NICE clinical guidelines are recommendations about the treatment and care of people with specific diseases and conditions in the NHS in England and Wales.
The guideline was developed by the National Clinical Guideline Centre. The Centre worked with a group of healthcare professionals (including consultants, GPs and nurses), patients and carers, and technical staff, who reviewed the evidence and drafted the recommendations. The recommendations were finalised after public consultation.
The methods and processes for developing NICE clinical guidelines are described in the guidelines manual. This guideline updates and replaces NICE clinical guideline 20 (published October 2004). This guidance also updates and replaces NICE technology appraisal 76 (published March 2004) and NICE technology appraisal 79 (published April 2004).
Recommendations are marked as , [2004, amended 2012],  or [new 2012].
 indicates that the evidence has not been updated and reviewed since 2004.
[2004, amended 2012] indicates that the evidence has not been updated and reviewed since 2004 but a small amendment has been made to the recommendation.
 indicates that the evidence has been reviewed but no changes have been made to the recommendation.
[new 2012] indicates that the evidence has been reviewed and the recommendation has been updated or added.
The recommendations from this guideline have been incorporated into a NICE Pathway. We have produced information for the public explaining this guideline. Tools to help you put the guideline into practice and information about the evidence it is based on are also available.