Analytical Method Validation In Herbal Products: Challenges, Strategies, And Global Regulatory Guidelines
Keywords:
Analytical method validation, Herbal products, Phytochemical standardization, Quality control, Regulatory guidelines, Chromatographic fingerprintingAbstract
In the fields of pharmaceutical and nutraceutical sciences, validating analytical techniques for herbal products is a challenging and dynamic task. Due to differences in plant species, growing circumstances, harvesting methods, and processing techniques, herbal formulations are naturally more varied than synthetic medications. Because of this inherent diversity, repeatability is a constant problem and the creation of uniform markers is made more difficult. Furthermore, sophisticated analytical instruments that can accurately evaluate identification, purity, potency, and stability are required due to the coexistence of several bioactive components in herbal medicines. When used alone, traditional techniques like HPLC, GC, and UV spectrophotometry are frequently insufficient, which leads researchers to turn to hyphenated and high-resolution approaches like LC–MS, NMR, and metabolomics-based profiling. Global regulatory frameworks, including as those of the US FDA, WHO, EMA, and AYUSH in India, place a strong emphasis on the necessity of scientifically proven techniques to guarantee the efficacy, safety, and quality of products. However, recommendations frequently have different standards, which makes worldwide harmonization and compliance difficult. The acceptance of herbal medicines and worldwide trade are made more difficult by this discrepancy. A comprehensive strategy that incorporates risk-based validation principles customized for herbal matrices, chemometric instrument application, reference standard utilization, and robust method development is required to overcome these obstacles. In the end, method validation for herbal medicines is not just a legal obligation; it is also a scientific necessity to protect patient safety and boost trust in conventional treatments as they become more widely used in healthcare. Innovative approaches and international collaboration to address these issues will open the door to more uniform quality standards and increased adoption of herbal remedies..
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Hosbas Coskun S, Wise SA, Kuszak AJ. The Importance of Reference Materials and Method Validation for Advancing Research on the Health Effects of Dietary Supplements and Other Natural Products. Frontiers in nutrition. 2021;8:786261.
2. Seo CS, Shin HK. Quality assessment of traditional herbal formula, Hyeonggaeyeongyo-tang through simultaneous determination of twenty marker components by HPLC-PDA and LC-MS/MS. Saudi pharmaceutical journal : SPJ : the official publication of the Saudi Pharmaceutical Society. 2020;28(4):427-39.
3. Pratiwi R, Dipadharma RHF, Prayugo IJ, Layandro OA. Recent Analytical Method for Detection of Chemical Adulterants in Herbal Medicine. 2021;26(21):6606.
4. van Breemen RB. Development of Safe and Effective Botanical Dietary Supplements. Journal of medicinal chemistry. 2015;58(21):8360-72.
5. Blessy M, Patel RD, Prajapati PN, Agrawal YK. Development of forced degradation and stability indicating studies of drugs-A review. Journal of pharmaceutical analysis. 2014;4(3):159-65.
6. Gafner S, Blumenthal M, Foster S, Cardellina JH, 2nd, Khan IA, Upton R. Botanical Ingredient Forensics: Detection of Attempts to Deceive Commonly Used Analytical Methods for Authenticating Herbal Dietary and Food Ingredients and Supplements. Journal of natural products. 2023;86(2):460-72.
7. An YL, Li JY, Wei WL, Li Y, Zhang JQ, Yao CL, et al. An automatic LC-MS/MS data analysis workflow for herbal compound annotation with AutoAnnotatoR: A case study of ten botanical origins of Fritillaria species. Phytomedicine : international journal of phytotherapy and phytopharmacology. 2024;135:156193.
8. Abraham EJ, Kellogg JJ. Chemometric-Guided Approaches for Profiling and Authenticating Botanical Materials. Frontiers in nutrition. 2021;8:780228.
9. Saberi N, Akhgari M, Bahmanabadi L, Bazmi E, Mousavi Z. Determination of synthetic pharmaceutical adulterants in herbal weight gain supplements sold in herb shops, Tehran, Iran. Daru : journal of Faculty of Pharmacy, Tehran University of Medical Sciences. 2018;26(2):117-27.
10. Seo CS, Shin HK. Simultaneous Analysis for Quality Control of Traditional Herbal Medicine, Gungha-Tang, Using Liquid Chromatography-Tandem Mass Spectrometry. Molecules (Basel, Switzerland). 2022;27(4).
11. Pratiwi R, Dipadharma RHF, Prayugo IJ, Layandro OA. Recent Analytical Method for Detection of Chemical Adulterants in Herbal Medicine. Molecules (Basel, Switzerland). 2021;26(21).
12. Sarma N, Upton R, Rose U, Guo D-a, Marles R, Khan I, et al. Pharmacopeial Standards for the Quality Control of Botanical Dietary Supplements in the United States. Journal of Dietary Supplements. 2021;20:1-20.
13. Ekor M. The growing use of herbal medicines: issues relating to adverse reactions and challenges in monitoring safety. Frontiers in pharmacology. 2014;4:177.
14. Habibi P, Shi Y, Fatima Grossi-de-Sa M, Khan I. Plants as Sources of Natural and Recombinant Antimalaria Agents. Molecular biotechnology. 2022;64(11):1177-97.
15. Indrayanto G. The importance of method validation in herbal drug research. Journal of pharmaceutical and biomedical analysis. 2022;214:114735.
16. Zhang J, Wider B, Shang H, Li X, Ernst E. Quality of herbal medicines: challenges and solutions. Complementary therapies in medicine. 2012;20(1-2):100-6.
17. Wang H, Chen Y, Wang L, Liu Q, Yang S, Wang C. Advancing herbal medicine: enhancing product quality and safety through robust quality control practices. Frontiers in pharmacology. 2023;14:1265178.
18. Fitzgerald M, Heinrich M, Booker A. Medicinal Plant Analysis: A Historical and Regional Discussion of Emergent Complex Techniques. Frontiers in pharmacology. 2019;10:1480.
19. Parveen A, Parveen B, Parveen R, Ahmad S. Challenges and guidelines for clinical trial of herbal drugs. Journal of pharmacy & bioallied sciences. 2015;7(4):329-33.
20. Zhou GL, Su SL, Yu L, Shang EX, Hua YQ, Yu H, et al. Exploring the liver toxicity mechanism of Tripterygium wilfordii extract based on metabolomics, network pharmacological analysis and experimental validation. Journal of ethnopharmacology. 2025;337(Pt 2):118888.
21. Wang Y, Dacosta C, Wang W, Zhou Z, Liu M, Bao Y. Synergy between sulforaphane and selenium in protection against oxidative damage in colonic CCD841 cells. Nutrition research (New York, NY). 2015;35(7):610-7.
22. Choudhury A, Singh PA, Bajwa N, Dash S, Bisht P. Pharmacovigilance of herbal medicines: Concerns and future prospects. Journal of ethnopharmacology. 2023;309:116383.
23. Liu J, He C, Tang Y, Liu W, Xu Y, Li Z, et al. A review of Cremastra appendiculata (D.Don) Makino as a traditional herbal medicine and its main components. Journal of ethnopharmacology. 2021;279:114357.
24. Noviana E, Indrayanto G, Rohman A. Advances in Fingerprint Analysis for Standardization and Quality Control of Herbal Medicines. Frontiers in pharmacology. 2022;13:853023.
25. Posadzki P, Watson L, Ernst E. Contamination and adulteration of herbal medicinal products (HMPs): an overview of systematic reviews. European journal of clinical pharmacology. 2013;69(3):295-307.
26. Luo L, Wang B, Jiang J, Fitzgerald M, Huang Q, Yu Z, et al. Heavy Metal Contaminations in Herbal Medicines: Determination, Comprehensive Risk Assessments, and Solutions. Frontiers in pharmacology. 2020;11:595335.
27. Opuni KFM, Kretchy JP, Agyabeng K, Boadu JA, Adanu T, Ankamah S, et al. Contamination of herbal medicinal products in low-and-middle-income countries: A systematic review. Heliyon. 2023;9(9):e19370.
28. Cassidy B, Bloomingdale T, Carmody J. Navigating ICH Q2(R2) compliance in analytical method validation: A gap analysis toolkit to streamline risk assessment and change management. Journal of pharmaceutical sciences. 2025;114(6):103749.
29. Verstraete J, Kiekens F, Strobbe S, De Steur H, Gellynck X, Van Der Straeten D, et al. Clinical determination of folates: recent analytical strategies and challenges. Analytical and bioanalytical chemistry. 2019;411(19):4383-99.
30. Rao W, Li L, Zhang C, Zheng J, Fan X, Luan B, et al. Development and validation of a stability-indicating RP-HPLC method for the determination of fifteen impurities in rivaroxaban. Journal of pharmaceutical and biomedical analysis. 2023;228:115325.
31. Cui D, Li Y, Lian M, Yang F, Meng Q. Development of a simple and stability-indicating RP-HPLC method for determining olanzapine and related impurities generated in the preparative process. The Analyst. 2011;136(15):3149-56.
32. Krishnaiah C, Vishnu Murthy M, Kumar R, Mukkanti K. Development of a stability-indicating UPLC method for determining olanzapine and its associated degradation products present in active pharmaceutical ingredients and pharmaceutical dosage forms. Journal of pharmaceutical and biomedical analysis. 2011;54(4):667-73.
33. Pydimarry SP, Cholleti VK, Vangala RR. Stability-indicating UPLC method for determining related substances and degradants in dronedarone. Journal of chromatographic science. 2014;52(7):666-75.
34. Shi ZQ, Song DF, Li RQ, Yang H, Qi LW, Xin GZ, et al. Identification of effective combinatorial markers for quality standardization of herbal medicines. Journal of chromatography A. 2014;1345:78-85.
35. Guo L, Duan L, Dou LL, Liu LL, Yang H, Liu EH, et al. Quality standardization of herbal medicines using effective compounds combination as labeled constituents. Journal of pharmaceutical and biomedical analysis. 2016;129:320-31.
36. Dursunoğlu B, Yuca H, Güvenalp Z, Gözcü S, Yilmaz B. Simultaneous Determination of Arbutin and Hydroquinone in Different Herbal Slimming Products Using Gas Chromatography-mass Spectrometry. Turkish journal of pharmaceutical sciences. 2018;15(3):298-303.
37. Jurica K, Karačonji IB, Šegan S, Opsenica DM, Kremer D. Quantitative analysis of arbutin and hydroquinone in strawberry tree (Arbutus unedo L., Ericaceae) leaves by gas chromatography-mass spectrometry. Arhiv za higijenu rada i toksikologiju. 2015;66(3):197-202.
38. Martin AR. Spectroscopic methods in biology, with application to neurophysiology. Advances in biological and medical physics. 1973;14:225-84.
39. Sasidharan S, Chen Y, Saravanan D, Sundram KM, Yoga Latha L. Extraction, isolation and characterization of bioactive compounds from plants' extracts. African journal of traditional, complementary, and alternative medicines : AJTCAM. 2011;8(1):1-10.
40. Ong ES. Extraction methods and chemical standardization of botanicals and herbal preparations. Journal of chromatography B, Analytical technologies in the biomedical and life sciences. 2004;812(1-2):23-33.
41. Riswanto FDO, Windarsih A, Lukitaningsih E, Rafi M, Fadzilah NA, Rohman A. Metabolite Fingerprinting Based on (1)H-NMR Spectroscopy and Liquid Chromatography for the Authentication of Herbal Products. Molecules (Basel, Switzerland). 2022;27(4).
42. Liu C, Zuo Z, Xu F, Wang Y. Authentication of Herbal Medicines Based on Modern Analytical Technology Combined with Chemometrics Approach: A Review. Critical reviews in analytical chemistry. 2023;53(7):1393-418.
43. Sdrigotti N, Collard M, Purcaro G. Evolution of hyphenated techniques for mineral oil analysis in food. Journal of separation science. 2021;44(1):464-82.
44. Wagner M, Oellig C. Screening for mineral oil saturated and aromatic hydrocarbons in paper and cardboard directly by planar solid phase extraction and by its coupling to gas chromatography. Journal of chromatography A. 2019;1588:48-57.
45. Wagner M, Oellig C. Screening for mineral oil hydrocarbons in vegetable oils by silver ion-planar solid phase extraction. Journal of chromatography A. 2022;1662:462732.
46. García-Cicourel AR, van de Velde B, Roskam G, Janssen HG. Supercritical fluid chromatography as a rapid single-step method for the determination of mineral oil saturated and aromatic hydrocarbons in purified mineral oils for food and cosmetics applications. Journal of chromatography A. 2020;1614:460713.
47. Khalil I, Hashem A, Nath AR, Muhd Julkapli N, Yehye WA, Basirun WJ. DNA/Nano based advanced genetic detection tools for authentication of species: Strategies, prospects and limitations. Molecular and cellular probes. 2021;59:101758.
48. Campuzano S, Ruiz-Valdepeñas Montiel V, Serafín V, Yáñez-Sedeño P, Pingarrón JM. Cutting-Edge Advances in Electrochemical Affinity Biosensing at Different Molecular Level of Emerging Food Allergens and Adulterants. Biosensors. 2020;10(2).
49. Georget M, Pisan E. [Next Generation Sequencing (NGS) for beginners]. Revue des maladies respiratoires. 2023;40(4):345-58.
50. Slatko BE, Gardner AF, Ausubel FM. Overview of Next-Generation Sequencing Technologies. Current protocols in molecular biology. 2018;122(1):e59.
51. Patel R, Purohit S, Solanki R, Khunt D, Patel C, Patel R, et al. Development and validation of an analytical method for trace-level quantification of genotoxic nitrosamine impurities in losartan and hydrochlorothiazide fixed-dose combination tablets using ultra performance liquid chromatography triple quadrupole mass spectrometry. Rapid communications in mass spectrometry : RCM. 2023;37(8):e9488.
52. Pum J. A practical guide to validation and verification of analytical methods in the clinical laboratory. Advances in clinical chemistry. 2019;90:215-81.
53. Abeillé A, Hemforth B, Winckel E, Gibson E. Extraction from subjects: Differences in acceptability depend on the discourse function of the construction. Cognition. 2020;204:104293.
54. Gururani R, Patel S, Yaduvanshi N, Dwivedi J, Paliwal S, Sharma S. Tylophora indica (Burm. f.) merr: An insight into phytochemistry and pharmacology. Journal of ethnopharmacology. 2020;262:113122.
55. Srinivasan M, Gangurde A, Chandane AY, Tagalpallewar A, Pawar A, Baheti AM. Integrating network pharmacology and in silico analysis deciphers Withaferin-A's anti-breast cancer potential via hedgehog pathway and target network interplay. Briefings in bioinformatics. 2024;25(2).
56. Kumar S, Singh R, Gajbhiye N, Dhanani T. Extraction Optimization for Phenolic- and Withanolide-Rich Fractions from Withania somnifera Roots: Identification and Quantification of Withaferin A, 12-Deoxywithastromonolide, and Withanolide A in Plant Materials and Marketed Formulations Using a Reversed-Phase HPLC-Photodiode Array Detection Method. Journal of AOAC International. 2018;101(6):1773-80.
57. Zellner L, Wierer M, Himmelsbach M, Schatzmann B, Thalhamer B, Klampfl CW. Determination of Withanolides and Withanosides in Ashwagandha Based Products Using HPLC-Drift-Tube-Ion-Mobility Quadrupole Time-of-Flight Mass Spectrometry. Electrophoresis. 2025;46(5-6):340-6.
58. Araujo P. Key aspects of analytical method validation and linearity evaluation. Journal of chromatography B, Analytical technologies in the biomedical and life sciences. 2009;877(23):2224-34.
59. Balkrishna A, Joshi M, Tomer M, Verma S, Gujral S, Mulay VP, et al. Identification, Validation and Standardization of Bioactive Molecules Using UPLC/MS-QToF, UHPLC and HPTLC in Divya-Denguenil-Vati: A Penta-Herbal Formulation for Dengue Fever. Chromatographia. 2022;85(9):831-50.
60. Balkrishna A, Verma S, Sharma P, Tomer M, Srivastava J, Varshney A. Comprehensive and Rapid Quality Evaluation Method for the Ayurvedic Medicine Divya-Swasari-Vati Using Two Analytical Techniques: UPLC/QToF MS and HPLC-DAD. Pharmaceuticals (Basel, Switzerland). 2021;14(4).
61. Balkrishna A, Sharma P, Joshi M, Srivastava J, Varshney A. Development and validation of a rapid high-performance thin-layer chromatographic method for quantification of gallic acid, cinnamic acid, piperine, eugenol, and glycyrrhizin in Divya-Swasari-Vati, an ayurvedic medicine for respiratory ailments. Journal of separation science. 2021;44(16):3146-57.
62. Jalil B, Heinrich M. Pharmaceutical quality of herbal medicinal products and dietary supplements - a case study with oral solid formulations containing Lavandula species. European journal of pharmaceutical sciences : official journal of the European Federation for Pharmaceutical Sciences. 2025;208:107042.
63. Trapmann S, Linsinger TPJ, Koeber R. Certified reference materials for GMO analysis-more than 25 years of GMO CRM production at EC JRC. Analytical and bioanalytical chemistry. 2025;417(12):2387-403.
64. Rajpoot M, Bhattacharya R, Sharma S, Gupta S, Sharma V, Sharma AK. Melamine contamination and associated health risks: Gut microbiota does make a difference. Biotechnology and applied biochemistry. 2021;68(6):1271-80.
65. Cuadros-Rodríguez L, Ortega-Gavilán F, Martín-Torres S, Arroyo-Cerezo A, Jiménez-Carvelo AM. Chromatographic Fingerprinting and Food Identity/Quality: Potentials and Challenges. Journal of agricultural and food chemistry. 2021;69(48):14428-34.
66. Cuadros-Rodríguez L, Ruiz-Samblás C, Valverde-Som L, Pérez-Castaño E, González-Casado A. Chromatographic fingerprinting: An innovative approach for food 'identitation' and food authentication - A tutorial. Analytica chimica acta. 2016;909:9-23.
67. O'Neill F, McLoughlin E, Riwanto M, Manz J, Adler A, Sutill E, et al. Reproducibility and biological variability of HDL's vascular functional assays. Atherosclerosis. 2015;241(2):588-94.
68. Townsend BA, Sihlahla I, Naidoo M, Naidoo S, Donnelly DL, Thaldar DW. Mapping the regulatory landscape of AI in healthcare in Africa. Frontiers in pharmacology. 2023;14:1214422.
69. Mykhailenko O, Buydin Y, Ivanauskas L, Krechun A, Georgiyants V. Innovative GACP Approaches for Obtaining the Quality Iris hybrida Leaves for the Pharmaceutical Industry. Chemistry & biodiversity. 2022;19(4):e202200149.
70. Gerschler S, Neumann N, Schultze N, Guenther S, Schulze C. Quality parameters for the medicinal plant Drosera rotundifolia L.: A new approach with established techniques. Archiv der Pharmazie. 2024;357(1):e2300436.
71. Eberle M, Wasylenko JT, Kostelac D, Kiehna S, Schellinger A, Zhang Z, et al. A Modern Framework for Analytical Procedure Development and Lifecycle Management Based on ICH Q14 Principles. Analytical chemistry. 2025;97(1):12-21.
72. Sudsakorn S, Bahadduri P, Fretland J, Lu C. 2020 FDA Drug-drug Interaction Guidance: A Comparison Analysis and Action Plan by Pharmaceutical Industrial Scientists. Current drug metabolism. 2020;21(6):403-26.
73. Bidwell J, Whelply K, Shepard S, Hariadi J. A Contextual Inquiry: FDA Investigational New Drug Clinical Review. AMIA Joint Summits on Translational Science proceedings AMIA Joint Summits on Translational Science. 2021;2021:122-31.
74. Holbein ME, Berglund JP, Weatherwax K, Gerber DE, Adamo JE. Access to Investigational Drugs: FDA Expanded Access Programs or "Right-to-Try" Legislation? Clinical and translational science. 2015;8(5):526-32.
75. Bateman-House A, Robertson CT. The Federal Right to Try Act of 2017-A Wrong Turn for Access to Investigational Drugs and the Path Forward. JAMA internal medicine. 2018;178(3):321-2.
76. Pagani E, Ropke CD, Soares CM, Perez SAC, Benevides PJC, Barbosa BS, et al. Technology Readiness Level Roadmap for Developing Innovative Herbal Medicinal Products. Pharmaceuticals (Basel, Switzerland). 2024;17(6).
77. Qu L, Zou W, Wang Y, Wang M. European regulation model for herbal medicine: The assessment of the EU monograph and the safety and efficacy evaluation in marketing authorization or registration in Member States. Phytomedicine : international journal of phytotherapy and phytopharmacology. 2018;42:219-25.
78. Qu L, Li X, Xiong Y, Wang Z, Zhou Y, Zou W, et al. Opportunities and hurdles to European market access for multi-herbal traditional Chinese medicine products: An analysis of EU regulations for combination herbal medicinal products. Pharmacological research. 2022;186:106528.
79. Xiong Y, Li M, Sun P, Liang W, Hornbeck RG, Che X, et al. Market access for Chinese herbal medicinal products in Europe-A ten-year review of relevant products, policies, and challenges. Phytomedicine : international journal of phytotherapy and phytopharmacology. 2022;103:154237.
80. Qu LP, Zhang XQ, Xiong Y, Wang YT, Zou WJ. [Analysis of difficult problems on European Union laws and regulations of traditional herbal medicinal products]. Zhongguo Zhong yao za zhi = Zhongguo zhongyao zazhi = China journal of Chinese materia medica. 2017;42(20):4040-4.
81. Muthappan S, Elumalai R, Shanmugasundaram N, Johnraja N, Prasath H, Ambigadoss P, et al. AYUSH digital initiatives: Harnessing the power of digital technology for India's traditional medical systems. Journal of Ayurveda and integrative medicine. 2022;13(2):100498.
82. Muthappan S, Bagepally BS, Ponnaiah M. Promoting health economic evaluation studies in the AYUSH system of medicine: the need of the hour. International journal of technology assessment in health care. 2021;37(1):e82.
83. Leong F, Hua X, Wang M, Chen T, Song Y, Tu P, et al. Quality standard of traditional Chinese medicines: comparison between European Pharmacopoeia and Chinese Pharmacopoeia and recent advances. Chinese medicine. 2020;15:76.
84. Liao B, Hu H, Xiao S, Zhou G, Sun W, Chu Y, et al. Global Pharmacopoeia Genome Database is an integrated and mineable genomic database for traditional medicines derived from eight international pharmacopoeias. Science China Life sciences. 2022;65(4):809-17.
85. Park JH, Fernando K, Park YH, Park EO. Global perspectives on bipolar disorder treatment: in-depth comparative analysis of international guidelines for medication selection. BJPsych open. 2024;10(3):e75.
86. Abramovits W, Gupta AK. Veregen (sinecatechins ointment) 15%. Skinmed. 2010;8(1):46-9.
87. Veregen: a botanical for treatment of genital warts. The Medical letter on drugs and therapeutics. 2008;50(1280):15-6.
88. Kamal S, Malik S, Batool F, Rehman K, Akash MSH. Metabolomics of heavy metal exposure. Advances in clinical chemistry. 2025;128:109-54.
89. Sahana S, Sarkar J, Mandal S, Chatterjee I, Dhar S, Datta S, et al. Multi-omics approaches: transforming the landscape of natural product isolation. Functional & integrative genomics. 2025;25(1):132.
90. Amin A, Zaman W, Park S. Harnessing Multi-Omics and Predictive Modeling for Climate-Resilient Crop Breeding: From Genomes to Fields. Genes. 2025;16(7).
91. Theodosiou AA, Read RC. Artificial intelligence, machine learning and deep learning: Potential resources for the infection clinician. The Journal of infection. 2023;87(4):287-94.
92. Praveen SV, Deepika R. Exploring the perspective of infection clinicians on the integration of Large Language Models (LLMs) in clinical practice: A deep learning study in healthcare. The Journal of infection. 2023;87(4):e68-e9.
93. Abd-Alrazaq A, AlSaad R, Alhuwail D, Ahmed A, Healy PM, Latifi S, et al. Large Language Models in Medical Education: Opportunities, Challenges, and Future Directions. JMIR medical education. 2023;9:e48291.
94. Claman D, Sezgin E. Artificial Intelligence in Dental Education: Opportunities and Challenges of Large Language Models and Multimodal Foundation Models. JMIR medical education. 2024;10:e52346.
95. Uddin M, Salah K, Jayaraman R, Pesic S, Ellahham S. Blockchain for drug traceability: Architectures and open challenges. Health informatics journal. 2021;27(2):14604582211011228.
96. Akram W, Joshi R, Haider T, Sharma P, Jain V, Garud N, et al. Blockchain technology: A potential tool for the management of pharma supply chain. Research in social & administrative pharmacy : RSAP. 2024;20(6):156-64.
97. Kumar D, Tanwar R, Kar Mahapatra D, Lohan N, Dahiya G, Jain D. Assessment of Blockchain Technology in the Improvement of Supply Chain Management in the Pharmaceutical Industry. Recent patents on biotechnology. 2025.
98. Li Z, Yin S, Feng J, Gao X, Yang Q, Zhu F. Acupuncture combined with Chinese herbal medicine in the treatment of perimenopausal insomnia: A systematic review and meta-analysis. Medicine. 2023;102(45):e35942.
99. Porceddu SV, Daniels C, Yom SS, Liu H, Waldron J, Gregoire V, et al. Head and Neck Cancer International Group (HNCIG) Consensus Guidelines for the Delivery of Postoperative Radiation Therapy in Complex Cutaneous Squamous Cell Carcinoma of the Head and Neck (cSCCHN). International journal of radiation oncology, biology, physics. 2020;107(4):641-51.
100. Grégoire V, Evans M, Le QT, Bourhis J, Budach V, Chen A, et al. Delineation of the primary tumour Clinical Target Volumes (CTV-P) in laryngeal, hypopharyngeal, oropharyngeal and oral cavity squamous cell carcinoma: AIRO, CACA, DAHANCA, EORTC, GEORCC, GORTEC, HKNPCSG, HNCIG, IAG-KHT, LPRHHT, NCIC CTG, NCRI, NRG Oncology, PHNS, SBRT, SOMERA, SRO, SSHNO, TROG consensus guidelines. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. 2018;126(1):3-24.
101. Gordon M, Nigam GB, Sinopoulou V, Al Bakir I, Bateman AC, Din S, et al. Update from 2010 (standard operating procedure): protocol for the 2024 British Society of Gastroenterology Guidelines on colorectal surveillance in inflammatory bowel disease. BMJ open gastroenterology. 2024;11(1).
102. Lutgens M, van Oijen M, Mooiweer E, van der Valk M, Vleggaar F, Siersema P, et al. A risk-profiling approach for surveillance of inflammatory bowel disease-colorectal carcinoma is more cost-effective: a comparative cost-effectiveness analysis between international guidelines. Gastrointestinal endoscopy. 2014;80(5):842-8.
103. Harris C, Allen K, Ramsey W, King R, Green S. Sustainability in Health care by Allocating Resources Effectively (SHARE) 11: reporting outcomes of an evidence-driven approach to disinvestment in a local healthcare setting. BMC health services research. 2018;18(1):386.
104. Harris C, Allen K, Brooke V, Dyer T, Waller C, King R, et al. Sustainability in Health care by Allocating Resources Effectively (SHARE) 6: investigating methods to identify, prioritise, implement and evaluate disinvestment projects in a local healthcare setting. BMC health services research. 2017;17(1):370.
105. Walsh-Bailey C, Tsai E, Tabak RG, Morshed AB, Norton WE, McKay VR, et al. A scoping review of de-implementation frameworks and models. Implementation science : IS. 2021;16(1):100
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