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                         (including economic modelling) from the evidence used to form recommendations were also
                         prepared. In areas where no substantial evidence was identified, the GDG considered other
                         evidence-based  guidelines  and consensus statements  or used their collective  experience  to
                         identify good practice. The GDG also identified areas where evidence to answer their clinical
                         questions was lacking and used this information to draft recommendations for future research.
                         Towards the end of the guideline development process, formal consensus methods were used to
                         consider all the clinical care recommendations that had been drafted previously. Consensus was
                         again used to agree the wording of recommendations. All recommendations for which at least
                         one GDG member indicated any level of disagreement were discussed at a subsequent GDG
                         meeting, and the final wording was agreed following discussion of the relevant issues.
                         The  GDG identified  key priorities for implementation which were those recommendations
                         expected to have the biggest impact on patients’ care and patients’ outcomes in the NHS as a
                         whole. Each GDG member submitted a paper form indicating their top ten recommendations in
                         order of priority. The GDG members’ votes were collated and priority recommendations were
                         obtained by including all recommendations that had  been  voted for by at least four GDG
                         members in order of popularity.
                         Stakeholder involvement in the guideline development process

                         Registered stakeholder organisations were invited to comment on the draft scope of the
                         guideline and on the draft guideline. Stakeholder organisations were also invited to undertake a
                         pre-publication check of the final guideline to identify factual inaccuracies. The GDG carefully
                         considered and responded to all comments received from stakeholder organisations. The
                         comments and responses,  which were reviewed independently for NICE by a Guidelines
                         Review Panel, are published on the NICE website.



















































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