Persius/hicric huggingface dataset:
High-intensity focused ultrasound for glaucoma

Evidence-based recommendations on high-intensity focused ultrasound for glaucoma in adults. This involves using high-intensity ultrasound to destroy a small amount of the tissue that makes fluid in the eye. This reduces the amount of fluid in the eyeball and reduces pressure, preventing more damage to vision.

# Recommendations
Evidence on the safety and efficacy of high-intensity focused ultrasound for glaucoma 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.
Research should ideally take the form of randomised controlled trials comparing this procedure with standard therapies and should report safety events and long-term outcomes.
NICE may update the guidance on publication of further evidence.# The condition, current treatments and procedure

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

# Current treatments
NICE's guideline on glaucoma describes its diagnosis and management. Treatment is usually eye drops containing drugs that either reduce the production of aqueous humor (fluid) or increase its drainage. Surgical procedures such as trabeculectomy, drainage tubes, deep sclerectomy, viscocanalostomy or laser trabeculoplasty may also be used.

# The procedure
This procedure uses high-intensity focused ultrasound (HIFU) to partially destroy the ciliary body to reduce the production of aqueous humor and thereby decrease the intraocular pressure.
The procedure can be done under regional, general or topical anaesthesia. One device available for this procedure consists of a compact operator console and a disposable probe (which includes a coupling cone and a therapy probe that generates the ultrasound beams). The coupling cone is placed directly on the centre of the patient's cornea and held in place by a low-vacuum suction ring. A ring-shaped therapy probe (connected to the console) that generates ultrasound beams is inserted into the cone. The space between the eye, cone and the probe is filled with saline solution to ensure dissemination of ultrasound energy. By pressing the foot switch, miniature transducers in the ring-shaped probe are sequentially activated to deliver HIFU beams directly into the ciliary body. These beams pass through the scleral tissue without disruption of ocular tissue to reach the ciliary body. The ultrasound heats and inactivates tissue within the ciliary body to decrease the production of aqueous humor.
Bioprosthetic plug insertion for anal fistula

Evidence-based recommendations on bioprosthetic plug insertion for anal fistula in adults. This involves putting a plug into the fistula and stitching it in place. The plug is made from animal tissue (bioprosthetic). The aim is to block the fistula.

# Recommendations
Current evidence on the safety and efficacy of bioprosthetic plug insertion for anal fistula is adequate to support the use of 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.
The procedure should only be done by a surgeon experienced in managing anal fistulas.# The condition, current treatments and procedure

# The condition
An anal fistula is an abnormal tract between the anal canal and the skin around the anus. It usually results from previous anal abscesses (cryptoglandular) and can be associated with other conditions such as inflammatory bowel disease and cancer. It may cause symptoms such as pain or discomfort in the anal area, and leakage of blood or pus. Anal fistulas can be classified according to their anatomical relationship with the external sphincter. Intersphincteric fistulas are the most common type and cross only the internal sphincter. Trans-sphincteric fistulas pass through the internal and external sphincter.

# Current treatments
Treatment of anal fistulas commonly involves surgery. The type of surgery depends on the location and complexity of the fistula. For intersphincteric and low trans-sphincteric anal fistulas, the most common treatment is a fistulotomy or laying open of the fistula tract. For deeper fistulas that involve more muscle, and for recurrent fistulas, a seton (a piece of suture material or rubber sling) may be used, either alone or with fistulotomy. Setons can be loose (designed to drain the sepsis but not for cure), or snug or tight (designed to cut through the muscles in a slow controlled fashion). Fistulas that cross the external sphincter at a high level are sometimes treated with a mucosal advancement flap or other procedures to close the internal opening. Other options for treating anal fistulas are to fill the tract with glue or paste.

# The procedure
Bioprosthetic plug insertion for anal fistula aims to leave the sphincter muscles intact, allowing the use of subsequent treatments if needed.
The procedure is usually done using general anaesthesia. The fistula tract is identified using a probe or by imaging techniques, and it may be irrigated. A conical plug, usually made of porcine intestinal submucosa, is pulled into the tract until it blocks the internal opening. It is sutured in place at the internal opening. The external opening is not completely sealed so that drainage of the fistula can continue. The plug acts as a scaffold into which new tissue can grow.
Implant insertion for prominent ears

Evidence-based recommendations on implant insertion for prominent ears in children, young people and adults. This involves inserting small curved implants under the skin of each ear.

# Recommendations
Current evidence on the safety and efficacy of implant insertion for prominent ears 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 comparisons of this procedure with current best therapy. It should address issues of patient selection, such as age and type of ear shape, nature of ear implants used, long-term efficacy and safety outcomes, and patient-reported outcomes using validated quality-of-life measures.# The condition, current treatments and procedure

# The condition
Protruding or prominent ears result when cartilaginous folds fail to form within the ear.

# Current treatments
Surgery to correct protruding ears aims to reposition the elastic cartilage permanently while preserving a natural appearance. Cartilage-sparing techniques such as scoring, drilling and suturing of the cartilage may be used. Most techniques involve a post-auricular skin incision, although there has been a report of an incisionless otoplasty.

# The procedure
This procedure is done under local anaesthesia. One or more implants (gold-coated curved nitinol devices) are used to create or reshape the antihelical fold of the ear. The aim is to correct any ear prominence resulting from either poor definition or a lack of this fold.
The position of any implants is discussed and agreed with the patient before the procedure and marked on the ear. The implant is inserted using an introducer and released onto the anterior surface of the cartilage, immediately reshaping it and correcting the ear prominence. The incision is closed using 1 or 2 dissolvable sutures, and the wound is then dressed with sterile tape.
Typically, 1 implant is used in each ear, but more may be needed. The procedure usually takes about 20 minutes for both ears.
Low-energy contact X-ray brachytherapy (the Papillon technique) for locally advanced rectal cancer

Evidence-based recommendations on low-energy contact Xray brachytherapy (the Papillon technique) for locally advanced rectal cancer in adults. This involves using an Xray tube inserted into the rectum to destroy the cancer cells.

# Recommendations
Current evidence on the safety and efficacy of low-energy contact Xray brachytherapy (the Papillon technique) for locally advanced rectal cancer is inadequate in quantity and quality. 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 this procedure with standard care and report details of patient selection (including tumour type and suitability for surgery), patient-reported outcomes, quality of life and long-term outcomes.# The condition, current treatments and procedure

# The condition
Rectal cancer is a common form of bowel cancer. The risk of developing it rises with age. Symptoms include rectal bleeding, obstruction, perforation, pain and discharge. Symptoms may result from the tumour invading organs near the rectum (such as the bladder). Early stages of rectal cancer may be asymptomatic and some patients present with locally advanced rectal cancer, commonly defined as T3 or T4 primary tumours or nodal metastases, or stage 2 (T3 to T4, node negative) or stage 3 (T1 to T4, node positive).

# Current treatments
There is variation in the clinical management and treatments offered for locally advanced rectal cancer. Radical surgery in the form of total mesorectal excision (TME) offers the best chance for cure in some patients. Patients who choose not to have surgery, or are not fit enough to have it, may have neoadjuvant chemoradiotherapy (such as external beam radiotherapy, with or without brachytherapy). The aim is to reduce the tumour size, alleviate symptoms, and improve survival and quality of life.

# The procedure
Low-energy contact Xray brachytherapy (CXB) is also known as the Papillion technique. It may be given with external beam radiotherapy or chemotherapy, or both. It is usually delivered in a day-patient setting. The patient is given an enema before treatment to empty the rectum. With the patient in a knee-to-chest, prone jack-knife or supine position, local anaesthesia and glyceryl trinitrate are applied to the anal sphincter to numb the area and relax the sphincter muscles. A sigmoidoscope is inserted through the anal sphincter to ascertain the size and position of the tumour. Then a rigid endorectal treatment applicator is inserted and placed in contact with the tumour. A contact Xray tube is introduced into the applicator. It emits low-energy Xrays that penetrate tissue by only a few millimetres, minimising damage to deeper tissues.
Cardiac contractility modulation device implantation for heart failure

Evidence-based recommendations on cardiac contractility modulation device implantation for heart failure in adults. This involves placing a device under the skin of the chest, which delivers electrical pulses to make the heart contract more strongly.

# Recommendations
The evidence on cardiac contractility modulation device implantation for heart failure raises no major safety concerns. However, the evidence on efficacy is inadequate in quantity and quality. 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 ideally be in the form of randomised controlled trials. These should report details of patient selection, duration and timing of stimulation, and duration of effect of stimulation. Outcomes should include ejection fraction, oxygen consumption, New York Heart Association classification and patient-reported outcomes, including quality of life.# The condition, current treatments and procedure

# The condition
Heart failure is a complex clinical syndrome of symptoms and signs that happen when the heart is not working well enough, leading to reduced blood flow to body tissues. It can lead to oedema in the lungs (causing breathlessness) and swelling of the legs. Other symptoms include reduced ability to exercise, fatigue and malaise. Heart failure can be caused by structural or functional abnormalities of the heart.

# Current treatments
NICE's guideline describes the diagnosis and management of chronic heart failure in adults. Treatments for heart failure include drugs to improve heart function, cardiac rehabilitation, cardiac resynchronisation therapy and cardiac transplantation. Cardiac contractility modulation device implantation may be an option for people with advanced heart failure that hasn't responded to conventional therapy.

# The procedure
Cardiac contractility modulation device implantation for heart failure is usually done under local anaesthesia. A device similar to a pacemaker is implanted in the right or left pectoral region and is connected to 2 standard pacemaker leads that are threaded through veins into the right ventricle. The electrodes in the right ventricle are placed on the ventricular septum at least 2 cm apart. These sense ventricular activity and deliver cardiac contractility modulation signals. An optional additional lead may be used to sense atrial activity (usually placed in the right atrial appendage). In contrast to a pacemaker or a defibrillator, the system is designed to modulate the strength of contraction of the heart muscle rather than the rhythm. Pulses are delivered at regular intervals throughout the day.
The device is recharged using a home-based charger system, typically on a weekly basis. Charging sessions last about 40 to 60 minutes.
The aim is to improve the heart's contractility, therefore improving a person's ability to exercise and quality of life.
Therapeutic hypothermia for acute ischaemic stroke

Evidence-based recommendations on therapeutic hypothermia for acute ischaemic stroke in adults. This involves using a cooling device to reduce the bodys temperature after a stroke.

# Recommendations
Current evidence on the safety of therapeutic hypothermia for acute ischaemic stroke shows that there are serious complications. Evidence on efficacy does not show any meaningful improvement in outcomes. Therefore, this procedure should not be used. Find out why NICE recommends not to use some procedures on the NICE interventional procedures guidance page.# The condition, current treatments and procedure

# The condition
Acute ischaemic stroke is characterised by the sudden loss of blood circulation to an area of the brain and a corresponding loss of neurological function. This may lead to symptoms such as numbness or weakness of the face, arm or leg on 1 side of the body, and often problems with speech and swallowing. Stroke severity can be measured using scales such as the National Institutes of Health Stroke scale and the Modified Rankin scale. Broadly, strokes are classified as either haemorrhagic or ischaemic. Acute ischaemic stroke refers to a stroke caused by an arterial thrombosis or embolism. It is more common than haemorrhagic stroke.

# Current treatments
Patients suspected to be having an acute ischaemic stroke should have rapid assessment and early intervention with specialist care according to NICE's guideline on stroke and transient ischaemic attack in over 16s. Recanalisation strategies, such as thrombolysis, attempt to re-establish blood flow so that cells starved of oxygen can be rescued before they are irreversibly damaged. Effective stroke care also includes specialised supportive care and rehabilitation when appropriate.

# The procedure
The timing, duration and degree of therapeutic hypothermia in trials has varied. Typically, however, cooling has been attempted as close to stroke onset as possible (usually within 6 hours) and continued for at least 12 to 24 hours, with body temperature maintained at 33C to 36C. This guidance only refers to the use of therapeutic hypothermia and not to other targeted temperature management approaches that treat or prevent pyrexia.
Before the procedure, the patient's temperature is measured and further temperature monitoring is done continuously with an internal (intravesical, rectal or oesophageal) probe connected to the cooling device. Cooling devices can be surface (ice-cold saline, surface cooling, cooling helmets and nasal cooling) or endovascular systems. After cooling, the body is slowly rewarmed, at a rate of 0.25C to 0.5C every hour. Rewarming takes about 8 hours. During cooling, patients need close cardiovascular monitoring in an intensive care environment, and may also need intubation and sedation. Drugs, including neuromuscular blockers, may be used to manage shivering.
The procedure may be used with thrombolysis (intravenous alteplase), mechanical thrombectomy or other vascular reperfusion techniques.
The aim of the procedure is to reduce the risk of secondary brain damage.
Endoscopic ablation for a pilonidal sinus

Evidence-based recommendations on endoscopic ablation for a pilonidal sinus in adults. This involves applying heat to the pilonidal sinus.

# Recommendations
Current evidence on endoscopic ablation for a pilonidal sinus raises no major safety concerns and the evidence on efficacy is adequate in quality and quantity. Therefore, this procedure can be used 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.# The condition, current treatments and procedure

# The condition
A pilonidal sinus is a small infected tract or a network of interlinking tracts under the skin between the buttocks. The exact cause is unknown but it may be from loose hairs pushing into the skin, combined with friction from clothes. The risk of developing a pilonidal sinus is increased by spending long periods of time sitting down, being overweight, a persistent irritation or injury to the affected area, having a hairy buttock cleft or a family history of the condition.
A pilonidal sinus does not usually cause symptoms unless it is infected and an abscess develops causing pain, redness, swelling under the skin and leakage of blood and pus.

# Current treatments
Treatments include conservative management with regular bathing and keeping the area dry, and antibiotics if the sinus is infected. However this does not close the sinus tract. Procedures to close the sinus include injecting fibrin glue and surgical excision.

# The procedure
Endoscopic ablation of a pilonidal sinus is less invasive than surgery and is usually done as a day case, using spinal or local anaesthesia. With the patient in the prone position, the external opening of the sinus is incised and a fistuloscope is inserted into the sinus tract. A continuous jet of irrigation solution is used, allowing optimal visualisation and assessment of the inside of the sinus. Under direct vision, forceps are used to remove hairs, infected tissue and any debris. Then an electrode is passed through the fistuloscope to cauterise the main sinus tract and any secondary tracts or abscess cavities. Necrotic material is removed using an endobrush and the sinus tract is cleaned using irrigation solution.
Laparoscopic cerclage for cervical incompetence to prevent late miscarriage or preterm birth

Evidence-based recommendations on laparoscopic cerclage for cervical incompetence to prevent late miscarriage or preterm birth. This involves placing a stitch around the upper part of the cervix to keep it closed.

# Recommendations
Current evidence on the safety and efficacy of laparoscopic cerclage for cervical incompetence to prevent late miscarriage or preterm birth is adequate to support the use of 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.
Patient selection should be done by a multidisciplinary team experienced in the management and prevention of preterm delivery.# The condition, current treatments and procedure

# The condition
Cervical incompetence may be caused by a congenital weakness of the cervix, or previous obstetric or gynaecological trauma. It is characterised by painless dilatation of the cervix in the second or third trimester, followed by second trimester miscarriage or premature rupture of the membranes and preterm delivery. The condition is usually diagnosed after 1 or more late second trimester pregnancy losses or early third trimester delivery, and after other causes have been excluded.

# Current treatments
Cervical incompetence is traditionally treated by transvaginal cervical cerclage. This involves placing a strong suture or tape around the cervix, via the vagina, and tightening it to keep the cervix closed. The procedure is typically done at the end of the first trimester or the beginning of the second trimester. The suture or tape is then usually removed at around 37 weeks of gestation to allow delivery.
Cervical cerclage using a transabdominal approach may be needed if transvaginal cerclage is technically difficult or has proved ineffective. With this approach, caesarean section is necessary to deliver the baby.

# The procedure
Laparoscopic cervical cerclage can be done during pregnancy or in women who are not pregnant. Under general anaesthesia, the peritoneal cavity is insufflated with carbon dioxide through a needle inserted into the umbilicus. Several small incisions are made to provide access for the laparoscope and surgical instruments. In women who are not pregnant, a dilator may initially be inserted into the cervix through the vagina for uterine manipulation. The bladder is dissected away from the uterus and a suture or tape is secured around the cervical isthmus, above the cardinal and uterosacral ligaments. As with the open transabdominal approach, caesarean section is necessary to deliver the baby. The suture or tape may be left in place for future pregnancies.