Intrapartum care

This guideline covers the care of women and their babies during labour and immediately after birth. It focuses on women who give birth between 37 and 42 weeks of pregnancy ('term'). The guideline helps women to make informed choices about where to have their baby and about their care in labour. It also aims to reduce variation in aspects of care.

Spinal metastases and metastatic spinal cord compression

This guideline covers recognition, referral, investigation and management of spinal metastases and metastatic spinal cord compression (MSCC). It is also relevant for direct malignant infiltration of the spine and associated cord compression. It aims to improve early diagnosis and treatment to prevent neurological injury and improve prognosis.

MRI fusion biopsy systems for diagnosing prostate cancer

This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer. All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme. Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures. Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Automated ankle brachial pressure index measurement devices to detect peripheral arterial disease in people with leg ulcers

Evidence-based recommendations on automated ankle brachial pressure index measurement devices to detect peripheral arterial disease in people with leg ulcers.

Intramuscular diaphragm stimulation for ventilator-dependent chronic respiratory failure from high spinal cord injuries

Intramuscular diaphragm stimulation for ventilator-dependent chronic respiratory failure from high spinal cord injuries should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.

Head injury: assessment and early management

This guideline covers assessment and early management of head injury in babies, children, young people and adults. It aims to ensure that people have the right care for the severity of their head injury, including direct referral to specialist care if needed.

Risankizumab for previously treated moderately to severely active Crohn's disease

Evidence-based recommendations on risankizumab (Skyrizi) for previously treated moderately to severely active Crohn's disease in people 16 years and over.

Ciltacabtagene autoleucel for treating relapsed or refractory multiple myeloma (terminated appraisal)

NICE is unable to make a recommendation on ciltacabtagene autoleucel (Carvykti) for treating relapsed or refractory multiple myeloma in adults. This is because Janssen withdrew its evidence submission for the appraisal. We will review this decision if the company decides to make a submission.

Difelikefalin for treating pruritus in people having haemodialysis

Evidence-based recommendations on difelikefalin (Kapruvia) for pruritus in adults with chronic kidney disease having haemodialysis.

Digitally enabled therapies for adults with anxiety disorders: early value assessment

Six digitally enabled therapies can be used as treatment options for adults with anxiety disorders while further evidence is generated on their clinical and cost effectiveness, once they have appropriate approval. The following technologies can only be used once they have Digital Technology Assessment Criteria (DTAC) approval and an NHS Talking Therapies for anxiety and depression digitally enabled therapies assessment from NHS England: • Beating the Blues (365 Health Solutions) for generalised anxiety symptoms or unspecified anxiety disorder • iCT-PTSD (OxCADAT) for post-traumatic stress disorder (PTSD) • iCT-SAD (OxCADAT) for social anxiety disorder • Space from Anxiety (SilverCloud) for generalised anxiety symptoms or unspecified anxiety disorder. The following technologies can only be used once they have CE or UK Conformity Assessed (UKCA) mark approval, DTAC approval and an NHS Talking Therapies for anxiety and depression digitally enabled therapies assessment: • Perspectives (Koa Health) for body dysmorphic disorder (BDD) • Spring (Cardiff University) for PTSD. Low intensity interventions should be supported by a psychological wellbeing practitioner and high intensity interventions by a high intensity therapist in NHS Talking Therapies for anxiety and depression services.

Digitally enabled therapies for adults with depression: early value assessment

Three digitally enabled therapies can be used as treatment options for adults with depression while further evidence is generated on their clinical and cost effectiveness. The therapies should be used with support from a trained practitioner or therapist in NHS Talking Therapies for anxiety and depression services. These technologies can be used once they have Digital Technology Assessment Criteria (DTAC) approval and an NHS Talking Therapies for anxiety and depression digitally enabled therapies assessment from NHS England.

Olaparib for adjuvant treatment of BRCA mutation-positive HER2-negative high-risk early breast cancer after chemotherapy

People with BRCA mutation-positive HER2­negative high-risk early breast cancer usually have chemotherapy followed by surgery (neoadjuvant chemotherapy), or surgery followed by chemotherapy (adjuvant chemotherapy). Clinical trial evidence shows that, compared with placebo, olaparib after neoadjuvant or adjuvant chemotherapy decreases the chance of the cancer returning or getting worse, and increases the length of time people live. The cost-effectiveness estimates for olaparib are within what NICE considers to be an acceptable use of NHS resources. So, olaparib is recommended.

Olaparib for previously treated BRCA mutation-positive hormone-relapsed metastatic prostate cancer

This evaluation uses new cost-effectiveness estimates to update olaparib for previously treated BRCA mutation-positive hormone-relapsed metastatic prostate cancer (NICE technology appraisal guidance TA831). No new clinical evidence was reviewed. Treatments for BRCA mutation-positive hormone-relapsed metastatic prostate cancer that has progressed after enzalutamide or abiraterone include taxanes (for example, docetaxel or cabazitaxel), radium­223 dichloride and best supportive care. The company provided evidence based on whether or not people had already had a taxane. This is because people have different treatments depending on whether they have had a taxane before. Clinical trial evidence shows that people taking olaparib have more time before their cancer gets worse, and live longer overall, than people having retreatment with abiraterone or enzalutamide. However, this retreatment is not considered effective and is not standard care in the NHS. For people who have had a taxane before, olaparib has not been directly compared with docetaxel, cabazitaxel or radium­223 dichloride. An indirect comparison suggests that olaparib increases how long people live compared with cabazitaxel. For people who have not had a taxane before there is also no direct evidence comparing olaparib with docetaxel or best supportive care. But an exploratory indirect comparison suggests that olaparib may increase how long people live compared with both best supportive care and docetaxel. Olaparib likely meets NICE's criteria for a life-extending treatment at the end of life. When taking this into account, the most likely cost-effectiveness estimates are within what NICE considers an acceptable use of NHS resources. So olaparib is recommended.

Olaparib for previously treated BRCA mutation-positive hormone-relapsed metastatic prostate cancer

Evidence-based recommendations on olaparib (Lynparza) for previously treated BRCA mutation-positive hormone-relapsed metastatic prostate cancer in adults. Commercial arrangement There is a simple discount patient access scheme for olaparib. NHS organisations can get details on the Commercial Access and Pricing (CAP) Portal. Non-NHS organisations can contact Market.AccessUK@astrazeneca.com for details.

Point-of-care tests for urinary tract infections to improve antimicrobial prescribing: early value assessment

Early value assessment (EVA) guidance on point-of-care tests for urinary tract infections to improve antimicrobial prescribing. Guidance development process Early value assessment (EVA) guidance rapidly provides recommendations on promising health technologies that have the potential to address national unmet need. NICE has assessed early evidence on these technologies to determine if earlier patient and system access in the NHS is appropriate while further evidence is generated. The diagnostics advisory committee has considered the evidence and the views of clinical and patient experts. This topic is part of the pilot using the new EVA approach. How we develop NICE early value assessment guidance

Tafasitamab with lenalidomide for treating relapsed or refractory diffuse large B-cell lymphoma

People with relapsed or refractory diffuse large B-cell lymphoma who cannot have an autologous stem cell transplant usually have polatuzumab vedotin plus rituximab and bendamustine. The clinical evidence is from a small study that did not directly compare tafasitamab plus lenalidomide with any other treatment. The committee considered that the study results were promising because they show that some people's disease responds to tafasitamab plus lenalidomide. Indirect evidence suggests that people who have tafasitamab plus lenalidomide have more time before their disease gets worse than people who have polatuzumab vedotin plus rituximab and bendamustine. It also suggests that they live longer. But there is uncertainty about these results because the survival times for people having polatuzumab vedotin plus rituximab and bendamustine used in the modelling do not reflect the real-world survival times of the treatment in clinical practice, compared with bendamustine and rituximab alone. The methods used for the indirect comparisons are also not clear.

Capmatinib for treating advanced non-small-cell lung cancer with MET exon 14 skipping (terminated appraisal)

NICE is unable to make a recommendation on capmatinib (Tabrecta) for treating advanced non-small-cell lung cancer with MET exon 14 skipping in adults. This is because Novartis Pharmaceuticals did not provide an evidence submission. We will review this decision if the company decides to make a submission.

Pembrolizumab plus chemotherapy with or without bevacizumab for persistent, recurrent or metastatic cervical cancer

Evidence-based recommendations on pembrolizumab (Keytruda) plus chemotherapy with or without bevacizumab for persistent, recurrent or metastatic cervical cancer in adults.

Voclosporin with mycophenolate mofetil for treating lupus nephritis

Evidence-based recommendations on voclosporin (Lupkynis) with mycophenolate mofetil for treating lupus nephritis in adults.

Ripretinib for treating advanced gastrointestinal stromal tumour after 3 or more treatments

Evidence-based recommendations on ripretinib (Qinlock) for treating gastrointestinal stromal tumour in adults after 3 or more treatments.