Persius/hicric huggingface dataset:
Magnetic resonance therapy for knee osteoarthritis

Evidence-based recommendations on magnetic resonance therapy for knee osteoarthritis in adults. This involves placing a magnetic resonance device over the knee to stimulate cartilage to heal and relieve the symptoms of osteoarthritis.

# Recommendations
Evidence on the safety of magnetic resonance therapy for knee osteoarthritis shows no major safety concerns. Evidence on efficacy is inadequate in quality and quantity and shows no benefit over placebo. Therefore, this procedure should not be used unless it is part of a research study. Find out what only in research means on the NICE interventional procedures guidance page.
Further research should be in the form of appropriately powered randomised controlled trials comparing the procedure with placebo. It should report patient selection and treatment protocols, including the number of sessions and magnetic field strength.# The condition, current treatments and procedure

# The condition
Osteoarthritis of the knee is the result of progressive deterioration of the articular cartilage and menisci of the joint, usually because of trauma and wear and tear. This leads to exposure of the bone surface. Symptoms include pain, stiffness, swelling and difficulty walking. Acute exacerbations of pain are common and usually selflimiting after 14 days. Only a small number of patients develop progressive symptoms needing treatment.

# Current treatments
Treatment depends on the severity of the symptoms. Conservative treatments include analgesics and corticosteroid injections to relieve pain and inflammation, and physiotherapy and prescribed exercise to improve function and mobility. When symptoms are severe, surgery may be indicated: options include upper tibial osteotomy and unicompartmental or total knee replacement.

# The procedure
Magnetic resonance therapy (MRT) for osteoarthritis is a non-invasive procedure that uses a special device to administer electromagnetic energy to an osteoarthritic joint. A range of devices with different physical designs are available. The aim is to relieve the symptoms and to improve the osteoarthritis by stimulating the cartilage cells.
MRT is done in an outpatient setting. During the procedure, the patient lies on the couch and a section of the MRT device slides over the knee. The device generates electromagnetic fields which are targeted to the cartilaginous tissue in the affected joint. The aim is to promote joint repair and relieve the symptoms of osteoarthritis. Each treatment lasts 60 minutes. Depending on the severity of the disease and MRT therapy device, a course of treatment typically consists of 5 to 10 treatment sessions on consecutive days.
Inducing and maintaining normothermia using temperature modulation devices to improve outcomes after stroke or subarachnoid haemorrhage

Evidence-based recommendations on inducing and maintaining normothermia using temperature modulation devices after stroke or subarachnoid haemorrhage in adults. This involves cooling the body using pads placed on the skin or tubes put into the body.

# Recommendations
Evidence on the safety and efficacy of inducing and maintaining normothermia using temperature modulation devices to improve outcomes after stroke or subarachnoid haemorrhage 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 preferably be randomised controlled trials. It should report details of patient selection (including cause of fever, severity of stroke and neurological injury), method and duration of cooling, time from the neurological injury and onset of fever to starting cooling, complications related to the procedure and the device, neurological outcomes assessed using validated measures, and patient-reported outcomes (including quality of life) in the long term.# The condition, current treatments and procedure

# The condition
Stroke (ischaemic stroke and intracerebral haemorrhage) is an acute neurological event presumed to be vascular in origin and causing cerebral ischaemia, cerebral infarction or cerebral haemorrhage. Subarachnoid haemorrhage (SAH) is a haemorrhage from a cerebral blood vessel, aneurysm or vascular malformation into the subarachnoid space.
Both conditions can interrupt blood flow to the brain, damage brain cells and cause abnormalities of thermoregulation and an abnormally high body temperature (neurogenic fever). The abnormally high temperature may result in secondary neurological injury and is associated with worse outcomes, greater morbidity and mortality.

# Current treatments
Diagnosis and initial management of stroke is described in NICE's guideline on stroke and transient ischaemic attack in over 16s. Current treatments for managing fever after stroke or SAH include identifying and treating a cause, antipyretic medications and standard physical methods of cooling such as fans and cooling blankets to lower body temperature.

# The procedure
In this procedure, a temperature modulation device is used to maintain the patient's core temperature within normal limits (37.00.5oC). Either surface techniques (such as heat exchange cooling pads) or internal techniques (such as an endovascular cooling device) may be used. Heat is exchanged between the patient and the device to allow the body temperature to be controlled to a pre-set point determined by the clinician.
This procedure aims to reduce brain injury and improve neurological outcomes after stroke or SAH by maintaining normothermia with precise temperature control.
Transvaginal laser therapy for stress urinary incontinence

Evidence-based recommendations on transvaginal laser therapy for urinary stress incontinence. This involves using a laser in the vagina to strengthen the vaginal walls, to help support the bladder and reduce symptoms of urinary stress incontinence.

# Recommendations
The evidence on transvaginal laser therapy for stress urinary incontinence does not show any short-term safety concerns. Evidence on long-term safety and efficacy 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 long-term safety and efficacy outcomes, the type of laser and energy used, treatment protocols, and patient selection including age, menopausal status and severity of stress urinary incontinence.
NICE encourages further research into transvaginal laser therapy for stress urinary incontinence and may update the guidance on publication of further evidence.# The condition, current treatments and procedure

# The condition
Stress urinary incontinence is the involuntary leakage of urine during exercise or certain movements, such as coughing, sneezing and laughing. In women, it is most commonly associated with previous pregnancy, with or without recognised obstetric trauma. Previous urogynaecological surgery may also result in stress urinary incontinence.

# Current treatments
NICE's guideline on urinary incontinence and pelvic organ prolapse makes recommendations for the management of urinary incontinence in women, accompanied by a patient decision aid to promote shared decision making. Conventional treatment is conservative and includes lifestyle changes, such as weight loss and pelvic floor muscle training. Surgical options are only offered if conservative measures do not help.

# The procedure
Transvaginal laser therapy for stress urinary incontinence is done as an outpatient procedure and can be done without anaesthetic. A laser-probe device is inserted into the vagina to apply laser energy to the vaginal wall. The laser causes a controlled thermal injury, which is claimed to promote tissue remodelling and the production of new collagen. Treatment typically consists of 3 sessions at 4 to 6 weeks apart. The aim is to improve the support to the bladder and reduce the symptoms of stress urinary incontinence.
There are different types of lasers used for this procedure, including CO2 and erbium-doped yttrium aluminium garnet (Er:YAG) lasers. The type of laser and the energy level used have different tissue penetration and can cause different types of thermal injury.
Transvaginal laser therapy for urogenital atrophy

Evidence-based recommendations on transvaginal laser therapy for urogenital atrophy. This involves using a laser in the vagina to increase its strength and elasticity, to improve symptoms of urogenital atrophy.

# Recommendations
The evidence on transvaginal laser therapy for urogenital atrophy does not show any short-term safety concerns. Evidence on long-term safety and efficacy 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 be appropriately powered randomised controlled trials and report details of patient selection, treatment protocols, and long-term safety and efficacy including patient-reported outcomes.
NICE encourages further research into transvaginal laser therapy for urogenital atrophy and may update the guidance on publication of further evidence.# The condition, current treatments and procedure

# The condition
Urogenital atrophy most often happens during or after the menopause. Lack of the hormone oestrogen leads to thinning of the tissues around the vaginal area and reduction in the number of mucus-producing glands. The most common symptoms affect the vulva and vagina including dryness, pain on sexual intercourse, itching and vaginal discharge. There is increased vulnerability to inflammation, trauma and infection. Urogenital atrophy can also result in urinary symptoms, such as urgency to urinate and urinary tract infections.

# Current treatments
NICE's guideline on diagnosis and management of menopause describes the management of menopausal symptoms. The main treatments for urogenital atrophy are vaginal oestrogen, and non-hormonal lubricants and moisturisers.

# The procedure
Transvaginal laser therapy for urogenital atrophy is done as an outpatient procedure and can be done without anaesthetic. A laser-probe device is inserted into the vagina to apply laser energy to the vaginal wall. The laser causes controlled thermal injury, which is claimed to make the tissue remodel, improve tissue elasticity and stimulate the production of new collagen. Treatment typically consists of 3 sessions at 4 to 6 weeks apart. The aim is to reduce the symptoms of urogenital atrophy.
There are different types of lasers used for this procedure, including CO2 and erbium-doped yttrium aluminium garnet (Er:YAG) lasers. The type of laser and the energy level used have different tissue penetration and can cause different types of thermal injury.
Repetitive short-pulse transscleral cyclophotocoagulation for glaucoma

Evidence-based recommendations on short-pulse transscleral cyclophotocoagulation for glaucoma. This involves using repeated short pulses of laser energy to destroy some of the cells in the eye that produce fluid. The aim is to reduce fluid, and so pressure, in the eye.

# Recommendations
Evidence on the safety of repetitive short-pulse transscleral cyclophotocoagulation for glaucoma shows no major safety concerns. 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 ideally be in the form of randomised controlled trials comparing the procedure with standard care. It should report details of patient selection, particularly whether the glaucoma is refractory or non-refractory. Outcomes should include duration of effect.# The condition, current treatments and procedure

# The condition
Glaucoma is usually a chronic condition associated with raised intraocular pressure. The most common type of glaucoma in the UK is primary (or 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 aqueous humor 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
Repetitive short-pulse transscleral cyclophotocoagulation (commonly known as micropulse transscleral cytophotocoagulation) uses a laser to target the same tissue as conventional cyclodiode laser treatment but it is delivered in pulses lasting microseconds. This allows the tissue to cool between pulses, with the aim of reducing collateral damage.
The procedure is normally done under local or general anaesthesia and usually takes 10 to 20 minutes. A probe is applied to the surface of the eye with firm pressure and moved in a continuous sliding motion over the upper or lower limbus of the eye, or both. To prevent ciliary neurovascular injury, the 3 and 9 o'clock positions are avoided. The device is set to deliver repetitive short-pulse (micropulse) laser energy with specified 'on' and 'off' times. Lower laser settings are used for patients with higher pigments to avoid overtreatment and inflammation. The laser treatment usually lasts between 100 seconds and 360 seconds per session. After the procedure, patients may need to wear an eye patch over the treated eye for about 24 hours and may be prescribed topical corticosteroids and antibiotics.
Free-functioning gracilis transfer to restore upper limb function in brachial plexus injury

Evidence-based recommendations on free-functioning gracilis transfer to restore upper limb function in brachial plexus injury in adults. This involves a piece of hamstring muscle and its nerve and blood supply (free-functioning gracilis) being taken from the inner thigh, transferred to the arm and joined to the damaged nerve.

# Recommendations
Evidence on the safety of free-functioning gracilis transfer to restore upper limb function in brachial plexus injury shows well-recognised complications. Evidence on its 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.
This procedure should only be done in a specialist brachial plexus unit by a multidisciplinary team including specialised physiotherapists, with input from microvascular surgeons.# The condition, current treatments and procedure

# The condition
The brachial plexus is a network of nerves that carries signals from the spinal cord to the shoulder, arm and hand. These nerves can be damaged by being stretched, compressed or torn from the spinal cord. The most severe brachial plexus injuries are often a result of road traffic accidents. Severe nerve damage can lead to paralysis of an upper limb, with a loss of function and sensation, and severe pain.

# Current treatments
Treatment depends on the type and severity of the injury, and the length of time since the injury. Injuries of the upper brachial plexus roots affect the muscles around the shoulder. Injuries of the lower roots affect the hand. Many injuries affect both upper and lower roots. Current treatments include medicines to treat pain and conservative care (such as physiotherapy). For some people, surgical procedures are needed to restore function. These include direct suture, nerve grafts, nerve transfer, tendon transfer and free-functioning muscle transfer.

# The procedure
This procedure aims to restore the function of the upper limb after brachial plexus injury, improving the patient's ability to carry out daily activities.
The procedure is done under general anaesthesia, with the patient in a supine position. A functioning gracilis muscle, with its own nerve and blood supply, is dissected from the inner thigh. The gracilis muscle is then transferred and joined to the prepared recipient site of the upper limb. The gracilis muscle's nerve is connected to a functioning nerve in the arm. The transfer is usually to 1 muscle group but transfer to different sites, such as the biceps or the finger flexors, may be needed depending on the nerve injury. The aim is usually to reconstruct a single function, such as elbow flexion.
After the procedure, the patient needs to wear a cast or splint for about 6 weeks to immobilise the elbow and protect the transferred gracilis muscle. Long-term physiotherapy is needed after the procedure so that the patient can learn to control the transferred muscle.
Pressurised intraperitoneal aerosol chemotherapy for peritoneal carcinomatosis

Evidence-based recommendations on pressurised intraperitoneal aerosol chemotherapy for peritoneal carcinomatosis in adults. This involves spraying the inside of the peritoneal cavity with chemotherapy.

# Recommendations
Evidence on the safety of pressurised intraperitoneal aerosol chemotherapy for peritoneal carcinomatosis shows that this procedure can cause serious but well-recognised side effects. Evidence on its 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 be in the form of randomised controlled trials comparing pressurised intraperitoneal aerosol chemotherapy with standard care. Studies should report details of patient selection including type of tumour, the chemotherapy drugs used, survival and quality-of-life outcomes.# The condition, current treatments and procedure

# The condition
Peritoneal metastases commonly result from the regional spread of gastrointestinal, gynaecological and other malignancies. Peritoneal carcinomatosis is an advanced form of cancer associated with short survival and poor quality of life. It may lead to bowel obstruction, fluid build-up in the peritoneal cavity and pain.

# Current treatments
There is no curative treatment. Current standard treatment uses systemic chemotherapy or surgery for short-term palliation of complications such as bowel obstruction.

# The procedure
Pressurised intraperitoneal aerosol chemotherapy for peritoneal carcinomatosis is a laparoscopic procedure that is usually done using general anaesthesia. The aim is to distribute the drug uniformly to all surfaces of the abdomen and pelvis.
Trocars are inserted and the abdomen insufflated with carbon dioxide. Peritoneal biopsies or local partial peritonectomy may be done at this time. The chemotherapy is delivered using an aerosol device containing normothermic chemotherapy solution. This device is connected to a high-pressure injector, which is inserted into the abdomen through an access port. For operator safety, the procedure takes place in an operating room with laminar air flow. Once in position, the device is operated remotely. A laparoscopic camera can be used to visualise the treatment. The chemotherapy is kept in the insufflated peritoneum for about 30 minutes. The chemotherapy aerosol is then exsufflated using a closed extraction system. The trocars are removed, and the laparoscopy completed. The procedure is usually repeated several weeks later. One standard course of treatment comprises 3 procedures, usually given 6 weeks apart, although the timing can vary.
Balloon cryoablation for Barrett's oesophagus

Evidence-based recommendations on balloon cryoablation for Barretts oesophagus. This involves using a balloon filled with cold gas to destroy abnormal cells.

# Recommendations
Evidence on the safety and efficacy of balloon cryoablation for Barrett's oesophagus is inadequate in quantity and quality. Therefore, this procedure should only be used in the context of research. This could be in the form of randomised controlled trials or published registry data. Find out what only in research means on the NICE interventional procedures guidance page.
Patient selection should be done by clinicians experienced in managing Barrett's oesophagus.
Further research should report patient selection, longer-term follow up and complications, including oesophageal stricture.# The condition, current treatments and procedure

# The condition
Barrett's oesophagus happens when the normal stratified squamous epithelium in the oesophagus transforms into simple columnar epithelium. In some people, this condition may become malignant.

# Current treatments
Current management includes lifestyle change, acid-suppressing medicines, endoscopic mucosal resection, endoscopic submucosal dissection, ablative therapies and surgery. Ablative therapies include radiofrequency ablation, photodynamic therapy, argon plasma coagulation, laser ablation, multipolar electrocoagulation and cryotherapy. See the section on endoscopy treatments in NICE's guideline on Barrett's oesophagus: ablative therapy.

# The procedure
This procedure is usually done using sedation. A balloon catheter is inserted through an endoscope, aligned with the dysplastic tissue in the oesophagus, and inflated. Nitrous oxide is then sprayed through a radial diffuser head within the balloon aimed at the target tissue. The tissue is destroyed by the extreme cold. The nitrous oxide gas remains fully contained within the balloon and exits through the proximal end of the catheter.
The ablation sequence is repeated until all the abnormal cells have been destroyed. Multiple ablations can be done without removing the balloon. The procedure typically takes 15 to 20 minutes to complete.
Balloon cryoablation for squamous dysplasia of the oesophagus

Evidence-based recommendations on balloon cryoablation for squamous dysplasia of the oesophagus. This involves using a balloon filled with cold gas to destroy abnormal cells.

# Recommendations
Evidence on the safety and efficacy of balloon cryoablation for squamous dysplasia of the oesophagus is inadequate in quantity and quality. Therefore, this procedure should only be used in the context of research. This could be in the form of randomised controlled trials or published registry data. Find out what only in research means on the NICE interventional procedures guidance page.
Patient selection should be done by clinicians experienced in managing squamous dysplasia of the oesophagus.
Further research should report patient selection, longer-term follow up and complications, including oesophageal stricture.# The condition, current treatments and procedure

# The condition
Squamous cells in the oesophagus may become dysplastic (squamous dysplasia). In some people, this condition may become malignant.

# Current treatments
Current management includes lifestyle change, acid-suppressing medicines, endoscopic mucosal resection, endoscopic submucosal dissection, ablative therapies and surgery. Ablative therapies include radiofrequency ablation, photodynamic therapy, argon plasma coagulation, laser ablation, multipolar electrocoagulation and cryotherapy.

# The procedure
This procedure is usually done using sedation. A balloon catheter is inserted through an endoscope, aligned with the dysplastic tissue in the oesophagus, and inflated. Nitrous oxide is then sprayed through a radial diffuser head within the balloon aimed at the target tissue. The tissue is destroyed by the extreme cold. The nitrous oxide gas remains fully contained within the balloon and exits through the proximal end of the catheter.
The ablation sequence is repeated until all the abnormal cells have been destroyed. Multiple ablations can be done without removing the balloon. The procedure typically takes 15 to 20 minutes to complete.