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1.
Eur J Vasc Endovasc Surg ; 60(1): 108-117, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-1454123

ABSTRACT

OBJECTIVE: Post-procedure limb compression, hitherto routine following open varicose vein surgery, has been extended to endovenous procedures. However, no robust evidence exists to support this practice. Most of the previous studies have focused on the ideal duration of compression. This study evaluates the clinical and patient reported outcomes with and without post-procedure leg compression following radiofrequency ablation (RFA). METHODS: This single centre, prospective, non-inferiority randomised controlled trial recruited adult patients, into two groups (A: RFA with compression stocking for two weeks, B: RFA alone). The primary outcome was ultrasound determined target vein obliteration at 12 weeks. Secondary outcome measures included a Quality of Life (QoL) score [Aberdeen Varicose Vein Severity Score (AVSS) and Revised Venous Clinical Severity Score (RVCSS)], patient satisfaction, pain score, and complications. RESULTS: In total, 100 consecutive patients were recruited (A: 51; B: 49) classified as clinical class C2-C6 of the Clinical-Etiological-Anatomical-Pathophysiological (CEAP) classification. At 12 weeks the occlusion rate of the target vein was similar in both groups at 98% (n = 47) and 98% (n = 45), respectively (p = 1.0). There was no statistically significant difference in mean AVSS 6 vs. 5.0 (mean difference -1, 95% CI -2 - 3, p = .57) and mean RVCSS 3 vs. 4 (mean difference 1, 95% CI -1 - 2, p = .46) scores at 12 weeks. Comparable patient satisfaction scores were observed (p = .72) and pain score 2.0 vs. 2.0 (p = .92) were achieved in both groups. Two patients in each group developed deep vein thrombosis at two weeks follow up (p = 1.0 for above the knee and p = 1.0 for below the knee). CONCLUSION: The clinical and patient reported outcomes following RFA without compression are no worse than with compression. This trial supports the conclusion that the widely practised use of compression after RFA adds no clinical benefit for the patients. However, a much larger study, preferably a multicentre trial, may be required to confirm this conclusion.


Subject(s)
Compression Bandages , Radiofrequency Ablation , Varicose Veins/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Postoperative Care/methods , Radiofrequency Ablation/methods , Treatment Outcome , Young Adult
2.
Br J Community Nurs ; 26(Sup10): S6-S15, 2021 Oct 01.
Article in English | MEDLINE | ID: covidwho-1431158

ABSTRACT

Management of secondary head and neck lymphoedema has undergone little research investigation. Its treatment is time and labour intensive and involves multiple therapeutic modalities without a clear understanding of which is most effective. This study aimed to determine the feasibility of a randomised controlled trial comparing two therapeutic modalities to manage head and neck lymphoedema. The secondary objective was to evaluate the clinical effects of these treatments. Participants were randomised to receive treatment with manual lymphatic drainage or compression over 6 weeks, with the primary outcome-percentage tissue water-measured 12 weeks after treatment. Six participants were recruited until the study was ceased due to restrictions imposed by the COVID-19 pandemic. Some 86% of required attendances were completed. Percentage tissue water increased in all participants at 12 weeks. No consistent trends were identified between internal and external lymphoedema. The small number of people recruited to this study informs its feasibility outcomes but limits any conclusions about clinical implications.


Subject(s)
COVID-19 , Lymphedema , Nursing Research , Pandemics , COVID-19/epidemiology , Compression Bandages , Feasibility Studies , Head , Humans , Lymphedema/nursing , Manual Lymphatic Drainage , Neck , Nursing Research/organization & administration , Treatment Outcome , United Kingdom/epidemiology
3.
Br J Community Nurs ; 26(Sup4): S16-S22, 2021 Apr 01.
Article in English | MEDLINE | ID: covidwho-1168173

ABSTRACT

During the course of the COVID-19 pandemic, lymphoedema and community clinicians have had to modify how they implement intensive treatments for patients with lymphoedema and chronic oedema. Using novel approaches to treat and move patients towards self-management regimes has enabled patients to be in control of their condition, particularly if they are unable to attend normal clinic appointments. This article explores how using Haddenham easywrap instead of time- and resource-intensive bandaging regimes, alongside the Haddenham LymphFlow Advance, as part of self-management programmes, can benefit patients' quality of life, reduce costs and resource use and enable patients to self-manage this long-term chronic condition more effectively.


Subject(s)
COVID-19 , Compression Bandages , Delivery of Health Care , Intermittent Pneumatic Compression Devices , Lymphedema/therapy , Manual Lymphatic Drainage/methods , Self Care/methods , Humans , SARS-CoV-2 , Self-Management
4.
BMC Cancer ; 20(1): 1074, 2020 Nov 09.
Article in English | MEDLINE | ID: covidwho-1067206

ABSTRACT

BACKGROUND: Breast cancer (BC) is a major public health issue. More than one out of five women treated for breast cancer will develop lymphedema in an upper extremity. Current evidence advocates transdisciplinary oncological rehabilitation. Therefore, research in this area is necessary since limited consensus having been reached with regard to the basic essential components of this rehabilitation. Consensus has, however, been reached on the use of decongestive lymphedema therapy (DLT), but due to a lack of tests, the necessary dosages are unknown and its level is moderately strong. This study attempts to verify both the efficacy of activity-oriented proprioceptive antiedema therapy (TAPA), as compared to conventional treatments such as DLT or Complex Physical Therapy (CPT), as well as its efficiency in terms of cost-effectiveness, for patients affected by breast cancer-related arm lymphedema. METHODS: Controlled, randomized clinical trial with dual stratification, two parallel arms, longitudinal and single blind. 64 women with breast cancer-related arm lymphedema will take part in the study. The experimental group intervention will be the same for stage I and II, and will consist of neuro-dynamic exercises oriented to the activity, proprioceptive neuromuscular facilitation activities and proprioceptive anti-edema bandaging. The control group intervention, depending on the stage, will consist of preventive measures, skin care and exercise-prescribed training in the lymphedema workshop as well as compression garments (Stage I) or conservative Complex Decongestive Therapy treatment (skin care, multi-layer bandaging, manual lymphatic drainage and massage therapy) (Stage II). RESULTS: Sociodemographic and clinical variables will be collected for the measurement of edema volume and ADL performance. Statistical analysis will be performed on intent to treat. DISCUSSION: It has been recommended that patient training be added to DLT, as well as a re-designing of patient lifestyles and the promotion of health-related aspects. In addition, clinical trials should be undertaken to assess neural mobilization techniques and proprioceptive neuromuscular facilitation should be included in the therapy. Cohesive bandaging will also be performed as an early form of pressotherapy. The proposed study combines all of these aspects in order to increased comfort and promote the participation of individuals with lymphedema in everyday situations. LIMITATIONS: The authors have proposed the assessment of the experimental treatment for stages I and II. One possible limitation is the lack of awareness of whether or not this treatment would be effective for other stages as well as the concern for proper hand cleansing during use of bandages, given the current COVID-19 pandemic situation. TRIAL REGISTRATION: This trial was registered in ClinicalTrials.gov ( NCT03762044 ). Date of registration: 23 November 2018. Prospectively Registered.


Subject(s)
Breast Cancer Lymphedema/rehabilitation , Physical Therapy Modalities , Breast Cancer Lymphedema/therapy , Compression Bandages , Edema/rehabilitation , Exercise Therapy , Female , Humans , Manual Lymphatic Drainage , Massage , Single-Blind Method , Treatment Outcome , Upper Extremity
5.
Rehabilitacion (Madr) ; 54(4): 276-283, 2020.
Article in Spanish | MEDLINE | ID: covidwho-735390

ABSTRACT

The COVID-19 pandemic poses a challenge to the management of non-COVID pathologies such as lymphatic diseases and lipoedema. The use of telemedicine can prevent the spread of the disease. A system is needed to help determine the clinical priority and selection of face-to-face or telemedicine options for each patient and how to carry them out during the pandemic. The Spanish Lymphology Group has drafted a consensus document with recommendations based on the literature and clinical experience, as clinical practice guidelines for the management of lymphatic abnormalities and lipoedema during the COVID-19 pandemic. These recommendations must be adapted to the characteristics of each patient, the local conditions of the centres, and the decisions of health care professionals. The document contains minimum criteria, subject to modifications according to the evolution of the pandemic, scientific knowledge and instructions from health authorities.


Subject(s)
Betacoronavirus , Coronavirus Infections , Lipedema/therapy , Lymphatic Diseases/therapy , Pandemics , Pneumonia, Viral , Telemedicine , COVID-19 , Comorbidity , Compression Bandages , Continuity of Patient Care , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Disease Management , Emergencies , Equipment Design , Health Services Needs and Demand , Humans , Lipedema/complications , Lipedema/rehabilitation , Lymphatic Diseases/complications , Lymphatic Diseases/rehabilitation , Manual Lymphatic Drainage , Office Visits , Pandemics/prevention & control , Patient Education as Topic , Patient Participation , Physical Therapy Modalities , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Precision Medicine , SARS-CoV-2 , Telephone , Triage , Videoconferencing
6.
BMJ Case Rep ; 13(7)2020 Jul 16.
Article in English | MEDLINE | ID: covidwho-650048

ABSTRACT

We describe a 40-year-old woman with severe, persistent macroglossia following prone positioning as part of treatment for COVID-19. We used the treatment method of lingual compression with satisfactory results.


Subject(s)
Betacoronavirus , Compression Bandages , Coronavirus Infections/complications , Macroglossia/complications , Macroglossia/therapy , Patient Positioning/methods , Pneumonia, Viral/complications , Acute Disease , Adult , COVID-19 , Female , Humans , Macroglossia/etiology , Pandemics , Patient Positioning/adverse effects , SARS-CoV-2 , Saline Solution/therapeutic use , Tongue
7.
Lymphat Res Biol ; 18(2): 99-100, 2020 04.
Article in English | MEDLINE | ID: covidwho-11509

ABSTRACT

This strain of coronavirus is a new one and scientists do not yet know all there is to know about it. While these common sense points will always be helpful, it is important that you keep up to date with the advice being given by the Centers for Disease Control and Prevention (CDC) and NHS England and how it might affect you personally. These suggestions have been produced using the most up-to-date advice available to us from our Scientific and Medical Advisors and are not intended to replace or supersede advice you may have been given from your health care professional.


Subject(s)
Coronavirus Infections/prevention & control , Lymphedema/complications , Pandemics/prevention & control , Patient Education as Topic , Pneumonia, Viral/prevention & control , Betacoronavirus , COVID-19 , Compression Bandages , Coronavirus Infections/complications , Gloves, Protective , Humans , Hygiene , Pneumonia, Viral/complications , SARS-CoV-2
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