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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 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

 

 

Symptoms and diagnosis

Warning Warning: This guideline is 167 day(s) past its review date.

Men:

  • asymptomatic in over 50%
  • urethral discharge
  • dysuria.

Women:

  • asymptomatic in up to 90%
  • increase in vaginal discharge
  • dysuria
  • deep dyspareunia
  • post coital, intermenstrual bleeding or breakthrough bleeding
  • lower abdominal pain
  • mucopurulent cervicitis with or without contact bleeding
  • pelvic tenderness
  • cervical motion tenderness.

Rectal Infections

Usually asymptomatic but may cause anal discharge and anorectal discomfort.Rates of rectal infections in MSM have been estimated at between 3% and 10.5%. Some studies in women report high rates (up to 77.3%) of concurrent urogenital and anorectal infection. Other studies however, report lower rates. Not all women with rectal chlamydia report anal sex. Further studies are needed to ascertain the utility of targeted versus routine rectal sampling in women.

Pharyngeal Infection

Usually asymptomatic.

Rates of chlamydia carriage in MSM range from 0.5 to 2.3%. There is a paucity of good data on rates of pharyngeal infections in women.

 

  • In all West of Scotland boards chlamydia testing is provided as a dual NAAT test for chlamydia and gonorrhoea using a variety of platforms.
  • Good sample collection technique improves sensitivity.
  • Patients presenting within two weeks of an exposure giving rise for concern should be asked to return for testing / retesting two weeks after the exposure.

 

Genital

Pharyngeal (all NAAT tests unlicensed)

Rectum (all NAAT tests unlicensed)

 

 

Males

 

First void urine

 

Offer pharyngeal swab to all MSM

 

Offer rectal swab to all MSM

 

Females

Vulvovaginal swab (several studies
indicate that vulvovaginal swab
sensitivities are greater than those of
cervical swabs).
First Void Urine in females has lower
sensitivity for the diagnosis of chlamydia
and GC compared to other specimens so
is not recommended.
Urethral swab in women who have
undergone hysterectomy (in addition to
vulvovaginal swab)

 

If anal intercourse has taken place

Blind swab if no rectal symptoms

 

Proctoscopy if rectal symptoms

*Several studies indicate that vulvovaginal swab sensitivities are greater than those of cervical swabs.
First void urine in females has lower sensitivity for the diagnosis of chlamydia and GC compared to other specimens so is not recommended.

Urine

20ml first void urine (NB: technique should be carefully explained to patient, to ensure that the correct sample is obtained) in a plain universal container. The patient must not have urinated for at least one hour (or 2 hrs for some kits) NB: Do not insert urinalysis dipsticks in the sample, as it may introduce contamination and adversely affect the amplification process.

Vulvovaginal swab

This may be self taken by patient (self obtained vulvovaginal swab (SOLVS) or by the clinician. Insert the dry swab approx 5 cm into the vagina and gently rotate the swab for 10 to 30 seconds.
Bleeding may reduce sensitivity.


Pharyngeal swab

Rub the swab over the posterior pharynx and tonsillar crypts.

 

Rectal swab

  • Proctoscopy: The swab should be rubbed against the rectal wall.
  • Blind: The swab should be inserted 3cm into the anus and rotated once, gently pushing upwards and keeping in place for 10-30 seconds.

  1. British Association of Sexual Heath and HIV Clinical Effectiveness Unit BASHH 2015 UK
    National Guideline for the Management of Infection with Chlamydia trachomatis (2015).
    https://www.bashhguidelines.org/media/1192/ct-2015.pdf [accessed 4th August 2022]
  2. Update on the treatment of Chlamydia trachomatis (CT) infection BASHH Clinical
    Effectivesness Group September 2018 [accessed 4th August 2022] https://www.bashhguidelines.org/media/1191/update-on-the-treatment-of-chlamydia-trachomatis-infection-final-16-9-18.pdf [accessed 4th August 2022]
  3. British Association of Sexual heath and HIV Clinical Effectiveness Unit BASHH UK National Guideline for the Management of Lymphogranuloma Venerum (2013) https://www.bashh.org/documents/2013%20LGV%20guideline.pdf [accessed 4th August 2022]
  4. 2019 European Guideline on the Management of Lymphogranuloma Venereum
    https://onlinelibrary.wiley.com/doi/full/10.1111/jdv.15729 [accessed 4th August 2022]
  5. UK National Guidelines for the Management of Pelvic Inflammatory Disease 2018
    https://www.bashhguidelines.org/media/1170/pid-2018.pdf [accessed 4th August 2022]
  6. United Kingdom National Guideline for the Management of Pelvic Inflammatory Disease
    (2019 Interim Update) https://www.bashhguidelines.org/media/1217/pid-update-2019.pdf[accessed 4th August 2022]
  7. Scottish Bacterial Sexually Transmitted Infections Reference Laboratory (SBSTIRL)
    Samples and Request Forms | Edinburgh and Lothians Laboratory Medicine LGV PCR form Dec 20.pdf (edinburghlabmed.co.uk) [accessed 4th August 2022]
  8. Dr Kate Templeton, Head of Service, Regional Virus Laboratory Specialist Virology
    Centre, Edinburgh [pers comm. 4th August 2022]

Editorial Information

Last reviewed: 30/09/2022

Next review date: 30/09/2024

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

Version: 8.1

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