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Guidance from the National Institute for Clinical Excellence
(NICE) must be implemented more effectively to improve NHS practice. Bloor and colleagues (p 578) analysed surgical repair of inguinal hernias before and after NICE recommended the open mesh
technique rather than laparoscopic repair. One year after the
guidelines were published, the authors found they had had no
impact. They state that although laparoscopic repair of hernias is
a small part of NHS practice, lack of impact suggests that NICE
guidelines need more active dissemination and implementation
procedures.