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Important: please update your RDS app to version 4.7.3 Details with newsletter below.

Please update your RDS app to v4.7.3

We asked you in January to update to v4.7.2.  After the deployment planned for 27th February, this new update will be needed to ensure that you are able to download RDS toolkits even when the RDS website is not available. We will wait until as many users as possible have downloaded the new version before switching off the old system for app downloads and moving entirely to the new approach.

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. 

To update to the latest release:

 On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Right Decision Service newsletter: February 2025

Welcome to the February 2025 update from the RDS team

1.     Next release of RDS

 

A new release of RDS is planned (subject to outcomes of current testing) for week beginning 24th February. This will deliver:

 

  • Fixes to mitigate the recurring glitches with the RDS admin area and the occasional brief user interface outages which have arisen following implementation of the new distributed technology infrastructure in December 2024.

 

  • Capability to embed content from Google calendar, Google Maps, Daily Motion, Twitter feeds, Microsoft Stream into RDS pages.

 

  • Capability to include simple multiplication in RDS calculators.

 

The release will also incorporate a number of small fixes, including:

  • Exporting of form within Medicines Sick Day Guidance in polypharmacy toolkit
  • Links to redundant content appearing in search in some RDS toolkits
  • Inclusion of accordion headers alongside accordion text in search result snippets.
  • Feedback form on mobile app.
  • Internal links on mobile app version of benzo tapering tool

 

We will let you know when the date and time for the new release are confirmed.

 

2.     New RDS developments

There is now the capability to publish toolkits on the web with left hand side navigation rather than tiles on the homepage. To use this feature, turn on the “Toggle navigation panel” option at the top of the Page settings menu at toolkit homepage level – see below. Please note that publication to downloadable mobile app for this type of navigation is still under development.

The Benzodiazepine tapering tool (https://rightdecisions.scot.nhs.uk/benzotapering) is now available as part of the RDS toolkit for the national benzodiazepine prescribing guidance developed by the Scottish Government Effective Prescribing team. The tool uses this national guidance developed with a wide-ranging multidisciplinary group. This should be used in combination with professional judgement and an understanding of the needs of the individual patient.

3.     Archiving and version control and new RDS Search and Browse interface

Due to the intensive work Tactuum has had to undertake on the new technology infrastructure has pushed back the delivery dates again and some new requirements have come out of the recent user acceptance testing. It now looks likely to be an April release for the search and browse interface. The archiving and version control functionality may be released earlier. We’ll keep you posted.

4.     Statistics

At the end of January, Olivia completed the generation of the latest set of usage statistics for all RDS toolkits. If you would like a copy of the stats for your toolkit, please contact Olivia.graham@nhs.scot .

 

5.     Review of content past its review date

We have now generated reports of all RDS toolkit content that has exceeded its review date by 6 months or more. We will be in touch later this month with toolkit owners and editors to agree the plan for updating or withdrawing out of date content.

 

6.     Toolkits in development

Some important toolkits in development by the RDS team include:

  • National CVD prevention pathways – due for release end of March 2025.
  • National respiratory pathways, optimal cancer diagnostic pathways and cancer prehabilitation pathways from the Centre for Sustainable Delivery. We will shortly start work on the national cancer referral pathways, first version due for release via RDS around end of June 2025.
  • HIS Quality of Care Review toolkit – currently in final stages of quality assurance.

 

The RDS team and other information scientists in HIS have also been producing evidence summaries for the Scottish Government Realistic Medicine team, to inform development of national guidance around Procedures of Limited Clinical Value. This guidance will in due course be translated into an RDS toolkit.

 

7. Training sessions for new editors (also serve as refresher sessions for existing editors) will take place on the following dates:

  • Friday 28th February 12-1 pm
  • Tuesday 11th March 4-5 pm

 

To book a place, please contact Olivia.graham@nhs.scot, providing your name, organisation, job role, and level of experience with RDS editing (none, a little, moderate, extensive.)

 

To invite colleagues to sign up to receive this newsletter, please signpost them to the registration form  - also available in End-user and Provider sections of the RDS Learning and Support area.   If you have any questions about the content of this newsletter, please contact his.decisionsupport@nhs.scot  If you would prefer not to receive future newsletters, please email Olivia.graham@nhs.scot and ask to be removed from the circulation list.

With kind regards

 

Right Decision Service team

Healthcare Improvement Scotland

 

 

Benign Lesions

Not all treatment options may be listed in this guidance. Please refer to local formulary for a complete list.

Patient Presentation

Lipoma

  • Asymptomatic. Slow growing 
  • Dome or egg-shaped, soft, mobile sub-cutaneous nodule 

Lipoma

 

Epidermoid (sebaceous) cyst 

  • Smooth mobile flesh coloured nodule within and fixed to overlying skin 
  • Presence of punctum helps confirm diagnosis 

Epidermoid (sebaceous) cyst

 

Spider haemangioma 

  • Compressible central feeding blood vessel of variable size 
  • May be associated with high levels of oestrogen e.g pregnancy, liver cirrhosis 

 

Xanthelasma

  • Yellowish plaques nodules above and below the eyes 

Xanthelasma

 

Giant comedones 

  • Like a small cyst with punctum 

Giant comedones

 

Pyogenic granuloma 

  • Rapidly growing vascular lesion often trauma site 

Pyogenic Granuloma

 

Skin Tags 

  • Soft flesh coloured or pigmented pedunculated tags in body folds (neck, armpit, groin) 
  • Especially in obese patients and in those with type 2 diabetes 

Skin Tags

 

Seborrhoeic Warts

  • Yellow / brown greasy palpules or rough grey / black hyperkeratotic papules with ‘stuck-on’ appearance 
  • Keratin plugs or inclusion cysts may help differentiate from melanoma 
  • Often multiple 

Seborrhoeic WartsSeborrhoeic WartsSeborrhoeic Warts

 

Benign Naevi (moles)

  • Flat or raised, symmetrical, uniform border, uniform pigment, pale, dark or reddish brown 
  • May darken/enlarge during pregnancy.  If hairy may become inflamed (folliculitis) 

Benign Naevi (moles)Benign Naevi (moles)Benign Naevi (moles)

 

Dermatofibroma 

  • Firm reddish brown nodules often on the limbs. May be tender on pressure 
  • If the skin over a dermotofibroma is squeezed a dimple forms, indicating tethering of the skin to the underlying fibrous tissue 

DermatofibromaDermatofibromaDermatofibroma

 

GP Management

Referral of patients with benign tumours may be appropriate if there is: 

  • Diagnostic doubt 
  • Significant risk of neoplasm 
  • Lesion causing functional problems or significant disfiguration 
  • Lesion prone to recurrent infection 

If benign skin lesion is diagnosed, it will not be removed in secondary care for cosmetic reasons alone. 

National guidance on exceptional referral protocol is available here: 

https://www.publications.scot.nhs.uk/files/cmo-2019-05.pdf 

 

Lipoma

  • Symptomatic lesions may be removed in primary care (where this service is offered), but treatment usually not indicated 

Epidermal (sebaceous) cyst 

  • Treatment not usually indicated. Symptomatic cysts may be removed in primary care (where this service is offered). 

Spider haemangioma

  • No treatment as they may resolve spontaneously, especially in children 

Xanthelasma

  • Reassure patient, no treatment required 

Giant comedones

  • Reassure patient, content often easily expressed 

Pyogenic granuloma

  • Due to frequent bleeding, excision or curettage/cautery required 
  • Caution with lesions with an atypical history or appearance as could be a malignancy 

Skin tags 

  • If symptomatic, consider treatment in Primary Care by cryotherapy (if available) or snip/shave + cautery (where this service is offered).  

Seborrhoeic Warts

  • If diagnosis certain, reassure that no treatment is needed 
  • Treatment in Primary Care (where this service is offered), can be considered for symptomatic lesions: 
    • Cryotherapy administrated by trained nurse 
    • Curettage for large lesions  
  • Specimen to pathology 

Benign Naevi (moles)

  • Do not refer patients with moles for cosmetic removal 
  • Excise or shave benign naevi only if they meet the criteria as outlined in the exceptional referral pathway: 

https://www.publications.scot.nhs.uk/files/cmo-2019-05.pdf   

Dermatofibroma 

  • If diagnosis is certain, reassure that no treatment is needed 
  • Excision, if indicated e.g. significant pain or discomfort, is the treatment of choice 
  • Warn patient about resulting scar 
  • Send specimen to pathology 

Dermatology Referral

Criteria for referral

Lipoma

  • Lipoma only if there is diagnostic doubt 

Epidermal (sebaceous) cyst

  • If  diagnostic doubt 

Spider haemangioma

  • Referral not generally required 
  • Cautery, hyfrecation or laser only in exceptional circumstances 

Xanthelasma

  • Exceptionally consider referral 

Giant comedones

  • Referral not generally required 

Pyogenic granuloma

  • Diagnostic doubt, or for excision 

Skin Tags

  • Rarely any indication for referral to secondary care 

Seborrhoeic Warts

  • Referral only if there is diagnostic doubt. Follow pathway for suspicious pigmented lesion 

Benign Naevi (moles)

  • Referral only if there is diagnostic doubt. Follow pathway for suspicious pigmented lesion. 

Dermatofibroma

  • Referral only if there is diagnostic doubt 

Patient information resources

Copyright

Images for the ‘Skin Tags’, ‘Seborrhoeic Warts’, ‘Benign Naevi (moles)’, and ‘Dermatofibroma’ reproduced with permission from http://www.dermnetnz.org/

Editorial Information

Author(s): Adapted from Dermatology Patient Pathways.

Co-Author(s): Dermatology Specialty Delivery Group, Centre for Sustainable Delivery.