Persius/hicric huggingface dataset:
Transcranial magnetic stimulation for obsessive-compulsive disorder

Evidence-based recommendations on transcranial magnetic stimulation for obsessive-compulsive disorder in adults. This involves pulsing electromagnetic energy through the skull to stimulate the brain.

# Recommendations
Evidence on the safety of transcranial magnetic stimulation for obsessive-compulsive disorder raises no major safety concerns. However, evidence on its 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 website.
Research should ideally be in the form of pre-registered, adequately powered, randomised controlled trials. It should report details of patient selection, including the use of concurrent therapies, type, duration and frequency of stimulation, and the intended target in the brain. Outcomes should include improvement in symptoms, quality of life and duration of effect.# The condition, current treatments and procedure

# The condition
Obsessive-compulsive disorder is a mental health condition in which a person has obsessive thoughts (repeated, unwanted and unpleasant thoughts, images or urges). The person feels compelled to carry out compulsive (repetitive) behaviours to try to relieve the unpleasant feelings brought on by the obsessive thoughts.

# Current treatments
NICE's clinical guideline on obsessive-compulsive disorder and body dysmorphic disorder describes the treatment of the disorder. Treatment options include psychological interventions and drug treatment (typically, selective serotonin reuptake inhibitors).

# The procedure
Transcranial magnetic stimulation (TMS) is done with the patient awake and sitting in a comfortable chair. The operator places an electromagnetic coil over a specific region of the head. The coil delivers electromagnetic pulses through the skull that stimulate neurons (brain cells) by inducing small electrical currents within the brain. Different areas of the brain may be targeted, and a variety of stimulation protocols may be used. Treatment with TMS usually comprises daily sessions lasting about 30 minutes, for a few weeks. The aim is to reduce the symptoms of obsessive-compulsive disorder.
In repetitive TMS (rTMS), repetitive pulses of electromagnetic energy are delivered at various frequencies (low or high) or stimulus intensities. The intensity of stimulation is usually titrated against the minimum intensity needed to elicit a motor response when stimulating the motor cortex, known as the motor threshold. Determining the motor threshold for rTMS can be done visually (such as by observing targeted hand muscle movements) or by using electromyography.
Conventional rTMS is repeated individual pulses at a pre-set interval (train of pulses), and theta-burst rTMS is repeated short bursts of pulses at a pre-set interval (train of bursts). Deep TMS stimulates deeper and broader brain regions compared with conventional rTMS.
Electrical stimulation to improve muscle strength in chronic respiratory conditions, chronic heart failure and chronic kidney disease

Evidence-based recommendations on electrical stimulation to improve muscle strength in chronic respiratory conditions, chronic heart failure and chronic kidney disease. This involves delivering electrical impulses to weakened muscles using electrodes placed on the skin.

# Recommendations
Evidence on the safety of electrical stimulation to improve muscle strength in chronic respiratory conditions, chronic heart failure and chronic kidney disease shows no major safety concerns.
For people who are having an acute exacerbation of their chronic condition and are unable to exercise, evidence of efficacy 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 website.
For people who are able to exercise, evidence on efficacy is inadequate in quality. Therefore, this procedure should only be used in the context of research. Find out what only in research means on the NICE website.
Further research should include long term, suitably powered and appropriately controlled randomised trials. These should report details of patient selection, and type and duration of treatment. Outcomes should include quality of life, social functioning and physiological measures.# The condition, current treatments and procedure

# The condition
Chronic respiratory conditions, chronic heart failure and chronic kidney disease can cause impaired muscle function and weakness.

# Current treatments
Rehabilitation is described in NICE's guidelines on rehabilitation after critical illness, chronic obstructive pulmonary disease and chronic heart failure. Management for muscle weakness or dysfunction caused by chronic respiratory conditions, chronic heart failure or chronic kidney disease includes lifestyle change, medication (including oxygen therapy), rehabilitation (such as pulmonary rehabilitation or cardiac rehabilitation) and treating the underlying conditions.

# The procedure
Electrical stimulation produces muscle contractions that aim to mimic exercise training. Small electrical impulses are applied to nerves supplying groups of muscles typically in either the arms or legs, using self-adhesive electrodes applied to the skin and connected to an electrical stimulator. This causes the muscles supplied by the nerve to contract and relax. A typical programme consists of 30 to 60 minutes of stimulation.
Artificial iris insertion for congenital aniridia

Evidence-based recommendations on artificial iris insertion for congenital aniridia. This involves inserting an artificial iris into the eye.

# Recommendations
Evidence on the safety and efficacy of artificial iris implant insertion for congenital aniridia 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 website.
Research could include the use of observational data from cohort studies or high-quality case series. Studies should report details of patient selection and the type of implant used. Outcomes should include quality of life and other patient-reported outcomes.
NICE may update the guidance on publication of further evidence.# The condition, current treatments and procedure

# The condition
Congenital aniridia is a rare condition in which the iris has not formed properly, so it is missing or underdeveloped. It affects both eyes. The amount of iris tissue missing varies from person to person. Many people with congenital aniridia also have a part of their retina that is not fully developed, and many have nystagmus.
People with congenital aniridia may be very light sensitive (photophobic) and report symptoms of glare. They may develop other eye problems such as glaucoma, cataract and corneal opacification. The degree of vision loss varies.

# Current treatments
Treatment includes contact lenses with iris prints and tinted spectacle lenses.
Surgical implantation of an artificial iris device may be an option for some people with complete or partial congenital aniridia.

# The procedure
There are different devices available, including a solid acrylic ring or segment and a flexible silicone disc which can be custom-made for each patient. The implant has a defined pupil size, which offers a compromise between day and night vision.
The artificial iris implant is inserted using local or general anaesthesia. The exact details of the procedure vary according to the type of implant being used.
Flexible implants are rolled up and inserted through a cut about 3 mm long at the edge of the cornea, into the posterior chamber of the eye. They are then unfolded and fixed in the eye. If sutures are needed to hold the implant in place, a larger cut may be necessary. The implant insertion can be done on its own or at the time of cataract or lens fixation surgery.
Solid ring implants are typically inserted during cataract surgery along with an intraocular lens. In some patients, an iris reconstruction lens containing both an artificial iris and a lens is implanted. Depending on the condition of the eye, the lens and iris device may need to be sutured to the sclera.
The aim of artificial iris implant insertion is to improve visual acuity, reduce photophobia and glare, and improve the eye's appearance.
Bilateral cervicosacropexy (CESA) or vaginosacropexy (VASA) using mesh for pelvic organ prolapse

Evidence-based recommendations on bilateral cervicosacropexy (CESA) or vaginosacropexy (VASA) using mesh for pelvic organ prolapse in adults. This involves replacing weakened or stretched ligaments that support the uterus and hold the pelvic organs in place with mesh tape.

# Recommendations
Evidence on the safety and efficacy of bilateral cervicosacropexy (CESA) or vaginosacropexy (VASA) using mesh for pelvic organ prolapse 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, and report details of patient selection, technique, improvement in the prolapse, procedure-related adverse events and patient-reported outcome measures.# The condition, current treatments and procedure

# The condition
Pelvic organ prolapse is defined as symptomatic descent of 1 or more of: the anterior vaginal wall, the posterior vaginal wall, the cervix or uterus, or the apex of the vagina (vault or cuff). Symptoms include a vaginal bulge or sensation of something coming down, urinary, bowel and sexual symptoms, and pelvic and back pain. These symptoms affect women's quality of life.

# Current treatments
NICE's guideline on urinary incontinence and pelvic organ prolapse describes its management. Non-surgical management options include lifestyle modification, such as losing weight and minimising heavy lifting, topical oestrogen, pelvic floor muscle training and vaginal pessaries. Surgery may be needed when the prolapse is severe. Different surgical procedures are available using vaginal or abdominal (open, laparoscopic or robotic) approaches. Some procedures involve using mesh, the aim being to provide additional support.

# The procedure
Bilateral cervicosacropexy (CESA) or vaginosacropexy (VASA) for pelvic organ prolapse are mesh procedures, done through open or laparoscopic approaches using general anaesthesia. If the uterus is still in place, the first step of the procedure is a hysterectomy. A polyvinylidene fluoride (PVDF) mesh ligament-replacement structure is then placed within the peritoneal fold of both the left and right uterosacral ligaments. Anterior fixation of each PVDF structure is done by centrally suturing it to the cervix or vaginal vault with 3 or 4 interrupted, nonabsorbable polyester sutures. For posterior fixation, the PVDF structures are fixed to the left and right prevertebral fascia of the sacral vertebra at the level of S1 and S2, using a fixation device or sutures. The peritoneum above the cervix or vaginal vault is then closed to cover the PVDF structure. The aim is to support the pelvic organs in their correct position, and to improve symptoms associated with the prolapse.
Cyanoacrylate glue occlusion for varicose veins

Evidence-based recommendations on cyanoacrylate glue occlusion for varicose veins. This involves injecting medical glue (cyanoacrylate) into a vein to close it with the aim of improving symptoms.

# Recommendations
Evidence on the safety and efficacy of cyanoacrylate glue occlusion for varicose veins 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 clinicians with appropriate training in this procedure and experience in the use of venous ultrasound.# The condition, current treatments and procedure

# The condition
Varicose veins are a sign of underlying venous insufficiency. Primary valvular incompetence is the most common underlying cause of varicose veins. The saphenous veins are the most frequently affected vessels. Most people with varicose veins have no symptoms, but venous insufficiency may cause fatigue, heaviness, aching, throbbing, itching and cramps in the legs. Chronic venous insufficiency can lead to skin discoloration, inflammatory dermatitis and ulceration.

# Current treatments
NICE's guideline describes the diagnosis and management of varicose veins. Interventional treatment options include endothermal ablation (such as radiofrequency ablation and endovenous laser ablation therapy), foam sclerotherapy, mechanochemical ablation and surgery (usually stripping and ligation of the great and small saphenous veins, and phlebectomies).

# The procedure
Cyanoacrylate glue occlusion for varicose veins aims to close the veins by adherence then fibrosis of the lumen, without the need for tumescent anaesthesia and with reduced need for postoperative compression therapy.
The procedure is done using local anaesthesia. An introducer sheath is inserted into the distal great saphenous vein and, using ultrasound guidance, a delivery catheter is advanced into position before the saphenofemoral junction. The proximal vein is compressed, and medical glue is delivered in measured doses through the tip of the catheter to seal the vein.
This is repeated at different positions as the catheter is withdrawn, using ultrasound imaging to monitor the procedure. The procedure may also be done in a similar way for the small saphenous vein.
Balloon dilation for chronic eustachian tube dysfunction

Evidence-based recommendations on balloon dilation for chronic eustachian tube dysfunction in adults and children. This involves using a balloon filled with saline to widen the eustachian tube.

# Recommendations
Evidence on the safety and efficacy of balloon dilation for eustachian tube dysfunction 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 condition, current treatments and procedure

# The condition
The eustachian tube is a narrow tube that connects the middle ear with the back of the nose. If it is blocked or does not open properly, there can be symptoms such as muffled hearing, pain, a feeling of fullness in the ear, tinnitus or dizziness. The eustachian tube typically becomes blocked after an upper respiratory tract infection or allergic rhinitis. It is usually a temporary problem that resolves spontaneously, but sometimes symptoms persist and treatment is necessary. Long-term eustachian tube dysfunction is associated with damage to the eardrum and middle-ear transformer mechanism.

# Current treatments
Medical treatments include oral and nasal corticosteroids, decongestants and antihistamines. Autoinflation is a technique that reopens the eustachian tube by raising pressure in the nose. This can be achieved in several ways, including forced exhalation against a closed mouth and nose.
If eustachian tube dysfunction persists, a tympanostomy tube (also known as a ventilation tube or grommet) may be inserted through a small incision in the tympanic membrane. These typically fall out after several months, and repeated tube insertions may be needed. Some tubes are designed to stay in place for longer, but these can become crusted, infected or obstructed. Tympanostomy tubes may result in a small permanent hole in the tympanic membrane; this is more common with long-lasting tubes.

# The procedure
Balloon dilation of the eustachian tube is done using local or general anaesthesia. A balloon catheter is introduced into the eustachian tube via the nose, under transnasal endoscopic vision. Once the balloon is correctly positioned in the eustachian tube, it is filled with saline up to a pressure of about 10 to 12 bars. Pressure is maintained for about 2 minutes. The balloon is then emptied and removed.
The aim of the procedure is to widen the eustachian tube and improve its function.
Irreversible electroporation for primary liver cancer

Evidence-based recommendations on irreversible electroporation for primary liver cancer in adults. This involves passing short electrical pulses of high-voltage current into the cancer cells.

# Recommendations
Evidence on the safety of irreversible electroporation for primary liver cancer shows serious but infrequent and well-recognised complications. Evidence on its 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.
Patient selection should be done by a multidisciplinary team.
The procedure should only be done in specialist centres by clinicians with experience and specific training.
Further research could be in the form of case series or registry-based research. It should include: details of patient selection; tumour position and size; long-term outcomes including overall survival, progression-free survival and tumour regression; and patient-reported outcomes including quality of life.# The condition, current treatments and procedure

# The condition
The most common primary liver cancers are hepatocellular carcinoma and cholangiocarcinoma.

# Current treatments
Treatment for primary liver cancer depends on several factors, including the exact location and stage of the cancer, the patient's liver function and any patient-related comorbidities. For most patients, treatment with curative intent is not possible. The treatment options include surgical excision, chemotherapy (either systemic or local hepatic artery infusion), transarterial chemoembolisation, percutaneous ethanol injection, and thermal ablation techniques such as cryotherapy, radiofrequency and microwave ablation. Liver transplantation (with curative intent) may be appropriate for some patients.

# The procedure
The aim of irreversible electroporation (IRE) is to destroy cancerous cells by subjecting them to short pulses of high-voltage direct current. This creates multiple holes in the cell membrane, irreversibly damaging the cell's homeostasis mechanisms and leading to cell death.
IRE for primary liver cancer is done with the patient under general anaesthesia. A neuromuscular blocking agent is used to prevent muscle spasms. Needle-like electrodes are introduced percutaneously into the tumour under imaging guidance (either CT or, less commonly, ultrasound). The distance between the electrodes is confirmed by imaging. This is to ensure that the electrodes are correctly placed parallel to each other, and that enough current flow would be generated to ensure IRE. The procedure may also be done through an open surgical or laparoscopic approach, although the percutaneous route is the most common.
Electrodes are repositioned under imaging guidance to extend the zone of electroporation until the entire tumour and an appropriate margin have been ablated. The number of ablations is determined by the volume of the target tumour. When the ablation procedure is completed, further imaging may be done to confirm the extent of the ablation.
Midcarpal hemiarthroplasty for wrist arthritis

Evidence-based recommendations on midcarpal hemiarthroplasty for wrist arthritis in adults. This involves using a metal implant to create an artificial wrist joint, to relieve pain and maintain movement.

# Recommendations
Evidence on the safety and efficacy of midcarpal hemiarthroplasty for wrist arthritis 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 could be in the form of case series. It should report patient selection, type and severity of arthritis, patient-reported outcome measures and the need for revision in the longer term (at least 5 years).# The condition, current treatments and procedure

# The condition
Wrist arthritis can be caused by rheumatoid arthritis, osteoarthritis, trauma or sepsis. It can cause pain, stiffness and swelling.

# Current treatments
Treatments include analgesics, non-steroidal anti-inflammatory drugs, disease-modifying antirheumatic drugs and corticosteroid injections. If these do not work well enough, surgical treatments can be used. These include proximal row carpectomy, limited or partial carpal fusion, total wrist arthrodesis or total wrist arthroplasty.

# The procedure
The procedure is done using general or regional anaesthesia, with a tourniquet applied to the upper arm. A radiographic template is created preoperatively to determine the implant size. An incision is made over the wrist, in line with the third metacarpal. The joint is exposed, and the first row of carpal bones and the radial articular cartilage are removed. A trial implant is put into position, the carpus is reduced onto the bearing surface and the implant size, range of motion and stability are assessed. The final implant is then put in place and fully seated on the contoured subchondral plate.
Strengthening exercises are started 4 to 6 weeks after surgery and full activity can start several weeks after that. The aim is to relieve pain while keeping the midcarpal articulation and the anatomic centre of wrist rotation.