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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

 

Vitiligo

Vitiligo: Is an acquired autoimmune disorder of pigmentation of the skin and mucous membranes where progressive dysfunction and destruction of melanocytes results in loss of skin pigmentation. Incidence: 1% of world population, 50% appearing before the age of 20 years. A family history may be present in up to 30% of cases. Associated with other autoimmune conditions, particularly thyroid disease occurring in 20% of patients over the age of 20 years. Also associated with Type 1 diabetes, pernicious anaemia, alopecia areata, Addison’s disease, systemic lupus erythematosus, rheumatoid arthritis and psoriasis. There is currently no definitive treatment, but spontaneous improvement may occur. Irrespective of clinical severity Vitiligo may cause significant psycho-social distress and referral for psychological support should always be considered. 

 

Treatment/ therapy

Severity 

Depends on proportions of physical appearance and psychological impact. 

Mild:  Localised segmental Vitiligo. Non segmental Vitiligo sparing face and hands. Minimal psychological impact. 

  • In absence of definitive treatment, for minimal disease with low psychological impact patients may not seek further treatment. 
  • Recommend a high-factor (SPF50+) sunscreen with protection against ultraviolet A and B. 
  • Check TSH and thyroid antibodies. 
  • For adults with limited areas on trunk and limbs a potent topical steroid may be applied once daily (off licence) for up to 2 months 
  • Not suitable for face and flexures. 
  • Topical calcineurin inhibitor may be useful such as Tacrolimus 0.1% applied BD for face and flexures 
  • Avoid use of sunbeds. 
  • Provide contact details for Changing Faces for advice on skin camouflage and the Vitiligo Society for further information and support.

Moderate: More widespread.  Acrofacial.  Significant psychological impact. 

  • Check TSH and thyroid antibodies. 
  • For adults with limited areas on trunk and limbs a potent topical steroid may be applied once daily (off licence) for up to 2 months or daily for one week on one week off for longer periods of time. Not suitable for face and flexures. 
  • Topical calcineurin inhibitor may be useful such as Tacrolimus 0.1% applied BD for face or flexures. Consider referral to secondary care if failing to respond to simple measures for further assessment  

Expert recommendations: camouflage 

  • Self-tanning agents in gel, cream, lotion or spray: These give the skin a brown colour that resembles a natural tan and normally lasts from 3 to 5 days. 
  • Highly pigmented cover creams: May require guidance on selection and application 

Severe:  Generalised / Universal / Active Progressive spread, Rapidly progressive spread and/or Major psychological impact 

For all patients for whom the condition is progressing rapidly; or where there is diagnostic uncertainty; or if the condition has a significant psychosocial impact; or the condition is not responding to topical treatment 

Refer to secondary care services for consideration of treatment with: 

  • Topical steroids 
  • Topical calcineurin inhibitor 
  • Narrowband – UVB 
  • Emerging treatments

NB. treatments may help but none are curative at present.

 

 

Referral Management

Severity 

Depends on proportions of physical appearance and psychological impact. 

Mild: Localised segmental Vitiligo. Non segmental Vitiligo sparing face and hands. Minimal psychological impact. 

Refer to secondary care: 

  • If the condition is progressing rapidly 
  • there is diagnostic uncertainty 
  • the condition has a significant psychosocial impact, or 
  • the condition is not responding to topical treatment. 

Moderate: More widespread.  Acrofacial.  Significant psychological impact. 

Refer to secondary care: 

  • If the condition is progressing rapidly 
  • there is diagnostic uncertainty 
  • the condition has a significant psychosocial impact, or 
  • the condition is not responding to topical treatment. 

Severe:  Generalised / Universal / Active Progressive spread, Rapidly progressive spread and/or Major psychological impact 

Refer to secondary care: 

  • If the condition is progressing rapidly 
  • there is diagnostic uncertainty 
  • the condition has a significant psychosocial impact, or 
  • the condition is not responding to topical treatment. 

Clinical resources

NICE CKS – Vitiligo   

BAD Guidelines – Vitiligo (2021)

European Dermatology Forum vitiligo guidelines 2012 

PCDS- Vitiligo

DermNet NZ- Vitiligo 

Clinical tips

  • Be aware of possible association with other autoimmune disorders. 
  • Post-inflammatory hypopigmentation can be common in skin of colour and should be clinically distinguishable from depigmentation seen in vitiligo, which may often be symmetrical. 
  • Psychological effects are important. Vitiligo is often immediately visible to others and those with the condition may suffer social and emotional consequences including low self-esteem, social anxiety, depression, stigmatization and, in extreme cases, rejection by those around them. This can be accentuated in darker skin types, where loss of pigment is more visible. 

Patient information resources

BAD patient information leaflet – Vitiligo:  

BAD patient information leaflet – Skin camouflage:   

Patient.info leaflet – Vitiligo:   

NHS Conditions- Vitiligo:  

ICD search categories

Epidermal/ 

Appendageal 

ICD11 code - ED63.0 

Editorial Information

Last reviewed: 30/05/2023

Next review date: 30/05/2025

Author(s): Adapted from the BAD Referral Guidelines.

Version: BAD 1

Co-Author(s): Publisher: Centre for Sustainable Delivery, Scottish Dermatological Society.

Approved By: Scottish Dermatological Society