Lipoedema: a neglected area of women's health.

Lipoedema is an adipose tissue disorder almost exclusively affecting women. Evidence shows lipoedema is both poorly recognised and misdiagnosed which results in many women struggling to get a diagnosis and to gain access to specialist NHS services. This article aims to raise awareness of lipoedema and highlight the main role that community and primary care nurses can play in identifying this long-term condition earlier. It provides detail on the condition to help signpost, refer for diagnosis and initiate conservative management for those individuals with this challenging condition.

Setting up a social enterprise for clinician-led lymphoedema services.

The introduction of social enterprises into healthcare has brought about opportunities and challenges for providers and clinicians. Dudley Lymphoedema Service, a team originally of five staff members, has undergone radical changes. The team has successfully gone through the Department of Health's right to request programme to move from a primary care trust service to become a social enterprise, LymphCare UK, which is a community interest company. There are only approximately 40 NHS services throughout the country that have taken this option as part of government changes and plans to put clinicians at the helm of services. Becoming a social enterprise has led to the service becoming bespoke, more responsive, flexible and innovative. Stepping out of the NHS has not been an easy journey but is one that the team is confident will improve outcomes for the organisation and the patients it serves.

The introduction of a "trial without catheter" model in primary care.

Action research was used to compare and evaluate the current nursing practice of urinary catheter removal. The aim of this study was to plan, implement and evaluate a trial without catheter (TWOC) model in primary care and compare it with the clinical procedure being performed in the secondary care setting. Two sample groups were used; the first sample consisted of 10 patients who had undergone a TWOC in hospital, and the second consisted of 10 patients who had a TWOC in the community. An interview with the urology nurse specialist was also undertaken to gain further qualitative data. Statistics were analysed using an unpaired t-test. Results showed that 80% of hospital patients and all community patients stated that given the choice they would prefer to have their TWOC at home. Infection rates were monitored and 40% of hospital TWOC patients developed a urine infection, whereas no infection was reported in the community group. From this small study, it was evident that there were major benefits to providing a TWOC service within the community setting.