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Evidence-based Chinese Medicine Clinical Practice Guideline for Stroke in Hong Kong.

ABSTRACT: Background: Stroke in Chinese Medicine (CM) includes the concepts of ischemic and hemorrhagic strokes from Western Medicine and is a common disease in Hong Kong. This clinical practice guideline (CPG) aims to evaluate and demonstrate CM treatment options for stroke, provide guideline for local CM practice, and act as a reference for decision makers on drafting CM related health policies.

Methods: Based on the principle of multidisciplinary integration and evidence-based medicine, a steering committee oversaw the CPG development process in accordance with a published protocol. Clinical questions and evidences were identified, appraised, and synthesised through systematic literature reviews, text mining, and two rounds of Delphi surveys with a multidisciplinary panel of experts.

Results: In this CPG, we defined stroke from the perspectives of both CM and Western Medicine, reported corresponding CM treatment options, and carried out evaluation based on levels of evidence and grade of recommendation. Suggested CM interventions include herbal medicine treatment based on pattern differentiation, acupuncture treatment, and nursing care.

Conclusion: The target population is Hong Kong stroke patients with prodrome or sequela stage. This CPG is intended to help standardizing CM clinical practice and enhancing efficiency of clinical service in Hong Kong.

SUBMITTER: Zhong LLD

PROVIDER: S-EPMC7607854 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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Evidence-based Chinese Medicine Clinical Practice Guideline for Stroke in Hong Kong.

Zhong Linda L D LLD Kun Wai W Shi Nannan N Ziea Tat Chi TC Ng Bacon F L BFL Gao Ying Y Bian Zhaoxiang Z Lu Aiping A

Chinese medicine 20201103 1

<h4>Background</h4>Stroke in Chinese Medicine (CM) includes the concepts of ischemic and hemorrhagic strokes from Western Medicine and is a common disease in Hong Kong. This clinical practice guideline (CPG) aims to evaluate and demonstrate CM treatment options for stroke, provide guideline for local CM practice, and act as a reference for decision makers on drafting CM related health policies.<h4>Methods</h4>Based on the principle of multidisciplinary integration and evidence-based medicine, a ...[more]

PMID: 33292342

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Project description:BackgroundIn response to the World Health Organization's recommendation, policy makers have been adopting evidence-based healthcare approach to promote the development of traditional, complementary and integrative medicine (TCIM) into Hong Kong's health system. Disseminating synopses of clinical evidence from systematic reviews or randomized trials is regarded as a potentially effective strategy to promote evidence uptake. The study aimed to identify barriers and facilitators to implementing this strategy among Hong Kong Chinese medicine practitioners (CMPs).MethodsTwenty-five CMPs aged under 45 years and trained in Hong Kong after reunification with China in 1997 were interviewed individually. Four clinical evidence synopses of randomized trials and systematic reviews on Chinese medicine interventions were presented, and CMPs were asked to comment on their applicability in routine practice. The Consolidated Framework for Implementation Research (CFIR) was applied to guide interview and analysis.ResultsThe barriers included: i) CMPs' perceived difficulties in applying complex evidence in decision-making and ii) inadequate training and limited consultation time. The facilitators were i) availability of publicly accessible and user-friendly synopses, ii) formation of community of evidence-based practice among CMPs with input from key opinion leaders, iii) opportunity for interprofessional collaborations with conventional healthcare providers, and iv) patients' demand for evidence-based clinical advice. Besides, i) CMPs' knowledge and beliefs in evidence-based healthcare approach, ii) presentations of evidence-based information in the synopses, and iii) clinical decision making as influenced by quality of evidence reported acted as both barriers and facilitators.ConclusionsThis CFIR-based qualitative study investigated how the World Health Organization recommendation of promoting evidence use in routine practice was perceived by CMPs trained in Hong Kong after reunification with China in 1997. Key barriers and facilitators to applying evidence were identified. Such results will inform tailoring of implementation strategies for promoting evidence uptake, in the context of a well-developed health system dominated by conventional medicine.

Project description:IntroductionThis guideline establishes clinical practice recommendations for the diagnosis of obstructive sleep apnea (OSA) in adults and is intended for use in conjunction with other American Academy of Sleep Medicine (AASM) guidelines on the evaluation and treatment of sleep-disordered breathing in adults.MethodsThe AASM commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence. The task force developed recommendations and assigned strengths based on the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use. In addition, the task force adopted foundational recommendations from prior guidelines as "good practice statements", that establish the basis for appropriate and effective diagnosis of OSA. The AASM Board of Directors approved the final recommendations.RecommendationsThe following recommendations are intended as a guide for clinicians diagnosing OSA in adults. Under GRADE, a STRONG recommendation is one that clinicians should follow under most circumstances. A WEAK recommendation reflects a lower degree of certainty regarding the outcome and appropriateness of the patient-care strategy for all patients. The ultimate judgment regarding propriety of any specific care must be made by the clinician in light of the individual circumstances presented by the patient, available diagnostic tools, accessible treatment options, and resources. Good Practice Statements: Diagnostic testing for OSA should be performed in conjunction with a comprehensive sleep evaluation and adequate follow-up. Polysomnography is the standard diagnostic test for the diagnosis of OSA in adult patients in whom there is a concern for OSA based on a comprehensive sleep evaluation.Recommendations: We recommend that clinical tools, questionnaires and prediction algorithms not be used to diagnose OSA in adults, in the absence of polysomnography or home sleep apnea testing. (STRONG). We recommend that polysomnography, or home sleep apnea testing with a technically adequate device, be used for the diagnosis of OSA in uncomplicated adult patients presenting with signs and symptoms that indicate an increased risk of moderate to severe OSA. (STRONG). We recommend that if a single home sleep apnea test is negative, inconclusive, or technically inadequate, polysomnography be performed for the diagnosis of OSA. (STRONG). We recommend that polysomnography, rather than home sleep apnea testing, be used for the diagnosis of OSA in patients with significant cardiorespiratory disease, potential respiratory muscle weakness due to neuromuscular condition, awake hypoventilation or suspicion of sleep related hypoventilation, chronic opioid medication use, history of stroke or severe insomnia. (STRONG). We suggest that, if clinically appropriate, a split-night diagnostic protocol, rather than a full-night diagnostic protocol for polysomnography be used for the diagnosis of OSA. (WEAK). We suggest that when the initial polysomnogram is negative and clinical suspicion for OSA remains, a second polysomnogram be considered for the diagnosis of OSA. (WEAK).

Project description:ObjectiveThere were studies evaluating advanced nursing practice independently in the mainland and Hong Kong Special Administrative Region of China, but there was no attempt to make a comparison of practice between them. This study employed a case study method to examine and compare advanced nursing practice in Hong Kong and Guangzhou.MethodPurposive sampling method was used to recruit 24 advanced practice nurses (APN) who came from the specialty of medical, surgical and pediatric in Hong Kong and Guangzhou. A questionnaire survey and semi-structured interview were conducted to solicit quantitative and qualitative data for exploring the structure-process-outcome of advanced nursing practice. The structure component explored the factors influencing advanced nursing practice. The process part examined APN role components and illustrations of exemplary advanced nursing practice. The outcomes described outcome indicators that best reflected advanced nursing practice.FindingsFindings revealed that in the structure domain, APN education and career development, team approach in healthcare, and support from management, physicians and professional associations were important contextual factors for APN development in both cities. For the process domain, participants had at least 80% of their time practicing independently/interdependently and were engaged in APN activities including direct/indirect patient care, research/project work, initiation of staff and patient protocols. All participants demonstrated competencies with impacts on patient, service and profession in their description of exemplary practice. Participants from both cities ranked patient-related outcomes as top indicators for their advanced nursing practice.ConclusionThis study has revealed that APNs in Guangzhou and Hong Kong shared similar work involvement and impacts and their demonstrated competencies were on par with international counterparts. Continued efforts need to be put in establishing formal APN education, clear clinical career pathway and title protection to empower nurses to provide optimal care to the fullest extent that they are prepared for.

Dataset Information

Evidence-based Chinese Medicine Clinical Practice Guideline for Stroke in Hong Kong.

Publications

Evidence-based Chinese Medicine Clinical Practice Guideline for Stroke in Hong Kong.

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