Headache is one of the most common clinical complaints and is listed as one of the top 10 disability disorders by the World Health Organization (WHO). For standardizing the diagnosis and treatment of headache and improve the level of clinical diagnosis and treatment of traditional Chinese medicine (TCM), on 30 January 2019, China Association of Chinese Medicine officially issued the Guidelines for Diagnosis and Treatment of Common Internal Diseases in Chinese Medicine-Headache (T/CACM 1271–2019). The Guidelines were developed following the method process recommended by Technical Requirements for the Revision of TCM Clinical Diagnosis and Treatment Guidelines (pilot edition), and also referring to WHO Handbook for Guideline Development. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was also followed. The protocol was formulated by the guideline project team, which comprised of specialists of TCM encephalopathy, guideline methodologist, patient representative, etc. Question regarding the treatment of headaches in TCM were formulated and 18 most important ones were chosen as PICOs (population, intervention, comparison, outcomes). Comprehensive search and review of the literature were performed and the quality of the evidence was assessed and rated based on certain criteria. Twenty-five recommendations were put forward in the Guidelines through three rounds of expert consensus based on their quality of evidence, in addition to the balance of pros and cons of these interventions, patient preferences and values, and economic factors. It is the first and the only clinical practice guide for Chinese medicine accepted by National Guidelines Clearinghouse in the world.

Background: Many healthcare professionals use smartphones and tablets to inform patient care. Contemporary research suggests that handheld computers may support aspects of clinical diagnosis and management. This systematic review was designed to synthesise high quality evidence to answer the question; Does healthcare professionals' use of handheld computers improve their access to information and support clinical decision making at the point of care? Methods: A detailed search was conducted using Cochrane, MEDLINE, EMBASE, PsycINFO, Science and Social Science Citation Indices since 2001. Interventions promoting healthcare professionals seeking information or making clinical decisions using handheld computers were included. Classroom learning and the use of laptop computers were excluded. Two authors independently selected studies, assessed quality using the Cochrane Risk of Bias tool and extracted data. High levels of data heterogeneity negated statistical synthesis. Instead, evidence for effectiveness was summarised narratively, according to each study's aim for assessing the impact of handheld computer use. Results: We included seven randomised trials investigating medical or nursing staffs' use of Personal Digital Assistants. Effectiveness was demonstrated across three distinct functions that emerged from the data: accessing information for clinical knowledge, adherence to guidelines and diagnostic decision making. When healthcare professionals used handheld computers to access clinical information, their knowledge improved significantly more than peers who used paper resources. When clinical guideline recommendations were presented on handheld computers, clinicians made significantly safer prescribing decisions and adhered more closely to recommendations than peers using paper resources. Finally, healthcare professionals made significantly more appropriate diagnostic decisions using clinical decision making tools on handheld computers compared to colleagues who did not have access to these tools. For these clinical decisions, the numbers need to test/screen were all less than 11. Conclusion: Healthcare professionals' use of handheld computers may improve their information seeking, adherence to guidelines and clinical decision making. Handheld computers can provide real time access to and analysis of clinical information. The integration of clinical decision support systems within handheld computers offers clinicians the highest level of synthesised evidence at the point of care. Future research is needed to replicate these early results and to identify beneficial clinical outcomes.

Background The process of implementation of clinical guidelines i.e. getting guidelines into practice has been extensively reviewed and meta-reviewed from a generic perspective. However, in relation to stroke care, there has been no review of these studies to date, although implementing stroke clinical guidelines is a topic of great interest within the stroke literature. This review aims to identify stroke studies that have addressed adherence to generic and specific stroke care clinical guidelines. Method A computer search was conducted using PubMed, CINAHL, PsychINFO, Web of Science and the Cochrane Systematic Reviews databases. Search terms included those relevant to the implementation of stroke clinical guidelines. We assessed all studies retrieved against specific inclusion criteria and collated only those studies that emphasized adherence to stroke clinical guidelines. Results Eighty-eight articles were selected for further review from 153 articles retrieved. Of those, 27 were studies on adherence to stroke clinical guidelines and were included in this review – 16 were categorized as generic stroke guidelines and 11 were on specific aspects of stroke care. Each category was further divided into studies that assessed adherence to stroke guidelines only and those that intervened to improve adherence. Adherence was generally greater for studies that included an intervention. Specific stroke care guidelines were poorly adhered to compared to generic stroke guidelines but these studies were better at identifying organizational and team barriers to implementation. Most studies conducted audits of patient medical records and a limited number assessed health professionals’ views or used a behavioural framework to assess adherence. Discussion Adherence to stroke guidelines varied in the studies reviewed. Given the evidence that implementation of clinical guidelines in stroke care leads to better quality of care and improved health outcomes for patients, there is a need to increase adherence behaviours of health professionals towards recommended guidelines, in particular for long term stroke care.

Purpose and setting This review aimed to evaluate the effectiveness of strategies to implement clinical guidelines for chronic disease management in primary care in EU Member States. Methods We conducted a systematic review of interventional studies assessing the implementation of clinical guidelines. We searched five databases (EMBASE, MEDLINE, CENTRAL, Eppi-Centre and Clinicaltrials.gov) following a strict Cochrane methodology. We included studies focusing on the management of chronic diseases in adults in primary care. Results A total of 21 studies were found. The implementation strategy was fully effective in only four (19%), partially effective in eight (38%), and not effective in nine (43%). The probability that an intervention would be effective was only slightly higher with multifaceted strategies, compared to single interventions. However, effect size varied across studies; therefore it was not possible to determine the most successful strategy. Only eight studies evaluated the impact on patients’ health and only two of those showed significant improvement, while in five there was an improvement in the process of care which did not translate into an improvement in health outcomes. Only four studies reported any data on the cost of the implementation but none undertook a cost-effectiveness analysis. Only one study presented data on the barriers to the implementation of guidelines, noting a lack of awareness and agreement about clinical guidelines. Conclusion Our results reveal that there are only a few rigorous studies which assess the effectiveness of a strategy to implement clinical guidelines in Europe. Moreover, the results are not consistent in showing which strategy is the most appropriate to facilitate their implementation. Therefore, further research is needed to develop more rigorous studies to evaluate health outcomes associated with the implementation of clinical guidelines; to assess the cost-effectiveness of implementing clinical guidelines; and to investigate the perspective of service users and health service staff.