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[null,"Baseline assessment tool for renal and ureteric stones: assessment and management (NICE guideline NG118)"]
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[null,"This baseline assessment tool can be used to evaluate whether practice is in line with the recommendations in Renal and ureteric stones: assessment and management.  It can also help to plan activity to meet the recommendations."]
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[null,"The tool can be used by individual services or organisations. Alternatively, an assessment completed with the involvement of all relevant services or organisations would help to develop a picture of activity in the local area."]
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[null,"It should be used in conjunction with Renal and ureteric stones: assessment and management (NICE guideline NG118)."]
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[null,"In the first instance, consider whether the guideline is relevant and record the conclusion in the box below."]
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[null,"Is the guideline relevant?"]
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[null,"The data sheet contains the recommendations from the guideline. Information can be entered about current activity relevant to the recommendation, actions needed to meet the recommendation, deadlines and the names of the responsible leads.  Useful documents can be added as hyperlinks."]
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[null,"The table can be adapted to include any other local information that is thought to be useful."]
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[null,"If it would be helpful to group the recommendations, for example those that are key priorities for implementation or by deadline, use the filter function in the data menu. "]
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[null,"Tools and resources to help put the guidance into practice are available on the NICE website. "]
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[null,"National Institute for Health and Care Excellence\nLevel 1A, City Tower, Piccadilly Plaza, Manchester M1 4BT; www.nice.org.uk\n\nCopyright\n© NICE 2019. All rights reserved. Subject to Notice of rights.\n"]

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[null,"Baseline assessment tool for renal and ureteric stones: assessment and management (NICE guideline NG118)"]
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[null,null,null,null,null,"Number of relevant recommendations",{"$f":"COUNTIF(E8:E46,\"Yes\")","v":0}]
[null,null,null,null,null,"Number of recommendations met",{"$f":"COUNTIF(G8:G46,\"Yes\")","v":0}]
[null,null,null,null,null,"Percentage of recommendations met",{"$f":"IF(ISERROR(G4/G3),\"\",G4/G3)","v":""}]
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[null,"NICE recommendation","Guideline reference","Year of recommendation","Is the recommendation relevant?","Current activity/evidence","Recommendation met?","Actions needed to implement recommendation","Is there a risk associated with not implementing this recommendation?","Is there a cost or saving?","Deadline","Lead"]
[null,"1.1  Diagnostic imaging"]
[null,"Offer urgent (within 24 hours of presentation) low-dose non-contrast CT to adults with suspected renal colic. If a woman is pregnant, offer ultrasound instead of CT.","1.1.1"]
[null,"Offer urgent (within 24 hours of presentation) ultrasound as first-line imaging for children and young people with suspected renal colic.","1.1.2"]
[null,"If there is still uncertainty about the diagnosis of renal colic after ultrasound for children and young people, consider low-dose non-contrast CT.","1.1.3"]
[null,"1.2 Pain management"]
[null,"Offer a non-steroidal anti-inflammatory drug (NSAID) by any route as first-line treatment for adults, children and young people with suspected renal colic.","1.2.1"]
[null,"Offer intravenous paracetamol to adults, children and young people with suspected renal colic if NSAIDs are contraindicated or are not giving sufficient pain relief.","1.2.2"]
[null,"Consider opioids for adults, children and young people with suspected renal colic if both NSAIDs and intravenous paracetamol are contraindicated or are not giving sufficient pain relief.","1.2.3"]
[null,"Do not offer antispasmodics to adults, children and young people with suspected renal colic.","1.2.4"]
[null,"1.3  Medical expulsive therapy"]
[null,"Consider alpha blockers for adults, children and young people with distal ureteric stones less than 10 mm.","1.3.1"]
[null,"1.4  Stenting before shockwave lithotripsy"]
[null,"Do not offer pre-treatment stenting to adults having shockwave lithotripsy (SWL) for ureteric or renal stones.","1.4.1"]
[null,"Consider pre-treatment stenting for children and young people having SWL for renal staghorn stones.","1.4.2"]
[null,"1.5  Surgical treatments (including shockwave lithotripsy)"]
[null,"Renal stones"]
[null,"Consider watchful waiting for asymptomatic renal stones in adults, children and young people if:\n- the stone is less than 5 mm or\n- the stone is larger than 5 mm and the person (or their family or carers as appropriate) agrees to watchful waiting after an informed discussion of the possible risks and benefits.","1.5.1"]
[null,"Follow the recommendations in table 1 for surgical treatment (including SWL) of renal stones in adults, children and young people.","1.5.2"]
[null,"Ureteric stones"]
[null,"Follow the recommendations in table 2 for surgical treatment (including SWL) of ureteric stones in adults, children and young people.","1.5.3"]
[null,"Timing of surgical treatment (including SWL) for adults with ureteric stones and renal colic"]
[null,"Offer surgical treatment (including SWL) to adults with ureteric stones and renal colic within 48 hours of diagnosis or readmission, if:\n- pain is ongoing and not tolerated or\n- the stone is unlikely to pass.","1.5.4"]
[null,"Medical expulsive therapy as an adjunct to SWL for adults with ureteric stones less than 10 mm"]
[null,"Consider alpha blockers as adjunctive therapy for adults having SWL for ureteric stones less than 10 mm.","1.5.5"]
[null,"1.6  Stenting after ureteroscopy for adults with ureteric stones less than 20 mm"]
[null,"Do not routinely offer post-treatment stenting to adults who have had ureteroscopy for ureteric stones less than 20 mm.","1.6.1"]
[null,"1.7  Metabolic testing"]
[null,"Consider stone analysis for adults with ureteric or renal stones.","1.7.1"]
[null,"Measure serum calcium for adults with ureteric or renal stones.","1.7.2"]
[null,"Consider referring children and young people with ureteric or renal stones to a paediatric nephrologist or paediatric urologist with expertise in this area for assessment and metabolic investigations.","1.7.3"]
[null,"1.8  Preventing recurrence"]
[null,"Dietary and lifestyle advice"]
[null,"Discuss diet and fluid intake with the person (and their family or carers, as appropriate), and advise:\n- adults to drink 2.5 to 3 litres of water per day and children and young people (depending on their age) 1 to 2 litres\n- adding fresh lemon juice to drinking water\n- avoiding carbonated drinks\n- adults to have a daily salt intake of no more than 6 g and children and young people (depending on their age) 2 to 6 g\n- not restricting daily calcium intake, but maintaining a normal calcium intake of 700 to 1,200 mg for adults and 350 to 1,000 mg per day for children and young people (depending on their age).","1.8.1"]
[null,"The following recommendations apply alongside the recommendations on dietary and lifestyle advice.","1.8.2"]
[null,"Potassium citrate"]
[null,"Consider potassium citrate for adults with a recurrence of stones that are predominantly (more than 50%) calcium oxalate.","1.8.3"]
[null,"Consider potassium citrate for children and young people with a recurrence of stones that are predominantly (more than 50%) calcium oxalate, and with hypercalciuria or hypocitraturia.","1.8.4"]
[null,"Thiazides"]
[null,"Consider thiazides for adults with a recurrence of stones that are predominantly (more than 50%) calcium oxalate and hypercalciuria, after restricting their sodium intake to no more than 6 g a day.","1.8.5"]

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[null,"Table 1 Surgical treatment (including shockwave lithotripsy) of renal stones in adults children and young people"]
[null,"Stone type and size","Treatment for adults (16 years and over)","Treatment for children and young people (under 16 years)"]
[null,"Renal stone less than 10 mm","Offer SWL","Consider URS or SWL"]
[null,null,"Consider URS:","Consider PCNL if:"]
[null,null,"·        if there are contraindications for SWL or","·        URS or SWL have failed, or"]
[null,null,"·        if a previous course of SWL has failed or","·        for anatomical reasons PCNL is the more favourable option"]
[null,null,"·        because of anatomical reasons, SWL is not indicated."]
[null,null,"Consider PCNL if SWL and URS have failed to treat the current stone or they are not an option"]
[null,"Renal stone 10 to 20 mm","Consider URS or SWL","Consider URS, SWL or PCNL1"]
[null,null,"Consider PCNL if URS or SWL have failed"]
[null,"Renal stone larger than 20 mm, including staghorn stones","Offer PCNL2","Consider URS, SWL or PCNL1"]
[null,null,"Consider URS if PCNL is not an option"]
[null,"Abbreviations: PCNL, percutaneous nephrolithotomy; SWL, shockwave lithotripsy; URS, ureteroscopy."]
[null,"1 Use clinical judgement when considering mini or standard PCNL."]
[null,"2 Use clinical judgement when considering tubeless, mini or standard PCNL, and supine or prone positions."]
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[null,"Table 2 Surgical treatment (including shockwave lithotripsy) of ureteric stones in adults, children and young people"]
[null,"Stone type and size","Treatment for adults (16 years and over)","Treatment for children and young people (under 16 years)"]
[null,"Ureteric stone less than 10 mm","Offer SWL","Consider URS or SWL"]
[null,null,"Consider URS if:"]
[null,null,"·      stone clearance is not possible within 4 weeks with SWL or"]
[null,null,"·      there are contraindications for SWL or"]
[null,null,"·      the stone is not targetable with SWL or"]
[null,null,"·     a previous course of SWL has failed"]
[null,"Ureteric stone 10 to 20 mm","Offer URS","Consider URS or SWL"]
[null,null,"Consider SWL if local facilities allow stone clearance within 4 weeks"]
[null,null,"Consider PCNL for impacted proximal stones when URS has failed"]
[null,"Abbreviations: PCNL, percutaneous nephrolithotomy; SWL, shockwave lithotripsy; URS, ureteroscopy."]