literature review on pharmacy management system

Pharmaceutical Health Services Administration, Planning, Management, and Leadership: Lessons Learned for LMICs

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• First Online: 17 September 2022
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• Mohamed Izham Mohamed Ibrahim 2  

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Complex and continually changing health systems require effective pharmacy managers and leaders to respond to the current and emerging issues at each pharmacy service level. Pharmacy practice services have shifted from a drug-specific to a patient-centered model. The pharmaceutical sector’s reform and advancement of services have been driven by high-quality administration, planning, management, and leadership. Small-, medium-, and large-degree pharmacy authorities use different skills, i.e., technical, conceptual, and human relations, to manage pharmacy units, departments, and organizations. This chapter will feature the factors that are required in pharmaceutical health services administration, planning, management, and leadership in LMICs.

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Mohamed Ibrahim, M.I. (2022). Pharmaceutical Health Services Administration, Planning, Management, and Leadership: Lessons Learned for LMICs. In: Encyclopedia of Evidence in Pharmaceutical Public Health and Health Services Research in Pharmacy. Springer, Cham. https://doi.org/10.1007/978-3-030-50247-8_78-1

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DOI : https://doi.org/10.1007/978-3-030-50247-8_78-1

Received : 14 January 2022

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Writing literature reviews - an article from Nature

Tips from 8 authors.

• How to Write a Superb Literature Review

What is a Literature Review?

A literature review surveys scholarly articles, books, dissertations, conference proceedings & other resources that are relevant to a particular issue, area of research, or theory & provides context for a dissertation by identifying past researchon a topic.

Research tells a story, & the existing literature helps us identify where we are in the story currently. It is up to those working on a research project to continue that story with new research and new perspectives, but they must first be familiar with the story before they can move forward. 

Purpose of a Literature Review

A literature review:

• Helps you to discover the research that has been conducted on a topic already & identifies gaps in current knowledge
• Increases the breadth of your knowledge in your area of research
• Helps you identify seminal works in your area
• Allows you to provide the intellectual context for your work & position your research with other, related research
• Provides you with opposing viewpoints
• Helps you to discover research methods that may be applicable to your work

Greenfield, T. (2002). Research methods for postgraduates. 2nd ed. London: Arnold.

While there are many specific types of literature reviews, you will be writing a critical literature review to demonstrate your knowledge of a specific area & that your project is viable. 

To read more about the different types of reviews, read this article, which provides a good overview:  Maria J. Grant & Andrew Booth. "A typology of reviews: an analysis of 14 review types and associated methodologies". Health Information and Libraries Journal (26):91–108.  DOI: 10.1111/j.1471-1842.2009.00848.x

The Process of Writing a Literature Review

Frequently asked questions.

What kinds of literature are appropriate for my research question?    This will depend on your area of research, but in the health sciences, you will most often rely on scholarly journal articles, patents, conference proceedings, & data sets.

How much literature should I use?    There is no standard answer to this question, but make sure that you have enough literature to tell your story. Discuss this question with your advisor & peers.

How will I find all appropriate information to inform my research?    You should consult multiple databases & resources appropriate for your research area so that you can have a comprehensive view of the research that has already been done in your area. Browse the Pharmacy research guide for databases & other recommended resources.  Also consult with your informationist at the Taubman Health Sciences Library to determine the resources you should investigate.

How will I evaluate the literature to include trustworthy information and eliminate unnecessary or untrustworthy information?    Start with scholarly sources, such as peer-reviewed journal articles & books. Always pay attention to creditability of the source(s) & the author(s) you cite. Citation analysis (see research guides  http://guides.lib.umich.edu/citeanalysis &  http://guides.lib.umich.edu/citation ) can be useful to check the creditability of sources & authors.

How should I organize my literature? What citation management program is best for me?    Citation management software, such as Mendeley, a free citation management program, helps you collect & organize references & easily insert citations & format citations & bibliographies in thousands of styles in your Word document.

To choose the program that's right for you, consider which one works best with your literature search & writing process. This guide compares different types of citation management software & provides tutorials for each type. You may also ask your library informationist for advice.

How do I ensure academic integrity (i.e., avoid plagiarism)?    Familiarize yourself with different types of intentional and unintentional plagiarism and learn about the University's standards for academic integrity here.  Remember, citation management tools can help you avoid unintentional plagiarism by making it easy to collect & cite sources.

What Kind of Literature Should You Choose?

Different types of information sources may be critical for particular disciplines.  Please contact your library informationist for additional guidance on information sources appropriate to your research.  In addition to books, reference resources, journal articles, & datasets, these sources may be helpful.

Government documents

The U.S. Government Printing Office produces a great deal of information that is useful to researchers. Congress, the Supreme Court, the Office of the President & federal agencies are rich sources of policy information, legislation, & historical records. The University of Michigan's Clark Library is a federal depository library. Librarians there can help you find documents and records created by the federal government, as well as state & local laws & legislation.  International government information can be found in United Nations documents , available in print & online since 1946.  Also check the Grey Literature guide for more resources.

Statistics reported by government or private sources can be useful, but can also be difficult to find.  Use the Health Statistics research guide for more information on how to search & for sources.

Grey Literature

Theses & Dissertations :    Dissertations on topics similar to yours may contain information & technical details not published in other forms. You may also be inspired by how others approach similar topics.  

Conference proceedings :    For many fields, researchers present their most up-to-date research results at professional conferences. These results will later be published in conference proceedings, abstracts, or preprints. 

Other unpublished information :    For all of the above and resources, including clinical & pharmaceutical research, FDA reports, & more, visit the Grey Literature research guide .

Related Research Guides

• Grey Literature Resources & strategies for searching for information not contained in databases.
• Finding Tests & Measurement Instruments Resources, tips, & tricks for finding tests & measurement instruments in the health & social sciences.
• Bioinformatics Resources on the interdisciplinary science that uses information technology to solve molecular biology problems.
• Research Impact Assessment (Health Sciences) Explore methods and tools for assessing your research impact, including citation tracking and altmetrics.

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How to conduct a literature review

The purpose of literature reviews and how to execute them.

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In recent decades, the ‘evidence-based medicine’ movement has become widely accepted and, consequently, decisions regarding what is best practice are informed by the best available evidence [1] . However, an ever-increasing quantity of evidence published in literature has meant that healthcare providers, researchers, and policy makers are inundated with unmanageable amounts of information, which can hinder, rather than inform, rational decision making [2] . It is therefore vital that healthcare professionals, including pharmacists, appreciate the importance of evaluating the available evidence when attempting to answer a clinical question [3] . A literature review can therefore be considered “the comprehensive study and interpretation of literature that relates to a particular topic” [4] .

When conducted correctly, a literature review can be viewed as more than simply a cursory overview of the literature on a given topic. Indeed, they are often viewed as a piece of research in their own right. A historical example of the value of literature reviews in informing evidence-based practice is that of streptokinase in the treatment of myocardial infarction (MI). In the 1970s, 33 separate clinical trials comparing streptokinase with a placebo for the treatment of MI had been conducted and their results published. Individually, these trials provided inconclusive evidence regarding the role of streptokinase. However, a re-analysis of their combined results clearly demonstrated the beneficial effect of streptokinase. As a result the medicine became part of the standard treatment following MI, thereby transforming care and saving lives [2] .

Narrative versus systematic literature reviews

Literature reviews can be broadly divided into narrative (descriptive) reviews and systematic reviews [5] . The most important difference between the two categories of reviews is the difference in their level of associated scientific rigour. Narrative literature reviews provide an overview of the literature, typically from the perspective of an ‘expert in the field’ [1] . Such reviews often report findings in a format that includes a brief summary of each included study. While such reviews can be informative, particularly when there has been no previous attempt to assimilate the literature in a given area, narrative reviews are often criticised as having a high risk of various types of bias associated with them [6] . Narrative reviews typically rely on subjective and non-systematic methods of selecting and reviewing data. Consequently, authors may intentionally or unintentionally cite only those literature sources that reinforce the author’s preconceived hypotheses or promote their own views on a topic [7] .

In contrast to a narrative review, a systematic literature review aims to identify all the available evidence on a topic and appraise the quality of that evidence [4] . Therefore, such reviews have the ability to either answer the research question or, failing that, identify gaps in the existing literature which highlight the need for further high quality research into a specific area [8] . Established in 1993, the Cochrane collaboration is an international organisation that produces systematic reviews, often regarded as the gold standard of evidence, concerning the effectiveness of healthcare interventions.

The purpose of a literature review

Literature reviews may be conducted for a variety of reasons, for example, to form part of a research proposal or introductory section in an academic paper, or to inform evidence-based practice [8] . The original focus of evidence-based medicine concerned mainly clinical research questions, such as the streptokinase example. However, increasingly, more research is being conducted in the area of health services research, which incorporates social science perspectives with the contribution of individuals and institutions that deliver care. Pharmacy practice research (a sub-type of health services research) is concerned with investigating how and why people access pharmacy services, new roles for pharmacists, and outcomes for patients as a result of pharmacy services [9] . Whether conducting either a clinical pharmacy or a pharmacy practice literature review, the following basic principles outlined in this article should be followed.

Searching with a strategy

While time and resource constraints may not allow for a definitive systematic review to be conducted, those attempting to undertake a literature review should nevertheless adopt a ‘systematic approach’ [10] . The first step in any literature review is to define the research question (i.e. the scope of the review). This will inform which studies or other forms of evidence are to be included and excluded from the literature review.

Questions that should be asked at this stage include:

• Which study designs are relevant to the review? For example, double-blind randomised controlled trials, observational studies or qualitative research.
• Is there a particular population of interest? For example, paediatrics, pregnant women or people living in care homes.
• Are there particular outcomes of interest? For example, mortality, costs or quality of life.

The literature search strategy is a fundamental component of any literature review, because errors in the search process could produce an incomplete and therefore biased evidence base for the review. Where possible, reviewers should consult with a pharmacy or healthcare librarian who can assist in developing and refining an appropriate search strategy [11] . The search should be conducted in more than one electronic database to help ensure all relevant papers are identified. The main medical literature databases are Medline and Embase. International Pharmaceutical Abstracts (IPA) is also an important database to consider because it indexes many pharmacy-specific journals not found in the larger databases. It should also be remembered that pharmacy literature often overlaps with other disciplines therefore consideration should be given to databases such as the Cumulative Index of Nursing and Allied Health (CINAHL), as well as condition-specific databases, for example PsycInfo.

When conducting searches on electronic databases, thought must be given to the search terms used. Several keywords can exist for each search term and all should be included in the search (e.g. older adult/elderly/aged, are all terms that could be used synonymously). Most databases also have the facility to identify all possible endings of the key terms; this is usually denoted with an asterisk. For example, by searching for ‘pharm*’, articles containing any of the following would be retrieved: pharmacist, pharmacists, pharmacy, pharmaceutical. Boolean operators (e.g. ‘and’, ‘or’, ‘not’) can also be used to combine search terms to refine the search results [12] .

Avoiding publication bias

It has been well documented that studies that report significant results are more likely than those reporting non-significant results to be published, cited by others and produce multiple publications, introducing what is known as ‘publication bias’. Consequently, such studies are also more likely to be identified and included in systematic reviews [13] .

For this reason, efforts should be made to identify all relevant literature on the review topic so the search should not be limited solely to electronic databases [14] . Additional search strategies include hand-checking relevant article reference lists and personal communication with experts in the field. Searching the ‘grey literature’ is of particular importance for pharmacy practice literature reviews because relevant articles written by non-academic pharmacists are often not published in traditional academic journals [15] .

The importance of such additional search strategies cannot be underestimated. Greenhalgh and Peacock reported that, in a literature review concerning innovations in healthcare organisations, 51% of the sources included in the eventual review were identified by hand-searching reference lists, while an additional 24% were identified through personal communications [7] . The search strategy, including databases searched, all search terms used, the limits of the search (for example, written in the English language, published in the last decade), the number of results retrieved from each resource and the date the search was conducted should be carefully documented. Although it can never be guaranteed that the entirety of relevant literature will be identified, conducting the search in a systematic manner will help avoid omissions, and where they do exist they can be said to be unintentional [9] .

Once the search has been performed, the next step is to screen the titles or abstracts (or both) of the identified articles against the predefined inclusion and exclusion criteria. If the article cannot be excluded on the basis of the information contained in the abstract, efforts must be made to access the full paper in order to reach a decision. Conducting a literature review can be a time-consuming process and the time taken to complete is directly related to number of citations identified by the initial search. Allen et al . [16] calculated that it would take a reviewer more than 1,000 hours to complete a literature review involving the screening of 2,500 articles. For this reason, it is worth considering the use of free citation management software, such as Refworks, Mendeley and Endnote, which can be used to manage references retrieved from the literature search.

Drawing conclusions

Studies identified as part of a literature review may report contradictory findings and the quality of the individual studies will have a direct impact on the overall findings of the literature review. When assimilating the evidence identified, the reviewer should attempt to assess the quality of the evidence provided by the individual studies to arrive at valid conclusions [6] . It is recommended that when conducting a literature review, the author should make a judgement of the quality of the evidence provided within the included studies or articles using appropriate assessment guidelines [17] . For example, the Cochrane Collaboration’s risk-of-bias tool attempts to aid quality assessment in terms of assessing potential sources of bias in studies.

In an effort to draw quantitative conclusions within a systematic review, data from individual studies may be pooled quantitatively and reanalysed. A meta-analysis is a statistical method used to combine the outcomes of individual studies to produce data with more power than the individual studies. By pooling the results of individual studies, the sample size is effectively increased, thereby increasing the statistical power of the analysis, which in turns narrows the confidence interval around the effect size, with the result that the overall estimate of effect is more robust [9] . Individual studies included in the analysis are assigned weights, with greater weight assigned to studies with larger sample sizes. The results of a meta-analysis are often displayed graphically in what is known as a “forest plot” [18] .

Publishing your literature review

Targeting an appropriate journal.

• Ensure the scope of your review aligns with the scope of the journal. Familiarise yourself with the journal’s mission statement and the typical content of the journal.
• Be aware of the journal’s target audience in relation to the scope of the review (e.g. does the journal have a pharmacy-specific or multidisciplinary audience? Does the journal have a national or international readership?)
• Consider whether the journal offers open-access publishing. Increasingly, funding bodies stipulate that articles are published only in open-access journals.
• Look at the journal’s impact factor. While articles published in journals with higher impact factors tend to get cited more, high-impact journals have lower article acceptance rates, making it potentially more challenging to get your review published.

Submitting the manuscript

• Familiarise yourself with the journal’s ‘guidelines for authors’. These will dictate the accepted word limit of a review in addition to other formatting and submission stipulations surrounding tables, figures and references, etc.
• Write a cover letter, addressed to the editor of the journal, to accompany your manuscript submission. The cover letter should highlight why the review is important and why you think it is a good fit for the chosen journal. 

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• NLM ID: 101723284
• OCoLC: 999826537
• LCCN: 2017202541

Research Article Open Access

Automated drugs dispensing systems in hospital pharmacies and wards: a systematic literature review volume 53- issue 5.

Elisabetta Garagiola 1 *, Emanuela Foglia 1 , Federica Asperti 1 , Grazia Antonacci 2,3 , Yogini Jani4, Daniele Bellavia 1 and Fabrizio Schettini 1

• 1 LIUC- University Cattaneo, Healthcare Datascience LAB, Italy
• 2 Department of Primary Care and Public Health, Imperial College London, UK
• 3 Business School, Centre for Health Economics and Policy Innovation (CHEPI), Imperial College London, UK
• 4 University College London Hospitals NHS Foundation Trust, UK

Received: November 01, 2023;   Published: November 16, 2023

*Corresponding author: Elisabetta Garagiola, LIUC Business School, LIUC- University Cattaneo, Healthcare Datascience LAB, Corso Matteotti 22, 21053 Castellanza, Varese, Italy

DOI: 10.26717/BJSTR.2023.53.008454

• Introduction
• Materials and Methods
• Search Strategy
• Data Extraction

Objectives: Over the last few years, hospitals have embraced automated drug dispensing technologies aiming to streamline processes, minimise medication errors, and boost safety for patients and medical staff alike. This review endeavours to synthesise and critically assess current evidence concerning these technologies and their integration into clinical practice. Methods: The research, conducted in October 2022, based on two databases, Scopus and PubMed, searches peer-reviewed articles or reviews published in English, considering a time frame between 1995 and 2022. In addition, grey literature is considered. Four distinct comparison scenarios were delineated for evidence evaluation. Only studies using a comparative approach to describe the safety, efficacy, and efficiency of technologies and undergoing quality assessment (Newcastle-Ottawa Scale, IMPAQHTA model and AACODS checklist) were incorporated. Results were synthesised with a narrative approach. Results: After removing duplicates, 203 papers were screened, and nine observational studies were included in the narrative synthesis. Evidence indicates that automation substantially mitigates errors in drug administration, encompassing dosage mistakes and curtails errors in drug dispensing and distribution. Furthermore, it economises the time healthcare professionals devote to medication management. Conclusions: Automated dispensing technologies bolster safety and efficiency for both patients and healthcare staff. Yet, existing evidence chiefly pertains to either pharmacy-based or ward-based scenarios, side-lining integrated solutions across both and results are not completely generalizable considering the observational local approach. To truly gauge these technologies’ merits, a broad multi-dimensional research lens is essential, furnishing insights for informed decision-making.

Keywords: Automated Technologies; Hospital; Drug Management; Medication Errors

The pivotal role of medication administration in patient therapy is undeniable, acting as a fundamental pillar for ensuring safety and well-being, particularly considering that a significant majority of hospitalised patients need pharmacological intervention as part of their healthcare regimen [1]. The multifaceted landscape of the medication management process within the hospital milieu encapsulates a spectrum of activities, including the prescribing, preparation, and dispensing phases, the subsequent administration to the patients, and vigilant observation of effectiveness and safety, notably potential adverse events or side effects [2]. Drug administration frequently represents the culmination of the drug management process, and consequently, errors in this phase could significantly compromise patient safety [3], potentially prolonging hospital stays and escalating healthcare expenditure due to systemic inefficiencies or failures [4]. However, quantifying the impact of errors in clinical practice, including potential harm throughout the drug management process, often poses a challenge, primarily because some errors may not result in harm or are relatively minor. On the other hand, some errors, while corrected before precipitating adverse events, could nonetheless create additional workload for healthcare professionals and organisations [5]. In many hospitals drugs are still stored in an alphabetical order on open shelves.

This system is susceptible to errors, given the human propensity for mistakes, particularly in high-stress or complex situations, during communication breakdowns, or in the absence of standardisation [5- 7]. Manual dispensing often involves ward nurses and pharmacists in tasks that could be automated, thereby enabling them to divert more time to value-added clinical activities [8]. Additionally, the literature suggests that many administration errors remain undetected and previous studies indicated a possible role for automation and related technologies in mitigating this issue [9]. The advent of automated logistic solutions for drug management in hospital settings has garnered increasing attention in recent years [10], considering these solutions as potential instruments to rationalise processes, reduce medication errors, and enhance patient safety [11,12]. Automated logistic solutions comprise diverse technologies and systems designed to automate various stages of drug management, including ordering, dispensing, and administering medications [13], due also to their nature of information technologies [14]. Examples include computerised physician order entry (CPOE), barcode medications administration (BCMA) systems [15], pharmacy dispensing technologies [16], and dispensing cabinets. Such automated systems could mitigate the risk of human errors, reducing medication errors and improving patient safety [17], alleviating the workload on healthcare professionals.

Previous studies suggest that augmenting the degree of automation within one or more stages of the medication management process could reduce error rates [3-18]. As for the efficiency profile of automated dispensing systems, some authors have demonstrated that these logistics systems may confer advantages to healthcare professionals and facilities at large, potentially saving time for hospital pharmacies, departments, and nursing staff, improving medication management processes, and reducing the time required for medication administration [19]. Automation has been particularly lauded in the dispensing stage, where medication errors (MEs) occur [20], and traditional manual dispensing systems are more prone to mistakes and inefficiencies [21]. However, a comprehensive analysis of the supplementary benefits and advantages resulting from implementing integrated solutions, both in the centralised pharmacies and wards, remains limited.

This review was undertaken to identify, summarise, and critically assess the current state of knowledge and available evidence about automated solutions for drug dispensing processes within hospital settings and their integration within the broader drug management and administration process [22]. The objective was to assess the safety, efficacy, and efficiency of various automation scenarios within hospital dispensing processes. This endeavour is expected to offer insights into distinct and additional benefits of existing automated solutions for hospital dispensing, thereby assisting the decision-making process of healthcare managers and other hospital stakeholders. Moreover, the findings of this study are anticipated to augment the understanding of the subject matter and lay the groundwork for the design of more comprehensive empirical investigations. These could enhance current hospital practices in drug management and administration processes by identifying existing knowledge gaps that could inform the implementation of such technologies.

A systematic literature review with a narrative synthesis [23] was conducted in October 2022 to gather evidence about safety, efficacy, and efficiency profiles concerning four scenarios.

• Scenario 1, related to the drug manual management and dispensing (see also [8]). • Scenario 2, in which centralised pharmacy automated dispensing systems are implemented (described in [16]). • Scenario 3, in which decentralized systems and dispensing cabinets are implemented in the wards, to help drug traceability and dispensing activities (defined in [24]). • Scenario 4, in which all the technologies of Scenarios 2 and 3 are integrated into a hybrid automated system (see also [25]).

PRISMA methodology [26] was used to conduct the systematic review. The PICO approach (Patient/Population, Intervention, Comparator and Outcome) was used to define the research questions and shape the review [27,28] was as follows.

• Patient/population: drugs dispensed in the hospital setting (in-patient and out-patient). • Intervention: automation in the drug distribution system (in the Pharmacy and/or in the Wards settings that are represented by Scenarios 2, 3, and 4). • Comparator: the absence of automated distribution systems (represented by Scenario 1). • Outcome: (i) Safety considering all the potential errors throughout the drug management process (outpatient dispensing error rate, at discharge dispensing error rate, labelling dispensing error rate, documentation dispensing error rate, medication administration error, dosage error rate, etc…); (ii) Efficacy referring to the ability of an automated system to curtail the dispensing error rates; (iii) Efficiency is related to the reduction of the drug preparation time and drug administration time.

Two separate databases, Pubmed and Scopus, were explored to find peer-reviewed articles with a specific set of keywords present in either the title or abstract. These keywords included: “Drug*” or “Medicine” or “Medication”, “Centralised” or “Pharmacy Based”, “Cabinet” or “Ward Based”, “Automated Dispensing System” or “Robot” or “Device” or “Machine”, and “Safety” or “Efficacy” or “Efficiency”. In addition, also the grey literature was investigated. The selection of these keywords followed a structured process of ideation inspired by Osborn’s “brainstorming” model [29]. This process was conducted by a team of eight healthcare professionals with extensive experience in hospital settings to ensure a comprehensive and relevant search. Then the team performed a prioritization process to determine the most pertinent keywords to be incorporated into the search strategy. Moreover, publications were also identified through hand-searching and cross-referencing citations. Evidence between 1995 and 2022 was considered in the search process, ensuring a comprehensive exploration of the topic, acknowledging the historical antecedents, and enabling a more thorough analysis of the development over time, considering also the first evidence related to the manual scenario.

Study Inclusion and Exclusion Criteria

Studies were included if they met the following criteria: (i) Peer-reviewed journal articles, reviews and grey literature published in English between 1995 and 2022; (ii) They specifically assessed the safety, efficacy, and efficiency of automated dispensing technologies within a hospital setting; and (iii) Comparative studies involving at least two of the four scenarios under evaluation.

Exclusion criteria encompassed articles in languages other than English and publication types such as conference proceedings, book chapter and discussion papers. Moreover, any article demonstrating substantial flaws in its quality was also excluded. Studies solely focusing on automated technologies like prescribing systems and Barcode Medication Administration (BCMA) were not incorporated into the narrative synthesis.

Screening And Selection Process

One author performed the initial database search, exporting citations into a reference management software (Mendeley Ltd). This software facilitated the process of duplicate removal, which was supplemented by a manual check to eliminate any overlooked redundancies. A double-blind review process was subsequently conducted. The selection process was initiated by two authors — a health economist and a management engineer, both with expertise in the healthcare sector. They screened the titles and abstracts of the citations and then reviewed the full texts to identify pertinent papers. A further review of the selected papers was conducted by two other authors, specialists in health technology assessment and pharmaceutical logistics, to verify their eligibility for inclusion in the review. In the event of discrepancies, issues were resolved through collaborative discussion until a consensus was reached among the authors. The validated articles were then forwarded to the next stage for quality assessment and data extraction.

Study Quality Assessment

The quality and potential risk of bias in the selected studies were evaluated by an expert panel of eight professionals, encompassing pharmacists, nurses, decision-makers, and other specialists such as biomedical engineers and management engineers. Their evaluations employed both qualitative and quantitative approaches, aiming to meticulously assess the technologies under investigation. From a qualitative standpoint, the Newcastle-Ottawa Scale [30] was used for the assessment of observational studies, evaluating the three following aspects:

(i) The selection of the study groups, (ii) The comparability of the groups and (iii) The ascertainment of either the exposure or outcome of interest for case-control or cohort studies.

On the quantitative front, the panel adopted the evaluation tool proposed by the IMPAQHTA model [31]. This model employs a numerical rating system, ranging from 1 (insufficient) to 4 (excellent), to gauge the following aspects:

(i) Overall quality of the paper, (ii) Generalizability of the results, and (iii) Completeness of the findings. The grey literature was evaluated according to the AACODS checklist, including six different domains: Authority, Accuracy, Coverage, Objectivity, Date and Significance [32]. More detailed information can be found in the Supplementary material.

In line with the aim and objective of this review, a data extraction template was created and incorporated into an Excel spreadsheet. The extraction process was carried out by two authors, with any discrepancies resolved through deliberation among the other authors until consensus was achieved. The data extracted from each article included general identifying information (authors, title, publication year, source title, affiliations, abstract, authors keywords), methodological aspects (study design, information about data collection and analysis) and a range of items related to the three primary outcomes of interest considered for the review process (safety, efficacy, efficiency). The comprehensive data extraction template can be found in the Supplementary material.

Data Synthesis and Presentation

A bibliometric network was created considering the information regarding the papers included in the review to find the most relevant subjects within those scientific publications, which would become the focus of this research, helping identify possible knowledge and literature gaps. A bibliometric network consists of nodes and edges used to determine the correlation between the words and the strength of the connection through the edges [33]. To help create and visualise the bibliometric network, the software VOS Viewer was used to perform a distance-based network, in which the distance between two nodes indicates their correlation and the bigger the node, the bigger the number of citations the word has [32]. Then, given the anticipated heterogeneity in methodology and resulting data [34], a narrative synthesis supplemented by tabular representation was selected for this review. Findings about the safety, efficacy, and efficiency profiles were summarised for the four scenarios under examination. The analysis only considered primary outcomes as delineated in the PICO strategy. Where available, data reflecting statistical significance between different methods were reported. Microsoft Excel, provided by Microsoft Corporation, served as the primary tool for data analysis and presentation.

The PRISMA flowchart of the review is reported in Figure 1. Nine peer-reviewed publications [35-43] out of the 261 records retrieved with the initial search, met the eligibility criteria Table 1. The evaluation of the scientific evidence indicated a potentially high risk of bias, and a low-quality literature level was observed for all three outcomes of interest Table 2. Given the observational nature of included studies, the results presented might not be easily replicable, and diverge in different settings. This factor contributed to the lower scores in the IMPAQHTA model regarding replicability Table 2. In addition, the retrieved biases affect the results, which could not be used as unique evidence for the decision-making process and to perform a complete evaluation of drug automated dispensing systems for the hospital setting, highlighting the need to also collect further evidence such as expert opinion and perceptions, or design further studies to cover the knowledge gaps. Figure 2 shows the results of the defined bibliometric network, performed using keywords identified by the authors in their papers, clearly generating three clusters of reference. The first keywords, the ones represented with the green colour, are related to the departmental problems, which then resulted connected with the institutional part of centralised pharmacy. The third aspect that was considered by the already published scientific evidence is related to the results or outcomes. The outcomes resulted studied with a single perspective approach, not allowing an integration between the decentralised and the centralised levels. Findings concerning the three different dimensions of outcomes under analysis are described below.

Table 1: Overview of the studies included in the review.

Table 2: Risk of bias evaluated with the Newcastle-Ottawa Scale and final synthetic result from the assessing tool suggested by the IMPAQHTA model, considering Efficacy/Safety and Efficiency as Outcomes.

Note: *Considering Safety as an Outcome °Considering Efficacy as an Outcome §Considering Efficiency as an Outcome N.A. if there is no evidence for the Scenario under assessment and so the Quality Assessment was not applicable or if the validation model could not be applied considering the nature of the publication type ^This study, using the AACODS checklist was validated with a positive score of 28/34 (82.35%).

Two of the selected studies performed a comparative analysis of safety aspects across various scenarios Table 3 [35,36]. However, [35] were unable to test the difference between scenarios due to the small sample size, whereas [36] found statistically significant difference between the results from the various scenarios only for one of the three metrics assessed. [35] revealed that automation in the Central Pharmacy could lead to a substantial reduction in dispensing errors for outpatients and in labelling and documentation errors within the Central Pharmacy, compared to traditional dispensing. However, these differences were not calculated considering that the data were available for less than 50% of the prescriptions assessed during the study. On the other hand, [36] compared manual dispensing with a ward-based automated scenario, discovering that automated systems implemented in the wards led to statistically significant improvements in terms of reducing Medication Administration Errors (MAEs), dosage errors, and drug error rates (p<0.05).

Table 3: Safety and efficacy dimension.

Four of the selected papers examined the efficacy dimension and conducted comparisons among various scenarios Table 3. All the studies utilized the dispensing error rate as a measure of the dispensing process efficacy. They reported that scenarios employing automated dispensing technologies, either in the Pharmacy or in the Wards, demonstrated statistically significant lower error rates (p<0.005) compared to the scenario involving manual dispensing. Two studies, [35,37] compared Pharmacy-based automated systems with manual dispensing. Their findings suggested that the implementation of automation in the Central Pharmacy resulted in a reduction of dispensing errors — from 2.9% to 1.7% (p<0.001) and from a range of 1.4%- 2.7% to 0.6%-1% (p<0.005), respectively. Another study conducted by [38] determined that dispensing errors significantly decreased when automation was introduced in the Wards (comparison between Scenario 3 and Scenario 1) (p<0.005).

Six studies delved into the efficiency dimension from various perspectives among the drug management process (Table 4). Two studies juxtaposed the Central Pharmacy-Based automated scenario with the manual dispensing scenario [35] reported that pharmacy automation could enhance the time allocated for picking and the total turnaround time for discharge (p<0.01). [43] examined the efficiency outcomes before and after implementing a central dispensing drug system, demonstrating a reduction in the overall time for drug dispensing by 15%, attributable to the introduction of automation. Four studies contrasted the Ward-based automated scenario with traditional dispensing. [38] found that Ward-based automated systems could reduce the time spent on administration (p=0.003). Conversely [42], reported that ward automation could potentially increase the average medication retrieval time, thereby negatively impacting the efficiency dimension, considering the entire medication management process. This phenomenon could be explained by healthcare professionals’ queuing considering that only one person could use an ADD system at any time [42].

Table 4: Efficiency dimension.

The present review identified nine studies that assessed safety, efficacy, or efficiency of the four comparative scenarios, depending on the technologies’ introduction. The evidence suggests the existence of ADD systems’ benefits; however, none of the studies has detailed the incremental benefits of centralised versus decentralised systems, nor have they exhaustively explored the impact of automation on efficacy, particularly concerning process time. In addition, other errors, such as prescribing errors, should persist if organisations do not adopt integrated systems, even with the introduction of an electronic prescription system [44]. Additionally, specific risks and disadvantages have been associated with using automated dispensing technologies. As per the literature, implementing automated technologies can introduce new organisational and technical risks due to alterations in the dispensing process and the organisation of hospital tasks [45,46] proposes that changes in the work routine following the introduction of automated dispensing technologies can be managed by organising regular meetings with professionals involved in the dispensing process. This would foster knowledge sharing, heighten awareness of automated solutions, and facilitate revising human resource plans in the early stages of implementation. This approach could impact organisational investments related to the learning curve, an impact that warrants further investigation.

This systematic review is a first attempt to present a comparative analysis of various levels of automation in drug dispensing systems within a hospital setting, synthesising existing research findings from a broad spectrum of studies and providing a comprehensive understanding of the current state of knowledge on the topic. From a practical standpoint, this study indicates that ADD systems could enhance drug dispensing processes’ safety, efficacy, and efficiency profiles in hospitals. Consequently, these technologies provide an opportunity for healthcare facilities to optimise their operations, reallocate resources more effectively, and augment patient safety. On a theoretical level, this study elucidates the technical profile of these automated drug dispensing systems from a multi-dimensional perspective. However, the diversity in methodologies, measures, quantitative approaches and investigated primary outcomes poses several challenges in making direct comparisons. Another limitation concerns the efficacy profile related to the implementation of technological solutions. Existing literature only presents data for Scenarios 2 and 3. In contrast, efficacy data for Scenario 4 needs to be more studied, hindering comparisons between scenarios and obscuring the incremental benefits of introducing integrated drug management systems between the Central Pharmacy and the Wards. It is also worth noting that factors such as hospital size or the number of human resources involved in the drug dispensing process could have influenced the results.

Finally, considering the quality assessment and the observational and monocentric nature of the evidence, the findings may not easily be replicable or extendable to other organisational settings. In contrast, considering all the potential advantages and benefits for healthcare facilities and patients, more comparable evidence of centralised, decentralised, and integrated systems should be produced, also guiding the training and allocation of resources within the hospital setting. The present review identified different literature gaps that must be evaluated and investigated deeply. Firstly, some dimensions were not assessed in the literature, and future research efforts could be directed towards integrating this literature review into a multi-dimensional assessment that not only considers safety and efficacy but also embraces other aspects, such as organisational, and social implications, also involving a panel of healthcare professionals (including pharmacists, nurses, decision makers, IT professionals, and biomedical engineers) from different countries, to enhance results’ validation and improvement, but also the generalizability of the results. In addition, the incremental benefits related to the integration of multiple automated systems, joining drug dispensing solutions in conjunction with other systems (e.g., BCMA or electronic prescribing) and extending the analyses to the entire logistics process from the central pharmacy to the wards, considering other drug process management phases (e.g., drug preparation, drug labelling, documentation preparation), must be supported by the need for more evidence-based information, opening up avenues for future research, both from a clinical and a managerial perspective.

In conclusion, also to support the appraisal phase and the decision- making process, future advancements and research should extend to incorporate economic considerations. This would facilitate a more nuanced understanding of economic sustainability linked to the deployment of automated solutions, an aspect often highlighted by healthcare professionals as a hurdle to their broader adoption.

Author Contributions

EF conceived the study, participated in its design and coordination, and helped in drafting of the manuscript; EG, FA, DB and FS performed the literature search, the data extraction and the data synthesis; FA and EG drafted the manuscript; EF, YG and GA critically revised the work. All authors read and approved the final manuscript.

One author is funded by the National Institute for Health and Care Research Applied Research Collaboration Northwest London. The views expressed in this publication are those of the authors and not necessarily those of the National Institute for Health Research or the Department of Health and Social Care.

EG, EF, FA, GA, DB, FS were funded by BD, being supported with research grants or fee for educational activities, but this review was conducted independently.

Competing Interests

The authors of this review do not have any conflicts of interest. The review was not registered and the ethical approval was obtained by the Carlo Cattaneo – LIUC University Ethical Committee (protocol number #R05-23, dated February 24th, 2023).

Table 1: CT Exam Protocol.

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• Zheng WY (2021) The impact of introducing automated dispensing cabinets, barcode medication administration, and closed-loop electronic medication management systems on work processes and safety of controlled medications in hospitals: A systematic review. Research in Social and Administrative Pharmacy 17(5): 832-841.
• Pedersen CA, Schneider PJ, Scheckelhoff DJ (2014) ASHP national survey of pharmacy practice in hospital settings: Dispensing and administration. Am J Health Syst Pharm 72: 1119-1137.

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Chapter 2: Review of Related Literature in Pharmacy Management System

This article about Chapter 2: Review of Related Literature in Pharmacy Management System will give you the following ideas how to create the chapter of pharmacy management system that focus on review of related literature.

Here’s the Outline of Chapter 2: Review of Related Literature in Pharmacy Management System.

Pharmacy Management System Thesis Chapter 2

REVIEW OF RELATED LITERATURE AND PRIOR ARTS

This Chapter 2: Review of Related Literature in Pharmacy Management System includes the reviewing of local and foreign related literature that can help the researchers to gather valuable data and ideas that can guide for the development of the proposed system. It is easy to the readers or researchers to understand the concept of the study. It gives an overview of the different study that has been done before and the proponents collect some ideas from other study to formulate a new concept to be apply to the develop system.

Local Related Literature

The importance of sales monitoring with your cable tv.

According to Villanueva (2015), from the book The Importance of Sales Monitoring with Your Cable TV , Monitoring of sales whenever it comes to doing business online is very vital. To be able to make sure that everything is in order, it has to practice monitoring. It is because monitoring is important in a business one must hire a person who is loyal and trustworthy. Otherwise the online business will fall apart in a matter of time. One of the modus operandi commonly practiced is the falsification of sales and revenue reports by the person trusted by the owner. A part of the total sales might be pocketed. You cannot have a hundred percent assurance that the sales reported back to you are valid.

In this citation it says that monitoring of sales is essential in every business. Without proper monitoring a business my fall apart due to falsification of sales and revenue reports. Monitoring of sales helps the owner of the business to keep track of sales and ensure that the sales reports are valid.

Medicines management

According to Western Pac Surveil Response J. (2015), Medicines management is the entire process of how medicines are selected, procured, delivered, prescribed, administered and reviewed to optimize the contribution they make to producing informed and desired outcomes of patient care. In the Philippines, medicines management occurs at all levels of government and is different during emergency and non-emergency times.

Health service delivery in the Philippines has been repeatedly disrupted as a result of disasters and emergencies – particularly so after Typhoon Haiyan in November 2013. The objectives of this study were to document existing policies for medicines management in the Philippines during emergency and non-emergency periods and to assess the public sector medicines management system in Haiyan-affected areas during the response.

According to Dan Brian (2011) a lot of the websites we visit nowadays are testing and requiring that we create so-called “strong” passwords. Unfortunately, it is not a practice that every site accommodates, whether because it has not update, edits code to meet these most recent standards, or simply because it lacks the resources to do so. It is then up to the user to create its own personal “Security Best Practices”.

Foreign Related Literature

Records management.

According to Patricia Faulhaber (2015), Record management is a systematic, organized, planned and controlled process of managing or tracking the life cycle of records. A record can be a tangible paper object or it can be in digital or electronic form. Records can kept on financial, medical, informative, formal documents, office documents, payroll, government forms and emails among hundreds of other types of records. Record management addresses the three phases of the life cycle of records: The creation or the receipt of a record; the maintenance, safe storage, retrieval, or general use of a record; the disposal of a record.

System analysis and Design

Cashman stated in her book “System Analysis and Design” (2011) that transaction processing system data generated by day-to-day business operations. Transaction processing are efficient because they process a set of transaction related commands as a group rather than individually to protect data integrity however, TP systems ensure that if any single element of a transaction fails, the system does not process the next transaction.

According to Hold (2010) article, “Inventory refers to stocks of anything necessary to do business”. The U.S Small Business Administration publication describes what constitutes successful inventory management balancing cost versus benefits of inventory, including: Maintaining a wide assortment without sacrificing service; Keeping stock low without sacrificing performance; Obtaining lower prices by making volume purchases; and Maintaining an adequate inventory without an excess of obsolete items. (Espinosa, n.d.)

Local Related System

Development and evaluation of a computerized sales and inventory system of mother’s best company.

According to Eskow (2010) for the study, Development and Evaluation of a Computerized Sales and Inventory system of Mother’s Best Company (CSISMBC) with SMS Confirmation, an integrated inventory system, may range in platform complexity. Researchers believe that inventory systems are made not in same faces.

Inventories have different faces because it varies upon use and it depends upon the user’s need.

By understanding the Strength and Weaknesses of people and technologies you have opportunity to design the process that best utilize the strength of each to offset inherent weaknesses as said by Piaseki(2009) from his book entitle, Inventory Accuracy : People Process and Technology.

Technology literate person with a high and technology makes a process minimal. The similarities of the proposed system to the Development and Evaluation of a Computerized Sales and Inventory system of Mother’s Best Company are almost the same in terms of Automated System, Connectivity, Platforms (PC or Android), Point of Sale, and Payroll.

Supplies and Inventory System

This is a simple inventory system that computers the running balance of an item. It records the item received and item issued. As stated by Pabuaya (2010) from his book entitled, “Supplies and Inventory System”.

Inventory system is a simple system that keeps track of the item received and items issued. The similarities of the proposed system to the Supplies and Inventory System

are almost the same in terms of Automated System, Connectivity, Platforms (PC or Android), and Point of Sale.

­­ Sales and Inventory Monitoring System

 According to Jeonsoft (2014), Inventory System aims to provide easier and faster way to monitor the movement of the business’ stock of goods. It is interactively designed to possibly do the common tasks done in customary way. From item entry, releasing of items, inventory adjustment, transferring of goods from one warehouse to another and production, sure you can keep track of your inventory. JIS uses Jibes XP Tools that has been especially configured with properties that would help you organize well the flow of your inventory. To ensure the security maintenance of JBS system, it has JADE (Jeonsoft Administrative Enforcer) programmed to protect the transactions in your system. Users will be asked to enter their login name and password to confirm if they are entitled to access the system. Using JADE, Administrators can also assign a specific module for employees to access since they are only entitled to access modules that are related to their work.

      A sales and inventory monitoring system collects data to aid in production scheduling, accurate details, and reliable information. For example, some systems use recent sales data to forecast how many of a type of product will be needed to meet consumer demand in the near future. This includes monitoring the levels of a product at all locations. A good example is a global company with customers all over the world. The customer may live in Philippines, but the system must see if the warehouse in China has a product available to ship to Philippines. The similarities of the proposed system to the Sales and Inventory Monitoring Systemare almost the same in terms of Automated System, Connectivity, Platforms (PC or Android), and Point of Sale.

Foreign Related System

Pharmacy inventory management system.

According to King Saud Bin Abdulaziz  (2015), the preliminary findings of the implementation process of a pharmacy inventory management system at a local Saudi hospital. Meeting documents, key informant interviews, and experience of the researcher were part of the data collection sources used in the study. A thematic analysis of the data was conducted. Preliminary findings show that the implementation process of the pharmacy inventory management system needs the involvement and support of senior management and experienced technical expertise. Future research will focus on investigating the impacts of the pharmacy inventory management system on workflow and medication errors. The similarities of the proposed system to the Pharmacy Inventory Management System are almost the same in terms of Automated System, Connectivity, Platforms (PC or Android), and Point of Sale.

Computerized Payroll System

According to Grace Ferguzon (2017), Computerized systems offer a number of advantage, including increased accuracy and speed. Computerized payroll systems can round employee work hours into quarter-hour segments and accurately calculate the total hours worked and to be paid, thereby saving time spent on manual calculations. These systems calculate all pay frequencies, such as weekly, biweekly, semimonthly, based upon the input data received. The similarities of the proposed system to the Computerized Payroll System are almost the same in terms of Automated System, Connectivity, Platforms (PC or Android), and Payroll.

Computer Based System

As a stated at the book of Passion (2011 ), to improve their efficiency and reduce their cost of operation. Reports are more timely and accurate. Computers have a large capacity to store data and tremendous speed to manipulate and recall data to the format a user wished to use which introduction of microcomputer computation of business is more affordable (Espinosa, n.d.). The similarities of the proposed system to the Computer Based System are almost the same in terms of Automated System, Connectivity, Platforms (PC or Android), Point of Sale, and Payroll.

Table 1. Features and Comparison of Foreign and Local System

Table 1 shows the differences of the system and studies related to the proponent’s proposed system.

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Here’s the complete Source code  Pharmacy management System project

Related Article

• Pharmacy Management System Thesis Chapter 1
• Pharmacy Management System Thesis Chapter 3

if you have any questions or suggestions about Chapter 2: Review of Related Literature in Pharmacy Management System , please let’s me know by dropping your comment below.

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Pharmacy research project guidance: Doing your literature review

• Project Management
• Ethical Approval
• Doing a systematic literature search
• Evaluating your sources
• Doing your literature review
• Citing references
• Using EndNote
• File and Data Management
• Your Lab/Log Book
• Reflective Writing
• Supervisory Expectations
• Frequently Asked Questions

Introduction

All projects will include a literature review:

• In a lab-based project the review may just be part of the introduction helping to outline the state of the knowledge and gap you are trying to address.
• For literature-based projects this will be the bulk of your discussion, although the way your report is structured will depend on the type of review you are doing. If you are doing a systematic review you will need to follow a specific protocol for writing it up. See ' Doing a systematic literature search ' for guidance and links.

Getting started

• Video tutorial on doing a literature review

A literature review sets up your project and positions it in relation to the background research. It also provides evidence you can refer back to later to help interpret your own results. When getting started on your literature review, it helps to know what role this plays in your overall project.

A literature review:

• Provides the background / context to your topic
• Demonstrates familiarity with previous research
• Positions your study in relation to the research
• Provides evidence that may help explain your findings later
• Highlights any gaps in the research
• Identifies your research question/s

In your literature review you should include:

• Background to the topic (e.g. general considerations, mechanisms of formation, analytical techniques, etc…)
• Why it is important (e.g. food with improve flavour, less carcinogens, more taste, less processed foods, new probiotics ......... & etc.)
• What research has been performed and what has been found out
• The specific area you are interested in (e.g. cheese, snacks, fruits, ….)
• Current ideas and hypotheses in this area
• The key research questions which remain

It can seem difficult to know where to start with your literature review, but to a certain extent it doesn’t matter where you start…as long as you do!

If you like understanding the bigger picture and seeing the whole of an idea before getting into the detail – try starting with a general text and then using the bibliography of this to find more specific journal articles.

If you like to start small with one idea or study, find a relevant journal article or single study and then build up by trying to find related studies and also contrasting studies.

Further help

For more on this view the video tutorial on the other tab in this box, or take a look at these study guides:

• Starting a literature review
• Undertaking a literature review

Read the script for the video (PDF)

Note-taking

• Tips on note-taking
• Video tutorial on critical note taking

A key to a good literature review, is having a good system for recording and keeping track of what you are reading. Good notes means you will have done a lot of the thinking, synthesising, and interpreting of the literature before you come to write it up and it will hopefully make the writing process that bit smoother. Systematic note-taking will also ensure you have all the details you need to write your references and won’t accidentally plagiarise.

Have a format for recording your notes that suits you – whether this is in a table, bullet points, spider diagrams, using a programme like Evernote, or in a traditional notebook! 

Tables can be a useful way of recording notes for a literature review as it enables you to compare and contrast studies side-by-side in the table. It also forces you to write a concise summary or it won’t fit into the table!  

e.g.  A suggested outline for a note-making table

Have a system for distinguishing quotations and your own words – you don’t want to accidentally include something only to discover it was someone else’s words and you may have plagiarised by mistake. Always make sure your quotation marks are clear in your notes (it is easy to miss them in a hurry) and it really helps to record the page number of any direct quotation so you can go back to check easily.

Avoid the temptation to copy out text – copying out large chunks of text is slow and also means you tend not to process and understand what you copy. Summarising and writing short phrases instead means you are likely to have a better understanding and will remember it and be able to use your notes more easily later. 

Summarise – writing a short summary or overview of what you have just read helps you to clarify their argument and position. It also means you have a handy short reminder when you come back to it later – you don’t want to be re-reading notes that are as long as the original text in the first place!

Always record the full bibliographical details – it only takes a few moments to write down everything you need for your reference. You may think it is fine to leave it as you will be able to find these details later…but you probably won’t and you will waste time searching for them when your deadline is fast approaching.

A top tip if you find it hard to put things in your own words – try reading a longer section of the text before taking notes. It is very difficult to paraphrase something line-by-line as you go along, because everything seems important and it is too easy to just lift the phrases the author has used. Reading a longer section will give you a better overview and fuller understanding, meaning you can choose what is important and relevant to your own project. 

For more on this watch the video tutorial on the other tab in this box, or take a look at these study guides:

• Managing academic reading
• Effective note-taking study guide This guide produced by the Study Advice Team gives tips on note-taking and outlines some different approaches.

If you are unable to view this video on YouTube it is also available on YuJa - view the Critical note taking video on YuJa (University username and password required)

Referencing and avoiding plagiarism

• Managing references
• Video tutorial on avoiding unintentional plagiarism

It is a good idea to keep your references up to date as you write so that you know exactly where each idea comes from (and it will save a tedious job at the end ).

Make sure you reference every idea that comes from another source, which includes things like images, diagrams, and statistics, not just word-for-word quotations.

Use the referencing style detailed in the 'Referencing' page in this guide and stick to it consistently! Don’t switch between styles or formats. It may seem petty, but meticulously formatted referencing shows you have taken care in your work and have a professional academic approach (and it will get you marks!). You could consider using a reference management tool, such as EndNote Online, for storing your references and inserting them into your report (see the 'Referencing' page ) - this will be essential if you are doing a literature-based project or a systematic review.

A top tip is to have a proof-read through for referencing only – print out your literature review as it is easier to spot mistakes on paper than on screen.

Referencing checklist

• Is every idea from another source referenced?
• Does every word-for-word quotation have quote marks and is referenced?
• Are all paraphrases in your own words (not just changing a few words) and referenced?
• Does every in-text reference match a full reference in the bibliography?
• Are all names and titles in the references spelled correctly?
• Have you followed the department’s preferred referencing style consistently?

For more on this watch the video tutorial on the other tab in this box.

For detailed help on citing references see the Referencing page in this guide:

• Referencing guidance for the Pharmacy research project

If you are unable to view this video on YouTube it is also available on YuJa - view the Avoiding Unintentional Plagiarism video on YuJa (University username and password required)

Structuring your review

A literature review compares and contrasts the research that has been done on a topic. It isn’t a chronological account of how the research has developed in the field nor is it a summary of each source in turn like a ‘book review’. Instead a literature review explores the key themes or concepts in the literature and compares what different research has found about each theme.

Use sub-headings to structure your literature review as this helps you group the different studies to compare and contrast them and avoids a straight chronological narrative.

To help find your sub-headings:

• Brainstorm all the different concepts or themes in the research that relate to your topic or title
• Identify the ones that are important to your research question – think of what the reader needs to know about to understand the different aspects of your project
• Place the themes in an order that would make sense to your reader – usually going from broad themes to themes more directly related to your project (see funnel diagram in Getting started)
• Turn these into sub-headings
• Use these sub-headings as an outline plan for your literature review – what will come under each sub-heading

Below is an example structure of a literature review that starts broad and starts to narrow by linking the concepts that are specific to this project:

For more on this see the following study guide:

Writing the literature review

When writing a literature review, you want to be comparing and contrasting the studies to build up a picture of what the research says about your topic.

This means you should be using comparative and evaluative language more than descriptive language:

For more examples of the kinds of comparative and evaluative language used in literature reviews see:

• Academic Phrasebank Use this site for examples of linking phrases and ways to refer to sources.

Be selective

Also you want to be selective in how you refer to the literature . In a literature review, you don’t have to refer to each study in the same depth. Think of the points you want to make and then include just enough detail about the study to provide evidence for this. For example, you don’t have to analyse the strengths and weaknesses of the methodology for each study in depth, you only need to do this if you are making a point which relates to the methodology or a point about the findings which depends on the methods being robust and valid (e.g. the authors claim there are wide-spread applications of their trials, but they have used a very small sample size, which suggests they can’t make such a bold assertion). 

For example - the summary below maps out the state of current research and the positions taken by the key researchers. A significant amount of reading and in-depth understanding of the field has gone in to being able to summarise the research in these few sentences.

Sometimes you need to go into greater depth and refer to some sources in more detail in order to interrogate the methods and stand points expressed by these researchers. Even in this more analytical piece of writing, only the relevant points of the study and the theory are mentioned briefly - but you need a confident and thorough understanding to refer to them so concisely.

For example:

See the following study guide for more on this:

• Developing your literature review

Returning to your literature review - link to the discussion

Once you have written your literature review, its job doesn’t end there. The literature review sets up the ideas and concepts that you can draw upon later to help interpret your own findings.

Do your own findings confirm or contradict the previous research? And why might this be?

If your literature review funnels down from broad to narrow, you can think of your discussion like the other half of the hour-glass, broadening out to the wider applications of your project at the end:

So although you may draft your literature review as one of your first steps, you will probably come back to it towards the end of your project to redraft it to help fit in with your discussion. You may need to emphasise some studies that didn’t initially seem that important, but which are now more useful because of what you have found in your own experiments.

This is an example of the thinking that might go on behind interpreting a result and linking it to the previous literature:

• << Previous: Evaluating your sources
• Next: Citing references >>
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• v.23(5); 2015 Oct

Quality in the pharmaceutical industry – A literature review

Reham m. haleem.

a The National Organization for Research and Control of Biologicals, Cairo, Egypt

Maissa Y. Salem

b Analytical Chemistry Department, Faculty of Pharmacy, Cairo University, Cairo, Egypt

Faten A. Fatahallah

Laila e. abdelfattah.

c Faculty of Pharmacy, Misr University for Science and Technology, 6th of October City, Egypt

The aim of this study is to:

• a. Highlight the most important guidelines and practices of quality in the pharmaceutical industry.
• b. Organize such guidelines and practices to create a guide to pave the way for other researchers who would like to dig deeper into these guidelines and practices.

A review was conducted of 102 publications; 56 publications were concerned with the pharmaceutical quality directly while 46 publications were concerned with the general quality practices. The content of those sources was analyzed and the following themes were identified:

• a. Research theme 1: Guidelines of the pharmaceutical quality.
• b. Research theme 2: General practices recently applied in the pharmaceutical industry.

Main outcome measures

The following guidelines were identified and reviewed: WHO guidelines, FDA guidelines, EU guidelines and ICH guidelines in the research theme I.

In research theme II; the following topics were identified and reviewed: quality risk management, quality by design, corrective actions and preventive actions, process capability analysis, Six Sigma, process analytical technology, lean manufacturing, total quality management, ISO series and HACCP.

Upon reviewing the previously highlighted guidelines and the practices that are widely applied in the pharmaceutical industry, it was noticed that there is an abundant number of papers and articles that explain the general guidelines and practices but the literature lack those describing application; case studies of the pharmaceutical factories applying those guidelines and significance of those guidelines and practices.

Conclusions

It is recommended that the literature would invest more in the area of application and significance of guidelines and practices. New case studies should be done to prove the feasibility of such practices.

1. Introduction

The quality in the pharmaceutical industry has become a very important topic. Since the world has gathered together to harmonize its practices and guides and the launching of the FDA current good manufacturing practices – the cGMP; for the 21st century – there has been a growing awareness for the significance of the quality of the pharmaceutical products ( Woodcock, 2004 ). This awareness is represented through the appearance of several definitions defining exactly what the quality of the medicine should be ( LEE and Webb, 2009 ). Many articles were written to demonstrate the special nature of the product-customer relationship of medicine and patients ( Woodcock, 2004 ). Also the important role of governments was emphasized through the joint statement between the international pharmaceutical federation; FIP; and the international federation of pharmaceutical manufacturers associations; IFPMA; to ensure the safety of medicinal products in order to protect the patient ( FIP Council, 1999 ), providing that the pharmaceutical industry is one of the most closely regulated industries for more than 50 years ( Woodcock, 2004 ).

Since 2002, FDA began an initiative to address cGMP for the 21st century ( Woodcock, 2004 ). This effort involved taking new looks at both the regulatory and industrial systems for insuring drug quality (Larson, 2006).

A literature review was conducted on the quality in the pharmaceutical industry, identifying 102 publications that focus on conceptual issues, methodological issues, or the application of different practices and/or guidelines applied in the pharmaceutical industries. The content of these sources was analyzed, and a number of themes were identified.

The literature review has two objectives concerned with the quality guidelines and practices of the pharmaceutical industry and the organization such as practices and guidelines to make a guide for others to use.

A research of this kind serves to integrate past research and can help current and future researchers, and practitioners employing the suitable guideline or practice to develop their methodological decisions in upgrading the industry.

This article introduced some issues regarding what is so special about pharmaceutical quality and different drivers of quality are then identified ( Fraser, 2005; Dean and Bruttin, 2001 ). This is followed by the identified research themes and their development. Finally, managerial implications are discussed.

A search was made of the following databases: WHO, FDA, ICH, and EU to download their corresponding guidelines. Using the Google search engine; also a number of papers and articles were downloaded. Search words used were: pharmaceutical quality, quality and pharmaceutical industry. Papers that were not academic in nature were rejected (for example, those that did not provide reference citations).

The final sample consisted of 102 publications; 56 publications were related to the pharmaceutical quality directly while 46 publications were concerned with the general quality practices.

Two research themes could be identified in the articles studied in this literature review.

They included:

• • Guidelines of the pharmaceutical quality.
• • General practices recently applied in the pharmaceutical industry.

For each of these research themes the authors synthesize the main findings and offer suggestions for further research.

2.1. Research theme 1: guidelines of the pharmaceutical quality

The most important guidelines that are widely applied in the pharmaceutical industry are:

2.1.1. WHO guidelines

WHO has published a handbook on the GMP in particular, entitled: Quality assurance of pharmaceuticals, a compendium of guidelines and related materials, Volume 2: good manufacturing practices and inspection ( Quality Assurance of Pharmaceuticals, 2004 ).

It consists of 4 chapters:

• Chapter 1: WHO GMP: main principles for pharmaceutical products.
• Chapter 2: Good manufacturing practices: starting materials.
• Chapter 3: Good manufacturing practices: specific pharmaceutical products.
• Chapter 4: Inspection.

And 7 annexes:

• Annex 3: Radiopharmaceutical products.
• Annex 4: Good manufacturing practices for pharmaceutical products: main principles.
• Annex 5: Model Certificate of GMP.
• Annex 6: Sterile pharmaceutical products.
• Annex 6: Guidance on GMP inspection.
• Annex 7: Pre-approval inspection.
• Annex 8: Quality system requirements for national GMP inspectorates.

2.1.2. FDA guidelines

Pharmaceutical manufacturers have just begun to understand and apply the FDA’s cGMPs for the 21st century: A Risk-Based Approach; the initiative outlines immediate, near and longer-term stages that FDA believes will take two years to be implemented ( Larson 2004 ).

On the technical side, FDA states three concepts that will guide the reevaluation process: advances in risk management science, advances in quality management science and advances in pharmaceutical science and manufacturing technology ( Larson, 2004 ).

The most important guidelines are Code of Federal Regulation 210, 211 .

21CFR Part 210: The regulations contain the minimum current good manufacturing practice for methods to be used in, and the facilities or controls to be used for, the manufacture, processing, packing, or holding of a drug to assure that such a drug meets the requirements of the act as to safety, and has the identity and strength and meets the quality and purity characteristics that it claims to possess.

21CFR Part 211: The regulations in this part contain the minimum current good manufacturing practice for preparation of drug products for administration to humans or animals.

The FDA has concluded that modern quality systems together with manufacturing processes and product knowledge, can handle many types of changes to facilities, equipment and processes without the need for regulatory submission ( Fraser, 2005 ).

2.1.3. EU guidelines

The core of European Union legislation in the pharmaceutical sector is gathered in Volume 1 and Volume 5 of the publication; “ The rules governing medicinal products in the European Union ”.

• • Volume 1 – EU pharmaceutical legislation for medicinal products for human use.
• • Volume 5 – EU pharmaceutical legislation for medicinal products for veterinary use.

The basic legislation is supported by a series of guidelines that are also published in the following volumes of “ The rules governing medicinal products in the European Union ”:

• • Volume 2 – Notice to applicants and regulatory guidelines for medicinal products for human use.
• • Volume 3 – Scientific guidelines for medicinal products for human use.
• • Volume 4 – Guidelines for good manufacturing practices for medicinal products for human and veterinary use.
• • Volume 6 – Notice to applicants and regulatory guidelines for medicinal products for veterinary use.
• • Volume 7 – Scientific guidelines for medicinal products for veterinary use.
• • Volume 8 – Maximum residue limits.
• • Volume 9 – Guidelines for pharmacovigilance for medicinal products for human and veterinary use.
• • Volume 10 – Guidelines for clinical trial.

2.1.4. ICH guidelines

The International Conference on Harmonization of technical requirements for registration of pharmaceuticals for human use (ICH) is a special project that gathers the regulatory authorities of Europe, Japan and the United States and experts from the pharmaceutical industry in the three different regions; to discuss scientific and technical aspects of product registration.

The objective of such harmonization is a more efficient use of human, animal and material resources, and the removal of any delay that is not essential in the global development and availability of new medicines while maintaining safeguards on quality, safety and efficacy, and regulatory obligations to protect public health.

2.2. Research theme 2: general practices recently applied in the pharmaceutical industry

2.2.1. quality risk management.

All products and all processes have an inherent element of risk ( Griffith, 2004 ).

In an organization that is intending to apply an effective quality risk management approach, a clear definition of what is considered ”risk” should be agreed upon because of the too many stakeholders in the pharmaceutical industry and their corresponding diverse interests ( ICH Q9, 2003 ).

The FDA has noticed that it needs to reorganize its procedures and processes to merge the use of risk management programs (RMP) within the agency and within the industries it regulates. Consequently, the FDA has started publishing position papers and guidelines on what it expects to see in an RMP ( Griffith, 2004 ).

Risk management plans should be used to identify risk ( Griffith 2004 ).

Quality Risk Management is defined as a method for the assessment, control, communication and review of risks to the quality of the drug (medicinal) product through the product lifecycle where decisions can occur at any point in the process ( ICH Q9, 2003 ).

In the guideline entitled Medical Device Use-Safety: incorporating human factors engineering into risk management; it clarifies how hazards related to medical device use should be directed during device development as part of the risk management process ( CDRH, 2000 ).

2.2.2. Quality by design

ICH Q8 defines design space from the concept that quality cannot be tested into product but has to be built in by design ( ICH Q8, 2005–2008 ).

Based on the ICH Q8; which concerns pharmaceutical development with targeting designing quality into the ingredients, formulation and manufacturing process to deliver the intended performance of the product. Design space is presented by the applicant and is subject to regulatory assessment and approval ( ICH Q8, 2005–2008 ).

In these situations, opportunities exist to develop more flexible regulatory approaches.

The design and conduct of pharmaceutical development research should be consistent with their intended scientific purpose ( ICH Q8, 2005–2008 ).

2.2.3. Corrective action and preventive actions

QMS nonconformities and other system deficiencies, including legal noncompliance, should be analyzed to detect patterns or trends. Identifying trends allows the manufacturer to anticipate and prevent future problems ( EPA, 2009 ).

The organization should focus on correcting and preventing problems. Preventing problems is generally cheaper than fixing them after they occur. The organization should also start thinking about problems as opportunities to improve ( EPA, 2009 ).

“Root cause analysis” is a process by which the manufacturer can identify causes and preventive actions ( EPA, 2009 ).

In general, CAPA experts recommend that root-cause investigations follow a four-step process ( Bartholomew, 2006 ):

• • Identify the problem.
• • Evaluate its magnitude, which includes assessing risk.
• • Investigate and assign responsibility.
• • Analyze and document the root cause of the problem.

For example a new corrective action tracking system had helped Alcon Laboratories Inc. unite its many corrective and preventive action systems worldwide resulting in faster time of closure on corrective action, both access and speed to information are much greater and finally quality professionals are able to focus on more important issues ( Davis, 2003 ).

2.2.4. Process capability analysis

Process capability is the comparison of the “Voice of the Customer” (VOC) with the “Voice of the Process” (VOP). VOC, which is built on customer requirements, is defined by the specification limits of the process, which are fixed, while VOP is defined by control limits, which are based on performance data and vary over time ( Tarpley, 2004 ).

Metrics such as capability index namely Cp and Cpk were developed several years ago to calculate this comparison between control and specification limits ( Tarpley, 2004 ).

The capability index a ratio that compares process spread to tolerance spread and results in a single number. It is a management tool which is used to compare process performance ( Ruth II, 2005 ).

2.2.5. Six Sigma

Harry and Schroeder (2000) define Six Sigma as “…a business process that enables companies to increase profits dramatically by streamlining operations, improving quality, and eliminating defects or mistakes in everything a company does….” It can help an organization reduce defects and improve profitability using several basic tenets (Harry and Schroeder, 2000; Johnson and Swisher, 2003; Pande et al., 2000; Williams 2003; Goeke and Offodile, 2005 )

Six Sigma Projects are based on the DMAIC model ( Stamatis, 2002 ).

The DMAIC model is the generic model of six sigma methodology. It is an acronym that stands for; Define, Measure, Analyze, Improve and Control. Sometimes this model includes recognize as an awareness item to the model. Each of the components addresses a different aspect of the overall improvement and breakthrough strategy ( Stamatis, 2002 ).

The pharmaceutical industry sigma level is from 2 to 3; this results in a 25–35% defects ( Hussain, 2005 ).

An example of the pharmaceutical firms that adopted the methodology of Six Sigma is AstraZeneca where the operations and quality staff were trained to apply DMAIC principles every day, to measure and improve performance through cross-functional “continuous improvement” (CI) teams ( Shanley, 2005 ). Two years ago, at Westborough, Massachusetts, cross-functional CI teams involving QA, engineering and operations applied DMAIC principles to solve a major capacity problem for a key product. The teams discovered wasteful processes, effectively adding 20 million extra units of capacity per year. Where a capital investment of less than $100,000 led to $60 million to $70 million in revenue gains, without hiring new staff as Ron Matthews, vice president of manufacturing and supply chain at the company, said ( Shanley, 2005 ).

2.2.6. Process analytical technologies

Process analytical technologies (PAT); play a key role in enabling “quality by design” and scientific aspect of manufacturing. PAT’s main aim is to understand and control the manufacturing process through the application of integrated chemical, physical, microbiological, mathematical and risk analysis methods. PAT has been applied in non-Pharma industries for many years, yielding cost savings and manufacturing efficiencies ( Fraser, 2005 ).

The implementation of process analytical technology (PAT) is bringing lots of benefits and improvements for many pharmaceutical processes. The benefits are lower production cycle times, improved manufacturing efficiency, reduced rejects and increased production operating time ( Rockwell Automation, 2004 ).

Within pharmaceutical industry, there have been a number of successful PAT-based comparability protocol submissions, ranging from single-unit operation application at GlaxoSmithKline to a more all-including application covering both drug substance and drug product at Sanofi-Aventis ( Shanley, 2005 ).

2.2.7. Lean manufacturing

Japanese manufacturers re-building after the Second World War were facing declining human, material, and financial resources. These circumstances led to the development of new, lower cost, manufacturing practices. Early Japanese leaders such as the Toyota Motor Company’s Eiji Toyoda, Taiichi Ohno, and Shingeo Shingo developed a disciplined, process-focused production system now known as the “Toyota Production System”, or “lean production.” The objective of this system was to minimize the consumption of resources that added no value to a product ( Womack et al., 1990 ).

Lean manufacturing is about eliminating waste across an entire company and focusing on the big picture through learning how to do more with less ( Nystuen, 2002 ).

Lean means putting the right things in the right place at the right time the first time while minimizing waste and being open to change. This leads to less waste, less design time, fewer organizational layers, and fewer suppliers with more employee empowerment, more flexibility and capability, more productivity, more customer satisfaction and without a doubt, more long-term competitive success. Lean principles incorporated in the workplace today can spell business survival for the future ( Nave, 2002 ).

In AstraZeneca; rather than being submerged into Lean, the company launched a limited initiative at its global facilities in 2002 which is the Pull Manufacturing; this initiative required that the company’s manufacturing teams shift their focus from output to customer alignment and service. Also, the initiative has lead to reduction in the cycle time. In one case, it allowed lead time for a key $1.5-billion-per year product to be reduced by 25% during a period when demand for the drug was increasing by 30% ( Shanley, 2005 ) (see Table 1 ).

ICH categories and main topics.

Eli Lilly had suffered factory losses – process barely capable with some nonconformance and variability in product quality, the application of lean lead to system improvement and cost savings as shown in the following Table 2 ( Mohan, 2006 ).

The cost of system improvements in Lilly.

2.2.8. Total quality management

Total quality management (TQM) is a concept rather than a technique. It is a philosophy that stresses a systematic, integrated, and consistent perspective that would involve everyone and everything in the organization ( Isaac et al., 2004 ).

TQM is a management philosophy that builds a customer driven, learning organization that is devoted to the total customer satisfaction through continuous improvement in the effectiveness and efficiency of the organization and its corresponding processes ( Corrigan, 1995 ).

TQM is widely known for improving quality and other performances such as productivity, profit, market share, and competitive edge of organizations of various types (Sun, 2000; Isaac et al., 2004 ).

2.2.9. ISO series

ISO 9000 series: ISO 9000 is concerned with “quality management”. This means what the organization does to increase customer satisfaction through meeting customer and regulatory requirements and continually improving its performance ( ISO 9000 and 14001 in brief, 2009 ).

ISO 14000: ISO 14000 is an environmental management system, describes the requirements for an organization’s environmental management system and can be used for certification/registration and/or self declaration of an organization’s environmental management system ( ISO 14001, 2004 ).

This means what the organization does to ( ISO 9000 and 14001 in brief, 2009 ):

• • Minimize harmful effects on the environment caused by its activities.
• • Achieve continual improvement of its environmental performance.

ISO 17025: It gives the general requirements for the competence of testing and calibration laboratories ( ISO/IEC 17025, 2005 ).

A specific version of this standard for Medical Laboratories has been developed; ISO 15189:2003 then ISO 15189, 2007 was published on 19th April 2007 ( ISO 15189, 2007 ).

Through the accreditation process; the testing laboratory reaches the status of an independent institution ( Mettler-Toledo GmbH, 2003 ).

2.2.10. HACCP

The Hazard Analysis and Critical Control Point (HACCP) methodology was known to be a safety management system used in the food industry. Their main aim is to prevent known hazards and to reduce the risks that they will cause at specific points in the food chain (Annex 7; WHO TRS No. 908, 2003 ).

Procedures, including GMP, address operational conditions and provide the basis for HACCP. HACCP is a systematic method for the identification, assessment and control of safety hazards. The hazards are classified as biological, chemical, or physical agents or operations that might cause illness or injury if not controlled. In the manufacture of pharmaceuticals, this includes the manufacture of certain antibiotics, hormones, cytotoxic substances or other highly active pharmaceuticals. Together with operations such as fluid bed drying, granulation is an example of hazard unit operations. The use of inflammable solvents (solutions) and certain laboratory operations may also produce hazards (Annex 7; WHO TRS No. 908, 2003 ).

The HACCP system is based on seven principles (Annex 7; WHO TRS No. 908, 2003 ):

• • Conduct a hazard analysis.
• • Determine the critical control points (CCPs).
• • Establish target levels and critical limit(s).
• • Establish a system to monitor the CCPs.
• • Establish the corrective action to be taken when monitoring indicates that a particular CCP is not under control.
• • Establish procedures to verify that the HACCP system is working effectively.
• • Establish documentation concerning all procedures and keep records appropriate to these principles and their application.

4. Discussions

It is recommended that the literature would invest more in the area of application and significance of guidelines and practices.

Also, there are some new practices that are recently applied to the pharmaceutical industry though they are widely applied in non pharmaceutical industries, such as: the lean manufacturing; the Six Sigma; the total quality management. Both managers at the pharmaceutical industry and literature should focus on the adoption of such practices into the pharmaceutical industry making use of the previous research in the non-pharmaceutical industry application. New case studies should be done to prove the feasibility of such practices.

Peer review under responsibility of King Saud University.

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Why do a literature review?

A literature review is an essential part of the research process. By conducting a review-- searching for and reading articles-- it helps you to understand who else has worked on your topic, methods that have been used to investigate this topic, and results/outcomes from similar studies, and develop your own research questions. When writing a literature review, you selective choose some of the readings you identified during your exploration, and write a short paragraph to prove to readers that your research question is necessary, important, and unanswered.

You do not need to conduct a Systematic Review. A Systematic Review is a research methodology where you attempt to gather all relevant literature describing a narrowly defined question. You may use a systematic technique to ensure you have searched relevant databases thoroughly, but your literature review does not need to be as extensive as a Systematic Review.

For a literature review, expect:

- That you will read two articles or book chapters for every one included in your final written review.

- You will need to search 2-6 subject-specific databases containing articles, book chapters, dissertations/theses, and other scholarly output. This typically happens at the start of the review.

- Your goal is to be thorough: expect to use both keywords and indexing terms to search databases

- You may need to use statistical sources, newspaper articles, articles from popular press magazines, reports from government organizations, or other types of unique sources in your review. These are unlikely to be a major part of your literature review, but can help to prove that a problem is widespread and deserving of research attention.

Process of a literature review

1. Define your question-- develop a hypothesis or research question.  For example, "If we teach nurses to use asthma puffers correctly, does this increase patient-reported compliance with use of puffers and increase the rate of refills?"

2. Consider which databases would best provide information on your topic. Databases tend to focus on disciplines or subjects. If your research is about clinical use of drugs, you may only need to use clinically-focused databases. If your research concerns motivation for behavior, you may want to use psychology databases. If your research question is about economics of drugs, you may want to use business/economics-focused databases. Use this list of databases on this page or talk to a librarian to find the best databases for researching your question.

2. Break apart your question into concepts. With the question above, major concepts include nurses, asthma puffers, drug compliance, technique, refills.

3. For each concept, brainstorm synonyms. For example, puffer= inhaler, Flovent (or other brand names), etc.

3a. If using an indexed database like PubMed, look for the preferred indexing term for each concept and add it to your synonym list.

4. Combine the synonyms in your database. Use OR to connect synonyms. Use AND to connect different concepts. For example: (Nurse OR nurses) AND (inhaler OR puffer) AND (education OR training OR instruction).

4a. It is sometimes easier to look for research covering parts of your question rather than the whole. It is unlikely that there has been research on exactly your topic (nurses, and asthma puffers, and instruction, and compliance, and refills). Consider looking for research on nurses and inhalers; instruction with inhalers and if that affects patient compliance; use of puffers and refill rates; or other ways to break down the question into smaller parts.

5. Examine the results in your first database by reading the abstracts. Add to your list of synonyms by seeing what terms are used in the abstracts, and consider re-running the search with additional terms. Create a list of materials from this database that seem relevant. Next, download the full text of articles, book chapters, etc. on your list. Get older articles in print from the library's print collections. Repeat this process in your other databases.

6. Read the materials you found in step 5. Consider whether the information you have found allows you to demonstrate:

• That your topic is relevant and important, and deserves you and your group spending a year in investigating it.
• That you have found articles that cover a relevant timeframe and scope for your question.
• That you have seen any landmark studies, or major studies that have changed thinking on a topic. Not every topic area has landmark studies.
• That you can summarize the research methods that have been used to study this question/problem before and their results.

7. If you cannot demonstrate each of these, repeat steps 4 and 5 until you can.

8. Write your literature review, summarizing why your question/problem is important, other methods that have been used to investigate this problem and what they have found, and explain why your research question will help fill gaps in current knowledge. You can consider using the FINER criteria (Feasible, Interesting, Novel, Ethical, Relevant) to ensure you have covered the key aspects of the topic in enough depth. You will likely cite/reference about half the items you read. Your goal here is to select enough materials to demonstrate that you know this topic, without overwhelming your audience.

Help on literature reviews

• Bailey's Research for the Health Professional, 3rd ed ISBN: 9780803645134 Includes detailed help on literature reviews

Databases to use

USC subscribes to over 1300 databases, so only the primary databases you may use are listed here. If these do not cover your topic fully, examine the A-Z list of databases and read descriptions, or ask a librarian for help.

• Databases licensed by USC Libraries This link opens in a new window A-Z list of all databases licensed by USC Libraries.

Clinical databases

• CINAHL Complete This link opens in a new window Most comprehensive database of full-text for nursing & allied health journals from 1937 to present. Includes access to scholarly journal articles, dissertations, magazines, pamphlets, evidence-based care sheets, books, and research instruments.
• Embase This link opens in a new window Embase provides access to over more than 29 million citations for biomedical articles and conference proceedings. This version has been customized for USC users to find the full-text of articles from library holdings.

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• Biosis Citation Index This link opens in a new window Life sciences and biomedical research database covering pre-clinical and experimental research, methods and instrumentation, animal studies, and more.
• International Pharmaceutical Abstracts (Ovid) This link opens in a new window Worldwide coverage of pharmaceutical science and practice literature. Includes coverage of drug development, pharmacoeconomics, toxicity, regulation, and technology.
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• ERIC (ProQuest) This link opens in a new window Education focused database.
• Global Health This link opens in a new window Public health database, focus on international coverage.
• PsycINFO This link opens in a new window Abstract and citation database of scholarly literature in psychological, social, behavioral, and health sciences. Includes journal articles, books, reports, theses, and dissertations from 1806 to present.
• EconLit This link opens in a new window Literature in economics.

General Databases These databases include multiple subjects. They are useful databases for looking for landmark studies; determining if your topic is well-studied by another subject (as this would lead you to select a database that focuses on just that subject); and ensuring you did not miss research published in prominent scientific journals.

• Scopus This link opens in a new window Large abstract and citation database of peer-reviewed literature in science, technology, medicine, social sciences, and arts and humanities. Includes bibliometrics tools to track, analyze and visualize research.
• Web of Science This link opens in a new window
• Google Scholar This link opens in a new window Filtered Google Search finding scholarly journal articles, books, citations, and case law.

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• Using Review Articles Review this handout to make sure you're using review articles appropriately.
• Quick Citing Reference- AMA 11th ed 2 page handout covering the basics of using AMA style, 11th edition
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PHARMACY MANAGEMENT SYSTEM OF PUBLIC SECTOR 2016 PHARMACY MANAGEMENT SYSTEM OF PUBLIC SECTOR PHARMACY MANAGEMENT SYSTEM OF PUBLIC SECTOR 2016

Pharmacy management system that is designed to enhance the security and management system to improve the accuracy and efficiency in pharmaceutical stores. It is a computer-based inventory management system, the cost; the pharmacist helps to improve medical safety, etc.

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Muhammad Abdul Hadi

Keywords: Adverse Drug Reactions, Pharmacist, Pharmacovigilance, Malaysia reporting rate is mainly due to reporting by pharmacists working in the public sector. Adverse drug reaction reports generated by pharmacists increased from 726 (28.5%) in 2006 to 3357 (57.4%) in 200911. On the other hand, the contribution by physicians towards ADR reporting was 22.9% in 200911. The increase in the number of reports submitted by pharmacists could be a reflection of the increase in pharmacists working in public hospitals.

Eric Mbonyi

Pharmaceutical practices have evolved over time to become fully encompassed in all aspects of pharmacy itself. Such practices include: dispensing of drugs, consultation, drug regulation, and the sale of these drugs. The community pharmacies and hospital pharmacies have key roles to play in the pharmaceutical practices. For the community pharmacies in Sub-Saharan Africa, a strict approach to the sale and dispensation of drugs is not normally the case, due to the fact that laws governing pharmaceutical practices have not been fully enforced. On the part of the hospital pharmacies, there is a more controlled approach to the dispensing of drugs, as the prescriptions are readily available from the in-house doctors. There is a need for these practices to be fully enforced, and a management system introduced to the fray. With software such as the Online Pharmaceutical Management System, which provides a platform has been provided to help with drug regulation, as well as providing ease to all parties involved. The methodology used in the implementation of the software is the Incremental Model of System Development Life Cycle, which allows room for scalability as time goes on. Creating an Online Pharmaceutical Management System would help in pharmaceutical practices for all parties involved. It is eminent that the system provides a safe, secure and verified platform for all parties which help to bridge the communication gap and provide legitimate drugs. Therefore, if all recommendations are strictly adhered to, there will be strict monitoring and regulation of how drugs are circulated and a decrease in the spread of fake drugs.

Alan Lyles , T. Fulda

BACKGROUND: The Omnibus Budget Reconciliation Act of 1990 offered the promise that prospective drug utilization review (pDUR) systems would improve the quality of drug prescribing and patient drug use. There is little evidence that this promise has been fulfilled. To the contrary, there is growing evidence that suboptimal use of drugs (in terms of preventable drug-related morbidity) is at least

Journal of Computer Science IJCSIS

Mobile technologies are fast developing and it has completely changed the way we interact and provide healthcare services. The rapid spread of mobile technologies and inventive applications to address health related problems has evolved into a new field known as mobile-Health. The purpose of this research is to improve the quality and access to health care services with the aid of mobile-Health application software known as “Crescent Mobile Health”. This paper will address the problem of self medication by creating a channel of communication between a patient and doctor at distant environment there by solving emergency situations. The method used to address this problem is by designing and developing mobile-Health application software, which can be used by patients via an android smartphone that is used to communicate with a doctor/pharmacist/laboratory scientist using electronic-Health application software known as Crescent Health Information System on a desktop via the intranet. The two applications on smartphone and desktop are able to communicate via instant messaging by a persistent connection known as “sockets” and “pusher” which provides implementation for interconnectivity. The Crescent Health Information System can carry out major functionalities such as drugs and tests inventory, instant messaging, prescriptions of drugs, prescription of tests and profile update. The Crescent Mobile Health can also carry out functionalities such as instant messaging, viewing of prescribed drugs, tests, health tips and help file. The mobile-Health application software was developed using java programming language and android development studio while the electronic-Health (E-Health) application software was developed using PHP programming language and MYSQL database. The results of the development of this project concludes that mobile-Health application software has been able to resolve the problem of communication between a patient and a doctor and has provided a means to verify drugs available and tests carried out in the clinic/health sector. https://sites.google.com/site/ijcsis/

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