Nice Guidelines

NICE clinical guidelines are recommendations on the appropriate treatment and care of people with specific diseases and conditions within the NHS in England and Wales. They are based on the best available evidence and aim to improve the quality of healthcare by changing the process of healthcare and improving people's chances of getting as well as possible. NICE clinical guidelines:

The NICE guidelines for glaucoma1 gave key priorities for implementation in the management of glaucoma and ocular hypertension. It includes the minimum assessments and investigations. We assessed the adherence to NICE glaucoma guidelines in a university hospital. In addition, we assessed variation of investigations in relation to grade of doctor and final documentation of diagnosis.

Nice Guidelines

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The records of 50 consecutive new referrals for glaucoma, from September to December 2009, were reviewed. The records of the 25 patients who were diagnosed with glaucoma (including suspects) or ocular hypertension were further analysed. A pro forma of the NICE guidelines was created, which included age and sex of patient, investigations, documentation of diagnosis, and grade of doctor.

Adherence to the NICE glaucoma guidelines is varied and depends on whether the patient is seen by a non-glaucoma or a glaucoma specialist. The key priorities highlighted by the guidelines need to be reinforced to improve adherence for a more adequate patient assessment. This sequentially can lead to fewer patients receiving avoidable follow-up appointments.

This resource series, curated by the BGS Cardiovascular SIG, brings together key principles and guidelines on the management of cardiovascular disease in older adults. This section looks at syncope or transient loss of consciousness (TLOC).

Clinical guidelines and tailored resources from NICE on supporting people with dementia, mental wellbeing of older people in care homes and a video illustrating the NICE quality standards for mental wellbeing in care homes.

In relation to the rapid guidelines, we remained independent from government. The guidelines were developed at the request of NHS England and NHS Improvement in response to the COVID-19 pandemic, a level 4 national emergency. Normally a topic selection oversight group at NICE considers topics for guideline development, taking into account a range of factors such as:

On 17 March 2021, we moved our priorities for the first wave of the pandemic to publish only those guidelines that were therapeutically critical and/or addressed COVID-19 diagnostic or therapeutic interventions. We worked with NHS England and NHS Improvement to identify topics to support managing symptoms of COVID-19, managing conditions that increased risk, or providing services during the pandemic. We developed interim process and methods that retained the core elements of scoping, evidence search and retrieval, working with experts, consultation, equality impact assessment and quality assurance. Inevitably, because of the urgency with which the guidance was required by the system, the process was rapid.

Because COVID-19 is a new disease, evidence and practice are developing rapidly and we have implemented a process to keep the guidelines up to date as new evidence emerges. The guidelines have been very well received by clinicians and commissioners and our rapid response widely praised.

The National Institute for Health and Clinical Excellence (NICE) produces clinical guidelines for the National Health Service (NHS) in England and Wales. These guidelines are developed by groups that combine people with expertise in conducting systematic reviews and health economic analyses, with those with expertise in the clinical area (from healthcare professionals and patients). During guideline development, the group poses about 20 to 25 clinical questions, which are then addressed by systematic reviews. As described in the NICE Guidelines Manual,[1] groups routinely search for existing relevant systematic reviews. The NHS funds NICE and makes substantial contributions to The Cochrane Collaboration, so there is a common interest in making the best use of Cochrane Reviews for informing guidelines. One way of assessing the extent to which systematic reviews are used in guidelines is to look at the number of citations of reviews in each guideline. In a recent piece of work, we aimed to find out the extent of citation of Cochrane Reviews in NICE guidelines.

The coding of Cochrane Reviews by CRG used the CRG listed in the latest version of the CDSR; if the Cochrane Review cited in the guideline was not in the latest version, we used the Cochrane Review with the most similar title to the citation. The citations in guidelines may be several years old, authors and titles of Cochrane Reviews change, and some Cochrane Reviews are allocated to new CRGs. Therefore, there may be some errors in these data, but it is likely these are only a small percentage.

The data show that some CRGs do not have any Cochrane Reviews cited in NICE guidelines, which may be because they do not map clearly on to the topics covered to date in NICE clinical guidelines. More recently established CRGs would also have had less chance to both develop Cochrane Reviews and have them cited. Even with these limitations, the data show the extensive use of Cochrane Reviews in the development of NICE clinical guidelines. Preliminary work in analysing the types of questions posed in NICE guidelines suggests that around half of the questions concern interventions of the type addressed by most Cochrane Reviews, with a mean of about 14 intervention questions per guideline.

This idea of working together is not new, and there have been a number of initiatives around particular clinical guidelines to make better use of Cochrane Reviews.[2, 3] Within England and Wales, there is an increasing appetite to try to make this relationship work better for mutual benefit. In September 2011, there will be a workshop between the clinical guidelines team at NICE and several people with various roles in The Cochrane Collaboration. Let's make this the start of a constructive dialogue to make sure all our efforts better inform clinical practice.

The work, from Annette Pluddemann, Richard Hobbs, Kamal R. Mahtani, Trisha Greenhalgh and Carl Heneghan, has been used to support one of four new guidelines recently published by the National Institute for Health and Care excellence (NICE). 2351a5e196