1
|
Stanton J, Knowles A, Russell L, Bevis C. Integrated lymphoedema and tissue viability service: improving patient and wound outcomes. Br J Community Nurs 2024; 29:S19-S26. [PMID: 38578928 DOI: 10.12968/bjcn.2024.29.sup4.s19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
This article will focus on the integration of tissue viability and lymphoedema services to improve outcomes for patients with leg ulceration. It will highlight why there is a need for lymphoedema specialist knowledge within the care of patients with leg ulceration and how the services are closely aligned. Lymphoedema can adversely affect wound healing and the article will provide case studies that highlight how developing a hybrid tissue viability and lymphoedema clinician or integration of the specialists can provide effective patient-centred care at reduced cost. The article offers potential strategies and suggestions on how to address inequalities in care and how to improve service provision.
Collapse
Affiliation(s)
- Julie Stanton
- Director of Nursing (community telehealth), Pioneer Wound Healing and Lymphoedema Centres
| | - Aaron Knowles
- Tissue Viability and Lymphoedema Consultant, Pioneer Wound Healing and Lymphoedema Centres
| | - Laura Russell
- Tissue Viability and Lymphoedema Consultant, Pioneer Wound Healing and Lymphoedema Centres
| | - Claire Bevis
- Tissue Viability and Lymphoedema Consultant, Pioneer Wound Healing and Lymphoedema Centres
| |
Collapse
|
2
|
Cooper-Stanton G, Gale N, Sidhu M, Allen K. UK survey on experiences of men with non-cancer-related lymphoedema: part one. Br J Community Nurs 2024; 29:S27-S31. [PMID: 38578925 DOI: 10.12968/bjcn.2024.29.sup4.s27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
This initial article delves into the methodology, methods and theories, while the subsequent article will centre on the discoveries, discussion and conclusion. The study aimed to address the research question: how do men perceive their engagement in the self-management of non-cancer-related lymphoedema? An interpretivist qualitative methodology was employed, utilising an online survey based on the validated lymphoedema quality of life tool (LYMQoL). The data underwent inductive narrative inquiry. The study incorporated theories such as hegemonic masculinity and the health, illness, men and masculinities (HIMM) framework. The findings will be detailed in the second article in this series. This article has delineated the objective, methodologyand methods, employing a qualitative interpretivist approach through narrative inquiry. The study incorporated masculinity theories, including hegemonic masculinity and HIMM. The second article will present the findings and their significance within the broader literature.
Collapse
Affiliation(s)
- Garry Cooper-Stanton
- Doctoral Researcher, Associate Dean UCLan, Clinical Nurse Specialist Lymphoedema, University of Birmingham, Health Services Management Centre (HSMC), 40 Edgbaston Park Road, Birmingham, B15 2RT
| | - Nicola Gale
- Head of School of Social Policy, Professor of Health Policy and Sociology, University of Birmingham, School of Social Policy, Muirhead Tower, Edgbaston, Birmingham, B15 2TT
| | - Manbinder Sidhu
- Associate Professor, School of Social Policy, HSMC, Park House, Edgbaston, Birmingham, B15 2RT
| | - Kerry Allen
- Associate Professor Head of Education, University of Birmingham, School of Social Policy, HSMC, Park House, Edgbaston, Birmingham, B15 2RT
| |
Collapse
|
3
|
Farkas K, Stanek A, Zbinden S, Borea B, Ciurica S, Moore V, Maguire P, Abola MTB, Alajar EB, Marcoccia A, Erer D, Casanegra AI, Sharebiani H, Sprynger M, Kavousi M, Catalano M. Vascular Diseases in Women: Do Women Suffer from Them Differently? J Clin Med 2024; 13:1108. [PMID: 38398419 PMCID: PMC10889109 DOI: 10.3390/jcm13041108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 02/05/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
According to the World Health Organization, cardiovascular disease (CVD) is the leading cause of death among women worldwide, yet its magnitude is often underestimated. Biological and gender differences affect health, diagnosis, and healthcare in numerous ways. The lack of sex and gender awareness in health research and healthcare is an ongoing issue that affects not only research but also treatment and outcomes. The importance of recognizing the impacts of both sex and gender on health and of knowing the differences between the two in healthcare is beginning to gain ground. There is more appreciation of the roles that biological differences (sex) and sociocultural power structures (gender) have, and both sex and gender affect health behavior, the development of diseases, their diagnosis, management, and the long-term effects of an illness. An important issue is the knowledge and awareness of women about vascular diseases. The risk of cardiovascular events is drastically underestimated by women themselves, as well as by those around them. The purpose of this review is to draw attention to improving the medical care and treatment of women with vascular diseases.
Collapse
Affiliation(s)
- Katalin Farkas
- Department of Angiology, Szent Imre University Teaching Hospital, Tétényi út 12-16, 1115 Budapest, Hungary
- VAS-European Independent Foundation in Angiology/Vascular Medicine, Via GB Grassi 74, 20157 Milan, Italy; (A.S.); (S.Z.); (B.B.); (S.C.); (M.T.B.A.); (A.M.); (D.E.); (H.S.); (M.S.); (M.K.); (M.C.)
| | - Agata Stanek
- VAS-European Independent Foundation in Angiology/Vascular Medicine, Via GB Grassi 74, 20157 Milan, Italy; (A.S.); (S.Z.); (B.B.); (S.C.); (M.T.B.A.); (A.M.); (D.E.); (H.S.); (M.S.); (M.K.); (M.C.)
- Department of Internal Medicine, Angiology and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Batorego 15 Street, 41-902 Bytom, Poland
| | - Stephanie Zbinden
- VAS-European Independent Foundation in Angiology/Vascular Medicine, Via GB Grassi 74, 20157 Milan, Italy; (A.S.); (S.Z.); (B.B.); (S.C.); (M.T.B.A.); (A.M.); (D.E.); (H.S.); (M.S.); (M.K.); (M.C.)
- Department of Angiology, Zurich University Hospital, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Barbara Borea
- VAS-European Independent Foundation in Angiology/Vascular Medicine, Via GB Grassi 74, 20157 Milan, Italy; (A.S.); (S.Z.); (B.B.); (S.C.); (M.T.B.A.); (A.M.); (D.E.); (H.S.); (M.S.); (M.K.); (M.C.)
- Department of Angiology and Haemostasis, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Genève, Switzerland
| | - Simina Ciurica
- VAS-European Independent Foundation in Angiology/Vascular Medicine, Via GB Grassi 74, 20157 Milan, Italy; (A.S.); (S.Z.); (B.B.); (S.C.); (M.T.B.A.); (A.M.); (D.E.); (H.S.); (M.S.); (M.K.); (M.C.)
- Department of Cardiology, Marie Curie Civil Hospital, CHU Charleroi, Chaussée de Bruxelles 140, 6042 Lodelinsart, Belgium
| | - Vanessa Moore
- European Institute of Women’s Health, Ashgrove House, Kill Avenue, Dún Laoghaire, A96 N9K0 Dublin, Ireland; (V.M.); (P.M.)
| | - Peggy Maguire
- European Institute of Women’s Health, Ashgrove House, Kill Avenue, Dún Laoghaire, A96 N9K0 Dublin, Ireland; (V.M.); (P.M.)
| | - Maria Teresa B. Abola
- VAS-European Independent Foundation in Angiology/Vascular Medicine, Via GB Grassi 74, 20157 Milan, Italy; (A.S.); (S.Z.); (B.B.); (S.C.); (M.T.B.A.); (A.M.); (D.E.); (H.S.); (M.S.); (M.K.); (M.C.)
- Clinical Research Department, Education, Training and Research Services, Philippine Heart Center, University of the Philippines College of Medicine, 547 Pedro Gil Street, Manila 1000, Metro Manila, Philippines
| | - Elaine B. Alajar
- Manila Doctors Hospital, 667 United Nations Ave, Ermita, Manila 1000, Metro Manila, Philippines;
| | - Antonella Marcoccia
- VAS-European Independent Foundation in Angiology/Vascular Medicine, Via GB Grassi 74, 20157 Milan, Italy; (A.S.); (S.Z.); (B.B.); (S.C.); (M.T.B.A.); (A.M.); (D.E.); (H.S.); (M.S.); (M.K.); (M.C.)
- Angiology and Autoimmunity Medical Unit, Rare Diseases Reference Center for Systemic Sclerosis, Sandro Pertini Hospital, 00157 Rome, Italy
| | - Dilek Erer
- VAS-European Independent Foundation in Angiology/Vascular Medicine, Via GB Grassi 74, 20157 Milan, Italy; (A.S.); (S.Z.); (B.B.); (S.C.); (M.T.B.A.); (A.M.); (D.E.); (H.S.); (M.S.); (M.K.); (M.C.)
- Gazi University Hospital, Mevlana Blv. No:29, Yenimahalle, Ankara 06560, Turkey
| | - Ana I. Casanegra
- Gonda Vascular Center, Department of Cardiovascular Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN 55901, USA;
| | - Hiva Sharebiani
- VAS-European Independent Foundation in Angiology/Vascular Medicine, Via GB Grassi 74, 20157 Milan, Italy; (A.S.); (S.Z.); (B.B.); (S.C.); (M.T.B.A.); (A.M.); (D.E.); (H.S.); (M.S.); (M.K.); (M.C.)
- Support Association of Patients of Buerger’s Disease, Buerger’s Disease NGO, Mashhad 9183785195, Iran
| | - Muriel Sprynger
- VAS-European Independent Foundation in Angiology/Vascular Medicine, Via GB Grassi 74, 20157 Milan, Italy; (A.S.); (S.Z.); (B.B.); (S.C.); (M.T.B.A.); (A.M.); (D.E.); (H.S.); (M.S.); (M.K.); (M.C.)
- Department of Cardiology, University Hospital of Liège, Hospital Boulevard, 4000 Liege, Belgium
| | - Maryam Kavousi
- VAS-European Independent Foundation in Angiology/Vascular Medicine, Via GB Grassi 74, 20157 Milan, Italy; (A.S.); (S.Z.); (B.B.); (S.C.); (M.T.B.A.); (A.M.); (D.E.); (H.S.); (M.S.); (M.K.); (M.C.)
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Mariella Catalano
- VAS-European Independent Foundation in Angiology/Vascular Medicine, Via GB Grassi 74, 20157 Milan, Italy; (A.S.); (S.Z.); (B.B.); (S.C.); (M.T.B.A.); (A.M.); (D.E.); (H.S.); (M.S.); (M.K.); (M.C.)
- Department of Biomedical and Clinical Science, Inter-University Research Center on Vascular Disease, University of Milan, GB Grassi 74, 20157 Milan, Italy
| |
Collapse
|
4
|
Paediatric lymphoedema: An audit of patients seen by the paediatric and primary lymphoedema group of vascular European Reference Network (VASCERN). Eur J Med Genet 2022; 65:104641. [DOI: 10.1016/j.ejmg.2022.104641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 09/19/2022] [Accepted: 10/09/2022] [Indexed: 11/17/2022]
|
5
|
Colgan MP, Kyne N, Hannon B, Grehan E, Morris K, Conway M, Murray N, Carney O, Mac Sweeney M. A Snapshot of Lymphedema in Ireland: Results from LIMPRINT. Lymphat Res Biol 2021; 19:473-478. [PMID: 34672791 DOI: 10.1089/lrb.2021.0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: To estimate the prevalence and impact of chronic edema (CE) in two Irish health care settings as part of LIMPRINT, an international study developed and co-ordinated by the International Lymphoedema Framework (ILF), and researched in Ireland by the National Lymphoedema Framework Ireland (NLFI). Methods and Results: Data were collected using clinical assessment tools previously validated by the ILF. Three hospital settings were chosen, both an in-patient and out-patient oncology unit in Galway and a vascular out-patient unit in Dublin. Patients attending an oncology clinic or in an in-patient ward on a specified day were invited to participate as desired, and all patients attending vascular out-patients for a 4-week period were included in the study. All patients were assessed for the presence of CE, and if present, patients were asked to answer several questionnaires regarding diagnosis, available services, quality of life, and wound care where appropriate. The collection of data was anonymized and was inputted to a central database (Clindex). A total of 152 patients were assessed, 76 from the oncology service and 76 from the vascular service. Eighty-seven (57%) patients were female and 65 (43%) patients were male. The mean age was 65 years with a range 15-93 years. Twenty-five patients (16%) had CE, 8 (11%) in the oncology service and 17 (22%) in the vascular service. All the oncology patients were normal weight while almost 60% (n = 10) of the vascular patients were obese. Two (25%) of the oncology patients had a history of cellulitis, whereas seven (41%) of the vascular patients had a history of cellulitis. Four of the oncology patients (50%) received full lymphedema management whereas two oncology patients (20%) received no treatment at all. In contrast, in the vascular group, only two patients (12%) received full lymphedema management. Eight patients (47%) were receiving no treatment at all and seven (41%) were in compression garments and received skin care advice only. Conclusion: Though number of patients are small, these results highlight the high prevalence of CE in both oncology and vascular service patients as well as the disparities in management. In addition, there is a high incidence of cellulitis reported that is possibly not surprising given the low number of patients receiving full lymphedema care. Good data collection is essential if we are to provide and fund a comprehensive service in the future.
Collapse
Affiliation(s)
| | - Norah Kyne
- Furbo Hill, Spiddal, Co. Galway, Ireland
| | | | - Elaine Grehan
- Tiaquin, Colmanstown, Ballinasloe, Co. Galway, Ireland
| | - Kay Morris
- Primary Care Strategy and Planning, HSE, Model Business Park, Cork, Ireland
| | - Monica Conway
- Bio-Health Centre, Mary Street Medical Centre, Clonmel, Ireland
| | - Nina Murray
- Local Government and Heritage, Wexford, Ireland
| | - Olive Carney
- Centre for Nurse Education, Mater Misericordiae University Hospital, Dublin, Ireland
| | | |
Collapse
|
6
|
Rockson SG. The Impact of LIMPRINT. Lymphat Res Biol 2021; 19:409-410. [PMID: 34672787 DOI: 10.1089/lrb.2021.29112.sr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S G Rockson
- MD, Editor-in-Chief Stanford University School of Medicine Lymphatic Research and Biology, Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|
7
|
Cestari M, Michelini S, Ricci M, Franks PJ, Murray S, Moffatt CJ, Michelini S. LIMPRINT in Italy. Lymphat Res Biol 2021; 19:468-472. [PMID: 34672792 DOI: 10.1089/lrb.2021.0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: To define the profile of patients presenting with chronic edema (CE) in three centers in Italy (Lymphoedema IMpact and PRevalence INTernational). Methods and Results: Data were collected in patients referred for CE between September 2016 and July 2017. A total of 1637 were recruited, 86.7% (1419) outpatients and 13.3% (218) inpatients with 80.6% (1319) female and mean age 54 years. Primary lymphedema occurred in 28.2% (461). In the 71.8% (1176) with secondary CE cancer occurred in 72% (846) and 28% (330) due to other causes. Data showed that 84.2% (226) had full upper body mobility, 15.5% (41) had limited mobility and 0.2% (2) had lost all mobility. Lower limb mobility status: 90.4% (1205) complete mobility, 8.4% (112) reduced mobility and 1.2% (21) wheelchair bound. Concurrent leg ulceration occurred in 32.9% (322) with 3.1% (51) having antibiotics. Treatment patterns varied with only 32.4% (530) receiving instructions in skin care, 61.2% (1002) multilayer compression and a further 67.8% (1110) compression garment with 17.6% (288) having sequential pressure therapy. Only 1.4% (23) had received psychological support. Out of the total 481/1637 (29.4%) were not prescribed any treatment. Only 50.4% (825) had access to subsidized treatments within the National and Regional Health Care System, whereas 49.6% (81) had to pay themselves with only half (50.9%) having access to treatment centers that were near their home. Conclusion: Results from this study and active lobbying have led to changes in reimbursement of care for primary and secondary lymphedema in Italy; this has led to a much more optimistic picture for those affected.
Collapse
Affiliation(s)
- Marina Cestari
- O.U. Territorial Rehabilitation, NHS Umbria 2, Terni, Italy
| | | | - Maurizio Ricci
- University Hospital Company, Hospitals Reunited, Ancona, Italy
| | - Peter J Franks
- Centre for Research and Implementation of Clinical Practice, London, United Kingdom
| | - Susie Murray
- Centre for Research and Implementation of Clinical Practice, London, United Kingdom
| | - Christine J Moffatt
- Centre for Research and Implementation of Clinical Practice, London, United Kingdom.,Institute of Nursing and Midwifery Care Excellence, City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.,Copenhagen Wound Healing Centre, Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Serena Michelini
- Unit of Physical Medicine and Rehabilitation, Sant'Andrea Hospital, "Sapienza," University 13 of Rome, Rome, Italy
| |
Collapse
|
8
|
Newman A, Keeley V, Pinnington L, Green C, Riches K, Franks PJ, Idris I, Moffatt CJ. Prevalence and Impact of Chronic Edema in Bariatric Patients: A LIMPRINT Study. Lymphat Res Biol 2021; 19:431-441. [PMID: 34672794 DOI: 10.1089/lrb.2021.0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Chronic edema (CO) is a complex condition, arising from different factors, including immobility and obesity. Edema and obesity can have a significant impact on quality of life of patients and their families. Understanding how to manage edema in obese patients is an increasing challenge for both patients and clinicians. As effective treatment options are limited for this population, it is more cost-effective for patients to lose weight before starting treatment. When patients cannot maintain weight loss, one option is to have bariatric surgery. This study was part of LIMPRINT: Lymphedema IMpact and PRevalence INTernational, a study with the aim of identifying the prevalence and impact of CO in different countries and health care settings. Study Purpose: To evaluate the prevalence and impact of CO among patients in a United Kingdom bariatric surgical service. Methods and Results: The gold standard pitting test assessed the presence of edema. General (EuroQOL-5 Dimensions [EQ-5D], RAND 36-Item Short Form Health Survey, Version 1.0 [SF-36], Generalized Anxiety Disorder 7-Item Scale [GAD-7] and Patient Health Questionnaire-9 [PHQ-9]), and edema-specific (Lymphedema Quality of Life [LYMQOL]) quality-of-life questionnaires were used to evaluate impact of edema. The prevalence of edema was 52.1% (25 of 48 participants had edema), potentially linked to obesity, immobility, and medications. Most participants had International Society of Lymphology (ISL) Stage I edema. There were no statistically significant differences between the quality of life of participants with and without edema. However, comparing SF-36 results and normative population data indicated that quality of life was much lower than those in the normative population. Conclusions: This study highlights the high prevalence of edema and low quality of life of this bariatric population. ClinicalTrials.gov ID: NCT03154593.
Collapse
Affiliation(s)
- Amy Newman
- University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby, United Kingdom
| | - Vaughan Keeley
- University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby, United Kingdom.,School of Medicine, Royal Derby Hospital Centre, University of Nottingham, Derby, United Kingdom
| | - Lorraine Pinnington
- School of Medicine, Royal Derby Hospital Centre, University of Nottingham, Derby, United Kingdom
| | - Carol Green
- University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby, United Kingdom
| | - Katie Riches
- University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby, United Kingdom
| | - Peter J Franks
- Centre for Research and Implementation of Clinical Practice, London, United Kingdom
| | - Iskandar Idris
- University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby, United Kingdom.,School of Medicine, Royal Derby Hospital Centre, University of Nottingham, Derby, United Kingdom
| | - Christine J Moffatt
- Centre for Research and Implementation of Clinical Practice, London, United Kingdom.,Copenhagen Wound Healing Centre, Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark.,Institute of Nursing and Midwifery Care Excellence, City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| |
Collapse
|
9
|
Burian EA, Karlsmark T, Nørregaard S, Kirketerp-Møller K, Kirsner RS, Franks PJ, Quéré I, Moffatt CJ. Wounds in chronic leg oedema. Int Wound J 2021; 19:411-425. [PMID: 34258856 PMCID: PMC8762561 DOI: 10.1111/iwj.13642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 12/31/2022] Open
Abstract
Wounds and chronic oedema are common disorders, but rarely studied together. The objective of this cross-sectional study was to investigate the point-prevalence and risk factors of wounds on the leg, in chronic leg oedema. Forty sites in nine countries were included. Of 7077 patients with chronic leg oedema, 12.70% had wounds. Independent risk factors were: peripheral arterial disease (odds ratio (OR) 4.87, 95% confidence intervals (CI) 3.63-6.52), cellulitis within the past 12 months (OR 2.69, 95% CI 2.25-3.21), secondary lymphoedema (OR 2.64, 95% CI 1.93-3.60), being male (OR 2.08, 95% CI 1.78-2.44), being over 85 years of age (OR 1.80, 95% CI 1.23-2.62), underweight (OR 1.79, 95% CI 1.14-2.79), bed bound (OR 1.79, 95% CI 1.01-3.16), chair bound (OR 1.52, 95% CI 1.18-1.97), diabetes (OR 1.47, 95% CI 1.23-1.77), and walking with aid (OR 1·41, 95% CI 1.17-1.69). 43.22% of those with wounds had clinically defined well-controlled oedema, associated with a significantly lower risk of wounds (OR 0.50, 95% CI 0.42-0.58, P < .001). Hard/fibrotic tissue (OR 1.71, 95% CI 1.19-2.48), and a positive Stemmers sign (OR 1.57, 95% CI 1.05-2.35) were associated with wounds. The study reinforces the importance of measures to control oedema, as controlled swelling was associated with a 50% lower risk of wounds.
Collapse
Affiliation(s)
- Ewa Anna Burian
- Department of Dermato-Venereology, Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
| | - Tonny Karlsmark
- Department of Dermato-Venereology, Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
| | - Susan Nørregaard
- Department of Dermato-Venereology, Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
| | - Klaus Kirketerp-Møller
- Department of Dermato-Venereology, Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
| | - Robert Scott Kirsner
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Peter John Franks
- Centre for Research and Implementation of Clinical Practice, London, UK
| | - Isabelle Quéré
- Department of Vascular Medicine, Montpellier University Hospital Centre, University of Montpellier, Montpellier, France
| | - Christine Joy Moffatt
- Department of Dermato-Venereology, Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark.,Centre for Research and Implementation of Clinical Practice, London, UK.,Nottingham University Hospitals NHS Trust, Nottingham, UK
| |
Collapse
|
10
|
Burian E, Karlsmark T, Franks P, Keeley V, Quéré I, Moffatt C. Cellulitis in chronic oedema of the lower leg: an international cross‐sectional study. Br J Dermatol 2021; 185:110-118. [DOI: 10.1111/bjd.19803] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2021] [Indexed: 01/03/2023]
Affiliation(s)
- E.A. Burian
- Department of Dermato‐Venereology & Wound Healing Centre Bispebjerg Hospital Copenhagen Denmark
| | - T. Karlsmark
- Department of Dermato‐Venereology & Wound Healing Centre Bispebjerg Hospital Copenhagen Denmark
| | - P.J. Franks
- Centre for Research and Implementation of Clinical Practice London UK
| | - V. Keeley
- Lymphoedema Department Royal Derby HospitalDerby and University of Nottingham Medical School Nottingham UK
| | - I. Quéré
- Department of Vascular Medicine Montpellier University Hospital CentreUniversity of Montpellier France
| | - C.J. Moffatt
- Department of Dermato‐Venereology & Wound Healing Centre Bispebjerg Hospital Copenhagen Denmark
- School of Social Sciences Nottingham Trent University Nottingham UK
- Nottingham University Hospitals NHS Trust Nottingham UK
| |
Collapse
|
11
|
Vignes S, Poizeau F, Dupuy A. Cellulitis risk factors for patients with primary or secondary lymphedema. J Vasc Surg Venous Lymphat Disord 2021; 10:179-185.e1. [PMID: 33957278 DOI: 10.1016/j.jvsv.2021.04.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 04/01/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Limb lymphedema is a chronic disease with primary and secondary forms, with the latter occurring essentially after cancer treatment. In the present study, we retrospectively analyzed the cellulitis frequency and its associated risk factors for patients with primary or secondary limb lymphedema. METHODS Information from all 1991 patients referred to a specialized lymphedema center from January to June 2018 was collected, including previous cellulitis episodes and the clinical and lymphedema characteristics. RESULTS Of the 1846 patients whose information could be analyzed, 695 (37.6%) had experienced one or more cellulitis episodes, and 23.3% had had recurrent cellulitis. Cellulitis occurred in 39.5%, 30.5%, and 38.6% (P = .02) of the patients with secondary upper limb, secondary lower limb, and primary lower limb lymphedema, respectively. The corresponding duration of lymphedema was 106.5, 97, and 243.1 months. For secondary upper limb lymphedema, a long interval from lymphedema onset to the first consultation at our specialized center, younger age at lymphedema onset, and the use of radiotherapy were independently associated with cellulitis. However, axillary lymph node excision, the use of chemotherapy, and segmentation of the upper limb lymphedema were not associated with cellulitis. A longer interval from lymphedema onset to the first consultation and lymph node excision were associated with cellulitis in those with lower limb secondary lymphedema but higher body mass index and younger age at lymphedema onset were not. For primary lower limb lymphedema, male sex, greater body mass index, and younger age at lymphedema onset were associated with cellulitis. CONCLUSIONS Different risk factors for cellulitis were identified for patients with lymphedema at risk. Awareness of those factors is important for physicians to recognize lymphedema promptly and refer patients to specialized centers to optimize treatment.
Collapse
Affiliation(s)
- Stéphane Vignes
- Department of Lymphology, Referral Center for Rare Vascular Diseases, Cognacq-Jay Hospital, Paris, France.
| | - Florence Poizeau
- Department of Dermatology, Centre Hospitalier Universitaire de Rennes, Rennes, France; EA 7449 REPERES (Pharmacoepidemiology and Health Services Research), Rennes 1 University, Rennes, France
| | - Alain Dupuy
- Department of Dermatology, Centre Hospitalier Universitaire de Rennes, Rennes, France; EA 7449 REPERES (Pharmacoepidemiology and Health Services Research), Rennes 1 University, Rennes, France
| |
Collapse
|
12
|
Brix B, Sery O, Onorato A, Ure C, Roessler A, Goswami N. Biology of Lymphedema. BIOLOGY 2021; 10:biology10040261. [PMID: 33806183 PMCID: PMC8065876 DOI: 10.3390/biology10040261] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/15/2021] [Accepted: 03/23/2021] [Indexed: 12/17/2022]
Abstract
Simple Summary Lymphedema is a chronic, debilitating disease of the lymphatic vasculature. Although several reviews focus on the anatomy and physiology of the lymphatic system, this review provides an overview of the lymphatic vasculature and, moreover, of lymphatic system dysfunction and lymphedema. Further, we aim at advancing the knowledge in the area of lymphatic system function and how dysfunction of the lymphatic system—as seen in lymphedema—affects physiological systems, such as the cardiovascular system, and how those might be modulated by lymphedema therapy. Abstract This narrative review portrays the lymphatic system, a poorly understood but important physiological system. While several reviews have been published that are related to the biology of the lymphatic system and lymphedema, the physiological alternations, which arise due to disturbances of this system, and during lymphedema therapy, are poorly understood and, consequently, not widely reported. We present an inclusive collection of evidence from the scientific literature reflecting important developments in lymphedema research over the last few decades. This review aims at advancing the knowledge on the area of lymphatic system function as well as how system dysfunction, as seen in lymphedema, affects physiological systems and how lymphedema therapy modulates these mechanisms. We propose that future studies should aim at investigating, in-detail, aspects that are related to fluid regulation, hemodynamic responses, and endothelial and/or vascular changes due to lymphedema and lymphedema therapy.
Collapse
Affiliation(s)
- Bianca Brix
- Gravitational Physiology and Medicine Research Unit, Division of Physiology, Otto Loewi Research Center, Medical University of Graz, 3810 Graz, Austria; (B.B.); (A.R.)
| | - Omar Sery
- Faculty of Science, Masaryk University, Kotlářská 2, 61137 Brno, Czech Republic;
| | | | - Christian Ure
- Wolfsberg Clinical Center for Lymphatic Disorders, Wolfsberg State Hospital, KABEG, 9400 Wolfsberg, Austria;
| | - Andreas Roessler
- Gravitational Physiology and Medicine Research Unit, Division of Physiology, Otto Loewi Research Center, Medical University of Graz, 3810 Graz, Austria; (B.B.); (A.R.)
| | - Nandu Goswami
- Gravitational Physiology and Medicine Research Unit, Division of Physiology, Otto Loewi Research Center, Medical University of Graz, 3810 Graz, Austria; (B.B.); (A.R.)
- Correspondence: ; Tel.: +43-316-385-73852
| |
Collapse
|
13
|
Tidhar D, Deutscher D, Armer JM. Lymphoedema, a significant health problem in Israel: A descriptive community-based study. Int Wound J 2020; 20:1343-1360. [PMID: 33236836 PMCID: PMC10088862 DOI: 10.1111/iwj.13523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/03/2020] [Accepted: 11/07/2020] [Indexed: 11/27/2022] Open
Abstract
Lymphoedema (LE) is recognised as a chronic disabling disease. Knowledge on patient characteristics, treatments, and outcomes in Israel is lacking. The aim of the study was to (a) describe demographic and health characteristics, treatments, utilisation, and functional outcomes of patients receiving physical therapy due to LE in a large nationwide healthcare provider in Israel; and (b) assess the feasibility of conducting a future practice-based evidence (PBE) study. This is a retrospective observational cohort study. Descriptive analyses of an electronic medical record database were performed. Data from 6013 patient episodes were analysed. A high proportion of patients had two or more comorbidities (80%) and chronic medication use (85%) with increasing rates over the 8-year period. The most frequent LE classification was stage 2 (45%). A majority of LE was in the lower limbs (51%) with increasing rates over the years. The most frequent treatment-related activity was measuring limb circumference and the most frequent intervention was educating for self-management. This study provides a first comprehensive description of patient characteristics receiving physical therapy for LE in Israel. The available database offers an opportunity for PBE studies. Recommendations for improvements in specific data collection processes were identified.
Collapse
Affiliation(s)
- Dorit Tidhar
- Department of Physical Therapy, Maccabi Healthcare Services, Netivot, Israel
| | - Daniel Deutscher
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel-Aviv, Israel
| | - Jane M Armer
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri, USA
| |
Collapse
|
14
|
Fluid Shifts Induced by Physical Therapy in Lower Limb Lymphedema Patients. J Clin Med 2020; 9:jcm9113678. [PMID: 33207688 PMCID: PMC7697258 DOI: 10.3390/jcm9113678] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/18/2020] [Accepted: 11/12/2020] [Indexed: 12/18/2022] Open
Abstract
Complete decongestive therapy (CDT), a physical therapy including manual lymphatic drainage (MLD) and compression bandaging, is aimed at mobilizing fluid and reducing limb volume in lymphedema patients. Details of fluid shifts occurring in response to CDT are currently not well studied. Therefore, we investigated fluid shifts before, during and after CDT. Thirteen patients (3 males and 10 females, aged 57 ± 8.0 years, 167.2 ± 8.3 cm height, 91.0 ± 23.4 kg weight) diagnosed with stage II leg lymphedema participated. Leg volume, limb and whole-body fluid composition (total body water (limbTBW/%TBW), extracellular (limbECF/%ECF) and intracellular (limbICF/%ICF fluid), as well as ECF/ICF and limbECF/limbICF ratios were determined using perometry and bioelectrical impedance spectroscopy. Plasma volume, proteins, osmolality, oncotic pressure and electrolytes were assessed. Leg volume (p < 0.001), limbECF (p = 0.041), limbICF (p = 0.005) and limbECF/limbICF decreased over CDT. Total leg volume and limbTBW were correlated (r = 0.635). %TBW (p = 0.001) and %ECF (p = 0.007) decreased over time. The maximum effects were seen within one week of CDT. LimbICF (p = 0.017), %TBW (p = 0.009) and %ICF (p = 0.003) increased post-MLD, whereas ECF/ICF decreased due to MLD. Plasma volume increased by 1.5% post-MLD, as well as albumin and the albumin-to-globulin ratio (p = 0.005 and p = 0.049, respectively). Our results indicate that physical therapy leads to fluid shifts in lymphedema patients, with the greatest effects occurring within one week of therapy. Fluid shifts due to physical therapy were also reflected in increased plasma volume and plasma protein concentrations. Perometry, in contrast to bioelectrical impedance analysis, does not seem to be sensitive enough to detect small fluid changes caused by manual lymphatic drainage.
Collapse
|