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Lipoedema is a chronic progressive disorder of adipose tissue leading to an enlargement of lower extremities. It is considered to be rare; however, the prevalence of the disease is underestimated because it is commonly misdiagnosed as obesity or lymphedema and the general awareness is poor. The etiology of the disorder is considered to be multifarious, including genetic inheritance, hormonal imbalance and microcirculation alterations. Diagnosis is mainly based on medical history and physical examination. Management of lipoedema is focused on reducing the symptoms, improving the quality of life and preventing further progression of the disease. The aim of this paper is to raise the awareness of the disease and provide appropriate clinical guidance for the assessment of lipoedema. We searched through the PubMed/MEDLINE database and took into consideration all of the results available as of 6September, 2020 and outlined the current evidence regarding lipoedema epidemiology, etiology, clinical presentation, differential diagnosis, and management. Better understanding of lipoedema is crucial for establishing an early diagnosis and a proper treatment, which in turn will reduce the psychological and physical implications associated with the disease.

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. [ABSTRACT FROM AUTHOR]

Prompt application of appropriate compression therapy is essential for effective treatment of lymphoedema. However, it is accepted that prior to the application of compression to the lower limbs, either with bandaging or compression garments, patients should demonstrate a satisfactory vascular status, as assessed via axillary brachial pressure index (ABPI). Unfortunately, the presence of peripheral oedema may render a reading impossible or grossly inaccurate. Relying solely on ABPI assessment is potentially harmful to patients, who may be denied appropriate treatment or experience complications and deterioration of their condition due to delayed treatment. The British Lymphology Society recognises a need to focus more on clinical assessment skills to determine vascular status, rather than relying on ABPI alone. Thus, the Society has developed guidance and a practical tool to support clinical decision-making and enhance practitioner confidence in the safe application of compression therapy in the absence of ABPI. [ABSTRACT FROM AUTHOR]

Aim: We aimed to evaluate the quality of clinical practice guidelines (CPGs) for breast cancer related lymphoedema (BCRL) and compare the similarities and differences in recommendations. Background: Many CPGs of BCRL have been developed; however, their recommendations and quality are controversial. Methods: Relevant papers were retrieved from electronic databases, professional associations and guideline development organizations, from 1 January 2015 to 30 September 2021. The Appraisal of Guidelines Research and Evaluation (AGREE) II instrument was used to evaluate the quality of the guidelines. Intraclass correlation coefficient (ICC) analysis was used to evaluate the overall consistency among evaluators. Results: Eight CPGs were included. The ICC values evaluation for CPGs ranged from 0.76 to 0.95, with good consensus among evaluators. The highest median score was 68.75% (61.46, 72.22%) for clarity, and the lowest was 37.50% (25.78, 51.30%) for applicability. The NICE, ACS/ACSO and APTA CPGs were rated well in most areas. Professional health education, individualized exercise programme and regular surveillance are the main methods to prevent lymphoedema. Conclusion: In the past 6 years, the quality of BCRL guidelines has varied greatly, especially in the domains of rigour and applicability. Interrater agreement was excellent, but recommendation showed some inconsistencies in the details. Summary statement: What is already known about this topic? Providing recommendations based on evidence‐based guidelines for care of cancer treatment‐related lymphoedema will help to improve outcomes for patients with this chronic condition. What this paper adds? The rigour of the guidelines needs to be improved.Guideline‐making organizations have the responsibility to promote the application of guidelines into practice using a variety of methods.Multifactorial reasons were responsible for the differences inguidelines' recommendations The implications of this paper Nurses need to be more aware of guideline recommendations.There are inconsistencies in the details, despite many similarities.The formulation of individual nursing care programmes should be tailored to the local clinical situation and working environment. [ABSTRACT FROM AUTHOR]

Optimal management of breast cancer-related lymphoedema (BCRL), a common and debilitating complication of surgery and radiotherapy, depends on early detection, personalised risk assessment and proactive intervention. For instance, a recent review advises healthcare professionals to reframe the narrative about the daily-living skin trauma risks away from 'what to avoid' to 'what to do'. Another review recommends daily, or nearly daily, exercise at home to reduce lymphoedema severity. However, several questions await full answers. There is, for instance, no consensus regarding the most appropriate surgical technique for preventing BCRL. This feature summarises some recent papers updating healthcare professionals about BCRL. [ABSTRACT FROM AUTHOR]

Translation of evidence into practice in healthcare is challenging, particularly with new innovations. Indocyanine Green (ICG) lymphography is a novel innovation where the superficial lymphatics are imaged to provide information about lymphoedema diagnosis and to guide individualised therapy for a person's long‐term chronic management of lymphoedema, supporting care across the continuum to the community setting. Despite the unique information ICG lymphography provides, the technology itself is complex and highly specialised and currently has limited adoption in clinical practice. This paper sought to determine the barriers and enablers to establishing an ICG lymphography clinic within an outpatient lymphoedema service by exploring staff perceptions and experiences. An interpretive descriptive design was used with semi‐structured interviews of key staff participants from a quaternary public hospital six months after ICG lymphography clinic establishment. An interview guide was developed, underpinned by the Consolidated Framework for Implementation Research (CFIR), to guide the inquiry. Interview data were transcribed, inductively coded and analysed to identify themes. All eligible management, clinical and ancillary staff were included (N = 8). Four key themes were identified from the data as essential to implementation success. These were support is critical for implementation; beliefs about the technology; practicalities are achievable; and sustainability for ongoing success. Themes were found to be interrelated and centred around support from staff and the organisation as a critical process facilitator. The study demonstrated an ICG lymphography clinic can be successfully established as part of an outpatient lymphoedema service. Key enablers related to positive staff attitudes and beliefs about ICG lymphography and its application. Future implementation sites may consider that although the complexity of this innovation creates process challenges, the use of an implementation framework can assist in identifying determinants of success for effective implementation to practice. [ABSTRACT FROM AUTHOR]

Aim: The aim of this rapid-evidence assessment of the literature is to assess the existing evidence relating to the management of cancer and non-cancer related chronic oedema/Lymphoedema in the community setting. Methods: Using the PICO (Patient/Population/Problem Intervention Comparison Outcomes) method online journal databases MEDLINE, CINAHL and PUBMED, were searched between June 2016 and August 2016. Additional studies were identified through searching bibliographies of related publications and using the Google Scholar internet search function. The following search terms were used in line with the different PICO domains: chronic oedema; Lymphoedema; exercise; compression hosiery; compression bandages; bandages; hosiery; stockings; self-care; self-management; Health-related quality of life; managing chronic oedema; cost of; burden of; economic evaluation; QALY. Results: Fifty nine potentially relevant abstracts were found from the search. Twenty one papers were chosen for inclusion in the final review - eight US studies, four UK studies, one joint UK and Canadian study, four Australian studies, two German studies and one study each from Japan and Italy. The papers were thematically categorised (based on health-related quality of life and cost burden outcomes of the study) by Self-managing chronic oedema, Exercise, Compression devices, Dressings/Stockings, Quality of life and Cost studies/Economic burden. Conclusion: There is sufficient evidence in the literature that suggests promoting self-management of lymphoedema, the quality of life of lymphoedema patients and the correct use of bandages and stockings is vitally important to clinical practice. Moreover, these issues have a major impact in the health outcomes of patients in the community. This review is a valuable addition to the evidence base for both the care and management of lymphoedema, and an opportunity to add valuable research into the economic burden of the disease. [ABSTRACT FROM AUTHOR]

This paper reports on the application of design-based tools used to uncover the needs of people living with a chronic condition. It was built on increasing rhetoric calling for greater involvement of patients in the creation of appropriate support mechanisms and presents a means to achieve this using design approaches and tools. The paper presents the development and use of scenario-based design probes to facilitate the participation of People Living with Lymphoedema (PLWL) early in the design process. Lymphoedema is a chronic condition requiring a cumbersome everyday management routine. Self-management is necessary to increase quality of life and decrease complications and hospitalisation. However, consistent practice of self-management among PLWL is low and the need to improve support is recognised. This research explored how PLWL's transitions towards becoming experts of their condition might be supported. Literature describing the lymphoedema experience was systematically investigated from a behavioural perspective to develop scenario-based probes. These probes provided rich insights by facilitating the envisioning of alternative futures to self-management support with interview participants with lymphoedema. To inform the design of better support for chronic conditions, the stages and components of behaviour change for lymphoedema self-management and the associated support needs are presented. [ABSTRACT FROM AUTHOR]

Background: Lymphoedema is a common, distressing and debilitating condition that can be related to cancer and its treatment or other conditions. Little is known about current practices in the diagnosis, assessment and management of lymphoedema in low- and middle-income countries (LMIC).Aim: To describe current practices in diagnosing, assessing and managing cancer-related and other forms of lymphoedema in LMIC, and related barriers and facilitators.Methods: An exploratory-descriptive qualitative study. Participants were lymphoedema experts or health care professionals identified via published lymphoedema papers and professional organizations respectively. Sampling was purposive to ensure a diversity of perspectives and experience. Data collection was via semi-structured telephone/video interviews, and questions canvassed participants' experiences and perceptions of lymphoedema care in LMIC. Interviews were audio-recorded and transcribed verbatim. Analysis proceeded via inductive coding before mapping codes to the World Health Organization's (WHO) Innovative Care for Chronic Conditions Framework.Results: Nineteen participants were interviewed, most of whom were physiotherapists (n = 11). Ten participants worked permanently in a LMIC, while the remainder were based in a high-income country (HIC) and had been involved in initiatives to improve lymphoedema care across multiple LMIC. Participants indicated that management of cancer versus non-cancer related lymphoedema was similar, but that pathways to care were more straight-forward for those receiving cancer care, leading to earlier diagnosis. Key facilitators to optimizing lymphoedema care in LMIC included: 1) joining forces to overcome lymphoedema-related stigma; 2) building workforce capabilities; and 3) partnering with patients and families to support self-management. Ideas for building workforce included developing health professional knowledge, supporting a commitment to multidisciplinary team care, and adapting HIC guidelines for lymphoedema care to LMIC. Partnering with patients and families to support self-management involved following the person-centred approach, establishing clear communication, promoting adherence to management, adapting management to available resources, and involving patient family and friends in lymphoedema care.Conclusion: Raising community and health professional awareness regarding lymphoedema and its management is a key first step to improving care outcomes. Resources for clinicians and patients/families developed for lymphoedema care in HIC need to be adapted for low resource settings. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to highlight a less illustrated topic in Romanian bibliographic resources. According to the World Health Organization reports, breast cancer is one of the most common types of cancer worldwide. The sequelae of mastectomy are systematised as follows: conditions secondary to the application of local radiotherapy, systemic conditions after oncological treatment and psychosocial conditions. The most common side effect of the treatment applied for breast cancer is lymphoedema and, according to a study carried out in Pennsylvania, 42% of patients develop lymphoedema. Some authors classify it into mild, moderate and severe, but others highlight four stages of lymphoedema development. Physiotherapy has a major role in post-mastectomy recovery and requires various kinetic means, which can be both specific (physical exercise, hydrokinetic therapy, massage, posture) and non-specific (multilayer compression bandage and wearing a compression sleeve). Over time, a lot of clinical studies have been conducted on the implications of physical therapy for post-mastectomy functional recovery. Thus, physical exercise performed during the kinetic programme improves muscle strength, the activity of the cardiorespiratory system and self-esteem. Several authors recommend the practice of aerobic exercise and moderate-intensity exercise twice a week during chemotherapy treatment to prevent the development of lymphoedema. [ABSTRACT FROM AUTHOR]

Purpose: This paper addresses the diagnostic idea proposed in [11] to measure the parameter called rate of creep of axillary fold of tissue using modified Harpenden skinfold caliper in order to distinguish normal and edematous tissue. Our simulations are intended to help understanding the creep phenomenon and creep rate parameter as a sensitive indicator of edema existence. The parametric analysis shows the tissue behavior under the external load as well as its sensitivity to changes of crucial hydro-mechanical tissue parameters, e.g., permeability or stiffness. Methods: The linear viscoelastic and poroelastic models of normal (single phase) and oedematous tissue (twophase: swelled tissue with excess of interstitial fluid) implemented in COMSOL Multiphysics environment are used. Simulations are performed within the range of small strains for a simplified fold geometry, material characterization and boundary conditions. The predicted creep is the result of viscosity (viscoelastic model) or pore fluid displacement (poroelastic model) in tissue. Results: The tissue deformations, interstitial fluid pressure as well as interstitial fluid velocity are discussed in parametric analysis with respect to elasticity modulus, relaxation time or permeability of tissue. The creep rate determined within the models of tissue is compared and referred to the diagnostic idea in [11]. Conclusions: The results obtained from the two linear models of subcutaneous tissue indicate that the form of creep curve and the creep rate are sensitive to material parameters which characterize the tissue. However, the adopted modelling assumptions point to a limited applicability of the creep rate as the discriminant of oedema. [ABSTRACT FROM AUTHOR]

Cambridge and Peterborough NHS Foundation Trust had planned to assess and implement the impact of managing chronic oedema and wet legs more effectively in the community in 2020. The article outlines how the service reacted to the sudden change of direction needed in response to COVID-19 pandemic and how the work we had already undertaken in this project facilitated this new way of working. When the TVN team was redeployed, they used information from our original audit to target the patients who had been deemed the highest risk. Ensuring the patient had the most appropriate care began to improve outcomes and reduce visits. A small dip check audit was completed to prove the impact of appropriate compression in the community. This paper highlights the positive impacts made in the first 3 months of the pandemic. [ABSTRACT FROM AUTHOR]

Background: Intermittent Pneumatic Compression (IPC) is shown to improve the healing rate of Venous Leg Ulcers (VLU) in the hospital setting. The current Australian "Gold Standard" treatment according to the Australian and New Zealand Wound Management Associations' (AWMA) Prevention & Management of Venous Leg Ulcer guidelines is compression, generally in the form of bandaging then progressing to hosiery once wounds are healed to prevent recurrence. This is recommended in conjunction with other standards of wound management including; nutrition, exercise, client education and addressing underlying pathophysiology and psychosocial factors. Compression bandaging is predominantly attended by community nurses in the clients' home. Barriers to delivery of this treatment include; client concordance and or suitability for bandaging including client habitus, (shape of legs), client lifestyle, clinician knowledge and clinicians physical ability to attend bandaging, in particular for obese clients with limited mobility who pose a manual handling risk to the clinician themselves. The use of IPC may assist in mitigating some of these concerns, therefore it would seem wise to explore the use of IPC within the home setting. Case presentation: This paper will present an original case report on the successful treatment of a woman living with chronic bilateral lower leg ulcers using IPC as an adjunct treatment in her home. This paper supports recommendations to explore the use of IPC therapy in the home setting, for treatment of chronic leg ulcers requiring compression. Conclusion: Use of IPC in the home is anticipated to improve client involvement, concordance, client outcomes and reduce risk to staff applying conventional compression bandaging systems, particularly for obese clients with limited mobility. [ABSTRACT FROM AUTHOR]

Background: A screening tool was developed to identify morbidity emerging in the years after breast cancer treatment. Aims: This project aimed to investigate patient responses to a newly developed screening tool for lymphoedema, reduced arm function, fatigue and pain. Methods: Interviews were conducted following completion of the screening tool by 40 women attending review appointments post-treatment for breast cancer (86% response rate). Questions addressed ease of completion and administration. Results: On average, participants were 5.8 years post-treatment (1-28) and 64 years of age (38-79). It took eight to 20 minutes to complete the screening tool, with five participants needing assistance. Ninety-eight per cent of participants generally understood the instructions and 76% were able to answer all questions. There was some confusion about unfamiliar terminology (i.e. 'the axilla') and a question was raised relating to experiences of pain (people had difficulty differentiating pain relating to breast cancer and other conditions). Twenty per cent of respondents would prefer to receive the questionnaire by post, with 41% preferring paper to electronic completion. Conclusions: With minor modifications and further pilot testing of validity and reliability, this screening tool has the potential to enable rapid identification of morbidity, enabling appropriate action to be taken as well as facilitating service planning. [ABSTRACT FROM AUTHOR]

The Encouragement, Normalcy, Counselling, Opportunity, Reaching Out, Energies Revived (ENCORE) programme is a community-based, multi-modality evidence-based education and exercise programme designed to aid the physical and emotional recovery of women who have undergone breast cancer treatment. ENCORE provides a package of tailored education, therapeutic exercises, relaxation techniques and supportive community engagement. Funded through a combination of government funding, private donations and community support, ENCORE represents a significant achievement in the application of evidence-based practice within the realm of cancer care. ENCORE has demonstrated improved clinical outcomes relating to participants' physical strength, mobility and quality of life. The programme's achievements underscore the critical value of exercise and peer support in cancer rehabilitation. [ABSTRACT FROM AUTHOR]

Accessibility is a broad concept that considers the capacity of individuals to autonomously and easily utilise and derive benefit from a physical environment, equipment, technology, and services. Accessibility, in the context of a blind massage practitioner specialising in lymphoedema therapy pertains to the necessary modifications and supports required to deliver clinical services effectively and safely without the sense of sight. This case study explores Kate's successes and challenges, in the 12 months since becoming an accredited lymphoedema practitioner in the Casley-Smith method, in working as a lymphoedema practitioner. [ABSTRACT FROM AUTHOR]

Objective: Breast cancer-related lymphoedema (BCRL) is a common complication after breast cancer treatment. We investigated whether acupuncture could be used to manage limb oedema in women after breast cancer surgery. Methods: The Cochrane Library, PubMed, Embase, Web of Science, CINAHL, and four Chinese databases were electronically searched for papers published through November 2017. Randomised controlled trials (RCTs) of acupuncture for BCRL were included. Results: In total, six RCTs with 318 patients were identified. The main analysis revealed a positive overall effect of acupuncture intervention on pre/post-treatment differences in the diameter of the elbow joint, reductions in upper limb lymphoedema and effectiveness index based on arm measurement data in patients with breast cancer. Two studies evaluating the outcome of acupuncture on the diameter of the elbow joint found a significant reduction in diameter between the acupuncture and control groups (weighted mean difference (WMD) 6 cm, 95% CI 5.11 to 6.89 cm; P<0.001). The same two studies investigated the effect of acupuncture on upper limb lymphoedema reduction and found a significant difference between the acupuncture and control groups (risk ratio 1.4, 95% CI 1.17 to 1.67; P<0.001). Two other studies used the effectiveness index to assess the arm and found a significant difference between the acupuncture and control groups (WMD 23.34, 95% CI 10.74 to 35.94; P<0.001). The fifth study used bioelectrical impedance spectroscopy to assess lymphoedema at several points on the arm before and after acupuncture; this study also reported a significant reduction in lymphoedema. The sixth study reported no significant difference in bioimpedance between the groups. Conclusions: The present meta-analysis and systematic review suggests that acupuncture is effective at reducing BCRL in patients after breast cancer treatment. [ABSTRACT FROM AUTHOR]

The risks of developing energy or nutrient deficits are of great concern in infants and children with the rare lymphoedema cholestasis syndrome 1 (LCS1)/Aagenaes syndrome. In adolescents and adults, it is not known whether LCS1 patients need specific dietary advice outside periods of cholestasis. The primary objective of the present study was to evaluate the progression of the liver disease and nutritional status in patients with LCS1 over a period of nine years. Dietary and biochemical data were obtained for patients and healthy controls in two cross-sectional studies, a baseline (2000) and a follow-up study (2009). Thirteen patients above 18 years of age with LCS1 (65%) were included (six females). Dietary intake and biochemical measures were stable in the patients from baseline until follow-up. Compared to healthy controls, the patients had significantly higher serum levels of alkaline phosphatase (p = .015 and p = .002), gamma-glutamyltransferase (p = .001 and p < .001), total bile acids (p = .037 and p = .016), and fibrinogen (p = .046 and p < .001) and lower albumin (p = .033 and p < .001) and α-tocopherol (p = .011 and p = .003) at baseline and follow-up. Despite stable liver function, the presence of a low grade of hepatobiliary dysfunction in these patients was suggested. Patients with LCS1 had a nutritional status similar to healthy controls, with no clinical deterioration of liver function during the nine-year period. The findings presented in this paper support that more than 50% of patients with LCS1 can expect a normal lifespan. [ABSTRACT FROM AUTHOR]

Introduction: Lymphedema is a chronic condition characterized by the accumulation of lymph fluid in the upper or lower extremities, leading to swelling, discomfort, and disability in everyday life. While various treatment modalities exist, microsurgical lymphatic vessel transplantation (LVT) has emerged as a promising option. However, there is little to no long-term follow-up data regarding patients' improvement in quality of life for this surgical technique. The present study conducts an investigation of the long-term health-related quality of life (HRQoL) over more than 20 years in patients with lymphedema treated with LVT and accomplishes this by utilizing an adapted SF-12 survey. Patients and methods: A retrospective analysis was conducted on patients who underwent LVT between 1 January 1983 and 1 October 2010 at LMU Clinic Munich (n = 35). Quality of life scores were assessed preoperatively and today in terms of physiological conditions, psychological conditions, and burden of therapy using a SF-12 survey adapted to the symptoms and impairments that chronic lymphedemas are known to cause. Results: Our findings demonstrate a significant improvement in HRQoL following LVT, with notable enhancements in physiological and psychological conditions such as burden of therapy. Physiological conditions showed a significant positive change of 3.2648 (p < 0.01). Psychological conditions improved significantly by a factor of 2.0882 (p < 0.01). Additionally, the burden of therapy improved significantly by 1.5883 points (p < 0.01). Conclusion: Previous studies have already shown a significant improvement of HRQoL within the first postoperative years for patients treated by LVT. This study also demonstrates significant long-term improvement after LVT, thus underlining the effectiveness of using LVT to improve the quality of live for patients with both primary and secondary lymphedema long-term. [ABSTRACT FROM AUTHOR]

Suboptimal management of leg ulcers has been identified as a UK- wide problem that is both costly to the NHS and a drain on nursing resources (Guest et al, 2020). The overall annual NHS cost of wound care has increased by 48% in real terms over the five years since Guest et al's (2015) original work. Guest et al's studies (2015; 2020) also found a common pattern with regard to a failure on the part of healthcare professionals to establish the underlying aetiology of a wound. This article highlights the importance of changing the way we treat leg ulceration in relation to identifying and managing patients with lymphovenous disease, and explores new treatments surrounding the care of leg ulceration to help break down fibrosis in complex wounds caused by lymphatic changes. [ABSTRACT FROM AUTHOR]

Background: Lymphatic filariasis (LF) is one of the primary causes of lymphoedema in sub-Saharan Africa, and has a significant impact on the quality of life (QoL) of those affected. In this paper we assess the relative impact of lymphoedema on mobility and income in Chikwawa district, Malawi. Methods: A random sample of 31 people with lymphoedema and 31 matched controls completed a QoL questionnaire from which both an overall and a mobility-specific score were calculated. Two mobility tests were undertaken, namely the 10 m walking test [10MWT] and timed up and go [TUG] test, and a subset of 10 casescontrol pairs wore GPS data loggers for 3 weeks to measure their mobility in a more natural setting. Retrospective economic data was collected from all 31 case-control pairs, and each participant undertaking the GPS activity recorded daily earnings and health expenditure throughout the observation period. Results: Cases had a significantly poorer overall QoL (cases = 32.2, controls = 6.0, P < 0.01) and mobility-specific (cases = 43.1, controls = 7.4, P < 0.01) scores in comparison to controls. Cases were also significantly slower (P < 0.01) at completing the timed mobility tests, e.g. mean 10MWT speed of 0.83 m/s in comparison to 1.10 m/s for controls. An inconsistent relationship was observed between mobility-specific QoL scores and the timed test results for cases (10MWT correlation = -0.06, 95% CI = (-0.41, 0.30)), indicating that their perceived disability differed from their measured disability, whereas the results were consistent for controls (10MWT correlation = -0.61, 95% CI = (-0.79, -0.34)). GPS summaries indicated that cases generally walk shorter distances at slower speeds than control, covering a smaller geographical area (median area by kernel smoothing: cases = 1.25 km2, controls = 2.10 km2, P = 0.16). Cases reported earning less than half that earned by controls per week (cases = $0.70, controls = $1.86, P = 0.064), with a smaller proportion of their earnings (16% vs 22%, P = 0.461) being spent on healthcare. Conclusions: Those affected by lymphoedema are at a clear disadvantage to their unaffected peers, experiencing a lower QoL as confirmed by both subjective and objective mobility measures, and lower income. This study also indicates that objective measures of mobility may be a useful supplement to self-assessed QoL questionnaires when assessing the future impact of lymphoedema management interventions. [ABSTRACT FROM AUTHOR]

Recent research on an international level has reported a high prevalence of wounds of diverse aetiology in patients with chronic leg oedema/lymphoedema. Multiple factors contribute to the development of wounds, delayed wound healing, and/or to the development of oedema in these patients. Due to the complex nature of these conditions, they can present a diagnostic and therapeutic challenge for the clinician. Despite the efforts and recommendations over the past decades that support compression therapy as the core intervention to reduce oedema and stimulate wound healing, a substantial percentage of the patients have been shown not to have well-controlled oedema. In this clinical paper, we provide the link between wounds and chronic oedema/lymphoedema, and highlight important factors to remember in the assessment and management of these patients, to provide a holistic, individualised and realistic care plan. Generating research is challenging and requires research design for complex interventions to achieve an evidence-based approach for this complex group of patients. [ABSTRACT FROM AUTHOR]

Compression is the cornerstone of treatment for lymphoedema; however, in patients with Stage III lymphoedema that causes a significant alteration of limb shape and size, additional creative problem solving is required in order to find a solution that fits the person, their limb and their personal circumstances. Medical adaptive compression (MAC) systems provide solutions to complex situations. We present two cases of individuals who completed an inpatient rehabilitation stay for intensive treatment of their lymphoedema and were fitted with MAC devices to ensure long-term success. [ABSTRACT FROM AUTHOR]

The aim of this review is to assess the efficacy and safety of using heat and cold therapy for adults with lymphoedema. A multi-database search was undertaken. Only studies which included adults with lymphoedema who were treated with heat or cold therapy reporting any outcome were included. Screening, data extraction, and assessment of bias were undertaken by a single reviewer and verified by a second. Due to the substantial heterogeneity, a descriptive synthesis was undertaken. Eighteen studies were included. All nine studies which assessed the effects of heat-therapy on changes in limb circumference reported a point estimate indicating some reduction from baseline to end of study. Similarly, the five studies evaluating the use of heat-therapy on limb volume demonstrated a reduction in limb volume from baseline to end-of-study. Only four studies reported adverse events of which all were deemed to be minor. Only two studies explored the effects of cold therapy on lymphoedema. Tentative evidence suggests heat-therapy may have some benefit in treating lymphoedema with minimal side effects. However, further high-quality randomised controlled trials are required, with a particular focus on moderating factors and assessment of adverse events. This review highlights the potential benefit that heat therapy may have on reducing limb circumference and volume for adults with lymphoedema. There was no evidence that controlled localised heat therapy was unsafe. The current evidence-base is at a point where no specific clinical recommendations can be made. The use of heat therapy should only be applied as part of a methodologically robust study to treat lymphoedema. [ABSTRACT FROM AUTHOR]

Lymphoedema effects approximately 200 000 people in UK. It is a chronic condition without a cure but there is much that can be done to ease and manage these complications. This article looks at the eight most common complications, providing advise on how to manage them, derived from the literature and the author's own experience. It also presents advise on how nurses can promote self-management of these complications, promoting patients' self-care. [ABSTRACT FROM AUTHOR]

The aim of the present study was to evaluate the effects of compression bandages, sleeves, intermittent pneumatic compression (IPC) and active exercise on the reduction of breast cancer-related lymphoedema (BCRL). A systematic literature search up to the year January 2016 was performed in CINAHL, Cochrane Register of Controlled Trials, Embase, International Clinical Trials Registry Platform (WHO), PEDro and PubMed. Inclusion criteria were (1) RCTs, (2) reported adequate statistics for meta-analysis, (3) English or German language. Exclusion criteria were (1) effects of drugs, hormonal, radiation and surgical procedures, (2) studies with children, (3) non-breast cancers, lower extremity oedema, (4) impact on fatigue only, diets or sexually transmitted diseases, (5) cost-analysis only and (6) non-carcinogenic syndromes or (7) prevention of breast cancer. After scoring the methodological quality of the selected studies, data concerning volume reduction of the oedema swelling were extracted. Thirty-two studies were included in this systematic review. Nine studies were selected for the RCT-based studies and 19 studies were included in the pre-post studies-based random-effects meta-analyses. All conclusions should be taken with precautions because of the insufficient quality of the selected papers. Exercise seems beneficial in reducing oedema volume in BCRL. IPC seems beneficial in helping to reduce the oedema volume in the acute phase of treatment. Compression sleeves do not aid in the volume reduction in the acute phase; however, they do prevent additional swelling. [ABSTRACT FROM AUTHOR]

Lymphoedema is complex disorder with high disease morbidity characterised initially by progressive fluid accumulation and subsequently by altered tissue fibrosis and fat deposition. Primary lymphoedema is the result of congenital conditions that affect how lymph vessels are formed, whilst the inciting event in secondary lymphoedema is classically the disruption of normal lymphatic flow in the context of surgery or trauma. In addition to the altered fluid and fat homeostasis, lymphoedema is characterised by immune deficits that typically manifest as an increased susceptibility to infection and altered wound healing in the affected site. In contrast to the common perception of the lymphatics as a passive conduit for fluid, waste products, and immune cells, the altered immune homeostasis in lymphoedema patients suggests that the lymphatics play a more active role in the immune response. Indeed, lymphatic dysfunction appears to be a global phenomenon in all immune-related diseases. In this review, we highlight papers that support an active role for the lymphatics in immunity and link this evidence to the observed deficits in wound healing and immune surveillance present in lymphoedema. [ABSTRACT FROM AUTHOR]

Lymphoedema is a debilitating condition, manifesting in excess lymphatic fluid and swelling of subcutaneous tissues. Lymphoedema is as of yet still an incurable condition and current treatment modalities are not satisfactory. The capacity of mesenchymal stem cells to promote angiogenesis, secrete growth factors, regulate the inflammatory process, and differentiate into multiple cell types make them a potential ideal therapy for lymphoedema. Adipose tissue is the richest and most accessible source of mesenchymal stem cells and they can be harvested, isolated, and used for therapy in a single stage procedure as an autologous treatment. The aim of this paper was to review all studies using mesenchymal stem cells for lymphoedema treatment with a special focus on the potential use of adipose-derived stem cells. A systematic search was performed and five preclinical and two clinical studies were found. Different stem cell sources and lymphoedema models were used in the described studies. Most studies showed a decrease in lymphoedema and an increased lymphangiogenesis when treated with stem cells and this treatment modality has so far shown great potential. The present studies are, however, subject to bias and more preclinical studies and large-scale high quality clinical trials are needed to show if this emerging therapy can satisfy expectations. [ABSTRACT FROM AUTHOR]

Lymphoedema of the arm is a potentially serious consequence of any axillary procedure performed during the management of breast cancer. In an attempt to reduce its incidence and severity, patients are instructed to avoid venepunctures and blood pressure measurements on the treated arm. These precautions are not possible in some patients and attempts to adhere to them can cause discomfort, anxiety and stress for both patients and their health-care workers. The strength with which these recommendations are made is in contrast to the level of evidence underpinning them. This paper reviews this evidence regarding the safety, or lack thereof, of blood pressure monitoring and intravenous puncture in women who have had axillary surgery. With this evidence generally being anecdotal in nature, there appears to be no rigorous evidence-based support for the risk-reduction behaviours of avoiding blood pressure monitoring and venepuncture in the affected arm in the prevention of lymphoedema after axillary procedure. A clinical trial was proposed to investigate whether such avoidance measures were valuable, but failed during its inception. There remains a need for research from prospective trials on this controversial topic to determine the most appropriate patient recommendations that should be provided after axillary procedure regarding the risks for development of lymphoedema. [ABSTRACT FROM AUTHOR]

Mammalian target of rapamycin inhibitor (mTOR-I)/proliferation signal inhibitors (PSI) including sirolimus and everolimus represent a new class of drugs increasingly used in solid-organ transplantation as alternatives to calcineurin inhibitors for patients with renal dysfunction, transplant coronary arterial vasculopathy or malignancy. The most frequently occurring mTOR-I/PSI-related adverse events are similar to those associated with other immunosuppressive therapies, but some side effects are more characteristic of proliferation signal inhibitors (e.g. lymphocele, arthralgia, oedema and hyperlipidaemia). The present paper review incidence, clinical presentation and mechanism of oedema within the clinical experience of mTOR-I/PSI in solid organ transplantation. [ABSTRACT FROM PUBLISHER]

It is generally accepted that lymphoedema and fibrosis can lead to impaired mobility. This will generally lead to a process of adaptation and changes in the neuro-motor system and motor activity. These changes can lead to degenerative processes in the articular and muscular structures, resulting in reduced mobility, inactivity, pain, loss of function, all of which can overtax the circulation. This paper shows that breaking this vicious circle can be used as part of the treatment regimen for chonic oedema to improve patient mobility and quality of life. [ABSTRACT FROM AUTHOR]

Liposuction for late-stage lymphoedema remains a controversial technique. While it is clear that conservative therapies such as combined decongestive therapy (CDT) and controlled compression therapy (CCT) should be tried in the first instance, options for the treatment of late-stage lymphoedema that is not responding to treatment is not so clear. Liposuction has been used for many years to treat lipodystrophy. Some results have been far from optimal; however, improvements in technique, patient preparation and patient follow-up have led to a greater and a wider acceptance of liposuction as a treatment for lymphoedema. This paper outlines the bene?ts of using liposuction and presents the evidence to support its use. [ABSTRACT FROM AUTHOR]

chan d.n.s., lui l.y.y. & so w.k.w. (2010) Effectiveness of exercise programmes on shoulder mobility and lymphoedema after axillary lymph node dissection for breast cancer: systematic review. Journal of Advanced Nursing 66(9), 1902–1914. Aim. This article is a report of a review of the effectiveness of exercise programmes on shoulder mobility and lymphoedema in postoperative patients with breast cancer having axillary lymph node dissection, as revealed by randomized controlled trials. Background. Breast cancer is the most common malignancy in women. After surgery, the most common postoperative complications are reduced range of motion in the shoulder, muscle weakness in the upper extremities, lymphoedema, pain and numbness. To reduce these impairments, shoulder exercises are usually prescribed. However, conflicting results regarding the effect and timing of such exercises have been reported. Data sources. Studies were retrieved from a systematic search of published works over the period 2000–2009 indexed in the Cumulative Index to Nursing and Allied Health Literature, Ovid Medline, the British Nursing Index, Proquest, Science Direct, Pubmed, Scopus and the Cochrane Library, using the combined search terms ‘breast cancer’, ‘breast cancer surgery’, ‘exercise’, ‘lymphoedema’, ‘shoulder mobility’ and ‘randomized controlled trials’. Methods. A quantitative review of effectiveness was carried out. Studies were critically appraised by three independent reviewers, and categorized according to levels of evidence defined by the Joanna Briggs Institute. Results. Six studies were included in the review. Early rather than delayed onset of training did not affect the incidence of postoperative lymphoedema, but early introduction of exercises was valuable in avoiding deterioration in range of shoulder motion. Conclusion. Further studies are required to investigate the optimal time for starting arm exercises after this surgery. Nurses have an important role in educating and encouraging patients to practise these exercises to speed up recovery. [ABSTRACT FROM AUTHOR]

This paper reports on a study in the UK that explored the experience of children suffering with Lymphoedema and that of their families. Qualitative data was collected from 20 children between the ages of 6 and 18 and their respective parents. Single, semi-structured interviews were used in which children and their parents were asked to share how lymphoedema impacted on their family life. Children were asked about their school experience, their dreams and their aspirations. Three categories emerged. Firstly, the negotiation of the health care system. Themes included correct diagnosis, finding robust information and reaching a knowledgeable expert. The second category explored the complex role of the parents as advocates. Themes within this category included the dilemmas of parenting and the increasing challenges as children reached adolescence. The final category involved the impact on the family unit. The first theme concerned the integration of lymphoedema into daily activities and the intrusion on family time. The second explored the impact on siblings and the final theme the changing dilemmas as children moved through the stages of childhood and faced adulthood. [ABSTRACT FROM AUTHOR]

The Cochrane Library of Systematic Reviews is published quarterly. Issue four for 2004 of the library was published in October 2004. The Cochrane Librao, now contains 2170 complete reviews, 1500 protocols of reviews and 4918 one-page summaries of systematic reviews published in the general medical literature. In addition there are citations of 427,807 randomised controlled trials, 18 methodology reviews and 5968 cited papers in the Cochrane methodology register. The health technology assessment database contains 4395 citations. In this edition of the Library issued in October 2004, there were 96 new reviews of which 12 have potential relevance for practitioners in pain and palliative medicine. Regular readers will note that the format of the citation has changed with the move to publication of The Cochrane Library, by John Wiley & Sons. Citations will probably change again in the future as currently there is no indication of the date when a review was first published. [ABSTRACT FROM AUTHOR]

Primary lymphoedema associated with chylous reflux is a very rare clinical entity. We report a 3-year-old girl with unilateral lymphoedema, xanthomatosis and vaginal lymphorrhoea. Biopsy also revealed intestinal lymphangiectasia. This paper also presents a brief review of the literature and draws attention to the significance of the xanthomatous eruption in the diagnosis of a chylous reflux. [ABSTRACT FROM AUTHOR]

This paper documents the validation of a quality of life scale (QOL) designed to assess the impact of arm morbidity on patients following breast cancer surgery. A four item arm subscale was developed to supplement a multi-dimensional, validated breast cancer QOL tool, the functional assessment of cancer therapy (FACT-B.) The new questionnaire, the FACT-B+4, was validated on 279 women participating in a trial of sentinel node guided axillary therapy and 29 women attending a lymphoedema clinic. The subscale demonstrated good internal consistency (alpha co-efficient=0.62 to 0.88) and stability (test–retest reliability=0.97). Lymphoedema patients reported significantly greater arm problems than a matched sample of pre-operative trial participants. The lymphoedema group also scored lower than trial patients on the FACT-B+4 indicating a poorer quality of life ( p<0.05). A subset of 66 trial patients who had completed three consecutive assessments was used to evaluate the sensitivity of the questionnaire to change over time. Scores on the FACT-B+4 were found to decline significantly between the pre-operative assessment and post-operative assessment at 1 month. Arm problems significantly increased during this period. FACT-B+4 score increased again from 1 month to 12 weeks post-surgery and symptoms reduced, as the extent of arm morbidity resolved. The FACT-B+4 appears to be psychometrically robust and sensitive to patient rehabilitation, making it suitable for use in longitudinal surgical trials. Given the dearth of existing scales available to measure arm morbidity, we hope this new tool will prove useful to researchers [ABSTRACT FROM AUTHOR]

Lymph node swelling is a side effect of the mRNA COVID-19 vaccines, a distressing side effect for women treated for breast cancer. The purpose of this study is to present side effects reported by a cohort of patients treated for breast cancer. A survey link was sent to 4945 women who received breast cancer treatment and were prospectively screened for breast cancer-related lymphedema. In total, 621 patients who received an mRNA vaccine and responded to the survey were included in analysis. We assessed the frequency and predictors of side effects. The most frequent side effects reported were injection site soreness, fatigue, generalized muscle soreness, headache, and chills, with median duration ≤ 48 h. Lymph node swelling occurred most often in the axilla ipsilateral to the vaccine. The median duration was 1 week or less after all doses. These data will inform patient education regarding future vaccine doses, including reassurances about which side effects to expect, particularly lymph node swelling which may impact mammograms after vaccination. Type and duration of side effects were similar to that reported by the general population in Phase 3 testing trials of the mRNA vaccines. Clinical Trial Registration NCT04872738 posted May 4, 2021. [ABSTRACT FROM AUTHOR]

The aim of this descriptive review is to summarise the current knowledge of non-invasive bioelectrical impedance analysis (BIA) used with gynaecological surgical patients in regard to postoperative development of lymphoedema and determination of perioperative fluid balance, and as a prognostic factor in cancer mortality and a predictor of postoperative complications. The databases PubMed, MEDLINE, Scopus Web of Science, the Cochrane Library, and reference lists of selected articles were searched for relevant articles published during the period January 2008-April 2018. Only papers published in English were retrieved. Thirty-seven articles were evaluated. Where gynaecological studies were lacking, studies with a study population from neighbouring clinical fields were used instead. Studies on the clinical use of BIA with gynaecological surgical patients were divided into three categories: the postoperative development of lower limb lymphoedema (n = 7), perioperative hydration measuring (n = 3), and the BIA parameter phase angle as a prognostic factor in cancer survival and as predictive for postoperative complications (n = 6). Of these 16 studies only three used a pure gynaecological study population. Three different methods of BIA were used in these articles: single frequency-BIA, multifrequency-BIA and bioimpedance spectroscopy. BIA was found to detect lymphoedema with a sensitivity of 73% and a specificity of 84%. Studies indicated that BIA was able to detect lower limb lymphoedema at an early stage even before it became clinically detectable. During postoperative hydration measurements, an increase in extracellular fluid volume and extracellular fluid volume in relation to total body fluid volume, as well as a decrease in phase angle, were associated with higher frequencies of postoperative complications. Moreover, low values for the phase angle have been associated with increased mortality in cancer patients. However, the number of studies in this field was limited. From our review, BIA seems to be a useful tool for use in the clinical setting of the gynaecological surgical patient. The theoretical approach of using bioelectrical impedance values to measure the fluid distribution in the body compartments offers wide opportunities in the clinical setting. However, so far, all studies have set up cut-off limits within the study population, and reference values for a general population need to be defined. There are also rather few studies on a gynaecological study population. Hence, there is a need for further studies within gynaecological surgery focusing on early detection of lower limb lymphoedema, perioperative fluid balance, and postoperative complications in order to establish the value of BIA in clinical praxis. [ABSTRACT FROM AUTHOR]

The aim of the study was to examine the following: (a) the trajectory of external and internal head and neck lymphoedema (HNL) in patients with head and neck cancer (HNC) up to 12 months post-chemoradiotherapy (CRT) and (b) the relationship between HNL and swallowing function. Using a prospective longitudinal cohort study, external/internal HNL and swallowing were examined in 33 participants at 3, 6 and 12 months post-CRT. External HNL was assessed using the Assessment of Lymphoedema of the Head and Neck and the MD Anderson Cancer Centre Lymphoedema Rating Scale. Internal HNL was rated using Patterson's Radiotherapy Oedema Rating Scale. Swallowing was assessed via clinical, instrumental and patient-reported measures. Associations between HNL and swallowing were examined using multivariable regression models. External HNL was prevalent at 3 months (71%), improved by 6 months (58%) and largely resolved by 12 months (10%). In contrast, moderate/severe internal HNL was prevalent at 3 months (96%), 6 months (84%) and at 12 months (65%). More severe penetration/aspiration and increased diet modification were associated with higher severities of external HNL (p=0.006 and p=0.031, respectively) and internal HNL (p<0.001 and p=0.007, respectively), and more diffuse internal HNL (p=0.043 and p=0.001, respectively). Worse patient-reported swallowing outcomes were associated with a higher severity of external HNL (p=0.001) and more diffuse internal HNL (p=0.002). External HNL largely resolves by 12 months post-CRT, but internal HNL persists. Patients with a higher severity of external and/or internal HNL and those with more diffuse internal HNL can be expected to have more severe dysphagia. [ABSTRACT FROM AUTHOR]

This study aimed to estimate costs associated with managing patients with cellulitis from the UK National Health Service (NHS) perspective. The analysis was undertaken through the Secure Anonymised Information Linkage Databank, which brings together population‐scale, individual‐level anonymised linked data from a wide range of sources, including 80% of primary care general practices within Wales (population coverage ~3.2 million). The data covered a 20‐year period from 1999 to 2019. All patients linked to the relevant codes were tracked through primary care settings, recording the number of general practice visits (number of days with an event recorded) and number of in‐patient stays. Resources were valued in monetary terms (£ sterling), with costs determined from national published sources of unit costs. These resources were then extrapolated out to reflect UK NHS costs. This is the first attempt to estimate the financial burden of cellulitis using routine data sources on a national scale. The estimated direct annual costs to the Welsh NHS (£28 554 338) are considerable. In‐Patient events and length of stay costs are the main cost drivers, with annual Welsh NHS estimates of £19 664 126 with primary care events costing £8 890 212. Initiatives to support patients and healthcare professionals in identifying early signs/risks of cellulitis, improve the accuracy of initial diagnosis, prevent cellulitis recurrence, and improve evidence‐based treatment pathways would result in major financial savings, to both the Welsh and UK NHS. In light of these findings, Wales has developed the innovative National Lymphoedema cellulitis Improvement Programme to address these burdens; providing a proactive model of cellulitis care. [ABSTRACT FROM AUTHOR]