As we develop guidance, we identify gaps and uncertainties in the evidence base which could benefit from further research. The most important unanswered questions are developed into research recommendations. Read our process and methods guide (PDF).

Browse the list below to find a topic of interest. Only research recommendations made from 2011 onwards are shown. Please contact us if you need more information.



Recommendation ID Recommendation Name
CG103/01

Delirium assessment tools:
What is the diagnostic accuracy, and ease of implementation, of different delirium assessment tools:

  • for people with pre-existing cognitive impairment, for example dementia, learning disability or severe depression
  • for people who do not speak English as a first language
  • in different settings, for example emergency departments, residential care homes or virtual consultations
  • when delivered by different types of health and social care practitioners, for example healthcare assistants or allied health professionals such as paramedics?
CG103/02

Pharmacological prevention: In people in hospital who are at high risk of delirium, which medication (atypical antipsychotics, typical antipsychotics, benzodiazepines or acetylcholinesterase inhibitors), compared with placebo or each other, is more clinically and cost effective in preventing the development of delirium?

CG103/03

Pharmacological treatment: In people in hospital who have delirium, which is the most effective medication (atypical antipsychotics, typical antipsychotics or benzodiazepines) compared with placebo or each other for treating delirium?

CG103/04

Multicomponent intervention: For people in long-term care, is a multicomponent non-pharmacological intervention more clinically and cost effective than usual care in preventing the development of delirium?

CG103/05

Delirium in long-term care: How common is delirium and what are its adverse outcomes in people in long-term care?

CG103/06

Education programme: Does a staff education programme (compared with an educational leaflet or usual care) reduce the incidence of delirium and improve the recognition and recording of delirium in people in hospital?

CG113/1 What is the relative effectiveness of sertraline compared with cognitive behavioural therapy (CBT) in people with generalised anxiety disorder (GAD) that has not responded to guided self-help and psychoeducation in a stepped-care model?
CG113/2 In well-defined generalised anxiety disorder (GAD), what is the clinical and cost effectiveness of two cognitive behavioural therapy (CBT) based low-intensity interventions (CCBT and guided bibliotherapy) compared with a waiting-list control?
CG113/3 For people with generalised anxiety disorder (GAD) who are ready to start a low-intensity intervention, what is the clinical effectiveness of physical activity compared with waiting-list control?
CG113/4 Is chamomile/ginkgo biloba more effective than placebo in increasing response and remission rates and decreasing anxiety ratings for people with generalised anxiety disorder (GAD)?
CG113/5 What are the benefits of a primary care-based collaborative care approach to improving the treatment of generalised anxiety disorder (GAD) compared with usual care?
CG113/6 In well-defined panic disorder, what is the clinical and cost effectiveness of two cognitive behavioural therapy (CBT) based low-intensity interventions (CCBT and guided bibliotherapy) compared with a waiting-list control?
CG114/1 Intravenous iron in children:- A prospective study of adequate duration of intravenous iron preparations in children with anaemia of chronic kidney disease (CKD), including safety, dosing and efficacy outcomes.
CG114/2 Trials of erythropoiesis-stimulating agents (ESAs) in children:- Trials of ESAs in children with anaemia of chronic kidney disease (CKD) (including darbepoetin, which is currently not licensed for use in children younger than 12 years) including safety, dosing and efficacy outcomes.
CG114/3 Haemoglobin levels in older people:- An observational study of haemoglobin (Hb) levels and adverse outcomes in older people.
CG114/4 Erythropoiesis-stimulating agent (ESA) tolerance test:- A trial of an ESA tolerance test including collection of data on ESA regimens and haemoglobin (Hb) levels achieved.
CG114/5 Iron levels in pre-dialysis patients:- A randomised controlled trial to assess haemoglobin (Hb) level as an outcome in pre-dialysis patients treated to serum ferritin levels lower than 200 micrograms/l versus those treated to 300–500 micrograms/l.
CG115/1 Is contingency management effective in reducing alcohol consumption in people who misuse alcohol compared with standard care?
CG115/2 What methods are most effective for assessing and diagnosing the presence and severity of alcohol misuse in children and young people?
CG115/3 Is acupuncture effective in reducing alcohol consumption compared with standard care?
CG115/4 For which service users who are moderately and severely dependent on alcohol is an assertive community treatment model a clinically and cost-effective intervention compared with standard care?
CG115/5 For people with moderate and severe alcohol dependence who have significant comorbid problems, is an intensive residential rehabilitation programme clinically and cost effective when compared with intensive community-based care?
CG115/6 For people with alcohol dependence, which medication is most likely to improve adherence and thereby promote abstinence and prevent relapse?
CG116/1 Prevalence and natural history of non-IgE-mediated food allergy:- How common are non-IgE-mediated food allergies in children and young people in primary care and community settings and when food allergies may be outgrown?
CG116/2 Clinical predictors of non-IgE-mediated food allergy:- Which features in the clinical history best predict the presence of non-IgEmediated food allergy in children and young people in primary care and community settings?
CG116/3 Information needs for children and young people:- during their care pathway to diagnosis of food allergy:- What do children and young people with IgE-mediated food allergy and their parents or carers want to know during the process of diagnosis and how is this demand best met?
CG116/4 Values of skin prick testing and specific IgE antibody testing and their predictive value:- Can skin prick testing and specific IgE antibody testing cut-off points be established to diagnose IgE-mediated food allergy in children and young people, and to predict the severity of reaction?
CG116/5 Modes of provision of support to healthcare professionals:- What would be the impact of dietetic telephone support to healthcare professionals to aid in the diagnosis and assessment of babies showing non-IgE-mediated food allergy symptoms in primary care and community settings?
CG117/1 Interferon-gamma tests: - A diagnostic and qualitative study is needed to assess whether interferon-gamma tests are acceptable to patients and are more effective than tuberculin skin tests for:
• predicting subsequent development of active e tuberculosis (TB), or
• diagnosing or ruling out current active TB
when undertaking TB screening in:
• new entrants from high TB prevalence countries
• healthcare workers
• children in high-risk areas who missed neonatal Bl Bacille Calmette-Guèrin (BCG)
• contacts of people with sputum smear-positive TB
• HIV positive patients.
This study should compare the strategies of Mantoux test only, Mantoux test then interferon gamma test if positive, and interferon gamma test only.
CG117/2 Directly observed therapy:- A cluster randomised controlled trial of directly observed therapy (DOT) compared with self-administered treatment for latent and/or active tuberculosis (TB) should be conducted in a UK population. This should be targeted at homeless people, and those with a history of non-adherence, alcoholism, drug abuse or mental illness.
CG117/3 New entrant screening and treatment for latent tuberculosis (TB) infection:- A study is needed of people found by new entrant screening to be Mantoux positive and interferon-gamma positive, to establish better estimates of the cost effectiveness of screening and treatment for latent TB infection in this population. This could identify factors predisposing people to developing active TB so that more effective targeted treatment programmes can be developed for latent TB infection.
CG117/4 Protective effects of Bacille Calmette-Guèrin (BCG):- A case-control study is needed, comparing people who developed active or latent tuberculosis (TB) with those who did not, and comparing the proportions of people in each group who had been vaccinated and the time since vaccination. The aim will be to derive improved estimates of protective efficacy and duration of protection of the BCG vaccine.
CG117/5 Quality of life:- A study is needed to ascertain quality-of-life score estimates from those with tuberculosis (TB) (both active disease and latent infection), including adverse treatment effects, using an appropriate quality-of-life instrument. This will improve economic decision-making throughout TB care.
CG117/6 Contact tracing in household contacts and homeless people:- Research is needed to determine whether contact tracing is more effective (in terms of identifying cases of latent infection and active disease) among household contacts than among street homeless contacts of patients with confirmed tuberculosis (TB) (including those using direct-access hostels for the homeless).
CG117/7 Incentives for attending new entrant screening:- Research is needed to determine whether Port of Arrival scheme referrals with incentives for attending screening identify more cases of latent tuberculosis (TB) infection and active TB disease in new entrants than Port of Arrival scheme referrals with no incentives.
CG117/8 Incentives for homeless people attending chest X-ray screening:- Research is needed to determine whether incentives for attending chest X-ray screening achieve better coverage in the homeless population, or identify more cases of latent tuberculosis (TB) infection and active TB disease, than no incentives.
CG118/1 Surveillance programmes for people at increased risk of colorectal cancer:- How effective are colonoscopic surveillance programmes in improving overall survival and cancer-related survival in people at increased risk of colorectal cancer?
CG118/2 Natural history of progression to colorectal cancer in people at increased risk:- What is the natural history of progression to colorectal cancer in people with inflammatory bowel disease (IBD) or adenomas?
CG118/3 Effectiveness of biomarkers for determining level of risk of colorectal cancer:- Which biomarkers, including epigenic and genetic markers, are predictors of colorectal cancer? How should these be used to improve risk stratification?
CG118/4 Adenoma types and risk of colorectal cancer:- Does the risk of colorectal cancer depend on the type of adenoma?
CG119/1 Further research should be undertaken to determine the clinical and cost effectiveness of the following therapies; negative pressure wound therapy, total contact casting, hyperbaric oxygen therapy and surgical debridement for diabetic foot problems.
CG119/2 What is the optimum wound-healing environment and what is the optimum dressing to treat diabetic foot ulcers?
CG119/3 Does early revascularisation improve outcome in patients with diabetes and a foot ulcer?
CG120/1 What are the prevalence, risk and protective factors, and course of illness for different combinations of psychosis and coexisting substance misuse (for example, schizophrenia and cannabis misuse or bipolar disorder and alcohol misuse)?
CG120/10 What risk factors predict the onset of substance misuse in young people with psychosis?
CG120/2 What and how should training be provided to healthcare professionals working with people with psychosis and substance misuse?
CG120/3 Is providing treatment for psychosis and substance misuse services within staffed accommodation more cost-effective than a combination of hospital and home treatment?
CG120/4 What service delivery models allow people with psychosis and coexisting substance misuse to remain living outside hospital?
CG120/5 Are interventions for psychosis or substance misuse clinically and cost effective when compared with standard care for people with psychosis and coexisting substance misuse?
CG120/6 Are psychosocial interventions clinically and cost effective when compared with standard care for people with psychosis and coexisting substance misuse?
CG120/7 Are environmental interventions clinically and cost effective when compared with standard care for people with psychosis and coexisting substance misuse?
CG120/8 Are interventions for psychosis or substance misuse clinically and cost effective when compared with standard care for people with psychosis and coexisting substance misuse?
CG120/9 Is clozapine clinically and cost effective when compared with other pharmacological interventions for people with psychosis and coexisting substance misuse?
CG121/1 Selection of patients with non-small-cell lung cancer (NSCLC) for treatment with curative intent:- Further studies should be performed into factors that predict successful outcome of treatment with curative intent. Studies should include fitness parameters and functional imaging.
CG121/2 Effectiveness of surgery with or without multimodality treatment in N2 disease:- Patients with non-bulky single zone N2 disease should be considered for trials of surgery with or without multimodality treatment. Outcomes should include mortality and 5-year survival.
CG121/3 Pulmonary rehabilitation, optimisation of drug treatment and enhanced recovery programmes:- Research should be undertaken into the benefits of pulmonary rehabilitation, optimisation of drug treatment and enhanced recovery programmes before and after surgery. Outcomes should include mortality, survival, pulmonary complications, pulmonary function and quality of life (including assessment by EQ-5D).
CG121/4 New regimens for radiotherapy with curative intent:- Research should be considered into dose escalation in radiotherapy with curative intent, including stereotactic body irradiation (SBRT). Outcomes should include mortality, pulmonary complications, pulmonary function and validated quality of life measures (including assessment by EQ-5D).
CG121/5 Imaging modalities for monitoring response and recurrent disease:- Randomised controlled trials should be conducted to examine the value of imaging modalities and other interventions in the monitoring of response and recurrent disease.
CG122/1 Relationship between duration of symptoms of ovarian cancer and stage at diagnosis:- Further research should be undertaken on the relationship between the duration and frequency of symptoms in women with ovarian cancer before diagnosis, the stage of disease at diagnosis and subsequent survival.
CG122/3 Imaging in the diagnostic pathway for women with ovarian cancer:- Large multicentre case–control studies should be conducted to compare the accuracy of CT versus MRI for staging and for predicting optimal cytoreduction in women with ovarian cancer.
CG122/5 The value of primary surgery for women with advanced ovarian cancer:- Research should be undertaken to determine the effectiveness of primary surgery for women with advanced ovarian cancer whose tumour cannot be fully excised.
CG123/1 Comprehensive assessment versus a brief assessment:- For people with a suspected common mental health disorder, what is the clinical and cost effectiveness of using a comprehensive assessment (conducted by mental health professional) versus a brief assessment (conducted by a paraprofessional)?
CG123/2 'Walking across’ from one assessment instrument to another:- What methodology should be used to allow ‘walking across’ from one assessment instrument for common mental health disorders to another?
CG123/3 Generalized Anxiety Disorder scale (GAD-2) for people with suspected anxiety disorders:- In people with suspected anxiety disorders, what is the clinical utility of using the GAD-2 compared with routine case identification to accurately identify different anxiety disorders? Should an avoidance question be added to improve case identification?
CG123/4 Routine outcome measurement:- In people with a common mental health disorder, what is the clinical utility of routine outcome measurement and is it cost effective compared with standard care?
CG123/5 Use of a simple algorithm compared with a standard clinical assessment:- For people with a common mental health disorder, is the use of a simple algorithm (based on factors associated with treatment response), when compared with a standard clinical assessment, more clinically and cost effective?
CG123/6 Priority of treatment for people with anxiety and depression:- For people with both anxiety and depression, which disorder should be treated first to improve their outcomes?
CG124/01

Imaging options in occult hip fracture: In people with a continuing suspicion of a hip fracture but whose radiographs are normal, what is the clinical and cost effectiveness of CT compared with MRI, in confirming or excluding the fracture?

CG124/02

Anaesthesia: What is the clinical and cost effectiveness of regional versus general anaesthesia on postoperative morbidity in people with hip fracture?

CG124/03

Undisplaced intracapsular hip fractures: For people with undisplaced (or non-displaced) intracapsular hip fracture, what features should be used to characterise the injury and what are the optimal clinical and cost-effective management strategies?

CG124/04

Intensive rehabilitation therapies after hip fracture: What is the clinical and cost effectiveness of additional intensive physiotherapy and/or occupational therapy (for example, progressive resistance training) after hip fracture?

CG124/05

Early supported discharge in care home patients: What is the clinical and cost effectiveness of early supported discharge on mortality, quality of life and functional status in people with hip fracture who are admitted from a care home?

CG124/06

Long-term effectiveness of total hip replacement: What is the long-term clinical and cost effectiveness for adults (including different subgroups) undergoing total hip replacement compared with hemiarthroplasty for displaced intracapsular hip fracture?

CG124/07

Femoral component design: In adults undergoing hemiarthroplasty for displaced intracapsular hip fracture (including in different subgroups), which femoral component design has the best long-term outcomes?

CG125/1 Process of decision-making:- How should the process of decision-making about the choice of dialysis modality, including peritoneal dialysis, be supported?
CG125/2 Effectiveness of modality:- What factors determine the effectiveness of any modality of dialysis, including peritoneal dialysis?
CG125/3 Treatment sequence:- What is the most effective sequence of treatment?
CG125/4 Nutritional status:- Is there any significant difference in nutritional status between people on the different dialysis treatment modalities?
CG125/5 Evaluating effectiveness:- Which outcomes should be used in evaluating effectiveness?
CG126/1 Adding a newer anti-anginal drug to a calcium channel blocker:- What is the clinical and cost effectiveness of adding a newer anti-anginal drug (nicorandil, ivabradine or ranolazine) to a calcium channel blocker for treating stable angina?
CG126/2 Management of stable angina in people with evidence of ischaemia on non-invasive functional testing:- Do people with stable angina and evidence of reversible ischaemia on noninvasive functional testing who are on optimal drug treatment benefit from routine coronary angiography with a view to revascularisation?
CG126/3 Early revascularisation strategy for people with angina and multivessel disease:- In people with stable angina and multivessel disease (including left main stem disease) whose symptoms are controlled with optimal drug treatment, would an initial treatment strategy of revascularisation be clinically and cost effective compared with continued drug treatment?
CG126/4 Cardiac rehabilitation:- Is an 8-week, comprehensive, multidisciplinary, cardiac rehabilitation service
more clinically and cost effective for managing stable angina than current clinical practice?
CG126/5 Patient self-management plans:- What is the clinical and cost effectiveness of a self-management plan for people with stable angina?
CG127/1 Out-of-office monitoring: In adults with primary hypertension, does the use of out-of-office monitoring (home blood pressure monitoring-HBPM or ambulatory blood pressure monitoring-ABPM) improve response to treatment?
CG127/2 Intervention thresholds for people aged under 40 with hypertension In people aged under 40 years with hypertension, what are the appropriate thresholds for intervention?
CG127/3 Methods of assessing lifetime cardiovascular risk in people aged under 40 years with hypertension:- In people aged under 40 years with hypertension, what is the most accurate method of assessing the lifetime risk of cardiovascular events and the impact of therapeutic intervention on this risk?
CG127/4 Optimal systolic blood pressure: - In people with treated hypertension, what is the optimal systolic blood pressure?
CG127/5 Step 4 antihypertensive treatment:- In adults with hypertension, which drug treatment (diuretic therapy versus other step 4 treatments) is the most clinically and cost effective for step 4 antihypertensive treatment?
CG127/6 Automated blood pressure monitoring in people with atrial fibrillation: - Which automated blood pressure monitors are suitable for people with hypertension and atrial fibrillation?
CG128/1 Training professionals:- Does training professionals to recognise signs and symptoms of autism lead to earlier assessment of needs and earlier diagnosis (and by implication reduce morbidity/improve health outcomes) among children and young people with suspected autism compared with no training?
CG128/2 Gathering information in schools or nurseries:- Does routine additional information from educational settings (such as nursery or school) improve accuracy in diagnosing autism among children or young people up to the age of 19 compared with signs and symptoms alone?
CG128/3 Additional assessments:- Do additional assessments (for IQ, language ability and motor ability) improve accuracy in diagnosing autism among preschool children (younger than 5 years) compared with signs and symptoms alone?
CG128/4 Comparative genomic hybridisation array:- What is the effectiveness and acceptability of comparative genomic hybridisation (CGH) array compared with current genetic testing in children and young people with identified autism?
CG129/1 Information and emotional support:- Does additional information and emotional support improve outcomes in twin and triplet pregnancies?
CG129/2 Specialist care:- Does specialist antenatal care for women with twin and triplet pregnancies improve outcomes for women and their babies?
CG129/3 Monitoring for intrauterine growth restriction:- What is the pattern of fetal growth in healthy twin and triplet pregnancies, and how should intrauterine growth restriction be defined in twin and triplet pregnancies?
CG129/4 Preventing preterm birth:- What interventions are effective in preventing spontaneous preterm birth in women with twin and triplet pregnancies, especially in those at high risk of preterm birth?
CG129/5 Indications for referral to a tertiary level fetal medicine centre:- What is the incidence of monochorionic monoamniotic twin and triplet pregnancies, and what clinical management strategies are most effective in such pregnancies?
CG129/6 Timing of birth:- What is the incidence of perinatal and neonatal morbidity and mortality in babies born by elective birth in twin and triplet pregnancies?
CG130/1 Optimal management of hyperglycaemia in acute coronary syndromes (ACS): What is the optimal management of hyperglycaemia in people with acute coronary syndrome who have diagnosed or previously undiagnosed diabetes?
CG131/1 Treatment of patients with moderate-risk locally advanced rectal cancer:- The effectiveness of preoperative chemotherapy should be compared with short-course preoperative radiotherapy (SCPRT), chemoradiotherapy or surgery alone in patients with moderate-risk locally advanced rectal cancer. Outcomes of interest are local control, toxicity, overall survival, quality of life and cost effectiveness.
CG131/2 The value of prognostic factors in guiding optimal management in patients with locally excised, pathologically confirmed stage I cancer:- An observational study should be conducted, incorporating standardised assessment of pathological prognostic factors, to assess the value of the proposed prognostic factors in guiding optimal management in patients with locally excised, pathologically confirmed stage I cancer. Outcomes of interest are disease-free survival, overall survival, local and regional control, toxicity, cost effectiveness and quality of life.
CG131/3 The most effective sequence to perform magnetic resonance imaging (MRI and PET-CT in patients with colorectal cancer metastasised to the liver to determine whether the metastasis is resectable:- A prospective trial should be conducted to investigate the most clinically-effective and cost-effective sequence in which to perform MRI and PET-CT, after an initial CT scan, in patients with colorectal cancer that has metastasised to the liver, to determine whether the metastasis is resectable. The outcomes of interest are reduction in inappropriate laparotomies and improvement in overall survival.
CG131/4 Follow-up after completion of oncological treatment:- Strategies to integrate oncological surveillance with optimising quality of life, reducing late effects, and detecting second cancers in survivors of colorectal cancer should be developed and explored.
CG131/5 Patient-reported outcome measures in colorectal cancer:- Colorectal cancer-specific patient-reported outcome measures (PROMs) should be developed for use in disease management and to inform outcome measures in future clinical trials.
CG133/1 Effectiveness of training:- For healthcare professionals who work with people who self-harm, does the provision of training in assessment and management improve outcomes compared with no additional specialist training?
A well-powered randomised controlled trial should examine the effectiveness of training. Researchers should consider the format and length of training. The outcomes chosen should include both healthcare professionals' and service users' evaluation of the training, and the effect on subsequent knowledge, attitude and behavioural changes. It should include longer-term follow-up of 12 months or more.
CG133/3 Clinical and cost effectiveness of psychological therapy:- with problem-solving elements for people who self-harm:- For people who have self-harmed, does the provision of a psychological therapy with problemsolving elements, compared with treatment as usual, improve outcomes? What is the differential effect for people with a past history of self-harm, compared with people who self-harm for the first time? This question should be answered using a well-conducted randomised controlled trial. Consider six sessions of psychological therapy with problem-solving elements, delivered immediately after discharge for the index episode of self-harm. The therapist should be trained and experienced in working with people who self-harm. Participants' history of previous self-harm, methods used and psychiatric history should be noted. Primary outcomes should include both hospital-reported and self-reported repetitions of self-harm. Other important outcomes, such as quality of life, depressive symptoms, service users' experience and adverse events (for example, distress or exacerbation of symptoms associated with therapy) should be included. The study design should take into account the complex motives that underpin self-harm. Studies need to be large enough to determine the intervention's costs and cost effectiveness.
CG133/4 Clinical effectiveness of low-intensity/brief psychosocial interventions for people who self-harm:- For people who self-harm, does the provision of potentially cheap low-intensity/brief psychosocial interventions, compared with treatment as usual, improve outcomes? This question should be answered using a well-conducted randomised controlled trial. Consider using a variety of approaches, including postcards, emergency cards, phone calls, or the use of electronic media in community mental health settings. The outcomes should include service users' engagement and experience, and hospital-reported and self-reported repetitions of self harm. Other important outcomes, such as quality of life, depressive symptoms and adverse events (for example, distress or exacerbation of symptoms associated with contact with services) should be included.
CG133/5 Observational study exploring different harm-reduction approaches:- What are the different approaches to harm reduction following self-harm in NHS settings?
A study should be carried out to investigate the different approaches to harm reduction following self-harm currently in use in NHS settings. This could use survey methodology with all, or a selected sample of, mental health service providers. Audit data should be used to provide a preliminary evaluation of potential utility. Promising interventions might be tested in small-scale pilot randomised controlled trials, which use frequency and severity of self-harm, and standard measures of distress and psychological symptoms, as outcome measures. Other outcomes such as quality of life, service users' experience and adverse events should be included.
CG134/1 Mediators of anaphylactic reactions:- Aside from mast cell tryptase, which other chemical inflammatory mediators offer potential as indicators of anaphylaxis?
CG134/1

Aside from mast cell tryptase, which other chemical inflammatory mediators offer potential as indicators of anaphylaxis?

CG134/2 The frequency and effects of biphasic reactions:- What are the frequency, timing, severity and predictors of biphasic reactions in people who have received emergency treatment for anaphylaxis?
CG134/2

What are the frequency, timing, severity and predictors of biphasic reactions in people who have received emergency treatment for anaphylaxis?

CG134/3 Length of observation period following emergency treatment for anaphylaxis:- For how long should a person who has received emergency treatment for anaphylaxis be observed?
CG134/3

For how long should a person who has received emergency treatment for anaphylaxis be observed?

CG134/4 Prevalence of anaphylactic reactions and related outcomes:- What is the annual incidence of anaphylaxis and its related outcomes within the UK?
CG134/4

What is the annual incidence of anaphylaxis and its related outcomes within the UK?

CG134/5 Effect of specialist services on health-related quality of life:- For people who have experienced suspected anaphylaxis, what is the effect on health-related quality of life of (a) referral to specialist allergy services and (b) provision of adrenaline injectors, when compared with emergency treatment alone?
CG134/5

For people who have experienced suspected anaphylaxis, what is the effect on health-related quality of life of (a) referral to specialist allergy services and (b) provision of adrenaline injectors, when compared with emergency treatment alone?

CG135/2 Reasons for refusal for consent:- Why do families refuse to give permission for organ donation?
CG135/3 Improving rates of identification and referral of potential donors:- What are the key components of an intervention to improve identification and referral rates?
CG135/4 Improving consent rates:- What are the key components of an intervention to improve consent rates?
CG135/5 The experience of consenting for organ donation:- Does a positive experience of approach and process of consent for families increase consent rates?
CG136/1 Training in the use of the national quality standard and guidance on service user experience of care:- For people using adult mental health services, what is the effect of training community mental health teams (CMHTs) and inpatient ward staff in the use of the national quality standard and underpinning guidance on service user experience, when compared to no training, on service
users' experience of care?
CG136/2 Late access to services and compulsory and intensive treatment:- For people using adult mental health services, what are the personal and demographic factors associated with late access to services and an increased likelihood of compulsory and intensive treatment, and what are the key themes that are associated with poor engagement? This should include an examination of factors that impact on access to services among younger people and older adults.
CG136/3 Shared decision-making:- For people using adult mental health services, what are the key aspects of 'shared decision-making' that they prefer, and does a training programme for health and social care professionals designed around these key aspects, when compared with no training, improve service users' experience of care? A study should be undertaken to evaluate the impact on treatment choice, the experience of care and treatment effectiveness of training service users to deal with health and social care professionals assertively.
CG136/4 Activities and occupations on inpatient wards:- For people receiving adult mental health hospital care, what activities and occupations do service users want when staying on inpatient wards?
CG136/5 Compulsion, control and restraint:- For people using adult mental health services, how is compulsory treatment and 'control and restraint' used in different settings and what is the impact on the service user?
CG137/1

Newly diagnosed seizures (focal and generalised) – monotherapy: How do the newer AEDs compare in efficacy to the standard AEDs in the treatment of newly diagnosed epilepsy?

  • Focal seizures: carbamazepine, eslicarbazepine acetate, lacosamide, lamotrigine, levetiracetam, pregabalin and zonisamide.

  • Generalised seizures: lamotrigine, levetiracetam, sodium valproate and zonisamide.

CG137/2

Epilepsy syndromes: What are the initial and add-on AEDs of choice in the treatment of the epilepsy syndromes with onset in childhood, for example, myoclonic-astatic epilepsy and Dravet syndrome?

CG137/3

Infantile spasms: Does treatment response relate to cause in infantile spasms? Does early treatment success in seizure control and resolution of the hypsarrhythmic EEG influence the long-term developmental and cognitive outcomes more than the underlying cause of the spasms?

CG137/4

Treatment of convulsive status epilepticus (that is, not just refractory): What is the most effective and safest AED to treat:

  • established (usually lasting longer than 30 minutes) convulsive status epilepticus

  • refractory convulsive status epilepticus?

CG137/5

AEDs and pregnancy: What is the malformation rate and longer term neurodevelopmental outcome of children born to mothers who have taken AEDs during pregnancy?

CG139/1 Standard principles of infection prevention and control:- What are the barriers to compliance with the standard principles of infection prevention and control that patients and carers experience in their own homes?
CG139/2 Hand decontamination:- When clean running water is not available, what is the clinical and cost effectiveness of using wipes, gels, handrubs or other products to remove visible contamination?
CG139/3 Intermittent urinary catheters: catheter selection:- For patients performing intermittent self-catheterisation over the long term, what is the clinical and cost effectiveness of single-use non-coated versus single-use hydrophilic versus single-use gel reservoir versus reusable non-coated catheters with regard to the following outcomes: symptomatic urinary tract infections, urinary tract infection-associated bacteraemia, mortality, patient comfort and preference, quality of life, and clinical symptoms of urethral damage?
CG139/4 Indwelling urinary catheters: catheter selection:- For patients using a long-term indwelling urinary catheter, what is the clinical and cost effectiveness of impregnated versus hydrophilic versus silicone catheters in reducing symptomatic urinary tract infections, encrustations and/or blockages?
CG139/5 Indwelling urinary catheters: antibiotic prophylaxis:- When recatheterising patients who have a long-term indwelling urinary catheter, what is the clinical and cost effectiveness of single-dose antibiotic prophylaxis in reducing symptomatic urinary tract infections in patients with a history of urinary tract infections associated with catheter change?
CG139/6 Vascular access devices: skin decontamination:- What is the clinical and cost effectiveness of 2% chlorhexidine in alcohol versus 0.5% chlorhexidine in alcohol versus 2% chlorhexidine aqueous solution versus 0.5% chlorhexidine aqueous solution for cleansing skin (before insertion of peripheral vascular access devices [VADs] and during dressing changes of all VADs) in reducing VAD-related bacteraemia and VAD site infections?
CG140/1 Communication:- What are the most clinically effective and cost-effective methods of addressing patient and carer concerns about strong opioids, including anticipating and managing adverse effects, and engaging patients in prescribing decisions?
CG142/1

What is the clinical and cost effectiveness of facilitated self-help for the treatment of mild anxiety and depressive disorders in autistic adults?

CG142/2

What structure and organisation of specialist autism teams are associated with improvements in care for autistic people?

CG142/3

What is the clinical and cost effectiveness of augmentative communication devices for autistic adults?

CG143/1 Pain management for patients with an acute painful sickle cell episode:- For patients with an acute painful sickle cell episode, what are the effects of different opioid formulations, adjunct pain therapies and routes of administration on pain relief and acute sickle cell complications?
CG143/2 Use of low-molecular-weight heparin to treat patients with an acute painful sickle cell episode:- Are therapeutic doses of low-molecular-weight heparin (LMWH) effective, compared with prophylactic doses of LMWH, in reducing the length of stay in hospital of patients with an acute painful sickle cell episode?
CG143/4 Non-pharmacological interventions for patients with an acute painful sickle cell episode:- For patients with an acute painful sickle cell episode, are non-pharmacological interventions, such as massage, effective in improving their recovery from the episode?
CG143/5 Cost effectiveness of daycare units for treating patients with an acute painful sickle cell episode:- Are daycare units cost effective compared with emergency settings for treating patients with an
acute painful sickle cell episode?
CG144/1 Diagnosis of deep vein thrombosis:- What is the clinical and cost effectiveness of a whole-leg ultrasound scan compared with a proximal leg vein ultrasound scan in the diagnosis of acute deep vein thrombosis (DVT)?
CG144/2 Long-term versus 3-month oral anticoagulation treatment in subgroups of patients at increased risk of VTE recurrence:- What is the clinical and cost effectiveness of long-term oral anticoagulation treatment in specific subgroups of patients with a first unprovoked VTE?
CG144/3 Long-term anticoagulation treatment with low molecular weight heparin versus a vitamin K antagonist in patients with VTE and active cancer:- In patients with VTE and active cancer who have had 6 months of anticoagulation treatment with low molecular weight heparin (LMWH), what is the clinical benefit (in terms of VTE recurrence rates, all-cause mortality and major bleeding) and cost effectiveness of continued anticoagulation treatment with LMWH versus a vitamin K antagonist (VKA)?
CG144/4 Thrombolytic therapy for DVT:- What is the clinical and cost effectiveness of clot removal using catheter-directed thrombolytic therapy or pharmacomechanical thrombolysis compared with standard anticoagulation therapy for the treatment of acute proximal DVT?
CG144/5 Systemic pharmacological thrombolysis compared with standard anticoagulation treatment in patients with pulmonary embolism and right ventricular dysfunction:- What is the clinical and cost effectiveness of systemic pharmacological thrombolysis compared with standard initial anticoagulation therapy in patients with confirmed PE and haemodynamic stability who present with right ventricular dysfunction?
CG145/1 Inhibitors of functional ability:- What are the greatest inhibitors of functional ability in children and young people with upper motor neurone lesions?
CG145/3 Botulinum toxin type A:- What is the clinical and cost effectiveness of botulinum toxin type A when used routinely or according to clinical need in children and young people who are at Gross Motor Function Classification System (GMFCS) level I, II or III?
CG145/4 Intrathecal baclofen:- What is the clinical and cost effectiveness of continuous pump-administered intrathecal baclofen compared with usual care in children and young people who are at Gross Motor Function Classification System (GMFCS) level IV or V?
CG145/5 Selective dorsal rhizotomy:- Does selective dorsal rhizotomy followed by intensive rehabilitation performed between the ages of 3 and 9 years in children who are at Gross Motor Function Classification System (GMFCS) level II or III result in good community mobility as a young adult?
CG146/1 Using GP practice lists to identify people at high risk:- What is the clinical and cost effectiveness of using GP practice lists to identify people at high risk of fracture, leading to formal risk assessment and possible treatment?
CG146/2 FRAX and QFracture in adults receiving bone protective therapy:- What is the utility of FRAX and QFracture in adults receiving bone protective therapy?
CG146/3 FRAX and QFracture in adults with secondary causes of osteoporosis:- What is the utility of FRAX and QFracture in detecting risk of fragility fracture in adults with secondary causes of osteoporosis?
CG146/4 Bone mineral density (BMD) with FRAX:- What is the added prognostic value of BMD in the assessment of fracture risk with FRAX?
CG146/5 FRAX and QFracture in adults living in residential care:- What is the utility of FRAX and QFracture in detecting risk of fragility fracture in adults living in residential care?
CG147/1 Angioplasty versus bypass surgery for treating people with critical limb ischaemia caused by disease of the infra-geniculate arteries:- What is the clinical and cost effectiveness of a 'bypass surgery first' strategy compared with an 'angioplasty first' strategy for treating people with critical limb ischaemia caused by disease of the infra-geniculate (below the knee) arteries?
CG147/2 Supervised exercise programmes for treating people with intermittent claudication:- What is the clinical and cost effectiveness of supervised exercise programmes compared with unsupervised exercise for treating people with intermittent claudication, taking into account the effects on long-term outcomes and continuing levels of exercise?
CG147/3 Patient attitudes and beliefs about peripheral arterial disease:- What is the effect of people's attitudes and beliefs about their peripheral arterial disease on the management and outcome of their condition?
CG147/4 Primary versus secondary stenting for treating people with critical limb ischaemia caused by disease of the infra-geniculate arteries:- What is the clinical and cost effectiveness of selective stent placement compared with angioplasty plus primary stent placement for treating people with critical limb ischaemia caused by disease of the infra-geniculate arteries?
CG147/5 Chemical sympathectomy for managing critical limb ischaemic pain:- What is the clinical and cost effectiveness of chemical sympathectomy in comparison with other methods of pain control for managing critical limb ischaemic pain?
CG147/6

What is the most clinically and cost-effective tool for diagnosing peripheral arterial disease in people with diabetes?

CG147/7

What is the most clinically and cost-effective tool for establishing the severity of peripheral arterial disease and the impact on mortality, morbidity and limb amputation in people with diabetes?

CG148/1 Safety and efficacy of antimuscarinics:- What is the safety and efficacy of more recently developed antimuscarinics compared with (a) placebo/usual care and (b) other antimuscarinics in the treatment of neurogenic lower urinary tract dysfunction?
CG148/2 Safety and efficacy of botulinum toxin:- What is the safety and efficacy of botulinum toxin compared with (a) usual care, (b) antimuscarinics and (c) augmentation cystoplasty in people with neurogenic lower urinary tract dysfunction?
CG148/3 Management strategies to reduce the risk of symptomatic urinary tract infections:- In people with neurogenic lower urinary tract dysfunction, which management strategies (including the use of prophylactic antibiotics and various invasive and non-invasive techniques to aid bladder drainage) reduce the risk of symptomatic urinary tract infections?
CG148/4 Bladder management strategies:- What are the long-term risks and effects on quality of life of different bladder management strategies for lower urinary tract dysfunction in people with neurological disease?
CG148/5 What is the safety and efficacy of botulinum toxin compared with (a) usual care, (b) antimuscarinics and (c) augmentation cystoplasty in people with primary cerebral conditions with lower urinary tract dysfunction?
CG150/1

Amitriptyline to prevent recurrent migraine:- Is amitriptyline a clinically and cost effective prophylactic treatment for recurrent migraine?

CG150/2 Pizotifen to prevent recurrent migraine:- Is pizotifen a clinically and cost effective prophylactic treatment for recurrent migraine?
CG150/3 Topiramate to prevent recurrent cluster headache:- Is topiramate a clinically and cost effective prophylactic treatment for recurrent cluster headache?
CG150/4 Psychological interventions to manage chronic headache disorders:- Does a psychological intervention such as cognitive behavioural therapy (CBT) improve headache outcomes and quality of life for people with chronic headache disorders?
CG150/5 Pharmacological treatments for headache prophylaxis to aid withdrawal treatment in medication overuse
headache:- Does a course of steroid treatment or pharmacological treatments used for headache prophylaxis help people with medication overuse headaches withdraw from medication?
CG151/1 Service provision for neutropenic sepsis in patients with cancer:- A prospective national cohort study should be carried out to assess the incidence of suspected and proven neutropenic sepsis in patients having anticancer treatment.
CG151/2 Patient support and information:- A descriptive study involving patients who have had neutropenic sepsis and their carers should be undertaken to find out what types of support and information patients and carers were given, which of these they found helpful or unhelpful, and whether they think additional or different types of support or information are needed.
CG151/3 Signs and symptoms that predict neutropenic sepsis in the community:- A prospective study should be carried out to determine which signs and symptoms experienced by patients in the community predict neutropenic sepsis and the outcomes of these episodes.
CG151/4 Reducing the risk of complications of anticancer treatment in children and young people, and in adults diagnosed with lymphoma:- Randomised studies should investigate primary prophylaxis of neutropenic sepsis in 2 populations: children and young people (aged under 18) having treatment for solid tumours or haematological malignancies, or stem cell transplantation; and adults (aged 18 and older) diagnosed with lymphoma. The studies should compare the effectiveness of fluoroquinolone antibiotics given alone, fluoroquinolone antibiotics given together with G-CSF preparations, and G-CSF preparations given alone. Outcome measures should include overall mortality, infectious episodes and adverse events. In addition, quality of life should be determined using quantitative and qualitative methods. The resulting data should be used to develop a cost-effectiveness analysis comparing these 3 forms of prophylaxis in children and young people having anticancer treatment, and in adults diagnosed with lymphoma.
CG151/5 Switching from inpatient intravenous to outpatient oral antibiotic therapy in patients with neutropenic sepsis:- A randomised controlled trial should be undertaken to evaluate the clinical and cost effectiveness of stopping intravenous antibiotic therapy and switching to oral therapy within the first 24 hours of treatment in patients with neutropenic sepsis who are having treatment with intravenous antibiotics. The outcomes to be measured are overtreatment, death, need for critical care, length of hospital stay, duration of fever and quality of life.
CG152/1 Azathioprine:- For patients with intestinal Crohn's disease, does the addition of azathioprine to glucocorticosteroid treatment at diagnosis improve the long-term outcome compared with glucocorticosteroid treatment alone?
CG152/2 Enteral nutrition:- What are the benefits, risks and cost effectiveness of enteral nutrition compared with glucocorticosteroid treatment in adults and children?
CG152/3

5-aminosalicylate (5-ASA) treatment:- Following successful medical induction of remission of Crohn's disease of the colon, is mesalazine more clinically and cost effective than no treatment?

CG152/4 Surgery versus medical treatment for the distal ileum:- What is the effect on quality of life of medical treatment (immunosuppressive or biological therapy) compared with early surgery for Crohn's disease limited to the distal ileum?
CG152/5 Patient information and support:- What are the information needs of people with Crohn's disease, as defined by people with the condition, and can education and support based on these needs lead to better clinical and quality of life outcomes?
CG153/1 Assessment of disease severity and impact:- In children, young people and adults with psoriasis, can tools be developed and/or existing ones further refined and validated to:
- assess disease severity and impact in both non-specialist and specialist healthcare settings, to facilitate assessment, appropriate referral, treatment planning and measurement of outcomes
- measure burden and cumulative effect of disease activity, severity and impact for people with both psoriasis and psoriatic arthritis?
CG153/2 Methotrexate and risk of hepatotoxicity:- What is the impact of methotrexate compared with other approaches to care (for example other systemic non-biological or biological treatments) on risk of significant liver disease in people with psoriasis and do risk factors such as obesity, alcohol use or diabetes alter this risk?
CG153/3 Rapid escalation to systemic treatments:- In people with psoriasis, does early intervention with systemic treatments improve the long-term prognosis of psoriasis severity, comorbidities (including psoriatic arthritis), or treatment -related adverse effects, and are there any clinical (for example demographic or phenotypic) or laboratory (for example genetic or immune) biomarkers that can be used to identify those most likely to benefit from this treatment approach?
CG153/4 Self-management:- Do structured psoriasis-focused self-management programmes improve patient confidence, wellbeing and disease control compared with standard care?
CG153/5 Topical therapy:- In people of all ages with psoriasis: 1. How should topical therapies be used to maintain disease control i) safely; ii) effectively and iii) what are the health economic implications?
2. What are the risks of 'real life' long term corticosteroid use, are there particular people at risk
and what strategies can be used to modify or avoid risks?
CG154/1 Early pregnancy assessment units:- A national evaluation of early pregnancy assessment unit service provision should be carried out to identify factors affecting outcomes. Factors should include whether care is provided in a dedicated unit, staffing configuration and opening hours of dedicated services. Outcomes should include both process (service) outcomes and pregnancy-related outcomes. Data collected should be used to analyse the cost effectiveness of early pregnancy assessment units compared with other models of care.
CG154/2 Ultrasound for determining a viable intrauterine pregnancy:- How does the timing and frequency of ultrasound examination affect diagnosis and outcomes of early pregnancy complications, including women's experience and cost effectiveness?
CG154/3 Progesterone/progestogen for threatened miscarriage Are progesterone or progestogens effective in treating threatened miscarriage?
CG154/4 Management of miscarriage:- In women with confirmed miscarriage, does the type of management strategy (expectant, medical and surgical) impact on women's experience, including psychological and emotional outcomes?
CG154/5 Surgical compared with medical management of ectopic pregnancy:- In women with ectopic pregnancy, does the type of intervention (laparoscopy or medical management) impact on women's experience, including psychological and emotional outcomes?
CG155/1 What are the long-term outcomes, both psychotic and nonpsychotic, for children and young people with attenuated or transient psychotic symptoms suggestive of a developing psychosis, and can the criteria for 'at risk states' be refined to better predict those who will and those who will not go on to develop psychosis?
CG155/2 What is the clinical and cost effectiveness of omega-3 fatty acids in the treatment of children and young people considered to be at high risk of developing psychosis?
CG155/3 What is the clinical and cost effectiveness for family intervention combined with individual CBT in the treatment of children and young people considered to be at high risk of developing psychosis and their parents or carers?
CG155/4 What is the clinical and cost effectiveness of psychological intervention alone, compared with antipsychotic medication and compared with psychological intervention and antipsychotic
medication combined, in young people with first episode psychosis?
CG155/5 What is the clinical effectiveness of clozapine for children and young people with schizophrenia with symptoms unresponsive to antipsychotic medication and psychological treatment combined?
CG155/6 What is the most effective management strategy for preventing the development of excessive weight gain and metabolic syndrome associated with the use of antipsychotic medication in children and
young people?
CG156/1 Expectant management before IVF:- What is the optimum period of expectant management for women of different age groups before invasive treatment such as IVF is considered?
CG156/2 Embryo selection for single embryo transfer:- Further research is needed to improve embryo selection to facilitate single embryo transfers.
CG156/3 Adjuvant luteal phase support treatments in IVF:- Further research is needed to assess the efficacy of adjuvant luteal phase support treatments such as low-dose aspirin, heparin, prednisolone, immunoglobulins and/or fat emulsions.
CG156/4 Long-term safety of ovarian stimulation and ovulation induction for women:- Is there an association between ovulation induction or ovarian stimulation and adverse long-term (over 20 years) effects in women in the UK?
CG156/5 Long-term effects of IVF with or without intracytoplasmic sperm injection in children:- What are the long-term (over 20 years) effects of IVF with or without intracytoplasmic sperm injection (ICSI) in children in the UK?
CG156/6 People who are concerned about their fertility should be informed that the effectiveness of complementary therapies for fertility problems has not been properly evaluated and that further research is needed before such interventions can be recommended. [2004]
CG156/7 The effectiveness of pulsatile gonadotrophin-releasing hormone in women with clomifene citrate-resistant polycystic ovary syndrome is uncertain and is therefore not recommended outside a research context. [2004]
CG157/1 Phosphate binders in adults with chronic kidney disease (CKD) stage 4 or 5:- Which binders are most effective in controlling serum phosphate in adults with stage 4 or 5 CKD who are not on dialysis?
CG157/2 Effectiveness and safety of aluminium hydroxide in adults:- In adults with stage 4 or 5 chronic kidney disease (CKD), including those on dialysis, what is the long-term effectiveness and safety of aluminium hydroxide in controlling serum phosphate?
CG157/3 Effectiveness and safety of magnesium carbonate in adults:- In adults with stage 4 or 5 chronic kidney disease (CKD), including those on dialysis, what is the long-term effectiveness and safety of magnesium carbonate in controlling serum phosphate?
CG157/4 Phosphate binders in children Which binders are most effective in controlling serum phosphate in children with stage 4 or 5 chronic kidney disease (CKD), including those who are on dialysis?
CG157/5 Sequencing and combining of phosphate binders in adults:- For adults with stage 4 or 5 chronic kidney disease (CKD), including those on dialysis, what is the most effective sequence or combination of phosphate binders to control serum phosphate?
CG158/1 Parent training programmes for children aged 12 years and over with a conduct disorder:- What is the effectiveness of parent training programmes for conduct disorders in children and young people aged 12 years and over?
CG159/1 Adults' uptake of and engagement with interventions for social anxiety disorder:- What methods are effective in improving uptake of and engagement with interventions for adults with social anxiety disorder?
CG159/2 Specific versus generic CBT for children and young people with social anxiety disorder:- What is the clinical and cost effectiveness of specific CBT for children and young people with social anxiety disorder compared with generic anxiety-focused CBT?
CG159/3 The role of parents in the treatment of children and young people with social anxiety disorder:- What is the best way of involving parents in the treatment of children and young people (at different stages of development) with social anxiety disorder?
CG159/4 Individual versus group CBT for children and young people with social anxiety disorder:- What is the clinical and cost effectiveness of individual and group CBT for children and young people with social anxiety disorder?
CG159/5 Combined interventions for adults with social anxiety disorder:- What is the clinical and cost effectiveness of combined psychological and pharmacological interventions compared with either intervention alone in the treatment of adults with social anxiety disorder?
CG160/1 Symptoms and signs of serious illness: - NICE recommends a UK-based epidemiological study on the symptoms and signs of serious illness. [new 2013]
CG160/2 Management by remote assessment:- NICE recommends that a UK study is undertaken to determine the validity of symptoms reported on remote assessment for children with fever. [2007]
CG160/3 Diagnosis:- NICE recommends that a UK study of the performance characteristics and cost-effectiveness
of procalcitonin versus C-reactive protein in identifying serious bacterial infection in children with fever without apparent source be carried out. [2007]
CG160/4 Antipyretics:- NICE recommends that studies are conducted in primary care and secondary care to
determine whether examination or re-examination after a dose of antipyretic medication is of
benefit in differentiating children with serious illness from those with other conditions. [2007]
CG160/5 Home-based antipyretic use:- NICE recommends studies on home-based antipyretic use and parental perception of distress caused by fever. [new 2013]
CG161/1 Environmental adaptations aimed at reducing the risk of falling in older inpatients:- What environmental adaptations can be made in existing inpatient units, and should be considered when inpatient units are built, to reduce the risk of falls and injuries in older inpatients?
CG161/2 Prevalence of risk factors for falling in older inpatients:- Which risk factors for falling that can be treated, improved or managed during the hospital stay are most prevalent in older patients who fall in inpatient settings in the UK?
CG161/3 Causes of unwitnessed falls among older inpatients:- What are the causes of unwitnessed falls among older inpatients?
CG161/4 Interventions for preventing falls in older inpatients:- How can falls among older inpatients be prevented? Which patients are most likely to benefit from falls prevention interventions, and does the effectiveness of interventions relate to the patient's length of stay?
CG162/1 Upper limb electrical stimulation:- What is the clinical and cost effectiveness of electrical stimulation (ES) as an adjunct to rehabilitation to improve hand and arm function in people after stroke, from early rehabilitation through to use in the community?
CG162/2 Intensive rehabilitation after stroke:- In people after stroke what is the clinical and cost effectiveness of intensive rehabilitation (6 hours per day) versus moderate rehabilitation (2 hours per day) on activity, participation and quality of life outcomes?
CG162/3 Neuropsychological therapies:- Which cognitive and which emotional interventions provide better outcomes for identified subgroups of people with stroke and their families and carers at different stages of the stroke pathway?
CG162/4 Shoulder pain:- Which people with a weak arm after stroke are at risk of developing shoulder pain? What management strategies are effective in the prevention or management of shoulder pain of different aetiologies?
CG162/5 Offer electromechanical gait training to people after stroke only in the context of a research study.
CG163/3 Pulmonary rehabilitation to improve outcomes in people with idiopathic pulmonary fibrosis:- Does pulmonary rehabilitation improve outcomes for people with idiopathic pulmonary fibrosis?
CG163/4 Ambulatory oxygen to improve outcomes in idiopathic pulmonary fibrosis:- Does ambulatory oxygen improve outcomes in idiopathic pulmonary fibrosis?
CG163/5 Anti-reflux therapy as a treatment for idiopathic pulmonary fibrosis:- Is anti-reflux therapy an effective treatment for idiopathic pulmonary fibrosis?
CG164/1 Carrier probability calculation models:- Further research is recommended into developing and validating models for calculating carrier probability, which incorporate additional data, such as the molecular pathology of tumours and the prevalence of mutations in different ethnic groups. [new 2013]
CG164/2 Rapid genetic testing:- Research is recommended to determine the benefits and harms of creating rapid access to genetic testing for people with newly diagnosed breast cancer. This research should address the optimum model for service delivery and organisation, the clinical and cost effectiveness of such a change, uptake outcomes and patients' experience. [new 2013]
CG164/3 Benefits of MRI surveillance in women over 50 years:- Research is recommended to establish the risk and benefits of MRI surveillance compared with mammography in women over 50 years with a personal history of breast cancer. Studies should include sub-analysis for breast density. [new 2013]
CG164/4 Chemoprevention to reduce incidence of breast cancer:- A randomised controlled trial is recommended to compare the clinical and cost effectiveness of aromatase inhibitors and tamoxifen for reducing the incidence of breast cancer in women with a family history of breast or ovarian cancer. [new 2013]
CG164/5 Impact of risk-reducing surgery:- Further research is recommended to compare psychosocial and clinical outcomes in women who choose and women who do not choose to have risk-reducing surgery. [new 2013]
CG165/1 Stopping antiviral treatment in HBeAg-negative disease:- Further research should be undertaken to evaluate the clinical and cost effectiveness of hepatitis B surface antigen (HBsAg) quantitative assays in determining treatment duration in hepatitis B e antigen- (HBeAg) negative disease.
CG165/2 ALT values for children and young people:- Further research should be undertaken to examine whether the upper limit of normal ALT values for adults (below 30 IU/ml for males and below 19 IU/ml for females) are appropriate for use in children and young people with chronic hepatitis B when making decisions on when to initiate treatment.
CG165/3 Long-term safety of tenofovir disoproxil in chronic hepatitis B:- Further research should be undertaken to determine the long-term safety of tenofovir disoproxil, including the risk of clinically significant hypophosphataemia and related bone toxicity, in people with chronic hepatitis B. The cost effectiveness of routine monitoring for phosphate loss and bone disease in people with chronic hepatitis B who are receiving tenofovir disoproxil treatment needs further evaluation.
CG165/4 Prophylactic treatment in people receiving immunosuppressive therapy:- Further research should be undertaken to determine whether long-term use of mild immunosuppressive agents for autoimmune and allergic problems presents a risk for reactivation of HBV infection in people with previous or current chronic hepatitis B, including occult HBV infection. The cost effectiveness of routine tests for HBV in this population, including HBV DNA for occult HBV infection, and the need for prophylactic treatment with nucleoside or nucleotide analogues needs further evaluation.
CG166/1 Induction of remission for people with moderate ulcerative colitis: prednisolone compared with
aminosalicylates:- What is the clinical and cost effectiveness of prednisolone compared with aminosalicylates for the induction of remission for people with moderate ulcerative colitis?
CG166/2 Induction of remission for people with moderate ulcerative colitis: prednisolone compared with
beclometasone:- What is the clinical and cost effectiveness of prednisolone plus an aminosalicylate compared with beclometasone plus an aminosalicylate for induction of remission for people with moderate ulcerative colitis?
CG166/3 Induction of remission for people with subacute ulcerative colitis that is refractory to systemic corticosteroids:- What are the benefits, risks and cost effectiveness of methotrexate, ciclosporin, tacrolimus, adalimumab and infliximab compared with each other and with placebo for induction of remission for people with subacute ulcerative colitis that is refractory to systemic corticosteroids?
CG166/4 Maintenance treatment for people with mild to moderate ulcerative colitis:- What is the clinical and cost effectiveness of regular maintenance treatment compared with no regular treatment (but rapid standard treatment if a relapse occurs) in specific populations with mild to moderate ulcerative colitis?
CG166/5 Risk tool for predicting the likelihood of needing surgery for adults with acute severe ulcerative colitis:- To develop and validate a risk tool that predicts the likelihood of needing surgery for adults admitted to hospital with acute severe ulcerative colitis.
CG167/1 Primary PCI and fibrinolysis in people with acute STEMI who present very early:- If a person with acute STEMI presents within 1 hour of the onset of symptoms, is it better for that person to be given fibrinolysis with a short call to needle time rather than to be transferred to a centre that carries out primary PCI for primary PCI with a delay of up to 120 minutes?
CG167/2 Primary PCI and fibrinolysis in people with acute STEMI who have a long anticipated transfer time for primary PCI:- In people with acute STEMI who present more than 1 hour after the onset of symptoms, is a primary PCI-related delay of 120–180 minutes associated with outcomes similar to, better or worse than pre-hospital administered fibrinolysis?
CG167/3 Radial arterial access primary PCI versus femoral arterial access primary PCI:- What is the clinical and cost effectiveness of radial arterial access compared with femoral arterial access for coronary angiography or primary PCI in people with acute STEMI managed by primary PCI?
CG167/4 Culprit vessel primary PCI versus multivessel PCI:- Does multivessel PCI, at the time of presentation of people with acute STEMI, confer an advantage over a strategy of 'culprit vessel only' primary PCI, followed by further elective revascularisation driven by symptoms and evidence of ischaemia?
CG167/5 Relationship between volume of procedures and clinical outcomes:- What is the relationship between hospital volume of primary PCI procedures and optimal outcomes in people with acute STEMI?
CG168/1 Natural history of varicose veins:- In people with varicose veins at CEAP (Clinical, etiological, anatomical and pathophysiological) stage C2 or C3, what are the factors that influence progression of the disease to CEAP stages C5 or C6?
CG168/2 Compression as a management option:- What is the clinical and cost effectiveness of compression hosiery versus no compression for the management of symptomatic varicose veins?
CG168/3 Compression after interventional treatment:- What is the clinical and cost effectiveness of compression bandaging or hosiery after interventional treatment for varicose veins compared with no compression? If there is benefit, how long should compression bandaging or hosiery be worn for?
CG168/4 Truncal treatment with or without concurrent tributary treatment:- What is the clinical and cost effectiveness of concurrent phlebectomies or foam sclerotherapy for varicose tributaries during truncal endothermal ablation for varicose veins compared with:
- truncal endothermal ablation without concurrent phlebectomies or foam sclerotherapy?
- truncal endothermal ablation with phlebectomies or foam sclerotherapy, if needed, 6–12 weeks later?
CG168/5 Optimal interventional and conservative treatments at different stages of disease:- What is the optimal treatment (compression, surgery, endothermal ablation or foam sclerotherapy) for varicose veins at each of the CEAP stages, that is CEAP stages 2–3, CEAP stage 4 and CEAP stages 5–6?
CG169/1 Long-term outcomes of acute kidney injury:- What are the long-term outcomes of acute kidney injury in adults, children and young people?
CG169/2 Rapid referral to nephrology services for moderate to severe acute kidney injury:- What is the clinical and cost effectiveness of rapid referral (within 12 hours) to nephrology services for adults with moderate to severe (stage 2 to 3) acute kidney injury not needing critical care?
CG169/3 Definition of acute kidney injury – system for staging and detection:- Can a simplified definition and staging system, based on Système International (SI) units, be used to predict short- to medium-term outcomes in acute kidney injury?
CG169/4 Introducing renal replacement therapy:- What is the clinical and cost effectiveness of early versus later introduction of renal replacement therapy in patients with acute kidney injury stages 2 and 3, when there is no urgent need for therapy?
CG169/5 Preventing deterioration:- What is the clinical and cost effectiveness of continuing ACE inhibitor or ARB treatment, versus stopping treatment 24 hours before cardiac surgery and resuming 24 hours after, in people with chronic kidney disease and an eGFR of less than 30 ml/min/1.73 m2?
CG170/1

What is the value of a key worker approach (defined by protocol and delivered in addition to usual care) for autistic children and young people in terms of parental satisfaction, functioning and stress and child psychopathology?

CG170/2

Is a group-based parent training intervention for parents or carers of autistic children and young people clinically and cost effective in reducing early and emerging behaviour that challenges in the short- and medium-term compared with treatment as usual?

CG170/3

What is the comparative clinical and cost effectiveness of pharmacological and psychosocial interventions for anxiety disorders in autistic children and young people?

CG170/4

Are comprehensive early interventions that combine multiple elements and are delivered by parents and teachers (for example, the Learning Experiences – an Alternative Program for Preschoolers and their Parents [LEAP] model) effective in managing the core features of autism and coexisting difficulties (such as adaptive behaviour and developmental skills) in pre‑school children?

CG171/1 Pelvic floor muscle training:- How effective are different pelvic floor muscle training regimens in the management of women with overactive bladder (OAB) symptoms and to whom should it be offered?
CG171/2 Neurostimulation:- What is the comparative effectiveness and cost-effectiveness of transcutaneous stimulation of the sacral nerve roots, and transcutaneous and percutaneous posterior tibial nerve stimulation for the treatment of OAB?
CG171/3 Botulinum toxin A:- What is the long-term effectiveness, optimal dose and optimal frequency of repeat therapy of botulinum toxin A in women with OAB based on detrusor overactivity including risk of adverse events such as urinary infection and intermittent catheterisation?
CG171/4 Sequence of invasive OAB procedures:- What is the effectiveness and optimum sequence of treatment with botulinum toxin A and percutaneous sacral nerve stimulation for the treatment of OAB after failed conservative (including drug) management?
CG171/5 Predictors of tape failure:- What are the effects of the following predictors on tape failure?
- Age per decade
- Lower maximum urethral closure pressure
- Secondary surgery versus primary surgery
- Higher maximal flow rate
- Concurrent pelvic organ prolapse surgery
- Nocturia versus no nocturia
- Urgency versus no urgency
- Pad weight (per 10 g)
 Previous urinary incontinence surgery versus no surgery
 Q-tip maximum straining less than 30 degrees, yes versus no
 Urge score (per 10 points)
 Urgency symptoms versus no urgency symptoms
 More than 20 procedures for each surgeon versus first 10 procedures for each surgeon
 General anaesthesia versus local anaesthesia
 BMI over 35 versus 30 or less
 Maximum urethral closure pressure of 31 or more versus 30 or less
 Primary surgery versus secondary surgery
 Preoperative anticholinergic medication use versus no use
CG172/1 In people who have not undergone revascularisation after an MI, does clopidogrel and placebo have a better outcome than clopidogrel and aspirin?
CG172/2 Does continuing beta-blocker treatment beyond 1 year after an MI improve outcomes for people with normal left ventricular systolic function?
CG172/3 Is treatment with an oral anticoagulant, aspirin and clopidogrel preferable to treatment with an oral
anticoagulant and clopidogrel in people who have had an MI, have an indication for oral anticoagulation and are treated either medically, by primary PCI or by coronary artery bypass grafting surgery?
CG172/4 What characteristics are associated with uptake and adherence to cardiac rehabilitation after an acute MI when rehabilitation is started early?
CG172/5 In people who have had a STEMI who undergo primary PCI with a bare-metal stent, and 4 weeks of aspirin and clopidogrel, is there an additional benefit to continuing clopidogrel for a further 11 months?
CG173/1 Monotherapy versus combination therapy for treating neuropathic pain:- What is the clinical effectiveness, cost effectiveness and tolerability of pharmacological monotherapy compared with combination therapy for treating neuropathic pain?
CG173/1

What is the clinical effectiveness, cost effectiveness and tolerability of pharmacological monotherapy compared with combination therapy for treating neuropathic pain?

CG173/10

What is the clinical and cost effectiveness of alternative treatments as firstline treatment for trigeminal neuralgia compared with other better-tolerated pharmacological treatments?

CG173/2 Relationship between symptoms, cause of neuropathic pain and its treatment:- Is response to pharmacological treatment predicted more reliably by underlying aetiology or by symptom characteristics?
CG173/2

Is response to pharmacological treatment predicted more reliably by underlying aetiology or by symptom characteristics?

CG173/3 Carbamazepine for treating trigeminal neuralgia:- What is the clinical and cost effectiveness of carbamazepine as initial treatment for trigeminal neuralgia compared with other pharmacological treatments?
CG173/3

What is the clinical and cost effectiveness of carbamazepine as initial treatment for trigeminal neuralgia compared with other pharmacological treatments?

CG173/4 Factors affecting participation and quality of life:- What are the key factors, including additional care and support, that influence participation and quality of life in people with neuropathic pain?
CG173/4

What are the key factors, including additional care and support, that influence participation* and quality of life in people with neuropathic pain?

CG173/5 Impact of drug-related adverse effects on cost effectiveness and quality of life:- What is the impact of drug-related adverse effects on health economics and quality of life in neuropathic pain?
CG173/5

What is the impact of drug-related adverse effects on health economics and quality of life in neuropathic pain?

CG173/6 Potential for dependence associated with pharmacological drugs for neuropathic pain:- Is there a potential for dependence associated with pharmacological agents for neuropathic pain?
CG173/6

Is there a potential for dependence associated with pharmacological agents for neuropathic pain?

CG173/7

How should the symptomatic treatment of neuropathic pain relate to its cause?

CG173/8

Does early intervention to treat neuropathic pain reduce the likelihood of chronic pain?

CG173/9

What is the clinical and cost effectiveness of lidocaine patches for localised peripheral pain?

CG174/1 Assessment and monitoring:- What is the incidence of complications during, and as a consequence of, IV fluid therapy?
CG175/1 Prognostic indicators:- Further research is required into the identification of prognostic indicators in order to differentiate effectively between men who may die with prostate cancer and those who might die from prostate cancer. [2008]
CG175/2 Androgen deprivation therapy and/or brachytherapy added to radiotherapy for men with intermediate- and high-risk localised non-metastatic prostate cancer:- Does the addition of androgen deprivation therapy and/or brachytherapy to high-dose external beam radiotherapy improve outcomes for men with intermediate- and high-risk localised non-metastatic prostate cancer? Outcomes of interest are biochemical disease-free survival, metastasis-free survival, overall survival, side effects and quality of life. [new 2014]
CG175/3 Using biomarkers to diagnose brain injury:- In adults with medium risk indications for brain injury under the 2014 NICE CT head injury guidance, what is the clinical and cost effectiveness of using the diagnostic circulating biomarker S100B to rule out significant intracranial injury?
CG175/4 Bisphosphonates and denosumab to treat osteoporosis:- What is the clinical and cost effectiveness of standard care with bisphosphonates compared with denosumab to treat osteoporosis caused by long-term androgen deprivation therapy? Outcomes of interest are bone mineral density, fracture risk, tolerability and skeletal-related events. [new 2014]
CG175/5 Duration of exercise to combat fatigue in men having androgen deprivation therapy:- Does a longer (more than 12 weeks) programme of supervised aerobic resistance exercise reduce fatigue more effectively than a 12-week programme in men having androgen deprivation therapy? Outcomes of interest are measures of fatigue, aerobic capacity, cardiovascular function and quality of life. [new 2014]
CG176/2 Criteria for CT head scanning:- What is the clinical and cost effectiveness of the 2014 NICE guideline recommendation on CT head scanning versus clinical decision rules (including CHALICE, CATCH and PECARN) for selecting children and infants for head CT scanning?
CG176/3 Antiplatelet and anticoagulant drugs:- In patients with head injury does the use of antiplatelet and anticoagulant drugs increase the risk of intracranial haemorrhage over and above factors included in the current recommendations for CT head scans?
CG176/4 Using biomarkers to diagnose brain injury:- In adults with medium risk indications for brain injury under the 2014 NICE CT head injury guidance, what is the clinical and cost effectiveness of using the diagnostic circulating biomarker S100B to rule out significant intracranial injury?
CG176/5 Predictors of long-term sequelae following head injury:- Research is needed to summarise and identify the optimal predictor variables for long-term sequelae following mild traumatic brain injury (TBI). A systematic review of the literature could be used to derive a clinical decision rule to identify relevant patients at the time of injury. This would in turn lay the foundation for a derivation cohort study.
CG177/1 Treatments for osteoarthritis in very old people:- What are the short-term and long-term benefits of non-pharmacological and pharmacological treatments for osteoarthritis in very old people (for example, aged 80 years and older)?
CG177/2 Combinations of treatments for osteoarthritis:- What are the benefits of combinations of treatments for osteoarthritis, and how can these be included in clinically useful, cost-effective algorithms for long-term care?
CG177/3 Treating common presentations of osteoarthritis for which there is little evidence:- What are effective treatments for people with osteoarthritis who have common but poorly researched problems, such as pain in more than one joint or foot osteoarthritis?
CG177/4 Biomechanical interventions in the management of osteoarthritis:- Which biomechanical interventions (such as footwear, insoles, braces and splints) are most beneficial in the management of osteoarthritis, and in which subgroups of people with osteoarthritis do they have the greatest benefit?
CG177/5 Treatments that modify joint structure in people with osteoarthritis:- In people with osteoarthritis, are there treatments that can modify joint structure, resulting in delayed structural progression and improved outcomes?
CG178/1 Peer support interventions:- What is the clinical and cost effectiveness of peer support interventions in people with psychosis and schizophrenia?
CG178/2 People who choose not to take antipsychotic medication:- What is the clinical and cost effectiveness of psychological intervention alone, compared with treatment as usual, in people with psychosis or schizophrenia who choose not to take antipsychotic medication?
CG178/3 The physical health benefits of discontinuing antipsychotic medication:- What are the short- and long-term benefits to physical health of guided medication discontinuation and/or reduction in first episode psychosis and can this be achieved without major risks?
CG178/4 Maintaining the benefits of early intervention in psychosis services after discharge:- How can the benefits of early intervention in psychosis services be maintained once service users are discharged after 3 years?
CG178/5 Interventions for PTSD symptoms in people with psychosis and schizophrenia:- What is the benefit of a CBT-based trauma reprocessing intervention on PTSD symptoms in people with psychosis and schizophrenia?
CG179/1 Debridement:- What is the effect of enzymatic debridement of non-viable tissue compared with sharp
debridement on the rate of healing of pressure ulcers in adults?
CG179/2 Negative pressure wound therapy:- Does negative pressure wound therapy (with appropriate dressing) improve the healing of pressure ulcers, compared with the use of dressing alone in adults with pressure ulcers?
CG179/3 Risk assessment in neonates, infants, children and young people:- Which pressure ulcer tools are most effective for predicting pressure ulcer risk in children?
CG179/4 Pressure redistributing devices: Dopressure redistributing devices reduce the development of pressure ulcers for those who are at risk of developing a pressure ulcer?
CG179/5 Repositioning:- When repositioning a person who is at risk of developing a pressure ulcer, what is the most effective position – and optimum frequency of repositioning – to prevent a pressure ulcer
developing?
CG180/1 Cognitive behavioural therapy for people with atrial fibrillation:- What is the clinical and cost effectiveness of cognitive behavioural therapy (CBT) compared with usual care for people with newly diagnosed atrial fibrillation?
CG180/2 Rate control drug treatment for people aged 75 and over with atrial fibrillation:- What is the comparative effectiveness of the 3 main drug classes used for rate control (beta-blockers, calcium-channel blockers and digoxin) in people aged 75 and over with atrial fibrillation in controlling symptoms, improving quality of life and reducing morbidity and mortality?
CG180/3 Case volume as an indicator of quality for people offered left atrial catheter ablation:- What is the effect of case volume on complications and outcomes after left atrial catheter ablation?
CG180/4 Non-vitamin K antagonist oral anticoagulants:- Do people with atrial fibrillation whose anticoagulant control is poor, or is predicted to be poor, with warfarin benefit from changing to one of the non-vitamin K antagonist (non-VKA) oral anticoagulants?
CG180/5 Stroke risk assessment:- Can routine data from UK primary care databases clarify stroke risk in people with atrial fibrillation according to baseline risk factors and treatment?
CG181/1 What is the effectiveness of age alone and other routinely available risk factors compared with the formal structured multifactorial risk assessment to identify people at high risk of developing CVD?
CG181/2 What is the improvement in the cost-effectiveness metrics for statin therapy in reducing CVD that can be obtained when using a complete individual patient-based outcomes meta-analysis data set compared with using published outcomes data?
CG181/3 What is the effectiveness of statin therapy in older people?
CG181/4 What is the effectiveness of statins and/or other LDL-cholesterol-lowering treatment in people with type 1 diabetes?
CG181/5 What is the clinical effectiveness and rate of adverse events of statin therapy using atorvastatin 20 mg per day compared with atorvastatin 40 mg per day and atorvastatin 80 mg per day in people without established CVD?
CG183/1 Designing systems for documenting drug allergy:- Which documentation strategies would be most clinically and cost effective to minimise the number of people who are re-exposed to drugs to which they have a suspected or confirmed allergy, looking in particular at:
- electronic health records that include features specifically designed to record and alert
clinicians to drug allergy information, compared with systems without such features and
- different formats for patient-held, structured drug allergy documentation?
CG183/2 Communicating information about drug allergy:- In people with suspected or confirmed drug allergies, are patient-focused information strategies more effective than standard NHS practice in increasing people's likelihood of disclosing their drug allergy (or their suspected drug allergy) and therefore reducing the risk of being re-exposed to the affected drug?
CG183/3 Using selective cyclooxygenase 2 inhibitors in people with previous severe allergic reactions to non-selective non-steroidal anti-inflammatory drugs:- Should all patients who have experienced a severe allergic reaction to a non-selective non-steroidal anti-inflammatory drug (NSAID) be assessed by specialist drug allergy services or should they be advised to take a selective cyclooxygenase 2 (COX 2) inhibitor without further investigations if clinically appropriate?
CG183/4 Oral antibiotic challenge for diagnosing antibiotic allergy in children:- In children who have a suspected allergy to an antibiotic, is it clinically and cost effective to proceed directly (without prior skin or intradermal tests) to a diagnostic oral antibiotic challenge rather than referring them to specialist drug allergy services?
CG184/1 Patient characteristics, risk factors and predictors that indicate endoscopy for excluding Barrett's oesophagus:- In people who experience symptoms of gastro-oesophageal reflux disease (GORD) or symptoms suggestive of GORD, what patient characteristics, risk factors and predictors indicate when endoscopy is needed to exclude Barrett's oesophagus?
CG184/1

In people who experience symptoms of gastro-oesophageal reflux disease (GORD) or symptoms suggestive of GORD, what patient characteristics, risk factors and predictors indicate when endoscopy is needed to exclude Barrett's oesophagus?

CG184/2 Laparoscopic fundoplication compared with medical management:- What is the effectiveness of laparoscopic fundoplication compared with medical management in people with GORD that does not respond to optimal proton pump inhibitor (PPI) treatment?
CG184/2

What is the effectiveness of laparoscopic fundoplication compared with medical management in people with GORD that does not respond to optimal proton pump inhibitor (PPI) treatment?

CG184/3 Effective proton pump inhibitor dosage for severe erosive reflux disease:- What is the clinical effectiveness of double-dose PPIs in people with severe erosive reflux disease (Los Angeles classification grade C/D or Savary–Miller grade 3/4):
- to reduce severe oesophagitis
- to control symptoms
- as maintenance therapy?
CG184/3

What is the clinical effectiveness of double-dose PPIs in people with severe erosive reflux disease (Los Angeles classification grade C/D or Savary–Miller grade 3/4):

  • to reduce severe oesophagitis

  • to control symptoms

  • as maintenance therapy?

CG184/4 Other specialist management:- What specialist management is effective for people whose symptoms do not respond to PPIs despite optimum primary care, or for people whose symptoms return after surgery?
CG184/4

What specialist management is effective for people whose symptoms do not respond to PPIs despite optimum primary care, or for people whose symptoms return after surgery?

CG184/5 Specialist investigation:- What specialist investigations should be conducted to exclude a diagnosis of functional dyspepsia in people with uninvestigated dyspepsia that does not respond to PPIs or H2 receptor antagonists (H2RAs) despite optimum primary care?
CG184/5

What specialist investigations should be conducted to exclude a diagnosis of functional dyspepsia in people with uninvestigated dyspepsia that does not respond to PPIs or H2 receptor antagonists (H2RAs) despite optimum primary care?

CG185/2 Maintenance treatment:- In the maintenance treatment of bipolar disorder, what is the relative effect on quality of life of lithium, an antipsychotic (haloperidol, olanzapine, quetiapine or risperidone), or a combination of lithium and an antipsychotic?
CG186/1 What is the clinical and cost effectiveness of cognitive rehabilitation for people with Multiple sclerosis (MS)?
CG186/2 Is intravenous methylprednisolone more clinically and cost effective than oral methylprednisolone in people with relapsing–remitting Multiple Sclerosis (MS) and people with secondary progressive MS with continued relapses?
CG186/3 What is the optimal frequency, intensity and form of rehabilitation for mobility problems in people with Multiple Sclerosis (MS)?
CG186/4 What non-pharmacological interventions are effective in reducing spasticity in people with Multiple Sclerosis (MS)?
CG186/5 Can vitamin D slow down the progression of disability in Multiple Sclerosis (MS)?
CG187/01

Dopamine: In people with acute heart failure, congestion and worsening renal function, does the addition of low‑dose dopamine to standard therapy lead to greater diuresis and renal protection compared with adding placebo to standard therapy?

CG187/02

Thiazide: In people with acute heart failure and persistent congestion, does the addition of a thiazide diuretic to standard therapy lead to greater diuresis compared with adding placebo to standard therapy?

CG187/03

Intra-aortic balloon counter‑pulsation: In people with acute heart failure and hypoperfusion syndrome, is the use of intra‑aortic balloon counter‑pulsation pump (IABP) better than the use of intravenous inotropes?

CG187/04

Ultrafiltration: In people with decompensated heart failure, fluid congestion and diuretic resistance, does ultrafiltration lead to more rapid and effective decongestion compared with continuing diuretic treatment?

CG188/1 What are the long-term benefits and harms, and cost effectiveness of endoscopic ultrasound (EUS) compared with magnetic resonance cholangiopancreatography (MRCP) in adults with suspected common bile duct stones?
CG188/2 What are the benefits and harms, and cost effectiveness of routine intraoperative cholangiography in people with low to intermediate risk of common bile duct stones?
CG188/3 What models of service delivery enable intraoperative endoscopic retrograde cholangiopancreatography (ERCP) for bile duct clearance to be delivered within the NHS? What are the costs and benefits of different models of service delivery?
CG188/4 In adults with common bile duct stones, should laparoscopic cholecystectomy be performed early (within 2 weeks of bile duct clearance), or should it be delayed (until 6 weeks after bile duct clearance)?
CG188/5 What is the long-term effect of laparoscopic cholecystectomy on outcomes that are important to patients?
CG189/01

Measurements for assessing health risks in adults: What are the most accurate and suitable measurements and boundary values to assess the health risks associated with overweight, obesity and central adiposity in adults of different ethnicities, particularly those from Black, Asian and minority ethnic family backgrounds?

CG189/02

Measurements for assessing health risks in children and young people: What are the most accurate and suitable measurements and boundary values to assess the health risk associated with overweight, obesity and central adiposity in children and young people of different ethnicities, particularly those from Black, Asian and minority ethnic family backgrounds?

CG189/03

Follow-up care after bariatric surgery: Do post-operative lifestyle intervention programmes (exercise, behavioural or dietary) improve weight loss and weight-loss maintenance following bariatric surgery?

CG189/03

What is the effectiveness and cost effectiveness of bariatric surgery in achieving weight loss and improving treatment outcomes in people who are unable to receive treatment for other health conditions (such as joint replacement surgery or fertility treatment) because they are living with obesity? 

CG189/04

Long-term outcomes of bariatric surgery on people with type 2 diabetes: What is the long-term effect of bariatric surgery on diabetes-related complications and quality of life in people with type 2 diabetes compared with optimal medical treatment?

CG189/04

What is the effectiveness and cost effectiveness of bariatric surgery in achieving weight loss and maintaining a healthier weight in adults from minority ethnic family backgrounds who are living with obesity? 

CG189/05

Bariatric surgery in children and young people: What are the long-term outcomes of bariatric surgery in children and young people living with obesity?

CG189/06

Obesity management for people with a condition associated with an increased risk of obesity: What is the best way to deliver obesity management interventions to people with particular conditions associated with increased risk of obesity (such as people with a physical disability that limits mobility, a learning disability or enduring mental health difficulties)?

CG189/07

Long-term effect of very-low-calorie diets on people with a BMI of 40 kg/m2 or more: What are the long-term effects of using very-low-calorie diets (VLCDs) versus low-calorie diets (LCDs) on weight and quality of life in patients with a body mass index (BMI) of 40 kg/m2 or more, including the impact on weight cycling?

CG189/08

Comparative risks for different generations of immigrants: Is the risk of ill health the same for first-, second- and third-generation immigrants from black, Asian and other minority ethnic groups at the same BMI and waist-to-height ratio thresholds?

CG189/09

Single cut-off points: What are the risks and benefits of developing single-figure cut-off points on BMI and waist-to-height ratio for black, Asian and other minority ethnic groups to help prevent diabetes and other conditions?

CG189/10

Awareness of risk among black, Asian and other minority ethnic groups: Are black, Asian and other minority ethnic groups aware that they are at the same risk of type 2 diabetes and mortality at a lower BMI, compared with the white population?

CG189/11

Practitioners and providers' awareness of risk in black, Asian and other minority ethnic groups: Are clinicians, practitioners and weight management service providers aware that black, Asian and other minority ethnic groups are at the same risk of type 2 diabetes and mortality at a lower BMI compared with the white population. If so, do they intervene at lower BMI and waist-to-height ratio thresholds?

CG189/12

Lifestyle interventions for black, Asian and other minority ethnic groups: How effective and cost effective are lifestyle interventions for people from black, Asian and other minority ethnic groups at different BMI and waist-to-height ratio thresholds, compared with the general population?

CG190/03

Long‑term consequences of planning birth in different settings: What are the long‑term consequences for women and babies of planning birth in different settings?

CG190/04

Education about the latent first stage of labour: Does enhanced education specifically about the latent first stage of labour increase the number of nulliparous women who wait until they are in established labour before attending the obstetric or midwifery unit (or calling the midwife to a home birth), compared with women who do not receive this education?

CG190/05

Postpartum haemorrhage: What is the most effective treatment for primary postpartum haemorrhage?

CG191/1 In moderate- to high-severity community-acquired pneumonia does using legionella and pneumococcal urinary antigen testing in addition to other routine tests improve outcomes?
CG191/2 In patients hospitalised with moderate- to high-severity community-acquired pneumonia, does using C-reactive protein monitoring in addition to clinical observation to guide antibiotic duration safely reduce the total duration of antibiotic therapy compared with a fixed empirical antibiotic course?
CG191/3 What is the clinical effectiveness of continuous positive pressure ventilation compared with usual care in patients with community-acquired pneumonia and type I respiratory failure without a history of chronic obstructive pulmonary disease?
CG191/4 Can rapid microbiological diagnosis of hospital-acquired pneumonia reduce the use of xtendedspectrum antibiotic therapy, without adversely affecting outcomes?
CG192/1 What methods can improve the identification of women at high risk of postpartum psychosis and reduce this risk?
CG192/2

How safe are drugs used to treat bipolar disorder in pregnancy and the postnatal period?

CG192/3 Are interventions designed to improve the quality of the mother–baby relationship in the first year after childbirth effective in women with a diagnosed mental health problem?
CG192/4 Is structured clinical management for moderate to severe personality disorders in pregnancy and the postnatal period effective at improving outcomes for women and their babies?
CG192/5 Are psychological interventions effective for treating moderate to severe anxiety disorders (including obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder and social anxiety disorder) in pregnancy?
CG28/1 An appropriately blinded, randomised controlled trial should be conducted to assess the efficacy (including measures of family and social functioning as well as depression) and the cost effectiveness of another self-help intervention compared with computerised [Cognitive Behavioural Therapy (CBT)] and treatment as usual in a sample of children and young people treated in primary care who have been diagnosed with depression. The trial should be powered to examine the effect of treatment in children and young people separately and involve a follow-up of 12 to 18 months (but no less than 6 months).[2015]
CG28/2 An appropriately blinded, randomised controlled trial should be conducted to assess the efficacy (including measures of family and social functioning as well as depression) and the cost effectiveness of individual [cognitive behavioural therapy] (CBT), systemic family therapy and child psychodynamic psychotherapy compared with each other and treatment as usual in a broadly based sample of children and young people diagnosed with moderate to severe depression (using minimal exclusion criteria). The trial should be powered to examine the effect of treatment in children and young people separately and involve a follow-up of 12 to 18 months (but no less than 6 months).[2015]
CG28/3 An appropriately blinded, randomised controlled trial should be conducted to assess the efficacy (including measures of family and social functioning as well as depression) and the cost effectiveness of fluoxetine, the favoured psychological therapy [emerging from another suggested trial - as specified in paragraph 4.1 of the document], the combination of fluoxetine and psychological therapy compared with each other and placebo in a broadly based sample of children and young people diagnosed with moderate to severe depression (using minimal exclusion criteria). The trial should be powered to examine the effect of treatment in children and young people separately and involve a follow-up of 12 to 18 months (but no less than 6 months).[2015]
CG30/1

Few women use contraception perfectly (that is, exactly in accordance with the product instructions) and consistently. Pregnancy rates during typical use reflect effectiveness of a method among women who use the method incorrectly or inconsistently. Few data are available on typical use of any contraceptive method among women in the UK. Much of the data on contraceptive effectiveness used in the guideline come from clinical trials or surveys undertaken in other countries such as the USA. Large prospective cohort studies are needed to compare the contraceptive effectiveness of LARC methods with non‑LARC methods during typical use in the UK.

CG30/2

Most women will need to use contraception for more than 30 years. Patterns of contraceptive use vary with age, ethnicity, marital status, fertility intention, education and lifestyle. Large prospective cohort studies are needed to identify:

  • patterns of use (initiation, continuation and switching between methods) of LARC methods compared with non‑LARC methods

  • factors that influence the patterns of use of LARC.

CG30/3

In addition to individual circumstances and needs, a woman's choice and acceptance of LARC may be influenced by potential health disbenefits (side effects and risks) as well as non‑contraceptive benefits of LARC (such as alleviation of menorrhagia). Large population studies of appropriate design are needed to determine the effect of these factors on the uptake of LARC methods and the implications for NHS resources.

CG30/4

The effect of injectable contraceptives on bone mineral density in women who have used DMPA for longer than 2 years is uncertain. Adequately powered surveys or cross‑sectional studies are needed to examine the recovery of bone mineral density after discontinuation of DMPA after long‑term and very long‑term use. Studies are also needed to examine the risk of bone fractures in older women.

CG61/2 Psychological interventions:- Are the psychological interventions [cognitive behavioural therapy] (CBT), hypnotherapy and psychological therapy all equally effective in the management of [Irritable bowel syndrome] (IBS) symptoms, either as first-line therapies in primary care, or in the treatment of people with IBS that is refractory to other treatments?
CG61/3 Refractory [Irritable bowel syndrome] (IBS):- What factors contribute to refractory IBS?
CG61/4 Relaxation and biofeedback:- What is the effect of relaxation and biofeedback therapies on [Irritable bowel syndrome] (IBS) symptoms and patient-related outcomes?
CG61/5 Herbal medicines:- Are Chinese and non-Chinese herbal medicines safe and effective as first-line therapy in the treatment of [Irritable bowel syndrome] (IBS), and which is the most effective and safe option?
CG71/1

What is the clinical and cost effectiveness of using different thresholds of LDL‑C concentration in primary care case finding?

CG71/2

What are the long-term effects of statin therapy on sub-clinical atherosclerosis in children with FH who are treated with statin therapy?

CG71/3

What is the clinical effectiveness and safety of differing doses of lipid-modifying therapy in children with FH?

CG71/4

What are the appropriate indications, effectiveness and safety of LDL apheresis in people with heterozygous FH?

CG71/5

What are the implications of FH for the safety of a mother during pregnancy and what are the risks of fetal malformations attributable to pharmacological therapies

CG71/6

What is the utility of routine cardiovascular evaluation for asymptomatic people with FH?

CG81.1/1

What is the role of arm and shoulder specific exercises compared with and/or used as an adjunct to established lymphoedema treatments (such as compression garments and complex decongestive therapy)?

DG1/1 Research is needed to quantify the health outcome benefits associated with imaging improvements with the EOS system. Examples of such benefits might include reduced back pain or reduced postural difficulties in people with scoliosis, or longer lasting and less painful joint replacements. Although research into the use of the EOS system is appropriate for all the indications included in the scope, the research most likely to be useful is for planning hip and knee replacement, including patient selection, device selection, and surgical approach. Joint replacement operations are more common than the other indications and the EOS system is thought to be most likely to provide benefit to these patients.
DG1/2 Additional methodological research is needed to determine the most appropriate model structures to assess the benefit arising from radiation dose reduction. Additional work is needed to assess when the radiation-induced cancers actually occur and the impact of the timing of the emergence of cancer on health status.
DG1/3 Research is needed to determine whether, and for which conditions, use of the EOS system for 3D reconstruction provides benefit for diagnosis or treatment planning.
DG10/1 MammaPrint: research is recommended on the clinical validity of the test in people that are representative of the population in England. In particular, information on how the test reclassifies people when compared with current practice in England and their risk of distant recurrence would be useful. Research into the clinical utility of the test is also recommended; in particular, evidence of the impact of the test on clinical decision-making in England and robust data on its ability to predict the benefit of chemotherapy.
DG10/2 Oncotype DX: research is recommended on the clinical utility of the test, including robust evidence on the impact of Oncotype DX on clinical decisionmaking in England (containing consideration of informal approaches compared with a formal algorithm for combining the Oncotype DX score with clinicopathological variables) and its ability to predict the benefit of chemotherapy. As part of the adoption of Oncotype DX by the NHS, NICE encourages the collection of clinical utility and any other useful data by the health system, potentially by a multicentre audit.
DG10/3 IHC4: research into the analytical validity (reliability and reproducibility) of the complete IHC4 test is recommended (an algorithm combining 4 markers and classical clinical and pathological variables), particularly within the NHS and when performed in local laboratories. Studies to confirm the prognostic ability and to determine the impact of IHC4 on clinical decision-making in England and, ideally, to predict the benefit of chemotherapy are recommended.
DG10/4 Mammostrat: research on the analytical validity (reliability and reproducibility) of the test is recommended. Research on the clinical utility of the test is also recommended. In particular, evidence of how the test reclassifies people's risk when compared with current practice in England, evidence on the impact of Mammostrat on clinical decision-making in England, and its ability to predict the benefit of chemotherapy.
DG11/1 Further research is needed on the use and clinical utility of faecal calprotectin testing, and support pathways for the long-term management of these conditions in the community should be developed.
DG11/2 Further research is needed on the impact of faecal calprotectin testing on clinical decision-making when added to current practice. This includes research into optimal cut-off values for tests and the investigation of repeat testing strategies in people with intermediate levels of faecal calprotectin. Development of a consistent definition for the 'intermediate range' is encouraged.
DG11/3 Robust evidence is needed on the comparative performance of different faecal calprotectin tests, including the performance of POCTs compared with laboratory-based tests.
DG12/1 NICE discussed the potential for future research. NICE accepted that there is a need to further establish the accuracy of current practice in diagnosing asthma and the incremental accuracy associated with
the addition of FeNO testing.
DG12/2 NICE also considered the role of FeNO measurement in asthma management. It accepted that currently available evidence on the use of FeNO measurement in asthma management is unclear on whether benefits of treatment are maintained long-term. NICE concluded that long-term studies following patients for several years could address this gap.
DG12/3 NICE also considered the role of FeNO in guiding inhaled corticosteroid dosing through stepping-up and stepping-down protocols. It accepted there is a need for more evidence on which protocols offer the safest and most optimal asthma management when used in UK clinical practice. Therefore, further studies are recommended, with consideration for the different protocols and cut-off points that may be necessary in different populations.
DG13/1 NICE recommends further research to demonstrate the utility of the Sonoclot system in detecting, managing and monitoring haemostasis in cardiac surgery.
DG13/2 NICE recommends further research in using viscoelastometric testing in the emergency control of bleeding after trauma and during postpartum haemorrhage to assess its effectiveness compared with standard laboratory testing. NICE recommends that outcomes should include, but may not be limited to, bleeding outcomes, mortality, duration of hospital or intensive care unit stay, transfusion rates and volumes transfused.
DG13/3 NICE recommends further research comparing the clinical effectiveness of all 3 viscoelastometric devices (ROTEM, TEG and Sonoclot systems) in cardiac surgery and in the emergency control of bleeding after trauma and during postpartum haemorrhage. In particular, NICE recommends research to determine which of the parameters included in the viscoelastometric testing systems are the most significant in changing clinical decision-making and improving clinical outcomes. The degree of change needed in these parameters to affect clinical decision-making and clinical outcomes should also be considered.
DG13/4 NICE recommends that future trials should include longer-term follow-up, beyond the initial hospital episode, with a view to informing the cost-effectiveness modelling and reducing uncertainty.
DG13/5 NICE recommends further research to understand the characteristics of patients at high risk of haemostatic instability in whom viscoelastometric testing may be most cost effective.
DG16/1 NICE recommends further research to validate the accuracy and precision of the My5-FU assay for the quantitative determination of 5-fluorouracil (5-FU) at the lower end of its measuring range with analytical reference standard methods, including high-performance liquid chromatography and liquid chromatography-mass spectrometry.
DG16/2 NICE recommends that robust evidence be generated to show the clinical effectiveness of pharmacokinetic dose adjustment of continuous infusion 5-FU in people with colorectal cancer.
DG16/3 NICE recommends further research to establish optimal target dose ranges for 5-FU plasma levels in people with head and neck cancer, stomach cancer and pancreatic cancer.
DG16/4 NICE recommended further research to explore the impact of having experiences of patients having continuous infusion 5-FU and take into account the impact on quality of life. The potential consequences of introducing pharmacokinetic dose adjustment should also be explored.
DG18/1

What is the impact and longer-term clinical outcomes of adding procalcitonin testing to standard clinical practice with protocol-driven care in the NHS, to guide the use of antibiotic treatment in people with confirmed or highly suspected sepsis in intensive care units and in people with suspected bacterial infections presenting to the emergency department?

DG18/2

What is the impact and longer-term clinical outcomes of adding procalcitonin testing to standard clinical practice with protocol-driven care in the NHS, to guide the use of antibiotic treatment in children having antibiotics for a suspected or proven infection in an intensive care unit?

DG18/3

What is the impact and longer-term clinical outcomes of adding procalcitonin testing to standard clinical practice with protocol-driven care in the NHS, to guide the use of antibiotic treatment in children and adults presenting to the emergency department with respiratory tract infection?

DG18/4

What is the impact and longer-term clinical outcomes of adding procalcitonin testing to standard clinical practice with protocol-driven care in the NHS, to guide the use of antibiotic treatment in adults presenting to the emergency department with exacerbations of chronic inflammatory respiratory conditions such as chronic obstructive pulmonary disease?

DG19/1

What is the impact of using the VivaScope 1500 and 3000 imaging systems in the clinical workflow of melanoma and basal cell carcinoma assessment in secondary care in England, particularly on excision rates, diagnostic accuracy, health related quality of life and associated NHS costs?

DG19/2

What proportion of people with melanoma who are referred into secondary care under the 2 week wait rule, have equivocal moles that are excised and have equivocal moles that are monitored?

DG19/3

How many confirmatory diagnostic biopsies are carried out before definitive treatment, in people who have a clinical diagnosis of basal cell carcinoma and which different modalities used to treat basal cell carcinoma?

DG19/4

What is the clinical effectiveness of using the VivaScope 1500 and 3000 imaging systems to define margins of lentigo maligna and basal cell carcinoma compared with histological margins determined by Mohs surgery?

DG19/5

What is the incidence of lentigo maligna diagnosed in England and which different therapies are used to treat lentigo maligna?

DG21/1

NICE recommends further research to quantify the impact of hypoglycaemia on quality of life for people with type 1 diabetes and their carers.
Future research should include adults and children and should capture the impact of persistent anxiety associated with the fear of catastrophic events related to severe hypoglycaemic events.

DG21/2

NICE recommends further research to investigate the clinical effectiveness of the integrated sensor-augmented insulin pump therapy systems in younger children and pregnant women. No data are currently available for these subgroups and their inclusion in future studies is encouraged.

DG21/3

NICE recommends that health economic models are developed to capture the impact of interventions on short-term outcomes such as hypoglycaemia. In addition, the feasibility of incorporating more recently developed risk prediction models for cardiovascular disease such as QRisk2 and observational data from registries such as the Swedish National Diabetes Register into health economic models for type 1 diabetes should be explored.

DG22/1

Further research into the analytical and clinical validity of the enzyme-linked immunosorbent assay (ELISA) kits (LISA-TRACKER, IDKmonitor and Promonitor) is recommended, specifically on:
- the best methods to measure tumour necrosis factor (TNF)-alpha-inhibitor levels in the presence of antibodies to TNF-alpha inhibitors
- developing primary reference standards
- the accuracy for predicting clinical state
- clinically meaningful thresholds.

DG22/2

Further research is recommended on clinical outcomes associated with using the ELISA kits (LISA-TRACKER, IDKmonitor and Promonitor) in people whose Crohn's disease is losing response to a TNF-alpha inhibitor. This could be through a prospective study, for local audit, or for submission to a registry. (The IBD Registry is being adapted to receive data on TNF-alpha inhibitor levels and antibodies against TNF-alpha inhibitors).

DG22/3

Further research is recommended on clinical outcomes associated with using the ELISA kits (LISA-TRACKER, IDKmonitor and Promonitor) to monitor TNF-alpha-inhibitor levels and antibodies to a TNF-alpha inhibitor in people with Crohn's disease whose disease responds to treatment with TNF-alpha inhibitors. This should be evaluated using prospective studies.

DG23/1

Further research is recommended on the use of repeat PlGF-based testing (Triage PlGF test and Elecsys immunoassay sFlt-1/PlGF ratio), with standard clinical assessment, in women presenting with suspected pre-eclampsia between 20 weeks and 34 weeks plus 6 days of gestation, who have had a negative PlGF-based test result (Triage PlGF test result of 100 picograms/ml or more; Elecsys immunoassay sFlt 1/PlGF ratio of less than 38) that was used to rule-out pre-eclampsia. This should include:
- exploration of the different scenarios in which repeat testing may be indicated
- the appropriate intervals between PlGF-based tests
- the diagnostic accuracy of PlGF-based testing in women with suspected pre-eclampsia who have previously had 1 or more negative PlGF-based test results.

DG23/2

Further research is recommended on the use of the Triage PlGF test and Elecsys immunoassay sFlt-1/PlGF ratio, with standard clinical assessment, to rule-in pre-eclampsia in women presenting with suspected pre-eclampsia between 20 weeks and 34 weeks plus 6 days of gestation. This should specifically investigate how a positive PlGF-based test result (Triage PlGF test result of 12 picograms/ml or less; Elecsys immunoassay sFlt 1/PlGF ratio of greater than 38) used to rule-in pre-eclampsia would affect management decisions on time to delivery and the outcomes associated with this.

DG24/2

Further research is recommended on using ImmunoCAP ISAC 112 for diagnosing allergy and clinical outcomes associated with using allergy testing for people with allergy that is difficult to diagnose, specifically in people with:
- idiopathic anaphylaxis
- multiple allergies and multiple sensitisations
- plant-derived food allergy
- seafood allergy, but who have a positive history and negative diagnostic test results.

DG25/1

Further research is recommended on alternative postpartum testing strategies that do not include cord blood typing of all babies born to rhesus-D (D) negative women.

DG26/1

Further research is recommended on resource use and clinical effects associated with using the xTAG Gastrointestinal Pathogen Panel, the FilmArray GI Panel and the Faecal Pathogens B assay.

DG28/1

Further research is recommended on patient acceptability of using virtual chromoendoscopy for real-time assessment of diminutive polyps compared with assessment using histopathology

DG28/2

Data collection and analysis are recommended to monitor the effect on endoscopy and histopathology services of using virtual chromoendoscopy instead of  histopathology to assess diminutive polyps. Measures may include:
- the length of time to do colonoscopies
- the number of polyps sent for histopathology analysis
- cost savings or workload reductions associated with reductions in histopathology.

DG29/1

NICE recommended further research into the clinical effectiveness of BCM – Body Composition Monitor-guided fluid management in people with chronic kidney disease having dialysis. It noted that the ongoing BISTRO study will assess the effect of the device in people aged 18 years or over having haemodialysis. Further research should collect clinical-outcome data in the following populations:
- adults (aged 18 years and over) having peritoneal dialysis
- babies, children and young people (aged under 18 years) having haemodialysis
- babies, children and young people (aged under 18 years) having peritoneal dialysis.

DG29/2

NICE recommended that data on the effect of BCM – Body Composition Monitor-guided monitoring on health-related quality of life is collected and published. Prospective within-patient studies, which record quality of life and symptoms before and after having BCM – Body Composition Monitor-guided fluid management should be considered.

DG30/1

NICE considered that further research is needed to determine whether faecal haemoglobin levels are influenced by age, sex and medicines that increase the risk of gastrointestinal bleeding. It noted that these data could be used to further develop risk scores that include variables such as age, sex and symptoms to help determine pre-test probability. The data could also be combined with faecal haemoglobin concentration to refine management after the use of faecal immunochemical tests in primary care.

DG30/2

NICE noted advice from clinical experts that there is variability between the faecal immunochemical tests. This may affect the number of positive and negative results reported by the tests when a single threshold is used. It recommended further research to investigate the variability between technologies and encouraged the companies to make sure that results can be standardised for use in a symptomatic population.

DG31/1

Further diagnostic accuracy studies, or analyses of existing data sets, are recommended to assess the accuracy of the tests included in this assessment in the following subgroups:
- people who are premenopausal
- people who are postmenopausal
- people with suspected early stage ovarian cancer, that is, disease apparently confined to the pelvis.
Future studies should be done in populations that are representative of people with suspected ovarian cancer who are assessed in NHS secondary care.

DG31/2

Further research is recommended to assess:
- inter-observer reproducibility of tests involving ultrasound scans (the ADNEX model and Simple Rules)
- changes in clinical management based on test results from the ADNEX model, Overa (MIA2G), ROMA and Simple Rules.

DG31/3

Further research is recommended to assess the diagnostic accuracy of the tests included in this assessment when used in combination; for example sequentially.

DG32/1

The committee recommended that further studies should be done in a HPV primary screening setting. These studies should incorporate clinical outcome data and be designed to minimise verification bias. Future studies should consider measuring variability and should also take into account HPV genotyping status when possible, so that the difference in accuracy in a population vaccinated against HPV types 16 and 18 can be better understood.

DG32/2

The  committee recommended that data should be collected to show how the results of the technologies affect decision-making, including biopsy decisions and decisions to
discharge people with a negative colposcopy examination back to routine screening.

DG32/3

Further research is needed to understand the effect of having the additional information provided by the adjunctive colposcopy technologies on anxiety for people having a colposcopy, when this information is shown to a person during the examination.

DG32/4

The committee recommended that further research is needed to better understand the natural history of low-volume cervical intraepithelial neoplasia (CIN) 2 lesions.

DG33/1

Further research on the routine adoption of Actim Partus and PartoSure to help diagnose preterm labour in women with intact membranes when transvaginal ultrasound measurement of cervical length is needed on the accuracy of the tests and their effect on clinical outcomes. Centres using the tests to help diagnose preterm labour in women with intact membranes are encouraged to take part in studies to address the research considerations (see the guidance sections 5.12 to 5.16). Data are needed on:
- the impact of gestational age on the accuracy of the tests
- how the tests affect clinical decision-making
- the effect of the tests on outcomes for mother and baby

DG35/1

The committee recommended further research to determine if using the lead‑I electrocardiogram (ECG) devices in primary care for people with signs or symptoms of atrial fibrillation, and an irregular pulse, increases the number of people with atrial fibrillation (including paroxysmal) detected, ompared with current practice (that is, a 12‑lead ECG done later). The committee considered the feasibility of collecting data to see if using the lead‑I ECG devices increased the detection of atrial fibrillation that would be missed if only 12‑lead ECGs done later were available. It noted that even if a lead‑I ECG is used and atrial fibrillation is detected, a subsequent 12‑lead ECG would still be done to check for structural cardiac abnormalities and inform further management decisions. The committee concluded that practices using lead‑I ECG devices could determine the number of additional cases of atrial fibrillation detected by the devices. This can be done by identifying people with a confirmed positive lead‑I ECG for atrial fibrillation who subsequently had a 12‑lead ECG that was negative because the atrial fibrillation had stopped. The committee also considered that data collected on the time between the initial lead‑I ECG and the subsequent 12‑lead ECG would be useful.

DG35/2

The committee recommended that data should be collected to evaluate the system impact of adopting the lead‑I ECGs on both primary and secondary care. In particular, data should be collected on how ECGs generated by the devices would be interpreted in practice, including staff time needed to interpret the ECG traces and associated costs.

DG36/1

Further primary research is recommended on the clinical effectiveness of using ELISA tests for therapeutic monitoring of TNF‑alpha inhibitors in people with rheumatoid arthritis.

DG36/2

secondary research is recommended to understand the clinical validity of enzyme-linked immunosorbent assay (ELISA) tests, that is the correlation between ELISA test results and health outcomes or states, such as remission, response, low or high disease activity or flares in rheumatoid arthritis

DG36/3

Secondary research is recommended to understand the comparative performance of different ELISA tests for therapeutic monitoring of tumour necrosis factor (TNF)‑alpha inhibitors in rheumatoid arthritis

DG37/1

The committee recommended further research on the incidence and effect of post-contrast acute kidney injury (PC‑AKI) in people with eGFR less than 30 ml/min/1.73 m2.

DG37/2

The committee recommended that a suitable risk factor screening tool for identifying risk of PC‑AKI for use across the NHS in people presenting for an outpatient CT scan with contrast agent is developed or an existing tool is validated.

DG37/3

The committee recommended studies to collect data on the rates of cancelled CT scans, whether cancelled appointments are filled and the effect on patients' experience before and after the introduction of point-of-care (POC) creatinine devices to radiology departments.

DG38/1

The committee recommended that further research is needed to measure the wider effects on public health and the costs of antimicrobial stewardship associated with different classes of antibiotics used in different healthcare settings. This will help to inform the development of technologies to guide more targeted use of antibiotics and wider UK antimicrobial resistance policy.

DG39/1

Companies should specify patient populations in the NHS who could benefit from test-guided preventive care for acute kidney injury. Further research is then recommended in these populations to assess the clinical effectiveness of defined care bundles designed to prevent or reduce the effect of acute kidney injury in the NHS. Research should be done in children, young people and adults, but specific considerations may be needed for children and young people when care differs from that for an adult population (see section 4.11).

DG39/2

Further research is recommended to assess the effect of test-guided preventive care (see section 5.1) on clinical outcomes (such as length of stay in hospital, mortality and need for renal replacement therapy and progression to chronic kidney disease). Research should be done in children, young people and adults, but specific considerations may be needed for children and young people when care differs from that for an adult population. Studies should investigate the effects of both positive and negative test results on clinical decisions and subsequent care.

DG40/1

Further research is recommended on the diagnostic performance of the TriageTrue high-sensitivity troponin test using samples at point of care.

DG40/2

Further research is recommended on how using sex-specific 99th percentile thresholds affects treatment decisions and clinical outcomes for men and women.

DG41/1

Further research is recommended to assess the diagnostic yield of the BioMonitor 2‑AF and Confirm Rx (or later devices) for atrial fibrillation when used in people who have had a cryptogenic stroke. The committee noted that existing ongoing research may provide further data for these devices (see section 3.51 and section 4.19).

DG44/01

Further data collection and research are recommended to understand how SeHCAT (tauroselcholic [75 selenium] acid) test results affect clinical decision making.

DG44/02

Further data collection and research are recommended to assess clinical outcomes after positive and negative SeHCAT test results. This research should focus on clinical outcomes relevant to people with chronic diarrhoea, such as severity of symptoms, including urgency. Clinical outcomes should be measured in the short and long term.

DG44/03

Further data collection and research are recommended to assess the effectiveness of treatment options for bile acid diarrhoea. Consideration should be given to how well the treatments are tolerated and how they affect the severity of symptoms in the longer term.

DG44/04

Further data collection and research are recommended to better understand the health-related quality of life in people with bile acid diarrhoea. Consideration should be given to how quality of life differs before and after a positive or negative test and diagnosis, and how it is affected by treatment and symptom severity.

DG45/01

The committee recommends more research on:

  • the accuracy of PredictSURE IBD and IBDX tests in identifying people at high or low risk of following a severe course of Crohn's disease
  • how PredictSURE IBD and IBDX tests, when used alongside clinical features, affect clinical decisions about whether step-up or top-down treatment is offered
  • the clinical outcomes and costs resulting from a top-down treatment strategy compared with a step-up treatment strategy
  • how PredictSURE IBD and IBDX tests affect clinical outcomes once someone has been assigned to top-down or step-up treatment, considering the different pathways that children and adults may follow.
DG46/01

Further research is recommended on:

  • The accuracy of EarlyCDT Lung, and the validity of the risk models used to combine EarlyCDT Lung results with the Brock and the Herder risk models.
  • The impact of EarlyCDT Lung on clinical management decisions.

A large retrospective audit is recommended to:

  • Understand how patient and nodule characteristics impact on malignancy prevalence and disease progression.
  • Understand current practice regarding clinical management of people with intermediate-risk lung nodules.
  • Determine the clinical consequences of CT surveillance, including the likelihood of disease progression during CT surveillance.
  • Determine the likelihood and impact of unnecessary biopsy or resection of indolent and benign nodules
  • If existing data on these points is limited or not routinely collected, a prospective data collection should be undertaken to obtain it.
DG49/01

A high-quality test accuracy study is needed for the BRAHMS sFlt‑1 Kryptor/BRAHMS PLGF plus Kryptor PE ratio test, using thresholds defined by the company, done in a population independent from that used to establish the test's thresholds, and with the test used as intended in the NHS.

Further research is recommended on repeat PLGF (placental growth factor)‑based testing, with standard clinical assessment, in women presenting with suspected preterm pre-eclampsia, who have had a previous PLGF‑based test result (see section 3.7). This should include:

- exploring the different scenarios in which repeat testing may be indicated

- the appropriate intervals between PLGF‑based tests

- the diagnostic accuracy of repeat PLGF‑based testing in women with suspected preterm pre-eclampsia.

Further research is recommended into how well the tests work when women are pregnant with more than 1 baby to find out if different cut-offs are needed (see section 3.15).

DG5/1 Research is recommended on the percentage of unenhanced ultrasound scans that are inconclusive, particularly in people with cirrhosis. Such studies should explicitly define and describe why scans are 'inconclusive'.
DG5/2 Research is recommended on patient preferences, and their impact on quality of life, for contrast-enhanced ultrasound and other imaging modalities. Ideally such research should compare all appropriate imaging modalities in the same patient group.
DG50/01

Further research is recommended on:
• the impact of LiverMultiScan test results on decisions about care, such as the decision to do a liver biopsy, or on adherence to lifestyle interventions (
see section 3.5)
• the test accuracy of LiverMultiScan compared with biopsy, or the prognostic ability of LiverMultiScan to predict clinical outcomes (see section 3.19).

DG50/02

Further research is recommended on:
• the impact of magnetic resonance elastography (MRE) test results on decisions about care, such as the decision to do a liver biopsy, or on adherence to lifestyle interventions (
see section 3.5)
• the test accuracy of MRE to assess the level of fibrosis or presence of cirrhosis compared with biopsy at thresholds specified by the company, or the prognostic ability of MRE to predict clinical outcomes (see section 3.20).

DG51/01

There is uncertainty about how much remote monitoring devices would affect resource use in the NHS and personal social services. Some impacts may not have been included in the external assessment group's (EAG) model because of a lack of data (see section 3.12), including resource use related to carers (see section 3.13). Adopting the technologies may change how care is provided (see section 3.4) so their effect on resources is hard to estimate without direct data. So, the committee recommended collecting data on how much using the devices affects resource use, to inform cost-effectiveness estimates. Data on time dedicated to training and spent reviewing device results should also be collected. The broader impact on services provided by Parkinson's specialist teams and carers should be considered.

DG51/02

How much using remote monitoring devices to guide decisions about care affects symptoms, and therefore health-related quality of life, is uncertain. How long after using the devices any impact would last is also uncertain. This had a sizeable influence on cost-effectiveness estimates (see section 3.10). Data on this came from studies that did not represent likely NHS practice (see section 3.6), which is itself uncertain (see section 3.3), and from assumptions made by the EAG because of lack of data. For its model, the EAG used a published algorithm from Chandler et al. (2020) to estimate quality-adjusted life years (QALYs) from the Unified Parkinson's Disease Rating Scale (UPDRS) domain scores. The clinical experts said that health-related quality of life questionnaires like the PDQ‑39 are increasingly used in trials to assess health-related quality of life for people with Parkinson's disease. The committee also recognised that the effect of the devices on the health-related quality of life of carers had not been included in the EAG's model because of a lack of data (see section 3.13).

DG51/03

How frequently the remote monitoring devices were modelled as being used substantially affected the cost-effectiveness estimates in the EAG's model (see section 3.9). There are many ways the devices could be used in the NHS (see section 3.3) and no data was available to compare different approaches. So, it is currently not possible to highlight particular approaches that are likely to be more clinically and cost effective. Centres using the devices should therefore collect data on how often they are used and under what circumstances. For example, regularly in advance of scheduled review appointments, to indicate when such appointments are needed, or targeted to people having issues with symptoms. This will help assess the clinical and cost effectiveness of the different uses of the devices in NHS practice.

DG52/1

The committee recommends more research on diagnostic accuracy in people with leg ulcers. The following considerations should be made when doing this research:

DG52/2

The committee recommends collecting further data on the impact of the automated devices on time to treatment for people with leg ulcers to reduce uncertainty in the economic modelling.

DG52/3

The committee recommends collecting further data on clinical outcomes such as time to healing, and incorrect use of compression and its associated adverse consequences when possible.

DG53/1

Further research is recommended to determine the impact of MRI fusion biopsy systems compared with cognitive fusion biopsy on the detection of different grades of prostate cancer.

DG53/2

Further data collection or research is recommended on the impact of implementing MRI fusion biopsy systems on the rate at which biopsies can be done, capacity resources and waiting times for this procedure.

DG7/1 Research is needed to establish the validity and accuracy of the SeHCAT (tauroselcholic [75selenium] acid) test and of any potential alternative technologies for measuring bile acid malabsorption in people with chronic diarrhoea diagnosed with irritable bowel syndrome (IBS-D) or Crohn's disease without ileal resection.
DG7/2 Research is needed to establish the nature of bile acid malabsorption and whether bile acid malabsorption is a primary or secondary condition in people diagnosed with irritable bowel syndrome (IBS-D) or Crohn's disease without ileal resection.
DG7/3 Research is needed to establish the efficacy and tolerability of bile acid sequestrants among people with irritable bowel syndrome (IBS-D) or Crohn's disease without ileal resection.
DG8/1 NICE recommends that a national registry is developed to collect data on the use of the RD-100i OSNA system in detecting sentinel lymph node metastases during breast cancer surgery. It also recommends that data on all patients having whole lymph node analysis by the RD-100i OSNA system should be submitted to this registry. These data should be integrated with data from other registries for breast cancer where appropriate.
DG9/1 NICE recommends that studies directly comparing different epidermal growth factor receptor tyrosine kinase (EGFR-TK) mutation test methods are performed. These studies should include the re-testing of stored non-small-cell lung cancer (NSCLC) tumour samples using different EGFR-TK mutation test methods and should link to patient outcomes.
HST1/1 NICE recommends the use of eculizumab for atypical haemolytic uraemic syndrome (aHUS) only if all the following arrangements are in place:
- coordination of eculizumab use through an expert centre
- monitoring systems to record the number of people with a diagnosis of atypical
- haemolytic uraemic syndrome and the number who have eculizumab, and the dose and duration of treatment
- a national protocol for starting and stopping eculizumab for clinical reasons
- a research programme with robust methods to evaluate when stopping treatment or dose adjustment might occur.
HST1/2 There is a need for further evidence on the long-term outcomes of treatment with eculizumab, and on the effect of treatment in children, adolescents and during pregnancy. The Committee supports enrolment of patients into the aHUS registry and the collection of high-quality information from these registries periodically to inform treatment decisions.
HST5/1

NICE encourages the company, NHS England and treatment centres to collect more evidence, particularly on the longer-term benefits and costs of eliglustat and enzyme replacement therapy for treating type 1 Gaucher disease.

HST8/1

In its evaluation of burosumab, the committee noted substantial uncertainty in several areas, and agreed that further research into the treatment benefit of burosumab in young people aged 13 years and over would relieve some of the clinical uncertainty in an age group covered by the marketing authorisation.

HST8/2

The committee also noted that the additional evidence exploring the relationship between radiological measures of bone defects (that is, the Rickets Severity Score and the Radiographic Global Impression of Change) and health-related quality of life would help to address several key uncertainties in the economic analysis.

HST8/3

Evidence on the progression of X-linked hypophosphataemia (XLH) over time and the long-term benefits of burosumab would also be valuable.

HTE12/1

More research is needed on the following artificial intelligence (AI)‑derived software to analyse chest X‑rays alongside clinician review for suspected lung cancer in adults referred from primary care:

HTE12/1

More research is needed on the following key outcomes:

HTE14

More research is needed on using the following digital weight-management technologies:

IPG172/01

NICE encourages further research into coronary sinus narrowing device implantation for refractory angina. This should report details of patient selection and long-term patient outcomes, including survival. 

IPG173/01

Evidence on the efficacy of transanal total mesorectal excision of the rectum is adequate. Evidence on its safety is inconsistent. It also shows the potential for major safety concerns, including damage to adjacent structures and seeding of malignancy. Therefore, this procedure should only be used in the context of research. Find out what only in research means on the NICE interventional procedures guidance page.

Further research, which could be randomised controlled trials or registry data, should report details of patient selection, including tumour type, use of neoadjuvant chemoradiotherapy and all complications, including malignancy dissemination.

IPG174/01

Evidence on the safety and efficacy of endobronchial nerve ablation for chronic obstructive pulmonary disease (COPD) is inadequate in quantity. Therefore, this procedure should only be used in the context of research. Find out what only in research means on the NICE interventional procedures guidance page.

Further research should be randomised controlled trials comparing the procedure with sham treatment. It should report details of patient selection, and short and long-term functional outcomes including lung functional outcomes, quality of life and patient-reported outcomes, incidence of exacerbations and hospital admissions, and all adverse events.

IPG179/01

Evidence on the safety of endoscopic balloon dilation for subglottic or tracheal stenosis is adequate. The most serious complication related to the procedure, independent of age, is tracheal laceration but this is well recognised. For adults, evidence on the efficacy of the procedure is limited. So, it should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.

IPG375/1 Current evidence on the efficacy and safety of distal iliotibial band lengthening for refractory greater trochanteric pain syndrome is inadequate in quantity and quality. Therefore this procedure should only be used in the context of research. Research studies should clearly define patient selection, and outcomes should include measures of function and quality of life.
IPG376/1 NICE encourages further research into extracorporeal shockwave therapy (ESWT) for refractory greater trochanteric pain syndrome. Research studies should clearly describe patient selection, imaging, and treatment protocols. Outcomes should include functional and quality-of-life scores with at least 1 year of follow-up.
IPG380/1 Further research into percutaneous atherectomy of femoropopliteal arterial lesions with plaque excision devices should take the form of well-conducted trials, which should define patient selection, treatment protocols and location and types of arterial lesions treated, and report long-term patency outcomes. NICE may review this procedure on publication of further evidence.
IPG381/1 Further research studies into deep brain stimulation (DBS) for intractable trigeminal autonomic cephalalgias (TACs) should clearly define patient selection and report the intensity and duration of stimulation, medication use and quality of life, in addition to documenting the effects on headache symptoms as clearly as possible.
IPG383/1 Further research into hand allotransplantation should include data on long-term functional outcomes, and any occurrence of malignancy associated with long-term immunosuppression should be published. NICE may review this procedure on publication of further evidence.
IPG387/1 NICE encourages further research into transaxial interbody lumbosacral fusion. Research outcomes should include fusion rates, pain and functional scores, quality of life measures and the frequency of both early and late complications. NICE may review this procedure on publication of further evidence.
IPG390/1 NICE encourages research into endovascular stentgrafting of popliteal aneurysms and may review this procedure on publication of further evidence.
IPG391/1 NICE encourages further research into the use of innovative technologies for the management of severe acute respiratory failure, and may review this guidance on publication of further evidence.
IPG393/1 Further research into endoscopic radiofrequency therapy of the anal sphincter for faecal incontinence should clearly define the patient groups being treated. It should also report the clinical impact in terms of quality of life and long-term outcomes. NICE may review the procedure on publication of further evidence.
IPG394/1 Further research on external aortic root support in Marfan syndrome should report on long-term outcomes, particularly the occurrence of dissection and aortic dilatation, and the need for further procedures.
IPG399/1 Further research for percutaneous endoscopic catheter laser balloon pulmonary vein isolation for atrial fibrillation (AF) should define patient-selection criteria and should clearly describe adverse events and long-term control of AF.
IPG401/1 Safety of selective internal radiation therapy (SIRT) is a potentially beneficial treatment for patients with on-resectable colorectal metastases in the liver, but that more research and data collection are required to demonstrate its efficacy.
IPG402/1 Collection and publication of data on the outcomes of percutaneous cryotherapy for renal cancer in the long term is encouraged. Further research should compare the long-term outcomes of cryotherapy with those of other treatments for renal cancer.
IPG404/1 Any further studies on endoluminal gastroplication for gastro-oesophageal reflux disease (GORD) should include measurements of oesophageal pH and report long-term outcomes.
IPG405/1 Further research into the comparative efficacy and safety of different surgical and ablative treatments would be useful.
IPG406/1 NICE encourages further research into microwave ablation for the treatment of liver metastases. Research should clearly define patient selection criteria and report tumour recurrence and patient survival. Comparison with other ablative techniques would be useful. NICE may review the procedure on publication of further evidence.
IPG409/1 Balloon dilatation of the Eustachian tube should only be used in the context of research, which should address the efficacy of the procedure in the short and longer term, and also document safety outcomes. Research studies should clearly describe which parts of the Eustachian tube are being treated and report subjective measurements of symptom improvement and objective measurements of Eustachian tube function.
IPG412/1 Drainage, irrigation and fibrinolytic therapy (DRIFT) for post-haemorrhagic hydrocephalus in preterm infants should only be used in the context of research. Research should aim to establish the risk of secondary haemorrhage and its consequences, and the need for shunt insertion. Outcomes should include death and disability in the long-term: these should be reported separately.
IPG413/1 NICE encourages further research into the efficacy of MRI-guided transcutaneous focused ultrasound for uterine fibroids. Research studies should report long-term outcomes, including the need for further treatment. Data on the incidence and outcomes of subsequent pregnancy in patients who choose this procedure because they wish to maintain or improve their fertility are particularly important.
IPG415/1 Epiretinal brachytherapy for wet age-related macular degeneration (AMD) should only be used in the context of research. Research studies should address whether epiretinal brachytherapy reduces the progression of wet AMD and whether it can reduce the number of injections of antivascular endothelial growth factor agents (anti-VEGF) required. Long-term outcomes should be reported.
IPG416/1 Further research on the efficacy of deep brain stimulation (DBS) for refractory epilepsy should describe patient selection and define clearly the target area of the brain. Outcomes should include measures of seizure frequency, functional ability, social inclusion and quality of life.
IPG418/1 NICE encourages further research on percutaneous transluminal radiofrequency sympathetic denervation of the renal artery for resistant hypertension. Patient selection criteria should be described clearly and reported outcome measures should include adverse events and the long-term effect of the procedure on blood pressure.
IPG418/2 NICE also encourages data collection and publication of outcomes on all patients having percutaneous transluminal radiofrequency sympathetic denervation of the renal artery for resistant hypertension. Clinicians should submit data on all patients having this procedure to the national register when it becomes available.
IPG419/1 NICE encourages further research into bronchial thermoplasty for severe asthma. Research outcomes should include objective measurements of lung function, symptom control, medication requirements and quality of life. Long-term safety and efficacy outcomes are particularly important. Collaboration between units to publish data on patients not involved in research studies would also be valuable.
IPG420/1 NICE encourages further research on percutaneous venoplasty for chronic cerebrospinal venous insufficiency (CCSVI) for multiple sclerosis (MS), in the form of robust controlled clinical trials. Studies should clearly define selection criteria and patient characteristics. They should also clearly define technical success which may include measurement of pressure gradients across treated vein segments before and after venoplasty. Outcomes should include clinical and quality of life measures.
IPG421/1 NICE encourages further research into transcatheter aortic valve implantation (TAVI) for aortic stenosis. In particular, NICE encourages clinicians to enter all suitable patients into the UK TAVI trial. Information from research trials that will be useful for future guidance includes patient selection criteria and comparisons between TAVI and surgical aortic valve replacement (SAVR) in patients who would be suitable for either procedure. Outcomes should include incidence of stroke and other adverse events, symptom relief, quality of life, occurrence of aortic regurgitation, and valve durability in the short and long term.
IPG422/1 Further research on incisionless otoplasty should describe the precise surgical techniques used and should report both short- and long-term outcomes, including the need for further procedures.
IPG423/1 NICE encourages further research into focal cryoablation for localised prostate cancer. This should take the form of controlled studies comparing the procedure against other forms of management. Studies should clearly define patient selection criteria and should report outcomes including local recurrence in the long term.
IPG423/2 Clinicians should collect data on all patients undergoing focal cryoablation (including details of case selection, methods of follow-up and outcomes) for local audit. Clinicians should enter details about all patients undergoing focal therapy using cryoablation for localised prostate cancer onto the European Registry for Cryosurgical Ablation of the Prostate (EuCAP) register and review clinical outcomes locally.
IPG424/1 NICE encourages further research into focal therapy using high-intensity focused ultrasound (HIFU) for localised prostate cancer. This should take the form of controlled studies comparing the procedure against other forms of management. Studies should clearly define patient selection criteria and should report outcomes including local recurrence in the long term.
IPG424/2 Clinicians should collect data on all patients undergoing focal high-intensity focused ultrasound (HIFU) (including details of case selection, methods of follow-up and outcomes) for local audit and for submission to national and/or international registers when these become available. The European Registry for Cryosurgical Ablation of the Prostate (EuCAP) register is being developed to receive data on focal therapy using HIFU for localised prostate cancer. When this facility is available clinicians should submit data on all patients undergoing focal therapy using HIFU for localised prostate cancer to that register.
IPG425/1 Further information from research and collaborative data collection would be useful. This should include clearly defined patient selection criteria and long-term outcomes. NICE may review this procedure on publication of further evidence.
IPG426/1 NICE encourages further research into micropressure therapy for refractory Ménière's disease. Research studies should report long-term outcomes, in particular the need for subsequent surgical treatment.
IPG427/1 NICE encourages clinicians to enter patients into research studies with the particular aims of guiding selection of patients and of defining the place of percutaneous balloon cryoablation in relation to other procedures for treating atrial fibrillation. Further research should define patient selection criteria clearly and should document adverse events and long-term control of atrial fibrillation.
IPG429/1 Endovascular stent insertion for intracranial atherosclerotic disease should only be used in the context of research. Research should clearly define patient selection and be designed to provide outcome data based on follow-up of at least 2 years.
IPG430/1 NICE encourages further research and data collection on partial replacement of the meniscus of the knee using a biodegradable scaffold. This should include clear descriptions of patient selection and adjunctive treatments. Outcome measures should include symptom relief and functional ability in the short term and the need for further treatment in the longer term.
IPG432/1 NICE encourages further research on laparoscopic gastric plication for severe obesity, which should include information about long-term efficacy and safety, and specifically how the procedure influences further gastric surgery. Comparison with alternative procedures would be useful.
IPG434/1 NICE encourages further research and data collection on radiofrequency cold ablation for respiratory papillomatosis. In particular, research and data collection should report treatment indication (whether for primary or secondary treatment of respiratory papillomatosis), outcomes related to timing and site of disease recurrence, the need for tracheostomy after the procedure, and longer-term survival. In addition, any effect of the procedure on voice quality should be documented.
IPG437/1 NICE encourages further research comparing autologous blood injection (with or without techniques to produce platelet-rich plasma) against established treatments for managing plantar fasciitis. Trials should clearly describe patient selection, including duration of symptoms and any prior treatments. Outcomes should include specific measures of pain and function.
IPG438/1 NICE encourages further research comparing autologous blood injections (with or without techniques to produce platelet-rich plasma) against established nonsurgical methods for managing tendinopathy. Trials should clearly describe patient selection (including the site of tendinopathy, duration of symptoms and any prior treatments) and document whether a 'dry needling' technique is used. Outcomes should include specific measures of pain, quality of life and function, and whether subsequent surgical intervention is needed.
IPG439/1 Further research and publication of observational data would be useful. Publications should describe details of patient selection, particularly in relation to previous treatments. They should also describe clinical outcomes (including all complications) and patient experience in the longer term. NICE may review the procedure on publication of further evidence.
IPG441/1 Current evidence on the safety and efficacy of irreversible electroporation for treating primary lung cancer and metastases in the lung is inadequate in quantity and quality. Therefore, this procedure should only be used in the context of research. In particular, studies should report the effect of the procedure on local tumour control and patient survival.
IPG442/1 Current evidence on the safety and efficacy of irreversible electroporation for treating pancreatic cancer is inadequate in quantity and quality. Therefore, this procedure should only be used in the context of research. In particular, studies should report the effect of the procedure on local tumour control and patient survival.
IPG443/1 Current evidence on the safety and efficacy of irreversible electroporation for treating renal cancer is inadequate in quantity and quality. Therefore, this procedure should only be used in the context of research. In particular, studies should report the effect of the procedure on local tumour control and patient survival.
IPG444/1 Current evidence on the safety and efficacy of irreversible electroporation for treating primary liver cancer is inadequate in quantity and quality. Therefore, this procedure should only be used in the context of research. In particular, studies should report the effect of the procedure on local tumour control and patient survival.
IPG445/1 Current evidence on the safety and efficacy of irreversible electroporation for treating liver metastases is inadequate in quantity and quality. Therefore, this procedure should only be used in the context of research. In particular, studies should report the effect of the procedure on local tumour control and patient survival.
IPG450/1 NICE encourages further research into percutaneous electrical nerve stimulation (PENS) for refractory neuropathic pain, particularly to provide more information about selection criteria and long-term
outcomes, with clear documentation of the indications for treatment.
IPG453/1 Further research on prostate artery embolisation for benign prostatic hyperplasiain the form of randomised trials or cohort studies (for example, using an appropriate register) should clearly document patient selection criteria and all complications, specifically including disturbance of sexual function. Efficacy outcomes should include measures of urinary function, symptoms and quality of life. Information about longer-term outcomes, including the need for further treatment, would be valuable.
IPG456/1 NICE encourages further research into sutureless aortic valve replacement for aortic stenosis. Studies should document patient selection, aortic cross-clamp times, cardiopulmonary bypass times, perioperative morbidity and specifically the incidence of paravalvular (and central) leaks in the short and long term. Research comparing outcomes of the procedure against those of standard surgical aortic valve replacement would be useful.
IPG458/1 Patients with acute ischaemic stroke for whom thrombolysis is unsuitable or has failed: Submit details of all patients to the Safe Implementation of Treatments in Stroke Thrombectomy (SITS-TBY) register. NICE encourages prospective studies of mechanical clot retrieval in these patients, including comparison of outcomes against those of patients who do not have the procedure. These studies should report details of patient selection, timing of the intervention after onset of symptoms, the devices and techniques used, and functional outcomes.
IPG458/2 Patients with acute ischaemic stroke for whom thrombolysis is suitable: The procedure should only be used in the context of research:
- Research should include randomised studies comparing mechanical clot retrieval against thrombolysis or other current methods of management and should report details of patient selection, timing of the intervention after onset of symptoms, the devices and techniques used, complications and functional outcomes.
- NICE encourages clinicians to enter patients into randomised trials such as the PISTE trial. In addition, details of all patients should be entered into the SITS-TBY register.
IPG459/1 NICE encourages research to guide future use of selective internal radiation therapy (SIRT) for primary intrahepatic cholangiocarcinoma. This should document patient characteristics, tumour response, survival and quality of life measures, and details of other treatments used adjunctively or sequentially. NICE may review the procedure on publication of further evidence.
IPG463/1 NICE encourages further research into the insertion and use of implantable pulmonary artery pressure monitors in chronic heart failure, particularly studies that look at their long-term effects on hospital admissions and quality of life and that record adverse events.
IPG464/1 Further research, in the form of comparative or observational studies, should document details of patient selection and should report all adverse events. Outcomes should include survival, quality of life, biliary patency and the need for further procedures.
IPG465/1 NICE encourages further research into insertion of endobronchial valves for lung volume reduction in emphysema. Research should take the form of studies that allow comparison of the procedure with the natural history of the disease and other treatment options including surgery. The studies should define the criteria and techniques used for patient selection. Outcome measures should include lung function, dyspnoea score, exercise tolerance, quality of life and long-term safety.
IPG466/1 NICE encourages further research into CXL using riboflavin and UVA for keratoconus and keratectasia, especially epithelium-on (transepithelial) CXL and the combination (CXL-plus) procedures. Details of the techniques used should be clearly described. Reported outcomes should include visual acuity, corneal topography and quality of life. Data on long-term outcomes for all types of CXL using riboflavin and UVA for keratoconus and keratectasia would be useful – specifically data about prevention of progression to corneal transplantation and about repeat procedures and their efficacy.
IPG467/1 NICE encourages further research into the role of negative pressure wound therapy (NPWT) for the open abdomen. Patient selection should be documented and research should report on efficacy outcomes such as impact on wound care and healing rates, and duration of hospital stay.
IPG469/1 NICE encourages further research into microwave ablation for treating primary lung cancer and metastases in the lung. Research studies should report details of patient selection and adverse events. Outcomes should include local tumour control, survival and quality of life.
IPG470/1 NICE encourages further research on ultra-radical (extensive) surgery for advanced ovarian cancer, either in the form of research trials or in audits intended for publication (ideally by collaboration between units). Clinicians should ensure that details of patient selection and the precise extent of surgery are fully documented. Reported outcomes should include all complications, survival, and quality of life. Trials comparing complication rates, survival and quality of life against those of standard surgery and chemotherapy would be especially useful.
IPG471/1 Well-controlled studies are needed to support the current limited evidence on weight loss in the short term. They should document patient selection, all complications (while the device is in place and after its removal) and technical problems associated with placing and removing the device.
IPG473/1 NICE encourages further research into the effects of uterine artery embolisation compared with other procedures to treat adenomyosis, particularly for patients wishing to maintain or improve their fertility.
IPG474/1 NICE encourages further research into arthroscopic trochleoplasty for patellar instability, including publication of consecutive patient series. Patient selection should be described in detail. Reported outcomes should include functional and quality‑of‑life measures, as well as reoperation rates.
IPG475/1 NICE encourages further research and publication of results from consecutive case series of patients having this procedure. Details of patient selection should be clearly documented. Reported outcomes should include the effects of the procedure on symptoms and quality of life, the duration of benefits, and the need for further procedures. All complications should be reported. NICE may review this procedure in the light of longer-term outcomes.
IPG476/1 NICE encourages further research into radiofrequency ablation of the soft palate for snoring. This could take the form of data collection, with the specific aim of documenting long-term outcomes and the need for further treatment.
IPG477/1 NICE encourages further research on transcranial magnetic stimulation (TMS) for treating and preventing migraine. Data should be collected for all patients not entered into controlled trials. Studies should describe clearly whether its use is for treatment or prevention. They should report details of patient selection and the dose and frequency of use. Outcome measures should include the number and severity of migraine episodes, and quality of life in both the short and long term. The development of any neurological disorders (such as epilepsy) in the short or longer term after starting treatment should be documented.
IPG479/1 Research (which may include observational studies) should clearly document the indications for use of the procedure and details of patient selection. Reported outcomes should include quality of life, overall survival and paracentesis-free survival, duration of function of the drainage system, nutritional parameters and any complications associated with its implantation or use.
IPG480/1 Further research into endoscopic thoracic sympathectomy (ETS) for primary facial blushing should include clear information on patient selection and should seek to identify which patient characteristics might predict severe side effects. All complications should be reported. Outcomes should include measurements of efficacy, including quality of life and social functioning both in the short and long term, and in particular the frequency and severity of compensatory hyperhidrosis.
IPG481/1 NICE encourages further research into optical coherence tomography (OCT) to guide PCI compared against percutaneous coronary intervention (PCI) with no intravascular imaging or PCI with intravascular ultrasound. Research outcomes should include data on medium- and long-term clinical outcomes, including the need for revascularisation.
IPG482/1 NICE encourages further research into efficacy of extracorporeal membrane oxygenation (ECMO) for acute heart failure. This should include clear documentation of patient selection and indications for the use of ECMO. Outcome measures should include survival, quality of life and neurological status.
IPG485/1 NICE encourages further research into faecal microbiota transplant for C. difficile infection, specifically to investigate optimal dosage, mode of administration and choice of donor.
IPG487/1 Further research into efficacy and safety of endoscopic thoracic sympathectomy (ETS) for primary hyperhidrosis of the upper limb should include clear information on patient selection and should seek to identify which patient characteristics might predict severe side effects. All complications should be reported. Outcomes should include measurements of efficacy, including quality of life and social functioning both in the short and long term and in particular the frequency and severity of compensatory hyperhidrosis.
IPG488/1 Chemosaturation via percutaneous hepatic artery perfusion and hepatic vein isolation for primary or metastatic liver cancer ('hepatic chemosaturation') should only be performed within the context of research, which may take the form of observational studies.
IPG490/1 NICE encourages further research into transcutaneous neuromuscular electrical stimulation (NMES) for oropharyngeal dysphagia, which should clearly document the indications for treatment and the details of patient selection. Research should document the timing of initiation of treatment after onset of symptoms, as well as precise information about the procedure technique. Outcome measures should include freedom from tube feeding, quality of life and duration of treatment effect. NICE may review the procedure on publication of further evidence.
IPG491/1 Further research into platelet-rich plasma injections for treating osteoarthritis of the knee should clearly describe patient selection and should take the form of well-designed, controlled studies that compare the procedure against other methods of management. Outcomes should include measures of knee function, patient-reported outcome measures and the timing of subsequent interventions. Studies aimed at assessing possible cartilage repair after platelet-rich plasma injections should include detailed radiographic or MRI imaging before and after the procedure.
IPG492/1 NICE encourages further research into bioresorbable stent implantation for treating coronary artery disease and may review the procedure on publication of further evidence. Details of subsequent antiplatelet therapy should be reported and outcomes should include major adverse cardiac events (MACE) and target vessel revascularisation (defined as any repeat percutaneous intervention or surgical bypass of any segment of the treated vessel), particularly in the long term (at least 2–3 years). Studies on the safety and efficacy of the procedure compared with other types of coronary stent implantation would be useful.
IPG493/1 Further research into arthroscopic radiofrequency chondroplasty of the knee should clearly document patient selection and the types of chondral defects being treated. More evidence on long-term outcomes would be useful.
IPG496/1 NICE encourages further research into endoscopic radiofrequency ablation for Barrett's oesophagus with no dysplasia. Studies should define clearly the policies used for histological diagnosis. Outcomes should include complete resolution of Barrett's oesophagus, change and progression to low-grade dysplasia, high-grade dysplasia or cancer. All complications should be reported, particularly development of strictures. Comparative studies against surveillance would be useful.
IPG497/1 NICE encourages further research into endoscopic radiofrequency ablation for squamous dysplasia of the oesophagus, including observational data collection. Studies should clearly define patient selection. Outcomes should include completeness of ablation, resolution of squamous dysplasia, progression to cancer and quality of life. All complications should be reported, particularly development of oesophageal strictures.
IPG502/1 NICE encourages further research into the use of a wireless capsule to assess motility of the gastrointestinal tract. Studies should include clear details of patient selection. They should report on the diagnostic accuracy of the procedure in different parts of the gastrointestinal tract, and should provide data on the clinical benefits of the procedure for patients.
IPG504/1 NICE encourages further research into valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) for aortic bioprosthetic dysfunction. Comparative studies between ViV-TAVI and surgical aortic valve replacement (SAVR) for patients who are judged to have a low risk from SAVR should describe patient selection clearly and should report fully on complications and valve durability in the short and long term.
IPG505/1 Further research should focus on the extended use of telemetric adjustable pulmonary artery banding for ventricular retraining and for its use pending the resolution of ventricular septal defects. Data collection may provide useful information. NICE may review the procedure on publication of further evidence.
IPG506/1 NICE encourages further research on insertion of an annular disc implant at lumbar discectomy, particularly comparative trials. All studies should report details of patient selection and recurrence rates.
IPG507/1 NICE encourages further research into insertion of a collagen plug to close an abdominal wall enterocutaneous fistula. Research should ideally take the formof prospective studies that compare the course of the enterocutaneous fistula (its natural history) with and without use of the procedure. Reports should record the conditions underlying all fistulas that are treated, their location, whether they are high or low output, and details of previous treatments. NICE may update the guidance on publication of further evidence.
IPG509/1 Further research should include clear documentation of patient selection and of all complications. Outcomes should include pregnancy rates, live birth rates and instances of preterm delivery. Comparative studies would be helpful. NICE may update the guidance on publication of further evidence.
IPG511/1 Further research into open reduction of slipped capital femoral epiphysis should clearly describe details of clinical presentation (for example, Loder classification), the degree of slip, its stability, and the surgical technique used; including whether surgical dislocation of the hip was done. Outcomes from 2 years onwards should include degree of correction, occurrence of avascular necrosis and need for subsequent hip surgery (and its timing).
IPG512/1 Further research into implantation of a shock or load absorber for mild to moderate symptomatic medial knee osteoarthritis should include comparative studies against existing forms of management. Studies should record patient selection, functional outcomes, quality of life and complications. They should also report the nature and timing of any further surgery on the knee and the effect of removing the device. A minimum follow-up period of 2–3 years is needed. NICE may update the guidance on publication of further evidence.
IPG514/1 NICE encourages further research into transanal total mesorectal excision (TaTME) of the rectum. Patient selection should be explicitly documented. If the procedure is used to treat malignancy, outcomes should include completeness of excision, recurrence rates, survival, quality of life outcomes and avoidance of the need for a stoma in the long term. All complications should be reported, specifically including incontinence.
IPG515/1 Further research and data collection for inserting a balloon device to disimpact an engaged fetal head before an emergency caesarean section should report the impact of performing the procedure on the time taken from the decision to perform a caesarean section to delivery of the baby. Technical failures, including the need for repositioning of the device and for subsequent manual disimpaction of the fetal head; and any complications resulting from use of the procedure should be recorded. Fetal outcomes should also be reported. NICE may update the guidance on publication of further evidence.
IPG517/1 Current evidence on the safety and efficacy of the insertion of endobronchial nitinol coils to improve lung function in emphysema is limited in quantity and quality. Therefore the procedure should only be used in the context of research.
IPG518/1 Current evidence on the safety and efficacy of implantation of a duodenal–jejunal bypass liner for managing type 2 diabetes is limited in quality and quantity. Therefore the procedure should only be used in the context of research.
IPG519/1

NICE encourages further research on insertion of an epiretinal prosthesis for retinitis pigmentosa. Outcomes should include the impact on quality of life and activities of day-to-day living, and durability of implants. NICE may update the guidance on publication of further evidence.

IPG520/1

NICE encourages further research into radiofrequency ablation for gastric antral vascular ectasia and collaborative publication of data from local audit. Patient selection should be clearly documented, including details of prior treatments. Outcomes should include success and duration of effect in controlling bleeding and the effect of this on the need for blood transfusion. All complications should be reported. NICE may update the guidance on publication of further evidence.

IPG522/1

NICE encourages further research into hysteroscopic morcellation of uterine leiomyomas (fibroids) which could include data collection with publication of the findings, particularly of safety outcomes. Patient selection should be clearly described. Outcomes should include symptom relief, quality of life, recurrence rates and information about fertility and subsequent pregnancies. All complications should be documented. NICE may update the guidance on publication of further evidence.

IPG523/1

NICE encourages further research comparing ultrasound-enhanced, catheter-directed thrombolysis for deep vein thrombosis against catheter-directed thrombolysis alone. Patient selection should be documented, including the duration and extent of thrombosis. The dose of thrombolytic agent used and the duration of thrombolysis should be reported, together with all complications. Outcome measures should include the success of thrombolysis (complete, partial or failed) and long-term sequelae. NICE may update the guidance on publication of further evidence.

IPG524/1

NICE encourages further research into ultrasound-enhanced, catheter-directed
thrombolysis for pulmonary embolism. Ideally this should include comparative studies against catheter-directed thrombolysis alone. Patient selection should be  documented. The dose of thrombolytic agent used and the duration of thrombolysis should be reported, together with all complications. Outcome measures should include the success of thrombolysis (complete, partial or failed) and long-term sequelae. NICE may update the guidance on publication of further evidence.

IPG527/1

NICE encourages further research on sphenopalatine ganglion stimulation for chronic cluster headache. Reported outcomes should include long-term efficacy and device durability.

IPG529/1

Further research into joint distraction for knee osteoarthritis without alignment  correction should include comparative studies against existing forms of management. Studies should record patient selection, joint space measurements in the medium to long term, functional outcomes, quality of life and complications. They should also report the nature and timing of any further surgery on the knee. NICE may update the guidance on publication of further evidence.

IPG530/1

NICE encourages further research into transcranial direct current stimulation (tDCS) for depression, which should document how patients were selected and any other treatments they were having. It should describe the precise method and regime used for administering tDCS. Outcome measures should include the duration of effect. NICE may update the guidance on publication of further evidence.

IPG531/1

NICE encourages further research into preoperative high dose rate brachytherapy for rectal cancer. Trials should be designed to provide clear data on the efficacy of this procedure, whether or not other adjunctive treatments are used. Research should document adjunctive treatments and details of patient selection. Outcomes should include local recurrence, survival, disease-free survival and quality of life. NICE may update the guidance on publication of further evidence.

IPG532/1

NICE encourages further research into low-energy contact X-ray brachytherapy (CXB) for early-stage rectal cancer. Research should clearly describe details of patient selection and treatment intent. It should document adjunctive treatments and subsequent procedures. Outcomes should include local recurrence, survival, disease-free survival and quality of life. NICE may update the guidance on publication of further evidence.

IPG533/1

Further research on implanting a baroreceptor stimulation device for resistant hypertension should document patient selection in detail and should specify the devices and techniques used, and any adjunctive therapies. It should describe the changes in blood pressure that are considered to result from baroreceptor stimulation, and those that might be caused by other factors. Outcomes should include the duration of effect of baroreceptor stimulation; device durability; and the complications of hypertension, such as myocardial infarction and stroke.

IPG537/1

NICE encourages further research on subretinal prosthesis system for retinitis pigmentosa. Outcomes should include the impact on quality of life and activities of day-to-day living, and durability of implants. NICE may update the guidance on publication of further evidence.

IPG538/1

Further research into joint distraction for ankle osteoarthritis should include comparative studies against the natural history of the disease and against other forms of management. Studies should record patient selection, pain relief, functional outcomes, complications, and quality of life in the long term. They should also report the nature and timing of any further surgery on the ankle.
Minimising loss to follow-up is of particular importance. NICE may update the guidance on publication of further evidence.

IPG539/1

NICE encourages further research into radiofrequency ablation for symptomatic Morton's neuroma. Further research should include details of patient selection and previous treatments. Studies should compare the procedure against other non-surgical treatments, such as steroid injections.
Outcome measures should include pain relief, the duration of treatment effect, and the need for subsequent treatments.

IPG540/1

Current evidence on the safety and efficacy of electrical stimulation of the lower oesophageal sphincter for treating gastro-oesophageal reflux disease (GORD) is limited in quantity and quality. Therefore, this procedure should only be used in the context of research.

IPG541/1

NICE encourages further research into transapical transcatheter mitral valve-in-valve implantation for a failed surgically implanted mitral valve bioprosthesis. This may include prospective observational studies. Studies should include details on patient selection, functional outcomes, quality of life, survival and complications. Studies should report long-term follow-up of clinical outcomes and valve durability. NICE may update this guidance on publication of further evidence.

IPG544/1

NICE encourages further research into percutaneous electrothermal treatment of the intervertebral disc  annulus. Further research should document details of patient selection, including the duration of their symptoms. It should report precise details of the technique used for treatment. Outcome measures should include pain relief and quality of life. Long-term follow-up data should include details of any subsequent procedures.

IPG545/1

NICE encourages further research into percutaneous intradiscal radiofrequency treatment of the intervertebral disc nucleus for low back pain. Further research should include details of patient selection, the duration of patients' symptoms, and a precise account of the technique used for treatment. Outcome measures should include pain relief and quality of life. Long-term follow-up data should
include details of any subsequent procedures.

IPG546/1

Further research on angioplasty and stenting to treat peripheral arterial disease causing refractory erectile dysfunction should provide clear details of patient selection. Efficacy outcomes should include procedural success (as measured by arterial imaging and blood-flow measurement), validated scoring systems of erectile dysfunction, and the duration of treatment effect. All complications should be reported. NICE may update the guidance on publication of further evidence.

IPG547/1

NICE encourages further research on endovascular aneurysm sealing for abdominal aortic aneurysmthis procedure in the form of controlled clinical trials, observational studies and analysis of registry data. Details about patient selection, including anatomical details, should be clearly documented.
Research should compare the procedure with conventional stent graft endovascular aneurysm repair. All complications should be reported. Long-term outcomes should be described as data become available. NICE may update the guidance on publication of further evidence.

IPG549/1

NICE encourages further research into normothermic extracorporeal preservation of hearts for transplantation following donation after brainstem death. Outcomes should include primary graft function, graft function in the long term and device-related complications.

IPG550/1

Further research on endoscopic carbon dioxide laser cricopharyngeal myotomy for relief of oropharyngeal dysphagia could include the publication of collaborative audit data. Reports should separate outcomes for different groups of patients; in particular for patients with primary neuromuscular dysfunction alone, those with associated phargyngeal diverticula and those with dysphagia caused by radiotherapy. Outcome measures should include dysphagia scores, quality of life, long-term outcomes and the need for further treatment. All complications should be reported. NICE may update this guidance on publication of further evidence.

IPG551/1

NICE encourages further research on corticosteroid-eluting bioabsorbable stent or spacer insertion during endoscopic sinus surgery and, specifically, controlled studies designed for between-patient (rather than within-patient) comparisons. Outcomes should include symptom scores, quality of life and the need for retreatment in the long term. All complications should be reported. NICE may update this guidance on publication of further evidence.

IPG552/1

NICE encourages further research on transcutaneous stimulation of the cervical branch of the vagus nerve for cluster headache and migraine. Studies should describe whether the procedure is used for treatment or prevention, and whether it is used for cluster headache or migraine. Clinicians should clearly document details of patient selection and the treatment regimen. Outcome measures should include changes in the number and severity of cluster headache or migraine episodes, medication use, quality of life in the short and long term, side effects, acceptability, and device  durability. NICE may update this guidance on publication of further evidence.

IPG554/1

NICE encourages further research into balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension. Details of patient selection, all complications, and subsequent treatments and interventions for pulmonary hypertension should be collected. Reports should include quality-of-life outcomes, long-term efficacy outcomes and survival. NICE may update the guidance on publication of further evidence.

IPG558/1

Current evidence on the efficacy and safety of biodegradable subacromial spacer insertion for rotator cuff tears is limited in quantity and quality. Therefore, this procedure should only be used in the context of research.

IPG559/1

NICE encourages further research on transcutaneous electrical stimulation of the supraorbital nerve for treating and preventing migraine. Data should be collected for all patients not entered into controlled trials. Studies should describe clearly whether the procedure is used for treatment or prevention. They should include details of patient selection and the dose and frequency of use. Outcome measures should include the number and severity of migraine episodes, quality of life in the short and long term and any changes in medication. The development of any complications after starting treatment should be documented. NICE may update the guidance on publication of further evidence.

IPG560/1

NICE encourages further data collection, including randomised controlled trials on microstructural scaffold insertion without autologous cell implantation for repairing symptomatic chondral knee defects. Studies should clearly describe patient selection, clinical indications and adjunctive treatments. Outcome measures should include symptom relief, functional ability, long-term outcomes measured by appropriate imaging techniques and patient-reported outcomes.

IPG565/1

NICE encourages further research and publication on efficacy of miniature lens system implantation for advanced age-related macular degeneration (AMD) which patients may benefit and on safety and efficacy outcomes, particularly longer-term results. NICE may update the guidance on publication of further evidence.

IPG569/1

NICE encourages further research into single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) for treating morbid obesity, particularly research examining long-term outcomes. NICE may update the guidance on publication of further evidence.

IPG570/1

NICE encourages further research into epiduroscopic lumbar discectomy through the sacral hiatus for sciatica and may update the guidance on publication of further evidence. Research studies should include details of patient selection, complications and long-term results.

IPG571/1

NICE encourages further research into extracorporeal shockwave therapy (ESWT) for Achilles tendinopathy, which may include comparative data collection. Studies should clearly describe patient selection, treatment protocols, use of local anaesthesia and the type and duration of energy applied (see section 3). Studies should include validated outcome measures and have a minimum of 1 year of follow-up. NICE may update the guidance on publication of further evidence.

IPG572/1

Current evidence on the safety and efficacy of irreversible electroporation for treating prostate cancer is inadequate in quantity and quality. Therefore, this procedure should only be used in the context of research. Studies should include randomised controlled trials comparing the procedure with current standards of care. They should report details of patient selection and short- and long-term outcomes, including patient-reported outcomes and the effect on any future prostate surgery.

IPG573/1

NICE encourages further research into radiation therapy for early Dupuytren's disease, including randomised controlled trials. Because of the uncertainty over the natural history of the disease, this should include studies comparing the long-term efficacy of radiation therapy with no radiation therapy. Studies should include details of patient selection, stage of disease progression, duration and types of treatment, patient-reported outcomes, and long-term efficacy and safety data. NICE may update the guidance on publication of further evidence.

IPG576/1

Further research into extraurethral (noncircumferential) retropubic adjustable compression devices for stress urinary incontinence in women should include detailed safety outcomes, long-term results and patient-reported outcome measures. NICE may update the guidance on publication of further evidence.

IPG579/1

Further research, preferably in the form of randomised controlled trials, should assess the effect of the procedure on local tumour control, patient survival, pain
control and quality of life.

IPG580/1

NICE encourages further research and data collection on endoscopic full thickness removal of non-lifting colonic polyps and may update the guidance on publication of further evidence. This should include safety and efficacy outcomes such as perforation, bleeding, the need for immediate re-intervention, inadequate resection and longer-term follow-up of patients found to have malignant disease.

IPG581/1

Clinicians are encouraged to collect long-term data on clinical outcomes and patient-reported quality-of-life outcomes using validated scales. NICE may update the guidance on publication of further evidence.

IPG582/1

Clinicians are encouraged to collect long-term data on clinical outcomes and patient-reported quality-of-life outcomes using validated scales. NICE may update the guidance on publication of further evidence into infracoccygeal sacropexy using mesh to repair uterine prolapse.

IPG585/1

NICE encourages further research into laparoscopic insertion of a magnetic titanium ring for gastro-oesophageal reflux disease (GORD), and may update the guidance on publication of further evidence. Long-term outcome data and comparative trials with other anti-reflux surgery would be helpful.

IPG589/1

NICE encourages further research into radiofrequency treatment for haemorrhoids, preferably randomised controlled trials. It may update the guidance on publication of further evidence. Outcomes should include pain, secondary haemorrhage, recurrence rate, the need for repeat procedures and quality-of-life measures. Details of patient selection should also be reported.

IPG592

Further research on high-intensity focused ultrasound for symptomatic breast fibroadenoma should include publication of patient-reported outcome measures and studies with long-term follow-up.

IPG594/1

Further research should give details of patient selection, patient-reported outcomes and long-term effects including survival and quality of life. NICE may update the guidance on publication of further evidence.

IPG595/1

Further research on the safety and efficacy of total distal radioulnar joint replacement for symptomatic joint instability or arthritis should provide information on patient selection, and continue to collect long-term outcomes. NICE may update the guidance on publication of further evidence.

IPG597/1

NICE encourages further research into processed nerve allografts to repair peripheral nerve discontinuities. This should include information on the type of nerve repaired, the anatomical site, the size of the defect, patient reported outcome measures, functional outcomes, time to recovery and long-term outcomes (12 months to 18 months).

IPG598/1

Further research including the use of observational data from registries should provide information on patient selection, safety outcomes, quality of life, long-term
outcomes and the position of the procedure in the treatment pathway. NICE may update the guidance on publication of further evidence.

IPG601/1

NICE encourages further research into transcutaneous microwave ablation for severe primary axillary hyperhidrosis and may update the guidance on publication of further evidence. Further research should include information on patient selection, objective measures of physiological effect, patient-reported outcome measures and long-term outcomes.

IPG602/1

NICE encourages further research into total artificial heart implantation as a bridge to transplantation for end-stage refractory biventricular heart failure, including well matched comparative studies. NICE may update the guidance on publication of further evidence.

IPG604/1

Further research on aortic valve reconstruction with processed bovine pericardium should address patient selection and report long-term outcomes, particularly the durability of the valve.

IPG606/1

Further research on unilateral MRI-guided focused ultrasound thalamotomy for moderate to severe tremor in Parkinson's disease, which could include randomised controlled trials, should address patient selection and report on long-term follow-up.

IPG608/1

Further research on laparoscopic mesh pectopexy for apical prolapse of the uterus or vagina should include details of patient selection and long-term outcomes.

IPG609/1

Further research on robot-assisted kidney transplant should include studies comparing robot-assisted kidney transplant with open surgery. This should collect data on patient selection, warm ischaemia times, the need for conversion to open surgery, graft function, and long-term graft and patient survival.

IPG610/1

The evidence on efficacy of nerve transfer to partially restore upper limb function in tetraplegia is limited in quantity. There are no major safety concerns. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research.

IPG612/1

NICE encourages further research into microinvasive subconjunctival insertion of a trans-scleral gelatin stent for primary open-angle glaucoma, including randomised studies. Further research should include details of patient selection and long-term outcomes.

IPG613/1

NICE encourages the peer-reviewed publication of all further research for percutaneous balloon valvuloplasty for fetal critical aortic stenosis. Further research could be in the form of controlled trials, analysis of registry data or other observational studies. It should address patient selection, timing of the intervention and the natural history of the disease.

IPG614/1

Further research on endoscopic bipolar radiofrequency ablation for treating biliary obstruction caused by cancer should address: patient selection, relief of biliary obstruction, quality of life and survival.

IPG616/1

Further research on the efficacy and safety of intranasal phototherapy for allergic rhinitis should include: details of patient selection including medication use; underlying medical conditions; the intensity, duration and wavelength of light used; patient-reported outcomes; comparison with existing treatments; and the effects of repeated long-term use. NICE may update the guidance if further evidence is published.

IPG617/1

Further research on the safety of unilateral MRI-guided focused ultrasound thalamotomy for treatment-resistant essential tremor, which could include randomised controlled trials, should address patient selection, report on functional improvement and quality of life, and provide long-term follow-up data.

IPG619/1

Research on the safety and efficacy of superior capsular augmentation for massive rotator cuff tears should address patient selection, type of graft and technique used,
long-term outcomes including shoulder function, and patient-reported outcome measures.

IPG622/1

Further research in low-intensity pulsed ultrasound to promote healing of fresh fractures at high risk of non-healing should include details of patient selection, fracture site, and risk factors and comorbidities that delay fracture healing.

IPG623/1

NICE encourages further research into low-intensity pulsed ultrasound to promote healing of delayed-union and non-union fractures. Further research should include details of patient selection, fracture site, and risk factors and comorbidities that delay fracture healing.

IPG626/1

Further research in people who could have conventional cardiac pacemaker implantation should report the patient selection criteria and compare leadless pacemakers with conventional pacemakers. Follow-up should be for at least 5 years and outcomes should include adverse events, symptom relief, quality of life and device durability in the long-term.

IPG627/1

Further research in superior rectal artery embolisation for haemorrhoids should report details of patient selection, and follow-up efficacy (including symptom relief), need for subsequent treatments, quality of life and safety outcomes for at least 1 year.

IPG628/1

NICE encourages further research into intravesical microwave hyperthermia and chemotherapy for non-muscle-invasive bladder cancer. Research should include randomised controlled trials, which stratify patients by risk and give adequate follow-up. They should report frequency of adverse events, patientreported outcome measures, overall and disease-free survival and quality of life.

IPG629/1

NICE encourages further research into transurethral water jet ablation for lower urinary tract symptoms caused by benign prostatic hyperplasia and may update the guidance on publication of further evidence. Further research should report long-term follow-up and include reintervention rates.

IPG630/1

Further research on selective internal radiation therapy (SIRT) for unresectable primary intrahepatic cholangiocarcinoma in the form of prospective studies, including randomised controlled trials, should address patient selection, quality-of-life outcomes and overall survival. Patient selection for the research studies should be done by a
multidisciplinary team. The procedure should only be done in specialist centres by clinicians trained and experienced in managing cholangiocarcinoma.

IPG630/2

Clinicians should enter details about all patients having selective internal radiation therapy (SIRT) for unresectable primary intrahepatic cholangiocarcinoma onto a suitable registry.

IPG631/1

Further research on subcutaneous automated low-flow pump implantation for refractory ascites should report details of patient selection, the frequency of pump-related complications, and the need for regular albumin infusions.

IPG633/1

Further research on percutaneous insertion of a temporary heart pump for left ventricular haemodynamic support in high-risk percutaneous coronary interventions should report details of patient selection and subsequent management.

IPG634/1

Further research on transcutaneous neuromuscular electrical stimulation for oropharyngeal dysphagia in adults should address patient selection, variations in technique, the need for retreatments and long-term outcomes.

IPG636/1

Further research on ex-situ machine perfusion for extracorporeal preservation of livers for transplantation should report the exact method of perfusion used (such as
hypothermic or normothermic), graft survival and the use of marginal grafts.

IPG637/1

Further research on platelet-rich plasma injections for knee osteoarthritis should be in the form of randomised controlled trials with medium- to long-term follow-up, including validated measures of knee function and patient-reported outcomes.

IPG638/1

Further research on electrically stimulated intravesical chemotherapy for nonmuscle-invasive bladder cancer should include randomised controlled trials compared with
standard care, which should report details of patient selection.

IPG641/1

Further research, ideally in the form of randomised controlled trials, on the safety and efficacy of prostatic urethral temporary implant insertion for lower urinary tract symptoms caused by benign prostatic hyperplasia should report details of patient selection (including prostate size and the amount of median lobe enlargement), improvement in lower urinary tract symptoms in the short term and long term, re-intervention rates, and outcome measures of sexual function using established methods.

IPG642/1

Further research should include details of patient selection, durability and the incidence of complications. Outcomes should be published.

IPG643/1

Further research should report details of patient selection, nodule size and position, and whether the nodule is cystic.

IPG644/1

Current evidence on the safety and efficacy of radially emitting laser fibre treatment of an anal fistula is limited in quantity and quality. Therefore, although there are no major safety concerns, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research.

IPG650/1

The evidence on percutaneous insertion of a cerebral protection device to prevent cerebral embolism during TAVI raises no major safety concerns other than those associated with the TAVI procedure. However, the evidence on efficacy for preventing TAVI-related stroke is inconclusive. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research.

IPG651/1

Current evidence on the safety of percutaneous mechanical thrombectomy for acute deep vein thrombosis (DVT) of the leg shows there are well-recognised but infrequent complications.

IPG651/2

Current evidence on the safety of percutaneous mechanical thrombectomy for acute deep vein thrombosis (DVT) of the leg shows there are well-recognised but infrequent complications.

IPG652/1

Current evidence on the safety and efficacy of bronchoscopic thermal vapour ablation for upper-lobe emphysema is inadequate in quantity and quality. Therefore the procedure should only be used in the context of research.

IPG653/1

Current evidence on the safety and efficacy of valve-in-valve transcatheter aortic valve implantation (ViV‑TAVI) for aortic bioprosthetic dysfunction is adequate to support the use of this procedure provided that standard arrangements are in place for clinical governance, consent and audit.

IPG654/1

The evidence on the safety of reinforcement of a permanent stoma with a synthetic or biological mesh to prevent a parastomal hernia shows there are serious but well-recognised complications. The evidence on efficacy is limited in quantity and quality. Therefore, this procedure should not be used unless special arrangements are in place for clinical governance, consent, and audit or research.

IPG655

The evidence on cardiac contractility modulation device implantation for heart failure raises no major safety concerns. However, the evidence on efficacy is inadequate in quantity and quality. Therefore, this procedure should only be used in the context of research.

IPG656/1

The evidence on the safety of transurethral laser ablation for recurrent non-muscle-invasive bladder cancer shows that there are no major safety concerns. However, current evidence on its efficacy is limited in quality and quantity. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research.

IPG657/1

Current evidence on the safety of ultrasound-guided high‑intensity transcutaneous focused ultrasound for symptomatic uterine fibroids shows there are well-recognised complications including skin burns. The evidence on efficacy is limited in quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research.

IPG658/1

Current evidence on the safety and efficacy of endovascular insertion of an intrasaccular wire-mesh blood-flow disruption device for intracranial aneurysms is adequate to support the use of this procedure provided that standard arrangements are in place for clinical governance, consent and audit.

IPG659/1

Current evidence on the safety and efficacy of low-energy contact X‑ray brachytherapy (the Papillon technique) for locally advanced rectal cancer is inadequate in quantity and quality. Therefore, this procedure should only be used in the context of research.

IPG660/1

Current evidence on the safety and efficacy of implant insertion for prominent ears is inadequate in quality and quantity. Therefore, this procedure should only be used in the context of research.

IPG661/1

Evidence on the safety and efficacy of high-intensity focused ultrasound for glaucoma is inadequate in quality and quantity. Therefore, this procedure should only be used in the context of research.

IPG663/1

Evidence on the safety and efficacy of midcarpal hemiarthroplasty for wrist arthritis is inadequate in quantity and quality. Therefore, this procedure should only be used in the context of research.

IPG664/1

Evidence on the safety of irreversible electroporation for primary liver cancer shows serious but infrequent and well-recognised complications. Evidence on its efficacy is inadequate in quantity and quality. Therefore, this procedure should only be used in the context of research.

IPG666/1

NICE may update this guidance after 3 years or sooner if important new information becomes available, including evidence on:

  • the epidemiology of CJD, including data on the prevalence of CJD and its infectivity in the UK population
  • the transmission of CJD by surgical instruments, including cases of CJD in which surgery is a possible route of transmission
  • the cost effectiveness of single-use instruments for use in interventional procedures on high-risk tissues
  • commercially available decontmination methods that are safe and cost effective against prions
  • the systems for, and cost effectiveness of, maintaining set integrity and traceability of instruments.
IPG668

Evidence on the efficacy of open prenatal repair of open neural tube defects in the fetus is adequate in quantity and quality. However, evidence on its safety shows serious but well recognised safety concerns for the mother and fetus. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research.

IPG668/1

Evidence on the safety and efficacy of fetoscopic prenatal repair of open neural tube defects in the fetus is inadequate in quantity and quality. Therefore, this procedure should only be used in the context of research. This could be in the form of randomised controlled trials or published registry data.

IPG669/1

Bilateral cervicosacropexy (CESA) or vaginosacropexy (VASA) using mesh for pelvic organ prolapse

IPG671/1

MRI-guided laser interstitial thermal therapy for drug-resistant epilepsy Interventional procedures guidance

IPG672/1

Selective internal radiation therapy for unresectable colorectal metastases in the liver

IPG674

Evidence on the safety and efficacy of artificial iris implant insertion for acquired aniridia is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE website.

IPG675/1

IPG676

Evidence on the safety of transcranial magnetic stimulation for obsessive-compulsive disorder raises no major safety concerns. However, evidence on its efficacy is inadequate in quantity and quality. Therefore, this procedure should only be used in the context of research. Find out what only in research means on the NICE website.

IPG677

1.1Evidence on the safety of electrical stimulation to improve muscle strength in chronic respiratory conditions, chronic heart failure and chronic kidney disease shows no major safety concerns.

  • For people who are having an acute exacerbation of their chronic condition and are unable to exercise, evidence of efficacy is adequate to support the use of this procedure provided that standard arrangements are in place for clinical governance, consent and audit. Find out what standard arrangements mean on the NICE website.

  • For people who are able to exercise, evidence on efficacy is inadequate in quality. Therefore, this procedure should only be used in the context of research. Find out what only in research means on the NICE website.

IPG6773/1

IPG678/1

Further research should describe patient selection and clearly define the target area of the brain. Outcomes should include reduction in seizure frequency and improvement in the epilepsy seizure outcome scale, quality of life, reduction in concomitant medication and hospital admissions.

IPG679/1

NICE encourages further research into implanted vagus nerve stimulation for treatment-resistant depression, in the form of randomised controlled trials with a placebo or sham stimulation arm. Studies should report details of patient selection. Outcomes should include validated depression rating scales, patient-reported quality of life, time to onset of effect and duration of effect, and any changes in concurrent treatments.

IPG680

Further research should be in the form of randomised controlled trials and should use well described treatment protocols. Studies should report details of patient selection including specific psychopathology, underlying disease and other treatments, the area of brain treated and the imaging used to target it, and long-term outcomes for at least 1 year.

IPG681/1

Evidence on the safety of pressurised intraperitoneal aerosol chemotherapy for peritoneal carcinomatosis shows that this procedure can cause serious but well-recognised side effects. Evidence on its efficacy is inadequate in quality. Therefore, this procedure should only be used in the context of research. Find out what only in research means on the NICE website.

IPG682/1

Evidence on the safety and efficacy of balloon cryoablation for Barrett's oesophagus is inadequate in quantity and quality. Therefore, this procedure should only be used in the context of research. This could be in the form of randomised controlled trials or published registry data. Find out what only in research means on the NICE interventional procedures guidance page.

IPG683/1

Evidence on the safety and efficacy of balloon cryoablation for squamous dysplasia of the oesophagus is inadequate in quantity and quality. Therefore, this procedure should only be used in the context of research. This could be in the form of randomised controlled trials or published registry data. Find out what only in research means on the NICE interventional procedures guidance page.

IPG684/1

Evidence on the safety of the swallowable gastric balloon capsule for weight loss shows infrequent but potentially serious adverse events:

IPG692/1

Evidence on the safety of repetitive short-pulse transscleral cyclophotocoagulation for glaucoma shows no major safety concerns. Evidence on efficacy is inadequate in quality. Therefore, this procedure should only be used in the context of research. Find out what only in research means on the NICE website.

IPG694/1

Evidence on the safety and efficacy of permanent His-bundle pacemaker implantation for treating heart failure is inadequate in quality and quantity.
Therefore, this procedure should only be used in the context of research. Find out what only in research means on the NICE interventional procedures guidance page.

IPG696/1

The evidence on transvaginal laser therapy for stress urinary incontinence does not show any short-term safety concerns. Evidence on long-term safety and
efficacy is inadequate in quality and quantity. Therefore, this procedure should only be used in the context of research. Find out what only in research means onthe NICE interventional procedures guidance page.

IPG697/1

The evidence on transvaginal laser therapy for urogenital atrophy does not show any short-term safety concerns. Evidence on long-term safety and efficacy is inadequate in quality and quantity. Therefore, this procedure should only be used in the context of research. Find out what only in research means on the NICE interventional procedures guidance page.

IPG701/1

Evidence on the safety and efficacy of inducing and maintaining normothermia using temperature modulation devices to improve outcomes after stroke or subarachnoid haemorrhage is inadequate in quality and quantity. Therefore, this procedure should only be used in the context of research. Find out what only in research means on the NICE interventional procedures guidance page.

IPG702/1

Evidence on the safety of magnetic resonance therapy for knee osteoarthritis shows no major safety concerns. Evidence on efficacy is inadequate in quality and quantity and shows no benefit over placebo. Therefore, this procedure should not be used unless it is part of a research study. Further research should be in the form of appropriately powered randomised controlled trials comparing the procedure with placebo. It should report patient selection and treatment protocols, including the number of sessions and magnetic field strength.

IPG703/1

Evidence on the safety of laparoscopic removal of uterine fibroids with power morcellation shows potentially serious complications. In particular there is a risk of spreading undiagnosed malignant tissue, which has higher prevalence in people who are postmenopausal or over 50. Evidence on the procedure's efficacy is limited in quantity. Therefore, further research should report details of patient selection, surgical technique (including any containment system used) and long-term outcomes.

IPG705/1

Evidence on the safety and efficacy of lateral elbow resurfacing for arthritis is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.

Further research, which could include case series with long-term follow up, should report range of motion, patient-reported outcomes and complications.

IPG706/1

NICE encourages further research into transapical transcatheter mitral valvein-valve implantation for a failed surgically implanted mitral valve bioprosthesis. Studies should include details on patient selection, type and size of valve used, functional outcomes (New York Heart Association functional class, mitral valve regurgitation), quality of life, patient-reported outcome measures, survival and complications. Studies should report long-term follow up of clinical outcomes and valve durability. NICE may update this guidance on publication of further evidence.

IPG707/1

NICE encourages further research into transapical transcatheter mitral valvein-ring implantation after failed annuloplasty for mitral valve repair. Studies should include details on patient selection, type and size of valve used, functional outcomes (New York Heart Association functional class, mitral valve regurgitation), quality of life, patient-reported outcome measures, survival and complications. Studies should report long-term follow up of clinical outcomes and valve durability. NICE may update this guidance on publication of further evidence.

IPG708/01

Evidence on the safety of genicular artery embolisation for pain from knee osteoarthritis shows no major safety concerns in the short term. Evidence on its efficacy and long-term safety is inadequate in quality and quantity. Therefore, this procedure should only be used in the context of research. Find out what only in research means on the NICE interventional procedures guidance page. Research should preferably be randomised controlled trials against sham and current best practice. It should report details of patient selection and identify those who would most benefit from this procedure. It should also report details of the technique used, long-term safety, and patient-reported outcomes. The procedure should only be done by interventional radiologists with specific training in this technique.

IPG709/01

Evidence on the safety and efficacy of laparoscopic renal denervation for loin pain haematuria syndrome is inadequate in quality and quantity. Therefore, this procedure should only be used in the context of research. Find out what only in research means on the NICE interventional procedures guidance page. Further research should report details of patient selection, technique used and long-term follow-up outcomes

IPG710/01

NICE encourages further research, preferably randomised controlled trials, into percutaneous endovascular forearm arteriovenous fistula creation for haemodialysis access. This should report details of patient selection, particularly about vascular anatomy, technique used, need for training, patency of the fistula and its subsequent ease of use, and quality of life.

IPG716/01

Evidence on the safety of microwave ablation for treating primary lung cancer and metastases in the lung is adequate but shows it can cause infrequent serious complications. Evidence on its efficacy shows it reduces tumour size. But the evidence on improvement in survival, long-term outcomes and quality of life is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.

Further research should be randomised controlled trials or disease registry studies. It should report patient selection, disease progression and quality of life, and take account of the effectiveness of managing oligometastatic disease in patients.

IPG718/01

Evidence on the safety and efficacy of intramedullary distraction for lower limb lengthening is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page. This guidance is not intended to cover this procedure for bilateral lower limb lengthening for people with short stature.

IPG720/01

Evidence on the safety and efficacy of percutaneous insertion of a cystic duct stent after cholecystostomy for acute calculous cholecystitis is inadequate in quality and quantity. But because patients would otherwise need permanent external drainage, the procedure can be considered for this condition, as long as special arrangements for clinical governance, consent, and audit or research are in place. Find out what special arrangements mean on the NICE interventional procedures guidance page.

IPG721/01

Evidence on the safety of liposuction for chronic lipoedema is inadequate but raises concerns of major adverse events such as fluid imbalance, fat embolism, deep vein thrombosis, and toxicity from local anaesthetic agents. Evidence on the efficacy is also inadequate, based mainly on retrospective studies with methodological limitations. Therefore, this procedure should only be used in the context of research. Find out what only in research means on the NICE interventional procedures guidance page.

IPG722/01

Evidence on the safety and efficacy of intramedullary distraction for upper limb lengthening is inadequate in quantity and quality. But because this is a rare condition with limited alternative treatments, the procedure can be considered as long as special arrangements for clinical governance, consent, and audit or research are in place. Find out what special arrangements mean on the NICE interventional procedures guidance page.

Further research, which could be registry data, should report details of patient selection, device selection, technique used, procedural outcomes, long-term outcomes including quality of life, the need for repeat interventions or surgery and complication rates.

IPG724/01

Evidence is adequate on the short-term safety and efficacy of personalised external aortic root support (PEARS) using mesh to prevent aortic root expansion and aortic dissection in people with Marfan syndrome. Evidence on long-term outcomes is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.

Further research should report details of patient selection, including aortic diameter, and long-term outcomes, including evidence of disease progression, such as dilation and dissection of the aortic root.

IPG725/01

For people with unfavourable aneurysm morphology needing an endovascular aortic aneurysm repair (EVAR) as a primary procedure, or for people with an existing EVAR who need a secondary procedure, evidence on the safety of using endoanchoring systems is adequate. Evidence on efficacy is limited in quantity and quality. Therefore, for these people, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.

IPG725/02

For people with favourable aneurysm morphology needing an EVAR as a primary procedure, evidence on the safety of using endoanchoring systems is adequate. However, evidence on efficacy is inadequate in quantity and quality. Therefore, for these people, this procedure should only be used in the context of research. Find out what only in research means on the NICE interventional procedures guidance page.

IPG726/01

Evidence on the safety and efficacy of supercapsular percutaneously assisted total hip arthroplasty for osteoarthritis is limited in quality and quantity. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.

IPG730/01

For people with severe and symptomatic tricuspid regurgitation, evidence on the efficacy of transcatheter tricuspid valve annuloplasty is limited in quantity and quality. Evidence on its safety shows there are serious but well-recognised complications. Therefore, for these people, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.

IPG730/02

For people with mild or moderate tricuspid regurgitation, evidence on the safety and efficacy of transcatheter tricuspid valve annuloplasty is inadequate in quantity and quality. Therefore, for these people, this procedure should only be used in the context of research. Find out what only in research means on the NICE interventional procedures guidance page.

IPG731/01

For people with severe and symptomatic tricuspid regurgitation, evidence on the efficacy of transcatheter tricuspid valve leaflet repair is limited in quantity and quality. Evidence on its safety shows there are serious but well-recognised complications. Therefore, for these people, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.

IPG731/02

For people with mild or moderate tricuspid regurgitation, evidence on the safety and efficacy of transcatheter tricuspid valve leaflet repair is inadequate in quantity and quality. Therefore, for these people, this procedure should only be used in the context of research. Find out what only in research means on the NICE interventional procedures guidance page.

IPG732/01

Evidence on the efficacy of bioresorbable stent implantation to treat coronary artery disease is inadequate. Evidence on its safety has shown an increased risk of serious complications in the longer term. This includes an increased risk of myocardial infarction and death with some types of bioresorbable stents. Therefore, this procedure should only be used in the context of research. Find out what only in research means on the NICE interventional procedures guidance page.

IPG733/01

Evidence on the safety and efficacy of aortic remodelling hybrid stent insertion during surgical repair of an acute type A aortic dissection is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.

IPG734/01

Evidence on the efficacy of focal resurfacing implants to treat articular cartilage damage in the knee is limited in quality and quantity. Short-term evidence shows no major safety concerns, but long-term evidence on safety is limited in quality and quantity. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.

IPG735/01

Evidence on the safety of transcutaneous electrical neuromuscular stimulation for urinary incontinence raises no major safety concerns. Evidence on its efficacy is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.

IPG737/01

Evidence on the safety and efficacy of prostatic urethral temporary implant insertion for lower urinary tract symptoms caused by benign prostatic hyperplasia is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.

IPG738/01

Evidence on the safety and efficacy of removal, preservation and subsequent reimplantation of ovarian tissue to prevent symptoms from the menopause is inadequate in quality and quantity. Therefore, this procedure should not be done unless it is part of a formal research study, with appropriate governance and ethics approval. Find out what only in research means on the NICE interventional procedures guidance page.

IPG739/01

Evidence on the efficacy and safety of neurostimulation of lumbar muscles for refractory non-specific chronic low back pain is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.

IPG740/01

The evidence for treating an acute migraine attack is adequate but, for treating subsequent attacks, is limited in quality and quantity. So, for treating acute migraine, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.

The evidence for preventing migraine is inadequate in quality. So, for preventing migraine, this procedure should only be used in the context of research. Find out what only in research means on the NICE interventional procedures guidance page.

IPG741/01

Evidence on the safety and efficacy of YAG laser vitreolysis for symptomatic vitreous floaters is inadequate in quality and quantity. Therefore, this procedure should only be used in the context of research. Find out what only in research means on the NICE interventional procedures guidance page.

IPG742/01

Evidence on the safety of extracorporeal shockwave therapy for calcific tendinopathy in the shoulder shows no major safety concerns in the short term. Evidence on efficacy is inadequate. Therefore, this procedure should only be used in the context of research. Find out what only in research means on the NICE interventional procedures guidance page

IPG745/01

Evidence on the safety of ab interno canaloplasty for open-angle glaucoma shows no major safety concerns. Evidence on the efficacy is limited in quality and quantity, particularly in the long term. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.

IPG746/01

Evidence on the safety of long-term tunnelled peritoneal drainage catheter insertion for refractory ascites in cirrhosis is limited but shows well-recognised complications. Evidence on the efficacy is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.

IPG747/01

Evidence on the safety and efficacy of percutaneous image-guided cryoablation of peripheral neuroma for chronic pain is inadequate in quality and quantity. Therefore, this procedure should only be used in the
context of research. 
Find out what only in research means on the NICE interventional procedures guidance page.

IPG751/01

Evidence on the safety and efficacy of transvenous obliteration of gastric varices is adequate in the short term but limited in the long term. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.

IPG752/01

Evidence on the safety and efficacy of biodegradable spacer insertion to reduce rectal toxicity during radiotherapy for prostate cancer is limited in quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.

IPG753/1

Evidence on the safety of endoluminal gastroplication for gastro-oesophageal reflux disease is adequate. However, evidence on its efficacy is inadequate in quality, particularly in terms of patient selection and long-term outcomes. Therefore, this procedure should be used only
in research. Find out
what only in research means on the NICE interventional procedures guidance page.

IPG754/01

Percutaneous transluminal renal sympathetic denervation for resistant hypertension should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.

IPG755/1

Evidence on the safety and efficacy of percutaneous thoracic duct embolisation for persistent chyle leak is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.

IPG756/1

Evidence on the safety of focal therapy using high-intensity focused ultrasound for localised prostate cancer is adequate, but evidence on its efficacy is limited. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.

IPG758/1

Evidence on the safety and efficacy of radiofrequency ablation for palliation of painful spinal metastases is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.

IPG760/1

Evidence on the safety and efficacy of daytime intraoral neuromuscular electrical tongue stimulation using a removable device for obstructive sleep apnoea is inadequate in quality and quantity. So, this procedure should be used only in research. Find out what only in research means on the NICE interventional procedures guidance page.

IPG761/1

Evidence on the safety and efficacy of endoscopic ultrasound-guided biliary drainage (EUS-BD) for biliary obstruction caused by distal malignant disease is adequate to support using this procedure. This is provided that standard arrangements are in place for clinical governance, consent and audit. Find out what standard arrangements mean on the NICE interventional procedures guidance page.

IPG765/1

Minimally invasive fusionless posterior-approach surgery to correct idiopathic scoliosis in children and young people should be used only in research. Find out what only in research means on the NICE interventional procedures guidance page.

IPG766

Further research should ideally be in the form of randomised controlled trials. Details of patient selection, the procedure and long-term outcomes should be reported.

IPG771

Further research should report details of patient selection, duration of the effect (including whether repeat procedures are needed), and long term outcomes.

IPG773

Further research should report:

IPG776

Research should report:

IPG777

Further research should include details of patient selection and report longer term outcomes.

IPG778

Further research should be in the form of randomised controlled trials or registries. It should report:

IPG779

Middle meningeal artery embolisation for chronic subdural haematomas should be used only in research. Find out what only in research means on the NICE interventional procedures guidance page.

MTG19/1 NICE considered that further research on the geko device in clinical settings could focus on reducing the current uncertainties about the reduction in relative risk in the defined patient population, and allow investigation into its use in broader patient populations.
MTG20/1

Research is recommended to address uncertainties about the claimed patient and system benefits of using Parafricta Bootees and Undergarments.

MTG21/1 Research is recommended to address uncertainties about the claimed patient and system benefits of the ReCell Spray-On Skin system. Clinical outcomes should include time to 95% healing, length of hospital stay, cosmetic appearance of the scar and function of the burned area, compared with standard care.
MTG22/1 Research is recommended to address uncertainties in the potential benefits to patients and the NHS of using VibraTip. Research is needed into the diagnostic accuracy of VibraTip compared with the 10 g monofilament and calibrated tuning fork in the diagnosis of peripheral neuropathy in people with diabetes. This research should also address the assessment of vibration perception compared with touch sensation in this clinical context.
MTG3/1 NICE considered that further research would be helpful to compare the CardioQ-ODM with other techniques for monitoring cardiac output, particularly in patients in the critical care environment.
MTG31/1

Research is recommended on HumiGard compared with standard insufflation gases in patients having laparoscopic or open surgery alongside general measures to reduce the risk of perioperative hypothermia (described in section 2.5). Research should report on the comparative rate of surgical site infections and other complications associated with hypothermia and normothermia, as well as related resource use.

MTG31/2

NICE concluded that the cost consequences of using HumiGard in abdominal surgery are very uncertain, and that further research is needed on resource use.

MTG38/1

Further research is needed on the benefits and consequences of detecting preclinical diabetic peripheral neuropathy.

MTG4/1 Research is recommended in the UK clinical setting to compare the BRAHMS copeptin assay in combination with cardiac troponin testing against sequential cardiac troponin testing for ruling out myocardial infarction.
MTG40/1

Research is recommended to address uncertainties about the claimed benefits of using Mepilex Border Heel and Sacrum dressings. This research should also explore issues such as:
- the incidence of heel and sacrum pressure ulcers in NHS acute care settings
- criteria for patient selection to reduce pressure ulcer incidence with Mepilex Border Heel and Sacrum dressings in addition to standard care.
NICE will consider reviewing this guidance when substantive new evidence becomes available.

MTG46/1

Further evidence to address the uncertainties in the current clinical evidence,
including the impact of gammaCore on all treatments and care as well as its
long-term benefits, would be welcome.

MTG47/1

Episcissors-60 show promise for mediolateral episiotomy. But there is currently not enough evidence to support the case for routine adoption in the NHS.

Research is recommended to address uncertainties about the efficacy and safety of using Episcissors-60. This research should:

- determine if using Episcissors-60 in addition to other care bundle measures is more effective in achieving an optimal episiotomy angle and in preventing episiotomy-related obstetric anal sphincter injuries (OASI) than standard episiotomy scissors

- include patient-reported outcome measures

- address potential equality considerations by ensuring patients at greatest risk of OASI are recruited

- determine the relative cost of using Episcissors-60 compared with standard episiotomy scissors.

MTG5/1 Comparative research is recommended in the UK to reduce uncertainty about the outcomes of patients with chronic, ‘hard-to-heal’, complex wounds treated by the MIST Therapy system compared with those treated by standard methods of wound care. This research should define the types and chronicity of wounds being treated and the details of other treatments being used. It should report healing rates, durations of treatment (including debridement) needed to achieve healing, and quality of life measures (including quality of life if wounds heal only partially). It is recommended that centres using the MIST Therapy system take part in research that delivers these outcomes. Current users of the MIST Therapy system who are unable to join research studies should use NICE’s audit criteria to collect further information on healing rates, duration of treatment and quality of life and publish their results.
MTG51/1

SEM Scanner 200, with visual skin assessment, shows promise for preventing pressure ulcers. However, there is not enough good-quality evidence to support the case for routine adoption in the NHS.

A randomised controlled trial is recommended to address uncertainties about the clinical benefits of using the scanner compared with standard risk assessment. This should assess:

  • using the scanner plus visual skin assessment compared with visual skin assessment alone for identifying pressure ulcer risk

  • whether changes in clinical decision making from using the scanner reduce pressure ulcer incidence

  • the clinical benefits and resource impact of using the scanner in different care settings

  • the clinical benefits for different skin tones

  • how well the scanner works across populations with a range of comorbidities

  • patient-related outcome measures.

MTG58/1

Further evidence to address uncertainties about the relative clinical and cost effectiveness of UroLift compared with Rezum, especially in the NHS, would be welcome. This should include:

• exploring long-term clinical outcomes and reintervention rates after UroLift

• assessing the suitability of UroLift for prostates larger than 80 ml and for those with an obstructive median lobe.

MTG60/01

A randomised controlled trial is recommended to compare DyeVert Systems with standard care. The aim of this research would be to address uncertainties about whether using DyeVert Systems reduces AKI incidence and rate of renal replacement therapy after using contrast media. This must include people with stage 4 chronic kidney disease (with an estimated glomerular filtration rate [eGFR] under 30 ml/min/1.73 m2), who are at risk of AKI and need elective coronary or peripheral angiography.

MTG63/01

Endo-SPONGE shows promise for treating low rectal anastomotic leaks. However, there is not enough good-quality evidence to support the case for routine adoption in the NHS. Further evidence in the form of real-world data collection is recommended to address uncertainties about selection criteria, patient-reported outcome measures, stoma reversal and bowel function recovery compared with other treatments. Find out more in the section on further research in this guidance.

MTG65/01

Further research is recommended to identify any health conditions or groups of patients that would benefit more from inhaled sedation with Sedaconda ACD-S than from standard care

MTG66/01

Additional research could help address uncertainties in the evidence, although the case for cost savings remains unlikely.

Although the committee acknowledged that the Game et al. (2018) RCT was well conducted, it felt that additional research could help resolve some uncertainties around the cost and clinical case for 3C Patch. Specifically, research identifying the most appropriate stopping rule, and the associated clinical outcomes of implementing the rule, would help address key uncertainties within the cost case. Additional collection of resource use data on unhealed hard-to-heal ulcers could also reduce uncertainty in the cost case. Further to this, evidence could be collected on an UrgoStart-experienced population, as this would be reflective of current NHS care. Clinical experts thought a trial on this population would be feasible. The committee concluded that although further research could be done, on balance it was unlikely to result in a cost-saving case for 3C Patch based on the decision problem evaluated in this guidance

MTG67/01

Randomised controlled trials comparing Prontosan with saline or water in the NHS are needed.

The committee concluded that further research is needed to address the uncertainties about the clinical effectiveness of Prontosan compared with saline or water. It recommended that randomised controlled trials should be done in the NHS. These should compare Prontosan with saline or water in different types of chronic wounds. The randomised controlled trial needs to be well designed to detect clinically meaningful results in subgroups (for example, pressure ulcers or venous leg ulcers). The committee agreed that a key outcome should be time to complete wound healing. The number of dressing changes should also be recorded for each wound included in the study. Other important outcomes should include pain and wound odour, measured using patient reported outcome measures (PROMs).

MTG68/01

Further good quality evidence is needed to address uncertainties about myCOPD's clinical benefits and its effect on healthcare resource use. myCOPD has potential for clinical benefits, but more evidence is needed to reduce uncertainties. The committee considered that comparative evidence is needed to show the clinical benefits of using myCOPD in 2 populations:

  • people using it to self-manage COPD
  • people referred to pulmonary rehabilitation

For self-management, a randomised controlled trial is preferred to show the clinical benefits of myCOPD. This could be powered based on the encouraging results in the RESCUE study. However, a high-quality comparative observational study designed to minimise bias in the results may provide acceptable evidence. Outcomes such as rates of exacerbations, hospital readmissions and unscheduled care appointments should be considered alongside patient-reported outcomes such as health-related quality of life. For pulmonary rehabilitation, further evidence is needed to show the clinical benefits of myCOPD. This could be a randomised controlled trial which is powered based on the encouraging results in the TROOPER study or a well-designed comparative observational study. Key outcomes will be the CAT score and 6-minute walk test, ideally supported by additional longer-term outcomes such as rates of exacerbations and hospital admissions.

Real-world data could be used to inform the uptake rates in the economic modelling. It should also include qualitative data on patient experience using myCOPD such as patient preferences and adherence.

MTG69/01

More research is recommended on UroShield for preventing catheter associated urinary tract infections (UTIs). It has potential to provide significant patient and healthcare system benefits but uncertainties in the evidence need to be addressed.

Research should be comparative, and it should address uncertainties about the effectiveness of UroShield in preventing catheter-associated UTIs and other catheter-related complaints such as blockages. Find out more in the further research section of this guidance.

MTG70/01

More research or data collection is recommended on Sleepio for people who are eligible for face-to-face cognitive behavioural therapy for insomnia (CBT-I) in primary care. This is because there is limited clinical evidence to show how effective Sleepio is compared with face-to-face CBT-I. A real-world study is suggested to compare the effectiveness of Sleepio with face-to-face CBT-I.

MTG75/01

Given the limited evidence available, the original guidance committee noted that it would be beneficial to routinely collect data on all ureteric stent placement procedures. This was ideally in collaboration with a national professional society such as the British Association of Urological Surgeons. Clinical experts confirmed that an NHS registry for stent procedures has not been set up since the original guidance, and the evidence base remains limited with no prospective data available. The committee for this guidance update considered it important to further emphasise the need for collecting data using a national database or clinical registry on ureteric stent procedures. The prospective data collection should cover information about patient selection, choice of stent placement procedure and stent used, and adverse events such as
stent migration and encrustation rates. It concluded that this should form part of its recommendations in section 1 of the guidance, and agreed that such data collection should be used to help inform the most appropriate patient population for Memokath 051.

MTG76/1

Long-term real-world data is needed on AposHealth's clinical effectiveness and cost benefit

MTG76/2

Long term real-world data is needed on AposHealth's clinical effectiveness and cost benefit

NG1/1 What are the symptoms of gastro-oesophageal reflux gastro-oesophageal reflux disease (GORD) in infants, children and young people with a neurodisability?
NG1/1

What are the symptoms of GORD in infants, children and young people with a neurodisability?

NG1/2 What is the effectiveness and cost effectiveness of a trial of hydrolysed formula in formula-fed infants with frequent regurgitation associated with marked distress?
NG1/2

What is the effectiveness and cost effectiveness of a trial of hydrolysed formula in formula‑fed infants with frequent regurgitation associated with marked distress?

NG1/3 In infants, children and young people with overt or occult reflux, is fundoplication effective in reducing acid reflux as determined by oesophageal pH monitoring?
NG1/3

In infants, children and young people with overt or occult reflux, is fundoplication effective in reducing acid reflux as determined by oesophageal pH monitoring?

NG10/1

Medication for promoting de-escalation:- Which medication is effective in promoting de-escalation in people who are identified as likely to demonstrate significant  violence?

NG10/2

Violence related to drug or alcohol misuse:- What is the best environment in which to contain violence in people who have misused drugs or alcohol?

NG10/3

Advance statements and decisions:- What forms of management of violence and aggression do service users prefer and do advance statements and decisions have an important role in management and prevention?

NG10/4

Content and nature of effective de-escalation:- What is the content and nature of effective de-escalatory actions, interactions and activities used by mental health nurses, including the most effective and efficient means of training nurses to use
them in a timely and appropriate way?

NG10/5

Long duration or very frequent manual restraint:- In what circumstances and how often are long-duration or repeated manual restraint used, and what alternatives are there that are safer and more effective?

NG100/1

Analgesics:- What is the clinical and cost effectiveness of analgesic drugs other than non-steroidal antiinflammatory drugs (NSAIDs) in adults with rheumatoid arthritis (RA) whose pain or stiffness control is not adequate?

NG100/2

Short-term bridging treatment with glucocorticoids:- What is the clinical and cost effectiveness of short-term bridging treatment with glucocorticoids for adults with RA starting a new disease-modifying anti-rheumatic drug (DMARD), including the most effective dosing strategy and mode of administration?

NG100/3

Ultrasound in monitoring:- What is the clinical and cost effectiveness of using ultrasound to monitor disease in adults with RA when clinical examination is inconclusive or inconsistent with other signs of disease activity?

NG100/4

Ultrasound in diagnosis:- What is the clinical and cost effectiveness of using ultrasound in addition to clinical assessment when there is uncertainty about the diagnosis in adults with suspected RA?

NG100/5

Management of poor prognosis:- What is the clinical and cost effectiveness of managing RA with a poor prognosis (identified as presence of anti-cyclic citrullinated peptide [CCP] antibodies or evidence of erosions on X-ray at diagnosis) with a different strategy from that used for standard management of RA?

NG100/6

Subcutaneous methotrexate:- What is the clinical and cost effectiveness of subcutaneous methotrexate compared with oral methotrexate for adults with early onset RA starting a new DMARD?

NG101/1

Surgery to the breast:- What is the optimum tumour-free margin width after breast-conserving surgery for women with ductal carcinoma in situ (DCIS) and invasive breast cancer?

NG101/10

Efectiveness of 26 Gy in 5 fractions over 1 week regimen in people receiving nodal irradiation- What is the effectiveness of radiotherapy given in 26 Gy in 5 fractions over 1 week compared with 40 Gy in 15 fractions over 3 weeks in people with early or locally advanced invasive breast cancer who are also offered nodal irradiation?

NG101/2

Adjuvant bisphosphonate therapy:- Which groups of people with early and locally advanced breast cancer would benefit from the use of adjuvant bisphosphonates?

NG101/3

Breast reconstruction:- What are the long-term outcomes for breast reconstruction in women having radiotherapy to the chest wall?

NG101/4

Neoadjuvant endocrine therapy in premenopausal women:- Is neoadjuvant endocrine therapy safe in premenopausal women with early breast cancer?

NG101/5

Neoadjuvant endocrine therapy in postmenopausal women:- Is there a benefit for neoadjuvant endocrine therapy in postmenopausal women with early breast cancer?

NG101/6

Neoadjuvant treatment:- What are the indications for postmastectomy radiotherapy after neoadjuvant chemotherapy?

NG101/7

What is the most effective and cost-effective way of delivering the intervention (for example, type of physiotherapy or exercise, mode of delivery, number of sessions) to reduce arm and shoulder problems after breast cancer surgery or radiotherapy, and what is the acceptability of the intervention for different groups, such as:

women, men, trans people and non-binary people

people from minority ethnic family backgrounds

people with learning disabilities or cognitive impairment, or physical disabilities, or both

neurodiverse people?

NG101/7

Strategies to reduce arm and shoulder problems- What is the most effective and cost-effective way of delivering the intervention (for example, type of physiotherapy or exercise, mode of delivery, number of sessions) to reduce arm and shoulder problems after breast cancer surgery or radiotherapy, and what is the acceptability of the intervention for different groups, such as:

women, men, trans people and non-binary people

people from minority ethnic family backgrounds

people with learning disabilities or cognitive impairment, or physical disabilities, or both

neurodiverse people?

NG101/8

What is the adherence to, and satisfaction with, different intervention formats (for example, individual, group, virtual, and face to face) to reduce arm and shoulder problems after breast cancer surgery or radiotherapy, and what is the impact of greater adherence on effectiveness for different groups, such as:

women, men, trans people and non-binary people

people from minority ethnic family backgrounds

people with learning disabilities or cognitive impairment, or physical disabilities, or both

neurodiverse people?

NG101/8

What is the adherence to, and satisfaction with, different intervention formats (for example, individual, group, virtual, and face to face) to reduce arm and shoulder problems after breast cancer surgery or radiotherapy, and what is the impact of greater adherence on effectiveness for different groups, such as:

women, men, trans people and non-binary people

people from minority ethnic family backgrounds

people with learning disabilities or cognitive impairment, or physical disabilities, or both

neurodiverse people?

NG101/9

Effectivness of 26 Gy in 5 fractions over 1 week regimen in people receiving breast construction- What is the effectiveness of radiotherapy given in 26 Gy in 5 fractions over 1 week compared with 40 Gy in 15 fractions over 3 weeks in people with early or locally advanced invasive breast cancer who are offered breast reconstruction? 

NG102/1

Referral within a formal care pathway:- Is referral from a community pharmacy within a formal local care pathway framework more effective and cost effective than signposting alone in improving access to, and uptake of, services by underserved groups and the general population?

NG102/2

Health and wellbeing interventions:- How effective and cost effective are awareness raising, advice and education or behavioural support interventions delivered by community pharmacy teams to improve health and behavioural outcomes in underserved groups and the general population?

NG102/3

Addressing health inequalities:- What are the barriers to and facilitators for increasing access to community pharmacy services by underserved groups? How should health and wellbeing interventions be tailored to increase service uptake in underserved groups?

NG102/4

Characteristics of a person delivering an intervention:- How do the professional characteristics of pharmacy staff affect the effectiveness and cost effectiveness of delivering information, advice, education or behavioural support to underserved groups and the general population? (Characteristics include, for example, job roles such as health champion, as well as competencies and level of training.)

NG102/5

Patient activation:- How effective and cost effective is advice, education or behavioural support offered by community pharmacy teams to improve patient activation and measures of behaviour and health changes, particularly in areas where activation levels are lower? This includes evaluating factors such as frequency, intensity and duration of the intervention.

NG103/1

People in eligible groups:- What are the important messages and how should they be tailored and delivered to encourage and sustain flu vaccination uptake in eligible groups?

NG103/2

Underserved groups:- What are the most effective and cost-effective ways of reaching underserved groups and removing barriers to access in order to increase their uptake of flu vaccination?

NG103/3

Carers:- In what context is it cost effective to increase uptake of flu vaccination among carers?

NG103/4

Opt-out strategies for front-line health and social care staff:- Are opt-out strategies effective and cost effective at increasing uptake of flu vaccination among front-line health and social care staff?

NG103/5

Community-based models of flu vaccination:- What models of community-based flu vaccination provision (for example, community pharmacies, community nursing and midwifery teams and outreach services) are effective and cost-effective for increasing uptake in eligible groups?

NG104/1

Diagnosis of chronic pancreatitis:- In people with suspected (or under investigation for) chronic pancreatitis, whose diagnosis has not been confirmed by the use of 'first-line' tests (for example, CT scan, ultrasound scan, upper gastrointestinal [GI] endoscopy or combinations of these), what is the accuracy of magnetic resonance cholangiopancreatography (MRCP) with or without secretin and endoscopic ultrasound to identify whether chronic pancreatitis is present?

NG104/2

Speed of intravenous fluid resuscitation for people with acute pancreatitis:- What is the most clinically effective and cost-effective speed of administration of intravenous fluid for resuscitation in people with acute pancreatitis?

NG104/3

Pain management: chronic pancreatitis:- Is the long-term use of opioids more clinically effective and cost effective than non-opioid analgesia (including non-pharmacological analgesia) in people with chronic pain due to chronic pancreatitis?

NG104/4

Pain management: small duct disease:- What is the most clinically effective and cost-effective intervention for managing small duct disease (in the absence of pancreatic duct obstruction, inflammatory mass or pseudocyst) in people with chronic pancreatitis presenting with pain?

NG104/5

Management of type 3c diabetes:- What is the most clinically effective and cost-effective insulin regimen to minimise hypo- and hyperglycaemia for type 3c diabetes secondary to pancreatitis?

NG105/1

Non-clinical interventions:- How effective and cost effective are non-clinical interventions to reduce suicidal behaviours?

NG105/2

Supporting people bereaved or affected by a suicide:- How effective and cost effective are interventions to support people in the community who are bereaved or affected by a suicide?

NG105/3

Suicide prevention in custodial and detention settings:- What interventions are effective and cost effective in reducing suicide rates in custodial and residential settings?

NG105/4

Training:- How effective and cost effective is gatekeeper training in preventing suicides?

NG106/1

Diuretic therapy for managing fluid overload in people with advanced heart failure in the community:-  In people with advanced heart failure and significant peripheral fluid overload, what is the clinical and cost effectiveness of oral, subcutaneous and intravenous diuretic therapy in the community?

NG106/2

Cardiac MRI versus other imaging techniques for diagnosing heart failure:- What is the optimal imaging technique for the diagnosis of heart failure?

NG106/3

The impact of atrial fibrillation on the natriuretic peptide threshold for diagnosing heart failure:- What is the optimal NT-proBNP threshold for the diagnosis of heart failure in people with atrial fibrillation?

NG106/4

The impact of advanced kidney disease on the natriuretic peptide threshold for diagnosing heart failure:- What are the optimal NT-proBNP thresholds for diagnosing heart failure in people with stage IIIb, IV or V chronic kidney disease?

NG106/5

Risk tools for predicting non-sudden death in heart failure:- What is the most accurate prognostic risk tool in predicting 1-year mortality from heart failure at specific clinically relevant thresholds (for example, sensitivity, specificity, negative predictive value and positive predictive value at a threshold of 50% risk of mortality at 1 year)?

NG107/1

Cardiac assessment:- What is the clinical and cost effectiveness of cardiac assessment before transplantation?

NG107/2

Timing of pre-emptive transplant:- What is the most clinical and cost-effective strategy for timing of pre-emptive transplantation?

NG107/3

Acute haemodialysis versus acute peritoneal dialysis:- What is the clinical and cost effectiveness of initial haemodialysis versus initial peritoneal dialysis for people who start dialysis in an unplanned way?

NG107/4

Frequency of review:- What is the most clinical and cost-effective frequency of review for people on peritoneal dialysis, haemodiafiltration, haemodialysis or conservative management?

NG107/5

Coordinating care:- What is the clinical and cost effectiveness of having keyworkers present in the context of renal replacement therapy (RRT)?

NG108/1

Training and support for practitioners:- What is the effectiveness and cost effectiveness of different training programmes on the Mental Capacity Act 2005 at improving practice for practitioners involved in supporting decision-making, conducting capacity assessments and making best interests decisions?

NG108/2

Targeted interventions to support and improve decision-making capacity for treatment:- What is the effectiveness and cost effectiveness of different targeted interventions (speech and language therapy and psychological and psychosocial interventions) to support and improve decision-making capacity for treatment in specific groups?

NG108/3

Advocacy and support for decision-making:- What is the effectiveness, cost effectiveness and acceptability of advocacy as a means of supporting people to make decisions?

NG108/4

Using mental capacity assessment tools to assess capacity:- What is the accuracy and/or effectiveness, cost effectiveness and acceptability of mental capacity assessment tools that are compliant with the Mental Capacity Act 2005?

NG108/5

Components of a mental capacity assessment:- What are the components of an effective assessment of mental capacity to make a decision (for example checklists, memory aids or standardised documentation)?

NG11/1

Preventing behaviour that challenges from developing in children aged under 5 years with a learning disability:- Can positive behaviour support provided for children aged under 5 years with a learning disability reduce the risk of developing behaviour that challenges?

NG11/2

Interventions to reduce the frequency and extent of moderate to severe behaviour that challenges in community settings:- Are interventions based on the science and practice of applied behaviour analysis or antipsychotic medication, or a combination of these, effective in reducing the frequency and severity of behaviour that challenges shown by adults with a learning disability?

NG11/3

Locally accessible care: - Does providing care where people live compared with out-of-area placement lead to improvements in both the clinical and cost effectiveness of care for people with a learning disability and behaviour that challenges?

NG11/4

Factors associated with sustained, high-quality residential care:- What factors (including service organisation and management, staff composition, training and
supervision, and the content of care and support) are associated with sustained high-quality residential care for people with a learning disability and behaviour that challenges?

NG115/1

Pulmonary rehabilitation during hospital admission:- In people with COPD, does pulmonary rehabilitation during hospital admission for exacerbation and/or in the early recovery period (within 1 month of an exacerbation) improve quality of life and reduce hospitalisations and exacerbations compared with a later (defined as after 1 month)
pulmonary rehabilitation programme, and in which groups is it most clinically and cost effective?

NG115/10

Pulmonary hypertension:- What are the most clinical and cost-effective treatments for pulmonary hypertension in people with COPD?

NG115/11

Mucolytic therapy:- In people with COPD, does mucolytic drug therapy prevent exacerbations in comparison with placebo and other therapies?

NG115/2

Multidimensional assessment of outcomes- How can the individual factors associated with COPD prognosis (collected from a range of sources including primary care, imaging and pulmonary rehabilitation results) be combined into a multidimensional analysis that provides accurate and useful information on prognosis?

NG115/3

Inhaled therapies for people with COPD and asthma- What is the clinical and cost effectiveness of inhaled therapies (bronchodilators and/or inhaled corticosteroids) in people with both stable COPD and asthma?

NG115/4

Inhaled corticosteroid responsiveness:- What features predict inhaled corticosteroid responsiveness most accurately in people with COPD?

NG115/5

Prophylactic antibiotics for preventing exacerbations:- Which subgroups of people with stable COPD who are at high risk of exacerbations are most likely to benefit from prophylactic antibiotics?

NG115/6

Diagnosing COPD: -  What are the characteristics of people diagnosed with COPD as a result of an incidental finding of
emphysema on a CT scan, compared with those diagnosed with symptoms?

NG115/7

Prophylactic antibiotics for preventing exacerbations: - What is the long-term clinical and cost effectiveness of prophylactic antibiotics for people with stable COPD who are at high risk of exacerbations?

NG115/8

Prophylactic antibiotics for preventing exacerbations:- What is the comparative effectiveness of different antibiotics, doses and regimens of prophylactic antibiotics for people with stable COPD who are at high risk of exacerbations?

NG115/9

Prophylactic antibiotics for preventing exacerbations:- What is the comparative effectiveness of seasonal versus continuous prophylactic antibiotics for people with stable COPD who are at high risk of exacerbations?

NG116/1

Stepped care for post-traumatic stress disorder:- What is the clinical and cost effectiveness of stepped care for post-traumatic stress disorder (PTSD)?

NG116/2

Sequencing and further line treatment:- What is the clinical and cost effectiveness of sequencing and further line treatment in PTSD?

NG116/3

Trauma-informed approaches:- What is the clinical and cost effectiveness of trauma-informed care or trauma-informed approaches?

NG116/4

Personalisation and risk markers:- What prognostic and prescriptive factors are important in determining the choice of PTSD treatment?

NG116/5

Complex PTSD:- What is the clinical and cost effectiveness of interventions to deliver stabilisation and reintegration for people with complex PTSD?

NG116/6

Emotional freedom techniques:- What is the clinical and cost effectiveness of emotional freedom techniques (EFT) for the treatment of PTSD in adults?

NG118/1

Metabolic assessment:- What is the clinical and cost effectiveness of full metabolic assessment compared with standard advice alone, in people with recurrent calcium oxalate stones?

NG118/2

Alpha blockers and ureteroscopy- What is the clinical and cost effectiveness of tamsulosin as an adjunct to ureteroscopy?

NG118/3

Preventive treatment following shockwave lithotripsy:- What is the clinical and cost effectiveness of empirical potassium citrate or bendroflumethiazide as preventive treatment for people with small residual fragments following shockwave lithotripsy for renal and ureteric stones?

NG118/4

Frequency of follow-up imaging:- What is the clinical and cost effectiveness of 6-monthly imaging for 3 years for people with recurrent calcium renal or ureteric stones?

NG118/5

Non-steroidal anti-inflammatory drugs (NSAIDs) – route of administration:- What is the most clinically and cost effective route of administration for NSAIDs in the management of acute pain thought to be due to renal or ureteric stones?

NG119/1

Method of botulinum toxin type A injection in treating focal spasticity:- Is guided botulinum toxin type A injection using electrical localisation (electrostimulation or
electromyography) of muscles more clinically and cost effective than ultrasound-guided injections or clinical positioning for localisation of injections in treating focal spasticity in adults with cerebral palsy?

NG119/2

Selective dorsal rhizotomy treatment to reduce spasticity:- What is the clinical and cost effectiveness of selective dorsal rhizotomy compared with intrathecal baclofen to reduce spasticity in adults with cerebral palsy?

NG119/3

Detection and management of respiratory disorders in primary and community care:- Can detection and management of respiratory disorders in adults with cerebral palsy be improved in primary and community care?

NG119/4

Prophylactic antibiotics for respiratory disorders:- Are prophylactic antibiotics clinically and cost effective in the management of respiratory symptoms in adults with cerebral palsy with significant respiratory comorbidity?

NG119/5

Splinting to improve or maintain posture or function:- What is the optimum regimen for splints applied to the upper limb in adults with cerebral palsy to improve or maintain posture or function?

NG119/6

Augmentative and alternative communication systems:- Are augmentative and alternative communication systems clinically and cost effective in promoting  communication for adults with cerebral palsy who have communication difficulties?

NG12/01

Age thresholds in cancer: Longitudinal studies should be carried out to identify and quantify factors in adults that are associated with development of specific cancers at a younger age than the norm. They should be designed to inform age thresholds in clinical guidance. The primary outcome should be likelihood ratios and positive predictive values for cancer occurring in younger age groups.

NG12/02

Primary care testing: Diagnostic accuracy studies of tests accessible to primary care should be carried out for a given cancer in symptomatic people. Priority areas for research should include tests for people with cough, non-visible haematuria, suspected prostate cancer, suspected pancreatic cancer, suspected cancer in childhood and young people and other suspected rare cancers. Outcomes of interest are the performance characteristics of the test, particularly sensitivity, specificity and positive and negative predictive values.

NG12/04

Patient experience: Qualitative studies are needed to assess the key issues in patient experience and patient information needs in the cancer diagnostic pathway, particularly in the interval between first presentation to primary care and first appointment in secondary care. Outcomes of interest are patient satisfaction, quality of life and patient perception of the quality of care and information.

NG12/05

Prostate-specific antigen testing: What is the diagnostic accuracy of using age-adjusted and fixed prostate-specific antigen thresholds for people with symptoms of prostate cancer, including those at high risk of developing prostate cancer (such as those with an African family background or a family history of prostate cancer)?

NG121/1

Does caesarean section protect against cerebral haemorrhage in women with a history of subarachnoid haemorrhage or cerebrovascular malformation?

NG121/2

Does the use of ultrasound of the lumbar spine improve siting of regional anaesthetic needles in pregnant women with a BMI over 30 kg/m2 at the booking appointment?

NG121/3

Is obesity an independent risk factor for perinatal morbidity and mortality?

NG121/4

What clinical features and laboratory investigations can be used to better stratify risk for women in labour with signs of sepsis (including fever and tachycardia)?

NG121/5

What is the clinical and cost effectiveness of intermittent auscultation compared with continuous cardiotocography for women in labour who have had a previous caesarean section?

NG122/01

What is the effectiveness and cost effectiveness of immunotherapy in people with stage IIIA-N2 non‑small‑cell lung cancer following multimodality treatment including surgery?

NG122/1

What is the effectiveness and cost effectiveness of immunotherapy in people with stage IIIA-N2 non-small-cell lung cancer following multimodality treatment including surgery?

NG122/2

Stereotactic ablative radiotherapy compared with surgery: What is the effectiveness and cost effectiveness of stereotactic ablative radiotherapy (SABR) compared with surgery (for example, sublobar, wedge resection, lobectomy) for people with non-small-cell lung cancer (stage I and IIA) in whom surgery is suitable?

NG122/3

What is the effectiveness and cost effectiveness of routinely performing contrast-enhanced brain CT at the time of initial diagnosis and/or staging CT?

NG122/4

Prophylactic cranial irradiation compared with routine MRI follow-up in extensive-stage small-cell lung cancer: What is the effectiveness and cost effectiveness of prophylactic cranial irradiation compared with routine MRI follow-up in people with extensive-stage small-cell lung cancer without brain metastases?

NG123/1

What is the effectiveness and safety of anticholinergic medicines for overactive bladder in older women?

NG123/2

What is the effectiveness of colpocleisis compared with sacrospinous fixation for pelvic organ prolapse in elderly women?

NG123/3

What is the effectiveness of ultrasound-guided visualisation compared with clinical assessment to identify complications after mesh surgery for stress urinary incontinence or pelvic organ prolapse in women?

NG123/4

What are the long-term outcomes, including patient satisfaction, from the use of pessaries compared with surgery for pelvic organ prolapse in women?

NG123/5

What are the long-term risks of mesh surgery compared with non-mesh surgery for stress urinary incontinence and pelvic organ prolapse in women?

NG123/6

What is the long-term effectiveness of bladder wall injection with botulinum toxin type A for overactive bladder in women?

NG123/7

What is the most effective surgical management for women with both stress urinary incontinence and pelvic organ prolapse, including the sequence of interventions?

NG123/8

What is the effectiveness of pain management for women who present with chronic pain 3 months after mesh surgery for stress urinary incontinence or pelvic organ prolapse?

NG124/1

What is the effectiveness of high-pressure non-invasive positive pressure ventilation (NIPPV) compared with continuous positive airways pressure (CPAP) flow driver as the primary mode of ventilation?

NG124/2

What is the best technique for delivering surfactant in a minimally invasive manner? 

NG124/3

What is the effectiveness of diuretics compared with placebo in preventing bronchopulmonary dysplasia (BPD) in preterm babies on respiratory support?

NG124/4

Does targeting higher oxygen saturations of 92% to 97% in preterm babies lead to improved survival without significant complications?

NG124/5

What is the most effective combination of an analgesic with a neuromuscular blocker, or an analgesic with an anaesthetic agent, for premedication in preterm babies requiring elective or semi-elective intubation? 

NG125/1

What is the clinical effectiveness of preoperative nasal decolonisation using mupirocin in combination with a chlorhexidine body wash in the whole population?

NG125/10

Does the use of barbed sutures for wound closure reduce the incidence of surgical site infection? 

NG125/11

Which closure method or technique is the most effective for reducing surgical site infections in patients undergoing emergency surgery?

NG125/2

Is the use of chlorhexidine body wash associated with increased antimicrobial resistance?

NG125/3

What is the clinical and cost effectiveness of chlorhexidine in alcohol at different concentrations in the prevention of surgical site infection when applied to the skin before incision?

NG125/4

Is the application of antiseptics and antibiotics in the operative field before wound closure, clinically and cost effective in reducing surgical site infection rates?

NG125/5

Which patient groups, contamination groups and which layers gain the most benefit from the use of triclosan-coated or triclosan-impregnated sutures?

NG125/6

What is the contribution to clinical effectiveness of the timing of nasal decolonisation and body wash for the prevention of surgical site infection?

NG125/7

What is the effectiveness of decolonisation using alternative interventions in combination with nasal decolonisation in the prevention of surgical site infections when chlorhexidine is contraindicated?

NG125/8

What is the clinical and cost effectiveness of a double application of antiseptic to the skin at the surgical site compared with a single application? 

NG125/9

What is the clinical and cost effectiveness of different modes of applying skin antiseptic before incision in the prevention of surgical site infection?

NG126/01

Early pregnancy assessment units: A national evaluation of early pregnancy assessment unit service provision should be carried out to identify factors affecting outcomes. Factors should include whether care is provided in a dedicated unit, staffing configuration and opening hours of dedicated services. Outcomes should include both process (service) outcomes and pregnancy-related outcomes. Data collected should be used to analyse the cost effectiveness of early pregnancy assessment units compared with other models of care.

NG126/02

Ultrasound for determining a viable intrauterine pregnancy: How does the timing and frequency of ultrasound examination affect diagnosis and outcomes of early pregnancy complications, including women's experience and cost effectiveness?

NG126/03

Effectiveness of progestogens in women with recurrent miscarriage: What is the clinical and cost effectiveness of progesterone for improving outcomes in women with unexplained recurrent miscarriage?

NG126/04

Effectiveness of different progestogens in women at risk of miscarriage: What is the clinical and cost effectiveness of vaginal micronised progesterone versus other progesterone preparations in improving outcomes in women at risk of miscarriage?

NG126/05

Management of miscarriage: In women with confirmed miscarriage, does the type of management strategy (expectant, medical and surgical) impact on women's experience, including psychological and emotional outcomes?

NG126/06

Comparison between expectant, medical or surgical management of ectopic pregnancy: In women with ectopic pregnancy, does the type of intervention impact on women's experience, including psychological and emotional outcomes?

NG128/01

Impact of intensive blood pressure lowering on people who are frail: What is the efficacy and safety of intensive interventions to lower blood pressure compared with less intensive interventions for people with acute intracerebral haemorrhage who are frail at presentation?

NG128/02

Impact of intensive interventions to lower blood pressure on cognitive function, functional ability and quality of life: What are the long-term effects of intensive interventions to lower blood pressure on cognitive function, functional ability and quality of life compared with standard interventions in people with acute intracerebral haemorrhage?

NG128/03

MRI brain scanning: Does early MRI brain scanning improve outcomes after suspected transient ischaemic attack (TIA)?

NG128/04

Avoidance of aspiration pneumonia: Does the withdrawal of oral liquids or the use of modified (thickened) oral fluids prevent the development of aspiration pneumonia after an acute stroke?

NG128/05

Aspirin and anticoagulant treatment for acute ischaemic stroke: Does modified-release dipyridamole or clopidogrel with aspirin improve outcome compared with aspirin alone when administered early after acute ischaemic stroke?

NG128/06

Aspirin treatment in acute ischaemic stroke: Should a person who has a stroke or a TIA and is already taking aspirin be prescribed the same or an increased dose of aspirin after the stroke?

NG128/07

Early mobilisation and optimum positioning of people with acute stroke: How safe and effective is very early mobilisation delivered by appropriately trained healthcare professionals after stroke?

NG128/08

Safety and efficacy of carotid stenting: What is the safety and efficacy of carotid stenting compared with carotid endarterectomy when these procedures are carried out within 2 weeks of TIA or recovered stroke?

NG129/1

What are the benefits, risk and cost effectiveness of enteral nutrition in maintaining remission in the post-surgical period of Crohn's disease?

NG13/1

How can the implementation of the recommendations made in this guideline be evaluated?

NG13/2

How can outcome measures relating to workplace health and wellbeing be measured?

NG13/3

How can the effectiveness of workplace health policies and programmes be measured?

NG13/4

How can the design and reporting of the outcomes used in intervention studies be improved, so researchers can identify 'active ingredients'? Which validated tools are effective at consistently measuring success, especially in relation to health and wellbeing, performance, productivity and in economic terms?

NG13/5

What are the most effective and cost-effective interventions to maintain and improve the health and wellbeing of older employees?

NG13/6

What are the most effective and cost-effective interventions to help older employees stay in or re-enter work? For example, to overcome the problems of a change in job specification?

NG13/7

What are the most effective and cost-effective interventions to help older employees plan and prepare for retirement?

NG13/8

What are the most effective and cost-effective interventions to challenge stereotypes and change employers' and workforce attitudes towards older employees?

NG130/1

In a mild-to-moderate first presentation or inflammatory exacerbation of proctitis that is resistant to standard treatment, what is the effectiveness of topical immunomodulators, such as tacrolimus, in achieving clinical remission and what is the most effective formulation (suppository/ointment)?

NG130/2

What is the effectiveness of oral tacrolimus and systemic (intramuscular/subcutaneous/oral) methotrexate in the induction of remission in mild-to-moderate ulcerative colitis unresponsive to aminosalicylates?

NG130/3

What is the clinical and cost effectiveness of prednisolone, budesonide, and beclometasone in addition to aminosalicylates compared with each other and with aminosalicylate monotherapy for the induction of remission for people with mild-to-moderate ulcerative colitis?

NG130/4

What is the clinical and cost effectiveness of prednisolone compared with aminosalicylates for the induction of remission for people with moderate ulcerative colitis?

NG130/5

What is the clinical and cost effectiveness of prednisolone plus an aminosalicylate compared with beclometasone plus an aminosalicylate for induction of remission for people with moderate ulcerative colitis?

NG130/6

What are the benefits, risks and cost effectiveness of methotrexate, ciclosporin, tacrolimus, adalimumab and infliximab compared with each other and with placebo for induction of remission for people with subacute ulcerative colitis that is refractory to systemic corticosteroids?

NG131/03

Cancers insufficiently researched in primary care: Observational studies of symptomatic primary care patients should be used to estimate the positive predictive value of different symptoms for specific cancers. Priority areas for research are those where the evidence base is currently insufficient and should include prostate cancer, pancreatic cancer, cancer in childhood and young people and other rare cancers. Outcomes of interest are positive predictive values and likelihood ratios for cancer.

NG131/1

What is the most suitable surveillance protocol (including the role of digital rectal examination [DRE] and prostate-specific antigen [PSA] measures) for people for whom active surveillance is appropriate, as assessed by multiparametric MRI and biopsy, when there are no clinical concerns during follow‑up?

NG131/2

What is the most clinically and cost-effective follow‑up protocol for people with prostate cancer who have had radical treatment, with specific regard to risk stratification, duration of follow‑up, frequency of follow‑up appointments, the type of examination or blood tests, and the roles of primary and secondary care in follow‑up?

NG131/3

What is the most clinically and cost-effective pathway for diagnosing clinically significant prostate cancer?

NG131/4

What is the most clinically and cost-effective pathway for diagnosing clinically significant prostate cancer?

NG131/5

What is the natural history of people with a Likert score on MRI of less than 3 without biopsy at long-term follow‑up?

NG131/6

Staging investigations for CPG 3 prostate cancer: What is the diagnostic accuracy of staging investigations for CPG 3 prostate cancer?

NG131/7

What is the prognostic value of different risk stratification methods for people with locally advanced prostate cancer?

NG131/7

In patients with negative MRI (Likert score 1 or 2), what is the next best diagnostic investigation to rule out clinically significant prostate cancer?

What is the diagnostic accuracy of transperineal mapping biopsy compared with transperineal non-mapping biopsy in the diagnosis of clinically significant prostate cancer?

NG131/8

What is the effectiveness and cost effectiveness of different scheduling of zoledronic acid in the prevention and reduction of skeletal events in people with hormone-refractory prostate cancer?

NG132/1

What is the clinical utility of bone turnover markers in the diagnosis and management of primary hyperparathyroidism?

NG132/2

What is the best and most cost-effective management strategy for people whose first surgery for primary hyperparathyroidism is not successful?

NG132/3

What are the long-term outcomes of different management strategies for primary hyperparathyroidism? Which strategies are most cost effective?

NG132/4

What are the optimal management strategies for primary hyperparathyroidism during pregnancy?

NG134/1

What is the clinical and cost effectiveness, post-treatment and at longer-term follow‑up, of psychological therapies in children aged 5 to 11 years with mild or moderate to severe depression?

NG134/2

What is the clinical and cost effectiveness, post-treatment and at longer-term follow‑up, of supported digital cognitive–behavioural therapy (CBT) compared with unsupported digital CBT in young people aged 12 to 18 years with mild depression, and what are the key components of the interventions that influence effectiveness?

NG134/3

What is the clinical and cost effectiveness, post-treatment and at longer-term follow‑up, of family therapy, psychodynamic psychotherapy and interpersonal psychotherapy for adolescents (IPT‑A) compared with each other and with individual CBT in young people aged 12 to 18 years with moderate to severe depression?

NG134/4

What is the clinical and cost effectiveness, post-treatment and at longer-term follow‑up, of a brief psychosocial intervention as reported by the IMPACT trial, but delivered by practitioners other than psychiatrists and in other settings, including primary care, to young people aged 12 to 18 years with mild or moderate to severe depression?

NG134/5

What is the clinical and cost effectiveness, post treatment and at longer-term follow‑up, of behavioural activation compared with other psychological therapies in children aged 5 to 11 years and young people aged 12 to 18 years with mild or moderate to severe depression?

NG135/1

What components of alcohol education delivery contribute to its effectiveness for children and young people aged 11 to 18 in full-time education, and those with special educational needs and disabilities (SEND) up to the age of 25?

NG135/2

How effective and cost effective are individual, compared with group, education-based interventions for children and young people aged 11 to 18 in full-time education who are thought to be vulnerable to alcohol misuse?

NG135/3

How effective and cost effective are universal, education-based alcohol interventions for children and young people aged 11 to 25 with SEND?

NG135/4

How effective and cost effective are education-based alcohol interventions targeted at children and young people aged 11 to 25 with SEND who are thought to be vulnerable to alcohol misuse?

NG135/5

How effective are education-based alcohol prevention interventions (universal or targeted) for children and young people aged 11 to 25 with SEND in full-time education?

NG135/6

What methods and techniques help secondary schools and providers to effectively engage with parents and carers as part of a whole-school approach to promote and support alcohol education?

NG136/01

Automated blood pressure monitoring in people with atrial fibrillation: Which automated blood pressure monitors are suitable for people with hypertension and atrial fibrillation?

NG136/02

Thresholds for interventions in adults aged under 40: In adults aged under 40 with hypertension (with or without type 2 diabetes), what are the appropriate risk and blood pressure thresholds for starting treatment?

NG136/03

Blood pressure targets for people aged over 80: What is the optimum blood pressure target for people aged over 80 with treated primary hypertension (with or without cardiovascular disease)?

NG136/04

Step 1 treatment: Are there subgroups of people with hypertension who should start on dual therapy?

NG136/05

Relaxation therapies: What is the clinical and cost effectiveness of relaxation therapies for managing primary hypertension in adults in terms of reducing cardiovascular events and improving quality of life?

NG136/06

Same-day hospital specialist assessment: Which people with extreme hypertension (220/120 mmHg or higher) or emergency symptoms should be referred for same-day hospital specialist assessment?

NG136/07

Blood pressure targets for people with aortic aneurysm: What are the optimal blood pressure targets in adults with hypertension and aortic aneurysm, and does this vary by age?

NG136/08

Blood pressure targets for people with prior ischaemic or haemorrhagic stroke: What are the optimal blood pressure targets in adults with prior ischaemic or haemorrhagic stroke, and does this vary by age?

NG137/1

What is the most accurate prenatal screening marker for TAPS, including middle cerebral artery peak systolic velocity (MCA‑PSV)?

NG14/01

Monitoring and response biomarkers: Can biomarkers accurately classify recurrence, progression and response to treatment?

NG14/02

Safety, prognostic and predictive biomarkers: Can biomarkers be used for risk stratification and treatment planning for people with melanoma?

NG14/03

Effectiveness of localised treatments: What is the effectiveness of localised treatment for people with stages III and IV melanoma?

NG14/04

Histological margins: What is the optimal histological excision margin in stage 0 melanoma?

NG14/05

Surveillance strategies: How frequently should surveillance imaging be conducted, and which imaging modality should be used for people with stage IIB to IIIC melanoma?

NG14/06

Survivorship: What are the experiences of people who are living with, through and beyond a melanoma diagnosis in terms of survivorship and their disease journey?

NG14/07

Techniques for confirming a diagnosis in people with suspected atypical Spitzoid melanocytic lesions: In people with reported atypical Spitzoid lesions, how effective are fluorescence in situ hybridization (FISH), comparative genomic hybridization (CGH) and tests to detect driver mutations compared with histopathological examination alone in predicting disease specific survival?

This should be investigated ina prospective diagnostic study. Secondary outcomes should include sensitivity, specificity, accuracy, positive predictive value, disease specific survival and progression free survival.

NG14/08

Surgical excision for people with lentigo maligna: For people with lentigo maligna (stage 0 in sun damaged skin, usually on the face) how effective is Mohs micrographic surgery, compared with excision with a 0.5 cm clinical margin, in preventing biopsy proven local recurrence at 5 years?

This should be investigated in a randomised controlled trial. Secondary outcomes should include cosmetic and functional outcomes.

NG14/09

Vitamin D supplementation: In people with stage I to III melanoma does vitamin D supplementation improve overall survival?

This should be investigated in a placebo controlled randomised trial. Secondary outcomes should include disease specific survival and toxicity, including the development of renal stones and hypercalcaemia.

NG14/10

The effect of drug therapy for concurrent conditions on melanoma survival: In people diagnosed with melanoma what is the effect of drug therapy to treat concurrent conditions on disease specific survival?

This should be investigated in a national prospective cohort study. Secondary outcomes should include overall survival and quality of life.

NG140/1

What is the optimal antibiotic prophylaxis regimen for women who are having a surgical abortion?

NG140/2

What are the most effective and acceptable methods of cervical priming before dilatation and evacuation after 16+0 weeks' gestation?

NG140/3

Should women having a surgical abortion up to and including 10+0 weeks' gestation have anti-D prophylaxis if they are RhD (or D) negative?

NG140/4

For women who are having medical abortion between 10+1 and 12+0 weeks, what is the efficacy and acceptability of expulsion at home compared with expulsion in a clinical setting?

NG140/5

What local anaesthetic techniques are most effective for women having surgical abortion?

NG140/6

What is the effectiveness and safety of regimens using mifepristone and misoprostol for women who are having medical abortion after 23+6 weeks' gestation, particularly for those who have had a previous caesarean section or uterine surgery?

NG140/7

What is the optimal regimen for general anaesthesia for women having surgical abortion?

NG142/1

Does early review of service provision and referral to additional specialist palliative care services improve outcomes for adults with progressive non-cancer disease thought to be approaching the end of their life?

NG142/2

Which of the electronic information-sharing systems perform best for the care of people approaching the end of their life?

NG142/3

What are the benefits of planned, regular community-based reviews compared with as-required review of non-cancer patients approaching the end of their life?

NG142/4

What is the optimal way of discharging people approaching the end of their life from hospitals back to their place of residence?

NG143/01

Symptoms and signs of serious illness: The Guideline Development Group (GDG) recommends a UK-based epidemiological study on the symptoms and signs of serious illness.

NG143/02

Management by remote assessment: The GDG recommends that a UK study is undertaken to determine the validity of symptoms reported on remote assessment for children with fever.

NG143/03

Diagnosis: The GDG recommends that a UK study of the performance characteristics and cost-effectiveness of procalcitonin versus C-reactive protein in identifying serious bacterial infection in children with fever without apparent source be carried out.

NG143/04

Antipyretics: The GDG recommends that studies are conducted in primary care and secondary care to determine whether examination or re-examination after a dose of antipyretic medication is of benefit in differentiating children with serious illness from those with other conditions.

NG143/05

Home-based antipyretic use: The GDG recommends studies on home-based antipyretic use and parental perception of distress caused by fever. [2013]

NG143/06

Thermometers and the detection of fever: Measuring temperature in young babies: tympanic versus axilla electronic versus axilla chemical dot versus temporal artery.

NG143/07

Management according to risk of serious illness: The GDG recommends that research is carried out on referral patterns between primary and secondary care for children with fever, so the health economic impact of this and future guidelines can be estimated.

NG143/08

Signs and symptoms of Kawasaki disease: Which signs and symptoms (or combinations of signs and symptoms) predict a diagnosis of Kawasaki disease in children under 5 presenting with fever lasting 5 days or more?

NG144/1

For adults with fibromyalgia or persistent treatment-resistant neuropathic pain, what is the clinical and cost effectiveness of cannabidiol (CBD), containing no, or traces of, delta-9-tetrahydrocannabinol (THC), as an add-on to standard treatment?

NG144/2

For children and young people with intractable cancer-related pain and pain associated with specific diseases (such as epidermolysis bullosa), what is the clinical and cost effectiveness of cannabis-based medicinal products as an add-on to standard treatment to improve symptoms compared with treatment with standard care?

NG144/3

What is the clinical and cost effectiveness of CBD in epileptic disorders in children, young people and adults?

NG144/4

Does the addition of THC to CBD have an effect on seizure frequency, brain structure and neuropsychological performance when compared with both CBD alone and placebo in epileptic disorders in children, young people and adults?

NG144/5

What is the clinical and cost effectiveness of cannabis-based medicinal products other than THC: CBD spray for children, young people and adults with spasticity? In particular, what is the impact of spasticity on improvements in quality of life?

NG144/6

What is the clinical and cost effectiveness of cannabis-based medicinal products as an add-on treatment for adults with chemotherapy-induced nausea and vomiting which persists with optimised conventional antiemetics?

NG144/7

What is the clinical and cost effectiveness of cannabis-based medicinal products as an add-on treatment in babies, children and young people with chemotherapy-induced nausea or vomiting which persists with optimised conventional antiemetics?

NG144/8

What is the clinical and cost effectiveness of cannabis-based medicinal products as an add-on treatment for adults with persistent nausea or vomiting not caused by chemotherapy which hasn't fully responded to optimised conventional antiemetics?

NG144/9

What is the clinical and cost effectiveness of cannabis-based medicinal products as an add-on treatment for babies, children and young people with persistent nausea or vomiting not caused by chemotherapy which hasn't fully responded to optimised conventional antiemetics?

NG145/1

What is the clinical and cost effectiveness of levothyroxine (T4) and liothyronine (T3) combination therapy compared with T4 alone for people with hypothyroidism whose symptoms have not responded sufficiently to T4 alone? Does DiO2 polymorphism affect the response to combination therapy with T4 and T3?

NG145/10

What is the clinical and cost effectiveness of iodine for people with subclinical hypothyroidism?

NG145/11

What is the clinical and cost effectiveness of selenium for people with subclinical hypothyroidism?

NG145/2

What is the clinical and cost effectiveness of treatment (antithyroid drugs or radioactive iodine) for improving long-term health outcomes for people with subclinical hyperthyroidism?

NG145/3

Are there subgroups of people with Graves' disease who have a particularly good response to antithyroid drugs?

NG145/4

What is the long-term clinical and cost effectiveness, including safety, of radioactive iodine for hyperthyroidism?

NG145/5

What is the clinical and cost effectiveness of dosimetry-guided radioactive iodine strategies for hyperthyroidism?

NG145/6

What is the clinical and cost effectiveness of different durations of antithyroid drug regimens for people with T3 thyrotoxicosis due to Graves' disease?

NG145/7

What is the clinical and cost effectiveness of levothyroxine for people under 65 with symptomatic subclinical hypothyroidism?

NG145/8

What is the clinical and cost effectiveness of a block and replace regimen compared with a titration regimen of antithyroid drugs for Graves' disease?

NG145/9

What is the clinical and cost effectiveness of percutaneous thermal ablation for benign thyroid nodules?

NG146/1

What interventions are effective and cost effective in supporting return to work, in all workplaces including micro-, small- and medium-sized organisations, after long-term sickness absence in the UK?

NG146/2

What interventions are effective and cost effective in supporting return to work after recurrent short-term sickness absence in the UK?

NG146/3

For people with common mental health conditions, what interventions are effective and cost effective in reducing long-term sickness absence and supporting return to work in the UK?

NG146/4

For people with common mental health conditions, what interventions are effective and cost effective in reducing recurrent short-term sickness absence and supporting return to work in the UK?

NG146/5

What are the challenges and potential solutions for UK employers and employees in micro-, small- and medium-sized organisations (which may not have easy access to additional services such as employee assistance programmes or occupational health services) in ensuring sickness policy is managed effectively and facilitating return to work?

NG146/6

Which interventions are effective and cost effective in supporting people working in organisations where employees are not centrally located to return to work after long-term sickness absence in the UK?

NG147/1

What is the clinical and cost effectiveness of antibiotics for the management of acute diverticulitis in primary care?

NG147/2

What is the most clinically and cost-effective conservative management for preventing diverticular disease in people with diverticulosis?

NG147/3

What is the most clinically and cost-effective treatment for diverticular disease?

NG147/4

What information and support do people with diverticulosis, diverticular disease or acute diverticulitis need?

NG147/5

What are the clinically and cost-effective surgical approaches to managing complicated acute diverticulitis, including timing of surgery (elective or emergency)?

NG147/6

What are the risk factors for diverticulosis progressing to diverticular disease?

NG148/1

Can risk of contrast-induced acute kidney injury be stratified by eGFR thresholds?

NG148/2

What is the relative effectiveness and cost effectiveness of different oral fluids and different oral fluid regimens, both with and without oral N-acetylcysteine, at preventing contrast-induced acute kidney injury?

NG149/1

What is the health impact of exposure to individual air pollutants alone or combined with each other in the home?

NG149/2

What is the effectiveness and cost effectiveness of interventions to improve indoor air quality at home for people without pre‑existing health conditions?

NG149/3

What is the minimum air exchange rate to minimise the health effects of poor indoor air quality in the home?

NG149/4

What are the emission profiles of indoor air pollutants released from building materials in a lived-in home environment?

NG149/5

What interventions are effective and cost effective at raising awareness of the health risks of damp and mould in the home?

NG149/6

How can damp and mould in the home be prevented?

How is damp and mould in the home best identified?

How is damp and mould in the home best fixed?

How can tenants be best made aware of whose responsibility it is to make any changes needed as a result of damp and mould in the home?

NG15/1

Reducing antimicrobial resistance:- What interventions, systems and processes are effective and cost effective in reducing antimicrobial resistance without causing harm to patients?

Ng15/2

Decision-making:- What interventions, systems and processes are effective and cost effective in changing health and social care practitioners' decision-making and ensuring appropriate antimicrobial stewardship?

NG150/1

What is the effectiveness, cost effectiveness and acceptability of the whole family approach to carers' assessments?

NG150/2

What is the effectiveness of personal health and social care budgets in supporting carers to return to work, education or training?

NG150/3

What training, support or interventions help to reduce caring-related accidents or incidents?

NG150/4

What is the effectiveness, cost effectiveness and acceptability of carer passport schemes?

NG150/5

What is the effectiveness, cost effectiveness and acceptability of social prescribing for carers?

NG151/1

What is the cost effectiveness and safety of non-surgical ablation and stereotactic body radiotherapy compared to resection for people with metastatic colorectal cancer in the lung amenable to local treatment?

NG151/2

What is the effectiveness and safety of sacral nerve stimulation and transanal irrigation compared to symptomatic treatment for people with major low anterior resection syndrome?

NG152/1

What is the clinical effectiveness of topical treatments (antibiotics and antiseptics) compared with oral antibiotics for the treatment of infected leg ulcer?

NG153/1

For which people with impetigo are antiseptics as effective as antibiotics?

NG154/1

What are the information and support needs of parents and carers with babies on parenteral nutrition?

NG154/2

What is the optimal ratio of non-nitrogen energy to nitrogen in parenteral nutrition for preterm and term babies?

NG154/3

What is the optimal timeframe for starting parenteral nutrition in term babies who are critically ill or require surgery?

NG154/4

What overall osmolality (or concentration of calcium and glucose/dextrose) in parenteral nutrition can determine whether to administer centrally or peripherally?

NG155/1

What is the clinical and cost effectiveness of cognitive behavioural therapy (CBT) for adults with tinnitus delivered by appropriately trained healthcare professionals other than psychologists (for example, audiologists)?

NG155/10

What is the clinical and cost effectiveness of amplification devices for people who are d/Deaf or who have a severe-to-profound hearing loss?

NG155/11

What is the clinical and cost effectiveness of psychological therapies for people who are d/Deaf or who have a severe-to-profound hearing loss and tinnitus-related distress?

NG155/12

What is the clinical and cost effectiveness of fitting amplification devices(s) in people with tinnitus who have hearing loss but no perceived hearing difficulties?

NG155/2

What is the clinical and cost effectiveness of a combination management strategy consisting of sound therapy and tinnitus support?

NG155/2

What is the clinical and cost effectiveness of a combination management strategy consisting of sound therapy and tinnitus support?

NG155/3

What is the optimal method for assessing tinnitus in general practice (including consultation questions, physical examinations and questionnaires)?

NG155/4

What is the clinical, cost effectiveness and safety of neuromodulation interventions for treating tinnitus in adults?

NG155/5

What is the clinical and cost effectiveness of psychological therapies for children and young people who have tinnitus-related distress?

NG155/6

What is the most clinically and cost-effective tinnitus questionnaire to assess tinnitus in children and young people?

NG155/7

What is the most clinically and cost-effective tinnitus questionnaire to assess tinnitus in people with a learning disability or cognitive impairment?

NG155/8

What is the most clinically and cost-effective tinnitus questionnaire to assess tinnitus in people who are d/Deaf or who have a severe-to-profound hearing loss?

NG155/9

Are relaxation strategies clinically and cost effective for the management of tinnitus for children, young people and adults?

NG156/1

What are the most effective and cost-effective frequencies for monitoring people with unruptured abdominal aortic aneurysms (AAA) of different diameters, and what is the optimal AAA threshold size (inner-to-inner maximum anterior-posterior diameter on ultrasound) for repair?

NG156/2

What is the effectiveness and cost effectiveness of complex endovascular aneurysm repair (EVAR) versus open surgical repair in people for whom open surgical repair is suitable for:

  • elective repair of an unruptured AAA or

  • emergency repair of a ruptured AAA?

NG157/10

What is the most effective technological solution for minimising wrong implant selection during joint replacement surgery?

NG157/11

Do the direct anterior, direct superior and supercapsular percutaneously assisted (SuperPATH) approaches to hip replacement improve patient-recorded outcome measures and reduce length of hospital stays, revision rates, neurological complications and surgical site infections compared with the posterior and anterolateral approaches?

NG157/12

What is the clinical and cost effectiveness of humeral hemiarthroplasty compared with conventional total shoulder replacement for adults aged under 60 having primary elective shoulder replacement for osteoarthritis with no rotator cuff tear?

NG157/13

In adults having primary elective shoulder replacement for pain and functional loss after a previous proximal humeral fracture (not acute trauma), what is the clinical and cost effectiveness of reverse total shoulder replacement compared with humeral hemiarthroplasty?

NG157/14

What are the best ways to support rehabilitation after hip knee or shoulder replacement for people with additional needs (such as people with dementia, a learning difficulty or multiple disabling medical comorbidities)?

NG157/15

For people who have had primary elective shoulder replacement, does self-directed, supervised group or supervised individual rehabilitation produce the most improvement in health-related quality of life 2 years after surgery?

NG157/16

What is the optimum time between follow‑up appointments for people who have had shoulder replacement, who should lead follow‑up and how this should be organised between hospital and community care?

NG157/6

In adults having elective knee replacement, what is the clinical and cost effectiveness of total knee replacement with patella resurfacing compared with selective resurfacing?

NG157/7

What are the components of a decision aid to support people referred for elective joint replacement in making decisions about their treatment (for example, the type of procedure, timing and implant choice)?

NG157/8

In adults having elective shoulder joint replacement with general anaesthesia, what is the clinical and cost effectiveness of supplementary local infiltration analgesia, a nerve block or regional anaesthesia?

NG157/9

In adults having elective shoulder joint replacement, what is the relative clinical and cost effectiveness of general anaesthesia, regional anaesthesia, and general combined with regional anaesthesia?

NG16/1

What is the prevalence of risk and protective factors in mid-life for the development of dementia, disability and frailty, and what are the longitudinal relationships between them? Are dose–response relationships evident and how strong are these? Which factors are independent and which mediate others?

NG16/2

What are the most effective and cost-effective population-level measures to help people in mid-life maintain or adopt healthy behaviours and build up resilience to dementia, disability and frailty? What are the best methods for evaluating their effect? How do these measures affect health inequalities?

NG16/3

What are the most effective and cost-effective mid-life services and interventions in the long term for reducing behavioural risk, leading to healthier ageing and preventing or delaying the development of dementia, disability and frailty in later life? How can these be delivered in a consistent and sustainable manner? How can multiple interventions be effectively packaged to maximise efficiency? What are the barriers and facilitators to the uptake of services and interventions, and to the development and maintenance of healthy behaviours of people in mid-life? What are the effects on health inequalities?

NG16/4

How strong are the associations between hearing and visual loss, and sleep patterns and positive and negative health outcomes, in particular the development of dementia, disability and frailty? What are the most effective and cost-effective interventions to protect hearing and vision and improve sleep and what is their effect on the development of dementia, disability and frailty?

NG16/5

How effective and cost-effective is the NHS Health Check programme? What are the patterns of uptake in relation to the demographics of the population and their degree of behavioural risk? What is the programme's effect on the development of dementia, disability and frailty? How feasible is extending the NHS Health Check programme to a younger age range?

NG161/1

Risk of systemic anticancer treatment in people with cancer and COVID-19: Are patients with cancer and COVID-19 who are receiving/have recently received systemic anticancer treatment (SACT) (that is, within the 4 weeks preceding a diagnosis of COVID-19) at increased risk of severe COVID-19 illness or death?

NG161/2

Duration of risk of systemic anticancer treatment in people with cancer and COVID-19: Are people who have had SACT recently (that is, within the 4 weeks preceding a diagnosis of COVID-19) at increased risk of poor outcomes from COVID-19 compared with those who had SACT less recently?

NG162/1

Risk of radiotherapy in people with cancer and COVID-19: Are patients with cancer and COVID-19 who are receiving/have recently received radiotherapy (that is, within the 4 weeks preceding a diagnosis of COVID-19) at increased risk of severe COVID-19 illness or death?

NG162/2

Duration of risk of radiotherapy in people with cancer and COVID-19: Are people who have had radiotherapy recently (that is, within the 4 weeks preceding a diagnosis of COVID-19) at increased risk of poor outcomes from COVID-19 compared with those who had radiotherapy less recently?

NG162/3

Radiation-induced lymphopenia and risk of new COVID-19 and severity of COVID-19: Does radiation-induced lymphopenia predispose patients to an increased risk of new COVID-19 and does it contribute to patients developing more severe COVID-19?

NG17/01

Clinical features for distinguishing between type 1 diabetes and other types of diabetes: What are the best clinical features or combination of features for distinguishing between type 1 diabetes and other types of diabetes?

NG17/02

The use of C-peptide in diagnosing diabetes: What is the effectiveness of C‑peptide at correcting misclassification of diabetes diagnosis and what is the optimal timing for the test in distinguishing subtypes of diabetes?

NG17/03

Use of routinely collected real-world data to examine the effectiveness and cost effectiveness of continuous glucose monitoring: Based on routinely collected real-world data, what is the effectiveness and cost effectiveness of CGM devices to improve glycaemic control?

NG173/1

Further research is recommended to:

  • help improve understanding about the value added by procalcitonin testing when used with clinical judgement

  • guide decisions about stopping antibiotics for people admitted to hospital with pneumonia in the context of the COVID‑19 pandemic.

NG18/01

Continuous glucose monitoring in children and young people with type 2 diabetes: What is the effectiveness and cost effectiveness of continuous glucose monitoring devices in children and young people with type 2 diabetes? 

NG18/02

Use of routinely collected real-world data to examine the effectiveness and cost effectiveness of continuous glucose monitoring: Based on routinely collected real-world data, what is the effectiveness and cost effectiveness of continuous glucose monitoring devices to improve glycaemic control in children and young people?

NG18/03

Continuous glucose monitor sensor adhesive to prevent sensitivities: What is the best continuous glucose monitor sensor adhesive to prevent sensitivities to the device, for example local skin reactions?

NG180/1

What is the clinical and cost effectiveness of preoperative optimisation clinics for older people?

NG180/2

For people with iron-deficiency anaemia, how long before surgery should oral iron supplementation be started, and what is the clinical and cost effectiveness of daily oral iron compared with oral iron given on alternate days?

NG180/3

What is the most clinical and cost-effective strategy, as identified by a consensus survey, for the perioperative management of anticoagulation treatment in people taking a vitamin K antagonist with a target international normalised ratio (INR) of more than 3 who need bridging therapy?

NG180/4

What is the clinical and cost effectiveness of enhanced recovery programmes for adults having major emergency surgery?

NG180/5

Which patients, other than those known to have a high risk of complications or mortality, would benefit from postoperative care in a specialist recovery area (a high-dependency unit, a post-anaesthesia care unit or an intensive care unit)?

NG180/6

What is the optimal timing of administration of carbohydrate drinks as part of a preoperative fasting strategy?

NG180/7

What is the most clinically and cost-effective timing and dose of a single administration of gabapentin to relieve pain in people undergoing surgery whose pain is expected to be moderate to severe?

NG181/1

What is the efficacy and cost effectiveness of rehabilitation services compared with treatment as usual for people with complex psychosis with residual disability, who are leaving early intervention services?

NG181/10

What tailored interventions (pharmaceutical and psychological) specific to rehabilitation are effective at equipping people with complex psychosis with the ability to live in the community?

NG181/11

What are the risks that predict the development of blood-borne virus infections in people with complex psychosis in the UK?

NG181/2

How can peer-support interventions be used most effectively to support people with complex psychosis using rehabilitation services?

NG181/3

What are the service and service user characteristics of highly specialist and longer-term high-dependency rehabilitation units that are associated with better outcomes?

NG181/4

What structured group activities are effective at improving interpersonal functioning (social skills) for people with complex psychosis?

NG181/5

What is the clinical and cost effectiveness of inpatient rehabilitation provided by the independent sector compared with that provided by the NHS?

NG181/6

Is an integrated care system effective at promoting successful progress for people with complex psychosis to a more independent setting?

NG181/7

What staff training interventions are effective at facilitating personal recovery for people with complex psychosis?

NG181/8

What is the impact of coexisting physical health conditions on the mortality of people with complex psychosis?

NG181/9

What interventions are effective to support medicines adherence for people with complex psychosis in supported accommodation?

NG183/1

How can providers and healthcare professionals identify groups that do not initially engage, or do not stay engaged, with digital and mobile health behaviour change interventions?

NG183/2

What components and characteristics of digital and mobile health behaviour change interventions are most effective, separately and in combination, to achieve behaviour change?

NG183/3

What is the effectiveness and cost effectiveness of digital and mobile health behaviour change interventions in low socioeconomic and other underserved groups?

NG183/4

Are digital and mobile health behaviour change interventions as effective as face-to-face, standard care, or combination approaches for some populations?

NG183/5

What are the harms and adverse effects associated with different digital and mobile health behaviour change interventions?

NG185/1

What is the most clinically and cost-effective dual antiplatelet therapy for people aged 75 and over with an acute coronary syndrome, who are having percutaneous coronary intervention (PCI)? 

NG186/1

What is the effectiveness and safety of standard-dose compared with intermediate‑dose pharmacological VTE prophylaxis for patients with COVID-19 pneumonia, with or without additional risk factors for VTE?

NG186/2

What is the effectiveness and safety of extended pharmacological VTE prophylaxis for patients who have been discharged after treatment for COVID-19 pneumonia?

NG188/1

What are the most clinically effective interventions (including social prescribing and structured community support) for managing post‑COVID‑19 syndrome?

Does effectiveness vary for different population groups (for example sex, age, socioeconomic group, black, Asian and minority ethnic group communities or people with learning disabilities)?

Do any symptoms of post‑COVID‑19 syndrome predict the need for specialist intervention?

Are there clusters of symptoms that identify response to interventions in post‑COVID‑19 syndrome?

What is the clinical effectiveness of different service models of multimodality/multidisciplinary post‑COVID‑19 syndrome rehabilitation in improving patient‑reported outcomes (such as quality of life)?

What is the clinical effectiveness of exercise interventions for people with post‑COVID‑19 syndrome? Does effectiveness vary for different population groups (for example sex, age, socioeconomic group, black, Asian and minority ethnic group communities or people with learning disabilities)?

Does early exercise rehabilitation assist in improving symptoms of post‑COVID‑19 syndrome?

NG188/2

What is the prevalence and incidence of post-COVID-19 syndrome in patients who have received single, double, or boosted doses of the approved vaccinations in the UK?

Does this vary across different population groups (for example in black, Asian and minority ethnic group communities)?

NG188/3

What is the clinical effectiveness of D-dimer and other blood tests and clinical features as prognostic markers of developing post‑COVID‑19 syndrome?

NG188/4

What symptoms do children, young people, pregnant women and older people with suspected post‑COVID‑19 syndrome present with?

NG188/5

What is the natural history of post-COVID-19 syndrome?

NG188/6

What pathophysiological mechanism(s) underlie the most common presentations of post-COVID-19 syndrome? For example, generalised fatigue, breathlessness, and “brain fog”?

NG188/7

Develop and validate new and existing screening tools (including physical, psychological and psychiatric aspects) for post-COVID-19 syndrome in a UK population.

What tools are validated for screening for post‑COVID‑19 syndrome, which are the most accurate at identifying post‑COVID‑19 syndrome in a UK population and what is their effectiveness in guiding management?

NG19/1

Intensive monitoring for people at risk of diabetic foot problems:- Does intensive monitoring of people at risk of diabetic foot disease reduce the morbidity associated with developing the disease and is such monitoring cost effective?

NG19/1

Does intensive monitoring of people at risk of diabetic foot disease reduce the morbidity associated with developing the disease and is such monitoring cost effective?

NG19/10

What is the clinical effectiveness of maggot debridement therapy in the debridement of diabetic foot ulcers?

NG19/11

Which risk stratification tools can be used to predict the likelihood of Charcot arthropathy?

NG19/12

When is it safe to stop contact casting in the treatment of acute Charcot arthropathy?

NG19/2

Referral criteria for the foot protection service and the multidisciplinary foot care service:- When and with what criteria should people with diabetes be referred to the foot protection service or the multidisciplinary foot care service?

NG19/2

When and with what criteria should people with diabetes be referred to the foot protection service or the multidisciplinary foot care service?

NG19/2

When and with what criteria should people with diabetes be referred to the foot protection service or the multidisciplinary foot care service?

NG19/3

Education and psycho-behavioural interventions for prevention:- What is the role of educational models and psycho-behavioural interventions in prevention of diabetic foot complications?

NG19/3

What is the role of educational models and psycho-behavioural interventions in prevention of diabetic foot complications?

NG19/4

Prevention strategies for Charcot arthropathy:- What strategies may be useful in the prevention of Charcot arthropathy?

NG19/4

What strategies may be useful in the prevention of Charcot arthropathy?

NG19/5

Diabetic ulcer dressings:- What is the clinical effectiveness of different dressing types in treating diabetic foot problems?

NG19/5

What is the clinical effectiveness of different dressing types in treating diabetic foot problems?

NG19/6

Within the hospital multidisciplinary team, when is it appropriate and effective to refer people with diabetes who have foot problems to specialist services such as investigative or interventional radiology, orthopaedic or vascular services, specialist pain management and specialist orthotics?

NG19/7

What is the effectiveness of different footwear, insoles and orthoses in the prevention of foot problems?

NG19/8

How often should people with diabetic foot problems (foot ulcers, soft tissue infections, osteomyelitis or gangrene) be reviewed?

NG19/9

What is the clinical effectiveness of negative pressure wound therapy in the treatment of diabetic foot ulcers?

NG191/1

What is the effectiveness and safety of standard-dose compared with intermediate-dose pharmacological venous thromboembolism (VTE) prophylaxis for people with COVID-19, with or without additional risk factors for VTE?

NG191/10

What risk factors in people who are critically ill and have, or have had, COVID-19 as part of their acute illness are associated with developing COVID-19-associated pulmonary aspergillosis (CAPA)?

NG191/11

What are the possible outcomes for people who are critically ill and have COVID-19-associated pulmonary aspergillosis (CAPA)?

NG191/12

In people with suspected COVID-19-associated pulmonary aspergillosis (CAPA), what are the most accurate tests for diagnosing the infection and when should they be done?

NG191/13

What are the views, preferences and experiences of people with COVID-19-associated pulmonary aspergillosis (CAPA), and their families or carers, on:
• available tests for diagnosing CAPA
• available treatments for CAPA?

NG191/14

What are the clinical and cost effectiveness, and the safety, of specific antifungal treatments for treating suspected or confirmed COVID-19-associated pulmonary aspergillosis (CAPA), and the optimal treatment duration? When should treatment be started, stopped or modified?

NG191/15

What is the effectiveness and safety of neutralising monoclonal antibodies against different SARS-CoV-2 variants?

NG191/16

What is the efficacy and safety of COVID-specific antiviral drugs in combination with other COVID-specific antiviral drugs or COVID-specific neutralising monoclonal antibodies in people who do not need supplemental oxygen and are within 7 days of symptom onset?

NG191/17

What is the efficacy and safety of remdesivir for people who have been vaccinated against COVID-19?

NG191/18

What is the effectiveness of awake body positioning in improving outcomes for people in hospital with COVID-19 who are not intubated and have higher oxygen needs?

NG191/19

What is the clinical effectiveness and safety of vitamin D for treating COVID-19 in children, young people and adults?

NG191/2

What is the effectiveness and safety of extended pharmacological venous thromboembolism (VTE) prophylaxis for people who have been discharged after treatment for COVID-19?

NG191/3

What is the effectiveness and safety of a treatment dose with a low molecular weight heparin (LMWHs) compared with a standard prophylactic dose for venous thromboembolism (VTE) prophylaxis in young people under 18 years with COVID-19?

NG191/4

Does early review and referral to specialist palliative care services improve outcomes for adults with COVID-19 thought to be approaching the end of their life?

NG191/5

Is high-flow nasal oxygen effective in reducing breathlessness compared with standard care or conventional oxygen therapy for people in hospital with COVID-19 and respiratory failure when it is agreed that treatment will not be escalated beyond non-invasive respiratory support or palliative care is needed?

NG191/6

Does a multidisciplinary team agreed approach to weaning from continuous positive airway pressure improve weaning times and result in stopping continuous positive airway pressure for people with COVID-19 and acute respiratory failure?

NG191/7

What is the effectiveness, cost effectiveness and safety of using a combination of casirivimab and imdevimab at doses other than 8 g for treating COVID-19?

NG191/8

What is the effectiveness, cost effectiveness and safety of the combination of casirivimab and imdevimab for treating COVID-19 in people with particular clinical characteristics (for example, people who are seropositive, of unknown serostatus, immunocompromised, or with specific comorbidities and within both the seropositive and seronegative groups, according to vaccination status or history of natural infection)?

NG191/9

What is the clinical and cost effectiveness of budesonide for treating COVID-19 in the community in adults, young people and children?

NG192/01

Short-term and long-term benefits and risks of planned caesarean birth compared to planned vaginal birth: What are the benefits and risks (short term and long term) of planned caesarean birth compared with planned vaginal birth at term for women and babies/infants/children?

NG192/02

Decision-to-birth interval (category 1 urgency): What factors influence the decision-to-birth interval when there is a category 1 level of urgency for caesarean birth?

NG192/03

Decision-to-birth interval (category 2 urgency): A prospective study to determine whether the decision-to-birth interval has an impact on maternal and neonatal outcomes when there is a category 2 level of urgency for caesarean birth.

NG192/04

Maternal request for caesarean birth: What support or psychological interventions would be appropriate for women who have a fear of vaginal childbirth and request a caesarean birth?

NG193/1

Psychological therapy – mindfulness for chronic primary pain: What is the clinical and cost effectiveness of mindfulness therapy for managing chronic primary pain in people aged 16 years and over?

NG193/10

Laser therapy for chronic primary pain: What is the clinical and cost effectiveness of laser therapy for managing chronic primary pain in people aged 16 years and over?

NG193/11

Transcranial magnetic stimulation for chronic primary pain: What is the clinical and cost effectiveness of transcranial magnetic stimulation for managing chronic primary pain in people aged 16 years and over?

NG193/2

Psychological therapy – CBT for insomnia in chronic primary pain: What is the clinical and cost effectiveness of cognitive behavioural therapy (CBT) for insomnia or CBT for insomnia and pain for managing chronic primary pain in people aged 16 years and over?

NG193/3

Manual therapies for chronic primary pain: What is the clinical and cost effectiveness of manual therapy for managing chronic primary pain in people aged 16 years and over?

NG193/4

Repeat courses of acupuncture for chronic primary pain: What is the clinical and cost effectiveness of repeat courses of acupuncture or dry needling for managing chronic primary pain in people aged 16 years and over?

NG193/5

Pharmacological interventions – gabapentinoids and local anaesthetics for complex regional pain syndrome: What is the clinical and cost effectiveness of gabapentinoids or local anaesthetics for managing complex regional pain syndrome in people aged 16 years and over?

NG193/6

Factors that may be barriers to successfully managing chronic pain, including chronic primary pain: What risk factors enable stratification of treatment for people aged 16 years and over with chronic pain?

NG193/7

Social interventions for chronic pain, including chronic primary pain: What is the clinical and cost effectiveness of social interventions aimed at improving the quality of life of people aged 16 years and over with chronic pain?

NG193/8

Psychotherapy for chronic primary pain: What is the clinical and cost effectiveness of psychodynamic psychotherapy for managing chronic primary pain in people aged 16 years and over?

NG193/9

Relaxation therapy for chronic primary pain: What is the clinical and cost effectiveness of relaxation therapies for managing chronic primary pain in people aged 16 years and over?

NG194/1

Length of postpartum stay and first midwife visit after transfer of care: How does the length of postpartum stay and the timing of the first midwife visit after transfer of care affect unplanned or emergency health contacts for women and babies?

NG194/2

Timing of first health visitor visit: What is the most effective timing of the first postnatal contact by a health visitor?

NG194/3

Clinical tools to assess women's health: What tools for the clinical review of women (including pain scores) are effective during the first 8 weeks after birth?

NG194/4

Perineal pain: What characteristics of perineal pain suggest the need for further evaluation?

NG194/5

Breastfeeding support for parents with twins or triplets: What support with breastfeeding do parents of twins or triplets find helpful?

NG195/1

Risk factors for and clinical indicators of early-onset infection: What is the accuracy of clinical prediction models for early-onset neonatal infection in the UK and what is their effectiveness in guiding management in the baby?

NG195/10

Intrapartum antibiotics: What is the clinical and cost effectiveness of intrapartum antibiotics for women with meconium-stained amniotic fluid?

NG195/11

Antibiotics for suspected early-onset infection: What is the incidence in England and Wales of resistance to commonly used antibiotics among bacteria that cause early-onset neonatal infection?

NG195/12

Antibiotics for suspected early-onset infection: What is the optimal antibiotic dosage regimen for the treatment of early-onset neonatal infection?

NG195/13

Antibiotics for suspected early-onset infection: What is the incidence and severity of adverse effects with antibiotics used to prevent or treat early-onset neonatal infection?

NG195/14

Antibiotics for suspected early-onset infection: What are the core exposures and outcomes that should be used to evaluate clinical effectiveness of antibiotics to prevent or treat early- onset neonatal infection?

NG195/15

Intravascular catheters for reducing the risk of late-onset neonatal infection: What is the effectiveness of antimicrobial-impregnated catheters other than those impregnated with rifampicin and miconazole for preventing late-onset catheter-related bloodstream infections in newborn babies?

NG195/16

Intravascular catheters for reducing the risk of late-onset neonatal infection: What is the effectiveness of catheters impregnated with silver zeolite for preventing late-onset catheter-related bloodstream infections in newborn babies?

NG195/17

Antifungals to prevent fungal infection during antibiotic treatment for late-onset neonatal infection: What is the optimum regimen (including treatment duration and dose) for using antifungals to prevent secondary fungal infection associated with antibiotic treatment for late-onset neonatal infection?

NG195/18

Early and late-onset meningitis: What is the optimal antibiotic treatment regimen for early-onset neonatal meningitis?

NG195/19

Care setting: What is the clinical and cost effectiveness of different models of care for the prevention and treatment of early-onset neonatal infection?

NG195/2

Risk factors for and clinical indicators of early-onset infection: What is the risk of early-onset neonatal infection with maternal obesity and how does this change with increasing body mass index?

NG195/3

Investigations for babies who may have early-onset infection: What is the clinical and cost effectiveness of laboratory investigations used individually or in combination to exclude early-onset neonatal infection in babies receiving antibiotics for suspected infection?

NG195/4

Antibiotics for suspected early-onset neonatal infection: What is the optimal duration of treatment (course length) in babies who receive antibiotics for confirmed early-onset neonatal infection?

NG195/5

Risk factors for and clinical indicators of late-onset infection: What is the accuracy of new or existing clinical prediction models for late-onset neonatal infection in the UK and what is their effectiveness in guiding management:

- for babies already on a neonatal unit?

- for babies admitted from home? 

NG195/6

Antibiotics for suspected late-onset neonatal infection: What is the optimal antibiotic treatment regimen for suspected late-onset neonatal infection?

NG195/7

Impact of neonatal infection on the baby's family: What is the impact of neonatal infection on the health-related quality of life of the baby's family?

NG195/8

Information and support: How does each step in the care pathway for prevention and treatment of early-onset neonatal infection impact on babies and their families?

NG195/9

Information and support: What is the clinical and cost effectiveness of information and support offered to parents and carers of babies who have received antibiotics for suspected or proven early-onset neonatal infection?

NG196/1

Tests to diagnose persistent atrial fibrillation: What is the diagnostic accuracy of key index tests (such as the KardiaMobile heart monitor (AliveCor), MyDiagnostik, Microlife BP monitors, iPhone plethysmography and pulse palpation) compared with the gold standard of 12‑lead ECG in people with risk factors for or symptoms of atrial fibrillation?

NG196/2

Tests to diagnose paroxysmal atrial fibrillation: What is the diagnostic accuracy of key index tests compared with the gold standard of prolonged ambulatory monitoring in people suspected of having paroxysmal atrial fibrillation?

NG196/3

Stopping anticoagulation after ablation: What is the clinical and cost effectiveness of stopping anticoagulation in people whose atrial fibrillation has resolved after ablation?

NG196/4

Stopping anticoagulation after resolution of postoperative atrial fibrillation: What is the clinical and cost effectiveness of stopping anticoagulation in people whose postoperative atrial fibrillation after cardiac surgery has resolved?

NG196/5

Cognitive behavioural therapy for people with atrial fibrillation: What is the clinical and cost effectiveness of cognitive behavioural therapy compared with usual care for people with newly diagnosed atrial fibrillation? 

NG196/6

Rate-control drug treatment for people aged 75 and over with atrial fibrillation: What is the comparative effectiveness of the 3 main drug classes used for rate control (beta‑blockers, calcium‑channel blockers and digoxin) in people aged 75 and over with atrial fibrillation in controlling symptoms, improving quality of life and reducing morbidity and mortality?

NG196/7

Stroke risk assessment: Can routine data from UK primary care databases clarify stroke risk in people with atrial fibrillation according to baseline risk factors and treatment?

NG197/1

Differing intervention effects in different groups: How do the same shared decision-making interventions differ in effectiveness between different groups of people and different care settings?

NG197/2

Measuring shared decision making: What are the best ways to measure the effectiveness of shared decision making in different contexts (in different settings and involving different people)?

NG197/3

Sustaining shared decision making: What interventions are most effective at transferring shared decision-making skills between people and departments, and in sustaining the implementation of shared decision making in an organisation and in clinical teams?

NG197/4

Acceptability of shared decision making: What influences the acceptability of shared decision making in populations that predominantly believe in the authority of the healthcare professional?

NG197/5

Shared decision making in remote discussions: How do shared decision-making skills and techniques need to be modified for remote discussions?

NG198/1

Oral isotretinoin treatment: What is the efficacy of reduced dose oral isotretinoin in the management of acne vulgaris?

NG198/1

What is the efficacy of reduced dose oral isotretinoin in the management of acne vulgaris?

NG198/2

Treatment options for people with polycystic ovary syndrome: What is the most effective first-line treatment option for any severity of acne vulgaris for people with polycystic ovary syndrome?

NG198/2

What is the most effective first-line treatment option for any severity of acne vulgaris for people with polycystic ovary syndrome?

NG198/3

Diet: What is the effect of dietary interventions or dietary changes on acne?

NG198/3

What is the effect of dietary interventions or dietary changes on acne?

NG198/4

Skin care advice: What skin care advice is appropriate for people with acne?

NG198/4

What skin care advice is appropriate for people with acne?

NG198/5

Physical treatments for acne vulgaris and acne vulgaris-related scarring: What is the effectiveness of physical treatments (such as light devices) in the treatment of acne vulgaris or persistent acne vulgaris-related scarring?

NG198/5

What is the effectiveness of physical treatments (such as light devices) in the treatment of acne vulgaris or persistent acne vulgaris-related scarring?

NG198/6

Acne-related scarring: What are the risk factors for acne vulgaris-related scarring?

NG198/6

What are the risk factors for acne vulgaris-related scarring?

NG198/7

Physical treatments for acne vulgaris and acne vulgaris-related scarring: What is the effectiveness of chemical peels for the treatment of acne vulgaris or persistent acne vulgaris-related scarring?

NG198/7

What is the effectiveness of chemical peels for the treatment of acne vulgaris or persistent acne vulgaris-related scarring?

NG198/8

Hormonal and hormone-modifying treatment option: What is the effectiveness of hormone-modifying agents in the treatment of acne vulgaris?

NG198/8

What is the effectiveness of hormone-modifying agents in the treatment of acne vulgaris?

NG198/9

Information and support: What information and support is valued by people with acne vulgaris?

NG198/9

What information and support is valued by people with acne vulgaris?

NG199/1

Oral teicoplanin compared with oral vancomycin or oral fidaxomicin for treating Clostridioides difficile infection: What is the clinical effectiveness, cost effectiveness and safety of oral teicoplanin 100 mg to 200 mg twice a day for 7 to 14 days compared with oral vancomycin or oral fidaxomicin for treating C. difficile infection in adults?

NG2/1 What are the causative and contributory factors underlying the persistently very low levels of reported patient satisfaction for bladder cancer?
NG2/2 Is primary radical cystectomy more effective than primary intravesical BCG (Bacille Calmette-Guérin) in high risk non-muscle-invasive bladder cancer, in terms of quality of life and cancer-specific outcomes?
NG2/3 In people with high-risk non-muscle-invasive bladder cancer, are these follow-up regimens equally
effective in terms of identification of progression, cost effectiveness and health-related quality of
life?
- Cystoscopic follow-up at 3, 6, 12, 18, 24, 36 and 48 months, and then annually, interspersed
with non-invasive urinary tests.
- Cystoscopic follow-up at 3, 6, 9, 12, 15, 18, 21, 24, 30, 36, 42 and 48 months, and then annually
thereafter.
NG2/4 In patients with muscle-invasive bladder cancer suitable for radical treatment, does the use of
biomarkers enable patients to select more effective treatment, and improve their outcomes,
compared with treatment selected without biomarkers?
NG2/5 Is symptom-based review as effective as scheduled follow-up for people treated with radical
cystectomy or radical radiotherapy for organ-confined, muscle-invasive bladder cancer? Outcomes
of interest are overall survival, health-related quality of life, resource use and cost.
NG20/1

Serological testing in people who have IgA deficiency:- What is the sensitivity and specificity of IgG tissue transglutaminase (tTG), IgG endomysial antibodies (EMA) and IgG deamidated gliadin peptide (DGP) tests in detecting coeliac disease in people with IgA deficiency?

NG20/2

Serological testing in people who test negative for anti-transglutaminase:- What is the sensitivity and specificity of IgA EMA and IgA DGP tests in detecting coeliac disease in
people who test negative for IgA tTG?

NG20/3

Dietary supplements:- Should people with coeliac disease be offered calcium and vitamin D supplements for a specific time period soon after their initial diagnosis?

NG20/4

Dietitian contribution to patient management:- How can the role of the dietitian contribute most effectively within a coeliac disease team?

NG20/5

Frequency of monitoring:- What is the effectiveness of more frequent monitoring compared with monitoring at 12 months after diagnosis in people with newly diagnosed coeliac disease?

NG201/1

Hospitalisation of pregnant women with unexplained vaginal bleeding: What is the clinical and cost effectiveness of hospitalisation compared with outpatient management for pregnant women with unexplained vaginal bleeding?

NG201/2

Medications for mild to moderate nausea and vomiting in pregnancy: What is the clinical and cost effectiveness of medication for women with nausea and vomiting in pregnancy?

NG201/3

Models of antenatal care: What is the clinical and cost effectiveness of different models of antenatal care with varying numbers and times of appointment, and should different models be used for groups at risk of worse outcomes?

NG201/4

Identification of breech presentation: What is the clinical and cost effectiveness of routine ultrasound from 36+0 weeks compared with selective ultrasound in identifying breech presentation?

NG201/5

Management of severe nausea and vomiting: What is the clinical and cost effectiveness of corticosteroids for women with severe nausea and vomiting in pregnancy?

NG202/1

Auto- versus fixed-level CPAP for OSAHS: What is the clinical and cost effectiveness of auto- and fixed-level continuous positive airway pressure (CPAP) for managing mild obstructive sleep apnoea/hypopnoea syndrome (OSAHS)?

NG202/2

What is the clinical and cost effectiveness of auto- and fixed-level continuous positive airway pressure (CPAP) for managing moderate and severe OSAHS?

NG202/3

Interventions to improve CPAP adherence: Which interventions, including behavioural interventions, are most clinically and cost effective to improve adherence to CPAP in people with OSAHS, obesity hypoventilation syndrome (OHS) and COPD–OSAHS (chronic obstructive pulmonary disease–OSAHS) overlap syndrome who have difficulty using CPAP?

NG202/4

Mandibular advancement splints for mild symptomatic OSAHS and moderate OSAHS: In mild symptomatic OSAHS, which clinical and physiological phenotypes predict treatment response to customised mandibular advancement splints?

NG202/5

In moderate OSAHS, which clinical and physiological phenotypes predict treatment response to customised mandibular advancement splints?

NG202/6

Mandibular advancement splints for severe OSAHS: What is the clinical and cost effectiveness of mandibular advancement splints for managing severe OSAHS?

NG202/7

Treatment for people with COPD–OSAHS overlap syndrome: What is the optimal treatment for people with COPD–OSAHS overlap syndrome: non-invasive ventilation or CPAP?

NG202/8

Upper airway surgery in people unable to tolerate or adhere to CPAP: What is the clinical and cost effectiveness of upper airway surgical interventions for people with OSAHS who are unable to tolerate or adhere to CPAP?

NG202/9

Oxygen therapy for OSAHS: What is the clinical and cost effectiveness of nocturnal oxygen compared with placebo in people with OSAHS who are unable to tolerate CPAP?

NG203/1

Creatinine-based estimate of eGFR – existing calculations: In adults, children and young people from black, Asian and other minority ethnic groups with chronic kidney disease (CKD) living in the UK, which existing eGFR calculations are the most accurate?

NG203/10

Risk assessment, referral criteria and shared care: What is the association between risk factors and CKD outcomes in children and young people?

NG203/11

Risk assessment, referral criteria and shared care: What is the accuracy of the 4-variable Kidney Failure Risk Equation in children and young people living in the UK?

NG203/12

Frequency of review: What is the most clinical and cost-effective frequency of review for children and young people with CKD?

NG203/13

Managing anaemia: For adults, children and young people with CKD and anaemia, what is the diagnostic accuracy of eGFR thresholds of 60, 45, and 30 ml/min/1.73 m2 for determining whether the anaemia is due to CKD?

NG203/14

Managing anaemia: For adults, children and young people with CKD and anaemia who are on peritoneal dialysis, what amount of intravenous (IV) iron is most clinically and cost effective in managing anaemia and its associated outcomes (including quality of life)?

NG203/15

Managing anaemia: What are the long-term consequences of high ferritin levels (above 800 micrograms/litre) in children and young people with CKD?

NG203/16

Phosphate binders: Which binders are the most clinically and cost effective in controlling serum phosphate in adults, children and young people with stage 4 or 5 CKD who are not on dialysis?

NG203/17

Phosphate binders: In adults with stage 4 or 5 CKD, including those on dialysis, what is the clinical and cost effectiveness and safety of long-term calcium acetate combined with magnesium carbonate for controlling serum phosphate?

NG203/18

Self-management of CKD: Does the provision of educational and supportive interventions to people with CKD by healthcare professionals increase the person's skills and confidence in managing their conditions and improve clinical outcomes?

NG203/19

Antiplatelet therapy: For people with CKD at the highest risk of cardiovascular disease, what is the clinical effectiveness of low-dose aspirin compared with placebo for primary prevention of cardiovascular disease?

NG203/2

Creatinine-based estimate of eGFR – improving accuracy of calculations: In adults, children and young people from black, Asian and other minority ethnic groups with CKD living in the UK, what biomarkers or factors, other than ethnicity, improve the diagnostic accuracy of eGFR calculations?

NG203/20

Renin–angiotensin–aldosterone system antagonists: For people aged over 75 years with CKD, what is the clinical effectiveness of renin–angiotensin–aldosterone system (RAAS) antagonists? [2014]

NG203/21

Vitamin D supplements in the management of CKD–mineral and bone disorders: In people with hyperparathyroidism secondary to CKD, does treatment with vitamin D or vitamin D analogues improve patient-related outcomes?

NG203/22

Management of anaemia of CKD with concurrent illness: What is the optimal management (in terms of clinical and cost effectiveness) of anaemia of CKD in people who are receiving erythropoietic stimulating agents (ESAs) and have a significant concurrent acute infectious illness?

NG203/23

Treatment of ESA resistance in people on haemodialysis: What is the most effective type of intervention to treat people on haemodialysis with ESA‑resistant anaemia?

NG203/3

Risk assessment for black, Asian and minority ethnic groups: What is the accuracy of the 4-variable Kidney Failure Risk Equation in adults, children and young people with CKD from black, Asian and minority ethnic groups living in the UK?

NG203/4

Managing anaemia – optimal Hb levels for children and young people: What is the efficacy and safety of different aspirational haemoglobin (Hb) targets for children and young people with CKD undergoing treatment for anaemia?

NG203/5

Hyperphosphatemia in people with CKD stage 4 or 5: What are people with CKD and their family members and carers views and beliefs about taking oral phosphate binders?

NG203/6

Cystatin-C equations: What is the diagnostic accuracy of cystatin-C equations to estimate GFR as a measurement of kidney function in adults, young people and children in the UK?

NG203/7

Investigations for proteinuria: In children and young people, what is the accuracy of reagent strips for detecting albumin in urine?

NG203/8

Investigations for proteinuria: What is the effect of measuring proteinuria with albumin:creatinine ratio compared with protein:creatinine ratio on the timing of treatment changes in children and young people with CKD? [2021]

NG203/9

Frequency of monitoring: For adults, children and young people with CKD, what is the optimal monitoring frequency for albumin:creatinine ratio?

NG204/1

Risks and benefits: What decision aids are the most cost effective and acceptable when explaining the risks and benefits of healthcare interventions to children and young people?

NG204/2

Independent advocacy: How can the views of babies, children and young people be best represented by independent advocates?

NG204/3

Improving healthcare experience: What elements of healthcare matter most to babies, children and young people to create positive experiences of healthcare?

NG204/4

Measuring experience: How can the experience of babies, children and young people be measured so as to improve their experience of healthcare?

NG205/01

Interventions to support placement stability in residential care: What interventions are effective in promoting placement stability among looked-after children and young people in residential care?

NG205/02

Interventions to support stability of permanent placements: What interventions are effective in supporting the stability of placements in looked-after children and young people moving out of care to permanency (incorporating the perspectives of lookedafter children and permanency carers)?

NG205/03

Supporting mental health of unaccompanied asylum-seeking children: What interventions are effective in supporting the mental health of unaccompanied asylumseeking children?

NG205/04

Using and safeguarding social media in contact with birth parents: How does social media contribute to contact arrangements for looked-after children and young people, and how can this be safeguarded?

NG205/05

Mental health support for reunification with birth parents: What is the effectiveness of mental health support for promoting reunification with birth parents?

NG205/06

Continuing support for the physical and mental health needs of care leavers: What interventions are effective in promoting and continuing to support physical and mental health and wellbeing in care leavers?

NG205/07

Promoting physical exercise, and a healthy diet and lifestyle: What interventions are effective in promoting physical exercise, and a healthy diet and lifestyle, in looked-after children, young people and care leavers?

NG205/08

Therapeutic interventions for promoting school stability and learning: What therapeutic interventions are effective and cost effective in improving learning outcomes and school attendance and reducing exclusion in educational settings for looked-after children and young people?

NG206/01

Diagnostic tests: What diagnostic tests are clinically and cost effective in people with suspected myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome (ME/CFS)?

NG206/02

A core outcome set: What core set of relevant health outcome measures should be used for trials of treatments for ME/CFS and managing symptoms of ME/CFS?

NG206/03

Diagnostic criteria: In people with suspected ME/CFS, how effective is the NICE 2021 consensus-based diagnostic criteria in identifying people with ME/CFS?

NG206/04

Self-monitoring management strategies: What is the clinical and cost effectiveness of self-monitoring strategies and techniques in guiding energy management?

NG206/05

Sleep management strategies: What is the clinical and cost effectiveness of sleep management strategies in managing ME/CFS?

NG206/06

Dietary strategies: What is the clinical and cost effectiveness of dietary strategies in managing ME/CFS?

NG207/01

Prevention of prolonged pregnancy: At what gestational age should induction of labour be offered in the subgroups of women who may be more likely to experience adverse outcomes if pregnancy continues?

NG207/02

Prevention of prolonged pregnancy: Based on individual patient data meta-analysis, what is the optimal timing of induction of labour?

NG207/03

Preterm prelabour rupture of membranes: What are the relative risks and benefits of induced labour versus expectant management in women whose membranes have ruptured spontaneously between 34 and 37 weeks?

NG207/04

Intrauterine fetal death after previous caesarean birth: How should labour be induced in women with intrauterine fetal death who have had a previous caesarean birth, and who choose to be induced?

NG207/05

Membrane sweeping: What are the effectiveness and acceptability of, and maternal satisfaction with, the following:

- multiple versus once-only membrane sweeping, at varying gestational ages, depending on parity

- membrane sweeping versus cervical massage?

NG207/06

Vaginal dinoprostone: What are the effectiveness, safety and maternal acceptability of:

- different regimens of vaginal dinoprostone, stratified by: clinical indications; cervical and membrane status; parity; and previous caesarean birth

- different management policies for unsuccessful induction of labour with vaginal dinoprostone (additional dinoprostone, oxytocin, elective caesarean birth or delay of induction, if appropriate). 

NG207/07

Setting for induction of labour: Is it safe, effective and cost effective to carry out induction of labour in an outpatient setting? What are the advantages and disadvantages of such an approach, taking into account women's views?

NG208/01

Monitoring when there is no current need for intervention: What is the most clinically and cost-effective monitoring (type and frequency of test) for adults with asymptomatic mild or moderate heart valve disease (aortic stenosis, aortic regurgitation, mitral stenosis, mitral regurgitation and tricuspid regurgitation) and no current need for intervention?

NG208/02

Interventions for tricuspid regurgitation: What is the most clinically and cost-effective management strategy for adults with tricuspid regurgitation?

NG208/03

Interventions for a failed valve: What is the clinical and cost effectiveness of transcatheter intervention compared with surgical redo intervention for adults with failing biological prosthetic tricuspid valves or failing repaired native tricuspid valves when either procedure is suitable?

NG208/04

Monitoring after an intervention: What is the most clinically and cost‑effective timing, nature and frequency of follow up for different types of valve interventions, including repair and replacement with tissue or mechanical valves?

NG208/05

Information and advice: What are the information and advice needs of all adult age groups with heart valve disease of all severities and stages?

NG208/06

Indications for interventions – stress testing or echocardiography: What is the prognostic value of severe mitral regurgitation unmasked on exercise echocardiography in adults with symptomatic non‑severe mitral regurgitation at rest?

NG208/07

Indications for interventions – stress testing or echocardiography: What is the prognostic value of parameters observed on exercise stress testing and exercise stress echocardiography in asymptomatic severe aortic regurgitation?

NG208/08

Indications for interventions – CT or MRI: In adults with aortic or primary mitral regurgitation in whom the need for intervention is unclear after echocardiography, what is the prognostic value and cost effectiveness of cardiac MRI to assess the severity of valvular regurgitation?

NG208/09

Indications for interventions – CT or MRI: In adults with aortic or mitral regurgitation in whom the need for intervention is unclear after echocardiography, what is the prognostic value and cost effectiveness of left ventricular ejection fraction (LVEF) measured on cardiac MRI to assess the need for intervention?

NG208/10

Indications for interventions – CT or MRI: In adults with asymptomatic severe aortic stenosis what is the prognostic value and cost effectiveness of LVEF measured on cardiac MRI to assess the need for intervention?

NG208/11

Indications for interventions – CT or MRI: In adults with asymptomatic severe tricuspid regurgitation what is the prognostic value and cost effectiveness of cardiac MRI for assessment of the right ventricle to assess the need for intervention?

NG208/12

Indications for interventions – global longitudinal strain: In adults with severe heart valve disease what is the prognostic value and cost effectiveness of global longitudinal strain to assess the need for intervention?

NG208/13

Indications for interventions – global longitudinal strain: In adults with asymptomatic, severe aortic regurgitation or mitral regurgitation what is the prognostic value and cost effectiveness of B‑type natriuretic peptide (BNP) to assess the need for intervention?

NG208/14

Pharmacological management for adults with heart valve disease: What is the clinical and cost effectiveness of ACE inhibitors, angiotensin II receptor antagonists, beta‑blockers and diuretics for adults with severe aortic stenosis?

NG208/15

Pharmacological management for adults with heart valve disease: What is the clinical and cost effectiveness of ACE inhibitors, angiotensin II receptor antagonists, beta‑blockers and calcium channel blockers, including compared with placebo, for adults with aortic regurgitation?

NG208/16

Pharmacological management for adults with heart valve disease: What is the clinical and cost effectiveness of ACE inhibitors, angiotensin II receptor antagonists, beta‑blockers and diuretics for adults with primary severe mitral regurgitation?

NG208/17

Pharmacological management for adults with heart valve disease: What is the clinical and cost effectiveness of beta‑blockers for adults over 75 years with non‑rheumatic/calcific mitral stenosis, in both sinus rhythm and atrial fibrillation?

NG208/18

Pharmacological management for adults with heart valve disease: What is the clinical and cost effectiveness of pharmacological management of heart failure for adults with heart failure and severe aortic stenosis, severe aortic regurgitation or severe mitral regurgitation?

NG208/19

Monitoring when there is no current need for intervention: What is the most clinically and cost‑effective monitoring strategy (type and frequency of test) for adults with asymptomatic severe heart valve disease (aortic regurgitation, mitral stenosis, mitral regurgitation or tricuspid regurgitation) and no current indication for intervention?

NG208/20

Monitoring when there is no current need for intervention: What is the most clinically and cost‑effective monitoring strategy (type and frequency of test) for adults with symptomatic moderate heart valve disease (aortic stenosis, aortic regurgitation, mitral stenosis, mitral regurgitation and tricuspid regurgitation) and no current indication for intervention?

NG208/21

Interventions: What is the most clinically and cost‑effective management strategy for adults with calcific mitral stenosis and an indication for intervention?

NG208/22

Anticoagulation and antiplatelet therapy: What is the clinical and cost effectiveness of single or dual antiplatelet therapies or anticoagulants compared with placebo after transcatheter or surgical valve replacement (implantation) with biological prosthesis and after valve repair?

NG208/23

Anticoagulation and antiplatelet therapy: In adults with biological valve replacement, what effect does anticoagulation or antiplatelet therapy have on long-term valve function and outcomes?

NG208/24

Repeat interventions: What is the clinical and cost effectiveness of transcatheter intervention compared with surgical redo intervention for adults with failing biological prosthetic aortic valves when either procedure is suitable?

NG208/25

Repeat interventions: What is the clinical and cost effectiveness of transcatheter intervention compared with surgical redo intervention for adults with failing biological prosthetic mitral valves when either procedure is suitable?

NG209/01

Health effects of e-cigarettes: What are the short- and long-term health effects of e-cigarette use? Are there any specific health effects relating to use in pregnancy, or use by children and young people?

NG209/02

Nicotine replacement therapy and e-cigarettes and pregnancy: Are nicotine replacement therapy or nicotine-containing e-cigarettes effective to help women stop smoking in pregnancy (and at what dose)?

NG209/03

Stop-smoking interventions for under-served groups: How can effective and cost-effective interventions to support people to stop smoking be modified to improve engagement with and accessibility for under-served groups? How acceptable are these interventions to these groups?

NG209/04

Support for people with mental health conditions to stop smoking: How can people with mental health conditions be supported effectively to stop smoking (at individual and system level)? What are the challenges and opportunities and how can they be addressed?

NG209/05

What are the views and concerns of:

- pregnant women who smoke

- the healthcare professionals who care for them,

about the use of nicotine-containing e‑cigarettes during pregnancy?

NG209/06

E-cigarettes for harm reduction: Are nicotine-containing e‑cigarettes effective and safe for harm reduction when used alongside tobacco products to cut down on smoking (dual-use approach)?

NG209/07

Use of e-cigarettes (amount and frequency): Does the effectiveness of nicotine-containing e‑cigarettes as an aid to stopping smoking vary according to the amount of nicotine they contain or the frequency of use?

NG209/08

E-cigarette flavours: Do the flavours used in nicotine-containing e‑cigarettes have an impact on their effectiveness as an aid to stopping smoking, and are there any adverse effects associated with them?

NG209/09

E-cigarettes and established future smoking: Is e‑cigarette use in children, young people and young adults who do not smoke associated with future established smoking?

NG209/10

Factors that may influence the use of nicotine replacement therapy and e-cigarettes: Which factors may prevent people who currently smoke tobacco from using other forms of nicotine such as NRT and nicotine-containing e‑cigarettes? Does this vary according to population group, particularly among under-served groups?

NG209/11

Relapse prevention: Are NRT or nicotine-containing e‑cigarettes effective for preventing relapse after a successful quit attempt?

NG209/12

Relapse prevention after enforced, temporary quit: How can people who have recently stopped or temporarily abstained from smoking in a smokefree inpatient or treatment environment be best supported after discharge to prevent relapse or to stop permanently?

NG209/13

Carbon monoxide monitoring: What is the validity of different thresholds of carbon monoxide in exhaled breath as markers of quitting, based on diagnostic review and modelling?

NG209/14

For adults who want to stop smoking, what is the effectiveness and cost effectiveness of Allen Carr's Easyway programme delivered in formats other than in-person group seminars (for example online or using the self-help book) compared with other methods of smoking cessation?

NG21/1

Intensity of home care packages:- What is the effectiveness and cost effectiveness of different intensities of home care packages for older people with a range of care and support needs?

NG21/2

Telecare:- What types of telecare are most effective and cost effective, when provided to older people as part of a package of home care?

NG21/3

Training:- What are the effects of different approaches to home care training on outcomes for people who use home care services?

NG21/4

Specialist dementia support:- What is the most effective and cost effective way to support people with dementia living at home?

NG21/5

Safety and safeguarding:- What safeguarding practices are most effective in improving outcomes for people using services?

NG210/01

How to provide pelvic floor muscle training: What is the most effective way to provide pelvic floor muscle training (covering the type of training, the timing, and who should supervise it), to improve adherence and prevent pelvic floor dysfunction?

NG210/02

Pelvic floor muscle training for preventing pelvic floor dysfunction in young women: Is pelvic floor muscle training for young women (between 12 and 17 years) effective in preventing pelvic floor dysfunction?

NG210/03

Pelvic floor muscle training for preventing pelvic floor dysfunction during pregnancy for women in higher-risk groups: How effective is pelvic floor muscle training in preventing pelvic floor dysfunction during pregnancy in women who are in higher-risk groups?

NG210/04

Lifestyle factors to reduce the risk of pelvic floor dysfunction: What lifestyle factors reduce the risk of developing pelvic floor dysfunction (diet, reducing carbonated drink and caffeine intake)?

NG210/05

Prediction tools: What is the effectiveness of prediction tools for identifying women who are at risk of pelvic floor dysfunction?

NG210/06

Pelvic floor muscle training for preventing pelvic floor dysfunction in older women: Is pelvic floor muscle training effective in preventing pelvic floor dysfunction for older women (aged 65 and over), and women in the perimenopausal or postmenopausal phases?

NG210/07

Coexisting long-term conditions: What coexisting long-term conditions (for example, chronic respiratory disorders) are associated with a higher risk of pelvic floor dysfunction?

NG210/08

Lifestyle factors to reduce the risk of pelvic floor dysfunction: What are the long-term effects of different types, intensities and frequencies of physical activity for preventing symptoms associated with pelvic floor dysfunction?

NG210/09

Universal postnatal pelvic floor muscle training for preventing pelvic floor dysfunction: Is universal postnatal pelvic floor muscle training effective in preventing pelvic floor dysfunction?

NG210/10

Pelvic floor muscle training for preventing bowel symptoms associated with pelvic floor dysfunction: How effective is pelvic floor muscle training in preventing bowel symptoms associated with pelvic floor dysfunction?

NG210/11

Weight loss for managing pelvic floor dysfunction: Can weight loss reduce symptoms of pelvic floor dysfunction in women who are overweight or obese?

NG210/12

Diet for managing pelvic floor dysfunction: What changes in diet can improve symptoms associated with pelvic floor dysfunction?

NG210/13

Weight training to improve symptoms of pelvic floor dysfunction: How effective is weight training at improving symptoms associated with pelvic floor dysfunction?

NG210/14

Unsupervised physical activity to improve symptoms of pelvic floor dysfunction: How effective is unsupervised physical activity (such as walking or swimming) at improving symptoms associated with pelvic floor dysfunction?

NG210/15

Psychological interventions to manage symptoms of pelvic floor dysfunction: How effective are psychological interventions (either on their own or combined with other interventions) in the management of pelvic floor dysfunction?

NG210/16

Raising awareness about pelvic floor dysfunction: Are community-based strategies effective in raising awareness about the prevention of pelvic floor dysfunction?

NG210/17

Information valued by young women with pelvic floor dysfunction: What are the experiences and information needs of young women (between 12 and 17 years) with pelvic floor dysfunction?

NG210/18

Effective ways of supporting women to start and continue interventions for pelvic floor dysfunction: What is the best way to support women to start and continue interventions for pelvic floor dysfunction (for example, apps, decision aids, or behavioural change techniques)?

NG210/19

Effective ways of providing information to women with pelvic floor dysfunction: What are best ways to provide information about pelvic floor dysfunction to young women (between 12 and 17 years), and to groups defined by protected characteristics under the Equality Act?

NG210/20

Medicines for pelvic floor dysfunction: Is vaginal oestrogen effective at treating the symptoms of pelvic floor dysfunction?

NG210/21

Community-based multidisciplinary pelvic floor dysfunction teams: What roles are needed in a community-based multidisciplinary pelvic floor dysfunction team?

NG210/22

Intravaginal devices and pessaries combined with pelvic floor muscle training for managing pelvic floor dysfunction: How effective is a pessary or intravaginal device combined with pelvic floor muscle training for managing pelvic floor dysfunction, compared with pelvic floor muscle training alone?

NG210/23

Virtual and in-person contact time for pelvic floor muscle training: How effective is virtual contact with a trainer, compared with in-person contact, for pelvic floor muscle training?

NG210/24

Anal plug devices and rectal irrigation for the management of bowel symptoms in women with pelvic floor dysfunction: How effective are anal plug devices and rectal irrigation for bowel symptoms in women with pelvic floor dysfunction?

NG210/25

Multiple pregnancy as an independent risk factor for pelvic floor dysfunction: Is multiple pregnancy an independent risk factor for pelvic floor dysfunction?

NG211/01

Effectiveness of intensive rehabilitation in adults: What is the effectiveness and cost effectiveness of intensive rehabilitation programmes in adults with complex rehabilitation needs after a traumatic injury?

NG211/02

Effectiveness of intensive rehabilitation in children and young people: What is the effectiveness and cost effectiveness of intensive rehabilitation programmes in children and young people with complex rehabilitation needs after a traumatic injury?

NG211/03

Thoracic lumbar sacral orthoses in older people: What are the benefits and harms of using thoracic lumbar sacral orthoses in older people with thoraco-lumbar vertebral fractures?

NG211/04

Self-management materials: What is the effectiveness and cost effectiveness of rehabilitation programmes combined with self-management materials, compared with rehabilitation programmes alone, in people with complex rehabilitation needs after a traumatic injury?

NG211/05

Length of bed rest after spinal cord injury: What is the effectiveness and cost effectiveness of short-term bed rest compared with long-term bed rest on functional outcomes in people with complex rehabilitation needs after traumatic injury that involves the spinal column or spinal cord injury?

NG212/01

Individual-level interventions: What is the long-term effectiveness and cost effectiveness of universal individual-level interventions on mental wellbeing in different types of organisations?

NG212/02

Organisational-level approaches for all organisations: What is the long-term impact and cost effectiveness of employee assistance programme provision on mental wellbeing?

NG212/03

Training for managers: What is the long-term effectiveness (more than 6 months) of manager training on employee mental wellbeing?

NG212/04

Approaches for micro, small and medium-sized enterprises: What are the specific needs of different kinds of micro, small and medium-sized enterprises (SMEs) in promoting mental wellbeing in the workplace, including organisational, targeted and individual level approaches?

NG212/05

Core outcomes for study reporting: Which mental wellbeing and productivity outcomes should be used in a core outcome set for research into workplace mental wellbeing?

NG212/06

Supportive work environment: What are the views of organisations about the benefits of investing in mental wellbeing?

NG212/07

Identifying employees at risk of poor mental wellbeing: What tools (for example, wellbeing surveys) can be used to identify employees at risk of poor mental wellbeing rather than mental ill health?

NG212/08

Needs of different employee groups: What specific needs of employees from different groups (such as income levels, ethnic groups, male or female groups, and age groups) need addressing to facilitate access to individual-level interventions?

NG212/09

Approaches for micro, small and medium-sized enterprises: What is the long-term effectiveness of universal individual-level interventions in different kinds of SMEs?

NG212/10

Addressing study reporting: What are the key characteristics of an organisation and its employees that need to be included in reporting research into workplace mental wellbeing?

NG213/01

Assistive technology: How effective is assistive technology in enabling disabled children and young people with severe complex needs to express their views to education, health, and social care services?

NG213/02

Environmental adaptations: What are the most effective environmental adaptations to ensure the suitability and accessibility of the settings where disabled children and young people with severe complex needs receive education, health and social care support?

NG213/03

Dedicated key workers: What is the effectiveness of dedicated key workers for delivering joined-up services to meet the education, health and social care needs of disabled children and young people with severe complex needs?

NG213/04

Care close to home: What are the most effective commissioning, practice and service delivery models to deliver joined-up services to meet the education, health and social care needs of disabled children and young people with severe complex needs while enabling them to stay close to home?

NG213/05

Short break services: What components of short break services are most effective for disabled children and young people with severe complex needs and their families and carers?

NG213/06

Telehealth and virtual platforms: What is the effectiveness of telehealth and virtual platforms for communicating with disabled children and young people with severe complex needs and providing education, health and social care interventions?

NG213/07

Joint commissioning arrangements: What are the most effective joint commissioning arrangements for disabled children and young people with severe complex needs?

NG214/01

Psychologically informed environments: What is the effectiveness and acceptability of clinical psychology-led psychologically informed environments and psychological approaches for people experiencing homelessness?

NG214/02

Health and social care to support housing: What structural and systems factors help or hinder commissioning and delivery of wraparound health and social care that is integrated with housing, for people experiencing homelessness?

NG214/03

Longer health and social care contacts: What is the effectiveness and cost effectiveness of longer health and social care contacts compared with usual care for people experiencing homelessness?

NG215/01

Multicomponent withdrawal interventions: What are the key components of an effective multicomponent intervention to support dose reduction during withdrawal of opioids?

NG215/02

Psychological interventions to support withdrawal: What are the most effective psychological interventions to support withdrawal and help people cope with withdrawal symptoms?

NG215/03

Service models for withdrawal interventions: What service models are most effective in supporting withdrawal from medicines associated with dependence and withdrawal symptoms?

NG215/04

Individual circumstances and the risk of dependence: Do individual circumstances such as social distress, low income or limited access to alternative sources of support lead to an increased risk of problems associated with dependence on prescribed medicines?

NG215/05

Information for family members or carers: What information and support are needed by family members or carers of people having treatment with an opioid, benzodiazepine, Z‑drug, antidepressant or gabapentinoid?

NG215/06

System-level factors and the risk of dependence: Do system-level factors, such as training received by prescribers alter the risk of developing problems associated with dependence on prescribed medicines?

NG215/07

Converting to a medicine with a different half‑life to aid withdrawal: What is the clinical and cost effectiveness of converting to medicines with a longer half‑life to aid withdrawal from benzodiazepines or antidepressants?

NG215/08

Cognitive behavioural therapy (CBT) to support withdrawal from benzodiazepines: What is the most effective model of CBT, including timing of CBT, to support withdrawal from benzodiazepines?

NG215/09

Acupuncture to support withdrawal from opioids: What is the clinical and cost effectiveness of acupuncture (including electroacupuncture) as an adjunct to aid withdrawal from opioids?

NG215/10

Withdrawal interventions for gabapentinoids: What are the most clinically and cost-effective strategies or interventions to aid withdrawal of gabapentinoids?

NG215/11

Aids to support withdrawal: What is the effectiveness of equipment, technologies, practical aids and medicine formulations in supporting people to manage dose reductions, compared with usual practice?

NG216/01

Needs assessment: From the perspective of everyone involved, what is the acceptability of strengths and rights-based approaches to social work assessment and what are the barriers and facilitators to delivering these?

NG216/02

Risk assessment: From the perspective of everyone involved, what works well and could be improved about the use of tools and checklists to support social work risk assessment for people with complex needs?

NG216/03

Supporting people to plan for the future: What is the effectiveness and cost-effectiveness of early, preventative support for people with complex needs?

NG216/04

Responding to an escalation of need: What is the effectiveness and acceptability of social work interventions to support people with complex needs during an escalation of need?

NG216/05

Helping people to connect with local communities and reduce isolation: What social and community support approaches are effective in promoting social inclusion of people with complex needs?

NG217/01

Antibody testing: What immunomodulation strategies are effective in people with defined autoimmune epilepsy syndromes?

NG217/02

Complex epilepsy syndromes: What antiseizure therapies (alternative or add-on) are effective in the treatment of complex epilepsy syndromes (that is, Dravet syndrome, Lennox–Gastaut syndrome, infantile spams syndrome and epilepsy with myoclonic-atonic seizures [Doose syndrome]) when first-line therapy is unsuccessful or not tolerated?

NG217/03

Risk prediction tool for all-cause epilepsy-related death: Development of a risk prediction tool to detect all-cause mortality including sudden unexpected death in epilepsy (SUDEP) in people with epilepsy or those who have had a single seizure, and an external validation of a risk prediction tool to detect the probability of epilepsy-related death.

NG217/04

Vagus nerve stimulation: What is the effectiveness of vagus nerve stimulation in treating epilepsy (including people with learning disabilities as a subgroup)?

NG217/05

Psychological treatments: What is the cost effectiveness of providing tailored psychological treatments for people with epilepsy?

NG217/06

Monitoring antiseizure medications in women and girls: What is the clinical and cost effectiveness of therapeutic drug monitoring in girls, young women and women with epilepsy?

NG217/07

Digital health technologies: What is the clinical and cost effectiveness of digital health technologies in people with epilepsy?

NG217/08

Antiseizure medication for repeated or cluster seizures: What antiseizure medications (monotherapy or add-on) are effective in the treatment of repeated or cluster seizures?

NG217/09

Risk prediction tool for second seizure: Development of a risk prediction tool for second seizures in people with a single seizure, and an external validation of a risk prediction tool to detect the probability of a second seizure in people with a single seizure at baseline.

NG217/10

Ketogenic diets: What is the short-term and long-term clinical and cost effectiveness of ketogenic diets in adults and children with drug-resistant epilepsy, and what factors affect the long-term maintenance and tolerability of ketogenic diets?

NG218/01

Increasing vaccination uptake in populations with low uptake: What are the most effective and acceptable interventions to increase uptake in populations or groups with low routine vaccine uptake in the UK?

NG218/02

Incentives aimed at individuals, family members and carers: What is the effectiveness and acceptability of incentives to increase uptake of routine vaccines in the UK?

NG218/03

Quasi-mandation of vaccinations: What is the effectiveness and acceptability of quasi-mandation to increase vaccine uptake of routine vaccines?

NG218/04

Tailoring Immunisation Programmes: Is the use of the World Health Organization 'Tailoring Immunisation Programmes' approach an effective way of designing interventions to increase vaccine uptake in a UK context?

NG218/05

Framing content in vaccination invitations: What is the relative effectiveness and acceptability of different styles of phrasing content in a vaccination invitation in the UK?

NG218/06

Increasing vaccination uptake in older people: What are the most effective and acceptable interventions to increase routine vaccine uptake in older people in the UK?

NG218/07

HPV vaccination for boys: What are the most effective and acceptable strategies to increase HPV (human papillomavirus) vaccine uptake in boys in the UK?

NG218/08

Increasing pertussis vaccination uptake by pregnant women: What are the most effective and acceptable interventions to increase pertussis vaccine uptake in pregnant women in the UK?

NG218/09

Provider incentives: What is the effectiveness and acceptability of giving incentives to providers to increase immunisation rates in the UK?

NG218/10

School-based versus GP-based catch-up campaigns: What is the effectiveness and acceptability of school-based catch-up vaccination sessions compared with GP-based catch-up campaigns in the UK?

NG218/11

Incentives for school-aged vaccinations: What levels and types of incentives are effective and acceptable for increasing vaccination uptake in a school-aged population in the UK?

NG22/1

Older people's experiences:- What is the lived experience of older people with social care needs and multiple long-term conditions?

NG22/2

Service delivery models:- Which models of service delivery are effective and cost-effective for older people with social care needs and multiple long-term conditions?

NG22/3

Supporting people in care homes to stay active:- What is the most effective and cost-effective way of supporting older people with social care needs and multiple long-term conditions in care homes to live as independently as possible?

NG22/4

Developing a 'risk positive' approach in care homes:- What is the effectiveness and acceptability of different strategies to enable positive risk-taking in care homes?

NG22/5

Self-management:- What is the impact of different early intervention-focused approaches to self-management on outcomes for older people with social care needs and multiple long-term conditions?

NG223/01

Early signs of poor social, emotional and mental wellbeing: What are the early signs of social, emotional and mental wellbeing issues, including in children and young people who are internalising it?

a) What early factors predict poor social, emotional and mental wellbeing?

b) How do children and young people with poor social, emotional and mental wellbeing describe their thoughts and feelings at early onset stage?

c) What are the barriers and facilitators to identifying children and young people at risk of poor social, emotional and mental wellbeing at school?

NG223/02

Intersecting social, cultural and personal factors: What is the role of intersecting social, cultural and personal factors in developing poor social, emotional and mental wellbeing?

NG223/03

Targeted support: What is the effectiveness (including long-term effectiveness) and cost effectiveness of targeted group or individual interventions for children and young people who have been identified as needing additional mental health support, and does it vary by ethnicity, socioeconomic status or other cultural and personal factors?

NG223/04

Effectiveness of interventions: What components of interventions or approaches to promote social, emotional and mental wellbeing are effective and cost effective?

NG223/05

System leadership and service delivery: How can practitioners, institutions and organisations work together to improve systems leadership that impacts collectively on positive outcomes for children and young people's social, emotional and mental wellbeing?

NG223/06

Children and young people with special educational needs: Are children and young people with special educational needs at higher risk of poor social, emotional and mental wellbeing?

NG223/07

Harms and unintended consequences: What are the possible harms and unintended consequences of targeted group or individual interventions for children and young people who have been identified as needing additional mental health support?

NG223/08

Targeted support: What are parents' and carers' views on targeted group or individual interventions for children and young people who have been identified as needing additional mental health support?

NG223/09

Views on transitions to secondary school: What are the views and experiences of children about moving to secondary school?

NG223/10

Support for transitions: What do children and young people, including those from underserved populations, find useful to support life changes in the context of their education?

NG223/11

Impact of COVID-19: What is the medium-to long-term impact of the COVID-19 pandemic on children and young people's social, emotional and mental wellbeing?

NG224/01

Symptoms and signs of urinary tract infection in children and young people aged 5 years and above but under 16 years: What are the symptoms and signs of urinary tract infection (UTI) in children and young people aged 5 years and above but under 16 years?

NG224/02

Long-term risk of renal scarring and impaired renal function: A well designed cohort study investigating long-term outcomes including renal scarring and renal function of children who have had UTI should be conducted in the UK.

NG224/03

Symptoms and signs of recurrent UTI:  Do the symptoms and signs of UTI in babies, children and young people aged under 16 years differ in those with a history of recurrent UTIs compared with those without a history of recurrent UTI?

NG224/04

Symptoms and signs of long-term (chronic) UTI: What symptoms and signs do children and young people with long-term (chronic) UTI report and what do they perceive is the impact on their health and quality of life?

NG225/01

Models of care: What is the effectiveness of different models of care for children and young people who self-harm?

NG225/02

Assessment in non-specialist settings: What are the most effective approaches to assessment in non-specialist settings?

NG225/03

Routine admission to hospital: Is routine or automatic admission effective for young people or older adults who have self-harmed?

NG225/04

Psychological interventions: What is the effectiveness of specific psychological interventions including digital compared with face-to-face (technology use) in different populations and settings?

NG225/05

Harm minimisation: What is the experience, feasibility, acceptability and effectiveness of harm minimisation strategies for people who self-harm?

NG226/01

Exercise: What is the clinical and cost effectiveness of supervised group and individual exercise compared with unsupervised exercise for people with osteoarthritis?

NG226/02

Devices: What is the clinical and cost effectiveness of devices compared with usual care for the management of painful foot and or ankle osteoarthritis?

NG226/03

Topical medicines: What is the clinical and cost effectiveness of topical non-steroidal anti-inflammatory drugs and topical capsaicin for osteoarthritis-affected joints other than the knee?

NG226/04

Follow-up strategies: What is the clinical and cost effectiveness of patient-initiated follow-up compared with routine follow-up for people with osteoarthritis?

NG226/05

Patient information:

- What information on the management of flares do people with osteoarthritis, their family and carers need after diagnosis?

- What information do people with osteoarthritis from different ethnic and socioeconomic groups, and those with learning disabilities, issues with health literacy and severe mental illness (and their family and carers), need?

NG226/06

Manual therapy: What is the clinical and cost effectiveness of manual therapy for people with osteoarthritis, when used alone and when in combination with therapeutic exercise?

NG226/07

Electroacupuncture: Is electroacupuncture a clinically and cost-effective treatment for any subgroup of people with osteoarthritis?

NG226/08

Extracorporeal shockwave therapy: What is the clinical and cost effectiveness of extracorporeal shockwave therapy for managing osteoarthritis?

NG226/09

Footwear: What is the clinical and cost effectiveness of footwear for managing lower limb osteoarthritis?

NG226/10

Topical and oral medicines:
- What is the clinical and cost effectiveness of topical local anaesthetics for people with osteoarthritis?

- What is the clinical and cost effectiveness of antiepileptics and antidepressants (other than duloxetine) for people with osteoarthritis?

- What is the clinical and cost effectiveness of weak oral opioids for people with osteoarthritis?

NG226/11

Intra-articular injections:
- What is the clinical and cost effectiveness of intra-articular corticosteroids for managing osteoarthritis-affected joints other than the knee?

- What is the clinical and cost effectiveness of intra-articular stem cells for managing osteoarthritis?

NG226/12

Referral criteria for joint replacement: What are the most important indicators that someone with osteoarthritis (including shoulder osteoarthritis) would benefit from joint replacement? For example:

- presence of night pain

- non-response to non-pharmacological interventions

- joint instability symptoms

- presence of flares

- numerical summary scores.

NG226/13

Imaging for management of osteoarthritis:
- What is the clinical and cost effectiveness of imaging for informing non-surgical management (for example, exercise or weight loss) in primary care for people with osteoarthritis?

- What is the clinical and cost effectiveness of imaging for use at different parts of the care pathway (for example, primary care, intermediate care or secondary care) before surgery for people with osteoarthritis?

NG227/01

Ways of providing advocacy services: What is the effectiveness and acceptability of providing advocacy through different approaches?

NG228/01

Timing of CT head scans: What is the relative accuracy of CT head scans at different time intervals, for example 12 hours or 24 hours after symptom onset, to diagnose subarachnoid haemorrhage?

NG228/02

Predictors of death and disability: What variables predict death or disability for people with aneurysmal subarachnoid haemorrhage?

NG228/03

Nimodipine: What is the clinical and cost effectiveness of nimodipine in the management of aneurysmal subarachnoid haemorrhage?

NG228/04

Novel endovascular interventions: What is the clinical and cost effectiveness of novel endovascular techniques and devices such as coated coils, endoluminal flow diverters and intrasaccular devices to treat aneurysmal subarachnoid haemorrhage?

NG228/05

Risk stratification tool to estimate risk of recurrence: What is the utility of a risk stratification tool to estimate the risk of subsequent aneurysmal subarachnoid haemorrhage?

NG228/06

Interventions for aneurysmal subarachnoid haemorrhage in people with major neurological deficit: What is the outcome of intervention to prevent rebleeding in people who present with or rapidly develop severe neurological deficits as a consequence of acute aneurysmal subarachnoid haemorrhage?

NG228/07

Managing acute hydrocephalus: What is the most clinically and cost-effective method of cerebrospinal fluid drainage or diversion (for example shunt surgery, external ventricular drain surgery or lumbar drain) for symptomatic acute hydrocephalus?

NG228/08

Transcranial doppler monitoring: What is the clinical and cost effectiveness of routine transcranial doppler monitoring to guide clinical management of aneurysmal subarachnoid haemorrhage?

NG228/09

Intracranial hypertension: What is the impact of routine monitoring of intracranial hypertension on subsequent management and outcome in people with aneurysmal subarachnoid haemorrhage who are unconscious or ventilated on an intensive care unit?

NG228/10

Intra-arterial therapies to manage delayed cerebral ischaemia: What is the impact of intra-arterial therapies to manage delayed cerebral ischaemia on outcome in people with aneurysmal subarachnoid haemorrhage?

NG228/11

Vasopressors to manage delayed cerebral ischaemia: What is the clinical and cost effectiveness of vasopressors to manage delayed cerebral ischaemia in people with aneurysmal subarachnoid haemorrhage?

NG228/12

Blood pressure targets: What is the clinical and cost effectiveness of a lower blood pressure treatment target relative to the standard blood pressure treatment target for people with aneurysmal subarachnoid haemorrhage?

NG228/13

Investigations for relatives: What is the clinical and cost effectiveness of investigations to detect intracranial arterial aneurysms in first-degree relatives of people who have had an aneurysmal subarachnoid haemorrhage?

NG23/1

Women with breast cancer:- What is the safety and effectiveness of alternatives to systemic HRT as treatments for menopausal symptoms in women who have had treatment for breast cancer?

NG23/2

Effects of HRT on breast cancer risk:- What is the difference in the risk of breast cancer in menopausal women on HRT with progesterone, progestogen or selective oestrogen receptor modulators?

NG23/3

Effects of HRT on venous thromboembolism risk:- How does the preparation of HRT affect the risk of venous thromboembolism (VTE)?

NG23/4

Effects of HRT on dementia risk:- What are the effects of early HRT use on the risk of dementia?

NG23/5

Premature ovarian insufficiency:- What are the main clinical manifestations of premature ovarian insufficiency and the short- and long-term impact of the most common therapeutic interventions?

NG230/01

Molecular tests: In fine-needle aspiration cytology (FNAC) samples that are adequate but cannot differentiate between benign and malignant samples, what is the clinical and cost effectiveness of molecular testing for thyroid cancer?

NG230/02

Duration of follow up: What is the clinical and cost effectiveness for different durations of follow up for people with differentiated thyroid cancer who have been treated?

NG230/03

Active surveillance compared with surgery: For people with stage 1 differentiated thyroid cancer, what is the clinical and cost effectiveness of active surveillance compared with surgery?

NG230/04

Duration of thyroid stimulating hormone suppression: For people with differentiated thyroid cancer who have had surgery and radioactive iodine (RAI), what is the optimal duration of thyroid stimulating hormone suppression?

NG230/05

Radioactive iodine: What is the clinical and cost effectiveness of RAI after total or completion thyroidectomy for people with T2 disease and no adverse pathological features?

NG230/06

Thyroid peroxidase antibody testing: For people with indeterminate cytopathology, what is the clinical and cost effectiveness of thyroid peroxidase antibody testing?

NG230/07

Imaging for further staging: For people with differentiated thyroid cancer who have initial ultrasound evidence of extensive local spread (T2N1), what is the clinical and cost effectiveness of CT, MRI or F-18 FDG PET-CT scanning, with or without ultrasound, as part of a further staging strategy?

NG230/08

External beam radiotherapy compared with usual care: What is the clinical and cost effectiveness of external beam radiotherapy for people with residual or recurrent thyroid cancer?

NG231/01

Diagnostic accuracy of endoscopic surveillance: What is the diagnostic accuracy of different endoscopic surveillance techniques including high resolution endoscopy and chromoendoscopy for use in adults?

NG231/02

Frequency and duration of endoscopic surveillance: What is the usefulness of clinical and molecular biomarkers to inform the optimal frequency and duration of endoscopic surveillance for adults with Barrett's oesophagus?

NG231/03

Oesophagectomy: What is the effectiveness of endoscopic resection with or without adjuvant chemoradiotherapy and oesophagectomy for adults with T1b oesophageal adenocarcinoma?

NG231/04A

Endoscopic treatments: For adults with Barrett's oesophagus with dysplasia, what is the effectiveness of different endoscopic ablation techniques alone or in combination with endoscopic resection?

NG231/04B

Endoscopic treatments: For adults with stage 1 oesophageal adenocarcinoma, what is the effectiveness of different endoscopic ablation techniques alone or in combination with endoscopic resection?

NG231/05A

Frequency and duration of endoscopic follow-up: What is the optimal frequency and duration of endoscopic follow-up for patients who have received endoscopic treatment for Barrett's oesophagus with dysplasia?

NG231/05B

Frequency and duration of endoscopic follow-up: What is the optimal frequency and duration of endoscopic follow-up for patients who have received endoscopic treatment for stage 1 oesophageal adenocarcinoma?

NG234/1

How effective is stereotactic ablative radiotherapy compared with standard radiotherapy in the postoperative treatment of metastatic spinal cord compression (MSCC)? 

NG234/2

What are the effective forms of immobilisation for people with MSCC? 

NG234/3

What are the effective forms of remobilisation for people with MSCC?

NG234/4

What is the effectiveness of surgery in the prevention of MSCC for people with spinal metastases without pain or instability? 

NG235/1

What is the effectiveness of hands on, hands poised or Finnish grip in the second stage of labour for reducing perineal trauma?

NG235/2

What is the most effective dosage at which oxytocin should be recommenced once stopped in labour because of an abnormal cardiotocography?

NG235/3

For a short explanation of why the committee made this recommendation for research, see the rationale section on position of the baby during cord clamping .

NG235/4

What is the impact of pharmacological interventions for the management of postpartum haemorrhage on breastfeeding and women's and their birth companions' experience and satisfaction in the postnatal period?

NG235/5

What is the effectiveness and cost effectiveness of intravenous compared with oral antibiotics for preventing postnatal infections after birth with forceps or ventouse?

NG236/1

What is the clinical and cost effectiveness of delivering rehabilitation for 7 days a week compared to 5 days a week for people after a stroke?

NG236/2

What is the clinical and cost effectiveness of more intensive cognitive and psychological therapy compared to usual care for people after a stroke?

NG236/3

For people after stroke with communication difficulties, what is the optimal tool for assessing fatigue?

NG236/4

What is the clinical and cost effectiveness of computer-based tools to treat problems with speech (dysarthria) and all domains of language (aphasia) for people with communication difficulties after stroke?

NG236/5

For people with different causes of shoulder pain after stroke, what is the clinical and cost effectiveness of interventions in reducing pain? 

NG238//2

What is the effectivness of statin treatment in older people?

NG238/1

What is the effectiveness of age alone and other routinely available risk factors compared with the formal structured multifactorial risk assessment to identify people at high risk of developing CVD? 

NG238/3

What is the effectivness of stains and/or other lipid-lowering treatment in people with type 1 diabetes?

NG24/1

Red blood cell transfusion thresholds for patients with chronic cardiovascular  disease:- What is the clinical and cost effectiveness of restrictive compared with liberal red blood cell thresholds and targets for patients with chronic cardiovascular disease?

NG24/2

Electronic Decision Support:- What is the clinical and cost effectiveness of an electronic decision support system compared with current practice in reducing inappropriate blood transfusions, overall rates of blood transfusion and mortality?

NG24/3

Post-operative cell salvage for patients having cardiac surgery with a significant risk of post-operative blood loss:- For patients having cardiac surgery with a significant risk of post-operative blood loss, is post-operative cell salvage and reinfusion clinically and cost effective in reducing red blood cell use and improving clinical outcomes,  compared with existing practice?

NG24/4

Fresh frozen plasma for patients with abnormal haemostasis who are having invasive procedures or surgery:- What dose of fresh frozen plasma is most clinically effective at preventing bleeding in patients with abnormal haemostasis who are having invasive procedures or surgery?

NG25/1

Prophylactic cervical cerclage compared with prophylactic vaginal progesterone for preventing preterm birth:- What is the clinical effectiveness of prophylactic cervical cerclage alone compared with prophylactic vaginal progesterone alone and with both strategies together for preventing preterm birth in women with a short cervix and a history of spontaneous preterm birth?

NG25/2

Identifying infection in women with preterm prelabour rupture of membranes (P-PROM):- What is the diagnostic accuracy of serial C-reactive protein testing to identify chorioamnionitis in women with P-PROM?

NG25/3

Effectiveness of 'rescue' cerclage:- What is the clinical effectiveness of 'rescue' cerclage in improving outcomes for women at risk of preterm birth?

NG25/4

Magnesium sulfate for neuroprotection: bolus plus infusion compared with bolus alone:- What is the clinical effectiveness of a bolus plus infusion of magnesium sulfate compared with a bolus alone for preventing neurodevelopmental injury in babies born preterm?

NG25/5

Does progesterone reduce the risk of preterm birth in women who have risk factors for preterm birth, but do not have a short cervix (cervical length of more than 25 mm)?

NG25/6

Does progesterone reduce the risk of preterm birth in women who have a short cervix (cervical length of 25 mm or less), but do not have other risk factors for preterm birth? 

NG25/7

At what gestation should treatment with prophylactic vaginal progesterone for the prevention of preterm birth be started and stopped? 

NG26/1

Screening assessment tools:- Develop reliable and valid screening assessment tools for attachment and sensitivity that can be made available and used in routine health, social care and education settings.

NG26/2

Attachment-focused interventions:- This research recommendation is composed of 2 parts.
Develop attachment-focused interventions to treat attachment difficulties in children aged over 5 years and young people who have been adopted or are in the care system.
Develop attachment-based interventions to promote secure attachment in children and young people who have been, or are at risk of being, maltreated.

NG26/3

Evaluation of extensively used interventions:- Evaluate currently unevaluated but extensively used interventions for attachment difficulties.

NG26/4

Interventions in a school setting:- Assess the clinical and cost effectiveness of an attachment-based intervention delivered in a school setting for children and young people on the edge of care, in the care system or adopted.

NG26/5

Relationship between attachment difficulties and complex trauma:- This research recommendation is composed of 2 parts:
Assess the prevalence of attachment difficulties (including attachment disorders), complex trauma and the combination of both in children and young people in the care system and on the edge of care.
Investigate the effect of various factors, such as multiple placements, on the likelihood of having attachment difficulties, complex trauma or both.

NG27/1

Training for hospital and social care practitioners:- What is the effect of hospital discharge or transitions training for health and social care practitioners on achieving successful transfers from hospital to home or the community, including the effects on formal and informal carers, and on avoidable readmissions?

NG27/2

Self-management support for people with mental health difficulties:- Which interventions are effective in supporting self-management for people with mental health difficulties who also have a physical condition and are moving into and out of general inpatient hospital settings?

NG27/3

Mental health interventions to support discharge from general inpatient hospital settings:- What interventions are cost effective in supporting people with mental health difficulties on discharge from general hospital inpatient settings?

NG27/4

Geriatric assessment and care:- What is the cost-effectiveness of comprehensive geriatric assessment and care on specialist units compared with alternative models of care on general wards?

NG27/5

Assessment at home to improve hospital discharge success rates:- How effective are home assessment interventions and approaches designed to improve hospital discharge outcomes?

NG28/01

The effects of stopping and/or switching drug treatments to control blood glucose levels: In adults with type 2 diabetes, what are the effects of stopping and/or switching drug treatments to control blood glucose levels, and what criteria should inform the decision?

NG28/02

Non-metformin-based drug treatment combinations to control blood glucose levels: In adults with type 2 diabetes, what treatment combinations (for example, glucagon‑like peptide‑1 [GLP‑1] mimetics and insulin combination therapy with meglitinides) are most effective when initial drug treatment with non‑metformin monotherapy fails to adequately control blood glucose levels?

NG28/04

Long-term outcomes associated with blood glucose lowering agents: In adults with type 2 diabetes, what are the long‑term effects of blood glucose lowering therapies such as dipeptidyl peptidase‑4 (DPP‑4) inhibitors, sodium–glucose cotransporter‑2 (SGLT2) inhibitors and meglitinides?

NG28/05

Self-monitoring of blood glucose levels: What is the optimal frequency for self‑monitoring of blood glucose in adults with type 2 diabetes?

NG28/05

Effectiveness of SGLT2 inhibitors for different ethnic groups: What is the clinical and cost effectiveness of SGLT2 inhibitors in adults with type 2 diabetes and chronic kidney disease, stratified across different ethnic groups?

NG28/06

Effectiveness of SGLT2 inhibitors for adults with a urine ACR below 3 mg/mmol: What is the clinical and cost effectiveness of SGLT2 inhibitors in adults with type 2 diabetes, chronic kidney disease and a urine ACR of less than 3 mg/mmol?

NG29/1

Complications of IV fluid therapy:- What is the incidence of complications during, and as a consequence of, IV fluid therapy in children and young people?

NG29/2

Glucose concentration:- What is the most appropriate glucose concentration in IV fluids for children and young people of different ages?

NG29/3

Fluid balance charts:- For children and young people receiving IV fluids, does the use of a standardised national fluid balance chart reduce the rate of complications arising as a result of prescription and/or administration errors?

NG29/4

Training and education of healthcare professionals:- Does ensuring that all hospital healthcare professionals involved in prescribing and delivering IV fluids for children and young people are appropriately trained in the principles of fluid prescribing and IV fluid therapy-related complications lead to a reduction in IV fluid-related  complications and associated healthcare costs?

NG3/1 What are the roles of insulin pump therapy (continuous subcutaneous insulin infusion) and
continuous glucose monitoring in helping women with diabetes to achieve blood glucose targets
before pregnancy?
NG3/2 When should testing for gestational diabetes take place – in the first or second trimester?
NG3/3 What are the barriers that women experience to achieving blood glucose targets?
NG3/4 How can fetuses at risk of intrauterine death be identified in women with diabetes?
NG3/5 Are there effective long-term pharmacological interventions to prevent the onset of type 2
diabetes that can be recommended postnatally for women who have been diagnosed with
gestational diabetes?
NG3/6

In women with type 1 diabetes who are planning to become pregnant, what is the most effective method of glucose monitoring to improve maternal and baby outcomes:

  • continuous glucose monitoring

  • flash glucose monitoring

  • intermittent capillary blood glucose monitoring?

NG3/7

In women with type 1 diabetes who are already pregnant, what is the most effective method of glucose monitoring to improve maternal and baby outcomes:

  • continuous glucose monitoring

  • flash glucose monitoring?

NG30/1

Oral health promotion advice:- For groups at high risk of poor oral health, how effective and cost effective is it to extend an existing appointment by a few minutes, or to offer separate sessions on oral health advice?

NG30/2

Reducing use of emergency dental care:- What interventions are effective and cost effective at encouraging people who usually only go to emergency dental services to use general dental services regularly, in a bid to improve their oral health?

NG30/3

Behaviour change methods and resources:- What behaviour change methods and resources (such as phone apps, leaflets and messaging) help dental teams to provide people with support to improve their oral health?

NG30/4

Encouraging people to change their oral health behaviour:- What triggers and other factors encourage groups at high risk of poor oral health to change their behaviours in response to oral health messages?

NG30/5

Motivating dental practice teams to take a preventive approach:- What would motivate dental practice teams to take a preventive approach to oral health – especially with high risk groups – and how does this fit into the dental practice business model?

NG31/1

Recognising dying:- What can multiprofessional teams do to reduce the impact of uncertainty of recognising when a person is entering the last days of life on clinical care, shared decision-making and communication with the dying person and those important to them?

NG31/2

Agitation and delirium:- What is the best way to control delirium, with or without agitation, in the dying person, without causing undue sedation and without shortening life?

NG31/3

Noisy respiratory secretions:- In people considered to be in the last few hours and days of life, are antisecretory anti-muscarinic drugs (used alongside nursing interventions, such as repositioning and oropharyngeal suction) better at reducing noisy respiratory secretions and patient, family and carer distress without causing unwanted side effects, than nursing interventions alone?

NG31/4

Anticipatory prescribing:- What is the clinical and cost effectiveness of anticipatory prescribing for patients dying in their usual place of residence, on patient and carer reported symptoms at end of life?

NG32/1

Interventions:- In the UK, which activity-based interventions are most effective and cost effective at protecting older people who are at risk of a decline in their independence and mental wellbeing?

NG32/2

Identifying older people at high risk:- In the UK, what are the most effective ways to identify older people who at risk of a decline in their independence and mental wellbeing?

NG32/3

Local coordination:- In the UK, what are the key components of a local coordination role to ensure best value for money in promoting older people's independence and mental wellbeing?

NG32/4

Involving older people in developing interventions:- In the UK, what are the most effective ways of involving older people in developing interventions to promote their independence and mental wellbeing?

NG32/5

Factors that influence older people's mental wellbeing:- In the UK, which factors or processes in an intervention influence older people's mental wellbeing?
How do these factors interact with one another and does the importance differ for different groups?

NG32/6

Mid-life interventions:- In the UK, which mid-life groups are currently at most risk of losing their independence or experiencing poor mental wellbeing in later life? And which interventions are most effective and cost effective in preparing these people for later life?

NG33/1

In people with suspected TB, what is the relative clinical and cost effectiveness of universal and
risk-based use of rapid nucleic acid amplification tests?

NG33/2

Apart from culture, what other diagnostic tests or combinations of tests are effective in
establishing an accurate diagnosis of active respiratory TB in children and young people with
suspected active TB?

NG33/3

For isoniazid-resistant TB, what is the most effective regimen for reducing mortality and
morbidity?

NG33/4

What effects does isolation have on the quality of life of people being treated for TB?

NG33/5

For people with active, drug susceptible TB who experience treatment interruptions because of adverse events, particularly hepatotoxicity, what approach to re-establishing treatment is most
effective in reducing mortality and morbidity?

NG34/1

How can factors that contribute to the balance of health risks and benefits of sunlight exposure for different populations be quantified? What factors should be included in tailored messages for people with different characteristics and levels of exposure to the sun, including skin colour, age, occupation and lifestyle?

NG34/2

What are the most effective ways of conveying complex risk messages and influencing behaviours in relation to over- and underexposure to sunlight? In particular, what are the most effective ways of using social and digital media? Consideration should be given to the following: how does effectiveness vary according to communicator, message, audience and medium? How does this vary at individual, group and population level in the UK? How does this vary for black and minority ethnic groups in the UK?

NG34/3

What are the most effective methods of identifying and targeting individuals and groups at risk of either over- or underexposure to sunlight?

NG34/4

What combinations of interventions are most effective at helping people to reduce their risks of, and benefit from, sunlight exposure? How much does this vary according to the type of intervention for example, the communicator, message, audience and medium?

NG35/1

Diagnostic investigations to predict treatment outcomes:- What is the prognostic value of the Hevylite assay and ratio compared with other prognostic factors and tests, including the serum-free light-chain assay and fluorescence in-situ hybridisation (FISH), in people with newly diagnosed myeloma who are starting treatment?

NG35/2

Imaging investigations for newly diagnosed myeloma:- What is the comparative effectiveness of whole-body MRI, fluorodeoxyglucose positron emission tomography CT (FDG PET-CT) and whole-body low-dose CT in detecting lesions that may determine the start of treatment for people with newly diagnosed myeloma?

NG35/3

Management of smouldering myeloma:- Which combinations of FISH, molecular technologies, bone marrow plasma cell percentage, whole-body imaging, immunophenotype, serum-free light-chain levels or ratio, Hevylite, paraprotein levels, immunoparesis, and International Staging System (ISS) are most effective at risk stratification for people with smouldering myeloma? What is the comparative effectiveness of fixed duration treatment (with or without bone-directed therapy), continuous treatment (with or without bone-directed therapy) and no treatment (with or without bone-directed therapy) for people with smouldering myeloma?

NG35/4

Allogeneic stem cell transplantation:- What is the effectiveness of combined autologous–allogeneic stem cell transplantation compared with autologous stem cell transplantation, plus consolidation and maintenance treatment in chemosensitive patients at first response or first relapse?

NG35/5

Bisphosphonates for the prevention of bone disease:- What is the effectiveness of monthly zoledronic acid given indefinitely compared with zoledronic acid given for a fixed duration in patients with myeloma?

NG36/1

Systemic imaging – who and why?:- What factors determine the risk of a person presenting with CUADT having metastasis or a second primary cancer?

NG36/2

HPV testing:- What is the comparative effectiveness of single-step laboratory diagnostic tests to identify human papillomavirus (HPV) against current diagnostic test algorithms and reference standards in people with cancer of the oropharynx?

NG36/3

Unknown primary of presumed upper aerodigestive tract origin:- In people with CUADT of unknown primary, can radiotherapy target volumes be selected based on clinical and pathological factors?

NG36/4

Enteral nutrition support:- What specific clinical and non-clinical factors allow risk stratification when selecting which people with CUADT would benefit from short- or long-term enteral nutrition?

NG36/5

Follow-up:- What is the optimal method, frequency and duration of follow-up for people who are disease-free after treatment for CUADT?

NG37/01

Temporary dressings for up to 72 hours between wound excision and definitive soft tissue cover: What is the most clinically and cost effective temporary (up to 72 hours) dressing (including negative pressure dressings) for open fractures after wound excision for:

- minimising the number of dressing changes or supplementary dressings

- minimising the number of associated bedding changes

- acceptability for patients, for example, in terms of minimising pain

- minimising nursing time.

NG37/02

Cystourethrogram: How accurate is the first CT scan with contrast (trauma scan) for detecting bladder injuries in people with suspected bladder injuries after a traumatic incident?

NG37/03

Pilon fractures: In adults with closed pilon fractures, what method of fixation provides the best clinical and cost effectiveness outcomes as assessed by function and incidence of major complications at 2 years (stratified for timing of definitive surgery early [under 36 hours] versus later [over 36 hours])?

NG37/1

Cystourethrogram:- How accurate is the first CT scan with contrast (trauma scan) for detecting bladder injuries in people with suspected bladder injuries after a traumatic incident?

NG37/2

Pilon fractures:- In adults with closed pilon fractures, what method of fixation provides the best clinical and cost effectiveness outcomes as assessed by function and incidence of major complications at 2 years (stratified for timing of definitive surgery early [under 36 hours] versus later [over 36 hours])?

NG38/1

Imaging of ankle fractures:- Is CT scanning in addition to initial plain film X-ray clinically effective and cost effective for planning surgical treatment of unstable/displaced ankle fractures compared with plain film X-ray alone?

NG38/2

Virtual compared with face-to-face clinics:- What is the clinical and cost effectiveness of virtual new patient fracture clinics compared with next-day consultant-led face-to-face clinics in people presenting with non-complex fractures in the emergency department and thought to need an orthopaedic opinion?

NG38/3

Image guidance in the reduction of displaced distal radius fractures:- For patients with displaced fractures of the distal radius, is manipulation with real-time image guidance more clinically and cost effective than manipulation without real-time image guidance?

NG38/4

Post-operative weight-bearing in people with ankle fractures:- What is the most clinically effective and cost-effective strategy for weight-bearing in people who have had surgery for internal fixation of an ankle fracture?

NG38/4

Warming in patients with major trauma:- Is warming clinically and cost effective in patients with major trauma? If so, which groups of patients will benefit from warming and what is the best method of warming?

NG38/5

Treatment of torus fractures:- What is the clinical effectiveness and cost effectiveness of no treatment for torus fractures of the distal radius in children compared with soft splints, removable splints or bandages?

NG39/1

Point-of-care coagulation testing:- What is the clinical and cost effectiveness of point-of-care coagulation testing using rotational thromboelastometry (ROTEM) or thromboelastography (TEG) to target treatment, compared with standard laboratory coagulation testing?

NG39/2

Lactate level for monitoring severity of shock:- Is lactate monitoring in patients with major trauma clinically and cost effective?

NG39/3

Morphine compared with ketamine for first-line management of pain:- Is morphine clinically and cost effective compared with ketamine for first-line pharmacological pain management (in both pre-hospital and hospital settings) in patients with major trauma?

NG4/1 What is the relationship between midwifery staffing and outcomes in maternity settings in
England, and what factors act as modifiers or confounders of the relationship between midwifery
staffing and outcomes?
NG4/2 What is the effectiveness of Birthrate Plus compared with other decision support methods or
professional judgement for identifying safe midwifery staffing requirements and midwifery skill
mix for maternity services in England?
NG40/1

Audit:- What is the clinical and cost effectiveness of collecting long-term outcomes in a national trauma audit system?

NG40/2

Rehabilitation: - What are the barriers to people with major trauma receiving early rehabilitation after rehabilitation assessment? What changes to services are needed to overcome these barriers?

NG40/3

Dedicated transfer service:- Is it clinically and cost effective to provide a dedicated service to transfer patients with major trauma from the emergency department for ongoing care?

NG40/4

National pre-hospital triage tool:- A national pre-hospital triage tool for major trauma should be developed and validated.

NG41/1

Neuropathic pain relief:- Does early treatment with a centrally acting analgesic (for example pregabalin) reduce the frequency or severity of neuropathic pain in people with spinal cord injury?

NG41/2

Cervical spine dislocation:- What is the clinical and cost effectiveness of emergency reduction of cervical spine dislocations following acute traumatic cervical spine injury?

NG41/3

Thoracic and lumbosacral assessment tool:- After injury, what is the best method of clinical assessment to determine who needs imaging of the thoracic and lumbar spine to exclude injury to the spinal column or cord, and who is safe to discharge without risk of missing significant injury?

NG42/1

Organisation of care:- Is a network-based model as effective as a clinic-based model to deliver multidisciplinary care to people with motor neurone disease (MND)?

NG42/2

Cognitive assessment:- What is the impact of assessing for cognitive and behaviour change in people with motor neurone disease (MND) on clinical practice, the person and their family and carers? Does repeated assessment provide more benefit than assessment at a single point at diagnosis?

NG42/3

Prognostic tools:- Is the amyotrophic lateral sclerosis (ALS) Prognostic Index an accurate predictor of survival in people with MND under NHS care in England and/or Wales?

NG42/4

Saliva:- How is excessive drooling of saliva (sialorrhoea) managed in people with motor neurone disease (MND)?

NG42/5

Nutrition:- Does a high calorific diet prolong survival of people with motor neurone disease (MND) if initiated following diagnosis or following initiation of feeding using a gastrostomy?

NG42/6

Augmentative and alternative communication:- What is the current pattern of provision and use of augmentative and alternative communication (AAC) by people with motor neurone disease (MND) in England?

NG43/1

Transition support for young adults:- What approaches to providing transition support for those who move from child to adult services are effective and/or cost-effective?

NG43/2

The role of families in supporting young adults discharged from children's services:- What is the most effective way of helping families to support young people who have been discharged from children's services (whether or not they meet criteria for adult services)?

NG43/3

The role of primary care in supporting young people discharged from children's services:- What are the most effective ways for primary care services to be involved in planning and implementing transition, and following-up young people after transfer (whether or not they meet criteria for adult services)?

NG43/4

The consequences and costs of poor transition:- What are the consequences and the costs of young people with ongoing needs not making a transition into adult services, or being poorly supported through the process?

NG43/5

Support to carers and practitioners to help young people's independence:- What is the most effective way to help carers and practitioners support young people's independence?

NG43/6

Supporting young people to manage their conditions:- What is the relationship between transition and subsequent self-management?

NG43/7

Transition in special groups: young offenders institutions:- What is the most effective way of supporting young offenders in transition from children's to adults' health and social care services?

NG43/8

Transition in special groups: looked-after young people:- What is the most effective way of supporting care leavers in transition from children's to adults' health services?

NG44/1

Effectiveness and cost effectiveness:- Are particular components of community engagement approaches more effective and cost effective at improving health and wellbeing and reducing health inequalities than other components?

NG44/2

Evaluation frameworks and logic models:- Which evaluation frameworks and logic models can be used to evaluate the impact of community engagement on health and wellbeing?

NG44/3

Collaborations and partnerships:- What are the components of collaborations and partnerships between people, local communities (including community  representatives, such as peers) and organisations that lead to improved health and wellbeing?

NG44/4

Social media:- How effective are online social media and networks at improving health and wellbeing and reducing health inequalities when they are used:
- as a method of community engagement?
- to support an existing community engagement approach?

NG45/1

Polysomnography:- Does preoperative screening of people who are at risk of obstructive sleep apnoea with polysomnography identify those at higher risk of postoperative complications?

NG45/2

Polysomnography:- Does treating obstructive sleep apnoea perioperatively improve outcomes?

NG45/3

Glycated haemoglobin testing:- Does optimisation of HbA1c in people with poorly controlled diabetes improve surgical outcomes?

NG48/1

Access to dental services in England for adults in care homes:- What effect does improving and maintaining access to dental services for adults in care homes have on their oral health and general health and wellbeing?

NG48/2

Effectiveness and costs of oral health interventions for care home residents:- How effective and cost effective are oral health interventions in care homes including suitable
person-centred outcome measures?

NG48/3

Measuring improvements in care home residents' oral health:- How can interventions to improve and maintain oral health and wellbeing, or to prevent dental disease, be measured using a patient-centred approach that can also be used to judge cost effectiveness?

NG48/4

Daily mouth care for residents:- Does the delivery of a daily mouth care regimen in care homes maintain or improve adult residents' oral health-related quality of life?

NG48/5

Reducing demands on health and social care services:- Do preventive oral health interventions in residential and nursing care homes reduce demands on other health and social care services?

NG48/6

Facilitators and barriers to carrying out daily mouth care and oral health assessments for adults in care homes:- What are the facilitators and barriers to delivering daily oral care and conducting oral health assessments in residential and nursing care homes?

NG49/1

Non-invasive tests for diagnosing NAFLD in adults:- Which non-invasive tests are most accurate and cost-effective in identifying non-alcoholic fatty liver disease (NAFLD) in adults with risk factors, type 2 diabetes and metabolic syndrome?

NG49/2

Non-invasive tests for diagnosing NASH:- Which non-invasive tests most accurately identify non-alcoholic steatohepatitis (NASH) in people with non-alcoholic fatty liver disease (NAFLD)?

NG49/3

Non-invasive tests for diagnosing NAFLD and advanced liver fibrosis in children and young people:- Which non-invasive tests most accurately diagnose NAFLD and advanced liver fibrosis in children and young people?

NG49/4

Probiotic and prebiotic supplements:- What is the clinical and cost effectiveness of probiotics or prebiotics to treat NAFLD in adults, young people and children?

NG49/5

Pharmacological therapy for advanced liver fibrosis in children and young people:- What is the clinical and cost effectiveness of pharmacological therapy in children and young people with advanced liver fibrosis?

NG5/1 Is a medication review more clinically and cost effective at reducing the suboptimal use of medicines and medicines-related patient safety incidents, compared with usual care or other
interventions, in children?
NG5/2 Is a medication review more clinically and cost effective at reducing the suboptimal use of
medicines and improving patient-reported outcomes, compared with usual care or other
intervention in the UK setting?
NG5/3 What is the clinical and cost effectiveness of using clinical decision support systems to reduce the
suboptimal use of medicines and improve patient outcomes from medicines, compared with usual
care, in the UK setting?
NG5/4

What models of cross-organisational working improve clinical and cost effectiveness in relation to the suboptimal prescribing of medicines – for example, between NHS and social care, or primary and secondary care, or between NHS and commercial organisations?

NG50/1

What is the effectiveness and cost effectiveness of endoscopic variceal band ligation plus a non-selective beta-blocker compared with either of these interventions alone for preventing variceal bleeding in adults with cirrhosis and medium or large oesophageal varices? 

NG50/2

Treating small oesophageal varices:- Do non-selective beta-blockers improve survival and prevent first variceal bleeds in people with cirrhosis that is associated with small oesophageal varices?

NG50/3

What is the clinical and cost effectiveness of non-selective beta-blockers for the primary prevention of decompensation in people with compensated cirrhosis and signs of clinically significant portal hypertension from non-invasive tests (such as tests to measure liver stiffness, or biomarkers)?

NG50/4

Assessing the risk of cirrhosis:- Development of a risk tool to identify people at risk of cirrhosis.

NG50/6

Antibiotic resistance in treating spontaneous bacterial peritonitis:- How frequently does antibiotic resistance occur, and how significant are antibiotic treatment-related complications when antibiotics are used for the primary prevention of spontaneous bacterial peritonitis in people at high risk of having, or developing, cirrhosis?

NG50/7

Transjugular intrahepatic portosystemic shunt:- What is the quality of life in people who have had a transjugular intrahepatic portosystemic shunt (TIPS)?

NG50/8

Acute hepatic encephalopathy:- In people with cirrhosis and an acute episode of hepatic encephalopathy secondary to a clearly identified, potentially reversible precipitating factor, does management of the precipitating event alone improve the hepatic encephalopathy without specific treatment?

NG51/1

Epidemiological study on presentation and management of sepsis in England:- What is the incidence, presentation and management of sepsis in the United Kingdom?

NG51/2

A complex service evaluation of implementation of NICE Sepsis guideline:- What effect will the NICE sepsis guideline have on patient care processes and outcomes in the UK over the next 5 years?

NG51/3

Use of biomarkers to diagnose and initiate treatment:- What is the clinical and cost effectiveness of procalcitonin (PCT) point-of-care tests at initial triage for diagnosis of serious infection and the initiation of appropriate antibiotic therapy?

NG51/4

Validation of clinical early warning scores in pre-hospital and emergency care settings:- Can early warning scores, for example NEWS (national early warning scores for adults) and PEWS (paediatric early warning score), be used to improve the detection of sepsis and facilitate prompt and appropriate clinical response in pre-hospital settings and in emergency departments?

NG51/5

Derivation of clinical decision rules in suspected sepsis:- Is it possible to derive and validate a set of clinical decision rules or a predictive tool to rule outsepsis which can be applied to patients presenting to hospital; with suspected sepsis?

NG51/6

In adults and young people (16 and over) with suspected sepsis in acute hospital settings, ambulance trusts and acute mental health facilities, what is the association between NEWS2 bands (0, 1 to 4, 5 to 6, 7 or above) and risk of severe illness or death? In adults and young people (16 and over) with suspected sepsis in acute hospital settings, ambulance trusts and acute mental health facilities, what is the association between the NEWS2 score of 3 in a single parameter and risk of severe illness or death?

NG52/1

Baseline FDG-PET-CT imaging for people with diffuse large B-cell lymphoma stage II or above:- In people with diffuse large B-cell lymphoma stage II or above, does a baseline FDG-PET-CT scan have any advantages over a baseline CT scan in the correct interpretation of the end-of-treatment FDG-PET-CT scan?

NG52/2

Factors predicting outcomes for people with high-grade transformation of follicular lymphoma:- In people with high-grade transformation of follicular lymphoma, which biological and clinical factors predict good outcomes with immunochemotherapy alone?

NG52/3

Radiotherapy in first-line treatment of diffuse large B-cell lymphoma:- In people presenting with diffuse large B-cell lymphoma and sites of bulky disease, are outcomes improved by radiotherapy to those sites following a full course of chemotherapy?

NG53/1

Care and support for people with dementia:- What is the effect of specific interventions to support people with dementia during transition between inpatient mental health settings and community or care home settings?

NG53/2

People with complex needs other than dementia:- What is the effect of specific interventions to support people with complex needs because of multiple diagnoses and resistance to treatment during transition between inpatient mental health settings and community or care home settings? (This includes people with physical or learning disabilities, people with personality disorder, people with complex psychosis, people with long-term severe mental illness and people on the autistic spectrum.)

NG53/3

Children and young people in transition between settings:- What is the effect of specific interventions to support children and young people during transition between inpatient mental health settings and community or care home settings? Is there any particular benefit for black, Asian and minority ethnic communities?

NG54/1

Develop case identification tools for common mental health problems:- Develop or adapt reliable and valid tools for the case identification of common mental health problems in people with learning disabilities, for routine use in primary care, social care and education settings.

NG54/2

Psychological interventions for children and young people with internalising disorders:- For children and young people with learning disabilities, what psychological interventions (such as cognitive behavioural therapy and interpersonal therapy) are clinically and cost effective for treating internalising disorders?

NG54/3

Psychological interventions for depression and anxiety disorders in adults with mild to moderate learning disabilities:- For adults with milder learning disabilities, what is the clinical and cost effectiveness of psychological interventions such as cognitive behavioural therapy (modified for people with learning disabilities) for treating depression and anxiety disorders?

NG54/4

Pharmacological interventions for anxiety disorders in people with learning disabilities who have autism:- What is the clinical and cost effectiveness and safety of pharmacological interventions for anxiety disorders in people with learning disabilities who have autism?

NG54/5

Psychosocial interventions for people with more severe learning disabilities:- For people with more severe learning disabilities, what is the clinical and cost effectiveness of psychosocial interventions to treat mental health problems?

NG54/6

The experiences of people with learning disabilities and mental health problems in services:- What experience do people with learning disabilities have of services designed to prevent and treat mental health problems and how does this relate to clinical outcomes?

NG55/1

Long-term outcomes for children and young people displaying harmful sexual behaviour:- What are the long-term outcomes for children and young people displaying harmful sexual behaviour, when should practitioners intervene and what potentially modifiable factors have the most important impact?

NG55/2

Effective interventions for children and young people displaying harmful sexual behaviour:- What interventions are effective with children and young people displaying harmful sexual behaviour?

NG55/3

Effective interventions for the families and carers of children and young people displaying harmful sexual behaviour:- What type of therapeutic interventions are effective when working with the family and carers of children and young people who display harmful sexual behaviour?

NG55/4

Early interventions to prevent problems escalating:- What interventions are effective in diverting children and young people away from further harmful sexual behaviour before a legal response is needed?

NG55/5

Assessment models for different groups of children and young people:- How effective are the models currently used for assessing the needs of, and level of risk for, children and young people from different population groups who display harmful sexual behaviour?

NG55/6

Electronic media:- How does the use of electronic media affect harmful sexual behaviour?

NG56/1

Organisation of care:- What is the clinical and cost effectiveness of alternative approaches to organising primary care compared with usual care for people with multimorbidity?

NG56/2

Holistic assessment in the community:- What is the clinical and cost effectiveness of a community holistic assessment and intervention for people living with high levels of multimorbidity?

NG56/3

Stopping preventive medicines:- What is the clinical and cost effectiveness of stopping preventive medicines in people with multimorbidity who may not benefit from continuing them?

NG56/4

Predicting life expectancy:- Is it possible to analyse primary care data to identify characteristics that affect life expectancy and to develop algorithms and prediction tools for patients and healthcare providers to predict reduced life expectancy?

NG57/1

Subsequent health assessment:- When should subsequent health assessments be carried out in prison for people serving long-term sentences?

NG57/2

Chronic conditions:- What is the prevalence of disease in the UK prison population?

NG57/3

Promoting health and wellbeing:- What is the most effective method for delivering health promotion activities and who should lead them (peers or professionals)?

NG57/4

Assessment tools for health promotion:- What are the most effective tools to determine the health promotion needs of people in prison?

NG57/5

Access to medicines:- Does the use of directly observed supply of named high-risk medicines (that is, not supplying the medicines to people to hold in-possession), reduce diversion, abuse and non-adherence?

NG58/1

Needs assessment:- In the UK, how prevalent is coexisting severe mental illness with substance misuse and what are the physical health, social care, housing or other support needs of people with this diagnosis?

NG58/2

What works? In the UK, how effective and cost effective are service delivery interventions such as peer support, contingency management or text messaging delivered alone or in combination (in conjunction with standard care) compared with standard care alone for young people and adults with coexisting severe mental illness and substance misuse?

NG58/3

Costing tool:- Which elements of health, social care or other support services work best at a local level and provide the best 'value for money' to address the needs of young people and adults with coexisting severe mental illness and substance misuse?

NG58/4

Barriers and facilitators:- What are the barriers and facilitators for young people and adults with coexisting severe mental illness and substance misuse to obtain an optimal service (including optimal time frame for delivering interventions) to meet their needs and enable their recovery?

NG58/5

Care pathway:- In the UK, what is the optimal care pathway for young people and adults with coexisting severe mental illness and substance misuse?

NG59/1

Pharmacological therapies:- What is the clinical and cost effectiveness of benzodiazepines for the acute management of low back pain?

NG59/2

Pharmacological therapies:- What is the clinical and cost effectiveness of codeine with and without paracetamol for the acute management of low back pain?

NG59/3

Radiofrequency denervation:- What is the clinical and cost effectiveness of radiofrequency denervation for chronic low back pain in the long term?

NG59/4

Epidurals:- What is the clinical and cost effectiveness of image-guided compared with non-image-guided epidural injections for people with acute sciatica?

NG59/6

What is the clinical and cost effectiveness of antidepressants for the management of sciatica?

NG59/7

What is the clinical and cost effectiveness of opioids for the management of acute sciatica?

NG59/8

What is the clinical and cost effectiveness of opioids for the management of acute sciatica? 

NG6/1 What effect does the temperature in the home have on the rate of illness, death and quality of life of different groups of vulnerable people?
NG6/2 What are the barriers to, and facilitators for, action and coping strategies among people vulnerable to cold-related illness and death with respect to cold homes (including ventilation)? (This includes self-disconnection when using pre-payment meters.)
NG6/3 How effective and cost effective are different types of intervention to prevent a range of cold-related illnesses and death? How do these vary with groups in different circumstances?
NG6/4 What is the relationship between improved home energy efficiency and the indoor temperature selected by people living in a representative cohort of UK housing types? What is the trade-off between reduced fuel bills and higher indoor temperatures following alterations to home energy efficiency?
NG6/5 What opportunities are there to use electronic systems to reduce the health risks associated with cold homes? For example, could temperature alert systems be linked from a smart meter to a health or social care provider?
NG60/1

Interventions to improve the acceptability and uptake of HIV testing among people at higher risk:- What interventions would be effective and cost effective among people at higher risk in the UK to increase uptake of HIV testing among people who may have undiagnosed HIV?

NG60/2

Supporting healthcare professionals to offer HIV tests:- What interventions are effective and cost effective to increase the likelihood of healthcare professionals offering and recommending an HIV test and of its subsequent uptake?

NG60/3

Self-sampling and self-testing:- How effective are self-sampling and self-testing in terms of accuracy of sampling, ability to reach different groups, test completion, receipt of results and subsequent care-seeking behaviour?

NG60/4

Indicator conditions:- What is the UK prevalence of HIV in various indicator conditions, and how effective are interventions using indicator condition-targeted testing compared with other testing strategies?

NG60/5

Cost utility:- What is the cost utility of increasing the offer or uptake of HIV testing in different settings, for different types of tests, using different strategies (for example opt-in or opt-out approaches) and in areas and groups with different background prevalence?

NG61/1

Preferred place of care and place of death:- When planning and managing end of life care, what factors help children and young people with life-limiting conditions and their parents or carers to decide where they would like end of life care to be provided and where they prefer to die?

NG61/2

Perinatal palliative care:- What impact does timely perinatal palliative care have on the experience of bereaved parents?

NG61/3

Emotional and psychological support and interventions:- What emotional support do children and young people with life-limiting conditions and their parents or carers need, and how would they like these needs to be addressed?

NG61/4

Managing breakthrough pain:- What is the acceptability, safety, and effectiveness of different types of opioid analgesia for breakthrough pain in children and young people with life-limiting conditions who are having end of life care in the community?

NG61/5

Recognising that a child or young person may be dying:- What signs and symptoms indicate that a child or young person with a life-limiting condition is likely to die within hours or days?

NG62/1

Optimising nutritional status in children with cerebral palsy:- What is the clinical and cost effectiveness of early interventions for optimising protein, energy and micronutrient nutritional status in children with cerebral palsy?

NG62/2

Managing communication difficulties in children with cerebral palsy:- What is the clinical and cost effectiveness of interventions for managing communication difficulties in children with cerebral palsy?

NG62/3

Recognition and early management of pain in children and young people with cerebral palsy:- Does use of pain assessment tools by parents or carers improve the recognition and early management of pain in children and young people with cerebral palsy in a community setting?

NG62/4

Association between treating infections in pregnancy and rates of cerebral palsy:- What is the association between different antibiotic regimes to treat genito-urinary and respiratory tract infections in pregnant women and subsequent rates of cerebral palsy in children?

NG62/5

Prevalence of mental health problems in young people (up to the age of 25) with cerebral palsy:- What is the prevalence of mental health problems in young people (up to the age of 25) with cerebral palsy?

NG63/1

Cost effectiveness:- What is the cost effectiveness of interventions to prevent infection and promote the appropriate use of antimicrobials?

NG63/2

Behavioural strategies and programmes:- What is the feasibility and effectiveness of specific behavioural strategies and programmes to reduce inappropriate antimicrobial demand and use and to prevent infections occurring and spreading?

NG63/3

High-risk groups:- What interventions to prevent infection and reduce antimicrobial resistance are effective for groups of people at high risk of infection?

This includes people who:
- have suppressed immune systems (for example, because of HIV, an inherited condition or treatment they may be having for conditions such as cancer or an organ transplant)
- have a chronic disease
- live in crowded conditions (see Shelter's definition)
- are homeless
- have been in prison
- have migrated from countries with a high prevalence of infectious diseases such as tuberculosis (examples include South Asia and sub-Saharan Africa).

NG63/4

Workplace:- How effective are interventions in the workplace that aim to prevent infection and reduce antimicrobial resistance?

NG63/5

Older people in day and residential care:- How effective are interventions in day and residential care for older people that aim to prevent infection and to reduce antimicrobial resistance?

NG64/1

Long-term consequences of drug use:- What are the long-term consequences of drug use?

NG64/2

Identifying current practice and provision:- What drug misuse prevention activities are currently used in the UK for groups at risk of drug misuse?

NG64/3

Effectiveness and cost effectiveness of drug misuse prevention interventions for groups vulnerable to drug misuse:- What is the effectiveness and cost effectiveness of drug misuse prevention interventions for groups vulnerable to drug misuse in the UK?

NG64/4

Acceptability of drug misuse prevention interventions:- How acceptable are drug misuse prevention interventions among groups vulnerable to drug misuse in the UK? How acceptable are drug misuse prevention interventions among practitioners in the UK? How can acceptability be improved for groups that are vulnerable to drug misuse and practitioners?

NG64/5

Effectiveness of digital technologies:- How effective and cost effective are digital technologies, such as web-based interventions, online self-assessment or targeted new media, for drug misuse prevention among groups at risk in the UK?

NG64/6

Use of image- and performance-enhancing drugs:- What are the most effective and cost effective interventions to prevent and reduce the use of image- and performance-enhancing drugs?

NG65/1

Referral criteria for people with suspected axial spondyloarthritis:- What are the optimal referral criteria for people with suspected axial spondyloarthritis?

NG65/2

Long-term complications of spondyloarthritis:- What is the incidence of long-term complications, in particular osteoporosis, cardiovascular disease (CVD) and metabolic syndrome, in people with spondyloarthritis, and how does this compare with the general population? Are any specific spondyloarthritis features or risk factors associated with the incidence and outcomes of these complications?

NG65/3

Educational intervention to improve healthcare professionals' awareness of spondyloarthritis:- What is the effectiveness and cost effectiveness of educational interventions for healthcare professionals in order to increase the number of prompt diagnoses of spondyloarthritis?

NG65/4

Pharmacological management of peripheral spondyloarthritis:- What is the comparative effectiveness and cost effectiveness of standard DMARDs for managing peripheral spondyloarthritis, and is this effectiveness affected by differences in dose escalation protocols?

NG65/5

Biological therapies for peripheral spondyloarthritis:- What is the effectiveness and cost effectiveness of biological DMARDs in people with persistent peripheral spondyloarthritis (excluding psoriatic arthritis) or undifferentiated spondyloarthritis?

NG66/1

Psychological and pharmacological interventions for people with paraphilic disorders:- What is the clinical effectiveness, cost effectiveness and safety of specific psychological and pharmacological interventions both in and out of prison among people with paraphilic disorders?

NG66/2

Structured clinical management interventions in probation service providers:- What is the effectiveness of structured clinical (case) management in improving mental health outcomes using interventions within probation service providers?

NG66/3

Interventions for coordination and delivery of care to improve access and uptake:- What models for the coordination and delivery of care for people in contact with the criminal justice system provide for the most effective and efficient coordination of care and improve access and uptake of services?

NG66/4

Tools for case identification for cognitive impairment in criminal justice system populations:- What are the reliable and valid tools to identify cognitive impairment among people in contact with the criminal justice system (including people who have experienced physical trauma, neurodevelopmental disorders or other acquired cognitive impairment)?

NG66/5

Prevalence of mental health problems:- What is the prevalence of mental health problems and associated social problems for those in contact with the criminal justice system?

NG66/6

Identification of factors associated with suicide:- What factors are associated with suicide attempts and completed suicides?

NG68/1

What measures would make up an effective, standardised approach to evaluation of condom distribution schemes?: How can we develop a standardised framework to evaluate condom schemes and what would be included in that evaluation?

NG68/1

What behaviour change techniques are most effective as part of a condom distribution scheme?:- What combinations of behaviour change techniques can be used to help condom schemes increase condom use among different high risk groups?

NG68/2

How can the effectiveness and cost effectiveness of condom schemes in the UK be improved for people at most risk of STIs? How can we ensure the effectiveness and cost effectiveness of the C-Card and other UK-based condom schemes for preventing sexually transmitted infections (STIs) and unintended pregnancies among groups at high risk? What are the essential components of an effective scheme?

NG68/4

How can digital technologies be used to increase access to, and uptake of, condom schemes?:- Can digital technologies such as web-based schemes increase access to, and uptake of, schemes among people who live in areas without a face-to-face condom scheme or who would prefer to remain anonymous?

NG68/5

Can GP practices deliver effective and cost effective condom schemes to reduce STIs?: -Can condom schemes be effective and cost effective in GP practices to reduce STIs? Can they be delivered in ways that are acceptable to GPs and other practice staff? In addition, how can the impact of such schemes be maximised?

NG69/1

Psychological treatments for binge eating disorder: - Compare the clinical and cost effectiveness of individual eating-disorder-focused cognitive behavioural therapy (CBT-ED) with guided self-help and group CBT-ED for adults with binge eating disorder. Compare the clinical and cost effectiveness of individual eating-disorder-focused CBT-ED with guided self-help and group CBT-ED for children and young people with binge eating disorder

NG69/2

Duration and intensity of psychological treatment:- What is the effectiveness of treating eating disorders with psychological treatments of reduced duration and reduced intensity, compared with standard treatment?

NG69/3

Predictors of acute physical risk:- What clinical and biochemical markers are the best predictors of acute physical risk for people with eating disorders?

NG69/4

Treating an eating disorder in people with a comorbidity:- What is the impact of comorbidities on treatment outcomes for eating disorders, and what
approaches are effective in managing these comorbidities?

NG69/5

Maintaining benefits after successful treatment of anorexia nervosa:- What factors (including comorbidities, personal, social and demographic factors, treatment type,
and subsequent relapse prevention interventions) are associated with continued benefit after successful treatment for anorexia nervosa?

NG7/1 What is the effect on weight outcomes of a collection of individually modifiable dietary habits, physical activity and other lifestyle behaviours?
NG7/2 What are effective and acceptable messages, routes and sources of communicating information about individually modifiable behaviours and weight outcomes for a range of population groups?
NG7/3 What are the optimal frequency and tools for self-monitoring body weight and associated behaviours in populations with a healthy weight?
NG70/1

Vegetation and street trees:- What factors influence how vegetation and street trees affect urban air quality?

NG70/2

Promoting a shift to zero- and low-emission travel:- What methods are effective and cost effective at promoting a shift to zero- and low-emission modes of travel, including active travel?

NG70/3

Clean air zones:- How do different elements of a clean air zone interact to improve air quality and what is the overall effect on people's health?

NG70/4

Telematics:- How can information about driving style gathered from telematics devices and other technologies (such as apps or in-car global positioning systems) be used to reduce individual fuel consumption and vehicle emissions?

NG70/5

Awareness raising:- What is the effectiveness and cost effectiveness of different methods of awareness raising about air pollution (including air pollution alerts) on people's behaviour and on acute and chronic health outcomes?

NG70/6

Exposure to air pollution using different modes of transport How does altering a person's mode of transport and route affect their personal exposure to air pollution?

NG71/1

Combination treatment for Parkinson's disease dementia:- What is the effectiveness of combination treatment with a cholinesterase inhibitor and memantine for people with Parkinson's disease dementia if treatment with a cholinesterase inhibitor alone is not effective or no longer effective?

NG71/2

Orthostatic hypotension treatment:- For people with Parkinson's disease, what is the most effective pharmacological treatment for orthostatic hypotension?
Particular interventions and comparisons of interest are:
- midodrine compared with fludrocortisone (primary comparison)
- pyridostigmine
- ephedrine
- pseudoephedrine.

NG71/3

Psychotic symptoms (hallucinations and delusions):- What is the effectiveness of rivastigmine compared with atypical antipsychotic drugs for treating psychotic symptoms (particularly hallucinations and delusions) associated with Parkinson's disease?

NG71/4

Rapid eye movement sleep behaviour disorder treatment:- What is the best first-line treatment for rapid eye movement sleep behaviour disorder (RBD) in people with Parkinson's disease?

NG71/5

Physiotherapy:- Does physiotherapy started early in the course of Parkinson's disease, as opposed to after motor symptom onset, confer benefits in terms of delaying symptom onset and/or reducing severity?

NG72/1

Predictive accuracy of the WPPSI-IV at age 4 years (uncorrected) for children born preterm:- What is the accuracy of a Wechsler Preschool and Primary Scale of Intelligence 4th Edition (WPPSI-IV) assessment at age 4 years (uncorrected) for predicting later educational difficulties in children of primary school age who were born before 28+0 weeks' gestation?

NG72/2

Predictive accuracy of the PARCA-R for children born preterm:- What is the accuracy of the parent-completed Parent Report of Children's Abilities – Revised
(PARCA-R) questionnaire carried out at age 2 years (corrected) for predicting learning disability (intellectual disability), language impairment and special educational needs at age 4 years (uncorrected) for children born preterm?

NG72/3

Predictive accuracy of the ASQ-3 for children born preterm:- What is the concurrent and predictive accuracy of the parent-completed Ages and Stages Questionnaire, 3rd edition (ASQ-3) for detecting concurrent learning disability (intellectual disability) and motor impairment between the ages of 2 years (corrected) and 4 years (uncorrected) in children born preterm?

NG72/3

Anticholinergic burden:- Does actively reducing anticholinergic burden in people living with dementia improve cognitive outcomes compared with usual care?

NG72/4

Accuracy of the SDQ for predicting social, attentional, emotional and behavioural problems in children born before 28+0 weeks' gestation What is the accuracy of the parent-completed Strengths and Difficulties Questionnaire (SDQ) for predicting social, attentional, emotional and behavioural problems in children born before 28+0
weeks' gestation?

NG72/5

Impact of enhanced developmental support and surveillance for children born preterm on parents and carers:- Does enhanced developmental support and surveillance improve outcomes for the parents and carers of children born preterm?

NG73/1

Pain management programmes:- Are pain management programmes a clinically and cost-effective intervention for women with endometriosis?

NG73/2

Laparoscopic treatment of peritoneal endometriosis (excision or ablation):- Is laparoscopic treatment (excision or ablation) of peritoneal disease in isolation effective for
managing endometriosis-related pain?

NG73/3

Lifestyle interventions (diet and exercise):- Are specialist lifestyle interventions (diet and exercise) effective, compared with no specialist lifestyle interventions, for women with endometriosis?

NG73/4

Information and support:- What information and support interventions are effective to help women with endometriosis deal with their symptoms and improve their quality of lives?

NG74/1

Optimal time between referral and starting intermediate care:- What is the optimal time between referral to and starting intermediate care in terms of effectiveness and cost effectiveness and in terms of people's experiences?

NG74/2

Team composition for home-based intermediate care:- How effective and cost effective are different approaches, in terms of team structure and composition, to providing home-based intermediate care for adults?

NG74/3

Crisis response:- What are the barriers and facilitators to providing an effective and cost effective crisis response service, with particular reference to different models for structuring delivery of this service?

NG74/4

Dementia care:- How effective and cost effective is intermediate care including reablement for supporting people living with dementia?

NG74/5

Reablement:- How effective and cost effective are repeated periods of reablement, and reablement that lasts longer than 6 weeks?

NG74/6

A single point of access for intermediate care:- How effective and cost effective is introducing a single point of access to intermediate care?

NG74/7

Duration and intensity of home-based intermediate care:- How effective and cost effective are different approaches, in terms of duration and intensity, to providing home-based intermediate care for adults?

NG74/8

Support for black and minority ethnic groups:- How effective and cost effective are different approaches to supporting people from black and minority ethnic groups using intermediate care?

NG75/1

High energy liquid feed supplements:- Do high energy liquid feed supplements improve growth in children with faltering growth?

NG75/2

Feeding interventions for the management of neonatal weight loss:- What is the effectiveness of feeding interventions compared with usual care/advice for breastfed
neonates (up to 28 days old) with weight loss of greater than 10%?

NG75/3

Behavioural interventions:- What is the effectiveness of behavioural interventions compared with usual care/advice for children with faltering growth?

NG75/4

Frequency of monitoring:- How frequently should children be measured to identify faltering growth?

NG75/5

Support needs of parents:- What are the experiences and concerns of parents of children with faltering growth?

NG76/1

Recognition of child sexual abuse:- What approaches to practice enable children (both boys and girls) who have been sexually abused to begin to tell practitioners about their experiences earlier, and in a way that does not contaminate the reliability of subsequent court proceedings?

NG76/10

Interventions with fathers and male carers:- What interventions are effective and cost effective when working with fathers and male carers to improve their parenting in families where children are being, or have been, abused or neglected?

NG76/11

Interventions with male foster carers and adoptive parents:- What interventions are effective and cost effective when working with male foster carers and adoptive parents who are caring for children and young people who have been abused in the past?

NG76/12

Effectiveness of home visiting following child abuse or neglect:- Are home visiting interventions effective and cost effective in improving parenting and preventing
recurrence of child abuse and neglect in families in which abuse or neglect is occurring or has occurred?

NG76/13

Effective interventions for parents or carers with substance misuse problems:- What interventions, including family behaviour therapy, are effective and cost effective in
improving parenting and preventing recurrence of neglect by parents or carers with substance misuse problems and whose children are on a child protection plan under the category of neglect in the UK?

NG76/14

Effectiveness of web-based parenting programmes:- Are web-based parenting programmes effective and cost effective for improving parenting and preventing recurrence of child abuse and neglect in families where child abuse or neglect has occurred?

NG76/15

Relative effectiveness of interventions to support foster carers:- What is the relative effectiveness and cost effectiveness of the KEEP intervention for foster carers
of abused or neglected children compared to other interventions?

NG76/16

Peer support for children and young people who have been abused or neglected:- What peer support programmes are effective and cost effective in improving the wellbeing of children and young people who have been abused or neglected?

NG76/2

Recognition of risk and prevention of female genital mutilation:- What interventions are effective and cost effective in:
- improving practitioners' recognition of children who are at risk of female genital mutilation (FGM) in the UK or overseas?
- improving recognition of co-occurring forms of abuse where relevant?
- preventing FGM in this group?

NG76/3

Recognition of risk and prevention of 'honour-based' violence and forced marriage:- What interventions are effective and cost effective in:
- improving practitioners' recognition of children who are at risk of or experiencing 'honourbased' violence and forced marriage?
- preventing 'honour-based' violence and forced marriage?

NG76/4

Early help home visiting:- What are the components of effective home visiting programmes for preventing child abuse and neglect in families of children and young people at risk of child abuse and neglect in the UK?

NG76/5

Effective prevention of child abuse and neglect in the UK:- What interventions are effective and cost effective in the UK to prevent abuse and neglect of children and young people in families at risk of, or showing early signs of, abuse and neglect?

NG76/6

Reducing social isolation and associated child abuse and neglect:- What is the impact of social isolation on children, young people and families at risk of abuse and
neglect in the UK? What interventions are effective and cost effective in a UK context in reducing social isolation and any associated child abuse and neglect?

NG76/7

Effective interventions for young people who have been abused or neglected:- What interventions are effective and cost effective in improving the wellbeing of young people aged 12 to 17 who have experienced abuse or neglect, including those who are now in temporary or permanent alternative care placements or living independently?

NG76/8

Effective interventions for children and young people who have experienced online-facilitated abuse, including online grooming:- What interventions are effective and cost effective in improving the wellbeing of children and young people who have experienced online-facilitated abuse, including grooming online?

NG76/9

Effective interventions for addressing child abuse and neglect in the UK:- What interventions, approaches and methodologies provided by social care and voluntary sector
services are effective and cost effective in the UK to prevent the recurrence of child abuse and neglect, and to improve the wellbeing of children, young people and families?

NG77/1

Toric lenses for astigmatism:- What is the cost effectiveness of toric lenses compared with on-axis or limbal-relaxing incision surgery, or non-toric lenses with no further intervention, in an NHS context, taking account of the whole care pathway cost implications from pre- to postoperative phases, stratified by the preoperative level of astigmatism?

NG77/2

Quality of life in cataract surgery:- What vision-specific, quality-of-life measures best capture visual changes in a population with cataracts?

NG77/3

Indicators and thresholds for referral for cataract surgery:- What is the association between preoperative vision- and health-related quality of life, and postoperative vision-related quality of life, health-related quality of life, and self-reported postoperative improvement?

NG77/4

Interventions to manage cystoid macular oedema:- What is the most effective postoperative medical management for cystoid macular oedema?

NG77/5

Interventions to prevent endophthalmitis:- What is the effectiveness of postoperative antibiotic drops to reduce rates of endophthalmitis after cataract surgery?

NG78/1

Liver disease:- Should all children with meconium ileus receive ursodeoxycholic acid from diagnosis?

NG78/2

Airway clearance techniques:- How effective are daily airway clearance techniques in maintaining lung function in infants and children with cystic fibrosis?

NG78/3

Monitoring pulmonary disease:- Is lung clearance index a useful and cost-effective tool for the routine assessment and monitoring of changes in pulmonary status in people with cystic fibrosis?

NG78/4

Psychological assessment:- What is the most effective measure of psychological functioning to use as a test for thresholds of concern in people with cystic fibrosis?

NG78/5

Monitoring for cystic-fibrosis-related diabetes:- What is the most effective strategy to detect diabetes in people with cystic fibrosis?

NG78/6

Mucoactive agents:- What is the most clinically and cost-effective dose of rhDNase (dornase alfa; recombinant human deoxyribonuclease) for people with cystic fibrosis?

NG8/1

Management of anaemia of chronic kidney disease with concurrent illness:- What is the optimal management (in terms of clinical and cost effectiveness) of anaemia of chronic kidney disease (CKD) in patients who are receiving erythropoietic stimulating agents (ESAs) and have a significant concurrent acute infectious illness?

NG8/2

Treatment of erythropoietic stimulating agents (ESAs) resistance:- In people with chronic ESA-resistant anaemia of CKD, what is the clinical and cost effectiveness of
treating with high-dose ESA compared with blood transfusion?

NG8/3

Treatment of erythropoietic stimulating agents (ESAs) resistance in haemodialysis patients:- What is the most effective type of intervention to treat haemodialysis patients with ESA-resistant anaemia?

NG8/4

Iron therapies for conservative care of anaemia of chronic kidney disease (CKD):- What is the clinical and cost effectiveness of different iron therapies for people with anaemia of CKD opting for conservative care (defined in relation to haemodialysis)?

NG8/5

Target haemoglobin levels in conservative management of anaemia of chronic
kidney disease (CKD):- In people with anaemia of CKD opting for conservative management, what is the clinical and cost effectiveness of treating to differing target haemoglobin (Hb) levels?

NG80/1

Diagnosing asthma in children and young people aged 5 to 16:- What is the acceptability and diagnostic accuracy of objective tests that could be used to comprise
a diagnostic pathway for asthma in children and young people aged 5 to 16 (for example, exercise challenge, direct bronchial challenge with histamine or methacholine, indirect bronchial challenge with mannitol and peripheral blood eosinophil count)?

NG80/10

Improving adherence to asthma medication:- What are the most clinically and cost-effective strategies to improve medicines adherence in adults, young people and children with asthma who are non-adherent to prescribed medicines?

NG80/11

Increasing the dose of ICS within a personalised self-management programme for children and young people - For children and young people with asthma that is managed in primary care, is there an advantage to increasing the inhaled corticosteroid (ICS) dose when asthma control has deteriorated compared with using the usual dose in a self-management programme?

NG80/2

Diagnosing asthma in adults (aged 17 and over):- What is the clinical and cost effectiveness of using an indirect bronchial challenge test with mannitol to diagnose asthma in adults (aged 17 and over)?

NG80/3

Monitoring adherence to treatment:- What is the clinical and cost effectiveness of using electronic alert systems designed to monitor and improve adherence with regular inhaled maintenance therapy in people with asthma?

NG80/4

Monitoring inhaler technique:- What is the current frequency and the current method being used to check the inhaler technique of people with asthma? What is the optimal frequency and the best method of checking inhaler technique to improve clinical outcomes for people with asthma?

NG80/5

Monitoring asthma control using tele-healthcare:- What is the long-term (more than 12 months) clinical and cost effectiveness of using telehealthcare as a means to monitor asthma control in adults, young people and children? Methods of tele-healthcare can include telephone interview (with healthcare professional involvement) and
internet or smartphone-based monitoring support (no healthcare professional involvement).

NG80/6

Starting asthma treatment:- In adults, young people and children with asthma who have not been treated previously, is it more clinically and cost effective to start treatment with a reliever alone (a short-acting beta2 agonist [SABA]) or with a reliever (a SABA) and maintenance therapy (such as ICS)? Are there specific
prognostic features that indicate that one of these treatment options may be more appropriate for some groups?

NG80/7

Second-line maintenance therapy in children and young people (under 16):- Is maintenance therapy more effective with a paediatric low dose of ICS plus a leukotriene receptor antagonist (LTRA) or with a paediatric low dose of ICS plus a long-acting beta2 agonist (LABA) in the treatment of asthma in children and young people (under 16) who have uncontrolled asthma on a paediatric low dose of ICS alone?

NG80/8

Additional maintenance therapy for asthma uncontrolled on a moderate dose of ICS plus LABA with or without LTRA:- What is the clinical and cost effectiveness of offering additional maintenance therapy to adults, young people and children with asthma that is uncontrolled on a moderate dose of ICS plus LABA with or without LTRA?

NG80/9

Decreasing pharmacological treatment:- In adults, young people and children with well-controlled asthma, what are the objective measurements and prognostic factors that indicate that a decrease in regular maintenance treatment is appropriate?

NG81/1

Risk tools to identify risk of developing COAG and risk of sight loss:- What is the predictive value of risk tools for identifying people in the community who are at
increased risk of developing chronic open angle glaucoma (COAG) and identifying people with COAG who are at increased risk of sight loss?

NG81/2

Long-term effectiveness of selective laser trabeculoplasty: What is the long-term effectiveness and cost effectiveness of selective laser trabeculoplasty as a first-line treatment compared with intraocular pressure-lowering eye drops in ocular hypertension or COAG in adults?

NG81/3

An instrument to measure quality of life in people with glaucoma:- What instrument should be used to measure health related quality of life in people with glaucoma?

NG81/4

Optical coherence tomography for glaucoma:- What is the effectiveness and cost effectiveness of optical coherence tomography (OCT) for diagnosing and monitoring glaucoma?

NG81/5

Referral filtering:- What is the effectiveness and cost effectiveness of the different models for glaucoma filtering (pathways from case-finding to assessment in secondary ophthalmic care) for detecting glaucoma and glaucoma-related conditions (ocular hypertension and suspected glaucoma)?

NG81/6

Treatment for people with an IOP of 22 or 23 mmHg:- What is the clinical and cost effectiveness of treating an intraocular pressure (IOP) of 22 or 23 mmHg in people with normal optic discs and visual fields?

NG82/1

Strategies to slow the progression of age-related macular degeneration (AMD):- What is the effectiveness of antioxidant and zinc supplements on AMD disease progression for people with early AMD at high risk of progression in the context of a randomised controlled trial?

NG82/2

Organisational models for AMD diagnosis and management:- What is the long-term effectiveness, in terms of patient-relevant outcomes including visual acuity
and quality of life, of different models of care that aim to reduce time from initial presentation to referral, diagnosis and treatment?

NG82/3

Stopping rules for antiangiogenic treatment for late AMD (wet):- When should anti-vascular endothelial growth factor (VEGF) treatment be suspended or stopped
in people with late AMD (wet)?

NG82/4

Frequency of monitoring:- What is the long-term cost effectiveness, in terms of patient-relevant outcomes including bestcorrected visual acuity and quality of life, of different review frequencies/strategies for people at risk of progression to late AMD (wet active)?

NG82/5

Self-monitoring strategies:- Does earlier detection of the incidence of late AMD (wet active) by self-monitoring in people diagnosed with early AMD, indeterminate AMD or late AMD (dry) lead to earlier treatment and better long-term outcomes?

NG83/1

Radical treatment of squamous cell carcinoma of the oesophagus:- Does the addition of surgery to chemoradiotherapy improve disease-free and overall survival in
people with squamous cell carcinoma of the oesophagus?

NG83/2

Radical treatment of T1bN0 adenocarcinoma of the oesophagus:- What is the optimal treatment for T1bN0 adenocarcinoma of the oesophagus?

NG83/3

Nutritional support after radical surgery:- What is the optimal method of delivering nutritional support to adults after surgery with curative intent for oesophago-gastric cancer?

NG83/4

Jejunostomy support after radical surgery:- What is the effectiveness of long-term jejunostomy support compared to intensive dietary counselling and support along with symptom management for people having radical surgery for oesophago-gastric cancer?

NG83/5

Follow-up after treatment with curative intent:- Is the routine use of CT and tumour markers effective in detecting recurrent disease suitable for radical treatment in asymptomatic people who have had treatment for oesophago-gastric cancer with curative intent?

NG85/1

Neoadjuvant therapy:- Prospective randomised trials should be undertaken to compare preoperative (neoadjuvant) therapy with standard postoperative therapy in people with resectable pancreatic cancer.

NG85/2

Cachexia interventions: - A cohort study followed by phase II and III studies should be undertaken in people with pancreatic cancer and cachexia or pre-cachexia, to compare cachexia assessment methods and anti-cachexia interventions with standard care.

NG85/3

Minimally invasive pancreatectomy:- Prospective randomised trials should be undertaken to compare the effectiveness of minimally invasive pancreatectomy or pancreatoduodenectomy (laparoscopic or robotic) with open pancreatectomy or pancreatoduodenectomy in people with pancreatic cancer.

NG85/4

Pain management:- A randomised trial should be undertaken comparing early endoscopic ultrasound-guided neurolytic coeliac plexus (EUS-guided NCP) interventions with on-demand EUS-guided NCP interventions in people with unresectable pancreatic cancer.

NG85/5

Psychological support needs:- A qualitative study should be undertaken to evaluate information and support interventions to address psychological needs at different points in the care pathway for people with pancreatic cancer.

NG86/1

Methods and approaches for gathering the experiences of people who use adult social care services:- When conducting research for the purposes of service improvement, what research methods are acceptable, appropriate and effective in meaningfully gathering the views and experiences of people who use services?

NG86/2

Co-producing research into the views and experiences of people who use services:- What approaches have been shown to work in supporting the co-production of research for the purposes of service improvement with people who use services?

NG86/3

Identifying barriers and enablers to using the views and experiences of people who use services to improve services:- What are the barriers and enablers to gathering, synthesising and applying data on the views and experiences of people who use services for the purposes of service improvement?

NG86/4

Use of technology in providing care- What are the views and experiences of people who use adult social care services on assistive technologies?

NG87/1

Children and young people aged 5 to 18 years – brief, group-based, ADHDfocused, parent-training intervention What is the clinical and cost effectiveness, and optimum length, of a brief parent-training intervention for parents and carers of children and young people with attention deficit hyperactivity disorder (ADHD) aged 5 to 18 years?

NG87/2

Medication choice in people with coexisting conditions:- What is the clinical and cost effectiveness of ADHD medications in people with ADHD and tic disorders, a history of psychosis or mania, or personality disorder?

NG87/3

Medication choice in people with no previous medication for ADHD:- What is the clinical and cost effectiveness of ADHD medications in people with ADHD with no
previous medication for the condition?

NG87/4

Prescribing beyond monotherapy:- What is the clinical and cost effectiveness of various ADHD prescribing strategies when monotherapy has failed?

NG88/1

Hysteroscopy compared with ultrasound or empiric pharmacological treatment in the diagnosis and management of heavy menstrual bleeding (HMB): -Is initial testing using hysteroscopy more effective than testing with pelvic ultrasound or empiric pharmacological treatment in the diagnosis and management of HMB?

NG88/2

Effectiveness of the progestogen-only pill, injectable progestogens, or progestogen implants in alleviating HMB:- How effective are the progestogen-only pill, injectable progestogens or progestogen implants in alleviating HMB?

NG88/3

Long-term outcomes of pharmacological and uterine-sparing surgical treatments for HMB associated with adenomyosis:- What are the long-term clinical outcomes of pharmacological and uterine-sparing surgical treatments in women with HMB associated with adenomyosis?

NG88/4

Hysteroscopic removal of submucosal fibroids compared with other uterine-sparing treatments for HMB:- Is hysteroscopic removal of submucosal fibroids more effective and cost-effective than other uterine-sparing treatments for the management of HMB?

NG88/5

Second-generation endometrial ablation for HMB associated with myometrial pathology:- Are outcomes after second-generation endometrial ablation for women with HMB associated with myometrial pathology (adenomyosis and/or uterine fibroids) equivalent to those for women without myometrial pathology?

NG89/1

Risk assessment:- What is the accuracy of individual risk assessment tools in predicting the risk of venous
thromboembolism (VTE) and risk of bleeding in people admitted to hospital?

NG89/2

Dose strategies for people who are obese:- What is the clinical and cost effectiveness of weight-based dose-adjustment strategies of lowmolecular-weight heparin (LMWH) compared with fixed-dose strategies of LMWH for preventing VTE in people who are very obese (BMI over 35) who are admitted to hospital or having day procedures (including surgery and chemotherapy)?

NG89/3

Direct oral anticoagulants for people with lower limb immobilisation:- What is the clinical and cost effectiveness of direct oral anticoagulants for preventing VTE in people with lower limb immobilisation?

NG89/4

Aspirin prophylaxis for people with fragility fractures of the pelvis, hip or proximal femur:- What is the clinical and cost effectiveness of aspirin alone versus other pharmacological and/or mechanical prophylaxis strategies (alone or in combination) for people with fragility fractures of the pelvis, hip or proximal femur?

NG89/5

Duration of prophylaxis for elective total hip replacement surgery:- What is the clinical and cost effectiveness of standard versus extended duration pharmacological prophylaxis for preventing VTE in people undergoing elective total hip replacement surgery?

NG9/1

Oxygen saturation measurement in primary care:- What is the clinical and cost effectiveness of oxygen saturation (SpO2) measurement in primary care in children with bronchiolitis?

NG9/2

Paediatric early warning score (PEWS) as predictors of deterioration In children with bronchiolitis can paediatric early warning score (PEWS) predict deterioration?

NG9/3

Combined bronchodilator and corticosteroid therapy for bronchiolitis:- What is the efficacy of combined bronchodilator and corticosteroid therapy?

NG9/4

High-flow humidified oxygen and oxygen:- What is the clinical and cost effectiveness of high-flow humidified oxygen versus standard supplemental oxygen?

NG9/5

Nasal suction:- What is the clinical and cost effectiveness of suction to remove secretions from the upper respiratory tract compared with minimal handling?

NG90/1

Public transport provision and ticketing:- How effective and cost effective are changes to public transport provision and ticketing in creating and sustaining an increase in physical activity at a population level?

NG90/2

Changes to public open spaces:- How effective and cost effective are environmental changes to public open spaces (including blue, green and grey spaces) in creating and sustaining an increase in physical activity at a population level?

NG90/3

Use of public open spaces by particular groups:- How effective and cost effective are environmental changes to increase physical activity through use of public open spaces (including blue, green and grey spaces) by the following groups:
- black and minority ethnic groups
- groups with low socioeconomic status
- groups experiencing other forms of disadvantage, for example carers, people with severe mental health conditions?
Are effects maintained over time?

NG90/4

People with limited mobility:- How effective and cost effective are environmental changes to increase physical activity among people with limited mobility because of either enduring or life-stage specific factors (for example, small children, parents with prams or buggies, disabled people including those with sensory
impairments and learning disabilities, older people, people with dementia and their carers)? Are effects maintained over time?

NG90/5

Reducing car ownership:- Does reducing car use or ownership change physical activity levels? Are effects maintained over time?

NG90/6

Interaction between behavioural and environmental interventions:- What is the effectiveness and cost effectiveness of interventions to change the environment alone, compared with interventions to change the environment that are supported by interventions to change people's behaviour?

NG92/1

Digital media:- How effective and cost effective are stop smoking interventions delivered using web-based
packages or apps?

NG92/2

Carbon monoxide monitoring:- What is the validity of different thresholds of carbon monoxide in exhaled breath as markers of quitting, based on diagnostic review and modelling?

NG93/1

Models of person-centred support:- What models of delivering person-centred support are effective and cost effective for people with a learning disability and behaviour that challenges, and their families and carers?
What are the views and experiences of people with a learning disability and behaviour that challenges and their family members and carers, of different models of delivering person-centred support?

NG93/2

Supporting family members, carers and staff:- What types of services or approaches are effective in supporting family members, carers and staffto be resilient and able to provide care and support to people with a learning disability and behaviour that challenges?

NG93/3

Models of supported living:- What is the effectiveness and cost effectiveness of models of shared, supported living, such as Shared Lives?
What are the views and experiences of people sharing their home and people who live with them
under programmes such as Shared Lives?

NG93/4

Effective components of integrated regional services for people with a learning disability and behaviour that challenges:- What are the effective components of an integrated regional service for people with a learning disability and behaviour that challenges across health and social care (including pooling budgets
and other resources)?
What are the barriers and facilitators to pooling budgets and other resources across regions?

NG94/1

Extended access to GP services:- Is extended access to GP services, for example during early mornings, evenings and weekends, more clinically and cost effective than standard access?

NG94/10

Extended access to community nursing:- What is the clinical and cost effectiveness of providing extended access to community nursing, for example during evenings and weekends? [See the evidence review on community nursing.]

NG94/11

Limiting emergency department opening hours:- What is the clinical and cost effectiveness of limiting emergency department opening hours, and what effect does this have on local healthcare provision and outcomes for people with medical emergencies? [See the evidence review on emergency department opening hours.]

NG94/12

Minor injury units, urgent care centres and walk-in centres:- Is a minor injury unit, urgent care or walk-in centre clinically and cost effective i) as a stand-alone unit and ii) when located on the same site as an emergency department? [See the evidence review on minor injury unit, urgent care centre or walk-in centre.]

NG94/13

Hospital diagnostic radiology services:- What is the optimal configuration in terms of clinical and cost effectiveness of hospital diagnostic radiology services to support 7-day care of people presenting with medical emergencies? [See the evidence review on 7-day diagnostic radiology.]

NG94/14

Standardised criteria for hospital discharge:- Are standardised criteria for hospital discharge clinically and cost effective in specific medical emergencies? [See the evidence review on standardised discharge criteria.]

NG94/15

'Physician extenders':- What is the clinical and cost effectiveness of providing 'physician extenders' such as advanced nurse practitioners, 'physician associates' and advanced clinical practitioners in secondary care?
[See the evidence review on physician extenders.]

NG94/16

Post-discharge early follow-up clinics:- What is the clinical and cost effectiveness of post-discharge early follow-up clinics for people who have had a medical emergency and are at risk of unscheduled hospital readmission? [See the evidence review on post-discharge early follow-up clinics.]

NG94/17

Hospital escalation policies:- Which components of a hospital escalation policy to deal with surges in demand are the most clinically and cost effective? [See the evidence review on escalation measures.]

NG94/2

Extended access to social care services:- What is the clinical and cost effectiveness of providing extended access to social care services, for example during early mornings and evenings, and 7 days a week?

NG94/3

GPs located in or near emergency departments:- What is the clinical and cost effectiveness of having GPs within or adjoining emergency departments?

NG94/4

Specialised units for older people:- What is the most clinically and cost effective way to configure services to assess frail older people who present to hospital with a medical emergency?

NG94/5

Integrated patient information systems:- What is the clinical and cost effectiveness of different methods for integrating patient information throughout the emergency medical care pathway?

NG94/6

Clinical call handlers:- What is the most clinically and cost-effective use of clinical call handlers in a telephone advisory service in terms of i) the ratio of clinical to non-clinical call handlers and ii) point of access to clinical call handlers in a telephone advisory service pathway? [See the evidence review on non-emergency telephone access and call handlers.]

NG94/7

Remote decision-support technologies:- Are paramedic remote decision-support technologies clinically and cost effective? [See the evidence review on paramedic remote support.]

NG94/8

Primary care-led assessment models:- Which primary care-led models of assessment of people with a suspected medical emergency in the community, such as GP home visits, are most clinically and cost effective? [See the evidence review on GP-led home visits.]

NG94/9

Same-day plain X-ray radiology or ultrasound:- What is the clinical and cost effectiveness of providing GPs with access to plain X-ray radiology or ultrasound with same-day results? [See the evidence review on GP access to radiology.]

NG95/1

Core outcome set for studies of management of Lyme disease:- Can a core outcome set be developed for clinical trials of management of Lyme disease?

NG95/2

Clinical epidemiology of Lyme disease in the UK:- What are the incidence, presenting features, management and outcome of Lyme disease in the UK?

NG95/3

Seroprevalence of Lyme disease-specific antibodies and other tick-borne infections in the UK population:- What is the current seroprevalence of Lyme disease-specific antibodies and other tick-borne infections in people in the UK?

NG95/4

Antimicrobial management of Lyme disease:- What are the most clinically and cost-effective treatment options for different clinical presentations of Lyme disease in the UK?

NG95/5

Laboratory tests to diagnose initial and ongoing infection and determine re-infection in the different presentations of Lyme disease in the UK:- What is the most clinically and cost-effective serological antibody-based test, biomarker or other test for diagnosing Lyme disease in the UK at all stages, including re-infection?

NG96/1

Models of care and support at home:- What is the effectiveness and cost effectiveness of care and support models (for example, assistive technology) for people growing older with learning disabilities to enable them to live in the family home?

NG96/2

Identifying health conditions:- What is the effectiveness and cost effectiveness of different ways of identifying age-related and other physical and mental health conditions, in people growing older with learning disabilities?
What can mainstream and specialist health services do to facilitate:
- early identification of health conditions in people with learning disabilities?
- equal access to health services in people with learning disabilities?

NG96/3

Education and training programmes: self-management:- What is the effectiveness and cost effectiveness of education programmes to improve information and advice and to support self-management of chronic health conditions (for example, obesity, diabetes and cardiovascular disease) for people growing older with learning disabilities, and their family members and carers?

NG96/4

Dementia education and training programmes for family members and carers:- What is the effectiveness, cost effectiveness and acceptability of training programmes (for
example, in the use of life story work) for families of people growing older with learning disabilities who have dementia or are at risk of developing it?

NG96/5

Advance planning about end of life care:- What is the effectiveness and cost effectiveness of advance care planning for end of life care for people growing older with learning disabilities, and their family members and carers?
What processes are in place to document and follow the wishes of people growing older with learning disabilities about their decisions on end of life care?

NG97/1

Case management:- What is the effectiveness and cost effectiveness of high-intensity case management compared with usual care on quality of life (for the person living with dementia and for their carers) and the timing of entry to long-term care?

NG97/2

Staff training:- What is the cost effectiveness of using a dementia-specific addition to the Care Certificate for community staff, including dementia-specific elements on managing anxiety, communication, nutritional status and personal care?

NG97/3

Anticholinergic burden:- Does actively reducing anticholinergic burden in people living with dementia improve cognitive outcomes compared with usual care?

NG97/4

Managing delirium superimposed on dementia:- What are the most clinically and cost-effective non-pharmacological interventions for helping the long-term recovery of people with delirium superimposed on dementia?

NG97/5

Care and support planning:- What are the most effective methods of care planning for people who do not have regular contact with an informal carer?

NG98/1

Idiopathic sudden sensorineural hearing loss:- What is the most effective route of administration of steroids as a first-line treatment for idiopathic sudden sensorineural hearing loss?

NG98/2

Earwax:- What is the clinical and cost effectiveness of microsuction compared with irrigation to remove earwax?

NG98/3

Use of hearing aids and incidence of dementia:- In adults with hearing loss, does the use of hearing aids reduce the incidence of dementia?

NG98/4

Hearing loss prevalence in people who under-present for hearing loss:- What is the prevalence of hearing loss among populations who under-present for possible hearing
loss?

NG98/5

Monitoring and follow-up for adults with hearing loss:- What is the clinical and cost effectiveness of monitoring and follow-up for adults with hearing loss post-intervention compared with usual care?

NG99/1

Managing glioma: management of IDH wildtype grade II glioma:- Does the addition of concurrent and adjuvant temozolomide to radiotherapy improve overall survival in patients with IDH wildtype grade II glioma?

NG99/2

Managing glioma: supportive care clinics for low-grade glioma:- Does a dedicated supportive care clinic in addition to standard care improve outcomes for people with low-grade gliomas?

NG99/3

Managing glioma: early referral to palliative care for glioblastoma:- Does early referral to palliative care improve outcomes for people with glioblastomas in comparison with standard oncology care?

NG99/4

Managing glioma: early detection of recurrence after treatment:- Does early detection of recurrence after treatment improve overall survival/outcomes in
molecularly stratified glioma?

NG99/5

Managing meningioma: immediate versus deferred radiotherapy for incompletely excised grade I meningioma:- Is immediate or deferred radiotherapy better for incompletely excised grade I meningioma?

NGO50/2

What is the clinical and cost effectiveness of antibiotic prophylaxis to prevent spontaneous bacterial peritonitis (SBP) in people with cirrhosis and ascites?

PH32/1 What is the incidence and prevalence of, and what are the demographic trends in, skin cancer in the UK? (Demographic variables might include whether someone is an outdoor or indoor worker, their skin type and socioeconomic status.)
PH32/2 What types of information provision, including mass-media campaigns, are effective and cost effective in preventing skin cancer in the UK? What factors influence effectiveness and cost effectiveness?
•Does effectiveness and cost effectiveness vary for different population groups? (Groups could be defined by gender, age, race/ethnicity, socioeconomic status or other characteristics such as lifestyle and at-risk behaviours.)
• What impact do they have on knowledge, attitudes, awareness and behaviour, including any impact on physical activity levels and vitamin D-related outcomes?
• What are the key factors that aid or hinder the success of these interventions or campaigns, including for different population groups? In particular, how does changing attitudes to sunbathing and tanning – and perceptions of the risk of skin cancer –influence success? Do attitudes vary for different population groups?
PH32/3 Which new (previously not researched) primary prevention interventions (that do not include information provision as a component) are effective and cost effective in preventing skin cancer in the UK? What factors influence effectiveness and cost effectiveness?
PH32/4 What proxy outcome measures are suitable for studies of the primary prevention of skin cancer?
PH33/1 What HIV testing services (both health and non-healthcare based) are effective and cost effective in increasing the uptake of HIV testing among black African communities living in England? (Examples may include tests in the home, within genitourinary medicine [GUM] clinics or in community venues.) Does effectiveness and cost effectiveness vary for different population groups? (Groups could be defined by gender, age, race/ethnicity, sexuality, faith, socioeconomic status or other characteristics such as lifestyle, those living in high or low HIV prevalence areas, those who have previously tested or not tested or at risk behaviours).
PH33/2 What factors aid or hinder the provision or uptake of HIV testing services in health and non-healthcare settings from the perspective of black African communities and different service providers (for example, healthcare professionals)? What ways of working or interventions can help overcome or make use of these factors?
PH33/3 How does HIV testing affect the subsequent sexual behaviour of black Africans living in England? How does this differ by the test result and population factors such as gender, age, sexuality, faith, culture? Does normalising HIV testing help change knowledge, attitudes and behaviour among black Africans living in England?
PH33/4 What interventions provide an effective and cost effective way of changing risky sexual behaviour after an HIV test (positive or negative) among black African communities living in England? What mechanisms lead to change and what, in particular, is effective and cost effective with higher risk sub-groups?
PH33/5 Are antenatal settings an effective and cost- effective location for increasing the uptake of HIV testing for black African male partners of women attending antenatal appointments? What factors influence the suitability and acceptability of antenatal settings; for example does acceptability vary by clinic setting (such as community or hospital based); by population factors (such as age, faith, race/ethnicity, or socioeconomic status) or by other characteristics such as lifestyle, those living in high or low HIV prevalence areas, whether or not they have had a previous test or whether they are involved in risky behaviours)?
PH34/1 What interventions provide an effective and cost effective way of increasing awareness and uptake of HIV testing among men who have sex with men (at population, community and individual level)? How does HIV testing affect the subsequent sexual behaviour of men who have sex with men? How does this differ by the test result and population factors such as gender, age, sexuality, faith and culture?
PH34/2 What interventions provide an effective and cost effective way of changing risky sexual behaviour after an HIV test (positive or negative)? What mechanisms lead to change and what, in particular, is effective with higher risk sub-groups?
PH34/3 Are home sampling and home testing kits a reliable, effective and cost effective method of increasing the uptake of HIV testing among men who have sex with men?
PH34/4 What interventions and approaches help reduce the stigma associated with HIV testing and a positive diagnosis among professionals, men who have sex with men and the wider population?
PH35/1 How effective and cost effective are interventions which use either a ‘total population’ or ‘high-risk population’ approach to preventing type 2 diabetes among people from black and minority ethnic or lower socioeconomic groups?
PH35/2 What are the most effective and cost effective ways of developing, implementing and assessing tailored and culturally appropriate community-level interventions to prevent type 2 diabetes among people at high risk? This includes people from a range of black and minority ethnic groups and those from lower socioeconomic communities.
PH35/3 Which participatory approaches are most effective and cost effective among populations at higher risk of type 2 diabetes? This should consider the awareness, knowledge, understanding and skills of the providers of interventions for people at high risk of developing type 2 diabetes?
PH35/4 How do socioeconomic, environmental, biological and psychosocial factors determine diet and physical activity behaviours and how do they contribute to differences in the risk of developing type 2 diabetes?
PH35/5 How do financial factors (including incentives, pricing and taxation of food and incentives, and pricing for physical activity opportunities) affect food and physical activity choices?
PH37/1 What factors aid or hinder the provision of tuberculosis (TB) screening services for hard-to-reach groups?
PH37/2 What factors help or prevent hard-to-reach groups from being screened for active tuberculosis (TB): when it involves different service providers (for example, healthcare professionals, community workers) when it involves different settings and/or a different approach (for example, clinics, hospitals, detention centres, outreach, drop-in centres)?
PH37/3 How effective and cost effective is tuberculosis (TB) testing (active and latent) for hard-to-reach groups when included as part of a broader health check (for example, blood-borne virus [BBV] screening)?
PH37/4 How effective and cost effective is routine testing for latent tuberculosis (TB) infection and subsequent, directly observed preventive therapy (DOPT) for hard-to-reach groups at risk of poor adherence?
PH37/5 How effective and cost effective is peer support as part of an enhanced case management (ECM) approach to ensuring hard-to-reach groups with active tuberculosis (TB) complete treatment? In particular, does effectiveness and cost effectiveness vary:
- according to the target population (that is, different hard-to-reach groups)
- by setting (for example, outreach versus clinic)
- by population (for example, age, gender, ethnicity)?
PH37/6 What demographic and socioeconomic factors aid or hinder treatment completion rates among hard-to-reach groups? (This includes, for example, housing, immigration status and recourse to public funds.)
PH37/7 What is the cost of treating hard-to-reach groups with active tuberculosis (TB)? (This includes enhanced case management, housing and hospital costs and the use of new technologies.)
PH38/1 Identification and monitoring:- Which combination of risk-assessment tools and blood tests (HbA1c or fasting plasma glucose [FPG]) are most cost effective and effective at identifying and assessing the risk of type 2 diabetes among populations at high risk? In addition, how frequently should testing take place to be efficient? How does effectiveness and cost effectiveness vary for different black and minority ethnic groups, for example, African-Caribbean and black African; people aged 18–40, people aged 75 and over, and for high-risk vulnerable adults?
PH38/2 Identification and monitoring:- What are the demographic characteristics and rates of progression to type 2 diabetes among people with a high risk score but normal blood glucose levels (fasting plasma glucose of less than 5.5 mmol/l or HbA1c of less than 42 mmol/mol)? How does this compare with people who have both a high risk score and blood glucose levels that indicate impaired glucose regulation (fasting plasma glucose 5.5–6.9 mmol/l or HbA1c 42–47 mmol/mol (6.0–6.4%)?
PH38/3 Identification and monitoring:- What are the most effective and cost-effective methods of increasing uptake of type 2 diabetes risk assessments and monitoring among those at greatest risk? Those at greatest risk include people from lower socioeconomic and black and minority ethnic groups, and those aged 75 or over.
PH38/4 Lifestyle interventions:- Which components of an intensive lifestyle-change programme contribute most to the effectiveness and cost effectiveness of interventions to prevent or delay type 2 diabetes in those at high risk? How does this vary for different black and minority ethnic groups, for people of different ages for example, aged 18–24, 25–39 and 75 and over, and for vulnerable adults?
PH38/5 Lifestyle interventions:- How effective and cost effective are different types of dietary regime in reducing short- and long-term blood glucose levels and preventing or delaying type 2 diabetes? How does this vary for different subgroups, for example, African-Caribbean and black African and other minority ethnic groups and for people of different ages, for example, aged 18–24, 25–39 and 75 and over?
PH38/6 Lifestyle interventions:- How effective and cost effective are different types (and levels and frequency) of physical activity in reducing short- and long-term blood glucose levels and preventing or delaying type 2 diabetes? How does this vary for different subgroups, for example, different black and minority ethnic groups and people of different ages, for example, aged 18–24, 25–39 and 75 and over?
PH38/7 Vulnerable groups:- What are the most effective and cost-effective methods for identifying, assessing and managing the risk of type 2 diabetes among high-risk, vulnerable adults? This group includes: frail older adults, homeless people, those with severe mental illness, learning or physical disabilities, prisoners, refugees, recent migrants and travellers.
PH39/1 What is the natural progression of disease for South Asian users of smokeless tobacco (for example, how prevalent is oropharyngeal cancer and periodontal disease among users)?
PH39/2 How prevalent is smokeless tobacco use among South Asian women who are pregnant and why? Is there a particular stage during pregnancy when smokeless tobacco is used? What impact does its use during pregnancy have on maternal and child health?
PH39/3 What are the similarities and differences between smokeless tobacco and smoked tobacco in terms of chemical content and the harm that it can cause? Should interventions to help people quit smokeless tobacco differ from those used for smoked tobacco?
PH39/4 How effective and cost effective are the following in terms of long-term (12 month) quit rates, and also for NHS standard, short-term quit rates (at 4 weeks and 6 months) for smokeless tobacco (confirmed by saliva cotinine test)?
- Pharmacotherapy combined with behavioural support and delivered by health professionals compared to brief advice, behavioural support or pharmacotherapy alone.
- Brief interventions (including brief advice) delivered by community members compared to brief interventions delivered by health professionals.
- Tobacco cessation services (including outreach services) that specifically focus on smokeless tobacco, compared to smokeless tobacco support provided by general tobacco cessation services.
- Training for health professionals (such as midwives, dentists and dental hygienists) to identify users of smokeless tobacco and raise awareness among them of the associated health risks.
- How does the effectiveness and cost effectiveness of the above differ by: age, gender and ethnic origin of the recipient; the status of the person delivering the intervention; the way it is delivered; its frequency, length and duration; and the setting in which it is delivered?
PH39/5 Are there unintended consequences from encouraging people of South Asian origin to stop using smokeless tobacco (for example, do they experience more dental pain or start smoking more tobacco)?
PH39/6 How strong are the cultural motivations (stemming from religion, tradition, media, and advertising) to use smokeless tobacco among people of South Asian origin? How do they compare with the physical addiction to nicotine? How might this information help in designing smokeless tobacco cessation programmes that are culturally appropriate?
PH39/7 What components of an intervention or which general approaches work best in attracting people of South Asian origin to smokeless tobacco cessation services? How does this differ by age, gender and ethnic origin?
PH40/1 How effective are interventions to promote social and emotional wellbeing among, and reduce the vulnerability of, different groups of vulnerable children aged under 5 years?
PH40/2 How can the factors that pose a risk to, or protect, the social and emotional wellbeing of children aged under 5 years be identified and assessed to determine how children can benefit from different interventions?
PH40/3 What approaches can be used to ensure fathers and grandparents help protect or improve the social and emotional wellbeing of vulnerable children aged under 5 years?
PH40/4 What types of home-based intervention are effective in promoting the social and emotional wellbeing of vulnerable children aged under 5 years without involving the parents? (This could include childcare provided by other family members or childminders.)
PH40/5 How can interventions which have been proven effective in other countries be assessed for their cultural relevance to the UK? What measures should be used to assess how transferrable they are?
PH40/6 What organisational mechanisms can ensure interventions to improve the social and emotional wellbeing and 'readiness for school' of vulnerable children aged under 5 years are effectively implemented? How do these differ according to the local context?
PH40/7 What are the short, medium and long-term economic benefits of interventions aimed at developing the emotional and social skills of vulnerable, preschool children – for the individual, family and wider society? How should these be assessed?
PH40/8 What indicators and datasets should be used to measure and predict social and emotional wellbeing over time? Which indicators and datasets can be used to assess the long-term benefits of interventions aimed at improving the social and emotional wellbeing of vulnerable children aged under 5 years?
PH41/1 How could existing guidance on evaluating complex, population-wide interventions be most usefully adapted and applied to approaches that aim to increase rates of walking and cycling?
PH41/2 What key factors influence the effectiveness of population-level or whole-area approaches to encouraging walking or cycling? How do these factors interact?
PH41/3 How do individual and local factors influence the effectiveness of specific approaches to encouraging walking or cycling?
PH41/4 What key factors ensure people continue to walk or cycle in the long term (over a year)? How do individual interventions (such as follow-up or goal-setting) interact with environmental factors (such as distance, perception of danger or provision of facilities) in encouraging people to continue to walk or cycle?
PH41/5 What key factors influence differences in walking and cycling behaviour among different groups – and what are the implications for interventions aiming to achieve population-level change and reduce inequalities?
PH42/1 What is the most effective way to monitor and evaluate community-wide approaches to obesity to ensure:
1) evidence of effectiveness is gathered across the breadth of the local system and 2) data are produced to help local communities adapt and improve their approach?
PH42/2 What factors are necessary for an effective and cost effective community-wide approach to obesity prevention?
PH43/1 How can case-finding for hepatitis B and C be improved? What modifiable factors influence whether or not specific groups at increased risk of hepatitis B and hepatitis C infection are identified and tested?
PH43/10 How many people in the UK are infected with chronic hepatitis B and C and which subgroups of the population do they come from?
PH43/11 How cost effective are cohort testing programmes:
- as a stand-alone programme, or
- as an extension of the NHS Health Check programme?
PH43/2 How can the uptake of hepatitis C treatment be improved? What factors influence whether or not specific groups at increased risk will begin and complete hepatitis C treatment?
PH43/3 What cost-effective interventions can be used to increase hepatitis B case-finding among migrant populations in primary and secondary care?
PH43/4 What cost-effective interventions ensure continuity of care for prisoners who are diagnosed with chronic hepatitis B or C in prison?
PH43/5 How cost effective are alternative testing sites, such as community pharmacist programmes, for increasing the number of people who are tested and treated for hepatitis B and C?
PH43/6 What are the most effective ways of involving people from groups at increased risk in awareness-raising about, and promoting testing and treatment for, hepatitis B and C infection? Specifically, how cost effective are peer mentor programmes at increasing the number of people at increased risk who are tested and treated for hepatitis B and C?
PH43/7 What impact does increased knowledge and awareness of hepatitis B and C among the general public have on the uptake of testing and treatment?
PH43/8 Which interventions for other communicable diseases could be used to encourage people at increased risk of hepatitis B and C infection to take up the offer of testing and treatment?
PH43/9 How many children in the UK are infected with chronic hepatitis B and C and which subgroups of the population do they come from?
PH44/1 How does the duration and frequency of brief advice influence its effectiveness and cost effectiveness? For example, do 'micro interventions' of less than 1–2 minutes have an impact on physical activity?
PH44/2 What impact does brief advice to promote physical activity have on mental wellbeing?
PH44/3 What impact does the delivery of brief advice by different primary care practitioners – for example, GPs and practice nurses – have on physical activity? For example, is the perceived value of the information greater when provided by a particular primary care practitioner?
PH44/4 How do different types of training help primary care professionals identify people who are inactive and deliver brief advice? What type of training is most effective?
PH44/5 How can brief advice be tailored to have the greatest impact on specific groups? For example, can it be tailored to meet the needs of people of a particular gender, socioeconomic status or with a particular disability?
PH44/6 Do primary care practitioners use NICE guidance when encouraging people to be physically active?
PH44/7 Are the Department of Health's 'Let's get moving' physical activity care pathway and the general practice physical activity questionnaire (GPPAQ) both commonly used in primary care? How do primary care practitioners view GPPAQ and, if they do not use it, why not?
PH44/8 What infrastructures and systems help increase the number of assessments of physical activity undertaken and the delivery of brief advice? (Examples studied could include integration of brief advice into long-term disease management strategies, or the use of incentive strategies.)
PH45/1 How effective are licensed nicotine-containing products when used for more than one year? What is the impact of different doses and duration of use? What is the effect on health of long-term use? What are smokers' and practitioners' views on long-term use?
PH45/2 What impact does stopping smoking but continued use of licensed nicotine-containing products for over a year have on the onset and progression of smoking-related health conditions?
PH45/3 How effective are interventions to help people reduce the amount they smoke (without the intention of stopping)? How great are the health benefits of smoking reduction (by substituting some cigarettes with licensed nicotine-containing products) compared to stopping smoking? What proportion of people who reduce the amount they smoke go on to stop smoking? How soon after starting to reduce the amount they smoke do they stop completely?
PH45/4 How effective are different behavioural strategies in helping people to cut down, either in order to stop smoking or to reduce the amount they smoke? This should include an evaluation of behavioural support used on its own and evaluations of specific components of such support (such as scheduling). It should also include evaluations of different types of behavioural support and follow-up, delivered within a clearly defined harm-reduction intervention.
PH45/5 What impact do different marketing strategies, including mass-media campaigns, have on the number of people who adopt a harm-reduction approach? For example, compare the prices, placements and promotions for different types of licensed nicotine-containing product.
PH45/6 Which harm-reduction approaches are smokers using and how do these correlate with smoking rates at the population level and among particular groups? For example, how do young people respond to the wider adoption of harm-reduction approaches? Do these approaches contribute to a continued reduction in smoking prevalence among young people, or does it make stopping smoking appear less important?
PH45/7 What are the most effective methods of monitoring smoking status at the population level? This includes the development of biomarkers that can distinguish between nicotine use and smoking in order to validate these measures.
PH47/1 Recommendation 1 Research studies and trials. Who should take action? Research councils, commissioners and funders.
PH47/2 Recommendation 2 Longer-term programme evaluation. Who should take action? Research councils, commissioners and funders.
PH47/3 Recommendation 3 Barriers and facilitators. Who should take action? Research councils, commissioners and funders. Researchers and investigators.
PH47/4 Recommendation 4 Weight management programmes. Who should take action? Research councils, commissioners and funders. Researchers and investigators.
PH48/1 How can interventions to increase the uptake and effectiveness of stop smoking interventions in acute, maternity and mental health settings be improved? (Examples include the identification and referral of smokers and staff training.) What components of an intervention help ensure someone will take up the support they are offered? How many people in these settings complete stop smoking treatment?
PH48/2 How can the effectiveness and cost effectiveness (in terms of 4-week, 6- and 12-month quit and relapse rates) of intensive stop smoking interventions for people using mental health services be improved and tailored for this group? Does effectiveness or cost effectiveness differ by age, diagnosis, ethnicity, gender, inpatient or outpatient, sexual orientation or socioeconomic status? What type of training do health professionals need to deliver these interventions? Examples might include training to: build up knowledge related to tobacco dependence, its treatment and links with mental illness; develop skills in delivering support; develop a positive attitude towards delivering interventions.
PH48/3 What is the effect and acceptability of approaches that aim to match nicotine dose (through licensed nicotine-containing products) to level of smoking addiction among women who are using maternity services?
PH48/4 Are stop smoking interventions that include incentives to quit effective and cost effective for people using secondary care services, including women who are pregnant or have recently given birth?
PH48/5 How effective and cost effective are stop smoking interventions for partners of pregnant and breastfeeding women?
PH48/6 How effective and cost effective are stop smoking interventions for parents and carers of children who are using secondary care services?
PH48/7 How effective and cost effective are interventions that use varenicline for people who are using acute, maternity and mental health services?
PH48/8 How effective and cost effective are relapse prevention interventions aimed at people who use secondary care services who have quit?
PH48/9 How can people who use secondary care services (particularly mental health services), staff and visitors, best be helped to temporarily abstain from smoking while in secondary care settings?
PH49/1 Which choice architecture interventions help to reduce increased-risk and higher-risk drinking of alcohol, improve sexual health behaviours, help stop or reduce smoking, or increase the physical activity levels of the general UK population? How is this related to sociodemographic variables?
PH49/2 What evidence of effectiveness is there on the use of choice architecture interventions in commercial settings to influence health-related behaviours? How can findings from commercial settings support non-commercial choice architecture approaches to support behaviour change to improve health?
PH49/3 Which combinations of behaviour change techniques and modes of delivery are effective and cost effective in initiating particular behaviour changes, and in maintaining those changes? How does this vary among people from different socio-demographic groups or with different levels of motivation, access to information or skills? Include research that builds the evidence base on the effectiveness of each behaviour change technique. For example, experimental and meta-analytic work could clarify which behaviour change techniques work when, and for whom.
PH49/4 Which behaviour change interventions and programmes are effective and cost effective at changing multiple behaviours and maintaining behaviour change? How does this vary among people from different sociodemographic groups?
PH49/5 What characteristics of behaviour change training influence the effectiveness of behaviour change practitioners?
PH49/6 How effective and cost effective are behaviour change interventions delivered remotely (that is, by telephone, text message, phone and tablet apps or the internet)? How does this vary among behaviours and among people from different sociodemographic groups?
PH49/7 How do behaviour change techniques lead to change? What are the best methods of testing the relationship between the theories that describe change processes and the effectiveness of interventions in practice?
PH50/1 How effective are programmes that aim to prevent domestic violence and abuse from ever happening in the first place? This includes media-based public health awareness campaigns. It also includes social movements to establish people's rights, and community-building and primary prevention activities that tackle underlying assumptions in society. (Examples of the latter might include the role and status of women.)
PH50/2 How effective are combinations of interventions to deal with domestic violence and abuse in the short, medium and long term? Are the outcomes sustainable and do they have a beneficial effect on quality of life and health in the longer term?
PH50/3 How effective are the following interventions in the short, medium and long term, across various levels of risk and including diverse and marginalised groups:
- advocacy
- domestic abuse recovery programmes
- perpetrator programmes
- psychological or social interventions modified for domestic violence and abuse, including programmes for those who have suffered multiple forms of abuse and those who are still experiencing it
- interventions for primary carers apart from mothers (for example, fathers, grandparents)
- interventions for other family members?
PH50/4 What are the most appropriate ways to collect and manage data about domestic violence and abuse across the health, social care and criminal justice sectors? Is there value in collecting anonymised aggregate data, or is there a more useful method of data capture?
PH50/5 What type of interventions (including training and referral pathways), in diverse health care settings, provide the most effective support for practitioners working with people who are experiencing, or have experienced, domestic violence and abuse?
PH51/1 What are the most effective and cost effective ways to provide contraceptive services for socially disadvantaged young people to prevent unwanted pregnancies? In particular, what are the most effective and cost effective ways to provide contraceptive services for looked after children, those with learning difficulties, those who are not in education, employment or training or women who have had an abortion?
PH51/2 What are the most effective ways to get socially disadvantaged young women and men involved in designing contraceptive services that meet their needs and reduce the barriers to access?
PH51/3 How effective and cost effective are interventions that reduce unintended conception and abortion rates among young people aged under 25 years?
PH51/4 What is the differential impact of interventions that aim to reduce unintended conception and abortion rates among young people aged under 25 years on subgroups of socially disadvantaged young people?
PH51/5 What interventions and service models enable young people from diverse faith and cultural communities to access contraceptive services and meet their contraceptive needs?
PH52/1 How can needle and syringe programmes encourage specific groups of people who inject drugs to use the service effectively? Examples include: those who have recently started injecting; women; sex workers; ex-prisoners; people who are homeless; people who occasionally inject drugs; and people who inject novel psychoactive drugs.
PH52/2 What are the most effective and cost effective ways of delivering needle and syringe programmes to: young people aged under 18; users of image- and performance- enhancing drugs?
PH52/3 What type of behaviour-change interventions delivered by needle and syringe programmes are effective in promoting safer drug use practices and reducing the incidence of overdose (apart from providing needles, syringes and other injecting equipment)?
PH52/4 What types of injecting equipment (including low dead-space syringes), paraphernalia and non-injecting equipment (for example, crack pipes or foil) effectively and cost effectively reduce the harm associated with injecting drug use?
PH52/5 Do needle and syringe programmes have any unintended consequences: Do they increase the uptake, frequency and length of injecting drug use? Does the provision of disposal facilities (for example, drop-boxes) affect the amount of drug-related litter in an area? Do they have a negative impact on the local community, for example, in terms of crime rates or the fear of crime?
PH53/1 How effective are lifestyle weight management programmes available in the UK, when directly compared using high-quality trials? In particular, what effect do specific components of a multicomponent lifestyle weight management programme have on adherence, effectiveness and cost effectiveness? This includes:
- components, or combinations of components, that support weight loss or the prevention of weight regain
- the effect of programme length, intensity, setting and means of delivery (examples of the latter include group, individual and remote support)
- specific behaviour change techniques (using a recognised taxonomy)
- the effect of new technologies
- the effect of additional support services, such as self-help groups and networks approaches to commissioning
- processes for collecting long-term follow-up data.
PH53/2 How effective and cost effective are lifestyle weight management programmes available in the UK over at least at least 3 to 5 years, and ideally beyond 10 years. Specifically:
- Do short-term (12-week) interventions provide adults with the self-management skills they need to maintain weight loss in the long term?
- Are alternative approaches to weight management (such as approaches that focus on a healthy lifestyle, behaviour change and the prevention of weight gain rather than weight loss) effective and cost effective in the long term?
- How effective and cost effective are programmes for people of different ages, gender, sexuality or from different ethnic or socioeconomic groups?
- How effective and cost effective are programmes for specific population groups, such as adults with depression or with disabilities?
PH53/3 What is the effect of lifestyle weight management programmes available in the UK on:
- Changes to dietary habits and choices, physical activity level and sedentary behaviour?
- Wider lifestyle factors, such as sleeping patterns or stress management?
- Psychological issues, such as body confidence or attitude, depression, anxiety or self-esteem?
- Health conditions, such as changes to blood pressure or lipids?
- Unintended outcomes such as musculoskeletal injuries, symptoms of an eating disorder; increased anxiety or depression?
- User adherence and satisfaction?
- Quality of life?
PH53/4 How can referrals to other services after involvement in a lifestyle weight management service be as effective and cost effective as possible? This includes: re-referrals to a lifestyle weight management service, referrals to other tiers of weight management services or referrals to other specialist services (such as alcohol or substance misuse). In particular:-
- How long should people wait before being re-referred to a programme?
- Does re-referral to the same (or a similar programme) influence adherence, effectiveness or cost effectiveness?
- In what circumstances should participants not be re-referred to the same (or a similar programme)?
- Who is best placed to provide ongoing support after the programme, and does this differ according to whether someone completed the programme or met their weight loss goal?
- Are there any unintended or adverse effects from repeated attempts to lose weight?
PH53/5 What effect does lifestyle weight management training for health professionals and lifestyle weight management staff have on:
- The referral process, including patient satisfaction?
- Programme outcomes (weight loss and prevention of weight regain), adherence to the programme and participants' satisfaction with it?
- Staff confidence in discussing weight issues and any concerns about their own weight?
- Staff ability to deliver the programme?
- General approach of staff (that is, whether they adopt a 'respectful and nonjudgemental' approach as a result)?
PH54/1 How effective and cost effective are different types of exercise referral scheme? Compare the relative effects of different models in controlled studies. Include health-related quality of life as an outcome. Compare exercise referral schemes that vary by:
- setting – for example, home-based, gym-based, community-based or outdoors
- intensity and duration – for example, a 12-week scheme involving 1 session a week, or a 6-week scheme involving 4 1-hour sessions per week
- the techniques used, for example, some use additional 'supportive' techniques such as 'motivational interviewing' and education sessions
- the target group, for example, people who are overweight and obese, people with raised blood pressure or cholesterol levels or those experiencing mild depression, anxiety or stress; or by age, gender, race or socioeconomic status
- other scheme characteristics including: design, content and delivery; referral mechanisms; choice of activity; cost and qualifications of instructors; and whether it is commissioned and delivered by an NHS, non-NHS or community-based organisation.
PH54/2 What factors encourage uptake of, and adherence to, an exercise referral scheme? Factors to consider include: design, content and delivery; referral mechanisms; choice of activity; qualifications and cost of instructors. Also identify any barriers preventing participation and factors that encourage it.
PH54/3 What factors encourage under-represented groups to participate in and complete an exercise referral scheme? What factors prevent these groups from participating? Under-represented groups include: people from black and minority ethnic groups, people with disabilities and those from lower socioeconomic groups.
PH54/4 What is the comparative effectiveness and cost effectiveness of exercise referral schemes compared with other interventions that aim to help people to become more physically active? Relative effectiveness and cost effectiveness should be compared in controlled trials.
PH55/1 What community-based interventions are effective and cost effective in improving oral health and reducing oral health inequalities among groups of adults at high risk of poor oral health?
PH55/2 What community-based interventions are effective and cost effective in improving oral health and reducing oral health inequalities among groups of children at high risk of poor oral health?
PH55/3 What community-based interventions are effective and cost effective at improving the uptake of, and reducing inequalities in the use of, dental services by groups of adults and children at high risk of poor oral health?
PH55/4 How can healthy habits that promote oral health be supported and encouraged in families with children at high risk of poor oral health?
PH55/5 What community-based interventions are effective and cost effective in improving dietary habits affecting the oral health of children and adults, and in particular those at high risk of poor oral health?
PH55/6 What is the relative effectiveness and cost effectiveness of the different components of multi-component, community-based oral health improvement programmes?
PH55/7 How cost effective are fluoride varnish programmes and tooth-brushing schemes?
PH56/1 How effective and cost effective are interventions to increase vitamin D access, uptake, adherence or status among identified at-risk groups? Does effectiveness vary by age, gender, ethnicity, socioeconomic or other specific population characteristics (such as depression or a disability)? The following could be considered:
- availability and uptake of supplements (including the impact of the cost of supplements)
- type of supplements provided and how that impacts on adherence
- knowledge and attitudes (of both the public and health and social care practitioners).
PH56/2 How cost effective are preventive approaches to vitamin D deficiency among all at-risk groups, compared with the cost of testing and treatment? This should include a comparison of universal provision of free supplements with the provision of low or standard cost supplements for different at-risk groups. (If there is any new legislation allowing for the sale of Healthy Start supplements, this would provide an opportunity to test this question.)
PH56/3 How can a multiagency approach to improving awareness, availability and uptake of vitamin D supplements best be established, improved and sustained?
PH56/4 What type of training and awareness-raising can improve how health and social care practitioners:
- promote vitamin D supplements among at-risk groups
- improve the local population's awareness of, and attitudes towards, vitamin D supplements
- uptake of vitamin D supplements?
PH56/5 What is the best way of monitoring the local system for distributing vitamin D supplements?
SG1/1 What is the relationship between the following factors and outcomes related to nursing care, patient safety and patients' and nursing staff satisfaction with the quality of care in the UK?
- Number of nursing staff
- Nursing skill mix
- Shift patterns
SG1/2 How do the following factors affect the nursing staff requirement at ward level in the UK?
- Patient factors
- Patients' nursing needs (sometimes referred to as acuity and dependency)
- Time of day
- Ward layout and size (including the use of single rooms)
- Ward level team leadership and management
- Organisational training approaches
- Organisational policies and procedures (for example, productive ward, Lean)
SG1/3 What is the effectiveness of using defined approaches or decision support toolkits to determine nursing staff requirements and skill mix on acute adult inpatient wards in the UK?
TA161/2 [NICE] recommends research into the long-term effects of bisphosphonates on bone quality, given the inhibitory effects on bone resorption of these drugs.
TA171/1

The Committee considered that rigorous data collection is needed on the life-extending benefits of lenalidomide when used in people with multiple myeloma who have received two or more prior therapies.

TA214/1 Further research designed to investigate differences in health-related quality of life and the clinical effectiveness of bevacizumab in subgroups, such as those with prior taxane exposure, would be particularly useful.
TA216/1 Research should be carried out to compare the clinical effectiveness of bendamustine with chlorambucil at the higher dose used in the Chronic Lymphocytic Leukaemia Trial 4 (CLL4).
TA217/1 Research is needed to generate robust and relevant data on the effects of treating people with Alzheimer’s disease on both short-term and long-term outcomes, disease progression through relevant health states, and quality of life.
TA217/2 Research is needed on the impact of treating Alzheimer’s disease on mortality and institutionalisation, and to assess the relationship between disease progression and carer utility (quality of life).
TA218/1 The Committee recommends that a study estimating utility values using directly observed health-related quality of life values (such as EQ 5D scores) in patients with myelodysplastic syndromes, chronic myelomonocytic leukaemia or acute myeloid leukaemia is conducted.
TA220/1 NICE highlighted the importance of collecting further data within registries of patients receiving biological treatments for psoriatic arthritis to obtain information on long-term outcomes, including adverse events.
TA222/1 NICE proposes that a trial should be undertaken to compare the efficacy of trabectedin plus pegylated liposomal doxorubicin hydrochloride (PLDH) with platinum-based chemotherapy because this is the standard treatment in the platinum-sensitive population.
TA223/1 A trial comparing the long-term effectiveness (beyond 24 weeks) of cilostazol, naftidrofuryl oxalate, pentoxifylline and inositol nicotinate and placebo would be beneficial. It should collect utility data as well as walking distance outcomes.
TA232/1 Research investigating the health-related quality of life of people with epilepsy would be of value.
TA235/1 Further studies on the clinical effectiveness of mifamurtide when combined with the chemotherapy typical of UK clinical practice would be useful to determine the size of the effect of mifamurtide.
TA235/2 Further collection of quality of life data from people who are cured and who have experience of amputation and chemotherapy are also needed. Additional data on the health effects on parents, siblings and others with life-threatening illness would also be of value.
TA236/1 Clinical trials should be conducted comparing ticagrelor with prasugrel in people with acute coronary syndromes (ACS).
TA236/2 Further research into whether ticagrelor is particularly beneficial in any clinical or biological subgroups would be useful.
TA244/1 NICE recommends that a study is conducted to generate robust evidence about the benefits of roflumilast as an add-on to LAMA plus LABA/ICS or LAMA plus LABA for those people who are intolerant to ICS.
TA244/2 Ideally roflumilast should be compared with theophylline in those people for whom theophylline would be suitable.
TA245/1 More trials of apixaban compared with other low molecular weight heparin (LMWHs) in total hip and knee replacement would decrease the uncertainty of the clinical and cost effectiveness of these treatments. Trials directly comparing apixaban with rivaroxaban, dabigatran etexilate and fondaparinux would strengthen the evidence base for these comparisons.
TA250/1 Health-related quality of life studies comparing eribulin with vinorelbine and capecitabine should be conducted.
TA254/1 NICE recommends the development of patient registries for multiple sclerosis to capture long-term treatment-related outcomes.
TA254/2 NICE recommends that a new model for multiple sclerosis is developed, ideally based on UK patient cohorts, which uses the best available evidence (including experience to date from the risk-sharing scheme) and includes all currently available treatments.
TA261/1 Further research on the clinical effectiveness of rivaroxaban compared with low molecular weight heparin (LMWH) in patients with active cancer should be conducted.
TA263/1 Studies exploring the effectiveness of bevacizumab in people previously treated with a taxane and its effects on health-related quality of life.
TA266/1 NICE proposes that a clinical trial is needed to establish the relative effectiveness of mannitol compared with hypertonic saline.
TA271/1 Further research to resolve uncertainties about the cost effectiveness of fluocinolone acetonide intravitreal implant for the treatment of chronic diabetic macular oedema is recommended. This should focus on a group of patients whose condition is unresponsive to other available therapies, and include measures of efficacy and health-related quality of life.
TA272/1 Research on second-line treatments for transitional cell carcinoma of the urothelial tract is needed. It noted that the vinflunine studies were the only studies in patients with transitional cell carcinoma of the urothelial tract whose disease had progressed after platinum-based chemotherapy. It was noted that there is a lack of evidence for the relative effectiveness of treatment options at this stage in the pathway of care. It is recommended that studies be undertaken to investigate the relative safety and efficacy of second-line treatments for transitional cell carcinoma of the urothelial tract, particularly randomised controlled trials.
TA274/1 NICE recommends that further research directly comparing the clinical and cost effectiveness of ranibizumab and bevacizumab in people with diabetic macular oedema should be conducted.
TA275/1 There is a need for additional research on the management of bleeds that occur while people are receiving apixaban, rivaroxaban or dabigatran etexilate, as there are no antidotes or established treatments to stop active bleeding for these agents.
TA275/1

During this appraisal it was noted that there is a need for additional research on the management of bleeds that occur while people are receiving apixaban, rivaroxaban or dabigatran etexilate, as there are no antidotes or established treatments to stop active bleeding for these agents.

TA283/1 NICE concluded that further research directly comparing the clinical and cost effectiveness of ranibizumab and bevacizumab in people with macular oedema secondary to retinal vein occlusion should be conducted.
TA287/1 There have been no head-to-head trials of rivaroxaban compared with a low molecular weight heparin for people who have cancer and experience an acute pulmonary embolism or deep vein thrombosis. As in NICE technology appraisal guidance 261 it is recommended that further research should be carried out.
TA287/2 Research into the long-term treatment effects of rivaroxaban is needed.
TA293/1 NICE recommends that research should be carried out to directly compare eltrombopag with non-thrombopoietin receptor agonist treatments routinely used in UK clinical practice.
TA293/2 NICE recommends research generating and analysing observational data including, but not limited to, the existing UK ITP Registry, which collects data on the long-term outcomes of patients treated with eltrombopag and romiplostim.
TA301/1 Further research is recommended to resolve uncertainties about the cost effectiveness of fluocinolone acetonide intravitreal implant for the treatment of chronic diabetic macular oedema. This should focus on a group of patients whose condition is unresponsive to other available therapies, and include measures of efficacy and health-related quality of life. Research should focus on identifying appropriate utility values, taking into account the utility values for different levels of visual acuity and the relative relationship in utility values from treating the best-seeing and the worse-seeing eye. The appropriateness of generalising utility values from one group of eye conditions to another group would also be of value.
TA304/1 NICE recommended that research should be carried out to determine the relationship between activity and prosthesis failure.
TA304/2 NICE recommended the collection of data on prosthesis failure or on the prevalence of people living with a failed hip but for whom revision surgery is not suitable or who choose not to have revision surgery. NICE further recommended that nomenclature for hip replacement failure needs to be established to allow demarcation of prosthesis-dependent and prosthesisindependent hip replacement failure. Furthermore, patient reported outcome measures collected as part of the National Joint Registry should allow for reporting of hip replacement failure in people who cannot or choose not to have revision surgery.
TA310/1 NICE recognised the importance of further clinical trials comparing the effectiveness of the tyrosine kinase inhibitors (afatinib, erlotinib and gefitinib) in EGFR mutation-positive locally advanced or metastatic NSCLC.
TA316/1 NICE supports the manufacturer's ongoing commitment to collect data on the effectiveness of enzalutamide after previous treatment with abiraterone.
TA316/2 NICE considered that if enzalutamide is used in routine clinical practice for treating hormone relapsed metastatic prostate cancer that has been previously treated with abiraterone, data should be collected on resource use and overall survival.
TA319/1 NICE considered that more research is needed to establish the treatment sequence for vemurafenib and ipilimumab in patients who have BRAF V600 mutation-positive melanoma.
TA319/2 Further research into whether concomitant dacarbazine enhances the clinical effectiveness of ipilimumab would be encouraged because it could provide information for future treatment strategies, as would more data on the relative effectiveness of ipilimumab when given as a first-line or second-line treatment.
TA320/1 NICE recommends further research to better inform future cost-effectiveness models of relapsing-remitting multiple sclerosis. In particular, this research should include a more comprehensive synthesis of available evidence on the underlying disease progression of multiple sclerosis in the UK context, the impact of disability and relapses on preference-based measures of quality of life, and associated resource use and costs.
TA322/1 NICE noted that the cost effectiveness of lenalidomide compared with standard care for people with low- or intermediate-1-risk MDS associated with an isolated deletion 5q cytogenetic abnormality when other therapeutic options are insufficient or inadequate, was sensitive to whether the patient access scheme would be realised in clinical practice. The Committee agreed that it would be critical to generate evidence to support the following:
- The proportion of people who become eligible for the patient access scheme, that is, that they remain on treatment beyond 26 cycles.
- The benefit of lenalidomide after 26 cycles, that is the associated overall survival and health related quality of life for those who remain on treatment beyond 26 cycles.
TA330/1 NICE recommended that clinical data, including genotype and sustained virological response at 12 weeks, is collected for all people treated with sofosbuvir in the NHS.
TA333/1 NICE recommended that clinical data, including genotype and sustained virological response at 12 weeks, are collected for all people having treatment with simeprevir in the NHS.
TA340/1

NICE considered that there is an important need for head-to-head comparisons between biological treatments for psoriatic arthritis, particularly in people for whom treatment with tumour necrosis factor (TNF) alpha inhibitors has been unsuccessful.

TA375/1

NICE agreed that further research would be of value to investigate factors which can predict the likelihood of rapid progression of disease and response to treatment with biological DMARDs. Factors to investigate include:
- persistent elevation of inflammatory markers (such as C-reactive protein [CRP]) and
- presence of erosions on X-ray and
- positive for anti-citrullinated protein antibodies (ACPA).

TA404/1

Further research is recommended to resolve uncertainties about the clinical effectiveness of degarelix compared with luteinising hormone-releasing hormone (LHRH) agonists such as leuprorelin, goserelin and triptorelin for treating advanced hormone-dependent prostate cancer, particularly in subgroups of people with preexisting cardiovascular disease, people with skeletal (including spinal) metastases and people with impending ureteric and urethral obstruction. Research should be planned as part of well-conducted randomised clinical trials.

TA455/1

Trials that evaluate utility values (using generic preference-based measures) in children and young people with severe psoriasis are needed to better inform future cost–utility analyses.

TA467/1

NICE agreed that further research was needed because there is currently no clinical- or cost-effectiveness evidence evaluating the use of Holoclar in both eyes in bilateral patients. The committee was aware of the ongoing HOLOCORE trial which is recruiting both unilateral and bilateral patients, but only evaluates the success of a second transplant in 1 eye rather than transplant success in both eyes.

TA467/2

NICE recommended that further research should be designed to generate robust evidence of the clinical- and cost-effectiveness of Holoclar for treating both eyes in people with bilateral limbal stem cell deficiency after eye burns if they do not have enough tissue for a conjunctival limbal autograft. The study should recruit people with bilateral disease and evaluate the effectiveness of treatment in both eyes. Outcomes should include transplant success and assessments of health-related quality of life using a generic preference-based measure.

TA553/1

Proposals for further data collection in the Cancer Drugs Fund include:
- recurrence-free survival
- distant metastases-free survival
- overall survival
- long-term follow-up of people who received pembrolizumab as an adjuvant treatment
- who develop advanced disease and receive pembrolizumab again to treat metastatic disease.

TA556/1

Further research is recommended to resolve the uncertainties about the long-term clinical effectiveness of darvadstrocel compared with standard care. In particular, estimates of long-term remission rates (minimum of 2 years' follow-up) in Crohn's disease with perianal fistulas are needed.

TA556/2

The health-related quality-of-life evidence of patients with perianal fistulas is also lacking, therefore further research is recommended. Any research should measure the effect of treatment using preference-based measures (such as use of the EQ-5D questionnaire).

TA566/1

What is the benefit of bilateral cochlear implantation compared with unilateral cochlear implantation in adults with severe to profound deafness?

TA574/1

What are the cost associated with best supportive care?

TA575/1

What are the costs associated with best supportive care? 

TA599/1

The committee noted that there was no clinical evidence showing that having sodium zirconium cyclosilicate improved length or quality of life or allowed patients to stay on optimal doses of renin-angiotensin-aldosterone system (RAAS) inhibitors. It therefore considered that it would be valuable to have studies comparing sodium zirconium cyclosilicate plus standard care with standard care alone in people with confirmed hyperkalaemia of 6.0 mmol/litre and above, and that these should investigate:

  • mortality
  • disease progression
  • patterns of RAAS inhibitor use
  • healthcare utilisation, and
  • health-related quality of life.
TA623/1

The committee noted that there was no clinical evidence showing that having patiromer improved length or quality of life or allowed patients to stay on optimal doses of renin-angiotensin-aldosterone system (RAAS) inhibitors. It therefore considered that it would be valuable to have studies comparing patiromer plus standard care with standard care alone in people with confirmed hyperkalaemia of 6.0 mmol/litre and above, and that these should investigate:

- mortality
- disease progression
- patterns of RAAS inhibitor use
- healthcare utilisation and
- health-related quality of life.

The committee recalled that the DIAMOND trial is ongoing and may help to provide evidence on mortality (see section 3.11). However, the trial is not going to complete until 2022. The committee concluded that the guidance should be reviewed when evidence from DIAMOND is available.

TA854/01

Further research is recommended to help address remaining clinical and cost-effectiveness uncertainties for esketamine, summarised in section 3.36.