Children and young people with lymphoedema: a project to assess the education needs of healthcare professionals.

Healthcare professionals need adequate preparatory education to treat children and young people with lymphoedema confidently and competently. This collaborative international project, based on existing literature and expert focus groups, seeks to identify the nature of that education need and in what format it could be addressed.

The education needs of health professionals conservatively managing genital oedema: UK survey findings.

BACKGROUND: Adults and children report genital oedema but prevalence is unknown. Pre-registration nurse training rarely includes genital oedema and postgraduate training opportunities are rare. AIM: To identify the education needs of health professionals regarding management of genital oedema. METHOD: An electronic survey was cascaded to health professionals through relevant professional groups and social media. FINDINGS: Of 149 UK respondents, most manage patients with genital oedema but only 2% felt current training was sufficient. Of 138 responding regarding supplemental training, only a half had completed genital oedema specific education, usually of 1-4 hours' duration. Confidence in knowledge was up to 22.5% higher in those with genital oedema education, even accounting for years of experience. The most common top three individual needs were compression, contemporary surgical and medical management and patient assessment. Educational resources are needed and both offline and online formats were suggested; collaborative events with urology/pelvic health are essential. CONCLUSION: Health professionals working in lymphoedema care have (unmet) specific education needs regarding genital oedema management. The desire for both offline and online resources reflects the necessity of accessing learning at a distance and on an 'as needed' basis.

Guidelines for managing people with lymphoedema remotely: a post-COVID-19 response document.

During the COVID-19 pandemic it was initially not possible to see people with lymphoedema face-to-face at lymphoedema services, due to the potential risks of the virus, because they were shielding, because of redeployment of rooms or staff, and due to sporadic restrictions of movement. The pandemic therefore accelerated adjustments in lymphoedema service delivery, while ensuring effective and efficient care was paramount. This document presents a pragmatic guide for lymphoedema services. Although clinical and non-clinical staff need to comply with guidance from their own organisations/commissioners, this document aims to provide specific guidance and share good practice in relation to lymphoedema management. These guidelines are based on analysis of the national response of Lymphoedema Network Wales during the first few months of the COVID-19 pandemic and incorporate supporting contemporary advice. They have been used throughout NHS Wales, providing a standardised approach in supporting care for people with lymphoedema. In light of the enduring nature of COVID-19, it is imperative that lymphoedema services have a means to provide suitable care for patients. Although face-to-face appointments are sometimes deemed necessary, many patients can be suitably supported via telehealth consultations. These guidelines may help lymphoedema services restore and reset in a safe and acceptable manner.

Are you handling genital oedema confidently?

Men, women or children can suffer from oedema (swelling) of the genitalia. When differential diagnosis has excluded acute trauma or pathology and swelling remains, the condition may be diagnosed as genital lymphoedema, a chronic condition that increases the relative risk of cellulitis. Diagnosis of genital oedema is often delayed due to problems with patient and health professional behaviour, in terms of embarrassment, lack of confidence or lack of knowledge. Awareness of this condition and knowledge on how to manage it will go a long way in helping both patients and clinicians overcome the challenges of addressing genital oedema. This article describes the authors' experiences in managing genital oedema. It also briefly discusses a new international project that seeks to identify the knowledge and training that health professionals need to manage this condition more confidently.

Taking a proactive approach to mild to moderate chronic oedema: a case study.

This case study demonstrates the benefits of early intervention and a proactive approach for a patient with chronic oedema living in the community. These benefited the patient and also supported value-based healthcare in the NHS. The patient's health and wellbeing significantly improved with an assessment of his chronic oedema and a management plan consisting of skincare, an exercise and movement programme and the introduction of a class 1 British standard compression garment.

Pilot evaluation of the management of chronic oedema in community settings project.

AIMS: The aim of this economic analysis was to estimate the economic impact of the On the Ground Education Programme (OGEP) within one local University Health Board (UHB) in Wales. BACKGROUND: The burden of managing chronic oedema can be considerable to the NHS. Developing innovative solutions to the care and management of patients with chronic oedema has the potential to deliver prudent, cost-effective and high quality care within NHS Wales. DESIGN: The study was a pilot Evaluation of the OGEP using retrospectively and prospectively collected patient recalled data. METHODS: A questionnaire collected health care service use data prior to receiving the OGEP (baseline) and at 3 months follow-up from 97 patients during the period June 2016 and January 2017. In addition, we analysed a patient reported health outcome using the EQ-5D 5L, which was completed by patients at the same two assessment points. RESULTS/FINDINGS: The total cost of managing chronic oedema in the 97 patients recruited was £563 729 (mean patient cost £5812 SD (£5870) at baseline and £445 098 (including the addition of intervention costs) (mean patient cost £4589 (SD £5465) at 3 months follow-up. Improvements in the EQ-5D 5L score increasing from 0.40 (SD 0.25) at baseline to 0.54 (SD 0.23) at 3 months follow-up. CONCLUSIONS: Our research show health care resource use and costs decreased, while health-related quality of life scores increased.

Evaluation of the economic impact of a national lymphoedema service in Wales.

Lymphoedema Network Wales has focused on maximising the impact of its service through the effective use of available resources to ensure high-quality and consistent care for people with lymphoedema across Wales. The aim of this evaluation was to estimate the economic impact of a national lymphoedema service on the NHS Wales budget. Work was undertaken to determine the care pathway within Lymphoedema Network Wales and develop a hypothetical 'world without' the service as a comparator. The four groups of patients that made up the pathways were group 0: 'at risk', group 1-2: 'uncomplicated lymphoedema', group 3: 'complicated/complex' and group 4: 'palliative care'. Overall resource utilisation between 6 months pre- and 6 months post-entry indicated that there were significant cost reductions to be seen after lymphoedema service entry for all patients in each group. This evaluation provides estimates that suggest that the service is likely to be cost saving when people with lymphoedema are managed within Lymphoedema Network Wales rather than in a 'world without' the service.

The development of Lymphoedema Network Wales to improve care.

Lymphoedema Network Wales was developed in 2011, after receiving a £1 million recurring investment from the Welsh Government to implement its Lymphoedema Strategy. This article describes the creation of the network and the importance of capturing performance data. It will also provide information on the three programmes of work, covering service development, education and research, and innovations and technology. Within Wales, the focus of lymphoedema service delivery is on 'prudent health care', working with patients for patients and only doing what is necessary to gain a good result. Centring our service on evidence-based practice is vital to ensure achievable patient outcomes. The network has grown considerably over the past 6 years and is recognised as a forward-thinking and proactive service.