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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 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

 

 

Multiple sclerosis (MS)

Centre for Sustainable Delivery

Introduction

This fact sheet provides information on how to treat patients with Multiple Sclerosis (MS) with different symptoms, situations and circumstances.

Please note this fact sheet is only designed as a brief summary of management.

 

Multiple Sclerosis (MS)

MS is an inflammatory disease affecting the central nervous system (i.e. brain and spinal cord) and is the most common non-traumatic disabling condition. The cause remains unknown, but a number of associations are known, including: female sex (3:1); cigarette smoking; genetic influences; previous Epstein Barr infection; low vitamin D levels.

The majority of people (90%) with MS present with a relapsing remitting syndrome (RRMS), while the remainder present with a gradually progressive clinical syndrome (Primary Progressive MS).

Before the era of disease modifying therapies, around 2/3 of people with RRMS would enter the secondary progressive stage from 10 to 15 years after their first symptoms. Presenting with MS for the first time before the age of 15, or after 50, is recognised, but unusual.

We receive many referrals from primary care where MS features high on the differential for both GPs and patients. This advice sheet is to help GPs identify which symptoms are more likely to represent the first presentation of MS.

 

Key features

  • MS typically presents in young adults, usually women, with rather stereotyped symptoms.
  • Unilateral visual loss, ataxia, double vision, progressive bilateral / unilateral weakness /  numbness are common.
  • Multiple, intermittent and variable symptoms associated with pain and fatigue are much less likely to represent MS.

 

 

What are the characteristics of an MS relapse including first-ever event?

Clinical MS inflammation (relapse) typically presents with a specific focal symptom evolving over hours to days (rarely stroke–like), persisting for days to weeks, then gradually resolving, often completely. Relapses are not characterised by numerous, non-focal symptoms waxing and waning over long periods of time.

 

What are the most common initial symptoms of MS?

  • Optic neuritis: typically painful loss of vision (including colour vision) in one eye
  • Brain stem / cerebellar syndromes: double vision, unsteadiness / ataxia, facial numbness
  • Spinal cord syndromes: evolving weakness / numbness of both legs (with or without arm involvement)
  • Cerebral hemisphere syndromes: hemiparesis / hemisensory symptoms

 

What symptoms are unlikely to represent MS?

Headache, isolated fatigue / tiredness, seizures / blackouts and intermittent sensory symptoms are unlikely to be due to MS. Intermittent sensory symptoms are perhaps the most common symptom referred regarding MS concerns and are usually benign – see the Benign sensory symptoms factsheet. The time course is important - MS symptoms usually worsen over days and persist for weeks while symptoms rarely last minutes or hours at a time.

 

Who needs urgent referral?

People with rapidly evolving and disabling neurological symptoms suggestive of MS (see above) should be
referred either via the SCI Gateway, or the on-call neurology team, if the situation is developing very rapidly. Unilateral visual loss may require ophthalmology assessment, initially to exclude primary eye disease.

 

What are the common alternative diagnoses?

Most people referred with a concern of MS from primary care prove to have an alternative and usually benign diagnosis. The most common are benign sensory symptoms, sometimes nerve entrapment syndromes. Functional neurological disorder can often mimic MS, but is characterised typically by a much broader clinical syndrome than the more monochrome MS presentations listed above (i.e. multiple different symptoms, often with pain and fatigue dominating).

 

Reference

Coles A. Multiple sclerosis. Pract Neurol. 2009 Apr;9(2):118-26. DOI: 10.1136/jnnp.2008.171132

 

Editorial Information

Last reviewed: 20/12/2024

Next review date: 17/12/2027

Author(s): Centre for Sustainable Delivery.

Version: 2