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Review Article | DOI: https://doi.org/10.31579/2637-8892/345
1Consultant neonatology, Al Jalila Children's Specialty Hospital, Dubai health, UAE.
2Neonatology specialist, Latifa hospital, Dubai health, UAE.
3Specialist neonatology, Latifa Hospital, Dubai health, UAE.
4Consultant Child and Adolescent Psychiatry, Al Jalila Children's Specialty Hospital, Dubai health, UAE.
*Corresponding Author: Munira Mahmoud Almaazmi, 1Consultant neonatology, Al Jalila Children's Specialty Hospital, Dubai health, UAE.
Citation: Munira M. Almaazmi, Dalwinder S Janju, Rocky R. Sonale, Tarig A. Diab, (2025), Challenges and Support Needs of Caregivers of Children with Medically Complex Conditions and Disabilities: A Mini Review, Psychology and Mental Health Care, 9(7): DOI:10.31579/2637-8892/345
Copyright: © 2025, Munira Mahmoud Almaazmi. 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: 14 August 2025 | Accepted: 11 September 2025 | Published: 26 September 2025
Keywords: caregivers; children; disabilities; medically complex conditions; palliative care; primary care
The enhanced survival rates of children with life-threatening conditions have led to an increased demand for caregiving support among this population. Children with medical complexity represent a small proportion of the pediatric population but account for disproportionately high healthcare use, costs, and family burden due to their extensive medical and psychosocial needs. Their care requires multidisciplinary teams and is increasingly supported by pediatric palliative care to optimize quality of life through symptom management and family support. General principles for models of care for CMC include medical comanagement, care coordination and family or caregiver support. Patient-Centered Care (PCC), Complex Care (CC), and Episode-Based (EB) models provide structured approaches for children with medical complexity. Each model offers benefits in continuity and specialized management but faces challenges such as high costs, limited resources, poor communication, and increased risks from fragmented care. The concept of caregiving in children with medical complexity is characterized by tasks including daily and instrumental activities, transitions such as delegation and shifts toward institutional care, roles beyond family duties with reciprocal nurturing and the overall caregiving process. We found that the affected domains of parental caregiver experience can be divided into four domains. Firstly, personal domain includes identity, physical and mental health. Second, family domain that is characterized by marriage, sibling and their quality of life. Third, social domain includes time limitations and isolating lived experience. Finally, financial domain include employment, medical and accessibility costs. Supporting caregivers of children with medical complexity requires accessible, comprehensive services that extend beyond the child’s medical needs to address family well-being and caregiver mental health. So, the caring for the caregiver (C4C) model is a phased, integrated approach that partners pediatric complex care programs with psychiatry. It provides tailored mental health support for caregivers, addressing the unique demands of caring for children with medical complexity. This model focuses on depression, trauma, anxiety, and related illnesses that may face caregivers.
Children with medical complexity (CMC) represent a specific group within the population of patients with special healthcare needs. They are characterized by the presence of multiple chronic health conditions that impact various organ systems, leading to significantly elevated healthcare utilization and dependence on medical technology. [1].
Patients with CMC frequently necessitate emergency care, endure prolonged inpatient stays, and encounter recurrent hospital readmissions. [2] Children with medical complexity requires a coordinated transition from the hospital to home to achieve positive outcomes for patients and families, as well as to ensure the continued efficient utilization of the healthcare system. [3]. Caregivers of children with complex medical conditions experience distinct needs and stressors in contrast to those caring for children without such complexities. A caregiver is defined as an individual who coordinates and engages in unpaid care, excluding nurses and professional paid caregivers.[4] The financial burden associated with caring for CMC is extensively documented. Research indicates that more than half of families with CMC experience considerable financial stress and elevated rates of workforce attrition due to their child's health, which further intensifies the financial strain on these families.[5,6] The prevalence of unmet needs related to income level and insurance status for CMC has prompted some researchers to propose that medical complexity may serve as an independent risk factor for health inequity.[7]. Higher levels of family functioning in children with chronic conditions correlate with enhanced quality of life (QoL), treatment adherence, and physical health. [8]. The emotional well-being of parents, along with community and emotional support, significantly influences family functioning. [9]. National organizations, CMC clinician experts, and family stakeholders have identified family health, well-being, and community integration as priority targets for the national research agenda. [10,11]. Pediatricians are uniquely equipped to recognize emotional distress and provide support to caregivers of children with significant needs. Pediatricians can offer interventions for mild cases, whereas more severe cases may necessitate a referral to a mental health provider. This role is challenging yet has the potential to enhance outcomes for parents, children, and overall family well-being. [12]. In order to capture all facets of the topic, this research examined several key themes, such as definition of children with medical complexity, their burden and their models of care delivery. In addition, our work described definition of concept of caregiving, the role of the caregivers, affected domains of parental caregiver experience and caregiver coping in pediatric complex hospitalization. We also focused on how to support caregivers of children with medical complexity to overcome challenges through discussing a program called “caring for the caregiver model” while also considering the development of this model to provide a comprehensive perspective on supporting caregivers of children with medical complexity.
Children With Medical Complexity
Children with medical complexity are characterized by the presence or risk of pathologies that may impact neurological development and lead to chronic behavioral or emotional issues. They require a broader and more intensive level of healthcare than what is typically necessary for the general pediatric population. [13,14] Children with medical complexity has been a specific focus for health system enhancement in individuals with chronic diseases due to their significant health care utilization, functional limitations, and family needs. [15] Care for CMC generally necessitates the involvement of multidisciplinary teams comprising pediatricians, pulmonologists, neurologists, gastroenterologists, nutritionists, respiratory physiotherapists, and specialized nurses who manage devices like tracheostomies and gastrostomies.[16] Population prevalence estimates for children vary significantly, ranging from 0.20% to 11.4%, largely due to inconsistent identification methods. [17,18] This group's significance stems from their distinct and profound needs, which health systems and caregivers frequently struggle to address. Population-level analyses indicate that while their prevalence is low, their impact is significant. [19,20] Despite comprising less than 1% of the pediatric population, children with CMC represent 33% of total pediatric health care expenditures, 37% of hospitalizations, 54% of inpatient days, and 57% of hospital costs.21-24 Their prevalence is expected to increase due to higher survival rates among premature infants, children with congenital anomalies, and oncology survivors. [16] All CMC classes shared common diseases specifically gastrointestinal disorders, respiratory diseases, and trauma.25 These diseases account for the major causes of hospitalization rates together with congenital anomalies, and cardiovascular and oncological diseases. The oncology class contained 36.0% of all CMC and was predominated by individuals aged up to 5 years. In accordance with the natural development of most respiratory diseases, its prevalence was highest in the mid-age range, and it accounted for 30% of all the CMC. [26]. In the last 10 years the percentage of prematurity has remained virtually unchanged (1 out of 10 new births), while the percentage of very preterm newborns that are part of CMC, has increased.[27]. Pediatric Palliative Care (PPC) is increasingly responsible for managing CMC. Palliative care focuses on providing comprehensive support for patients with life-limiting or life-threatening conditions and their families.[28]. The objectives PPC include ensuring symptom management, preventing suffering, and supporting families, with the aim of optimizing QoL. To achieve adequate symptom management, CMC frequently undergo treatment with complex medication regimens (CMRs) and polypharmacy. [29]
Models of Care Delivery for Children with Medical Complexity
General principles for models of care for CMC
Most current models of care for CMC incorporate enhanced care coordination services alongside additional supports.[30]Care coordination in this context comprises a collection of services delivered by a designated team, focusing on patient and family-centered approaches, driven by assessments, and aimed at fulfilling the goals and needs of both the patient and family.31 Enhanced care coordination emphasizes continuity, familiarity, accessibility, partnership, and early recognition of crises. The ideal care delivery model for CMC emphasizes the development of proactive plans aligned with family and children's goals, ensures timely treatment of urgent acute health issues, facilitates multidisciplinary shared decision-making, and involves a provider who is familiar with the child and/or family in addressing comprehensive needs.
Figure 1: Examples of Services Provided by Models of Care for CMC.[32]
Models of Care Delivery for Children with Medical Complexity are categorized into three main types: primary care–centered (PCC) models, consultative- or ecomanagement-centered (CC) models, and episode-based (EB) models.[32]
Primary care–centered models of care
The PCC models for care delivery in children with medical complexity incorporate the principles of the medical home as defined by the American Academy of Pediatrics.[33]The models can be categorized as community or tertiary care-based, focusing on the provision of services that are continuous, coordinated, compassionate, and culturally appropriate within a primary care center. [34]Various health, policy, and nonprofit organizations advocate for care coordination via patient-centered care models. Also, PCC models leverage established relationships among primary care practices, families, and local communities. [35]Relationships between primary care teams and families may commence prior to the onset of a child's illness, positioning providers within PCC models to deliver diverse services as the needs of children with medical complexities and their families develop.[32]While frequently endorsed as the optimal model, meeting the needs of this varied and intricate population poses challenges for primary care physicians (PCPs).[36]Primary care providers identify several barriers to delivering care, including elevated costs, insufficient reimbursement, and the time required for service provision, inadequate communication and coordination tools, limited knowledge for managing complex acute illnesses, and a scarcity of personnel and community resources.[37]
Consultative-centered models of care
Regarding CC models refer to frameworks where providers in subspecialty or complex care programs at tertiary care centers offer care
coordination services, frequently collaborating with primary care physicians.[38]. Unlike PCC models, CC models typically do not serve as the initial access point for patients seeking health care and frequently exclude routine childcare services. The efforts of CC models, like those of numerous palliative care programs, primarily emphasize care coordination services, goal-directed co-management of medical issues, and serving as a link between the tertiary care center and the community.[31]
Episode-based models of care
Episode-based models typically involve time- or location-restricted interventions aimed at delivering medical management and care coordination for a particular illness episode or transitional phase.[39]Examples of EB models encompass an inpatient service where a specialized care team experienced in managing complex conditions attends a specific group of CMC, transitional care homes that provide a living arrangement for children between hos[40]. Pitalization and home while their parents receive training on new medical equipment, and inpatient rehabilitation facilities. The benefits arise from the capacity of trained personnel to provide continuous care during periods of heightened vulnerability for children and families. Parents of children with medical complexities report feelings of isolation during hospitalizations, express concerns for their children's well-being, experience anxiety regarding their other children and missed workdays, and confront difficult decisions related to end-of-life care. The disadvantages are associated with the location and episodic characteristics of EB models. The increase in hand-offs necessary for 24/7 care, coupled with insufficient communication with ambulatory care teams (such as home nurses, schools, primary care providers, and outpatient subspecialists), significantly elevates the risk of medical errors and care gaps for children with medical complexity.[32] Features of each model are described below and summarized in Table 1
| Model | PCC | CC | EB |
| Advantages | Ease of travel for families | Connection to tertiary-based services | Ability to assess and impact treatment and/or clinical status at sickest time |
| Awareness of local culture, values, and resources | Cohorting of patients allows for streamlining processes and development of trained workforce | Burden of care provision not on family | |
| Covisits with siblings | Provider familiarity and comfort with complex diseases and/or creation of specialized “complex-ology” workforce | Focus on transitions: for example, the creation of discharge standardization to limit gaps in care and aim to reduce readmissions | |
Disadvantages
| Insufficient infrastructure and personnel for care coordination | Enrollment criteria may result in missing children with unmet needs | Services often provided at a distance from family |
| Time constraint | Finite tertiary center financial, structural, and staff resources | Risk of poor continuity of care between care locations | |
| Obstacles to sharing medical records across different systems | Service delivery may be more expensive | Inconsistent care teams | |
| Lack of skill set | Risk of diffusion of responsibility, given unclear patient ownership | ---- | |
| CMC may receive majority of care elsewhere | Lack of integration with community-based services | ---- |
Table 1: Features of the three categories of care for CMC.
Caregiver and concept of caregiving
A caregiver is defined as an individual who offers support and assistance, whether formal or informal, to people with disabilities, long-term conditions, or elderly individuals. This individual may offer emotional or financial assistance, in addition to practical support with various tasks. A significant number of caregivers are young individuals, including children. [42]Caregiving can adversely impact the mental and physical health, along with the economic and financial stability, of caregivers. [42]Research indicates that caregiving correlates with heightened psychological stress, anxiety, depression, physical health issues, and diminished social and family interactions.[43] The provision of long-term cares for chronically ill family members or significant others at home elevate the risk of financial difficulties for caregivers. [44,45]Employed caregivers have reported absenteeism; personal days taken, early retirement, and reduced paid working hours to fulfill caregiving responsibilities. [46]Caregiving may enhance positive self-identity and self-worth while fostering a sense of belonging among young caregivers.[47]A conceptual analysis identified four characteristics of family caregiving: tasks, transition, roles, and process [48]The identified tasks encompass activities of daily living, instrumental activities of daily living, the extent of care provided, and both direct and indirect care.[49] Transitions emphasize care management, delegation, and the shift from family to institutional care. Caregiving roles extend beyond typical family care and encompass reciprocal nurturing behaviors.[50]The concept of caregiving has been examined and applied in various disciplines beyond nursing. In sociology, caregiving is defined as the care provided by unpaid workers, including family members, friends, neighbors, and individuals associated with religious institutions.[51]Psychology is a discipline that examines caregiving, focusing on the psychological ramifications associated with the act. [50]We found that the affected domains of parental caregiver experience can be divided into four domains. Firstly, personal domain includes identity, physical and mental health. Second, family domain that is characterized by marriage, sibling and their quality of life. Third, social domain includes time limitations and isolating lived experience. Finally, financial domain include employment, medical and accessibility costs.
Affected Domains of Parental Caregiver Experience
Four major categories were identified to describe affected domains of parental caregiver experience: personal, family, social, and financial (Figure 2).
Figure 2: Affected domains of parental caregiver experience[53].
Personal
Family
Social
Financial
Caregiver Coping in Pediatric Complex Hospitalization
When a kid is admitted to the hospital, their caretakers may experience communication, psychological, and physical difficulties.[67]A viable intervention target to enhance the health and welfare of CMC caregivers may be caregiver coping, which is described as the behavioral or cognitive strategies an individual uses to reduce their discomfort.[68,69] Little is known about how to support caregiver coping during hospitalizations for the CMC population, even though interventions aimed at improving caregiver coping of hospitalized children have the potential to affect caregiver anxiety, stress, and quality of life. [70,71] Three factors, according to a recent study, influence how CMC caregivers cope when their children are in the hospital: they believe their child's interdisciplinary team is trustworthy, they feel their self-care routines are seamlessly integrated into the hospital's routine and flow, and they feel they are putting their child's needs ahead of their own. When developing future interventions, these CMC-specific variables should be considered as a chance to improve caregiver support. [72]Additionally, CMC caregivers discussed how crucial it is to concentrate on their child's needs when they are in the hospital. In addition to being in line with patient and family-centered care guidelines, this affirmation of the caregiver role may make caregivers feel more supported while they are in the hospital.53) One element that helped caregivers cope was their confidence in the interdisciplinary team member's expertise and regular communication. Even though the benefits of open communication and continuity of care with CMC caregivers have been extensively discussed, trust is a complicated concept, and further study is required to fully comprehend the subtleties of how trust improves caregivers coping with CMC hospitalizations.[73,74]Caregivers' coping skills are enhanced when they perceive that their self-care routines are regularly included into the hospital flow. [75]Numerous facets of the caregiver's life are disturbed when a kid is admitted to the hospital, such as their capacity to manage work, sleep, family responsibilities, and their practice of self-care routines. [76]Potential benefits of interventions that assist caregivers in modifying their current self-care routines for the hospital environment were proposed.[72]
Supporting caregivers of children with medical complexity
In order to support caregivers of CMC, families and healthcare professionals have realized the need for more thorough and easily accessible care.[72,12] While most pediatric complex care programs concentrate on the child's medical need, some have created more all-encompassing family support models. [79]Psychiatric treatment is necessary for evaluating and diagnosing caregiver psychiatric disorders, starting medication, and suggesting suitable management interventions, even though pediatric teams offer a variety of caregiver support services.[78] The incapacity of pediatric complex care programs to diagnose and treat adult patients in a pediatric setting is currently a limitation.[80].Geographical barriers, finding a provider who understands the unique dynamics of caring for CMC, limited access to psychiatric care, insurance barriers, and timely access given high caregiving demands and prolonged hospital admissions are some of the obstacles that caregivers of CMC face when trying to access appropriate mental health services.[12,82] Parents may be able to meet their caregiving responsibilities and enhance the health of both themselves and their children by having access to psychiatric treatment and other psychosocial supports.[82] Additionally, positive child psychosocial and functional outcomes are linked to psychosocial therapies for parents of preterm infants.[83] Supporting the caregiver in addition to the child may result in better health results for both parties through a two-generation approach to care.[84]
Caring for the caregiver model
An innovative partnership between a pediatric complicated care program and a psychiatrist is the Caring for the Caregiver (C4C) integrated, phased care model. Through this collaboration, a pediatric hospital's complicated care program integrates an outside psychiatrist to offer mental care that is tailored to the circumstances of caring for CMC patients.[85] By offering psychiatric therapies, the pediatric complex care program bridges a knowledge gap. Caregivers of CMC with suspected depression, trauma, anxiety, and related illnesses are the focus of the C4C model.[86,87]According to Cardenas et al.[88] in 2023, the paradigm comprises three steps: 1) early distress identification; 2) social work assessment, intervention, and psychotherapy; and 3) psychiatric care, including diagnosis or medication introduction, through visits with the integrated psychiatrist. The C4C approach seeks to enhance outcomes including stress, anxiety, and depression while also making it easier for caregivers to get mental health care.[89]
Figure 3: The three steps of caring for the caregiver integrated stepped care model.[88]
This is the first model to use an integrated stepped care model embedded in a pediatric complex care program to address the mental health needs of caregivers of CMC by integrating adult and pediatric health care delivery. This model creates a framework for subsequent research to explore integrated stepped care models of mental health support for caregivers, where the needs of both the child and family are addressed.
Step 1: Early identification of distress
For patients and families, nurse practitioners (NP) in the complicated care program are essential staff members who collaborate with doctors.[90,91] According to Alshaharni et al.[92] , NPs assist families with all facets of their clinical care requirements and collaborate with community providers to guarantee that the patient and family have the right kind of assistance in place. Adapting this paradigm to other clinical settings could allow equally qualified advanced practice nurses to undertake this position. Through routine visits to the complicated care clinic and more frequent check-ins depending on need, NPs maintain communication with families. During regular business hours, NPs are also available to talk to parents.[93]. Given their knowledge of continuing stressors and caregiver burden, NPs may recognize caregivers who require mental health help and recommend them to complex care social workers for evaluation. In addition to addressing parents' immediate worries and pressures, NPs offer parents comprehensive psychosocial assistance by referring them to local services and providers when necessary.[88] According to Foster et al. [80]and Nonoyama et al.[84], community support can include financial and housing support programs, respite care, childcare, early intervention services, school and educational resources, support groups, psychosocial support, home or community care nursing, rehabilitation, pediatricians, and more. Additionally, by recommending respite care or altering medication and feeding regimens, NPs can lessen the strain caregivers place on families. The innovative partnership with an integrated psychiatrist is one of the resources for CMC families that are highlighted in Figure 2. The complicated care program's participants collaborate to guarantee that caregivers receive adequate, comprehensive care. Many caregivers may find that these resources meet most of their needs.[88]
Figure 4: Sources of support for the mental health and well-being of families of children with medical complexity.[88]
Step 2: Social work assessment, intervention and psychotherapy
Members of the complex care team interview carers about their mental health and possible stressors as part of a complicated routine care unit. In the event that concerns are raised, Step 2 is started and caregivers are sent to the pediatric social workers employed by the complicated care program. [95].Social workers provide psychotherapy and support to caregivers who are exhibiting signs of depression, anxiety, trauma, and related disorders, such as stress and adjustment disorders.[96,97]. Doctors and NPs also provide continuing assistance. People, couples, and families (including siblings) can get continuous strength-based psychotherapy, safety planning, and mental health evaluation from complex care social workers who have received training in grieving and trauma treatment.[88]
Dialectical behavior therapy, internal family systems therapy, narrative therapy, narrative exposure therapy, emotion-focused therapy, and cognitive behavioral therapy are examples of psychotherapies.[98] If a caregiver gives their agreement, social workers can coordinate treatment plans with their primary care physician, home care coordinator, or community social worker.[99,100]According to Hudson et al,[101] social workers can mediate a crisis by recommending referrals for respite, connecting families with more community resources and support, or sending caregivers for immediate assessment or admission. To guarantee proper medical and/or mental health evaluation, members of the complex care team may consult with the caregiver's primary care physician.[102] According to the care required, social workers will keep evaluating and modifying the psychotherapeutic treatment plan until a case is settled or a caregiver is referred for further assistance. Visits for social work and complicated clinical care take place independently. These visits may be made by caregivers alone or in collaboration with their partners.[103]
Step 3: Psychiatric care for caregivers
Referrals can be made to the integrated psychiatrist when caregivers have a known or suspected mental health diagnosis that is significantly impairing function or causing distress and requires management beyond the psychotherapeutic interventions provided by the complex care program.[104,105].A member of the complicated care team or the caregiver's primary care physician may make the recommendation after obtaining the caregiver's consent. Following a referral, preexisting support from community services and the complex care program continues.[106] Through psychotherapy, medication initiation and monitoring, short-term therapies, and psychiatric/diagnostic evaluation, the psychiatrist offers non-emergent care. [88]In addition to communicating with the caregiver's primary care physician and offering psychoeducation on issues including trauma, mental health, and the transition to parenting, the psychiatrist may refer the caregiver to therapists, psychotherapists, and community resources.[107] The caregiver's primary care physician may give the psychiatrist a medical history, suggest additional resources for the caregiver, or follow up on medical concerns/investigations and medication management/initiation.[108] The psychiatrist may be accessible for up to six appointments, contingent on the diagnosis, treatment plan, and available supports. Appointments for psychiatry can be made in person or online, and they are scheduled separately from appointments for complex care. [88]For caregiver appointments, the psychiatrist has set aside one day each week. [109]In order to offer the caregiver and child with educated care that considers their mental health concerns, the psychiatrist will speak with the complex care social workers if the caregiver gives permission for information to be shared with the complicated care program. A strong treatment plan and sufficient follow-up are ensured by the psychiatrist's active involvement through interaction with members of the complex care team.[88]
Development of the Caregiver Care Model
To provide ongoing treatment, general practice plays a crucial role.[110] Primary care teams play a crucial role in starting and supporting patients and their family caregivers in primary palliative care.[111] Furthermore, according to Nielsen et al. [112]caregivers who experience the most grieving symptoms also typically interact with general practitioners more frequently. However, there is a knowledge gap in clinical assessment and caregiver support pathways, and caregiver support is not provided in an organized manner, even though general practitioners (GPs) view supporting family caregivers as a fundamental role.[113]To improve usability and facilitate adoption, a systematic approach to offering caregiver interventions in general practice must be established in a clinical setting with caregivers and medical professionals involved 114,115). Involving caregivers and medical professionals in the development process helped to guarantee that the intervention would work in a clinical setting. To promote sustainable acceptance and implementation in a "real-world" context, an implementation-based approach to intervention development was used. [116]. Three steps were taken to establish the Caregiver Care Model: Mygind et al. [117]. Conducted a workshop with medical professionals, pilot testing in general practice clinics, and a workshop with general practitioners from the pilot clinics (Figure 5).
Figure 5: Development steps of the Caregiver Care Model.117)
Proactive planning, pediatric palliative care, and family-centered coordination are all essential components of effective care models. Additionally, providing care, particularly for parents, entails hazards of stress, declining health, and financial difficulties. As demonstrated by the C4C approach, incorporating caregiver-focused mental health support and early stress screening offers promising ways to boost the wellbeing of caregivers. The necessity of systemic, multidisciplinary solutions is highlighted by the recognition of caregiving as a structured process with psychological components. The need to integrate caregiver interventions to transform mental health service delivery for children and their families has been identified in the literature and in clinical practice.
Consent for publication: all authors have read and revised well for the manuscript and agree to publish.
Availability of data and material: All data supporting the study are presented in the manuscript or available upon request.
Competing interests: There is no conflict of interest.
Funding: The author received no financial support for this article's research, authorship, and publication.
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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. Matteo Bonori.
I recommend without hesitation submitting relevant papers on medical decision making to the International Journal of Clinical Case Reports and Reviews. I am very grateful to the editorial staff. Maria Emerson was a pleasure to communicate with. The time from submission to publication was an extremely short 3 weeks. The editorial staff submitted the paper to three reviewers. Two of the reviewers commented positively on the value of publishing the paper. The editorial staff quickly recognized the third reviewer’s comments as an unjust attempt to reject the paper. I revised the paper as recommended by the first two reviewers.
Dear Maria Emerson, Editorial Coordinator, Journal of Clinical Research and Reports. Thank you for publishing our case report: "Clinical Case of Effective Fetal Stem Cells Treatment in a Patient with Autism Spectrum Disorder" within the "Journal of Clinical Research and Reports" being submitted by the team of EmCell doctors from Kyiv, Ukraine. We much appreciate a professional and transparent peer-review process from Auctores. All research Doctors are so grateful to your Editorial Office and Auctores Publishing support! I amiably wish our article publication maintained a top quality of your International Scientific Journal. My best wishes for a prosperity of the Journal of Clinical Research and Reports. Hope our scientific relationship and cooperation will remain long lasting. Thank you very much indeed. Kind regards, Dr. Andriy Sinelnyk Cell Therapy Center EmCell
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. It was truly a rewarding experience to work with the journal “Clinical Cardiology and Cardiovascular Interventions”. The peer review process was insightful and encouraging, helping us refine our work to a higher standard. The editorial office offered exceptional support with prompt and thoughtful communication. I highly value the journal’s role in promoting scientific advancement and am honored to be part of it. Best regards, Meng-Jou Lee, MD, Department of Anesthesiology, National Taiwan University Hospital.
