AUCTORES
Research Article
*Corresponding Author: Bisrat Hailemeskel, College of Pharmacy, Howard University, 2300 4th Street, Washington D.C., 20059, USA
Citation: Oluwatosin Dairo, Imani Akram, Christopher Bratcher, and Bisrat Hailemeskel, (2023), Review of Duloxetine Use in the Management of Stress Urinary Incontinence & Students’ Survey, J. General Medicine and Clinical Practice. 6(4); DOI:10.31579/2639-4162/083
Copyright: © 2023, Bisrat Hailemeskel. 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: 02 May 2023 | Accepted: 31 May 2023 | Published: 02 June 2023
Keywords: care pathway ; clinical pharmacy ; stroke
Introduction: Approximately 15 million adult women in the United States suffer from stress urinary incontinence (SUI), the most common form of incontinence among women. Currently, there is no Food and Drug Administration (FDA) approved medication for the treatment of SUI. Therefore, it is necessary to review potential drugs that have shown some benefits in clinical studies. One of these drugs is duloxetine. Many studies have shown a knowledge gap among healthcare providers regarding the off-label use of medications. However, studies show that one in five prescriptions written today are for off-label use. The goal of this study is to assess the knowledge and opinion of students regarding the off-label use of duloxetine in the treatment of SUI.
Methods: The Survey questions were provided during the Drug Information Course at Howard University (HU) College of Pharmacy in a class where first-year pharmacy students learn how to conduct a literature search and a survey. A total of 39 students responded to the survey.
Results: There were more females (n=23; 56.1%) with an age range between 18 – 24 years. About two-thirds (n=29; 70.7%) had a four-year degree before starting the pharmacy program. Overall, participants scored less than the passing 70% mark on the knowledge questions, which may call for educators to make a special effort to incorporate off-label and approved indications of medication teaching therapeutic-related courses. For example, more than sixty percent of respondents (n=25; 61%) incorrectly stated that duloxetine is a narrow therapeutic drug. The majority (n=; 34; 82.9%) of the participants responded wrongly that urinary incontinence is more common in women during their childbearing age. The opinion survey showed that most participants (n=25; 61%) did not believe there were many FDA-approved effective drugs for treating UI. Over sixty percent of participants (n=25; 61%) considered UI a severe illness and did not agree to use a non-approved drug such as duloxetine, although several published clinical studies support its effective use. Participants were split in their opinion regarding the non-approved use of medications.
Conclusion: Study results suggest that students may need encouragement to explore medications with non-FDA approvals.
Approximately 15 million adult women in the United States suffer from stress urinary incontinence (SUI), the most common form of incontinence among women.1 SUI is an involuntary leakage of urine resulting from urethral sphincter dysfunction and pelvic floor weakness, which occurs in response to increasing intraabdominal pressure when exerting effort, sneezing, or coughing, significantly impacting the patient's quality of life. Individuals can develop pelvic floor muscle loss due to chronic cough, rigorous exercise, pelvic floor trauma after vagina delivery, smoking, obesity, menopause, and constipation.2 Behavioral, pharmacological, and surgical approaches are available to manage stress urinary incontinence. However, conservative treatment often fails to meet the needs of patients with severe SUI, and surgery is rarely an option for an elderly population with a high level of morbidity.3 Duloxetine is effective in treating stress urinary incontinence in several studies.
Duloxetine is used off-label to treat stress urinary incontinence in both men and women. It is a serotonin and norepinephrine (5-HT and NE) reuptake inhibitor (SNRI). Duloxetine is generally approved for treating depression, generalized anxiety disorder, fibromyalgia, chronic musculoskeletal pain, and diabetic peripheral neuropathy. It has a common side effect of nausea, headache, dry mouth, drowsiness, or insomnia. Duloxetine has a possible risk of suicidal ideation in children, adolescents, and adults. The efficacy of Duloxetine for SUI is attributed to its ability to block presynaptic reuptake of 5-HT and NE in Onuf's nucleus, elevating the concentration of these neurotransmitters in the synaptic clefts.4 The bladder sphincter is controlled by serotonergic and norepinephrine terminals in Onuf's nucleus. Stimulating these receptors increases guarding reflex tone, suppressing voiding when abdominal pressure increases or is triggered by coughing or sneezing.
A double-blind, randomized, placebo-controlled trial was conducted to evaluate the efficacy and safety of Duloxetine in the treatment of stress urinary incontinence. The study was done on 553 women (18 to 65 years) with SUI. Patients were administered duloxetine 20 mg/day (138), 40 mg/day (137), and 80 mg/day (140) for 12 weeks. The results showed a significant and dose-dependent reduction in incontinence episode frequency (IEF), and improvements were reported in the Patient Global Impression of Improvement scale (PGI-I) and the Incontinence Quality of Life questionnaire (I-QOL). The highest dose, 80 mg daily, was statistically significant (P <.001). Most of the discontinuations were caused by nausea.[5]
A phase 3 randomized controlled study was conducted on 683 North American women (22 to 84 years) to assess the efficacy and safety of Duloxetine in women with SUI. Participants included in this trial must show symptoms of SUI with a weekly IEF of ≥7, the absence of urge incontinence (UI), regular diurnal and nocturnal frequency, a bladder capacity of ≥400 ml, and a positive cough stress test. The subjects were randomly allocated to receive Duloxetine 40mg BID or 80mg/day (344) vs. placebo (339) for 12 weeks. Compared with the placebo, there was a significant reduction in IEF with Duloxetine (50% vs. 27%, p 0.001) and a similar improvement in QOL (11.0 vs. 6.8, p 0.001). There was a significant increase in the voiding interval with Duloxetine compared to the placebo (20 vs. 2 minutes, p <0>
Another study compared Duloxetine alone, pelvic floor muscle training (PFMT) alone, combined therapy, and placebo in women with stress urinary incontinence. This randomized controlled trial enrolled 201 women (18–75 years) with predominant symptoms of SUI. Based on the analysis, the efficacy of Duloxetine was indicated, and it was more effective when used with PFMT than when used independently. Duloxetine alone and Duloxetine in combination with PFMT significantly (p < 0>
A meta-analysis of 4 randomized placebo-controlled trials of Duloxetine was performed on 1913 patients. A proposal for approval was submitted to the European Medicines Agency to treat women with stress urinary incontinence. Multiple clinical study reports were used to assess the benefits and adverse effects. Duloxetine significantly reduced weekly incontinence episodes compared to placebo (mean difference of 13.56%, 95% [CI] −21.59% to −5.53%). The NNT for a PGI-I of "much better or very much better" was 8 (95% CI 6 to 13). The NNH was 7 (95% CI 6 to 8) for discontinuing due to an adverse event. The was no report of suicidal events, violence, or akathisia.[8]
Off-label drug use (OLDU) involves prescribing medications currently on the market but for an indication that has not yet been approved by the Food and Drug Administration (FDA). Several factors may also contribute to the use of off-label drugs. For instance, if a specific patient population such as pediatric, geriatric, pregnant patients or dosages are not analyzed in clinical studies. In a patient suffering from a life-threatening disease, a healthcare professional may administer any appropriate treatment, irrespective of FDA approval.9 Therefore, it is crucial that healthcare providers educate themselves about off-label drug use in order to prevent medication errors. A study showed the frequency of off-label use among office-based physicians; approximately 21% of OLDU was reported in the trial.10 In general, antidepressants, anticonvulsant medications, and antipsychotic medications are commonly used off-label, as observed in a retrospective analysis of Georgia Medicaid recipients.[11]
A study was conducted to assess prescribing physicians' knowledge and perception of off-label drug use in a tertiary care hospital. A validated questionnaire was given to interns, junior residents, and faculty members. About 69% of the participants indicated that they had used a drug in an off-label manner primarily (36.5%) related to therapeutic purposes. Almost half of the study participants (48.2%) considered prescribing an off-label drug illegally, and only 29.3% of respondents believed that they had adequate Knowledge regarding off-label drug use.[12]
Another study reported the perceptions and attitudes of hospital-based pharmacists in Jordan towards off-label dispensing for pediatric patients. Pharmacy staff at 250 hospitals were randomly selected to complete a validated questionnaire regarding off-label dispensing to pediatric patients. The questionnaires were returned with 150 completed responses. Only 44% of respondents (n = 66) said they were familiar with off-label dispensing, stating their expertise mainly came from their dispensing experience. The survey found that 36% of respondents dispensed off-label drugs knowingly within their practices. There were concerns over the efficacy (82%, n = 123) and safety (98%, n = 147) of off-label medicines among respondents.[13]
Several studies show that most healthcare providers need to be more knowledgeable about off-label medicines before acquiring knowledge from their professional experiences. Off-label medicines are also subject to concerns regarding their efficacy and safety, especially in pediatric patients, due to the increase in adverse drug reactions (ADRs). We could not find research regarding the knowledge and opinions of OLDU pharmacy students. Pharmacists play a vital role in drug dispensing and patient outcomes. Thus, off-label use of medication should be integrated into the pharmacy curriculum. This study aims to assess the Knowledge and Opinions of Pharmacy Students regarding the off-label use of Duloxetine in managing Stress Urinary Incontinence.
This study enrolled 39 incoming first-year students from Howard University College of Pharmacy with a 100% response rate. The survey was optional and provided to students during the Drug Information course. All questions, demographics, and responses were analyzed using Qualtrics. The survey consisted of 8 demographic questions and ten opinion and knowledge questions and was administered using the Likert scale (Strongly agree to strongly disagree). Demographic data, including age, gender, residence state before the pharmacy program, prior work experience, annual income, and level of education, was collected through the survey. All results were analyzed using IBM SPSS, and statistical analysis was completed using crosstab and chi-square Pearson analysis, with a p-value of less than 0.05 considered significant.
A total of 39 students participated in this study. Most of the survey respondents (n=32; 78%) were 18 to 34 years (Table 1). There were more female respondents (n=23; 56.1%) than males (n=16; 39.0%). Twenty-nine (n=29; 70.7%) had a four-year degree before starting the pharmacy program. About (n=19; 46.6%) reported living in the Maryland/Virginia/Washington D.C. metropolitan area. Other demographic data are also summarized (Table 1&2).
Characteristics | Respondents (n, %) |
Age (years) | |
| 18 (43.9) |
| 14 (34.1) |
| 7 (17.1) |
Gender | |
| 16 (39.0) |
| 23 (56.1) |
Education | |
| 4 (9.8) |
| 3 (7.3) |
| 29 (70.7) |
| 3 (7.3) |
Resident | |
| 2 (4.9) |
| 10 (24.40 |
| 7 (17.1) |
| 20 (48.8) |
Table 1: Demographic characteristics of respondents
Worked | |
| 34 (82.9) |
| 5 (12.2) |
Type of Job | |
| 8 (19.5) |
| 13 (31.7) |
| 12 (29.3) |
Years Worked | |
| 3 (7.3) |
| 19 (46.3) |
| 2 (4.9) |
| 11 (26.8) |
Annual Income | |
| 12 (29.3) |
| 2 (4.9) |
| 5 (12.2) |
| 7 (17.1) |
| 4 (9.8) |
| 6 (14.6) |
Table 2: Work Related Characteristics of the respondents
Students were asked 5 knowledge and 5 opinion questions. The knowledge questions then were graded against the correct answers. According to the overall scoring of the knowledge section, sixty-five percent (n=23; 65%) of the respondents correctly answered the questions regarding duloxetine. The score is much lower than the passing scale, which is 70 percent or higher. The highest number of correct responses (n=34; 82.9%) was reported in the following knowledge question: Duloxetine has been shown to cause adverse side effects such as nausea, constipation, and dry mouth. The statement is true. The question with the least (n=4; 9.8%) correct answers was: Urinary incontinence is prevalent among women of childbearing age. The statement is incorrect (Table 3).
Survey Statement | Response [n, (%)] |
LK (m±SD) | |||
T. Correct Responses | T. Incorrect Responses | ||||
1. | Duloxetine is approved for the treatment of major depressive disorder | 31 (75.6) | 7 (17) | 3.34±0.85 | |
2. | Duloxetine is considered a narrow therapeutic drug and patients should be told not to exceed the maximum dose | 13(31.7) | 25 (61) | 2.87±1.04 | |
3. | Urinary incontinence is very common among childbearing-age women | 4 (9.8) | 34 (82.9)
| 3.29±0.65 | |
4. | Duloxetine has a black box warning that it increases suicidal thoughts and actions in children, adolescents, and young adults | 33 (80.5) | 5 (12.2) | 3.39±0.72 | |
5. | Duloxetine is well known to cause adverse effects that include nausea, dry mouth, and constipation | 34 (82.9) | 4 (9.8) | 3.29±0.65 | |
Abbreviations: T. Correct Responses= Total correct Responses; T. Incorrect Responses: Total incorrect Responses;
LK = Likert score; m±SD=mean± standard deviation.
Table 3: Responses to Knowledge - Related Survey Questionnaire Statements (n=39)
Duloxetine is a medication used to manage major depressive disorder (MDD), generalized anxiety disorder (GAD), fibromyalgia, diabetic peripheral neuropathy, and chronic musculoskeletal pain. Over three-fourths (n=31; 75%) of participants answered this question correctly. On the other hand, over sixty percent of participants (n=25; 61%) believed that the drug is considered a narrow therapeutic drug. Drugs are considered to have a narrow therapeutic index when there is only a small difference between the minimum effective concentrations and the minimum toxic concentrations in the blood. However, duloxetine is not considered one of them.
Over 25 million adult Americans experience temporary or chronic UI. This condition although can occur at any age, it is more common in women over the age of 50. However, the participants in our study (n=; 34; 82.9%) believed it is more common in women during their child-bearing age. On the other majority of the participants correctly answer about the black box warning and other adverse effects of the drug.
More than half of the participants (n=19; 51.5%) agreed with the statements regarding duloxetine based on their overall opinions. The survey revealed the highest response rate (n=31; 75.6%) in the group that agreed to the statement: Duloxetine has many adverse effects and thus should be reserved for only those indications approved by the FDA. The first and second statements had the lowest agreement rate (n= 13; 31.7%); the majority (n=25; 61%) of the respondents disagreed with these statements. Most of the participants do not believe in the off-label use of duloxetine in stress urinary incontinence. (Table 4)
Survey Statement | Response [n, (%)] | LK (m±SD) | |
Agreed | Disagreed | ||
I believe in the use of duloxetine outside of FDA-approved indications since there are not many effective drugs | 13 (31.7) | 25 (61) | 2.08±0.78 |
Urinary incontinence is a major illness that affects the well-being of patients and I do not recommend the use of unapproved drugs | 13 (31.7) | 25 (61) | 2.08±0.91 |
Duloxetine has many adverse effects and thus should be reserved for only those indications approved by FDA | 31 (75.6) | 7 (17.1) | 3.11±0.83 |
Non-approved drugs overall should be abounded from being used | 18 (43.9) | 20 (48.8) | 2.61±1.03 |
I do not believe duloxetine has enough evidence to use in women with stress urinary incontinence | 22 (53.6) | 16 (39) | 2.66±0.85 |
Table 4: Responses to Opinion-Related Questionnaire Statements
The majority of the survey participants (n=25; 61%) did not believe that there are many FDA-approved effective drugs for the treatment of UI although we know that there are over 20 drugs currently on the market including but not limited to oxybutynin (Ditropan XL), tolterodine (Detrol), darifenacin (Enablex), fesoterodine (Toviaz), solifenacin (Vesicare) and trospium chloride. Mirabegron (Myrbetriq). However, when it comes to SUI, there are no medications that have been approved in the United States although multiple medications have been evaluated.
Over sixty percent of participants (n=25; 61%) consider UI as a major illness and they did not agree with using a non-approved drug such as duloxetine. However, as is stated in the introduction section of this manuscript, there are a number of excellent studies in support of its use.
Three-quarters of the participants (n=31; 75.6%) believed that duloxetine has many adverse effects. However, compared to currently FDA-approved drugs, this drug is either less than or to the same level of adverse effects.
Participants were split in half in their opinion regarding the non-approved use of medications. Off-label prescribing is when a provider prescribes a drug that the FDA has not approved to treat a condition. This practice is legal and common. In fact, one in five prescriptions written today are for off-label use.
Over half of the participants did not believe there are enough supporting documents for the use of duloxetine in UI. That may be true to some extent, but the studies discussed in the introduction section clearly are evident that the drug is very effective in SUI.
We combined the knowledge and opinion questions responses, categorized each demographic into two values, and took the average scores. The only significant and the highest (n= 30; 78.9%; P<0 xss=removed>
Unfortunately, respondents’ opinions and knowledge about the off-label use of Duloxetine in SUI were not significantly affected by the type of demographic factors collected in this study. The general lack of knowledge about the off-label use of drugs could explain this.
Demographic | Overall score | P-Value |
Type of Job | ||
Knowledge Related Questions | Non-Pharmacy or Non-Healthcare Related (n= 8; 21.1%) Pharmacy or Other Healthcare Related (n= 30; 78.9%) | P<0> |
Table 4: Type of Job* One of the Predictive Factors to Determine Response
A survey of thirty-nine incoming first-year professional students at Howard University College of Pharmacy indicated that the majority had a poor level of knowledge regarding the overall score. However, they have a better handle on two of the five items on the knowledge-based questionnaire. The highest amount (n=34; 82.9%) was obtained for correct responses when asked about Duloxetine's adverse effects, including nausea, dry mouth, and constipation. Most participants (n=33; 80.5%) correctly identified that d has a black box warning related to increased suicidal thoughts and behaviors in children, adolescents, and young adults. However, approximately thirty-four students (n=34; 82.9%) incorrectly answered the question regarding the prevalence of urinary incontinence among childbearing-age women. The overall results of the opinions statements showed that more than half of the participants (n = 19, 51.5%) did not accept the off-label use of Duloxetine in stress urinary incontinence. This study shows that students may need to be encouraged to explore non-FDA-approved indications, particularly in conditions such as UTIs where no effective FDA-approved medications are lacking.
This study is limited by a small sample size of 39 participants in the survey. Therefore, a more extensive study that includes students from other schools may be needed to confirm the finding of this study.
Acknowledgments
Approval
Disclosure of conflict of interest
Statement of informed consent
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.