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• How to Write a Literature Review | Guide, Examples, & Templates

How to Write a Literature Review | Guide, Examples, & Templates

Published on January 2, 2023 by Shona McCombes . Revised on September 11, 2023.

What is a literature review? A literature review is a survey of scholarly sources on a specific topic. It provides an overview of current knowledge, allowing you to identify relevant theories, methods, and gaps in the existing research that you can later apply to your paper, thesis, or dissertation topic .

There are five key steps to writing a literature review:

• Search for relevant literature
• Evaluate sources
• Identify themes, debates, and gaps
• Outline the structure
• Write your literature review

A good literature review doesn’t just summarize sources—it analyzes, synthesizes , and critically evaluates to give a clear picture of the state of knowledge on the subject.

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Table of contents

What is the purpose of a literature review, examples of literature reviews, step 1 – search for relevant literature, step 2 – evaluate and select sources, step 3 – identify themes, debates, and gaps, step 4 – outline your literature review’s structure, step 5 – write your literature review, free lecture slides, other interesting articles, frequently asked questions, introduction.

• Quick Run-through
• Step 1 & 2

When you write a thesis , dissertation , or research paper , you will likely have to conduct a literature review to situate your research within existing knowledge. The literature review gives you a chance to:

• Demonstrate your familiarity with the topic and its scholarly context
• Develop a theoretical framework and methodology for your research
• Position your work in relation to other researchers and theorists
• Show how your research addresses a gap or contributes to a debate
• Evaluate the current state of research and demonstrate your knowledge of the scholarly debates around your topic.

Writing literature reviews is a particularly important skill if you want to apply for graduate school or pursue a career in research. We’ve written a step-by-step guide that you can follow below.

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Writing literature reviews can be quite challenging! A good starting point could be to look at some examples, depending on what kind of literature review you’d like to write.

• Example literature review #1: “Why Do People Migrate? A Review of the Theoretical Literature” ( Theoretical literature review about the development of economic migration theory from the 1950s to today.)
• Example literature review #2: “Literature review as a research methodology: An overview and guidelines” ( Methodological literature review about interdisciplinary knowledge acquisition and production.)
• Example literature review #3: “The Use of Technology in English Language Learning: A Literature Review” ( Thematic literature review about the effects of technology on language acquisition.)
• Example literature review #4: “Learners’ Listening Comprehension Difficulties in English Language Learning: A Literature Review” ( Chronological literature review about how the concept of listening skills has changed over time.)

You can also check out our templates with literature review examples and sample outlines at the links below.

Download Word doc Download Google doc

Before you begin searching for literature, you need a clearly defined topic .

If you are writing the literature review section of a dissertation or research paper, you will search for literature related to your research problem and questions .

Make a list of keywords

Start by creating a list of keywords related to your research question. Include each of the key concepts or variables you’re interested in, and list any synonyms and related terms. You can add to this list as you discover new keywords in the process of your literature search.

• Social media, Facebook, Instagram, Twitter, Snapchat, TikTok
• Body image, self-perception, self-esteem, mental health
• Generation Z, teenagers, adolescents, youth

Search for relevant sources

Use your keywords to begin searching for sources. Some useful databases to search for journals and articles include:

• Your university’s library catalogue
• Google Scholar
• Project Muse (humanities and social sciences)
• Medline (life sciences and biomedicine)
• EconLit (economics)
• Inspec (physics, engineering and computer science)

You can also use boolean operators to help narrow down your search.

Make sure to read the abstract to find out whether an article is relevant to your question. When you find a useful book or article, you can check the bibliography to find other relevant sources.

You likely won’t be able to read absolutely everything that has been written on your topic, so it will be necessary to evaluate which sources are most relevant to your research question.

For each publication, ask yourself:

• What question or problem is the author addressing?
• What are the key concepts and how are they defined?
• What are the key theories, models, and methods?
• Does the research use established frameworks or take an innovative approach?
• What are the results and conclusions of the study?
• How does the publication relate to other literature in the field? Does it confirm, add to, or challenge established knowledge?
• What are the strengths and weaknesses of the research?

Make sure the sources you use are credible , and make sure you read any landmark studies and major theories in your field of research.

You can use our template to summarize and evaluate sources you’re thinking about using. Click on either button below to download.

Take notes and cite your sources

As you read, you should also begin the writing process. Take notes that you can later incorporate into the text of your literature review.

It is important to keep track of your sources with citations to avoid plagiarism . It can be helpful to make an annotated bibliography , where you compile full citation information and write a paragraph of summary and analysis for each source. This helps you remember what you read and saves time later in the process.

To begin organizing your literature review’s argument and structure, be sure you understand the connections and relationships between the sources you’ve read. Based on your reading and notes, you can look for:

• Trends and patterns (in theory, method or results): do certain approaches become more or less popular over time?
• Themes: what questions or concepts recur across the literature?
• Debates, conflicts and contradictions: where do sources disagree?
• Pivotal publications: are there any influential theories or studies that changed the direction of the field?
• Gaps: what is missing from the literature? Are there weaknesses that need to be addressed?

This step will help you work out the structure of your literature review and (if applicable) show how your own research will contribute to existing knowledge.

• Most research has focused on young women.
• There is an increasing interest in the visual aspects of social media.
• But there is still a lack of robust research on highly visual platforms like Instagram and Snapchat—this is a gap that you could address in your own research.

There are various approaches to organizing the body of a literature review. Depending on the length of your literature review, you can combine several of these strategies (for example, your overall structure might be thematic, but each theme is discussed chronologically).

Chronological

The simplest approach is to trace the development of the topic over time. However, if you choose this strategy, be careful to avoid simply listing and summarizing sources in order.

Try to analyze patterns, turning points and key debates that have shaped the direction of the field. Give your interpretation of how and why certain developments occurred.

If you have found some recurring central themes, you can organize your literature review into subsections that address different aspects of the topic.

For example, if you are reviewing literature about inequalities in migrant health outcomes, key themes might include healthcare policy, language barriers, cultural attitudes, legal status, and economic access.

Methodological

If you draw your sources from different disciplines or fields that use a variety of research methods , you might want to compare the results and conclusions that emerge from different approaches. For example:

• Look at what results have emerged in qualitative versus quantitative research
• Discuss how the topic has been approached by empirical versus theoretical scholarship
• Divide the literature into sociological, historical, and cultural sources

Theoretical

A literature review is often the foundation for a theoretical framework . You can use it to discuss various theories, models, and definitions of key concepts.

You might argue for the relevance of a specific theoretical approach, or combine various theoretical concepts to create a framework for your research.

Like any other academic text , your literature review should have an introduction , a main body, and a conclusion . What you include in each depends on the objective of your literature review.

The introduction should clearly establish the focus and purpose of the literature review.

Depending on the length of your literature review, you might want to divide the body into subsections. You can use a subheading for each theme, time period, or methodological approach.

As you write, you can follow these tips:

• Summarize and synthesize: give an overview of the main points of each source and combine them into a coherent whole
• Analyze and interpret: don’t just paraphrase other researchers — add your own interpretations where possible, discussing the significance of findings in relation to the literature as a whole
• Critically evaluate: mention the strengths and weaknesses of your sources
• Write in well-structured paragraphs: use transition words and topic sentences to draw connections, comparisons and contrasts

In the conclusion, you should summarize the key findings you have taken from the literature and emphasize their significance.

When you’ve finished writing and revising your literature review, don’t forget to proofread thoroughly before submitting. Not a language expert? Check out Scribbr’s professional proofreading services !

This article has been adapted into lecture slides that you can use to teach your students about writing a literature review.

Scribbr slides are free to use, customize, and distribute for educational purposes.

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If you want to know more about the research process , methodology , research bias , or statistics , make sure to check out some of our other articles with explanations and examples.

• Sampling methods
• Simple random sampling
• Stratified sampling
• Cluster sampling
• Likert scales
• Reproducibility

 Statistics

• Null hypothesis
• Statistical power
• Probability distribution
• Effect size
• Poisson distribution

Research bias

• Optimism bias
• Cognitive bias
• Implicit bias
• Hawthorne effect
• Anchoring bias
• Explicit bias

A literature review is a survey of scholarly sources (such as books, journal articles, and theses) related to a specific topic or research question .

It is often written as part of a thesis, dissertation , or research paper , in order to situate your work in relation to existing knowledge.

There are several reasons to conduct a literature review at the beginning of a research project:

• To familiarize yourself with the current state of knowledge on your topic
• To ensure that you’re not just repeating what others have already done
• To identify gaps in knowledge and unresolved problems that your research can address
• To develop your theoretical framework and methodology
• To provide an overview of the key findings and debates on the topic

Writing the literature review shows your reader how your work relates to existing research and what new insights it will contribute.

The literature review usually comes near the beginning of your thesis or dissertation . After the introduction , it grounds your research in a scholarly field and leads directly to your theoretical framework or methodology .

A literature review is a survey of credible sources on a topic, often used in dissertations , theses, and research papers . Literature reviews give an overview of knowledge on a subject, helping you identify relevant theories and methods, as well as gaps in existing research. Literature reviews are set up similarly to other  academic texts , with an introduction , a main body, and a conclusion .

An  annotated bibliography is a list of  source references that has a short description (called an annotation ) for each of the sources. It is often assigned as part of the research process for a  paper .  

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How To Write An A-Grade Literature Review

3 straightforward steps (with examples) + free template.

By: Derek Jansen (MBA) | Expert Reviewed By: Dr. Eunice Rautenbach | October 2019

Quality research is about building onto the existing work of others , “standing on the shoulders of giants”, as Newton put it. The literature review chapter of your dissertation, thesis or research project is where you synthesise this prior work and lay the theoretical foundation for your own research.

Long story short, this chapter is a pretty big deal, which is why you want to make sure you get it right . In this post, I’ll show you exactly how to write a literature review in three straightforward steps, so you can conquer this vital chapter (the smart way).

Overview: The Literature Review Process

• Understanding the “ why “
• Finding the relevant literature
• Cataloguing and synthesising the information
• Outlining & writing up your literature review
• Example of a literature review

But first, the “why”…

Before we unpack how to write the literature review chapter, we’ve got to look at the why . To put it bluntly, if you don’t understand the function and purpose of the literature review process, there’s no way you can pull it off well. So, what exactly is the purpose of the literature review?

Well, there are (at least) four core functions:

• For you to gain an understanding (and demonstrate this understanding) of where the research is at currently, what the key arguments and disagreements are.
• For you to identify the gap(s) in the literature and then use this as justification for your own research topic.
• To help you build a conceptual framework for empirical testing (if applicable to your research topic).
• To inform your methodological choices and help you source tried and tested questionnaires (for interviews ) and measurement instruments (for surveys ).

Most students understand the first point but don’t give any thought to the rest. To get the most from the literature review process, you must keep all four points front of mind as you review the literature (more on this shortly), or you’ll land up with a wonky foundation.

Okay – with the why out the way, let’s move on to the how . As mentioned above, writing your literature review is a process, which I’ll break down into three steps:

• Finding the most suitable literature
• Understanding , distilling and organising the literature
• Planning and writing up your literature review chapter

Importantly, you must complete steps one and two before you start writing up your chapter. I know it’s very tempting, but don’t try to kill two birds with one stone and write as you read. You’ll invariably end up wasting huge amounts of time re-writing and re-shaping, or you’ll just land up with a disjointed, hard-to-digest mess . Instead, you need to read first and distil the information, then plan and execute the writing.

Step 1: Find the relevant literature

Naturally, the first step in the literature review journey is to hunt down the existing research that’s relevant to your topic. While you probably already have a decent base of this from your research proposal , you need to expand on this substantially in the dissertation or thesis itself.

Essentially, you need to be looking for any existing literature that potentially helps you answer your research question (or develop it, if that’s not yet pinned down). There are numerous ways to find relevant literature, but I’ll cover my top four tactics here. I’d suggest combining all four methods to ensure that nothing slips past you:

Method 1 – Google Scholar Scrubbing

Google’s academic search engine, Google Scholar , is a great starting point as it provides a good high-level view of the relevant journal articles for whatever keyword you throw at it. Most valuably, it tells you how many times each article has been cited, which gives you an idea of how credible (or at least, popular) it is. Some articles will be free to access, while others will require an account, which brings us to the next method.

Method 2 – University Database Scrounging

Generally, universities provide students with access to an online library, which provides access to many (but not all) of the major journals.

So, if you find an article using Google Scholar that requires paid access (which is quite likely), search for that article in your university’s database – if it’s listed there, you’ll have access. Note that, generally, the search engine capabilities of these databases are poor, so make sure you search for the exact article name, or you might not find it.

Method 3 – Journal Article Snowballing

At the end of every academic journal article, you’ll find a list of references. As with any academic writing, these references are the building blocks of the article, so if the article is relevant to your topic, there’s a good chance a portion of the referenced works will be too. Do a quick scan of the titles and see what seems relevant, then search for the relevant ones in your university’s database.

Method 4 – Dissertation Scavenging

Similar to Method 3 above, you can leverage other students’ dissertations. All you have to do is skim through literature review chapters of existing dissertations related to your topic and you’ll find a gold mine of potential literature. Usually, your university will provide you with access to previous students’ dissertations, but you can also find a much larger selection in the following databases:

• Open Access Theses & Dissertations
• Stanford SearchWorks

Keep in mind that dissertations and theses are not as academically sound as published, peer-reviewed journal articles (because they’re written by students, not professionals), so be sure to check the credibility of any sources you find using this method. You can do this by assessing the citation count of any given article in Google Scholar. If you need help with assessing the credibility of any article, or with finding relevant research in general, you can chat with one of our Research Specialists .

Alright – with a good base of literature firmly under your belt, it’s time to move onto the next step.

Need a helping hand?

Step 2: Log, catalogue and synthesise

Once you’ve built a little treasure trove of articles, it’s time to get reading and start digesting the information – what does it all mean?

While I present steps one and two (hunting and digesting) as sequential, in reality, it’s more of a back-and-forth tango – you’ll read a little , then have an idea, spot a new citation, or a new potential variable, and then go back to searching for articles. This is perfectly natural – through the reading process, your thoughts will develop , new avenues might crop up, and directional adjustments might arise. This is, after all, one of the main purposes of the literature review process (i.e. to familiarise yourself with the current state of research in your field).

As you’re working through your treasure chest, it’s essential that you simultaneously start organising the information. There are three aspects to this:

• Logging reference information
• Building an organised catalogue
• Distilling and synthesising the information

I’ll discuss each of these below:

2.1 – Log the reference information

As you read each article, you should add it to your reference management software. I usually recommend Mendeley for this purpose (see the Mendeley 101 video below), but you can use whichever software you’re comfortable with. Most importantly, make sure you load EVERY article you read into your reference manager, even if it doesn’t seem very relevant at the time.

2.2 – Build an organised catalogue

In the beginning, you might feel confident that you can remember who said what, where, and what their main arguments were. Trust me, you won’t. If you do a thorough review of the relevant literature (as you must!), you’re going to read many, many articles, and it’s simply impossible to remember who said what, when, and in what context . Also, without the bird’s eye view that a catalogue provides, you’ll miss connections between various articles, and have no view of how the research developed over time. Simply put, it’s essential to build your own catalogue of the literature.

I would suggest using Excel to build your catalogue, as it allows you to run filters, colour code and sort – all very useful when your list grows large (which it will). How you lay your spreadsheet out is up to you, but I’d suggest you have the following columns (at minimum):

• Author, date, title – Start with three columns containing this core information. This will make it easy for you to search for titles with certain words, order research by date, or group by author.
• Categories or keywords – You can either create multiple columns, one for each category/theme and then tick the relevant categories, or you can have one column with keywords.
• Key arguments/points – Use this column to succinctly convey the essence of the article, the key arguments and implications thereof for your research.
• Context – Note the socioeconomic context in which the research was undertaken. For example, US-based, respondents aged 25-35, lower- income, etc. This will be useful for making an argument about gaps in the research.
• Methodology – Note which methodology was used and why. Also, note any issues you feel arise due to the methodology. Again, you can use this to make an argument about gaps in the research.
• Quotations – Note down any quoteworthy lines you feel might be useful later.
• Notes – Make notes about anything not already covered. For example, linkages to or disagreements with other theories, questions raised but unanswered, shortcomings or limitations, and so forth.

If you’d like, you can try out our free catalog template here (see screenshot below).

2.3 – Digest and synthesise

Most importantly, as you work through the literature and build your catalogue, you need to synthesise all the information in your own mind – how does it all fit together? Look for links between the various articles and try to develop a bigger picture view of the state of the research. Some important questions to ask yourself are:

• What answers does the existing research provide to my own research questions ?
• Which points do the researchers agree (and disagree) on?
• How has the research developed over time?
• Where do the gaps in the current research lie?

To help you develop a big-picture view and synthesise all the information, you might find mind mapping software such as Freemind useful. Alternatively, if you’re a fan of physical note-taking, investing in a large whiteboard might work for you.

Step 3: Outline and write it up!

Once you’re satisfied that you have digested and distilled all the relevant literature in your mind, it’s time to put pen to paper (or rather, fingers to keyboard). There are two steps here – outlining and writing:

3.1 – Draw up your outline

Having spent so much time reading, it might be tempting to just start writing up without a clear structure in mind. However, it’s critically important to decide on your structure and develop a detailed outline before you write anything. Your literature review chapter needs to present a clear, logical and an easy to follow narrative – and that requires some planning. Don’t try to wing it!

Naturally, you won’t always follow the plan to the letter, but without a detailed outline, you’re more than likely going to end up with a disjointed pile of waffle , and then you’re going to spend a far greater amount of time re-writing, hacking and patching. The adage, “measure twice, cut once” is very suitable here.

In terms of structure, the first decision you’ll have to make is whether you’ll lay out your review thematically (into themes) or chronologically (by date/period). The right choice depends on your topic, research objectives and research questions, which we discuss in this article .

Once that’s decided, you need to draw up an outline of your entire chapter in bullet point format. Try to get as detailed as possible, so that you know exactly what you’ll cover where, how each section will connect to the next, and how your entire argument will develop throughout the chapter. Also, at this stage, it’s a good idea to allocate rough word count limits for each section, so that you can identify word count problems before you’ve spent weeks or months writing!

PS – check out our free literature review chapter template…

3.2 – Get writing

With a detailed outline at your side, it’s time to start writing up (finally!). At this stage, it’s common to feel a bit of writer’s block and find yourself procrastinating under the pressure of finally having to put something on paper. To help with this, remember that the objective of the first draft is not perfection – it’s simply to get your thoughts out of your head and onto paper, after which you can refine them. The structure might change a little, the word count allocations might shift and shuffle, and you might add or remove a section – that’s all okay. Don’t worry about all this on your first draft – just get your thoughts down on paper.

Once you’ve got a full first draft (however rough it may be), step away from it for a day or two (longer if you can) and then come back at it with fresh eyes. Pay particular attention to the flow and narrative – does it fall fit together and flow from one section to another smoothly? Now’s the time to try to improve the linkage from each section to the next, tighten up the writing to be more concise, trim down word count and sand it down into a more digestible read.

Once you’ve done that, give your writing to a friend or colleague who is not a subject matter expert and ask them if they understand the overall discussion. The best way to assess this is to ask them to explain the chapter back to you. This technique will give you a strong indication of which points were clearly communicated and which weren’t. If you’re working with Grad Coach, this is a good time to have your Research Specialist review your chapter.

Finally, tighten it up and send it off to your supervisor for comment. Some might argue that you should be sending your work to your supervisor sooner than this (indeed your university might formally require this), but in my experience, supervisors are extremely short on time (and often patience), so, the more refined your chapter is, the less time they’ll waste on addressing basic issues (which you know about already) and the more time they’ll spend on valuable feedback that will increase your mark-earning potential.

Literature Review Example

In the video below, we unpack an actual literature review so that you can see how all the core components come together in reality.

Let’s Recap

In this post, we’ve covered how to research and write up a high-quality literature review chapter. Let’s do a quick recap of the key takeaways:

• It is essential to understand the WHY of the literature review before you read or write anything. Make sure you understand the 4 core functions of the process.
• The first step is to hunt down the relevant literature . You can do this using Google Scholar, your university database, the snowballing technique and by reviewing other dissertations and theses.
• Next, you need to log all the articles in your reference manager , build your own catalogue of literature and synthesise all the research.
• Following that, you need to develop a detailed outline of your entire chapter – the more detail the better. Don’t start writing without a clear outline (on paper, not in your head!)
• Write up your first draft in rough form – don’t aim for perfection. Remember, done beats perfect.
• Refine your second draft and get a layman’s perspective on it . Then tighten it up and submit it to your supervisor.

Psst… there’s more!

This post is an extract from our bestselling short course, Literature Review Bootcamp . If you want to work smart, you don't want to miss this .

38 Comments

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You’re welcome, Yinka. Thank you for the kind words. All the best writing your literature review.

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Thank you so much Derek for such useful information on writing up a good literature review. I am at a stage where I need to start writing my one. My proposal was accepted late last year but I honestly did not know where to start

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Thank you. I requested to download the free literature review template, however, your website wouldn’t allow me to complete the request or complete a download. May I request that you email me the free template? Thank you.

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What is a Literature Review? How to Write It (with Examples)

A literature review is a critical analysis and synthesis of existing research on a particular topic. It provides an overview of the current state of knowledge, identifies gaps, and highlights key findings in the literature. 1 The purpose of a literature review is to situate your own research within the context of existing scholarship, demonstrating your understanding of the topic and showing how your work contributes to the ongoing conversation in the field. Learning how to write a literature review is a critical tool for successful research. Your ability to summarize and synthesize prior research pertaining to a certain topic demonstrates your grasp on the topic of study, and assists in the learning process. 

Table of Contents

What is the purpose of literature review , a. habitat loss and species extinction: , b. range shifts and phenological changes: , c. ocean acidification and coral reefs: , d. adaptive strategies and conservation efforts: .

• Choose a Topic and Define the Research Question: 
• Decide on the Scope of Your Review: 
• Select Databases for Searches: 
• Conduct Searches and Keep Track: 
• Review the Literature: 
• Organize and Write Your Literature Review: 
• How to write a literature review faster with Paperpal? 

Frequently asked questions 

What is a literature review .

A well-conducted literature review demonstrates the researcher’s familiarity with the existing literature, establishes the context for their own research, and contributes to scholarly conversations on the topic. One of the purposes of a literature review is also to help researchers avoid duplicating previous work and ensure that their research is informed by and builds upon the existing body of knowledge.

A literature review serves several important purposes within academic and research contexts. Here are some key objectives and functions of a literature review: 2  

1. Contextualizing the Research Problem: The literature review provides a background and context for the research problem under investigation. It helps to situate the study within the existing body of knowledge. 

2. Identifying Gaps in Knowledge: By identifying gaps, contradictions, or areas requiring further research, the researcher can shape the research question and justify the significance of the study. This is crucial for ensuring that the new research contributes something novel to the field.

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3. Understanding Theoretical and Conceptual Frameworks: Literature reviews help researchers gain an understanding of the theoretical and conceptual frameworks used in previous studies. This aids in the development of a theoretical framework for the current research. 

4. Providing Methodological Insights: Another purpose of literature reviews is that it allows researchers to learn about the methodologies employed in previous studies. This can help in choosing appropriate research methods for the current study and avoiding pitfalls that others may have encountered. 

5. Establishing Credibility: A well-conducted literature review demonstrates the researcher’s familiarity with existing scholarship, establishing their credibility and expertise in the field. It also helps in building a solid foundation for the new research. 

6. Informing Hypotheses or Research Questions: The literature review guides the formulation of hypotheses or research questions by highlighting relevant findings and areas of uncertainty in existing literature. 

Literature review example 

Let’s delve deeper with a literature review example: Let’s say your literature review is about the impact of climate change on biodiversity. You might format your literature review into sections such as the effects of climate change on habitat loss and species extinction, phenological changes, and marine biodiversity. Each section would then summarize and analyze relevant studies in those areas, highlighting key findings and identifying gaps in the research. The review would conclude by emphasizing the need for further research on specific aspects of the relationship between climate change and biodiversity. The following literature review template provides a glimpse into the recommended literature review structure and content, demonstrating how research findings are organized around specific themes within a broader topic. 

Literature Review on Climate Change Impacts on Biodiversity:  

Climate change is a global phenomenon with far-reaching consequences, including significant impacts on biodiversity. This literature review synthesizes key findings from various studies: 

Climate change-induced alterations in temperature and precipitation patterns contribute to habitat loss, affecting numerous species (Thomas et al., 2004). The review discusses how these changes increase the risk of extinction, particularly for species with specific habitat requirements. 

Observations of range shifts and changes in the timing of biological events (phenology) are documented in response to changing climatic conditions (Parmesan & Yohe, 2003). These shifts affect ecosystems and may lead to mismatches between species and their resources. 

The review explores the impact of climate change on marine biodiversity, emphasizing ocean acidification’s threat to coral reefs (Hoegh-Guldberg et al., 2007). Changes in pH levels negatively affect coral calcification, disrupting the delicate balance of marine ecosystems. 

Recognizing the urgency of the situation, the literature review discusses various adaptive strategies adopted by species and conservation efforts aimed at mitigating the impacts of climate change on biodiversity (Hannah et al., 2007). It emphasizes the importance of interdisciplinary approaches for effective conservation planning. 

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How to write a good literature review 

Writing a literature review involves summarizing and synthesizing existing research on a particular topic. A good literature review format should include the following elements. 

Introduction: The introduction sets the stage for your literature review, providing context and introducing the main focus of your review. 

• Opening Statement: Begin with a general statement about the broader topic and its significance in the field. 
• Scope and Purpose: Clearly define the scope of your literature review. Explain the specific research question or objective you aim to address. 
• Organizational Framework: Briefly outline the structure of your literature review, indicating how you will categorize and discuss the existing research. 
• Significance of the Study: Highlight why your literature review is important and how it contributes to the understanding of the chosen topic. 
• Thesis Statement: Conclude the introduction with a concise thesis statement that outlines the main argument or perspective you will develop in the body of the literature review. 

Body: The body of the literature review is where you provide a comprehensive analysis of existing literature, grouping studies based on themes, methodologies, or other relevant criteria. 

• Organize by Theme or Concept: Group studies that share common themes, concepts, or methodologies. Discuss each theme or concept in detail, summarizing key findings and identifying gaps or areas of disagreement. 
• Critical Analysis: Evaluate the strengths and weaknesses of each study. Discuss the methodologies used, the quality of evidence, and the overall contribution of each work to the understanding of the topic. 
• Synthesis of Findings: Synthesize the information from different studies to highlight trends, patterns, or areas of consensus in the literature. 
• Identification of Gaps: Discuss any gaps or limitations in the existing research and explain how your review contributes to filling these gaps. 
• Transition between Sections: Provide smooth transitions between different themes or concepts to maintain the flow of your literature review. 

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Conclusion: The conclusion of your literature review should summarize the main findings, highlight the contributions of the review, and suggest avenues for future research. 

• Summary of Key Findings: Recap the main findings from the literature and restate how they contribute to your research question or objective. 
• Contributions to the Field: Discuss the overall contribution of your literature review to the existing knowledge in the field. 
• Implications and Applications: Explore the practical implications of the findings and suggest how they might impact future research or practice. 
• Recommendations for Future Research: Identify areas that require further investigation and propose potential directions for future research in the field. 
• Final Thoughts: Conclude with a final reflection on the importance of your literature review and its relevance to the broader academic community. 

Conducting a literature review 

Conducting a literature review is an essential step in research that involves reviewing and analyzing existing literature on a specific topic. It’s important to know how to do a literature review effectively, so here are the steps to follow: 1  

Choose a Topic and Define the Research Question:  

• Select a topic that is relevant to your field of study. 
• Clearly define your research question or objective. Determine what specific aspect of the topic do you want to explore? 

Decide on the Scope of Your Review:  

• Determine the timeframe for your literature review. Are you focusing on recent developments, or do you want a historical overview? 
• Consider the geographical scope. Is your review global, or are you focusing on a specific region? 
• Define the inclusion and exclusion criteria. What types of sources will you include? Are there specific types of studies or publications you will exclude? 

Select Databases for Searches:  

• Identify relevant databases for your field. Examples include PubMed, IEEE Xplore, Scopus, Web of Science, and Google Scholar. 
• Consider searching in library catalogs, institutional repositories, and specialized databases related to your topic. 

Conduct Searches and Keep Track:  

• Develop a systematic search strategy using keywords, Boolean operators (AND, OR, NOT), and other search techniques. 
• Record and document your search strategy for transparency and replicability. 
• Keep track of the articles, including publication details, abstracts, and links. Use citation management tools like EndNote, Zotero, or Mendeley to organize your references. 

Review the Literature:  

• Evaluate the relevance and quality of each source. Consider the methodology, sample size, and results of studies. 
• Organize the literature by themes or key concepts. Identify patterns, trends, and gaps in the existing research. 
• Summarize key findings and arguments from each source. Compare and contrast different perspectives. 
• Identify areas where there is a consensus in the literature and where there are conflicting opinions. 
• Provide critical analysis and synthesis of the literature. What are the strengths and weaknesses of existing research? 

Organize and Write Your Literature Review:  

• Literature review outline should be based on themes, chronological order, or methodological approaches. 
• Write a clear and coherent narrative that synthesizes the information gathered. 
• Use proper citations for each source and ensure consistency in your citation style (APA, MLA, Chicago, etc.). 
• Conclude your literature review by summarizing key findings, identifying gaps, and suggesting areas for future research. 

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A literature review is a critical and comprehensive analysis of existing literature (published and unpublished works) on a specific topic or research question and provides a synthesis of the current state of knowledge in a particular field. A well-conducted literature review is crucial for researchers to build upon existing knowledge, avoid duplication of efforts, and contribute to the advancement of their field. It also helps researchers situate their work within a broader context and facilitates the development of a sound theoretical and conceptual framework for their studies.

Literature review is a crucial component of research writing, providing a solid background for a research paper’s investigation. The aim is to keep professionals up to date by providing an understanding of ongoing developments within a specific field, including research methods, and experimental techniques used in that field, and present that knowledge in the form of a written report. Also, the depth and breadth of the literature review emphasizes the credibility of the scholar in his or her field.  

Before writing a literature review, it’s essential to undertake several preparatory steps to ensure that your review is well-researched, organized, and focused. This includes choosing a topic of general interest to you and doing exploratory research on that topic, writing an annotated bibliography, and noting major points, especially those that relate to the position you have taken on the topic. 

Literature reviews and academic research papers are essential components of scholarly work but serve different purposes within the academic realm. 3 A literature review aims to provide a foundation for understanding the current state of research on a particular topic, identify gaps or controversies, and lay the groundwork for future research. Therefore, it draws heavily from existing academic sources, including books, journal articles, and other scholarly publications. In contrast, an academic research paper aims to present new knowledge, contribute to the academic discourse, and advance the understanding of a specific research question. Therefore, it involves a mix of existing literature (in the introduction and literature review sections) and original data or findings obtained through research methods. 

Literature reviews are essential components of academic and research papers, and various strategies can be employed to conduct them effectively. If you want to know how to write a literature review for a research paper, here are four common approaches that are often used by researchers.  Chronological Review: This strategy involves organizing the literature based on the chronological order of publication. It helps to trace the development of a topic over time, showing how ideas, theories, and research have evolved.  Thematic Review: Thematic reviews focus on identifying and analyzing themes or topics that cut across different studies. Instead of organizing the literature chronologically, it is grouped by key themes or concepts, allowing for a comprehensive exploration of various aspects of the topic.  Methodological Review: This strategy involves organizing the literature based on the research methods employed in different studies. It helps to highlight the strengths and weaknesses of various methodologies and allows the reader to evaluate the reliability and validity of the research findings.  Theoretical Review: A theoretical review examines the literature based on the theoretical frameworks used in different studies. This approach helps to identify the key theories that have been applied to the topic and assess their contributions to the understanding of the subject.  It’s important to note that these strategies are not mutually exclusive, and a literature review may combine elements of more than one approach. The choice of strategy depends on the research question, the nature of the literature available, and the goals of the review. Additionally, other strategies, such as integrative reviews or systematic reviews, may be employed depending on the specific requirements of the research.

The literature review format can vary depending on the specific publication guidelines. However, there are some common elements and structures that are often followed. Here is a general guideline for the format of a literature review:  Introduction:   Provide an overview of the topic.  Define the scope and purpose of the literature review.  State the research question or objective.  Body:   Organize the literature by themes, concepts, or chronology.  Critically analyze and evaluate each source.  Discuss the strengths and weaknesses of the studies.  Highlight any methodological limitations or biases.  Identify patterns, connections, or contradictions in the existing research.  Conclusion:   Summarize the key points discussed in the literature review.  Highlight the research gap.  Address the research question or objective stated in the introduction.  Highlight the contributions of the review and suggest directions for future research.

Both annotated bibliographies and literature reviews involve the examination of scholarly sources. While annotated bibliographies focus on individual sources with brief annotations, literature reviews provide a more in-depth, integrated, and comprehensive analysis of existing literature on a specific topic. The key differences are as follows: 

References 

• Denney, A. S., & Tewksbury, R. (2013). How to write a literature review.  Journal of criminal justice education ,  24 (2), 218-234. 
• Pan, M. L. (2016).  Preparing literature reviews: Qualitative and quantitative approaches . Taylor & Francis. 
• Cantero, C. (2019). How to write a literature review.  San José State University Writing Center . 

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• UConn Library
• Literature Review: The What, Why and How-to Guide
• Introduction

Literature Review: The What, Why and How-to Guide — Introduction

• Getting Started
• How to Pick a Topic
• Strategies to Find Sources
• Evaluating Sources & Lit. Reviews
• Tips for Writing Literature Reviews
• Writing Literature Review: Useful Sites
• Citation Resources
• Other Academic Writings

What are Literature Reviews?

So, what is a literature review? "A literature review is an account of what has been published on a topic by accredited scholars and researchers. In writing the literature review, your purpose is to convey to your reader what knowledge and ideas have been established on a topic, and what their strengths and weaknesses are. As a piece of writing, the literature review must be defined by a guiding concept (e.g., your research objective, the problem or issue you are discussing, or your argumentative thesis). It is not just a descriptive list of the material available, or a set of summaries." Taylor, D.  The literature review: A few tips on conducting it . University of Toronto Health Sciences Writing Centre.

Goals of Literature Reviews

What are the goals of creating a Literature Review?  A literature could be written to accomplish different aims:

• To develop a theory or evaluate an existing theory
• To summarize the historical or existing state of a research topic
• Identify a problem in a field of research 

Baumeister, R. F., & Leary, M. R. (1997). Writing narrative literature reviews .  Review of General Psychology , 1 (3), 311-320.

What kinds of sources require a Literature Review?

• A research paper assigned in a course
• A thesis or dissertation
• A grant proposal
• An article intended for publication in a journal

All these instances require you to collect what has been written about your research topic so that you can demonstrate how your own research sheds new light on the topic.

Types of Literature Reviews

What kinds of literature reviews are written?

Narrative review: The purpose of this type of review is to describe the current state of the research on a specific topic/research and to offer a critical analysis of the literature reviewed. Studies are grouped by research/theoretical categories, and themes and trends, strengths and weakness, and gaps are identified. The review ends with a conclusion section which summarizes the findings regarding the state of the research of the specific study, the gaps identify and if applicable, explains how the author's research will address gaps identify in the review and expand the knowledge on the topic reviewed.

• Example : Predictors and Outcomes of U.S. Quality Maternity Leave: A Review and Conceptual Framework:  10.1177/08948453211037398  

Systematic review : "The authors of a systematic review use a specific procedure to search the research literature, select the studies to include in their review, and critically evaluate the studies they find." (p. 139). Nelson, L. K. (2013). Research in Communication Sciences and Disorders . Plural Publishing.

• Example : The effect of leave policies on increasing fertility: a systematic review:  10.1057/s41599-022-01270-w

Meta-analysis : "Meta-analysis is a method of reviewing research findings in a quantitative fashion by transforming the data from individual studies into what is called an effect size and then pooling and analyzing this information. The basic goal in meta-analysis is to explain why different outcomes have occurred in different studies." (p. 197). Roberts, M. C., & Ilardi, S. S. (2003). Handbook of Research Methods in Clinical Psychology . Blackwell Publishing.

• Example : Employment Instability and Fertility in Europe: A Meta-Analysis:  10.1215/00703370-9164737

Meta-synthesis : "Qualitative meta-synthesis is a type of qualitative study that uses as data the findings from other qualitative studies linked by the same or related topic." (p.312). Zimmer, L. (2006). Qualitative meta-synthesis: A question of dialoguing with texts .  Journal of Advanced Nursing , 53 (3), 311-318.

• Example : Women’s perspectives on career successes and barriers: A qualitative meta-synthesis:  10.1177/05390184221113735

Literature Reviews in the Health Sciences

• UConn Health subject guide on systematic reviews Explanation of the different review types used in health sciences literature as well as tools to help you find the right review type
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Ten Simple Rules for Writing a Literature Review

Marco pautasso.

1 Centre for Functional and Evolutionary Ecology (CEFE), CNRS, Montpellier, France

2 Centre for Biodiversity Synthesis and Analysis (CESAB), FRB, Aix-en-Provence, France

Literature reviews are in great demand in most scientific fields. Their need stems from the ever-increasing output of scientific publications [1] . For example, compared to 1991, in 2008 three, eight, and forty times more papers were indexed in Web of Science on malaria, obesity, and biodiversity, respectively [2] . Given such mountains of papers, scientists cannot be expected to examine in detail every single new paper relevant to their interests [3] . Thus, it is both advantageous and necessary to rely on regular summaries of the recent literature. Although recognition for scientists mainly comes from primary research, timely literature reviews can lead to new synthetic insights and are often widely read [4] . For such summaries to be useful, however, they need to be compiled in a professional way [5] .

When starting from scratch, reviewing the literature can require a titanic amount of work. That is why researchers who have spent their career working on a certain research issue are in a perfect position to review that literature. Some graduate schools are now offering courses in reviewing the literature, given that most research students start their project by producing an overview of what has already been done on their research issue [6] . However, it is likely that most scientists have not thought in detail about how to approach and carry out a literature review.

Reviewing the literature requires the ability to juggle multiple tasks, from finding and evaluating relevant material to synthesising information from various sources, from critical thinking to paraphrasing, evaluating, and citation skills [7] . In this contribution, I share ten simple rules I learned working on about 25 literature reviews as a PhD and postdoctoral student. Ideas and insights also come from discussions with coauthors and colleagues, as well as feedback from reviewers and editors.

Rule 1: Define a Topic and Audience

How to choose which topic to review? There are so many issues in contemporary science that you could spend a lifetime of attending conferences and reading the literature just pondering what to review. On the one hand, if you take several years to choose, several other people may have had the same idea in the meantime. On the other hand, only a well-considered topic is likely to lead to a brilliant literature review [8] . The topic must at least be:

• interesting to you (ideally, you should have come across a series of recent papers related to your line of work that call for a critical summary),
• an important aspect of the field (so that many readers will be interested in the review and there will be enough material to write it), and
• a well-defined issue (otherwise you could potentially include thousands of publications, which would make the review unhelpful).

Ideas for potential reviews may come from papers providing lists of key research questions to be answered [9] , but also from serendipitous moments during desultory reading and discussions. In addition to choosing your topic, you should also select a target audience. In many cases, the topic (e.g., web services in computational biology) will automatically define an audience (e.g., computational biologists), but that same topic may also be of interest to neighbouring fields (e.g., computer science, biology, etc.).

Rule 2: Search and Re-search the Literature

After having chosen your topic and audience, start by checking the literature and downloading relevant papers. Five pieces of advice here:

• keep track of the search items you use (so that your search can be replicated [10] ),
• keep a list of papers whose pdfs you cannot access immediately (so as to retrieve them later with alternative strategies),
• use a paper management system (e.g., Mendeley, Papers, Qiqqa, Sente),
• define early in the process some criteria for exclusion of irrelevant papers (these criteria can then be described in the review to help define its scope), and
• do not just look for research papers in the area you wish to review, but also seek previous reviews.

The chances are high that someone will already have published a literature review ( Figure 1 ), if not exactly on the issue you are planning to tackle, at least on a related topic. If there are already a few or several reviews of the literature on your issue, my advice is not to give up, but to carry on with your own literature review,

The bottom-right situation (many literature reviews but few research papers) is not just a theoretical situation; it applies, for example, to the study of the impacts of climate change on plant diseases, where there appear to be more literature reviews than research studies [33] .

• discussing in your review the approaches, limitations, and conclusions of past reviews,
• trying to find a new angle that has not been covered adequately in the previous reviews, and
• incorporating new material that has inevitably accumulated since their appearance.

When searching the literature for pertinent papers and reviews, the usual rules apply:

• be thorough,
• use different keywords and database sources (e.g., DBLP, Google Scholar, ISI Proceedings, JSTOR Search, Medline, Scopus, Web of Science), and
• look at who has cited past relevant papers and book chapters.

Rule 3: Take Notes While Reading

If you read the papers first, and only afterwards start writing the review, you will need a very good memory to remember who wrote what, and what your impressions and associations were while reading each single paper. My advice is, while reading, to start writing down interesting pieces of information, insights about how to organize the review, and thoughts on what to write. This way, by the time you have read the literature you selected, you will already have a rough draft of the review.

Of course, this draft will still need much rewriting, restructuring, and rethinking to obtain a text with a coherent argument [11] , but you will have avoided the danger posed by staring at a blank document. Be careful when taking notes to use quotation marks if you are provisionally copying verbatim from the literature. It is advisable then to reformulate such quotes with your own words in the final draft. It is important to be careful in noting the references already at this stage, so as to avoid misattributions. Using referencing software from the very beginning of your endeavour will save you time.

Rule 4: Choose the Type of Review You Wish to Write

After having taken notes while reading the literature, you will have a rough idea of the amount of material available for the review. This is probably a good time to decide whether to go for a mini- or a full review. Some journals are now favouring the publication of rather short reviews focusing on the last few years, with a limit on the number of words and citations. A mini-review is not necessarily a minor review: it may well attract more attention from busy readers, although it will inevitably simplify some issues and leave out some relevant material due to space limitations. A full review will have the advantage of more freedom to cover in detail the complexities of a particular scientific development, but may then be left in the pile of the very important papers “to be read” by readers with little time to spare for major monographs.

There is probably a continuum between mini- and full reviews. The same point applies to the dichotomy of descriptive vs. integrative reviews. While descriptive reviews focus on the methodology, findings, and interpretation of each reviewed study, integrative reviews attempt to find common ideas and concepts from the reviewed material [12] . A similar distinction exists between narrative and systematic reviews: while narrative reviews are qualitative, systematic reviews attempt to test a hypothesis based on the published evidence, which is gathered using a predefined protocol to reduce bias [13] , [14] . When systematic reviews analyse quantitative results in a quantitative way, they become meta-analyses. The choice between different review types will have to be made on a case-by-case basis, depending not just on the nature of the material found and the preferences of the target journal(s), but also on the time available to write the review and the number of coauthors [15] .

Rule 5: Keep the Review Focused, but Make It of Broad Interest

Whether your plan is to write a mini- or a full review, it is good advice to keep it focused 16 , 17 . Including material just for the sake of it can easily lead to reviews that are trying to do too many things at once. The need to keep a review focused can be problematic for interdisciplinary reviews, where the aim is to bridge the gap between fields [18] . If you are writing a review on, for example, how epidemiological approaches are used in modelling the spread of ideas, you may be inclined to include material from both parent fields, epidemiology and the study of cultural diffusion. This may be necessary to some extent, but in this case a focused review would only deal in detail with those studies at the interface between epidemiology and the spread of ideas.

While focus is an important feature of a successful review, this requirement has to be balanced with the need to make the review relevant to a broad audience. This square may be circled by discussing the wider implications of the reviewed topic for other disciplines.

Rule 6: Be Critical and Consistent

Reviewing the literature is not stamp collecting. A good review does not just summarize the literature, but discusses it critically, identifies methodological problems, and points out research gaps [19] . After having read a review of the literature, a reader should have a rough idea of:

• the major achievements in the reviewed field,
• the main areas of debate, and
• the outstanding research questions.

It is challenging to achieve a successful review on all these fronts. A solution can be to involve a set of complementary coauthors: some people are excellent at mapping what has been achieved, some others are very good at identifying dark clouds on the horizon, and some have instead a knack at predicting where solutions are going to come from. If your journal club has exactly this sort of team, then you should definitely write a review of the literature! In addition to critical thinking, a literature review needs consistency, for example in the choice of passive vs. active voice and present vs. past tense.

Rule 7: Find a Logical Structure

Like a well-baked cake, a good review has a number of telling features: it is worth the reader's time, timely, systematic, well written, focused, and critical. It also needs a good structure. With reviews, the usual subdivision of research papers into introduction, methods, results, and discussion does not work or is rarely used. However, a general introduction of the context and, toward the end, a recapitulation of the main points covered and take-home messages make sense also in the case of reviews. For systematic reviews, there is a trend towards including information about how the literature was searched (database, keywords, time limits) [20] .

How can you organize the flow of the main body of the review so that the reader will be drawn into and guided through it? It is generally helpful to draw a conceptual scheme of the review, e.g., with mind-mapping techniques. Such diagrams can help recognize a logical way to order and link the various sections of a review [21] . This is the case not just at the writing stage, but also for readers if the diagram is included in the review as a figure. A careful selection of diagrams and figures relevant to the reviewed topic can be very helpful to structure the text too [22] .

Rule 8: Make Use of Feedback

Reviews of the literature are normally peer-reviewed in the same way as research papers, and rightly so [23] . As a rule, incorporating feedback from reviewers greatly helps improve a review draft. Having read the review with a fresh mind, reviewers may spot inaccuracies, inconsistencies, and ambiguities that had not been noticed by the writers due to rereading the typescript too many times. It is however advisable to reread the draft one more time before submission, as a last-minute correction of typos, leaps, and muddled sentences may enable the reviewers to focus on providing advice on the content rather than the form.

Feedback is vital to writing a good review, and should be sought from a variety of colleagues, so as to obtain a diversity of views on the draft. This may lead in some cases to conflicting views on the merits of the paper, and on how to improve it, but such a situation is better than the absence of feedback. A diversity of feedback perspectives on a literature review can help identify where the consensus view stands in the landscape of the current scientific understanding of an issue [24] .

Rule 9: Include Your Own Relevant Research, but Be Objective

In many cases, reviewers of the literature will have published studies relevant to the review they are writing. This could create a conflict of interest: how can reviewers report objectively on their own work [25] ? Some scientists may be overly enthusiastic about what they have published, and thus risk giving too much importance to their own findings in the review. However, bias could also occur in the other direction: some scientists may be unduly dismissive of their own achievements, so that they will tend to downplay their contribution (if any) to a field when reviewing it.

In general, a review of the literature should neither be a public relations brochure nor an exercise in competitive self-denial. If a reviewer is up to the job of producing a well-organized and methodical review, which flows well and provides a service to the readership, then it should be possible to be objective in reviewing one's own relevant findings. In reviews written by multiple authors, this may be achieved by assigning the review of the results of a coauthor to different coauthors.

Rule 10: Be Up-to-Date, but Do Not Forget Older Studies

Given the progressive acceleration in the publication of scientific papers, today's reviews of the literature need awareness not just of the overall direction and achievements of a field of inquiry, but also of the latest studies, so as not to become out-of-date before they have been published. Ideally, a literature review should not identify as a major research gap an issue that has just been addressed in a series of papers in press (the same applies, of course, to older, overlooked studies (“sleeping beauties” [26] )). This implies that literature reviewers would do well to keep an eye on electronic lists of papers in press, given that it can take months before these appear in scientific databases. Some reviews declare that they have scanned the literature up to a certain point in time, but given that peer review can be a rather lengthy process, a full search for newly appeared literature at the revision stage may be worthwhile. Assessing the contribution of papers that have just appeared is particularly challenging, because there is little perspective with which to gauge their significance and impact on further research and society.

Inevitably, new papers on the reviewed topic (including independently written literature reviews) will appear from all quarters after the review has been published, so that there may soon be the need for an updated review. But this is the nature of science [27] – [32] . I wish everybody good luck with writing a review of the literature.

Acknowledgments

Many thanks to M. Barbosa, K. Dehnen-Schmutz, T. Döring, D. Fontaneto, M. Garbelotto, O. Holdenrieder, M. Jeger, D. Lonsdale, A. MacLeod, P. Mills, M. Moslonka-Lefebvre, G. Stancanelli, P. Weisberg, and X. Xu for insights and discussions, and to P. Bourne, T. Matoni, and D. Smith for helpful comments on a previous draft.

Funding Statement

This work was funded by the French Foundation for Research on Biodiversity (FRB) through its Centre for Synthesis and Analysis of Biodiversity data (CESAB), as part of the NETSEED research project. The funders had no role in the preparation of the manuscript.

Systematic Literature Review in Management and Business Studies: A Case Study on University–Industry Collaboration

• January 2019
• Publisher: Sage
• ISBN: http://dx.doi.org/10.4135/9781526467263

• University of Leeds
• This person is not on ResearchGate, or hasn't claimed this research yet.

• Queen Mary, University of London

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Exploring the Latest Trends in Management Literature: Volume 1

Table of contents, presenting the power framework of conducting literature review.

To overcome and solve the problems of all the research community, in this chapter we offer everyone to focus on the Planning, Operationalizing, Writing, Embedding, and Reflecting (POWER) framework of conducting literature review. The framework guides the scholarly community on how to create and evaluate literature review papers to overcome the merit dilemma on the contribution made by review papers. With the sole focus toward review of literature, we are pleased to present “Review of Management Literature (RoML)” and introducing the first volume. This chapter and volume answers the present tensions accruing in the existing literature as well as present strategies on bridging the gaps. The chapters included in the first volume belong to emerging research areas such as marketing, human resources, international businesses, supply chain management, artificial neural network, luxury consumption, financial technology (FINTECH), mergers and acquisition, social media platforms like Instagram, cultural diversity, services, sustainability, quality 4.0, entrepreneurial ecosystem, and dividend decisions. The first volume is going to be useful to scholars in exploring future research areas across business management disciplines.

A Revolutionary Paradigm Shift in Supply Chain Management: The Blockchain Mechanism

Blockchain, in general, diversifies supply chain management in record-keeping and maintains authenticity. In addition, traditional issues and challenges like overflow and information overload press down mysteriously whenever the blockchain steering wheel of the supply chain turns. Factually, the miracle and twists in supply chain resilience have not been incorporated under systematic review homogeneously. As a result, this study reviews the potential impact of blockchain on logistics and supply chain (LSC) efficiency. The methodology of this study provides a subjective assessment of the utility of blockchain-based LSC performance.

On the other hand, the review reveals new insights on its current acceptance and applications, with a particular emphasis on the Limit Redundancy Mechanism and Core Information-based Direct Comparison. Prospectively, the identified facts under the research paradigm and extensive literature survey will subsidize the practices of blockchain technology and possible areas of extension in supply chain resilience in luminous fashion in the future. After all, this study materializes new solid magnitudes, adaptability, and a realistic overview of blockchain-based LSC movements.

Mapping the Intellectual Structure of Artificial Neural Network Research in Business Domain: A Retrospective Overview Using Bibliometric Review

Artificial neural networks (ANNs), which represent computational models simulating the biological neural systems, have become a dominant paradigm for solving complex analytical problems. ANN applications have been employed in various disciplines such as psychology, computer science, mathematics, engineering, medicine, manufacturing, and business studies. Academic research on ANNs is witnessing considerable publication activity, and there exists a need to track the intellectual structure of the existing research for a better comprehension of the domain. The current study uses a bibliometric approach to ANN business literature extracted from the Web of Science database. The study also performs a chronological review using science mapping and examines the evolution trajectory to determine research areas relevant to future research. The authors suggest that researchers focus on ANN deep learning models as the bibliometric results predict an expeditious growth of the research topic in the upcoming years. The findings reveal that business research on ANNs is flourishing and suggest further work on domains, such as back-propagation neural networks, support vector machines, and predictive modeling. By providing a systematic and dynamic understanding of ANN business research, the current study enhances the readers' understanding of existing reviews and complements the domain knowledge.

Mapping Luxury Consumption: A Bibliometric Analysis of Evolution, Antecedents, Outcomes, and Future Directions

The purpose of this research is to conduct a literature review on the evolution, antecedents, and outcomes of luxury consumption (LC). To accomplish our goal, we used a combination of bibliometrics and systematic approaches to review 165 articles published between 1998 and 2019. The investigation revealed that the evolution of LC is mostly driven by consumer motivation and is influenced by cultural and psychological variables. Furthermore, we explored the aforementioned antecedents of LC along four major axes. Antecedents related to (1) individual characteristics, (2) brand components, (3) cultural and social values, and (4) organizational strategies. Furthermore, based on the outcomes of LC, we found two categories (individual traits and social values). The chapter concludes by proposing a broader research agenda for the future.

Journey of Financial Technology (FinTech): A Systematic Literature Review and Future Research Agenda

The aim of this review is to reflect the current state of Financial Technology (FinTech) research along with its journey of development. Further, a conceptual framework showing the interaction of independent, mediating, and moderating variables with dependent variables (acceptance of FinTech products and services) along with propositions is prepared to facilitate the future researchers. This systematic literature review consists of 110 articles from 78 journals indexed in two academic databases (Scopus and/or Web of Science), extracting facts and figures about FinTech during 2016–2021. Our findings contribute to the literature by exemplifying that FinTech is a mixed set of threats and opportunities. In the present review only 18 articles belong to 2016–2017 but 54 articles are considered from 2020–2021, the increasing number of FinTech articles in high-ranking journals indicate the speedily growing popularity of FinTech. Similarly, secondary data based articles are dominating the primary data based ones. Further, regression analysis and PLS-SEM are the most popular statistical techniques among the authors of FinTech articles. To the best of knowledge of the authors, this is a unique study in which the latest FinTech research findings are skimmed.

A Bibliometric Analysis on CEOs' Role in M&A Activity of Organizations

The chapter reviews existing research on merger and acquisition (M&A) activities and chief executive officers (CEOs) in organizations. The study provides insights into the existing literature and proposes avenues for future research on M&A activities and CEOs. The present study adopts bibliometric analysis on 319 articles identified from the literature. The articles selected for analysis are extracted from the Scopus database and are selected based on the focus of the papers on M&A activities and CEOs. Existing studies on M&A activities and CEOs demonstrate that CEOs affect M&A activities, CEOs affect the performance of M&A activities, and M&A activities also influence the role of CEOs in M&A activities. We identify and list scientific mapping in trending topics, scientific production, citation analysis, prominent authors, and their affiliations. The study is relevant to academicians, practitioners, and policymakers interested in corporate finance, especially in the areas overlapping CEO attributes and M&A activities.

Instagram Marketing (2015–2021): A Review of Past Trends, Implications, and Future Research

Instagram is a social media platform that has quickly evolved from a photo-sharing application to a successful marketing tool. It holds various business opportunities, and its rapid growth helps showcase the business offerings. Its innovative use of adverts entices clients, and its visual nature complements the social media marketing strategy. Thus, looking at the dynamic nature and growth of the platform, this chapter outlines the past research trends in the literature of Instagram marketing as the primary objective. This structured review undertakes the study of 76 articles based on defined inclusion and exclusion criteria and analyzes the literature in different contexts. This chapter includes the hybrid review (narrative and framework-based), and findings from the literature highlight a significant influence of Instagram marketing on users. During the brief description of the literature in a different context, the numerous research gaps are outlined with future research directions based on the ADO framework. Lastly, it also presents a broader overview of the managerial and theoretical implications based on the literature of Instagram marketing.

Cultural Diversity in Tourism: A Bibliometric Analysis of 33 Years (1988–2021)

The aim of the present study is to perform bibliometric analysis on available literature on the subject of cultural diversity in the tourism sector. The Scopus database is used to retrieve the research article data and 133 articles were fetched over a period of 33 years (1988–2021). The further analysis is performed using and Biblioshiny tool package of R programming language and VOSviewer. The findings for study not only reveal the trends of publications but also produced the information on most influential authors, journals, and universities which are actively contributing to the subject of cultural diversity in tourism. Various network graphs are also generated using software to draw meaningful conclusions. The present study will not only aid future investigators in understanding the past developments on the subject of cultural diversity in tourism but also help industry professionals in formulating better strategies and tactics keeping in mind the cultural dimension of tourism. The present study is a maiden attempt to perform the bibliometric analysis on the subject of cultural diversity in tourism.

Advanced Services Accelerating Servitization: A Review Synthesis and Future Research Agenda

The article consolidates the servitization knowledge base from an industrial equipment manufacturing firm's performance perspective. This conceptual review is offering an integration of the extant literature. The authors identified various advanced services impacting a firm's overall revenue, profitability, customer satisfaction, and loyalty. This paper provides a conceptual framework for industrial manufacturers' basic and advanced services to understand their relationship with various performance parameters. This study also provides a direction for future research with individual advanced services and their value cocreation with customers.

The Role of Integrated Reporting in Advancing Sustainability: Reflections From Academic Literature and a Future Research Agenda

The diffusion of integrated reporting as a practice has stimulated an academic debate about whether integrated reporting has the potential to advance sustainability. The International Integrated Reporting Framework, which guides the preparation of integrated reports, focuses specifically on providers of financial capital and does not refer explicitly to sustainability in a significant way. But there is evidence that integrated reporting has enhanced the provision of sustainability disclosures. This chapter scrutinizes academic research on integrated reporting, focusing on sustainability published from 2010 to 2021. First, we synthesize arguments about aspects of integrated reporting that inhibit the advancement of sustainability as well as those that help advance sustainability. Then we explain a two-pronged approach for improving the sustainability orientation of any future connected reporting framework. The first one relates to building on the current strengths of integrated reporting for advancing sustainability. The second approach concerns tackling the obstacles to promoting sustainability through integrated reporting identified in the literature. This chapter also provides important insights for future research in the field.

Realization of Sociotechnical Systems Theory for Developing Quality 4.0-Based Production Service Systems: A Literature Perspective

The present study discusses the benefits and importance of sociotechnical thinking for the integration of industry 4.0 (I4.0), and their subsequent usefulness in analyzing the value-added activities and related quality issues, and their implications in the quality 4.0 (Q4.0), product-service systems (PSS) in the organization level/complex systems in the era of I4.0. I4.0 pushed the traditional manufacturing models toward product-service systems; for this transition, social and economic factors influence more, and technological advancements are going more rapidly than the social developments needed for the transition. The integration of social-technical system perspective with I4.0 technologies adoption would improve the value cocreation of PSS. The balance among the sociotechnical systems theory (STST) and I4.0 technologies are necessary for production and logistics organizations. This can be attained by sociotechnical systems thinking because it gives a comprehensive overview for integrating I4.0 and related quality issues in the production and logistics service systems.

Entrepreneurial Ecosystem and Value Creation: A Systematic Literature Review

Entrepreneurial ecosystems have become policy strategies to stimulate entrepreneurial activities, yet the current understanding underlying value creation and the factors influencing this value-capturing mechanism remains limited. In this chapter, we systematically review literature related to the entrepreneurial ecosystem, and we seek to provide a greater understanding of the value creation process within an ecosystem. The findings from our content analysis shed light on the multifaceted structures and drivers of the value creation process. The study contributes to studies and theory development in the field of entrepreneurial ecosystem literature and further advances potential future research.

The Dividend Decision Model: A Possible Solution for the Dividend Puzzle

This chapter provides an overview of the explanations and factors affecting dividend policy. This study employs a systematic literature review approach to review a large sample of studies related to the dividend puzzle. Although the analysis reveals mixed evidence involving the theories and determinants of dividend policy, some determinants appear in numerous studies. However, no consensus exists on an optimal dividend to resolve the dividend puzzle, and the authors propose a model to deal with the same. When examining dividend policy, researchers should consider the firm, market, behavior, and other determinants. When making significant dividend or stock decisions, managers and shareholders should also contemplate the factors, interactions, inadequacies, and consequences. Future researchers should strive to take a more comprehensive view when resolving the dividend puzzle. This study provides a current and complete picture of dividend policy's available theories and empirical determinants. Its significant contribution is identifying some of the more consistently essential determinants of dividend policy while proposing a holistic model to address the prevailing dividend dilemma.

• Sudhir Rana
• Jagroop Singh

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Engineering Management

• Getting Started
• Keeping Current

Introduction

Gather Your Tools

Determine the Project's Scope

Create the Search Strategy

Determine What Resources to Use

Search, read, refine, repeat.

Saved Searches, Alerts and Feeds

• STEM Biographies & Info
• Writing & Citing

This page focuses on how to do an in-depth literature review for a dissertation, thesis, grant application or lengthy term paper in electrical engineering.  

• For a more general description of what an in-depth literature review is and how it looks, see our guide on " Literature Reviews and Annotated Bibliographies " created by Ed Oetting, history and political science librarian.
• For lower-level engineering undergraduate students who are doing a short term paper, the " How to Research a Topic " page on the " Engineerng Basics" guide may be more applicable.

Library Account Is your library account clear of fines?   If not, you may not be allowed to check out more books nor renew books you already have.  All library notices are sent via email to your "asu.edu" address; if you prefer to receive email at a different address make sure you have forwarded your asu.edu correctly.  Also, make sure that your spam filter allows the library email to come through. 

Illiad (Interlibrary Loan) Account   If you don't already have an ILLiad account, please register for one.  Interlibrary loan services will get you material not available at the ASU Library and also scan or deliver materials from the libraries on the other ASU campuses.

Determine the Project's Scope.

Do you know what you are looking for?  Can you describe your project using one simple sentence or can you phrase the project as a question?  Without a clear idea of the project, you may not be able to determine which are the best resources to search, what terminology should be used in those resources, and if the results are appropriate and sufficient.    

If you're having difficulty getting your project described succinctly, try using a PICO chart to identify the concepts involved:

• P is the popluation, problem, predicament or process
• I is the intervention or improvement
• C is what you'll compare your intervention/improvment to, and
• O is the outcome (or results of the comparison of I and C ) 

For example: 

Your client, the owner of a nuclear power generating facility, has had several less than optimal safety inspections recently.  The inspectors have singled out operator error as a major concern and have required changes in employee training.  But is more training the solution?  The employees complain that the plant's poorly designed control room hampers their ability to respond to non-standard situations.  Could a redesign improve performance and decrease the occurance of unsafe events?   Your client wants more than just your opinion, he wants to see the data to back it up.   So, what can you find in the literature?

Here's one way that the PICO chart could be filled out:     

• P =   nuclear power safety  
• I  = human factors engineering
• C  =  additional training; little or no human factors engineering used  
• O = accident rate or safety inspection comparison

And here are examples of possible search statements:  

• I am looking for ways that human factors engineering can improve safety in the nuclear power industry.
• Is additional training or employing human factors engineering the better method for reducing safety violations in a nuclear power plant? 

Your research will always start with a " P AND I " search; those are the most important pieces of the puzzle.  However, once you have the results from that search, you'll need to know where you want to go with those results; that's when the C and O concepts need to be considered.  

 Also, don't forget --- determine if your project has limits.  For example:

• Are you reviewing the literature only within a specific time frame?
• Are you looking at English-language material only?
• Are you considering research from just the United States or worldwide?
• Are there types of material you won't be covering (trade magazines, patents, technical reports, etc.)?  

Take the simple sentence or question that describes what you are looking for.  What are the concepts in the sentence? Are there synonyms that describe the same concept?   If you filled out a PICO chart, concentrate on the  P (problem) and the  I (intervention) for the concept chart.  

Concept Chart:

Concept 1:   _______  OR _______  OR _______  AND Concept 2:   _______   OR   _______  OR   _______  AND Concept 3:  _______  OR  _______  OR   _______ 

  Example:  

I am looking for ways that human factors engineering can improve safety in the nuclear power industry. 

Concept 1:   nuclear power    OR _ nuclear industry _____   AND Concept 2:   _safety___  OR   _accident prevention____   AND Concept 3: _ human factors engineering ___   

What resources you'll use for your literature review depends on what types of materials you want to find.  

• Background Information The more you know about a topic, the better you'll be able to research it.  You'll be familiar with the terminology, understand the underlining science/technology and be aware of the issues in the field. Most importantly, you'll be able to understand what you've retrieved from your search.  But no matter how much you know before hand you'll likely run across terms and concepts with which you're unfamiliar.    Materials such as encyclopedias, dictionaries and handbooks will not only help you learn about the basics of your topic before you begin your search but they'll also help you understand the terminology used in the documents you found from your literature review.    You'll find these types of resources listed on the Dictionaries and Handbooks pages on this guide.
• Books The large size of books (usually 100-500 pages) allows a topic to be studied braodly, covering many different issues.  Conversely, the large size also allows for a specific aspect of the topic to be covered in great detail.  Because of the time it takes to publish, sci-tech books generally do not contain the most current information. To find print and online books from both the ASU Library as well as in other libraries, see the Books page on this guide.
• Conference Papers Scientists and engineers frequently present new findings at conferences before these findings are written up in journal articles or books.  Not every conference, however, publishes it proceedings.  In some cases, conferences publish only a few of the papers presented but not all.   Many resources that help you find journal articles, may also be used to find conference papers, see the Articles page on this guide.
• Journal and Trade Magazine Articles Articles in journals (also called magazines) are short, usually 5-20 pages in length and cover a specific finding, experiment or project.  Articles in scholary journals are usually written by academics or professional scientists/engineers and are aimed at others at the same level.   Articles in trade journals/magazines are written by the journal staff and report on industry news suchs as sales, mergers, prices, etc.   To find journal and trade magazine articles, use the resources listed on the Articles page on this guide. 
• Patents Patents are grants from governments that gives the inventor certain rights of manufacture.  Patents provide a wealth of information for how a technology is being advanced and by which companies.  It is frequently stated that 80% of the information in patents never appears elsewhere in the literature. 
• To identify patents granted in the U.S. and internationally see the " Searching for Patents " guide.
• To see statistical information for U.S. patents by technology class see the US Patent and Trademark's website.
• Technical Reports Technical reports are part of the "gray literature";  gray literature refers to documents that are not published commercially, hence they are difficult to both identify and find.  Technical reports focus on a specific experiment or research project and are meant to convey the results of the experiment or project back to the funding organization.  In the United States, common sources of technical reports are the government agencies that sponsor research projects.  Reports generated within a private corporation and funded soley by that corporation are seldom ever available to anyone outside of the company.      To find technical reports, use the resources listed on the Technical Reports page on this guide.     

Search, Read, Refine and Repeat

Now it's time to apply your search strategy in the resources you've decided to use.

• Use the Advanced Search feature (or whatever search is set up with the 3 lines of boxes) and enter your search strategy just as you recorded in your search strategy chart.  Don't forget to set your limits.   If the resource only provides a single search box, rearrange your chart from vertical into horizontal so that the search statement looks like this:   (Concept#1 OR synonym) AND (Concept#2 OR synonym) AND (Concept#3 OR synonym) Example: (nuclear power OR nuclear industry) AND (safety OR accident prevention) AND (human factors engineering)
• Examine the results to find the most appropriate items.  Keep your one-sentence project description (and/or your PICO chart) in mind to help you stay on track.
• Export the records/citations you want to keep into a citation manager.
• If there are subjects (may also be called subject headings, index terms, descriptors or controlled vocabulary) assigned to each item, make sure that those also transferred into a citation manager.  If not, add them manually.
• Get the full text of the items 
• Read the full text of the items and look at the subjects assigned to the item and consider:
• Do I have to change (narrow) my topic to something more specific because I'm finding way too much? 
• Do I have to change (broaden) my topic because I can't find enough about it? 
• Is there additional terminology for my topic/concepts that I hadn't included in my original search?
• Redo your search strategy according to what you found in step #6 and rerun the search in the resources again.
• You may need to repeat this cycle several times before you are able to identify the best terminology to use in each resource. 

If there will be several months in between when you search the literature and when you turn in the paper, consider setting up alerts and feeds so that you are notified should new items about your topic appear.   How you set up an alert or feed will vary.  In most cases you'll be required to set up a personal account or profile with the journal or database --- there is no charge for this but you will have to identify yourself and provide an email address.  

For instructions on setting up alerts and feeds, see the " Keep Current " page.

• << Previous: Keeping Current
• Next: Resources >>
• Last updated: Jan 2, 2024 8:27 AM
• URL: https://libguides.asu.edu/EM

The ASU Library acknowledges the twenty-three Native Nations that have inhabited this land for centuries. Arizona State University's four campuses are located in the Salt River Valley on ancestral territories of Indigenous peoples, including the Akimel O’odham (Pima) and Pee Posh (Maricopa) Indian Communities, whose care and keeping of these lands allows us to be here today. ASU Library acknowledges the sovereignty of these nations and seeks to foster an environment of success and possibility for Native American students and patrons. We are advocates for the incorporation of Indigenous knowledge systems and research methodologies within contemporary library practice. ASU Library welcomes members of the Akimel O’odham and Pee Posh, and all Native nations to the Library.

• Other Journals

An important role for librarians over the next five to ten years is to provide access to online library resources—free, open-access, or purchased, all valuable resources—in an intuitive, easy-to-use one-stop shop and not to be afraid of running a continual beta test in which new services and functions can be added when necessary. To fill this role, librarians and electronic resources managers need flexible, interoperable resource-discovery systems based on open-source software. In addition, we must continue to assess users’ needs and reach out by adapting our systems to fit their requirements, rather than expecting them to come to us; indeed, our very future depends on it. 1

Two decades after the advent of electronic journals and databases, librarians are still grappling with ways to best manage e-resources in conjunction with traditional print resources and at the same time explore new purchasing initiatives and practices, such as demand-driven acquisition of electronic books. In addition, these times of economic austerity are creating budgetary pressures at many institutions of higher education, resulting in librarians having to justify their spending on collections and resource management more than ever.

Techniques for Electronic Resource Management (TERMS) began in 2008 after a discussion about electronic resource management (ERM), current ERM tools, and what was lacking both in current practice and with the systems available. TERMS expands on Pesch’s electronic resources life cycle (see figure 1.1 ) and seeks to become a reference point for those who are new to ERM, those who have suddenly shifted job functions to oversee ERM, and those who may want to implement its recommendations of best practice.

TERMS Tumblr blog http://6terms.tumblr.com TERMS Facebook group https://www.facebook.com/groups/174086169332439 6TERMS on Twitter https://twitter.com/6terms

• TERMS 1: Investigating New Content for purchase/addition, assigned to Ann Kucera (Baker College, Michigan)
• TERMS 2: Acquiring New Content, assigned to Nathan Hosburgh (Montana State University, Montana)
• TERMS 3: Implementation, assigned to Stephen Buck (Dublin City University, Ireland)
• TERMS 4: Ongoing Evaluation and Access, assigned to Anita Wilcox (University College Cork, Ireland)
• TERMS 5: Annual Review, assigned to Anna Franca (King’s College, London, United Kingdom)
• TERMS 6: Cancellation and Replacement Review, assigned to Eugenia Beh (Texas A&M University, Texas)

TERMS Wiki: Main Page http://library.hud.ac.uk/wikiterms/Main_Page

In 2012, TERMS was also endorsed by the Knowledge Base + project in the United Kingdom, which has a project deliverable of providing “workflow management tools related to the selection, review, renewal and cancellation of publications” 2 and has also received interest in the United States from GoKB from Kuali OLE (open library environment), “a community of nine research libraries working together to build the first open-source system designed by and for academic and research libraries for managing and delivering intellectual information.” 3

Electronic Resources and Libraries website www.electroniclibrarian.com

One of the first things to note when performing a literature review on ERM is that there are no independent literature reviews solely on this area. Instead, ERM has now become an integral part of standard literature reviews for acquisitions processing, collection development and management, cataloging and classification, and serials management. At the same time, there are areas of ERM that sit outside of these traditional functioning areas in libraries. This makes performing a literature review on ERM more of a challenge.

From the field of library acquisitions, the issues most readily identified in recent years have been the switch from print processing to ERM and the continued struggle to find management tools that work within the local library context. 6

“Simply put, collection management is the systemic, efficient and economic stewardship of library resources.” 7 The term collection development has been with us since the 1960s. 8 However, it is a constantly evolving area, and as the library collection moves from one dominated by print to one dominated by electronic resources, collection development policies may have been patched rather than redesigned to reflect the different emphasis on delivery. In a 2012 study, Mangrum and Pozzebon found that “over half of the libraries tried to address ER [electronic resources] in some way. However, most policies contain traditional language with a section on library ER inserted into the latter portion of the document.” 9

In regard to collection development and management trends, the two biggest growth areas are e-book purchasing and purchase-on-demand or patron-driven acquisition models. There has been an explosion in collection management literature on these two topics over the past three to four years. 10 A single place for best practices, or from which a local library can create its own localized best practices, is definitely needed: “Bleiler and Livingston stressed that a lack of established policies and procedures for assessment puts a library at risk for financial loss and recommended that libraries create selection policies and standardized methods for assessment, train staff for contract negotiation, and share strategies, policies, and best practices.” 11

In addition to changes to the format of delivery of library resources, libraries must also contend with the impact of today’s economic environment. Hazen suggests that libraries need to rethink their collection development in light of these issues and move from collection to collection and content, where content is “a category that encompasses everything to which a library enjoys ready physical or digital access regardless of ownership status [and] is central to all that we do.” 12

In 2001, Jewell reported on the selection, licensing, and support of online materials by research libraries and concluded that several libraries had developed local systems for acquiring, managing, and supporting electronic resources. 13 Jewell’s report was followed in 2004 by a report from the Digital Library Federation’s (DLF) Electronic Resource Management Initiative (ERMI), which “was organized to support the rapid development of such systems by producing a series of interrelated documents to define needs and to help establish data standards.” 14 The report went on to provide a road map for ERM.

On the back end, we continue to rely on methods developed when we had 250 rather than 25,000 eresources. Information on our electronic resources is currently kept in paper files (license agreements), Excel spreadsheets (vendor contact information and administrative passwords), staff web pages (usage statistics), small databases (trial and decision tracking, divisional library resources, technical problem reports), SFX (ejournal holdings), and our ILS (acquisitions and payment data). Few of these systems are connected to each other; in some cases, information is readily accessible only to one or a few individuals, not by intent, but by the limitations of the storage mechanism. Many procedures are not documented and rely on informal channels of communication. 15

More recently there have been a number of open-source and community ERM systems, such as CORAL 16 and CUFTS, developed by Simon Fraser University (SFU) and implemented by SFU and the University of Prince Edward Island, which view this “technology not necessarily as a way of spending less money, but spending money more wisely.” 17

Another growing area of ERM is the work being performed to develop a suite of standards to support the vast amount of access and management knowledge and myriad of tools needed to maintain adequate access to electronic resources. 18 According to Sarah Glasser, “KBART and IOTA are both working to decrease OpenURL link failures that are caused by metadata deficiencies.” In addition, “PIE-J differs from KBART and IOTA because it is not focused on link resolver errors. Formed by NISO in 2010, PIE-J addresses access barriers that arise from the manner in which electronic journals are presented on provider websites.” 19

There has been a lot of discussion about the implementation of ERM systems in recent years. 20 However, use of these systems is still far from ubiquitous, and many academic libraries have yet to implement or even purchase a system. “A risk of ERMS implementations, more talked about than written about … was that the costs (in added work) to maintain a new system would outweigh the value of the added functionality.” 21 Despite early expectations, Collins and Grogg see the current crop of ERM systems as “less like a silver bullet and more like a round of buckshot.” 22

One of the most time-consuming parts of an ERM implementation is analyzing licenses and inputting them into the relevant fields of an ERM system in order for them to be meaningful to librarians and patrons. The University of Northern Colorado has developed an in-house system to perform license mapping that “makes information that is often deeply embedded within a license readily available to library personnel who could use such information in the daily operations of the library. This information is useful to any library that maintains license agreements for electronic resources.” 23

A panel session at the 2010 NASIG conference concluded that the “ERM system at UC has not solved all their problems, but some improvements have been realized. Budget tracking and staffing continue to be challenges. A final determination of the effectiveness will not be evident until the system becomes a part of the general staff workflow and not considered as something extra.” 24

Collins and Grogg cited workflow management as number one in librarians’ top six ERM priorities. They found that “over a third of librarians surveyed prioritized workflow or communications management, and they called it one of the biggest deficiencies (and disappointments) of ERMS functionality.” 25 This area has also been highlighted by the National Information Standards Organization (NISO), which has created a working group, ERM Data Standards and Best Practices Review, to undertake a gap analysis regarding ERM. 26

In the United Kingdom, the Managing Electronic Resource Issues (MERI) project at the University of Salford aimed “to produce a use case of ERM systems and a preliminary set of requirements for an electronic resource management system, for use by the University of Salford and other HE institutions and system suppliers.” 27 The requirements document from this project went on to inform the SCONUL shared ERM requirements project. An output of these projects was a set of workflows that describe the various processes involved in managing electronic resources. 28 The University of Huddersfield was one of the sixteen UK universities to take part, and like others, had never actually recorded these workflows until asked to do so by the project. All project members found that by recording workflows, they were able to take advantage of efficiencies discovered as part of documenting the process.

One of the objectives of the TERMS blog and wiki was to collect a number of e-resource workflows from a variety of different types of libraries. Both the University of Huddersfield and Portland State University shared their workflows as part of TERMS. The release of the six TERMS via the blog also encouraged other universities to share their workflows and discuss efficiencies; indeed, “rethinking e-resources workflows and developing practical tools to streamline and enhance various inelegant processes have become the priorities.” 29

Since the launch of the first draft of TERMS, the project has now attracted interest in various workflows from different libraries around the world, including the University of Cork, Duke University, Florida Gulf Coast University, and Texas A&M University.

A recent press release by Jisc in the United Kingdom suggested that international collaboration is needed to transform ERM in libraries—“Many of the concerns libraries have in the management of electronic resources are the same across the world”—and that projects such as GoKB and the Knowledge Base + service in the United Kingdom “are exploring community-based solutions.” 30

TERMS Wiki Investigating New Content for Purchase/Addition http://library.hud.ac.uk/wikiterms/Investigating_New_Content_for_purchase/addition Acquiring New Content http://library.hud.ac.uk/wikiterms/Acquiring_New_Content Implementation http://library.hud.ac.uk/wikiterms/Implementation Ongoing Evaluation and Access http://library.hud.ac.uk/wikiterms/Ongoing_Evaluation_and_Access Annual Review http://library.hud.ac.uk/wikiterms/Annual_Review Cancellation and Replacement Review http://library.hud.ac.uk/wikiterms/Cancellation_and_Replacement_Review

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Coronary artery aneurysms: a clinical case report and literature review supporting therapeutic choices.

1. Introduction

1.1. definition and classification of coronary artery aneurysms, 1.2. risk factors, 1.3. clinical presentation, 1.4. diagnostic skills, 1.5. treatment, 1.6. caas in kawasaki disease, 2. clinical case presentation, 2.1. medical history, 2.2. examinations, 2.3. management, 3. conclusions, author contributions, conflicts of interest.

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Sannino, M.; Nicolai, M.; Infusino, F.; Giulio, L.; Usai, T.L.; Biscotti, G.; Azzarri, A.; De Angelis D’Ossat, M.; Calcagno, S.; Calcagno, S. Coronary Artery Aneurysms: A Clinical Case Report and Literature Review Supporting Therapeutic Choices. J. Clin. Med. 2024 , 13 , 5348. https://doi.org/10.3390/jcm13185348

Sannino M, Nicolai M, Infusino F, Giulio L, Usai TL, Biscotti G, Azzarri A, De Angelis D’Ossat M, Calcagno S, Calcagno S. Coronary Artery Aneurysms: A Clinical Case Report and Literature Review Supporting Therapeutic Choices. Journal of Clinical Medicine . 2024; 13(18):5348. https://doi.org/10.3390/jcm13185348

Sannino, Michele, Matteo Nicolai, Fabio Infusino, Luciani Giulio, Tommaso Leo Usai, Giovanni Biscotti, Alessandro Azzarri, Marina De Angelis D’Ossat, Sergio Calcagno, and Simone Calcagno. 2024. "Coronary Artery Aneurysms: A Clinical Case Report and Literature Review Supporting Therapeutic Choices" Journal of Clinical Medicine 13, no. 18: 5348. https://doi.org/10.3390/jcm13185348

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Firms growth opportunities and accruals earnings management nexus: does corporate and national governance systems play a role?

• Original Article
• Published: 12 September 2024
• Volume 4 , article number  115 , ( 2024 )

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• Emmanuel Mensah   ORCID: orcid.org/0000-0002-3080-3598 1 ,
• Peter Ackah   ORCID: orcid.org/0000-0002-8265-8329 1 &
• Mamdouh Abdulaziz Saleh Al-Faryan   ORCID: orcid.org/0000-0003-1665-807X 2  

This paper sheds light on the intermediation of corporate and national governance systems as surveillance mechanisms, similar to Foucault’s panopticon, to produce stakeholders’ interest alignment as well as beneficial outcomes of earnings management practices of firms which have significant growth opportunities. The research included 104 companies that are listed on the stock markets of nine sub-Saharan African countries. Data was gathered from annual reports spanning the years 2007–2019, resulting in a total of 1044 firm-year observations. Panel data models were employed for the analysis. The study finds that, in line with the political cost hypothesis, there is a negative association between a firm’s growth opportunities and its accrual earnings management practices which suggest that growth firms are more inclined to utilise income decreasing accruals to deflect political attention and costs. The interaction effects of corporate and national governance systems tend to be the balancing act which realigns management’s actions in line with expectations much like the panopticon’s watchtower in Foucault’s theory which has useful policy implications. The current study is unique in that, it expands our understanding of the role governance plays in the firm growth—earnings management nexus using a novel lens of the Foucauldian panopticon theory.

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Source: Authors conceptual framework of the mechanism of governance surveillance on firm behaviours and decisions

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Data availability statement

The data that supports the findings of this study were obtained from three sources, namely: africanfinancials.com, machameratios.company.site and World Bank’s World Governance Indicators (WGI). These data can be made available on demand by email to the corresponding author.

Normally, companies in Africa which have significant growth prospects (which we refer herein as “growth-firms”) are those that often get listed on organised exchanges for the attraction of capital to fund their growth.

CACG refers to the Commonwealth Association for Corporate Governance, which have been promoting best practice corporate governance principles among Commonwealth nations.

OECD refers to the Organisation for Economic Cooperation and Development which have developed a Corporate Governance Factbook 2019. www.oecd.org/corporate/corporate-governance-factbook.htm .

According to Kaufmann et al. ( 2011 , p. 4), Government Effectiveness index captures “the quality of public services, the quality the civil service and the degree of its independence from political pressures, the quality of policy formulation and implementation, and the credibility of the government's commitment to such policies”. Regulatory Quality index captures “the ability of the government to formulate and implement sound policies and regulations that permit and promote private sector development”. Rule of Law index captures “the extent to which agents have confidence in and abide by the rules of society, and in particular the quality of contract enforcement, property rights, the police, and the courts, as well as the likelihood of crime and violence”.

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A scoping review of health literacy in rare disorders: key issues and research directions

• Una Stenberg   ORCID: orcid.org/0000-0002-6007-8630 1 , 2 ,
• Lydia Westfal 1 ,
• Andreas Dybesland Rosenberger 3 ,
• Kristin Ørstavik 4 ,
• Maria Flink 5 ,
• Heidi Holmen 6 ,
• Silje Systad 7 ,
• Karl Fredrik Westermann 2 &
• Gry Velvin 8  

Orphanet Journal of Rare Diseases volume  19 , Article number:  328 ( 2024 ) Cite this article

Metrics details

The ability to find, understand, appraise and utilise health information is crucial among individuals living with rare disorders. The aim of this study was to give a comprehensive overview of the literature on health literacy in adult persons with rare disorders.

We applied a scoping review methodology and performed a systematic search in 2021 in bibliographic databases. Searches were conducted in Medline (Ovid), Embase (Ovid), PsycInfo (Ovid), CINAHL (ebsco), and ERIC (Ovid). References were sorted and evaluated for inclusion using EndNote and Covidence. This review was guided by the question “What are the characteristics of research on health literacy in rare disorders?”

The database searches yielded 75 eligible reports. A total of 6223 individuals with rare disorders were represented alongside 1707 caregivers. The reports in this review have included study participants representing a total of 80 different rare disorders with unique ORPHA and ICD-10 codes. The results revealed that persons with rare disorders often exhibit gaps in health literacy through a lack of knowledge and access to information related to self-management, their own diagnosis and health, as well as daily coping and social rights. In addition, the importance of aid and information from healthcare personnel and the significance of getting social support from others in the same situation were accentuated.

This review emphasizes the importance of reinforcing health literacy among persons with rare disorders through peer support and education. This is the first review to give a comprehensive and state-of-the-art overview of literature investigating health literacy among persons with rare disorders and offers a basis for further research.

Introduction

In Europe, a disorder is considered rare when it affects less than 1:2000 individuals [ 1 ]. According to current calculations, more than 7000 different rare disorders have been identified. However, it is plausible that the actual number may be as high as 10,000 [ 2 ]. Although each rare disorder affects a limited quantity of individuals, it is estimated that the combined prevalence of all rare diseases is 3,5–5,9% [ 3 ]. Accordingly, up to 36 million people residing in the European Union are living with a rare disease [ 4 ]. Out of the total rare disorders, 72% have a genetic aetiology, and 70% have childhood onset [ 3 ]. Whilst there is a large clinical diversity between the rare disorders, they tend to have some aspects in common; they are known for being chronic, complicated, mostly degenerating, and often disabling [ 5 ].

Persons with rare disorders face some unique challenges in accessing information on their diagnosis, which may lead to issues in making beneficial health choices regarding treatment and care [ 6 ]. A key issue with rare disorders is the lack of research in the field [ 7 , 8 ]. Insufficient evidence and knowledge on rare diseases in general pose challenges both for professionals and people with these diseases [ 8 ]. Due to healthcare professionals’ limited understanding of their rare disorder in general, as well as a lack of information provided, persons with rare disorders often need to search for health-related information themselves [ 6 ]. A systematic review published in 2017 aimed to provide an overview of adults` shared experience of living with a rare disorder, found that in 12 out of 21 reports, persons with rare disorders reported progressively becoming “experts” on their own diagnosis [ 9 ]. In some cases, those living with rare disorders possess more information about the condition than the healthcare professionals they encounter [ 10 ].

Healthcare systems are increasingly challenging to navigate [ 11 ]. Simultaneously, the healthcare services share prospective aims of prioritising digitization, enabling more home-based care, promoting shared decision-making, and ensuring equitable access to services [ 5 , 12 , 13 ]. Managing one’s health while dealing with a rare disorder and the responsibility of seeking information can be especially demanding due to the challenging standards set by the healthcare system [ 6 ].

Increased participation and responsibility for one’s own health impose a demand on the individual to have adequate health literacy. Health literacy pertains to individuals’ ability to manage the complex health requirements of today’s society and make informed decisions regarding health [ 14 ]. This includes understanding the factors that affect one’s health, addressing health challenges, and making appropriate health choices. There is a lack of consensus on the definition of health literacy, and multiple interpretations have been made [ 14 ]. A review by Sørensen et al. [ 15 ] identified as many as 17 different definitions of health literacy and created a working definition of health literacy by considering the contents of each interpretation. The inclusive definition according to Sørensen et al. is stated as follows:

“Health literacy is linked to literacy and entails people’s knowledge , motivation and competencies to access , understand , appraise , and apply health information in order to make judgments and take decisions in everyday life concerning healthcare , disease prevention and health promotion to maintain or improve quality of life during the life course.” (ref p. 3).

Along with the comprehensive definition, Sørensen et al. developed an integrated model of health literacy [ 15 ]. The model has been widely used to understand the complex interaction between individual skills and abilities related to health literacy, social and environmental factors, and health outcomes. The core elements of the model are four cognitive competencies; to access, understand, appraise, and apply health-related information. These four competencies allow a person to manoeuvre three identified domains on the health spectrum: healthcare, disease prevention, and health promotion. The model suggests that an individual’s ability to access and use health information is determined by their own skills, motivation, and knowledge as well as the social and environmental context they reside within. These conditions, accordingly, affect individuals’ ability to address their health and ultimately impact their health outcomes.

Sorensen’s model emphasises that components such as empowerment, health outcomes, and health behaviour are interlaced and connected to an individual’s health literacy. Enhancing the level of health literacy allows individuals to become more empowered and take charge of their health, participate in health-promoting behaviours, and gradually attain improved health outcomes [ 15 ]. Thus, participation and empowerment can give persons with rare disorders enhanced control over their own health and treatment, and increased involvement in decision-making processes that concern their health. This may lead to better health outcomes and elevated health-related quality of life, which remain crucial as persons with rare disorders report lower quality of life compared to those with more common chronic conditions [ 16 ]. They can feel stigmatised and marginalised in the healthcare system, and it can be challenging to find psychosocial support. Examining how to increase health literacy and empowerment for persons with rare disorders can therefore be an important and relevant direction for further research. Health literacy of individuals with rare disorders is an emerging field of research, and the literature is based on a wide range of study methodologies [ 7 , 8 ]. Hence, this scoping review aims to give a comprehensive overview of empirical reports (from primary research studies) investigating health literacy among persons with rare disorders as reported in the international literature, by identifying characteristics of definitions, study populations, methods and interventions.

Study design and research questions

The scoping review process described by Arksey and O`Malley [ 17 ] aims to: “(…) map rapidly the key concepts underpinning a research area and the main sources and types of evidence available and can be undertaken as a stand-alone project in their own right , especially where an area is complex or has not been reviewed comprehensively before. ” A scoping review methodology is also suitable for examining the extent, range, variety, and characteristics of evidence on a topic, but also to identify research gaps. This scoping review was conducted according to the five-stage framework by Arksey and O`Malley [ 17 ], enhanced by Levac [ 18 ] and Daudt [ 19 ] and reported according to the PRISMA Extension for Scoping Reviews [ 20 ] (shown in Additional file 1 ). A protocol for this review is available on request.

The aim of this review was to identify the characteristics of research on health literacy in rare disorders. The specific research questions were:

What are the characteristics of study populations?

When and where have reports on health literacy been carried out?

What are the characteristics of research questions used to investigate health literacy?

What are the characteristics of methods used to investigate health literacy?

What are the characteristics of assessment tools used to measure health literacy?

What are the characteristics of interventions that have been described in the reports?

How is health literacy defined or described in the reports?

How is access to health information and support for individuals with rare disorders described the reports?

Overarching participatory approach

The study group in this scoping review included one co-researcher, one with experiential knowledge trained in research methods, several experienced healthcare professionals in the field of rare disorders, working in clinical practice (specialized health care), and experienced researchers in health literacy and scoping review methodology. All members have been involved in all stages of the review process.

Eligibility criteria

This scoping review included primary research reports that investigated health literacy in adults with rare disorders. Reports were included if they had investigated the individual`s capacities, skills and motivation to make judgements and decisions in everyday life concerning healthcare, disease prevention and health promotion in persons with a rare disorder. While being 18 years of age or older was set as a search criterion, reports that included both adults and persons below 18 were not excluded. Empirical reports in English and Scandinavian languages published in peer-reviewed journals were included. All study designs were included. Dissertations, reports published in abstract form only, editorials, commentaries and duplicates were excluded.

Systematic searches

In the first stage, research questions were developed by the study group in a highly iterative process. We agreed to apply a broad variety of synonyms, conducting many and extensive pilot searches and simultaneously enhancing the search strategy, and clarify the criteria for inclusion and exclusion of reports. A senior academic librarian, in close collaboration with the first author, developed a systematic literature search using MeSH-terms and free search terms combining a comprehensive set of synonyms and terms for health literacy and rare disorders. Both the librarian and the researchers in the study group had experience with previous literature searches in the field of rare disorders. The literature searches complied with the PICO principles and applied a combination of “OR” within groups and “AND” between groups. Searches were conducted in Medline (Ovid), Embase (Ovid), PsycInfo (Ovid), CINAHL (ebsco), and ERIC (Ovid) for publications between 2010 and 2021. No other sources for literature were searched for this review. The complete search strategy is displayed in Additional file 2 .

Selection of publications

All titles and abstracts were reviewed by the first author (US) and one of the co-authors independently using the systematic review software Covidence (Veritas Health Innovation). Disagreements and conflicts were resolved through discussion with a third review author.

Data extraction

All data from the included reports were extracted according to study characteristics, participant characteristics included ORPHA and ICD-codes, description of interventions, methods, assessment tools, definitions and understanding of health literacy was collected using data extraction forms and reported separately for each study in evidence summaries (Supplementary Material 4 – 9 : Tables 2–6). A full reference list of included reports is presented in Additional file 3 . Extracted data is presented in a descriptive manner using text, tables and figures. All members of the study group participated in the data extraction. We did not attempt to contact the authors in this review process.

The search of the online databases resulted in 5999 reports when duplicates were removed. From these, 5794 were excluded because they did not fulfil the inclusion criteria. A total of 177 reports were downloaded in full text and read by two authors. Of these, 102 reports were excluded, leaving 75 to undergo analysis in this review (Fig. 1). All the included reports were in English language.

Prisma flow diagram

Characteristics of study populations

A total of 6223 persons with a rare disorder and 1707 caregivers were represented in the 75 included reports. About 70% of the reports were based on data from samples with less than 100 participants. About 15% of the reports were based on samples with more than 200 participants. Of the included participants in the reports, about 60% were female. Of the reports that reported the mean age of the participants, approximately 75% of the participants were between 30 and 50 years of age. About 15% of the reports had participants with a mean age over 55 years, and eleven reports had participants with a mean age under 25 years.

The reports in this review have included study participants representing a total of 80 different rare disorders with unique ORPHA and ICD-10 codes. A detailed description of diagnoses is given in Table 1 (Additional file 4 ). Five of the reports included participants across rare disorders but did not specify what type of disorders. Most of the rare disorders had been investigated in one or two reports, but a few disorders were investigated in several reports: different types of Hemophilia were investigated in 24/75 reports, Cystic Fibrosis in 14/75 reports, Huntington’s disease in 7/75 reports, Scleroderma in 4/75 reports and Myotonic dystrophy type 1, Neurofibromatosis type 1 and Spina bifida in 3/75 reports.

Where and when have reports on health literacy been carried out?

Of the 75 included reports, 21 were conducted in the USA, 11 in Canada and eight in the UK (see Table 2 for details in Additional file 9 ). The included reports were published between 2010 and 2021, 54/75 after 2016.

Characteristics of research questions

The research questions most frequently investigated among the included reports were related to assessments of experienced knowledge and different health- and/or psychosocial outcomes (31/75). The second most investigated research questions (27/75) were about persons with rare disorders’ views, experiences and understanding of their own condition, care, health information, management, transition process or peer support (see Table 6 for details in Additional file 8 ). In addition, 16 reports were conducted to evaluate an intervention aimed to improve or strengthen participants` knowledge, health literacy or coping, and therefore included in this review.

Characteristics of methodological design

Of the included reports, 28/75 applied a quantitative cross-sectional design to explore characteristics of patient groups in terms of knowledge and disease-related variables. Among the cross-sectional reports, both digital and paper-based surveys were used, and some gathered data through medical charts or personal interviews. In addition, fourteen reports applied an experimental design investigating either the feasibility or effects of specific interventions, mainly to increase knowledge or health literacy. Among the qualitative designs (28/75), individual interviews were frequently applied, less so focus groups. Most of the qualitative reports aimed to explore experiences and gain insight into the views of persons who are living with a rare disorder, for example, needs of information and support, barriers to care and communication with health care providers. To present the qualitative results, a thematic analysis approach was most frequently applied. A minority of reports (5/75) reported a mixed or multi-method approach, combining interviews and surveys (see Table 3 for more details, Additional file 5 ).

Characteristics of assessment tools

Five of the assessment tools measured health literacy specifically. However, 23 standardized assessment tools aimed to assess important aspects relevant to health literacy, such as self-management skills, coping and medication adherence. Table 4 provides an overview of the standardised assessment tools used to measure health outcomes (Additional file 6 ). Quality of life was the outcome assessed most frequently (10/75) and was most commonly assessed with SF36 (4/75). Seven reports examined anxiety levels, while six estimated depression. Hospital Anxiety and Depression Scale (HAD) was the most commonly utilized tool to assess anxiety and depression (3/75). Correspondingly, 27 study-specific assessment tools sought to achieve outcomes closely related to health literacy, including health information-seeking patterns, medication information sources and knowledge, attitude and behaviour towards their condition. For a more detailed review of study-specific assessment tools, see Table 5 (Additional file 7 ).

Characteristics of interventions

A total of 16/75 of the reports included interventions. Each intervention originated from a distinct study and had diverse characteristics in terms of study design, objectives, intended recipients, implementation settings, and delivery personnel, including healthcare professionals and peers. Additional information regarding this is provided in Table 6 (Additional file 8 ). The interventions encompassed both face-to-face approaches, such as individual sessions [ 21 , 22 , 23 , 24 , 25 , 26 , 27 ] and group-based patient education [ 22 , 26 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ], and written information/online training [ 29 , 31 , 35 , 36 , 37 ]. The interventions took place in a variety of settings, including hospitals, clinics, and online platforms. The common thread between the interventions is that they all share the objective of enhancing patient outcomes and experiences through education, support, and empowerment. For example, they aim to improve knowledge, health literacy, and self-treatment skills, as well as to promote treatment adherence and reduce interruptions in care. In 9/16 interventions, the primary aim was to improve knowledge or understanding of the patient’s particular health condition or treatment. These nine interventions applied various components such as audiovisual materials, individualised training courses, or booklets. Out of those nine interventions, six demonstrated a significant ( p  < 0.05) improvement in knowledge of the targeted health condition or treatment [ 21 , 25 , 28 , 32 , 36 , 37 ].

Out of all interventions, 5/16 aimed predominantly at reducing psychiatric symptoms, such as depression, anxiety, and somatic symptom severity. Several interventions displayed positive effects on mental health, including improvements in emotional health, coping strategies, and quality of life [ 22 , 26 , 28 , 29 , 32 , 33 , 35 ]. Examples of such interventions included group counselling and group mindfulness training. The interventions were evaluated using methods such as self-report questionnaires, physiological measures, and clinical assessments. The outcomes measured included improvements in physical health, mental health, quality of life, and social support.

Description of health literacy

Only 6/75 reports described in the introduction how they defined health literacy [ 21 , 38 , 39 , 40 , 41 , 42 ]. Five of these reports were based on the understanding and definition of health literacy as the cognitive and social skills that determine the motivation and ability of individuals to gain access to, understand and use information in ways that promote and maintain good health (WHO). One of the reports defined health literacy as “the patients’ skills on reading, listening, analysing decisions making and applying these skills to the situation related to health monitoring and coordination for strategy plan in term of health promotion” [ 42 ].

Access to health information and support

Most of the reports included in this review investigated knowledge or understanding of one’s own health and diagnosis, and access to health information. Persons with rare disorders commonly lack information about:

Own diagnosis and health [ 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ].

Self-management and daily coping [ 6 , 10 , 54 , 59 , 60 , 61 , 62 , 63 ].

Medication, treatment options and research-based recommendations [ 6 , 10 , 28 , 51 , 64 , 65 , 66 , 67 ].

Peer and professional support [ 53 , 54 , 55 ].

Clinical trials and research [ 53 , 54 , 55 ].

Sexual knowledge [ 68 , 69 , 70 , 71 ].

Behaviour and attitude [ 28 , 72 , 73 ].

Social rights [ 28 , 60 ].

Pregnancy and childbirth [ 51 , 60 ].

Ageing [ 71 ].

Navigation and coordination [ 23 ].

The most important sources of health information summarized among the included reports were physicians, the internet, patient organizations and spouse/partner [ 74 , 75 , 76 ]. Transitions in life can be challenging and generate new needs for information and care. Three of the reports investigated the transition process from paediatric to adult services [ 23 , 77 , 78 ]. Persons with rare disorders and their family caregivers call for health information on various aspects of the disease burden including medical research and treatment, coping strategies, management, symptoms and general knowledge about the disease [ 57 , 63 ].

Only a few reports investigated how persons with rare disorders are navigating in healthcare and their experiences of healthcare services. These reports found that many persons with rare disorders feel let down by the system- and lack trust in the standards of health care [ 54 , 79 , 80 , 81 ]. Several reports described the frustration among persons with rare disorders because of a lack of knowledge about diagnosis and medication by healthcare professionals [ 54 , 56 , 59 , 62 , 73 , 81 , 82 ] and concerns about poor communication and information provision [ 83 ].

Some of the reports described the experiences of persons with rare disorders concerning limited access to peer- and professional support, like specialized care, treatment plans and access to peer groups [ 34 , 53 , 61 , 62 , 84 , 85 , 86 ]. Persons with rare disorders missed the engagement in health care to assist in their management of the disease [ 85 ], and one report claimed that hospital visits could be reduced with more information [ 52 ].

Several reports have investigated peer support [ 6 , 22 , 28 , 44 , 50 , 81 , 82 , 87 , 88 , 89 ]. Persons with rare disorders who connected and interacted with fellow individuals with rare disorders reported great improvements in overall health, disease severity, motivation to take care of health, emotional well-being and satisfaction with their primary treating physician [ 66 , 69 ].

This scoping review identified 75 reports presenting data on rare disorders and aspects of health literacy, thereby providing valuable insight into the characteristics of research in the field of health literacy in individuals with rare disorders. A total of 6223 individuals with rare disorders and 1707 caregivers were included, and 80 different rare disorders were represented. Most of the studies were published after 2016, and were conducted in the USA, Canada and UK. The most frequently investigated research questions were related to different health- and psychosocial outcomes, understanding of own condition, health information and support, or concerning evaluation of an intervention. The reports used a variety of research methodologies, including qualitative, quantitative, and mixed methods approaches. Cross-sectional designs were frequently employed to depict patient characteristics, knowledge and health-related variables, and qualitative designs were commonly used to capture the perspectives of persons living with rare disorders. In total 23 standardized assessment tools and 27 study-specific assessment used in the reports. Only five assessment tools measured health literacy specifically. Some of the reports also assessed interventions to improve elements such as knowledge, health literacy and coping strategies. These interventions encompassed both face-to-face approaches, such as individual sessions and group-based patient education.

Only six reports had described how they defined health literacy. Five of these reports were based on the understanding and WHO-definition of health literacy as the cognitive and social skills that determine the motivation and ability of individuals to gain access to, understand and use information in ways that promote and maintain good health (WHO). Concerning access to health information and support, the results revealed that individuals with rare disorders often exhibit gaps in knowledge and access to information related to self-management, their own diagnosis and health, as well as daily coping and social rights. In addition, the importance of aid and information from healthcare personnel and the significance of getting social support from others in the same situation were accentuated.

A recurring issue identified among the reports was that individuals with rare disorders consistently encounter challenges in accessing information on their own health and diagnosis, self-managing and coping [ 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ]. This observation has been established in previous research and can sometimes be ascribed to a lack of knowledge among healthcare personnel [ 6 , 9 , 10 ]. The understanding and appraisal of health information could pose difficulties since the information available on rare conditions often is complex and contains medical terminology that is challenging to comprehend. This particularly applies to those with cognitive impairments, which pertains to 44% of the rare disease population [ 90 ]. More than 7000 rare disorders are identified, and only 80 of these disorders are represented in this review. More than 50% of the included reports have included study participants with Haemophilia, Cystic Fibrosis and Huntington’s disease, which means that a range of different rare disorders have not been included in health literacy research. A majority of the interventions in this study focused on increasing knowledge and understanding of one’s own health and treatment. Acquiring the skills to apply health knowledge to everyday life efficiently can profoundly impact health outcomes and is especially important when it comes to self-management, such as adherence to medication and treatment [ 15 , 91 , 92 , 93 , 94 , 95 ].

Another possible challenge related to access to information and support is the often-large geographical distances between persons with rare disorders. This may result in difficulties when it comes to meeting or participating in peer-support groups in person [ 96 ]. Peer interactions appear particularly important in this population [ 6 , 53 , 54 , 55 ], and several of the perceived benefits of the interventions in this review were associated with the recognition, acceptance and companionship encountered within peer-support groups [ 16 , 28 , 32 , 35 ]. Interestingly, none of the included reports explored the potential benefits of online peer support, which has been found to be an effective supplement to in-person meetings in people with other disorders.

While there is reason to believe that health literacy has a significant impact on health outcomes, only one of the included reports investigated this possible correlation, finding that individuals who possessed adequate health literacy displayed more favourable health-related outcomes [ 38 ]. In that report, the authors observed that individuals who possessed adequate health literacy displayed more favourable health-related outcomes. None of the included reports explored health literacy across various types of rare disorders. One prominent finding across the reviewed reports is the shortage of accessible health information specifically targeted towards individuals with rare conditions. There is a need to investigate if there are structural or social barriers that limit access to information and support for the population. Furthermore, it would be valuable to examine the underlying factors that impact health literacy in persons with rare disorders, including the association between health literacy and socio-demographic variables, health status, self-efficacy and health-related quality of life. Another potential research topic could be to evaluate the success of interventions aiming at improving health literacy in persons with rare disorders and their caregivers.

To the best of our knowledge, only four previous reports have explicitly aimed to examine the levels of health literacy in persons with rare disorders [ 38 , 39 , 40 , 42 ]. Furthermore, the data does not provide enough information to say anything about relatives’ health literacy. Enhancing health literacy is known to be an enabler for improved empowerment and participation, which is associated with positive health outcomes [ 13 , 94 ]. Empowerment is especially important in the field of rare disorders, due to the unique challenges of low prevalence, limited knowledge and expertise, and compromised quality of life [ 94 ].

To achieve a better understanding of health literacy in rare disorders, we could benefit from the incorporation of different perspectives, including those of persons with rare disorders, their family members and healthcare providers. We need future research on how different dimensions of health literacy, and interventions aiming to strengthen health literacy, influence health outcomes according to health care, disease prevention and health promotion. We need to achieve a deeper understanding of how the personal determinants of health literacy, such as individual skills and motivation, interact with situational determinants, such as social and environmental factors, to shape health outcomes. To properly address the executive challenges faced by persons with rare disorders we need a greater understanding of health literacy in rare disorders [ 28 ]. The integrated model of health literacy [ 15 ] can serve as a tool to point us in the right direction when designing future research projects.

The strength of our work lies in providing a comprehensive overview of the reported findings from research on health literacy in rare disorders. We conducted an up-to-date systematic search in five databases without restrictions. Despite using an array of synonyms in database searches to maximise the identification of relevant reports, the search terms used are not exhaustive. Hence, some reports may not have been detected. To reduce the risk of selection bias, two authors independently assessed the abstracts and reports in full text according to the a priori eligibility criteria. Further, in line with the scoping review framework, we have not evaluated the methodological quality or risk of bias among the included reports. This may be seen as a limitation; however, the purpose of scoping reviews is to give an overview of the available research literature, characterise a research area and pinpoint gaps in knowledge that should be addressed in future systematic reviews.

This review has important implications for practice. Healthcare does not offer curative treatment options for most rare disorders, and several reports suggest the development of consensus recommendations for care. To optimise health and secure continuity of care several reports included in this review recommend formalisation of the transition process through the courses of illness and life. Moreover, the results reveal that some of the key challenges for persons with rare disorders are related to important aspects of health literacy, such as accessing, understanding, and applying health information. Our findings indicate a need for strengthened health literacy in the rare disease population, that could be accomplished by developing health communication strategies tailored to the needs and preferences of persons with rare conditions. Healthcare personnel can play a significant role in enhancing health literacy, which is an additional implication for practice. Health care personnel can achieve this by offering clear and understandable health-related information and encouraging an active dialogue between patients and professionals. Another way for healthcare personnel to assist persons with rare disorders is by offering them the support needed to accept, cope, and effectively manage their condition [ 97 ].

This scoping review consists of 75 reports presenting data on rare disorders and aspects of health literacy, thereby providing valuable insight into the characteristics of research in the field of health literacy in individuals with rare disorders. In total, 6223 individuals with rare disorders and 1707 caregivers were included, and 80 different rare disorders were represented. Most of the studies were published after 2016, and were conducted in the USA, Canada and UK.

The findings of this scoping review demonstrate that persons with rare disorders experience considerable gaps in knowledge and information, particularly in relation to their own diagnosis and health, treatment options, self-management and coping strategies. Moreover, the lack of diagnosis-specific knowledge and limited information provided by healthcare professionals are identified as a common concern among persons with rare disorders. Access to, and understanding, health information is key aspects of health literacy. Therefore, our results imply a need for increased awareness regarding the state of health literacy among individuals with rare disorders. The points of view expressed in this review offer valuable perspectives that can help health personnel in outlining the communicative strategy when caring for individuals with rare disorders.

This review provides a solid understanding block for future research into the emerging field of health literacy in rare disorders, by examining the challenges that persons with rare conditions encounter. Moreover, the findings enable us to develop a better understanding of the care and support persons with a rare disorder and their family members require.

These results pave the way for future research that looks to improve the healthcare experience of those with rare disorders and their caretakers and shed light on the importance of empowering the rare disease population through peer support, participation, education and increased health literacy. Future reports in this field are necessary to develop strategies and interventions that improve health literacy and enhance health outcomes and the quality of life for individuals with rare disorders.

Data availability

All data generated or analysed during this review are included in this published article (and its additional files).

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Acknowledgements

The authors want to thank leaders and colleagues. A special thank goes to librarian Hilde Iren Flaatten who has conducted systematic searches after literature and Anne Siri Albrigtsen for important contributions to this review. Several of the authors are members of Euro-NMD.

This work received funding from Norwegian National Advisory Unit on Rare Disorders. In addition the work was performed as part of regular activities at Frambu Resource Centre for Rare Disorders and Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital.

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Stenberg, U., Westfal, L., Dybesland Rosenberger, A. et al. A scoping review of health literacy in rare disorders: key issues and research directions. Orphanet J Rare Dis 19 , 328 (2024). https://doi.org/10.1186/s13023-024-03332-5

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Intraosseous myofibroma mimicking an odontogenic lesion: case report, literature review, and differential diagnosis

• José Wittor de Macêdo Santos 1   na1 ,
• Benito K. Benitez 1 , 2   na1 ,
• Daniel Baumhoer 3 ,
• Daphne Schönegg 1 ,
• Thomas Schrepfer 4 ,
• Andreas. A. Mueller 1 , 2   na2 &
• Florian M. Thieringer 1   na2  

World Journal of Surgical Oncology volume  22 , Article number:  246 ( 2024 ) Cite this article

Metrics details

Intraosseous myofibroma of the jaw is a rare neoplasm of mesenchymal origin with limited comprehensive understanding. It typically affects patients in the first two decades of life with a male predilection.

Case presentation

This study presents a rare case of myofibroma mimicking an odontogenic lesion in a 2-year-old boy. The patient presented with an incidental finding of a painless swelling of the right mandibular ramus of unknown etiology. Imaging analysis revealed a solid, expansile lesion adjacent to the germinal zone of the right mandibular first molar. Histopathologic analysis and immunohistochemistry after incisional biopsy suggested a possible central odontogenic fibroma, and the patient underwent total enucleation, leading to the final diagnosis of intraosseous myofibroma. Follow-up examinations showed no evidence of recurrence.

Conclusions

This report contributes to the understanding of myofibroma in pediatric patients and underscores the critical role of meticulous histopathologic examination for effective surgical planning and optimal patient outcomes.

Introduction

Myofibroma is a rare tumor with a predilection for the head and neck region. Its intraosseous variant stands out as a rare spindle cell tumor involving the jaws, with only a few well-described case series documented in the literature [ 1 ]. Typically, intraosseous myofibroma affects patients in the first two decades of life and is more common in males [ 1 , 2 , 3 , 4 ]. Clinically, these lesions generally present as an asymptomatic pink to red and firm mass in the oral region. Radiographically, unilocular and well-circumscribed osteolysis with potential tooth displacement and/or bone expansion may be seen [ 1 , 3 ].

Histologically, myofibroma is characterized by a polylobulated spindle cell proliferation arranged in a biphasic pattern. The tumor cells stain positive for alpha-smooth muscle actin (α-SMA) and are usually negative for myogenin, desmin, CD34, S-100 protein, and beta-catenin [ 5 ]. This study describes a case of a mandibular intraosseous myofibroma in a 2-year-old boy mimicking an odontogenic tumor and discusses the differential diagnoses and treatment considerations.

• Case report

This report follows the CARE [ 6 ] guideline. A 2-year-old boy presented with his parents for a routine pediatric examination, during which a previously unnoticed swelling of the right cheek was noted. The patient had no symptoms, and his medical and family history were unremarkable. Ultrasonography and subsequent magnetic resonance imaging (MRI) were performed, and the patient was referred to our tertiary center for further evaluation.

The patient presented with a round, firm swelling in the region of the right mandibular ramus without associated pain, dysfunction, paresthesia, or palsy (Fig.  1 A). The previous MRI showed a well-defined intraosseous contrast-enhancing mass along the right mandibular ramus without unequivocal infiltrative growth or signs of an aggressive periosteal reaction, measuring 3.2 × 2.9 × 2.5 cm (Fig.  1 B ) . No additional manifestations were found on clinical and radiological examination, excluding myofibromatosis. A computed tomography (CT) was recommended to delineate the extent of the lesion before any intervention. The lesion was found at the full height of the coronoid process, extending medially into the pterygomaxillary and laterally into the masticator space (Fig.  1 C).

A , Clinical frontal view at consultation with volume plus on the right side. B , MRI showing a well-delineated intraosseous contrast-enhancing mass along the right mandibular ramus and coronoid process without signs of infiltrative growth or neck involvement. C , CT highlighting the lesion at the full height of the coronoid process, extending medially into the pterygomaxillary and laterally into the masticator space

After interdisciplinary board discussion, the differential diagnosis included odontogenic tumors, unicystic ameloblastoma, and central giant cell granuloma. Intraoral incisional biopsy under general anesthesia and complete laboratory evaluation were recommended. Laboratory tests were normal. Histopathologic assessment revealed a monomorphic and well-vascularized lesion with a myxoid background. Immunohistochemical studies showed a low proliferation index (Ki-67 positive in 5–7% of the lesional cells). The stainings against pan-CK (CK22), CD31, PU.1, CD45, ERG, beta-catenin, desmin, and MyoD1 yielded negative results. Weak positivity for α-SMA and nestin was noted. The overall constellation was interpreted as being most likely in keeping with a benign mesenchymal odontogenic tumor, e.g., odontogenic fibroma or fibromyxoma, excluding the former non-odontogenic differential diagnoses (Fig.  2 A-B).

Incisional biopsy (hematoxylin/eosin stain and immunohistochemistry). A , monomorphic spindle cell proliferation against a myxoid background and a well-vascularized stroma ( 10x ). B , weakly positive reaction for α -SMA ( 10x )

Considering the age and a favorable prognosis, an intraoral enucleation under general anesthesia was planned. Radiology data was segmented to create an anatomical 3D-printed model (Fig.  3 A-B ). Surgery was executed by a senior experienced maxillofacial surgeon without complications, with preservation of the inferior alveolar nerve and no need for bony reconstruction (Fig.  3 C).

Anatomical 3D-printed model and intra-operative picture. A-B , 3D-printed mandible model with a segmented lesion in green. C , well-demarcated lesion after retromolar intraoral access

Histopathological evaluation after marginal excision revealed a monomorphic and partly fascicular spindle cell proliferation with a partly myxoid background (Fig.  4 A-C). The complete specimen allowed us to assess better the tumor’s architecture, which showed a lobulated and biphasic morphology with alternating hypo- and hypercellular areas and a densely vascularized background. Immunohistochemistry against α-SMA turned out consistently and strongly positive, whereas the cells remained negative in stainings against calponin, desmin, MyoD1, myogenin, CK22, CK8/18, and S100. The Ki-67 index stained 5–10% of tumor cells. Morphology, immunophenotype, and site were interpreted as diagnostic for an intraosseous myofibroma (Fig.  5 ).

Resection specimen (hematoxylin & eosin staining). A , lobulated and biphasic spindle cell proliferation separated by fibrous septae with increased capillary density ( 1.6x ). B-C , the background appears slightly myxoid, the cells are monomorphic and lack higher-grade cytologic atypia (5.2x , 10x )

Resection specimen (immunohistochemistry). A , the proliferation marker Ki-67 stains 5–10% of tumor cells ( 10x ). B , the reaction against α-SMA is strongly and consistently positive ( 5.2x )

The patient has been under follow-up for 12 months, demonstrating a normal mouth opening without complaints, palsy, or paresthesia (Fig.  6 A ) . A post-operative MRI conducted six months after surgery revealed no evidence of local recurrence or tumor persistence, a regular appearance of the joint, normal adjacent soft tissues, and the expected amount of bone remodeling (Fig.  6 B ) . These findings underscore the effectiveness of the treatment and point to a favorable prognosis for the patient.

Post-operative follow-up at six months. A , clinical aspect with resolution of facial asymmetry at cheek level. B , MRI showing no recurrence or tumor persistence but signs of bone remodeling

The parents and the surgeon expressed satisfaction with the treatment, considering it well-tolerated by the patient and with aesthetic and functional maintenance. Since the successful resolution was achieved through enucleation only, diligent follow-ups remain essential.

Myofibroma is a rare benign spindle cell tumor that can occur in both soft tissue and bone in children [ 2 ]. Solitary and multicentric forms can be distinguished, although some authors consider solitary myofibroma a variant of myofibromatosis. In contrast, others believe it is a separate lesion, with the most recent classification considering it under the category of myopericytomas / perivascular tumors [ 1 ]. Maxillofacial lesions are rare, corresponding to 2% of all cases, and usually affect the soft tissues [ 3 ]. Intraosseous myofibroma of the jaw is considered rare to ultra-rare and has a preference for the mandible [ 3 , 7 ]. The age range of patients with myofibroma varies between studies from birth to older age. However, the intraosseous variant of myofibroma is characteristically seen in the first two decades of life, especially before the age of two. Therefore, an intraosseous lesion in this patient population should include intraosseous myofibroma in the differential diagnosis [ 1 , 2 , 3 ]. Although this also varies widely between studies, males are more likely to be affected, ranging from 1.2:1 to 2.3:1 1,2,3,4 . The clinical aspects of the present case are well in line with those of previously reported cases: painless swelling without any other symptoms. Myofibromas may also present with intraoral growth, ulceration, as well as a rapid size increase, and mimic a malignant tumor [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 ].

Radiographically, intraosseous myofibroma are well-defined, unilocular, and radiolucent lesions that may or may not be associated with an unerupted tooth [ 1 , 3 , 4 ]. They can exhibit a multilocular aspect, tooth resorption or displacement, cortical bone expansion, or cortical perforation [ 1 , 4 ]. The present case was classic in presentation but was already large and close to the condyle with some bone expansion and cortical perforation. Since the patient’s parents did not notice the lesion before the pediatricians’ inspection, estimation of the growth dynamics was not possible.

Definitive diagnosis is usually difficult due to the rarity of the lesion, the equivocal clinical, radiographic, and histological findings as well as the lack of specific biomarkers. Myofibroma is therefore prone to misdiagnosis with the consequent risk of overtreatment [ 1 , 4 , 6 , 7 ]. In the case presented here, the initial biopsy showed a non-specific spindle cell proliferation with only weak α-SMA staining, pointing to the differential diagnoses of odontogenic fibroma or fibromyxoma. Only the resection specimen showed the typical polylobulated biphasic architecture and stronger staining for α-SMA, allowing the correct diagnosis of myofibroma. Incisional biopsies must always be interpreted cautiously and can sometimes be misleading, particularly if dealing with lesions for which specific biomarkers are not available [ 1 , 9 ]. In the literature, even cases initially interpreted as leiomyosarcomas have been reported, resulting in overtreatment of the patient with en bloc resection [ 10 ].

Regarding the differential diagnosis before incisional biopsy, odontogenic lesions such as odontogenic keratocysts (OKCs) and unicystic ameloblastoma were considered. OKCs typically originate in tooth-bearing regions, with a high prevalence in the posterior mandible, particularly among males, as in the present case [ 11 ]. However, several distinct features differentiate OKCs from myofibromas: the age range of involvement (8–82 years, with a peak in the third decade of life), the mesiodistal growth pattern rarely exhibiting cortical expansion, and the absence of a cystic lining covered by the pathognomonic basal layer with hyperchromatic cells in palisade [ 11 ].

Although unicystic ameloblastoma is considered in the differential diagnosis because of its location and radiographic similarities to solitary intraosseous myofibroma, it is most commonly seen in the third to sixth decades of life and is much less common than its multicystic counterpart [ 12 ]. In addition, our findings after an incisional biopsy, a well-vascularized solid lesion with monomorphic spindle cell proliferation on a myxoid background, suggested a mesenchymal tumor, thereby narrowing our differential hypotheses. In contrast, unicystic ameloblastomas typically present with an epithelial lining composed of loosely cohesive cells and a basal layer of columnar or cuboidal cells with hyperchromatic nuclei, reverse polarity, and basilar cytoplasmic vacuolization, resembling the stellate reticulum [ 12 ].

Beyond odontogenic lesions, other entities that pose a greater challenge in differentiating from myofibromas include desmoplastic fibromas [ 3 ]. This rare fibroblastic tumor is often considered as the intraosseous counterpart of desmoid fibromatosis [ 4 ]. Similar to our case, desmoplastic fibromas primarily affect young patients, typically manifesting as a painless swelling in the posterior mandible, though with more aggressive and destructive behavior [ 4 , 13 ]. Additionally, its occasional unilocular radiolucent appearance, combined with a similar histopathological spindle-cell fascicular architecture, can mimic myofibromas [ 4 ]. However, the absence of a hemangiopericytoma-like vascular pattern and less consistent α-SMA positivity in desmoplastic fibromas, as opposed to the pattern and strong α-SMA positivity in myofibromas, helps in distinguishing between the two lesions [ 14 , 15 ].

The rarity of well-documented cases with long-term follow-up and the limited experience with these intraosseous lesions, in general, make it difficult to predict these lesions’ behavior and the optimal treatment/follow-up. The typical characteristics of well-defined borders, benign nature, and low recurrence rates make conservative surgery with enucleation with/without curettage the treatment of choice [ 7 ]. In addition, wide excision and extraction of associated teeth are alternative approaches [ 1 ]. Instead of a specific protocol, it has been suggested to treat benign pediatric jaw tumors according to their biological behavior, with aggressive tumors requiring resection and nonaggressive tumors requiring enucleation [ 10 ].

A minimally invasive approach seems crucial when dealing with solitary myofibroma in pediatric patients to avoid lifelong sequelae. The short follow-up is a limitation of the present report. Nevertheless, we present a rare and well-documented case, including 3D planning, and discuss specific histologic features with differential diagnosis after rigorous investigation.

Like other rare pediatric mass lesions, intraosseous myofibroma presents a diagnostic challenge due to its non-specific histopathological features, particularly in biopsy material. In addition, there are no pathognomonic molecular markers. Early recognition and correct diagnosis are essential for effective management, as misdiagnosis may be associated with overtreatment and morbidity. This report describes a well-documented case of a rare disease for which diagnosis and treatment can be challenging. It highlights the importance of meticulous histopathological examination for well-planned surgery to ensure optimal outcomes and minimal morbidity.

Data availability

No datasets were generated or analysed during the current study.

Abbreviations

alpha-smooth muscle actin

magnetic resonance imaging

computed tomography

odontogenic keratocysts

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Jose Wittor de Macedo and Benito K. Benitez contributed equally to this work.

Andreas A. Mueller and Florian M. Thieringer contributed equally to this work.

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Oral and Craniomaxillofacial Surgery, University Hospital Basel, Spitalstrasse 21, Basel, 4031, Switzerland

José Wittor de Macêdo Santos, Benito K. Benitez, Daphne Schönegg, Andreas. A. Mueller & Florian M. Thieringer

Pediatric Maxillofacial Surgery, University Children’s Hospital Basel, Spitalstrasse 33, Basel, 4031, Switzerland

Benito K. Benitez & Andreas. A. Mueller

Bone Tumor Reference Center, Basel Research Centre for Child Health, Institute of Medical Genetics and Pathology, University Hospital Basel, Spitalstrasse 21, Basel, CH-4031, Switzerland

Daniel Baumhoer

Department of Otolaryngology, University of Florida, 1345 Center Drive, Box 100264, Gainesville, Florida, 32610, USA

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JWMS and BKB reviewed the patient’s chart and wrote the original draft. BKB performed the initial and follow-up consultation. BKB, DS, and TS performed the surgery and reviewed the manuscript. DB reviewed the manuscript and conducted histopathological and immunohistochemical exams. AAM and FMT supervised and reviewed the manuscript. All authors participated in drafting or revising this manuscript. All authors read and approved the final manuscript.

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de Macêdo Santos, J.W., Benitez, B.K., Baumhoer, D. et al. Intraosseous myofibroma mimicking an odontogenic lesion: case report, literature review, and differential diagnosis. World J Surg Onc 22 , 246 (2024). https://doi.org/10.1186/s12957-024-03520-4

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• Systematic Review
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• Published: 04 September 2024

Epidemiology and clinical characteristics of breast cancer in Ethiopia: a systematic review

• Firaol Guyassa Dandena 1 , 2 ,
• Berhanetsehay Teklemariam Teklewold 2 ,
• Tadele Dana Darebo 3 &
• Yisihak Debodina Suga 2  

BMC Cancer volume  24 , Article number:  1102 ( 2024 ) Cite this article

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According to GLOBOCAN 2020 Breast cancer is the most common cancer among women and the prevalence is increasing worldwide and in Ethiopia. This review assessed studies conducted in Ethiopia on the clinical features and epidemiology of breast cancer.

Data base search conducted PubMed, Google Scholar African Journals Online (AJOL), Cumulative Index of Nursing and Allied Health Literature (CINAHL) and Hinari without time restrictions. The search keywords included; prevalence and pattern, clinical presentation, histological and molecular subtypes, and management. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline to identify, search, extract articles, and report this systematic review. The protocol was registered in PROSPERO, ID: CRD42023403320.

Twenty studies were included in the review with 33,369 participants and 3 were community-based and 17 were hospital-based. In all except two reviewed studies, breast cancer is the most common cancer among women of Ethiopia. The most frequent presenting symptom was a breast lump/mass and commonly affected side was right breast. Most patients presented at a late stage and they were premenopausal age group. The commonest histology type is ductal carcinoma, that the most prevalent receptor was estrogen receptor positive, and the most common molecular subtype was Luminal A in pathology samples. Surgery is main stay of treatment and the most common surgical technique practiced in Ethiopia is modified radical mastectomy.

Breast cancer incidence is rising, and it accounts for the major cancer burden in the country. There is a need for additional awareness-raising and health education because delayed presentation are critical problems throughout Ethiopia. For planning and monitoring cancer patterns, comprehensive demographic and clinical data from a population or facility-based registry are needed in the regions. The available treatment options are still limited in Ethiopia it needs infrastructural development.

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Introduction

The World Health Organization (WHO) report shows that in 2020, 2.3 million women were diagnosed with breast cancer, making it the most common cancer with 685,000 deaths worldwide. It continues to cause more disability-adjusted life years (DALYs) in women worldwide than any other cancer. Deaths from breast cancer are high in African countries due to poor health infrastructure, poor vital records, delayed health-seeking behavior, and low community awareness [ 1 ].

Breast cancer incidence and mortality rates in the world have increased over the last three decades. Study done on Breast cancer incidence and mortality from 1990 to 2016. In 60 out of 102 countries, the incidence of breast cancer has more than doubled, while the death rate has doubled in 43 out of 102 countries [ 2 ]. By 2030, it is predicted that there will be 2.7 million new cases worldwide each year and 0.87 million deaths from breast cancer [ 3 ].

A country assessment showed that breast cancer is the most common cancer illness in Ethiopia, accounting for 16,133 (20.9%) of all cancer cases and 9,061 (17.5%) of all cancer-related deaths [ 4 ]. Approximately 80% of breast cancer cases in sub-Saharan Africa are detected at late stages (stage III or IV), compared to 15% in high-income countries [ 5 ].

Breast cancer arises from the epithelium lining the milk ducts, known as invasive ductal carcinoma. This is the most common subgroup (50–80%), followed by the group arising from the glandular tissue of the breast lobules [ 6 ]. Based on mRNA gene expression levels, breast cancer can be classified into molecular subgroups. The four main intrinsic subtypes of breast cancer (Luminal A, Luminal B, HER2-enriched, and basal-like). Regarding Hormone status of breast cancers ER-positive tumors account for almost 70% of all breast cancers in Western populations [ 7 , 8 ]. The TNM system for cancer staging refers to the classification of a tumor based on a list of factors, including the degree of disease affecting the main tumor (Tis to T4), regional lymph node status (N0 to N3), and distant metastases (M0 or M1) (0 to IV) [ 9 ].

When choosing a treatment plan, the type of breast cancer and its stage are often considered. Patients with breast cancer are often given several types of treatment. The current choices are radiation therapy, surgery, chemotherapy, hormonal therapy, biological therapy, and chemotherapy [ 10 ]. According to studies from underdeveloped countries, stage I and stage II have five-year survival rates of 90% and 65%, respectively, while stage III and stage IV have rates of only 33% and 6%, respectively [ 11 ].

Until April 2022, the Tikur Anbesa Specialized Hospital (TASH) was the only center in the country that offered radiotherapy. As of April 2022, Ethiopia has two additional functional radiation therapy centers: Jimma University Medical Center (JUMC) in the southwest of the country and Hiwot Fana Specialized Hospital at Haramaya University in the eastern part of the country.

Rationale of the study

Based on a preliminary search, we couldn’t find compressive evidence at the country level regarding breast cancer patients’ epidemiology and clinical profile. Therefore, a thorough examination of the existing evidence on breast cancer would aid in understanding breast cancer epidemiology and clinical profile in the country. This review provides evidence for the development of future strategies that are especially suited to the Ethiopian population.

Study objective

This study aimed to generate country wide evidence on epidemiology and clinical characteristics of breast cancer in Ethiopia.

The PROSPERO international prospective register of systematic review database checked for already-done or ongoing systematic reviews with the same objective before the data collection process started. The protocol of this review is registered in ID: CRD42023403320. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline to identify, search, extract articles, and report this systematic review [ 12 ].

Search strategy

The electronic databases and search engines PubMed, Google Scholar African Journals Online, Cumulative Index of Nursing and Allied Health Literature and Hinari were searched until June 20, 2023. The MeSH terms and key words were as follows: breast cancer, breast neoplasm, prevalence, epidemiology, Sign, Symptom Presentation, histology, molecular subtype, and management of breast cancer. The MeSH keywords were combined using Boolean operators (AND/OR), and Ethiopia’s name was appended at the end. To enhance the number of articles included and lower the number of missing articles, hand searching was done on the citations and references listed in the eligible articles ( Tables  1 and 2 ).

Eligibility criteria

Selection of study and extraction.

As shown in the PRISMA flowchart, all articles identified from the electronic database searches were imported into Zotero and Duplicates were removed. Further Exclusion of articles conducted using title and abstract screening. Articles with full text were assessed for eligibility and further full text exclusion done on those articles which do not have a clearly written result. FGD and BTT extracted data simultaneously and independently, and any disagreements were resolved after independent review by the TGD and YDS. Finally, we extracted relevant information from each literature using an Excel spreadsheet template to avoid missing important information when preparing the results of the review or for future cross-checking. The extracted data includes first author’s name, year of publication, study design, location, prevalence and pattern, Presenting Symptom, Stage at presentation, Histology findings, Molecular Features and Treatment.

PRISMA flowchart for article Search and Selection Process

Data analysis

The extracted data were further categorized into institution-based and community-based according to the setting in which the studies took place and further sorted according to the institution in which the studies were conducted. The methodological quality of the included studies was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist [ 13 ].

Study selection and characteristics

A total of 352 articles were found from electronic data base searching on the search engines and databases. All of these search results exported to Zotero computer software, where 140 duplicate records were removed and 149 were removed after being screened based on title and abstract. Further 43 articles were removed based on an objective of the review. Finally, 20 eligible articles, which enrolled 33,369 participants, were included in the systematic review (Fig.  1 ).

Most of the studies were conducted in Tikur Anbesa specialized hospital (TASH)(6/20), which was only hospital with radiotherapy treatment in the country until April 2022. Articles based on the study setting: 3 (15%) articles were community-based, and 17 (85%) articles were hospital-based. Based on study design, 9 (45%) articles were cross-sectional, 10 (50%) retrospective chart reviews, and one retrospective cohort.

Prevalence and pattern

Five studies assessed the prevalence and pattern of breast cancer in the country. All hospital-based studies showed the prevalence of breast cancer compared to other cancers. Breast cancer accounts for 15.2–26% of all cancers [ 14 , 15 ] and from female cancer 29.3–37% [ 11 , 16 ].

A community-based study done using the Addis Ababa City Cancer Registry (AACCR) showed the incidence of breast cancer (2012–2013) to be 31.5% of all female cancers [ 17 ] and a study done during 2012–2015 from AACCR and six regions showed breast cancer constituted 33% of all cancers in women and 23% of all cancers [ 18 ].

According to a study done at Hawassa University Comprehensive Specialized Hospital (HUCSH) from 2013 to 2019, the number of women diagnosed with breast cancer in hospitals has increased from 69 (12.3%) In 2013, 106 (19%) in 2019 [ 19 ].

A study from Gondar University Comprehensive Specialized Hospital (GUCSH), showed breast cancer accounts for 76 (14.1%) of all cancers [ 15 ] and finding from TASH showed breast cancer accounts for 26% of female cancers [ 14 ].

A study conducted at St. Paul’s Hospital Millennium Medical College (SPHMMC), of all malignancies, breast cancer accounted for 587 (29.3%) in 2019, making it the second most common disease after cervical CA [ 16 ].

Presenting symptom

Fourteen studies reported Age at diagnosis. The median age ranges 38-55.8 years [ 19 , 20 ] and mean age ranges 42.1–47.5 years [ 16 , 21 ].

Premenopausal patients represent the majority of female breast cancer patients at the time of diagnosis, with the median age being between 40 and 46 years (14,15,17,19,23,2829). Breast lumps or masses were the most common presenting symptoms in all studies, followed by breast pain and ulceration [ 20 , 22 , 23 , 24 , 25 ]. A study conducted at the GUCSH, where 65 (79%) patients presented with breast mass and breast ulceration in 15 patients (18%) [ 26 ].

Similar findings from two university hospitals (Gondar and Felege Hiwot University Comprehensive Specialized Hospital) (GUCSH and FHCSH) revealed that breast lump or mass was the most common presentable symptom in 328 (88.4%), followed by painful wound in 161 (43.4%) [ 22 ].

A study at Dessie Referral Hospital (DRH) showed 117 (57.4%) patients presented with breast lumps, followed by breast pain in 70 (34.3%) [ 25 ]. A multicenter study in Addis Ababa showed that breast lumps were found in 344 (78.0%) patients, followed by pain in 53 (10.2%) patients [ 24 ].

Regarding lymph node involvement, the findings from GUCSH and FHCSH showed that (320, 86.3%) and DRH 30, (14.7%), had a lymph node involvement at presentation [ 22 , 25 ]. According to studies done at the GUCSH and TASH, breast CA commonly affects the right breast 48 (59%), and, 160 (38.4%) respectively ( 26 , 19 and 27 )and unlike others finding from HUCSH showed left breast in is commonly affected 302 (54%), and the upper outer quadrant was the most commonly involved according to the findings from TASH 154 (78.2%) ,40 (9.6%) [ 27 , 28 ].

Stage at presentation

Nine studies included stage at presentation. Eight studies showed most of the patients presented in late stages (stage III and stage IV), and the prevalence of advanced stages ranges from 57 to 71.2% in ( 22 , 19 , 29 , and 25 ). This was shown in a study conducted in GUCSH and FHCSH, in which 53 (14.3%) patients were diagnosed at stage IV and 211 (56.9%) patients were diagnosed at stage III [ 22 ]. According to HUCSH findings, 24 (12.2%) were diagnosed with stage IV disease, 113 (57.4%) with stage III disease, and 160 (30.4%) with early-stage disease [ 19 ].

Findings from DRH showed 82 (40.2%) and 53 (25.5%) were diagnosed with stage IV and stage III, and early stage presentation was 69 (33.8%) [ 27 ]. TASH stages at diagnosis: 74 (57%) were diagnosed at stages III and IV. Stage III: 63 (48.5%); Stage IV: 11 (8.5%) [ 29 ].

Unlike the previous papers, a finding from the TASH showed that the majority of patients 56(59%) of patients presented with early and late stages accounted for 40(41%) [ 30 ].

Histology findings

Nine studies included histologic findings and in all reviewed studies, ductal carcinoma is the most prevalent histology type. The prevalence of ductal carcinoma in studies done in SPHMMC, (GUCSH and FHCSH), GUCSH, and HUCSH studies was 479 (81.6%), 347 (93.5%), 61 (74%), and 156 (79.2), respectively [ 16 , 22 , 26 , 28 ]. Out of nine studies 5 studies were from TASH. Ductal carcinoma is the most common histology type in TASH, followed by lobular carcinoma, with a prevalence ranging from 55.3 to 83.7% [ 20 , 27 , 29 , 30 , 31 ].

Regarding the level of differentiation, studies conducted in TASH and HUCSH, showed that moderate differentiation carcinoma is the commonest type (177 (31.7%) and 91 (46.2%), followed by poor differentiation (155 (27.7%) and 72 (36.5%), respectively [ 28 , 31 ]. Unlike the previous study findings, those from northern Ethiopia (GUCSH and FHCSH) and GUCSH showed that poor differentiation was the most common among types 140 (45.6%) and 30 (37%), followed by moderate differentiation in patients 79 (40.7%) and 14 (17%), respectively [ 22 , 26 ].

Molecular features

Two studies from TASH looked at the prevalence of hormone receptors and molecular subtypes. Both papers showed that the most prevalent receptor was estrogen receptor positive, and the most common molecular subtype was Luminal A in pathology samples. In a study from TASH in 2018, the prevalence of estrogen receptor positivity was 74 (65%), progesterone receptor positivity was 49 (43%), and HER2 positivity was 26 (23%). Regarding molecular subtype, the prevalence of Luminal A (ER + and/or PR+, HER2-) was 45 (40%), Luminal B (ER + and/or PR+, HER2+) was 30 (26%), HER2-enriched (ER-, PR-, HER2+) was 11 (10%), and Triple Negative/Basal like (ER-, PR-, HER2-) was 26 (23%) [ 30 ]. In a similar study from the same institution (2017), 137 biopsies were found to be ER+ (65.5%), PR+ (58%), and HER2 positive (28%) in a study, and the prevalence of molecular subtypes was shown to be Luminal A (54%), Luminal B (22%), HER2-enriched (6%), and Triple 29 Negative/Basal-like (18%) [ 29 ].

Studies included in this review Reported modalities of treatment, including surgery, chemotherapy, radiotherapy, and hormonal therapy. Surgery remain the mainstay of management in many settings in Ethiopia, and the most prevalent surgical technique was modified radical mastectomy (MRM) [ 19 , 22 , 25 ].

Finding from GUCSH showed, surgery was done for all 82 patients of which 51 (62%) of patients underwent MRM, and 79 (96%) received chemotherapy. The commonest chemotherapy regimen is Adriamycin and Cyclophosphamide (AC). Hormonal treatment given to 60 (73%) and Tamoxifen 18 (22%) was the commonest type [ 26 ].

Surgery was performed in 357 (96.2%) patients by two university hospitals (GUCSH and FHCSH); chemotherapy was performed in 163 (43.9%); and hormone therapy was performed in 50 (13.5%) [ 22 ].

According to a study conducted at HUCSH, chemotherapy provided for all 559 (100%) patients and Doxorubicin, cyclophosphamide, and paclitaxel were the chemotherapy regiment was commonest. Hormonal therapy provided 168(30%) and Tamoxifen regiment was commonest hormonal therapy patients, and surgery (modified radical mastectomy) was done for 196 (35.1%) [ 19 ].

Chemotherapy was given for 275 (90.7) patients in TASH in 2019, with the most prevalent regimen being 5-fluorouracil, doxorubicin, and cyclophosphamide (FAC) in 66.9% of cases. Surgery was done for 257 (85%) , combination therapy (surgery, chemotherapy, and palliative care) delivered to 189 (55.8%) and Radiotherapy was provided for 107 (35%) [ 21 ].

A similar study from TASH on 2013 Surgery was done for 902 (87%), and the majority had a modified radical mastectomy of 880 (95%). The majority of patients 893 (83%) also received chemotherapy, mainly anthracycline-containing chemotherapy (FAC)782 (73%). Hormonal therapy provided for 864 (81%) [ 31 ].

According to a study conducted at ACSH, 121 (65.1%) patients had surgery and 33 (17.7%) had chemotherapy, while the rest had both surgery and chemotherapy [ 30 ]. In TASH(2017), 192 (74%) patients received surgical intervention, the commonest being mastectomy 126, (65.6%); radiotherapy was provided for 53 (20.5%); and chemotherapy was provided for 231 (89.2%) patients [ 29 ].

Breast cancer is the most common type of cancer in Ethiopia in most reviewed studies, where the prevalence ranges from 15.2 to 26% from all cancers [ 14 , 15 ] and from female cancer 29.3–37% [ 11 , 16 ]. The pattern of breast cancer is increasing in Ethiopia. A study from HUCSH showed the breast cancer rate in hospitals has increased from 69 (12.3%) in 2013 to 106 (19%) in 2019 [ 19 ] and Results from TASH showed changes in breast cancer between 1997 and 2012, with a prevalence in 2012 has increased by more than seven times compared 1997 [ 32 ].

finding from different studies support this review’s finding which shows incidence increased by 1.44% per year from 1990 to 2017 and as for regional changes in incidence, all regions of breast cancer had increased incidence except North America, and the Middle East and North Africa had the largest increase in overall incidence [ 33 ]. In a similar study conducted between 2000 and 2012, incidence rates of breast cancer increased in South Korea, China, and the United Kingdom while decreasing in the United States [ 34 ]. The breast cancer incidence in Africa continues to increase and is projected to double by 2050.

This review showed commonest age group was from 40 to 46 years ( 7 , 22 , 23 , 21 , 16 , 28 , and 20 ) which similar finding other African studies [ 35 , 36 , 37 ].

Regarding stage at presentation, most of the patients presented with late stages (stages 3 and 4), with a prevalence range of 57–71.2% [ 19 , 22 , 25 , 29 ]. which is supported by papers from Africa showed with 89.6% and 72.8% of breast patients in Kenya and Nigeria respectively presenting with advanced stage disease [ 38 , 39 , 40 ]. Studies in South Africa reported an advanced stage breast cancer incidence of 50 and 55% [ 40 ]. This review showed that early-stage (stages I and II) accounts for 15–35% [ 6 , 8 , 15 , 27 ]. Similar findings were found in other developing countries, where only 20–50% of patients in the majority of low- and middle-income countries were diagnosed in these earlier stages [ 39 ].

Breast lump or mass is the most common presenting symptom in all studies from various parts of the country, ranging from 57.4 to 88.4% [ 22 , 24 , 25 , 26 ].

Regarding histological findings of breast cancer in Ethiopia, the commonest histology is ductal carcinoma, followed by lobar carcinoma in all reviewed research and prevalence ranges (55.3–93.5%) [ 16 , 20 , 22 , 26 , 27 , 28 , 29 , 31 , 41 ].

The prevalence of hormone receptors and molecular subtypes is high; estrogen receptor positivity is the most common receptor and is found in more than 65% of breast cancer patients. In terms of molecular subtype, Luminal A (ER + and/or PR+, HER2-) is the most common finding in breast cancer biopsies, accounting for more than 40% of cases, while Triple Negative/Basal-like cases account for more than 15% of cases [ 20 , 29 ]. Similar finding from studies from south Africa showed Estrogen Receptor is the commonest hormone receptors [ 39 , 40 ].

This review showed surgery is the mainstay treatment for breast cancer in Ethiopia, and radiotherapy is only provided in the capital city on TASH. A similar study from Africa showed a mastectomy rate greater than 85% and a huge difference from Europe’s breast cancer mastectomy of 30% [ 41 ].

Limitations of the study

Only English language articles were included.

Conclusion and recommendation

This review summarized the epidemiology, clinical and histological characteristics, and treatment modalities of breast cancer in Ethiopia. Breast cancer incidence is rising, and it accounts for the major cancer burden in the country. There is a need for additional awareness-raising and health education because delayed presentation is a critical problem throughout Ethiopia. For planning and monitoring cancer patterns, comprehensive demographic and clinical data from a population- or facility-based registry are needed. Currently, only one exists in the capital, the Addis Ababa City Cancer Registry (AACCR). There is a need to establish and strengthen histologic and pathology labs, as most hospitals are doing surgeries without histologic, molecular, or receptor identification since it helps with targeted therapy, according to what current best practice suggests. The available treatment options are still limited in Ethiopia; it needs Expanding radiation facilities is a major step toward improving outcomes for breast cancer patients.

Data availability

All data generated or analysed during this study are included in supplementary file .

Abbreviations

Addis Ababa City Cancer Registry 

Ayder Comprehensive Specialized Hospital

• Breast Cancer

Dessie Referral Hospital

Ethiopian Public Health Institute

Estrogen Receptor

Felege Hiwot Comprehensive specialized hospitals

Gondar University Comprehensive Specialized Hospital

Human Epidermal Receptor

Hawassa University Comprehensive Specialized Hospital

Institutional Review Board

Jimma University Medical Center

Low- and Middle-Income Country

Medical Subjects Headings

Modified Radical Mastectomy  

Progesterone Receptor

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

St. Paul’s Hospital Millennium Medical Collage

Tikur Anbesa specialized hospital

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Firaol Guyassa Dandena

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Firaol Guyassa Dandena, Berhanetsehay Teklemariam Teklewold & Yisihak Debodina Suga

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Tadele Dana Darebo

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FGD and BTT developed the protocol, reviewed the reference list, extracted data, and conducted the analyses. TDD and YDS assessed the quality of the data, ensured the absence of errors and arbitrated in case of disagreement. FGD developed the draft manuscript and TDD critically reviewed it. All authors have read and agreed to the published version of the manuscript.

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Dandena, F.G., Teklewold, B.T., Darebo, T.D. et al. Epidemiology and clinical characteristics of breast cancer in Ethiopia: a systematic review. BMC Cancer 24 , 1102 (2024). https://doi.org/10.1186/s12885-024-12822-5

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DOI : https://doi.org/10.1186/s12885-024-12822-5

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Supply chain trends 2024: The digital shake-up

With digital opportunities sweeping the supply chain landscape, readiness and line of sight will be paramount to success

Advanced technologies are shaking up the supply chain world. With quickly evolving capabilities across generative AI, data analytics, automation, machine learning, Internet of Things (IoT), blockchain and more, the ‘smart’ supply chain is well on its way to becoming the new normal.

Enabled with a raft of technology developments, a new paradigm is emerging in supply chain management. One where organizations can respond quicker to day-to-day requests, proactively address problem solving, and reduce errors and inefficiencies. It can also provide greater visibility, transparency and traceability. Most importantly, organizations will be more resilient to future supply chain shocks.

With a future that promises autonomous, self-learning machines seamlessly managing the broader supply chain process, now is the time for organizations to overcome the inherent silos and enterprise systems that will restrict their progress.

To get started, organizations need to first embrace the trends that will define 2024. This includes learning about emerging technologies from AI to distributed ledger technologies, low-code and no-code platforms and fleet electrification. This will need to be followed by managing the migration to a new digital architecture and executing it flawlessly.

Organizations will need to intensely focus on mining relevant, clean and well-governed data if they want to make the most of their new technology investments. Data will also be crucial as organizations are pressured to meet evolving ESG and Scope 3 commitments.

These structural trends will shape new operating models and improve broad processes. To avoid being left behind, it is important for organizations to understand these trends and apply specific actions to begin their transformation sooner rather than later. This way they can create a more agile and responsive supply chain that can capture the promise of value creation, cost reduction and improved shareholder value.

Trend 1: Generative AI in operations

Generative AI (GenAI) is a subset of AI that has the potential to revolutionize supply chain management, logistics and procurement. Software engines powered by GenAI can process much larger sets of data than previous forms of machine learning and can analyze an almost infinitely complex set of variables. GenAI can also  learn  —and teach itself — about the nuances of any given company’s supply chain ecosystem, allowing it to refine and sharpen its analysis over time.

The list of opportunities for GenAI is extensive. It can help ensure procurement and regulatory compliance, streamline, and enhance the efficiency of manufacturing production workflows, or enable virtual logistics communication by using virtual assistants to handle routine inquiries and provide quick responses.

The use of AI is an enterprise-wide consideration, organizations must avoid dissipating effort across several single point disconnected AI implementations. Core business processes should be strategically rethought and redesigned to effectively leverage GenAI.

Key actions to take in 2024 include:

Planning professionals need to increase their skills in analytical modeling capability, cross-functional expertise, and relationship management to maximize collaboration.

Make decision-making a business discipline: Be performance led: Start with performance goals – Don’t let technology dictate your decisions.

Blend expertise with data analytics: Inject data into your existing processes. Data management will be critical to success

Develop an ecosystem of technology partners, business integrators, and academic experts to access skilled individuals.

Through 2024, 50% of supply chain organizations will invest in applications that support artificial intelligence and advanced analytics capabilities. 1

Trend 2: AI enabled no touch / low touch planning

With the continued focus on resilience and ESG coupled with the expansion of sites, flows, and partners, the pressure on supply chain planning is increasing. Existing planning capabilities have been unable to meet the demands of a more complex, multi-tiered, more nuanced world. The result is few companies can run effective scenario analysis to determine the financial consequences of important decisions.

AI enabled sales and operational planning (S&OP) and integrated business planning (IBP) applications will help eliminate the gap between supply chain planning and execution. Low touch planning will take large swaths of manual work out of the end-to-end planning process and leverage the power of advanced analytics to answer deeper questions with minimal human intervention. AI will be able to analyze data at scale, identify anomalies, search for patterns that lead to unexpected disruptions, and make suggestions on how to solve them—almost instantaneously.

From a technology perspective, the capabilities to enable low touch planning are like a control tower or its more advanced counterpart, the cognitive decision center which includes digital twin capabilities. These promise improved predictability, enhanced gross margins and free up resources to focus on value adding activities.

Low touch planning, improves predictability enhancing Return on Equity (ROE) by 2 to 4 percentage points, and adds 1 to 3 percent to gross margins across revenue, cost, and assets 2

Trend 3: The critical role of data

Data is still one of the core challenges facing supply chain management. Each day millions and millions of date records are generated across the supply chain from multiple systems. The proliferation of digital technologies, IoT devices, and advanced tracking systems have compounded the problem. This wealth of data has given rise to greater silos of data within the organization which in turn has led to disconnected data sets. Duplication and misinterpretation will become increasingly problematic, too. Critically, the fragmentation of data impedes the creation of a holistic view of the organization’s supply chain.

Consequently, data availability, quality, cadence, and consistency – are now critical considerations. Supply chain professionals must manage the complexities within their data landscape efficiently; to be able to make informed decisions and enhance their operations.

A solution is to adopt a use case-driven approach to proactively address data quality issues. By focusing on specific use cases, organizations can prioritize data quality improvements where they matter most, thereby gradually refining and improving their datasets.

Placing a laser focus on the critical elements of data availability, quality, reliability, cadence, and consistency. Data is the linchpin that enables businesses to make informed decisions, optimize processes and ensure resilience in the face of disruptions

Acknowledge that data management is an ongoing journey rather than a one-time destination.

Take an iterative approach to data management. This allows organizations to refine their data strategies, adjust to changing circumstances, and learn from experience.

Develop a value-driven roadmap. Data must be aligned with a clear purpose and tied to value generation, such as cost savings, enhanced efficiency, improved customer satisfaction and innovation.

Low touch planning, improves predictability enhancing Return on Equity (ROE) by 2 to 4 percentage points, and adds 1 to 3 percent to gross margins across revenue, cost, and assets 3

Trend 4: Transparency and visibility beyond Tier 1 and 2

The lack of visibility across the layered tiers of a supply chain has major implications for organizations across industries, particularly for meeting regulatory requirements, and for the identification and mitigation of supply chain risks.

Breaking the barrier of visibility beyond Tier 1 allows organizations to look across their extended supply chain into partners, build greater and deeper insights into root causes, identify new risks that occur further into the supply chain and drive ESG goals through better traceability and transparency.

Technology tools such as control towers and digital twins can surface critical sub-tier supplier relationships, highlight common sub-tier suppliers, factory locations and provide clear insight into the depth of an organization’s supply chain. When implemented at scale they can improve supply chain resilience.

Move towards a more collective and data-driven approach by using technology solutions and partnerships. Extend visibility of product flows to create more in-depth views of the supply chain ecosystem.

Create cross-functional teams to provide a fuller picture of key use cases, the scope of visibility and surfacing downstream problems.

Build on the visibility of others – with organizations each embarking on their own projects and control towers to build visibility, explore partnerships that may provide access to a wealth of data and insights.

Embed ESG measures within the technology for improved procurement decision making and performance management, and incorporate ESG performance metrics into supplier evaluations or scorecards.

Less than half (43%) Forty-three percent of organizations have limited to no visibility of tier one supplier performance 4

Trend 5: Low-code platforms

A supply chain is a dynamic and complex process that includes provisioning, raw material supply, warehousing and the distribution of manufactured products to consumers. Historically, this has resulted in multiple systems and data sources. Implementing software change in this environment is time consuming with a high probability of errors.

Most supply chain tasks can be fully or partly automated through low-code platforms, which use a wide range of Application Programming Interfaces (APIs) and pre-packaged integrations to link previously separate systems. These cut the development time, enabling companies to swiftly react and adapt their applications to new market conditions, disruptive events, or changing strategies. It enables business users with little technical knowledge to quickly build, test and implement new capabilities.

Potential applications span planning, manufacturing, product life cycle, supply chain collaboration, and track and trace. Low-code platforms are not just a technological upgrade; they represent a paradigm shift in how organizations approach their operations providing a pathway to a more agile and adaptable future.Consequently, data availability, quality, cadence, and consistency – are now critical considerations. Supply chain professionals must manage the complexities within their data landscape efficiently; to be able to make informed decisions and enhance their operations.

Define and document cross-functional processes, tasks, and timelines – identify suitable use cases..

Leverage low-code apps to go from managing supply chains to building agile, resilient and predictable supply chains.

Use low-code platforms to modernize legacy systems, automate processes and connect disconnected systems.

Empower stakeholders and business domain experts to create apps for insights, actionable tasks and collaboration in the supply chain.

More than two-thirds of enterprises have already adopted low-code to their supply chains 5

Trend 6: ESG and Scope 3 emissions

While many businesses have traditionally prioritized the collection of their Scope 1 (direct emissions) and Scope 2 (purchased electricity) emissions data, the focus has now shifted decisively toward Scope 3 emissions – that is, emissions incurred throughout the entire value chain. Although voluntary to date, the collection and reporting of Scope 3 emissions data is becoming a legal requirement in many countries.

Establishing a solid emissions baseline is essential for monitoring progress and setting ambitious reduction targets. Scope 1 and Scope 2 emissions are relatively straightforward to assess however, when extending this to the full supply chain, as in Scope 3, the complexity multiplies exponentially.

To target reductions in carbon emissions, companies need primary sources of information from their suppliers, and are starting to use hybrid carbon accounting methodologies to produce a more accurate assessment of Scope 3 emissions. Digital platforms are providing a centralized system for suppliers to input their emissions data, which can then be easily integrated into a company’s sustainability reporting.

Carry out supplier segmentation based on key criteria such as spend and criticality to business to identify and prioritize supply chain categories.

Establish and implement a supplier engagement program. Start educating suppliers about the significance of Scope 3 emissions data capture and your sustainability goals.

Analyze technology solutions for collecting carbon emissions data from your suppliers. Identify technology options that work for the size of your business and your industry and start implementation. Investing into technology solutions now will lead to cost savings in the long run.

Educate and support employees in understanding Scope 3 emissions, carbon reduction approaches and technology solutions to collect and manage carbon data. It is vital that a change management strategy is built into the decarbonization action plan.

Only 5% of supply chain emissions stem from direct manufacturing, whereas emissions originating within the supply chain can be 5 to 10 times greater 6

Trend 7: Electric vehicles, transport and logistics

The logistics sector is also undergoing rapid transformation. Some elements of future-ready transport and logistics networks are already in evidence such as the automation of warehouses and ports, and the increasing use of autonomous vehicles. Their adoption will expand as organizations commit to emissions reduction targets and battery technology evolves to extend distance limits for electric trucks, buses and delivery vehicles.

Organizations will continue to accelerate the electrification and automation of the logistics transport value chain – especially those that remain costly or manual, such as processing of air freight and last mile delivery. Similarly, the transition from autonomous vehicles overseen by humans to fully automated vehicles without human intervention is almost ready to expand from controlled closed-loop environments to public roads.

Smart logistics and transport will also be accelerated with the continued ramp-up of AI, IoT, data analytics and cloud across many use cases – improving traditional route optimization and applying machine learning, predictive and sensing capabilities to make material improvements to network efficiency, customer experience, risk reduction and sustainability targets.

Conduct a fleet assessment to evaluate fleet composition, routes and usage patterns to identify opportunities for electrification, prioritizing vehicles that travel frequently in urban areas.

Identify broad transport and logistics automation opportunities to automate labor-intensive activities.

Analyze data from vehicle telematics, IoT devices, delivery data, customer satisfaction and sustainability information to drive decisions.

Develop a plan to transition delivery fleets to electric vehicles. New cloud-based AI driven technologies can simulate future transport network designs to optimize routes that reduce distance driven and prioritized routes and vehicles for electrification.

Embed sustainability at every step by looking across sourcing, planning, making, delivering and returns for opportunities to reduce vehicle tailpipe emissions.

Battery electric commercial vehicles (BECVs) could reach between15% and 34% sales penetration by 2030 7

As we stand on the brink of 2024, the supply chain landscape is on the cusp of profound transformation. AI and other advanced technologies are quickly reshaping the very core of supply chain management. KPMG professionals believe organizations with the right approach and culture can harness these seismic shifts.

In 2024 organizations could gain fundamental opportunity by focussing on the strategic application of GenAi, adopting a low-touch planning approach, striving for data excellence and transparency, adapting to low-code platforms, prioritizing Scope 3 ESG data reporting, and planning for the electric future. Time is of the essence, and those who are ready and willing to adapt quickly will be better able to unlock value, reduce costs and embrace new models of success.

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1  https://www.gartner.com/en/articles/gartner-predicts-the-future-of-supply-chain-technology

2  KPMG case study analysis

3  https://www.prnewswire.com/news-releases/global-big-data-markets-report-2022-2027-challenges-and-opportunities-technologies-and-business-cases-regulatory-issues-industry-vertical-applications-companies-and-solutions-301471783.html

4  https://kpmg.com/uk/en/home/insights/2021/07/the-future-of-supply-chain.html

5  https://www.bloomberg.com/press-releases/2019-08-12/low-code-is-the-future-outsystems-named-a-leader-in-the-2019-gartner-magic-quadrant-for-enterprise-low-code-application

6  https://www.weforum.org/agenda/2021/01/tackling-supply-chain-emissions-is-a-game-changer-for-climate-action/

7  https://supplychaindigital.com/articles/logistics-readying-itself-for-ev-revolution

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