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  7. Efficacy, suitability, side-effects, and drug interactions
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

 

 

Efficacy, suitability, side-effects, and drug interactions

Warning

Efficacy

The pregnancy rate associated with use of an implant is very low < 1 in 1000 over 3 years. Most pregnancies
have occurred when the client was already pregnant prior to insertion of the implant or had not observed
contraceptive cover after initial fitting.

No increased risk of pregnancy has been demonstrated in women weighing up to 149kg. However because of
the inverse relationship between weight and serum etonogestrel levels a reduction in the duration of
contraceptive efficacy cannot be completely excluded. Women using the contraceptive implant should be
informed that earlier replacement can be considered in obese women (but there is no direct evidence to support earlier replacement).

Suitability

Assessment of client suitability

A medical history (including sexual history) and a clinical assessment, together with consideration of the recommendations in the UK Medical Eligibility Criteria for Contraceptive Use (UKMEC) , should be used to assess the use of the implant.

Assessment of method suitability for the client

  • Discuss efficacy and failure rate and provide written method information.
  • Fully explain procedure and show demonstration of implant.
  • Decision to proceed taken by client and clinician.
  • All clients should be counselled and given the opportunity to take time to consider all their contraceptive options, and possible side effects, including changes to bleeding patterns, before implant insertion.
  • Further appointment made by client for insertion if required.
  • Women using anticoagulants- see FSRH guidance

 

Side effects

  • Bleeding: Altered bleeding patterns are common among women using an implant. Women should be
    advised that 20% of users will have no bleeding, 33% will have infrequent bleeding, 38% will have
    regular bleeds and 25% have frequent or prolonged bleeding. Women should be advised altered
    bleeding patterns are likely to remain irregular.
  • Weight change, mood change, loss of libido: Women should be advised that there is no evidence of a causal association between use of the implant these symptoms.
  • Acne: Women should be advised that acne may improve, occur, or worsen during the use of an implant.
  • Headache: There is no evidence of causal association between use of an implant and headache.
  • Migraine: Women who develop new symptoms of migraine with aura whilst using an implant should be advised to seek medical advice to discuss risks/benefits.
  • Breast cancer: There may be an association between current or recent use of hormonal contraception
    (including progestogen-only implants) and a small increase in risk of breast cancer; absolute
    risk remains very small.

Possible drug Interactions

It is recommended that you check the current status of drug interaction of new preparations with FSRH CEU Guidance: Drug Interactions with Hormonal Contraception (May 2022), BNF and, if necessary, any interaction with HIV drugs.

Concomitant use of enzyme inducing drugs reduces the efficacy of the implant. Women should be advised to switch to a method unaffected by enzyme inducing drugs or to use additional contraception until 28 days after stopping treatment.

 

Editorial Information

Last reviewed: 31/05/2024

Next review date: 31/05/2024

Author(s): West of Scotland Managed Clinical Network for Sexual Health Clinical Guidelines Group .

Version: 9.1

Approved By: West of Scotland Managed Clinical Network for Sexual Health