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  1. 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.

    Recommendation ID IPG668 Question Evidence on the efficacy of open prenatal repair of open neural tube defects in the fetus is adequate

  2. Optimal upper limit and timing for blood glucose measurements after meals for children and young people with type 1 diabetes:- What is the optimal upper limit and timing for blood glucose measurements after meals for children and young people with type 1 diabetes to reach an HbA1c level of 48 mmol/mol (6.5%) without unacceptable hypoglycaemia?

    Recommendation ID NG18/2 Question Optimal upper limit and timing for blood glucose measurements after meals for children and young people

  3. 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?

    Recommendation ID CG183/4 Question Oral antibiotic challenge for diagnosing antibiotic allergy in children:- In children who have a suspected

  4. 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.

    Recommendation ID NG71/2 Question Orthostatic hypotension treatment:- For people with Parkinson's disease, what is the most effective pharmacological

  5. 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?

    Recommendation ID CG184/1 Question Patient characteristics, risk factors and predictors that indicate endoscopy for excluding Barrett's

  6. 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.

    Recommendation ID NG12/4 Question Patient experience:- Qualitative studies are needed to assess the key issues in patient experience and

  7. 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.

    Recommendation ID CG151/2 Question Patient support and information:- A descriptive study involving patients who have had neutropenic sepsis

  8. 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.

    Recommendation ID TA623/1 Question The committee noted that there was no clinical evidence showing that having patiromer improved length

  9. 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.

    Recommendation ID CG30/2 Question Most women will need to use contraception for more than 30 years. Patterns of contraceptive use vary

  10. 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.

    Recommendation ID DG11/2 Question Further research is needed on the impact of faecal calprotectin testing on clinical decision-making when

  11. 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.

    Recommendation ID TA404/1 Question Further research is recommended to resolve uncertainties about the clinical effectiveness of degarelix

  12. 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.

    Recommendation ID TA301/1 Question Further research is recommended to resolve uncertainties about the cost effectiveness of fluocinolone

  13. 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.)

    Recommendation ID PH56/2 Question How cost effective are preventive approaches to vitamin D deficiency among all at-risk groups, compared