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  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.

    Recommendation ID DG38/1 Question The committee recommended that further research is needed to measure the wider effects on public health

  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.

    Recommendation ID DG39/2 Question Further research is recommended to assess the effect of test-guided preventive care (see section 5.1)

  3. 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 ).

    Recommendation ID DG39/1 Question Companies should specify patient populations in the NHS who could benefit from test-guided preventive

  4. 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.

    Recommendation ID TA599/1 Question The committee noted that there was no clinical evidence showing that having sodium zirconium cyclosilicate

  5. 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.

    Recommendation ID IPG666/1 Question NICE may update this guidance after 3 years or sooner if important new information becomes available

  6. 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.

    Recommendation ID IPG654/1 Question The evidence on the safety of reinforcement of a permanent stoma with a synthetic or biological mesh