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Clinical practice guidelines (CPGs) have been developed for many years with the aim of improving the quality of care. A review of the use of CPGs and assessments of CPG compliance among practitioners so far would aid the understanding of factors influencing CPG compliance. This study seeks to provide this.

A general review and discussion of CPGs in areas of their attributes, benefits and pitfalls were carried out. Articles concerning the assessment of CPG compliance were also reviewed to understand the kind of data collected for such assessments (qualitative vs quantitative), the methods used to collect data (objective versus subjective), and the assessment measures employed (process versus outcome).

A total of 57 CPG compliance assessment studies were reviewed. Almost two‐thirds employed objective methods. Of the subjective assessments, 47 per cent analysed solely quantitative data, 32 per cent analysed solely qualitative information and 21 per cent analysed both. More than four‐fifths of all studies used process measures to determine CPG compliance and only 5 per cent used solely outcome measures.

Depending on the methods used, assessments can help identify various factors influencing CPG compliance. Such factors may be related to the physician, guidelines, health system or patient. A good understanding of these factors and their role in influencing compliance behaviour will help health regulators and administrators plan better and more effective strategies to improve doctors' CPG compliance.

This review looks at the various aspects of CPGs to understand how these influence practitioners' compliance.

This paper aims at understanding how clinical guidelines' use in the labour process relates to clinical autonomy, that is, the self-control medical professionals exercise over medical practice.

Drawing on a qualitative case study research strategy, this paper explores how medical professionals use clinical guidelines in the labour process in one public general hospital of the Greek National Health System. Supplemented by an extensive study of documents, semi-structured interviews were conducted with 33 doctors of several specialties.

The analysis shows (1) how clinical autonomy, as a self-control structure, mediates the use of clinical guidelines as a knowledge tool in the labour process, and (2) how employing clinical guidelines as a means towards coordinating medical work, but also towards regulating and standardising medical practice, is exercising pressure on the individualistic character of clinical autonomy.

Advancing the analytic value of workplace control structures, this paper contributes novel theoretical understanding of emerging tendencies characterising medical work organisation and clinical autonomy, and explains how medical professionals' non-adherence to clinical practice guidelines (CPGs) relates to CPGs' role as a resource to medical practice. Finally, this research proposes a more critical approach to health policy towards addressing the challenges associated with centrally introducing clinical guidelines in healthcare organisations.

The purpose of this paper is to critically analyze empirical studies related to the implementation strategies for clinical practice guidelines (CPGs) in intensive care units (ICUs).

A systematic review with a narrative synthesis adapted from Popay et al.’s method for a narrative synthesis was conducted. A search using CINAHL, Google Scholar, Academic search complete, Cochrane Register for Randomized Controlled Trials, MEDLINE via PUBMED and grey literature was conducted in 2014 and updated in 2016 (August). After reading the abstracts, titles and full-text articles, 11 (n=11) research studies met the inclusion criteria.

After critical appraisal, using the Joanna Briggs Critical Appraisal Tools, eight randomized controlled trials conducted in adult and neonatal ICUs using implementation strategies remained. Popay et al.’s method for narrative synthesis was adapted and used to analyze and synthesize the data and formulate concluding statements. Included studies found that multi-faceted strategies appear to be more effective than single strategies. Strategies mostly used were printed educational materials, information/ sessions, audit, feedback, use of champion leaders, educational outreach visits, and computer or internet usage. Practical training, monitoring visits and grand rounds were less used.

Findings can be used by clinicians to implement the best combination of multi-faceted implementation strategies in the ICUs in order to enhance the optimal use of CPGs.

No systematic review was previously done on the implementation strategies that should be used best for optimal CPG implementation in the ICU.

The purpose of this paper is to model a motor region named the mesencephalic locomotors region (MLR) which is located in the end part of the brain and first part of the spinal cord. This model will be used for a Nao soccer player humanoid robot. It consists of three main parts: High Level Decision Unit (HLDU), MLR‐Learner and the CPG layer. The authors focus on a special type of decision making named curvilinear walking.

The authors' model is based on stimulation of some programmable central pattern generators (PCPGs) to generate curvilinear bipedal walking patterns. PCPGs are made from adaptive Hopfs oscillators. High level decision, i.e. curvilinear bipedal walking, will be formulated as a policy gradient learning problem over some free parameters of the robot CPG controller.

The paper provides a basic model for generating different types of motions in humanoid robots using only simple stimulation of a CPG layer. A suitable and fast curvilinear walk has been achieved on a Nao humanoid robot, which is similar to human ordinary walking. This model can be extended and used in other types of humanoid.

The authors' work is limited to a special type of biped locomotion. Different types of other motions are encouraged to be tested and evaluated by this model.

The paper introduces a bio‐inspired model of skill learning for humanoid robots. It is used for curvilinear bipedal walking pattern, which is a beneficial movement in soccer‐playing Nao robots in Robocup competitions.

The paper uses a new biological motor concept in artificial humanoid robots, which is the mesencephalic locomotor region.

The recent development of clinical practice heuristics is a logical consequence of outcomes and effectiveness research. Proponents of clinical practice guidelines (CPGs) believe they will lower costs, enhance quality, and reduce the incidence of malpractice claims. Although the process for generating CPGs appears relatively uncomplicated, guidelines alone do not produce lasting changes in physician behaviour. Discusses strategies for implementing CPGs based on the various factors that influence physician behaviour. Recommends direct behaviour management strategy based on financial contingencies.

This paper aims to imitate a cownose ray to develop a fish robot with paired flexible multi-fin-ray oscillating pectoral fins (OPFs) and control it to accomplish vivid stable 3-D motions using central pattern generators (CPGs) and fuzzy algorithm.

The cownose ray’s asymmetric sine-like oscillations were analyzed. Then a cownose-ray-like fish robot named Robo-ray was developed, which has paired flexible multi-fin-ray OPFs to actively control the fin shape and two tail fins to control the depth. To solve the problem of coordinated control for multi-degree-of-freedom Robo-ray, CPGs were adopted. An improved phase oscillator as a CPG unit with controlled amplitude, phase lag, smooth frequency transition and asymmetric oscillation characteristic was established. Furthermore, the CPG-fuzzy algorithm was developed for vivid stable 3-D motions. The open-loop speed control, the closed-loop control of depth and yaw were established.

The kinematic comparisons indicate that Robo-ray imitates the cownose ray realistically. The experimental results of closed-loop are obtained that the depth error of Robo-ray is less than ±100 mm and the course error is less than ±3°. Furthermore, the comprehensive experiments demonstrate that Robo-ray has high mobility, stability and robustness.

This research makes the fish robot with OPF propulsion closer to practical applications in complex underwater environment, for instance, ocean explorations, water quality monitoring and stealth military reconnaissance. In addition, Robo-ray can be taken as a scientific tool for better understanding of the hydrodynamics of OPF batoid.

Good medical practice, evidence-based medicine (EBM) and clinical practice guidelines (CPG) have been recurring subjects in the scientific literature. EBM advocates argue that good medical practice should be guided by evidence-based CPG. On the other hand, critical authors of EBM methodology argue that various interests undermine the quality of evidence and reliability of CPG recommendations. The purpose of this paper is to evaluate patient related outcomes of CPG implementation, in light of EBM critics.

The authors opted for a rapid literature review.

There are few studies evaluating the effectiveness of CPG in patient-related outcomes. The systematic reviews found are not conclusive, although they suggest a positive impact of CPGs in relevant outcomes.

This work was not a systematic review of literature, which is its main limitation. On the other hand, arguments from EBM and CPG critics were considered, and thus it can enlighten health institutions to recognize the caveats and to establish policies toward care improvement.

The paper is the first of its kind to discuss, based on the published literature, next steps toward better health practice, while acknowledging the caveats of this process.

The purpose of this paper is to generate a virtual knee angle reference to be followed by a knee prosthesis control, using an adaptive central pattern generator (CPG). Also, to study the feasibility of this approach to implement a continuous control strategy on the prosthesis.

A CPG based on amplitude controlled phase oscillators (ACPOs) to track the current percentage of gait cycle on the prosthesis is proposed. Then, the virtual knee angle reference is generated along gait cycle, by interpolation with the corresponding angle of a sound knee. The structure and coupling of the CPG, as well as the control strategy are presented.

The coupling of the CPG with real gait on the prosthesis was proven, regardless of gait speed. Also, it was found that the maximum knee angle reached during walking is proportional to gait speed. Finally, generation of virtual knee angle reference to be followed by a prosthesis is demonstrated.

As only one event detected along gait cycle was used to update the CPG phase, the response to gait speed changes might be slow. Updating the CPG with more events remains for a future work.

The coupling of the CPG with real gait on the prosthesis results in a continuous gait cycle tracker, useful for any control strategy to be applied.

It is the first time a bio‐inspired concept as CPGs is applied to the prosthetic field. This could mean the beginning of a new era of cybernetic prostheses, which reproduce the lost limb and also the control functions of it.

In 2002 the Singapore Ministry of Health (MOH) audited doctors' compliance with diabetes clinical practice guidelines in public healthcare institutions and attempted to postulate factors that influenced the degree of conformity. This study aims to address this issue

A retrospective cross‐sectional chart review of diabetes patient records sampled from hospital specialist outpatient clinics (SOCs) and polyclinics was performed. Childhood, gestational and secondary diabetes cases were excluded. The nine audit parameters used were process measures concerning the assessment of HbA1c, weight, blood pressure, urinary protein, serum creatinine, serum lipids, electrocardiography, retina and feet. Age‐standardised prevalence rate ratios of parameter adherence were calculated. Of the SOC cases, 89 per cent were analysed. Of the polyclinic cases, 94 per cent were analysed.

Adherence to ECG and foot assessment parameters was poor among SOC cases, while poor adherence to weight and foot assessment parameters was seen in the polyclinics. There was poorer adherence to blood pressure and ECG parameters in the SOCs, but better adherence was seen for weight assessment. Among the SOC cases, Cluster A fared better than Cluster B in ECG monitoring. In the polyclinics, better adherence was seen in Cluster A for urinary protein, serum creatinine, lipids, ECG, retinal and foot assessment parameters.

Based on pre‐existing information on local diabetes care, certain system, physician, patient and guideline factors are postulated to explain clinical practice guideline non‐compliance among doctors.

The Path.Finder NHS consortium consists of ten acute hospitals sharing a common approach to the production and dissemination of local information for primary care, including clinical practice guidelines. Ten local guidelines were studied across four clinical areas: dyspepsia, lipids, eczema, and menorrhagia. Local guideline developers largely appear to be unconvinced that investment of time and resources in “proper” guideline development is cost‐effective. At the same time, primary care professionals’ views about future NICE guidelines may have been coloured by their current much more variable experience. Successful implementation of local guidelines is unlikely to be straightforward.