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Definition: A literature review is a systematic examination and synthesis of existing scholarly research on a specific topic or subject.

Purpose: It serves to provide a comprehensive overview of the current state of knowledge within a particular field.

Analysis: Involves critically evaluating and summarizing key findings, methodologies, and debates found in academic literature.

Identifying Gaps: Aims to pinpoint areas where there is a lack of research or unresolved questions, highlighting opportunities for further investigation.

Contextualization: Enables researchers to understand how their work fits into the broader academic conversation and contributes to the existing body of knowledge.

tl;dr  A literature review critically examines and synthesizes existing scholarly research and publications on a specific topic to provide a comprehensive understanding of the current state of knowledge in the field.

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❌ An annotated bibliography

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Treatment continuation with cladribine at 5 years after initiation in people with multiple sclerosis: A case series and literature review

Affiliations.

• 1 Department of Neurosciences, Level 4 Central Wing, University Hospitals of Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK; Warwick Evidence, Warwick Medical School, Gibbet Hill Campus, Coventry, CV4 7AL, UK. Electronic address: [email protected].
• 2 Department of Neurosciences, Level 4 Central Wing, University Hospitals of Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK.
• PMID: 39180839
• DOI: 10.1016/j.msard.2024.105837

Background: Cladribine is an oral disease-modifying drug approved for the treatment of highly active relapsing multiple sclerosis (MS). The recommended number of treatment courses is two, with the courses given 1 year apart (i.e., in year 1 and year 2), followed by 2 years without treatment. Pivotal clinical trials showed that, compared with placebo, cladribine significantly reduced relapse rates, risk of disability progression and magnetic resonance imaging measures of disease activity for up to 4 years in treatment-naïve or -experienced adults with relapsing-remitting MS (RRMS). The management of patients and requirement for retreatment with cladribine beyond year 4 is unclear.

Methods: We describe the treatment history and outcomes of three people with MS retreated with cladribine, given as a third course 5 years after treatment initiation. We also include a review of evidence on retreatment with cladribine from year 3 onwards and a discussion of patient selection criteria for retreatment.

Results: The cases included a 53-year-old female patient with RRMS, a 43-year-old female patient with RRMS, and a 42-year-old male patient with RRMS. Six months after the third course of cladribine, all three patients were relapse-free and stable on magnetic resonance imaging, with no evidence of disease activity. At 11-12 months follow-up, all patients had clinical and radiological stability (i.e., no evidence of disease activity).

Conclusion: Continuation of oral cladribine treatment may be considered for people with MS beyond year 5 following completion of the initial two courses. Our real-world experience is ongoing and additional data are required to obtain insight into patient phenotypes which predict response to cladribine treatment.

Keywords: Case series; Cladribine; Long-term effectiveness; Multiple sclerosis; Retreatment.

Copyright © 2024 Elsevier B.V. All rights reserved.

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Declaration of competing interest None.

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Developing prerequisite skills in a cure through competency-based assignments.

Course-based undergraduate research experiences (CUREs) are increasingly popular, but less often implemented in core laboratory courses due to the strict learning objectives necessary for follow-on courses. A curricular core intermediate-level experimental biosciences laboratory course was implemented, which paired competency-based assignments with client-serving research projects to develop the prerequisite skills for upper-level courses in the context of authentic research. This CURE led to more favorable student outcomes and more positive perceptions than the previous course design. This approach was piloted at a private, research-intensive university in fall 2015 and scaled to full implementation the following year. Several considerations and the necessary resources for such a scaling are discussed.

Table of Contents – Winter 2022

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SPUR advances knowledge and understanding of novel and effective approaches to mentored undergraduate research, scholarship, and creative inquiry by publishing high-quality, rigorously peer reviewed studies written by scholars and practitioners of undergraduate research, scholarship, and creative inquiry. The SPUR Journal is a leading CUR member benefit. Gain access to all electronic articles by joining CUR.

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• Published: 24 August 2024

War and peace in public health education and training: a scoping review

• Lisa Wandschneider 1 , 2 ,
• Anna Nowak 1 , 2 ,
• Marta Miller 4 ,
• Anina Grün 1 , 2 ,
• Yudit Namer 2 , 5 ,
• Tomasz Bochenek 6 ,
• Lukasz Balwicki 7 ,
• Oliver Razum 1 , 2 &
• Colette Cunningham 3  

BMC Public Health volume  24 , Article number:  2303 ( 2024 ) Cite this article

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Armed conflict and war are public health disasters. Public health action has a crucial role in conflict-related emergencies and rehabilitation but also in war prevention and peace promotion. Translating this into public health training and competencies has just started to emerge, especially in Europe.

We conducted a Scoping Review to map and identify the role of public health education and training of public health workforce relating to the prevention of war and promoting peace, as reflected in the scientific literature. We searched in PubMed, CINAHL, PsycINFO, Embase, Web of Science Core Collections as well as the reference list of included material in English, German and Polish. Focusing initially on the European region, we later expanded the search outside of Europe.

We included 7 publications from opinion pieces to an empirical assessment of curricula and training. The educational programs were predominantly short-term and extra-curricular in postgraduate courses addressing both public health professionals in conflict-affected countries as well as countries not directly affected by war. Publications focused on public health action in times of war, without specifying the context and type of war or armed conflict. Competencies taught focused on emergency response and multi-disciplinary collaboration during emergencies, frequently drawing on experience and examples from natural disaster and disease outbreak management.

Conclusions

The scientific discourse on competences in public health education for times of war and for the promotion of peace, predominately focuses on immediate emergency response actions. The prevention of war and the promotion of peace are missing foci, that need to feature more prominently in public health training. Public Health Education and training should ensure that war prevention and peace promotion, as well as public health action in times of war, are included in their competencies for public health professionals.

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Introduction

War has profound adverse effects on public health [ 1 ].

War and armed conflict have far-reaching consequences, affecting the lives of millions of people, resulting in the loss of human life, but also in the disruption of social infrastructure such as safe food and water supplies, housing, and access to health services, leading to increased mortality and morbidity. War-torn countries and populations experience an increase in Disability Adjusted Life Years (DALYs) lost [ 2 ]. In addition, mass displacement, which disproportionately affects women, children, the elderly and vulnerable groups, exposes people to precarious living conditions and arduous travel, affecting their health and well-being. War and armed conflict have profound long-term physical and psychological consequences for those involved. They destroy communities and the fabric of society is often irreversibly undermined. This affects public health as well as legalizing and promoting violence as a way of solving problems [ 2 ]. In this paper, war and armed conflict is defined as ‘hostile contention by means of armed forces, carried on between nations, states, or rulers, or between parties in the same nation or state; the employment of armed forces against a foreign power, or against an opposing party in the state [ 3 ]. The International Committee of Red Cross (ICRC) casebook differentiates between an international armed conflict which “occurs when one or more States have recourse to armed force against another State, regardless of the reasons or the intensity of this confrontation” and a non-international armed conflict in which one or more non-State armed groups are involved (the vast majority of conflicts since 1945) [ 4 ]. Other authors differentiate wars by causes or intentions, for example imperial wars [ 5 ] or wars of annexation, such as Russia’s invasion of Ukraine. The reason is that preventive measures may be quite different. Much of the literature such as Levy et al. [ 1 , 6 ] covers armed conflict but not wars of annexation [ 2 , 7 ]. Today’s wars are often hybrid, meaning they are being fought by military as well as by destabilizing, non-military means [ 8 ]. Debates on preventing wars of annexation need to cover the role of the military, and the way in which public health relates to it, but also political determinants. For reasons of readability, however, the term ‘war’ will be used consistently throughout the text to include armed conflict and wars of annexation, as well as hybrid elements of warfare.

Conceptualizing war in public health is a relatively recent development, while international relations and defense studies have a longstanding tradition of analyzing and theorizing war and peace (e.g. [ 5 , 9 , 10 ]). Public health approaches focusing primarily on emergency response and relief care [ 11 , 12 , 13 ]. However, there is a growing shift in public health to emphasize its preventive role in peacetime, with the aim of minimizing the health impact of war on affected populations [ 14 , 15 , 16 ]. At the same time, one of public health’s major aims – reducing and dismantling (health) inequities — is also a crucial determinant for preventing armed conflict [ 17 , 18 , 19 ] presenting another valuable angle for public health’s role in peacebuilding and preventing war. This shift is consistent with modern public health care, given the emergence of complex global public health crises such as climate change, biodiversity loss, migration, cybersecurity, inequities, and pandemics such as COVID-19 [ 20 ]. We are looking at syndemics, whereby a set of linked health problems interact synergistically and contribute to the excess burden of disease in a population [ 21 ]. The preventative role provides an opportunity to develop a comprehensive public health framework that can effectively address the needs during war, its prevention, and post-conflict periods. Hagopian and Jabbour (2022) [ 22 ] proposed such a framework, using the Primary, Secondary and Tertiary Prevention (PSTP) Framework to address global inequalities and injustices that may contribute to war. It includes primary prevention, which focuses on addressing the root causes and social determinants of war; secondary prevention, which aims to reduce harm and damage during conflict; and tertiary prevention, which involves rebuilding health systems in post-conflict settings [ 22 ]. Wars of annexation have more to do with (re-)building imperia, rather than with inequalities and injustices. Nonetheless, there is no agreed-upon theory on the cause(s) of war [ 10 ].

While the role of public health in emergencies is increasingly well explored in public health research and in interdisciplinary collaboration, the translation of this knowledge into public health training and competencies is only just beginning to emerge, particularly in Europe. The literature is increasingly recommending that public health education and training programs should include an understanding of the health impacts of war and conflict, including the epidemiology of war-related injuries and illnesses, environmental impacts of war, and mental health effects of war on soldiers and civilians [ 2 , 23 , 24 , 25 ]. Additionally, public health professionals should be trained to respond to the health impacts of war, including strategies for preventing and treating war-related injuries and illnesses, as well as promoting peace and non-violent conflict resolution [ 2 , 23 , 24 , 25 ]. ,.

In light of contemporary conflicts and geopolitical tensions, such as the war in Ukraine, as well as those in Syria, Yemen, Myanmar, Israel and Gaza, and other regions, training on effective and systematic public health practice to support affected populations is needed. The role of public health in both the prevention of war and the promotion of peace work is increasingly recognized and calls for its inclusion in public health education, and in the training of public health professionals [ 7 , 25 , 26 ]. Considering the present circumstances, there is a need for public health professionals to develop a skill set that enables them to address the challenges of war, prevention, as well as peacebuilding, so that they can confidently navigate an increasingly multi-disciplinary role and take an active place in the dialogue on the prevention of war and its consequences. We conducted a Scoping Review of the scientific literature in public health to map available evidence and discourse on war. We covered public health perspectives on war prevention, reaction to war, rehabilitation, and peace promotion within public health education and training. More specifically we aimed to answer the following research questions:

How is public health education addressing competencies related to war and peacebuilding? Are there existing examples of teaching and can we build on them for future training?

What are the gaps in public health education on war and how can we address them?

Are there existent frameworks which can be used or adapted to develop public health education programs focused on war, war prevention, and peace promotion?

The research team, representing expertise from schools of public health across Europe, developed the search strategy with the help of the Population, Comparison and Context (PCC) Framework [ 27 ]. We opted for a Scoping Review methodology, since it allows for ‘a preliminary assessment of potential size and scope of available research literature’ as well as ‘identify the nature and extent of research evidence’ [ 28 , 29 ]. It enabled us to map a diverse range of evidence e.g., implementation research on training programs as well as commentaries and opinion pieces, as indicators of an on-going discourse within the public health community. War and peacebuilding in public health education represent an under-researched area, therefore our Scoping Review allowed for the capture and extent, as well as the type of available evidence. Our methodology was developed using the PRISMA-ScR Checklist to comply with reporting and methodological standards (supplementary material 1) [ 30 ]. A review protocol was not published, but the authors used an internal methods protocol which has been updated throughout the process (Supplementary material 3).

Search strategy

We searched in academic databases PubMed, CINAHL, PsycINFO, Embase, Web of Science Core Collections (using keywords and MeSH terms) to explore the scientific discourse on war and peacebuilding in public health education. Exploring grey literature, such as the extent of material at the level of Schools of Public Health exceeded the scope of this review and requires additional data collection tools. As related fields like disaster management and preparedness in public health are well represented within the scientific discourse, limiting this first mapping to scientific databases only, allows for a direct comparison and therefore seemed reasonable.

In our review, we defined the population as the body of interest, i.e., education and teaching body. Our search terms were chosen to identify literature that focused on public health education and training on war, war prevention and peace promotion. This method allowed the authors to capture examples of a broad range of education programs and training, both from individual courses to curricula. The concept element represents the thematic focus on war and peacebuilding. We aimed to integrate different stages of war e.g., armed conflict, active war and peacebuilding. In addition, we linked these search terms with closely-related fields, such as disaster management and preparedness, especially as these are competencies that are frequently linked to the context of war [ 31 ]. These terms have been informed by conflict-related health research as well as conceptual models systematizing the impact of war and peace promotion on public health [ 11 , 12 , 13 , 15 , 16 ]. For the context, being the third and last element of the PCC Framework, we used public health as the discipline and added global health since this is a field where the topic of war is frequently documented and addressed.

An experienced librarian supported the development of the search strategy (Table  1 , search protocols for all databases can be found in supplementary material 2). We conducted the searches on 8th September 2022 and extracted the records into the reference manager Zotero. In addition to the search in scientific databases, we checked the reference lists of included sources for further records that could warrant inclusion.

Eligibility criteria and study selection

In our review, we only included sources that had a primary interest in war and peacebuilding in the public health education context. This included publications that identified curricula, workshops, competencies, skills-sets and capacity-building trainings. For the war and peacebuilding element, this required an explicit definition of war and/or peacebuilding as the field of action or interest. We included academic literature, ranging from peer-reviewed articles to commentaries and editorials to capture a broad spectrum of the scientific discourse. We did not exclude any publication based on study design or period of the study.

We excluded sources that mentioned war or peacebuilding but did not elaborate further on how the courses addressed the specific needs or circumstances. Also, any material that solely addressed terrorist attacks was considered ineligible despite representing a potential weapon or strategy of war. Terrorist attacks were considered ineligible because they pertained to one, timely limited event that usually did not destroy the infrastructure of a complete region or country. Other competencies and frameworks for public health professionals is therefore warranted. The scoping review languages of the potential sources was limited to English, German, Polish.

For the screening process, we conducted a pilot with a random sample of 5% of the total records. This ensured inter-rater reliability between the reviewers by detecting inconsistencies and allowed us to adapt the eligibility criteria accordingly. Then, the reviewers (LW, MM, CC) started with the title and abstract screening. For the full texts, the reviewers changed (LW, MM, AG, AN), so we again conducted a pilot of a random 5% sample of the records identified in the abstract and title screening. Disagreements on the eligibility of full texts were discussed with all reviewers (LW, MM, AG, AN, CC) and resolved through discussion.

Data charting and analysis

The data charting and extraction focused on the context of war and the education/teaching element of the material, rather than the study details. The data charting table includes basic study characteristics, information on the context of war and peacebuilding as well as the teaching intervention ( Table  2 ). The standardized form guided the data charting process and was also tested in another pilot round between the reviewers. LW, MM, AG and AN extracted the data and modified the charting form in an iterative process, which was then discussed with the core reviewer team LW, MM, AG, AN and CC.

The data charting form also guided the descriptive and narrative synthesis of the findings. To structure the narrative analysis, we categorized the findings by the phase of war differentiating between a) preparedness and prevention, b) ongoing conflict and emergency, as well as c) recovery and rehabilitation based on Hagopian and Jabbour’s framework [ 22 ].

The initial literature search resulted in a total of 4922 citations (Fig.  1 ). After removing duplicates, a total of 2913 articles were screened. In the subsequent stages of this process, a total of 272 full‐text reports were assessed for eligibility, of which 264 studies were excluded because the focus was not on war or peacebuilding, or not on public health education/training.

Flowchart on the process identifying studies. This Study Flow Chart details the flow of information throughout the distinct phases of the review: identification, screening and included studies for final review

A total of seven articles reported on existing education/training or recommendation for training fulfilling the inclusion criteria (Fig.  1 ) [ 20 , 32 , 33 , 34 , 35 , 36 , 37 ]. We classified the study design of the 7 articles into three groups: 4 were reports [ 32 , 33 , 34 , 36 ]; two were commentaries [ 20 , 37 ]; and one was an empirical qualitative study [ 35 ].

Study characteristics

The 7 articles were published between 1998 and 2019, with most of them produced in the Global North, including the US ( n  = 3) [ 20 , 32 , 35 ], Croatia and Bosnia-Herzegovina ( n  = 1) [ 33 ] and Sweden ( n  = 1) [ 34 ]. Only one was conducted in the Global South, the empirical study from South Sudan [ 37 ]. The included publications take different phases of war into account, some take on several within one study: 4 publications reported on early warning/prevention and preparedness [ 33 , 34 , 35 , 36 ]; 4 publications on conflict situations [ 20 , 33 , 35 , 37 ]; 3 on emergency [ 20 , 32 , 37 ]; and one study on recovery / rehabilitation [ 35 ]. Four publications related to specific armed conflicts and time periods; (Balkan (1994–2001) [ 32 ], Sweden (time period not specified) [ 34 ], South Sudan (2013) [ 37 ], and after the First World War (1920–1939) [ 36 ]. Three studies did not specify the geographical region or period of the study. The characteristics of each study are shown in Table  3 , depicting the type of publication, type of war, period, geographic setting, and phase of military operations. Table 3 provides an overview of the teaching interventions recommended or described by the included studies.

Prevention and Preparedness

Four ( n  = 4) publications reported or commented on early warning, prevention and preparedness for war or war-like situations on a professional level. McDonnell et al. recommend that applied epidemiologists should be prepared for war by acquiring knowledge on international law, human rights, and complex interventions by working on specific case studies during training to be able to conduct assessments of the conflict setting and to communicate health-related interventions effectively with stakeholders and the local population [ 35 ]. Joshi strengthens this approach to take into account the psychological burden of mental health professionals working with war-affected children. He recommends analyzing the situation properly, gaining knowledge about the region, culture, and people, but also reflecting on one’s own limitations and resources [ 33 ]. Both commentaries point to the importance of (interdisciplinary) collaboration and training [ 33 , 35 ].

Kulling & Holst and McGann have shown what a training module could look like. While Kulling & Holst refer to the Swedish context, McGann describes in a historical analysis what the training of public health nurses looked like after the First World War [ 34 , 36 ]. On a national level, according to Kulling & Holst different topics should be addressed in regional and local courses for health professionals, such as disaster medicine, management of the healthcare system in a disaster/crisis, command and control at an accident site, chemical accidents, decontamination methods, radiation accidents, microbiological preparedness / bioterrorism, psychiatric / psycho-social support and planning preparedness for chemical, biological, or nuclear/radiological (C B N R) events on a national level [ 34 ]. McGann describes that the training of public health nurses in the 1920s consisted of both a theoretical and a practical part [ 36 ]. In the theoretical part there are already overlaps with the modules recommended by Kulling & Holst [ 34 ]. McGann shows that lectures were given on public health nursing, hygiene, bacteriology, psychology, social conditions, and social administration [ 36 ]. The practical part consisted of work placements in nursing-related fields, such as child welfare centers, TB dispensaries or in a district nursing association [ 36 ].

Conflict and emergency

Burkle et al. and McDonnell et al. refer to the importance of combining medical skills and knowledge in emergency and crisis situations [ 20 , 35 ]. Both reports discuss advanced courses for the development of specific skills for work in humanitarian settings. According to the authors, knowledge of legal frameworks, communication skills, documentation of human rights violations, and the design and management of needs-based health services are necessary skills for public health professionals, with McDonnell et al. also emphasizing competence in qualitative and quantiative data [ 20 , 35 ]. Burkle et al. recommend developing an all-encompassing international program which should be continously evaluated and adapted according to emergency sitations [ 20 ]. Joshi adds the importance of compentency in interdisciplinary cooperation and training of local populations [ 33 ].

Evans et al. and Rathner & Katona describe specific training programs in more detail [ 32 , 37 ]. While Evans et al. describe a program for graduated professionals and mid-careers public health leaders [ 32 ], Ratner & Katona’s training program focuses not only on public health professionals but also on the general public [ 37 ]. Both programs consist of lectures and hands-on-activities or practical work. Evans et al. describe a graduate program based at the Center for Humanitarian Emergencies at Emory University in Atlanta, US. The program covers topics on emergency preparedness, logistics, mental health, needs assessment, nutrition, and risk communication through lectures and group discussions, followed by a field practica at in-country host institutions. The field practica cover areas such as emergency management or global health security [ 32 ]. Ratner & Katona’s program is set in South Sudan and involves first aid courses, providing participants with the skills and knowledge to care for themselves and others in times of medical emergencies. The training brings together people from different tribes or community groups and focuses on specific medical needs. Supported by the local community and local leaders, the training leads to intergroup communication, stigma reduction, and health-related collaboration between different population groups. It not only provided essential healthcare skills, but also served as a platform for peacebuilding and community-building [ 37 ].

Recovery, rehabilitation and peacebuilding

All authors understand their programs as preparation for war-like situations but only two focus specifically on peacebuilding [ 35 , 37 ]. Ratner & Katona’s teaching activity in South Sudan lead to peacebuilding, communication, and interaction between different groups in the local communities [ 37 ]. McDonald et al. emphasize conflict assessment for peacebuilding, using quantitative and qualitative methods and effective communication skills for policy changes and interdisciplinary and interinstitutional cooperation. According to the authors, knowledge about predictors of violent conflict is necessary [ 35 ]. None of the studies in our review pertain to recovery or rehabilitation-related competencies or training programs.

We identified 7 publications dealing with education and/or training for public health professionals that related to war and peacebuilding [ 20 , 32 , 33 , 34 , 35 , 36 , 37 ]. Most of the publications covered public health training from prevention and preparedness, conflict and emergency to recovery, rehabilitation and peacebuilding. Literature is scarce regarding public health education in the context of war, armed conflict and peace promotion. We found a broad range of different manuscripts including commentaries and opinion pieces on different types of war and armed conflict, but only 7 publications met the review’s inclusion criteria. We did not identify research studies comparing different teaching methods, training modules or evaluating programs. However, there is a growing awareness of the topic and not least since Russia’s invasion of Ukraine (e.g. [ 19 , 38 , 39 , 40 ].). Nevertheless, more in-depth research needs to be done in this area.

The included publications are heterogeneous in terms of population, time, and war phases. Most of the programs described in the publications are aimed at public health professionals. Three studies ( n  = 3) focused on specific professional groups (e.g. psychologists, surgeons, nurses) [ 20 , 33 , 36 ]. Only Evans et al. targeted undergraduate and postgraduate students [ 32 ]. Just one publication included the local population in their education program and, in contrast to the other publications the context of the education program was within an emergency situation whereby there was an acute need for action due to the war-like situation in South Sudan [ 37 ]. Two studies described the educational program in more detail: While Kulling & Holst presented a current program in Sweden [ 34 ], McGann took a historical perspective and described the education of public health nurses between the First and Second World War [ 36 ]. Both studies pointed to similar teaching content for preparedness of professionals. Two other studies addressed general principals such as knowledge on human rights and complex interventions or self-reflection [ 33 , 35 ]. None of these publications used a conceptual educational framework.

We note from our scoping review that teaching war in public health education programs or in the training of public health professionals is predominately short-term and extra-curricular in post-graduate courses. A better understanding is needed of the intersections between war and health and of the indispensable role public health practitioners, academics and advocates could play particularly given the increasing significance of war as a determinant affecting population health [ 31 ].

The immediate emergency response in times of war was the main area of action in and for public health education. Some of the studies drew from or were also closely entangled with emergency management and/or disaster management (without any specific reference to war or peacebuilding). This finding is not surprising, given the relevance of this much more advanced and established field of public health practice. Emergency response and management, including infectious disease outbreaks and/or disasters especially natural disasters, are widely included in international standards and recommendations. For example, US [ 41 ] for public health education [ 42 ]. These topics are also frequently and systematically implemented in dedicated public health degrees [ 43 , 44 , 45 , 46 ]. These competencies play a major role for public response in the context of war, e.g. for first response, multidisciplinary coordination and crisis situation [ 44 ]. However, we also found that emergency management and public health education on war were often entangled, which led to a high number of full-text screenings. Few of the studies and commentaries explicitly differentiated between natural disasters or outbreaks and war/armed conflicts; yet wars require additional skillsets and competencies. For example, conflicts frequently result in waves of trauma cases and public health hazards depending on conflict intensity. Also, infrastructure can be repeatedly destroyed or supplies to rebuild cannot reach communities in need – again depending on conflict activities. Accordingly, we encourage studies and commentaries on public health practice and analysis to more explicitly differentiate between natural disasters and armed conflicts [ 6 ].

Highlighting the different disciplines involved as well as the range of competencies required in different phases of war and peacebuilding, our review reiterates the importance of interdisciplinary collaboration for developing and implementing public health education on war and peacebuilding. Building on this evidence, the growing conceptual understanding [ 6 , 14 , 16 , 22 ] and existing content-analyses of war-related public health education [ 20 , 31 ] will help to systematically advance public health training as well as the scientific discourse on this topic to support evidence-based decision-making for curriculum adaptations, teaching methods as well as adaptation for peacebuilding and in times of war.

Peacebuilding and war prevention were less discussed in the publications included in this review compared to other phases of war. Whoerle et al. suggest that health education can serve as a potential platform for integrating peace education into school curricula. The integration of health and peace involves four key approaches that could be translated into competencies: adopting a socio-ecological perspective; employing complexity thinking and problem mapping, recognizing the continuum of resilience and trauma, and considering the community as a site for practical implementation, calling for interdisciplinary cooperation [ 16 ]. Barry S. Levy, one of the long-standing experts in this field, proposes that citizens should confront the powerful in their country [ 6 ]. This is important advice in democratic societies, and there are precedents of successful protest and civic disobedience such as Daniel Ellsberg’s activism against the Vietnam war, which gave a boost to the US anti-war movement [ 47 ]. We reiterate this call and encourage to focus in on the competencies in public health required to specifically include peace promotion and war prevention in addition to the emergency war response. This is particularly important in an ‘era of geopolitical uncertainty’ [ 48 ] where peace and war play a dominant role and should be reflected as determinants of health and accordingly systematically addressed in public health education [ 49 ]. However, we also realize that advice such as Levy’s is tailored more at civil wars and wars attempting regime change, rather than wars of annexation. Russia’s full-scale invasion of Ukraine in 2022, was the first such event in Europe since World War II. Internal civic action, as recommended by Levy, carries grave personal risk when applied against the Putin regime. Diplomacy has not been successful as Russia, in the eyes of many observers, violates international treaties and security assurances [ 50 ]. In consequence, neighboring states may have to rely on a sufficiently funded military to protect their populations. This conclusion may come counter-intuitive to public health proponents [ 51 ], while in defense theories and international law and relation studies it is widely discussed and elaborated on [ 52 , 53 ]. Again, drawing from interdisciplinary collaboration could ensure deeper analytical and theoretical understandings of the terminology or concepts used in war and peacebuilding and comparability across fields. Moreover, given the contentious nature of these issues, students and teaching institutions should learn how to discuss conflicts constructively and fairly, avoiding the escalations of recent campus discourses in the Israel-Gaza conflict.

Strengths and limitations

In this Scoping Review, we analyzed the scope and extent of scientific discourse on war and peace promotion in public health education. Using a scoping review methodology allowed for a systematized and comprehensive mapping, which has been the first of its kind on the topic, at least to our knowledge. We included studies solely with a primary interest in war and peacebuilding in the public health education context. This allowed for a nuanced analysis of education programs, initiatives, or similar, which is of particular value for the overall aim of advancing public health education.

We thereby contribute to the identification of gaps and addressing them in an important area of public health work. Specifically, we have identified gaps in the European literature arena, where the topic of war and peace promotion has been mostly neglected over the past decades. In addition, we have synthesized war and peace promotion in public health education, which are usually assessed in parallel.

We limited our review to scientific databases aiming to assess the scientific discourse on war and peacebuilding in public health education and training. As a result, the review has not captured any grey literature relating to the topic; it exceeded the scope of this review. Nonetheless, it would be an important next step to assess the status quo at institutions of public health education and training within the European region. This includes Schools of Public Health and Higher Institutes or Centers for Public Health Education, many of whom lead to a graduate degree in public health and which is accredited by a recognized body, or bodies approved for such purpose. This could include for example the Secretary of Education in each European Region country or other authorizing bodies. Of note, a study in this regard, has been undertaken for specific schools of public health in the United States of America [ 31 ]. Such a study in Europe would allow for a more detailed overview of resources and expertise to advance and support the development of initiatives integrate war more systematically into public health education programs.

Since we only included studies with a primary interest in war and peacebuilding in the public health education context, we did not consider the scientific discussion touching on this topic. This was reflected many of full texts screened that ended with just a few publications with findings that could be generalized. The variability in the studies in terms of the type of war described, e.g., armed conflict or war of annexation, may present a challenge in drawing generalizable conclusions.

This scoping review identified a lack of scientific discourse on the role of war and peace promotion in public health education. The few public health education and training programs identified primarily focus on the immediate emergency response in conflict-affected areas. These were often entangled with emergency preparedness in different contexts such as infectious disease outbreaks. Peace promotion and war prevention are missing foci. This suggests a need for a far greater emphasis of the topic in public health training as well as its inclusion in competency frameworks. In addition to training public health professionals for emergencies, training with an emphasis on war prevention and promoting peace should be developed and implemented.

Availability of data and materials

All data generated or analyzed during this study are included in this published article [and its supplementary information files].

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LW, YN, CC, TB, LB and OR conceptualized and designed the Scoping Review with important intellectual input from all co-authors. LW, MM, AG, AN and CC, conducted the screening. LW, MM, AG, AN extracted the data. LW, MM and AN analyzed the data. LW, MM, AN, AG and CC created the first draft of the manuscript. CC and LW edited the manuscript prior to submission to all authors, who then contributed input to the final manuscript. CC and LW edited the final draft manuscript. All authors contributed to the final manuscript and provided important intellectual input.

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Wandschneider, L., Nowak, A., Miller, M. et al. War and peace in public health education and training: a scoping review. BMC Public Health 24 , 2303 (2024). https://doi.org/10.1186/s12889-024-19788-w

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Carfilzomib-induced thrombotic microangiopathy (TMA) refractory to eculizumab: A case report and literature review

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This case report describes the clinical course of a patient with relapsed IgA kappa multiple myeloma with high-risk cytogenetics. Initially treated with daratumumab–bortezomib–lenalidomide–dexamethasone (Dara-VRD) then transitioned to lenalidomide maintenance. However, he experienced a relapse and was treated with carfilzomib-based therapy (CFZ) but developed drug-induced thrombotic microangiopathy (DI-TMA). Despite receiving eculizumab and supportive care, the patient's condition worsened, leading to encephalopathy and refractory gastrointestinal bleeding in the setting of persistent thrombocytopenia. Ultimately, the decision was made to transition to comfort-focused care. DI-TMA has been documented with various proteasome inhibitors such as ixazomib and bortezomib. Additionally, other medications such as cyclosporine, tacrolimus, clopidogrel, ticlopidine, and interferon have been associated with DI-TMA as well (Pisoni et al. (Drug Saf 24:491–501, 2001) [ 18 ]). Here we discuss a case of carfilzomib-induced TMA (CFZ-TMA) refractory to eculizumab as well as a review of the published literature.

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Introduction

Multiple myeloma (MM) is a plasma cell neoplasm characterized by clonal proliferation of malignant plasma cells in the bone marrow with an abnormal increase of monoclonal protein leading to end-organ damage. Treatment approaches have evolved with the introduction of novel agents and immunotherapies, such as bispecific antibodies and CAR-T cell therapy. However, proteasome inhibitors (PI) are still the mainstay of treatment and come with the risk of adverse events, including TMA, particularly with CFZ, an irreversible PI.

TMA manifests across various clinical conditions including thrombotic thrombocytopenic purpura (TTP), hemolytic uremic syndrome (HUS), atypical HUS (aHUS), DI-TMA, disseminated intravascular coagulopathy (DIC), malignancy, malignant hypertension, and transplant. Several factors contribute to the pathogenesis of DI-TMA, including (a) multiple myeloma as an independent risk factor, (b) germline mutations in the complement alternative pathway (c) reduced VEGF production by renal epithelial cells [ 1 , 2 ], and (d) immune-mediated or dose-dependent drug toxicity [ 3 ]. These mechanisms lead to the common clinical manifestations of TMA syndromes, which include endothelial injury resulting in the formation of microvascular thrombi, microangiopathic hemolysis, and thrombocytopenia [ 3 , 4 , 5 ]. Additionally, viral infections have been reported as triggers of acute disease, especially in late-onset CFZ-TMA [ 6 ]. This case highlights the challenges in managing CFZ-TMA and the need for other therapeutic options.

Case report

A 77-year-old male underwent an anemia workup and received a diagnosis of IgA kappa multiple myeloma, Revised International Staging System (R-ISS) stage III. His labs showed serum IgA 4,792 mg/dL with suppressed IgG and IgM, free kappa light chain (FKLC) 16.58 mg/dL, free lambda light chain (FLLC) 0.47 mg/dL, serum creatinine 1.46 mg/dL, serum calcium 9.9 mg/dL, hemoglobin 7.9 g/dL, albumin 3.3 g/dl, B2-microglobulin 12.86 mg/L. Bone marrow biopsy showed 80% plasma cells of overall marrow cellularity. Cytogenetic analysis revealed 1q gain, t(14;16), 13q deletion, trisomy/tetrasomy of chromosomes 1, 4, 11, 13, 14, 15, 16, and 17. Whole body MRI showed no suspicious osseous lesions. He started on daratumumab–bortezomib–lenalidomide–dexamethasone (Dara-VRD) and after eight cycles achieved a complete response (CR) with negative minimal residual disease (MRD) by flow cytometry (10 –5 sensitivity). Following this, the patient transitioned to lenalidomide maintenance, and autologous stem cell transplant (ASCT) was deferred.

Seven months later, he had a biochemical relapse evidenced by FKLC 15.98 mg/dl and kappa/lambda ratio 10.8. A subsequent bone marrow biopsy demonstrated 70% plasma cells of overall marrow cellularity. The patient’s treatment regimen was adjusted to carfilzomib–pomalidomide–dexamethasone (KPD), consisting of an initial dose of CFZ at 20 mg/m 2 followed by subsequent doses of 70 mg/m 2 on days 1, 8, and 15 of each cycle [ 7 ]. Pomalidomide was administered at a daily dose of 4 mg for 21 days followed by a 7-day rest period, and dexamethasone 20 mg twice a week. Additionally, he was prescribed apixaban 5 mg twice daily due to an elevated risk of DVT from a history of atrial fibrillation, and acyclovir 400 mg twice daily for viral prophylaxis.

After he had completed the 3rd cycle of KPD, he presented to our institution with 6 days of generalized weakness fatigue, shortness of breath as well as poor appetite, and decreased urinary output. On admission, he had tachypnea (respiratory rate 27–32 breaths/minute), elevated blood pressure (151/77 mmHg), normal heart rate and temperature.

His admission labs showed hemoglobin level decreased from 9.5 g/dL to 7.5 g/dL, platelet count dropped from 161,000/µL to 30,000/µL, creatinine level increased from 1.19 mg/dL to 8.19 mg/dL, with a corresponding decline in estimated glomerular filtration rate (eGFR) from 60 to 6 mL/min/1.73m 2 , and potassium level was 7.3 mmol/l. He was subsequently admitted to the medical ICU and started on intermittent hemodialysis due to persistent hyperkalemia and oliguric acute kidney injury (AKI). A transthoracic echo (TTE) revealed normal cardiac function.

Laboratory findings further indicated evidence of microangiopathic hemolytic anemia (MAHA), with elevated lactate dehydrogenase (LDH) levels at 989 U/L, total bilirubin at 1.7 mg/dL, and haptoglobin levels below 10 mg/dL. Examination of the peripheral blood smear (Fig.  1 ) revealed the presence of schistocytes, immature myeloid cells, as well as abundant plasmacytoid and lymphocytic elements. Considering the patient's renal failure, thrombocytopenia, and hemolytic anemia, it was suspected that he was experiencing CFZ-TMA. Alternative causes of TMA were investigated and ruled out. The normal coagulation studies and ADAMTS13 activity of 56% (greater than 10%) effectively rule out DIC and TTP. Furthermore, the absence of a history of diarrhea made it unlikely that the TMA was associated with Shiga toxin-producing Escherichia coli (STEC)-related HUS. Complement analysis (C3, C4, and CH50) were within normal ranges further ruling out aHUS. Notably, he was in relapse as indicated by a monoclonal protein of 1.20 g/dL, IgA 4,792 mg/dL, FKLC 64.33 mg/dl, and kappa/lambda ratio 201.03.

Peripheral smear showing schistocytes (red arrows) (Wright Giemsa stain, 100X oil immersion)

On hospital day 7, a single dose of 900 mg of eculizumab, an anti-complement C5 monoclonal antibody was administered concurrently with the haemophilus B polysaccharide, pneumococcal 23-valent (Pneumovax 23), and meningococcal vaccines. This approach was taken because the risks associated with delaying eculizumab therapy were deemed greater than the risk of developing a serious infection. Additionally, the patient was initiated on prophylactic antibiotic, penicillin 250 mg twice daily, for 2 weeks. Despite administering another dose of eculizumab on day 14, there was no improvement observed in the patient's hemoglobin level, platelet count, or serum creatinine/eGFR (Fig.  2 ). He continued to rely on supportive measures, including red blood cell and platelet transfusions, as well as hemodialysis. Furthermore, the upper extremities doppler ultrasound revealed acute obstructive DVT in the left axillary and brachial veins. Despite efforts, the patient developed encephalopathy and refractory gastrointestinal bleeding due to ongoing thrombocytopenia. Given these complications, the patient's family decided to transition to comfort-focused care.

Lab values pre and post-Eculizumab administration

CFZ-TMA is an uncommon adverse reaction not initially reported in the original clinical trial. However, A retrospective study documented only 16 cases between 2012 and 2019 [ 8 ]. Among 281 newly diagnosed multiple myeloma patients (NDMM) treated with carfilzomib-cyclophosphamide, and dexamethasone in the CARDAMON trial, eight (2.8%) experienced a TMA [ 9 , 10 ]. Studies have shown that TMA can occur at any stage throughout the treatment course [ 3 , 4 , 6 , 11 ]. Despite the wide range of doses at which CFZ is administered, from 20 mg/m 2 to 70 mg/m 2 , with 56 mg/m 2 typically considered the therapeutic dose, no specific dose cutoff associated with TMA has been identified [ 8 , 12 ]. Nevertheless, in a study by Moscvin et al., who observed within their cohort, 7 out of 10 patients with TMA received CFZ at a dose of 56 mg/m 2 twice weekly indicating dose-dependent drug toxicity [ 1 ].

This condition is characterized by MAHA, thrombocytopenia, and acute renal failure. While the precise mechanism remains incompletely understood, it is believed to stem from several factors. Firstly, the effects of multiple myeloma. Secondly, CFZ acts as a ubiquitin–proteasome pathway inhibitor, thereby inhibiting the transcription factor NFκB. This inhibition can disrupt vascular endothelial growth factor (VEGF) production, contributing to complement overproduction. Consequently, this cascade of events can result in endothelial and renal microvasculature damage, microthrombi formation, hemolysis, and platelet consumption. Lastly, CFZ-mediated genetic variations in complement genes such as deletions of complement factor H-related proteins (CFHR) region [ 1 , 2 , 8 , 13 ]. Our patient developed TMA following three cycles of 70 mg/m 2 CFZ once weekly [ 7 ]. It is suspected that drug toxicity from this high dose, combined with disease progression, contributed to the development of CFZ-induced TMA.

TMA is typically diagnosed through a process of exclusion of other potential differentials including TTP, HUS, and aHUS. The workup should include a comprehensive assessment. This includes a complete blood count (CBC) to evaluate for anemia and thrombocytopenia. Additionally, a complete metabolic panel (CMP) is essential for assessing AKI. Examination of a peripheral smear is crucial to identify schistocytes, which, when accompanied by elevated LDH levels and low haptoglobin, suggest the presence of MAHA. Nonetheless, renal biopsy to visualize thrombotic angiopathy remains the gold standard for diagnosing TMA. However, it is associated with a significant risk of bleeding, particularly in individuals with thrombocytopenia [ 2 ]. Meanwhile, obtaining ADAMTS13 levels is essential to exclude TTP, while complement testing and, if available complement gene analysis are used to rule out aHUS.

The management approach for CFZ-TMA typically includes discontinuing CFZ to prevent further kidney damage. Additionally, early administering of a weekly 900 mg dose of eculizumab, a terminal complement inhibitor, has shown benefit in many case reports [ 5 , 14 ]. Although the duration may vary depending on the individual case, 4 weeks is recommended. Nevertheless, in a recent large case series study of CFZ-TMA, the patients presented with severe AKI and were treated with eculizumab, yet they showed no apparent improvement in pathophysiology or prognosis [ 15 ]. The lack of response to eculizumab could also imply that the pathogenesis may not solely involve the complement pathway.

Some cases have also reported the use of supportive therapies such as plasmapheresis, high-dose glucocorticoid, and hemodialysis [ 9 , 11 , 14 ]. The therapeutic plasma exchange (TPE) is a reasonable intervention in cases of suspected TTP; however, it can be halted if ADAMTS13 activity is found to be normal, thus ruling out TTP [ 16 ]. In a study by Fotiou et al., involving 114 CFZ-treated patients, all six patients who developed TMA received plasmapheresis and steroids; rituximab was additionally administered in one patient; but none were treated with eculizumab. Renal function and platelets recovered fully in five patients, whereas one died of sepsis. Notably, none of the patients had progressive myeloma at the time of the event and ADAMTS-13 was evaluated in two patients and was within normal limits [ 17 ].

Finally, our case emphasizes the significance of patients’ close monitoring for early signs of TMA during CFZ therapy. It is crucial to consider stopping the medication or early dose adjustments to the treatment as necessary to manage this complication effectively.

Despite advances in multiple myeloma treatment, managing treatment-related complications remains challenging, particularly in high-risk patients with refractory disease. Therapy-induced TMA, as seen in this case, presents a diagnostic challenge and can lead to serious, potentially life-threatening complications. While eculizumab is a standard treatment for TMA, it was ineffective in halting its progression in this instance. This case highlights the importance of a thorough diagnostic approach for CFZ-TMA and underscores the need for increased vigilance. Healthcare providers should closely monitor patients for early signs of TMA during CFZ therapy, and consider early modifications and dose adjustments to the treatment as necessary.

Funding declaration

The authors did not receive any specific grant from public, commercial, or not-for-profit funding agencies.

Data availability

No datasets were generated or analysed during the current study.

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Meseha, M., Qu, D., Lykon, J. et al. Carfilzomib-induced thrombotic microangiopathy (TMA) refractory to eculizumab: A case report and literature review. Ann Hematol (2024). https://doi.org/10.1007/s00277-024-05965-9

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Conduct a Literature Review

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This course guides you through the entire process of preparing a literature review, selecting and analyzing existing literature, and structuring and writing a quality literature review. Most importantly, the course develops skills in using evidence to create and present an engaging and critical argument.

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This course will help you to:

• Evaluate the purpose of a literature review
• Develop and clarify your thinking, embed your ideas, and articulate your thoughts clearly
• Identify the key preparation steps of a literature review and use each step to effectively articulate your research question and literature review plan
• Identify the key considerations when evaluating journals, selecting the most appropriate journal for your literature review
• Build a strong and convincing argument using suitable literature and data to develop and present your argument in your literature review
• Write and structure a strong literature review, avoiding common pitfalls
• Recognize what each section of the literature review requires and formulate your own with the help of examples and guidelines

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A literature review is a document or section of a document that collects key sources on a topic and discusses those sources in conversation with each other (also called synthesis ). The lit review is an important genre in many disciplines, not just literature (i.e., the study of works of literature such as novels and plays). When we say “literature review” or refer to “the literature,” we are talking about the research ( scholarship ) in a given field. You will often see the terms “the research,” “the scholarship,” and “the literature” used mostly interchangeably.

Where, when, and why would I write a lit review?

There are a number of different situations where you might write a literature review, each with slightly different expectations; different disciplines, too, have field-specific expectations for what a literature review is and does. For instance, in the humanities, authors might include more overt argumentation and interpretation of source material in their literature reviews, whereas in the sciences, authors are more likely to report study designs and results in their literature reviews; these differences reflect these disciplines’ purposes and conventions in scholarship. You should always look at examples from your own discipline and talk to professors or mentors in your field to be sure you understand your discipline’s conventions, for literature reviews as well as for any other genre.

A literature review can be a part of a research paper or scholarly article, usually falling after the introduction and before the research methods sections. In these cases, the lit review just needs to cover scholarship that is important to the issue you are writing about; sometimes it will also cover key sources that informed your research methodology.

Lit reviews can also be standalone pieces, either as assignments in a class or as publications. In a class, a lit review may be assigned to help students familiarize themselves with a topic and with scholarship in their field, get an idea of the other researchers working on the topic they’re interested in, find gaps in existing research in order to propose new projects, and/or develop a theoretical framework and methodology for later research. As a publication, a lit review usually is meant to help make other scholars’ lives easier by collecting and summarizing, synthesizing, and analyzing existing research on a topic. This can be especially helpful for students or scholars getting into a new research area, or for directing an entire community of scholars toward questions that have not yet been answered.

What are the parts of a lit review?

Most lit reviews use a basic introduction-body-conclusion structure; if your lit review is part of a larger paper, the introduction and conclusion pieces may be just a few sentences while you focus most of your attention on the body. If your lit review is a standalone piece, the introduction and conclusion take up more space and give you a place to discuss your goals, research methods, and conclusions separately from where you discuss the literature itself.

Introduction:

• An introductory paragraph that explains what your working topic and thesis is
• A forecast of key topics or texts that will appear in the review
• Potentially, a description of how you found sources and how you analyzed them for inclusion and discussion in the review (more often found in published, standalone literature reviews than in lit review sections in an article or research paper)
• 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 sentence to draw connections, comparisons, and contrasts.

Conclusion:

• Summarize the key findings you have taken from the literature and emphasize their significance
• Connect it back to your primary research question

How should I organize my lit review?

Lit reviews can take many different organizational patterns depending on what you are trying to accomplish with the review. Here are some examples:

• Chronological : The simplest approach is to trace the development of the topic over time, which helps familiarize the audience with the topic (for instance if you are introducing something that is not commonly known in your field). If you choose this strategy, be careful to avoid simply listing and summarizing sources in order. Try to analyze the patterns, turning points, and key debates that have shaped the direction of the field. Give your interpretation of how and why certain developments occurred (as mentioned previously, this may not be appropriate in your discipline — check with a teacher or mentor if you’re unsure).
• Thematic : If you have found some recurring central themes that you will continue working with throughout your piece, you can organize your literature review into subsections that address different aspects of the topic. For example, if you are reviewing literature about women and religion, key themes can include the role of women in churches and the religious attitude towards women.
• Qualitative versus quantitative research
• Empirical versus theoretical scholarship
• Divide the research by sociological, historical, or cultural sources
• Theoretical : In many humanities articles, the literature review is the foundation for the theoretical framework. You can use it to discuss various theories, models, and definitions of key concepts. You can argue for the relevance of a specific theoretical approach or combine various theorical concepts to create a framework for your research.

What are some strategies or tips I can use while writing my lit review?

Any lit review is only as good as the research it discusses; make sure your sources are well-chosen and your research is thorough. Don’t be afraid to do more research if you discover a new thread as you’re writing. More info on the research process is available in our "Conducting Research" resources .

As you’re doing your research, create an annotated bibliography ( see our page on the this type of document ). Much of the information used in an annotated bibliography can be used also in a literature review, so you’ll be not only partially drafting your lit review as you research, but also developing your sense of the larger conversation going on among scholars, professionals, and any other stakeholders in your topic.

Usually you will need to synthesize research rather than just summarizing it. This means drawing connections between sources to create a picture of the scholarly conversation on a topic over time. Many student writers struggle to synthesize because they feel they don’t have anything to add to the scholars they are citing; here are some strategies to help you:

• It often helps to remember that the point of these kinds of syntheses is to show your readers how you understand your research, to help them read the rest of your paper.
• Writing teachers often say synthesis is like hosting a dinner party: imagine all your sources are together in a room, discussing your topic. What are they saying to each other?
• Look at the in-text citations in each paragraph. Are you citing just one source for each paragraph? This usually indicates summary only. When you have multiple sources cited in a paragraph, you are more likely to be synthesizing them (not always, but often
• Read more about synthesis here.

The most interesting literature reviews are often written as arguments (again, as mentioned at the beginning of the page, this is discipline-specific and doesn’t work for all situations). Often, the literature review is where you can establish your research as filling a particular gap or as relevant in a particular way. You have some chance to do this in your introduction in an article, but the literature review section gives a more extended opportunity to establish the conversation in the way you would like your readers to see it. You can choose the intellectual lineage you would like to be part of and whose definitions matter most to your thinking (mostly humanities-specific, but this goes for sciences as well). In addressing these points, you argue for your place in the conversation, which tends to make the lit review more compelling than a simple reporting of other sources.

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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.

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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.

Prevent plagiarism. Run a free check.

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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Stanford Online

Introduction to systematic reviews.

Stanford School of Medicine

This course is for members of the Stanford Medicine community. Valid Stanford login is required to access some of the content in this course. This course was created to facilitate more meaningful consultations between librarians and Stanford Medicine community members interested in conducting systematic reviews. It opens with a definition of the necessary requirements for a systematic review and comparison between systematic review methodologies and those of other types of reviews.

There are multiple organizations that provide guidelines for successful completion of a systematic review and we provide an overview of these guidelines from the Cochrane Collaboration, the National Academy of Medicine (formerly Institute of Medicine), and Joanna Briggs Institute. Next is a discussion of the importance of protocols for determining whether or not a systematic review on your topic of interest has already been completed. Tools for supporting an organized systematic review project are then highlighted, followed by a detailed review of how/why librarians collaborate on these reviews. In the final module, we highlight how you can search for systematic reviews in three major databases: PubMed, Embase, and CINAHL. Throughout the course are small assessments to reinforce concepts and encourage reflection.

Who Should Enroll

• Understand the definition of a systematic review and its distinguishing features as compared to other types of reviews
• Know the different resource guidelines for conducting a systematic review
• Understand the facets of question development
• Introduction to software tools to facilitate the systematic review process
• Be able to search for systematic reviews on a given topic in PubMed and EMBASE
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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
• << Previous: Getting Started
• Next: How to Pick a Topic >>
• Last Updated: Sep 21, 2022 2:16 PM
• URL: https://guides.lib.uconn.edu/literaturereview

How To Structure Your Literature Review

3 options to help structure your chapter.

By: Amy Rommelspacher (PhD) | Reviewer: Dr Eunice Rautenbach | November 2020 (Updated May 2023)

Writing the literature review chapter can seem pretty daunting when you’re piecing together your dissertation or thesis. As  we’ve discussed before , a good literature review needs to achieve a few very important objectives – it should:

• Demonstrate your knowledge of the research topic
• Identify the gaps in the literature and show how your research links to these
• Provide the foundation for your conceptual framework (if you have one)
• Inform your own  methodology and research design

To achieve this, your literature review needs a well-thought-out structure . Get the structure of your literature review chapter wrong and you’ll struggle to achieve these objectives. Don’t worry though – in this post, we’ll look at how to structure your literature review for maximum impact (and marks!).

But wait – is this the right time?

Deciding on the structure of your literature review should come towards the end of the literature review process – after you have collected and digested the literature, but before you start writing the chapter. 

In other words, you need to first develop a rich understanding of the literature before you even attempt to map out a structure. There’s no use trying to develop a structure before you’ve fully wrapped your head around the existing research.

Equally importantly, you need to have a structure in place before you start writing , or your literature review will most likely end up a rambling, disjointed mess. 

Importantly, don’t feel that once you’ve defined a structure you can’t iterate on it. It’s perfectly natural to adjust as you engage in the writing process. As we’ve discussed before , writing is a way of developing your thinking, so it’s quite common for your thinking to change – and therefore, for your chapter structure to change – as you write. 

Need a helping hand?

Like any other chapter in your thesis or dissertation, your literature review needs to have a clear, logical structure. At a minimum, it should have three essential components – an  introduction , a  body   and a  conclusion . 

Let’s take a closer look at each of these.

1: The Introduction Section

Just like any good introduction, the introduction section of your literature review should introduce the purpose and layout (organisation) of the chapter. In other words, your introduction needs to give the reader a taste of what’s to come, and how you’re going to lay that out. Essentially, you should provide the reader with a high-level roadmap of your chapter to give them a taste of the journey that lies ahead.

Here’s an example of the layout visualised in a literature review introduction:

Your introduction should also outline your topic (including any tricky terminology or jargon) and provide an explanation of the scope of your literature review – in other words, what you  will   and  won’t   be covering (the delimitations ). This helps ringfence your review and achieve a clear focus . The clearer and narrower your focus, the deeper you can dive into the topic (which is typically where the magic lies). 

Depending on the nature of your project, you could also present your stance or point of view at this stage. In other words, after grappling with the literature you’ll have an opinion about what the trends and concerns are in the field as well as what’s lacking. The introduction section can then present these ideas so that it is clear to examiners that you’re aware of how your research connects with existing knowledge .

2: The Body Section

The body of your literature review is the centre of your work. This is where you’ll present, analyse, evaluate and synthesise the existing research. In other words, this is where you’re going to earn (or lose) the most marks. Therefore, it’s important to carefully think about how you will organise your discussion to present it in a clear way. 

The body of your literature review should do just as the description of this chapter suggests. It should “review” the literature – in other words, identify, analyse, and synthesise it. So, when thinking about structuring your literature review, you need to think about which structural approach will provide the best “review” for your specific type of research and objectives (we’ll get to this shortly).

There are (broadly speaking)  three options  for organising your literature review.

Option 1: Chronological (according to date)

Organising the literature chronologically is one of the simplest ways to structure your literature review. You start with what was published first and work your way through the literature until you reach the work published most recently. Pretty straightforward.

The benefit of this option is that it makes it easy to discuss the developments and debates in the field as they emerged over time. Organising your literature chronologically also allows you to highlight how specific articles or pieces of work might have changed the course of the field – in other words, which research has had the most impact . Therefore, this approach is very useful when your research is aimed at understanding how the topic has unfolded over time and is often used by scholars in the field of history. That said, this approach can be utilised by anyone that wants to explore change over time .

For example , if a student of politics is investigating how the understanding of democracy has evolved over time, they could use the chronological approach to provide a narrative that demonstrates how this understanding has changed through the ages.

Here are some questions you can ask yourself to help you structure your literature review chronologically.

• What is the earliest literature published relating to this topic?
• How has the field changed over time? Why?
• What are the most recent discoveries/theories?

In some ways, chronology plays a part whichever way you decide to structure your literature review, because you will always, to a certain extent, be analysing how the literature has developed. However, with the chronological approach, the emphasis is very firmly on how the discussion has evolved over time , as opposed to how all the literature links together (which we’ll discuss next ).

Option 2: Thematic (grouped by theme)

The thematic approach to structuring a literature review means organising your literature by theme or category – for example, by independent variables (i.e. factors that have an impact on a specific outcome).

As you’ve been collecting and synthesising literature , you’ll likely have started seeing some themes or patterns emerging. You can then use these themes or patterns as a structure for your body discussion. The thematic approach is the most common approach and is useful for structuring literature reviews in most fields.

For example, if you were researching which factors contributed towards people trusting an organisation, you might find themes such as consumers’ perceptions of an organisation’s competence, benevolence and integrity. Structuring your literature review thematically would mean structuring your literature review’s body section to discuss each of these themes, one section at a time.

Here are some questions to ask yourself when structuring your literature review by themes:

• Are there any patterns that have come to light in the literature?
• What are the central themes and categories used by the researchers?
• Do I have enough evidence of these themes?

PS – you can see an example of a thematically structured literature review in our literature review sample walkthrough video here.

Option 3: Methodological

The methodological option is a way of structuring your literature review by the research methodologies used . In other words, organising your discussion based on the angle from which each piece of research was approached – for example, qualitative , quantitative or mixed  methodologies.

Structuring your literature review by methodology can be useful if you are drawing research from a variety of disciplines and are critiquing different methodologies. The point of this approach is to question  how  existing research has been conducted, as opposed to  what  the conclusions and/or findings the research were.

For example, a sociologist might centre their research around critiquing specific fieldwork practices. Their literature review will then be a summary of the fieldwork methodologies used by different studies.

Here are some questions you can ask yourself when structuring your literature review according to methodology:

• Which methodologies have been utilised in this field?
• Which methodology is the most popular (and why)?
• What are the strengths and weaknesses of the various methodologies?
• How can the existing methodologies inform my own methodology?

3: The Conclusion Section

Once you’ve completed the body section of your literature review using one of the structural approaches we discussed above, you’ll need to “wrap up” your literature review and pull all the pieces together to set the direction for the rest of your dissertation or thesis.

The conclusion is where you’ll present the key findings of your literature review. In this section, you should emphasise the research that is especially important to your research questions and highlight the gaps that exist in the literature. Based on this, you need to make it clear what you will add to the literature – in other words, justify your own research by showing how it will help fill one or more of the gaps you just identified.

Last but not least, if it’s your intention to develop a conceptual framework for your dissertation or thesis, the conclusion section is a good place to present this.

Example: Thematically Structured Review

In the video below, we unpack a literature review chapter so that you can see an example of a thematically structure review in practice.

Let’s Recap

In this article, we’ve  discussed how to structure your literature review for maximum impact. Here’s a quick recap of what  you need to keep in mind when deciding on your literature review structure:

• Just like other chapters, your literature review needs a clear introduction , body and conclusion .
• The introduction section should provide an overview of what you will discuss in your literature review.
• The body section of your literature review can be organised by chronology , theme or methodology . The right structural approach depends on what you’re trying to achieve with your research.
• The conclusion section should draw together the key findings of your literature review and link them to your research questions.

If you’re ready to get started, be sure to download our free literature review template to fast-track your chapter outline.

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 .

28 Comments

Great work. This is exactly what I was looking for and helps a lot together with your previous post on literature review. One last thing is missing: a link to a great literature chapter of an journal article (maybe with comments of the different sections in this review chapter). Do you know any great literature review chapters?

I agree with you Marin… A great piece

I agree with Marin. This would be quite helpful if you annotate a nicely structured literature from previously published research articles.

Awesome article for my research.

I thank you immensely for this wonderful guide

It is indeed thought and supportive work for the futurist researcher and students

Very educative and good time to get guide. Thank you

Great work, very insightful. Thank you.

Thanks for this wonderful presentation. My question is that do I put all the variables into a single conceptual framework or each hypothesis will have it own conceptual framework?

Thank you very much, very helpful

This is very educative and precise . Thank you very much for dropping this kind of write up .

Pheeww, so damn helpful, thank you for this informative piece.

I’m doing a research project topic ; stool analysis for parasitic worm (enteric) worm, how do I structure it, thanks.

comprehensive explanation. Help us by pasting the URL of some good “literature review” for better understanding.

great piece. thanks for the awesome explanation. it is really worth sharing. I have a little question, if anyone can help me out, which of the options in the body of literature can be best fit if you are writing an architectural thesis that deals with design?

I am doing a research on nanofluids how can l structure it?

Beautifully clear.nThank you!

Lucid! Thankyou!

Brilliant work, well understood, many thanks

I like how this was so clear with simple language 😊😊 thank you so much 😊 for these information 😊

Insightful. I was struggling to come up with a sensible literature review but this has been really helpful. Thank you!

You have given thought-provoking information about the review of the literature.

Thank you. It has made my own research better and to impart your work to students I teach

I learnt a lot from this teaching. It’s a great piece.

I am doing research on EFL teacher motivation for his/her job. How Can I structure it? Is there any detailed template, additional to this?

You are so cool! I do not think I’ve read through something like this before. So nice to find somebody with some genuine thoughts on this issue. Seriously.. thank you for starting this up. This site is one thing that is required on the internet, someone with a little originality!

I’m asked to do conceptual, theoretical and empirical literature, and i just don’t know how to structure it

Asking questions are actually fastidious thing if you are not understanding anything fully, but this article presents good understanding yet.

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Approaching literature review for academic purposes: The Literature Review Checklist

Debora f.b. leite.

I Departamento de Ginecologia e Obstetricia, Faculdade de Ciencias Medicas, Universidade Estadual de Campinas, Campinas, SP, BR

II Universidade Federal de Pernambuco, Pernambuco, PE, BR

III Hospital das Clinicas, Universidade Federal de Pernambuco, Pernambuco, PE, BR

Maria Auxiliadora Soares Padilha

Jose g. cecatti.

A sophisticated literature review (LR) can result in a robust dissertation/thesis by scrutinizing the main problem examined by the academic study; anticipating research hypotheses, methods and results; and maintaining the interest of the audience in how the dissertation/thesis will provide solutions for the current gaps in a particular field. Unfortunately, little guidance is available on elaborating LRs, and writing an LR chapter is not a linear process. An LR translates students’ abilities in information literacy, the language domain, and critical writing. Students in postgraduate programs should be systematically trained in these skills. Therefore, this paper discusses the purposes of LRs in dissertations and theses. Second, the paper considers five steps for developing a review: defining the main topic, searching the literature, analyzing the results, writing the review and reflecting on the writing. Ultimately, this study proposes a twelve-item LR checklist. By clearly stating the desired achievements, this checklist allows Masters and Ph.D. students to continuously assess their own progress in elaborating an LR. Institutions aiming to strengthen students’ necessary skills in critical academic writing should also use this tool.

INTRODUCTION

Writing the literature review (LR) is often viewed as a difficult task that can be a point of writer’s block and procrastination ( 1 ) in postgraduate life. Disagreements on the definitions or classifications of LRs ( 2 ) may confuse students about their purpose and scope, as well as how to perform an LR. Interestingly, at many universities, the LR is still an important element in any academic work, despite the more recent trend of producing scientific articles rather than classical theses.

The LR is not an isolated section of the thesis/dissertation or a copy of the background section of a research proposal. It identifies the state-of-the-art knowledge in a particular field, clarifies information that is already known, elucidates implications of the problem being analyzed, links theory and practice ( 3 - 5 ), highlights gaps in the current literature, and places the dissertation/thesis within the research agenda of that field. Additionally, by writing the LR, postgraduate students will comprehend the structure of the subject and elaborate on their cognitive connections ( 3 ) while analyzing and synthesizing data with increasing maturity.

At the same time, the LR transforms the student and hints at the contents of other chapters for the reader. First, the LR explains the research question; second, it supports the hypothesis, objectives, and methods of the research project; and finally, it facilitates a description of the student’s interpretation of the results and his/her conclusions. For scholars, the LR is an introductory chapter ( 6 ). If it is well written, it demonstrates the student’s understanding of and maturity in a particular topic. A sound and sophisticated LR can indicate a robust dissertation/thesis.

A consensus on the best method to elaborate a dissertation/thesis has not been achieved. The LR can be a distinct chapter or included in different sections; it can be part of the introduction chapter, part of each research topic, or part of each published paper ( 7 ). However, scholars view the LR as an integral part of the main body of an academic work because it is intrinsically connected to other sections ( Figure 1 ) and is frequently present. The structure of the LR depends on the conventions of a particular discipline, the rules of the department, and the student’s and supervisor’s areas of expertise, needs and interests.

Interestingly, many postgraduate students choose to submit their LR to peer-reviewed journals. As LRs are critical evaluations of current knowledge, they are indeed publishable material, even in the form of narrative or systematic reviews. However, systematic reviews have specific patterns 1 ( 8 ) that may not entirely fit with the questions posed in the dissertation/thesis. Additionally, the scope of a systematic review may be too narrow, and the strict criteria for study inclusion may omit important information from the dissertation/thesis. Therefore, this essay discusses the definition of an LR is and methods to develop an LR in the context of an academic dissertation/thesis. Finally, we suggest a checklist to evaluate an LR.

WHAT IS A LITERATURE REVIEW IN A THESIS?

Conducting research and writing a dissertation/thesis translates rational thinking and enthusiasm ( 9 ). While a strong body of literature that instructs students on research methodology, data analysis and writing scientific papers exists, little guidance on performing LRs is available. The LR is a unique opportunity to assess and contrast various arguments and theories, not just summarize them. The research results should not be discussed within the LR, but the postgraduate student tends to write a comprehensive LR while reflecting on his or her own findings ( 10 ).

Many people believe that writing an LR is a lonely and linear process. Supervisors or the institutions assume that the Ph.D. student has mastered the relevant techniques and vocabulary associated with his/her subject and conducts a self-reflection about previously published findings. Indeed, while elaborating the LR, the student should aggregate diverse skills, which mainly rely on his/her own commitment to mastering them. Thus, less supervision should be required ( 11 ). However, the parameters described above might not currently be the case for many students ( 11 , 12 ), and the lack of formal and systematic training on writing LRs is an important concern ( 11 ).

An institutional environment devoted to active learning will provide students the opportunity to continuously reflect on LRs, which will form a dialogue between the postgraduate student and the current literature in a particular field ( 13 ). Postgraduate students will be interpreting studies by other researchers, and, according to Hart (1998) ( 3 ), the outcomes of the LR in a dissertation/thesis include the following:

• To identify what research has been performed and what topics require further investigation in a particular field of knowledge;
• To determine the context of the problem;
• To recognize the main methodologies and techniques that have been used in the past;
• To place the current research project within the historical, methodological and theoretical context of a particular field;
• To identify significant aspects of the topic;
• To elucidate the implications of the topic;
• To offer an alternative perspective;
• To discern how the studied subject is structured;
• To improve the student’s subject vocabulary in a particular field; and
• To characterize the links between theory and practice.

A sound LR translates the postgraduate student’s expertise in academic and scientific writing: it expresses his/her level of comfort with synthesizing ideas ( 11 ). The LR reveals how well the postgraduate student has proceeded in three domains: an effective literature search, the language domain, and critical writing.

Effective literature search

All students should be trained in gathering appropriate data for specific purposes, and information literacy skills are a cornerstone. These skills are defined as “an individual’s ability to know when they need information, to identify information that can help them address the issue or problem at hand, and to locate, evaluate, and use that information effectively” ( 14 ). Librarian support is of vital importance in coaching the appropriate use of Boolean logic (AND, OR, NOT) and other tools for highly efficient literature searches (e.g., quotation marks and truncation), as is the appropriate management of electronic databases.

Language domain

Academic writing must be concise and precise: unnecessary words distract the reader from the essential content ( 15 ). In this context, reading about issues distant from the research topic ( 16 ) may increase students’ general vocabulary and familiarity with grammar. Ultimately, reading diverse materials facilitates and encourages the writing process itself.

Critical writing

Critical judgment includes critical reading, thinking and writing. It supposes a student’s analytical reflection about what he/she has read. The student should delineate the basic elements of the topic, characterize the most relevant claims, identify relationships, and finally contrast those relationships ( 17 ). Each scientific document highlights the perspective of the author, and students will become more confident in judging the supporting evidence and underlying premises of a study and constructing their own counterargument as they read more articles. A paucity of integration or contradictory perspectives indicates lower levels of cognitive complexity ( 12 ).

Thus, while elaborating an LR, the postgraduate student should achieve the highest category of Bloom’s cognitive skills: evaluation ( 12 ). The writer should not only summarize data and understand each topic but also be able to make judgments based on objective criteria, compare resources and findings, identify discrepancies due to methodology, and construct his/her own argument ( 12 ). As a result, the student will be sufficiently confident to show his/her own voice .

Writing a consistent LR is an intense and complex activity that reveals the training and long-lasting academic skills of a writer. It is not a lonely or linear process. However, students are unlikely to be prepared to write an LR if they have not mastered the aforementioned domains ( 10 ). An institutional environment that supports student learning is crucial.

Different institutions employ distinct methods to promote students’ learning processes. First, many universities propose modules to develop behind the scenes activities that enhance self-reflection about general skills (e.g., the skills we have mastered and the skills we need to develop further), behaviors that should be incorporated (e.g., self-criticism about one’s own thoughts), and each student’s role in the advancement of his/her field. Lectures or workshops about LRs themselves are useful because they describe the purposes of the LR and how it fits into the whole picture of a student’s work. These activities may explain what type of discussion an LR must involve, the importance of defining the correct scope, the reasons to include a particular resource, and the main role of critical reading.

Some pedagogic services that promote a continuous improvement in study and academic skills are equally important. Examples include workshops about time management, the accomplishment of personal objectives, active learning, and foreign languages for nonnative speakers. Additionally, opportunities to converse with other students promotes an awareness of others’ experiences and difficulties. Ultimately, the supervisor’s role in providing feedback and setting deadlines is crucial in developing students’ abilities and in strengthening students’ writing quality ( 12 ).

HOW SHOULD A LITERATURE REVIEW BE DEVELOPED?

A consensus on the appropriate method for elaborating an LR is not available, but four main steps are generally accepted: defining the main topic, searching the literature, analyzing the results, and writing ( 6 ). We suggest a fifth step: reflecting on the information that has been written in previous publications ( Figure 2 ).

First step: Defining the main topic

Planning an LR is directly linked to the research main question of the thesis and occurs in parallel to students’ training in the three domains discussed above. The planning stage helps organize ideas, delimit the scope of the LR ( 11 ), and avoid the wasting of time in the process. Planning includes the following steps:

• Reflecting on the scope of the LR: postgraduate students will have assumptions about what material must be addressed and what information is not essential to an LR ( 13 , 18 ). Cooper’s Taxonomy of Literature Reviews 2 systematizes the writing process through six characteristics and nonmutually exclusive categories. The focus refers to the reviewer’s most important points of interest, while the goals concern what students want to achieve with the LR. The perspective assumes answers to the student’s own view of the LR and how he/she presents a particular issue. The coverage defines how comprehensive the student is in presenting the literature, and the organization determines the sequence of arguments. The audience is defined as the group for whom the LR is written.
• Designating sections and subsections: Headings and subheadings should be specific, explanatory and have a coherent sequence throughout the text ( 4 ). They simulate an inverted pyramid, with an increasing level of reflection and depth of argument.
• Identifying keywords: The relevant keywords for each LR section should be listed to guide the literature search. This list should mirror what Hart (1998) ( 3 ) advocates as subject vocabulary . The keywords will also be useful when the student is writing the LR since they guide the reader through the text.
• Delineating the time interval and language of documents to be retrieved in the second step. The most recently published documents should be considered, but relevant texts published before a predefined cutoff year can be included if they are classic documents in that field. Extra care should be employed when translating documents.

Second step: Searching the literature

The ability to gather adequate information from the literature must be addressed in postgraduate programs. Librarian support is important, particularly for accessing difficult texts. This step comprises the following components:

• Searching the literature itself: This process consists of defining which databases (electronic or dissertation/thesis repositories), official documents, and books will be searched and then actively conducting the search. Information literacy skills have a central role in this stage. While searching electronic databases, controlled vocabulary (e.g., Medical Subject Headings, or MeSH, for the PubMed database) or specific standardized syntax rules may need to be applied.

In addition, two other approaches are suggested. First, a review of the reference list of each document might be useful for identifying relevant publications to be included and important opinions to be assessed. This step is also relevant for referencing the original studies and leading authors in that field. Moreover, students can directly contact the experts on a particular topic to consult with them regarding their experience or use them as a source of additional unpublished documents.

Before submitting a dissertation/thesis, the electronic search strategy should be repeated. This process will ensure that the most recently published papers will be considered in the LR.

• Selecting documents for inclusion: Generally, the most recent literature will be included in the form of published peer-reviewed papers. Assess books and unpublished material, such as conference abstracts, academic texts and government reports, are also important to assess since the gray literature also offers valuable information. However, since these materials are not peer-reviewed, we recommend that they are carefully added to the LR.

This task is an important exercise in time management. First, students should read the title and abstract to understand whether that document suits their purposes, addresses the research question, and helps develop the topic of interest. Then, they should scan the full text, determine how it is structured, group it with similar documents, and verify whether other arguments might be considered ( 5 ).

Third step: Analyzing the results

Critical reading and thinking skills are important in this step. This step consists of the following components:

• Reading documents: The student may read various texts in depth according to LR sections and subsections ( defining the main topic ), which is not a passive activity ( 1 ). Some questions should be asked to practice critical analysis skills, as listed below. Is the research question evident and articulated with previous knowledge? What are the authors’ research goals and theoretical orientations, and how do they interact? Are the authors’ claims related to other scholars’ research? Do the authors consider different perspectives? Was the research project designed and conducted properly? Are the results and discussion plausible, and are they consistent with the research objectives and methodology? What are the strengths and limitations of this work? How do the authors support their findings? How does this work contribute to the current research topic? ( 1 , 19 )
• Taking notes: Students who systematically take notes on each document are more readily able to establish similarities or differences with other documents and to highlight personal observations. This approach reinforces the student’s ideas about the next step and helps develop his/her own academic voice ( 1 , 13 ). Voice recognition software ( 16 ), mind maps ( 5 ), flowcharts, tables, spreadsheets, personal comments on the referenced texts, and note-taking apps are all available tools for managing these observations, and the student him/herself should use the tool that best improves his/her learning. Additionally, when a student is considering submitting an LR to a peer-reviewed journal, notes should be taken on the activities performed in all five steps to ensure that they are able to be replicated.

Fourth step: Writing

The recognition of when a student is able and ready to write after a sufficient period of reading and thinking is likely a difficult task. Some students can produce a review in a single long work session. However, as discussed above, writing is not a linear process, and students do not need to write LRs according to a specific sequence of sections. Writing an LR is a time-consuming task, and some scholars believe that a period of at least six months is sufficient ( 6 ). An LR, and academic writing in general, expresses the writer’s proper thoughts, conclusions about others’ work ( 6 , 10 , 13 , 16 ), and decisions about methods to progress in the chosen field of knowledge. Thus, each student is expected to present a different learning and writing trajectory.

In this step, writing methods should be considered; then, editing, citing and correct referencing should complete this stage, at least temporarily. Freewriting techniques may be a good starting point for brainstorming ideas and improving the understanding of the information that has been read ( 1 ). Students should consider the following parameters when creating an agenda for writing the LR: two-hour writing blocks (at minimum), with prespecified tasks that are possible to complete in one section; short (minutes) and long breaks (days or weeks) to allow sufficient time for mental rest and reflection; and short- and long-term goals to motivate the writing itself ( 20 ). With increasing experience, this scheme can vary widely, and it is not a straightforward rule. Importantly, each discipline has a different way of writing ( 1 ), and each department has its own preferred styles for citations and references.

Fifth step: Reflecting on the writing

In this step, the postgraduate student should ask him/herself the same questions as in the analyzing the results step, which can take more time than anticipated. Ambiguities, repeated ideas, and a lack of coherence may not be noted when the student is immersed in the writing task for long periods. The whole effort will likely be a work in progress, and continuous refinements in the written material will occur once the writing process has begun.

LITERATURE REVIEW CHECKLIST

In contrast to review papers, the LR of a dissertation/thesis should not be a standalone piece or work. Instead, it should present the student as a scholar and should maintain the interest of the audience in how that dissertation/thesis will provide solutions for the current gaps in a particular field.

A checklist for evaluating an LR is convenient for students’ continuous academic development and research transparency: it clearly states the desired achievements for the LR of a dissertation/thesis. Here, we present an LR checklist developed from an LR scoring rubric ( 11 ). For a critical analysis of an LR, we maintain the five categories but offer twelve criteria that are not scaled ( Figure 3 ). The criteria all have the same importance and are not mutually exclusive.

First category: Coverage

1. justified criteria exist for the inclusion and exclusion of literature in the review.

This criterion builds on the main topic and areas covered by the LR ( 18 ). While experts may be confident in retrieving and selecting literature, postgraduate students must convince their audience about the adequacy of their search strategy and their reasons for intentionally selecting what material to cover ( 11 ). References from different fields of knowledge provide distinct perspective, but narrowing the scope of coverage may be important in areas with a large body of existing knowledge.

Second category: Synthesis

2. a critical examination of the state of the field exists.

A critical examination is an assessment of distinct aspects in the field ( 1 ) along with a constructive argument. It is not a negative critique but an expression of the student’s understanding of how other scholars have added to the topic ( 1 ), and the student should analyze and contextualize contradictory statements. A writer’s personal bias (beliefs or political involvement) have been shown to influence the structure and writing of a document; therefore, the cultural and paradigmatic background guide how the theories are revised and presented ( 13 ). However, an honest judgment is important when considering different perspectives.

3. The topic or problem is clearly placed in the context of the broader scholarly literature

The broader scholarly literature should be related to the chosen main topic for the LR ( how to develop the literature review section). The LR can cover the literature from one or more disciplines, depending on its scope, but it should always offer a new perspective. In addition, students should be careful in citing and referencing previous publications. As a rule, original studies and primary references should generally be included. Systematic and narrative reviews present summarized data, and it may be important to cite them, particularly for issues that should be understood but do not require a detailed description. Similarly, quotations highlight the exact statement from another publication. However, excessive referencing may disclose lower levels of analysis and synthesis by the student.

4. The LR is critically placed in the historical context of the field

Situating the LR in its historical context shows the level of comfort of the student in addressing a particular topic. Instead of only presenting statements and theories in a temporal approach, which occasionally follows a linear timeline, the LR should authentically characterize the student’s academic work in the state-of-art techniques in their particular field of knowledge. Thus, the LR should reinforce why the dissertation/thesis represents original work in the chosen research field.

5. Ambiguities in definitions are considered and resolved

Distinct theories on the same topic may exist in different disciplines, and one discipline may consider multiple concepts to explain one topic. These misunderstandings should be addressed and contemplated. The LR should not synthesize all theories or concepts at the same time. Although this approach might demonstrate in-depth reading on a particular topic, it can reveal a student’s inability to comprehend and synthesize his/her research problem.

6. Important variables and phenomena relevant to the topic are articulated

The LR is a unique opportunity to articulate ideas and arguments and to purpose new relationships between them ( 10 , 11 ). More importantly, a sound LR will outline to the audience how these important variables and phenomena will be addressed in the current academic work. Indeed, the LR should build a bidirectional link with the remaining sections and ground the connections between all of the sections ( Figure 1 ).

7. A synthesized new perspective on the literature has been established

The LR is a ‘creative inquiry’ ( 13 ) in which the student elaborates his/her own discourse, builds on previous knowledge in the field, and describes his/her own perspective while interpreting others’ work ( 13 , 17 ). Thus, students should articulate the current knowledge, not accept the results at face value ( 11 , 13 , 17 ), and improve their own cognitive abilities ( 12 ).

Third category: Methodology

8. the main methodologies and research techniques that have been used in the field are identified and their advantages and disadvantages are discussed.

The LR is expected to distinguish the research that has been completed from investigations that remain to be performed, address the benefits and limitations of the main methods applied to date, and consider the strategies for addressing the expected limitations described above. While placing his/her research within the methodological context of a particular topic, the LR will justify the methodology of the study and substantiate the student’s interpretations.

9. Ideas and theories in the field are related to research methodologies

The audience expects the writer to analyze and synthesize methodological approaches in the field. The findings should be explained according to the strengths and limitations of previous research methods, and students must avoid interpretations that are not supported by the analyzed literature. This criterion translates to the student’s comprehension of the applicability and types of answers provided by different research methodologies, even those using a quantitative or qualitative research approach.

Fourth category: Significance

10. the scholarly significance of the research problem is rationalized.

The LR is an introductory section of a dissertation/thesis and will present the postgraduate student as a scholar in a particular field ( 11 ). Therefore, the LR should discuss how the research problem is currently addressed in the discipline being investigated or in different disciplines, depending on the scope of the LR. The LR explains the academic paradigms in the topic of interest ( 13 ) and methods to advance the field from these starting points. However, an excess number of personal citations—whether referencing the student’s research or studies by his/her research team—may reflect a narrow literature search and a lack of comprehensive synthesis of ideas and arguments.

11. The practical significance of the research problem is rationalized

The practical significance indicates a student’s comprehensive understanding of research terminology (e.g., risk versus associated factor), methodology (e.g., efficacy versus effectiveness) and plausible interpretations in the context of the field. Notably, the academic argument about a topic may not always reflect the debate in real life terms. For example, using a quantitative approach in epidemiology, statistically significant differences between groups do not explain all of the factors involved in a particular problem ( 21 ). Therefore, excessive faith in p -values may reflect lower levels of critical evaluation of the context and implications of a research problem by the student.

Fifth category: Rhetoric

12. the lr was written with a coherent, clear structure that supported the review.

This category strictly relates to the language domain: the text should be coherent and presented in a logical sequence, regardless of which organizational ( 18 ) approach is chosen. The beginning of each section/subsection should state what themes will be addressed, paragraphs should be carefully linked to each other ( 10 ), and the first sentence of each paragraph should generally summarize the content. Additionally, the student’s statements are clear, sound, and linked to other scholars’ works, and precise and concise language that follows standardized writing conventions (e.g., in terms of active/passive voice and verb tenses) is used. Attention to grammar, such as orthography and punctuation, indicates prudence and supports a robust dissertation/thesis. Ultimately, all of these strategies provide fluency and consistency for the text.

Although the scoring rubric was initially proposed for postgraduate programs in education research, we are convinced that this checklist is a valuable tool for all academic areas. It enables the monitoring of students’ learning curves and a concentrated effort on any criteria that are not yet achieved. For institutions, the checklist is a guide to support supervisors’ feedback, improve students’ writing skills, and highlight the learning goals of each program. These criteria do not form a linear sequence, but ideally, all twelve achievements should be perceived in the LR.

CONCLUSIONS

A single correct method to classify, evaluate and guide the elaboration of an LR has not been established. In this essay, we have suggested directions for planning, structuring and critically evaluating an LR. The planning of the scope of an LR and approaches to complete it is a valuable effort, and the five steps represent a rational starting point. An institutional environment devoted to active learning will support students in continuously reflecting on LRs, which will form a dialogue between the writer and the current literature in a particular field ( 13 ).

The completion of an LR is a challenging and necessary process for understanding one’s own field of expertise. Knowledge is always transitory, but our responsibility as scholars is to provide a critical contribution to our field, allowing others to think through our work. Good researchers are grounded in sophisticated LRs, which reveal a writer’s training and long-lasting academic skills. We recommend using the LR checklist as a tool for strengthening the skills necessary for critical academic writing.

AUTHOR CONTRIBUTIONS

Leite DFB has initially conceived the idea and has written the first draft of this review. Padilha MAS and Cecatti JG have supervised data interpretation and critically reviewed the manuscript. All authors have read the draft and agreed with this submission. Authors are responsible for all aspects of this academic piece.

ACKNOWLEDGMENTS

We are grateful to all of the professors of the ‘Getting Started with Graduate Research and Generic Skills’ module at University College Cork, Cork, Ireland, for suggesting and supporting this article. Funding: DFBL has granted scholarship from Brazilian Federal Agency for Support and Evaluation of Graduate Education (CAPES) to take part of her Ph.D. studies in Ireland (process number 88881.134512/2016-01). There is no participation from sponsors on authors’ decision to write or to submit this manuscript.

No potential conflict of interest was reported.

1 The questions posed in systematic reviews usually follow the ‘PICOS’ acronym: Population, Intervention, Comparison, Outcomes, Study design.

2 In 1988, Cooper proposed a taxonomy that aims to facilitate students’ and institutions’ understanding of literature reviews. Six characteristics with specific categories are briefly described: Focus: research outcomes, research methodologies, theories, or practices and applications; Goals: integration (generalization, conflict resolution, and linguistic bridge-building), criticism, or identification of central issues; Perspective: neutral representation or espousal of a position; Coverage: exhaustive, exhaustive with selective citations, representative, central or pivotal; Organization: historical, conceptual, or methodological; and Audience: specialized scholars, general scholars, practitioners or policymakers, or the general public.

Skills Courses and Workshops: Literature Review

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Revising and Editing the Literature Review Workshop: CAEX 8030/8035

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SKIL 8030/8035: Revising and Editing the Literature Review

The Doctoral Writing Workshop: Revising and Editing the Literature Review is a 0 credit, 6-week course for doctoral candidates who have a working draft of the Literature Review of their dissertation, project study, or doctoral study but need writing guidance and support.

NOTE : Students must already have an approved premise or prospectus to be eligible for this workshop.

Free tuition for current Walden doctoral students. Students are responsible for any applicable fees, including the tech fee

Workshop Information

Is writing the Literature Review a stumbling block? Is the research relayed without purpose or synthesis?  This small-group workshop is for doctoral candidates who have a working draft of the Literature Review of their dissertation, project study, or doctoral study but need writing guidance and support.

With the help of the writing faculty member, students will spend 6 weeks advancing their Literature Review through tailored one-on-one writing instruction and supportive group work with their peers. Students will get to know the required components of the Literature Review and have the opportunity to learn how to address common writing issues, such as effective use of summary and synthesis, applying correct use of APA and source citations, and articulating search strategies.

Importantly, the instruction and feedback students receive will be anchored in their own work. The goal of this workshop is to help students make progress toward the completion of the Literature Review. As needed, the faculty member will help create a tailored plan based on students’ specific needs to ensure that they can continue to advance their draft.

• Week 1: Self-reflection: Strengths and weaknesses in writing
• Week 2: Course discussions/Submit 3-5 page section for review
• Week 3: Course discussions/Submit 3-5 page section for review
• Week 4: Course discussions/Submit 3-5 page section for review
• Week 5: Course discussions/Submit 3-5 page section for review
• Week 6: Create a plan for moving forward

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