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Thapa A, Chung ML, Wu JR, Latimer A, Lennie TA, Mudd-Martin G, Lin CY, Thompson JH, Kang J, Moser DK. Mediation by Fatalism of the Association Between Symptom Burden and Self-care Management in Patients With Heart Failure. J Cardiovasc Nurs 2024; 39:229-236. [PMID: 37830904 PMCID: PMC11014896 DOI: 10.1097/jcn.0000000000001053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
BACKGROUND Clinicians and researchers often assume that symptom burden is associated with self-care management (SCM) in patients with heart failure (HF). However, that association is often not borne out in simple regression analyses and may be because another variable mediates the association. Fatalism is an appropriate candidate for mediation and is the belief that circumstances are predetermined without opportunity for control by individuals. OBJECTIVE Our objective was to determine whether fatalism mediated the relationship of symptom burden with SCM among adults with HF. METHODS We conducted a secondary analysis (N = 95) from a clinical trial. We used Self-care of HF Index to measure SCM, the Memorial Symptom Assessment Scale-HF for symptom burden, and the Cardiovascular Disease Fatalism Instrument to measure fatalism. We used the PROCESS macro to evaluate mediation. RESULTS Symptom burden was not directly associated with SCM (effect coefficient [ C '] = 0.0805; 95% confidence interval, -0.048 to 0.209; P = .217). There was, however, an indirect pathway between symptom burden and SCM through fatalism ( ab = -0.040; 95% confidence interval, -0.097 to -0.002). Those with higher symptom burden were more fatalistic ( a = 0.004, P = .015), and greater fatalism was associated with worse SCM ( b = -9.132, P = .007). CONCLUSION Symptom burden, not directly associated with SCM, is associated through the mediator of fatalism. Interventions to improve SCM should include strategies to mitigate fatalistic views. Self-care management interventions should focus on promoting internal locus of control or increasing perceptions of perceived control to decrease fatalism and improve engagement in self-care.
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Affiliation(s)
- Ashmita Thapa
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY, 40536, USA
| | - Misook L. Chung
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY, 40536, USA
| | - Jia-Rong Wu
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY, 40536, USA
| | - Abigail Latimer
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY, 40536, USA
| | - Terry A. Lennie
- Senior Associate Dean and Marion E. McKenna Professor in Nursing Leadership College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY, 40536, USA
| | - Gia Mudd-Martin
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY, 40536, USA
| | - Chin-Yen Lin
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY, 40536, USA
| | | | - JungHee Kang
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY, 40536, USA
| | - Debra K. Moser
- Assistant Dean of PhD Program & Scholarly Affairs & Linda C. Gill, Professor in Nursing, College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY, 40536, USA
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2
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Carroll BJ, Singhal D. Advances in lymphedema: An under-recognized disease with a hopeful future for patients. Vasc Med 2024; 29:70-84. [PMID: 38166534 DOI: 10.1177/1358863x231215329] [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: 01/04/2024]
Abstract
Lymphedema has traditionally been underappreciated by the healthcare community. Understanding of the underlying pathophysiology and treatments beyond compression have been limited until recently. Increased investigation has demonstrated the key role of inflammation and resultant fibrosis and adipose deposition leading to the clinical sequelae and associated reduction in quality of life with lymphedema. New imaging techniques including magnetic resonance imaging (MRI), indocyanine green lymphography, and high-frequency ultrasound offer improved resolution and understanding of lymphatic anatomy and flow. Nonsurgical therapy with compression, exercise, and weight loss remains the mainstay of therapy, but growing surgical options show promise. Physiologic procedures (lymphovenous anastomosis and vascularized lymph node transfers) improve lymphatic flow in the diseased limb and may reduce edema and the burden of compression. Debulking, primarily with liposuction to remove the adipose deposition that has accumulated, results in a dramatic decrease in limb girth in appropriately selected patients. Though early, there are also exciting developments of potential therapeutic targets tackling the underlying drivers of the disease. Multidisciplinary teams have developed to offer the full breadth of evaluation and current management, but the development of a greater understanding and availability of therapies is needed to ensure patients with lymphedema have greater opportunity for optimal care.
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Affiliation(s)
- Brett J Carroll
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Dhruv Singhal
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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3
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Stanton J. Lymphatic insufficiency and stiff compression in venous leg ulceration. J Wound Care 2024; 33:S4-S9. [PMID: 38150277 DOI: 10.12968/jowc.2024.33.sup1.s4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Affiliation(s)
- Julie Stanton
- Director of Nursing, Community Telehealth, Pioneer, Sussex Wound Healing and Lymphoedema Centres
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4
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Affiliation(s)
- Julie Stanton
- Director of Nursing, Community Telehealth, Pioneer, Sussex Wound Healing and Lymphoedema Centres
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5
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Senger JLB, Kadle RL, Skoracki RJ. Current Concepts in the Management of Primary Lymphedema. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050894. [PMID: 37241126 DOI: 10.3390/medicina59050894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/03/2023] [Accepted: 05/03/2023] [Indexed: 05/28/2023]
Abstract
Primary lymphedema is a heterogeneous group of conditions encompassing all lymphatic anomalies that result in lymphatic swelling. Primary lymphedema can be difficult to diagnose, and diagnosis is often delayed. As opposed to secondary lymphedema, primary lymphedema has an unpredictable disease course, often progressing more slowly. Primary lymphedema can be associated with various genetic syndromes or can be idiopathic. Diagnosis is often clinical, although imaging can be a helpful adjunct. The literature on treating primary lymphedema is limited, and treatment algorithms are largely based on practice patterns for secondary lymphedema. The mainstay of treatment focuses on complete decongestive therapy, including manual lymphatic drainage and compression therapy. For those who fail conservative treatment, surgical treatment can be an option. Microsurgical techniques have shown promise in primary lymphedema, with both lymphovenous bypass and vascularized lymph node transfers demonstrating improved clinical outcomes in a few studies.
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Affiliation(s)
- Jenna-Lynn B Senger
- Wexner Medical Center, Department of Plastic Surgery, Ohio State University, Columbus, OH 43210, USA
| | - Rohini L Kadle
- Wexner Medical Center, Department of Plastic Surgery, Ohio State University, Columbus, OH 43210, USA
| | - Roman J Skoracki
- Wexner Medical Center, Department of Plastic Surgery, Ohio State University, Columbus, OH 43210, USA
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6
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Seo SH, Lee S, Park JKH, Yang EJ, Kim B, Lee JS, Kim MJ, Park SS, Seong MW, Nam SY, Heo CY, Myung Y. Clinical staging and genetic profiling of Korean patients with primary lymphedema using targeted gene sequencing. Sci Rep 2022; 12:13591. [PMID: 35948757 PMCID: PMC9365773 DOI: 10.1038/s41598-022-17958-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 08/03/2022] [Indexed: 11/23/2022] Open
Abstract
Lymphedema is a progressive disease caused by lymphatic flow blockage in the lymphatic pathway. Primary (hereditary) lymphedema is caused by genetic mutations without secondary causes. We performed clinical profiling on Korean primary lymphedema patients based on their phenotypes using lymphoscintigraphy and made genetic diagnoses using a next-generation sequencing panel consisting of 60 genes known to be related to primary lymphedema and vascular anomalies. Of 27 patients included in this study, 14.8% of the patients had lymphedema of the upper extremities, 77.8% had lymphedema of the lower extremities and 7.4% had 4-limbs lymphedema. Based on the International Society of Lymphology staging, 14, 10, and 3 patients had stage 3, 2, and 1 lymphedema, respectively. Only one family was genetically confirmed to harbor likely pathogenic variants in CELSR1. The proband was carrying two likely pathogenic variants in CELSR1, while her symptomatic mother was confirmed to carry only one of the variants. Furthermore, two other variants of uncertain significance in CELSR1 were detected in other patients, making CELSR1 the most commonly altered gene in our study. The clinical and genetic profile of hereditary lymphedema reported here is the first such data series reported for South Korea.
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Affiliation(s)
- Soo Hyun Seo
- Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Seungjun Lee
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Joseph Kyu-Hyung Park
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Eun Joo Yang
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Boram Kim
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jee-Soo Lee
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Man Jin Kim
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Sung Sup Park
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Moon-Woo Seong
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Sun-Young Nam
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Chan-Yeong Heo
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Yujin Myung
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, South Korea.
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7
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Zhang YD, Zhang X, Wang XY, Han DM, Du JS. Visual analysis of global research output of lymphedema based on bibliometrics. Front Oncol 2022; 12:926237. [PMID: 35992843 PMCID: PMC9389543 DOI: 10.3389/fonc.2022.926237] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background Globally, several generations of doctors in the field of lymphedema have created numerous publications. To date, no bibliometric analysis has been performed specifically on these publications. For the further promotion of research on lymphedema and to align with the international research frontiers, it is essential to understand the current state of Lymphedema research output. Objective This study aims to statistically and visually analyze the characteristics of publications output, distribution of contributions and development process of lymphedema, enriching the knowledge base of Lymphedema, and then seek potential research topics and collaborators. Methods Based on the Web of Science core collection database, we firstly analyzed the quantity and quality of publications in the field of lymphedema, secondly profiled the publishing groups in terms of country, institution, author's publication and cooperation network, and finally sorted out and summarized the hot topics of research. Results A total of 8569 papers were retrieved from 1900-2021. The top4 journals with the most publications were LYMPHOLOGY, LYMPHATIC RESEARCH AND BIOLOGY, PLASTIC AND RECONSTRUCTIVE SURGERY and ANNALS OF SURGICAL ONCOLOGY. The top 4 countries with the most publications were USA, Japan, UK, and China. The United States dominates the total number of publications and the international cooperation network. The most productive research institution is Harvard University, and the research institution with the most collaborating institutions is Memorial Sloan Kettering Cancer Center. Mortimer, Peter S contributes the most research in this field. The research achievements of Japanese scholars in this field are of great significance. The top 5 ranked keywords are "Breast Cancer", "Health-Related Quality Of Life", "Lymphscintigraphy", "Lymphovenous Anastomosis", and "Lymphangiogenesis". Conclusion More and more scholars are devoted to the research of cancer-related Lymphedema. It is foreseeable that breast cancer-related lymphedema and lymphangiogenesis will remain a focus of future research. Advances in Lymphatic vessel imaging and the development of lymphatic microsurgery will further play a role in the clinical workup of lymphedema. Meanwhile, This study can help researchers identify potential collaborators and partner institutions and contribute to further research.
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Affiliation(s)
- Yun-dong Zhang
- Department of the Lymphatic and Vascular Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
- Key Laboratory of Lymphatic Surgery Jilin Province, Engineering Laboratory of Lymphatic Surgery, Changchun, China
| | - Xue Zhang
- Chengdu Library and Information Center, Chinese Academy of Sciences, Chengdu, China
- Department of Library, Information and Archives Management, School of Economics and Management, University of Chinese Academy of Sciences, Beijing, China
| | - Xin-yu Wang
- Department of the Lymphatic and Vascular Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
- Key Laboratory of Lymphatic Surgery Jilin Province, Engineering Laboratory of Lymphatic Surgery, Changchun, China
| | - Dong-mei Han
- Department of the Lymphatic and Vascular Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
- Key Laboratory of Lymphatic Surgery Jilin Province, Engineering Laboratory of Lymphatic Surgery, Changchun, China
| | - Jian-shi Du
- Department of the Lymphatic and Vascular Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
- Key Laboratory of Lymphatic Surgery Jilin Province, Engineering Laboratory of Lymphatic Surgery, Changchun, China
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8
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Lee DG, Lee S, Kim KT. Computed Tomography-Based Quantitative Analysis of Fibrotic Changes in Skin and Subcutaneous Tissue in Lower Extremity Lymphedema Following Gynecologic Cancer Surgery. Lymphat Res Biol 2022; 20:488-495. [PMID: 35012367 DOI: 10.1089/lrb.2021.0069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Lymphedema produces protein-rich fluids that aggravate inflammation in the skin and subcutaneous tissue. Inflammation then induces fibroadipose tissue deposition and fibrosis. However, few methods have been developed to evaluate the severity of fibrosis. Therefore, we aimed to evaluate the subcutaneous fibrotic changes in lower extremity lymphedema following gynecologic cancer surgery using an image analysis tool, the FIJI software. Methods and Results: Seventy-four patients with lymphedema following gynecologic surgery were enrolled in this study. We quantitatively analyzed the cross-sectional area (CSA) of soft tissue compartments, including subcutaneous tissue with the skin, muscle volume, fibrotic changes in subcutaneous tissue, and the perimeter of skin boundaries. The limb circumference and the CSA of the subcutaneous tissue and skin on the affected side were significantly larger than those on the unaffected side. Fibrotic changes showed the same trend. However, muscle volume patterns were different from those of the other compartments. Some patients showed lower muscle volume on the unaffected side than on the affected side. Circumference and cellulitis significantly affected the extent of fibrotic changes in the skin and subcutaneous tissues. Age and duration of lymphedema did not affect fibrosis. Conclusion: Fibrosis of subcutaneous regions with the skin can be quantitatively calculated using an image analysis tool in lower extremity lymphedema following gynecologic cancer surgery. Edema and cellulitis increase fibrotic changes in the subcutaneous tissue with the skin.
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Affiliation(s)
- Dong Gyu Lee
- Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, Daegu, Korea
| | - Soyoung Lee
- Department of Rehabilitation Medicine, Keimyung University School of Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | - Kyoung Tae Kim
- Department of Rehabilitation Medicine, Keimyung University School of Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
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9
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Kitamura K, Iwase S, Komoike Y, Ogawa Y, Utsugi K, Yamamoto D, Odagiri H. Evidence-Based Practice Guideline for the Management of Lymphedema Proposed by the Japanese Lymphedema Society. Lymphat Res Biol 2022; 20:539-547. [PMID: 34981970 DOI: 10.1089/lrb.2021.0032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Secondary lymphedema mostly occurs as an aftereffect of cancer treatment, and it is estimated that 100,000-150,000 patients are affected in Japan. An estimated 3500 patients, develop lymphedema of the lower and upper extremities each year secondary to uterine and breast cancer treatment. Medical reimbursement was first instituted in April 2008 by the Ministry of Health, Labour and Welfare in Japan. Since 2008, we have developed guidelines regarding treatment options for patients with lymphedema based on scientific evidence. This is the third edition of the guidelines established by the Japanese Lymphedema Society (JLES), published in 2018. The JLES Practice Guideline-Making Committee (PGMC) developed 21 clinical questions (CQs). Methods and Results: A review of these 15 CQs was performed in accordance with the methodology for establishing clinical guidelines. The 15 recommendations for each of these CQs were developed and discussed until consensus by the PGMC was reached. Moreover, outside members who had no involvement in these guidelines evaluated the contents using the Appraisal of Guidelines for Research and Evaluation (AGREE) II reporting checklist. Conclusion: These guidelines have been produced for the adequate management of lymphedema by doctors and other medical staff on the lymphedema management team of medical institutes, including nurses, physical technicians, and occupational therapists.
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Affiliation(s)
- Kaoru Kitamura
- Medical Corporation, Department of Breast Surgery, Fukuoka, Japan
| | - Satoru Iwase
- Department of Emergency and Palliative Medicine, Saitama Medical University, Moroyama, Japan
| | - Yoshifumi Komoike
- Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan
| | - Yoshinari Ogawa
- Department of Breast Surgical Oncology, Osaka City General Hospital, Osaka, Japan
| | - Kuniko Utsugi
- Cancer Screening Center, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Koto, Japan
| | | | - Hiroki Odagiri
- Division of Breast Surgery, National Hirosaki Hospital, Hirosaki, Japan
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Yoshida S, Koshima I, Imai H, Roh S, Mese T, Uchiki T, Sasaki A, Nagamatsu S. Lymphaticovenous Anastomosis for Age-Related Lymphedema. J Clin Med 2021; 10:jcm10215129. [PMID: 34768657 PMCID: PMC8584733 DOI: 10.3390/jcm10215129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/26/2021] [Accepted: 10/30/2021] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Primary lymphedema is usually caused by intrinsic disruption or genetic damage to the lymphatics but may also be the result of age-related deterioration of the lymphatics. The aims of this study were to determine the characteristics of age-related lymphedema and to assess the effectiveness of lymphaticovenous anastomosis (LVA) in its treatment. METHODS Eighty-six patients with primary lymphedema affecting 150 lower limbs were divided into three groups according to whether the age of onset was younger than 35 years, 35-64 years, or 65 years or older. Indocyanine green (ICG) lymphography was performed, followed by LVA surgery. ICG lymphography images were visually classified according to whether the pattern was linear, low enhancement (LE), distal dermal backflow (dDB), or extended dermal backflow (eDB). The lower extremity lymphedema (LEL) index score was calculated before and after LVA. Lymphatic vessel diameter and detection rates were also recorded. RESULTS In the ≥65 group, the lymphedema was bilateral in 54 patients and unilateral in 1 patient. There was statistically significant deterioration in the LEL index score with progression from the linear, LE, dDB through to the eDB pattern in the ≥65 group. The lymphatic vessel diameter was significantly greater in the ≥65 group. The rate of improvement was highest in the ≥65 group. CONCLUSION Age-related lymphedema was bilateral and deterioration started distally. The lymphatic vessels in patients with age-related lymphedema tended to be ectatic, which is advantageous for LVA and may increase the improvement rate.
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Affiliation(s)
- Shuhei Yoshida
- The International Center for Lymphedema, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Japan; (I.K.); (H.I.); (S.R.); (T.M.)
- Correspondence: ; Tel.: +81-82-257-5555
| | - Isao Koshima
- The International Center for Lymphedema, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Japan; (I.K.); (H.I.); (S.R.); (T.M.)
| | - Hirofumi Imai
- The International Center for Lymphedema, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Japan; (I.K.); (H.I.); (S.R.); (T.M.)
| | - Solji Roh
- The International Center for Lymphedema, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Japan; (I.K.); (H.I.); (S.R.); (T.M.)
| | - Toshiro Mese
- The International Center for Lymphedema, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Japan; (I.K.); (H.I.); (S.R.); (T.M.)
| | - Toshio Uchiki
- Department of Plastic and Reconstructive Surgery, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima 739-8551, Japan; (T.U.); (A.S.); (S.N.)
| | - Ayano Sasaki
- Department of Plastic and Reconstructive Surgery, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima 739-8551, Japan; (T.U.); (A.S.); (S.N.)
| | - Shogo Nagamatsu
- Department of Plastic and Reconstructive Surgery, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima 739-8551, Japan; (T.U.); (A.S.); (S.N.)
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11
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Dean SM, Valenti E, Hock K, Leffler J, Compston A, Abraham WT. The clinical characteristics of lower extremity lymphedema in 440 patients. J Vasc Surg Venous Lymphat Disord 2020; 8:851-859. [DOI: 10.1016/j.jvsv.2019.11.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 11/13/2019] [Indexed: 02/04/2023]
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Abstract
The Middle-Range Theory of Self-Care of Chronic Illness has been used widely since it was first published in 2012. With the goal of theoretical refinement in mind, we evaluated the theory to identify areas where the theory lacked clarity and could be improved. The concept of self-care monitoring was determined to be underdeveloped. We do not yet know how the process of symptom monitoring influences the symptom appraisal process. Also, the manner in which self-care monitoring and self-care management are associated was thought to need refinement. As both of these issues relate to symptoms, we decided to enrich the Middle-Range Theory with knowledge from theories about symptoms. Here, we propose a revision to the Middle-Range Theory of Self-Care of Chronic Illness where symptoms are clearly integrated with the self-care behaviors of self-care maintenance, monitoring, and management.
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Shallwani SM, Hodgson P, Towers A. Examining Obesity in Lymphedema: A Retrospective Study of 178 New Patients with Suspected Lymphedema at a Canadian Hospital-Based Clinic. Physiother Can 2020; 72:18-25. [PMID: 34385745 PMCID: PMC8330978 DOI: 10.3138/ptc-2018-0076] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Purpose: Physiotherapists have an important role to play in the early detection and treatment of lymphedema, a chronic inflammatory condition characterized by excess interstitial protein-rich fluid, which is estimated to affect more than one million Canadians. Obesity has been identified both as an important cause of and as a risk factor for developing lymphedema of various aetiologies. Little is currently known about obesity in Canadians affected by lymphedema. The objective of this study was to report on the prevalence of overweight and obesity in a Canadian lymphedema clinic population and the relationships among BMI; demographic, medical, and lymphedema characteristics; and cellulitis history. Method: We conducted a retrospective electronic record review of the clinical data collected from new patients evaluated for suspected lymphedema at a specialized Canadian hospital-based clinic over a 2-year period. We used descriptive analyses to characterize the sample and one-way analysis of variance and χ2 tests for comparative analyses. Results: Of the 178 patients whose records were reviewed, 36.5% were classified as overweight and 39.3% as obese. Patients with non-cancer diagnoses had a higher mean BMI than those with cancer-related diagnoses (p < 0.001). A higher BMI was associated with a longer time since lymphedema onset (p < 0.001), bilateral lymphedema (p = 0.010), and history of cellulitis (p < 0.001). Conclusions: Obesity is prevalent in the Canadian population with lymphedema and is associated with delayed referral and increased cellulitis rates. Early detection and tailored management strategies are needed to address obesity in patients with lymphedema and the complexities associated with these two related conditions.
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Affiliation(s)
- Shirin M. Shallwani
- Lymphedema Program
- Physiotherapy Department, McGill University Health Centre, Montreal
- School of Rehabilitation Sciences, University of Ottawa, Ottawa
| | | | - Anna Towers
- Lymphedema Program
- Department of Oncology, McGill University, Montreal
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Yu Z, Liu N, Wang L, Chen J, Han L, Sun D. Assessment of Skin Properties in Chronic Lymphedema: Measurement of Skin Stiffness, Percentage Water Content, and Transepidermal Water Loss. Lymphat Res Biol 2019; 18:212-218. [PMID: 31596657 DOI: 10.1089/lrb.2018.0066] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background: Lymphedema (LE) is a chronic progressive protein-rich edema of the soft tissues. Measurement of extracellular fluid of the affected limbs is widely used in detecting LE; however, quantification of the skin alterations and early tissue changes in LE lacks approaches. Methods and Results: Ninety-one patients with LE were assessed. Measurement of transepidermal water loss (TEWL), skin stiffness (SF), and percentage water content (PWC) was assessed on five predetermined skin sites. The value of TEWL, SF, and PWC increased significantly in lymphedematous skin compare with controls, indicating damaged function and texture of the affected skin. Both PWC ratio and SF ratio strongly correlated with LE stage. High correlations were found among instruments assessing tissue fluid. Conclusions: Assessment of the skin parameters has contributed new information about the functional and structural alterations in chronic lymphedematous skin. Quantification of skin properties changes could be a valuable supplement to diagnosis and evaluation of chronic LE.
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Affiliation(s)
- Ziyou Yu
- Department of Plastic & Reconstructive Surgery, Lymphology Centre, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ningfei Liu
- Department of Plastic & Reconstructive Surgery, Lymphology Centre, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Wang
- Department of Plastic & Reconstructive Surgery, Lymphology Centre, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiajia Chen
- Department of Plastic & Reconstructive Surgery, Lymphology Centre, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Linghua Han
- Department of Plastic & Reconstructive Surgery, Lymphology Centre, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Di Sun
- Department of Plastic & Reconstructive Surgery, Lymphology Centre, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Self-care in Female Cancer Survivors With Secondary Lymphedema: Characteristics of Women Needing Support to Perform Self-care. REHABILITATION ONCOLOGY 2018. [DOI: 10.1097/01.reo.0000000000000106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Williams A. An updated review of the evidence for adjustable compression wrap devices in the lower limb. ACTA ACUST UNITED AC 2017. [DOI: 10.12968/npre.2017.15.sup10.6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Anne Williams
- Lecturer and lymphology nurse consultant Queen Margaret University
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Shallwani SM, Hodgson P, Towers A. Comparisons Between Cancer-Related and Noncancer-Related Lymphedema: An Overview of New Patients Referred to a Specialized Hospital-Based Center in Canada. Lymphat Res Biol 2017; 15:64-69. [PMID: 28135124 DOI: 10.1089/lrb.2016.0023] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Lymphedema is an irreversible inflammatory condition caused by accumulated lymph fluid and is associated with chronic swelling and increased risk of cellulitis. Our objectives were to: (1) describe the patient population referred to a Canadian lymphedema center and (2) compare lymphedema characteristics between patients with cancer and patients with noncancer diagnoses. METHODS AND RESULTS A retrospective cohort study was conducted of new patients referred for suspected lymphedema to a hospital-based center over a 2-year period. The mean age of the patients (n = 429) was 61.4 years; 85% were female and 81% had a history of cancer. Lymphedema characteristics were primary (7%) versus secondary (92%); upper body (51%) versus lower body (45%); unilateral (74%) versus bilateral (25%); and history of cellulitis (22%). Patients with noncancer diagnoses (n = 82) were more likely than patients with cancer diagnoses (n = 347) to have a history of cellulitis (44% vs. 17%), to have bilateral (61% vs. 16%) and lower limb (89% vs. 37%) lymphedema, and to experience a long delay between symptom onset and referral (14.0 vs. 3.5 years) (p < 0.001). CONCLUSION Most patients referred to our lymphedema center were female with a history of cancer. However, patients with noncancer diagnoses were more likely to have bilateral lower body lymphedema with an important history of cellulitis; this subgroup is at great risk of missed and delayed diagnoses in the medical setting and of experiencing long-term issues with mobility, recurrent hospitalizations, and poor quality of life.
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Affiliation(s)
- Shirin M Shallwani
- 1 Lymphedema Program, McGill University Health Centre , Montréal, Canada .,2 Physiotherapy Department, McGill University Health Centre , Montréal, Canada .,3 School of Rehabilitation Sciences, University of Ottawa , Ottawa, Canada
| | - Pamela Hodgson
- 1 Lymphedema Program, McGill University Health Centre , Montréal, Canada
| | - Anna Towers
- 1 Lymphedema Program, McGill University Health Centre , Montréal, Canada .,4 Department of Family Medicine, McGill University , Montréal, Canada .,5 Department of Oncology, McGill University , Montréal, Canada
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Deng J, Murphy BA. Lymphedema self-care in patients with head and neck cancer: a qualitative study. Support Care Cancer 2016; 24:4961-4970. [DOI: 10.1007/s00520-016-3356-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 07/11/2016] [Indexed: 11/24/2022]
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Watts TE, Davies RE. A qualitative national focus group study of the experience of living with lymphoedema and accessing local multiprofessional lymphoedema clinics. J Adv Nurs 2016; 72:3147-3159. [PMID: 27400246 DOI: 10.1111/jan.13071] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2016] [Indexed: 01/22/2023]
Affiliation(s)
- Tessa E. Watts
- Department of Nursing; College of Human and Health Sciences; Swansea University; Wales UK
| | - Ruth E. Davies
- Department of Nursing; College of Human and Health Sciences; Swansea University; Wales UK
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Fu MR, Axelrod D, Guth AA, Wang Y, Scagliola J, Hiotis K, Rampertaap K, El-Shammaa N. Usability and feasibility of health IT interventions to enhance Self-Care for Lymphedema Symptom Management in breast cancer survivors. Internet Interv 2016; 5:56-64. [PMID: 28255542 PMCID: PMC5328240 DOI: 10.1016/j.invent.2016.08.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The-Optimal-Lymph-Flow health IT system (TOLF) is a patient-centered, web-and-mobile-based educational and behavioral health IT system focusing on safe, innovative, and pragmatic self-care strategies for lymphedema symptom management. The purpose of this study was to evaluate usability, feasibility, and acceptability of TOLF among the end-user of breast cancer survivors. METHODS Two types of usability testing were completed with 30 breast cancer survivors: heuristic evaluation and end-user testing. Each participant was asked to think aloud while completing a set of specified tasks designed to explicate and freely explore the system features. A heuristic evaluation checklist, the Perceived Ease of Use and Usefulness Questionnaire, and The Post Study System Usability Questionnaire were used to evaluate usability of the system. Open-ended questions were used to gather qualitative data. Quantitative data were analyzed using descriptive statistics and qualitative data were summarized thematically. RESULTS Breast cancer survivors were very satisfied with the system: 90% (n = 27) rated the system having no usability problems; 10% (n = 3) noted minor cosmetic problems: spelling errors or text font size. The majority of participants 96.6% (n = 29) strongly agreed that the system was easy to use and effective in helping to learn about lymphedema, symptoms and self-care strategies. Themes from the qualitative data included empowerment, high quality information, loving avatar simulation videos, easy accessibility, and user-friendliness. CONCLUSIONS This usability study provided evidence on breast cancer survivor's acceptance and highly positive evaluation of TOLF's usability as well as feasibility of using technologically-driven delivery model to enhance self-care strategies for lymphedema symptom management.
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Affiliation(s)
- Mei R. Fu
- NYU Rory Meyers College of Nursing, New York University, New York, NY, United States
- Corresponding author at: NYU Rory Meyers College of Nursing, New York University, 433 First Avenue, 4th Floor, Room 424, New York, NY 10010, United States.
| | - Deborah Axelrod
- Department of Surgery, New York University School of Medicine, New York, NY, United States
- NYU Laura and Isaac Perlmutter Cancer Center, New York, NY, United States
| | - Amber A. Guth
- Department of Surgery, New York University School of Medicine, New York, NY, United States
- NYU Laura and Isaac Perlmutter Cancer Center, New York, NY, United States
| | - Yao Wang
- Department of Electrical and Computer Engineering, Tandon School of Engineering, New York University, New York, NY, United States
| | - Joan Scagliola
- NYU Laura and Isaac Perlmutter Cancer Center, New York, NY, United States
| | - Karen Hiotis
- Department of Surgery, New York University School of Medicine, New York, NY, United States
- NYU Laura and Isaac Perlmutter Cancer Center, New York, NY, United States
| | - Kavita Rampertaap
- NYU Rory Meyers College of Nursing, New York University, New York, NY, United States
- NYU Laura and Isaac Perlmutter Cancer Center, New York, NY, United States
| | - Nardin El-Shammaa
- NYU Rory Meyers College of Nursing, New York University, New York, NY, United States
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Abstract
UNLABELLED Compression therapy is a key component in the effective management of people with lower limb problems associated with venous, lymphatic and fat disorders such as lipoedema. Individuals with lymphoedema, venous ulceration and lipoedema often require long-term compression therapy to prevent and manage problems such as chronic ulceration and skin changes, persistent swelling and shape distortion. Challenges remain in achieving acceptable, safe, effective and cost-efficient compression therapy choices. Adjustable compression wrap devices using hook and loop fasteners, commonly called VELCRO brand fasteners, present new opportunities for improving treatment outcomes, supporting patient independence and self-management in the use of compression therapy. This paper reports the findings of an evidence review of adjustable compression wrap devices in people with lymphoedema, chronic oedema, venous ulceration and lipoedema. DECLARATION OF INTEREST The authors have no conflict of interest to declare.
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Affiliation(s)
- A Williams
- Lecturer and Lymphoedema Nurse Consultant Queen Margaret University
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Stolldorf DP, Dietrich MS, Ridner SH. A Comparison of the Quality of Life in Patients With Primary and Secondary Lower Limb Lymphedema: A Mixed-Methods Study. West J Nurs Res 2016; 38:1313-34. [PMID: 27151079 DOI: 10.1177/0193945916647961] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Patients with lower limb lymphedema experience symptoms that may differ in intensity and distress. This mixed-methods study compares symptom intensity and distress and the impact of lymphedema on patients' quality of life by primary and secondary (cancer and noncancer) lymphedema groups. Individuals completed an online questionnaire (i.e., demographic form, Lymphedema Symptom Intensity and Distress Survey-Leg, and an open-ended question). Analyses included descriptive and inferential statistics (quantitative data) and content analysis (qualitative data). Participants differed statistically significantly by gender, employment status, and lymphedema location. Groups differed significantly in lack of self-confidence, χ(2)(df = 2) = 9.19, p = .010. Cancer patients reported higher intensity and distress scores for some symptoms, but these differences were not statistically significant. Patients reported lacking psychosocial well-being and resources and experiencing physical and functional impairments and treatment and care challenges. Patients with lower limb lymphedema experience psychosocial impairments and problems with quality of and access to care.
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