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Announcements and latest updates

Welcome to the Right Decision Service (RDS) newsletter for August 2024.

  1. Contingency planning for RDS outages

Following the recent RDS outages, Tactuum and the RDS team have been reviewing the learning from these incidents. We are committed to doing all we can to ensure a positive outcome by strengthening the RDS to make it fully robust and clinically resilient for the future.

We would like to invite you to a webinar on 26th September 3-4 pm on national and local contingency planning for future RDS outages.  Tactuum and the RDS team will speak about our business continuity plans and the national contingency arrangements we are putting in place. This will also be a space to share local contingency plans, ideas and existing good practice. We would also like to gather your views on who we should send communications to in the event of future outages.

I have sent a meeting request for this date to all editors – please accept or decline to indicate attendance, and please forward on to relevant contacts. You can also contact Olivia.graham@nhs.scot directly to register your interest in participating.

 

2.National  IV fluid prescribing  calculator

This UK CA marked calculator is now live at https://righdecisions.scot.nhs.uk/ivfluids  . It has been developed by a multiprofessional steering group of leads in IV fluids management, as part of the wider Modernising Patient Pathways Programme within the Centre for Sustainable Delivery.  It aims to address a known cause of clinical error in hospital settings, and we hope it will be especially useful to the new junior doctors who started in August.

Please do spread the word about this new calculator and get in touch with any questions.

 

  1. New toolkits

The following toolkits are now live;

  1. Updated guidance on current and future Medical Device Regulations

We have updated and simplified this guidance within our standard operating procedures. We have clarified the guidance on how to determine whether an RDS tool is a medical device, and have provided an interactive powerpoint slideset to steer you through the process.

 

  1. Guide to six stages of RDS toolkit development

We have developed a guide to support editors and toolkit leads through the process of scoping, designing, delivering, quality assuring and implementing a new RDS toolkit.  We hope this will help in project planning and in building shared understanding of responsibilities throughout the full development process.  The guide emphasises that the project does not end with launch of the new toolkit. Implementation, communication and evaluation are ongoing activities throughout the lifetime of the toolkit.

 

  1. Training sessions for new editors (also serve as refresher sessions for existing editors) will take place on the following dates:
  • Thursday 5 September 1-2 pm
  • Wednesday 24 September 4-5 pm
  • Friday 27 September 12-1 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.)

7 Evaluation projects

Dr Stephen Biggart from NHS Lothian has kindly shared with us the results of a recent survey of use of the Edinburgh Royal Infirmary of Edinburgh Anaesthesia toolkit. This shows that the majority of consultants are using it weekly or monthly, mainly to access clinical protocols, with a secondary purpose being education and training purposes. They tend to find information by navigating by specialty rather than keyword searching, and had some useful recommendations for future development, such as access to quick reference guidance.

We’d really appreciate you sharing any other local evaluations of RDS in this way – it all helps to build the evidence base for impact.

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

Hormone Replacement Therapy and Cardiovascular Disease (689)

Warning

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

Cardiovascular disease is common; therefore we will inevitably see women with cardiovascular disease who wish to use hormone replacement therapy (HRT).

Until the late 1990s oestrogen was thought to protect against coronary heart disease (CHD).  However, an RCT, the Women’s Health Initiative (WHI) found an early, transient increase in coronary events in the combined HRT (oestrogen plus progestogen) arm.  However, the average age of participants in WHI was 63 years old, and more recent subgroup analyses of data from the WHI trials have questioned these results.  HRT use was stratified by age and time since menopause, and this analysis demonstrated more favourable results for all-cause mortality and myocardial infarction in women aged 50-59, and those starting HRT close to menopause (1).  The Danish Osteoporosis Prevention Study (DOPS) (2), an open label RCT, showed that HRT was associated with a reduction in cardiovascular disease in women of the same age group.

The NICE Guideline on Menopause (NG23) provides guidance on the use of HRT and the risk of cardiovascular risk, and this is summarized below.

Resources

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Editorial Information

Last reviewed: 01/06/2019

Next review date: 30/06/2024

Author(s): Jenifer Sassarini.

Approved By: Gynaecology Clinical Governance Group

Document Id: 689

Related resources

NICE Guidance: NG23. Diagnosis and management of menopause. https://www.nice.org.uk/guidance/ng23/

BMS Consensus Statements – www.thebms.org.uk

Alternatives to HRT for the Management of Symptoms of the Menopause (SAC Opinion Paper 6). RCOG; 2010. http://www.rcog.org.uk/womens-health/clinicalguidance/alternatives-hrt-management-symptoms-menopause  

References
  1. Manson JE, Chlebowski RT, Stefanick ML, et al. Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women's Health Initiative randomized trials. JAMA. 2013 Oct 2;310(13):1353-68. PubMed PMID: 24084921. Pubmed Central PMCID: 3963523.
  2. Schierbeck LL, Rejnmark L, Tofteng CL, et al. Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomised trial. 2012 2012-10-09 22:32:25;345.
  3. Windler E, Stute P, Ortmann O, Mueck AO. Is postmenopausal hormone replacement therapy suitable after a cardio- or cerebrovascular event? Archives of Gynecology and Obstetrics. 2015;291(1):213-7.
  4. Shlipak MG, Angeja BG, Go AS, et al. Hormone Therapy and In-Hospital Survival After Myocardial Infarction in Postmenopausal Women. Circulation. 2001;104(19):2300-4.
  5. Tackett AH, Bailey AL, Foody JM, et al. Hormone replacement therapy among postmenopausal women presenting with acute myocardial infarction: Insights from the GUSTO-III trial. American Heart Journal. 2010 10//;160(4):678-84.
  6. Mikkola TS, Tuomikoski P, Lyytinen H, et al. Increased Cardiovascular Mortality Risk in Women Discontinuing Postmenopausal Hormone Therapy. J Clin Endocrinol Metab. 2015 Dec;100(12):4588-94. PubMed PMID: 26414962.
  7. Renoux C, Dell'aniello S, Garbe E, Suissa S. Transdermal and oral hormone replacement therapy and the risk of stroke: a nested case-control study. BMJ. 2010;340:c2519. PubMed PMID: 20525678.