (2), general health (5), vitality (4), social functioning (sf) (2), role-emotional (re) (3) and mental health (5). An overall health rating item rates their health on a 0-10 response scale ranging from worst possible to best possible health. A score between 0 and 100 is calculated on the basis of well-defined guidelines, with a higher score indicating a better state of health. The 80 KDQOL-SF take about 16 minutes to complete. The reliability of the KDQOL-SF was r=0.80 in this study. Hence the instrument was valid and reliable for the study.
Demographic variables consist of age, gender, educational status, occupation, marital status, place of residence, type of family, family monthly income, distance of residence from hospital and medical insurance. Clinical variables include presence of co-morbidity, frequency of dialysis per week, physical activity, hemoglobin level, serum creatinine and body mass index.
Intervention:
Renal rehabilitation is defined as an optimal functioning for adults and restoration to productive activities. To nurture renal rehabilitation and guide program development, the Life Options Rehabilitation Advisory Council (LORAC) identified five core principles, called the “5 E's”—Encouragement, Education, Exercise, Employment, and Evaluation. Renal Rehabilitation Program with intervention include interactive education, exercise, life style modification, and coping was developed by the investigator and validated for content and concepts. Online, videos and CDs provided information based on the perceived needs of adults with CRD and life style modification, orientation to health team members, structure and functions of the kidneys, hemodialysis, stages of kidney failure, causes of CKD, signs and symptoms, tests, treatment, dietary guidelines and modification, quitting smoking and alcohol, strategies for slowing progression and treating conditions underlying chronic kidney disease, complications of chronic kidney disease may require medical treatment, dialysis and its impact, exercise, sexual life alteration , change of work, recreation and planning for holiday with their family members and process of leading to near normal life style. The sessions on education and exercise were provided in the local vernacular language before the dialysis. Counselling was provided by the nephrologists and the unit nurses. The control group subjects received the usual treatment and no intervention.
Data collection:
An ethical approval was also obtained from the Institution Ethics Board. The permission to conduct research in Dialysis Unit was obtained from concerned authorities. The eligible participants were identified from the hospital medical records after obtaining permission. Ethical principles were adhered too throughout the study. The purposes of the study and their right to participate or withdraw from the study were explained with written informed consent. Adults who volunteered and fulfilled the inclusion criteria were enrolled for the study. Baseline data on demographic variables was collected using interview technique. Privacy was provided during the data collection. Baseline data was collected from the selected voluntary adults with CRD in 2012. The first post test was taken after 4 weeks before initiating dialysis and reinforcement was given. The second post-test was taken after 8 weeks of the first post test before initiating dialysis and after the reinforcement was given on the same.
Data analysis:
SPSS21 was used to analyze the descriptive and inferential data. Paired ‘t’- test, independent ‘t’–test were applied to determine the effectiveness of education and exercise. Test of homogeneity indicated no significant difference between the groups in the demographic and clinical variables.
Demographic and clinical variables
One-third of the adults were 40-49 years in the intervention (31%) and control group (41.3%) (Table 1). One-third of the adults had primary education in the intervention (32%) and control group (42.7%).
Majority of the adults lived in the town in the intervention (62.7%) and control group (53.3%). Majority of the adults had dialysis more than once a week in the intervention (80%) and control group (73.3%) (Table 2).
Half-percentage of the adults had low hemoglobin in the intervention (54.7%) and control group (50.7%). Kidney disease quality of life after education and exercise
There is no differences in the KDQOL between the intervention and control group in the pre-test (Table 3).
The mean scores of the KD QOL was significantly higher with symptom, effect of kidney disease, burden of kidney disease, cognitive function, sexual function, sleep, social support, encouragement, overall health and satisfaction in the intervention group compared to the control
group in the post-test 1. The mean scores of the KDQOL was significantly higher with symptom, effect, social support, encouragement, overall health, and satisfaction (p<0.001) in the intervention compared to the control group.
General QOL after intervention
Mean QOL scores of physical functioning, role physical, pain, general health, role emotional, social function, were significantly higher in the intervention group compared to the control group (p<0.001) (Table 4).
Mean QOL scores of physical functioning, role physical, and role emotional were higher in the intervention group compared to control group (p<0.001).
Physical and Mental Composites of General QOL
The mean scores of the QOL physical composite significantly improved among the intervention group compared to the control group (p<0.001) in the post-test 1 and post-test 2 (Table 5).
*P<0.05
Association between variables and KDQOL
Middle age (40-59 years), male gender, higher income (more than 12,000 IRS) were significantly associated with QOL among adults in the intervention group (Table 6).
*Significant at p <0.05
Co-morbidity (DM and Hypertension), frequency of receiving dialysis more than once /week, moderate anemia (6-8.5 g), low Serum Creatinine (2-4 mg/dl), and underweight BMI were significantly associated with QOL among adults in the intervention group.
In this study education and exercise improved physical functioning among adults on hemodialysis leading to an improvement in their quality of life. Education and exercise had a positive effect on improving the quality of life of adults with dialysis. Other studies showed that increased QOL had a significant decrease in serum urea, intradialytic weight gain, and improving QOL [20]. Increased QOL was observed after an intradialytic exercises [25]. Education influences dietary compliance and medication regimen improves serum albumin and hemoglobin [35].
In this study middle age group, men, higher income, dialysis more than once /week, moderate anemia, low Serum Creatinine, and underweight BMI were significantly associated with QOL after intervention at 8 weeks among the intervention group. Education, diet, and regular exercise had a better impact on the adults on hemodialysis. Men who are independent, self-controlled good family support and good biochemical control have better QOL. Better QOL mean scores were observed among men, those married, working, good hemoglobin, low serum creatinine among adults with hemodialysis [27]. Cognitive function and quality of social interaction and QOL was associated with older age, socio-economic and higher educational level among adults on HD in Romania [7]. Education and employment influenced the physical and social domains of QOL as they are aware of the quality of service and individual rights [6].
In this study intervention group that participated in education and exercise showed better physical functional and QOL than the control group. These positive effects of participating in an education were seen after 8 weeks of dialysis treatment. Adults exposed to pre-dialysis education scored significantly better mood, less functional disabilities compared to the comparison group [36]. Education improves knowledge and self-management and treatment efficacy [4]. Physical exercise increased physical function among adults on hemodialysis [24] and increased exercise capacity, improves muscle function [6].
In this study education for adults with end-stage renal failure was found to improve QOL. Other studies showed that physical composite scores were correlated with age, hemoglobin and comorbidity, and mean PCS was lower in depressed adults on hemodialysis [19]. Physical functioning scale were significantly lower for obese subjects than for those with normal weight or moderately high BMI [9]. QOL of the intervention group was higher than the control group in 50% of the dimensions in KDQOL-SF and reported better emotional state, less bodily pain, improved social functioning and fewer problems with work [18]. QOL improved by 20% in coping among adults with hemodialysis [2].
In this study, the intervention group had higher general and kidney disease QOL compared to control group, except for energy fatigue, emotional well-being, social function and energy fatigue, work status, quality of social interaction, and social support. Physical and mental composites of general QOL were higher in the intervention group compared to the control group. Reduction in HRQOL of elderly adults of the same age and gender was lower than in younger adults. Elderly adults on hemodialysis had relatively better HRQOL [30]. Intervention improves QOL among adults with CRD [8].
In this study, physical, mental domains have significantly influenced QOL. QOL was improved with interactive education and supervised exercise among adults with CRD. Education and exercise improves knowledge and QOL and impacts adults with hemodialysis. Adults with CRD are encouraged to accept responsibility for their health and self-care. Education and exercise was shown to be a positive predictor of physical and mental health for people on hemodialysis as they have reported fewer symptoms and confidence in their ability to manage the symptoms they do have. They have reported better subjective quality of life, including social and role functioning, and emotional well-being. Hence education and exercise can enhance the potential for physical activity and improved quality of life and may influence other important outcomes.
A small sample size and past experiences among adults with dialysis may influence the results.
Implications
Adults with CRD may take more responsibility for things they can control, including exercise, remaining actively engaged in life, and renal meal plan. Their involvement in self-care can positively affect their adherence with treatment regimens. Education, exercise, staff encouragement toward education, exercise rehabilitation help adults form positive attitudes that will allow them to participate actively in life. Encouragement and counseling especially from families and dialysis staff, can increase autonomy, control, and participation in treatment. Adults with CRD on hemodialysis are encouraged and reinforced to learn about their self-care for improved quality of life. They take more responsibility for domains that they can control, including exercise, being actively engaged in life, and renal meal plan.
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
