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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

 

 

Postcoital Bleeding (893)

Please report any inaccuracies or issues with this guideline using our online form

Post-coital Bleeding (PCB) is bleeding from the genital tract which occurs after intercourse. PCB after the menopause should be regarded as PMB and investigated as such. PCB can be associated with genital tract carcinoma but only a very few women presenting with this symptom have such serious pathology, the remainder having benign causes.

It’s worth noting that approximately 13% of women age 20-24 will experience PCB in any given year but in this age group only 0.002% of PCB is due to cervical cancer. 80% of such cancers are visible to the naked eye on speculum.

Causes

Cervical

  • Ectopy
  • Cervicitis
  • STI
  • Condyloma
  • Carcinoma (rarely)

Vaginal/Vulval

  • Trauma
  • Vaginitis
  • Tumours (rarely)
  • Vulval Dermatoses

Uterine

  • Endometrial polyp
  • Dysfunctional Uterine Bleeding (DUB)
  • Endometritis
  • Endometrial Hyperplasia/malignancy

Iatrogenic

  • IUCD/IUS
  • Following smear or treatment to the cervix
  • Hormonal contraception

History

The following aspects should be covered in the history:

  • nature and timing of bleeding
  • menstrual history
  • smear/colposcopy history
  • contraception history
  • sexual history for STI where appropriate
  • medical History e.g. bleeding diathesis, diabetes
  • medication e.g. anticoagulants, antibiotics with secondary candidiasis
  • dyspareunia

Examination and Investigation

  • Bimanual examination
  • Speculum examination
  • HVS
  • STI screen where appropriate (Chlamydia and gonococcus)
  • Cervical smear if due
  • Urgent colposcopy referral in the event of clinical suspicion of cervical malignancy
  • If no lower genital tract cause found, consider TVS in women over the age of 40

Referral guidance

  • Women with PCB should be referred to Colposcopy as ‘URGENT: Suspicious of cancer’ and seen within 10 working days if the appearance of the cervix on speculum examination is suspicious of or consistent with cervical cancer.
  • Women with PCB with abnormal cervical screening should be referred to Colposcopy as per usual colposcopy protocols. Those in whom screening is absent or overdue should have a cervical smear and be referred based on the smear result and clinical examination findings.
  • Women with persistent PCB aged less than 40yrs with a normal smear history and normal speculum examination should have a self-obtained vulvovaginal swab for chlamydia and gonorrhea NAAT testing and, where appropriate, treatment for genital tract infection.
    Consideration should be given to a change of hormonal contraceptive if relevant. A therapeutic trial of Relactagel (PV for one week after menses and repeated for 2 months) should also be considered. If these measures are ineffective, patients can be referred as ‘Routine’ for further assessment to gynaecology / colposcopy depending on local service provision.
  • Women over 40 should be referred as urgent and seen within secondary care services within 14 days (gynaecology / coloposcopy).
  • Patients are invited to participate in the national cervical screening programme from the age of 25. PCB is not an indication for a cervical smear in those aged less than 25.

Differences in age cut off and referral times in these recommendations compared to the RCOG / BSGE Abnormal Uterine Bleeding Covid Guideline should be noted. Differences are due to the current GGC service structure and Scottish Government treatment time targets which differ from the UK system.

Management (where cervical pathology has been excluded)

  • Treat infection
  • Remove endocervical polyps
  • Consider change of contraceptive formulation or method
  • Consider Relactagel®/Balance Activ® gel to acidify vagina. This should be used after menses,nightly for 1 week and repeated for 2 months. (NB contra-indicated if patient or partner has shellfish allergy).
  • Topical oestrogen preparations in the presence of atrophic vaginitis e.g oestradiol pessary (Vagirux® or Vagifem®) or Orthogynest® cream
  • Endometrial assessment in women over 40 in whom the above measures have failed.

Editorial Information

Last reviewed: 03/12/2020

Next review date: 31/12/2025

Author(s): Morton Hair.

Approved By: Gynaecology Clinical Governance Group

Document Id: 893