AUCTORES
Globalize your Research
Research | DOI: https://doi.org/10.31579/2690-4861/905
Royal Medical Services, Jordan.
*Corresponding Author: Salem Rafiq Awd Alsalman., Royal Medical Services, Jordan.
Citation: Awd Alsalman SR, Ahmad Obeidat MZ, Mohammad Aburumman KA, Bin Tareef RMA, Hamad Al-Qaraleh TM, (2025), Critical Bleeding Management: a four-Year Analysis of Hemostatic agent Selection, Clinical Practices, and Patient Demographics in the Critical Care Units of the Jordanian Royal Medical Services, International Journal of Clinical Case Reports and Reviews, 27(5); DOI:10.31579/2690-4861/905
Copyright: © 2025, Salem Rafiq Awd Alsalman. 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: 01 July 2025 | Accepted: 09 July 2025 | Published: 16 July 2025
Keywords: hemostatic agents; factor vii; tranexamic acid; military hospitals; critical care; practice patterns
Background: Life-threatening bleeding is one of the major clinical concerns in emergency and critical care settings in which rapid hemorrhage control can prevent adverse outcomes. Medications such as Hemostatic agents especially coagulation factors will continue to be used as essential tools for the management of bleeding in these cases. Although these agents are widely used clinically, limited literature addressed how they are selected and used in military systems, particularly in structured networks such as the Jordanian Royal Medical Services (JRMS). comprehending the medical rationale, patients’ demographic factors, and individual institution contributing factors that impact their selection in critical care units will be essential to improve treatment processes, resource distribution, and medical education and training in military hospitals.
Objective: Over a four-year period (2019-2022), this study aims to examine the use of four key agents: Recombinant Factor VII, Factor VIII, Prothrombin Complex Concentrate (PCC), and Tranexamic Acid within JRMS critical care units. In addition, it will look at how Variables like patient age, Gender, specialty of hospital, and year of treatment affect agent selection. Particular notice will be taken of any differences in prescribing habits in pediatric versus adult patients in addition to any distinctions in clinical practices across the study hospitals. The research also aims to look for trends over time, which may help in understanding any changes in clinical practice, guidelines or availability issues.
Methods: Data of prescriptions and demographic information of patients from six hospitals within the JRMS (King Hussein Medical Hospital, Queen Alia Heart Institute, Prince Hashem Ben Abdullah II Hospital, Princess Haya Military Hospital, Queen Rania Pediatric Hospital and Queen Alia Military Hospital) will be collected in order to conduct this retrospective , cross-sectional study including data on age, gender, the hospital that prescribed the agent, year of treatment and the type of hemostatic agent used. Hospitals will be classified into three categories (General, Pediatric, or Specialized), and patients will be divided into groups according to their age Descriptive statistics will be then employed to summarize utilization patterns of agents across different groups. After which a comparison will be made to identify any differences in prescribing habits according to different hospitals and demographics factors. The study will also identify hospital-specific trends that may affect agent choice such as hospital specialization and whether there is critical care units dedicated to specific populations. The results of this research will help in understand how to improve the standardization of guidelines for life-threatening bleeding management and guide the future policies dealing with the use of such agents in military ICU’s.
Hemostatic diseases are a major problem in the intensive care units (ICUs), typically resulting in acute life-threatening complications, which need an immediate action. The multifaceted cascade of coagulation is mediated by several factors and by several pathways, and, accordingly, targeted therapy is necessary, which is determined according to the nature of the bleeding. Recent advances in our knowledge of coagulation have resulted in the development of more advanced strategies for hemostatic management and an increased range of agents that target specific components of the coagulation system [1]. Within this context, four particular hemostatic options were found the most relevance to contemporary practice: recombinant Factor VII (rFVIIa), Factor VIII concentrate, Prothrombin Complex Concentrate (PCC), and Tranexamic Acid (TXA). These agents all have different mechanisms of action, indications, and risk profiles, raising the potential for differences in outcomes and resource utilization based on the choice of agent [2]. In severe bleeding, Recombinant Factor VII, originally developed for patients with haemophilia with inhibitors, has demonstrated utility in a much wider spectrum of bleeding by improving thrombin generation at the site of the vascular injury [3]. rFVIIa's off-label use has been met with criticism; nevertheless, it is still commonly employed for the management of refractory bleeding in cases where conventional procedures have not been successful. Factor VIII concentrate is the cornerstone of care for hemophilia A and offers direct replacement of the deficient coagulation protein [4].Prothrombin Complex Concentrate which containing varying combinations of factors II, VII, IX, and X, has established itself as a rapid reversal agent for vitamin K antagonist therapy and a valuable instrument in the management of coagulopathy in liver disease and trauma [5]. Tranexamic acid, an antifibrinolytic agent that inhibits plasminogen activation has demonstrated mortality benefits in trauma and surgical bleeding and gained prominence following landmark studies such as CRASH-2 and WOMAN trials [6,7]. The Jordanian Royal Medical Services (JRMS) represents a broad military healthcare system serving military staff and their dependent relative and in many cases civilian populations. Encompassing multiple specialized hospitals across Jordan the JRMS manages a varied patient population with varying hemostatic needs from pediatric inherited coagulation disorders to adult trauma and surgical bleeding. However, patterns of hemostatic agent utilization within this system have not been previously characterized leaving important questions about clinical practice patterns, resource allocation, and potential prospects for standardization unanswered. Recognizing the utilization patterns of these agents within a specified healthcare system can provide valuable perceptions into clinical decision-making, resource allocation, and adherence to evidence-based practices This is particularly relevant in military health care structures which often function under unique restrictions while managing diverse patient populations with varying hemostatic needs. The present study seeks to investigate the patterns of hemostatic agent utilization throughout the Jordanian Royal Medical Services hospital network, with particular attention to: Age-stratified usage patterns across different hemostatic agents, Hospital-specific practices and potential factors influencing agent selection, Temporal trends in hemostatic agent utilization between 2019 and 2022 and Gender-based differences in prescribing patterns. By characterizing these patterns this study then seeks to provide insights that might help protocol development, resource allocation and use and quality enhancement programs within military healthcare systems.
2.1 Data Source and Collection: This study utilized a retrospective analysis of hemostatic agent prescriptions throughout six Jordanian Royal Medical Services hospitals between January 2019 and December 2022. Data were obtained from the pharmacy dispensing records of the JRMS. The dataset included anonymized patient information: gender, age at treatment time, treatment year, prescribed agent, and prescribing hospital. Four hemostatic agents were included in this investigation: recombinant Factor VII, Factor VIII concentrate, Prothrombin Complex Concentrate, and Tranexamic Acid which were selected based on their common use in critical care settings and their representation in the JRMS formulary.
2.2 Study Setting: The study encompassed six hospitals within the JRMS network: King Hussein Medical Hospital (KHMH): The largest tertiary care facility within the JRMS and serving as a referral center for complex cases, Queen Alia Heart Institute (QAHI): A specialized cardiac care center, Queen Rania Pediatric Hospital (QRPH): Dedicated to pediatric care including management of congenital bleeding disorders, Prince Hashem Ben Abdullah II Hospital (PHBAH): A regional hospital providing general medical and surgical services, Princess Haya Military Hospital (PHMH): A regional hospital serving the northern districts of Jordan and Queen Alia Military Hospital (QAMH): A general military hospital. These facilities represent a spectrum of care levels and specializations within the JRMS network, allowing for a more thorough analysis of hemostatic agent utilization across different clinical contexts.
2.3 Variables and Definitions: The key variables that will be analyzed in this study encompassed: Patient demographic characteristics: which include Age at treatment time and gender, Hemostatic agent used: Factor VII, Factor VIII, Prothrombin Complex Concentrate, or Tranexamic Acid, Treatment facility: The hospital where the prescription was issued and Treatment year: Calendar year of prescription (2019-2022).
For the age-stratified analyses, patients were categorized as: Neonates and infants: 0-1 years, Young children: 2-5 years, School-age children: 6-12 years, Adolescents: 13-17 years and Adults: ≥18 years.
2.4 Statistical Analysis: Descriptive statistics were utilized to describe the dataset. Frequencies and percentages were calculated for categorical variables (gender, agent type, hospital, treatment year) and for the continuous variables (age), mean, median, and range were calculated also cross-tabulations were made to examine relationships between: Agent type and different age groups, Agent type and hospital, Agent type and gender and Agent type and treatment year. Chi-square tests were also used to judge on the statistical significance of observed differences in categorical variables. As for the age-related analyses non-parametric tests (Mann-Whitney U and Kruskal-Wallis) were employed owing to the non-normal distribution of age data. Data analysis was performed using SPSS Statistics version 26.0.
2.5 Ethical Considerations: This study exploited de-identified pharmacy dispensing data with all patient identifiers removed before analysis. The study procedures was reviewed and approved by the Jordanian Royal Medical Services Research Ethics Committee and as a retrospective analysis of anonymized data informed consent was waived.
3.1 Overall Sample Characteristics: The dataset covered 34 hemostatic agent prescriptions give out between 2019 and 2022 across the six JRMS hospitals. The patient had a mean age of 17.1 years (median: 6.5 years; range: 0-80 years) with a bimodal distribution showing peaks in early childhood (0-5 years) and late adulthood (>60 years). Also males accounted for 58.8Percentage (n=20) of the patients while females represented 41.2 Percentage (n=14).
3.2 Agent Distribution: Factor VII was the most commonly prescribed hemostatic agent where it accounted for 67.6Percentage (n=23) of all the prescriptions followed by Tranexamic Acid (17.6Percentage, n=6), Factor VIII (8.8Percentage, n=3), and Prothrombin Complex Concentrate (5.9Percentage, n=2). The yearly allocation of prescriptions showed to be relative stability across the study period: with 2019 (20.6Percentage, n=7), 2020 (23.5Percentage, n=8), 2021 (38.2Percentage, n=13), and 2022 (17.6%, n=6).
3.3 Age-Stratified Agent Utilization: The analysis also revealed noticeable age-related patterns in hemostatic agent use (Table 1). The mean age of patients taking Factor VII was 12.9 years, compared to 42.5 years for Tranexamic Acid and 5.0 years for Factor VIII, and 4.0 years for PCC. This difference in age spreading throughout agent types was statistically significant (p<0>Agent Mean Age (years) Median Age (years) Range (years) Factor VII 12.9 3.0 0-69 Tranexamic Acid 42.5 39.5 8-80 Factor VIII 5.0 0.0 0-15 PCC 4.0 3.0 0-9 All Agents 17.1 6.5 0-80
Table 1: Age Distribution by Hemostatic Agent.
Stratification by age groups exposed that Factor VII was the main agent through all pediatric age categories which accounted for 87.5Percentage (21/24) of all the hemostatic prescriptions in patients under 18 years. On the contrast adult patients (≥18 years) demonstrated more varied agent selection with Tranexamic Acid representing 42.9Percentage (6/14) of the prescriptions and Factor VII accounting for 28.6Percentage (4/14) of them.
3.4 Hospital-Specific Patterns: Queen Rania Pediatric Hospital accounted for the prime proportion of the hemostatic agent prescriptions (70.6Percentage, n=24) then followed by King Hussein Medical Hospital (14.7Percentage, n=5), Prince Hashem Ben Abdullah II Hospital (8.8Percentage, n=3), and the remaining hospitals each signifying less than 5Percentage of the prescriptions. Each hospital demonstrated distinct prescribing patterns (Table 2). Queen Rania Pediatric Hospital predominantly used Factor VII (79.2Percentage, 19/24) with smaller amounts of Factor VIII (12.5Percentage, 3/24) and PCC (8.3Percentage, 2/24). On the contrast King Hussein Medical Hospital's prescriptions were uniformly divided between Factor VII (60Percentage, 3/5) and Tranexamic Acid (40Percentage, 2/5) Also Prince Hashem Ben Abdullah II Hospital utilized Factor VII and Tranexamic Acid in equal proportions (50Percentage each).
| Hospital | Factor VII | Tranexamic Acid | Factor VIII | PCC | Total |
| QRPH | 19 (79.2Percentage) | 0 (0Percentage) | 3 (12.5Percentage) | 2 (8.3Percentage) | 24 |
| KHMH | 3 (60Percentage) | 2 (40Percentage) | 0 (0Percentage) | 0 (0Percentage) | 5 |
| PHBAH | 1 (50Percentage) | 1 (50Percentage) | 0 (0Percentage) | 0 (0Percentage) | 2 |
| QAHI | 1 (100Percentage) | 0 (0Percentage) | 0 (0Percentage) | 0 (0Percentage) | 1 |
| PHMH | 1 (100Percentage) | 0 (0Percentage) | 0 (0Percentage) | 0 (0Percentage) | 1 |
| QAMH | 0 (0Percentage) | 1 (100Percentage) | 0 (0Percentage) | 0 (0Percentage) | 1 |
| Total | 23 (67.6Percentage) | 6 (17.6Percentage) | 3 (8.8Percentage) | 2 (5.9Percentage) | 34 |
Table 2: Agent Distribution by Hospital.
QRPH: Queen Rania Pediatric Hospital; KHMH: King Hussein Medical Hospital; PHBAH: Prince Hashem Ben Abdullah II Hospital; QAHI: Queen Alia Heart Institute; PHMH: Princess Haya Military Hospital; QAMH: Queen Alia Military Hospital; PCC: Prothrombin Complex Concentrate
3.5 Gender-Based Analysis: Analysis by gender revealed that Factor VII was the main agent in both males (65Percentage, 13/20) and females (71.4Percentage, 10/14) with no statistically significant difference in overall agent use between genders (p=0.74, chi-square test). The mean age of the male patients (18.7 years) was slightly higher than the female patients (14.9 years) but this deviation did not reach statistical significance (p=0.56, Mann-Whitney U test).
3.6 Temporal Trends: Assessment of prescribing patterns by year revealed relative steadiness in agent distribution over the study period years. Factor VII persisted to be the predominant agent across all years ranging from 57.1Percentage to 76.9Percentage of the annual prescriptions. However the absolute number of Factor VII prescriptions showed a raising trend from 2019 (n=4) to 2021 (n=10) followed by a decrease in 2022 (n=3). Interestingly PCC prescriptions were only observed in the years of 2019 (n=1) and 2021 (n=1) while Factor VIII prescriptions occurred in 2019 (n=1), 2020 (n=1), and 2021 (n=1).
4.1 Key Findings: This retrospective analysis of hemostatic agent utilization in Jordanian military hospitals reveals various remarkable patterns with consequences for clinical practice and resource allocation. The prevalence of Factor VII particularly in pediatric populations suggests a considerable liability of congenital bleeding conditions or other conditions needing targeted factor replacement the distinct age stratified patterns with Factor VII prevailing in pediatric patients and more varied agent selection in adults likely reflect the divergent etiologies of bleeding disorders across the lifespan. Hospital specific use patterns seem to be supporting the institutional specialization with the pediatric hospital displaying a preference for Factor VII and the adult facilities utilizing a wider range of agents. These patterns also may reflect not only differences in patient populations but also distinctions in institutional expertise, resource availability and clinical procedures.
4.2 Age-Stratified Patterns and Clinical Implications: The striking high proportion of Factor VII in pediatric patients (87.5% of pediatric prescriptions) warrants attention this pattern proposes a significant load of congenital bleeding disorders in the pediatric population which is served by the JRMS particularly conditions that would benefit from Factor VII replacement. Several possible justifications merit consideration: First, the pattern may reflect a high incidence of rare congenital factor deficiencies specifically Factor VII deficiency within this population. Factor VII deficiency is one of the rare inherited hemorrhage disorders with the anticipated incidence of 1 in 500,000 in general populations [8]. However in areas with higher proportions of kin marriage such as parts of the Middle East, the prevalence may be significantly higher [9]. Jordan has reported consanguinity rates of approximately 20-30% in various studies which could contribute to the higher rates of autosomal recessive bleeding disorders [10]. Second, the high use rate of Factor VII in pediatric patients may reflect it application in hemophilia patients with inhibitors approximately 20-30% of severe hemophilia A patients develop inhibitors to Factor VIII which necessitate bypass therapy with agents such as recombinant Factor VII [11] also the relatively low Factor VIII prescriptions in our sample (n=3) compared to Factor VII (n=23) could possibly suggest a high percentage of hemophilia patients with inhibitors although this understanding is limited by the absence of specific diagnostic data. Third, institutional preferences and procedures may play a significant role since the concentration of pediatric hemostatic care at Queen Rania Pediatric Hospital (70.6% of all prescriptions) suggests centralization of expertise in pediatric hemorrhage disorders this centralization may have led to the growth of specific procedures that favors Factor VII for a range of bleeding scenarios outside its licensed indications. The more diverse agent choices observed in the adult patients signals the diverse etiologies of bleeding in this population. With Tranexamic acid representing 42.9% of adult prescriptions which is particularly useful in trauma, surgical, and obstetric bleeding conditions which are more commonly encountered in the adults populations also the considerable evidence base for tranexamic acid in those contexts including the landmark CRASH-2 and WOMAN trials, may have lead to its adoption in adult trauma and surgical care within JRMS [6,7].
4.3 Hospital-Specific Practices: The individual prescribing patterns noticed across hospitals provides insights into the institutional specialization and potentially variations in their clinical approach. Queen Rania Pediatric Hospital's predominant use of Factor VII (79.2% of prescriptions) allies with its specialized role in managing the pediatric hematological disorders. Similarly in King Hussein Medical Hospital's the more reasonable distribution between Factor VII and Tranexamic Acid likely exhibits its broader patient population as a tertiary referral center also the non-appearance of Tranexamic Acid prescriptions at Queen Rania Pediatric Hospital is noteworthy given its proved safety profile in pediatric surgical contexts [12] which may reflect a specific institutional protocol or a prevalence of congenital bleeding disorders that lead to requiring factor replacement rather than the antifibrinolytic therapy in this population. Queen Alia Heart Institute's restricted use of Factor VII even though based on a single prescription may reflect its application in cardiac surgery where rFVIIa has been used as rescue therapy for refractory bleeding [13]. While its an off-label use in this context Factor VII has demonstrated an effectiveness in reducing the bleeding and blood transfusion requirements in complicated cardiac surgical cases [14].
4.4 Temporal Trends and Potential Influences: The relative consistency in agents distribution during the research duration points to the agreed clinical standards within the JRMS. Still the noted rise in Factor VII prescriptions from 2019 to 2021 followed by the deterioration in 2022 could be as a result of numerous elements: The height of the COVID-19 epidemic links with the peak in Factor VII prescriptions in 2021; however, resource limitations and changes in hospital admission trends or COVID-associated coagulopathy may have affected bleeding control strategies. The changes in institutional or international guidelines for hemostatic management also could have affected prescribing patterns over time for instance the World Federation of Hemophilia published an updated guidelines for hemophilia management in 2020 which may have affected the clinical practice [4]. Given the high cost of factor concentrates and possible supply limits during the epidemic, the availability and pricing issues could have also affected agent choice during specific periods.
4.5 Resource Utilization Implications: The noticed patterns also have significant consequences for resource allocation inside the JRMS. Recombinant Factor VII is among the most high-priced hemostatic agents with costs potentially go over $10,000 per regular adult dose [15]. The predominance of Factor VII in our sample (67.6% of prescriptions) implies considerable resource allocation to this agent particularly at Queen Rania Pediatric Hospital. On the other hand tranexamic acid is really affordable with costs typically less than $50 per treatment course [6]. So the limited utilization of this cost-effective agent in certain contexts particularly in pediatric care which may represent an opportunity for resource optimization if clinically appropriate. Factor VIII concentrate and PCC also represent significant costs even though they are typically lower than recombinant Factor VII for an equivalent hemostatic effect in appropriate indications. The relatively low utilization of those agents in our sample (8.8% and 5.9%, respectively) may also reflect specific patient needs rather than resource constraints. Recognizing these utilization patterns can inform policies decisions and formulary decisions, procurement strategies and budget allocation within the JRMS. For example the concentration of Factor VII use at Queen Rania Pediatric Hospital may rationalize specialized funding allocations for this high-cost agent at this facility while efforts to optimize Tranexamic Acid utilization might be prioritized at adult care centers.
4.6 Comparison with International Practices: The utilization patterns observed in this study both align with and conflict from international practices in several respects, the predominance of Factor VII in pediatric bleeding management seems more pronounced in our sample than what is reported in other healthcare systems where Factor VIII naturally represents the pillar of hemophilia management [4].The fairly limited use of PCC (5.9% of prescriptions) contrasts with its increasing adoption in many Western healthcare systems for warfarin reversal and trauma associated coagulopathy conditions [5] which may reflect differences in anticoagulation practices, trauma care protocols, or resource availability within the JRMS. Also Tranexamic acid utilization (17.6% of prescriptions) appears lower than what might be expected given its established efficacy and cost-effectiveness in the various bleeding conditions [16]. However its predominance in adult prescriptions (42.9%) suggesting appropriate targeting to relevant clinical contexts.
4.7 Clinical and Policy Implications: Several implications for clinical practice and policy emerge from this analysis:
4.8 Study Limitations: Several limitations should be considered when taking the findings of this study: First, the rather small sample size (n=34) limits the statistical analyses power and the ability to detect subtle patterns or trends but this also reflects the specialized nature of these agents and the relatively small population. Second, the non-existence of clinical indication data represents a substantial limitation since that without information on the specific conditions being treated our ability to review the appropriateness of agent selection was constrained therefor future studies integrating diagnostic data would provide valuable context for interpreting utilization patterns. Third, the analysis focuses merely on dispensing patterns without information on dosing and duration of therapy or clinical outcomes therefor it limits our ability to evaluate the effectiveness and efficiency of the hemostatic management. Fourth, the dataset does not include information on other hemostatic interventions such as fresh frozen plasma or platelet transfusions which are important components of comprehensive hemostatic management. Finally, the single system nature of this study may limit generalizability to other healthcare systems particularly those with different patient populations or resource constraints and clinical protocols.
This retrospective analysis offers valuable insights into how hemostatic agents are used within the Jordanian Royal Medical Services hospital network and highlighting unique patterns based on age and specific practices at different hospitals along with implications for resource allocation. The high presence of Factor VII, especially in children, indicates a strong emphasis on congenital bleeding disorders, while the wider range of agents used in adults highlights the different causes of bleeding in that group. The patterns of utilization specific to hospitals seem to match their areas of specialization, indicating that there are advantages to having concentrated expertise, while also pointing out the potential for standardizing protocols. The significant resource implications of current usage patterns, especially the heavy reliance on expensive Factor VII, highlight the need for evidence-based agent selection and careful resource management. The results lay the groundwork for additional research and enhancements in quality and the creation of policies focused on improving hemostatic management in military healthcare systems. Future research that includes clinical indications, dosing details and outcome data would deepen our understanding of how hemostatic agents are used and their effects on patient care.
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.
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
