Welcome to the Right Decision Service (RDS) newsletter for June 2024.
Hopefully you all received the notification on Friday 28th June about the worldwide security vulnerability relating to use of code from the Polyfill.io code library – typically used to enable use of functionality in older browsers and operating systems. This vulnerability has now been addressed within RDS. Thanks to Tactuum for their prompt action on this.
This incident served as a useful reminder about the importance of making sure all devices and desktop/laptop computers have up to date anti-malware installed.
The most recent information is that final fixes and developments will take place during July, with a view to user testing taking place in August 2024.
We will be running the six-monthly usage statistics reports for all RDS toolkits during July. Please contact his.decisionsupport@nhs.scot if you would like to receive the usage report for your toolkit(s).
The Scottish Palliative Care Group is carrying out a value and impact survey of the national Palliative Care Guidelines toolkit on RDS. We would appreciate your help in circulating this survey, available at https://rightdecisions.scot.nhs.uk/scottish-palliative-care-guidelines/evaluation-survey/ /
The Palliative Care Guidelines toolkit is using an adapted version of a generic impact evaluation form which the RDS team now encourages all toolkit owners to apply 6-12 months after launch of their toolkit. Please contact ann.wales3@nhs.scot if you would like to find out more.
The RDS Learning working group is in the final stages of developing and uploading new learning resources including:
We have also drafted a communication and training plan to support implementation of the redesigned RDS. The plan aims to reach both end-users and editors, who will benefit from new features such as the archiving and version control functionality.
4.1 Training sessions for new editors (also serve as refresher sessions for existing editors) will take place on the following dates:
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.)
Remember that you can also organise 1-1 training sessions with Olivia on running Google Analytics reports if you want to look at data more frequently than the six-monthly reports.
The following RDS toolkits are now live:
The following toolkits are due to go live imminently:
Some of the toolkits the RDS team is currently working on:
Please contact his.decisionsupport@nhs.scot if you would like to learn more about a toolkit. The RDS team will put you in touch with the relevant toolkit lead.
HIS is working with the Scottish Library and Information Council and the ALLIANCE to implement the second phase of the Collective Force for Health and Wellbeing Action Plan. This plan aims to strengthen the role of public, health and school libraries in empowering people to use digital tools and health information for self-management and choices about health and wellbeing. A key element of this new phase is supporting public libraries to promote the RDS citizen-facing apps for health and wellbeing.
We held a webinar on 28th June about the implementation challenge for health and wellbeing apps for citizens. This included an overview of the evidence base around implementation, the critical importance of health literacy skills, and the early findings from tests of change of implementing the Being a partner in my care app. Please contact his.decisionsupport@nhs.scot if you would like a copy of the slides or access to the recording of this webinar (NHS staff only.)
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
29/02/24 - atogepant tablets 10mg, 60mg SMC2599 added.
29/02/24 - rimegepant oral lyophilisate 75mg SMC2521 and 2603 added.
Base selection of migraine prophylaxis on age, gender and co-morbidity:
Titrate over several weeks and continue for a further 3 months, then assess and discontinue if ineffective.
Other antiepileptic drugs for migraine prophylaxis, the use of which should be discussed with a specialist, include gabapentin off-label: refer to BNF for dosing instructions.
Flunarizine unlicensed is used under specialist advice in patients with episodic migraine with failure to, or side-effects from, classical preventative migraine therapy.
Guidelines:
Tablets 10mg, 40mg
40mg 2 to 3 times daily; maintenance 80 to 160mg daily.
Modified release capsules 80mg, 160mg
maintenance 80 to 160mg daily.
Tablets 10mg, 25mg, 50mg
Migraine prophylaxis: initially 10mg at night, increased if necessary to maintenance of 50 to 75mg at night.
If amitriptyline is poorly tolerated consider nortriptyline.
Tablets 10mg, 25mg
Migraine prophylaxis if amitriptyline is poorly tolerated off-label: initially 10mg at night, increased if necessary to maintenance of 50 to 75mg at night.
Tablets 25mg, 50mg, 100mg
Migraine prophylaxis: initially 25mg at night for 1 week, increased in increments of 25mg/day at weekly intervals up to 50mg twice daily. Some patients may experience a benefit at 25mg twice daily. See SPC for dosing in renal impairment.
MHRA advice: Avoid in women of child-bearing age and those who are overweight (April 2018)(www.gov.uk).
Valproate medicines are contraindicated in women and girls of childbearing potential unless conditions of Pregnancy Prevention Programme are met (MHRA advice April 2018)
Crushable tablets 100mg
Migraine prophylaxis: off-label, initially 200mg twice daily; doses up to 500mg twice daily are effective in most patients.
Enteric coated tablets 200mg, 500mg
Migraine prophylaxis: off-label, initially 200mg twice daily; doses up to 500mg twice daily are effective in most patients.
Limited value in prophylaxis of migraine (SIGN 155). It may cause increased appetite and weight gain. It can also cause drowsiness and so night-time dosing may help prevent day-time sedation. Use with caution in patients with a history of epilepsy.
Tablets 500 micrograms, 1·5mg
Initially 500 micrograms at night increased gradually to usual dose of 1·5mg at night or in 3 divided doses; may be further increased up to maximum daily dose of 4·5mg (but rarely necessary), maximum single dose 3mg.
Solution for injection in a pre-filled pen 70mg/mL (specialist initiation and supply only)
Prophylaxis of migraine in adults with chronic migraine, who have at least four migraine days per month and in whom at least three prior prophylactic treatments have failed.
Solution for injection pre-filled syringes 225mg/1·5ml (hospital use only)
225mg once a month OR 675mg every three months.
See SMC advice 2226.
For prophylaxis of migraine in adults who have at least four migraine days per month.
SMC restriction: for the treatment of patients with chronic and episodic migraine who have had prior failure on three or more migraine preventive treatments.
Homecare is the preferred option - contact nhsh.homecare@nhs.scot.
Solution for injection pre-filled pens 120mg/ml (hospital use only)
240mg loading dose THEN 120mg injected subcutaneously once a month
See SMC advice 2313.
Prophylaxis of migraine in adults who have at least 4 migraine days per month.
SMC restriction: for the treatment of patients with chronic and episodic migraine who have had prior failure on three or more migraine preventive treatments.
Concentrate for solution for infusion 100mg (Restricted: hospital use only)
See SMC advice 2547: prophylaxis of migraine in adults who have at least 4 migraine days per month.
SMC restriction: for patients with chronic and episodic migraine who have had prior failure on three or more migraine preventive treatments.
Tablets 10mg, 60mg (Aquipta®) (Restricted: specialist initiation only)
Initiation and review in Secondary Care. May be prescribed in Primary Care for maintenance treatment only.
SMC2599: Prophylaxis of migraine in adults who have at least four migraine days per month.
Ordering atogepant:
AbbVie Direct ordering contact details:
Customer Services
Tel: 0800 783 1699
Email: orders.kr@abbvie.com
Oral lyophilisate 75mg (Vydura®) (Restricted: Specialist initiation only)
Initiation and review in Secondary Care. May be prescribed in Primary Care for maintenance treatment only.
SMC2603: For the preventive treatment of episodic migraine in adults who have at least four migraine attacks per month.
SMC restriction: for patients with episodic migraine who have at least 4 migraine attacks per month, but fewer than 15 headache days per month and who have had prior failure on three or more migraine preventive treatments.
TAM (Treatments and Medicines) NHS Highland