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Announcements and latest updates

Right Decision Service newsletter: October 2024

Welcome to the Right Decision Service (RDS) newsletter for October 2024.

1.Contingency arrangements for RDS outages

Development of the contingency solutions to maximise RDS resilience and minimise risk of future outages is in progress, aiming for completion by Christmas. As a reminder, these contingency arrangements  are:

  • Optimising mobile app build process
  • Mobile app always to be downloadable.
  • Serialising builds to mobile app; separate mobile app build from other editorial and end-user processes
  • Load balancing – provides failover (also enables separation of editorial processes from other processes to improve performance.)

 

In the meantime, a gentle reminder to encourage users to download essential clinical toolkits to their mobile devices so that there is an offline version always available.

 

2. New deployment with improvements.

A new scheduled deployment with minor improvements drawn from support tickets, externally funded projects, information related to outages, and feature requests will take place in early December. Key improvements planned are:

  • Deep-linking to individual toolkits within the RDS mobile app. Each toolkit will now have its own direct URL and QR code, both accessible from the app. These can be used to download the toolkit directly where users already have the RDS app installed. If the user does not yet have the RDS app installed, they will be taken to the app store to install the app and immediately afterwards the toolkit will automatically open and download. Note that this will go live a few days later than the improvements below due to the need to link up the mobile front end to the changes in the content management system.
  • Introducing an Announcement Header field to replace the hardcoded "Announcements and latest updates" text. This will enable users to see at a glance the focus of new announcements.
  • Automated daily emptying of the recycling bin (with a 30 day rolling grace period)  in the content management system. A bug preventing complete emptying of the recycling bin contributed to one of the outages earlier this year.
  • Supporting multiple passcodes (ticket 6079)
  • Expanding accordion section to show location of a search result rather than requiring user coming from a search result to manually open all sections and search again for the term.
  • Displaying first accordion section Content text as a snippet on the search results page as a fallback if default/main content is not provided
  • Displaying the context of each search result in the form of a link to the relevant parent tool/section. This will help users to choose which search result is most likely to be appropriate for their needs.
  • As part of release of the new national benzodiazepine quality prescribing guidance toolkit sponsored by Scottish Government Effective Prescribing and Therapeutics, a digital tool to support creation of benzodiazepine tapering/withdrawal schedules.

We are also seeking approval to use the NHS Scotland logo and title for the RDS app on the app stores to help with audience engagement and clarity around the provenance of RDS.

3. RDS Search, Browse and Archive/Version control enhancements

We are still hopeful that user acceptance testing for at least the Search and browse enhancements can take place before Christmas. Thank you for your patience and understanding in waiting for these improvements. Timescales have been pushed back by old app migration challenges, work to address outages, and most recently implementing the contingency arrangements.

4. Support tickets

We are aware that there continue to be some issues around a number of RDS support tickets, in part due to constraints around visibility for the RDS team of the tickets in the existing  support portal. We are investigating the potential to move to a new support ticket requesting system from early in the new year. We will organise the proposed webinar around support ticket processes once we have confirmed the way forward with the system.

Table formatting

There is a known issue with alterations in formatting of some RDS tables which seems to have arisen as a result of the 17 October deployment. Tactuum is working on a fix and on implementing additional regression testing to prevent this issue recurring.

5. New RDS toolkits

Recently launched toolkits include:

NHS Lothian Infectious Diseases

Scottish Health Technologies Group – Technology Assessment recommendations

NHS Tayside Anaesthetics and Critical Care projects – an innovative toolkit which uses PowerAutomate to manage review and response to proposals for improvement projects.

If you would like to promote one of your new toolkits through this newsletter, please contact ann.wales3@nhs.scot

A number of toolkits are expected to go live before Christmas, including:

  • Focus on dementia
  • Highland Council Getting it Right for Every Child
  • Dumfries and Galloway Adult Support and Protection procedures
  • National Waiting Well toolkit
  • Fertility Scotland National Network
  • NHS Lothian postural care for care homes

6.Sign up to RDS Editors Teams channel

We have had a good response to the recent invitation to sign up to the new Teams channel for RDS editors. This provides a forum for editors to share learning, ideas and questions and we hope to hold regular webinars on topics of interest.  The RDS team is in the process of joining participants to the channel and we’d encourage all editors to take part, using the registration form – available in Providers section of the RDS Learning and Support area.

 

7. Evaluation projects

The RDS team has worked with colleagues in NHS Grampian and the Digital Health & Care Innovation Centre to evaluate the impact of the Prevent the progress of diabetes web and mobile app in a small-scale pilot project. This app provides access to local and national resources and services targeted at people with prediabetes, a history of gestational diabetes, or candidates for remission. After just 8 weeks of using the app, 94% of patients reported increased their knowledge and understanding of diabetes, and 88% said it had increased their confidence and motivation to make lifestyle changes, highlighting specific behaviour changes. The learning from this project is informing development of a service model based on tailored support for patient groups with, high, medium and low digital self-efficacy.

Please contact ann.wales3@nhs.scot if you would like to know more about this project.

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

  • Friday 29th November 3-4 pm
  • Thursday 5 December 3.30 -4.30 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

 

The Right Decision Service:  the national decision support platform for Scotland’s health and care

Website: https://rightdecisions.scot.nhs.uk    Mobile app download:  Apple  Android

 

 

Squamous Cell Carcinoma

Squamous cell carcinoma: Squamous cell carcinoma (SCC) often appears as a firm pink lump with a rough or hyperkeratotic surface. There can be a lot of surface scale and sometimes even a spiky horn sticking up from the surface. The lump often feels tender when touched, bleeds easily and may develop into an ulcer. SCCs grow significantly quicker than BCCs (visible change over weeks rather than months). SCC predominantly arise on sun-exposed sites and there are often other signs of sun-damaged skin. 

The most commonly affected areas are the backs of hands and forearms, upper part of the face and, especially in males, the scalp, lower lip and pinna. For both SCC and BCC there can sometimes be considerable skin damage if the tumour is not treated. Approximately 25,000 squamous cell carcinomas of the skin are diagnosed each year. A full time GP is likely to diagnose at least one person with squamous cell carcinoma every 1–2 years. Death from squamous cell carcinoma is rare (<5%). The main advantage of early diagnosis is less extensive treatment. 

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

Treatment/ therapy

Low-risk: Factors relating to low-risk tumours - Diameter <2cm; Slow growing with a keratotic surface and regular features

 Refer via urgent suspicion of cancer (USOC) 

High-risk - Factors relating to high-risk tumours: Diameter 2-4cm; Rapidly growing with less keratin production and irregular features; Location on ear or lip; Tumour arising within scar or area of chronic inflammation; Immunosuppression 

Refer via USOC 

Very High-risk - Factors relating to very high-risk tumours: Diameter >4cm; Organ transplant recipients; Haematological malignancies

Refer via USOC 

Referral Management

Low-risk: Factors relating to low-risk tumours - Diameter <2cm; Slow growing with a keratotic surface and regular features

If alternative diagnoses (actinic keratosis or Bowen’s) have been suspected and treated surgically or non-surgically (topical therapies/cryotherapy), suspicions should be raised for possible SCC if there has been no response to these therapies within 3 months. 

Clinical resources

TNM Staging System - Basal and Squamous Cell Skin Cancer Stages (cancer.org) see also Cancer Research UK 

BAD SCC guidelines 2020 

NICE CKS – skin cancers – recognition and referral 

Patient.Info Doctors- Squamous Cell Carcinoma of Skin 

PCDS- Squamous Cell Carcinoma 

DermNet NZ- Cutaneous Squamous Cell Carcinoma 

Clinical tips

  • SCC predominantly arise in older patients, although immunosuppressed patients and the other high-risk groups e.g., xeroderma pigmentosum, can develop lesions at a much younger age 
  • Lesions may start de-novo or from pre-existing pre-cancerous skin lesions such as AK and Bowen's disease 
  • Transformation can also occur in areas of chronic inflammation such as leg ulcers 
  • Ulceration and granulation tissue more common than scale in poorly differentiated SCCs 
  • Pain/tenderness on palpation supports a diagnosis of SCC 
  • Can be difficult to distinguish from BCC. The latter can have diagnostic features of pearliness and telangiectasia and is more likely to have a history of spontaneous bleeding.  
  • SCCs increase in size significantly over several weeks; BCCs increase in size significantly over months 
  • SCC can be distinguished from AK and Bowen’s by looking for induration (thickening) beneath overlying keratin. When there is doubt lesions should be referred to secondary care.   
  • Beware of diagnosing a pyogenic granuloma in an elderly patient as this could be SCC or amelanotic melanoma 
  • Overlying scale/crust should be removed during clinical assessment where possible – to assess induration (suggestive of SCC)  
  • Have a higher index of suspicion/lower threshold for referral in immunocompromised patients, particularly transplant patients.

Patient information resources

  1. BAD Patient Information Leaflet - SCC 
  2. NHS page on non-melanoma skin cancers 
  3. DermnetNZ Patient Information Leaflet - SCC 
  4. NHS Inform Scotland- Skin Cancer (non-melanoma) 

ICD search categories

Malignant 

ICD11 code - 2C31 

Editorial Information

Last reviewed: 23/05/2023

Next review date: 23/05/2025

Author(s): Adapted from the BAD Referral Guidelines.

Version: BAD 1

Co-Author(s): Publisher: Centre for Sustainable Delivery, Scottish Dermatological Society.

Approved By: Scottish Dermatological Society