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Important: please update your RDS app to version 4.7.3

Welcome to the March 2025 update from the RDS team

1.     RDS issues - resolutions

1.1 Stability issues - Tactuum implemented a fix on 24th March which we believe has finally addressed the stability issues experienced over recent weeks.  The issue seems to have been related to the new “Tool export” function making repeated calls for content when new toolkit nodes were opened in Umbraco. No outages have been reported since then, and no performance issues in the logs, so fingers crossed this is now resolved.

1.2 Toolkit URL redirects failing– these were restored manually for the antimicrobial calculators on the 13th March when the issue occurred, and by 15th March for the remainder. The root cause was traced to adding a new hostname for an app migrated from another health board and made live that day. This led to the content management system automatically creating internal duplicate redirects, reaching the maximum number of permitted redirects and most redirects therefore ceasing to function.

This issue should not happen again because:

  • All old apps are now fully migrated to RDS. The large number of migrations has contributed to the high number of automated redirects.
  • If there is any need to change hostnames in future, Tactuum will immediately check for duplicates.

1.3 Gentamicin calculators – Incidents have been reported incidents of people accessing the wrong gentamicin calculator for their health board.  This occurs when clinicians are searching for the gentamicin calculator via an online search engine - e.g. Google - rather than via the health board directed policy route. When accessed via an external search engine, the calculator results are not listed by health board, and the start page for the calculator does not make it clearly visible which health board calculator has been selected.

The Scottish Antimicrobial Prescribing Group has asked health boards to provide targeted communication and education to ensure that clinicians know how to access their health board antimicrobial calculators via the RDS, local Intranet or other local policy route. In terms of RDS amendments, it is not currently possible to change the internet search output, so the following changes are now in progress:

  • The health board name will now be displayed within the calculator and it will be made clear which boards are using the ‘Hartford’ (7mg/kg) higher dose calculator
  • Warning text will be added to the calculator to advise that more than one calculator is in use in NHS Scotland and that clinicians should ensure they access the correct one for their health board. A link to the Right Decision Service list of health board antimicrobial prescribing toolkits will be included with the warning text. Users can then access the correct calculator for their Board via the appropriate toolkit.

We would encourage all editors and users to use the Help and Support standard operating procedure and the Editors’ Teams channel to highlight issues, even if you think they may be temporary or already noted. This helps the RDS team to get a full picture of concerns and issues across the service.

 

2.     New RDS presentation – RDS supporting the patient journey

A new presentation illustrating how RDS supports all partners in the patient journey – multiple disciplines across secondary, primary, community and social care settings – as well as patients and carers through self-management and shared decision-making tools – is now available. You will find it in the Promotion and presentation resources for editors section of the Learning and support toolkit.

3.     User guides

A new user guide is now available in the Guidance and tips section of Resources for providers within the Learning and Support area, explaining how to embed content from Google Calendar, Google Maps, Daily Motion, Twitter feeds, Microsoft Stream and Jotforms into RDS pages. A webinar for editors on using this new functionality is scheduled for 1 May 3-4 pm (booking information below.)

A new checklist to support editors in making all the checks required before making a new toolkit live is now available at the foot of the “Request a new toolkit” standard operating procedure. Completing this checklist is not a mandatory part of the governance process, but we would encourage you to use it to make sure all the critical issues are covered at point of launch – including organisational tags, use of Alias URLs and editorial information.

4.Training sessions for RDS editors

Introductory webinars for RDS editors will take place on:

  • Tuesday 29th April 4-5 pm
  • Thursday 1st May 4-5 pm

Special webinar for RDS editors – 1 May 3-4 pm

This webinar will cover:

  1. a) Use of the new left hand navigation option for RDS toolkits.
  2. b) Integration into RDS pages of content from external sources, including Google Calendar, Google Maps and simple Jotforms calculators.

Running usage statistics reports using Google analytics

  • Wednesday 23rd April 2pm-3pm
  • Thursday 22nd May 2pm-3pm

To book a place on any of these webinars, please contact Olivia.graham@nhs.scot providing your name, role, organisation, title and date of the webinar you wish to attend.

5.New RDS toolkits

The following toolkits were launched during March 2025:

SIGN guideline - Prevention and remission of type 2 diabetes

Valproate – easy read version for people with learning disabilities (Scottish Government Medicines Division)

Obstetrics and gynaecology induction toolkit (NHS Lothian) – password-protected, in pilot stage.

Oral care for care home and care at home services (Public Health Scotland)

Postural care in care homes (NHS Lothian)

Quit Your Way Pregnancy Service (NHS GGC)

 

6.New RDS developments

Release of the redesign of RDS search and browse, archiving and version control functionality, and editing capability for shared content, is now provisionally scheduled for early June.

The Scottish Government Realistic Medicine Policy team is leading development of a national approach to implementation of Patient-Reported Outcome Measures (PROMs) as a key objective within the Value Based Health and Care Action Plan. The Right Decision Service has been commissioned to deliver an initial version of a platform for issuing PROMs questionnaires to patients, making the PROMs reports available from patient record systems, and providing an analytics dashboard to compare outcomes across services.  This work is now underway and we will keep you updated on progress.

The RDS team has supported Scottish Government Effective Prescribing and Therapeutics Division, in partnership with Northern Ireland and Republic of Ireland, in a successful bid for EU funding to test develop, implement and assess new integrated care pathways for polypharmacy, including pharmacogenomics. As part of this project, the RDS will be working with NHS Tayside to test extending the current polypharmacy RDS decision support in the Vision primary care electronic health record system to include pharmacogenomics decision support.

7. Implementation projects

We have just completed a series of three workshops consulting on proposed improvements to the Being a partner in my care: Realistic Medicine together app, following piloting on 10 sites in late 2024. This app has been commissioned by Scottish Government Realistic Medicine to support patients and citizens to become active partners in shared decision-making and encouraging personalised care based on outcomes that matter to the person. We are keen to gather more feedback on this app. Please forward any feedback to ann.wales3@nhs.scot

 

 

Premenopausal Ovarian Masses (514)

Warning Warning: This guideline is 708 day(s) past its review date.

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

This guideline has been produced to assist clinicians with the initial assessment and appropriate management of suspected benign ovarian masses in premenopausal women. Up to 10% of women will have some form of surgery during their lifetime for the presence of an ovarian mass. In pre-menopausal women almost all ovarian masses and cysts are benign. The overall incidence of a symptomatic ovarian cyst in a pre-menopausal female being malignant is approximately 1:1000, increasing to 3:1000 at the age of 50. Pre-operative differentiation between the benign and the malignant ovarian mass in the pre-menopausal woman can be problematic with no specific tests. Exceptions are germ cell tumours with elevations of specific tumour markers such as alphafetoprotein (α-FP) and human chorionic gonadotrophin (hCG).

For the purposes of this guideline, simple cysts of 3cm or less should be considered physiological and do not merit further investigation.

The aim should be to minimise patient morbidity by conservative management where possible, use of laparoscopic techniques where appropriate, and referral to the gynaecological oncologists where appropriate.

A thorough medical history should be taken from the woman with specific attention to risk factors or protective factors for ovarian malignancy and a family history of ovarian or breast cancer.

Symptoms suggestive of endometriosis should be specifically considered along with any symptoms suggesting possible ovarian malignancy: persistent abdominal distension, appetite change including increased satiety, pelvic or abdominal pain, increased urinary urgency and/or frequency.

A careful physical examination of the woman is essential and should include abdominal and vaginal examination, and examination to determine the presence or absence of local lymphadenopathy. Although clinical examination has poor sensitivity in the detection of ovarian masses, its importance lies in the evaluation of mass tenderness, mobility, nodularity and ascites.

In the acute presentation with pain the diagnosis of accident to the ovarian cyst should be considered (torsion, rupture, haemorrhage).

Imaging

A pelvic ultrasound is the single most effective way of evaluating a pelvic mass with transvaginal ultrasonography being preferable due to its increased sensitivity over transabdominal ultrasound. Routine use of CT or MRI is not indicated but where clinical or ultrasound suspicion exists, refer to Guidelines for Imaging of Gynaecological Malignancy (West of Scotland Cancer Network Guideline). CT of the abdomen and pelvis should be performed for masses with RMI >200 or in those with RMI <200 where clinical or ultrasound suspicion exists. MRI pelvis / lower abdomen should be performed in those with a complex mass which is difficult to characterise clinically or on ultrasound, or in young women (<30yrs) with suspected malignant tumour or a complex pelvic mass.

Blood tests

  1. CA125 – a serum CA125 assay does not need to be undertaken in all premenopausal women when an ultrasonographic diagnosis of a simple ovarian cyst has been made, but should be performed in all other circumstances. However it must be recognised that it is unreliable in determining whether ovarian lesions are benign or malignant as CA125 is also raised in conditions such as fibroids, endometriosis, adenomyosis and pelvic infection. Note also that CA125 is primarily a marker for epithelial ovarian tumours but is only elevated in around 50% of early stage disease.
  2.  LDH, αFP and hCG should be measured in all women under the age of 40 with a complex ovarian mass to exclude germ cell tumours.
  3. Calculate RMI – see below.

Calculation of the RMI

RMI combines three presurgical features: serum CA125 (CA125); menopausal status (M); and ultrasound score (U).
The RMI is a product of the ultrasound scan score, the menopausal status and the serum CA125 level (IU/ml) as follows:     RMI = U x M x CA125

  • The ultrasound result is scored 1 point for each of the following characteristics: multilocular cysts, solid areas, metastases, ascites and bilateral lesions. U = 0 (for an ultrasound score of 0), U=1 (for an ultrasound score of 1, U=3 (for an ultrasound score of 2-5).
  • The menopausal status is scored as 1=premenopausal and 3=postmenopausal.
  • Postmenopausal can be defined as women who have not had a period for more than one year or women over the age of 50 who have had a hysterectomy.
  • Serum CA125 is measured in IU/ml and can vary between zero to hundreds or even thousands of units.

  • Women with an RMI of more than 200 should be discussed with the gynaecological oncology team and presented to the managed clinical network for gynaecological oncology after appropriate imaging as per WOSCAN Guidelines.
  • Women with small (less than 50mm diameter) ovarian cysts generally do not require follow-up as these cysts are very likely to be physiological and almost all resolve within 3 menstrual cycles.
  • Women with simple ovarian cysts of 50-70mm in diameter should have yearly ultrasound follow-up and those with larger simple cysts should be considered for either further imaging or surgical intervention.
  • Ovarian cysts that persist or increase in size are unlikely to be functional and may warrant surgical management.
  • The use of the combined oral contraceptive pill does not promote the resolution of ovarian cysts.

  • A laparoscopic approach should be used whenever possible.
  • Aspiration of ovarian cysts, either vaginally or laparoscopically, is less effective and is associated with a high rate of recurrence.
  • Spillage of cyst contents should be avoided where possible as pre-operative and intra-operative assessment cannot absolutely preclude malignancy.
  • Where minimal access surgery is employed, consideration should be given to the use of a tissue bag to avoid peritoneal spill of cystic contents, bearing in mind the likely pre-operative diagnosis.
  • The possibility of oophorectomy must be discussed prior to surgery, documented in the notes and included in the consent form.

Editorial Information

Last reviewed: 14/12/2016

Next review date: 30/04/2023

Author(s): Morton Hair.

Approved By: Gynaecology Clinical Governance Group

Document Id: 514

References

RCOG. Management of Suspected Ovarian Masses in Premenopausal Women (Greentop Guideline No. 62). November 2011

Guidelines for Imaging of Gynaecological Malignancy. West of Scotland Cancer Network. 2014