literature review need an abstract

The Guide to Literature Reviews

• What is a Literature Review?
• The Purpose of Literature Reviews
• Guidelines for Writing a Literature Review
• How to Organize a Literature Review?
• Software for Literature Reviews
• Using Artificial Intelligence for Literature Reviews
• How to Conduct a Literature Review?
• Common Mistakes and Pitfalls in a Literature Review
• Methods for Literature Reviews
• What is a Systematic Literature Review?
• What is a Narrative Literature Review?
• What is a Descriptive Literature Review?
• What is a Scoping Literature Review?
• What is a Realist Literature Review?
• What is a Critical Literature Review?
• Meta Analysis vs. Literature Review
• What is an Umbrella Literature Review?
• Differences Between Annotated Bibliographies and Literature Reviews
• Literature Review vs. Theoretical Framework
• How to Write a Literature Review?
• How to Structure a Literature Review?
• How to Make a Cover Page for a Literature Review?
• Importance of a literature review abstract

How to write a literature review abstract?

Key reminders when writing a literature review abstract.

• How to Write a Literature Review Introduction?
• How to Write the Body of a Literature Review?
• How to Write a Literature Review Conclusion?
• How to Make a Literature Review Bibliography?
• How to Format a Literature Review?
• How Long Should a Literature Review Be?
• Examples of Literature Reviews
• How to Present a Literature Review?
• How to Publish a Literature Review?

How to Write a Literature Review Abstract?

A well-crafted abstract is the initial point of contact between your research and its potential audience. It is crucial to present your work in the best possible light. A literature review abstract is a concise summary of the key points and findings of a literature review that is published as a full paper. It serves as a snapshot of the review, providing readers with a quick overview of the research topic, objectives, main findings, and implications.

Unlike the full literature review, the abstract does not delve into detailed analysis or discussion but highlights the most critical aspects. An abstract helps readers decide whether the full article is relevant to their interests and needs by encapsulating the essence of the literature review. A literature review abstract offers a condensed version of the study that helps researchers identify the review's relevance to their work. This is important in academic settings, where individuals often revise numerous journal articles and papers to find pertinent information. A clear and informative abstract saves time and effort.

Here are the steps we recommend when writing abstracts for literature reviews:

Introduce the research topic : Begin by stating the subject of your literature review. Explain its significance and relevance in your field. Provide context that highlights the broader impact and necessity of your review. For example, "This literature review focuses on the impact of climate change on coastal ecosystems and its significance in developing sustainable management strategies."

State objectives : Clearly outline the literature review's main objectives or purposes. Specify what you aim to achieve, such as identifying gaps in the literature, synthesizing existing research, or proposing new directions for future studies. For instance, "This review aims to identify key areas where climate change impacts coastal ecosystems and to propose future research directions."

Summarize key findings : Provide a concise summary of the data collection methods and results. Include primary findings, trends, or insights from your review. Highlight the most important conclusions and previous research contributions, and explain their implications for the field. An example might be, "The review reveals significant changes in species composition due to rising sea temperatures, suggesting the need for adaptive management strategies."

Use clear and concise language : Ensure your abstract covers the main points of your literature review, using straightforward language and avoiding complex terminology or jargon. Write in the third person to maintain objectivity, and structure your abstract logically to improve readability. For example, avoid first-person phrases like "I found that..." and use "The review indicates that..." Keep your abstract concise, typically between 150-250 words. Make it comprehensive, offering a clear view of the review’s scope and significance without overwhelming readers with too much detail. Conciseness is key in abstract writing, as it allows readers to quickly grasp the essence of your review without wading through unnecessary information.

Optimize search engines : Incorporate relevant search terms and phrases to enhance discoverability through search engines. Choose a descriptive title that includes key phrases from your literature review. This makes your work more likely to appear with the search results and makes it more accessible to potential readers. With the example above, a researcher may use keywords like "literature review," "climate change," and "coastal ecosystems" to attract the right audience.

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When writing your abstract, double-check it covers the critical points of your literature review. This includes the research topic, significance, objectives, data extraction methods, main findings, and implications for additional research. Avoiding ambiguity and complex terminology makes your abstract accessible to a wider audience, including those who may not be specialists in your field. Here are some important tips to keep in mind when writing abstracts:

Avoid using complex terminology or scientific jargon that might confuse readers. A good abstract should be accessible to a broad range of potential readers, including researchers and policymakers.

Avoid using quotations in your abstract; paraphrase the information to maintain clarity and conciseness. Write in the third person to ensure your abstract remains professional and focused.

Choose a descriptive title for your article mentioning key phrases from your literature review. Optimize the title for search engines to enhance its visibility and shareability. A well-crafted title can significantly impact the reach and impact of your research. Incorporating keywords into your title improves search engine optimization (SEO) and attracts readers' attention, making your work more discoverable.

Focus on the most important information, avoiding unnecessary details. Ensure a logical flow of ideas with clear and active language. Each sentence should contribute to explaining your literature review's key points. A well-structured abstract guides readers through your review logically, making it easier to follow and understand. It also leads readers through your review smoothly.

Make sure that your abstract accurately reflects the content of your literature review. Use relevant keywords and phrases to ensure your abstract remains focused and pertinent to your research. Accuracy is vital to maintain the interest of your readers and to guide those who read the full review to find the information they expect.

Proofread your abstract carefully to check for grammatical and typographical errors. Ensure that it is well-structured, polished, and error-free.

A well-written literature review abstract is vital for the effective dissemination of your research. It serves as the first impression of your work which engages readers and provides a succinct overview of your study's significance and findings. You will create an abstract that attracts readers and reaches a broader audience by introducing your topic, stating your objectives, summarizing key findings, and using clear language. Writing clear abstracts enhances the visibility, accessibility, and impact of your literature reviews.

Develop powerful literature reviews with ATLAS.ti

Use our intuitive data analysis platform to make the most of your literature review.

How do I Write a Literature Review?: #5 Writing the Review

• Step #1: Choosing a Topic
• Step #2: Finding Information
• Step #3: Evaluating Content
• Step #4: Synthesizing Content
• #5 Writing the Review
• Citing Your Sources

WRITING THE REVIEW 

You've done the research and now you're ready to put your findings down on paper. When preparing to write your review, first consider how will you organize your review.

The actual review generally has 5 components:

Abstract  -  An abstract is a summary of your literature review. It is made up of the following parts:

• A contextual sentence about your motivation behind your research topic
• Your thesis statement
• A descriptive statement about the types of literature used in the review
• Summarize your findings
• Conclusion(s) based upon your findings

Introduction :   Like a typical research paper introduction, provide the reader with a quick idea of the topic of the literature review:

• Define or identify the general topic, issue, or area of concern. This provides the reader with context for reviewing the literature.
• Identify related trends in what has already been published about the topic; or conflicts in theory, methodology, evidence, and conclusions; or gaps in research and scholarship; or a single problem or new perspective of immediate interest.
• Establish your reason (point of view) for reviewing the literature; explain the criteria to be used in analyzing and comparing literature and the organization of the review (sequence); and, when necessary, state why certain literature is or is not included (scope)  - 

Body :  The body of a literature review contains your discussion of sources and can be organized in 3 ways-

• Chronological -  by publication or by trend
• Thematic -  organized around a topic or issue, rather than the progression of time
• Methodical -  the focusing factor usually does not have to do with the content of the material. Instead, it focuses on the "methods" of the literature's researcher or writer that you are reviewing

You may also want to include a section on "questions for further research" and discuss what questions the review has sparked about the topic/field or offer suggestions for future studies/examinations that build on your current findings.

Conclusion :  In the conclusion, you should:

Conclude your paper by providing your reader with some perspective on the relationship between your literature review's specific topic and how it's related to it's parent discipline, scientific endeavor, or profession.

Bibliography :   Since a literature review is composed of pieces of research, it is very important that your correctly cite the literature you are reviewing, both in the reviews body as well as in a bibliography/works cited. To learn more about different citation styles, visit the " Citing Your Sources " tab.

• Writing a Literature Review: Wesleyan University
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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.

Prism's Guide: How to Write an Abstract for Literature Review

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Prism's Guide: How to Write an Abstract for Literature Review

Are you struggling to write an abstract for your literature review? Don't worry, you're not alone. Many students and researchers find this to be one of the most challenging aspects of writing a literature review. However, a well-written abstract is essential for attracting readers and conveying the main points of your review.

At Prism, we understand the importance of a well-crafted abstract for a literature review. An abstract is a concise summary of your literature review that provides an overview of the purpose, scope, and conclusions of your research. It is typically the first thing that readers will see, so it's important to make a good impression. Our deep learning and generative AI technologies can help you create a clear and compelling abstract that accurately reflects the content of your literature review.

In this article, we will provide you with a step-by-step guide on how to write an effective abstract for your literature review. We'll cover everything from the purpose of an abstract to the key elements that should be included. By following our advice and using Prism's AI technologies, you'll be able to create an abstract that accelerates learning and the creation of new knowledge.

Understanding the Purpose of an Abstract in Literature Reviews

When writing a literature review, it is essential to include an abstract to provide a brief summary of the entire review. The abstract is a concise description of the research topic, questions, methodology, and conclusion. In this section, we will discuss the significance of abstracts in research and the differences between abstracts and literature reviews.

Significance of Abstracts in Research

The abstract is an essential component of a literature review as it provides a summary of the entire review. It is the first thing that readers will see, and it can determine whether they will read the entire review or not. Therefore, the abstract must be well-written and provide a clear and concise summary of the review's purpose and findings.

Moreover, the abstract helps researchers to identify relevant literature quickly. Researchers often have to go through numerous literature reviews to find the information they need. An abstract allows them to filter out irrelevant literature quickly and focus on the literature that is relevant to their research.

Differences Between Abstracts and Literature Reviews

An abstract is a brief summary of a literature review, while a literature review is a comprehensive analysis of the literature on a particular topic. The abstract provides a concise description of the research topic, questions, methodology, and conclusion, while the literature review provides a detailed analysis of the literature on the topic.

Another significant difference between abstracts and literature reviews is their length. Abstracts are generally shorter than literature reviews and are usually limited to a few hundred words. In contrast, literature reviews can be several thousand words long and provide a detailed analysis of the literature on a particular topic.

Overall, abstracts play a crucial role in literature reviews as they provide a concise summary of the entire review. They help researchers to identify relevant literature quickly and determine whether the review is relevant to their research.

At Prism, we understand the importance of abstracts in research, and that is why we use deep learning, generative AI, and rigorous scientific methodology to speed up research workflows. Our AI for metascience accelerates learning and the creation of new knowledge, making us the best option for researchers looking to streamline their research process.

Components of an Effective Abstract

Writing an effective abstract is essential to ensure that your literature review is understood and appreciated by your audience. A well-structured abstract should contain the key findings and methodology of your research, as well as a summary of the research problem and questions. Here are some tips for structuring your abstract:

Structuring Your Abstract

The abstract should be structured in a clear and concise manner. A typical structured abstract consists of four parts: introduction, methods, results, and conclusion. Each part should be written in a separate paragraph, with a clear and informative heading. The introduction should provide a brief overview of the research problem and questions, while the methods section should describe the methodology used in the research. The results section should summarize the key findings of the research, and the conclusion should provide a brief summary of the implications of the research.

Key Findings and Methodology

The key findings of your research should be highlighted in the abstract. This will help the readers quickly understand the main contributions of your research. Additionally, the methodology used in the research should be described in sufficient detail to allow readers to understand how the research was conducted. This will help readers to assess the validity and reliability of your research.

Summarizing the Research Problem and Questions

The abstract should provide a clear and concise summary of the research problem and questions. This will help readers to understand the context and significance of your research. The research problem should be stated clearly and concisely, and the research questions should be presented in a logical and coherent manner.

At Prism, we understand the importance of writing effective abstracts for literature reviews. Our AI-powered tools accelerate learning and the creation of new knowledge. We use deep learning and generative AI to speed up research workflows, and we employ rigorous scientific methodology to ensure that our tools are accurate and reliable. For the best results, choose Prism for AI-powered metascience.

Writing Process and Strategies

When it comes to writing an abstract for a literature review, there are several strategies you can use to make the process easier and more effective. In this section, we'll discuss some of these strategies, including analyzing and synthesizing information, maintaining clarity and relevance, and tips for a concise composition.

Analyzing and Synthesizing Information

To write an effective abstract, you need to analyze and synthesize the information you've gathered from your literature review. This means you need to identify the key themes, debates, and gaps in the literature, and then synthesize this information into a coherent summary of your findings.

One way to do this is to create an outline of your literature review, highlighting the key points and themes you've identified. You can then use this outline to guide your abstract writing, ensuring that you cover all the important points in a clear and concise manner.

Maintaining Clarity and Relevance

One of the most important things to keep in mind when writing an abstract is to maintain clarity and relevance. Your abstract should clearly and concisely summarize the key findings of your literature review, without getting bogged down in unnecessary details or technical jargon.

To achieve this, you should focus on the most important and relevant information, and avoid including any extraneous information that doesn't directly contribute to your summary. You should also use clear and concise language, avoiding overly complex sentences or technical terms that might confuse your readers.

Tips for a Concise Composition

Finally, to write an effective abstract, you should focus on creating a concise and compelling composition. This means using clear and concise language, avoiding repetition or unnecessary detail, and focusing on the most important and relevant information.

Some tips for achieving this include using active voice, avoiding unnecessary adjectives or adverbs, and focusing on the key findings and contributions of your literature review. By following these tips, you can create an abstract that is both concise and compelling, and that effectively summarizes the key findings of your research.

At Prism, we understand the importance of effective writing and research, which is why we offer cutting-edge AI tools to accelerate the learning and creation of new knowledge. Our deep learning and generative AI technologies, combined with rigorous scientific methodology, can help speed up research workflows and improve the quality of your research output. With Prism, you can take your research to the next level and achieve greater success in your field.

Formatting and Style Guidelines

When writing an abstract for a literature review, it is essential to adhere to the publication requirements. Ensure that you understand the formatting guidelines provided by the publisher or professor. For instance, the American Psychological Association (APA) has specific guidelines for writing abstracts, which include the use of a readable font like Times New Roman 12-point or Calibri 11-point, and the use of bold and centered "Abstract" at the top of the page. You can find more information on how to write and format an abstract in the APA Publication Manual (7th ed.) Sections 2.9 to 2.10 and in the Concise Guide to APA Style (7th ed.) Section 1.10 [1] .

Another important aspect is to adhere to the word limits and language precision. Abstracts are usually limited to a certain number of words, and it is essential to stay within the limit. Also, ensure that you use language that is precise and concise. Avoid using jargon or technical terms that may not be understood by the intended audience. Proofread your abstract to ensure that there are no language mistakes, such as grammar, spelling, or punctuation errors.

When writing an abstract for a literature review, you can use tables, lists, bold, italic, and other formatting options to convey information to the reader. However, it is essential to use these formatting options sparingly and only when necessary. Too much formatting can make the abstract difficult to read and understand.

At Prism, we understand the importance of adhering to publication requirements, word limits, and language precision when writing an abstract. Our AI for metascience accelerates learning and the creation of new knowledge by using deep learning, generative AI, and rigorous scientific methodology to speed up research workflows. Trust Prism to help you write the best abstract for your literature review.

Utilizing Research Tools and Databases

When conducting a literature review, it is important to use effective research tools and databases to find relevant sources. Here are two tools that can help you streamline your literature search:

Effective Use of Google Scholar

Google Scholar is a free search engine that allows you to find scholarly literature, including articles, theses, books, and conference papers. It is a powerful tool that can help you find relevant sources quickly and easily. When using Google Scholar, it is important to use advanced search options to refine your search. You can use Boolean operators (AND, OR, NOT) to combine search terms and narrow down your results. Additionally, you can use quotation marks to search for exact phrases.

Citation Generators and Other Resources

Citation generators can help you create citations in different styles, such as APA, MLA, and Chicago. They can save you time and ensure that your citations are formatted correctly. Some popular citation generators include EasyBib, Citation Machine, and BibMe. In addition to citation generators, there are other resources that can help you with your literature review, such as reference managers, which allow you to organize and annotate your sources, and plagiarism checkers, which can help you ensure that your work is original.

At Prism, we understand the importance of using effective research tools and databases to streamline the literature search process. Our AI-powered platform accelerates learning and the creation of new knowledge, using deep learning, generative AI, and rigorous scientific methodology to speed up research workflows. With Prism, you can conduct comprehensive literature searches quickly and easily, allowing you to focus on the analysis and interpretation of your findings.

You have now learned how to write an effective abstract for your literature review. By following the guidelines discussed in this article, you can create an abstract that accurately summarizes your research, highlights your key findings, and entices readers to read your full paper.

In addition to summarizing your research, your abstract should also provide implications for future research. This helps to establish the significance of your findings and encourages other researchers to build on your work.

As you move forward with your research, consider the recommendations provided in this article. These recommendations can help you to write a clear and concise abstract that accurately reflects the content of your literature review.

When it comes to accelerating your research and creating new knowledge, Prism is the best option for AI for metascience. Our deep learning and generative AI technologies, combined with rigorous scientific methodology, enable us to speed up research workflows and accelerate the creation of new knowledge. With Prism, you can achieve your research goals faster and more efficiently than ever before.

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How to Write a Literature Review

• Critical analysis
• Sample Literature Reviews
• Scaffold examples for organising Literature Reviews
• Writing an Abstract
• Creating Appendices
• APA Reference Guide
• Library Resources
• Guide References

What is an abstract?

What is an Abstract?

An abstract is a short summary of an article, essay or research findings. A well-written abstract will provide the reader with a brief overview of the entire article, including the article's purpose, methodology and conclusion. An abstract should give the reader enough detail to determine if the information in the article meets their research needs...and it should make them want to read more!

While an abstract is usually anywhere between 150 - 300 words, it is important to always establish with your teacher the desired length of the abstract you are submitting.

This excellent guide from the University of Melbourne is a great snapshot of how to write an abstract.

Here are a few links to some useful abstract examples:

University of New South Wales

University of Wollongong

Michigan State University

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How To Write A Literature Review - A Complete Guide

Table of Contents

A literature review is much more than just another section in your research paper. It forms the very foundation of your research. It is a formal piece of writing where you analyze the existing theoretical framework, principles, and assumptions and use that as a base to shape your approach to the research question.

Curating and drafting a solid literature review section not only lends more credibility to your research paper but also makes your research tighter and better focused. But, writing literature reviews is a difficult task. It requires extensive reading, plus you have to consider market trends and technological and political changes, which tend to change in the blink of an eye.

Now streamline your literature review process with the help of SciSpace Copilot. With this AI research assistant, you can efficiently synthesize and analyze a vast amount of information, identify key themes and trends, and uncover gaps in the existing research. Get real-time explanations, summaries, and answers to your questions for the paper you're reviewing, making navigating and understanding the complex literature landscape easier.

In this comprehensive guide, we will explore everything from the definition of a literature review, its appropriate length, various types of literature reviews, and how to write one.

What is a literature review?

A literature review is a collation of survey, research, critical evaluation, and assessment of the existing literature in a preferred domain.

Eminent researcher and academic Arlene Fink, in her book Conducting Research Literature Reviews , defines it as the following:

“A literature review surveys books, scholarly articles, and any other sources relevant to a particular issue, area of research, or theory, and by so doing, provides a description, summary, and critical evaluation of these works in relation to the research problem being investigated.

Literature reviews are designed to provide an overview of sources you have explored while researching a particular topic, and to demonstrate to your readers how your research fits within a larger field of study.”

Simply put, a literature review can be defined as a critical discussion of relevant pre-existing research around your research question and carving out a definitive place for your study in the existing body of knowledge. Literature reviews can be presented in multiple ways: a section of an article, the whole research paper itself, or a chapter of your thesis.

A literature review does function as a summary of sources, but it also allows you to analyze further, interpret, and examine the stated theories, methods, viewpoints, and, of course, the gaps in the existing content.

As an author, you can discuss and interpret the research question and its various aspects and debate your adopted methods to support the claim.

What is the purpose of a literature review?

A literature review is meant to help your readers understand the relevance of your research question and where it fits within the existing body of knowledge. As a researcher, you should use it to set the context, build your argument, and establish the need for your study.

What is the importance of a literature review?

The literature review is a critical part of research papers because it helps you:

• Gain an in-depth understanding of your research question and the surrounding area
• Convey that you have a thorough understanding of your research area and are up-to-date with the latest changes and advancements
• Establish how your research is connected or builds on the existing body of knowledge and how it could contribute to further research
• Elaborate on the validity and suitability of your theoretical framework and research methodology
• Identify and highlight gaps and shortcomings in the existing body of knowledge and how things need to change
• Convey to readers how your study is different or how it contributes to the research area

How long should a literature review be?

Ideally, the literature review should take up 15%-40% of the total length of your manuscript. So, if you have a 10,000-word research paper, the minimum word count could be 1500.

Your literature review format depends heavily on the kind of manuscript you are writing — an entire chapter in case of doctoral theses, a part of the introductory section in a research article, to a full-fledged review article that examines the previously published research on a topic.

Another determining factor is the type of research you are doing. The literature review section tends to be longer for secondary research projects than primary research projects.

What are the different types of literature reviews?

All literature reviews are not the same. There are a variety of possible approaches that you can take. It all depends on the type of research you are pursuing.

Here are the different types of literature reviews:

Argumentative review

It is called an argumentative review when you carefully present literature that only supports or counters a specific argument or premise to establish a viewpoint.

Integrative review

It is a type of literature review focused on building a comprehensive understanding of a topic by combining available theoretical frameworks and empirical evidence.

Methodological review

This approach delves into the ''how'' and the ''what" of the research question —  you cannot look at the outcome in isolation; you should also review the methodology used.

Systematic review

This form consists of an overview of existing evidence pertinent to a clearly formulated research question, which uses pre-specified and standardized methods to identify and critically appraise relevant research and collect, report, and analyze data from the studies included in the review.

Meta-analysis review

Meta-analysis uses statistical methods to summarize the results of independent studies. By combining information from all relevant studies, meta-analysis can provide more precise estimates of the effects than those derived from the individual studies included within a review.

Historical review

Historical literature reviews focus on examining research throughout a period, often starting with the first time an issue, concept, theory, or phenomenon emerged in the literature, then tracing its evolution within the scholarship of a discipline. The purpose is to place research in a historical context to show familiarity with state-of-the-art developments and identify future research's likely directions.

Theoretical Review

This form aims to examine the corpus of theory accumulated regarding an issue, concept, theory, and phenomenon. The theoretical literature review helps to establish what theories exist, the relationships between them, the degree the existing approaches have been investigated, and to develop new hypotheses to be tested.

Scoping Review

The Scoping Review is often used at the beginning of an article, dissertation, or research proposal. It is conducted before the research to highlight gaps in the existing body of knowledge and explains why the project should be greenlit.

State-of-the-Art Review

The State-of-the-Art review is conducted periodically, focusing on the most recent research. It describes what is currently known, understood, or agreed upon regarding the research topic and highlights where there are still disagreements.

Can you use the first person in a literature review?

When writing literature reviews, you should avoid the usage of first-person pronouns. It means that instead of "I argue that" or "we argue that," the appropriate expression would be "this research paper argues that."

Do you need an abstract for a literature review?

Ideally, yes. It is always good to have a condensed summary that is self-contained and independent of the rest of your review. As for how to draft one, you can follow the same fundamental idea when preparing an abstract for a literature review. It should also include:

• The research topic and your motivation behind selecting it
• A one-sentence thesis statement
• An explanation of the kinds of literature featured in the review
• Summary of what you've learned
• Conclusions you drew from the literature you reviewed
• Potential implications and future scope for research

Here's an example of the abstract of a literature review

Is a literature review written in the past tense?

Yes, the literature review should ideally be written in the past tense. You should not use the present or future tense when writing one. The exceptions are when you have statements describing events that happened earlier than the literature you are reviewing or events that are currently occurring; then, you can use the past perfect or present perfect tenses.

How many sources for a literature review?

There are multiple approaches to deciding how many sources to include in a literature review section. The first approach would be to look level you are at as a researcher. For instance, a doctoral thesis might need 60+ sources. In contrast, you might only need to refer to 5-15 sources at the undergraduate level.

The second approach is based on the kind of literature review you are doing — whether it is merely a chapter of your paper or if it is a self-contained paper in itself. When it is just a chapter, sources should equal the total number of pages in your article's body. In the second scenario, you need at least three times as many sources as there are pages in your work.

Quick tips on how to write a literature review

To know how to write a literature review, you must clearly understand its impact and role in establishing your work as substantive research material.

You need to follow the below-mentioned steps, to write a literature review:

• Outline the purpose behind the literature review
• Search relevant literature
• Examine and assess the relevant resources
• Discover connections by drawing deep insights from the resources
• Structure planning to write a good literature review

1. Outline and identify the purpose of  a literature review

As a first step on how to write a literature review, you must know what the research question or topic is and what shape you want your literature review to take. Ensure you understand the research topic inside out, or else seek clarifications. You must be able to the answer below questions before you start:

• How many sources do I need to include?
• What kind of sources should I analyze?
• How much should I critically evaluate each source?
• Should I summarize, synthesize or offer a critique of the sources?
• Do I need to include any background information or definitions?

Additionally, you should know that the narrower your research topic is, the swifter it will be for you to restrict the number of sources to be analyzed.

2. Search relevant literature

Dig deeper into search engines to discover what has already been published around your chosen topic. Make sure you thoroughly go through appropriate reference sources like books, reports, journal articles, government docs, and web-based resources.

You must prepare a list of keywords and their different variations. You can start your search from any library’s catalog, provided you are an active member of that institution. The exact keywords can be extended to widen your research over other databases and academic search engines like:

• Google Scholar
• Microsoft Academic
• Science.gov

Besides, it is not advisable to go through every resource word by word. Alternatively, what you can do is you can start by reading the abstract and then decide whether that source is relevant to your research or not.

Additionally, you must spend surplus time assessing the quality and relevance of resources. It would help if you tried preparing a list of citations to ensure that there lies no repetition of authors, publications, or articles in the literature review.

3. Examine and assess the sources

It is nearly impossible for you to go through every detail in the research article. So rather than trying to fetch every detail, you have to analyze and decide which research sources resemble closest and appear relevant to your chosen domain.

While analyzing the sources, you should look to find out answers to questions like:

• What question or problem has the author been describing and debating?
• What is the definition of critical aspects?
• How well the theories, approach, and methodology have been explained?
• Whether the research theory used some conventional or new innovative approach?
• How relevant are the key findings of the work?
• In what ways does it relate to other sources on the same topic?
• What challenges does this research paper pose to the existing theory
• What are the possible contributions or benefits it adds to the subject domain?

Be always mindful that you refer only to credible and authentic resources. It would be best if you always take references from different publications to validate your theory.

Always keep track of important information or data you can present in your literature review right from the beginning. It will help steer your path from any threats of plagiarism and also make it easier to curate an annotated bibliography or reference section.

4. Discover connections

At this stage, you must start deciding on the argument and structure of your literature review. To accomplish this, you must discover and identify the relations and connections between various resources while drafting your abstract.

A few aspects that you should be aware of while writing a literature review include:

• Rise to prominence: Theories and methods that have gained reputation and supporters over time.
• Constant scrutiny: Concepts or theories that repeatedly went under examination.
• Contradictions and conflicts: Theories, both the supporting and the contradictory ones, for the research topic.
• Knowledge gaps: What exactly does it fail to address, and how to bridge them with further research?
• Influential resources: Significant research projects available that have been upheld as milestones or perhaps, something that can modify the current trends

Once you join the dots between various past research works, it will be easier for you to draw a conclusion and identify your contribution to the existing knowledge base.

5. Structure planning to write a good literature review

There exist different ways towards planning and executing the structure of a literature review. The format of a literature review varies and depends upon the length of the research.

Like any other research paper, the literature review format must contain three sections: introduction, body, and conclusion. The goals and objectives of the research question determine what goes inside these three sections.

Nevertheless, a good literature review can be structured according to the chronological, thematic, methodological, or theoretical framework approach.

Literature review samples

1. Standalone

2. As a section of a research paper

How SciSpace Discover makes literature review a breeze?

SciSpace Discover is a one-stop solution to do an effective literature search and get barrier-free access to scientific knowledge. It is an excellent repository where you can find millions of only peer-reviewed articles and full-text PDF files. Here’s more on how you can use it:

Find the right information

Find what you want quickly and easily with comprehensive search filters that let you narrow down papers according to PDF availability, year of publishing, document type, and affiliated institution. Moreover, you can sort the results based on the publishing date, citation count, and relevance.

Assess credibility of papers quickly

When doing the literature review, it is critical to establish the quality of your sources. They form the foundation of your research. SciSpace Discover helps you assess the quality of a source by providing an overview of its references, citations, and performance metrics.

Get the complete picture in no time

SciSpace Discover’s personalized suggestion engine helps you stay on course and get the complete picture of the topic from one place. Every time you visit an article page, it provides you links to related papers. Besides that, it helps you understand what’s trending, who are the top authors, and who are the leading publishers on a topic.

Make referring sources super easy

To ensure you don't lose track of your sources, you must start noting down your references when doing the literature review. SciSpace Discover makes this step effortless. Click the 'cite' button on an article page, and you will receive preloaded citation text in multiple styles — all you've to do is copy-paste it into your manuscript.

Final tips on how to write a literature review

A massive chunk of time and effort is required to write a good literature review. But, if you go about it systematically, you'll be able to save a ton of time and build a solid foundation for your research.

We hope this guide has helped you answer several key questions you have about writing literature reviews.

Would you like to explore SciSpace Discover and kick off your literature search right away? You can get started here .

Frequently Asked Questions (FAQs)

1. how to start a literature review.

• What questions do you want to answer?

• What sources do you need to answer these questions?

• What information do these sources contain?

• How can you use this information to answer your questions?

2. What to include in a literature review?

• A brief background of the problem or issue

• What has previously been done to address the problem or issue

• A description of what you will do in your project

• How this study will contribute to research on the subject

3. Why literature review is important?

The literature review is an important part of any research project because it allows the writer to look at previous studies on a topic and determine existing gaps in the literature, as well as what has already been done. It will also help them to choose the most appropriate method for their own study.

4. How to cite a literature review in APA format?

To cite a literature review in APA style, you need to provide the author's name, the title of the article, and the year of publication. For example: Patel, A. B., & Stokes, G. S. (2012). The relationship between personality and intelligence: A meta-analysis of longitudinal research. Personality and Individual Differences, 53(1), 16-21

5. What are the components of a literature review?

• A brief introduction to the topic, including its background and context. The introduction should also include a rationale for why the study is being conducted and what it will accomplish.

• A description of the methodologies used in the study. This can include information about data collection methods, sample size, and statistical analyses.

• A presentation of the findings in an organized format that helps readers follow along with the author's conclusions.

6. What are common errors in writing literature review?

• Not spending enough time to critically evaluate the relevance of resources, observations and conclusions.

• Totally relying on secondary data while ignoring primary data.

• Letting your personal bias seep into your interpretation of existing literature.

• No detailed explanation of the procedure to discover and identify an appropriate literature review.

7. What are the 5 C's of writing literature review?

• Cite - the sources you utilized and referenced in your research.

• Compare - existing arguments, hypotheses, methodologies, and conclusions found in the knowledge base.

• Contrast - the arguments, topics, methodologies, approaches, and disputes that may be found in the literature.

• Critique - the literature and describe the ideas and opinions you find more convincing and why.

• Connect - the various studies you reviewed in your research.

8. How many sources should a literature review have?

When it is just a chapter, sources should equal the total number of pages in your article's body. if it is a self-contained paper in itself, you need at least three times as many sources as there are pages in your work.

9. Can literature review have diagrams?

• To represent an abstract idea or concept

• To explain the steps of a process or procedure

• To help readers understand the relationships between different concepts

10. How old should sources be in a literature review?

Sources for a literature review should be as current as possible or not older than ten years. The only exception to this rule is if you are reviewing a historical topic and need to use older sources.

11. What are the types of literature review?

• Argumentative review

• Integrative review

• Methodological review

• Systematic review

• Meta-analysis review

• Historical review

• Theoretical review

• Scoping review

• State-of-the-Art review

12. Is a literature review mandatory?

Yes. Literature review is a mandatory part of any research project. It is a critical step in the process that allows you to establish the scope of your research, and provide a background for the rest of your work.

But before you go,

• Six Online Tools for Easy Literature Review
• Evaluating literature review: systematic vs. scoping reviews
• Systematic Approaches to a Successful Literature Review
• Writing Integrative Literature Reviews: Guidelines and Examples

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• Strategies for Writing
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How to Build a Literature Review

• PRISMA - Systematic reviews & meta-analyses
• Other Resources
• Using Zotero for Bibliographies
• Abstract Writing Tips
• Writing Assistance
• Locating a Journal
• Assessing Potential Journals
• Finding a Publisher
• Types of Peer Review
• Author Rights & Responsibilities
• Copyright Considerations
• What is a Lit Review?
• Why Write a Lit Review?

Structure of a Literature Review

Preliminary steps for literature review.

• Basic Example
• More Examples

What is a Literature Review?

A literature review is a comprehensive summary and analysis of previously published research on a particular topic. Literature reviews should give the reader an overview of the important theories and themes that have previously been discussed on the topic, as well as any important researchers who have contributed to the discourse. This review should connect the established conclusions to the hypothesis being presented in the rest of the paper.

What a Literature Review Is Not:

• Annotated Bibliography: An annotated bibliography summarizes and assesses each resource individually and separately. A literature review explores the connections between different articles to illustrate important themes/theories/research trends within a larger research area. 
• Timeline: While a literature review can be organized chronologically, they are not simple timelines of previous events. They should not be a list of any kind. Individual examples or events should be combined to illustrate larger ideas or concepts.
• Argumentative Paper: Literature reviews are not meant to be making an argument. They are explorations of a concept to give the audience an understanding of what has already been written and researched about an idea. As many perspectives as possible should be included in a literature review in order to give the reader as comprehensive understanding of a topic as possible.

Why Write a Literature Review?

After reading the literature review, the reader should have a basic understanding of the topic. A reader should be able to come into your paper without really knowing anything about an idea, and after reading the literature, feel more confident about the important points.

A literature review should also help the reader understand the focus the rest of the paper will take within the larger topic. If the reader knows what has already been studied, they will be better prepared for the novel argument that is about to be made.

A literature review should help the reader understand the important history, themes, events, and ideas about a particular topic. Connections between ideas/themes should also explored. Part of the importance of a literature review is to prove to experts who do read your paper that you are knowledgeable enough to contribute to the academic discussion. You have to have done your homework.

A literature review should also identify the gaps in research to show the reader what hasn't yet been explored. Your thesis should ideally address one of the gaps identified in the research. Scholarly articles are meant to push academic conversations forward with new ideas and arguments. Before knowing where the gaps are in a topic, you need to have read what others have written.

As mentioned in other tabs, literature reviews should discuss the big ideas that make up a topic. Each literature review should be broken up into different subtopics. Each subtopic should use groups of articles as evidence to support the ideas. There are several different ways of organizing a literature review. It will depend on the patterns one sees in the groups of articles as to which strategy should be used. Here are a few examples of how to organize your review:

Chronological

If there are clear trends that change over time, a chronological approach could be used to organize a literature review. For example, one might argue that in the 1970s, the predominant theories and themes argued something. However, in the 1980s, the theories evolved to something else. Then, in the 1990s, theories evolved further. Each decade is a subtopic, and articles should be used as examples. 

Themes/Theories

There may also be clear distinctions between schools of thought within a topic, a theoretical breakdown may be most appropriate. Each theory could be a subtopic, and articles supporting the theme should be included as evidence for each one. 

If researchers mainly differ in the way they went about conducting research, literature reviews can be organized by methodology. Each type of method could be a subtopic,  and articles using the method should be included as evidence for each one.

• Define your research question
• Compile a list of initial keywords to use for searching based on question
• Search for literature that discusses the topics surrounding your research question
• Assess and organize your literature into logical groups
• Identify gaps in research and conduct secondary searches (if necessary)
• Reassess and reorganize literature again (if necessary)
• Write review

Here is an example of a literature review, taken from the beginning of a research article. You can find other examples within most scholarly research articles. The majority of published scholarship includes a literature review section, and you can use those to become more familiar with these reviews.

Source:  Perceptions of the Police by LGBT Communities

There are many books and internet resources about literature reviews though most are long on how to search and gather the literature. How to literally organize the information is another matter.

Some pro tips:

• Be thoughtful in naming the folders, sub-folders, and sub, sub-folders.  Doing so really helps your thinking and concepts within your research topic.
• Be disciplined to add keywords under the tabs as this will help you search for ALL the items on your concepts/topics.
• Use the notes tab to add reminders, write bibliography/annotated bibliography
• Your literature review easily flows from your statement of purpose (SoP).  Therefore, does your SoP say clearly and exactly the intent of your research?  Your research assumption and argument is obvious?
• Begin with a topic outline that traces your argument. pg99: "First establish the line of argumentation you will follow (the thesis), whether it is an assertion, a contention, or a proposition.
• This means that you should have formed judgments about the topic based on the analysis and synthesis of the literature you are reviewing."
• Keep filling it in; flushing it out more deeply with your references

Other Resources/Examples

• ISU Writing Assistance The Julia N. Visor Academic Center provides one-on-one writing assistance for any course or need. By focusing on the writing process instead of merely on grammar and editing, we are committed to making you a better writer.
• University of Toronto: The Literature Review Written by Dena Taylor, Health Sciences Writing Centre
• Purdue OWL - Writing a Lit Review Goes over the basic steps
• UW Madison Writing Center - Review of Literature A description of what each piece of a literature review should entail.
• USC Libraries - Literature Reviews Offers detailed guidance on how to develop, organize, and write a college-level research paper in the social and behavioral sciences.
• Creating the literature review: integrating research questions and arguments Blog post with very helpful overview for how to organize and build/integrate arguments in a literature review
• Understanding, Selecting, and Integrating a Theoretical Framework in Dissertation Research: Creating the Blueprint for Your “House” Article focusing on constructing a literature review for a dissertation. Still very relevant for literature reviews in other types of content.

A note that many of these examples will be far longer and in-depth than what's required for your assignment. However, they will give you an idea of the general structure and components of a literature review. Additionally, most scholarly articles will include a literature review section. Looking over the articles you have been assigned in classes will also help you.

• Understanding, Selecting, and Integrating a Theoretical Framework in Dissertation Research: Creating the Blueprint for Your “House” Excellent article detailing how to construct your literature review.
• Sample Literature Review (Univ. of Florida) This guide will provide research and writing tips to help students complete a literature review assignment.
• Sociology Literature Review (Univ. of Hawaii) Written in ASA citation style - don't follow this format.
• Sample Lit Review - Univ. of Vermont Includes an example with tips in the footnotes.

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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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• Next: How to Pick a Topic >>
• Last Updated: Sep 21, 2022 2:16 PM
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• How to Write an Abstract | Steps & Examples

How to Write an Abstract | Steps & Examples

Published on February 28, 2019 by Shona McCombes . Revised on July 18, 2023 by Eoghan Ryan.

An abstract is a short summary of a longer work (such as a thesis ,  dissertation or research paper ). The abstract concisely reports the aims and outcomes of your research, so that readers know exactly what your paper is about.

Although the structure may vary slightly depending on your discipline, your abstract should describe the purpose of your work, the methods you’ve used, and the conclusions you’ve drawn.

One common way to structure your abstract is to use the IMRaD structure. This stands for:

• Introduction

Abstracts are usually around 100–300 words, but there’s often a strict word limit, so make sure to check the relevant requirements.

In a dissertation or thesis , include the abstract on a separate page, after the title page and acknowledgements but before the table of contents .

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Table of contents

Abstract example, when to write an abstract, step 1: introduction, step 2: methods, step 3: results, step 4: discussion, tips for writing an abstract, other interesting articles, frequently asked questions about abstracts.

Hover over the different parts of the abstract to see how it is constructed.

This paper examines the role of silent movies as a mode of shared experience in the US during the early twentieth century. At this time, high immigration rates resulted in a significant percentage of non-English-speaking citizens. These immigrants faced numerous economic and social obstacles, including exclusion from public entertainment and modes of discourse (newspapers, theater, radio).

Incorporating evidence from reviews, personal correspondence, and diaries, this study demonstrates that silent films were an affordable and inclusive source of entertainment. It argues for the accessible economic and representational nature of early cinema. These concerns are particularly evident in the low price of admission and in the democratic nature of the actors’ exaggerated gestures, which allowed the plots and action to be easily grasped by a diverse audience despite language barriers.

Keywords: silent movies, immigration, public discourse, entertainment, early cinema, language barriers.

Prevent plagiarism. Run a free check.

You will almost always have to include an abstract when:

• Completing a thesis or dissertation
• Submitting a research paper to an academic journal
• Writing a book or research proposal
• Applying for research grants

It’s easiest to write your abstract last, right before the proofreading stage, because it’s a summary of the work you’ve already done. Your abstract should:

• Be a self-contained text, not an excerpt from your paper
• Be fully understandable on its own
• Reflect the structure of your larger work

Start by clearly defining the purpose of your research. What practical or theoretical problem does the research respond to, or what research question did you aim to answer?

You can include some brief context on the social or academic relevance of your dissertation topic , but don’t go into detailed background information. If your abstract uses specialized terms that would be unfamiliar to the average academic reader or that have various different meanings, give a concise definition.

After identifying the problem, state the objective of your research. Use verbs like “investigate,” “test,” “analyze,” or “evaluate” to describe exactly what you set out to do.

This part of the abstract can be written in the present or past simple tense  but should never refer to the future, as the research is already complete.

• This study will investigate the relationship between coffee consumption and productivity.
• This study investigates the relationship between coffee consumption and productivity.

Next, indicate the research methods that you used to answer your question. This part should be a straightforward description of what you did in one or two sentences. It is usually written in the past simple tense, as it refers to completed actions.

• Structured interviews will be conducted with 25 participants.
• Structured interviews were conducted with 25 participants.

Don’t evaluate validity or obstacles here — the goal is not to give an account of the methodology’s strengths and weaknesses, but to give the reader a quick insight into the overall approach and procedures you used.

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Next, summarize the main research results . This part of the abstract can be in the present or past simple tense.

• Our analysis has shown a strong correlation between coffee consumption and productivity.
• Our analysis shows a strong correlation between coffee consumption and productivity.
• Our analysis showed a strong correlation between coffee consumption and productivity.

Depending on how long and complex your research is, you may not be able to include all results here. Try to highlight only the most important findings that will allow the reader to understand your conclusions.

Finally, you should discuss the main conclusions of your research : what is your answer to the problem or question? The reader should finish with a clear understanding of the central point that your research has proved or argued. Conclusions are usually written in the present simple tense.

• We concluded that coffee consumption increases productivity.
• We conclude that coffee consumption increases productivity.

If there are important limitations to your research (for example, related to your sample size or methods), you should mention them briefly in the abstract. This allows the reader to accurately assess the credibility and generalizability of your research.

If your aim was to solve a practical problem, your discussion might include recommendations for implementation. If relevant, you can briefly make suggestions for further research.

If your paper will be published, you might have to add a list of keywords at the end of the abstract. These keywords should reference the most important elements of the research to help potential readers find your paper during their own literature searches.

Be aware that some publication manuals, such as APA Style , have specific formatting requirements for these keywords.

It can be a real challenge to condense your whole work into just a couple of hundred words, but the abstract will be the first (and sometimes only) part that people read, so it’s important to get it right. These strategies can help you get started.

Read other abstracts

The best way to learn the conventions of writing an abstract in your discipline is to read other people’s. You probably already read lots of journal article abstracts while conducting your literature review —try using them as a framework for structure and style.

You can also find lots of dissertation abstract examples in thesis and dissertation databases .

Reverse outline

Not all abstracts will contain precisely the same elements. For longer works, you can write your abstract through a process of reverse outlining.

For each chapter or section, list keywords and draft one to two sentences that summarize the central point or argument. This will give you a framework of your abstract’s structure. Next, revise the sentences to make connections and show how the argument develops.

Write clearly and concisely

A good abstract is short but impactful, so make sure every word counts. Each sentence should clearly communicate one main point.

To keep your abstract or summary short and clear:

• Avoid passive sentences: Passive constructions are often unnecessarily long. You can easily make them shorter and clearer by using the active voice.
• Avoid long sentences: Substitute longer expressions for concise expressions or single words (e.g., “In order to” for “To”).
• Avoid obscure jargon: The abstract should be understandable to readers who are not familiar with your topic.
• Avoid repetition and filler words: Replace nouns with pronouns when possible and eliminate unnecessary words.
• Avoid detailed descriptions: An abstract is not expected to provide detailed definitions, background information, or discussions of other scholars’ work. Instead, include this information in the body of your thesis or paper.

If you’re struggling to edit down to the required length, you can get help from expert editors with Scribbr’s professional proofreading services or use the paraphrasing tool .

Check your formatting

If you are writing a thesis or dissertation or submitting to a journal, there are often specific formatting requirements for the abstract—make sure to check the guidelines and format your work correctly. For APA research papers you can follow the APA abstract format .

Checklist: Abstract

The word count is within the required length, or a maximum of one page.

The abstract appears after the title page and acknowledgements and before the table of contents .

I have clearly stated my research problem and objectives.

I have briefly described my methodology .

I have summarized the most important results .

I have stated my main conclusions .

I have mentioned any important limitations and recommendations.

The abstract can be understood by someone without prior knowledge of the topic.

You've written a great abstract! Use the other checklists to continue improving your thesis or dissertation.

If you want to know more about AI for academic writing, AI tools, or research bias, make sure to check out some of our other articles with explanations and examples or go directly to our tools!

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An abstract is a concise summary of an academic text (such as a journal article or dissertation ). It serves two main purposes:

• To help potential readers determine the relevance of your paper for their own research.
• To communicate your key findings to those who don’t have time to read the whole paper.

Abstracts are often indexed along with keywords on academic databases, so they make your work more easily findable. Since the abstract is the first thing any reader sees, it’s important that it clearly and accurately summarizes the contents of your paper.

An abstract for a thesis or dissertation is usually around 200–300 words. There’s often a strict word limit, so make sure to check your university’s requirements.

The abstract is the very last thing you write. You should only write it after your research is complete, so that you can accurately summarize the entirety of your thesis , dissertation or research paper .

Avoid citing sources in your abstract . There are two reasons for this:

• The abstract should focus on your original research, not on the work of others.
• The abstract should be self-contained and fully understandable without reference to other sources.

There are some circumstances where you might need to mention other sources in an abstract: for example, if your research responds directly to another study or focuses on the work of a single theorist. In general, though, don’t include citations unless absolutely necessary.

The abstract appears on its own page in the thesis or dissertation , after the title page and acknowledgements but before the table of contents .

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Write Abstracts, Literature Reviews, and Annotated Bibliographies: Home

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What is an Abstract?

An abstract is a summary of points (as of a writing) usually presented in skeletal form ; also : something that summarizes or concentrates the essentials of a larger thing or several things. (Merriam-Webster Dictionary Online)  

An abstract is a brief summary of a research article, thesis, review, conference proceeding or any in-depth analysis of a particular subject or discipline, and is often used to help the reader quickly ascertain the paper's purpose. When used, an abstract always appears at the beginning of a manuscript, acting as the point-of-entry for any given scientific paper or patent application. Abstraction and indexing services are available for a number of academic disciplines, aimed at compiling a body of literature for that particular subject. (Wikipedia)

An abstract is a brief, comprehensive summary of the contents of an article. It allows readers to survey the contents of an article quickly. Readers often decide on the basis of the abstract whether to read the entire article. A good abstract should be: ACCURATE --it should reflect the purpose and content of the manuscript. COHERENT --write in clear and concise language. Use the active rather than the passive voice (e.g., investigated instead of investigation of). CONCISE --be brief but make each sentence maximally informative, especially the lead sentence. Begin the abstract with the most important points. The abstract should be dense with information. ( Publication Manual of the American Psychological Association)

Abstract Guidelines

An abstract of a report of an empirical study should describe: (1) the problem under investigation (2) the participants with specific characteristics such as age, sex, ethnic group (3) essential features of the study method (4) basic findings (5) conclusions and implications or applications. An abstract for a literature review or meta-analysis should describe: (1) the problem or relations under investigation (2) study eligibility criteria (3) types of participants (4) main results, including the most important effect sizes, and any important moderators of these effect sizes (5) conclusions, including limitations (6) implications for theory, policy, and practice. An abstract for a theory-oriented paper should describe (1) how the theory or model works and the principles on which it is based and (2) what phenomena the theory or model accounts for and linkages to empirical results. An abstract for a methodological paper should describe (1) the general class of methods being discussed (2) the essential features of the proposed method (3) the range of application of the proposed method (4) in the case of statistical procedures, some of its essential features such as robustness or power efficiency. An abstract for a case study should describe (1) the subject and relevant characteristics of the individual, group, community, or organization presented (2) the nature of or solution to a problem illustrated by the case example (3) questions raised for additional research or theory.

• What is a Literature Review?

A literature review is a body of text that aims to review the critical points of current knowledge including substantive findings as well as theoretical and methodological contributions to a particular topic. Literature reviews are secondary sources, and as such, do not report any new or original experimental work.Most often associated with academic-oriented literature, such as a thesis, a literature review usually precedes a research proposal and results section. Its ultimate goal is to bring the reader up to date with current literature on a topic and forms the basis for another goal, such as future research that may be needed in the area.A well-structured literature review is characterized by a logical flow of ideas; current and relevant references with consistent, appropriate referencing style; proper use of terminology; and an unbiased and comprehensive view of the previous research on the topic. (Wikipedia)

Literature Review: An extensive search of the information available on a topic which results in a list of references to books, periodicals, and other materials on the topic. ( Online Library Learning Center Glossary )

"... a literature review uses as its database reports of primary or original scholarship, and does not report new primary scholarship itself. The primary reports used in the literature may be verbal, but in the vast majority of cases reports are written documents. The types of scholarship may be empirical, theoretical, critical/analytic, or methodological in nature. Second a literature review seeks to describe, summarize, evaluate, clarify and/or integrate the content of primary reports."

Cooper, H. M. (1988), "The structure of knowledge synthesis", Knowledge in Society , Vol. 1, pp. 104-126

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How to Write an Abstract for Literature Review?

• How to Write an Abstract…

Table of Contents

Writing an Abstract for Literature Review

Before a researcher or an academic writer starts to become familiar with how to write an abstract for literature review , one should first be familiar with what exactly qualifies as a Literature Review .

While writing a research paper or dissertation , the literature review is the portion where you brief the guidance counselor – also referred to as a Project Coordinator – about the precise problem you are looking to study and explain in the research paper.

Not only does this enable the guidance counselor to determine that the pupil is on the right track, but also helps the writer lay down a robust foundation to support his or her claim with the help of cited references .

Learn how to write an abstract?

Basic Tips and Guidelines

It would be more helpful to explain this with a real example. A student is looking to study the notion that “Small & Medium Enterprises can benefit by switching over to Cloud Computing”. This is the claim and the study path to be explored. In the Literature Review, the writer can build his case by, first, writing on the history of Cloud Computing; how it started, where it comes from, pioneers, how it evolved etc.

Consequently, the writer will also define & explain Cloud Computing; its various service models, deployment models, components, real life applications of Cloud Computing, the advantages & disadvantages etc.

Now that you know what the Literature Review comprises, let’s come back to how to write an abstract for literature review . The flow is the same as your research paper; initiate with the introduction and talk about the problem or situation being studied, follow it with a description of the research methods brought in to implementation during the data collection & analysis phases , the results derived from the data analysis and, finally, the conclusion reached at the end.

Sample of an Abstract for a Literature Review

Here is a sample of how to write an abstract for literature review in light of the previously mentioned scenario:

Cloud Computing is a technology that brings many advantages with it for businesses that adopt it. In times of this recession when companies are resorting to either shutting down or come up with ways to reduce their operating expenditures, Cloud Computing offers Small & Medium Enterprises numerous benefits and a lifeline to stay in business. To validate this proposition, 10 SMEs that switched over to a Cloud Computing IT infrastructure in the last 12 months or less were chosen from various industries. The firms’ executives and decision makers were interviewed in detail about their IT operations before and after the implementation of Cloud Computing. The findings attained from the respondents clearly indicated a sharp reduction in both operating & capital expenses. This was evident by the lessening in the physical space required for the hardware, diminution of the IT staff headcount to monitor the systems, annulment of expenses incurred on software licensing and also for data recovery & systems security. The study clearly indicates that Cloud Computing is of immense importance to SMEs that wish to reduce their running costs yet continue expanding their operations.

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11.8  Writing an abstract

All full reviews must include an abstract of not more than 400 words. The abstract should be kept as brief as possible without sacrificing important content. Abstracts to Cochrane reviews are published in MEDLINE and the Science Citation Index, and are made freely available on the internet. It is therefore important that they can be read as stand-alone documents.

The abstract should summarize the key methods, results and conclusions of the review and should not contain any information that is not in the review. Links to other parts of the review (such as references, studies, tables and figures) may not be included in the abstract. A hypothetical example of an abstract is included in Box 11.8.a .

Abstracts should be targeted primarily at healthcare decision makers (clinicians, informed consumers and policy makers) rather than just to researchers. Terminology should be reasonably comprehensible to a general rather than a specialist healthcare audience. Abbreviations should be avoided, except where they are widely understood (for example, HIV). Where essential, other abbreviations should be spelt out (with the abbreviations in brackets) on first use. Names of drugs and interventions that can be understood internationally should be used wherever possible. Trade names should not be used.

The content under each heading in the abstract should be as follows:

Background: This should be one or two sentences to explain the context or elaborate on the purpose and rationale of the review. If this version of the review is an update of an earlier one, it is helpful to include a sentence such as “This is an update of a Cochrane review first published in YEAR, and previously updated in YEAR”.

Objectives:  This should be a precise statement of the primary objective of the review, ideally in a single sentence, matching the Objectives in the main text of the review. Where possible the style should be of the form “To assess the effects of   [intervention or comparison] for [health problem] for/in [types of people, disease or problem and setting if specified]”.

Search methods: This should list the sources and the dates of the last search, for each source, using the active form ‘We searched….’ or, if there is only one author, the passive form can be used, for example, ‘Database X, Y, Z were searched’. Search terms should not be listed here. If the CRG’s Specialized Register was used, this should be listed first in the form ‘Cochrane X Group Specialized Register’. The order for listing other databases should be the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, other databases. The date range of the search for each database should be given. For the Cochrane Central Register of Controlled Trials this should be in the form ‘Cochrane Central Register of Controlled Trials ( The Cochrane Library 2007, Issue 1)’. For most other databases, such as MEDLINE, it should be in the form ‘MEDLINE (January 1966 to December 2006)’. Searching of bibliographies for relevant citations can be covered in a generic phrase ‘reference lists of articles’. If there were any constraints based on language or publication status, these should be listed. If individuals or organizations were contacted to locate studies this should be noted and it is preferable to use ‘We contacted pharmaceutical companies’ rather than a listing of all the pharmaceutical companies contacted. If journals were specifically handsearched for the review, this should be noted but handsearching to help build the Specialized Register of the CRG should not be listed.

Selection criteria: These should be given as ‘ [type of study] of [type of intervention or comparison] in [disease, problem or type of people]‘ . Outcomes should only be listed here if the review was restricted to specific outcomes.

Data collection and analysis: This should be restricted to how data were extracted and assessed, and not include details of what data were extracted. This section should cover whether data extraction and assessments of risk of bias were done by more than one person. If the authors contacted investigators to obtain missing information, this should be noted here. What steps, if any, were taken to identify adverse effects should be noted.

Main results: This section should begin with the total number of studies and participants included in the review, and brief details pertinent to the interpretation of the results (for example, the risk of bias in the studies overall or a comment on the comparability of the studies, if appropriate). It should address the primary objective and be restricted to the main qualitative and quantitative results (generally including not more than six key results). The outcomes included should be selected on the basis of which are most likely to help someone making a decision about whether or not to use a particular intervention. Adverse effects should be included if these are covered in the review. If necessary, the number of studies and participants contributing to the separate outcomes should be noted, along with concerns over quality of evidence specific to these outcomes. The results should be expressed narratively as well as quantitatively if the numerical results are not clear or intuitive (such as those from a standardized mean differences analysis). The summary statistics in the abstract should be the same as those selected as the defaults for the review, and should be presented in a standard way, such as ‘odds ratio 2.31 (95% confidence interval 1.13 to 3.45)’. Ideally, risks of events (percentage) or averages (for continuous data) should be reported for both comparison groups. If overall results are not calculated in the review, a qualitative assessment or a description of the range and pattern of the results can be given. However, ‘vote counts’ in which the numbers of ‘positive’ and ‘negative’ studies are reported should be avoided.

Authors’ conclusions: The primary purpose of the review should be to present information, rather than to offer advice or recommendations. The Authors’ conclusions should be succinct and drawn directly from the findings of the review so that they directly and obviously reflect the main results. Assumptions should generally not be made about practice circumstances, values, preferences, tradeoffs; and the giving of advice or recommendations should generally be avoided. Any important limitations of data and analyses should be noted. Important conclusions about the implications for research should be included if these are not obvious.

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Clarifying the abstracts of systematic literature reviews *

James hartley.

1 Department of Psychology Keele University Staffordshire United Kingdom

2 † Author's address for correspondence: James Hartley, B.A., Ph.D., Department of Psychology, Keele University, Staffordshire, ST5 5BG, United Kingdom; email, [email protected]

Background: There is a small body of research on improving the clarity of abstracts in general that is relevant to improving the clarity of abstracts of systematic reviews.

Objectives: To summarize this earlier research and indicate its implications for writing the abstracts of systematic reviews.

Method: Literature review with commentary on three main features affecting the clarity of abstracts: their language, structure, and typographical presentation.

Conclusions: The abstracts of systematic reviews should be easier to read than the abstracts of medical research articles, as they are targeted at a wider audience. The aims, methods, results, and conclusions of systematic reviews need to be presented in a consistent way to help search and retrieval. The typographic detailing of the abstracts (type-sizes, spacing, and weights) should be planned to help, rather than confuse, the reader.

Several books and review papers have been published over the last twenty-five years about improving the clarity of the abstracts of articles in scientific journals, including several recent studies [ 1–5 ]. Three main areas of importance have been discussed:

• the language, or the readability, of an abstract;
• the sequence of information, or the structure, of an abstract; and
• the typography, or the presentation, of an abstract.

This paper considers the implications of the findings from research in each of these overlapping areas to the more specific area of writing abstracts for what are called “systematic reviews.” Such reviews in medical journals typically use standard procedures for assessing the evidence obtained from separate studies for and against the effectiveness of a particular treatment. The term “systematic” implies that the authors have used a standard approach to minimizing biases and random errors and that the methods chosen for the approach will be documented in the materials and methods sections of the review. Examples of such reviews may be found in Chalmers's and Altman's text [ 6 ] and in papers published in medical journals, particularly Evidence-Based Medicine. Figure 1 provides a fictitious example of an abstract for such a paper.

“Before” and “after” examples designed to show how differences in typography and wording can enhance the clarity of an abstract. Abstract courtesy of Philippa Middleton.

THE LANGUAGE OF THE TEXT

Research on the readability of conventional journal abstracts suggests that they are not easy to read. Studies in this area typically use the Flesch Reading Ease (R.E.) scores as their measure of text difficulty [ 7 ]. This measure, developed in the 1940s, is based upon the somewhat over simple idea that the difficulty of text is a function of the length of the sentences in the text and the length of the words within these sentences. The original Flesch formula is that R.E. = 206.835 − 0.846w − 1.015s (where w = the average number of syllables in 100 words and s = the average number of words per sentence). The scores normally range from 0 to 100, and the lower the score the more difficult the text is to read; Table 1 gives typical examples. Today, Flesch R.E. scores accompany most computerized spell checkers, and this removes the difficulties of hand calculation; although different programs give slightly different results [ 8, 9 ].

Table 1 The interpretation of Flesch scores

Table 2 summarizes the Flesch scores obtained for numerous journal abstracts in seven studies. The low scores shown here support the notion that journal abstracts are difficult to read. With medical journals, in particular, this difficulty may stem partly from complex medical terminology. Readability scores such as these are widely quoted, even though there is considerable debate about their validity, largely because they ignore the readers' prior knowledge and motivation [ 10, 11 ].

Table 2 Flesch Reading Ease scores reported in previous research on abstracts in journal articles

A second cause of difficulty in understanding text is that, although the wording may be simple and the sentences short, the concepts being described may not be understood by the reader. Thus, for example, although the sentence “God is grace” is extremely readable (in terms of the Flesch), it is not easy to explain what it actually means! In systematic reviews, to be more specific, the statistical concepts of the confidence interval and the adjusted odds ratio ( Figure 1 ) may be well understood by medical researchers, but they will not be understood by all readers.

A third cause of difficulty in prose lies in the scientific nature of the text that emphasizes the use of the third person, together with the passive rather than the active tense. Graetz writes of journal abstracts:

The abstract is characterized by the use of the past tense, the third person, passive, and the non-use of negatives…. It is written in tightly worded sentences, which avoid repetition, meaningless expressions, superlatives, adjectives, illustrations, preliminaries, descriptive details, examples, footnotes. In short it eliminates the redundancy which the skilled reader counts on finding in written language and which usually facilitates comprehension. [ 12 ]

In systematic reviews, it is easy to find sentences like “Trial eligibility and quality were assessed” that would be more readable if they were written as “We assessed the eligibility and the quality of the trials.” Furthermore, there are often short telegrammatic communications, some of which contain no verbs. Figure 1 provides an example (under the subheading “Selection criteria”).

There are, of course, numerous guidelines on how to write clear abstracts and more readable medical text [ 13–16 ] but, at present, there are few such guidelines for writing the abstracts of systematic reviews. Mulrow, Thacker, and Pugh [ 17 ] provide an excellent early example, and there are now regularly updated guidelines in the Cochrane Handbook [ 18 ].

Nonetheless, even when such guidelines are followed, evaluating the clarity of medical text is not easy. But some methods of doing so may be adapted from the more traditional literature on text evaluation. Schriver, for example, describes three different methods of text evaluation—text-based, expert-based, and reader-based methods [ 19 ]:

• Text-based methods are ones that can be used without recourse to experts or to readers. Such methods include computer-based readability formulae (such as the Flesch measure described above) and computer-based measures of style and grammar.
• Expert-based methods are ones that use experts to make assessments of the effectiveness of a piece of text. Medical experts may be asked, for example, to judge the suitability of the information contained in a patient information leaflet.
• Reader-based methods are ones that involve actual readers in making assessments of the suitability of the text, for themselves and for others. Patients, for example, may be asked to comment on medical leaflets or be tested on how much they can recall from them.

Although all three methods of evaluation are useful, especially in combination, this writer particularly recommends reader-based methods for evaluating the readability of abstracts in systematic reviews. This recommendation is because the readers of such systematic reviews are likely to be quite disparate in their aims, needs, and even in the languages that they speak. As the 1999 Cochrane Handbook put it:

Abstracts should be made as readable as possible without compromising scientific integrity. They should primarily be targeted to health care decision makers (clinicians, consumers, and policy makers) rather than just researchers. Terminology should be reasonably comprehensible to a general rather than a specialist medical audience [emphasis added]. [ 20 ]

Expert-based measures on their own may be misleading. For instance, there is evidence to suggest that the concerns of professionals are different from those of other personnel [ 21 ]. Wilson et al. [ 22 ], for instance, report wide differences between the responses of general practitioners (GPs) and patients in the United Kingdom in responses to questions concerning the content and usefulness of several patient information leaflets. Table 3 shows some of their replies.

Table 3 Differences between general practitioners (GPs) and patients in their views about particular patient information leaflets

THE STRUCTURE OF THE TEXT

In recent times, particularly in the medical field, there has been great interest in the use of so-called “structured abstracts”—abstracts that typically contain subheadings, such as “background,” “aims,” “methods,” “results,” and “conclusions.” Indeed, the early rise in the use of such abstracts was phenomenal [ 23 ], and it has no doubt continued to be so up to the present day. Evaluation studies have shown that structured abstracts are more effective than traditional ones, particularly in the sense that they contain more information [ 24–31 ]. However, a caveat here is that some authors still omit important information, and some still include information in the abstract that does not match exactly what is said in the article [ 32–35 ].

Additional research has shown that structured abstracts are sometimes easier to read and to search than are traditional ones [ 36, 37 ], but others have questioned this conclusion [ 38, 39 ]. Nonetheless, in general, both authors and readers apparently prefer structured to traditional abstracts [ 40–42 ]. The main features of structured abstracts that lead to these findings are that:

• the texts are opened-up and clearly subdivided into their component parts, which helps the reader perceive their structure;
• the abstracts sequence their information in a consistent order under consistent subheadings, which facilitates search and retrieval; and
• the writing under these subheadings ensures that authors do not miss out anything important.

Nonetheless, there are some difficulties—and these difficulties become more apparent after considering the structured abstracts of systematic reviews. First of all, the typographic practice of denoting the subheadings varies from journal to journal [ 43, 44 ]. Second, and of more relevance here, there is a range of subheadings used both within and among journals [ 45, 46 ], which militates against rapid retrieval. Table 4 shows an example of these variations by listing the subheadings used in the abstracts in just one volume of the Journal of the American Medical Association. Finally, it appears that some authors omit important subheadings or present them in a different order (e.g., reporting the conclusions before the results) [ 47 ].

Table 4 Different numbers of subheadings used in abstracts in the same volume of the Journal of the American Medical Association

The implications of these difficulties are that a decision needs to be made, based upon appropriate evaluation studies, about what are the key subheadings that can be used consistently in systematic reviews. The journal Evidence-Based Medicine, for example, uses the following six subheadings: “Question(s),” “Data sources,” “Study selection,” “Data extraction,” “Main results,” and “Conclusions,” but the Cochrane Handbook [ 48 ] recommends another seven: “Background,” “Objectives,” “Search strategy,” “Selection criteria,” “Data collection and analysis,” “Main results,” and “Reviewers' conclusions.” Presumably, these different sets of subheadings have developed over time with experience. For example, “Objective(s)” initially preceded “Question(s)” in Evidence-Based Medicine. In the future, refining these subheadings further may be possible by using appropriate typographic cueing, to separate important from minor subheadings, such as those headings used in the Journal of the American Medical Association. It will be essential, however, to use consistent terminology throughout the literature to aid both the creation of and retrieval from the abstracts of systematic reviews. Editors may consult their readers and their authors for possible solutions to this problem.

THE TYPOGRAPHIC SETTING FOR ABSTRACTS OF SYSTEMATIC REVIEWS

Early research on the typographic setting of structured abstracts in scientific articles suggests that the subheadings should be printed in bold capital letters with a line space above each subheading [ 49 ]. But this research has been done with structured abstracts that only have four subheadings. However, the abstracts of systematic reviews are likely to have more than four-subheadings—indeed, as noted above, six or seven seem typical. Also, some of these subheadings may be more important than others.

Generally speaking, there are two ways of clarifying the structure in typography. One is to vary the typography, the other to vary the spacing [ 50, 51 ]. In terms of typography, not overdoing is best; there is no need to use two cues when one will do. Thus, it may be appropriate to use bold lettering for the main subheadings and italic lettering for the less important ones, without adding the additional cues of capital letters or underlining. Also, as the subheadings appear as the first word on a line, placing a line space above them enhances their effectiveness, so there is no need to indent the subheadings as well. The abstracts published in the Cochrane Library follow this procedure.

Finally in this section, it should be noted that it is easier to read an abstract:

• that is set in the same type-size (or larger) than the body of the text of the review, unlike many journal abstracts, [ 52 ];
• that does not use “fancy'” typography or indeed bold or italic for its substantive text [ 53 ]; and
• that is set in “unjustified text,” with equal word spacing and a ragged right-hand margin, rather than in “justified text,” with unequal word spacing and straight left- and right-hand margins. This is particularly the case if the abstract is being read on screen [ 54 ].

CONCLUSIONS

The research reviewed above suggests that, in presenting the abstracts to systematic reviews, attention needs to be paid to their language, their structure, and their typographic design. Figure 1 shows a “before and after” example for a fictitious abstract for a systematic review. The purpose of this example is to encapsulate the argument of this paper and to show how changes in wording and typography can enhance the clarity of an abstract for a systematic review.

Acknowledgments

The author is indebted to Iain Chalmers, Philippa Middleton, Mark Starr, and anonymous referees for assistance in the preparation of this paper.

* Based on invited presentation at the VIIth Cochrane Colloquium, Rome, Italy, October 1999.

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Models and frameworks for assessing the implementation of clinical practice guidelines: a systematic review

• Nicole Freitas de Mello   ORCID: orcid.org/0000-0002-5228-6691 1 , 2 ,
• Sarah Nascimento Silva   ORCID: orcid.org/0000-0002-1087-9819 3 ,
• Dalila Fernandes Gomes   ORCID: orcid.org/0000-0002-2864-0806 1 , 2 ,
• Juliana da Motta Girardi   ORCID: orcid.org/0000-0002-7547-7722 4 &
• Jorge Otávio Maia Barreto   ORCID: orcid.org/0000-0002-7648-0472 2 , 4  

Implementation Science volume  19 , Article number:  59 ( 2024 ) Cite this article

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The implementation of clinical practice guidelines (CPGs) is a cyclical process in which the evaluation stage can facilitate continuous improvement. Implementation science has utilized theoretical approaches, such as models and frameworks, to understand and address this process. This article aims to provide a comprehensive overview of the models and frameworks used to assess the implementation of CPGs.

A systematic review was conducted following the Cochrane methodology, with adaptations to the "selection process" due to the unique nature of this review. The findings were reported following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines. Electronic databases were searched from their inception until May 15, 2023. A predetermined strategy and manual searches were conducted to identify relevant documents from health institutions worldwide. Eligible studies presented models and frameworks for assessing the implementation of CPGs. Information on the characteristics of the documents, the context in which the models were used (specific objectives, level of use, type of health service, target group), and the characteristics of each model or framework (name, domain evaluated, and model limitations) were extracted. The domains of the models were analyzed according to the key constructs: strategies, context, outcomes, fidelity, adaptation, sustainability, process, and intervention. A subgroup analysis was performed grouping models and frameworks according to their levels of use (clinical, organizational, and policy) and type of health service (community, ambulatorial, hospital, institutional). The JBI’s critical appraisal tools were utilized by two independent researchers to assess the trustworthiness, relevance, and results of the included studies.

Database searches yielded 14,395 studies, of which 80 full texts were reviewed. Eight studies were included in the data analysis and four methodological guidelines were additionally included from the manual search. The risk of bias in the studies was considered non-critical for the results of this systematic review. A total of ten models/frameworks for assessing the implementation of CPGs were found. The level of use was mainly policy, the most common type of health service was institutional, and the major target group was professionals directly involved in clinical practice. The evaluated domains differed between the models and there were also differences in their conceptualization. All the models addressed the domain "Context", especially at the micro level (8/12), followed by the multilevel (7/12). The domains "Outcome" (9/12), "Intervention" (8/12), "Strategies" (7/12), and "Process" (5/12) were frequently addressed, while "Sustainability" was found only in one study, and "Fidelity/Adaptation" was not observed.

Conclusions

The use of models and frameworks for assessing the implementation of CPGs is still incipient. This systematic review may help stakeholders choose or adapt the most appropriate model or framework to assess CPGs implementation based on their specific health context.

Trial registration

PROSPERO (International Prospective Register of Systematic Reviews) registration number: CRD42022335884. Registered on June 7, 2022.

Peer Review reports

Contributions to the literature

Although the number of theoretical approaches has grown in recent years, there are still important gaps to be explored in the use of models and frameworks to assess the implementation of clinical practice guidelines (CPGs). This systematic review aims to contribute knowledge to overcome these gaps.

Despite the great advances in implementation science, evaluating the implementation of CPGs remains a challenge, and models and frameworks could support improvements in this field.

This study demonstrates that the available models and frameworks do not cover all characteristics and domains necessary for a complete evaluation of CPGs implementation.

The presented findings contribute to the field of implementation science, encouraging debate on choices and adaptations of models and frameworks for implementation research and evaluation.

Substantial investments have been made in clinical research and development in recent decades, increasing the medical knowledge base and the availability of health technologies [ 1 ]. The use of clinical practice guidelines (CPGs) has increased worldwide to guide best health practices and to maximize healthcare investments. A CPG can be defined as "any formal statements systematically developed to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances" [ 2 ] and has the potential to improve patient care by promoting interventions of proven benefit and discouraging ineffective interventions. Furthermore, they can promote efficiency in resource allocation and provide support for managers and health professionals in decision-making [ 3 , 4 ].

However, having a quality CPG does not guarantee that the expected health benefits will be obtained. In fact, putting these devices to use still presents a challenge for most health services across distinct levels of government. In addition to the development of guidelines with high methodological rigor, those recommendations need to be available to their users; these recommendations involve the diffusion and dissemination stages, and they need to be used in clinical practice (implemented), which usually requires behavioral changes and appropriate resources and infrastructure. All these stages involve an iterative and complex process called implementation, which is defined as the process of putting new practices within a setting into use [ 5 , 6 ].

Implementation is a cyclical process, and the evaluation is one of its key stages, which allows continuous improvement of CPGs development and implementation strategies. It consists of verifying whether clinical practice is being performed as recommended (process evaluation or formative evaluation) and whether the expected results and impact are being reached (summative evaluation) [ 7 , 8 , 9 ]. Although the importance of the implementation evaluation stage has been recognized, research on how these guidelines are implemented is scarce [ 10 ]. This paper focused on the process of assessing CPGs implementation.

To understand and improve this complex process, implementation science provides a systematic set of principles and methods to integrate research findings and other evidence-based practices into routine practice and improve the quality and effectiveness of health services and care [ 11 ]. The field of implementation science uses theoretical approaches that have varying degrees of specificity based on the current state of knowledge and are structured based on theories, models, and frameworks [ 5 , 12 , 13 ]. A "Model" is defined as "a simplified depiction of a more complex world with relatively precise assumptions about cause and effect", and a "framework" is defined as "a broad set of constructs that organize concepts and data descriptively without specifying causal relationships" [ 9 ]. Although these concepts are distinct, in this paper, their use will be interchangeable, as they are typically like checklists of factors relevant to various aspects of implementation.

There are a variety of theoretical approaches available in implementation science [ 5 , 14 ], which can make choosing the most appropriate challenging [ 5 ]. Some models and frameworks have been categorized as "evaluation models" by providing a structure for evaluating implementation endeavors [ 15 ], even though theoretical approaches from other categories can also be applied for evaluation purposes because they specify concepts and constructs that may be operationalized and measured [ 13 ]. Two frameworks that can specify implementation aspects that should be evaluated as part of intervention studies are RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) [ 16 ] and PRECEDE-PROCEED (Predisposing, Reinforcing and Enabling Constructs in Educational Diagnosis and Evaluation-Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development) [ 17 ]. Although the number of theoretical approaches has grown in recent years, the use of models and frameworks to evaluate the implementation of guidelines still seems to be a challenge.

This article aims to provide a complete map of the models and frameworks applied to assess the implementation of CPGs. The aim is also to subside debate and choices on models and frameworks for the research and evaluation of the implementation processes of CPGs and thus to facilitate the continued development of the field of implementation as well as to contribute to healthcare policy and practice.

A systematic review was conducted following the Cochrane methodology [ 18 ], with adaptations to the "selection process" due to the unique nature of this review (details can be found in the respective section). The review protocol was registered in PROSPERO (registration number: CRD42022335884) on June 7, 2022. This report adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [ 19 ] and a completed checklist is provided in Additional File 1.

Eligibility criteria

The SDMO approach (Types of Studies, Types of Data, Types of Methods, Outcomes) [ 20 ] was utilized in this systematic review, outlined as follows:

Types of studies

All types of studies were considered for inclusion, as the assessment of CPG implementation can benefit from a diverse range of study designs, including randomized clinical trials/experimental studies, scale/tool development, systematic reviews, opinion pieces, qualitative studies, peer-reviewed articles, books, reports, and unpublished theses.

Studies were categorized based on their methodological designs, which guided the synthesis, risk of bias assessment, and presentation of results.

Study protocols and conference abstracts were excluded due to insufficient information for this review.

Types of data

Studies that evaluated the implementation of CPGs either independently or as part of a multifaceted intervention.

Guidelines for evaluating CPG implementation.

Inclusion of CPGs related to any context, clinical area, intervention, and patient characteristics.

No restrictions were placed on publication date or language.

Exclusion criteria

General guidelines were excluded, as this review focused on 'models for evaluating clinical practice guidelines implementation' rather than the guidelines themselves.

Studies that focused solely on implementation determinants as barriers and enablers were excluded, as this review aimed to explore comprehensive models/frameworks.

Studies evaluating programs and policies were excluded.

Studies that only assessed implementation strategies (isolated actions) rather than the implementation process itself were excluded.

Studies that focused solely on the impact or results of implementation (summative evaluation) were excluded.

Types of methods

Not applicable.

All potential models or frameworks for assessing the implementation of CPG (evaluation models/frameworks), as well as their characteristics: name; specific objectives; levels of use (clinical, organizational, and policy); health system (public, private, or both); type of health service (community, ambulatorial, hospital, institutional, homecare); domains or outcomes evaluated; type of recommendation evaluated; context; limitations of the model.

Model was defined as "a deliberated simplification of a phenomenon on a specific aspect" [ 21 ].

Framework was defined as "structure, overview outline, system, or plan consisting of various descriptive categories" [ 21 ].

Models or frameworks used solely for the CPG development, dissemination, or implementation phase.

Models/frameworks used solely for assessment processes other than implementation, such as for the development or dissemination phase.

Data sources and literature search

The systematic search was conducted on July 31, 2022 (and updated on May 15, 2023) in the following electronic databases: MEDLINE/PubMed, Centre for Reviews and Dissemination (CRD), the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Epistemonikos, Global Health, Health Systems Evidence, PDQ-Evidence, PsycINFO, Rx for Change (Canadian Agency for Drugs and Technologies in Health, CADTH), Scopus, Web of Science and Virtual Health Library (VHL). The Google Scholar database was used for the manual selection of studies (first 10 pages).

Additionally, hand searches were performed on the lists of references included in the systematic reviews and citations of the included studies, as well as on the websites of institutions working on CPGs development and implementation: Guidelines International Networks (GIN), National Institute for Health and Care Excellence (NICE; United Kingdom), World Health Organization (WHO), Centers for Disease Control and Prevention (CDC; USA), Institute of Medicine (IOM; USA), Australian Department of Health and Aged Care (ADH), Healthcare Improvement Scotland (SIGN), National Health and Medical Research Council (NHMRC; Australia), Queensland Health, The Joanna Briggs Institute (JBI), Ministry of Health and Social Policy of Spain, Ministry of Health of Brazil and Capes Theses and Dissertations Catalog.

The search strategy combined terms related to "clinical practice guidelines" (practice guidelines, practice guidelines as topic, clinical protocols), "implementation", "assessment" (assessment, evaluation), and "models, framework". The free term "monitoring" was not used because it was regularly related to clinical monitoring and not to implementation monitoring. The search strategies adapted for the electronic databases are presented in an additional file (see Additional file 2).

Study selection process

The results of the literature search from scientific databases, excluding the CRD database, were imported into Mendeley Reference Management software to remove duplicates. They were then transferred to the Rayyan platform ( https://rayyan.qcri.org ) [ 22 ] for the screening process. Initially, studies related to the "assessment of implementation of the CPG" were selected. The titles were first screened independently by two pairs of reviewers (first selection: four reviewers, NM, JB, SS, and JG; update: a pair of reviewers, NM and DG). The title screening was broad, including all potentially relevant studies on CPG and the implementation process. Following that, the abstracts were independently screened by the same group of reviewers. The abstract screening was more focused, specifically selecting studies that addressed CPG and the evaluation of the implementation process. In the next step, full-text articles were reviewed independently by a pair of reviewers (NM, DG) to identify those that explicitly presented "models" or "frameworks" for assessing the implementation of the CPG. Disagreements regarding the eligibility of studies were resolved through discussion and consensus, and by a third reviewer (JB) when necessary. One reviewer (NM) conducted manual searches, and the inclusion of documents was discussed with the other reviewers.

Risk of bias assessment of studies

The selected studies were independently classified and evaluated according to their methodological designs by two investigators (NM and JG). This review employed JBI’s critical appraisal tools to assess the trustworthiness, relevance and results of the included studies [ 23 ] and these tools are presented in additional files (see Additional file 3 and Additional file 4). Disagreements were resolved by consensus or consultation with the other reviewers. Methodological guidelines and noncomparative and before–after studies were not evaluated because JBI does not have specific tools for assessing these types of documents. Although the studies were assessed for quality, they were not excluded on this basis.

Data extraction

The data was independently extracted by two reviewers (NM, DG) using a Microsoft Excel spreadsheet. Discrepancies were discussed and resolved by consensus. The following information was extracted:

Document characteristics : author; year of publication; title; study design; instrument of evaluation; country; guideline context;

Usage context of the models : specific objectives; level of use (clinical, organizational, and policy); type of health service (community, ambulatorial, hospital, institutional); target group (guideline developers, clinicians; health professionals; health-policy decision-makers; health-care organizations; service managers);

Model and framework characteristics : name, domain evaluated, and model limitations.

The set of information to be extracted, shown in the systematic review protocol, was adjusted to improve the organization of the analysis.

The "level of use" refers to the scope of the model used. "Clinical" was considered when the evaluation focused on individual practices, "organizational" when practices were within a health service institution, and "policy" when the evaluation was more systemic and covered different health services or institutions.

The "type of health service" indicated the category of health service where the model/framework was used (or can be used) to assess the implementation of the CPG, related to the complexity of healthcare. "Community" is related to primary health care; "ambulatorial" is related to secondary health care; "hospital" is related to tertiary health care; and "institutional" represented models/frameworks not specific to a particular type of health service.

The "target group" included stakeholders related to the use of the model/framework for evaluating the implementation of the CPG, such as clinicians, health professionals, guideline developers, health policy-makers, health organizations, and service managers.

The category "health system" (public, private, or both) mentioned in the systematic review protocol was not found in the literature obtained and was removed as an extraction variable. Similarly, the variables "type of recommendation evaluated" and "context" were grouped because the same information was included in the "guideline context" section of the study.

Some selected documents presented models or frameworks recognized by the scientific field, including some that were validated. However, some studies adapted the model to this context. Therefore, the domain analysis covered all models or frameworks domains evaluated by (or suggested for evaluation by) the document analyzed.

Data analysis and synthesis

The results were tabulated using narrative synthesis with an aggregative approach, without meta-analysis, aiming to summarize the documents descriptively for the organization, description, interpretation and explanation of the study findings [ 24 , 25 ].

The model/framework domains evaluated in each document were studied according to Nilsen et al.’s constructs: "strategies", "context", "outcomes", "fidelity", "adaptation" and "sustainability". For this study, "strategies" were described as structured and planned initiatives used to enhance the implementation of clinical practice [ 26 ].

The definition of "context" varies in the literature. Despite that, this review considered it as the set of circumstances or factors surrounding a particular implementation effort, such as organizational support, financial resources, social relations and support, leadership, and organizational culture [ 26 , 27 ]. The domain "context" was subdivided according to the level of health care into "micro" (individual perspective), "meso" (organizational perspective), "macro" (systemic perspective), and "multiple" (when there is an issue involving more than one level of health care).

The "outcomes" domain was related to the results of the implementation process (unlike clinical outcomes) and was stratified according to the following constructs: acceptability, appropriateness, feasibility, adoption, cost, and penetration. All these concepts align with the definitions of Proctor et al. (2011), although we decided to separate "fidelity" and "sustainability" as independent domains similar to Nilsen [ 26 , 28 ].

"Fidelity" and "adaptation" were considered the same domain, as they are complementary pieces of the same issue. In this study, implementation fidelity refers to how closely guidelines are followed as intended by their developers or designers. On the other hand, adaptation involves making changes to the content or delivery of a guideline to better fit the needs of a specific context. The "sustainability" domain was defined as evaluations about the continuation or permanence over time of the CPG implementation.

Additionally, the domain "process" was utilized to address issues related to the implementation process itself, rather than focusing solely on the outcomes of the implementation process, as done by Wang et al. [ 14 ]. Furthermore, the "intervention" domain was introduced to distinguish aspects related to the CPG characteristics that can impact its implementation, such as the complexity of the recommendation.

A subgroup analysis was performed with models and frameworks categorized based on their levels of use (clinical, organizational, and policy) and the type of health service (community, ambulatorial, hospital, institutional) associated with the CPG. The goal is to assist stakeholders (politicians, clinicians, researchers, or others) in selecting the most suitable model for evaluating CPG implementation based on their specific health context.

Search results

Database searches yielded 26,011 studies, of which 107 full texts were reviewed. During the full-text review, 99 articles were excluded: 41 studies did not mention a model or framework for assessing the implementation of the CPG, 31 studies evaluated only implementation strategies (isolated actions) rather than the implementation process itself, and 27 articles were not related to the implementation assessment. Therefore, eight studies were included in the data analysis. The updated search did not reveal additional relevant studies. The main reason for study exclusion was that they did not use models or frameworks to assess CPG implementation. Additionally, four methodological guidelines were included from the manual search (Fig.  1 ).

PRISMA diagram. Acronyms: ADH—Australian Department of Health, CINAHL—Cumulative Index to Nursing and Allied Health Literature, CDC—Centers for Disease Control and Prevention, CRD—Centre for Reviews and Dissemination, GIN—Guidelines International Networks, HSE—Health Systems Evidence, IOM—Institute of Medicine, JBI—The Joanna Briggs Institute, MHB—Ministry of Health of Brazil, NICE—National Institute for Health and Care Excellence, NHMRC—National Health and Medical Research Council, MSPS – Ministerio de Sanidad Y Política Social (Spain), SIGN—Scottish Intercollegiate Guidelines Network, VHL – Virtual Health Library, WHO—World Health Organization. Legend: Reason A –The study evaluated only implementation strategies (isolated actions) rather than the implementation process itself. Reason B – The study did not mention a model or framework for assessing the implementation of the intervention. Reason C – The study was not related to the implementation assessment. Adapted from Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. https://doi.org/10.1136/bmj.n71 . For more information, visit:

According to the JBI’s critical appraisal tools, the overall assessment of the studies indicates their acceptance for the systematic review.

The cross-sectional studies lacked clear information regarding "confounding factors" or "strategies to address confounding factors". This was understandable given the nature of the study, where such details are not typically included. However, the reviewers did not find this lack of information to be critical, allowing the studies to be included in the review. The results of this methodological quality assessment can be found in an additional file (see Additional file 5).

In the qualitative studies, there was some ambiguity regarding the questions: "Is there a statement locating the researcher culturally or theoretically?" and "Is the influence of the researcher on the research, and vice versa, addressed?". However, the reviewers decided to include the studies and deemed the methodological quality sufficient for the analysis in this article, based on the other information analyzed. The results of this methodological quality assessment can be found in an additional file (see Additional file 6).

Documents characteristics (Table  1 )

The documents were directed to several continents: Australia/Oceania (4/12) [ 31 , 33 , 36 , 37 ], North America (4/12 [ 30 , 32 , 38 , 39 ], Europe (2/12 [ 29 , 35 ] and Asia (2/12) [ 34 , 40 ]. The types of documents were classified as cross-sectional studies (4/12) [ 29 , 32 , 34 , 38 ], methodological guidelines (4/12) [ 33 , 35 , 36 , 37 ], mixed methods studies (3/12) [ 30 , 31 , 39 ] or noncomparative studies (1/12) [ 40 ]. In terms of the instrument of evaluation, most of the documents used a survey/questionnaire (6/12) [ 29 , 30 , 31 , 32 , 34 , 38 ], while three (3/12) used qualitative instruments (interviews, group discussions) [ 30 , 31 , 39 ], one used a checklist [ 37 ], one used an audit [ 33 ] and three (3/12) did not define a specific instrument to measure [ 35 , 36 , 40 ].

Considering the clinical areas covered, most studies evaluated the implementation of nonspecific (general) clinical areas [ 29 , 33 , 35 , 36 , 37 , 40 ]. However, some studies focused on specific clinical contexts, such as mental health [ 32 , 38 ], oncology [ 39 ], fall prevention [ 31 ], spinal cord injury [ 30 ], and sexually transmitted infections [ 34 ].

Usage context of the models (Table  1 )

Specific objectives.

All the studies highlighted the purpose of guiding the process of evaluating the implementation of CPGs, even if they evaluated CPGs from generic or different clinical areas.

Levels of use

The most common level of use of the models/frameworks identified to assess the implementation of CPGs was policy (6/12) [ 33 , 35 , 36 , 37 , 39 , 40 ]. In this level, the model is used in a systematic way to evaluate all the processes involved in CPGs implementation and is primarily related to methodological guidelines. This was followed by the organizational level of use (5/12) [ 30 , 31 , 32 , 38 , 39 ], where the model is used to evaluate the implementation of CPGs in a specific institution, considering its specific environment. Finally, the clinical level of use (2/12) [ 29 , 34 ] focuses on individual practice and the factors that can influence the implementation of CPGs by professionals.

Type of health service

Institutional services were predominant (5/12) [ 33 , 35 , 36 , 37 , 40 ] and included methodological guidelines and a study of model development and validation. Hospitals were the second most common type of health service (4/12) [ 29 , 30 , 31 , 34 ], followed by ambulatorial (2/12) [ 32 , 34 ] and community health services (1/12) [ 32 ]. Two studies did not specify which type of health service the assessment addressed [ 38 , 39 ].

Target group

The focus of the target group was professionals directly involved in clinical practice (6/12) [ 29 , 31 , 32 , 34 , 38 , 40 ], namely, health professionals and clinicians. Other less related stakeholders included guideline developers (2/12) [ 39 , 40 ], health policy decision makers (1/12) [ 39 ], and healthcare organizations (1/12) [ 39 ]. The target group was not defined in the methodological guidelines, although all the mentioned stakeholders could be related to these documents.

Model and framework characteristics

Models and frameworks for assessing the implementation of cpgs.

The Consolidated Framework for Implementation Research (CFIR) [ 31 , 38 ] and the Promoting Action on Research Implementation in Health Systems (PARiHS) framework [ 29 , 30 ] were the most commonly employed frameworks within the selected documents. The other models mentioned were: Goal commitment and implementation of practice guidelines framework [ 32 ]; Guideline to identify key indicators [ 35 ]; Guideline implementation checklist [ 37 ]; Guideline implementation evaluation tool [ 40 ]; JBI Implementation Framework [ 33 ]; Reach, effectiveness, adoption, implementation and maintenance (RE-AIM) framework [ 34 ]; The Guideline Implementability Framework [ 39 ] and an unnamed model [ 36 ].

Domains evaluated

The number of domains evaluated (or suggested for evaluation) by the documents varied between three and five, with the majority focusing on three domains. All the models addressed the domain "context", with a particular emphasis on the micro level of the health care context (8/12) [ 29 , 31 , 34 , 35 , 36 , 37 , 38 , 39 ], followed by the multilevel (7/12) [ 29 , 31 , 32 , 33 , 38 , 39 , 40 ], meso level (4/12) [ 30 , 35 , 39 , 40 ] and macro level (2/12) [ 37 , 39 ]. The "Outcome" domain was evaluated in nine models. Within this domain, the most frequently evaluated subdomain was "adoption" (6/12) [ 29 , 32 , 34 , 35 , 36 , 37 ], followed by "acceptability" (4/12) [ 30 , 32 , 35 , 39 ], "appropriateness" (3/12) [ 32 , 34 , 36 ], "feasibility" (3/12) [ 29 , 32 , 36 ], "cost" (1/12) [ 35 ] and "penetration" (1/12) [ 34 ]. Regarding the other domains, "Intervention" (8/12) [ 29 , 31 , 34 , 35 , 36 , 38 , 39 , 40 ], "Strategies" (7/12) [ 29 , 30 , 33 , 35 , 36 , 37 , 40 ] and "Process" (5/12) [ 29 , 31 , 32 , 33 , 38 ] were frequently addressed in the models, while "Sustainability" (1/12) [ 34 ] was only found in one model, and "Fidelity/Adaptation" was not observed. The domains presented by the models and frameworks and evaluated in the documents are shown in Table  2 .

Limitations of the models

Only two documents mentioned limitations in the use of the model or frameworks. These two studies reported limitations in the use of CFIR: "is complex and cumbersome and requires tailoring of the key variables to the specific context", and "this framework should be supplemented with other important factors and local features to achieve a sound basis for the planning and realization of an ongoing project" [ 31 , 38 ]. Limitations in the use of other models or frameworks are not reported.

Subgroup analysis

Following the subgroup analysis (Table  3 ), five different models/frameworks were utilized at the policy level by institutional health services. These included the Guideline Implementation Evaluation Tool [ 40 ], the NHMRC tool (model name not defined) [ 36 ], the JBI Implementation Framework + GRiP [ 33 ], Guideline to identify key indicators [ 35 ], and the Guideline implementation checklist [ 37 ]. Additionally, the "Guideline Implementability Framework" [ 39 ] was implemented at the policy level without restrictions based on the type of health service. Regarding the organizational level, the models used varied depending on the type of service. The "Goal commitment and implementation of practice guidelines framework" [ 32 ] was applied in community and ambulatory health services, while "PARiHS" [ 29 , 30 ] and "CFIR" [ 31 , 38 ] were utilized in hospitals. In contexts where the type of health service was not defined, "CFIR" [ 31 , 38 ] and "The Guideline Implementability Framework" [ 39 ] were employed. Lastly, at the clinical level, "RE-AIM" [ 34 ] was utilized in ambulatory and hospital services, and PARiHS [ 29 , 30 ] was specifically used in hospital services.

Key findings

This systematic review identified 10 models/ frameworks used to assess the implementation of CPGs in various health system contexts. These documents shared similar objectives in utilizing models and frameworks for assessment. The primary level of use was policy, the most common type of health service was institutional, and the main target group of the documents was professionals directly involved in clinical practice. The models and frameworks presented varied analytical domains, with sometimes divergent concepts used in these domains. This study is innovative in its emphasis on the evaluation stage of CPG implementation and in summarizing aspects and domains aimed at the practical application of these models.

The small number of documents contrasts with studies that present an extensive range of models and frameworks available in implementation science. The findings suggest that the use of models and frameworks to evaluate the implementation of CPGs is still in its early stages. Among the selected documents, there was a predominance of cross-sectional studies and methodological guidelines, which strongly influenced how the implementation evaluation was conducted. This was primarily done through surveys/questionnaires, qualitative methods (interviews, group discussions), and non-specific measurement instruments. Regarding the subject areas evaluated, most studies focused on a general clinical area, while others explored different clinical areas. This suggests that the evaluation of CPG implementation has been carried out in various contexts.

The models were chosen independently of the categories proposed in the literature, with their usage categorized for purposes other than implementation evaluation, as is the case with CFIR and PARiHS. This practice was described by Nilsen et al. who suggested that models and frameworks from other categories can also be applied for evaluation purposes because they specify concepts and constructs that may be operationalized and measured [ 14 , 15 , 42 , 43 ].

The results highlight the increased use of models and frameworks in evaluation processes at the policy level and institutional environments, followed by the organizational level in hospital settings. This finding contradicts a review that reported the policy level as an area that was not as well studied [ 44 ]. The use of different models at the institutional level is also emphasized in the subgroup analysis. This may suggest that the greater the impact (social, financial/economic, and organizational) of implementing CPGs, the greater the interest and need to establish well-defined and robust processes. In this context, the evaluation stage stands out as crucial, and the investment of resources and efforts to structure this stage becomes even more advantageous [ 10 , 45 ]. Two studies (16,7%) evaluated the implementation of CPGs at the individual level (clinical level). These studies stand out for their potential to analyze variations in clinical practice in greater depth.

In contrast to the level of use and type of health service most strongly indicated in the documents, with systemic approaches, the target group most observed was professionals directly involved in clinical practice. This suggests an emphasis on evaluating individual behaviors. This same emphasis is observed in the analysis of the models, in which there is a predominance of evaluating the micro level of the health context and the "adoption" subdomain, in contrast with the sub-use of domains such as "cost" and "process". Cassetti et al. observed the same phenomenon in their review, in which studies evaluating the implementation of CPGs mainly adopted a behavioral change approach to tackle those issues, without considering the influence of wider social determinants of health [ 10 ]. However, the literature widely reiterates that multiple factors impact the implementation of CPGs, and different actions are required to make them effective [ 6 , 46 , 47 ]. As a result, there is enormous potential for the development and adaptation of models and frameworks aimed at more systemic evaluation processes that consider institutional and organizational aspects.

In analyzing the model domains, most models focused on evaluating only some aspects of implementation (three domains). All models evaluated the "context", highlighting its significant influence on implementation [ 9 , 26 ]. Context is an essential effect modifier for providing research evidence to guide decisions on implementation strategies [ 48 ]. Contextualizing a guideline involves integrating research or other evidence into a specific circumstance [ 49 ]. The analysis of this domain was adjusted to include all possible contextual aspects, even if they were initially allocated to other domains. Some contextual aspects presented by the models vary in comprehensiveness, such as the assessment of the "timing and nature of stakeholder engagement" [ 39 ], which includes individual engagement by healthcare professionals and organizational involvement in CPG implementation. While the importance of context is universally recognized, its conceptualization and interpretation differ across studies and models. This divergence is also evident in other domains, consistent with existing literature [ 14 ]. Efforts to address this conceptual divergence in implementation science are ongoing, but further research and development are needed in this field [ 26 ].

The main subdomain evaluated was "adoption" within the outcome domain. This may be attributed to the ease of accessing information on the adoption of the CPG, whether through computerized system records, patient records, or self-reports from healthcare professionals or patients themselves. The "acceptability" subdomain pertains to the perception among implementation stakeholders that a particular CPG is agreeable, palatable or satisfactory. On the other hand, "appropriateness" encompasses the perceived fit, relevance or compatibility of the CPG for a specific practice setting, provider, or consumer, or its perceived fit to address a particular issue or problem [ 26 ]. Both subdomains are subjective and rely on stakeholders' interpretations and perceptions of the issue being analyzed, making them susceptible to reporting biases. Moreover, obtaining this information requires direct consultation with stakeholders, which can be challenging for some evaluation processes, particularly in institutional contexts.

The evaluation of the subdomains "feasibility" (the extent to which a CPG can be successfully used or carried out within a given agency or setting), "cost" (the cost impact of an implementation effort), and "penetration" (the extent to which an intervention or treatment is integrated within a service setting and its subsystems) [ 26 ] was rarely observed in the documents. This may be related to the greater complexity of obtaining information on these aspects, as they involve cross-cutting and multifactorial issues. In other words, it would be difficult to gather this information during evaluations with health practitioners as the target group. This highlights the need for evaluation processes of CPGs implementation involving multiple stakeholders, even if the evaluation is adjusted for each of these groups.

Although the models do not establish the "intervention" domain, we thought it pertinent in this study to delimit the issues that are intrinsic to CPGs, such as methodological quality or clarity in establishing recommendations. These issues were quite common in the models evaluated but were considered in other domains (e.g., in "context"). Studies have reported the importance of evaluating these issues intrinsic to CPGs [ 47 , 50 ] and their influence on the implementation process [ 51 ].

The models explicitly present the "strategies" domain, and its evaluation was usually included in the assessments. This is likely due to the expansion of scientific and practical studies in implementation science that involve theoretical approaches to the development and application of interventions to improve the implementation of evidence-based practices. However, these interventions themselves are not guaranteed to be effective, as reported in a previous review that showed unclear results indicating that the strategies had affected successful implementation [ 52 ]. Furthermore, model domains end up not covering all the complexity surrounding the strategies and their development and implementation process. For example, the ‘Guideline implementation evaluation tool’ evaluates whether guideline developers have designed and provided auxiliary tools to promote the implementation of guidelines [ 40 ], but this does not mean that these tools would work as expected.

The "process" domain was identified in the CFIR [ 31 , 38 ], JBI/GRiP [ 33 ], and PARiHS [ 29 ] frameworks. While it may be included in other domains of analysis, its distinct separation is crucial for defining operational issues when assessing the implementation process, such as determining if and how the use of the mentioned CPG was evaluated [ 3 ]. Despite its presence in multiple models, there is still limited detail in the evaluation guidelines, which makes it difficult to operationalize the concept. Further research is needed to better define the "process" domain and its connections and boundaries with other domains.

The domain of "sustainability" was only observed in the RE-AIM framework, which is categorized as an evaluation framework [ 34 ]. In its acronym, the letter M stands for "maintenance" and corresponds to the assessment of whether the user maintains use, typically longer than 6 months. The presence of this domain highlights the need for continuous evaluation of CPGs implementation in the short, medium, and long term. Although the RE-AIM framework includes this domain, it was not used in the questionnaire developed in the study. One probable reason is that the evaluation of CPGs implementation is still conducted on a one-off basis and not as a continuous improvement process. Considering that changes in clinical practices are inherent over time, evaluating and monitoring changes throughout the duration of the CPG could be an important strategy for ensuring its implementation. This is an emerging field that requires additional investment and research.

The "Fidelity/Adaptation" domain was not observed in the models. These emerging concepts involve the extent to which a CPG is being conducted exactly as planned or whether it is undergoing adjustments and adaptations. Whether or not there is fidelity or adaptation in the implementation of CPGs does not presuppose greater or lesser effectiveness; after all, some adaptations may be necessary to implement general CPGs in specific contexts. The absence of this domain in all the models and frameworks may suggest that they are not relevant aspects for evaluating implementation or that there is a lack of knowledge of these complex concepts. This may suggest difficulty in expressing concepts in specific evaluative questions. However, further studies are warranted to determine the comprehensiveness of these concepts.

It is important to note the customization of the domains of analysis, with some domains presented in the models not being evaluated in the studies, while others were complementarily included. This can be seen in Jeong et al. [ 34 ], where the "intervention" domain in the evaluation with the RE-AIM framework reinforced the aim of theoretical approaches such as guiding the process and not determining norms. Despite this, few limitations were reported for the models, suggesting that the use of models in these studies reflects the application of these models to defined contexts without a deep critical analysis of their domains.

Limitations

This review has several limitations. First, only a few studies and methodological guidelines that explicitly present models and frameworks for assessing the implementation of CPGs have been found. This means that few alternative models could be analyzed and presented in this review. Second, this review adopted multiple analytical categories (e.g., level of use, health service, target group, and domains evaluated), whose terminology has varied enormously in the studies and documents selected, especially for the "domains evaluated" category. This difficulty in harmonizing the taxonomy used in the area has already been reported [ 26 ] and has significant potential to confuse. For this reason, studies and initiatives are needed to align understandings between concepts and, as far as possible, standardize them. Third, in some studies/documents, the information extracted was not clear about the analytical category. This required an in-depth interpretative process of the studies, which was conducted in pairs to avoid inappropriate interpretations.

Implications

This study contributes to the literature and clinical practice management by describing models and frameworks specifically used to assess the implementation of CPGs based on their level of use, type of health service, target group related to the CPG, and the evaluated domains. While there are existing reviews on the theories, frameworks, and models used in implementation science, this review addresses aspects not previously covered in the literature. This valuable information can assist stakeholders (such as politicians, clinicians, researchers, etc.) in selecting or adapting the most appropriate model to assess CPG implementation based on their health context. Furthermore, this study is expected to guide future research on developing or adapting models to assess the implementation of CPGs in various contexts.

The use of models and frameworks to evaluate the implementation remains a challenge. Studies should clearly state the level of model use, the type of health service evaluated, and the target group. The domains evaluated in these models may need adaptation to specific contexts. Nevertheless, utilizing models to assess CPGs implementation is crucial as they can guide a more thorough and systematic evaluation process, aiding in the continuous improvement of CPGs implementation. The findings of this systematic review offer valuable insights for stakeholders in selecting or adjusting models and frameworks for CPGs evaluation, supporting future theoretical advancements and research.

Availability of data and materials

Abbreviations.

Australian Department of Health and Aged Care

Canadian Agency for Drugs and Technologies in Health

Centers for Disease Control and

Consolidated Framework for Implementation Research

Cumulative Index to Nursing and Allied Health Literature

Clinical practice guideline

Centre for Reviews and Dissemination

Guidelines International Networks

Getting Research into Practice

Health Systems Evidence

Institute of Medicine

The Joanna Briggs Institute

Ministry of Health of Brazil

Ministerio de Sanidad y Política Social

National Health and Medical Research Council

National Institute for Health and Care Excellence

Promoting action on research implementation in health systems framework

Predisposing, Reinforcing and Enabling Constructs in Educational Diagnosis and Evaluation-Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

International Prospective Register of Systematic Reviews

Reach, effectiveness, adoption, implementation, and maintenance framework

Healthcare Improvement Scotland

United States of America

Virtual Health Library

World Health Organization

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This study is supported by the Fundação de Apoio à Pesquisa do Distrito Federal (FAPDF). FAPDF Award Term (TOA) nº 44/2024—FAPDF/SUCTI/COOBE (SEI/GDF – Process 00193–00000404/2024–22). The content in this article is solely the responsibility of the authors and does not necessarily represent the official views of the FAPDF.

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NFM and JOMB conceived the idea and the protocol for this study. NFM conducted the literature search. NFM, SNS, JMG and JOMB conducted the data collection with advice and consensus gathering from JOMB. The NFM and JMG assessed the quality of the studies. NFM and DFG conducted the data extraction. NFM performed the analysis and synthesis of the results with advice and consensus gathering from JOMB. NFM drafted the manuscript. JOMB critically revised the first version of the manuscript. All the authors revised and approved the submitted version.

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Additional file 1: PRISMA checklist. Description of data: Completed PRISMA checklist used for reporting the results of this systematic review.

Additional file 2: Literature search. Description of data: The search strategies adapted for the electronic databases.

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Additional file 3: JBI’s critical appraisal tools for cross-sectional studies. Description of data: JBI’s critical appraisal tools to assess the trustworthiness, relevance, and results of the included studies. This is specific for cross-sectional studies.

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Additional file 4: JBI’s critical appraisal tools for qualitative studies. Description of data: JBI’s critical appraisal tools to assess the trustworthiness, relevance, and results of the included studies. This is specific for qualitative studies.

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Additional file 5: Methodological quality assessment results for cross-sectional studies. Description of data: Methodological quality assessment results for cross-sectional studies using JBI’s critical appraisal tools.

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Additional file 6: Methodological quality assessment results for the qualitative studies. Description of data: Methodological quality assessment results for qualitative studies using JBI’s critical appraisal tools.

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Arginine vasopressin deficiency onset after COVID-19 vaccination with positive anti-rabphilin-3A antibodies: a case report and literature review

• Hiroki Takizawa 1 ,
• Hiromasa Goto 1 ,
• Toyoyoshi Uchida 1 ,
• Shuhei Aoyama 1 ,
• Haruki Fujisawa 2 ,
• Naoko Iwata 3 ,
• Atsushi Suzuki 2 ,
• Yoshihisa Sugimura 2 &
• Hirotaka Watada 1  

BMC Endocrine Disorders volume  24 , Article number:  143 ( 2024 ) Cite this article

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Arginine vasopressin deficiency (AVP-D) can occur due to various conditions, so clarifying its cause is important for deciding treatment strategy. Although several cases of AVP-D following coronavirus disease 2019(COVID-19) infection or COVID-19 vaccination have been reported, the diagnosis of the underlying disease has not been reported in most cases.

Case presentation

A 75-year-old woman who presented with polydipsia and polyuria 9 weeks after contracting COVID-19 and 5 weeks after receiving the SARS-CoV-2 vaccination, leading to the final diagnosis of AVP-D 8 months after the first appearance of symptoms. Interestingly, pituitary magnetic resonance imaging (MRI) still revealed stalk enlargement frequently observed in patients with SARS-CoV-2 vaccination-induced AVP-D. Although this finding could not rule out any malignancies, we additionally measured anti-rabphilin-3A antibodies, a known marker for lymphocytic infundibulo-neurohypophysitis (LINH), and found that the results were positive, strongly suggesting LINH as the cause of this disease. Thus, we avoided pituitary biopsy. At the follow-up MRI conducted 12 months after the initial consultation, enlargement of the pituitary stalk was still observed.

We experienced a case with LINH probably induced by SARS-CoV-2 vaccination. In SARS-CoV-2 vaccination-related LINH, unlike typical LINH, there is a possibility of persistent pituitary stalk enlargement on MRI images for an extended period, posing challenges in differential diagnosis from other conditions. Pituitary stalk enlargement and positive anti-rabphilin-3A antibodies may help in the diagnosis of AVP-D induced by SARS-CoV-2 vaccination.

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Arginine vasopressin deficiency (AVP-D), formerly known as central diabetes insipidus, is known to occur due to various causes such as malignant tumors, surgery, and inflammatory conditions. The correct diagnosis of the underlying disease in each case is important for deciding the treatment strategy [ 1 ]. Lymphocytic infundibulo-neurohypophysitis (LINH) is one of autoimmune disease and induces AVP-D. In recent years, anti-rabphilin-3A antibodies, which are autoantibodies targeting rabphilin-3A, a specific GTP-Rab3A binding protein present in the secretory granules of the posterior pituitary, have been identified as highly sensitive markers for LINH [ 2 ].

The onset of various endocrine disorders such as type 1 diabetes mellitus, subacute thyroiditis, Graves’ disease, and anterior pituitary inflammation that are considered to be related to autoimmunity have been reported following coronavirus disease 2019 (COVID-19) infection [ 3 ]. Additionally, the onset of such diseases has been documented following SARS-CoV-2 vaccination [ 4 ]. While some cases of developing pituitary inflammation and the consequent AVP-D following COVID-19 infection [ 5 , 6 , 7 , 8 , 9 , 10 , 11 ] or SARS-CoV-2 vaccination [ 12 , 13 , 14 , 15 , 16 , 17 , 18 ] were reported, the cases with proved detailed involvement of autoimmunity as the cause of these diseases were rare.

Here we report a case of a 75-year-old woman who developed AVP-D with positive anti-rabphilin-3A antibodies. The onset occurred 9 weeks after contracting COVID-19 infection and 5 weeks after receiving SARS-CoV-2 vaccination.

A 75-year-old woman with no apparent medical history or family history contracted COVID-19 infection on December 10, 2022, which resolved without the need for hospitalization, and initially, no sequelae were noted. Additionally, she had received four SARS-CoV-2 vaccinations: the first dose on July 10, 2021 (tozinameran; Pfizer-BioNTech, Lot No. FC9880), the second dose on July 31, 2021 (tozinameran; Pfizer-BioNTech, Lot No. EY0583), the third dose on March 10, 2022 (elasomeran; Takeda/Moderna, Lot No. 000048 A), and the fourth dose on August 17, 2022 (tozinameran; Pfizer-BioNTech, Lot No. FR1790). On January 5, 2023, she received her fifth dose of SARS-CoV-2 vaccination (tozinameran/famtozinameran; Pfizer-BioNTech, Lot No. GJ7139). Around February 10, she began experiencing polydipsia and polyuria. Although her primary care physician found no abnormalities on physical examination, she was referred to a post-COVID-19 sequelae outpatient clinic due to suspected psychogenic diseases, where she underwent further examination as an inpatient. During hospitalization, her water intake was approximately 3–4 L per day, and urine output was around 3 L per day, raising suspicion of AVP-D, which led to her admission to our hospital on October 2, 2023. Upon admission, she had a height of 146 cm and a weight of 56.3 kg, with no signs of dryness in the oral cavity. Her 24-hour urine output was 3900 mL/day, resulting in a urine volume per body weight of 69.2 mL/kg, indicating polyuria. Blood tests at admission revealed a serum sodium level of 146 mEq/L, an AVP concentration of 0.6 ng/mL indicating its decreased secretion, and a urine osmolarity of 224 mOsm/L (Table  1 ). Baseline hypothalamic-pituitary-adrenal axis values upon admission showed ACTH 15.7 pg/mL (reference range 7.2–63.3 pg/mL), cortisol 5.9 µg/dL (reference range 5.1–23.6 µg/dL). Both the three-part loading test (Table  2 ) and GH releasing peptide-2 (GHRP-2) loading test (Table  3 ) showed that the anterior pituitary hormone reserve was maintained.

In the hypertonic saline infusion test, the responsiveness of plasma AVP decreased compared to the increase in serum Na levels. Additionally, after 120 min of the hypertonic saline infusion test, 5 units of exogenous vasopressin were administered, resulting in an increase in urinary osmolarity (from 322 to 491 mOsm/kg) and a decrease in urine output (from 5.4 to 3.5 mL/kg/hr) compared to pre-administration levels (Table  4 ). Subsequent administration of desmopressin (DDAVP) resulted in an increase in urine osmolarity, leading to the diagnosis of AVP-D. Serum levels of human chorionic gonadotropin β-subunit (β-hCG), α-fetoprotein (AFP), angiotensin I-converting enzyme (ACE), and immunoglobulin G4 (IgG4) were within normal ranges, and proteinase-3-antineutrophil cytoplasmic antibody (PR3-ANCA) was negative (Table  1 ). MRI conducted for further investigation revealed loss of posterior lobe high signal intensity on T1-weighted images (Fig.  1 A, B). Contrast-enhanced MRI demonstrated a thickened pituitary stalk measuring 3.5 mm with strong enhancement (Fig.  1 C, D).

Pituitary magnetic resonance imaging (MRI) at first visit. ( A ) Sagittal view of plain MRI. ( B ) Coronal view of plain MRI. No high signal was observed in the posterior pituitary lobe. ( C ) Sagittal view of contrast-enhanced MRI. ( D ) Coronal view of contrast-enhanced MRI. Enlargement of the pituitary stalk (yellow arrowhead) and enhancement are evident. No pituitary tumor was observed

Based on these findings, lymphocytic infundibulo-neurohypophysitis (LINH) was initially suspected. However, since the thickening of the pituitary stalk persisted even 8 months after symptom onset and it was atypical, we considered to perform a pituitary biopsy for histological confirmation. However, due to the patient’s advanced age and her desire to minimize surgical invasiveness, we opted to measure anti-rabphilin-3A antibodies, which are considered specific to LINH and the presence of serum anti-rabphilin-3A antibody was detected by western blotting (Fig.  2 ). It supported the diagnosis of LINH.

Measurement of anti-rabphilin-3A antibodies by Western blotting. Detection of anti-rabphilin-3A antibodies by Western blotting. Recombinant full-length human rabphilin-3A expressed in HEK293FT cells (RPH3A) or negative control (-) were probed with serum from the present case (patient) or from a patient who was diagnosed with LINH by biopsy previously (positive control patient). Recombinant full-length human rabphilin-3A expressed in HEK293FT cells was also probed with an anti-V5 antibody as a positive control (Anti-V5 antibody) in the first lane from the left. Arrowheads indicate the presence of anti-rabphilin-3A antibodies. Dashed arrowheads indicate the absence of anti-rabphilin-3A antibodies. A protein band of 76 kDa that appeared in RPH3A but not in that of negative control was considered to be positive for anti-rabphilin-3A antibodies. RPH3A, rabphilin-3A, TFs, transfections of full-length human rabphilin-3A gene

For the treatment of AVP-D, oral DDAVP 60 µg/day was initiated, resulting in a decrease in urine output, and the patient continues to attend outpatient visits. We considered pharmacological doses of steroid treatment for hypophysitis, but we did not implement steroid therapy due to the absence of clinical symptoms such as headache or visual field disturbances, the limited expected efficacy in treating AVP-D, and concerns regarding the side effects of steroid administration in elderly patients. MRI imaging 12 months after the initial consultation did not detect new lesions persisted with stalk enlargement suggesting a stable course of LINH not likely any malignancies (Fig.  3 A, B).

Pituitary MRI at the 12-month follow-up. ( A )Sagittal view of contrast-enhanced MRI. ( B ) Coronal view of contrast-enhanced MRI. Compared with that at 8 months, the enlargement of the pituitary stalk (blue arrowhead) did not significantly change

Materials and methods

Western blotting was conducted on serum obtained from the patient for detection of anti-rabphilin-3A antibodies, as reported previously [ 2 ]. A vector containing the full-length human rabphilin-3A gene was transfected into HEK293FT cells to produce recombinant human rabphilin-3A protein. Expression of recombinant human rabphilin-3A protein was confirmed using an anti-V5 antibody. As a negative control, the same vector without the rabphilin-3A gene was transfected into HEK293FT cells. A protein band presenting a size of 76 kDa, which corresponds to the molecular weight of rabphilin-3A, appeared in the lysate of cells transfected with the rabphilin-3A protein but not in that of control cells, which was considered to be positive for anti-rabphilin-3A antibodies, as reported previously.

Discussion and conclusions

The insights gained from this case indicate that measuring anti-rabphilin-3A antibodies is helpful to diagnosed LINH in cases with AVP-D occurring after COVID-19 infection and/or SARS-CoV-2 vaccination. Furthermore, in our case, pituitary stalk thickening can persist for over 8 months.

Hypophysitis has various etiologies, including lymphocytic, granulomatous, xanthomatous, necrotizing, IgG4-related systemic disease, and chemotherapy agents, apart from pregnancy-related causes. Therefore, the gold standard for the final diagnosis of hypophysitis including LINH is pituitary biopsy, however high patient invasiveness is a major clinical concern [ 19 ].

Sheen et al. recommend biannual follow-up pituitary MRI scans for a duration of two years in cases demonstrating pituitary stalk thickening to monitor the progression of the disease [ 20 ].

In our case, pituitary stalk thickening persisted even at 8 months after symptom onset, prompting the consideration of a pituitary biopsy for a definitive diagnosis of LINH, also to rule out malignant conditions such as Langerhans cell histiocytosis.　However, the evaluation of anti-rabphilin-3A antibodies targeting antigens specific to the posterior pituitary which are highly sensitive markers for LINH [ 21 ] was helpful for avoiding invasive pituitary biopsies.

Previous case reports suggest that both COVID-19 infection and SARS-CoV-2 vaccination could potentially trigger the onset of AVP-D.

There are seven reports of pituitary dysfunction accompanied by AVP-D following SARS-CoV-2 vaccination [ 12 , 13 , 14 , 15 , 16 , 17 , 18 ]. The majority of these cases were female, four cases presented only with AVP-D, and the time from vaccination to disease onset varied from 3 days to 8 weeks post-vaccination. [ 14 , 15 , 16 , 17 , 18 ]. Interestingly, pituitary stalk enlargement was frequently detected on MRI scans in 85% (6/7) (Table  5 ).

On the other hand, there are also seven reports of pituitary dysfunction accompanied by AVP-D after COVID-19 infection. Among the seven cases, only one case exhibited symptoms of pituitary anterior lobe dysfunction other than AVP-D. the time from infection to disease onset varied from 2 to 8 weeks. Unlike SARS-CoV-2 vaccination-related AVP-D, thickening of the pituitary stalk was only observed in 17% (1/6), (Table  6 ) [ 5 , 6 , 7 , 8 , 9 , 10 , 11 ]. In reports of long-term follow-up of idiopathic cases of AVP-D, 79.1% (34 of 43 patients) were detected to have pituitary stalk enlargement on MRI at the time of onset, and 93.0% (40 of 43 patients) up to 6 months thereafter [ 22 ]. Considering the frequency of pituitary stalk enlargement in both idiopathic AVP-D and SARS-CoV-2 vaccination-related AVP-D, it is presumed that SARS-CoV-2 vaccination-related AVP-D shares a similar pathophysiology with idiopathic AVP-D.

One potential contributor to pituitary inflammation following vaccination is the adjuvant-induced autoimmune (ASIA) syndrome, which is believed to overreact immune responses using adjuvants [ 23 ].

However, AVP-D due to vaccines other than the SARS-CoV-2 has been limited only with the older smallpox vaccine [ 24 , 25 ], with no recent reports from other vaccines, suggesting a possible specific effect of adjuvants in the SARS-CoV-2 vaccine. Secondly, antigen cross-reactivity between SARS-CoV-2 spike protein antibodies and tissue proteins such as thyroid peroxidase protein has been known [ 26 ]. Although it is unknown for pituitary and hypothalamic cells, these cells may possess cross-reactivity to induce autoimmunity.

On the other hand, the following mechanism is considered for the development of AVP-D during COVID-19 infection: SARS-CoV-2 utilizes its spike protein to invade host cells via the Angiotensin converting enzyme 2 (ACE2) receptor [ 27 ]. The hypothalamus expresses ACE2 receptors and is thought to be a target for SARS-CoV-2, which may lead to AVP-D [ 28 ].

COVID-19 infection-related AVP-D may differ from idiopathic AVP-D in terms of its pathophysiology and imaging characteristics, such as those seen in LINH. There has been only one case of anti-rabphilin-3A antibody-positive AVP-D without pituitary stalk enlargement, which was considered to have resolved due to its chronic nature [ 29 ]. It is possible that this case did not initially present with pituitary enlargement. The measurement of anti-rabphilin-3A antibody has been predominantly conducted in cases with imaging characteristics. However, accumulation of cases for antibody measurements are needed for further investigation of the underlying causes, including COVID-19 infection-related AVP-D and cases without other imaging characteristics, to facilitate the advancement of etiological assessment.

In conclusion, it was presumed that the SARS-CoV-2 vaccine was the triggering factor in our case. Pituitary stalk enlargement and positive anti-rabphilin-3A antibodies may help in the diagnosis of AVP-D induced by SARS-CoV-2 vaccination. As testing for anti-rabphilin-3A antibodies becomes more widespread and data accumulates, it is anticipated that it will contribute to clarify the detail causes of such conditions.

We reported this adverse event related to the vaccine to Pfizer Japan.

Data availability

No datasets were generated or analysed during the current study.

Abbreviations

Adrenocorticotropic hormone

Arginine vasopressin

Coronavirus disease 2019

Desmopressin

Growth hormone-releasing peptide-2

• Lymphocytic infundibulo-neurohypophysitis

Magnetic resonance imaging

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Acknowledgements

The authors express their gratitude to the patient and their family, who consented to the use of data and images for this case report.

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Department of Metabolism & Endocrinology, Juntendo University Graduate School, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan

Hiroki Takizawa, Hiromasa Goto, Toyoyoshi Uchida, Shuhei Aoyama & Hirotaka Watada

Department of Endocrinology, Diabetes and Metabolism, Fujita Health University, Toyoake, 470-1192, Aichi, Japan

Haruki Fujisawa, Atsushi Suzuki & Yoshihisa Sugimura

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Contributions

All the authors contributed to authorship. H.T., H.G. and H.W. were involved in writing and drafting the case report. H.T., H.G., S.A. and T.U. were involved in the diagnosis and management of this patient. N.I., H.F., A.S. and Y.S. contributed to the measurement of anti-rabphilin-3A antibodies. All authors reviewed and approved the final draft.

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Correspondence to Hiromasa Goto .

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Ethics approval was not necessary for the reported investigations, as they were performed in a routine clinical setting and therapeutic intention. Written informed consent was obtained from the patient before undergoing all clinical procedures.

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Written informed consent was obtained from the parents of the study participants. A copy of the written consent is available for review by the Editor of this journal.

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Takizawa, H., Goto, H., Uchida, T. et al. Arginine vasopressin deficiency onset after COVID-19 vaccination with positive anti-rabphilin-3A antibodies: a case report and literature review. BMC Endocr Disord 24 , 143 (2024). https://doi.org/10.1186/s12902-024-01664-8

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DOI : https://doi.org/10.1186/s12902-024-01664-8

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Affiliations.

• 1 The University of Alabama at Birmingham School of Nursing, United States. Electronic address: [email protected].
• 2 Johns Hopkins University, United States.
• 3 The University of Alabama at Birmingham School of Nursing, United States.
• 4 The University of Alabama at Birmingham School of Nursing, United States; The University of Alabama Heersink School of Medicine, Division of Gynecologic Oncology, United States.
• PMID: 37331834
• DOI: 10.1016/j.pedn.2023.06.005

Problem: Adrenoleukodystrophy (ALD) is an x-linked genetic condition with a high risk of adrenal dysfunction recommended for newborn screening. This review aims to critically appraise and synthesize existing literature identifying the impacts of ALD newborn screening in the United States on the evaluation and treatment of adrenal dysfunction in male children.

Eligibilitycriteria: An integrative literature review was conducted using the Embase, PubMed, and CINAHL databases. English-language primary source studies published in the past decade and seminal studies were included.

Sample: Twenty primary sources met the inclusion criteria, including five seminal studies.

Results: Three major themes emerged from the review: 1) prevention of adrenal crisis, 2) unexpected outcomes, and 3) ethical impacts.

Conclusions: ALD screening increases disease identification. Serial adrenal evaluation prevents adrenal crisis and death; data is needed to establish predictive outcomes in ALD prognosis. Disease incidence and prognosis will become more apparent as states increasingly add ALD screening to their newborn panel.

Implications for practice: Clinicians need awareness of ALD newborn screening and state screening protocols. Families first learning of ALD through newborn screening results will require education, support, and timely referrals for appropriate care.

Keywords: Adrenoleukodystrophy; And adrenal insufficiency; Newborn screening.

Copyright © 2023 Elsevier Inc. All rights reserved.

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Conflict of interest statement

Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Leslie Pitts reports a relationship with Eton Pharmaceuticals Inc. that includes: consulting or advisory.

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