Welcome to the Right Decision Service (RDS) newsletter for April 2024.
Tactuum has been working hard to address the issues experienced during the last week. They have identified a series of three mitigation measures and put the first of these in place on Friday 3rd May. If this does not resolve the problems, the second mitigation will be actioned, and then the third if necessary.
Please keep a lookout for any slowing down of the system or getting locked out. Please email myself, mbuchner@tactuum.com and onivarova@tactuum.com if you experience any problems, and also please raise an urgent support ticket via the Support Portal.
Thank you for your patience and understanding while we achieve a full resolution.
A rotating carousel presenting some of the key RDS tools and capabilities, and an editable slideset, are now available in the Resources for RDS providers section of the Learning and Support toolkit.
The redesign of RDS Search and Browse is still on-track for delivery by mid-June 2024. We then plan to have a 3-week user acceptance testing phase before release to live. All editors and toolkit owners on this mailing list will be invited to participate in the UAT.
The archiving and version control functionality is also progressing well and we will advise on timescales for user acceptance testing shortly.
Tactuum is also progressing with the deep linking to individual toolkits within the mobile RDS app. There are several unknowns around the time and effort required for this work, which will only become clear as the work progresses. So we need to be careful to protect budget for this purpose.
These have all been compiled and effort estimated. Once the redesign work is complete, these will be prioritised in line with the remaining budget. We expect this to take place around late June.
Many thanks to those of you completed the value and impact survey we distributed in February. Here are some key findings from the 65 responses we received.
Figure 1: Impact of RDS on direct delivery of care
Key figures
Figure 2 shows RDS impact to date on delivery of health and care services
Key figures
These data show how RDS is already contributing to NHS reform priorities and supporting delivery of more sustainable care.
Saving time and money
Quality assurance and governance
Service innovation and workforce development
A few examples of toolkits published to live in the last month:
Some of the toolkits the RDS team is currently working on:
Please contact his.decisionsupport@nhs.scot if you would like to learn more about a toolkit. The RDS team will put you in touch with the relevant toolkit lead.
Thanks to all of you who have responded to the retrospective quality audit survey and to the follow up questions. We still have some following up to do, and to work with owners of a further 23 toolkits to complete responses. An interim report is being presented to the HIS Quality and Performance Committee.
Eight clinical services and two public library services are undertaking tests of change to implement the Being a partner in my care app. This app aims to support patients and the public to become active participants in Realistic Medicine. It has a strong focus on personalised, person-centred care and a library of shared decision aids, as well as simple explanations and videoclips to help the public to understand the aims of Realistic Medicine. The tests of change will inform guidance and an implementation model around wider adoption and spread of the app.
With kind regards
Right Decision Service team
Healthcare Improvement Scotland
Melanoma should be staged using the tumour, node, metastasis (TNM) staging classification described by the American Joint Committee on Cancer Staging Manual, 8th edition (AJCC8).
Click here for pathological reporting on therapeutic and sentinel lymph node dissection specimens.
If there is palpable lymphadenopathy fine needle aspiration cytology should be used to obtain cytological confirmation of metastases, with ultrasound if required.
If open biopsy is undertaken the incision must be placed in the same line as for a potential radical lymphadenectomy.
Therapeutic lymph node dissection requires complete and radical removal of all draining lymph nodes to allow full pathological examination.
Patients with a confirmed metastatic lymph node(s) should be radiologically staged prior to lymph node dissection.
Regional lymph node dissection carries a well defined and significant morbidity and should be undertaken only by surgeons with appropriate expertise.
Patients should be advised of the risk of lymphoedema following lymph node dissection. If lymphoedema occurs, patients should be referred to a lymphoedema specialist.
Sentinel lymph node biopsy (SLNB) should be considered as a staging technique in patients with IB-IIC melanoma with a Breslow thickness of >1mm.
Consider sentinel lymph node biopsy for people who have melanoma with a Breslow thickness 0.8 mm to 1.0 mm and at least one of the following features:
While the above criteria have been shown to be the statistically significant thresholds for SLNB positivity in thin tumours, the likelihood of SLNB positivity in any individual is multifactorial. Outwith the above criteria, after consensus within the multidisciplinary team and careful discussion with the patient, SLNB may be considered in patients with thin melanomas (<1.0 mm) where the clinical team feel an individual patient’s risk merits the procedure.
Patients with resected stage IIB or IIC melanoma have the option of being considered for SLNB or proceeding directly to adjuvant immunotherapy, where appropriate. These patients should be discussed on an individual basis by the multidisciplinary team.
Completion lymphadenectomy is not recommended for the majority of patients.
There may be specific clinical cases where completion lymphadenectomy may be considered following multidisciplinary team discussion.
Cutaneous melanoma (SIGN)