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  6. Audiological Investigation in patients with Cystic Fibrosis, Paediatrics (1031)
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

 

 

Audiological Investigation in patients with Cystic Fibrosis, Paediatrics (1031)

Objectives

This guideline describes referral, monitoring and follow-up pathways for audiological screening of children with cystic fibrosis (CF) at RHC Glasgow who may have received IV or Nebulised aminoglycosides or oral Macrolides as part of their treatment. The aim of the Guideline is to allow for early detection of hearing loss in these children with referral to Audiological Specialist services where required.

Scope

Children with CF attending RHC Glasgow who may receive IV Aminoglycosides or oral Macrolides.

Background

Audiological screening is recommended for patients with Cystic Fibrosis (CF) in order to monitor potential drug induced ototoxicity following Aminoglycoside and Macrolide administration 1,2

AMINOGLYCOSIDE USE IN CF

Children with CF may require several courses of IV Aminoglycosides per year and some patients require daily nebulised Aminoglycosides longer-term.

Aminoglycoside antibiotics, however administered, have been shown to be associated with ototoxicity 1. Classical findings are of high frequency hearing loss =/- vestibular symptoms.

MACROLIDES USE IN CF

Children with CF are often prescribed oral Azithromycin for treatment of infections and as an anti-inflammatory agent long-term.  There is evidence 2 that long-term use of Macrolide antibiotics may be associated with sensorineural hearing loss. We have arranged that CF patients receiving regular Macrolide therapy undergo audiological screening outlined below.

M ABSCESSUS TREATMENT

Children with CF who are undergoing treatment for M abscessus lung disease will be receiving daily Nebulised Aminoglycosides (usually Amikacin) and an oral Macrolide. They may also be receiving intermittent IV Aminoglycosides. These patients require to have audiological assessment at least 6 monthly.  

Referral pathway

Patients with CF attending RHC Glasgow are classified according to the following Screening Groups. Referral for Audiological Screening and follow up is based on Screening Group and outcome of testing.

REFERRAL AND FOLLOW-UP BY SCREENING GROUP

Image of referral pathway

Genetic screening

Although assays for IV Aminoglycoside levels are monitored closely, published literature has highlighted evidence that there may be a small percentage of patients who may exhibit enhanced susceptibility to Aminoglycoside-induced ototoxicity, even at normal serum assay levels.

This susceptibility may be genetically determined and may predispose to hearing impairment many years after initial exposure to Aminoglycoside.
[Fischel-Ghodsian et al UCLA 2004] 

  • A1555G / delT961Cn in the mitochondrial 12s ribosomal RNA gene
  • Multiple studies reporting presence of A1555G in patients with sensorineural hearing loss associated with Aminoglycoside antibiotics.
    • 17% A1555G +ve in study of 41 adults exhibiting hearing impairment post-Aminoglycosides
      [Fischel-Ghodsian et al UCLA 2004]
  • A1555G mutation also reported in hearing-impaired patients with NO history of Aminoglycoside exposure
    [Tang et al 2002]
  • Overall population prevalence of A1555G and delT196Cn
    • AI555G 09%
    • DelT961Cn 6%
      [Tang et al ; Texas 2002]

Ongoing research may be informative for the co-utilisation of protective measures in genetically susceptible individuals who, for clinical reasons, would be disadvantaged by the cessation of all Aminoglycoside therapy. 3

Genetic screening for AI555G mutation will be carried out as part of first Annual Review investigations for patients with Cystic Fibrosis attending RHC.

Parent information sheet

Hearing Test Information Sheet (pdf)

Editorial Information

Last reviewed: 14/12/2020

Next review date: 31/05/2025

Author(s): Dr Jane Wilkinson; Dr Juan Mora; Mr Jim Harrigan; Kirstin Marchbanks.

Version: 1

Approved By: Paediatric Clinical Effectiveness & Risk Committee

Document Id: 1031

References
  1. Rizzi, Mark Douglas; Hirose, Keiko. Aminoglycoside ototoxicity. Current Opinion in Otolaryngology & Head & Neck Surgery. 15(5):352-357, 2007.
  2. Westerberg, Mick P. Sensorineural hearing loss as a probable serious adverse drug reaction associated with low-dose oral azithromycin. Journal of Otolaryngology. 36(5):257-63, 2007.
  3. Tien Nguyen, Anita Jeyakumar. Genetic susceptibility to aminoglycoside ototoxicity. International Journal of Pediatric Otorhinolaryngology. Vol 120, May 2019, pp15-19.