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National Guideline Centre (UK). Suspected neurological conditions: recognition and referral. London: National Institute for Health and Care Excellence (NICE); 2019 May. (NICE Guideline, No. 127.)
3.1. What is a NICE guideline?
NICE guidelines are recommendations for the care of individuals in specific clinical conditions or circumstances within the NHS – from prevention and self-care through primary and secondary care to more specialised services. These may also include elements of social care or public health measures. We base our guidelines on the best available research evidence with the aim of improving the quality of healthcare. We use predetermined and systematic methods to identify and evaluate the evidence relating to specific review questions.
NICE guidelines can:
- provide recommendations for the treatment and care of people by health professionals
- be used to develop standards to assess the clinical practice of individual health professionals
- be used in the education and training of health professionals
- help patients to make informed decisions
- improve communication between patients and health professionals.
While guidelines assist the practice of healthcare professionals, they do not replace their knowledge and skills.
We produce our guidelines using the following steps:
- A guideline topic is referred to NICE from NHS England.
- Stakeholders register an interest in the guideline and are consulted throughout the development process.
- The scope is prepared by the National Guideline Centre (NGC).
- The NGC establishes a guideline committee.
- A draft guideline is produced after the group assesses the available evidence and makes recommendations.
- There is a consultation on the draft guideline.
- The final guideline is produced.
The NGC and NICE produce a number of versions of this guideline:
- The ‘full guideline’ contains all the recommendations, plus details of the methods used and the underpinning evidence.
- The ‘NICE guideline’ lists the recommendations.
- ‘Information for the public’ is written using suitable language for people without specialist medical knowledge.
- NICE Pathways bring together all connected NICE guidance.
This version is the full version. The other versions can be downloaded from NICE at www.nice.org.uk.
3.2. Remit
NICE received the remit for this guideline from NHS England. NICE commissioned the NGC to produce the guideline.
The remit for this guideline is to produce a guideline on the assessment, diagnosis and referral of suspected neurological conditions.
3.3. Who developed this guideline?
A multidisciplinary guideline committee comprising health professionals and researchers as well as lay members developed this guideline (see the list of guideline committee members and the acknowledgements).
The National Institute for Health and Care Excellence (NICE) funds the National Guideline Centre (NGC) and thus supported the development of this guideline. The committee was convened by the NGC and chaired by Richard Grünewald in accordance with guidance from NICE.
The group met approximately every 5 to 6 weeks during the development of the guideline. At the start of the guideline development process, all committee members declared interests including consultancies, fee-paid work, shareholdings, fellowships and support from the healthcare industry. At all subsequent committee meetings, members declared arising conflicts of interest.
Members were either required to withdraw completely or for part of the discussion if their declared interest made it appropriate. The details of declared interests and the actions taken are shown in appendix B.
Staff from the NGC provided methodological support and guidance for the development process. The team working on the guideline included a project manager, systematic reviewers (research fellows), health economists and information specialists. They undertook systematic searches of the literature, appraised the evidence, conducted meta-analysis and cost-effectiveness analysis where appropriate and drafted the guideline in collaboration with the committee.
3.3.1. What this guideline covers
This guideline will cover children, young people and adults who present in non-specialist settings with symptoms suggestive of a neurological condition. Children aged 5 years and under have been identified as a subgroup needing specific consideration. For further details, please refer to the scope in appendix A and the review questions in section 4.3.
3.3.2. What this guideline does not cover
This guideline does not cover neonates (infants aged 28 days and under).
3.3.3. Relationships between the guideline and other NICE guidance
Related NICE guidelines:
- Chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy): diagnosis and management. NICE guideline CG53. August 2007
- Meningitis (bacterial) and meningococcal septicaemia in under 16s: recognition, diagnosis andmanagement. NICE guideline CG102. June 2010.
- Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcoholdependence. NICE guideline CG115. February 2011.
- Autism spectrum disorder in under 19s: recognition, referral and diagnosis. NICE guideline CG128. September 2011.
- Patient experience in adult NHS services: improving the experience of care for people using adultNHS services. NICE guideline CG138. February 2012.
- Headaches in over 12s: diagnosis and management. NICE guideline CG150. September 2012.
- Falls in older people: assessing risk and prevention. NICE guideline CG161. June 2013.
- Head injury: assessment and early management. NICE guideline CG176. January 2014.
- Transient loss of consciousness (‘blackouts’) in over 16s. NICE guideline CG109. September 2014.
- Multiple sclerosis in adults: management. NICE guideline CG186. October 2014.
- Obesity: identification, assessment and management. NICE guideline CG189. November 2014.
- Gastro-oesophageal reflux disease in children and young people: diagnosis and management. NICE guideline NG1. January 2015.
- Suspected cancer: recognition and referral. NICE guideline NG12. June 2015.
- Coeliac disease: recognition, assessment and management. NICE guideline. NG20. September 2015
- Epilepsies: diagnosis and management. NICE guideline CG137. February 2016.
- Motor neurone disease: assessment and management. NICE guideline NG42. February 2016.
- Spinal injury: assessment and initial management. NICE NG41. February 2016.
- Sepsis: recognition, diagnosis and early management. NICE guideline NG51. July 2016.
- Low back pain and sciatica in over 16s: assessment and management. NICE guideline NG59. November 2016.
- Cerebral palsy in under 25s: assessment and management. NICE guideline NG62. January 2017.
- Neuropathic pain in adults: pharmacological management in non-specialist settings. NICE guideline CG173. February 2017.
- Stroke and transient ischaemic attack in over 16s. NICE guideline CG68. March 2017.
- Constipation in children and young people: diagnosis and management. NICE guideline CG99. July 2017.
Related NICE guidance currently in development
- Parkinson’s disease in over 20s: diagnosis and management. NICE guideline. Publication expected July 2017.
- Attention deficit hyperactivity disorder (update). NICE guideline. Publication expected February 2018.
- Dementia: assessment, management and support for people living with dementia and theircarers. NICE guideline. Publication expected June 2018.
- Brain tumours (primary) and brain metastases in adults. NICE guideline. Publication expected July 2018.
- Development of the guideline - Suspected neurological conditionsDevelopment of the guideline - Suspected neurological conditions
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