AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/2639-4162/289
Euclid University / Engelhardt School of Global Health and Bioethics, United States.
*Corresponding Author: Julian Lloyd Bruce, Euclid University / Engelhardt School of Global Health and Bioethics, United States.
Citation: Julian L. Bruce, PhD (2025), Improving Mid-Level Autonomy: Integrating Artificial Intelligence–based Clinical Decision Support Systems in Outpatient Practice, J. General Medicine and Clinical Practice, 8(9); DOI:10.31579/2639-4162/289
Copyright: © 2025, Julian Lloyd Bruce. 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: 27 June 2025 | Accepted: 18 July 2025 | Published: 04 September 2025
Keywords: artificial intelligence; nurse practitioners; physician assistants; natural language processing; clinical decision support systems; primary health care
The expanding autonomy of mid-level clinicians, including nurse practitioners (NPs) and physician assistants (PAs), is reshaping outpatient care delivery—particularly in private practice and underserved settings. Legislative reforms and workforce growth have accelerated this shift and positioned mid-level providers as frontline decision-makers. Despite their increasing independence, these clinicians continue to face persistent challenges such as diagnostic uncertainty, limited subspecialty support, documentation burden, and inconsistent access to decision-making resources.
Artificial intelligence–based clinical decision support systems (AI-CDSS), which encompass tools like natural language processing (NLP) and documentation automation, present scalable solutions to these issues. These technologies enhance diagnostic precision, reduce administrative overhead, and improve risk stratification. However, adoption remains uneven due to factors such as increased cognitive load, poor integration into clinical workflows, and limited trust in algorithmic outputs.
This paper examines how tailored AI-CDSS tools can assist mid-level clinicians in areas including clinical reasoning, workflow efficiency, and patient communication. It emphasizes system design elements such as transparency, explainability, and adaptive learning, which are critical for acceptance and usability in mid-level practice environments. To ensure that technology supports clinical autonomy and improves patient care, future AI development must prioritize the specific needs of mid-level providers and avoid introducing new layers of complexity or fragmentation.
The evolving role of mid-level clinicians, primarily nurse practitioners (NPs) and physician assistants (PAs), has fundamentally reshaped the outpatient care landscape in the United States. Once considered supplementary members of physician-led teams, mid-levels now function as autonomous or semi-autonomous primary care providers, particularly in private practice and rural health settings. This transformation is driven by physician shortages, cost-containment pressures, and policy shifts that promote team-based and value-based care models [1].
Workforce data underscore the scale of this transition. Between 2008 and 2016, the proportion of rural practices employing at least one NP rose from 31.4% to 43.4%, while nonrural practices saw an increase from 18.3% to 26.5%, according to a study of over 35,000 practices [2]. The American Association of Medical Colleges (AAMC) projects that by 2034, the supply of NPs will grow by 66% and PAs by 37%, trends accelerated by expanded training pipelines and high labor demand [3]. The U.S. Bureau of Labor Statistics anticipates a 46% increase in NP employment alone by 2033, one of the fastest-growing occupations nationally [4]. This trajectory is not merely supplementary—it is transformative. Workforce modeling predicts that excess NP (~74,770) and PA (~13,190) capacity could fully offset projected primary care physician shortfalls by 2036 [5].
Legislative reforms have further catalyzed this shift. By 2021, over 20 U.S. states had enacted full practice authority laws for NPs, removing requirements for physician supervision in diagnosis, prescribing, and treatment decisions [6]. These laws have been associated with a 21% higher NP-to-population ratio in rural Health Professional Shortage Areas compared to restrictive states, suggesting that autonomy regulations can directly influence provider accessibility [7].
This paper examines how artificial intelligence (AI)–based decision support tools can support mid-level clinicians, particularly in private practice and resource-limited settings. It outlines key challenges faced by NPs and PAs working independently, and evaluates how AI tools such as clinical decision support systems (CDSS), natural language processing (NLP), and automated documentation aids are being used to improve diagnostic accuracy, efficiency, and communication. The aim is to identify how AI can be designed and implemented to enhance mid-level autonomy without adding complexity, and to offer recommendations for policymakers, designers, and clinical leaders.
AI-based Clinical Decision Support for Mid-Level Needs
Despite recent expansions in autonomy, mid-level clinicians in private practice continue to face structural and clinical challenges not typically encountered by physicians. These include broad generalist responsibilities, limited subspecialty exposure, and lack of formal residency training, all of which contribute to higher levels of diagnostic uncertainty [8]. A comparative survey found that mid-level providers report 15% lower confidence than physicians when managing atypical or multimorbid presentations, with 74% relying heavily on protocol-driven support tools in complex scenarios [9]. A narrative review of clinician–AI interactions found that while generalist providers—including mid-levels—“often acknowledge high accuracy” of AI-based decision support systems, they “remain cautious about recommendations” and are hesitant to adopt them due to poor workflow integration and the absence of robust and verifiable clinical backups [10].
Studies have demonstrated that AI-CDSS can significantly enhance diagnostic accuracy in outpatient settings. A 2024 scoping review of six real-world primary care AI-CDSS implementations (across the US, Spain, the Netherlands, and China) found consistent improvements in diagnostic guidance, treatment staging, and efficiency, although success was closely tied to well-integrated workflows [11]. Despite these benefits, adoption is frequently hindered by poor usability and lack of explainability. Surveys indicate that over 40% of mid-levels cite poor workflow integration and cognitive overload as reasons for discontinuing CDSS use despite acknowledging clinical value [12]. A systematic review highlighted that clinicians often abandon AI tools due to high cognitive burden and unclear reasoning pathways [13]. An aggregated analysis of 43 HCI-focused studies further emphasized that seamless integration and transparent explanation functions are critical success factors for CDSS adoption [14].
AI-powered decision-support tools have shown they can improve chronic disease management. A recent randomized trial in China tested an AI-driven insulin titration system for hospitalized patients with type 2 diabetes. The system maintained blood sugar within the target range 76.4% of the time, compared to 73.6% in physician-managed care, meeting noninferiority standards. Clinicians described the tool as “clear, time-saving, effective, and safe,” with an overall satisfaction score of 4.1 of 5.0 [15].
Mitigating Supervision Constraints Through AI Assistance
Mid-level clinicians in private practice—particularly in solo and rural clinics—often work without immediate physician supervision, which presents challenges in clinical ambiguity. A 2014 study of dermatology mid-level practitioners highlighted significant variation in scopes of practice, physician oversight, and independent decision-making. Many mid-levels performed procedural and diagnostic functions with limited direct physician backup, underscoring the need for standardized supervisory frameworks to ensure patient safety [16]. Though specific to dermatology, these concerns mirror broader trends in primary care, where autonomy without consistent oversight can heighten risks during critical decision-making.
AI-driven triage systems offer a potential solution by flagging high-risk cases based on real-time patient data, including vital signs, symptoms, and medical history. A 2025 narrative analysis of emergency department (ED) algorithms demonstrated their ability to prompt timely escalation or consultation [17]. Although these tools were initially developed for acute care, the principles directly translate to primary and outpatient settings, where algorithmic alerts function as virtual supervisors—identifying abnormal cases and recommending physician involvement or specialist referrals.
Importantly, these AI alerts are designed as support tools, not punitive oversight mechanisms. Clinical pilots have demonstrated that alerts improve decision confidence without undermining provider autonomy [18]. Machine-learning (ML)-based triage systems consistently outperform traditional risk assessment scales. Porto et al. (2024) reviewed 60 studies assessing 57 ML and NLP algorithms used for ED triage. Models such as XGBoost, gradient-boosted decision trees, and deep neural networks showed greater accuracy and reliability compared to traditional logistic regression. Predictive features included vital signs (e.g., oxygen saturation, systolic blood pressure), patient demographics (age), and arrival mode, highlighting their importance in effective ML-based triage. Studies reported 15–20% reductions in under-triage and 10–15% reductions in over-triage compared to conventional Manchester or ESI scales. Additionally, algorithmic classifications demonstrated lower variability across different patient subgroups and shift patterns [19].
These AI-enabled triage tools function as virtual supervisors, flagging critical cases such as chest pain, abnormal lab results, or polypharmacy concerns. By generating structured alerts and risk scores based on objective data, they provide clinical safeguards while supporting independent decision-making. They also enhance documentation of reasoning in environments without on-site supervision. Through AI-driven risk stratification, mid-level clinicians can maintain autonomy while ensuring timely escalation for patient safety [17-19].
Streamlining Protocol-Based Care and Documentation Burden
Mid-level clinicians in private practice manage chronic disease care while handling significant administrative tasks, often without strong support systems. Conditions like hypertension, type 2 diabetes, and hyperlipidemia require strict adherence to guidelines, including lab monitoring, medication adjustments, and structured documentation. At the same time, clinicians must ensure coding accuracy and regulatory compliance, which adds complexity and workload. In resource-limited settings, this dual burden can strain efficiency, increasing the risk of documentation errors or delays in care [20].
AI-driven documentation tools, especially those using natural language processing (NLP), offer a promising solution. These systems extract clinically relevant data from free-text notes and automate structured documentation. Lindvall et al. (2021) demonstrated that NLP tools could accurately identify advance care planning documentation in multisite cancer care settings, achieving F1 scores between 0.84 and 0.97 across key domains. Notably, the NLP system required just 1 to 5 minutes per patient to extract this data, compared to 30 to 120 minutes for manual chart review [21]. Similar tools could be adapted for chronic disease metrics like HbA1c levels, blood pressure readings, and medication changes.
Several pilots highlight NLP’s impact on workflow efficiency. One study reported a 30% reduction in manual note entry time and better guideline adherence, with mid-level providers confirming that automated medication titration details aligned well with documentation needs. A 2022 pilot study found that embedding NLP within a primary care EHR cut documentation time by 29% and improved billing accuracy. Users also reported that automation of SOAP note elements and ICD-10 code suggestions streamlined their workflow without disrupting patient interaction [22]. These tools are particularly relevant in solo or small-group practices, where mid-level clinicians often serve as primary providers and handle the bulk of documentation responsibilities.
Beyond clinical summaries, AI is increasingly used to automate administrative tasks such as diagnostic coding, prior authorization requests, and referral letter generation. A 2024 implementation study found that an NLP-based documentation assistant reduced manual data entry by 35% and improved billing accuracy in a family medicine group led by mid-level clinicians [23]. These tools not only support reimbursement accuracy but also reduce the risk of audits due to incomplete or inconsistent documentation—an issue of particular concern in independently billed mid-level encounters.
Despite clear benefits, adoption challenges remain. A usability audit found that 42% of mid-level clinicians discontinued or underused AI documentation tools due to information overload, irrelevant suggestions, and workflow disruptions [24]. A separate study showed that 40% of advanced practice providers abandoned similar tools for the same reasons. These findings underscore the need for custom AI solutions that prioritize low cognitive load, transparent logic, and adaptable workflows. Refining these tools for efficiency, compliance, and seamless integration will be key to their success in private practice.
Patient Communication and Trust in AI-Augmented Mid-Level Care
Mid-level clinicians serve as the first point of contact for many patients in private outpatient settings, where continuity of care and strong communication shape clinical relationships. The integration of AI into clinical workflows, whether through AI-generated documentation, predictive risk scores, or real-time treatment suggestions, has the potential to influence patient trust, credibility, and transparency. For mid-level providers, who already face occasional skepticism regarding their autonomy, the way AI is presented during patient interactions can either reinforce trust or undermine confidence [25].
Despite AI’s growing presence in healthcare, public trust remains a challenge. A nationally representative survey found that 65.8% of U.S. adults expressed low confidence in health systems’ ability to use AI responsibly, while 57.7% doubted AI’s ability to prevent harm. Notably, female respondents showed lower trust than men, and general confidence in healthcare institutions was a stronger predictor of AI acceptance than technical familiarity [26]. These findings emphasize that clinician framing and transparent communication are critical in ensuring patient trust in AI-assisted care.
Pilot studies demonstrate that AI-generated visit summaries and visual aids can improve patient comprehension when clinicians actively integrate and explain them. These tools enhance clarity and recall, making complex medical information more accessible. However, over-reliance on AI-generated content without personalization has been associated with decreased perceived provider competence and integrity, particularly in serious medical scenarios [27]. This suggests that while AI can support communication, clinician oversight and contextualization are essential for maintaining trust.
Mid-level clinicians must carefully balance the presentation of AI-generated recommendations to preserve patient trust. A 2025 retrospective cohort study from Annals of Internal Medicine analyzed 461 virtual urgent care visits, comparing initial AI-generated recommendations to final physician decisions. Expert adjudicators rated AI suggestions as "optimal" in 77.1% of cases, outperforming physician decisions (67.1% optimal). Notably, AI was superior in 20.8% of encounters, particularly in flagging urgent complaints such as antibiotic-resistant infections and urinary issues. Patients accepted AI-assisted recommendations more readily when mid-level clinicians explained and contextualized the AI’s role, demonstrating that AI can function as a diagnostic safety net when appropriately framed [28].
The 2025 JMIR randomized experiment by Madanay et al. examined patient reactions to clinician-AI agreement vs. conflict in 1,200 simulated lung cancer screening scenarios. Patients rated provider competence and likability lower when clinicians under-called AI recommendations (i.e., recommended less testing than AI suggested), compared to cases where clinicians either agreed with AI or recommended more testing. Specifically, mean agreement with clinician recommendations was 4.01/5 in undercalling scenarios, versus 4.55–4.63 in other conditions (P < .001). Interestingly, patient reactions varied by individual risk attitudes: “maximizers” (patients preferring aggressive care) responded more favorably to AI-overcalling clinicians, while “minimizers” (those preferring conservative approaches) showed no strong reaction when clinicians recommended less than AI [29]. These findings suggest that patient trust in clinician judgment is shaped by personal risk preferences, further emphasizing the need for transparent communication when AI and human recommendations diverge.
Discussion: Future Directions and Design Recommendations
The continued expansion of AI in mid-level clinical practice requires tools that are technically robust yet aligned with the workflows, autonomy, and cognitive demands of NPs and PAs. Future AI systems must emphasize contextual adaptability, decision transparency, and task-specific augmentation, particularly in solo and resource-limited outpatient settings.
AI solutions for mid-level clinicians must align with their distinct practice dynamics, including independent decision-making, limited specialist backup, and tailored workflows. Giordano et al. (2021) emphasize that optimizing AI for real-world clinical environments requires streamlined data input, task-specific alerts, and adaptive information density. Without these features, generalized systems risk increasing cognitive burden and contributing to alert fatigue [30]. Mid-level clinicians benefit most from intuitive, flexible AI tools that minimize unnecessary complexity, offer adjustable alert settings, improve contextual data visibility, and maintain transparent decision logic.
To support adoption, clinical decision support systems (CDSS) should be configurable to accommodate scope-of-practice rules, encounter types, and clinician preferences. This ensures that AI enhances workflow rather than disrupting it. A systematic review of CDSS usability, grounded in human-computer interaction (HCI) research, identified 12 key usability factors. These include interface simplicity, user control, explainability, visibility, cognitive load management, alert optimization, and customization, all of which directly influence clinician satisfaction, efficiency, and decision accuracy [31]. Embedding these elements helps reduce cognitive strain, supports autonomous decision-making, and ensures AI functions as a true asset to mid-level workflows.
Transparent AI, also known as Explainable AI (XAI), is essential for usability, trust, and clinical oversight. Okada et al. (2023) define explainability as an AI model’s ability to clearly communicate its reasoning using decision trees, feature visualization, textual justifications, or relevance rankings. In emergency medicine, clinicians reported greater acceptance and situational awareness when AI tools included explainability features compared to opaque "black-box" models. For mid-level clinicians practicing independently, transparent AI is especially valuable because it supports clinical reasoning, facilitates documentation for audits, and ensures that appropriate escalation pathways are followed when necessary [32]. Embedding SHAP value explanations, rule-based summaries, or interactive visual aids can enhance clinical judgment rather than obscure it.
To fully support mid-level workflows, AI-CDSS tools must incorporate multimodal data inputs, including structured EHR entries, free-text clinical notes, patient-reported outcomes, and auxiliary diagnostics. A 2025 scoping review of 86 empirical AI systems found that only 7% of studies evaluated tools in real-world clinical environments using multiple data streams, while 79% relied on hybrid models and few were tested in primary care settings [33]. This gap highlights an opportunity to develop AI solutions that synthesize narrative notes, structured clinical data, and patient-reported metrics, improving diagnostic accuracy and workflow efficiency for mid-level providers.
One major barrier to AI adoption among mid-level clinicians is that most existing tools remain static, lacking mechanisms to improve over time based on practice-specific feedback. Systems that adapt to local clinical patterns and incorporate user-generated feedback loops into retraining pipelines can better align with mid-level clinicians’ evolving needs and patient populations [34].
Finally, regulatory frameworks must evolve to reflect the shared decision-making dynamics between AI and mid-level providers. While the FDA’s Total Product Lifecycle (TPLC) model outlines a regulatory framework for AI-based medical devices, current policies do not differentiate physician and non-physician users regarding liability, oversight, and post-market surveillance [35]. Future policies must promote equitable AI access while ensuring safety in independently managed care settings.
The expanding role of mid-level clinicians calls for AI-based tools that support accurate diagnosis, clinical decision-making, and efficient workflows. NPs and PAs are increasingly operating as primary providers in outpatient settings, often without direct physician oversight. To meet the demands of these roles, AI-driven clinical decision support systems must be tailored to their specific challenges and designed to function reliably within limited-resource environments.
While these tools have the potential to reduce cognitive and administrative burdens, their effectiveness depends on thoughtful implementation. Poor usability, workflow misalignment, and lack of transparency continue to limit adoption. Moving forward, regulatory frameworks must clearly define standards for safety, accountability, and appropriate use. By embedding explainability, adaptability, and seamless integration into AI-CDSS, developers and policymakers can help mid-level clinicians deliver consistent, high-quality care with confidence and autonomy.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.
Dear Ms. Mayra Duenas, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. “The International Journal of Clinical Case Reports and Reviews represented the “ideal house” to share with the research community a first experience with the use of the Simeox device for speech rehabilitation. High scientific reputation and attractive website communication were first determinants for the selection of this Journal, and the following submission process exceeded expectations: fast but highly professional peer review, great support by the editorial office, elegant graphic layout. Exactly what a dynamic research team - also composed by allied professionals - needs!" From, Chiara Beccaluva, PT - Italy.
Dear Maria Emerson, Editorial Coordinator, we have deeply appreciated the professionalism demonstrated by the International Journal of Clinical Case Reports and Reviews. The reviewers have extensive knowledge of our field and have been very efficient and fast in supporting the process. I am really looking forward to further collaboration. Thanks. Best regards, Dr. Claudio Ligresti
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation. “The peer review process was efficient and constructive, and the editorial office provided excellent communication and support throughout. The journal ensures scientific rigor and high editorial standards, while also offering a smooth and timely publication process. We sincerely appreciate the work of the editorial team in facilitating the dissemination of innovative approaches such as the Bonori Method.” Best regards, Dr. Giselle Pentón-Rol.
