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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

 

 

Vertigo and dizziness

Centre for Sustainable Delivery

Introduction

This fact sheet provides information on how to treat patients with vertigo and dizziness in different situations and circumstances.

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

 

Dizziness – vertigo, light-headedness, presyncope or dysequilibrium?

Dizziness is a very common symptom patients may experience and has varying levels of indicators, which are mostly benign. Patient history will help distinguish the cause, but patience and thorough examination are often required.

Dizziness can present itself in the following ways:

  • Lightheadedness / presyncope: a feeling you might pass out.
  • Dissociation: a spaced out feeling as if disconnected from your body or the world around you.

 

Vertigo – the illusion of movement

Vertigo arises from lesions of either the inner ear (vestibular apparatus) or the brain, although the former is far more common.

 

Common causes of vertigo (in order of frequency)

  • Benign paroxysmal positional vertigo (BPPV): short lasting (seconds) bursts of vertigo with movement, typically rolling over in bed, getting in and out of bed, chairs, car, looking up at cupboards, hanging up washing. It is common after head injury and under-recognised, but is highly treatable without drugs. 
  • Vestibular migraine: the only common brain cause of vertigo. Attacks can last from a few hours to several day. This is usually associated with other migrainous features, but not always headache.
  • Acute vestibular syndrome (aka labyrinthitis, vestibulo-neuronitis): typically disabling vertigo lasts a few days. Most people recover fully, but it can occasionally recur and/or leads to PPPD (see below).
  • Persistent Perceptual Postural Dizziness (PPPD): This is not vertigo, but it may evolve after having vertigo, persistent disequilibrium - the “chronic fatigue syndrome” of the brain/inner ear axis. More information: https://neurosymptoms.org/en/symptoms/fnd-symptoms/functional-dizziness-pppd/
  • Meniere’s disease/syndrome: vertiginous episodes which last hours, usually with associated unilateral aural fullness / tinnitus / fluctuating hearing loss.

All other causes of isolated vertigo, including central causes such as Transient Ischaemic Attack (TIA), acoustic neuroma, Multiple Sclerosis (MS), are rare or very rare. People with brainstem TIA and MS nearly always present with vertigo and other brainstem / focal symptoms.

 

Do patients need investigation in primary care?

The most useful investigation is a Dix-Hallpike manoeuvre to identify BPPV which can be viewed below. Routine blood tests and imaging are rarely helpful.

 

 

 

Do patients need Ear Nose and Throat (ENT), neurology assessment?

Most people with vertigo do not need secondary care assessment. If you suspect the lesion is in the vestibular apparatus, ENT is the best route. Central brain causes of vertigo other than migraine are rare.

 

Vertebrobasilar insufficiency (VBI) does not exist

This “condition” does not exist. While VBI was taught at medical school, the teaching was erroneous. Your brain has 4 arteries which stops this happening. Vertigo/dizziness with neck movement is almost always BPPV.

 

Post head injury dizziness

Dizziness is a common post head injury symptom and is often explained by BPPV. See also: www.headinjurysymptoms.org

 

Treatment of vertigo

Many people will require nothing more than reassurance, while an Epley manoeuvre for BPPV can be curative.

Vestibular sedatives (prochlorperazine, cinnarizine, betahistine etc) should only be used for acute vestibular syndrome as long-term use is not recommended. Vestibular migraine can be hard to treat, but standard migraine treatment is to be used.

The Epley manoeuvre is shown in the image and video below. 

Diagram showing Epley manoeuvre for BPPV

 

 

Patient information

NHS Inform: Vertigo https://www.nhsinform.scot/illnesses-and-conditions/ears-nose-and-throat/vertigo

 

Editorial Information

Last reviewed: 20/12/2024

Next review date: 17/12/2027

Author(s): Centre for Sustainable Delivery.

Version: 2