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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

 

 

Ovarian Cysts in Post-Menopausal Women (549)

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

Ovarian cysts are common in post-menopausal women (amenorrhoea for 1 year or more), and may be discovered during investigation of gynaecological symptoms or during imaging for other reasons.

Many of these cysts will have a low risk of malignancy, and not all need to be managed surgically. However it is important to triage women appropriately to decide the correct management and place for this to occur.

Investigations

No single test offers 100% sensitivity or specificity for the detection of ovarian cancer. CA125 is elevated in >80% of epithelial ovarian cancers. However a maximum of only 50% of women with clinically detectable stage 1 disease have elevated levels. Ovarian cysts in post-menopausal women should be assessed using CA125 and trans-vaginal ultrasound which offers greater sensitivity than the trans-abdominal method. However larger cysts may require to be assessed abdominally. Routine use of other imaging techniques is not recommended (MRI /CT), although these may be of value in selected cases.

The RMI (Risk of Malignancy Index)

The use of RMI scoring has been shown to be an effective method of determining which women are at low / medium/ high risk of malignancy. RMI scoring includes measurement of CA125 and the assessment of specific ultrasound features. Therefore, ultrasound reporting must detail the morphological features present to enable calculation of the RMI accurately.

The RMI is calculated as follows:

RMI = U x M x CA125

U depends on presence of the following ultrasound features:

  • Multi-loculation
  • Evidence of solid areas
  • Evidence of metastases
  • Bilateral lesions
  • Presence of ascites

U value 0: no ultrasound features
U value 1: 1 ultrasound feature
U value 3: 2 – 5 ultrasound features

M scores 3 for post-menopausal women (1 for pre-menopausal)

See attached pro-forma for Calculation of RMI

Management

Simple unilateral, unilocular ovarian cysts measuring <5cm, in the presence of a normal CA125, should be managed conservatively in the vast majority of cases, with follow-up TV scans and CA125 measurements, which should be performed at 4-monthly intervals for a year. If there has been no change over the course of a year then the woman can be discharged.

If the RMI is <200, but the woman is symptomatic or CA125 >25, then surgical management should be considered (oophorectomy). Surgery should also be considered if the RMI is < 200 but the cyst >5cm in diameter.

If the RMI is >200, then the case should be referred to the Gyn / Oncology MDT for surgery in a cancer centre, and a CT scan of chest, abdomen and pelvis arranged in the interim.

The management is summarised in the flow diagram.

Flowchart for the management of ovarian cysts in post-menopausal woman

Appendix: Calculating the Risk of Malignancy Index (RMI)

Calculating the Risk of Malignancy Index (RMI) proforma

Editorial Information

Last reviewed: 14/07/2022

Next review date: 14/07/2025

Author(s): Claire Higgins.

Version: 2

Approved By: Gynaecology Clinical Governance Group

Document Id: 549

References

RCOG Guideline No.34: Ovarian Cysts in Postmenopausal Women
SIGN Guideline No.75: Epithelial Ovarian Cancer