NICE short clinical guideline (SCG)
development: An overview of the
role of the information specialist
Lynda Ayiku and Hanna Lewin (NICE Information Specialists)
What is NICE?
• The National Institute for Health and Clinical Excellence
(NICE) was set up in 1999 and is responsible for
– providing national guidance on the promotion of good
health and the prevention and treatment of ill health
– setting quality standards
– managing NHS Evidence
Minhas, R. BMJ 2006;332:1394
Copyright ©2006 BMJ Publishing Group Ltd.
The information services team at NICE
The NICE
information
services team
provides
“professional expertise to
enable access to quality
information. Their work
supports NICE staff,
contributes directly to the
development of guidance and
the work of the Directorates,
and facilitates the
development of a knowledgeled culture at NICE” (NICE
Business plan)
Presentation overview
1. Introduction to NICE clinical guidelines
2. Role of information specialists in the
development of NICE short clinical guidelines
3. Collaboration to share knowledge and best
practice
NICE clinical guidelines
• NICE clinical guidelines are recommendations on the appropriate
treatment and care of people with specific diseases and conditions
within the NHS in England and Wales
• Standard clinical guidelines (CGs):
– cover the full pathway of care for diseases and conditions
– are developed externally by national collaborating centres (NCCs)
that are contracted by NICE
• Short clinical guidelines (SCGs):
– cover a specific aspect of the pathway of care for diseases and
conditions
– are produced in-house at NICE
• Guideline topics are referred to NICE by the Department of Health
NICE clinical guideline development
Draft scope
Stakeholder consultation
Final scope
Scoping
GDG develops guideline
Development
Stakeholder consultation
Consultation on draft guideline
Revise guideline after comments
Pre-publication check
Prepare and publish guideline
Validation
Final guideline published
Publication and dissemination
NICE short clinical guidelines (SCGs)
• The NICE SCG programme was established in 2006
• SCGs are developed to the same rigorous methods as standard
clinical guidelines but they are produced in 11-13 months
(instead of 18-24 months)
• They allow the rapid development of guidance on aspects of
care for which the NHS requires urgent advice
NICE short clinical guidelines
To date, 7 SCGs have been published on a wide variety of topics:
•
CG96 Neuropathic pain: the pharmacological management of neuropathic pain in adults
in non-specialist settings (Mar 2010)
•
CG93 Donor breast milk banks: the operation of donor breast milk bank services (Feb
2010)
•
CG86 Recognition and assessment of coeliac disease (May 2009)
•
CG83 Rehabilitation after critical illness (Mar 2009)
•
CG69 Prescribing of antibiotics for self-limiting respiratory tract infections in adults and
children in primary care (Jul 2008)
•
CG64 Antimicrobial prophylaxis against infective endocarditis (Mar 2008)
•
CG50 Acutely ill patients in hospital (Jul 2007)
Role of information specialists
• A core team of 5 NICE information specialists (ISs) provide information
support for SCGs (led by a senior information specialist)
• They work alongside a multidisciplinary NICE technical team including
technical analysts, health economists, clinical advisers, and medical
editors to aid the development of SCGs
• ISs are involved throughout all SCG development stages:
1. Topic selection
2. Scoping
3. Development
Topic selection
• The Department of Health sometimes suggests topics directly to
NICE
• Topics for potential guidance are suggested to NICE by
organisations such as the National Horizon Scanning Centre (Univ. of
Birmingham)
• Topics are also suggested by health professionals, patients, and
members of the public – ISs filter topic suggestions to assist with the
identification of potential SCG topics
Scoping
•
DH Referral
– Department of Health refers SCG topics to NICE. The referred topics
are usually broad and non-specific
•
Scoping searches
– ISs conduct comprehensive high level scoping searches for
guidance documents, economic evaluations, and systematic reviews
– aim to identify gaps in evidence to help focus SCGs on aspects of
care where current guidance is insufficient or contradictory
•
Scope document
– developed by the technical analysts and health economists based on
the findings of the scoping search
– sets out the focus of the SCG topic, lists the proposed guideline
review questions, and states inclusion/exclusion criteria
Scoping workshops - working with experts
•
Scoping workshops
–
a scoping workshop is held during the SCG scoping stage
–
health professionals and patient representatives attend the
workshops to discuss the proposed SCG scope. The purpose
is to ensure that the scope is feasible and relevant for NHS
clinical practice
–
the technical team amends the scope as required on the basis
of the feedback from the meetings
–
ISs attend the meetings to gain a greater understanding of the
SCG topic to help with the development literature searches
Example of IS role in scoping: CG93 Donor breast
milk banks (Feb 2010)
• Original DH remit
– To produce a short clinical guideline on the use of human donor
breast milk in preterm babies
• However scoping search results and experts’ feedback highlighted
benefits of donor breast milk for full-term as well as pre-term babies
• In addition, scoping searches and expert feedback indicated that
comprehensive, high quality guidance was required on delivering donor
milk bank services
• As a result of these scoping activities, the remit was broadened and the
title was changed to
– Donor breast milk banks: the operation of donor breast milk
bank services
Development
•
Guideline review questions
– each SCG has 4-6 review questions that make up the guideline
– the technical analysts and health economists produce structured questions
(PICOs) for each of the review questions
– information specialists use the PICOs to inform the development of
literature searches
•
Development literature searches
In adherence with the methods detailed in the NICE Guidelines Manual (2009),
literature searches are conducted to answer each guideline review question.
This involves:
– determining which sources to search (core databases include Medline,
Embase, and the Cochrane Library)
– developing search strategies to search sources effectively and efficiently
– creating and maintaining reference management databases
– documenting the search process
GDG meetings – working with experts
• Guideline Development Group (GDG) meetings
– 4 GDG meetings are held for each SCG topic
– attended by the NICE technical team and recruited external GDG
members (clinicians, patient representatives, and other experts)
– GDG members are responsible for developing guideline
recommendations based on literature search evidence and expert
consensus
– ISs present their literature search methods at GDG meetings and
are responsible for answering queries about the searches
IS role in development example: CG 96
Neuropathic pain (March 2010)
• Referred by DH 19th wave
August 2008
– Scoping searches
conducted October 2008
• Development phase Feb-Oct
2009
– Development literature
searches completed April
2009
• Guideline published March
2010
Guideline reviews questions - CG 96
Neuropathic pain (March 2010)
• Full title - Neuropathic pain: the pharmacological management of
neuropathic pain in adults in non-specialist settings
• 4 guideline review questions on the following pharmacological
interventions:
–
–
–
–
antidepressants
anti-epileptics
opioid analgesics
topical pain preparations
Search example: CG96 Neuropathic pain
(March 2010)
1. (neuropathic$ adj3 pain$).tw.
2. Diabetic Neuropathies/
3. (diabet$ adj3 neurop$).tw.
4. Neuralgia, Postherpetic/
5. (postherp$ adj3 neuralg$).tw.
6. Trigeminal Neuralgia/
7. (trigemin$ adj3 neuralg$).tw.
8. (central$ adj3 pain).tw.
9. etc…
10. or/1-9
11. antidepressants search terms
12. anti-epileptics search terms
13. opioid analgesics search terms
14. topical pain preparations search
terms
15. or/11-14
16. 10 and 15
•
A total of 23,207 studies retrieved
by the systematic searches
– antidepressants = 2781
– anti-epileptics = 4757
– opioid analgesics = 9612
– topical pain preparations=
6057
•
A total of104 studies included in
the guideline:
– 90 randomised placebocontrolled trials
– 10 head-to-head comparative
trials
– 4 combination therapy trials
Collaboration
• Collaborate with National Collaborating Centre (NCC) information
professionals:
– best practice is shared and developed between the information
professionals at NICE and the NCCs by a dedicated discussion
list and bi-annual meetings
– joint working groups are set up as necessary to take forward
specific methodological issues
• Participate in a range of professional interest groups. For example:
– Consortium of Independent Health Information Libraries in
London (CHILL) and Library and Information Health Network
North West (LIHNN)
– Health Technology Assessment International (HTAi) and
Special Interest Group on Information Resources (SPIG-IR)
– Guidelines International Network (GIN) - SEARCH group
Any questions?
NICE Information Services: InformationServices@nice.org.uk
Lynda Ayiku: lynda.ayiku@nice.org.uk
Hanna Lewin: hanna.lewin@nice.org.uk