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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

 

 

Endometrial Ablation (123)

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

Heavy menstrual bleeding (HMB) is an important cause of morbidity affecting 1 in 5 of the population and leads to 21% of gynaecology referrals from general practitioners. Endometrial ablation is an effective treatment for HMB and can be performed under local anaesthesia as an office procedure or under general anaesthesia in theatre.

History

  • Date of LMP
  • Frequency and duration of menses
  • Previous treatments for menorrhagia
  • Previous caesarean sections or uterine surgery
  • Contraception - ablation should not be used as a method of contraception and women must be willing to make appropriate contraceptive provision

Examination

  • Pelvic examination
  • BMI if being considered for ablation under GA

Investigations

  • All women undergoing endometrial ablation should have an endometrial biopsy, ideally in advance of the procedure (well tolerated endometrial biopsy is an indication that ablation is suitable to be carried out under local anaesthetic in a clinic setting rather general anaesthetic in theatre)
  • All women undergoing endometrial ablation should have a pelvic ultrasound prior to the procedure to determine uterine size and morphology and to assess the endometrial cavity. A measurement of any previous LUSCS scar should be made (scar thickness < 8 mm – consider treating only endometrium above level of scar).
  • If there is doubt regarding suitability of the cavity for an ablation, then consideration should be given to performing hysteroscopy to confirm suitability before dating for the procedure.
  • Hysteroscopic assessment of the endometrial cavity must be made prior to the procedure. This should be performed immediately following dilation of the cervix, prior to insertion of the ablation device. This is essential to exclude perforation or creation of a false passage.

Contra-indications to endometrial ablation

  • Woman wishes to retain her fertility
  • Genital tract malignancy
  • Unexplained vaginal bleeding
  • Acute pelvic infection
  • Uterine abnormalities e.g. septate uterus
  • Previous classical caesarean section
  • Other contra-indications will depend on the technique employed e.g. regularity of the uterine cavity, presence and size of fibroids. The surgeon should be familiar with the manufacturer’s guidelines for all products that are used and their limitations.

Ablation technique

This guideline refers only to second generation ablation techniques in use in GG&C. It does not refer to first generation techniques such as TCRE and rollerball ablation. The ablation method used will depend on local expertise and availability of equipment.

Novasure®

This uses impedance controlled bipolar energy to cause ablation using a gold mesh electrode to conform to the contours of the uterine cavity. Depth of ablation is 2-3mm at the cornu and 5-7mm in the main body of the uterus. Treatment time is 90-120 seconds. There is an added safety feature using carbon dioxide to test for uterine perforation before treatment. Safety and efficacy have not been assessed in uterine cavities with a sounded length of greater than 10cm.

Complications of second generation devices

Minor complications are common and include pain and nausea. Serious complications are relatively rare but have been reported e.g. uterine perforation and damage to adjacent structures e.g. bowel. Patients should receive an information leaflet giving instructions about post-operative pain and how to access out-of-hours emergency gynaecology services.

Patients who require readmission following an ablation procedure should be assessed by senior staff to rule out intra-abdominal injury. Where there is any doubt, laparoscopy or laparotomy should be performed.

Antibiotic Prophylaxis

Antibiotic prophylaxis is not required.

Patient information

RCOG. Endometrial ablation (2015)

Appendix: Ablation proforma

Ablation proforma

Editorial Information

Last reviewed: 30/04/2018

Next review date: 30/04/2023

Author(s): Claire Higgins.

Approved By: Gynaecology Clinical Governance Group

Document Id: 123