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On 1 April 2013, NICE became a non-departmental public body in accordance with the Health and Social Care Act 2012. In addition to providing guidance for the NHS and public health communities, the organisation now has responsibility for developing quality standards and guidance for social care in England. To reflect these changes NICE has been renamed the National Institute for Health and Care Excellence.

There can be few colleagues who have not heard about NICE from one source or another. It is often in the national news for the drugs it approves or does not approve for use in the NHS and more recently there has been much debate in the British Dental Journal on the current NICE guideline on wisdom teeth.1

NICE Guidance and using evidence-based practice

NICE states that 'NICE guidance is designed to promote good health and prevent ill health and is produced by the people involved in the work, including health and social care professionals, patients and the public. It is based on best evidence, transparent in its development, consistent, reliable and based on a rigorous development process. It is also good value for money, weighing up the cost and benefits of treatment, as well as being internationally recognised for its excellence'.

A laudable goal and while those guidelines of direct relevance to the general dental practitioner may be few in number, several are still the subject of controversy and concern within the profession. None is currently more hotly debated than clinical guideline TA1, Guidance on the extraction of wisdom teeth, published in March 2000.2 Well over 10 years after the publication of the guideline there is growing body of evidence on this. The consensus of opinion is that it is time for a comprehensive review and this new evidence has now been submitted to NICE for their consideration.

NICE are currently in the early stages of developing guidelines on local authority oral health improvement strategies, oral healthcare in nursing and residential care, and oral health promotion - the patient experience.

Overall and to date NICE has produced guidelines on 417 interventional procedures, 306 technology appraisals, 186 clinical guidelines and 50 public health guidelines, as well as medical technology and diagnostic guidance.

NICE Evidence Services

Picture the scenario: a new patient, a 60-year-old man with a history of a chronic heart disease comes to the surgery with toothache asking that the offending tooth be removed. After an examination and X-ray it is agreed that he requires an extraction as the result of advanced periodontal disease. He has been prescribed a number of medications for his medical condition, including a high dose statin, an ACE inhibitor, aspirin and another drug that you have never heard of. To add to his risk profile, he is a smoker.

Where could you go for fast access to evidence-based information to ensure you are caring for your patient in line with current best practice guidance?

NICE Evidence Services (www.evidence.nhs.uk), provide a range of resources that provide fast and easy access to authoritative clinical and non-clinical information. One of these resources is the Evidence Search feature.

A simple search using this function allows you to identify a broad range of comprehensive evidence that includes the latest NICE and non-NICE clinical guidelines, systematic reviews and medicines information as well as patient information from over 250,000 NICE accredited and non-accredited resources compiled by 1,500 organisations.

British National Formulary

What about that medicine mentioned in the scenario that you have never come across before? This now commonplace problem can simply be solved by accessing the British National Formulary (BNF), or in the case of children, the British National Formulary for Children (BNFC). If you can't find your hard copy of the BNF in the surgery when you need it, both formularies can be accessed through the NICE Evidence Search. Increasingly useful is the information alerting clinicians to any potential drug interactions, side effects, contraindications or cautions to be noted, warfarin and miconazole gel being a case in point.

More recently, NICE has developed a NICE BNF and NICE BNFC app, and both can be downloaded for free. All you need is an NHS Athens user name and password to activate the apps and download the content. Dental care professionals working within the NHS who do not have an NHS Athens password can register via www.evidence.nhs.uk or directly from their smartphone by following the instructions displayed in the Apple App store, the Google Play store or in the app itself.

From 1 April 2013, NICE and UK Medicines Information have brought medicines information together in Evidence Search. Resources previously available through the National Electronic Library for Medicines are now only available via Evidence Search.

Evidence and information for patients

Patients nowadays are usually IT savvy and often access the Internet to find their own information on a disease or condition, the lifestyle options that might improve it or the treatments available, not all of which will be evidence-based.

Evidence Search allows you to search for patient information accredited under the Department of Health's Information Standard.3 So if the patient in the scenario above asks for more information on how to prevent further loss of teeth, all staff can be confident about recommending the use of 'NICE Evidence Search' to find easily understandable accredited information on 'gingivitis and periodontitis'. This ensures that the dental team are providing care that puts people at the centre, involving both patients and their families and carers in making decisions and informed choices about their treatment. Helpful when the Care Quality Commission comes to call.

NICE pathways

As a clinician, one of the biggest challenges is trying to keep up to date with all the advances in medicine, but NICE Pathways provides a simple, intuitive way of accessing a range of information from NICE about health, public health and social care. The pathways include up to date NICE guidance, quality standards and related information, and are a useful starting point for new users to a topic while also giving specialists access to updated recommendations.

To support the patient in the scenario to quit smoking, you could access the relevant NICE pathway (http://pathways.nice.org.uk/pathways/smoking). This would allow you to see at a glance what NICE recommends around smoking, including clinical guidelines, technology appraisals and public health guidance. The pathway allows easy drilling down of information to find the most appropriate recommendations for your patient.

Working through the scenario helps demonstrate how NICE Evidence Services can be used to support the delivery of excellent patient care. But there is more to NICE Evidence Services that can be used to help support the whole dental team in the delivery of best practice.

My evidence

A useful tool in keeping up to date is the 'My evidence' function of NICE Evidence Search. It provides the option of creating a personal log to save searches and to set up alerts when new information relating to any saved searched becomes available. It is also a useful facility in terms of saving information for continuing professional development and the forthcoming revalidation programme by the General Dental Council (GDC).

NICE also provides a number of bulletins, alerts and evidence awareness services that helps one keep up to date with important new evidence.

Journals and databases on NICE Evidence Services

The 'Journals and databases' section of NICE Evidence Services allows access to more comprehensive information for research or other purposes. This service provides access to a number of journals and databases such as MEDLINE, the Journal of the American Medical Association, Cochrane reviews and Pubmed.

These resources are procured by NICE and require an Open/NHS Athens password, which is free to all eligible NHS employees and can be accessed as above.

NICE clinical knowledge summaries and A-z of topics

Other useful parts of NICE Evidence Services are the NICE Clinical Knowledge Summaries (CKS) and the A-Z of topics. These provide summaries of the best available evidence and practical guidance on good practice in an accessible, easy to use scenario-based format, covering a full range of primary care presentations for over 300 conditions ranging from acne to warts. From a dental point of view, there is information on apthous ulcers, analgesia for mild to moderate pain, teething and trigeminal neuralgia to name but a few. The topic pages include subjects such as head, neck and oral cancers, Bell's palsy, sinusitis as well as caries and periodontal disease. The number of summaries and topics covered is growing rapidly and is regularly updated. They have all been carefully selected from high quality sources of information and are well worth a browse.

UK database of uncertainties about the effect of treatments (UK DUETs)

This interesting section on the NICE Evidence Services website currently contains about 80 references to dental uncertainties and provides researchers and research funders with access to the 'known unknowns' in the evidence base.

Conclusion

This article provides a mere snapshot of the wealth of information available on the NICE website.

Easily accessible, comprehensive, up to date quality information and evidence is a fundamental requirement in ensuring that patients experience safe and effective evidence-based person-centred care and this website goes a long way to assist the dental team in providing this care.

NICE fellowships and scholarships

NICE Fellows are senior health and social care leaders who are ambassadors for the Institute at regional and national levels and among their professional groups and peers. Over the course of the 3-year fellowship NICE Fellows have the opportunity to use their expertise to shape the Institute's guidance programmes and initiatives. As well as shaping guidance, being appointed a Fellow can support an individual's professional development.

NICE Scholarships are 1-year opportunities for qualified health and social care professionals to find out about the inner workings of NICE and undertake a supported improvement project, related to NICE guidance, within their local organisation. For more information on these awards visit the NICE website at www.nice.org.uk.