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Kurik G, Kelly-Bissue C, Lõhmus A, Muhhamedjanov K, Ilves N, Forbes A. Standardising and simplifying the Global Leadership Initiative on Malnutrition (GLIM) for its more general application. Clin Nutr ESPEN 2024; 62:120-127. [PMID: 38901933 DOI: 10.1016/j.clnesp.2024.05.010] [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] [Received: 10/17/2023] [Revised: 04/27/2024] [Accepted: 05/15/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Malnutrition is present in 20-50% of hospital patients but its recognition is often neither timely nor complete. The Global Leadership Initiative on Malnutrition (GLIM) aims to improve this, but its successful implementation may be compromised by its dependence on (a choice of) prior screening tools and difficulties in consistent assessment of muscle mass. AIMS To explore different approaches to screening and muscle assessment in GLIM and to offer simpler choices for its more widespread application. METHODS (1) Data from 300 consenting in-patients provided Nutritional Risk Screening (NRS-2002), Malnutrition Universal Screening Tool (MUST), and Subjective Global Assessment (SGA) scores. GLIM scoring was preceded by NRS-2002 or MUST (using threshold scores of 1 or 2 for MUST), or no prior screening. The results of GLIM scoring preceded by different screening approaches were compared with those of SGA. (2) The literature on mid-upper arm circumference (MUAC) and calf circumference (CC) as simple, non-invasive, objective methods of muscle assessment methods was reviewed (3) The cumulative times taken to obtain GLIM scores were measured and corrected for the different screening strategies. RESULTS (1) Participants' mean age was 60 years, 157 (52%) were female and mean BMI was 27.8 kg/m2. In comparison with SGA, GLIM with no prior screening had the highest sensitivity (65%) and negative predictive value (NPV) (76%), but the lowest specificity (90%) and positive predictive value (PPV) (84%). The equivalent figures for GLIM with prior MUST "1" were 62%, 75%, 93% and 88%; with prior NRS-2002, 55%∗, 73%, 98%∗ and 95%∗; and with prior MUST "2", 44%∗, 69%∗, 98%∗, 95%∗. The area under an ROC curve was the highest (0.78) when GLIM was performed without screening or with prior MUST "1". (2) Being less affected by oedema and gender differences than calf circumference, MUAC could serve as a standard globally accessible muscle mass assessment method which can be supplemented by technical approaches if available and deemed necessary. (3) The overall per-capita time requirement of GLIM was 240-245 s without prior screening, and was increased by 2-3% with prior MUST "1", by 27-29% with prior NRS-2002 and decreased by 8-9% with prior MUST "2". CONCLUSIONS Preceding GLIM by screening can decrease its sensitivity and increase overall time utilisation; "gold standard" muscle assessment is not globally accessible. Our results therefore support considering using GLIM as a combined screening and assessment tool, with MUAC as the method of muscle assessment which can be supplemented by technical approaches if available and deemed necessary. This could potentially both simplify the use of GLIM and improve the early detection of malnutrition. ∗Indicates statistically significant difference from use of GLIM without prior screening.
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Affiliation(s)
- G Kurik
- Institute of Clinical Medicine, University of Tartu, Puusepa 8, 50406, Tartu, Estonia
| | - C Kelly-Bissue
- Institute of Clinical Medicine, University of Tartu, Puusepa 8, 50406, Tartu, Estonia
| | - A Lõhmus
- Institute of Clinical Medicine, University of Tartu, Puusepa 8, 50406, Tartu, Estonia
| | - K Muhhamedjanov
- Institute of Clinical Medicine, University of Tartu, Puusepa 8, 50406, Tartu, Estonia
| | - N Ilves
- Institute of Clinical Medicine, University of Tartu, Puusepa 8, 50406, Tartu, Estonia
| | - A Forbes
- Institute of Clinical Medicine, University of Tartu, Puusepa 8, 50406, Tartu, Estonia.
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Thomas M, Morgan K, Humphreys I. Lymphoedema specialists embedded into community nurse and wound services: impacts and outcomes. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:360-370. [PMID: 38639747 DOI: 10.12968/bjon.2024.33.8.360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
BACKGROUND Lymphoedema is a progressive condition causing significant alterations to life, exerting pressures on unscheduled care from complications including cellulitis and wounds. An on the ground education programme (OGEP) was implemented to raise knowledge, competence and confidence in lymphoedema management in community clinical services. The aim of this study was to explore the impact and outcomes of the OGEP intervention. METHODS Data were captured before and after OGEP on 561 lymphoedema patients in the community setting. Data recorded included resource use, costs and outcomes (EQ-5D-5L and LYMPROM). RESULTS Data demonstrated statistically significant reductions in resource allocations including staff visits (P<0.001), cellulitis admissions (P<0.001), compression consumables and wound dressing costs (P<0.001). Overall, the total mean per patient cost decreased from £1457.10 to £964.40 (including intervention) with outcomes significantly improved in EQ-5D-5L/LYMPROM scores. CONCLUSION The analysis suggests the OGEP intervention may offer reductions in resource costs and improvements in patient outcomes. OGEP may therefore provide an innovative solution in future care delivery.
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Affiliation(s)
| | - Karen Morgan
- Clinical Lead, Lymphoedema Wales Clinical Network
| | - Ioan Humphreys
- Senior Researcher, School of Health and Social Care, Swansea University
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Morris K, Colgan MP, McMahon N, Slattery S. Outcomes from a proof-of-concept specialist lymphoedema clinic in the community. Br J Community Nurs 2024; 29:S14-S18. [PMID: 38578921 DOI: 10.12968/bjcn.2024.29.sup4.s14] [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
The Health and Safety Execultive lymphoedema model of care was published in 2018 highlighting the lack of dedicated lymphoedema services in Ireland. This led to the introduction of a proof-of-concept primary care specialist lymphoedema clinic. The clinic was responsible for all patients from their county. A comprehensive dataset was gathered which included the patient's history for 1 year prior to their presentation at clinic and then 6 monthly. A quality of life tool (LymQoL) and a patient satisfaction survey were completed. Completed 1-year data showed a significant reduction in GP and public health nurse visits as well as a reduction in the occurrence of cellulitis and associated hospital admissions. All areas of quality of life were improved and patient satisfaction was either excellent (89%) or very good (11%). The 1-year findings strongly support the roll-out of specialist clinics to all regional health areas.
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Affiliation(s)
- Kay Morris
- Project Manager, National Lymphoedema Services, Ireland
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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.
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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
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Yates J. Use of simple lymphatic drainage on truncal lymphoedema for a patient with diabetes and peripheral arterial disease. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:100-103. [PMID: 38335097 DOI: 10.12968/bjon.2024.33.3.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
Lymphoedema is the gradual, abnormal build-up of lymph fluid in the tissues resulting from a failure of the lymphatic system. The swelling impedes movement and is painful. Compression garments are contraindicated and not tolerated by patients with extensive peripheral arterial disease. In this case study, simple lymphatic drainage was therefore considered a safer treatment option to reduce oedema and to encourage proactive self-management for a patient with bilateral amputations, diabetes and peripheral arterial disease.
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Affiliation(s)
- Jennifer Yates
- Vascular and Lymphoedema Nurse Specialist, Sheffield Teaching Hospitals
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Rabe E, Blanc-Guillemaud V, Onselaer MB, Blangero Y, Yaltirik HP, Nicolaides A. Reduction of lower-limb edema in patients with chronic venous disease by micronized purified flavonoid fraction: a systematic literature review and meta-analysis. INT ANGIOL 2023; 42:488-502. [PMID: 38131655 DOI: 10.23736/s0392-9590.23.05084-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
INTRODUCTION The prevalence of lower limb edema is high among patients with chronic venous disease (CVD). Several clinical studies with various designs have assessed the effect of micronized purified flavonoid fraction (MPFF) on edema. The aim of this work was to provide a comprehensive and accurate evaluation of the reduction in ankle and calf circumference as an indicator of lower limb edema reduction in patients with CVD treated with MPFF by combining studies that use different designs in a single group meta-analysis. EVIDENCE ACQUISITION We conducted a systematic literature review in April 2022 based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria to identify prospective studies investigating the effect of oral MPFF treatment 1000 mg/day on ankle and calf circumference in patients with CVD. Studies with population including at least one patient with an ulcer were excluded. All prospective studies irrespectively of design (i.e., interventional and non-interventional studies, randomized controlled trials (RCTs), non-randomized studies, studies without a control or reference treatment) were eligible. The Medline, Embase and Cochrane databases were searched. Endpoints were ankle and calf circumference measurements and their overall mean change from baseline estimated with random-effects meta-analysis methods. The evaluation criterion feeling of swelling was also analyzed as a standardized mean change (SMC) with 95% confidence intervals after combination of quantitative scales. EVIDENCE SYNTHESIS Among 861 articles identified, eight studies (five RCTs including one placebo-controlled, three non-comparative studies) met the criteria. The overall population consisted of 1635 patients, predominantly female (89% ranging from 64% to 94%) with a mean age of 47 years ranging from 41 to 48 years. Mean reduction in ankle circumference was 6.0 mm (95%CI: 3.6 to 8.4; P<0.001) and 7.0 mm (95%CI: 0.9 to 13.1; P=0.024) after two and at least six months of treatment respectively. The results were similar when considering the study type RCTs and non-RCTs. Mean reduction in calf circumference was 5.7 mm (95%CI: 2.8 to 8.6; P<0.001) and 6.7 mm (95%CI: 5.2 to 8.1; P<0.001), at two months and at the last post-baseline evaluation respectively. Heterogeneity among studies was statistically significant (degree of consistency I2=93.5%; P<0.001 and I2=81.1%, P<0.01 for ankle and calf circumference, respectively). In the three studies reporting the effect on feeling of swelling a significant standardized mean change (SMC) reduction of 2.2 (95%CI: 0.2 to 4.2; P=0.028) on a quantitative scale was observed after two months of treatment with MPFF. CONCLUSIONS MPFF appeared to be effective in reducing ankle and calf circumference as well as feeling of swelling irrespective of study design. The circumference reduction is present at short and long term, suggesting that benefit occurs early and is maintained overtime. Despite the observed heterogeneity among included studies, this meta-analysis supports the significant therapeutic efficacy of MPFF in reducing lower-limb edema in patients with CVD. The complete video presentation of the work is available online at www.minervamedica.it (Supplementary Digital Material 1: Supplementary Video 1, 5 min, 192 MB).
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Affiliation(s)
- Eberharde Rabe
- Department of Dermatology, University of Bonn, Bonn, Germany
| | | | | | | | | | - Andrew Nicolaides
- Vascular Screening and Diagnostic Center, University of Nicosia Medical School, Nicosia, Cyprus -
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Thomas M, Pike C, Humphreys I, Bragg T, Ghattaura A. Impact and outcomes after lymphaticovenous anastomosis for 150 cases of lymphoedema followed up over 24 months. J Plast Reconstr Aesthet Surg 2023; 85:104-113. [PMID: 37473641 DOI: 10.1016/j.bjps.2023.06.068] [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] [Received: 03/20/2023] [Revised: 06/22/2023] [Accepted: 06/29/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Lymphoedema is a chronic condition affecting daily activities of life, causing significant alterations and adjustments. Since 2015, lymphaticovenous anastomosis (LVA) has been available on the National Health Service for people with lymphoedema in Wales, United Kingdom. This study aimed to explore the impact and outcomes after LVA over a 24-month follow-up. METHODS Data were prospectively captured before and after LVA surgery on 150 patients with unilateral upper or lower limb lymphoedema. The same team (three lymphoedema specialists and two plastic surgeons) assessed/operated on all patients. Data captured included a quality of life tool (EQ5D5L), circumferential measurements (tape measure/perometer), compression garment usage, occurrence of cellulitis and a range of patient-reported outcome measures. RESULTS People who underwent LVA surgery had predominantly cancer-related lymphoedema (n = 118). Reviewing baseline data and 24-months after LVA, quality of life statistically improved (p = <0.005), as well as pain, heaviness, anxiety, impact on hobbies, work, purchasing clothes and intimacy/desirability. Mean perometer and circumferential measurements did not reduce over the 24 months. Number of days per week and hours that the patient wore compression garments did lessen and was statistically significant (p = <0.001). The quantity of cellulitis episodes captured from two years before and two years after LVA decreased from 4.22 to 0.10 (p = <0.001). Significant results (p = <0.001) were also found in a reduction in patients taking days off work due to cellulitis (5.81 to 0.16). CONCLUSION LVA resulted in significant improvements in patient-reported outcome measures, cellulitis episodes and reduced need for compression garments. Limb circumference via tape measure/perometer did not alter, yet the patient's quality of life considerably improved.
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Affiliation(s)
- M Thomas
- Swansea Bay UHB - Lymphoedema Wales Clinical Network, United Kingdom.
| | - C Pike
- Swansea Bay UHB - Lymphoedema Wales Clinical Network, United Kingdom
| | - I Humphreys
- School of Health and Social Care, Swansea University, United Kingdom
| | - T Bragg
- Swansea Bay UHB - Plastic and Reconstructive Department, United Kingdom
| | - A Ghattaura
- Swansea Bay UHB - Plastic and Reconstructive Department, United Kingdom
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Sierla R, Dylke E, Poon S, Shaw T, Kilbreath S. Attaining consensus on a core dataset for upper limb lymphoedema using the Delphi method: A foundational step in creating a clinical support system. HEALTH INF MANAG J 2023:18333583231188396. [PMID: 37653585 DOI: 10.1177/18333583231188396] [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: 09/02/2023]
Abstract
Background: Lymphoedema is a condition of localised swelling caused by a compromised lymphatic system. The protein-rich fluid accumulating in the interstitial tissue can create inflammation and irreversible changes to the skin and underlying tissue. An array of methods has been used to assess and report these changes. Heterogeneity is evident in the clinic and in the literature for the domains assessed, outcomes and outcome measures selected, measurement protocols followed, methods of analysis, and descriptors used to report change. Objective: This study seeks consensus on the required items for inclusion in a core data set for upper limb lymphoedema to digitise the monitoring and reporting of upper limb lymphoedema. Methods: The breadth of outcomes and descriptors in common use were captured in prior studies by this research group. This list was refined by frequency and proposed to experts in the field (n = 70) through a two-round online modified Delphi study. These participants rated the importance of each item for inclusion in the dataset and identified outcomes or descriptors they felt were missing in Round 1. In Round 2, participants rated any new outcomes or descriptors proposed and preference for how numeric data is displayed. Results: The core dataset was confirmed on completion of Round 2. Interlimb difference as a percentage, and limb volume were preferred for graphed display over time; and descriptors for observed and palpated change narrowed from 42 to 20. Conclusion: This dataset provides the foundation to create a clinical support system for upper limb lymphoedema.
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Affiliation(s)
- Robyn Sierla
- The University of Sydney, Australia
- Royal Prince Alfred Hospital, Australia
| | | | | | - Tim Shaw
- The University of Sydney, Australia
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Phillips J, Witt S, Piller N, Gordon S. Seasonal Variation in Upper Limb Size, Volume, Fluid Distribution, and Lymphedema Diagnosis, Following Breast Cancer Treatment. Lymphat Res Biol 2023; 21:351-358. [PMID: 36812466 DOI: 10.1089/lrb.2022.0017] [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: 02/24/2023] Open
Abstract
Background: Breast cancer-related lymphedema (BCRL) is a common complication of breast cancer treatment. Anecdotal and qualitative research suggests that heat and hot weather cause an exacerbation of BCRL; however, there is little quantitative evidence to support this. The aim of this article is to investigate the relationship between seasonal climate variation and limb size, volume, fluid distribution, and diagnosis in women following breast cancer treatment. Methods and Results: Women older than the age of 35 years who had undergone treatment for breast cancer were invited to participate. Twenty-five women aged between 38 and 82 years were recruited. Seventy-two percent received surgery, radiation therapy, and chemotherapy as part of their breast cancer treatment. Participants completed anthropometric, circumferential, and bioimpedance measures and a survey on three occasions: November (spring), February (summer), and June (winter). Diagnostic criteria of >2 cm and >200 mL difference between the affected and unaffected arm, and a positive bioimpedance ratio of >1.139 for a dominant arm and >1.066 for nondominant arm was applied across the three measurement occasions. No significant correlation between seasonal variation in climate and upper limb size, volume, or fluid distribution were found in women diagnosed with or at risk of developing BCRL. Lymphedema diagnosis depends on the season and diagnostic measurement tool utilized. Conclusion: There was no statistically significant variation in limb size, volume, or fluid distribution in this population across spring, summer, and winter, although there were linked trends in these values. The diagnosis of lymphedema, however, varied between individual participants throughout the year. This has important implications for the implementation/commencement of treatment and management. Further research with a larger population in different climates is required to explore the status of women with respect to BCRL. The use of common clinical diagnostic criteria did not result in consistent diagnostic classification of BCRL for the women involved in this study.
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Affiliation(s)
- Jennifer Phillips
- Physiotherapy, Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
- Allied Health Department, The Wesley Hospital, Uniting Care Health, Auchenflower, Queensland, Australia
| | - Susan Witt
- Lymphoedema Clinical Research Unit, Flinders University, Adelaide, Australia
| | - Neil Piller
- Lymphoedema Clinical Research Unit, Flinders University, Adelaide, Australia
| | - Susan Gordon
- Caring Futures Institute, Flinders University, Adelaide, Australia
- James Cook University, Townsville, Queensland, Australia
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Loibnegger-Traußnig K, Schwerdtfeger AR, Flaggl F. Effects of a Stress Management Training in Patients With Lymphedema and Obesity During Rehabilitation. EUROPEAN JOURNAL OF HEALTH PSYCHOLOGY 2023. [DOI: 10.1027/2512-8442/a000128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Abstract: Background: Evidence for behavioral weight loss interventions demonstrates promising effects, but stress management training for weight loss and stress reduction in patients with lymphedema and obesity during rehabilitation has not been investigated yet. Aim: This study aims to examine innovative psychological treatment options for weight loss and stress management through a multifaceted approach in patients with lymphedema and obesity. Method: Seventy-one patients with lymphedema and obesity participating in an existing rehabilitation took part in this clinical trial. Half of them ( n = 36) were allocated to an additional stress management intervention. At the beginning of rehabilitation and the end (after 3 weeks; n = 66) participants’ weight, physical fitness, heart rate variability (HRV), and perceived stress were assessed. After around 8 months ( n = 28) chronic and perceived stress were evaluated again. Results: Irrespective of group allocation, rehabilitation had a positive, but short-term effect on perceived stress ( d = 0.60). Although patients receiving the additional stress management training did neither show a decrease in perceived stress nor an increase of HRV from pre- to post-assessment, they lost more weight and improved physical fitness at post-assessment as compared to the control group. Limitations: A stress-reducing effect of the training was not found, thus questioning the underlying mechanism of the applied intervention. Conclusions: Findings suggest a clinically relevant impact of psychological interventions in patients with lymphedema and a promising pathway for further research.
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O'Neill C, Elwell R. British Lymphology Society's position paper for management of people with lymphoedema in presence of deep vein thrombosis: a summary. Br J Community Nurs 2022; 27:S24-S26. [PMID: 35373619 DOI: 10.12968/bjcn.2022.27.sup4.s24] [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: 11/11/2022]
Abstract
There is some confusion surrounding the management of people with lymphoedema in the presence of deep vein thrombosis (DVT). This may be in relation to the suitability of commencing compression therapy or regarding the continuation of compression therapy in those who develop DVT. The purpose of this British Lymphology Society position paper is to support evidence-based practice and debunk the myths surrounding the management of DVT and lymphoedema.
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Affiliation(s)
- Catriona O'Neill
- Director of Clinical Services and Lymphoedema, Accelerate CIC; British Lymphology Society Trustee
| | - Rebecca Elwell
- Macmillan Lymphoedema ANP, University Hospitals of North Midlands NHS Trust, and British Lymphology Society Trustee
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Deutscher D, Hayes D, Cook KF, Werneke MW, Tucker CA, Mioduski JE, Levenhagen K, Tidhar D, Pfarr M, Kallen MA. Upper Quadrant Edema Patient-Reported Outcome Measure Is Reliable, Valid, and Efficient for Patients With Lymphatic and Venous Disorders. Phys Ther 2021; 101:pzab219. [PMID: 34636891 DOI: 10.1093/ptj/pzab219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 06/02/2021] [Accepted: 08/01/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The main aims of this study were to (1) create a patient-reported outcome measure (PROM) item bank for measuring the impact of upper quadrant edema (UQE) on physical function by calibrating responses to newly developed items; and (2) assess reliability, validity, and administration efficiency of scores based on computerized adaptive test (CAT) and 10-item short-form (SF) administration modes. METHODS This was a retrospective study including data from patients treated in outpatient rehabilitation clinics for UQE that responded to all 27 candidate items at intake. Item response theory model assumptions of unidimensionality, local item independence, item fit, and presence of differential item functioning were evaluated. UQE-CAT- and UQE-SF-generated scores were assessed for reliability, validity, and administration efficiency. RESULTS The total cohort included 3486 patients (mean [SD] age = 61 [13] years; range = 14-89 years). After removing 2 items, a 25-item solution was supported for its unidimensionality and fit to the item response theory model with reliability estimates of more than 0.93 for scores based on both CAT and SF administration modes. No items demonstrated differential item functioning. Scores discriminated among multiple patient groups in clinically logical ways and were moderately responsive to change with negligible floor and acceptable ceiling effects. CAT scores were generated using an average of 5.6 items (median = 5). CONCLUSION Scores on the UQE PROM were reliable, valid, and efficient for assessing perceived physical function of patients with upper quadrant edema; thus, the measure is suitable for research and routine clinical administration. IMPACT The newly developed UQE PROM is reliable and valid and offers efficient administration modes for assessing perceived physical function of patients with UQE caused by lymphatic and venous disorders, both for research and routine clinical care in busy outpatient rehabilitation settings. As an item response theory-based measure, the UQE PROM allows administration of condition-specific functional questions with low response burden for patients. This study supports a transition to PROMs that are based on modern measurement approaches to achieve high accuracy and efficiency.
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Affiliation(s)
- Daniel Deutscher
- Net Health Systems, Inc, Pittsburgh, Pennsylvania, USA
- Maccabitech Institute for Research & Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Deanna Hayes
- Net Health Systems, Inc, Pittsburgh, Pennsylvania, USA
| | | | | | - Carole A Tucker
- Department of Health and Rehabilitation Sciences, College of Public Health, Temple University, Philadelphia, Pennsylvania, USA
| | | | - Kim Levenhagen
- Program in Physical Therapy, Saint Louis University, Saint Louis, Missouri, USA
| | - Dorit Tidhar
- Physical Therapy Department, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Megan Pfarr
- HSHS Wisconsin & Prevea Health, Green Bay, Wisconsin, USA
| | - Michael A Kallen
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Dai M, Minematsu T, Ogawa Y, Kawamoto A, Nakagami G, Sanada H. Association of Dermal Hypoechogenicity and Cellulitis History in Patients with Lower Extremity Lymphedema: A Cross-Sectional Observational Study. Lymphat Res Biol 2021; 20:376-381. [PMID: 34762544 DOI: 10.1089/lrb.2021.0004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Recurrent cellulitis has high impact on physical, psychological, and social aspects for lymphedema patients. We speculated that identification of characteristics of skin and subcutaneous adipose tissue with cellulitis history can help considering new approach for prevention of recurrent cellulitis in lymphedema patients. Therefore, in this study, we aimed to noninvasively identify the ultrasonographic features of skin and subcutaneous tissue of lymphedema in patients with a cellulitis history. Method and Results: This was a cross-sectional study, and all data were collected from patients' medical records. We assessed ultrasonographic images of the lower extremity of patients with lymphedema that were obtained in a lymphedema clinic. The ultrasonographic images were analyzed on the basis of the following five features: dermal hypoechogenicity, unclear dermal border, unclear superficial fascia, increased subcutaneous echogenicity, and subcutaneous cobblestone appearance. Fifty-two ultrasonographic images from 19 female patients with lower extremity lymphedema, including 8 with and 11 without a cellulitis history, were analyzed. The proportion of dermal hypoechogenicity on the upper leg was significantly higher in the patients with than in those without a cellulitis history (75.0% vs. 9.1%, p = 0.006). Conclusion: Cellulitis history in lymphedema patients appears to be associated with dermal hypoechogenicity, particularly in the proximal lower extremity. This finding suggests that it may be the initial step to consider new approach for prevention of recurrent cellulitis in lymphedema patients.
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Affiliation(s)
- Misako Dai
- Department of Skincare Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Research Center for Implementation Nursing Science Initiative, School of Health Sciences, Fujita Health University, Aich, Japan
| | - Takeo Minematsu
- Department of Skincare Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Division of Care Innovation, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Atsuo Kawamoto
- Division of Ultrasound, Department of Diagnostic Imaging, Tokyo Medical University Hospital, Tokyo, Japan
| | - Gojiro Nakagami
- Division of Care Innovation, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiromi Sanada
- Division of Care Innovation, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Atkin L, Bullock L, Chadwick P, Elwell R, Gardner S, Goodwin T, Hopkins A, O'Connor C, Sneddon M, Wiles K, Williams K. Making Legs Matter: A Case for System Change and Transformation in Lower-Limb Management. J Wound Care 2021; 30:S1-S25. [PMID: 34756097 DOI: 10.12968/jowc.2021.30.sup11.s1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This consensus document is endorsed by The Queen's Nursing Institute (QNI) and The Queen's Nursing Institute Scotland (QNIS).
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Affiliation(s)
- Leanne Atkin
- Legs Matter Chair; Vascular Nurse Consultant, Mid Yorks NHS Trust/University of Huddersfield, UK
| | - Lynn Bullock
- PA to Ellie Lindsay, The Lindsay Leg Club Foundation, UK
| | - Paul Chadwick
- National Clinical Director, The College of Podiatry, UK
| | - Rebecca Elwell
- Macmillan Lymphoedema ANP and Team Leader, Lymphoedema Clinic, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, UK
| | | | | | | | | | - Margaret Sneddon
- Honorary Senior Research Fellow, University of Glasgow; Chair, British Lymphology Society, UK
| | | | - Kate Williams
- Tissue Viability Nurse, Leeds Community Health NHS Trust, UK
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15
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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.
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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
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16
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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.
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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
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17
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Gibson L, Moffatt CJ, Narahari SR, Kabiri L, Ikhile D, Nchafack A, Dring E, Nursing D, Kousthubha SN, Gorry J. Global Knowledge Gaps in Equitable Delivery of Chronic Edema Care: A Political Economy Case Study Analysis. Lymphat Res Biol 2021; 19:447-459. [PMID: 34672793 DOI: 10.1089/lrb.2021.0063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Most existing research in chronic edema (CO) care takes place in high-income countries and is both clinically and medically focused, although often accorded low prestige and status. A myriad of challenges define the problems and important gaps in understanding and translating what we know into sustainable practice. Less considered, however, are the consequences and socioeconomic significance of this "knowledge gap" in an increasingly globalized world. This article seeks to address this lacuna by suggesting a political economy approach across three different income settings, the United Kingdom (high), Kerala in India (middle), and Uganda (low), to learn from international practice and understand the contribution of local (community-specific) health traditions. Methods and Result: We used a comparative case study approach. In the three case studies we demonstrate how particular thinking, sets of power relationships, and resource distributions influence and structure the provision of CO management more generally. We demonstrate how these intertwined and often invisible processes reflect a market-led biomedical hierarchization that focuses on high-interventionist, high-cost approaches that are then imposed on lower income settings. At the same time, low-cost but evidence-based local knowledge innovation in wound and CO care from low- or middle-income countries is neither recognized nor valued. Conclusion: We conclude that unpacking these dynamics is a necessary route to providing a more equitable health delivery accessible for the many rather than the few.
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Affiliation(s)
- Linda Gibson
- Institute of Health and Allied Professions, Nottingham Trent University, Nottingham, 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
| | - S R Narahari
- Institute of Applied Dermatology, Kasaragod, India
| | - Lydia Kabiri
- School of Health Sciences, Makerere University, Kampala, Uganda, Africa
| | - Deborah Ikhile
- Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Almighty Nchafack
- Institute of Health and Allied Professions, Nottingham Trent University, Nottingham, United Kingdom
| | | | - Dip Nursing
- Institute of Nursing and Midwifery Care Excellence, Nottingham University Hospitals, Nottingham, United Kingdom
| | - S N Kousthubha
- Shri Dharmasthala Manjunatheshwara College of Medical Sciences, Dharwad, India
| | - Jonathan Gorry
- School of Social Sciences, Nottingham Trent University, Nottingham, United Kingdom
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18
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Thomas M, Morgan K, Lawrence P. Introducing the new Chronic Oedema Wet Leg Pathway. Br J Community Nurs 2021; 26:S16-S21. [PMID: 34542314 DOI: 10.12968/bjcn.2021.26.sup10.s16] [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: 06/13/2023]
Abstract
Reticence to apply compression therapy has been widely observed in clinical practice, compounded by an absence of evidenced-based pathways for application of prompt compression prior to measuring ankle brachial pressure index (ABPI). Importantly, delaying compression therapy for patients with chronic oedema and lymphorrhoea causes many avoidable complications. In 2017, Lymphoedema Network Wales (LNW) developed an evidenced-based pathway to improve the management of chronic oedema and wet legs (lymphorrhoea) for community nurses. During the past 4 years, the Chronic Oedema Wet Leg Pathway has been presented, published and used internationally, as well as being translated into different languages. It is commonly used in community nursing Teams as an evidenced-based document. However, like all documents and guidelines, when more evidence becomes available, the pathway needs updating. Therefore, this clinical focus article will present the new and enhanced Chronic Oedema Wet Leg Pathway, introducing a new level four compression section, which increases the layers of compression bandaging for patients with venous insufficiency or who are morbidly obese.
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Affiliation(s)
| | - Karen Morgan
- National Lymphoedema Education Lead in Wales: Lymphoedema Network Wales
| | - Paula Lawrence
- National Lymphoedema Community Educator Lead in Wales; Lymphoedema Clinical Nurse
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19
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O'Donnell TF. "A paradox, a paradox, a most ingenious paradox. This paradox". J Vasc Surg Venous Lymphat Disord 2021; 9:1087-1088. [PMID: 34399937 DOI: 10.1016/j.jvsv.2021.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 04/20/2021] [Indexed: 12/01/2022]
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20
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Gabe-Walters M, Thomas M. Development of the Lymphoedema Patient Reported Outcome Measure (LYMPROM). ACTA ACUST UNITED AC 2021; 30:592-598. [PMID: 34037455 DOI: 10.12968/bjon.2021.30.10.592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
To ensure lymphoedema patients in Wales receive the right care, at the right time, by the right person, patient-reported outcome measures (PROMs) were routinely completed within the All-Wales lymphoedema assessment documentation. This evaluation describes the development of the Lymphoedema Patient Reported Outcome Measure (LYMPROM), which is a tool developed by Lymphoedema Network Wales clinicians and key stakeholders. The tool was explored for face, form and content validity during 3 months in 2019; 128 anonymised completions of LYMPROM were reviewed to establish feasibility, acceptability and internal validity using Cronbach's alpha. LYMPROM was feasible and acceptability was high. Face and content validity were reported (i-CVI [item content validity index] range=0.43 - 1; s-CVI/Ave=0.94) and internal consistency was excellent (0.958). LYMPROM was easily integrated within lymphoedema services in Wales, promoting patient-led care and supporting value-based health care. Further evaluations of reliability and validity of LYMPROM are proceeding along with digital integration.
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Affiliation(s)
- Marie Gabe-Walters
- National Research and Innovation Lymphoedema Specialist, Lymphoedema Network Wales, Cimla Health and Social Care Centre, Cimla, Neath
| | - Melanie Thomas
- National Clinical Lead/Associate Director for Lymphoedema in Wales, Lymphoedema Network Wales, Cimla Health and Social Care Centre, Cimla, Neath
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21
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Cooper-Stanton G. Best practice for chronic oedema in community settings: what can we learn? Br J Community Nurs 2020; 25:610-614. [PMID: 33275509 DOI: 10.12968/bjcn.2020.25.12.610] [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: 06/12/2023]
Abstract
There are various opportunities and challenges in the delivery of care to those diagnosed with chronic oedema/lymphoedema. Service provision is not consistent within the UK, and non-specialist nurses and other health professionals may be called on to fill the gaps in this area. The latest best practice guidance on chronic oedema is directed at community services that care for people within their own homes in primary care. This guide was developed in order to increase awareness, knowledge and access to an evidence base. Those involved in its creation cross specialist fields (lymphoedema and tissue viability), resulting in the document covering a number of areas, including an explanation of chronic oedema, its assessment and management and the association between chronic oedema and wet legs. The document complements existing frameworks on the condition and its management and also increases the available tools within chronic oedema management in the community. The present article provides an overview of the guidance document and discusses its salient features.
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Affiliation(s)
- Garry Cooper-Stanton
- Clinical Nurse Specialist, Walsall Lymphoedema Service; Queen's Nurse; Adult Nurse Lecturer, University of Birmingham
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22
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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.
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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
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23
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Collett M. A point-of-care app for chronic oedema management. Br J Community Nurs 2020; 25:S12-S16. [PMID: 33030379 DOI: 10.12968/bjcn.2020.25.sup10.s12] [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: 06/11/2023]
Abstract
The COVID-19 pandemic of 2020 has led to considerable changes in how healthcare is delivered, as it has pushed people to think outside the box technologically. Mobile working is becoming more widespread, useful and valuable in this innovative period in the NHS. Point-of-care (POC) technology encompasses mobile devices and systems that support health professionals in their daily activities of patient care. It allows the user to safely assess and diagnose individuals at the point of care, providing actionable information to allow rapid clinical decision-making. POC technology also has the ability to support and educate patients with health needs, encouraging patients and their carers to assume greater more control of and responsibility over their health. Providing patients individual care plans to maintain their health will help realise the future of self-care. This article describe the development of a mobile app-Juzo Care-designed to enhance the management of chronic oedema and lymphoedema in mobile working settings.
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24
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Kankariya N, Laing RM, Wilson CA. Textile-based compression therapy in managing chronic oedema: Complex interactions. Phlebology 2020; 36:100-113. [PMID: 32819205 DOI: 10.1177/0268355520947291] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Compression is a common therapy for management of chronic disease, including oedema of the lower limb. Modern compression interventions exert pressure on the lower limb through use of one or more materials which exert pressure against the limb over time. Where these materials are textiles, they range from elastic to inelastic, and are produced using knitting, weaving, or other textile technologies which can be manipulated to control performance properties. Thus, understanding of both the materials/textiles and the human body is needed if the most appropriate compression device and treatment strategy is to be used. Neither is independent of the other. This review aims to enhance understanding of critical textile performance properties and how selection of textiles may affect treatment efficacy when managing chronic oedema of the lower limb. METHOD Relevant papers for review were identified via PubMed Central® library, and Google Scholar using keywords associated with textile-based treatments of the oedematous lower limb and wider interdisciplinary factors. RESULTS Assessment of the disorder, the severity of oedema, and location of fluid accumulation are required to inform treatment of chronic oedema. While the need to understand the patient is well established (e.g. age, sex, body mass index, skin thickness and colour, patient compliance with treatment), information about preferred compression systems and material structures, and inherent properties of these, is generally lacking. CONCLUSION Greater detail about materials used (e.g. fabric structure, number and order of layers, fibre content) and patient diagnosis (e.g. underlying cause, severity, location of oedema; patient age and sex; evidence of compliance with treatment; pressure exerted; lower leg shape, size, and properties of the tissue) is needed to facilitate advances in efficacy of compression treatment. Reduced limb swelling with a textile-based treatment occurs simultaneously with changes to the textile itself. Textiles cannot be considered inert.
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Affiliation(s)
- Nimesh Kankariya
- Centre for Materials Science and Technology, University of Otago, Dunedin, New Zealand
| | - Raechel M Laing
- Centre for Materials Science and Technology, University of Otago, Dunedin, New Zealand
| | - Cheryl A Wilson
- Centre for Materials Science and Technology, University of Otago, Dunedin, New Zealand
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25
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Abstract
Lymphoedema is the accumulation of protein-rich interstitial fluid within subcutaneous tissue and skin as a result of dysfunction of the lymphatic system. It is an underestimated, widely neglected and debilitating chronic condition. This article presents an overview of lymphoedema and recent advances in its management.
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Affiliation(s)
- Kai Yuen Wong
- Plastic and Reconstructive Surgery Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Dominic Furniss
- Plastic and Reconstructive Surgery Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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26
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Cooper-Stanton G. Chronic oedema and lymphoedema: what is the difference? Br J Community Nurs 2020; 25:S31-S35. [PMID: 32271099 DOI: 10.12968/bjcn.2020.25.sup4.s31] [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: 06/11/2023]
Abstract
Chronic oedema is a term that encompasses several causes that lead to oedema formation in any part of the body. This includes lymphoedema and its subcategories. Despite the assumption that these are different, there are more commonalities amongst them. This makes the transfer of knowledge and experience, from chronic oedema conditions to lymphoedema, and vice versa easier to achieve. However, this takes both time and support, to achieve the ultimate patient outcome of self-care, with generalist able to support this process and journey.
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Affiliation(s)
- Garry Cooper-Stanton
- Clinical Nurse Specialist, Walsall Lymphoedema Service; Queen's Nurse; Adult Nurse Lecturer, University of Birmingham
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27
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Phillips N, Lawrance S. Haddenham Comfiwave: a unique compression device for lymphoedema treatment. Br J Community Nurs 2020; 25:S23-S30. [PMID: 32271103 DOI: 10.12968/bjcn.2020.25.sup4.s23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Compression therapy is the mainstay of treatment in venous and lymphatic diseases. Optimisation of compression therapy is not a new concept, but, in the UK, the use of 24-hour compression therapy as part of the maintenance phase of treatment has not been standard practice and, until recently, has only been adopted by certain specialist centres. One such modality in the process of optimisation is the use of products that are classed as 'reduced compression' or 'night-time garments'. These are not traditional flat- or circular-knit garments but are made of various components to include foam and, more recently, knitted cotton fabrics. Haddenham Comfiwave is a new product that has recently been brought to market and does not feature in the literature reviewed. Although a new unique product in its own right, it has been demonstrated to fit within the common groups of products discussed.
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Affiliation(s)
- Natalie Phillips
- Clinical Manager, Haddenham Healthcare Ltd; Senior Trainer, Lymphoedema Training Academy; Honorary Lymphoedema Specialist, Compton Care
| | - Sue Lawrance
- Clinical Nurse Specialist, Florence Nightingale Hospice; Trainer, Haddenham Healthcare Ltd and Lymphoedema Training Academy
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28
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Thomas M, Morgan K, Humphreys I, Hocking K, Jehu D. The benefits of raising awareness of lymphoedema among care home staff. ACTA ACUST UNITED AC 2020; 29:190-198. [DOI: 10.12968/bjon.2020.29.4.190] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Patients with lymphoedema referred to a lymphoedema service from care homes in one health board area in Wales were often complex cases, with repeated cellulitis, a history of falls and other complications. A pilot project was initiated to develop education and raise awareness of lymphoedema among care home staff. Aims: To enable care staff to identify residents with lymphoedema, promote prompt referrals, raise the importance of skin care and exercise in the management of lymphoedema and estimate the likely costs from complications associated with lymphoedema. Methods: An education tool was developed and 47 care homes were asked to participate. A lymphoedema therapist carried out a scoping review of the residents. Results: Forty-four care homes agreed to participate in the project with 1216 education packs being issued to care home staff. Initial findings suggest that of the 960 residents reviewed, 262 had lymphoedema (27%); 4% suffered with frequent falls, 1% had wounds and 3% had recurrent cellulitis. Only 13% (35/262) of residents with lymphoedema were known to the local lymphoedema service. Of the 31 residents reporting cellulitis, 81% had lymphoedema; of the 11 residents identified with a wound, 100% had lymphoedema and of the 40 residents reporting falls, 70% had lymphoedema. Conclusion: This educational project has identified the value of raising awareness of lymphoedema within care homes.
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Affiliation(s)
- Melanie Thomas
- National Clinical Lead for Lymphoedema in Wales, Swansea Bay University Health Board
| | - Karen Morgan
- National Lymphoedema Education and Research Lead, Swansea Bay University Health Board
| | - Ioan Humphreys
- Senior Researcher, Health and Wellbeing Academy, Swansea University
| | - Karl Hocking
- National Lymphoedema Specialist, Swansea Bay University Health Board
| | - Diane Jehu
- Lymphoedema Specialist, Cwm Taff Morgannwg University Health Board
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29
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Cooper-Stanton G. Men with lymphoedema: how can services be made more inclusive? ACTA ACUST UNITED AC 2020; 29:200-201. [PMID: 32105525 DOI: 10.12968/bjon.2020.29.4.200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Garry Cooper-Stanton
- Clinical Nurse Specialist, Walsall Lymphoedema Service, Queens Nurse, Adult Nurse Lecturer, University of Birmingham
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30
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Edwards G, Freeman K, Llewelyn MJ, Hayward G. What diagnostic strategies can help differentiate cellulitis from other causes of red legs in primary care? BMJ 2020; 368:m54. [PMID: 32051117 DOI: 10.1136/bmj.m54] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- George Edwards
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Oxford, UK
| | - Karoline Freeman
- Warwick Medical School, Division of Health Sciences, University of Warwick, Coventry, UK
| | | | - Gail Hayward
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Oxford, UK
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Exploring the impact of lymphoedema on individuals and if lymphatic venous anastomosis surgery effects perceptions on quality of life: A qualitative study. Eur J Oncol Nurs 2020; 44:101720. [DOI: 10.1016/j.ejon.2019.101720] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 12/19/2019] [Accepted: 12/24/2019] [Indexed: 11/23/2022]
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Nairn S, Dring E, Aubeeluck A, Quéré I, Moffatt C. LIMPRINT: A Sociological Perspective on "Chronic Edema". Lymphat Res Biol 2020; 17:168-172. [PMID: 30995186 PMCID: PMC6639108 DOI: 10.1089/lrb.2018.0082] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Chronic edema is a condition that is biologically complex, distressing for patients and sociopolitically weak. Like many other complex and chronic conditions, it has a low status within health care. The result is that it has a low priority in health policy and consequently is undervalued and undertreated. While evidence-based practice promotes a hierarchy of evidence, it is also the case that clinical practice is influenced by a hierarchy of social status. These are as much political as they are scientific. Methods and Results: This article will provide an explanation for why chronic edema is a low priority. It will do this through a critical review of the literature. We examine this through the theoretical lens of Pierre Bourdieu. The sociology of Bourdieu frames an understanding of power relations through habitus, field, and capital. We will employ these theoretical tools to understand the way that chronic edema is situated within the policy arena. We identify a number of social mechanisms that affect the status of chronic edema, including diagnostic uncertainty, social capital, scientific capital, cultural capital and economic capital. Conclusion: We argue that a whole system approach to care, based on human need rather than unequal power relations, is a prerequisite for the delivery of good health care. The specialty of chronic edema is not a powerless group and we identify some of the ways that the social mechanism that acts as barriers to change, can also be employed to challenge them.
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Affiliation(s)
- Stuart Nairn
- School of Health Sciences, University of Nottingham, Royal Derby Hospital Center, Derby, United Kingdom
| | - Eleanor Dring
- Nottingham University Business School, University of Nottingham, Jubilee Campus Nottingham, United Kingdom
| | - Aimee Aubeeluck
- School of Health Sciences, University of Nottingham, Queens Medical Center, Nottingham, United Kingdom
| | - Isabelle Quéré
- Montpellier Medecine Vasculaire, EA2992, Universite Montpellier I, CHU Saint Eloi, Montpellier, France
| | - Christine Moffatt
- School of Social Sciences, Nottingham Trent University, Nottingham, United Kingdom
- Address correspondence to: Christine Moffatt, CBE, Nottingham School of Social Sciences, Nottingham Trent University, 50 Shakespeare Street, Nottingham NG1 4FQ, United Kingdom
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Quéré I, Palmier S, Noerregaard S, Pastor J, Sykorova M, Dring E, Franks PJ, Murray S, Keeley V, Bermark S, Karlsmark T, Kyne N, Colgan MP, Coulombe MM, Mestre S, Mercier G, Moffatt CJ. LIMPRINT: Estimation of the Prevalence of Lymphoedema/Chronic Oedema in Acute Hospital in In-Patients. Lymphat Res Biol 2020; 17:135-140. [PMID: 30995191 PMCID: PMC6639107 DOI: 10.1089/lrb.2019.0024] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: To estimate the prevalence of lymphedema/chronic edema (CO) and wounds in acute hospital inpatients in five different countries. Methods and Results: A point-prevalence study was carried out during working day periods in six general hospitals in four countries (Denmark, France, United Kingdom, and Australia) and one hospital oncology inpatient unit in one other country (Ireland). The study used validated clinical tools for the assessment and collection of data. Data were collected by expert clinicians through interviews and physical examination of the patients present in the wards. A total of 1905 patients could be included and investigated among the 3041 total bed occupancy in the seven hospitals. Lymphedema/CO was present in 723 of them (38%). Main risk factors associated with CO were age, morbid obesity, and heart failure, as well as chair bound immobility and neurological deficiency. History of cellulitis was frequent in patients with CO and wounds (24.8%) and CO alone (14.1%) compared to the 1.5% prevalence in patients without CO. Conclusion: Lymphedema/CO is very frequent in patients hospitalized in hospital acute wards. It is strongly associated with obesity, venous insufficiency, and heart failure. Our results strongly suggest a hidden health care burden and cost linked to CO independently of chronic wounds.
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Affiliation(s)
- Isabelle Quéré
- 1 Department of Vascular Medicine, EA2992, University of Montpellier, CHU Montpellier, Montpellier, France
| | - Sylvie Palmier
- 2 Department of Dermatology, University Hospital of Montpellier, Montpellier, France
| | - Susan Noerregaard
- 3 Copenhagen Wound Healing and Lymphoedema Centre, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Jenica Pastor
- 4 Épidémiologiste Unité de Recherche Médico-Economique, DIM, CHU de Montpellier, Montpellier, France
| | - Martina Sykorova
- 5 School of Health Sciences, University of Nottingham, Queens Medical Centre, Nottingham, United Kingdom
| | - Eleanor Dring
- 6 Nottingham University Business School, University of Nottingham, Nottingham, United Kingdom
| | - Peter J Franks
- 7 Centre for Research and Implementation of Clinical Practice, London, United Kingdom
| | - Susie Murray
- 7 Centre for Research and Implementation of Clinical Practice, London, United Kingdom
| | - Vaughan Keeley
- 8 Lymphoedema Service, Royal Derby Hospital, Derby, United Kingdom
| | - Susan Bermark
- 3 Copenhagen Wound Healing and Lymphoedema Centre, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Tonny Karlsmark
- 3 Copenhagen Wound Healing and Lymphoedema Centre, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Norah Kyne
- 9 Department of Physiotherapy, University Hospital Galway, Galway, Ireland
| | - Mary-Paula Colgan
- 10 Department of Vascular and Endovascular Surgery, St. James's Hospital, Dublin, Ireland
| | | | - Sandrine Mestre
- 1 Department of Vascular Medicine, EA2992, University of Montpellier, CHU Montpellier, Montpellier, France
| | - Gregoire Mercier
- 1 Department of Vascular Medicine, EA2992, University of Montpellier, CHU Montpellier, Montpellier, France
| | - Christine J Moffatt
- 1 Department of Vascular Medicine, EA2992, University of Montpellier, CHU Montpellier, Montpellier, France.,3 Copenhagen Wound Healing and Lymphoedema Centre, Bispebjerg University Hospital, Copenhagen, Denmark.,12 School of Social Sciences, Nottingham Trent University, Nottingham, United Kingdom
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Keeley V, Franks P, Quere I, Mercier G, Michelini S, Cestari M, Borman P, Hughes A, Clark K, Lisle J, Benson M, Noerregaard S, Karlsmark T, Murray S, Moffatt C. LIMPRINT in Specialist Lymphedema Services in United Kingdom, France, Italy, and Turkey. Lymphat Res Biol 2020; 17:141-146. [PMID: 30995195 PMCID: PMC6639110 DOI: 10.1089/lrb.2019.0021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: There is no standardized international model for specialist lymphedema services, which covers the types of lymphedema treated and the treatments provided. The aim of this study was to provide a profile of patients attending specialist lymphedema services in different countries to explore similarities and differences. Methods and Results: The LIMPRINT core tool was used in specialist lymphedema services in the United Kingdom, France, Italy, and Turkey. Services in Turkey saw a slightly younger age group, with a higher proportion of female patients reflecting a particular focus on breast cancer-related lymphedema. There were higher levels of obesity and restricted mobility in patients in the United Kingdom compared with other countries. Italy and France saw the highest percentage of patients with primary lymphedema. Diabetes was a common comorbidity in the United Kingdom and Turkey. The United Kingdom saw the largest number of patients with lower limb lymphedema. Conclusions: The results show a wide range of complexity of patients treated in specialist lymphedema services. Some of the differences between countries may reflect different stages in the evolution of specialist lymphedema services, rather than a true difference in prevalence, with those with "younger" services treating a high proportion of patients with cancer and those with more established services treating a wider range of different types of lymphedema, including more elderly people with multiple comorbidities.
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Affiliation(s)
- Vaughan Keeley
- 1 Lymphoedema Service, Royal Derby Hospital, Derby, United Kingdom.,2 School of Health Sciences and Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Peter Franks
- 3 Centre for Research & Implementation of Clinical Practice, London, United Kingdom
| | - Isabelle Quere
- 4 Montpellier Medecine Vasculaire, EA2992, Universite Montpellier I, CHU Saint Eloi, Montpellier, France
| | - Gregoire Mercier
- 4 Montpellier Medecine Vasculaire, EA2992, Universite Montpellier I, CHU Saint Eloi, Montpellier, France
| | - Sandro Michelini
- 5 Dipartimento di Medicina Fisica e Riabilitativa, Ospedale San Giovanni Battista-ACISMOM, Roma, Italy
| | | | - Pinar Borman
- 7 Department of Physical Medicine and Rehabilitation (PMR), University of Hacettepe Faculty of Medicine, Ankara, Turkey.,8 Hacettepe University Lymphedema Research and Practice Center, Ankara, Turkey
| | - Andrew Hughes
- 9 St. Oswalds Hospice, Newcastle Upon Tyne, United Kingdom
| | - Kath Clark
- 9 St. Oswalds Hospice, Newcastle Upon Tyne, United Kingdom
| | - Jill Lisle
- 9 St. Oswalds Hospice, Newcastle Upon Tyne, United Kingdom
| | | | - Susan Noerregaard
- 11 Copenhagen Wound Healing and Lymphoedema Centre, Bispebjerg Hospital, Kobehavn, Denmark
| | - Tonny Karlsmark
- 11 Copenhagen Wound Healing and Lymphoedema Centre, Bispebjerg Hospital, Kobehavn, Denmark
| | - Susie Murray
- 3 Centre for Research & Implementation of Clinical Practice, London, United Kingdom
| | - Christine Moffatt
- 4 Montpellier Medecine Vasculaire, EA2992, Universite Montpellier I, CHU Saint Eloi, Montpellier, France.,11 Copenhagen Wound Healing and Lymphoedema Centre, Bispebjerg Hospital, Kobehavn, Denmark.,12 School of Social Sciences, Nottingham Trent University, Nottingham, United Kingdom
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Moffatt C, Franks P, Keeley V, Murray S, Mercier G, Quere I. The Development and Validation of the LIMPRINT Methodology. Lymphat Res Biol 2020; 17:127-134. [PMID: 30995185 PMCID: PMC6636670 DOI: 10.1089/lrb.2018.0081] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The acronym Limprint stands for Lymphedema IMpact and PRevalence INTernational and was run under the auspices of the International Lymphedema Framework (ILF), a charity dedicated to improving provision of care globally. The primary aim was to identify the number of people with chronic edema (chronic edema present for >3 months and due to a range of underlying etiologies and associated risk factors) within diverse health services in nine participating countries and to determine its impact using validated methods. An international protocol and sampling framework, online data capture system, and standard operating procedures were adopted. An international consensus was used to create a core data tool that covered 13 domains. Specialist data on demographics and disability, details of swelling, wounds, cancer, and health-related quality of life were also available for sites. The study protocol was designed to allow flexibility in the types of studies undertaken within complex health care systems. All cases were confirmed using the modified pitting test. Sensitivity and specificity for this method were determined in Japanese and European populations. Following confirmation of a chronic edema case, Lymphologists defined whether it was a primary of a secondary form. The study was designed to provide robust evidence that chronic edema is an important and unrecognized public health problem in health services with significant morbidity. Without evidence of the size and complexity, it will remain considered a rare phenomenon and people affected will be denied access to appropriate treatment that would allow them to have fulfilled and productive lives.
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Affiliation(s)
- Christine Moffatt
- 1 School of Social Sciences, Nottingham Trent University, Nottingham, United Kingdom.,2 Montpellier Medecine Vasculaire, EA2992, Universite Montpellier I, CHU Saint Eloi, Montpellier, France.,3 Copenhagen Wound Healing and Lymphoedema Centre, Bisperberg University Hospital, Copenhagen, Denmark
| | - Peter Franks
- 4 Center for Research & Implementation of Clinical Practice, London, United Kingdom
| | | | - Susie Murray
- 4 Center for Research & Implementation of Clinical Practice, London, United Kingdom
| | - Gregoire Mercier
- 2 Montpellier Medecine Vasculaire, EA2992, Universite Montpellier I, CHU Saint Eloi, Montpellier, France
| | - Isabelle Quere
- 2 Montpellier Medecine Vasculaire, EA2992, Universite Montpellier I, CHU Saint Eloi, Montpellier, France
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Moffatt CJ, Keeley V, Hughes A, Clark K, Lisle J, Benson M, Gaskin R, Sykorova M, Dring E, Murray S, Mercier G, Quere I, Franks PJ. LIMPRINT: The UK Experience-Subjective Control of Swelling in Patients Attending Specialist Lymphedema Services. Lymphat Res Biol 2020; 17:211-220. [PMID: 30995196 PMCID: PMC6639106 DOI: 10.1089/lrb.2019.0020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background and Study Design: This study was undertaken as part of the UK LIMPRINT international study to determine the number of people with chronic edema (CO) and its impact on health services. Overall 7436 with CO were recruited in the main UK study from a range of health settings. Methods and Results: Factors relating to subjective control of arm and leg CO were defined in the UK. A total of 1565 patients were included in the study with exclusions for: no limb swelling or not recorded (1669), having concurrent arm/leg CO (272), control of assessment missing (5) and professional being unsure of control status of CO (325). Arm swelling occurred in 953 (18.5%) with leg CO in 4212 (81.5%). Poor control was found in 1430 (27.2%) and good control in 3735 (72.3%). Control of arm swelling was worse in men and control increased overall in those aged over 45 years. In contrast control of CO worsened in those with leg CO with increasing age and multiple co-morbidities. Obesity and cellulitis, particularly an episode in the last year were associated with poor control. Independent risk factors for arm CO were : obesity, neurological disease and cellulitis in the last year and for leg CO, obesity, poor mobility, heart disease, presence of a wound, cellulitis in the last year and duration of swelling. Conclusion: Control of CO within specialized centers is complex due to sociodemographic and clinical comorbidities.
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Affiliation(s)
- Christine J Moffatt
- 1 School of Social Sciences, Nottingham Trent University, Nottingham, United Kingdom.,2 Montpellier Medecine Vasculaire, EA2992, Universite Montpellier I, CHU Saint Eloi, Montpellier, France.,3 Copenhagen Wound Healing and Lymphoedema Centre, Bisperberg University Hospital, Copenhagen, Denmark
| | - Vaughan Keeley
- 4 Lymphoedema Service, Royal Derby Hospital, Derby, United Kingdom
| | - Andrew Hughes
- 5 St Oswalds Hospice, Newcastle Upon Tyne, United Kingdom
| | - Kath Clark
- 5 St Oswalds Hospice, Newcastle Upon Tyne, United Kingdom
| | - Jill Lisle
- 5 St Oswalds Hospice, Newcastle Upon Tyne, United Kingdom
| | | | - Rebecca Gaskin
- 7 Royal Derby Hospital Centre, School of Health Sciences, University of Nottingham, Derby, United Kingdom
| | - Martina Sykorova
- 8 Queens Medical Centre, School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Eleanor Dring
- 8 Queens Medical Centre, School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Susie Murray
- 9 Centre for Research & Implementation of Clinical Practice, London, United Kingdom
| | - Gregoire Mercier
- 2 Montpellier Medecine Vasculaire, EA2992, Universite Montpellier I, CHU Saint Eloi, Montpellier, France
| | - Isabelle Quere
- 2 Montpellier Medecine Vasculaire, EA2992, Universite Montpellier I, CHU Saint Eloi, Montpellier, France
| | - Peter J Franks
- 9 Centre for Research & Implementation of Clinical Practice, London, United Kingdom
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Moffatt CJ, Gaskin R, Sykorova M, Dring E, Aubeeluck A, Franks PJ, Windrum P, Mercier G, Pinnington L, Quere I. Prevalence and Risk Factors for Chronic Edema in U.K. Community Nursing Services. Lymphat Res Biol 2020; 17:147-154. [PMID: 30995181 PMCID: PMC6639109 DOI: 10.1089/lrb.2018.0086] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background and Study Design: Chronic edema (CO) is believed to be a major clinical problem within community nursing services in the United Kingdom. This study was undertaken as part of the LIMPRINT international study to determine the number of people with CO and its impact on health services. Methods and Results: Three urban-based community nursing services participated in the United Kingdom with prospective evaluation for 4 weeks of all patients receiving nursing care using a questionnaire-based interview and clinical assessment using the LIMPRINT tools. Of the total 2541 patients assessed, 1440 (56.7%) were considered to have CO, comprising Leicester City [768/1298 (59.2%)], Nottingham West [124/181 (68.5%)], and Nottingham City [548/1062 (51.6%)]. The mean age for women with CO was 78.6 (standard deviation [SD] 12.8) years and that for men with CO was 72.9 (SD 14.5). More patients with CO suffered from diabetes (32.1% vs. 27.9%, p = 0.027), heart failure/ischemic heart disease (27.3% vs. 14.0%, p < 0.001), and peripheral arterial occlusive disease (5.5% vs. 1.9%, p < 0.001). By far the greatest association was with the presence of a wound (73.6% vs. 37.9%, p < 0.001). Cellulitis affected 628 patients (24.7%) and 688 patients (47.8%) had a concurrent leg ulcer. Rates of reduced mobility (71.6% vs. 61.9%) and obesity were higher in those with CO. Six independent factors associated with CO were service location, age, ethnicity, obesity, heart failure, and the presence of a wound. Conclusion: CO is a major and growing health care problem within primary care that has been previously unrecognized and requires effective service provision.
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Affiliation(s)
- Christine J Moffatt
- 1 School of Social Sciences, Nottingham Trent University, Nottingham, United Kingdom.,2 Montpellier Medecine Vasculaire, EA2992, Universite Montpellier I, CHU Saint Eloi, Montpellier, France.,3 Copenhagen Wound Healing and Lymphoedema Centre, Bisperberg University Hospital, Copenhagen, Denmark
| | - Rebecca Gaskin
- 4 School of Health Sciences, University of Nottingham, Royal Derby Hospital Centre, Derby, United Kingdom
| | - Martina Sykorova
- 5 Nottingham University Business School, University of Nottingham, Jubilee Campus, Nottingham, United Kingdom
| | - Eleanor Dring
- 5 Nottingham University Business School, University of Nottingham, Jubilee Campus, Nottingham, United Kingdom
| | - Aimee Aubeeluck
- 6 School of Health Sciences, University of Nottingham, Queens Medical Centre, Nottingham, United Kingdom
| | - Peter J Franks
- 7 Centre for Research & Implementation of Clinical Practice, London, United Kingdom
| | - Paul Windrum
- 5 Nottingham University Business School, University of Nottingham, Jubilee Campus, Nottingham, United Kingdom
| | - Gregoire Mercier
- 2 Montpellier Medecine Vasculaire, EA2992, Universite Montpellier I, CHU Saint Eloi, Montpellier, France
| | - Lorraine Pinnington
- 8 School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, United Kingdom
| | - Isabelle Quere
- 2 Montpellier Medecine Vasculaire, EA2992, Universite Montpellier I, CHU Saint Eloi, Montpellier, France
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Dai M, Nakagami G, Sugama J, Kobayashi N, Kimura E, Arai Y, Sato A, Mercier G, Moffatt C, Murray S, Sanada H. The Prevalence and Functional Impact of Chronic Edema and Lymphedema in Japan: LIMPRINT Study. Lymphat Res Biol 2020; 17:195-201. [PMID: 30995194 PMCID: PMC6639102 DOI: 10.1089/lrb.2018.0080] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: This was a part of LIMPRINT (Lymphoedema IMpact and PRevalence—INTernational), an international study aimed at capturing the size and impact of lymphedema and chronic edema in different countries and health services across the world. The purpose of this study was to clarify the prevalence and the impact of chronic edema in Japan. Methods and Results: This was a two-phase facility-based study to determine the prevalence and functional impact of chronic edema in the adult population in Japan between 2014 and 2015. The prevalence study involved a university hospital, an acute community hospital, and a long-term medical facility. The impact study involved six facilities, including two outpatient clinics in acute care hospitals (one led by a physician and the other led by a nurse), inpatient wards in two acute care hospitals, and two nursing home/long-term care facilities. Various questionnaires and clinical assessments were used to gather patient demographic data and assess the functional impact of chronic edema. The results showed that chronic edema was much more prevalent in the long-term care facility than in acute care hospitals; cellulitis episodes occurred in ∼50% of cases in the gynecologist-led outpatient clinic, even though >80.0% of patients received standard management for edema; edema was found in the trunk region, including the buttock, abdomen, and chest-breast areas, in addition to the upper and lower limbs; and subjective satisfaction with edema control was low, even though the quality-of-life scores were good. Conclusions: The prevalence of chronic edema varied according to the facility type, ranging from 5.0% to 66.1%. The edema was located in all body parts, including the trunk region. Subjective satisfaction with control of edema was poor, while general quality of life was good. This large health care issue needs more attention.
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Affiliation(s)
- Misako Dai
- 1 Department of Clinical Nursing, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Gojiro Nakagami
- 2 Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,3 Division of Care Innovation, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Junko Sugama
- 4 Advanced Health Care Science Research Unit, Innovative Integrated Bio-Research Core, Institute for Frontier Science Initiative, Kanazawa University, Kanazawa, Japan
| | - Noriko Kobayashi
- 5 Department of Gynecology, Hokkaido University Hospital, Sapporo, Japan
| | - Emiko Kimura
- 6 Department of Nursing, Aomori University of Health and Welfare, Aomori, Japan
| | | | - Aya Sato
- 8 Faculty of Nursing and Social Welfare Sciences, Fukui Prefectural University, Eiheiji, Japan
| | - Gregoire Mercier
- 9 Département d'Information Médicale, Hôpital La Colombière, Montpellier, France
| | - Christine Moffatt
- 10 Nottingham Trent University, School of Social Sciences, Nottingham, United Kingdom
| | - Susie Murray
- 11 Centre for Research & Implementation of Clinical Practice, London, United Kingdom
| | - Hiromi Sanada
- 2 Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,3 Division of Care Innovation, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Moffatt C, Keeley V, Quere I. The Concept of Chronic Edema-A Neglected Public Health Issue and an International Response: The LIMPRINT Study. Lymphat Res Biol 2020; 17:121-126. [PMID: 30995179 PMCID: PMC6639104 DOI: 10.1089/lrb.2018.0085] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Lymphedema has always been a neglected global health care problem. A central requirement for the development of any chronic disease is the clear use of public health definitions that can be used internationally to define populations. The term "lymphedema" has historically been defined as either primary, resulting from failure of lymphatic development, or secondary, following damage to the lymphatics (e.g., cancer treatment, injury, or filariasis). Attempts to integrate causes of edema arising from damage to the venous system or the effects of gravity, immobility, and systemic disease have rarely been integrated. More recently, the prominent role of the lymphatics in tissue fluid homeostasis in all forms of chronic edema has been recognized. These advances led to the development of the term: "Chronic edema: a broad term used to describe edema, which has been present for more than three months." It can be considered an umbrella term that includes not only conventional "lymphedema" but also chronic swelling, which may have a more complex cause. This definition has been adapted in the international epidemiology study (LIMPRINT) that identified people throughout the health and social care systems in participating countries. Clearer definitions will allow for examination of this important public health problem that is likely to escalate given the projections of an aging population with multiple comorbidities. It will be possible to define both the hidden mortality and morbidity associated with complications, such as cellulitis and the impact on health-related quality of life. This evidence is urgently required to lobby for increased resource and effective health care in an increasingly competitive health care arena in which more established conditions have greater priority and funding.
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Affiliation(s)
- Christine Moffatt
- 1 School of Social Sciences, Nottingham Trent University, Nottingham, United Kingdom.,2 Montpellier Medecine Vasculaire, EA2992, Universite Montpellier I, CHU Saint Eloi, Montpellier, France.,3 Copenhagen Wound Healing and Lymphoedema Centre, Bisperberg University Hospital, Copenhagen, Denmark
| | - Vaughan Keeley
- 4 Lymphoedema Service, Royal Derby Hospital, Derby, United Kingdom
| | - Isabelle Quere
- 2 Montpellier Medecine Vasculaire, EA2992, Universite Montpellier I, CHU Saint Eloi, Montpellier, France
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Lower limb chronic edema management program: Perspectives of disengaged patients on challenges, enablers and barriers to program attendance and adherence. PLoS One 2019; 14:e0219875. [PMID: 31765379 PMCID: PMC6876834 DOI: 10.1371/journal.pone.0219875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 11/05/2019] [Indexed: 11/19/2022] Open
Abstract
Background Chronic edema (CO) is a progressive, physically disfiguring and currently incurable condition. A multifaceted program has been recommended to manage the swelling. However, there is little evidence investigating patients’ perspectives following the program, particularly for those who have poor adherence and/or are disengaged. Aim To investigate the perceived challenges faced by disengaged participants with lower limb CO by identifying their enablers and barriers to participating in a Physiotherapy CO program. Method An exploratory qualitative approach was used. A purposive sampling strategy was adopted to recruit participants. Those with more than three months swelling and who had low adherence and/or attendance (disengaged) to the CO program were invited to participate. Semi-structured interviews with six participants from a CO clinic in a tertiary hospital were conducted. Data were thematically analyzed and findings in terms of enablers and barriers were subsequently reflected in the light of a theoretical framework. Results All six participants were morbidly obese (BMI 47 ± 4 kg/m2) with multiple chronic comorbidities. Enablers and barriers detected included physical, psychological and social factors that interplay to present multidimensional challenges that influence the participants’ adjustment to managing their CO. For the disengaged participants in this study, their under-managed lower limb CO was a progression towards being housebound and having a gradually increasing level of disability. Conclusion This study has identified the multidimensional challenges faced by low adherent and/or disengaged participants with lower limb CO to participating in a hospital-based CO program. Perceived enablers and barriers included physical, psychological and social factors. These were mapped using a health behavior change theoretical framework. Understanding these challenges has implications for developing a multidisciplinary approach aimed at enhancing patient engagement and participation in the physiotherapy CO program.
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Todd M. Compression therapy for chronic oedema and venous leg ulcers: CoFlex TLC Calamine. ACTA ACUST UNITED AC 2019; 28:S32-S37. [PMID: 31242115 DOI: 10.12968/bjon.2019.28.12.s32] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The prevalence of venous leg ulcers and chronic oedema is increasing because of the rise in the older population who have comorbidities. Managing and living with these conditions is extremely costly in resource and human terms and there is often a cyclical process of ulceration, healing and recurrence, resulting in significant physical and psychosocial morbidity. Identifying those at risk and advising on lifestyle changes to prevent progression of these conditions will help in avoiding high wound management and compression costs, nursing input and associated patient morbidity. Compression bandaging is the linchpin in managing these conditions and it must be started as early as possible. However, many patients find it difficult to tolerate bandaging because of issues such as pain, the inability to wear shoes and itch. Therefore, if compliance is to be achieved, it is important to select a compression bandaging system that addresses the issues that patients have difficulty with. AndoFlex TLC Calamine is a compression bandaging system that deals with many of these problems, and is easy to apply and remove. Testimonials by practitioners treating patients with chronic oedema, ulceration and/or skin problems will demonstrate the benefits and effectiveness of AndoFlex TLC Calamine.
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Affiliation(s)
- Marie Todd
- Lymphoedema Clinical Nurse Specialist, Glasgow Lymphoedema Service
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Son A, O'Donnell TF, Izhakoff J, Gaebler JA, Niecko T, Iafrati MA. Lymphedema-associated comorbidities and treatment gap. J Vasc Surg Venous Lymphat Disord 2019; 7:724-730. [PMID: 31248833 DOI: 10.1016/j.jvsv.2019.02.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 02/15/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Lymphedema (LE) has been called the forgotten vascular disease, given such scant knowledge about LE-associated comorbidities or causes. Such knowledge of the comorbidities and treatment of LE may assist in diagnostic decisions and health care planning. METHODS To determine the proportion of LE patients with various LE-associated comorbidities as well as the rate of associated treatment, deidentified Health Insurance Portability and Accountability Act-compliant commercial administrative claims from the Blue Health Intelligence (BHI) research database (165 million Blue Cross Blue Shield members) were queried. We analyzed a BHI study sample of 26,902 patients with LE who had been enrolled with continuous medical benefits for 12 months before and after the index date for the complete years 2012 through 2016. Patients were first identified by comorbidity and then grouped into those receiving no treatment for LE and those receiving any treatment for LE. Any treatment was defined as receiving manual lymphatic drainage, physical therapy, compression garments, or a pneumatic compression device. The purpose of this study was to determine the proportion of LE patients comorbid with various known LE-associated conditions and the treatment rates of LE patients with each comorbidity. RESULTS Among the 84,579,269 BHI patients enrolled during the study window, 81,366 patients were identified with LE. From this LE group, our study focused on the 26,902 patients who were enrolled with continuous medical and pharmacy benefits for 12 months before and after the index date. Among these 26,902 LE patients, breast cancer was the most frequent comorbidity with LE (32.1%), and these patients almost universally received any treatment (94.2%); other cancer types, such as melanoma (2.1%) and prostate cancer (0.7%), were less frequent and received any treatment less often, 75% and 82% of the time, respectively. Venous leg ulcer was the most common non-cancer-linked comorbidity for LE (9.6%), but only 81.7% of venous leg ulcer patients received any treatment for LE. CONCLUSIONS To our knowledge, this is the largest study to date detailing the comorbidities associated with LE and LE treatment rates within each. Our findings suggest that a sizable proportion of cancer-related LE patients do not receive appropriate treatment. Furthermore, this study highlights the role of advanced venous disease as an LE comorbidity that is frequently untreated and its associated gap in treatment.
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Affiliation(s)
- Andrew Son
- Cardiovascular Center, Tufts Medical Center, Department of Surgery, Tufts University School of Medicine, Boston, Mass.
| | - Thomas F O'Donnell
- Cardiovascular Center, Tufts Medical Center, Department of Surgery, Tufts University School of Medicine, Boston, Mass
| | | | | | | | - Mark A Iafrati
- Cardiovascular Center, Tufts Medical Center, Department of Surgery, Tufts University School of Medicine, Boston, Mass
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Underwood E, Woods M, Riches K, Keeley V, Wallace A, Freeman J. Lymphedema Research Prioritization Partnership: A Collaborative Approach to Setting Research Priorities for Lymphedema Management. Lymphat Res Biol 2019; 17:356-361. [PMID: 30358472 PMCID: PMC6589491 DOI: 10.1089/lrb.2018.0026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: More research is needed in lymphedema management to strengthen the evidence base and ensure patients receive clinically and cost-effective treatment. It is critical that patients and clinicians are involved in prioritizing research to ensure that it reflects their needs and is not biased by commercial interests. This study aimed to set the research priorities for lymphedema management in the United Kingdom, through collaboration with patients, carers, and clinicians. Methods and Results: Following the James Lind Alliance's methodology, a national survey was conducted to identify unanswered questions about lymphedema management from the perspective of patients, carers, and clinicians. These were collated and verified against an in-depth evidence review. Unanswered questions were formatted into broad research questions, which were prioritized by a purposive sample of patients, carers, and clinicians, using an online Delphi survey. The initial survey generated 631 submissions from 213 participants, including 108 patients, 9 carers, and 88 clinicians. Of these, 485 met inclusion criteria and were grouped into 12 overarching themes. The evidence review demonstrated that 101 submissions were answered by existing research and identified an additional 78 questions. The remaining unanswered submissions were collated into 126 broad research questions, which were prioritized over four rounds of the Delphi survey to produce the top 10 priorities. Conclusions: This study is the first to attempt to systematically identify research priorities for lymphedema management in the United Kingdom, from the perspective of patients, carers, and clinicians. The results provide guidance for researchers and funders to ensure future research meets the needs of those living with lymphedema.
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Affiliation(s)
- Emma Underwood
- Lymphoedema Clinic, Therapy Department, PAW, Royal Cornwall Hospital NHS Trust, Truro, United Kingdom
| | - Mary Woods
- Lymphoedema Service, Royal Marsden Hospital, London, United Kingdom
| | - Katie Riches
- Lymphoedema Service, Derby Hospitals NHS Foundation Trust, Derby, United Kingdom
- British Lymphology Society Scientific Committee, United Kingdom
| | - Vaughan Keeley
- Lymphoedema Service, Derby Teaching Hospitals NHS Foundation Trust, Derby, United Kingdom
- University of Nottingham, Nottingham, United Kingdom
| | - Anita Wallace
- The Lymphoedema Support Network, London, United Kingdom
| | - Jennifer Freeman
- Faculty of Health and Human Sciences, Plymouth University, Plymouth, United Kingdom
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Nørregaard S, Bermark S, Karlsmark T, Franks PJ, Murray S, Moffatt CJ. LIMPRINT: Prevalence of Chronic Edema in Health Services in Copenhagen, Denmark. Lymphat Res Biol 2019; 17:187-194. [PMID: 30995193 PMCID: PMC6639101 DOI: 10.1089/lrb.2019.0019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: The International Lymphedema Framework developed an international study, Lymphedema Impact and Prevalence International (LIMPRINT), to estimate the prevalence and impact of chronic edema (CO) in heterogeneous populations. Methods and Results: A validation study using the LIMPRINT methodology was undertaken in Denmark. Participants with CO were identified from inpatient services and compared with those identified within a specialist lymphedema service and three primary care settings. Of 452 inpatients available for screening, CO was present in 177 (39%) and absent in 275 (61%). In addition, 723 participants were found from specialist and primary care services (LPCSs). Inpatients were significantly older and more likely to be underweight or normal weight. They were more likely to suffer from heart failure/ischaemic heart disease (44.6% vs. 23.4%, p < 0.001) and have neurological problems (18.1% vs. 10.9% p = 0.009). Patients in the inpatient group were nearly all suffering from secondary lymphedema and were less likely to have a cancer or venous diagnosis, but more likely to have immobility as the cause of CO (44.0% vs. 17.7%, p < 0.001). No inpatients had midline CO compared with 30 within LPCSs. Fewer in the inpatient group had standard CO treatment (17.1% vs. 73.5%, p < 0.001) and subjective control of swelling was worse (19.9% vs. 66.7%, p < 0.001). While the inpatient group experienced fewer acute infections, when they did so, they were more likely to be admitted to hospital for this (78.6% vs. 51.0%, p = 0.049). Conclusion: The prevalence of CO in inpatient facilities is high and those with CO have multiple comorbidities that vary according to setting. The feasibility study showed that the methodology could be adapted for use in different health systems.
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Affiliation(s)
- Susan Nørregaard
- 1 Copenhagen Wound Healing and Lymphoedema Centre, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Susan Bermark
- 1 Copenhagen Wound Healing and Lymphoedema Centre, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Tonny Karlsmark
- 1 Copenhagen Wound Healing and Lymphoedema Centre, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Peter J Franks
- 2 Centre for Research and Implementation of Clinical Practice, London, United Kingdom
| | - Susie Murray
- 2 Centre for Research and Implementation of Clinical Practice, London, United Kingdom
| | - Christine J Moffatt
- 1 Copenhagen Wound Healing and Lymphoedema Centre, Bispebjerg University Hospital, Copenhagen, Denmark.,3 School of Social Sciences, Nottingham Trent University, Nottingham, United Kingdom
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Moffatt CJ, Sykorova M, Aubeeluck A, Franks PJ, Pankhurst S, Bussey R, Whiston S, Murray S, Mercier G, Quere I, Gordon S. Clinical and Ethical Challenges in Undertaking LIMPRINT in Vulnerable Populations. Lymphat Res Biol 2019; 17:155-162. [PMID: 30995187 PMCID: PMC6639103 DOI: 10.1089/lrb.2018.0083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Study Objective: To estimate the prevalence of chronic edema (CO) and wounds within two vulnerable populations, a male high security prison in the East Midlands (United Kingdom) and residential and nursing homes in the United Kingdom and Australia. Methods and Results: Methods for screening for CO and wounds were adapted from the main LIMPRINT methodology. Prison Population: In total, 195 inmates were recruited with 22 (11%) having CO. While the majority were white Caucasian (156/83.4%) a further 20 (10.7%) were dark skinned with 11 (5.95%) from other minority populations. Comorbidities included 123 (63%) smokers, 22 (11%) alcohol dependant, 60 (31%) with mental health problems, and 35 (18%) a history of self-harm. Only three had a current wound with 30 (16%) having had a traumatic stab wound. Residential and Nursing Homes (United Kingdom and Australia): In the United Kingdom, the total population available for inclusion was 189 with only 137 (73%) recruited. Seventy-two of the 137 (52%) suffered from CO and a further 16 (23%) had a history of cellulitis. Results from the Australian residential care facilities have been published in full. In summary, of the 37 participants 20 (54%) experienced CO with 25 (68%) having comorbidities and 11 (30%) having a concurrent wound. Conclusion: Obtaining an accurate picture of the prevalence and impact of CO in vulnerable populations is extremely challenging due to issues of access and consent. Lack of reliable data for these populations will contribute to poor service provision.
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Affiliation(s)
- Christine J Moffatt
- 1 School of Social Sciences, Nottingham Trent University, Nottingham, United Kingdom.,2 Montpellier Medecine Vasculaire, EA2992, Universite Montpellier I, Montpellier, France.,3 Copenhagen Wound Healing and Lymphoedema Centre, Bisperberg University Hospital, Copenhagen, Denmark
| | - Martina Sykorova
- 4 Nottingham University Business School, University of Nottingham Jubilee Campus, Nottingham, United Kingdom
| | - Aimee Aubeeluck
- 5 School of Health Sciences, Queens Medical Centre, University of Nottingham, Nottingham, United Kingdom
| | - Peter John Franks
- 6 Centre for Research & Implementation of Clinical Practice, London, United Kingdom
| | - Sarah Pankhurst
- 7 Nottingham CityCare Partnership Cic and Tissue Viability Services, Nottingham, United Kingdom
| | - Rachel Bussey
- 8 Nottinghamshire Healthcare NHS Foundation Trust, Duncan MacMillan House, Nottingham, United Kingdom
| | - Siobhan Whiston
- 8 Nottinghamshire Healthcare NHS Foundation Trust, Duncan MacMillan House, Nottingham, United Kingdom
| | - Susie Murray
- 6 Centre for Research & Implementation of Clinical Practice, London, United Kingdom
| | - Gregoire Mercier
- 2 Montpellier Medecine Vasculaire, EA2992, Universite Montpellier I, Montpellier, France
| | - Isabelle Quere
- 2 Montpellier Medecine Vasculaire, EA2992, Universite Montpellier I, Montpellier, France
| | - Susan Gordon
- 9 College of Nursing and Health Sciences, Flinders University and ACH Group, Adelaide, South Australia
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Green T. Management in the absence of a specialist service. Br J Community Nurs 2019; 24:S3. [PMID: 30969792 DOI: 10.12968/bjcn.2019.24.sup4.s3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Tracy Green
- Clinical Advisor, Sigvaris Britain Ltd; Honorary Lymphoedema Clinical Nurse Specialist, University Hospitals of North Midlands
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Lee N, Lawrance S. Haddenham Easywrap: an alternative to compression bandaging in chronic oedema and wound care. Br J Community Nurs 2019; 24:S22-S28. [PMID: 30969788 DOI: 10.12968/bjcn.2019.24.sup4.s22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Haddenham Easywrap has been available since 2016 and since then case studies have been presented to demonstrate the efficacy of the product in clinical practice. The aim of the article is to demonstrate how its use in chronic oedema, and wound care is beneficial and cost effective and how versatile one product can be in treating both of these conditions. Information gained from the evaluation of easywrap in wound care and management of chronic oedema, demonstrates that easywrap can be a suitable cost effective alternative to traditional compression therapy modalities, whilst improving concordance and quality of life.
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Affiliation(s)
- Natalie Lee
- Clinical Manager, Haddemham Healthcare Ltd; Senior Trainer, Lymphoedema Training Academy
| | - Sue Lawrance
- Lymphoedema Nurse Specialist, Florence Nightingale Hospice
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Green T. Compression systems used in lymphoedema management. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2018; 27:1150-1152. [PMID: 30418858 DOI: 10.12968/bjon.2018.27.20.1150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Tracy Green
- Clinical Advisor, Sigvaris Britain, and Honorary Lymphoedema Nurse Specialist, University Hospital of North Staffordshire NHS Trust
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Lee N, Lawrance S. Haddenham Star Cotton: improving treatment outcomes in maintaining chronic oedema. Br J Community Nurs 2018; 23:S22-28. [PMID: 30260277 DOI: 10.12968/bjcn.2018.23.sup10.s22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The aim of compression therapy is to apply pressure on the skin and underlying structures to counteract the force of gravity, supporting venous and lymphatic function, to prevent or minimise oedema in the affected tissues. Compression therapy to manage lymphoedema is supported by a plethora of research, as it helps to increase the velocity of flow and lymphatic contraction of the lymphatic collecting vessels. This encourages drainage to the route of the limb, which increases fluid drainage from the tissues into the lymphatics. It is becoming more apparent that with an increase in clinical knowledge of how compression therapy works, clinicians are becoming less focused on the level of compression and more concerned with the stiffness of fabrics. This article looks at how adapting compression therapy regimes can improve patient outcomes of treatment and maintenance, while empowering patients to self-manage.
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Affiliation(s)
| | - Sue Lawrance
- Clinical Nurse Specialist, Florence Nightingale Hospice
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50
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Tennison JM, Fu JB, Bruera E. Improvement of Refractory Peripheral Edema With Multilayered Compression Bandaging: A Case Report. Phys Ther 2018; 98:763-766. [PMID: 30085127 PMCID: PMC6692702 DOI: 10.1093/ptj/pzy072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 06/17/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND PURPOSE Lower extremity edema, which can be caused by several factors, is often poorly managed with commonly prescribed compression stockings and diuretics. Diuretics are often erroneously given in all forms of edema and may cause problems because their long-term application may induce chronicity of the edema due to disturbance of the renin-angiotensin relationship. Compression therapy, although effective against venous edema, is widely underused. CASE DESCRIPTION A 64-year-old man with a history of hypertension, coronary artery disease, psoriasis, and multiple myeloma was admitted to the hospital for neutropenic fever, right lower extremity (RLE) cellulitis, bilateral lower extremity (BLE) weakness, RLE pain, and significant BLE edema. The patient was referred to a lymphedema-certified therapist to apply lower extremity multilayered compression bandaging and document serial limb circumference measurements. OUTCOMES The patient's weight decreased from 94.5 kg on day 1 of compression bandaging to 86.3 kg on day 7. The circumferences of the affected limbs also decreased. DISCUSSION This case demonstrates the utility of multilayered compression bandaging, typically used in the management of lymphedema, in the control of peripheral edema that is refractory to diuretic therapy.
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Affiliation(s)
- Jegy M Tennison
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1414, Houston, TX 77030 (USA),Address all correspondence to Dr Tennison at:
| | - Jack B Fu
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center
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