Persius/hicric huggingface dataset:
Trabeculectomy with a biodegradable collagen matrix implant for glaucoma

Evidence-based recommendations on trabeculectomy with a biodegradable collagen matrix implant for glaucoma. This involves cutting a small flap in the white of the eye and putting a patch over the flap to help healing and prevent scarring. Fluid slowly drains out of the flap and the patch dissolves over time. The aim is to reduce pressure in the eye and slow or stop damage to sight.

# Recommendations
Evidence on the safety and efficacy of trabeculectomy with biodegradable collagen matrix implant for glaucoma is adequate to support using this procedure, provided that standard arrangements are in place for clinical governance, consent and audit. Find out what standard arrangements mean on the NICE interventional procedures guidance page.
Audit and review clinical outcomes of everyone having the procedure. The main efficacy and safety outcomes identified in this guidance can be entered into NICE's interventional procedure outcomes audit tool (for use at local discretion).# The condition, current treatments and procedure

# The condition
Glaucoma is usually a chronic condition associated with raised intraocular pressure. It leads to progressive damage to the optic nerve. Early stages are usually asymptomatic. But, as the condition progresses, it causes visual field impairment and, if untreated, blindness. There are several types of glaucoma but the most common type of glaucoma in the UK is primary (or chronic) open-angle glaucoma.

# Current treatments
NICE's guideline on glaucoma describes its diagnosis and management. Treatment usually involves eye drops containing different drugs that either reduce aqueous humour production or increase its drainage. Surgical procedures such as trabeculectomy, drainage tubes, deep sclerectomy, viscocanalostomy, laser trabeculoplasty and cyclodiode laser treatment may also be used.

# The procedure
Trabeculectomy with an adjunctive biodegradable collagen matrix aims to modify wound healing and improve the drainage of aqueous humour to lower intraocular pressure. It reduces or avoids the use of antimetabolites and antifibrotic agents (mitomycin C, 5fluorouracil).
In this procedure, with the person under local (intracameral) anaesthesia, the conjunctiva is lifted (or an opening is created) to access the sclera, and then a partial-thickness scleral flap is dissected. Within the scleral bed, a full-thickness opening (or a perforating scleral entrance) is created into the anterior chamber, to allow drainage of aqueous humour. Sometimes trabecular meshwork and adjacent structures are also removed. The scleral flap is then sutured loosely with 1 or 2 loops, to allow the aqueous fluid to drain into the subconjunctival space through the scleral hole. Cohesive viscoelastic is injected under the scleral flap. Then a subconjunctival biodegradable collagen matrix implant is placed directly on top of the scleral flap, and the conjunctiva is sutured (using continuous sutures) and closed around it.
Transcutaneous electrical stimulation of the trigeminal nerve for ADHD

Evidence-based recommendations on transcutaneous electrical stimulation of the trigeminal nerve for ADHD. This involves a single-use electrode patch stuck to the forehead, which sends small electrical pulses through the skin during sleep.

# Recommendations
Evidence on the safety and efficacy of transcutaneous electrical stimulation of the trigeminal nerve for attention deficit hyperactivity disorder (ADHD) is inadequate in quality and quantity. Therefore, this procedure should only be used in the context of research. Find out what only in research means on the NICE interventional procedures guidance page.
Further research could be in the form of multicentre, shamcontrolled (or other suitable comparator) trials and should include details of patient selection, treatment protocols, adherence and long-term outcomes.# The condition, current treatments and procedure

# The condition
Attention deficit hyperactivity disorder (ADHD) is a heterogeneous disorder characterised by the core symptoms of hyperactivity, impulsivity and inattention, which are judged excessive for the person's age or level of overall development. Symptoms are usually evident in childhood and may persist into adulthood.

# Current treatments
Treatment for ADHD may be non-pharmacological, pharmacological or a combination of both. Non-pharmacological treatment includes cognitive behavioural therapy and parenttraining programmes (for parents of children and young people with ADHD). Pharmacological treatment includes central nervous system stimulants such as methylphenidate and amphetamines, and non-stimulants such as atomoxetine.

# The procedure
In this procedure, an external trigeminal nerve stimulation device is worn on the clothes and attached by wires to a single-use adhesive patch which is worn overnight. The patch contains 2 electrodes placed over the left and right V1 branches of the trigeminal nerve on the forehead. The stimulator bilaterally stimulates the trigeminal nerve for approximately 8 hours. For children, parents or carers attach the device. In a typical treatment course, stimulation is given nightly for approximately 4 weeks. Treatment duration may vary; a clinical response may take longer, and continued therapy may be needed.
The mechanism of action is not completely understood. The trigeminal nerve connects to regions of the brain that may be associated with selective maintenance of attention and arousal, and it is thought that its stimulation improves the symptoms of ADHD.
Percutaneous ultrasound-guided microwave ablation for symptomatic benign thyroid nodules

Evidence-based recommendations on percutaneous ultrasound-guided microwave ablation for symptomatic benign thyroid nodules . This involves inserting a thin wire into the nodule under local anaesthetic and guiding it into position using ultrasound. Microwaves from the wire heat the nodule to destroy it (ablation). The aim is to make the nodule smaller, relieve symptoms and improve appearance.

# Recommendations
Evidence on the safety of percutaneous ultrasound-guided microwave ablation for symptomatic benign thyroid nodules shows some well-recognised complications. Evidence on efficacy is adequate. Therefore, this procedure can be used provided standard arrangements are in place for clinical governance, consent and audit. Find out what standard arrangements mean on the NICE interventional procedures guidance page.
Patient selection should be done by a multidisciplinary team.
This procedure should only be done by a clinician with experience in the procedure and specific training in thyroid ultrasound.
Patients should be assessed to exclude thyroid cancer before the procedure.
Immediate support should be available to deal with airway complications.# The condition, current treatments and procedure

# The condition
Thyroid nodules may be cystic, colloid, hyperplastic, adenomatous, or cancerous. Most are benign and often asymptomatic. They may be single (solitary nodule) or multiple (multinodular goitre). Some thyroid nodules produce thyroxine or triiodothyronine and cause thyrotoxicosis. These are called hyperfunctioning or toxic thyroid nodules.

# Current treatments
Benign thyroid nodules may need treatment if they are symptomatic or causing cosmetic problems. Conventional treatment includes surgery. Less invasive alternatives to surgery include ethanol ablation, percutaneous laser ablation, high intensity focused ultrasound ablation and radiofrequency ablation.

# The procedure
Ultrasound-guided percutaneous microwave ablation for symptomatic benign thyroid nodules is a minimally invasive procedure done in an outpatient setting using local anaesthesia. The aim is to reduce symptoms and improve cosmetic appearance by making the nodule smaller while preserving thyroid function and with fewer complications than surgery.
The patient is placed in the supine position with moderate neck extension. A microwave antenna is inserted into the nodule using ultrasound guidance to visualise the electrode during the procedure. Once in position, the microwave antenna is activated to heat and destroy the tissue by coagulative necrosis. The antenna may be repositioned to ensure that most of the nodule is ablated.
Extracorporeal shockwave therapy for calcific tendinopathy in the shoulder

Evidence-based recommendations on extracorporeal shockwave therapy for calcific tendinopathy in the shoulder. This involves placing a device on the skin that delivers short pulses of sound into the shoulder. The aim is to reduce pain and improve shoulder function.

# Recommendations
Evidence on the safety of extracorporeal shockwave therapy for calcific tendinopathy in the shoulder shows no major safety concerns in the short term. Evidence on efficacy is inadequate. Therefore, this procedure should only be used in the context of research. Find out what only in research means on the NICE interventional procedures guidance page.
Further research should include randomised controlled trials comparing the procedure with current best practice. It should report details of patient selection, including site and density of calcification, duration of symptoms, and other treatments used at the same time. It should also report details of the technique, including dose and number of treatments, and long-term safety outcomes.# The condition, current treatments and procedure

# The condition
Calcific tendinopathy (also known as calcific tendonitis) is a disorder of the shoulder characterised by the formation of deposits of calcium crystals in 1 or more of the rotator cuff tendons. It can cause symptoms such as pain in the upper arm and shoulder, reduced range of movement, stiffness and weakness. The exact cause is unknown.

# Current treatments
Most cases of calcific tendinopathy resolve in time without treatment. In the early stages, symptom management includes painkillers and anti-inflammatory medication. If symptoms persist, physiotherapy may be needed. Other treatment options include steroid injection, percutaneous lavage or barbotage (using a needle to suck up or break up the calcium deposits), or surgery.

# The procedure
Extracorporeal shockwave therapy (ESWT) is a non-invasive treatment in which a device is used to pass controlled, short-duration acoustic shockwaves through the skin to the affected area. This produces transient pressure disturbances, which break up calcium deposits. There are 2 different types of ESWT. In focused ESWT the energy generated converges at a selected depth in the body tissues where the maximal pressure is reached. In radial ESWT the maximal pressure is at the skin surface and then diverges as it penetrates deeper.
Local anaesthesia is sometimes used for pain relief during the procedure and ultrasound guidance can be used to assist with positioning the device.
Treatment protocols for ESWT vary according to the energy density and frequency of shockwaves.
YAG laser vitreolysis for symptomatic vitreous floaters

Evidence-based recommendations on YAG laser vitreolysis for symptomatic vitreous floaters. This involves a special type of laser (YAG) firing short pulses of energy into the floaters, to break them up (vitreolysis) and reduce sight disturbances.

# Recommendations
Evidence on the safety and efficacy of YAG laser vitreolysis for symptomatic vitreous floaters is inadequate in quality and quantity. Therefore, this procedure should only be used in the context of research. Find out what only in research means on the NICE interventional procedures guidance page.
Further research should include suitably powered randomised controlled trials. Research should report details of patient selection (including type, size and location of floaters), degree of visual disturbance and details of the procedure.
This procedure should only be done by retinal specialists experienced in laser surgery and with expertise in managing vitreoretinal disease.# The condition, current treatments and procedure

# The condition
Vitreous floaters are microscopic clumps of collagen fibres in the vitreous that cast shadows on the retina, appearing as floaters. The most common cause of vitreous floaters is posterior vitreous detachment, when the posterior hyaloid face separates from the retina.
Vitreous floaters can be primary or secondary. Primary vitreous floaters originate from the vitreous body. Secondary vitreous floaters originate from outside the vitreous body, generally from proteins, amyloid or cells.

# Current treatments
Vitreous floaters do not usually threaten vision and can be managed conservatively. When they do affect vision, treatment options include vitrectomy and vitreolysis with YAG laser.

# The procedure
This procedure aims to improve vision and reduce symptoms by removing or reducing the size of floaters.
The pupil is dilated and anaesthetic eye drops are administered. A specialised contact lens is placed on the cornea. Coaxial illumination is used. A laser microscope focuses on the front surface of the floater and creates short bursts of energy (nanosecond pulses). The laser energy usually starts at a low level, and is increased until it is high enough to break up the floater. The laser is stopped once all visually significant floaters are treated.
YAG laser vitreolysis is done as an outpatient procedure. Depending on the characteristics and numbers of floaters, more than 1 session may be needed.
COVID-19 rapid guideline: vaccine-induced immune thrombocytopenia and thrombosis (VITT)

This guideline covers vaccine-induced immune thrombocytopenia and thrombosis (VITT), a syndrome which has been reported in rare cases after COVID-19 vaccination. VITT may also be called vaccine-induced prothrombotic immune thrombocytopenia (VIPIT) or thrombotic thrombocytopenic syndrome (TTS). Because VITT is a new condition, there is limited evidence available to inform clinical management, identification and management of the condition is evolving quickly as the case definition becomes clearer. This guideline was produced to support clinicians to diagnose and manage this newly recognised syndrome.

# Recommendations
How to use this guideline
Introduction
Identifying suspected VITT
Investigations and diagnosis
Initial investigations
Further care when VITT is unlikely
Further investigations for probable VITT
Management
Person-centred care
Managing thrombosis
Anticoagulants
Additional considerations for treating thrombosis
Managing the VITT immune response
Initial treatment
Further treatments
Intensive treatment for people with signs of poor prognosis
Ongoing management
Patient-centred care
Monitoring response and treating relapse
Reporting cases
Further vaccination
Equality considerations
Equalities impact assessment during scoping
Equalities impact assessment during guideline development
Methods and processes
Transanal total mesorectal excision for rectal cancer

Evidence-based recommendations on transanal total mesorectal excision for rectal cancer in adults. This involves removing the cancer through the anus or a small cut in the abdomen.

# Recommendations
Evidence on the efficacy of transanal total mesorectal excision of the rectum is adequate. Evidence on its safety is inconsistent. It also shows the potential for major safety concerns, including damage to adjacent structures and seeding of malignancy. Therefore, this procedure should only be used in the context of research. Find out what only in research means on the NICE interventional procedures guidance page.
Further research, which could be randomised controlled trials or registry data, should report details of patient selection, including tumour type, use of neoadjuvant chemoradiotherapy and all complications, including malignancy dissemination.# The condition, current treatments and procedure

# The condition
The incidence of rectal cancer rises sharply with age. Symptoms include rectal bleeding and change in bowel habit, although the early stages may be asymptomatic.

# Current treatments
The management of rectal cancer is described in NICE's guideline on colorectal cancer. The main treatment is surgery. It involves resecting the affected part of the rectum with anus preservation or, when anus preservation is not technically possible, colostomy formation. Adjunctive radiotherapy and chemotherapy may also be used to reduce the risk of local recurrence and prevent metastatic disease.

# The procedure
The aim of transanal total mesorectal excision is to improve the clinical outcome of rectal resection, and to reduce length of hospital stay and morbidity after surgery. It may enable proctectomy (removal of all or part of the rectum) that would be difficult by an open or laparoscopic approach. This could be in people with a narrow pelvis or high body mass index, or where the position of the tumour is low in the rectum.
Before surgery, the patient has bowel preparation and prophylactic antibiotics. Using general anaesthesia, and with the patient in the lithotomy position, standard abdominal laparoscopic mobilisation of the left colon and upper rectum is done. After inserting an operating platform into the anus, the lower rectum including the total mesorectum is mobilised. At the start of the transanal part of the procedure, a purse-string suture is put in to close the rectal lumen. This is followed by a full thickness rectotomy. After identifying the total mesorectal excision plane, the dissection progresses proximally until it connects with the dissection from above. The specimen can be removed through the transanal platform or, if the tumour is large, through the abdomen using a small incision. Anastomosis to connect the colon and the anus can be done using sutures (hand-sewn technique) or staples, and a temporary ileostomy is usually created. When anastomosis is not possible, a permanent stoma is created.
Endobronchial nerve ablation for chronic obstructive pulmonary disease

Evidence-based recommendations endobronchial nerve ablation for chronic obstructive pulmonary disease. This involves destroying (ablating) the nerves on the outside of the airway (endobronchial nerves) to improve breathing.

# Recommendations
Evidence on the safety and efficacy of endobronchial nerve ablation for chronic obstructive pulmonary disease (COPD) is inadequate in quantity. Therefore, this procedure should only be used in the context of research. Find out what only in research means on the NICE interventional procedures guidance page.
Further research should be randomised controlled trials comparing the procedure with sham treatment. It should report details of patient selection, and short and long-term functional outcomes including lung functional outcomes, quality of life and patient-reported outcomes, incidence of exacerbations and hospital admissions, and all adverse events.# The condition, current treatments and procedure

# The condition
Chronic obstructive pulmonary disease (COPD) includes emphysema and chronic bronchitis. It's a common condition that mostly affects middle-aged and older adults. Approximately 4.5% of over 40s in the UK have diagnosed COPD. The main cause of COPD is smoking. The main symptoms are breathlessness, a persistent cough and wheezing, and frequent chest infections. COPD gradually gets worse over time and people can have sudden flare-ups (exacerbations).

# Current treatments
Although the damage to the lungs caused by COPD is permanent, treatment can help slow disease progression. Treatments include stopping smoking, pulmonary rehabilitation, inhaled beta2 agonists, antimuscarinic and steroid inhalers, oral medication such as bronchodilators, mucolytics and steroids, and oxygen. In a very small number of people, surgery or lung transplant may be indicated.

# The procedure
In COPD, acetylcholine released from parasympathetic airway nerve fibres mediates smooth muscle tone, reflex bronchoconstriction, mucus hyper-secretion and airway inflammation. This procedure disrupts parasympathetic signalling to the lungs and decreases neuronal release of acetylcholine. The aim is to produce permanent bronchodilation, decrease mucus production and improve breathing.
Endobronchial nerve ablation is a minimally invasive outpatient procedure carried out under general anaesthesia. A bronchoscope is used to visualise the airways and a dual-cooled radiofrequency (RF) catheter, which has a balloon and an electrode on the end, is positioned in the distal mainstem bronchus. Once in position, coolant is passed through the catheter and the balloon inflates, pressing the electrode against the airway wall. RF energy is then delivered from the electrode to ablate the parasympathetic nerves that run along the outside of the mainstem bronchus. The balloon is then deflated and rotated, and the ablation repeated until the whole circumference of the bronchus has been treated. Both main bronchi are treated during a single procedure. Most patients return home on the day of the procedure.
COVID-19 rapid guideline: managing the long-term effects of COVID-19

This guideline covers identifying, assessing and managing the long-term effects of COVID-19, often described as long COVID. It makes recommendations about care in all healthcare settings for adults, children and young people who have new or ongoing symptoms 4 weeks or more after the start of acute COVID-19. It also includes advice on organising services for long COVID.

# Recommendations
How to use this guideline
Identification
Assessment
Investigations and referral
Planning care
Management
Self-management and supported self-management
Multidisciplinary rehabilitation
Additional support
Follow up, monitoring and discharge
Sharing information and continuity of care
Service organisation
Common symptoms
Recommendations for research
Equality considerations
Equalities impact assessment during scope development
Equalities impact assessment during scoping - final scope
Equalities impact assessment during guideline development
Equalities impact assessment final guideline
Methods and evidence reviews
Methods and processes
Evidence reviews
Laparoscopic renal denervation for loin pain haematuria syndrome

Evidence-based recommendations on laparoscopic renal denervation for loin pain haematuria syndrome in adults. This involves the stripping away of nerves from the kidney using keyhole surgery to relieve pain.

# Recommendations
Evidence on the safety and efficacy of laparoscopic renal denervation for loin pain haematuria syndrome is inadequate in quality and quantity. Therefore, this procedure should only be used in the context of research. Find out what only in research means on the NICE interventional procedures guidance page.
Further research should report details of patient selection, technique used and long-term follow-up outcomes.# The condition, current treatments and procedure

# The condition
Loin pain haematuria syndrome (LPHS) causes severe, recurrent flank pain and haematuria (either macroscopic or microscopic). The cause of LPHS is unknown and diagnosis is only made after excluding all other possible renal causes of flank pain and haematuria.

# Current treatments
Initial treatment of LPHS involves prescription of analgesics, up to and including opioids. Other treatments include transcutaneous electrical nerve stimulation, regional nerve blocks and radiofrequency ablation. If these are unsuccessful, surgical intervention can be tried, including open surgical renal denervation, capsulotomy (often done in conjunction with open surgical renal denervation), nephrectomy, and renal autotransplantation.

# The procedure
Laparoscopic renal denervation is a minimally invasive procedure to interrupt the sensorial and sympathetic innervation of the kidney to control pain. The procedure is done under general anaesthesia, using a retroperitoneal approach. Lymphatic and nervous tissue is stripped off the renal artery and vein with subsequent division of all perihilar nervous tissue, with or without mobilisation of the kidney. Laparoscopic renal denervation does not include capsulotomy, which may be included in open surgical renal denervation.
The laparoscopic technique aims to reduce the anaesthetic time and produce a quicker recovery time than open surgery.