Persius/hicric huggingface dataset:
Intranasal phototherapy for allergic rhinitis

Evidence-based recommendations on intranasal phototherapy for allergic rhinitis in adults. This involves using light to reduce inflammation inside the nose.

# Recommendations
Current evidence on the efficacy and safety of intranasal phototherapy for allergic rhinitis is limited 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: details of patient selection including medication use; underlying medical conditions; the intensity, duration and wavelength of light used; patient-reported outcomes; comparison with existing treatments; and the effects of repeated long-term use. NICE may update the guidance if further evidence is published.# The condition, current treatments and procedure

# The condition
Allergic rhinitis is inflammation of the inside of the nose caused by an allergen such as pollen, house dust mites or mould. It causes symptoms such as sneezing, itchiness and a blocked or runny nose. Most people with allergic rhinitis have mild symptoms that can be easily and effectively treated. For some people, however, symptoms can be severe and persistent and have a significant impact on quality of life.

# Current treatments
First-line treatments for allergic rhinitis include medication such as antihistamines and intranasal corticosteroids. For more severe or persistent symptoms that do not respond to medication, immunotherapy (sublingual or subcutaneous) is sometimes used.

# The procedure
Intranasal phototherapy involves using a device with light-emitting probes, which are inserted into the nasal cavity for several minutes at a time. Some devices are designed to be self-administered, whereas others are administered by a clinician. There are different devices available and the duration and dose of treatment varies. The devices use different frequencies of light, ranging from ultraviolet to infrared.
Intranasal phototherapy is claimed to increase local blood flow and suppress inflammation. The aim is to reduce the symptoms of allergic rhinitis.
Endoscopic bipolar radiofrequency ablation for treating biliary obstruction caused by cancer

Evidence-based recommendations on endoscopic bipolar radiofrequency ablation for treating biliary obstruction caused by cancer in adults. This involves using heat energy both to clear blockage in the bile ducts before inserting stents and to clear blocked stents.

# Recommendations
Current evidence on endoscopic bipolar radiofrequency ablation for treating biliary obstruction caused by cancer shows there are serious but well recognised safety concerns. Evidence on efficacy is limited in quality and quantity. Therefore, this procedure should only be used in the context of research, which should include randomised controlled trials. Find out what only in research means on the NICE interventional procedures guidance page.
Further research should address: patient selection, relief of biliary obstruction, quality of life and survival.# The condition, current treatments and procedure

# The condition
Biliary obstruction caused by cancers such as cholangiocarcinoma or pancreatic adenocarcinoma causes symptoms including jaundice, nausea, bloating and abdominal pain. Surgical resection is often not possible.

# Current treatments
Current management of unresectable cholangiocarcinoma or pancreatic cancer includes biliary stenting during endoscopic retrograde cholangiopancreatography, chemotherapy, biological therapies (for example, monoclonal antibodies), radiation therapy and photodynamic therapy, which involves using a light-sensitive drug and a light source to destroy abnormal cells. Stents often need to be replaced because of blockage by tumour ingrowth.

# The procedure
Endoscopic bipolar radiofrequency ablation uses heat energy to ablate malignant tissue that is obstructing the bile or pancreatic ducts. This may be done before inserting stents or to clear obstructed stents.
The procedure is done with the patient under sedation. Endoscopic retrograde cholangiopancreatography with fluoroscopic guidance is used to establish the length, diameter and position of the stricture. Under endoscopic visualisation, a bipolar endoscopic radiofrequency ablation catheter is deployed over a guide wire across the stricture. Controlled pulses of radiofrequency energy are applied to obstructing tumour tissue to ablate it, and to allow insertion of a stent or clear the lumen of a previously placed stent. Sequential applications are applied throughout the length of the stricture to achieve recanalisation. Repeat treatments may be used if obstruction recurs.
Low-level laser therapy for preventing or treating oral mucositis caused by radiotherapy or chemotherapy

Evidence-based recommendations on low-level laser therapy for preventing or treating oral mucositis caused by radiotherapy or chemotherapy. This involves applying low-energy lasers to the affected tissue.

# Recommendations
Current evidence on the safety of low-level laser therapy for oral mucositis shows no major safety concerns. 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
Oral mucositis (OM) is a common side effect of chemotherapy or radiotherapy used for treating head and neck cancer or before bone marrow transplantation. Symptoms usually start 5 to 10 days after chemotherapy or 14 days after radiotherapy and include dryness, halitosis, pain, inflammation and oral mucosa ulceration. Chemotherapy-associated OM can resolve within a few days after completion of chemotherapy, but radiotherapy-associated OM can last for weeks. OM can affect nutritional status (which may need enteral or parental nutrition) and quality of life, and can increase hospital stay. It can also require interruptions or dose reductions in chemotherapy or radiotherapy treatment.

# Current treatments
Comprehensive oral hygiene, good hydration, a bland soft diet and avoiding alcohol and tobacco may increase the person's comfort. Ice, water-based moisturisers, painkillers and non-steroidal anti-inflammatory drugs can help reduce symptoms. Drugs such as palifermin are sometimes used to prevent or treat OM. Antibiotics may be needed to treat infectious complications.

# The procedure
Low-level laser therapy aims to treat or prevent OM by promoting healing, reducing inflammation and increasing cell metabolism. A hand-held probe is used to deliver light in the red or near-infrared spectrum to the oral mucosa. It can be delivered intra-orally or extra-orally, or as a combination of both approaches. During intra-oral treatment the probe, which is about the size of a dental curing light, is introduced into the mouth. For extra-oral treatment the probe is positioned close to the cheek. The procedure typically takes 20 to 30 minutes, and is delivered 2 to 5 times a week for the duration of the oncology treatment. The procedure may be started before treatment with chemotherapy or radiotherapy begins, with the intention of preventing OM.
Prostate artery embolisation for lower urinary tract symptoms caused by benign prostatic hyperplasia

Evidence-based recommendations on prostate artery embolisation for lower urinary tract symptoms caused by benign prostatic hyperplasia in adults. This involves blocking the blood vessels supplying the prostate with tiny plastic particles.

# Recommendations
Current evidence on the safety and efficacy of prostate artery embolisation for benign prostatic hyperplasia 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 urologist and an interventional radiologist.
This technically demanding procedure should only be done by an interventional radiologist with specific training and expertise in prostatic artery embolisation.# The condition, current treatments and procedure

# The condition
Benign prostatic hyperplasia is common in older men. Stromal and epithelial cells increase in number, causing the prostate to increase in size. It often occurs in the periurethral region of the prostate, with large discrete nodules compressing the urethra. Symptoms include hesitancy during micturition, interrupted or decreased urine stream (volume and flow rate), nocturia, incomplete voiding and urinary retention.

# Current treatments
Mild symptoms are usually managed conservatively. Drugs may also be used, such as alpha blockers and 5alpha-reductase inhibitors. If other treatments have not worked, then surgical options include transurethral resection of the prostate, transurethral vaporisation of the prostate, holmium laser enucleation of the prostate or prostatectomy (see the NICE clinical guideline on lower urinary tract symptoms in men). Insertion of prostatic urethral lift implants has been introduced more recently as an alternative treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia. Potential complications of surgical procedures include bleeding, infection, strictures, incontinence and sexual dysfunction.

# The procedure
Prostate artery embolisation for benign prostate hyperplasia is usually done using local anaesthesia. Under Xray guidance, the prostate is approached through the left or right femoral artery. Super-selective catheterisation of the small prostatic arteries is done using fine microcatheters through the pelvic arteries. Embolisation involves the introduction of microparticles to completely block the prostatic vessels. Embolisation agents include polyvinyl alcohol (PVA) and other newer synthetic biocompatible materials.
The aim of prostate artery embolisation is to reduce the prostate's blood supply, causing some of it to undergo necrosis and shrink. It is common for patients to experience pelvic pain during and after the procedure. This does not usually last more than 1 to 3 days. The potential benefits of prostate artery embolisation compared with surgery include fewer complications, avoiding a general anaesthetic and it may be done as a day case procedure.
Laparoscopic mesh pectopexy for apical prolapse of the uterus or vagina

Evidence-based recommendations on laparoscopic mesh pectopexy for apical prolapse of the uterus or vagina. This involves inserting mesh to hold the uterus or the top of the vagina in place.

# Recommendations
Current evidence on the safety and efficacy of laparoscopic mesh pectopexy for apical prolapse of the uterus or vagina is insufficient 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.
The procedure should only be done by surgeons experienced and trained in laparoscopic urogynaecological surgery.
All adverse events involving the medical devices (including the mesh) used in this procedure should be reported to the Medicines and Healthcare products Regulatory Agency.
Further research should include details of patient selection and long-term outcomes.# The condition, current treatments and procedure

# The condition
Apical prolapse is the descent of the uterus, cervix, or vaginal vault. Vaginal vault prolapse is when the upper part of the vagina descends from its usual position, sometimes out through the vaginal opening. It is common after hysterectomy. Apical prolapse can affect quality of life by causing pressure and discomfort, and by its effect on urinary, bowel and sexual function.

# Current treatments
Treatment is rarely indicated if there are no symptoms. Mild-to-moderate prolapse may be treated with conservative measures such as pelvic floor muscle training, electrical stimulation and biofeedback. Topical oestrogens and mechanical measures such as pessaries may also be used. Surgery may be needed when the prolapse is severe. Several surgical procedures are available including hysterectomy, mesh sacrocolpopexy, uterine suspension sling (including sacrohysteropexy) and uterine or vault suspension (without sling). Some procedures involve using mesh to provide additional support.

# The procedure
Laparoscopic mesh pectopexy is done with the patient under general anaesthesia. Using a laparoscopic approach, a polyvinylidene fluoride (PVDF) monofilament mesh is inserted into the abdominal cavity. The ends of the mesh are attached to the iliopectineal ligaments on each side of the pelvis, using nonabsorbable suture material. The cervical stump or vaginal apex is elevated to the intended tension-free position and sutured to the central part of the mesh. The mesh is then completely covered with peritoneum, secured using absorbable suture material, so that no mesh is visible in the abdominal cavity.
This procedure may offer an alternative to laparoscopic sacrohysteropexy when access to the sacral promontory is limited, for example because of abnormal anatomy, obesity, adhesions, or previous surgery.
Unilateral MRI-guided focused ultrasound thalamotomy for moderate to severe tremor in Parkinson's disease

Evidence-based recommendations on unilateral MRI-guided focused ultrasound thalamotomy for moderate to severe tremor in Parkinsons disease in adults. This involves applying ultrasound to a specific area on 1 side of the brain (thalamus).

# Recommendations
Current evidence on the safety and efficacy of unilateral MRI-guided focused ultrasound thalamotomy for moderate to severe tremor in Parkinson's disease 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, which could include randomised controlled trials, should address patient selection and report on long-term follow-up.# The condition, current treatments and procedure

# The condition
Parkinson's disease is a progressive neurodegenerative disease characterised by gradually worsening tremor, muscle rigidity, and difficulties with starting and stopping movements. The tremor in Parkinson's disease occurs at rest and becomes less prominent with voluntary movement. It typically occurs first in the distal upper extremities then moves proximally and spreads to affect other parts of the body over time.

# Current treatments
Treatment for Parkinson's disease includes supportive therapies and medications such as levodopa, dopamine agonists and monoamine oxidase B inhibitors.
Surgery may be considered in people whose condition has not responded adequately to best medical therapy. Surgical treatments include deep brain stimulation and radiofrequency thalamotomy.

# The procedure
This procedure is carried out with the patient lying supine inside an MRI scanner. The patient's head is shaved and a stereotactic head frame is attached. Patients are kept awake so they can report any improvement or adverse events to the operator during the procedure. However, they may be offered light sedation. Continuous MRI and thermal mapping are used to identify the target area of the brain and monitor treatment. Low-power (sub-lethal) ultrasound is delivered to confirm the chosen location. Then, high-power focused ultrasound pulses are administered to irreversibly ablate target tissue. Chilled water is circulated around the head during the treatment to prevent thermal damage to the scalp caused by the increase in bone temperature. The procedure takes about 3 hours and symptom relief should be immediate.
The potential benefits of unilateral MRI-guided focused ultrasound thalamotomy are that it: is less invasive than the other existing procedures; results in a faster recovery time; and allows for testing of the effects of sub-lethal doses before ablation. However, unlike deep brain stimulation it can only be done on 1 side.
Aortic valve reconstruction with processed bovine pericardium

Evidence-based recommendations on aortic valve reconstruction with processed bovine pericardium. This involves replacing a damaged aortic valve with a new valve made from chemically treated cow pericardium.

# Recommendations
Current evidence on the safety and efficacy of aortic valve reconstruction with processed bovine pericardium 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 address patient selection and report long-term outcomes, particularly the durability of the valve.# The condition, current treatments and procedure

# The condition
Aortic valve disease (stenosis or regurgitation) is usually progressive and causes an increase in cardiac workload, left ventricular hypertrophy and heart failure. Symptoms can include palpitations, fatigue, shortness of breath and chest pain on exertion. Mortality rates are high in symptomatic patients.

# Current treatments
Conventional treatment for a significantly diseased aortic valve is surgical replacement with an artificial (biological or mechanical) prosthesis. Transcatheter aortic valve implantation may also be considered. Bioprosthetic valves do not perform as well as native valves and have limited durability, which may be an issue for younger patients. Lifelong anticoagulation is needed in patients with mechanical valves, which increases the risk of haemorrhagic complications and is not optimal in women wishing to become pregnant. In some patients with aortic regurgitation, the aortic valve may be repaired with patches as an alternative to replacement.
Aortic valve reconstruction with bovine pericardium may be considered in patients who cannot or who refuse to take anticoagulation, patients with an aorta too narrow for a standard prosthetic valve and young patients who wish to avoid long-term anticoagulation.

# The procedure
With the patient under general anaesthesia, the heart is accessed by a sternotomy and cardiopulmonary bypass is established. The heart is stopped with cardioplegic arrest, the aorta is opened and the valve is inspected. The diseased valve cusps are carefully removed and the intercommissural distances are measured. Commercially available bovine pericardium is trimmed to the desired size using a template, and sutured to the annulus to replace the removed cusp(s). The aorta is closed, normal circulation is restored and the chest is closed. The function of the valve is assessed intraoperatively by transoesophageal echocardiography.
Afatinib for treating advanced squamous non-small-cell lung cancer after platinum-based chemotherapy (terminated appraisal)

NICE is unable to make a recommendation about the use in the NHS of afatinib for treating locally advanced or metastatic squamous non-small-cell lung cancer after platinum-based chemotherapy because no evidence submission was received from Boehringer Ingelheim. We will review this decision if the company decides to make a submission.

# Background
Boehringer Ingelheim was invited to submit evidence for this single technology appraisal for afatinib in November 2016.
The company's main clinical trial (LUX-LUNG 8) to support the appraisal compared afatinib with erlotinib for treating locally advanced or metastatic squamous non-small-cell lung cancer progressing on or after platinum-based chemotherapy, irrespective of epidermal growth factor receptor tyrosine kinase (EGFR-TK) mutation status. At the time the trial was carried out, NICE recommended erlotinib for this patient population. NICE then updated the erlotinib guidance, recommending erlotinib after platinum-based chemotherapy only for a small group of patients with EGFR-TK mutation-positive non-small-cell lung cancer.
Because the NICE recommendation for erlotinib has changed, and given the resources and time involved in a NICE technology appraisal, the company felt that it would not be of value to submit evidence for this appraisal.
NICE has therefore terminated this single technology appraisal.# Information
NHS organisations should take into account the reasons why the company did not make an evidence submission when considering whether or not to recommend local use of afatinib for treating locally advanced or metastatic squamous non-small-cell lung cancer after platinum-based chemotherapy. If, after doing this, organisations still wish to consider afatinib for treating locally advanced or metastatic squamous non-small-cell lung cancer after platinum-based chemotherapy, they should follow the advice on rational local decision-making in the NHS Constitution for England and the NHS Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012. This outlines the approach that should be taken when NICE guidance is unavailable.
NICE will review the position if the company decides that it wants to make a full submission.
ISBN: 978-1-4731-2510-0
Panitumumab in combination with chemotherapy for the treatment of metastatic colorectal cancer (terminated appraisal)

NICE is unable to recommend panitumumab with 5fluorouracil, folinic acid and irinotecan (FOLFIRI) for previously treated metastatic colorectal cancer in adults because no evidence submission was received from the manufacturer or sponsor of the technology.

# Background
The manufacturer of panitumumab (Amgen) was invited to submit evidence for this single technology appraisal of panitumumab in combination with chemotherapy for the treatment of metastatic colorectal cancer.
In July 2011, Amgen informed NICE that it would not be making an evidence submission.  Amgen stated that, taking into account approaches previously used by NICE to appraising drugs for the treatment of colorectal cancer, there was not sufficient evidence to robustly estimate the cost effectiveness of panitumumab for this indication.
NICE has therefore terminated this single technology appraisal.# Information
NHS organisations should take into account the reasons why the company did not make an evidence submission when considering whether or not to recommend local use of panitumumab in combination with chemotherapy for the treatment of metastatic colorectal cancer. If, after doing this, organisations still wish to consider panitumumab in combination with chemotherapy for the treatment of metastatic colorectal cancer, they should follow the advice on rational local decision-making in the NHS Constitution for England and the NHS Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012. This outlines the approach that should be taken when NICE guidance is unavailable.
NICE will review the position if the company decides that it wants to make a full submission.
ISBN: 978-1-4731-2442-4