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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

 

 

Vitiligo

Vitiligo: Is an acquired autoimmune disorder of pigmentation of the skin and mucous membranes where progressive dysfunction and destruction of melanocytes results in loss of skin pigmentation. Incidence: 1% of world population, 50% appearing before the age of 20 years. A family history may be present in up to 30% of cases. Associated with other autoimmune conditions, particularly thyroid disease occurring in 20% of patients over the age of 20 years. Also associated with Type 1 diabetes, pernicious anaemia, alopecia areata, Addison’s disease, systemic lupus erythematosus, rheumatoid arthritis and psoriasis. There is currently no definitive treatment, but spontaneous improvement may occur. Irrespective of clinical severity Vitiligo may cause significant psycho-social distress and referral for psychological support should always be considered. 

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

 

Treatment/ therapy

Severity 

Depends on proportions of physical appearance and psychological impact. 

Mild:  Localised segmental Vitiligo. Non segmental Vitiligo sparing face and hands. Minimal psychological impact. 

  • In absence of definitive treatment, for minimal disease with low psychological impact patients may not seek further treatment. 
  • Recommend a high-factor (SPF50+) sunscreen with protection against ultraviolet A and B. 
  • Check TSH and thyroid antibodies. 
  • For adults with limited areas on trunk and limbs a potent topical steroid may be applied once daily (off licence) for up to 2 months 
  • Not suitable for face and flexures. 
  • Topical calcineurin inhibitor may be useful such as Tacrolimus 0.1% applied BD for face and flexures 
  • Avoid use of sunbeds. 
  • Provide contact details for Changing Faces for advice on skin camouflage and the Vitiligo Society for further information and support.

Moderate: More widespread.  Acrofacial.  Significant psychological impact. 

  • Check TSH and thyroid antibodies. 
  • For adults with limited areas on trunk and limbs a potent topical steroid may be applied once daily (off licence) for up to 2 months or daily for one week on one week off for longer periods of time. Not suitable for face and flexures. 
  • Topical calcineurin inhibitor may be useful such as Tacrolimus 0.1% applied BD for face or flexures. Consider referral to secondary care if failing to respond to simple measures for further assessment  

Expert recommendations: camouflage 

  • Self-tanning agents in gel, cream, lotion or spray: These give the skin a brown colour that resembles a natural tan and normally lasts from 3 to 5 days. 
  • Highly pigmented cover creams: May require guidance on selection and application 

Severe:  Generalised / Universal / Active Progressive spread, Rapidly progressive spread and/or Major psychological impact 

For all patients for whom the condition is progressing rapidly; or where there is diagnostic uncertainty; or if the condition has a significant psychosocial impact; or the condition is not responding to topical treatment 

Refer to secondary care services for consideration of treatment with: 

  • Topical steroids 
  • Topical calcineurin inhibitor 
  • Narrowband – UVB 
  • Emerging treatments

NB. treatments may help but none are curative at present.

 

 

Referral Management

Severity 

Depends on proportions of physical appearance and psychological impact. 

Mild: Localised segmental Vitiligo. Non segmental Vitiligo sparing face and hands. Minimal psychological impact. 

Refer to secondary care: 

  • If the condition is progressing rapidly 
  • there is diagnostic uncertainty 
  • the condition has a significant psychosocial impact, or 
  • the condition is not responding to topical treatment. 

Moderate: More widespread.  Acrofacial.  Significant psychological impact. 

Refer to secondary care: 

  • If the condition is progressing rapidly 
  • there is diagnostic uncertainty 
  • the condition has a significant psychosocial impact, or 
  • the condition is not responding to topical treatment. 

Severe:  Generalised / Universal / Active Progressive spread, Rapidly progressive spread and/or Major psychological impact 

Refer to secondary care: 

  • If the condition is progressing rapidly 
  • there is diagnostic uncertainty 
  • the condition has a significant psychosocial impact, or 
  • the condition is not responding to topical treatment. 

Clinical resources

NICE CKS – Vitiligo   

BAD Guidelines – Vitiligo (2021)

European Dermatology Forum vitiligo guidelines 2012 

PCDS- Vitiligo

DermNet NZ- Vitiligo 

Clinical tips

  • Be aware of possible association with other autoimmune disorders. 
  • Post-inflammatory hypopigmentation can be common in skin of colour and should be clinically distinguishable from depigmentation seen in vitiligo, which may often be symmetrical. 
  • Psychological effects are important. Vitiligo is often immediately visible to others and those with the condition may suffer social and emotional consequences including low self-esteem, social anxiety, depression, stigmatization and, in extreme cases, rejection by those around them. This can be accentuated in darker skin types, where loss of pigment is more visible. 

Patient information resources

BAD patient information leaflet – Vitiligo:  

BAD patient information leaflet – Skin camouflage:   

Patient.info leaflet – Vitiligo:   

NHS Conditions- Vitiligo:  

ICD search categories

Epidermal/ 

Appendageal 

ICD11 code - ED63.0 

Editorial Information

Last reviewed: 30/05/2023

Next review date: 30/05/2025

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