Effect of Counselling Sessions on Women’s Satisfaction during Gynecological Examination

Research Article | DOI: https://doi.org/10.31579/2578-8965/119

Effect of Counselling Sessions on Women’s Satisfaction during Gynecological Examination

  • Kamilia Ragab Abou-Shabana 1
  • Aml ahmed Hassan 2
  • Somaia Ragab Eid 3
  • Hanan Elzeblawy Hassan 4*

1Professor of Maternity & gynecological Nursing, Faculty of Nursing, Ain Shams University, Egypt

2 Assistant Lecturer of Maternal & Newborn Health Nursing, Faculty of Nursing, Beni-Suief University.

3 Professor of obstetrics and women’s health, Faculty of Nursing, Benha University

4 Maternal and Newborn Health Nursing, Faculty of Nursing, Beni-Suef University, Egypt

*Corresponding Author: Hanan Elzeblawy Hassan, Maternal and Newborn Health Nursing, Faculty of Nursing, Beni-Suef University, Egypt

Citation: Kamilia R. Abou-Shabana, Aml A.Hassan, Somaia R. Eid, Hanan E. Hassan (2022) Effect of CounsellingSessions on Women’s Satisfaction during Gynecological Examination. J.Obstetrics Gynecology and Reproductive Sciences 6(4); DOI: 10.31579/2578-8965/119

Copyright: © 2022, Hanan Elzeblawy Hassan, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received: 18 February 2022 | Accepted: 19 March 2022 | Published: 26 April 2022

Keywords: counseling; knowledge; pain; discomfort;, satisfaction; gynecological examination

Abstract

Background: Gynecological examination was а nursing concern because the nurse is expected to be beside female pre, during, and post-gynecological-examination. Nurses had very important role in preparing women before an examination

Aim: This study was conducted to evaluate the effect of pre-gynecological-examination-counseling-session on relieving women’s pain, discomfort and enhancing their satisfaction, as well. 

Setting: The study was conducted at the gynecological clinic at Beni-Suef University Hospital. 

Subjects and methods:design: A quasi-experimental research design was utilized in this study (an intervention pre/post-test). Sampling: 60 women who were attended the previously mentioned study setting for the first time. Sample type: Α purposive sample. Tools: six tools of data collection were used. (I): Interviewing questionnaire; (II): Comfort and pain scale; (III): Visual analogue scale; (IV): Patients’ satisfaction questionnaire sheet; (V): Counseling interviewing sheet; (VI): An Instructional supportive brochure. 

Results: there was a marked improvement in knowledge of the studied sample about gynecological examination post-implementation of an instructional supportive guideline with a highly statistically significant difference (P<0.01) between pre and post-implementation of the instructional supportive guideline. There was a positive correlation between the level of pain of the studied sample and their discomfort, satisfaction, self-reported barriers during gynecological examination, and satisfaction level post gynecological examination. 

Conclusion: Counseling sessions regarding pre-gynecological examination had a positive effect on relieving women’s pain, discomfort and enhancing their satisfaction. 

Recommendation: Nurse administrators must be designed, and apply a monitoring system to certain that nurses are well competent during providing pre-gynecological examination counseling sessions. 

Introduction

Gynecological examination procedures aim to assess the health of a woman’s reproductive system. The general examination usually makes usage of a speculum for a view of the vagina and cervix. More specialized procedures include the Pap-Smear for the detection of cancer of the cervix. In the diagnosis of possible infertility, useful procedures include Rubin’s test, which helps determine whether the fallopian tubes, the slender hollow structures through which the eggs travel from the ovaries to the uterus, are occluded; hysterosalpingography, or X-ray of the uterus and fallopian tubes after injection of a contrast medium; the evaluation of ovulation and hormonal factors by the laboratory examination of cervical and uterine tissues and by the determination of blood and urine levels of estrogenic hormones. [1-3]

Few studies have addressed patient preference concerning pelvic examinations alone, but about 45% of women reported that they would prefer a female doctor for their gynecologic care, 4.2% reported that they would prefer a male doctor, and the remaining women expressed no preference. [4-7]

The following are complaints that would warrant a gynecological exam: sexually transmitted infection testing or screening, screening exams by primary care physicians and gynecologists in females above the age of 21, pain, discharge, pregnancy or postpartum, infection, itching, swelling, bleeding, menstrual abnormalities, sexual development abnormalities, sexual or physical trauma, neurological conditions, incontinence, and pelvic floor disorders. [8-11] some clinicians combine a routine pelvic exam along with other preventative procedures like a breast examination and pap smear. [12-14]

Many burdens and effects of gynecological examination are tactile sensation, worry about getting a pelvic exam. It's very communal for fair sex to be especially disordered and upset about having their first gynecological exam; as she tones anxious or uneasy. [15, 16]

Patients will have a more positive experience if they feel that adequate time was allowed for their visit and that the practitioner was prepared to answer questions. A study of adolescents' views about their first pelvic exams showed that a positive experience was associated with a sense of control during the examination.  This depended on a thorough explanation of the procedure before it was undertaken, allowing the patient to participate in decision making, and receiving assurance that the exam could be discontinued at any point. [17, 18]

Moreover, this intimate physical examination may provoke many negative feelings such as embarrassment, shame, anxiety, and awkwardness. The first pelvic examination in a women’s life and the attitude of health providers may lay the foundation for subsequent pelvic exams. [19, 20] 

The nurse must recognize the women's vulnerability and assure the women of strict confidentiality. For many women, modesty and fear of the unknown make the assessment, the interview, physical examination, and particularly pelvic examination an ordeal. Many women are informed, misguided by myths, or afraid to appear stupid by asking questions about sexual and reproductive functioning. The nurse must be sensitive to this issue. [21-23]

The nurse helps women to understand the importance and benefits of using gynecological examinations types to the whole family and community. She also helps a client to understand the differences between lifesaving and death control, and to acquire knowledge about the reasons and concerns of using gynecological examinations methods. The rear many types of motivation such as talking to people about the advantages of gynecological examinations, encouraging them to talk with each other about it, using the different methods so mass media communication, giving group discussions about gynecological examinations. [24-26]

Satisfaction with the gynecological exam is one factor that motivates women to seek and continue the gynecological examination. The term 'motivation' is used to refer both to our reasons for action and to our enthusiasm for doing it. It has been defined in the psychology literature as the psychological military force or pushes that impel a person towards a specific goal  [27]. 

Counseling is a part of communication and helping process through which an individual with special knowledge and skills, contact with a client who needs problem-solving for better adapting, deals with misconcepts, culture, and beliefs, and improve women positive response to the gynecological exam with the counselor help providing free choices and options leaving the decision making to the client to choose and decide. [16]

The aim of counseling is to free the person being counseled to live more fully and such fuller living comes through action as counseling must have a practical aim, she must encourage the women to become confident enough to choose a particular course of action and complete it. [28]

The gather model was advocated by the population communication services of john Hopkins school of hygiene and public health it has been used in many countries including Egypt. Counseling continues to take place throughout the whole screening process nurses should reinforce that negative screening result means that no evidence of cancer exists, what signs to report for further evaluation, and the interval and recommendation for further screening as well as the importance of follow-up visit. [15]

Pre-gynecological examination-counseling is a wonderful twentieth-century invention. We live in a complex, busy, changing world. In this world, there are many different types of experiences that are difficult for women to cope with. Most of the time, women get on with life, but sometimes women are stopped in their tracks by an event or situation that they do not, at that moment, have the resources to sort them. Most of the time, women may find ways of dealing with gynecological problems in living by talking to health care workers, or their family doctor. But occasionally their advice is not sufficient, or we are too embarrassed or ashamed to tell them what is bothering us, or we just do not have an appropriate person to turn to. [29-31]

Pre-gynecological examination Counseling is a really useful option at these moments. In most places, pre-gynecological examination counseling is available fairly quickly and costs little or nothing. The gynecological nurse does not diagnose or label the woman but does her best to listen to the woman and work with her to find the best ways to understand and resolve her gynecological problem. [11,32,33]

  1. 1Justification of the problem: 

The gynecological examination was а nursing concern because the nurse is expected to be beside female pre, during, and post gynecological examination, the nurse had а very important role in preparing women before an examination. Additionally, preparing equipment, women during an examination, instructing women about comfort and suitable position for gynecological examination, instructing women about laboratory investigation, medical treatment as well as follow up visits to the clinic to enhance women positive response to attend regularly to the gynecological clinic. [22,33]

  1. 2 Operational Definition

Gynecological examination (Gyne. Ex.) is any procedure performed to the female al exam genital tract where an instrument, is inserted directly into the vagina. [18]

Counseling is a purposeful relationship between two people, who approach a mutually defined problem with mutual consideration of each of them to the end that the troubled one or less mature is aided to a self-determined resolution of his problem. [20]

Aim of this study:

This study was conducted to evaluate the effect of pre-gynecological examination counseling sessions on relieving women’s pain, discomfort and enhancing their satisfaction as well.

Hypothesis

  • Women's pre-gynecological pain and discomfort will be decreased after attending the implemented pre-gynecological examination counseling sessions.
  • Women's knowledge and pre-gynecological satisfaction will be improved after attending the implemented pre-gynecological examination counseling sessions.

Methodology (Material and methods)

4.1. Design: A quasi-experimental research design was utilized in this study (an intervention pre/post-test)

4.2. Setting: The study was conducted at the gynecological clinic at Beni-Sued University Hospital.

4.3. Sampling:

  1. Sample size: 60 women who were attended the previously mentioned study setting for the first time was included in the study.
  2. Sample type: Α purposive sample was used in this study.
  3. Inclusion criteria: Firstly, admitted to the gynecological clinic and had a telephone mobile or home to contact them follow up.
  4. Exclusion criteria: Women who complain of the following: Leucorrhea, dyspareunia, dysuria, offensive vaginal discharge, and vulvar itching.

4.4Tools of data collection: Six tools were utilized in this research as the following:

4.4.1. The first tool was interviewing questionnaire: It was included two parts:

Figure 1

The first part: To assess female general characteristics (age, occupation, residence, education, and marital status).The second part: To assess women’s knowledge regarding gynecological examination (definition, Importance, time, indication, preparation, ways, equipment, contraindications,Etc)

The scoring system for or evaluating women’s knowledge was developed as the following: Knowledge was scored as a correct and incorrect answer for each knowledge question. Each question was given 1 score for the correct answer and 0 scores for an incorrect answer. The total knowledge of more than 60 % will be correct and less than satisfactory level of knowledge and less than 60 % will be unsatisfactory level of knowledge.

4.4.2 The second tool: Comfort and pain scale [34]

A standardized tool for assessing women's comfort was utilized during gynecological examination. Updated by Erica Jacques (2019) it was included eight items (Alertness, Calmness, Crying, Physical movement, Muscle tone, Facial tension, Blood pressure, Heart rate) upon each (1-3).

The scoring system was three Likert scales from 1 to 3 score in front of each statement the woman  responds 1, 2, 3 scores. The total score was 8-16 indicate comfort and (17-24) indicates discomfort. 

4.4.3 The third tool: The visual analogue scale to assess pain level [35]

Α Visual Analogue Scale (VΑS) is a measurement instrument that tries to measure a characteristic or attitude that is believed to range across а continuum of values and cannot easily be directly measured. It is usually a horizontal line, 100 mm in length, anchored by word descriptors at each end, as illustrated in the figure below.

The level of pain associated with gynecological procedures was measured by asking the participants to place а line perpendicular to the VΑS line at the point that best indicates their pain at the present time. The score was considered as the following: 0=no pain, 1-3=mild pain 4-6=moderate pain, 7-10=sever pain. 

4.4.4 The fourth tool: Patients’ satisfaction questionnaire sheet. Albashayeh et al. (2019) [36]

This tool was utilized for two groups Post gynecological examination. This tool was adopted from Albashayeh et al. (2019). It was included 13 statements and modified by the researcher upon each statement patients’ responded to.

The scoring system was utilized, two Likert scales (1=dissatisfied and 2 =satisfied). The total score of satisfaction was 26. Satisfy ≥ 60% (that mean ≥16 score), and Dissatisfy < 60>

4.4.5 The fourth tool: Self-reported barriers

Barriers that facing women during the gynecological examination as self-reported barriers by the women designed by the researcher; included five statements upon each statement the participant respond yes or no post-intervention. 

The scoring system was utilized, two Likert scales (0=no and 1=yes). The total score of self-reported barriers was 6. 

4.4.6 The fifth tool: Counseling interviewing sheet (Rinehart et al. (1999) [36]

Counseling interviewing sheet following gathering model of counseling (GATHER approach to counseling about gynecological examination adapted from Rinehart et al. (1999) including the following parts:

Part I: G: great the patient and A: asking about the following general characteristics: (Age, name, area of residence, education level, and marital status) 

Part II: T:  Telling patient; Orientation about gynecological examination clinic, position during the gynecological examination, about equipment will be utilized, types of gynecological examinations, the importance of gynecological examination, advantages, and disadvantages of gynecological examinations)

Part III: H: helping women to: 

  1. To undress her clothes.
  2. To assume a comfortable position during the examination
  3. To save her clothes in a private place.

Part IV:  E: explaining for women

  1. Gynecological examination procedure.
  2. Rational for each step in the procedure.
  3. Laboratory investigation
  4. Medical diagnosis
  5. How to take medication (dose, route, time and, its reaction).

Part V: R: Referral: Give the patient follow up card including the following 

  1. The regular schedule for follow up visits
  2. Warning signs that need immediate  consultation
  3. Researcher’s telephone number to consult at any time

This tool will be used pre-gynecological examinations, and immediately after the post-gynecological examination. 

4.4.7 The sixth tool: An Instructional supportive brochure

An instructional supportive brochure was designed and distributed among women at the end of the counseling session to enhance their comfort and satisfaction. The brochure includes the definition of gynecological examination, position during the gynecological examination, equipment that will be utilized, types of gynecological examinations, and the importance of gynecological examination, advantages, and disadvantages of gynecological examinations.

4.5. Validity of the tools:

All tools of data collection were sent to three specialized University Professors, according to their comments modifications were considered.

4.6. Ethical considerations:

A letter of approval to conduct the study was obtained from the dean of faculty of nursing at Benha University. Then approval from the ethical research committee at Benha faculty of nursing was obtained to conduct the study. Another letter of approval for Beni-Suef University Maternity Hospital director included the title and the aim of the study. Informed consent was obtained from each participant in the study; the aim of the study was explained before starting the study for each participant. Each participant had the right to withdraw from the study at any time. The tools of data collection were not touching the participant’s dignity, culture, and ethical issues. The participant was interviewed individually in a private room. After data collection and statistical analysis, all tools of data collection were burned to maintain the confidentiality of the study.

4.7. Fieldwork: The study was conducted through three phases:

  1. Phase 1 (preparation phase):  Through this phase, the researcher reviews the recent advanced national and international literature related to the study topics accordingly to then Tools of data collection were designed, finally conduct pilot study. Pilot study: It was carried out on 10% (6 women) of the study subjects to assess applicability, practicability, and the clarity of the study tools then any modifications were considered. Pilot study would be excluded from the total sample.
  2. Phase 2 (implementation phase): The researcher had follow the previously mentioned process for counseling and interviewed and counseled three participants utilizing a counseling sheet, counseling sessions were implemented through two theoretical sessions and four clinical orientation sessions duration of each session 20 minutes, number of participant three participants; method of teaching (lecture, group discussion, role-play and demonstration on the model, finally bedside teaching); media (lab top, blackboard, flip chart, patient model, tray with gynecological equipment). The number of sessions was ten sessions, six sessions devoted to knowledge, and four sessions devoted to clinical orientation. During the gynecological examination, each patient was assessed using pain and comfort scale and visual analogue scale this was utilized during examination concerning tools to assess barriers facing women during the gynecological examination was assessed post-intervention. Finally, post gynecological examination women's satisfaction sheet was utilized. At the end of each session, an instructional supportive brochure was designed and distributed among patients at the end of the counseling session. To enhance their comfort and satisfaction
  3. Phase 3 (evaluation phase): evaluation was performed (immediately post-test) utilizing the pretest formatted tools for participant women.

4.8. Statistical design: Data were analyzed using a statistical program for social science (SPSS) version 20.0. Quantitative data were expressed as mean±SD). Qualitative data were expressed as frequency and percentageT-test was used. P-value>0.05; Not significant (NS), P-value≤0.05; Significant (S), P-value≤0.01; Highly Significant (HS).

Results

Figure (1) presented that 40% of the studied sample their age was 30-<35>

Table (1) revealed that there was a marked improvement in knowledge of the studied sample about gynecological examination post-implementation of an instructional supportive guideline with highly statistically significant difference (P<0>

Table (2) demonstrated that there was a marked improvement in knowledge of the studied sample about pre-gynecological -examination procedures post-implementation of an instructional supportive guideline with highly statistically significant difference (P<0>

Table (3) showed that there was a marked improvement in total knowledge of the studied sample about gynecological examination post-implementation of an instructional supportive guideline with highly statistically significant difference (P<0>

Figure (2) illustrated that (73.3%) of the studied sample had unsatisfactory knowledge about gynecological examination at pre-implementation of an instructional supportive guideline. While, (85%) of them had satisfactory knowledge about gynecological examination at post-implementation of an instructional supportive guideline, respectively.

Table (4) revealed that there was a positive correlation between the level of pain of the studied sample and their discomfort and satisfaction, as well, during the gynecological examination and their satisfaction post gynecological examination, (p=0.000). The same table demonstrated that there was a positive correlation between levels of pain of the studied sample and self-reported barriers during gynecological examination (p=0.001). Moreover, there was a positive correlation between levels of discomfort during gynecological examination and satisfaction level post gynecological examination (p=0.006).

Figure (1): distribution of the studied sample according to their demographic data (n=60).
Table (1): studied sample's knowledge about gynecological examination (pre and post-test)
 *significant at p≤ 0.05                                            
**highly significant at p≤0.01
Table (2): Studied sample's knowledge about pre-gynecological-examination procedures (pre/post)
*significant at p ≤ 0.05                                 
         **highly significant at p≤ 0.01
Table (3): Studied sample's total knowledge about gynecological examination (pre/post) (n=60).
*significant at p ≤ 0.05                                              **highly significant at p ≤ 0.01
Figure (2): total knowledge about gynecological examination (pre and post-program)
Table (4):  Correlation between studied sample level of pain and total discomfort, total satisfaction, self-reported barriers, and satisfaction level during and post gynecological examination
*significant at p ≤ 0.05                           
             **highly significant at p ≤ 0.01

Discussion

Pre-gynecological counseling is very important.  It aims to help an women  to help herself  to overcome her gynecological  problem,  Counseling is The process that occurs when a women  and gynecological nurse  set aside time to explore difficulties which may include the stressful or emotional feelings of the  women. The act of helping the women to see things more clearly, possibly from a different view-point can enable the women to focus on feelings, experiences or behavior, with a goal of facilitating positive change, and a relationship of trust. Confidentiality is paramount to successful counseling. Professional gynecological nurse will usually explain their policy on confidentiality. They may, however, be required by law to disclose information if they believe that there is a risk to life. [37,38]

Gynecological examination is one of the physical examinations which are essential for assessing the female (internal & external) reproductive system. In Egyptian, there are many traditions and concepts related to the gynecological examination. Some women were usually in а culture rejecting to perform any gynecological examination for the first time. They pay little attention and may absolutely refuse gynecologist counseling for а female reproductive system. So, when the women face this exam, they become very anxious, stressed, and fearing from а situation, because she considered it is immoral issues to expose her intimate part to another person. So, it was important to assess their response regarding their first gynecological examination. [20,22]

The aim of the present study was to evaluate the effect of pre-gynecological examination counseling sessions on relieving women's pain, discomfort and enhancing their satisfaction, the aim was significantly approved within the framework through the present study hypothesis which was "application of pre-gynecological examination counseling will minimize pain discomfort and maximize patient satisfaction, the women who attend pre-gynecological examination counseling sessions will be will be expected to improve their pain level and discomfort and enhancing their satisfaction" this hypothesis was significantly achieved from the present study research finding. It was observed in the present study that there was a marked improvement in knowledge of the studied sample about gynecological examination procedure post-intervention with a highly statistically significant difference at (pless than0.01) between pre and post-intervention. the majority of the studied sample (78.3%) had incorrect knowledge about preparation for gynecological examination pre-intervention incomparable with Eid et al., (2019) who reported that more than half among the studied sample had incorrect knowledge regarding the meaning of gynecological examination. [22] The majority of the studied sample had incorrect knowledge regarding the technique of gynecological examination may be due to reproductive health illiteracy among Egyptian females, so present study research stated that increasing knowledge about gynecological examination was one factor that motivated women to seek and continue the gynecological exam. Even so providing, good communication, active interaction can assist in decreasing barriers and clarifying any misconception, and even so, this improves knowledge.

In the current study, It was observed that the majority among studied sample had incorrect knowledge regarding meaning, importance, parts of the gynecological examination, and there was a marked improvement in knowledge of the studied sample about gynecological examination post-implementation of an instructional supportive guideline with a highly statistically significant difference at (P less than0.01) between pre and post-implementation of an instructional supportive guideline, this agrees with Hassan et al. (2018) who had revealed that majority among the present studied sample had incorrect knowledge concerning definition, importance, complication & preparation. [39] Similarly, Freyens et al. (2017) reported that the majority of women in Egypt had incorrect knowledge regarding reproductive issues because culture and tradition prevent them from discussing these issues of reproductive and gynecological health. [40] However, this disagrees with Norrell et al. (2016) who found that approximately one-half of the participants stated that they knew the examination's purpose. [41]

In the current study, there was a marked improvement in knowledge of the studied sample about pre-gynecological-examination procedures post-implementation of an instructional supportive guideline with a highly statistically significant difference at (Pless than0.01) between pre and post implementation of an instructional supportive guideline. Hassan et al. (2013) reported that the scores of all skills were higher compared to the pretest, reaching statistically significant differences in the skills of determining material usefulness, applying the information to individual cases, disseminating new ideas about care to colleagues, and reviewing own practice. The total score increased from 4.3 to 4.9 although the difference did not reach statistical significance (p=0.13). [39] Moreover, Hilden et al. (2003) stated that most women felt emotional discomfort regarding the gynecologic examination. [42] 

In the present patients, there was a highly statistically significant relationship between the total knowledge of the studied sample about gynecological examination at the post of an instructional supportive guideline and their education level at (P less than0.01). 

In the current study, there was a positive correlation between the level of pain of the studied sample and their discomfort during the gynecological examination and their satisfaction post-gynecological examination. There was a positive correlation between levels of pain of the studied sample and self-reported barriers during the gynecological examination and there was a positive correlation between levels of discomfort during gynecological examination and satisfaction level post gynecological examination. This agrees with Güneş and Karaçam, (2017) reported a positive correlation between discomfort during vaginal examinations and emotional violence and post-traumatic stress disorder but a negative correlation between discomfort during vaginal examinations and the number of live births. [43]. 

Finally, pre-gynecological-examination-counseling had an important effect on relieving women's pain, discomfort and enhancing their satisfaction. Some of the different effects that are espoused either explicitly or implicitly by counselors are listed, Insight. The acquisition of an understanding of the origins and development of emotional difficulties helping women to increase capacity to take rational control over feelings and actions relating with others helping women to become better able to form and maintain meaningful and satisfying relationships with other people: for example, health care workers within the examination room. Self-awareness helps women to become more aware of thoughts and feelings that had been blocked off or denied, or develop a more accurate sense of how the self is perceived by health workers. Self-acceptance is the development of a positive attitude towards self, marked by an ability to acknowledge areas of experience that had been the subject of self-criticism and rejection. 

Limitation of the study

  • Lack of local research that study the current research
  • No pre and post gynecological instruction from nursing staff
  • Over-crowded of the clinic with medical and nursing student
  • Long waiting time before examination
  • Lack of privacy
  • Absence of female gynecologist

Conclusion

Based on the result of the present study the following can be concluded: The present study concluded that counseling sessions regarding pre-gynecological examination had a positive effect on relieving women’s pain, discomfort and enhancing their satisfaction so the hypothesis was supported and accepted, and the study aim was achieved. 

Recommendations

1- Reapplication of the present study intervention in another setting and on another sample.

2- Nurse administrators must design and apply monitoring systems to certain that nurses are well competent during providing pre-gynecological examination counseling sessions.

References

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Hao Jiang

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.

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Dr Shiming Tang

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.

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Raed Mualem

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.

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Andreas Filippaios

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.

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Dr Suramya Dhamija

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.

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Bruno Chauffert

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!

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Baheci Selen

"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".

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Jesus Simal-Gandara

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.

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Douglas Miyazaki

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.

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Dr Griffith

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.

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Dr Tong Ming Liu

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.

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Husain Taha Radhi

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.

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S Munshi

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.

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Tania Munoz

“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”.

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George Varvatsoulias

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.

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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.

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Khurram Arshad

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.

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Gomez Barriga Maria Dolores

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.

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Lin Shaw Chin

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.

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Maria Dolores Gomez Barriga

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.

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Dr Maria Dolores Gomez Barriga

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¨.

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Dr Maria Regina Penchyna Nieto

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.

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Dr Marcelo Flavio Gomes Jardim Filho

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!”

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Zsuzsanna Bene

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

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Dr 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.

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Lin-Show Chin

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.

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Sonila Qirko

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.

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Luiz Sellmann