AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/2692-9406/112
1ΑΤΕΙ of Epirus, School of Health & Welfare, Department of Speech Therapy, Ioannina, Greece.
2 Private Speech Therapy Center, Thessaloniki, Greece.
3Greek Company of Alzheimer Disease «Saint John», Thessaloniki, Greece.
43rd Department of Neurology, Papanikolaou Hospital Thessaloniki.
5 University of Ioannina, Medical School, Department of Nervous System & Sensors
6Medical School, Democritus University of Thrace.
*Corresponding Author: Erkotidou Sofia, Thessalonikis 37B Pulaia, Thessaloniki, Greece.
Citation: Erkotidou Sofia, Grigorios Nasios, Tafiadis Dionisios, Magda Tsolaki and Eleni Erkotidou, (2022) Application of The Diagnostic Tool Efa-4 In Dementia. Biomedical Research and Clinical Reviews, 6(5); DOI: 10.31579/2692-9406/112
Copyright: © 2022 Erkotidou Sofia, 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: 25 February 2022 | Accepted: 18 April 2022 | Published: 28 April 2022
Keywords: εfa -4; speech and language disorders; dementia, ad
Speech is a brain function that includes virtual, mobile and sensory part for the understanding and the production of spoken and written language. The aim of this study was to present the adaptation of the diagnostic tool Examining for aphasia – 4th edition (EFA -4) in the Greek language. In dementia and especially in Alzheimer’s disease (AD), the speech and language disorders are the main diagnostic features, along with the worsening impairment of memory. The diagnostic tool EFA-4 is a standardized, reliable and valid measure of speech and language disorders. The test was administered to 50 adults separately. The sample selection, although it had uniformity in age, was regardless of origin, marital status and socioeconomic status. According to the results of the research, the EFA-4 is perceived to be particularly useful in the setting of language deficits of the patients with AD, who participated in the survey.
The specific scientific term aphasia refers to any loss, partial or total, of language ability in children and adults, as well as to any general speech impairment after a normal brain establishment. Aphasia is defined as the acquired disorder of language understanding, production and symbolic knowledge [1]. In the case of aphasia the patient cannot speak, apply the correct meaning to words, understand speech and at times cannot write or read. Every aphasic disorder is different and unique and is morphologically affected depending on the locus, the severity and the starting point of the disfunction. Aphasia comes as a result of a brain damage (AEE, head injury). However, it has been proven that speech disorders and particularly aphasia are a common phenomenon of neurodegenerative diseases.
Speech disorders – Aphasia and Alzheimer’s (AD)
Scientific research has shown a great interest in speech disorders, aphasia, dementia and more particularly AD. It has been scientifically documented that aphasia is present in all kinds of dementia and is one of the diagnostic criteria [2,3,4]. Specifically, the first Alzheimer's patient was aphasic [5]. However, only recently has aphasia been acknowledged as a major feature of AD. AD is the most common type of dementia, representing the 2/3 of all dementias. In the past years it was considered relatively rare and specific to people under 65 years of age. In the first half of the 20th century there were only 100 AD cases noted. Nowadays we are aware of the exact opposite: the disease is extremely common, especially in developed countries, while there is an exponential growth in its frequency as people get older. Age is the most important danger factor for the application of the disease. Between the ages of 65 and 85 the prevalence of the disease is constantly increasing, reaching at the age of 85 a striking 35-40%. AD is not related to the typical aging process and is characterized by a non-typical decline of brain functions; among which speech has a central role. Language deficiencies are obvious from the very early stages of the disease [7]. All AD patients show aphasic speech disorders as dementia progresses [8]. AD speeds up speech decline independently of the patient’s age, compared to the decline present in typical aging and mild cognitive impairment – MCI (. Moreover, the type of speech impairment in AD is different from that in Vascular Dementias [10,11] or Front Temporal Dementias [12]. The functional use of language, or Pragmatics, contributes to the communicative loss in dementia [13]. There is poor maintenance threads in conversation, there is short but frequent change of subject, request for more instructions, pauses in speech production with many ambiguities, incoherent speech, difficulty in maintaining eye-contact and difficulty in giving turns during a conversation [14,17]. Pragmatic deficiency may depend on the kind of interaction [18]. AD speech is described as lacking coherence [16], deranged and shortened in content [16,19,20], as well as a wide use of vague references [15,16].
Lexical – semantic deficiencies in AD are characterized by a restricted vocabulary use [21] and difficulty in naming(22), which are probably caused by an interruption in cognitive processing, perhaps during the pre-lexical stage. Lexical difficulty is one of the early deficiencies noted in people suffering from dementia [23]. Naming difficulty is the central issue of the many researches concerning speech disorders in dementia(24,25,26,27,28).The majority of researches seem to support the view that the initial interruption in word recovery is due to a cognitive and not a perceptive deficiency.
Furthermore, syntax remains unaffected in AD, except for the last stage [24,25,29,30,31]. Nevertheless, there have been reported syntactic errors such as phrase and sentence loss, as well as interruption of phrases and grammatical disagreement [32]. The perception of syntax is relatively more affected than the production [33,34]. One explanation could be that syntax is a relatively automatic cognitive function which remains unaffected during a general cognitive decline [35].
As far as phonology is concerned, phonological decline in AD patients are very rare and present only in the last stages. Even though phonological errors have been reported in some researches, they appear to be a part of a higher semantic or syntactic decline and not an individual decline in verbal sounds or morpho-phonemes (individual linguistic units that signify a change in meaning).
Schematically AD can be divided into three stages. The speech disorders of each stage can be presented as follows. In the first stage of AD, as far as pragmatics is concerned, there is difficulty in the use of naming references, difficulty in coherence, instruction, narration of stories, understanding of humour and sarcasm, there is difficulty in understanding abstract notions, difficulty in starting speech production as well as in retaining the subject of a conversation. Additionally, there is an ambiguous use of language while there need to be repeated clarifications. In semantics there is difficulty in finding the required word and frequent use of periphrasis as well as hand gestures. In syntax and phonology, during this stage, we come up with almost no error. In the second stage of mild AD, there is a poor usage of the naming reference, as far as syntax is concerned, lack of coherence and difficulty in preserving the subject of conversation. There is little use of abstract ideas and frequent repetitions. Speech is largely depended on stereotypic expressions. In Semantics, there is poor word flow with a limited vocabulary and increased use of periphrasis and failing replacements. There is frequent use of empty speech. In Syntax there are occasional grammatical errors and difficulty in understanding complex structures. In phonology there are generally no errors at all. In the third, also known as late, stage of AD there is lack of coherence, difficulty in maintaining eye contact, expression of irrelevant ideas, persistence, irrational speech and even silence. In Semantics there has been observed paraphasia, echolalia, extremely poor understanding, severely weakened naming ability, frequent ideoglossia and incomprehensible speech. In Syntax, while grammar remains generally unaffected, there is a fragmented use of incomplete sentences and phrases, as well as a poor understanding of grammatical structures. In the late stage phonological errors are more common.
It is therefore made clear that speech disorders are part of each of the three stages. Despite the universality of aphasia, in dementia the qualitative substance as well as its severity vary depending on the pathological process and its detection [6]. It is the duty of health professionals to do an initial correct diagnosis and then create a complete treatment plan. What we should keep in mind is that the more accurate the diagnosis is the more effective will the treatment be.
Diagnosis
The existence of dementia must be attested by a clinical examination – application of criteria DSM-IV, NINCDS-ADRDA – and the stage of the disease must be confirmed with the Mini-Mental State Examination (MMSE). During the paraclinic control, along with the blood and biochemic routine tests, there also needs to be a measuring of Vitamin B12 level and of the Thyroid hormones [36,37].
In our effort to improve the diagnosis and to better specify the patients’ speech difficulties we translated and adapted the diagnostic testing EFA-4 (Examining for Aphasia) into the Greek language.
Purpose
The aim of our research was to manage to give another diagnostic look for Dementias. The diagnostic approach should be characterized by reliability and validity , including new measurement methods of aphasia. Our purpose as therapists is to be able to rely on the results of our measurements in order to improve the therapeutic processes for these people. This improvement will help us improve the daily lives of patients with dementia.
What is EFA-4 diagnostic testing
EFA-4 is a regulatory, reliable and valid measuring of aphasia. It is suitable for adults whose language functions weakened after a normal establishment of language. EFA-4 offers to the clinic a method for evaluating possible aphasic linguistic deficiencies and other acquired disorders which are usually closely related to language functions. It also allows the examiner to find out about the individual’s participation in activities that might have been amended by aphasia.
EFA -4 Subtests
EFA-4 includes 10 subtests which have been created in order to evaluate the basic brain functions. Those subtests include visual recognition, acoustic recognition, tactile sensing, the acoustic comprehension of oral speech and the silent recognition with understanding. Additionally, verbal as well as non-verbal behaviour is tested, meaningful speech production and meaningful writing ability. Finally, we evaluatecommunicative and descriptive speech.
The parts of EFA-4
EFA-4 consists of the examiner’s manual, a book of images, a results record sheet – diagnostic form, an answer sheet – short test form, a brief diagnostic sheet, a form of personal medical records and an object box.
In the research conducted we used the results record sheet – the diagnostic form, the results record form and the object box.
The use of EFA-4
EFA-4 is a well structured tool with excellent psychometric properties. It has five main uses: (a) to detect the existence of aphasia, (b) to define the severity of aphasic signs and symptoms and their effect on life participation and activities, (c) to set goals for the rehabilitation of communication, (d) to record the progress made during the treatment, and (e) to inform and consult patients of aphasia, their families and the supporting social network, as well as to inform the doctors, the medical staff and Insurance Funds.
Scoring of the testing
The activities are scored with 2, 1, or 0. The main parameters of the test taker’s answers that should be taken into account during the scoring are accuracy, consistency and effectiveness. An activity should be scored with a 2 for an answer that is correct, direct and effectively produced as well as when the test taker indicates or writes correctly as required.
Scoring 1 should be given for an answer that is correct but according to the examiner is delayed or inefficiently produced (usually due to non-standard, unsteady or poorly coordinated verbal or writing movements). Scoring 1 should also be given when an answer itself is correct, but the form of the answer is not correct (i.e. a written answer to an oral question).
Scoring 0 should be given if the test taker does not respond to the activity at all, or answers incorrectly. The examiner should indicate the cases where there is no answer by writing down N/A (No Answer) next to the activity along with 0.
The scoring of answers in EFA-4 activities requires a careful observation of the behaviours and clinical judgement.
Research design
The research was divided into four parts. We began with the translation of both examinations in Greek. Then we did a pilot research to check the adaptations to the Greek language. The third part consists of the administration of the test, the coding data and the introduction of the data. The fourth part is about the analysis of the data and the interpretation of the results.
Translations and adaptation of the axamination
The translation of EFA-4 from English into Greek was done in the following procedure: the original versions of the examination were translated independently by three native speakers of Greek who were efficient in both written and spoken English. The three Greek versions were again translated into English by three different native speakers of English who were efficient in written and spoken Greek. From the three translations, the stimulus – images that were accurately translated from English into Greek and vice versa – were included in the final versions of the examination. Furthermore, the three Greek versions were given to three bilingual (English-Greek) judges, along with the English versions, in order to attest the final outcome. Finally, two speech therapists and a linguist – who edited the changes in both linguistic and lexical level – were chosen to check whether the adaptations were adequate and they attested the final Greek version.
Pilot research
The pilot research was conducted from July 2010 to January 2011 in order to define the difficulty of the objects and to verify their accuracy and other characteristics.
Sample
In the current research the examination was administered to 100 adults separately (50 with AD and 50 as control group). The sample selection, although it had uniformity in age, was regardless of origin, marital status and socioeconomic status. It should be noted that in order to successfully administrate the scale and measurements we had to reassure the participants that their personal data would remain confidential and that they would have to sign a participation letter.
Data collection
The administration of the examination took place at the Outpatient Department of the C’ Neurologic Clinic of G.H. Papanikolaou, in the presence of the patients and their caregiver. After the introductions with the test takers we proceeded to the explanation of the purpose of the examination and we asked for their consent by signing the participation letter. Afterwards the test takers were seated in front of a table across and slightly to the right of the examiner. The lighting conditions were appropriate and the materials were placed in such a way that the patients could see and use them without difficulty. The examination was distributed to all participants under the same procedure, and it followed the instructions found in the administrative manual.
During the evaluation the examiner did not change their facial expression or express verbal disapproval. However, in order to obtain the highest performance on the part of the test takers, the examiners tried to encourage them. They were supportive but objective. They would tell the participants when they did well and they calmed them down when they failed. According to Schuell (1964), a simple and honest way to do that, is to comment on reality when the test taker faces a difficulty with a task. This will help the patient relax, get back on track and clear his mind in order to proceed. This is what each examiner should learn. This is not an easy work nor does it aim to simply collect random numbers. The aim is to have the best possible cooperation between the patient and the examiner. There should be successful communication, always with a smile and discussion.
The duration of the examination varies from participant to participant but the average is between 45 to 60 minutes.
Standardness or nonstandardness control of the observations’ distribution for the whole sample as well as the subgroups was done using the Kolmogorov – Smirnov method. The Standardness control showed that our sample had a standard distribution. An independent sample t-test was conducted in order to see whether there is a statistically significant difference between standard witnesses and dementia patients. The analysis gave us the following Table 1.
According to Table 1, there were statistically significant differences between the two subgroups in all subtests of the speech scale and MMSE/HINDI. All measurements are attested by the διαστήματα εμπιστοσύνης of the statistical analysis.
In our effort to relate the educational level with pathology separately, in terms of the subtests and MMSE/HINDI scale, we came up with the following Table 2:
Table 2 shows that answers are affected by educational level, but such relation is not statistically significant. In contrast to pathology and MMSE/HINDI, where the relation presents a statistical significance.
In trying to examine whether the stimuli for every scale axis separately affect the final performance, we created a multiple linear model for all stimuli. From the statistical analysis for the pathological sample we came up with Table 3:
Whether the selection of stimuli affects the parameter of the test that explains the existence of a satisfactory level of promptiness, the above Table gave us statistically significant effects for every scale axis separately, but further improvements are possible.
In order to check the predictive accuracy we used the application of the paired sampled t-test, on the basis of pathology –with which we evaluated the performances for every test thematic – and we examined the possibilities of rejection or verification of our zero hypothesis. The results aresummarized in Tables 4 and 5.
According to the Table above, there are satisfactory levels of accuracy and unequivocal differences on the basis of pathology.
Finally, for the structural validity (or validity of the notional structure) and reliability control, we created the reliability indicator of internal validity – relevance of the thematic indicators alpha Cronbach, split half, and Kuder – Richardson. These results are summarized in Table 6.
As far as the internal relevance control or the uniformity of the scale stimuli are concerned, we calculated the alpha Cronbach’s factor. The analysis provided us with the following:
Reliability Coefficients 5 items Alpha = .924 N of Cases = 100
Another method has to do with internal relevance control or uniformity about scale stimuli the coefficient alpha Cronbach’s splits in half. From this analysis we came up with the following (Table 6):
As you can see, the above Table presents satisfactory validity and reliability levels.
The aim of this research was the pilot application of EFA-4 in Greek language to dementia patients. Additionally, our aim was to test whether the selected stimuli can lead to a possible diagnosis of the existence of speech disorders in dementia, as well as the validity and reliability control of the specific test. The results of the research are summarized in the following list:
1. There is a statistically significant difference between the average rate of answers of the control group and the dementia patients, for all EFA-4 axis.
2. There is a statistically significant difference between the average rate of answers between the average rate of answers of the control group and the dementia patients, for MMSE/HINDI.
3. To the question whether educational level affects performance for EFA-4 axis, there was a statistically insignificant inverse correlation effect (due to low educational level of the sample).
4. To the question as to whether pathology affects performance for the EFA-4 axis there was a statistically significant inverse correlation effect (that is, the more advanced the stage is the less effective the performance is for all axis of the test). This effect varied from 65,1% for reading and 91,1% for comprehension.
5. To the question whether there is a relation between MMSE/HINDI scale and EFA-4 axis, the answer is that there is a statistically significant proportional relationship, with a positive correlation of 84,1% for reading and 94,9% for comprehension.
6. As to whether each stimulus separately can -and to what extend- explain the level of each EFA-4 axis, the research showed that they can actually be explained to a high or even absolute degree.
7. To the question whether we have a reliable scale – measuring tool, the research showed that the current form of the scale is actually a highly reliable tool.
8. Finally, to the question whether we have a valid scale – measuring tool, the research showed that for the specific age group the scale is considered a valid tool.
It should be mentioned that there are no conflicts of interest.
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.
