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

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

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

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

There are five key steps to writing a literature review:

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

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

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Table of contents

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

• Quick Run-through
• Step 1 & 2

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

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

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

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

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

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

Download Word doc Download Google doc

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

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

Make a list of keywords

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

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

Search for relevant sources

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

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

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

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

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

For each publication, ask yourself:

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

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

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

Take notes and cite your sources

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

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

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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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Writing a Literature Review

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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.

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

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

Table of Contents

• What is the purpose of literature review? 
• a. Habitat Loss and Species Extinction: 
• b. Range Shifts and Phenological Changes: 
• c. Ocean Acidification and Coral Reefs: 
• d. Adaptive Strategies and Conservation Efforts: 

How to write a good literature review 

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

What is a literature review?

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

What is the purpose of literature review?

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

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

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

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

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

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

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

Literature review example

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

Literature Review on Climate Change Impacts on Biodiversity:

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

a. Habitat Loss and Species Extinction:

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

b. Range Shifts and Phenological Changes:

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

c. Ocean Acidification and Coral Reefs:

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

d. Adaptive Strategies and Conservation Efforts:

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

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

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

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

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

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

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

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

Conducting a literature review

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

Choose a Topic and Define the Research Question:

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

Decide on the Scope of Your Review:

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

Select Databases for Searches:

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

Conduct Searches and Keep Track:

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

Review the Literature:

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

Organize and Write Your Literature Review:

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

Whether you’re exploring a new research field or finding new angles to develop an existing topic, sifting through hundreds of papers can take more time than you have to spare. But what if you could find science-backed insights with verified citations in seconds? That’s the power of Paperpal’s new Research feature!  

How to write a literature review faster with Paperpal?

Paperpal, an AI writing assistant, integrates powerful academic search capabilities within its writing platform. With the Research feature, you get 100% factual insights, with citations backed by 250M+ verified research articles, directly within your writing interface with the option to save relevant references in your Citation Library. By eliminating the need to switch tabs to find answers to all your research questions, Paperpal saves time and helps you stay focused on your writing.   

Here’s how to use the Research feature:  

• Ask a question: Get started with a new document on paperpal.com. Click on the “Research” feature and type your question in plain English. Paperpal will scour over 250 million research articles, including conference papers and preprints, to provide you with accurate insights and citations. 
• Review and Save: Paperpal summarizes the information, while citing sources and listing relevant reads. You can quickly scan the results to identify relevant references and save these directly to your built-in citations library for later access. 
• Cite with Confidence: Paperpal makes it easy to incorporate relevant citations and references into your writing, ensuring your arguments are well-supported by credible sources. This translates to a polished, well-researched literature review. 

The literature review sample and detailed advice on writing and conducting a review will help you produce a well-structured report. But remember that a good literature review is an ongoing process, and it may be necessary to revisit and update it as your research progresses. By combining effortless research with an easy citation process, Paperpal Research streamlines the literature review process and empowers you to write faster and with more confidence. Try Paperpal Research now and see for yourself.  

Frequently asked questions

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

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

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

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

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

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

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

References 

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

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

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

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

What are Literature Reviews?

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

Goals of Literature Reviews

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

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

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

What kinds of sources require a Literature Review?

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

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

Types of Literature Reviews

What kinds of literature reviews are written?

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

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

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

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

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

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

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

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

Literature Reviews in the Health Sciences

• UConn Health subject guide on systematic reviews Explanation of the different review types used in health sciences literature as well as tools to help you find the right review type
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Literature reviews, what is a literature review, learning more about how to do a literature review.

• Planning the Review
• The Research Question
• Choosing Where to Search
• Organizing the Review
• Writing the Review

A literature review is a review and synthesis of existing research on a topic or research question. A literature review is meant to analyze the scholarly literature, make connections across writings and identify strengths, weaknesses, trends, and missing conversations. A literature review should address different aspects of a topic as it relates to your research question. A literature review goes beyond a description or summary of the literature you have read. 

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• What is a Literature Review? | Guide, Template, & Examples

What is a Literature Review? | Guide, Template, & Examples

Published on 22 February 2022 by Shona McCombes . Revised on 7 June 2022.

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.

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 summarise sources – it analyses, synthesises, and critically evaluates to give a clear picture of the state of knowledge on the subject.

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Table of contents

Why write 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, frequently asked questions about literature reviews, introduction.

• Quick Run-through
• Step 1 & 2

When you write a dissertation or thesis, you will 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 scholarly context
• Develop a theoretical framework and methodology for your research
• Position yourself in relation to other researchers and theorists
• Show how your dissertation addresses a gap or contributes to a debate

You might also have to write a literature review as a stand-alone assignment. In this case, the purpose is to evaluate the current state of research and demonstrate your knowledge of scholarly debates around a topic.

The content will look slightly different in each case, but the process of conducting a literature review follows the same steps. We’ve written a step-by-step guide that you can follow below.

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

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

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

Download Word doc Download Google doc

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

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

If you are writing a literature review as a stand-alone assignment, you will have to choose a focus and develop a central question to direct your search. Unlike a dissertation research question, this question has to be answerable without collecting original data. You should be able to answer it based only on a review of existing publications.

Make a list of keywords

Start by creating a list of keywords related to your research topic. 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 if 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 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 use boolean operators to help narrow down your search:

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.

To identify the most important publications on your topic, take note of recurring citations. If the same authors, books or articles keep appearing in your reading, make sure to seek them out.

You probably won’t be able to read absolutely everything that has been written on the topic – you’ll have to evaluate which sources are most relevant to your questions.

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?
• How does the publication contribute to your understanding of the topic? What are its key insights and arguments?
• 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 find out how many times an article has been cited on Google Scholar – a high citation count means the article has been influential in the field, and should certainly be included in your literature review.

The scope of your review will depend on your topic and discipline: in the sciences you usually only review recent literature, but in the humanities you might take a long historical perspective (for example, to trace how a concept has changed in meaning over time).

Remember that you can use our template to summarise and evaluate sources you’re thinking about using!

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’s important to keep track of your sources with references to avoid plagiarism . It can be helpful to make an annotated bibliography, where you compile full reference 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.

You can use our free APA Reference Generator for quick, correct, consistent citations.

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To begin organising your literature review’s argument and structure, you need to 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 organising the body of a literature review. You should have a rough idea of your strategy before you start writing.

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 summarising sources in order.

Try to analyse 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 organise 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.

If you are writing the literature review as part of your dissertation or thesis, reiterate your central problem or research question and give a brief summary of the scholarly context. You can emphasise the timeliness of the topic (“many recent studies have focused on the problem of x”) or highlight a gap in the literature (“while there has been much research on x, few researchers have taken y into consideration”).

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, make sure to follow these tips:

• Summarise and synthesise: give an overview of the main points of each source and combine them into a coherent whole.
• Analyse and interpret: don’t just paraphrase other researchers – add your own interpretations, 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 transitions and topic sentences to draw connections, comparisons and contrasts.

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

If the literature review is part of your dissertation or thesis, reiterate how your research addresses gaps and contributes new knowledge, or discuss how you have drawn on existing theories and methods to build a framework for your research. This can lead directly into your methodology section.

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 dissertation , thesis, research paper , or proposal .

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

• To familiarise 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  dissertation . After the introduction , it grounds your research in a scholarly field and leads directly to your theoretical framework or methodology .

Cite this Scribbr article

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What is a literature review? [with examples]

What is a literature review?

The purpose of a literature review, how to write a literature review, the format of a literature review, general formatting rules, the length of a literature review, literature review examples, frequently asked questions about literature reviews, related articles.

A literature review is an assessment of the sources in a chosen topic of research.

In a literature review, you’re expected to report on the existing scholarly conversation, without adding new contributions.

If you are currently writing one, you've come to the right place. In the following paragraphs, we will explain:

• the objective of a literature review
• how to write a literature review
• the basic format of a literature review

Tip: It’s not always mandatory to add a literature review in a paper. Theses and dissertations often include them, whereas research papers may not. Make sure to consult with your instructor for exact requirements.

The four main objectives of a literature review are:

• Studying the references of your research area
• Summarizing the main arguments
• Identifying current gaps, stances, and issues
• Presenting all of the above in a text

Ultimately, the main goal of a literature review is to provide the researcher with sufficient knowledge about the topic in question so that they can eventually make an intervention.

The format of a literature review is fairly standard. It includes an:

• introduction that briefly introduces the main topic
• body that includes the main discussion of the key arguments
• conclusion that highlights the gaps and issues of the literature

➡️ Take a look at our guide on how to write a literature review to learn more about how to structure a literature review.

First of all, a literature review should have its own labeled section. You should indicate clearly in the table of contents where the literature can be found, and you should label this section as “Literature Review.”

➡️ For more information on writing a thesis, visit our guide on how to structure a thesis .

There is no set amount of words for a literature review, so the length depends on the research. If you are working with a large amount of sources, it will be long. If your paper does not depend entirely on references, it will be short.

Take a look at these three theses featuring great literature reviews:

• School-Based Speech-Language Pathologist's Perceptions of Sensory Food Aversions in Children [ PDF , see page 20]
• Who's Writing What We Read: Authorship in Criminological Research [ PDF , see page 4]
• A Phenomenological Study of the Lived Experience of Online Instructors of Theological Reflection at Christian Institutions Accredited by the Association of Theological Schools [ PDF , see page 56]

Literature reviews are most commonly found in theses and dissertations. However, you find them in research papers as well.

There is no set amount of words for a literature review, so the length depends on the research. If you are working with a large amount of sources, then it will be long. If your paper does not depend entirely on references, then it will be short.

No. A literature review should have its own independent section. You should indicate clearly in the table of contents where the literature review can be found, and label this section as “Literature Review.”

The main goal of a literature review is to provide the researcher with sufficient knowledge about the topic in question so that they can eventually make an intervention.

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What is a literature review?

A literature review is an integrated analysis -- not just a summary-- of scholarly writings and other relevant evidence related directly to your research question.  That is, it represents a synthesis of the evidence that provides background information on your topic and shows a association between the evidence and your research question.

A literature review may be a stand alone work or the introduction to a larger research paper, depending on the assignment.  Rely heavily on the guidelines your instructor has given you.

Why is it important?

A literature review is important because it:

• Explains the background of research on a topic.
• Demonstrates why a topic is significant to a subject area.
• Discovers relationships between research studies/ideas.
• Identifies major themes, concepts, and researchers on a topic.
• Identifies critical gaps and points of disagreement.
• Discusses further research questions that logically come out of the previous studies.

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1. Choose a topic. Define your research question.

Your literature review should be guided by your central research question.  The literature represents background and research developments related to a specific research question, interpreted and analyzed by you in a synthesized way.

• Make sure your research question is not too broad or too narrow.  Is it manageable?
• Begin writing down terms that are related to your question. These will be useful for searches later.
• If you have the opportunity, discuss your topic with your professor and your class mates.

2. Decide on the scope of your review

How many studies do you need to look at? How comprehensive should it be? How many years should it cover? 

• This may depend on your assignment.  How many sources does the assignment require?

3. Select the databases you will use to conduct your searches.

Make a list of the databases you will search. 

Where to find databases:

• use the tabs on this guide
• Find other databases in the Nursing Information Resources web page
• More on the Medical Library web page
• ... and more on the Yale University Library web page

4. Conduct your searches to find the evidence. Keep track of your searches.

• Use the key words in your question, as well as synonyms for those words, as terms in your search. Use the database tutorials for help.
• Save the searches in the databases. This saves time when you want to redo, or modify, the searches. It is also helpful to use as a guide is the searches are not finding any useful results.
• Review the abstracts of research studies carefully. This will save you time.
• Use the bibliographies and references of research studies you find to locate others.
• Check with your professor, or a subject expert in the field, if you are missing any key works in the field.
• Ask your librarian for help at any time.
• Use a citation manager, such as EndNote as the repository for your citations. See the EndNote tutorials for help.

Review the literature

Some questions to help you analyze the research:

• What was the research question of the study you are reviewing? What were the authors trying to discover?
• Was the research funded by a source that could influence the findings?
• What were the research methodologies? Analyze its literature review, the samples and variables used, the results, and the conclusions.
• Does the research seem to be complete? Could it have been conducted more soundly? What further questions does it raise?
• If there are conflicting studies, why do you think that is?
• How are the authors viewed in the field? Has this study been cited? If so, how has it been analyzed?

Tips: 

• Review the abstracts carefully.  
• Keep careful notes so that you may track your thought processes during the research process.
• Create a matrix of the studies for easy analysis, and synthesis, across all of the studies.
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Introduction to Literature Reviews

Introduction.

• Step One: Define
• Step Two: Research
• Step Three: Write
• Suggested Readings

A literature review is a written work that :

• Compiles significant research published on a topic by accredited scholars and researchers;
• —Surveys scholarly articles, books, dissertations, conference proceedings, and other sources;
• —Examines contrasting perspectives, theoretical approaches, methodologies, findings, results, conclusions.
• —Reviews critically, analyzes, and synthesizes existing research on a topic; and,
• Performs a thorough “re” view, “overview”, or “look again” of past and current works on a subject, issue, or theory.

From these analyses, the writer then offers an overview of the current status of a particular area of knowledge from both a practical and theoretical perspective.

Literature reviews are important because they are usually a  required  step in a thesis proposal (Master's or PhD). The proposal will not be well-supported without a literature review. Also, literature reviews are important because they help you learn important authors and ideas in your field. This is useful for your coursework and your writing. Knowing key authors also helps you become acquainted with other researchers in your field.

Look at this diagram and imagine that your research is the "something new." This shows how your research should relate to major works and other sources.

Olivia Whitfield | Graduate Reference Assistant | 2012-2015

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Literature Reviews

What this handout is about.

This handout will explain what literature reviews are and offer insights into the form and construction of literature reviews in the humanities, social sciences, and sciences.

Introduction

OK. You’ve got to write a literature review. You dust off a novel and a book of poetry, settle down in your chair, and get ready to issue a “thumbs up” or “thumbs down” as you leaf through the pages. “Literature review” done. Right?

Wrong! The “literature” of a literature review refers to any collection of materials on a topic, not necessarily the great literary texts of the world. “Literature” could be anything from a set of government pamphlets on British colonial methods in Africa to scholarly articles on the treatment of a torn ACL. And a review does not necessarily mean that your reader wants you to give your personal opinion on whether or not you liked these sources.

What is a literature review, then?

A literature review discusses published information in a particular subject area, and sometimes information in a particular subject area within a certain time period.

A literature review can be just a simple summary of the sources, but it usually has an organizational pattern and combines both summary and synthesis. A summary is a recap of the important information of the source, but a synthesis is a re-organization, or a reshuffling, of that information. It might give a new interpretation of old material or combine new with old interpretations. Or it might trace the intellectual progression of the field, including major debates. And depending on the situation, the literature review may evaluate the sources and advise the reader on the most pertinent or relevant.

But how is a literature review different from an academic research paper?

The main focus of an academic research paper is to develop a new argument, and a research paper is likely to contain a literature review as one of its parts. In a research paper, you use the literature as a foundation and as support for a new insight that you contribute. The focus of a literature review, however, is to summarize and synthesize the arguments and ideas of others without adding new contributions.

Why do we write literature reviews?

Literature reviews provide you with a handy guide to a particular topic. If you have limited time to conduct research, literature reviews can give you an overview or act as a stepping stone. For professionals, they are useful reports that keep them up to date with what is current in the field. For scholars, the depth and breadth of the literature review emphasizes the credibility of the writer in his or her field. Literature reviews also provide a solid background for a research paper’s investigation. Comprehensive knowledge of the literature of the field is essential to most research papers.

Who writes these things, anyway?

Literature reviews are written occasionally in the humanities, but mostly in the sciences and social sciences; in experiment and lab reports, they constitute a section of the paper. Sometimes a literature review is written as a paper in itself.

Let’s get to it! What should I do before writing the literature review?

If your assignment is not very specific, seek clarification from your instructor:

• Roughly how many sources should you include?
• What types of sources (books, journal articles, websites)?
• Should you summarize, synthesize, or critique your sources by discussing a common theme or issue?
• Should you evaluate your sources?
• Should you provide subheadings and other background information, such as definitions and/or a history?

Find models

Look for other literature reviews in your area of interest or in the discipline and read them to get a sense of the types of themes you might want to look for in your own research or ways to organize your final review. You can simply put the word “review” in your search engine along with your other topic terms to find articles of this type on the Internet or in an electronic database. The bibliography or reference section of sources you’ve already read are also excellent entry points into your own research.

Narrow your topic

There are hundreds or even thousands of articles and books on most areas of study. The narrower your topic, the easier it will be to limit the number of sources you need to read in order to get a good survey of the material. Your instructor will probably not expect you to read everything that’s out there on the topic, but you’ll make your job easier if you first limit your scope.

Keep in mind that UNC Libraries have research guides and to databases relevant to many fields of study. You can reach out to the subject librarian for a consultation: https://library.unc.edu/support/consultations/ .

And don’t forget to tap into your professor’s (or other professors’) knowledge in the field. Ask your professor questions such as: “If you had to read only one book from the 90’s on topic X, what would it be?” Questions such as this help you to find and determine quickly the most seminal pieces in the field.

Consider whether your sources are current

Some disciplines require that you use information that is as current as possible. In the sciences, for instance, treatments for medical problems are constantly changing according to the latest studies. Information even two years old could be obsolete. However, if you are writing a review in the humanities, history, or social sciences, a survey of the history of the literature may be what is needed, because what is important is how perspectives have changed through the years or within a certain time period. Try sorting through some other current bibliographies or literature reviews in the field to get a sense of what your discipline expects. You can also use this method to consider what is currently of interest to scholars in this field and what is not.

Strategies for writing the literature review

Find a focus.

A literature review, like a term paper, is usually organized around ideas, not the sources themselves as an annotated bibliography would be organized. This means that you will not just simply list your sources and go into detail about each one of them, one at a time. No. As you read widely but selectively in your topic area, consider instead what themes or issues connect your sources together. Do they present one or different solutions? Is there an aspect of the field that is missing? How well do they present the material and do they portray it according to an appropriate theory? Do they reveal a trend in the field? A raging debate? Pick one of these themes to focus the organization of your review.

Convey it to your reader

A literature review may not have a traditional thesis statement (one that makes an argument), but you do need to tell readers what to expect. Try writing a simple statement that lets the reader know what is your main organizing principle. Here are a couple of examples:

The current trend in treatment for congestive heart failure combines surgery and medicine. More and more cultural studies scholars are accepting popular media as a subject worthy of academic consideration.

Consider organization

You’ve got a focus, and you’ve stated it clearly and directly. Now what is the most effective way of presenting the information? What are the most important topics, subtopics, etc., that your review needs to include? And in what order should you present them? Develop an organization for your review at both a global and local level:

First, cover the basic categories

Just like most academic papers, literature reviews also must contain at least three basic elements: an introduction or background information section; the body of the review containing the discussion of sources; and, finally, a conclusion and/or recommendations section to end the paper. The following provides a brief description of the content of each:

• Introduction: Gives a quick idea of the topic of the literature review, such as the central theme or organizational pattern.
• Body: Contains your discussion of sources and is organized either chronologically, thematically, or methodologically (see below for more information on each).
• Conclusions/Recommendations: Discuss what you have drawn from reviewing literature so far. Where might the discussion proceed?

Organizing the body

Once you have the basic categories in place, then you must consider how you will present the sources themselves within the body of your paper. Create an organizational method to focus this section even further.

To help you come up with an overall organizational framework for your review, consider the following scenario:

You’ve decided to focus your literature review on materials dealing with sperm whales. This is because you’ve just finished reading Moby Dick, and you wonder if that whale’s portrayal is really real. You start with some articles about the physiology of sperm whales in biology journals written in the 1980’s. But these articles refer to some British biological studies performed on whales in the early 18th century. So you check those out. Then you look up a book written in 1968 with information on how sperm whales have been portrayed in other forms of art, such as in Alaskan poetry, in French painting, or on whale bone, as the whale hunters in the late 19th century used to do. This makes you wonder about American whaling methods during the time portrayed in Moby Dick, so you find some academic articles published in the last five years on how accurately Herman Melville portrayed the whaling scene in his novel.

Now consider some typical ways of organizing the sources into a review:

• Chronological: If your review follows the chronological method, you could write about the materials above according to when they were published. For instance, first you would talk about the British biological studies of the 18th century, then about Moby Dick, published in 1851, then the book on sperm whales in other art (1968), and finally the biology articles (1980s) and the recent articles on American whaling of the 19th century. But there is relatively no continuity among subjects here. And notice that even though the sources on sperm whales in other art and on American whaling are written recently, they are about other subjects/objects that were created much earlier. Thus, the review loses its chronological focus.
• By publication: Order your sources by publication chronology, then, only if the order demonstrates a more important trend. For instance, you could order a review of literature on biological studies of sperm whales if the progression revealed a change in dissection practices of the researchers who wrote and/or conducted the studies.
• By trend: A better way to organize the above sources chronologically is to examine the sources under another trend, such as the history of whaling. Then your review would have subsections according to eras within this period. For instance, the review might examine whaling from pre-1600-1699, 1700-1799, and 1800-1899. Under this method, you would combine the recent studies on American whaling in the 19th century with Moby Dick itself in the 1800-1899 category, even though the authors wrote a century apart.
• Thematic: Thematic reviews of literature are organized around a topic or issue, rather than the progression of time. However, progression of time may still be an important factor in a thematic review. For instance, the sperm whale review could focus on the development of the harpoon for whale hunting. While the study focuses on one topic, harpoon technology, it will still be organized chronologically. The only difference here between a “chronological” and a “thematic” approach is what is emphasized the most: the development of the harpoon or the harpoon technology.But more authentic thematic reviews tend to break away from chronological order. For instance, a thematic review of material on sperm whales might examine how they are portrayed as “evil” in cultural documents. The subsections might include how they are personified, how their proportions are exaggerated, and their behaviors misunderstood. A review organized in this manner would shift between time periods within each section according to the point made.
• Methodological: A methodological approach differs from the two above in that the focusing factor usually does not have to do with the content of the material. Instead, it focuses on the “methods” of the researcher or writer. For the sperm whale project, one methodological approach would be to look at cultural differences between the portrayal of whales in American, British, and French art work. Or the review might focus on the economic impact of whaling on a community. A methodological scope will influence either the types of documents in the review or the way in which these documents are discussed. Once you’ve decided on the organizational method for the body of the review, the sections you need to include in the paper should be easy to figure out. They should arise out of your organizational strategy. In other words, a chronological review would have subsections for each vital time period. A thematic review would have subtopics based upon factors that relate to the theme or issue.

Sometimes, though, you might need to add additional sections that are necessary for your study, but do not fit in the organizational strategy of the body. What other sections you include in the body is up to you. Put in only what is necessary. Here are a few other sections you might want to consider:

• Current Situation: Information necessary to understand the topic or focus of the literature review.
• History: The chronological progression of the field, the literature, or an idea that is necessary to understand the literature review, if the body of the literature review is not already a chronology.
• Methods and/or Standards: The criteria you used to select the sources in your literature review or the way in which you present your information. For instance, you might explain that your review includes only peer-reviewed articles and journals.

Questions for Further Research: What questions about the field has the review sparked? How will you further your research as a result of the review?

Begin composing

Once you’ve settled on a general pattern of organization, you’re ready to write each section. There are a few guidelines you should follow during the writing stage as well. Here is a sample paragraph from a literature review about sexism and language to illuminate the following discussion:

However, other studies have shown that even gender-neutral antecedents are more likely to produce masculine images than feminine ones (Gastil, 1990). Hamilton (1988) asked students to complete sentences that required them to fill in pronouns that agreed with gender-neutral antecedents such as “writer,” “pedestrian,” and “persons.” The students were asked to describe any image they had when writing the sentence. Hamilton found that people imagined 3.3 men to each woman in the masculine “generic” condition and 1.5 men per woman in the unbiased condition. Thus, while ambient sexism accounted for some of the masculine bias, sexist language amplified the effect. (Source: Erika Falk and Jordan Mills, “Why Sexist Language Affects Persuasion: The Role of Homophily, Intended Audience, and Offense,” Women and Language19:2).

Use evidence

In the example above, the writers refer to several other sources when making their point. A literature review in this sense is just like any other academic research paper. Your interpretation of the available sources must be backed up with evidence to show that what you are saying is valid.

Be selective

Select only the most important points in each source to highlight in the review. The type of information you choose to mention should relate directly to the review’s focus, whether it is thematic, methodological, or chronological.

Use quotes sparingly

Falk and Mills do not use any direct quotes. That is because the survey nature of the literature review does not allow for in-depth discussion or detailed quotes from the text. Some short quotes here and there are okay, though, if you want to emphasize a point, or if what the author said just cannot be rewritten in your own words. Notice that Falk and Mills do quote certain terms that were coined by the author, not common knowledge, or taken directly from the study. But if you find yourself wanting to put in more quotes, check with your instructor.

Summarize and synthesize

Remember to summarize and synthesize your sources within each paragraph as well as throughout the review. The authors here recapitulate important features of Hamilton’s study, but then synthesize it by rephrasing the study’s significance and relating it to their own work.

Keep your own voice

While the literature review presents others’ ideas, your voice (the writer’s) should remain front and center. Notice that Falk and Mills weave references to other sources into their own text, but they still maintain their own voice by starting and ending the paragraph with their own ideas and their own words. The sources support what Falk and Mills are saying.

Use caution when paraphrasing

When paraphrasing a source that is not your own, be sure to represent the author’s information or opinions accurately and in your own words. In the preceding example, Falk and Mills either directly refer in the text to the author of their source, such as Hamilton, or they provide ample notation in the text when the ideas they are mentioning are not their own, for example, Gastil’s. For more information, please see our handout on plagiarism .

Revise, revise, revise

Draft in hand? Now you’re ready to revise. Spending a lot of time revising is a wise idea, because your main objective is to present the material, not the argument. So check over your review again to make sure it follows the assignment and/or your outline. Then, just as you would for most other academic forms of writing, rewrite or rework the language of your review so that you’ve presented your information in the most concise manner possible. Be sure to use terminology familiar to your audience; get rid of unnecessary jargon or slang. Finally, double check that you’ve documented your sources and formatted the review appropriately for your discipline. For tips on the revising and editing process, see our handout on revising drafts .

Works consulted

We consulted these works while writing this handout. This is not a comprehensive list of resources on the handout’s topic, and we encourage you to do your own research to find additional publications. Please do not use this list as a model for the format of your own reference list, as it may not match the citation style you are using. For guidance on formatting citations, please see the UNC Libraries citation tutorial . We revise these tips periodically and welcome feedback.

Anson, Chris M., and Robert A. Schwegler. 2010. The Longman Handbook for Writers and Readers , 6th ed. New York: Longman.

Jones, Robert, Patrick Bizzaro, and Cynthia Selfe. 1997. The Harcourt Brace Guide to Writing in the Disciplines . New York: Harcourt Brace.

Lamb, Sandra E. 1998. How to Write It: A Complete Guide to Everything You’ll Ever Write . Berkeley: Ten Speed Press.

Rosen, Leonard J., and Laurence Behrens. 2003. The Allyn & Bacon Handbook , 5th ed. New York: Longman.

Troyka, Lynn Quittman, and Doug Hesse. 2016. Simon and Schuster Handbook for Writers , 11th ed. London: Pearson.

You may reproduce it for non-commercial use if you use the entire handout and attribute the source: The Writing Center, University of North Carolina at Chapel Hill

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What is a Literature Review?

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." - Quote from Taylor, D. (n.d)."The Literature Review: A Few Tips on Conducting it".

• Citation: "The Literature Review: A Few Tips on Conducting it"

What kinds of literature reviews are written?

Each field has a particular way to do reviews for academic research literature. In the social sciences and humanities the most common are:

• Narrative Reviews: The purpose of this type of review is to describe the current state of the research on a specific research topic and to offer a critical analysis of the literature reviewed. Studies are grouped by research/theoretical categories, and themes and trends, strengths and weaknesses, and gaps are identified. The review ends with a conclusion section that 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.
• Book review essays/ Historiographical review essays : A type of literature review typical in History and related fields, e.g., Latin American studies. For example, the Latin American Research Review explains that the purpose of this type of review is to “(1) to familiarize readers with the subject, approach, arguments, and conclusions found in a group of books whose common focus is a historical period; a country or region within Latin America; or a practice, development, or issue of interest to specialists and others; (2) to locate these books within current scholarship, critical methodologies, and approaches; and (3) to probe the relation of these new books to previous work on the subject, especially canonical texts. Unlike individual book reviews, the cluster reviews found in LARR seek to address the state of the field or discipline and not solely the works at issue.” - LARR

What are the Goals of Creating a Literature Review?

• 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.

When do you need to write a Literature Review?

• When writing a prospectus or a thesis/dissertation
• When writing a research paper
• When writing a grant proposal

In all these cases you need to dedicate a chapter in these works to showcase what has been written about your research topic and to point out how your own research will shed new light into a body of scholarship.

Where I can find examples of Literature Reviews?

Note:  In the humanities, even if they don't use the term "literature review", they may have a dedicated  chapter that reviewed the "critical bibliography" or they incorporated that review in the introduction or first chapter of the dissertation, book, or article.

• UCSB electronic theses and dissertations In partnership with the Graduate Division, the UC Santa Barbara Library is making available theses and dissertations produced by UCSB students. Currently included in ADRL are theses and dissertations that were originally filed electronically, starting in 2011. In future phases of ADRL, all theses and dissertations created by UCSB students may be digitized and made available.

Where to Find Standalone Literature Reviews

Literature reviews are also written as standalone articles as a way to survey a particular research topic in-depth. This type of literature review looks at a topic from a historical perspective to see how the understanding of the topic has changed over time. 

• Find e-Journals for Standalone Literature Reviews The best way to get familiar with and to learn how to write literature reviews is by reading them. You can use our Journal Search option to find journals that specialize in publishing literature reviews from major disciplines like anthropology, sociology, etc. Usually these titles are called, "Annual Review of [discipline name] OR [Discipline name] Review. This option works best if you know the title of the publication you are looking for. Below are some examples of these journals! more... less... Journal Search can be found by hovering over the link for Research on the library website.

Social Sciences

• Annual Review of Anthropology
• Annual Review of Political Science
• Annual Review of Sociology
• Ethnic Studies Review

Hard science and health sciences:

• Annual Review of Biomedical Data Science
• Annual Review of Materials Science
• Systematic Review From journal site: "The journal Systematic Reviews encompasses all aspects of the design, conduct, and reporting of systematic reviews" in the health sciences.
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Introduction

Literature reviews take time. here is some general information to know before you start.  .

•  VIDEO -- This video is a great overview of the entire process.  (2020; North Carolina State University Libraries) --The transcript is included --This is for everyone; ignore the mention of "graduate students" --9.5 minutes, and every second is important  
• OVERVIEW -- Read this page from Purdue's OWL. It's not long, and gives some tips to fill in what you just learned from the video.  
• NOT A RESEARCH ARTICLE -- A literature review follows a different style, format, and structure from a research article.  

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What Is A Literature Review?

A plain-language explainer (with examples).

By:  Derek Jansen (MBA) & Kerryn Warren (PhD) | June 2020 (Updated May 2023)

If you’re faced with writing a dissertation or thesis, chances are you’ve encountered the term “literature review” . If you’re on this page, you’re probably not 100% what the literature review is all about. The good news is that you’ve come to the right place.

Literature Review 101

• What (exactly) is a literature review
• What’s the purpose of the literature review chapter
• How to find high-quality resources
• How to structure your literature review chapter
• Example of an actual literature review

What is a literature review?

The word “literature review” can refer to two related things that are part of the broader literature review process. The first is the task of  reviewing the literature  – i.e. sourcing and reading through the existing research relating to your research topic. The second is the  actual chapter  that you write up in your dissertation, thesis or research project. Let’s look at each of them:

Reviewing the literature

The first step of any literature review is to hunt down and  read through the existing research  that’s relevant to your research topic. To do this, you’ll use a combination of tools (we’ll discuss some of these later) to find journal articles, books, ebooks, research reports, dissertations, theses and any other credible sources of information that relate to your topic. You’ll then  summarise and catalogue these  for easy reference when you write up your literature review chapter. 

The literature review chapter

The second step of the literature review is to write the actual literature review chapter (this is usually the second chapter in a typical dissertation or thesis structure ). At the simplest level, the literature review chapter is an  overview of the key literature  that’s relevant to your research topic. This chapter should provide a smooth-flowing discussion of what research has already been done, what is known, what is unknown and what is contested in relation to your research topic. So, you can think of it as an  integrated review of the state of knowledge  around your research topic. 

What’s the purpose of a literature review?

The literature review chapter has a few important functions within your dissertation, thesis or research project. Let’s take a look at these:

Purpose #1 – Demonstrate your topic knowledge

The first function of the literature review chapter is, quite simply, to show the reader (or marker) that you  know what you’re talking about . In other words, a good literature review chapter demonstrates that you’ve read the relevant existing research and understand what’s going on – who’s said what, what’s agreed upon, disagreed upon and so on. This needs to be  more than just a summary  of who said what – it needs to integrate the existing research to  show how it all fits together  and what’s missing (which leads us to purpose #2, next). 

Purpose #2 – Reveal the research gap that you’ll fill

The second function of the literature review chapter is to  show what’s currently missing  from the existing research, to lay the foundation for your own research topic. In other words, your literature review chapter needs to show that there are currently “missing pieces” in terms of the bigger puzzle, and that  your study will fill one of those research gaps . By doing this, you are showing that your research topic is original and will help contribute to the body of knowledge. In other words, the literature review helps justify your research topic.  

Purpose #3 – Lay the foundation for your conceptual framework

The third function of the literature review is to form the  basis for a conceptual framework . Not every research topic will necessarily have a conceptual framework, but if your topic does require one, it needs to be rooted in your literature review. 

For example, let’s say your research aims to identify the drivers of a certain outcome – the factors which contribute to burnout in office workers. In this case, you’d likely develop a conceptual framework which details the potential factors (e.g. long hours, excessive stress, etc), as well as the outcome (burnout). Those factors would need to emerge from the literature review chapter – they can’t just come from your gut! 

So, in this case, the literature review chapter would uncover each of the potential factors (based on previous studies about burnout), which would then be modelled into a framework. 

Purpose #4 – To inform your methodology

The fourth function of the literature review is to  inform the choice of methodology  for your own research. As we’ve  discussed on the Grad Coach blog , your choice of methodology will be heavily influenced by your research aims, objectives and questions . Given that you’ll be reviewing studies covering a topic close to yours, it makes sense that you could learn a lot from their (well-considered) methodologies.

So, when you’re reviewing the literature, you’ll need to  pay close attention to the research design , methodology and methods used in similar studies, and use these to inform your methodology. Quite often, you’ll be able to  “borrow” from previous studies . This is especially true for quantitative studies , as you can use previously tried and tested measures and scales. 

How do I find articles for my literature review?

Finding quality journal articles is essential to crafting a rock-solid literature review. As you probably already know, not all research is created equally, and so you need to make sure that your literature review is  built on credible research . 

We could write an entire post on how to find quality literature (actually, we have ), but a good starting point is Google Scholar . Google Scholar is essentially the academic equivalent of Google, using Google’s powerful search capabilities to find relevant journal articles and reports. It certainly doesn’t cover every possible resource, but it’s a very useful way to get started on your literature review journey, as it will very quickly give you a good indication of what the  most popular pieces of research  are in your field.

One downside of Google Scholar is that it’s merely a search engine – that is, it lists the articles, but oftentimes  it doesn’t host the articles . So you’ll often hit a paywall when clicking through to journal websites. 

Thankfully, your university should provide you with access to their library, so you can find the article titles using Google Scholar and then search for them by name in your university’s online library. Your university may also provide you with access to  ResearchGate , which is another great source for existing research. 

Remember, the correct search keywords will be super important to get the right information from the start. So, pay close attention to the keywords used in the journal articles you read and use those keywords to search for more articles. If you can’t find a spoon in the kitchen, you haven’t looked in the right drawer. 

Need a helping hand?

How should I structure my literature review?

Unfortunately, there’s no generic universal answer for this one. The structure of your literature review will depend largely on your topic area and your research aims and objectives.

You could potentially structure your literature review chapter according to theme, group, variables , chronologically or per concepts in your field of research. We explain the main approaches to structuring your literature review here . You can also download a copy of our free literature review template to help you establish an initial structure.

In general, it’s also a good idea to start wide (i.e. the big-picture-level) and then narrow down, ending your literature review close to your research questions . However, there’s no universal one “right way” to structure your literature review. The most important thing is not to discuss your sources one after the other like a list – as we touched on earlier, your literature review needs to synthesise the research , not summarise it .

Ultimately, you need to craft your literature review so that it conveys the most important information effectively – it needs to tell a logical story in a digestible way. It’s no use starting off with highly technical terms and then only explaining what these terms mean later. Always assume your reader is not a subject matter expert and hold their hand through a journe y of the literature while keeping the functions of the literature review chapter (which we discussed earlier) front of mind.

Example of a literature review

In the video below, we walk you through a high-quality literature review from a dissertation that earned full distinction. This will give you a clearer view of what a strong literature review looks like in practice and hopefully provide some inspiration for your own. 

Wrapping Up

In this post, we’ve (hopefully) answered the question, “ what is a literature review? “. We’ve also considered the purpose and functions of the literature review, as well as how to find literature and how to structure the literature review chapter. If you’re keen to learn more, check out the literature review section of the Grad Coach blog , as well as our detailed video post covering how to write a literature review . 

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 .

16 Comments

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Literature Review: Conducting & Writing

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Review: Olympics opening ceremony shined with best of Paris and France, but failed as TV

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France took the opening ceremony of the Olympics out of the customary arena and onto the River Seine — and into the rain — Friday in what was undeniably a bold, unprecedented and, given the security nightmare, crazy take on the event . An Olympics whose motto is “Games Wide Open” ironically came with fences, checkpoints and police and soldiers numbering in the many tens of thousands. But they remained practically invisible through the broadcast, once again from NBC and also streaming on Peacock.

Almost nothing was revealed about the program ahead of time, past a few facts and figures — 300,000 spectators expected, a 3.7-mile route running west downriver from the Pont d’Austerlitz to the Eiffel Tower and Trocadéro, some 90 boats carrying 10,000 athletes, 12 thematic “scenes.” With little to go on, it was tempting to imagine what those scenes might encompass. Bearded existentialists drinking apricot cocktails? A nude descending a staircase? Jean-Pierre Léaud making one last appearance as Antoine Doinel? Striking railway workers? The band Telephone reunited? I was hoping to see at least one performer dressed as Jacques Tati’s M. Hulot, though I would have made it 100. Would there be mimes?

2024 Paris Olympics

Paris shines through summer storm in spectacular Olympic opening ceremony

Pouring rain can’t derail a bold a Paris Olympic opening ceremony that featured athletes on the Seine and performances from Lady Gaga and Celine Dion.

July 26, 2024

The answer to all those questions was no. Working with a team that included a historian, novelist, screenwriter and playwright, to say nothing of the choreographers and costumers, director Thomas Jolly — known for a 24-hour marathon staging of Shakespeare’s three “Henry VI” plays plus “Richard III” — cooked up something at once stranger and more appropriate: daffy, sexy, occasionally alarming — I would not have expected the decapitated Marie Antoinettes — and, one would say, quintessentially French. Even the rain, which, having arrived, stayed to enjoy itself, had a sort of Parisian quality, adding drama and romance. Though, of course, that part wasn’t scripted.

Taking the Games into the city center and putting the ceremony onto the river was a smart idea to begin with. You don’t go to Paris to stay indoors unless it’s to look at art or eat things cooked in butter; and if you’ve seen the inside of one over-lit stadium, you’ve seen them all. The Seine put the athletes, riding on their larger and smaller bateaux mouches, within spitting distance of Notre Dame, the Louvre, the Tuileries, Place Concorde, the Grand Palais and the Eiffel Tower.

There had been a few performers mentioned beforehand, including French Malian superstar Aya Nakamura; the “eco-metal” band Gojira, which, with its frequent collaborator the Franco-Swiss opera singer Marina Viotti, represented the Revolution; and the never publicly confirmed Celine Dion — who, in the event, did close the show, with a powerful rendition of Edith Piaf’s “L’Hymne à l’amour,” sung from high upon the Eiffel Tower. Lady Gaga, whose presence in the city had been noted, opened it — if you don’t count the winged accordion player on what I assume was the Austerlitz bridge — with a glamorous cabaret production of Zizi Jeanmaire’s ‘60s hit “Mon truc en plumes” set on gilded steps leading down to the river. That translates as “my thing with feathers,” and there were feathers, indeed — big pink fans, pink being the hue associated with that leg of the color-coded program.

Jolly mixed filmed pieces into the live performance. Most provocatively there was a gender-bending love story told through book titles that wound toward a suggested threesome — the show contained a decent amount of queer content. There was a dance in the scaffolding around Notre Dame. More crucial to the narrative, such as it was, were segments surrounding a masked and hooded torch bearer who would also be glimpsed in person along (and zip-lining above) the route. This bit included trips through the Metro, the catacombs — undoubtedly this was the first and surely the last opening ceremony to feature human skulls — and alligator-inhabited sewers, as well as the Louis Vuitton atelier (where they made the trunks that held the torch on its travels) and the Louvre, where figures left their paintings, later to emerge as giant heads in the river.

Olympics 2024: Celine Dion closes dazzling opening ceremony atop the Eiffel Tower

Read analysis of the Paris Olympics opening ceremony from our television writers, who weighed in on the spectacle held on the Seine.

Behind the clock in the Musée d’Orsay, we got a clip from the Lumière brothers’ seminal film of a train arriving in a station and a puppet animation that nodded to Georges Méliès‘ “A Trip to the Moon,” “The Little Prince” and “The Planet of the Apes,” which, of course, featured that statue the French made us. I did find this part particularly delightful.

This operatic mix of mediums, spread out across the city, could only make complete sense as television — anyone present would have only seen what was in front of them. And yet, as television, it mostly failed — further fragmenting a fragmented event, which alternated between the parade and the show over some four hours, with commentary and cutaways and, after the first hour, commercials. It spoke only of the banality of TV and to remind you that this is not an ad-free world. (The insertion of a “Despicable Me” short, from NBC’s parent company, Universal, had corporate cross-promotion written all over it.)

The commentary, by Mike Tirico, Kelly Clarkson and Peyton Manning, had the effect of people talking during a play, or that jarring feeling when you’re in a foreign country and you suddenly hear American voices. They were perhaps working at a disadvantage, given the secrecy that had surrounded the production and a less-than-native understanding of French culture and history. But apart from the sort of sports statistics that no viewer will keep in their head longer than it takes to say them, they spoke largely of how they felt and how they imagined the athletes must feel. It turned the parade of athletes into the Macy’s parade.

I say “mostly” failed. Often enough the grandeur, audacity and nuttiness of the event shone through the screen — mezzo-soprano Axelle Saint-Cirel singing “La Marseillaise” from the top of the Grand Palais, a silver chevalier on a robot horse skimming along the river to carry the Olympic flag to the Trocadéro, where the athletes had finally debarked, and where speeches from International Olympic Committee President Thomas Bach and Games President Tony Estanguet made one feel there might be something more to the Olympic spirit than winning medals.

And there was the genuinely moving finale, with Dion coming across like Liberty Leading the People in Delacroix’s famous painting and the Eiffel Tower putting on its laser show. White-clad athletes from many years passed the torch and became a crowd as they jogged together to the Louvre and back to the Tuileries, where a giant gold hot air balloon — the French invented it — was tethered. It became the Olympic cauldron, and then rose into the air, where I assume it will stay until the closing ceremony comes to tell us its story.

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This paper is in the following e-collection/theme issue:

Published on 29.7.2024 in Vol 10 (2024)

This is a member publication of University College London (Jisc)

Preferences for COVID-19 Vaccines: Systematic Literature Review of Discrete Choice Experiments

Authors of this article:

• Yiting Huang 1, 2 * , MPH   ; 
• Shuaixin Feng 3 * , MPH   ; 
• Yuyan Zhao 1 * , BMed   ; 
• Haode Wang 4 , PhD   ; 
• Hongbo Jiang 1, 5 , PhD  

1 Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China

2 Department of Medical Statistics, School of Basic Medicine and Public Health, Jinan University, Guangzhou, China

3 Outpatient department of Baogang, the First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China

4 School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom

5 Institute for Global Health, University College London, London, United Kingdom

*these authors contributed equally

Corresponding Author:

Hongbo Jiang, PhD

Department of Epidemiology and Biostatistics, School of Public Health

Guangdong Pharmaceutical University

Department of Epidemiology and Biostatistics, School of Public Health Guangdong Pharmaceutical University

No. 283 Jianghai Road, Haizhu District

Guangzhou, 510310

Phone: 86 0 203 405 5355

Fax:86 0 203 405 5355

Email: [email protected]

Background: Vaccination can be viewed as comprising the most important defensive barriers to protect susceptible groups from infection. However, vaccine hesitancy for COVID-19 is widespread worldwide.

Objective: We aimed to systematically review studies eliciting the COVID-19 vaccine preference using discrete choice experiments.

Methods: A literature search was conducted in PubMed, Embase, Web of Science, Scopus, and CINAHL Plus platforms in April 2023. Search terms included discrete choice experiments , COVID-19 , and vaccines and related synonyms. Descriptive statistics were used to summarize the study characteristics. Subgroup analyses were performed by factors such as high-income countries and low- and middle-income countries and study period (before, during, and after the pandemic wave). Quality appraisal was performed using the 5-item Purpose, Respondents, Explanation, Findings, and Significance checklist.

Results: The search yield a total of 623 records, and 47 studies with 53 data points were finally included. Attributes were grouped into 4 categories: outcome, process, cost, and others. The vaccine effectiveness (21/53, 40%) and safety (7/53, 13%) were the most frequently reported and important attributes. Subgroup analyses showed that vaccine effectiveness was the most important attribute, although the preference varied by subgroups. Compared to high-income countries (3/29, 10%), a higher proportion of low- and middle-income countries (4/24, 17%) prioritized safety. As the pandemic progressed, the duration of protection (2/24, 8%) during the pandemic wave and COVID-19 mortality risk (5/25, 20%) after the pandemic wave emerged as 2 of the most important attributes.

Conclusions: Our review revealed the critical role of vaccine effectiveness and safety in COVID-19 vaccine preference. However, it should be noticed that preference heterogeneity was observed across subpopulations and may change over time.

Trial Registration: PROSPERO CRD42023422720; https://tinyurl.com/2etf7ny7

Introduction

Although the World Health Organization has declared the end of COVID-19 as a public health emergency [ 1 ], the persistence of this disease as a global threat should not be overlooked or underestimated [ 2 ]. Vaccination has been regarded as one of the most effective strategies against COVID-19 and reduced global COVID-19 mortality, severe disease, symptomatic cases, and COVID-19 infections [ 2 , 3 ]. Furthermore, studies have shown that COVID-19 vaccine also had a preventive effect against post–COVID-19 condition [ 4 - 6 ].

Despite significant progress made with vaccination efforts, achieving high vaccination coverage remains a challenge due to disparities in vaccine distribution and vaccine hesitancy [ 7 - 9 ]. Disparities in vaccine distribution have been observed between different countries, with vaccination rates varying markedly between high- and low-income countries [ 10 ]. In addition, COVID-19 vaccine hesitancy has been reported across countries [ 11 ], and booster hesitancy has also become a growing concern for public health officials [ 12 ]. Vaccine hesitancy can change over time and in response to different circumstances. Notably, vaccine hesitancy tends to increase when population-level side-effect studies are released after emergency approvals [ 13 ]. These challenges underline the need for well-designed vaccination programs to ensure equitable access and high uptake.

Designing a successful vaccination program, including vaccine selection, rollout, and accessibility, is crucial [ 14 , 15 ]. A thorough understanding of individual needs and preferences will allow us to better tailor vaccination programs, which will facilitate the appeal and uptake of COVID-19 vaccines [ 16 , 17 ]. One approach increasingly used to elicit preferences for vaccines and vaccination programs is the discrete choice experiment (DCE) [ 18 , 19 ]. DCEs are scientific research methods that assess preferences by presenting respondents with a series of hypothetical scenarios. In these scenarios, individuals choose among different alternatives which are characterized by specific attributes. By analyzing these choices, researchers can identify the relative importance of each attribute and estimate utility functions [ 20 , 21 ]. DCEs provide valuable insights into decision-making processes and allow for objective evaluation of attribute-based benefits [ 22 - 24 ]. Published studies have been conducted to identify and review choice-based experiments that assess vaccine preferences [ 18 , 19 ]. However, it is important to note that the nature of various vaccines is different, and the preference for vaccines of COVID-19 was not specifically included in these studies.

The COVID-19 vaccines were developed under emergency conditions where there were no peer-reviewed systematic reviews of DCEs on COVID-19 vaccine preference data to inform global decision-making. The diversity in COVID-19 vaccine preferences may be attributed to disparities in vaccine development and production, vaccination scheduling and management, public trust and uptake, as well as vaccine prioritization strategies across various countries and regions [ 25 ]. Moreover, new mutant variants are more likely to infect new individuals, highlighting the need for more effective booster vaccines [ 26 , 27 ]. This study provides empirical evidence on the development, implementation, and follow-up of the COVID-19 vaccine and provides references for vaccine decision-making of other infectious diseases.

We conducted our review following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines ( Multimedia Appendix 1 ) [ 28 ]. This study was registered in the international prospective register of systematic reviews (PROSPERO CRD42023422720).

Search Strategy

A literature search was conducted in PubMed, Embase, Web of Science, Scopus, and CINAHL Plus platforms in April 2023. Search terms included discrete choice experiments , COVID-19 , and vaccines and related synonyms. Further details are provided in Multimedia Appendix 2 .

Eligibility Criteria

The inclusion and exclusion criteria are detailed in Textbox 1 .

Inclusion criteria

• Study focus: Focused on preferences for COVID-19 vaccine (product, service and distribution, policy intervention, etc)
• Article or study type: First-hand discrete choice experiment (DCE) data analysis research

Exclusion criteria

• Study focus: No preferences for COVID-19 vaccine reported
• Article or study type: Not DCE research; nonoriginal research (including secondary reports, systematic reviews, conference abstracts and presentations, correspondence, editorials, and commentaries); theoretical articles; protocols; book chapters; and duplicates

Data Screening and Extraction

Two reviewers (YH and SF) independently performed a 2-stage screening process to identify eligible studies. In the first stage, titles and abstracts were screened to exclude irrelevant studies using the web-based tool Rayyan (Rayyan Systems, Inc [ 29 ]). In the second stage, full-text versions of selected papers were assessed to ensure that the inclusion criteria were met. Both reviewers compared the selected papers at each stage to ensure agreement. Any discrepancy or uncertainty between the reviewers was addressed through discussion until a consensus was reached. If not, a third (senior) reviewer (HJ) was consulted to resolve the disagreement.

The extracted data were recorded and managed in Microsoft Excel (Microsoft Corp) software. Full texts were extracted and reviewed independently by 2 authors (YH and YZ), and any disagreements were resolved by a third reviewer (HJ). Data extraction was performed for 3 specific aspects, focusing on their relevance and importance for the analysis of the DCE: (1) study information (author, publication year, study period, country, population, and sample size); (2) information on the DCE methodology (survey administration, attribute and level selection, pilot-tested, experimental study design, choice sets per respondent, options per choice set, inclusion of an opt-out option, and statistical models); and (3) information on the DCE results (number of attributes, included attributes classified into 4 categories [outcome, process, cost, and other], and the most important attribute).

Choice-based experiments use different definitions for similar attributes [ 19 ]. To address this issue, the attributes were initially grouped into 4 main categories: outcomes, process, cost, and other. The outcomes category encompassed the outcomes or consequences of vaccine administration, such as safety and effectiveness. The process category included activities related to the delivery and administration of vaccines, such as service delivery, dosing, and visits. The cost category focused on the financial aspects of vaccines. Any attributes that did not fit into these 3 categories were classified as other , such as disease risk, incentives or penalties for vaccination, vaccine advice or support, and so on. The classification of outcome, process, cost, and other attributes depended on the aim and design of the studies. It should be noted that vaccine effectiveness and safety were phrased differently in different studies. To facilitate a comparison between studies, efficacy [ 11 , 30 - 41 ], protection rate [ 42 , 43 ], and decreased deaths [ 44 ] were summarized as vaccine effectiveness, whereas side effects [ 11 , 26 , 31 , 35 , 37 , 40 , 41 , 43 , 45 - 61 ], rare but serious risks [ 62 ], and the likelihood of having a flare [ 62 ] were summarized as vaccine safety ( Multimedia Appendix 3 [ 11 , 26 , 30 - 74 ]).

High-income countries (HICs) and low- and middle-income countries (LMICs) were classified according to the World Bank [ 75 ]. LMICs encompass low-income, lower-middle–income, and upper-middle–income countries. On the basis of previous literatures [ 63 , 76 , 77 ], we hypothesized that individuals’ preferences for vaccines may vary depending on the status of the pandemic. Therefore, we sought to explore how COVID-19 vaccine preferences differed during different study periods. To do this, we used data from the surveillance website [ 78 ] to define the pandemic periods based on daily COVID-19 cases. The first group, before the pandemic wave , referred to the period before the outbreak of the pandemic, when the number of incident cases was low. The second group, during the pandemic wave , represented the peak of the pandemic or was characterized by a rapid increase in the number of incident cases. The third group, after the pandemic wave , was when the number of incident cases decreased and remained low ( Multimedia Appendix 4 [ 11 , 26 , 30 - 74 ]).

Quality Appraisal

The 5-item Purpose, Respondents, Explanation, Findings, and Significance (PREFS) checklist, developed by Joy et al [ 79 ], is widely accepted and used to assess the reporting quality of preference studies [ 18 , 80 - 84 ]. It evaluates studies based on criteria such as the study’s purpose, respondent sampling, explanation of assessment methods, inclusion of complete response sets in the findings, and use of significance testing.

Data Synthesis and Analysis

This review used a combination of text and summary tables to effectively convey information about the characteristics and results of the included studies. Descriptive statistics were used to summarize the study characteristics. The findings were synthesized in a narrative format, providing an overview of the included studies, highlighting the key features of the study designs, and presenting the main findings of the COVID-19 vaccine preference studies. Subgroup analyses were performed by independent factors such as HICs or LMICs and study period (before, during, and after the pandemic wave).

Study Selection

The search yielded a total of 623 records. After title and abstract screening, 513 (82.3%) records were excluded. An additional 63 (10.1%) studies were excluded after full-text assessment. Finally, 47 (7.5%) studies met the eligibility criteria and were included in the review ( Figure 1 ).

Study and Sample Characteristics

We included 47 studies from 29 countries. Among them, 5 (11%) studies were conducted in multiple countries, with 4 studies conducted in both HICs and LMICs and 1 study conducted in >1 HICs. In addition, 22 (47%) studies were conducted in HICs, while 21 (45%) studies were conducted in LMICs. China stood out with the highest number of preference-based DCEs for COVID-19 vaccines, with 19 (40%) studies. The United States followed closely with 9 (19%) studies, followed by France (n=5, 11%), the United Kingdom (n=4, 9%), Germany (n=4, 9%), and Spain (n=3, 6%). Australia, Canada, India, Italy, Japan, the Netherlands, and South Africa had 2 (4%) studies each. All other countries had only 1 (2%) study ( Figure 2 ). The studies were published between the years 2020 and 2023, with sample sizes ranging from 194 to 13,128 participants. The median number of participants per study was 1456 (IQR 872-2109).

Most participants were adults, although the specific focus varied. Most studies (36/47, 77%) involved general population samples, whereas some studies (11/47, 23%) included specific groups of participants. These included 5 studies conducted in universities using web-based tools, including 3 studies with university students and 2 studies with both students and staff. In addition, 3 studies involved health care workers (Chinese intensive care unit clinicians, health care workers, and health care and welfare workers); 2 studies involved parents with children aged <18 years, and 1 study involved people with chronic immune-mediated inflammatory diseases ( Table 1 ).

a ICU: intensive care unit.

b NR: not reported.

The Implementation of DCEs

Among these 47 studies, researchers commonly used a multifaceted approach to identify and select attributes and levels. Among the studies reviewed, 23 (49%) studies reported a literature review with qualitative assessments such as expert interviews and public surveys. A total of 25 (53%) studies reported a pilot DCE survey. In terms of survey administration, most studies (40/47, 85%) reported that the DCE was conducted through web-based surveys ( Table 2 ).

a NR: not reported.

b CDC: Center for disease control and prevention.

c UKZN: the University of KwaZulu-Natal.

Attributes in DCE Studies

Of the 286 attributes identified in the 47 studies, 126 (44.1%) were categorized as outcome attributes, followed by 82 (28.7%) as process attributes, and 22 (7.7%) as cost attributes. The remaining 55 (19.2%) attributes were categorized as other attributes ( Table 3 and Multimedia Appendix 3 ).

a Attribute is significant ( P <.05).

b Not available.

c The corresponding coefficients and P values are not provided.

The Most Important Attribute Reported in DCE Studies

In total, 2 of the 5 multicountry studies did not report preferences for each country and were therefore excluded from the synthesis of the most important attribute. A total of 53 data points on COVID-19 vaccine preferences were collected from the study population of the corresponding country. In the outcome category, among the 30 attributes examined, effectiveness emerged as the most prominent, accounting for 40% (21/53) of the studies [ 31 , 35 , 36 , 38 - 42 , 48 , 50 - 52 , 57 , 58 , 60 - 62 , 64 - 67 ]. Safety was addressed in 13% (7/53) of the studies [ 33 , 43 , 47 , 56 , 59 , 68 , 69 ], while protection duration was mentioned in 4% (2/53) [ 11 , 50 ]. In the process category, 13 attributes were identified. Brand (1/53, 2%) [ 32 ], region of vaccine manufacturer (1/53, 2%) [ 34 ], and halal content (1/53, 2%) [ 53 ] were associated with vaccine production. In addition, waiting time for COVID-19 vaccination (1/53, 2%) [ 70 ] and vaccine frequency (1/53, 2%) [ 71 ] were considered. Furthermore, 3 (6%) studies on vaccine distribution prioritized vaccination for the medical risk group (1/53, 2%) [ 72 ], those who had a higher COVID-19 mortality risk (6/53, 11%) [ 63 ], and those who had the potential capacity to spread the virus (1/53, 2%) [ 72 ]. In the cost category, personal vaccination cost accounted for 6% (3/53) [ 31 , 37 , 41 ]. Among the other attributes (7/53, 13%), disease risk threat was of particular importance, including possible trends of the epidemic (1/53, 2%) [ 30 ] and COVID-19 mortality rate (1/53, 2%) [ 55 ]. In addition, incentives and penalties for vaccination were identified, including quarantine-free travel (1/53, 2%) [ 33 ] and mandatory testing at own expense if not vaccinated (1/53, 2%) [ 44 ]. Vaccine advice or support included vaccination invitation sender (1/53, 2%) [ 73 ] and recommenders (1/53, 2%) [ 46 ]. The proportion of friends and family members who had received the vaccine (1/53, 2%) [ 26 ] was also among the other attributes influencing decision-making ( Table 2 ).

Although effectiveness remained the most important attribute, it is worth noting that variations in preferences were also observed among different subgroups. A higher proportion of studies conducted in LMICs (4/24, 17%) than in HICs (3/29, 10%) prioritized on safety ( Multimedia Appendix 5 ). In addition, COVID-19 mortality risk was the second most important attribute (6/29, 21%) after effectiveness in HICs. Cost was considered to be another most important attribute (3/24, 13%) in LMICs. Interestingly, many other attributes also became more important as the pandemic progressed. Protection duration (2/24, 8%) emerged as one of the most important attributes during the pandemic wave. COVID-19 mortality risk (5/25, 20%) and cost (3/25, 12%) were considered as the most important attributes after the pandemic wave ( Multimedia Appendix 6 ).

Study Quality

The overall reporting quality was deemed acceptable but there is room for improvement. The PREFS scores of the 47 studies ranged from 2 to 4, with a mean of 3.23 (SD 0.52). No study scored 5. Most studies scored 3 (32/47, 68%) or 4 (13/47, 28%), while 2 studies (2/47, 4%) scored 2 ( Multimedia Appendix 7 [ 11 , 26 , 30 - 74 ]).

Principal Findings

This systematic review synthesizes existing data on preference for COVID-19 vaccine using DCE, with the aim of informing improvements in vaccine coverage and vaccine policy development. We identified 47 studies conducted in 29 countries, including 21 HICs and 8 LMICs. HICs had an adequate supply of vaccine since the early emergency availability of COVID-19 vaccine, and HICs had 1.5 times more doses of COVID-19 vaccinations than LMICs by September 2023 [ 85 ]. In total, 19 (40%) studies were conducted in China and 9 (19%) in the United States, demonstrating their significant contribution to the research and their leadership in vaccine research and development. Vaccine effectiveness and safety were the most important attributes in DCEs, although preferences differed among subgroups.

Recent years have seen new trends in the design, implementation, and validation of the DCE. For example, most studies (40/47, 85%) reported that the DCE was administered through web-based surveys, which have become a quick and cost-effective way to collect DCE data [ 66 ]. Almost half of the studies (25/47, 53%) did not report a pilot test. However, piloting in multiple stages throughout the development of a DCE is conducive to identifying appropriate and understandable attributes, considering whether participants can effectively evaluate the full profiles, and producing an efficient design [ 21 , 86 , 87 ].

Overall, vaccine effectiveness and safety have emerged as the most commonly investigated attributes in the outcome category. Despite heterogeneity in preferences across subpopulations, effectiveness remains the primary driver for COVID-19 vaccination across the studies [ 31 , 35 , 36 , 38 - 42 , 48 , 50 , 51 , 57 , 58 , 60 - 62 , 64 - 67 ], similar to the previous findings [ 18 ]. A study conducted in India and Europe found that respondents’ preference for the COVID-19 vaccine increased with effectiveness and peaked at 95% effectiveness [ 45 ]. Another study conducted among university staff and students in South Africa found that vaccine effectiveness not only was a concern but also significantly influenced vaccine choice behavior [ 64 ]. Interestingly, a nationwide stated choice survey in the United States found a strong interaction between effectiveness and other attributes [ 58 ]. These findings support the ongoing efforts to maximize vaccine effectiveness while emphasizing the importance of communicating information on vaccine effectiveness to the target population for promotion [ 62 ].

Safety has also been identified as a crucial factor influencing the acceptance of COVID-19 vaccine [ 33 , 43 , 47 , 56 , 59 , 68 , 69 ]. One study indicated that the likelihood of the general public choosing vaccines with low or moderate side effects increased by 75% and 63%, respectively, compared with vaccines with high side effects. While the likelihood changed within a 30% range when most attributes other than effectiveness and safety were changed [ 69 ]. In addition, respondents in Australia expressed a willingness to wait an additional 0.04 and 1.2 months to reduce the incidence of mild and severe adverse events by 1/10,000, respectively [ 56 ].

Similar to the results of previous systematic reviews of DCEs for various vaccines [ 18 , 19 ], the most common predictors of COVID-19 vaccine acceptance are effectiveness and safety, particularly during the rapid development and rollout of COVID-19 vaccines, which essentially boils down to trust in the vaccine [ 31 ]. Respondents expressed the importance of having a safe and effective COVID-19 vaccine available as soon as possible, but the majority preferred to wait a few months to observe the experience of others rather than be the first in line [ 43 ]. Therefore, collaborating to enhance vaccine effectiveness while reducing the risk of severe side effects could be a highly effective strategy to address vaccine hesitancy and augment vaccine desirability. Dissemination of this important vaccine-related information by governments and health care institutions, along with effective communication by health care professionals, can help build public trust and ultimately increase vaccination rates [ 69 ]. However, these inherent vaccine attributes are typically beyond the control of a vaccination program, and given the ongoing mutations of SARS-CoV-2, it is challenging to predict the effectiveness of the vaccines currently in development [ 66 ]. Global collaboration between scientists and pharmaceutical companies is therefore essential to improve vaccine effectiveness and minimize side effects [ 41 ].

Vaccine production, including its origin, brand, vaccine frequency, and content, are key considerations in the process category. Vaccine brand also has a significant impact on vaccine choice [ 32 ], independent of effectiveness and safety, due to factors such as reputation, country of origin, technological advances, and reported side effects associated with the brands [ 35 ]. For vaccine origin, some studies found that participants preferred domestic vaccines to imported vaccines, which may depend on the availability or the approval of vaccines in different countries [ 31 , 41 , 50 ] or the incidence of side effects among different types of COVID-19 vaccines [ 37 ]. However, some studies found that imported vaccines were more likely to be accepted than domestically produced vaccines, which may be attributed to less trust in domestically produced vaccines [ 57 , 66 ]. A study on vaccine preferences among the Malaysian population found that the composition and production process of the COVID-19 vaccine, which complied with Islamic dietary requirements (ie, halal content) was an important factor for many Malaysians when deciding whether to be vaccinated. This underscores the substantial influence of religion on vaccine choice [ 53 ].

Vaccine frequency was emphasized to play an important role in the choice of COVID-19 vaccine among the US public, while the 90% efficacy with low side effect rate of the COVID-19 vaccine was set. The prospect of vaccinating once to get lifelong immunity was very attractive, reflecting the fact that people were effort minimizers [ 71 ]. This is similar to the nature of the 2 studies referenced in the outcome attribute, where the protection duration is prioritized. Given the threat of COVID-19, people expect the protection duration to be as long as possible [ 11 , 50 ].

When vaccine supply is limited, people tend to prioritize vaccination for those who are more susceptible to the disease, have higher mortality rates from infectious diseases, or have greater potential to spread the virus. A study in Iran found that individuals tend to prioritize vaccination for those in the community with higher potential for virus transmission [ 57 ]. In addition, results from a study in 6 European countries revealed unanimous agreement among respondents that candidates with higher mortality and infection risks should be prioritized for vaccination [ 63 ]. While another study conducted among Belgians also found that respondents would prioritize populations at higher medical risk [ 72 ].

Cost was another important factor influencing COVID-19 vaccine preferences, mostly related to out-of-pocket costs [ 31 , 37 , 41 ]. In 2 studies comparing public preferences for COVID-19 vaccines in China and the United States, vaccine efficacy emerged as the most important driver for the American public, whereas the cost of vaccination had the greatest impact on the Chinese public. This difference was likely due to the relatively stable pandemic situation in China at the time and the lower perceived risk of COVID-19. As a result, the Chinese population was more price sensitive and reluctant to pay for vaccination [ 31 , 37 , 41 ].

For the other category, several different attributes were highlighted, depending on the specific population or situation. When people perceive the threat of a disease, their desire to be vaccinated becomes more urgent. In a study among health care workers in China, participants’ expectations about the future development of COVID-19 had a greater impact on their decision to be vaccinated than their perceived risk of infection or actual case rates, which may have been influenced by their previous experience with seasonal influenza vaccination [ 30 ]. The mortality rate of COVID-19 was considered the most influential factor in the uptake of COVID-19 booster shots in Vietnam. This study was conducted during a pandemic wave in Vietnam, which may have led to an increased perception of public health risks and a greater inclination toward COVID-19 vaccination [ 55 ]. To achieve herd immunity, government authorities can implement policies of incentives and penalties for vaccination to encourage population-wide uptake. A study conducted in the Netherlands revealed that respondents particularly disliked policies that penalized those who were not vaccinated, such as mandatory testing at their own expense if they were not vaccinated [ 44 ]. Instead, they favored policies that rewarded vaccination, such as giving vaccinated individuals additional privileges through a vaccination passport. This finding is consistent with a study in Hong Kong, which found that quarantine-free travel was considered the most important motivator among university students and staff, given their frequent engagement in international travel [ 33 ].

The source of vaccine information also influences vaccine decision-making [ 30 ]. Variation in the sender of vaccination appointment invitation via SMS text messaging and recommenders may potentially influence the public’s willingness to vaccinate against a disease [ 30 , 46 , 73 ]. Furthermore, the acceptance of vaccines was observed to change as the firsthand information about vaccine side effects and effectiveness was provided by friends and family in India [ 26 ].

In HICs, COVID-19 mortality risk was the second most important attribute after effectiveness, as respondents in all 6 high-income European countries from a study of public preferences for COVID-19 vaccine distribution prioritized candidates with higher mortality risks [ 63 ]. However, individuals from LMICs appeared to be more concerned about vaccine safety than those from HICs. This may be related to greater confidence in vaccine safety in HICs due to the earlier initiation and higher rates of COVID-19 vaccination [ 85 ]. In contrast, in some LMICs, vaccine safety was reported as the main reason influencing the willingness to vaccinate due to the rapid development of the COVID-19 vaccines [ 26 , 43 , 47 , 59 , 68 , 69 , 74 , 88 ].

Interestingly, the preference for COVID-19 vaccines may also have changed as the pandemic progressed [ 63 ]. Similarly, effectiveness remained the most important attribute in all periods, possibly due to the continuing severity of the pandemic and the fear of the possible emergence of new coronavirus strains [ 43 ]. Before the pandemic wave, the information on vaccine effectiveness was limited [ 26 ], but people still considered vaccine effectiveness to be the most important driver of vaccination. However, during the pandemic, the public’s perception of the health risk increased. As vaccines were introduced and used, people seemed to become more concerned about the duration of vaccine protection and preferred a longer vaccine protection [ 11 , 50 ]. After the pandemic wave, as the pandemic situation gradually stabilized, cost, combined with their perception of the risk of susceptibility, became more important in their preferences. However, despite this shift, most of the public still believed that people who are at higher risk of infection or death should be vaccinated first [ 63 ].

Limitations

Our study had several limitations. First, not all studies used the same attributes and levels, which limited our ability to perform a quantitative synthesis and directly compare the estimates of model parameters. Instead, we qualitatively synthesized and summarized the range of attributes that may be useful in the formative stage of attribute selection in future DCE surveys investigating the preference for COVID-19 vaccine. Second, although DCEs have been shown to be a valid method for eliciting preferences, the experiment may not represent real market choices but rather hypothetical scenarios with plausible and realistic attributes. However, it offers opportunities to evaluate vaccines that are not yet available in the market or to specific population [ 68 ]. Third, the commonly used classification of outcome, cost, and process was used in order to better explain the public’s preference for vaccine attributes. However, several attributes could not be properly classified, and a fourth category (ie, other attributes) had to be added [ 19 ]. Meanwhile, the variety of attributes included may make it difficult to appropriately name and interpret this category as a whole. Fifth, the PREFS checklist is limited to 5 questions and fails to elicit several criteria that should be reported in DCE studies. Also, it does not provide sufficient tools to assess the biases in a DCE, such as selection bias and nonresponse bias [ 79 , 89 ]. Finally, although there was no specific theoretical framework to structure our qualitative analysis from the 4 identified categories, our classification was based on previous studies [ 18 , 19 , 82 , 90 , 91 ] and our own findings. This synthesis led us to categorize attributes into 4 main classes, providing a clear structure for analyzing and presenting participants’ vaccine preferences and making it easier to compare their preferences across different studies.

Conclusions

In conclusion, this systematic review synthesized the global evidence on preferences for COVID-19 vaccines using the DCE methodology. Vaccine effectiveness and safety were found to be the main drivers for COVID-19 vaccination, highlighting the importance of global collaboration to improve vaccine effectiveness and minimize side effects, as well as the importance of communicating this vaccine-related information to the public to maximize the uptake of COVID-19 vaccines. The subgroup analyses emphasized the importance of differences in vaccine preference of specific populations and time periods in optimizing the acceptance of COVID-19 vaccines. These findings may serve as valuable insights for government agencies involved in the social mobilization process for COVID-19 vaccination. However, the response to the pandemic is a continuous learning process [ 92 ]. It is crucial for policy makers to consider preference evidence when designing policies to promote vaccination.

Acknowledgments

The authors have not received a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

Data Availability

All data relevant to the study are included in the article or uploaded as supplemental information. Data sets of this study are available upon reasonable request to the corresponding author.

Authors' Contributions

YH, SF, and YZ are joint first authors. HJ conceived the study and its methodology. YH, SF, and YZ designed, refined, and implemented the search strategy; screened articles for inclusion; and extracted and curated the data. All authors contributed to the interpretation of the results. YH, SF, and YZ wrote the initial draft of the manuscript. HJ and HW critically reviewed the manuscript. HJ supervised the study design and provided overall guidance. All authors approved the final draft of the manuscript. HJ had full access to all the data used in this study, and all authors had final responsibility for the decision to submit for publication.

Conflicts of Interest

None declared.

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 checklist.

Search strategies.

Attributes included in each category.

The detailed distribution of the study period across countries.

Preference for COVID-19 vaccines among high-income countries and low- and middle-income countries (n=53).

Preference for COVID-19 vaccines in the different study periods (n=53).

Assessment of 47 included studies quality using the Purpose, Respondents, Explanation, Findings, and Significance checklist.

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• Al-Aqeel S, Alotaiwi R, Albugami B. Patient preferences for epilepsy treatment: a systematic review of discrete choice experimental studies. Health Econ Rev. Mar 18, 2023;13(1):17. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Schaarschmidt ML, Schmieder A, Umar N, Terris D, Goebeler M, Goerdt S, et al. Patient preferences for psoriasis treatments: process characteristics can outweigh outcome attributes. Arch Dermatol. Nov 01, 2011;147(11):1285-1294. [ CrossRef ] [ Medline ]
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Abbreviations

Edited by A Mavragani; submitted 19.01.24; peer-reviewed by T Ricks, I Saha; comments to author 11.04.24; revised version received 01.05.24; accepted 26.05.24; published 29.07.24.

©Yiting Huang, Shuaixin Feng, Yuyan Zhao, Haode Wang, Hongbo Jiang. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 29.07.2024.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Public Health and Surveillance, is properly cited. The complete bibliographic information, a link to the original publication on https://publichealth.jmir.org, as well as this copyright and license information must be included.

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Case report and literature review: Laparoscopic extended right hemicolectomy for a 55-year-old patient with idiopathic mesenteric phlebosclerosis

Affiliations.

• 1 Department of Breast Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China.
• 2 Department of Hepatobiliary Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China.
• 3 Department of Urology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China.
• 4 NHC Key Laboratory of Nuclear Technology Medical Transformation, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China.
• PMID: 39081687
• PMCID: PMC11286469
• DOI: 10.3389/fmed.2024.1382475

Idiopathic mesenteric phlebosclerosis (IMP) is an extremely rare disease with an unclear pathogenesis and risk factors. The clinical manifestations of IMP are mostly non-specific, mainly consisting of digestive symptoms such as abdominal pain, bloating and diarrhea. The diagnosis of IMP mainly relies on abdominal computed tomography (CT) and colonoscopy. Pathological changes associated with IMP often involve fibrous degeneration of the venous wall, which results in the thickening of the colonic wall and longitudinal calcification of the mesenteric arteries. Currently, there is no standard treatment protocol for IMP, and nonsurgical treatment is the mainstay of most medical centers. In this study, we reported a case of a 55-year-old female patient with IMP whose main clinical presentation was recurrent abdominal pain. The patient's initial diagnosis was considered an incomplete intestinal obstruction and received non-surgical treatments; however, the efficacy of the treatment was unsatisfactory. After completing abdominal CT and colonoscopy, we excluded common diseases of the digestive system (e.g., tumors, Crohn's disease), and finally considered that this patient had a high likelihood of IMP. This patient eventually underwent laparoscopic enlarged right hemicolectomy due to recurrent symptoms and poor outcomes of non-surgical treatment. Postoperative pathological results confirmed the diagnosis of IMP. During the follow-up period, the patient recovered well without recurrence of IMP. Furthermore, we have reviewed the literature related to IMP and summarized the etiology, risk factors, diagnostic methods, treatment options and prognosis of IMP.

Keywords: case report; digestive disease; idiopathic mesenteric phlebosclerosis; laparoscopic surgery; literature review.

Copyright © 2024 Liu, Tong, Shi, Zeng, Luo, Yang, Cai, Wang, Luo and Wang.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Preoperative abdominal computed tomography (A,B)…

Preoperative abdominal computed tomography (A,B) and colonoscopy results (C,D) .

Intraoperative image (A) and the…

Intraoperative image (A) and the surgical specimen (B) .

Postoperative histopathological results. (A) HE…

Postoperative histopathological results. (A) HE stain of colonic mucosa (magnification × 100); (B)…

• Yao T, Iwashita A, Hoashi T, Matsui T, Sakurai T, Arima S, et al. . Phlebosclerotic colitis: value of radiography in diagnosis--report of three cases. Radiology. (2000) 214:188–92. doi: 10.1148/radiology.214.1.r00ja01188 - DOI - PubMed
• Iwashita A, Yao T, Schlemper RJ, Kuwano Y, Yao T, Iida M, et al. . Mesenteric phlebosclerosis: a new disease entity causing ischemic colitis. Dis Colon Rectum. (2003) 46:209–20. doi: 10.1097/01.DCR.0000044720.43258.6E - DOI - PubMed
• Chou JW, Chang CH, Wu YH, Chang KC, Cheng KS, Huang PJ. Idiopathic mesenteric Phlebosclerosis: a single-institute experience in Taiwan. Turk J Gastroenterol. (2023) 34:483–9. doi: 10.5152/tjg.2023.22335 - DOI - PMC - PubMed
• Shimizu S, Kobayashi T, Tomioka H, Ohtsu K, Matsui T, Hibi T. Involvement of herbal medicine as a cause of mesenteric phlebosclerosis: results from a large-scale nationwide survey. J Gastroenterol. (2017) 52:308–14. doi: 10.1007/s00535-016-1218-9 - DOI - PubMed
• Kang MJ, Khanal T, Kim HG, Lee DH, Yeo HK, Lee YS, et al. . Role of metabolism by human intestinal microflora in geniposide-induced toxicity in HepG2 cells. Arch Pharm Res. (2012) 35:733–8. doi: 10.1007/s12272-012-0418-y - DOI - PubMed

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• PMC11233259

Fulminant demyelinating disease of the central nervous system effectively treated with a combination of decompressive craniectomy and immunotherapy: A case report and literature review

Toshihiro ide.

1 Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga Japan

2 Department of Neurosurgery, Faculty of Medicine, Saga University, Saga Japan

Makoto Eriguchi

Shinichi aishima.

3 Department of Pathology and Microbiology, Faculty of Medicine, Saga University, Saga Japan

Tatsuya Abe

Associated data.

All the required information is included in the manuscript.

Key Clinical Message

Accurately identifying fulminant demyelinating diseases is important for sudden onset of asymmetric cerebral white matter lesions with mass effect. Initially, immunotherapy should be administered; however, surgical intervention should be performed with poor response to medical management and evident signs of cerebral herniation.

A case of fulminant demyelinating disease of the central nervous system that required decompressive craniectomy 8 days after symptom onset is presented. The patient recovered without sequelae after a combination of neurosurgery and immunotherapy with steroids and has remained relapse‐free for 4 years.

1. INTRODUCTION

Fulminant demyelinating disease is a rare group of inflammatory demyelinating disorders that rapidly progress to disability within days to weeks, eventually requiring hospitalization and aggressive treatment for acute attacks. 1 The present patient developed brain herniation within 8 days after symptom onset, but recovered without neurological sequelae after decompressive craniectomy and immunotherapy with steroids. Nevertheless, there have been few case reports of decompressive craniectomy for fulminant demyelinating disease, and the present case report aimed to clarify the clinical characteristics of such cases along with a review of the literature.

2. CASE HISTORY/EXAMINATION

A 63‐year‐old woman with no history of prior viral infections or vaccinations developed a headache in mid‐October 2018. On the following day, she became lightheaded and developed nausea, and she visited a local general hospital. On medical examination, her consciousness was clear, and she had no paralysis. However, she had diplopia and ataxia of both upper limbs. Magnetic resonance imaging (MRI) of the brain showed T2 high‐signal intensity lesions around the dentate nuclei of bilateral cerebellar hemispheres to the cerebellar peduncles, the right ventral side of the medulla oblongata, and the tegmentum (Figure  1A ). On the 5th day, a mild disturbance of consciousness and paralysis of the left upper limb appeared, and MRI of the brain showed a new lesion in the right temporal lobe (Figure  1B ). On the 6th day, she was urgently transferred to our hospital for further examination and treatment.

Brain MRI. Fluid attenuated inversion recovery (FLAIR) images show T2 high‐signal intensity lesions around the dentate nuclei, cerebellar peduncles, the right ventral side of the medulla oblongata, and tegmentum (Day 3, A). A new lesion is detected in the right temporal lobe (Day 5, B). The lesions expand rapidly, and extensive T2 high‐signal intensity lesions are observed in the bilateral cerebellar hemispheres, brainstem, bilateral thalami, right basal ganglia, right posterior limb of the internal capsule, and subcortical cerebral hemispheres. The abnormal signal area also extends to the left cingulate gyrus via the body of the corpus callosum. The lesion has a mass effect; the right ventricle is slightly deformed, and the median structure is deviated to the left (Day 6, C). The lesion has enlarged further, and the brain swelling is aggravated (Day 8, D). The brain swelling has improved, and the lesion has shrunk (4 years after onset, E).

On admission, her temperature was 36.8°C, pulse was 63 beats/min, blood pressure was 146/88 mmHg, respiratory rate was 17 breaths/min, and general physical examination showed no abnormalities of note. On neurological examination, mild impairment of consciousness (Glasgow Coma Scale (GCS) E4V4M6), left hemiparesis (MMT 3), and ataxia of the extremities were evident. Meningeal stiffness was also observed. Blood tests showed mild inflammatory findings, with white blood cell count of 11,100 cells/μL and C‐reactive protein (CRP) of 1.26 mg/dL, but liver function, renal function, electrolytes, and coagulation function were all normal. Serum rheumatoid factor, anti‐nuclear antibody, anti‐SS‐A antibody, anti‐SS‐B antibody, myeloperoxidase‐anti‐neutrophil cytoplasmic antibody (MPO‐ANCA), serine proteinase3‐anti‐neutrophil cytoplasmic antibody (PR3‐ANCA), and other autoimmune markers were all negative. Anti‐aquaporin4‐antibody (anti‐AQP4 antibody) was negative, measured by both an enzyme‐linked immunosorbent assay (ELISA) and a cell‐based assay (CBA). Anti‐MOG antibody was also negative by a CBA. A cerebrospinal fluid (CSF) examination showed a normal initial pressure of 11 cmH 2 0 and a mildly elevated cell count with mononuclear cell predominance (50 cells/μL). CSF protein, β2‐microglobulin, and IgG were elevated at 96 mg/dL, 1.71 μg/mL, and 10.7 mg/dL, respectively. Myelin basic protein (MBP) was markedly elevated at 33,000 pg/mL. The IgG index was 0.64. There were no atypical cells on CSF cytology. The interleukin 6 (IL‐6) level in the CSF was markedly elevated at 1410 pg/mL. The electrocardiogram and chest X‐ray showed no abnormalities. MRI of the brain showed extensive T2 high‐signal intensity lesions in the bilateral cerebellar hemispheres, brainstem, bilateral thalami, right basal ganglia, right posterior limb of the internal capsule, and subcortical cerebral hemispheres. The abnormal signal area also extended to the left cingulate gyrus via the body of the corpus callosum. The lesion had a mass effect, with the right ventricle slightly deformed and the median structures deviated to the left (Figure  1C ). A faint contrast effect was seen at the margins of the bilateral frontal lobe lesions. No lesion was found on spinal cord MRI.

3. DIFFERENTIAL DIAGNOSIS, INVESTIGATIONS AND TREATMENT

The rapid appearance of the white matter‐dominant lesions required a distinction between an inflammatory demyelinating disease of the central nervous system (CNS) and drug‐induced, toxic, or metabolic encephalopathy. However, the medical history and laboratory findings of the patient did not support the latter etiology. Furthermore, if the bilateral cerebellar hemispheres, brainstem, and bilateral thalami were involved, the asymmetric nature of cerebral white matter lesions with a pronounced mass effect and the marked increase in MBP in the CSF strongly suggested fulminant inflammatory demyelinating disease of the CNS. Therefore, steroid pulse therapy (methylprednisolone 1 g/day for 5 days) was started on the 6th day, but the disturbance of consciousness gradually worsened despite the initiation of steroids, and a follow‐up MRI showed further worsening of the brain swelling (Figure  1D ). On the 8th day, her level of consciousness decreased to GCS E1V2M4, and she appeared to have developed brain herniation; emergency decompressive craniectomy was performed on the same day. At the time of craniotomy, a brain biopsy from the right temporal lobe was performed for diagnosis. The brain biopsy specimens showed small haemorrhagic foci in the cerebral white matter (Figure  2A ) and infiltration of CD68‐positive foamy macrophages around the perivascular area (Figure  2B,C ). Klüver–Barrera staining showed demyelinating plaques around the perivascular area (Figure  2D ). These pathological findings were consistent with acute demyelinating encephalomyelitis (ADEM). After the decompressive craniectomy, immunotherapy with steroids was continued.

Brain biopsy specimens obtained from the right temporal lobe. Small haemorrhagic foci are scattered in the cerebral white matter (A). The white matter has been infiltrated with foamy macrophages (B). CD68 immunohistochemical staining is positive for histiocytes in the cerebral white matter (C). Demyelinating plaques with decreased density and staining of myelinated sheaths are seen on Klüver–Barrera staining (D). These findings suggest demyelinating disease. (A, B, hematoxylin and eosin staining, scale bar = 100 μm; C, CD68 immunostaining, scale bar = 100 μm; D, Klüver–Barrera staining, scale bar = 100 μm).

4. OUTCOME AND FOLLOW‐UP

The patient required mechanical ventilation, but she was extubated on the 20th day, and she was able to follow instructions. After extubation, she was able to speak without aphasia. Following the steroid pulse therapy, oral prednisolone 50 mg/day was started, which was maintained for 2 weeks and then gradually decreased by 5 mg/week. The left hemiplegia recovered gradually, and gait training was started on the 36th day of the disease; she was able to walk on her own within 2 months from disease onset. Cranioplasty was performed on the 42nd day after improvement of brain swelling and herniation on brain MRI. After tapering, prednisolone was maintained at 10 mg/day. The left hemiplegia recovered completely, and she was discharged home on the 122nd day. For 4 years after discharge, she has been clinically and radiologically free of recurrence (Figure  1E ).

5. DISCUSSION

Fulminant inflammatory demyelinating disease of the CNS is a rare group of diseases in which immune‐mediated destruction of myelin occurs, but the clinical course, histopathology, and imaging findings differ from those of classical multiple sclerosis (MS). They include ADEM and its variants, acute haemorrhagic leukoencephalitis (AHL or Hurst disease), severe relapses of MS, variants of MS (tumefactive MS, Marburg variant, Baló's concentric sclerosis, myelinoclastic diffuse sclerosis), and neuromyelitis optica (NMO)‐spectrum disorders. 1 In the present case, since the patient met the diagnostic criteria for ADEM and had no recurrence for 4 years, she was diagnosed with monophasic ADEM as a clinical subtype of ADEM. 2 ADEM is an immune‐mediated demyelinating disease of the CNS that commonly affects children and young adults. 3 The radiological features of ADEM include multifocal and diffuse white matter lesions with bilateral thalamic and bilateral basal ganglia involvement, which often affects the cerebellum and the brainstem. 1 The imaging findings in our case were also compatible with ADEM. The hyperacute form of ADEM accounts for 2% of cases and is associated with rapid progression of symptoms, malignant brain edema, and a high mortality rate. 4

The interesting feature of this case is that, although the patient presented with rapid cerebral herniation due to fulminant demyelination, she recovered with no neurological sequelae after treatment by a combination of decompressive craniectomy and immunotherapy. There are a few reports of cases requiring decompressive craniectomy for autoimmune diseases of the CNS, including demyelinating diseases, primary angiitis of the CNS, 5 and neuropsychiatric systemic lupus erythematosus. 6 The reports of fulminant demyelinating disease of the CNS requiring decompressive craniectomy are summarized in Table  1 . So far, 17 cases have been reported (including the present case), with 8 cases of ADEM, 7 , 8 , 9 , 10 , 11 , 12 , 13 4 cases of AHL, 14 , 15 , 16 , 17 3 cases of TDLs, 18 , 19 , 20 and 2 cases of the Marburg variant of MS. 21 , 22 The age of onset ranged widely from 1 to 63 years, but 16 of 17 cases were in their 50s or younger, and 4 were children. The age of onset was the oldest in the present case. In addition, the incidence was higher in females (12 of 17 cases). Prior infections were known in 9 cases, and most of them were respiratory tract infections such as upper respiratory tract infection and pneumonia (including 2 cases of mycoplasma infection). In addition, ADEM and AHL were often accompanied by prior infection (9 of 12 cases). Steroids were the most commonly used immunotherapy in combination with decompressive craniectomy (all 16 cases with information available). Intravenous methylprednisolone (IVMP) was the most common, with 8 cases. Intravenous immunoglobulin (IVIG) and plasma apheresis therapy were also used in some cases. The outcome was complete recovery in 5 cases, neurological sequelae in 10 cases, and death in 1 case. Of the 16 cases—including the present case and the cases with information available—most (14/16) initially underwent immunotherapy. For the remaining cases, only one underwent immunotherapy after decompressive craniectomy, whereas another underwent both treatments simultaneously. In cases where immunotherapy was administered first, surgical intervention was subsequently performed if the response to medical management was inadequate, specifically in cases with (1) deteriorating consciousness, (2) increased intracranial pressure, and (3) worsening radiological findings. Previous reviews on fulminant demyelinating diseases emphasized that immunotherapy should be the first line of treatment, with decompressive craniectomy considered thereafter if the response to medical management was poor. 1 Therefore, immunotherapy with steroids should be initially administered in fulminant demyelinating diseases aiming to reduce inflammation and edema, although decompressive craniectomy should be performed in cases that present signs of cerebral herniation.

Clinical characteristics of reported cases of decompressive craniectomy for fulminant demyelinating disease.

Abbreviations: ADEM, acute disseminated encephalomyelitis; AHL, acute haemorrhagic leukoencephalitis; DEX, dexamethasone; IVIG, intravenous immunoglobulin; IVMP, intravenous methylprednisolone; MP, Mycoplasma pneumoniae ; mRS, modified Rankin Scale; MS, multiple sclerosis; PE, plasma exchange; PP, plasmapheresis; PSL, prednisolone; RTI, respiratory tract infection; TDLs, tumefactive demyelination lesions.

Although the cytokine profile in the CSF was not investigated in any of these reports, the present case was characterized by a markedly elevated IL‐6 level in the CSF. IL‐6 is a pleiotropic cytokine present during inflammation. In inflammatory diseases of the CNS, elevated levels of IL‐6 in CSF have been reported in NMO, 23 ADEM, 24 AHL, 25 and progressive leukoencephalitis after SARS‐CoV‐2 infection. 26 The clinical efficacy of satralizumab, a humanized monoclonal antibody targeting the IL‐6 receptor, has already been demonstrated in NMO in a randomized, controlled trial, 27 and tocilizumab, another humanized monoclonal antibody targeting the IL‐6 receptor, has been reported to be effective in AHL in childhood. 28 Although decompressive craniectomy and immunotherapy with steroids were effective in the present case, it may be important to evaluate IL‐6 levels in the CSF, and administration of IL‐6 receptor inhibitors may be one treatment option for the clinical management of fulminant demyelinating disease, considering that mortality and serious disability may accompany the disease. It is important to continue to enhance our knowledge of IL‐6 in CNS inflammatory diseases.

In summary, a case of a fulminant demyelinating disease of the CNS that required decompressive craniectomy for rapid development of cerebral herniation was presented. It is important to perform neurosurgery with immunotherapy within a reasonable period of time because fatal cerebral herniation can develop even in autoimmune diseases of the CNS within a week of onset. In addition, the IL‐6 level in the CSF was significantly elevated in this case. It is important to investigate the cytokine/chemokine profile in the CSF of cases of fulminant demyelination.

AUTHOR CONTRIBUTIONS

Toshihiro Ide: Conceptualization; investigation; writing – original draft; writing – review and editing. Ryo Ebashi: Supervision. Makoto Eriguchi: Supervision. Shinichi Aishima: Supervision. Tatsuya Abe: Supervision. Hideo Hara: Writing – review and editing.

FUNDING INFORMATION

This case report did not receive any specific grant from funding agencies in the public, commercial, or not‐for‐profit sectors.

CONFLICT OF INTEREST STATEMENT

None declared.

Written, informed consent was obtained from the patient to publish this report in accordance with the journal's patient consent policy.

ACKNOWLEDGMENTS

Ide T, Ebashi R, Eriguchi M, Aishima S, Abe T, Hara H. Fulminant demyelinating disease of the central nervous system effectively treated with a combination of decompressive craniectomy and immunotherapy: A case report and literature review . Clin Case Rep . 2024; 12 :e9059. doi: 10.1002/ccr3.9059 [ CrossRef ] [ Google Scholar ]

DATA AVAILABILITY STATEMENT

• Artificial intelligence in healthcare

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ChatGPT shows potential for clinical knowledge review

Chatgpt could help clinicians more effectively review medical literature by prioritizing and summarizing research abstracts from journals related to their specialties..

• Shania Kennedy, Assistant Editor

University of Kansas Medical Center researchers have demonstrated that ChatGPT could help clinicians keep up with ever-growing medical knowledge by prioritizing and summarizing journal abstracts.

The research team emphasized that global clinical knowledge is expanding at a pace that makes it difficult for clinicians to stay abreast of new medical literature and practice guidelines.

"There are about a million new articles added to PubMed every year," explained Daniel Parente, MD, Ph.D., assistant professor of family medicine and community health at the University of Kansas Medical Center, in a press release. "Even if you're a physician restricting your focus to your field, it can still be many thousands of articles you might think about reading."

The study authors further noted that on top of sifting through the literature to find articles relevant to their fields, clinicians must then review each article. Article abstracts can help streamline this process, but reviewing these -- many of which are around 300 words -- can be time-consuming, as well.

This study shows us that these tools already have some ability to help us review the literature a little bit faster, as well as figure out where we need to focus our attention. Daniel Parente, MD, Ph.D. Assistant professor of family medicine and community health, University of Kansas Medical Center

Given recent developments in AI technology, the researchers set out to investigate whether a large language model ( LLM ) could be used by clinicians to systematically review medical literature.

The team selected ChatGPT-3.5 and tasked the tool with summarizing 140 peer-reviewed abstracts from 14 journals. To assess the LLM's performance, human physicians were asked to rate the quality, accuracy and bias of the ChatGPT-generated summaries.

From there, the researchers compared how well both ChatGPT and the clinicians could rate the relevance of each journal and abstract to particular medical specialties.

The analysis revealed that the LLM's summaries were on average 70% shorter than the original abstracts, reducing the length from 2,438 to 739 characters. The human raters determined that ChatGPT's summaries were also generally high-quality and accurate, with low bias.

However, the LLM was found to have hallucinated in four of the 140 cases, and there were 20 instances of minor inaccuracies found. Despite the presence of these inaccuracies, it was established that they did not change the meanings of the original abstracts.

ChatGPT was less successful at identifying relevance. The LLM performed similarly to the clinicians when classifying whether an entire journal was relevant to a given specialty, but the model fell short when asked to do the same with individual articles.

"We asked the human (physician) raters to say, is this relevant to primary care or internal medicine or surgery? And then we compared to ChatGPT's relevance ratings, and we found that at least the ChatGPT-3.5 model is not quite ready to do that yet. It works well at identifying if a journal is relevant to primary care, but it's not great for identifying if an article is relevant to primary care," Parente noted.

These findings led the researchers to conclude that the use of ChatGPT in healthcare could help family physicians streamline their literature review process, and the team designed software for this purpose during the study. However, the authors underscored that critical medical decisions should still be made based on thorough evaluations of full-text research and clinical guidelines.

The researchers also indicated that as new versions of ChatGPT are released, they are likely to get better at determining the relevance of scientific articles.

"This study shows us that these tools already have some ability to help us review the literature a little bit faster, as well as figure out where we need to focus our attention," said Parente. "And it seems very likely that future versions of these technologies that are smarter and more capable will only enhance that."

Shania Kennedy has been covering news related to health IT and analytics since 2022.

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