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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

 

 

Restless legs syndrome (RLS)

Centre for Sustainable Delivery

Introduction

This fact sheet provides information on how to treat patients for the management of Restless Leg Syndrome (RLS) with different symptoms, situations and circumstances.

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

 

Restless legs syndrome (RLS)

RLS is a common condition, although most people do not seek medical attention. The diagnosis is clinical (see box below) along with the exclusion of alternative explanations and is diurnal, which means it can be constant day and night, but is generally worse in the evening/night, affecting sleep. It is often associated with Periodic Limb Movements of Sleep (PLMS). Some will have a family history and it may occur at any age. Symptomatic mimics include peripheral neuropathy, cramps, varicose veins, akathisia, anxiety and spinal stenosis.

 

Restless legs syndrome does not include hypnic jerks / involuntary movement

Diagnostic features:

  • Urge to move legs often with uncomfortable / unpleasant sensations
  • Symptoms begin / worsen during rest or inactivity
  • Symptoms relieved by movement (walking or stretching)
  • Symptoms occur / worsen in evening / night

Other leg movements, especially involuntary hypnic jerks, are commonly misdiagnosed as RLS. Hypnic jerks are sudden jerky movements people have normally as they fall off to sleep, which can be amplified in people with sleep disorders, on opiates and with anxiety. They are not RLS and should not be treated with the medications below.

 

Do patients need investigation in primary care?

All with suspected RLS should have a basic blood screen, including glucose and serum ferritin.

 

Do patients need to see a neurologist?

Not necessarily, but this is an option for further advice/appointments for diagnostic clarification or management problems.

 

General lifestyle advice

Most people with RLS can be managed without resorting to drugs. Good sleep hygiene is important including avoidance of stimulants in the evening. Cognitive Behaviour Therapy (CBT) for insomnia may be effective. Relaxation therapy, walking or stretching before bedtime, warm evening bath and/ or massage may be helpful. Some drugs, notably Tricyclic antidepressants such as amitriptyline, may worsen symptoms.

 

Treatment of RLS

Most will require nothing more than reassurance and sensible lifestyle advice, as above. Drug therapy should be reserved for the most distressing cases. Treatment responses are often accompanied by augmentation - this is the worsening of symptoms or manifestation earlier in the day after a period of successful dopaminergic treatment. The lowest possible doses should be used to try and avoid this effect.

 

First line therapies

Iron replacement: if serum ferritin is low / low normal, then replace orally.

 

Second line therapies

  • Consider additional dose later at night if breakthrough symptoms.
  • Dopamine agonists oral ropinirole 0.25mg-4mg, pramipexole up to 0.75mg base (i.e. 0.088 tablets salt x 3) or rotigotine patch 1mg-3mg / day. Counsel for possibility of impulse control disorders (e.g. excessive gambling, shopping, hypersexuality, binge eating). See Garcia-Borreguero et al. 2016
  • Levo-dopa (co-careldopa or co-beneldopa).
  • Gabapentin (starting dose 300mg nocte, range 300-1200mg) or Pregabalin (starting dose 50-75mg nocte, range up to 300mg).

 

Patient information

RLS-UK https://www.rls-uk.org

 

Reference

Based on:

Trenkwalder C, Allen R, Högl B, Clemens S, Patton S, Schormair B, Winkelmann J. Comorbidities, treatment, and pathophysiology in restless legs syndrome. Lancet Neurol. 2018 Nov;17(11):994-1005. DOI: 10.1016/S1474-4422(18)30311-9

 

Editorial Information

Last reviewed: 20/12/2024

Next review date: 17/12/2027

Author(s): Centre for Sustainable Delivery.

Version: 2