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Announcements and latest updates

Right Decision Service newsletter: March 2024

Welcome to the Right Decision Service (RDS) newsletter for March 2024. Please forward this newsletter to others who may be interested. They can contact olivia.graham@nhs.scot to be added to the circulation list.

Promotion and communication resources

Promotional flyers are now available in the Learning and Support area of RDS:

What is RDS and what impact does it have? (infographic)

General RDS flyer

Being a partner in my care: Realistic medicine app for citizens

Managing medicines for patients and carers app

Home care decisions app

Child protection app (South Lanarkshire HSCP)

All except the infographic are also available as editable Word versions. Please contact his.decisionsupport@nhs.scot  if you would like Word versions.  

Redesign and improvements to RDS

Search and browse improvements are progressing well and the plan is still to release these in mid-May.  The first stages of work on archiving and version control are complete. User stories (requirements) are being defined for:

  • Deep linking to individual toolkit URLs/QR codes
  • Translating content from a structured Word document directly into RDS
  • Capability to review and edit changes made to shared content

New feature requests

These have all been compiled and effort estimated. Once the redesign work is complete, these will be prioritised in line with the remaining budget. We expect this to take place around late June.

Evaluation

A big thank you to all of you who have completed our Impact and Value questionnaire. The data from this will be really helpful in informing the first draft of the business case for long term provision of the RDS. This will be reviewed by the National Advisory Board for RDS later this month.

We welcome further responses. If you haven’t yet completed the survey, please follow this link, and please encourage other RDS toolkit leads and users to do so.

New toolkits

A few examples of toolkits published to live in the last month:

 

Toolkits in development

Some of the toolkits the RDS team are currently working on:

  • Updates to the Respiratory prescribing guidance and Manage Medicines for patients and carers toolkits
  • Respiratory Managed Clinical Network Pathways
  • Child abuse pathways in NHS Tayside
  • Patient information leaflet collection in NHS Borders
  • Referral management toolkit for NHS Borders
  • NHS Lothian – Infectious diseases; Acute oncology guidelines; Royal Infirmary of Edinburgh Emergency Care.

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.

Learning opportunities

The RDS Learning working group is progressing with developing training resources for editors, and intend to have resources to share by end of June. This includes resources for:

  • Each stage of the development journey for RDS toolkits – Scoping to Implementation/Evaluation and Maintenance.
  • RDS content governance.
  • Core functionality – learning bytes.

 

Editor webinars

Just a reminder that we are offering webinars for existing and potential new editors on the following dates:

  • Wednesday 10 April 3.30-4.30 pm
  • Thursday 18 April 12-1 pm

 

To book for one of these webinars, please complete the registration form at https://forms.office.com/e/eGjKqNVjeF

Quality audit

Many thanks to all of you who have met with me recently to complete or clarify your responses to the quality audit survey at the end of last year.  Work to complete the quality audit for all toolkits published on RDS prior to November last year will continue for the next few months.

Implementation projects

The RDS team is now working with Moray HSCP to evaluate impact of the new RDS toolkit “Preventing progress of diabetes”  (https://preventdiabetes.scot.nhs.uk ) to support people at high risk of diabetes type 2 and those who are candidates for remission. We are looking at the impact of use of the app with SMS prompts on people’s readiness for lifestyle change over an 8 week period. This includes comparing impact in people who have a call with a dietitian in addition to using the app to people who only use the app.

If you have any questions about the content of this newsletter, please contact us on his.decisionsupport@nhs.scot.

With kind regards

Right Decision Service team

Healthcare Improvement Scotland

 

Fungal Nail Infections

Treatment/ therapy

  • Fungal nail infection 
  • Yellowish discolouration 
  • Soft subungual hyperkeratosis 
  • Spread from distal edge 
  • Superficial white onychomycosis 

Fungal nail infection

Fungal nail infection

Funal nail infection

Perform mycological examination of nail clippings INCLUDING soft subungual material to detect fungal elements. 

Do not prescribe systemic antifungal drugs without laboratory confirmation of the diagnosis. 

Dermatophyte nail infection 

  • No treatment is an option especially in the elderly - regular podiatry if required 
  • Terbinafine 250mg od for six weeks for finger and 12–16 weeks for toe nails and review progress. Caution in patients with liver and auto- immune diseases 
  • Itraconazole 200mg bd for one week pulsed monthly for two courses (fingernail) or three courses (toenail) 
  • Topical amorolfine lacquer for superficial white distal and lateral nail involvement only

Referral Management

Dermatology Referral Criteria 

  • Diagnosis uncertain 
  • Suspicion of subungual tumour 
  • Failure of fungal nail infections to respond to treatment 

Consider referral to podiatrist 

  • Toe nail dystrophy secondary to trauma 
  • Painful psoriatic toe nails 

Differential Diagnosis

Subungual haematoma 

  • History of trauma 
  • Discolouration migrates with nail growth 

Subungual haematoma

Chronic paronychia 

  • Rounded nail folds with loss of cuticle and ridged nail 
  • Treat with clotrimazole cream four × daily 
  • Protect hands with gloves for wet work 

Chronic Paronychia

Psoriasis 

Pitting and onycholysis 

Psoriasis

Patient information resources

Editorial Information

Author(s): Adapted from Dermatology Patient Pathways .

Co-Author(s): NHS Scotland, Scottish Dermatology Society.