Article Data

  • Views 725
  • Dowloads 171

Reviews

Open Access

Medicolegal relevance of the transient loss of consciousness

  • Ivan Šoša1,*,
  • Manuela Perković2
  • Loredana Labinac2

1University of Rijeka, Faculty of Medicine, 51000 Rijeka, EU, Croatia

2Pula General Hospital, 52000 Pula, EU, Croatia

DOI: 10.22514/sv.2023.123 Vol.20,Issue 2,February 2024 pp.1-12

Submitted: 28 July 2023 Accepted: 20 October 2023

Published: 08 February 2024

*Corresponding Author(s): Ivan Šoša E-mail: ivan.sosa@uniri.hr

Abstract

Transient and hardly traceable signs of diminished consciousness might be the only signs that are apparent and reported during the scrutinous care of intensive care unit (ICU) staff. Unfortunately, most transient loss of consciousness (TLoC) episodes occur elsewhere. This review aims to help recognize TLoC and identify situations when these conditions mean that certain legal privileges should be held. With this aim, the current literature was scoped for conceptualizing consciousness, its alterations, and loss as regarded in the legal system. This review was partly inceptive for increasing the use of unconsciousness as a defense against criminal charges. This paper tackles working ability and the legal liability of individuals suffering from TLoC. What has been most discussed is so-called syncope—a TLoC without actual focal neurological deficit which occurs due to hypoperfusion of the brain. Therefore, it is a symptom of the nervous system indicating a cardiovascular condition. Unlike stroke or transient ischemic attack (TIA), hypoperfusion affects the entire brain. The sudden loss of consciousness in everyday workplace situations can lead to dangerous situations. Likewise, as a result of avoiding these situations, being aware of the possible loss of consciousness can preclude a patient from performing the duties of occupation—or any activity.


Keywords

Disorders of consciousness; Legal liability; Syncope; Transient loss of consciousness; Working ability


Cite and Share

Ivan Šoša,Manuela Perković,Loredana Labinac. Medicolegal relevance of the transient loss of consciousness. Signa Vitae. 2024. 20(2);1-12.

References

[1] van Dijk JG. The meaning of ‘Consciousness’ in syncope and related disorders. Syncope. 2020; 22: 17–32.

[2] Trevethan R. Deconstructing and assessing knowledge and awareness in public health research. Frontiers in Public Health. 2017; 5: 194.

[3] Rogers G, O’Flynn N. NICE guideline: transient loss of consciousness (blackouts) in adults and young people. British Journal of General Practice. 2011; 61: 40–42.

[4] van Dijk JG, Wieling W. Pathophysiological basis of syncope and neurological conditions that mimic syncope. Progress in Cardiovascular Diseases. 2013; 55: 345–356.

[5] Bassetti CL. Transient loss of consciousness and syncope. Handbook of Clinical Neurology. 2014; 4: 169–191.

[6] van Dijk JG, Harms MPM, de Lange FJ, Rutten JHW, Thijs RD, van der Velde N. Transient loss of consciousness. Nederlands Tijdschrift voor Geneeskunde. 2022; 166: D6651. (In Dutch)

[7] Brignole M. Guidelines on management (diagnosis and treatment) of syncope. European Heart Journal. 2001; 22: 1256–1306.

[8] Task Force for the Diagnosis and Management of Syncope; European Society of Cardiology (ESC); European Heart Rhythm Association (EHRA); Heart Failure Association (HFA); Heart Rhythm Society (HRS); Moya A, Sutton R, Ammirati F, Blanc JJ, Brignole M, Dahm JB, et al. Guidelines for the diagnosis and management of syncope (version 2009). European Heart Journal. 2009; 30: 2631–2671.

[9] Evers K. Neurotechnological assessment of consciousness disorders: five ethical imperatives. Dialogues in Clinical Neuroscience. 2016; 18: 155–162.

[10] Cox CL, Miller BM, Kuhn I, Fritz Z. Diagnostic uncertainty in primary care: what is known about its communication, and what are the associated ethical issues? Family Practice. 2021; 38: 654–668.

[11] Bandhu K, Rao A, Nehra A, Dwivedi SN, Chakrawarty A, Dey AB. Recurrent syncope in long survivors and its association with geriatric syndromes. Aging Medicine. 2023; 6: 49–55.

[12] Ali NJ, Grossman SA. Geriatric syncope and cardiovascular risk in the emergency department. The Journal of Emergency Medicine. 2017; 52: 438–448.e3.

[13] Bhise V, Rajan SS, Sittig DF, Morgan RO, Chaudhary P, Singh H. Defining and measuring diagnostic uncertainty in medicine: a systematic review. Journal of General Internal Medicine. 2018; 33: 103–115.

[14] Edlow BL, Fins JJ. Assessment of covert consciousness in the intensive care unit: clinical and ethical considerations. Journal of Head Trauma Rehabilitation. 2018; 33: 424–434.

[15] Wenzke KE, Walsh KE, Kalscheur M, Wasmund SL, Page RL, Brignole M, et al. Clinical characteristics and outcome of patients with situational syncope compared to patients with vasovagal syncope. Pacing and Clinical Electrophysiology. 2017; 40: 591–595.

[16] Zyśko D, Sutton R, Timler D, Furtan S, Melander O, Fedorowski A. History of syncope predicts loss of consciousness after head trauma: retrospective study. Cardiology Journal. 2014; 21: 674–678.

[17] Zy ko D, Szewczuk-Bogus awska M, Kaczmarek M, Agrawal AK, Rudnicki J, Gajek J, et al. Reflex syncope, anxiety level, and family history of cardiovascular disease in young women: case-control study. Europace. 2015; 17: 309–313.

[18] Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Systematic Reviews. 2021; 10: 89.

[19] Hansen KL, Bratholm Å, Pradhan M, Mikkelsen S, Milling L. Physicians’ experiences and perceived challenges working in an emergency setting in Bharatpur, Nepal: a qualitative study. International Journal of Emergency Medicine. 2022; 15: 61.

[20] Soteriades ES, Evans JC, Larson MG, Chen MH, Chen L, Benjamin EJ, et al. Incidence and prognosis of syncope. New England Journal of Medicine. 2002; 347: 878–885.

[21] Ouyang H, Quinn J. Diagnosis and evaluation of syncope in the emergency department. Emergency Medicine Clinics of North America. 2010; 28: 471–485.

[22] Thiruganasambandamoorthy V, Rowe BH, Sivilotti MLA, McRae AD, Arcot K, Nemnom M, et al. Duration of electrocardiographic monitoring of emergency department patients with syncope. Circulation. 2019; 139: 1396–1406.

[23] Thiruganasambandamoorthy V, Hess EP, Turko E, Perry JJ, Wells GA, Stiell IG. Outcomes in Canadian emergency department syncope patients—are we doing a good job? The Journal of Emergency Medicine. 2013; 44: 321–328.

[24] Schwartz K. Trends in overall and non-COVID-19 hospital admissions. 2020. Accessible at https://oncpracticemanagement.com/issues/2020/december-2020-vol-10-no-12/1859-trends-in-overall-and-non-covid-19-hospital-admissions (Accessed: 22 July 2023).

[25] Henry TR, Ezzeddine MA. Approach to the patient with transient alteration of consciousness. Neurology: Clinical Practice. 2012; 2: 179–186.

[26] Brignole M, Alboni P, Benditt DG, Bergfeldt L, Blanc JJ, Bloch Thomsen PE, et al. Guidelines on management (diagnosis and treatment) of syncope—update 2004. Europace. 2004; 6: 467–537.

[27] Numé A, Kragholm K, Carlson N, Kristensen SL, Bøggild H, Hlatky MA, et al. Syncope and its impact on occupational accidents and employment. Circulation: Cardiovascular Quality and Outcomes. 2017; 10: e0032002.

[28] Nume AK, Carlson N, Gerds TA, Holm E, Pallisgaard J, Søndergaard KB, et al. Risk of post-discharge fall-related injuries among adult patients with syncope: a nationwide cohort study. PLOS ONE. 2018; 13: e0206936.

[29] Jorge JG, Pournazari P, Raj SR, Maxey C, Sheldon RS. Frequency of injuries associated with syncope in the prevention of syncope trials. EP Europace. 2020; 22: 1896–1903.

[30] Tajdini M, Tavolinejad H, Aminorroaya A, Aryan Z, Jalali A, Alaeddini F, et al. Clinical associations of injuries caused by vasovagal syncope: a cohort study from a tertiary syncope unit. Journal of the American Heart Association. 2023; 12: e027272.

[31] Reuber M, Chen M, Jamnadas-Khoda J, Broadhurst M, Wall M, Grünewald RA, et al. Value of patient-reported symptoms in the diagnosis of transient loss of consciousness. Neurology. 2016; 87: 625–633.

[32] Taşdelen A, Ekici A. Transient loss of consciousness in children: syncope or epileptic seizure? Neurology Asia. 2022; 27: 309–315.

[33] Vandenberk B, Morillo CA, Sheldon RS, Chew DS, Aksu T, Raj SR. Clinician needs and perceptions about cardioneuroablation for recurrent vasovagal syncope: an international clinician survey. Heart Rhythm. 2021; 18: 2160–2166.

[34] Hoefnagels WAJ, Padberg GW, Overweg J, Velde EA, Roos RAC. Transient loss of consciousness: the value of the history for distinguishing seizure from syncope. Journal of Neurology. 1991; 238: 39–43.

[35] Thijs RD, Wagenaar WA, Middelkoop HAM, Wieling W, van Dijk JG. Transient loss of consciousness through the eyes of a witness. Neurology. 2008; 71: 1713–1718.

[36] Alciati A, Shiffer D, Dipaola F, Barbic F, Furlan R. Psychogenic pseudosyncope: clinical features, diagnosis and management. Journal of Atrial Fibrillation. 2020; 13: 2399.

[37] Walsh KE, Baneck T, Page RL, Brignole M, Hamdan MH. Psychogenic pseudosyncope: not always a diagnosis of exclusion. Pacing and Clinical Electrophysiology. 2018; 41: 480–486.

[38] Raj V, Rowe AA, Fleisch SB, Paranjape SY, Arain AM, Nicolson SE. Psychogenic pseudosyncope: diagnosis and management. Autonomic Neuroscience. 2014; 184: 66–72.

[39] Turner-Stokes L, Rose H, Knight A, Williams H, Siegert RJ, Ashford SA. Prolonged disorders of consciousness: identification using the UK FIM + FAM and cohort analysis of outcomes from a UK national clinical database. Disability and Rehabilitation. 2023; 45: 620–629.

[40] Saal DP, van Dijk JG. Classifying syncope. Autonomic Neuroscience. 2014; 184: 3–9.

[41] Ropper AH, Samuels MA, Klein JP. Adam and Victor’s principles of neurology. 10th edn. McGraw Hill Professional: New York. 2014.

[42] Torabi P, Rivasi G, Hamrefors V, Ungar A, Sutton R, Brignole M, et al. Early and late-onset syncope: insight into mechanisms. European Heart Journal. 2022; 43: 2116–2123.

[43] Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction—executive summary. Circulation. 2004; 110: 588–636.

[44] Lee CY, Lai HY, Lee CH, Chen MM. Medical dispute cases caused by errors in clinical reasoning: an investigation and analysis. Healthcare. 2022; 10: 2224.

[45] Shahrokhi M, Asuncion RMD. Neurologic Exam. StatPearls Publishing: Treasure Island (FL). 2023.

[46] Varkey B. Principles of clinical ethics and their application to practice. Medical Principles and Practice. 2021; 30: 17–28.

[47] Niveau G, Welle I. Forensic psychiatry, one subspecialty with two ethics? A systematic review. BMC Medical Ethics. 2018; 19: 25.

[48] Hemming V, Camaclang AE, Adams MS, Burgman M, Carbeck K, Carwardine J, et al. An introduction to decision science for conservation. Conservation Biology. 2022; 36: e13868.

[49] Virameteekul S, Bhidayasiri R. We Move or Are We Moved? Unpicking the origins of voluntary movements to better understand semivoluntary movements. Frontiers in Neurology. 2022; 13: 834217.

[50] Mahmood M, Ridgway P, GI CU, et al. End-Of-Life Decision Making. 2022. Accessible at: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2015/01/end-of-life-decision-making (Accessed: 5 December 2023).

[51] Blume ED, Kirsch R, Cousino MK, Walter JK, Steiner JM, Miller TA, et al. Palliative care across the life span for children with heart disease: a scientific statement from the American heart association. Circulation: Cardiovascular Quality and Outcomes. 2023; 16: e000114.

[52] Iezzoni LI, Rao SR, Ressalam J, Bolcic-Jankovic D, Agaronnik ND, Lagu T, et al. Us physicians’ knowledge about the Americans with disabilities act and accommodation of patients with disability. Health Affairs. 2022; 41: 96–104.

[53] Medeiros FA. Biomarkers and surrogate endpoints: lessons learned from glaucoma. Investigative Opthalmology & Visual Science. 2017; 58: BIO20.

[54] Vlachopoulos C, Xaplanteris P, Aboyans V, Brodmann M, Cífková R, Cosentino F, et al. The role of vascular biomarkers for primary and secondary prevention. A position paper from the European Society of Cardiology Working Group on peripheral circulation: endorsed by the association for research into arterial structure and physiology (ARTERY) society. Atherosclerosis. 2015; 241: 507–532.

[55] Yaffe G. The voluntary act requirement. The Routledge companion to philosophy of law (pp. 174–190). In Marmor, Andrei, ed. The Routledge companion to philosophy of law. Routledge, Milton Park, Abingdon-on-Thames, Oxfordshire, England, UK; 2012.

[56] Guan G, Lee CMY, Begg S, Crombie A, Mnatzaganian G. The use of early warning system scores in prehospital and emergency department settings to predict clinical deterioration: a systematic review and meta-analysis. PLOS ONE. 2022; 17: e0265559.

[57] Martin-Rodriguez F, Del Pozo Vegas C, Mohedano-Moriano A, Polonio-López B, Maestre Miquel C, Viñuela A, et al. Role of biomarkers in the prediction of serious adverse events after syncope in prehospital assessment: a multi-center observational study. Journal of Clinical Medicine. 2020; 9: 651.

[58] Griffith R. Assessing capacity in cases of fluctuating decision-making ability. British Journal of Nursing. 2020; 29: 908–909.

[59] Villanueva Rábano R, Martín-Rodríguez F, López-Izquierdo R. National Early Warning Score 2 Lactate (NEWS2-L) in Predicting Early Clinical Deterioration in Patients with Dyspnoea in Prehospital Care. Investigación y Educación en Enfermería. 2021; 39: e05.

[60] Martin-Rodriguez F, Lopez-Izquierdo R, Del Pozo Vegas C, Delgado Benito JF, Del Brio Ibáñez P, Moro Mangas I, et al. Predictive value of the prehospital NEWS2-L—National Early Warning Score 2 Lactate—for detecting early death after an emergency. Emergencias. 2019; 31: 173–179.

[61] Durantez-Fernández C, Martín-Conty JL, Polonio-López B, Castro Villamor MÁ, Maestre-Miquel C, Viñuela A, et al. Lactate improves the predictive ability of the National Early Warning Score 2 in the emergency department. Australian Critical Care. 2022; 35: 677–683.

[62] Health NIF, Excellence C. National early warning score systems that alert to deteriorating adult patients in hospital. Medical Technology Innovations Brief. 2020; 4731: 1–18.

[63] Walker G. Calculated decisions: EGSYS (Evaluation of Guidelines in SYncope Study) score for syncope. Emerg Med Pract. 2021; 23: CD3–CD4.

[64] Zimmermann T, du Fay de Lavallaz J, Nestelberger T, Gualandro DM, Lopez-Ayala P, Badertscher P, et al. International validation of the Canadian syncope risk score: a cohort study. Annals of Internal Medicine. 2022; 175: 783–794.

[65] Barbic F, Dipaola F, Casazza G, Borella M, Minonzio M, Solbiati M, et al. Syncope in a working-age population: recurrence risk and related risk factors. Journal of Clinical Medicine. 2019; 8: 150.

[66] Sumner GL, Rose MS, Koshman ML, Ritchie D, Sheldon RS. Recent history of vasovagal syncope in a young, referral‐based population is a stronger predictor of recurrent syncope than lifetime syncope burden. Journal of Cardiovascular Electrophysiology. 2010; 21: 1375–1380.

[67] Freund O, Caspi I, Shacham Y, Frydman S, Biran R, Abu Katash H, et al. Holter ECG for syncope evaluation in the internal medicine department-choosing the right patients. Journal of Clinical Medicine. 2022; 11: 4781.

[68] Perego M, Porteiro Vàzquez DM, Ramera L, Lombardo SF, Pane C, Bontempi LV, et al. Heart rhythm characterisation during unexplained transient loss of consciousness in dogs. The Veterinary Journal. 2020; 263: 105523.

[69] Kułach A, Dewerenda M, Majewski M, Lasek-Bal A, Gąsior Z. 72 hour Holter monitoring, 7 day Holter monitoring, and 30 day intermittent patient-activated heart rhythm recording in detecting arrhythmias in cryptogenic stroke patients free from arrhythmia in a screening 24 h Holter. Open Medicine. 2020; 15: 697–701.

[70] Bagnato S, Boccagni C. Cerebrospinal fluid and blood biomarkers in patients with post-traumatic disorders of consciousness: a scoping review. Brain Sciences. 2023; 13: 364.

[71] Masoumi B, Mozafari S, Golshani K, Heydari F, Nasr-Esfahani M. Differential diagnosis of seizure and syncope by the means of biochemical markers in emergency department patients. International Journal of Preventive Medicine. 2022; 13: 58.

[72] Huang HZ, Hu XF, Wen XH, Yang LQ. Serum neuron-specific enolase, magnetic resonance imaging, and electrophysiology for predicting neurodevelopmental outcomes of neonates with hypoxic-ischemic encephalopathy: a prospective study. BMC Pediatrics. 2022; 22: 290.

[73] Sandhu RK, Sheldon RS. Are cardiac biomarkers the key to solving the syncope mystery? Circulation. 2019; 139: 2419–2421.

[74] Miranda CM, Silva RMFLD, Peruhybe-Magalhães V, Brugada J. Vasoactive biomarkers in patients with vasovagal syncope during head-up tilt test: a case-control study. Clinical Medicine Insights: Cardiology. 2022; 16: 117954682211168.

[75] Song H, Bang HJ, You Y, Park JS, Kang C, Kim HJ, et al. Novel serum biomarkers for predicting neurological outcomes in postcardiac arrest patients treated with targeted temperature management. Critical Care. 2023; 27: 113.

[76] Martikainen K, Seppä K, Viita P, Rajala S, Laippala P, Keränen T. Transient loss of consciousness with and without injuries. European Journal of General Practice. 2003; 9: 91–95.

[77] Gedzelman ER, LaRoche SM. Long-term video EEG monitoring for diagnosis of psychogenic nonepileptic seizures. Neuropsychiatric Disease and Treatment. 2014; 10: 1979–1986.

[78] Vaughn MN, Winston CN, Levin N, Rissman RA, Risbrough VB. Developing biomarkers of mild traumatic brain injury: promise and progress of CNS-derived exosomes. Frontiers in Neurology. 2021; 12: 698206.

[79] Dadas A, Washington J, Diaz-Arrastia R, Janigro D. Biomarkers in traumatic brain injury (TBI): a review. Neuropsychiatric Disease and Treatment. 2018; 14: 2989–3000.

[80] Guedes VA, Devoto C, Leete J, Sass D, Acott JD, Mithani S, et al. Extracellular vesicle proteins and MicroRNAs as biomarkers for traumatic brain injury. Frontiers in Neurology. 2020; 11: 663.

[81] Xu B, Chen Y, Peng M, Zheng JH, Zuo C. Exploring the potential of exosomes in diagnosis and drug delivery for pancreatic ductal adenocarcinoma. International Journal of Cancer. 2023; 152: 110–122.

[82] Špirková S. Free will, moral responsibility and automatisms. Ethics & Bioethics. 2023; 13: 83–94.

[83] Mazor M, Brown S, Ciaunica A, Demertzi A, Fahrenfort J, Faivre N, et al. The scientific study of consciousness cannot and should not be morally neutral. Perspectives on Psychological Science. 2023; 18: 535–543.

[84] Seth AK, Bayne T. Theories of consciousness. Nature Reviews Neuroscience. 2022; 23: 439–452.

[85] Kleiner J. Mathematical models of consciousness. Entropy. 2020; 22: 609.

[86] Cleeremans A, Tallon-Baudry C. Consciousness matters: phenomenal experience has functional value. Neuroscience of Consciousness. 2022; 2022: niac007.

[87] Parés-Pujolràs E, Matić K, Haggard P. Feeling ready: neural bases of prospective motor readiness judgements. Neuroscience of Consciousness. 2023; 2023: niad003.

[88] Marton F, Booth S. Learning and awareness. Routledge: Milton Park, Abingdon-on-Thames, Oxfordshire, England, UK. 2013.

[89] Onyeukaziri JN. Action and agency in artificial intelligence: a philosophical critique. Philosophia: International Journal of Philosophy. 2023; 24: 73–90.

[90] Goodman LE. An idea is not something mute like a picture on a pad. The Review of Metaphysics. 2009; 62: 591–631.

[91] Perler D. Ancient and medieval theories of intentionality. Brill: Leiden. 2021.

[92] Cavedon MP. Early stirrings of modern liberty in the thought of St. Politics and Religion. 2023; 1–18.

[93] Pitman L. The Trojan Horse in your head: cognitive threats and how to counter them. Old Dominion University. 2019.

[94] Bechler CJ, Tormala ZL, Rucker DD. The attitude-behavior relationship revisited. Psychological Science. 2021; 32: 1285–1297.

[95] Graziano MSA. A conceptual framework for consciousness. Proceedings of the National Academy of Sciences. 2022; 119: e2116933119.

[96] Fesce R. Imagination: the dawn of consciousness. Physiology & Behavior. 2023; 259: 114035.

[97] Hildt E. The prospects of artificial consciousness: ethical dimensions and concerns. AJOB Neuroscience. 2023; 14: 58–71.

[98] Neafsey EJ. Conscious intention and human action: review of the rise and fall of the readiness potential and Libet’s clock. Consciousness and Cognition. 2021; 94: 103171.

[99] Keller I, Heckhausen H. Readiness potentials preceding spontaneous motor acts: voluntary vs. involuntary control. Electroencephalography and Clinical Neurophysiology. 1990; 76: 351–361.

[100] Margulescu AD, Anderson MH. A review of driving restrictions in patients at risk of syncope and cardiac arrhythmias associated with sudden incapacity: differing global approaches to regulation and risk. Arrhythmia & Electrophysiology Review. 2019; 8: 90–98.

[101] Parsons IT, Cox AT, Mollan IA, Boos CJ. Managing the military patient with syncope. Journal of the Royal Army Medical Corps. 2015; 161: 180–186.

[102] Staples JA, Erdelyi S, Merchant K, Yip C, Khan M, Redelmeier DA, et al. Syncope and the risk of subsequent motor vehicle crash. JAMA Internal Medicine. 2022; 182: 934.

[103] Numeroso F, Mossini G, Grieco I, Bergamin M, Maggio M, Lippi G, et al. Incidence and predictive factors of acute diseases in patients with syncope: the ESCAPE study. Internal and Emergency Medicine. 2022; 17: 215–221.


Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 1.0 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time

Conferences

Top