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What is Lymphoedema?   Tissue Viability Remains in the Headlines   Wounds UK Books	This month sees the launch of the new Lymphoedema journal in association with the British Lymphoedema Society. The months' editorial comes from the Editor of the Journal, Christine Moffatt. Lymphoedema steps into the healthcare spotlight The journal of lymphoedema has been produced in partnership with the Lymphoedema Framework Project (LFP) and Wounds UK. The LFP is a UK-based research collaboration that involves lymphoedema specialists from the British Lymphology Society (BLS), organisations responsible for care delivery, researchers and patients from the Lymphoedema Support Network (LSN), and the compression and hosiery industry. The LFP was established to put lymphoedema care firmly on the healthcare agenda. Wounds UK is a healthcare communications company that is dedicated to providing affordable education to all healthcare professionals working in wound and lymphoedema management. The launch of this publication comes at a time when specialists involved in lymphoedema management and patients with lymphoedema are fighting to increase awareness of, and dispel the myths surrounding, this distressing condition. While lymphoedema management is well-developed in many countries in mainland Europe and treatment is reimbursed, this is not the case in many countries throughout the world. In many areas, lymphoedema is not considered a health priority despite the huge waste of resources associated with its poor management, and the considerable clinical and psychological morbidity associated with the condition. A lack of understanding of the nature of the condition has led to the misconception that lymphoedema arises only as complication of cancer treatment, when the fact is that half of all cases of lymphoedema are either primary or other secondary forms of the condition that are unrelated to cancer. The Journal of Lymphoedema aims to put lymphoedema care on the map, and help develop the clinical practice of all professionals involved in this area of care. The journal, published twice a year, is peer-reviewed throughout to ensure a consistent high editorial standard that reflects current clinical practice and issues surrounding lymphoedema care. In this issue, we begin a series on diagnostic investigations with an excellent review of lymphoscintigraphy by Vaughan Keely. This article shows the complexity of this investigation and calls for an international standard of use and interpretation; a sentiment that is echoed throughout many of the articles. Neil Piller's refreshing review of the past five years of development in lymphoedema allows us to reflect on many aspects of established care. The debate within this edition, on the role of breathing in lymphoedema treatment, highlights just how different professional views on areas of established practice are and the need for further research to tease out the potential of this component of treatment. Lymphoedema, secondary to breast cancer, remains a considerable health problem. Peter Franks, highlights how differences in methodology make comparisons between populations difficult to interpret. The article on the LSN shows how effective this patient organisation has been in raising political awareness and highlights the value of involving patients in developments in care. In this issue, one of its members gives a touching insight into the realities of living with the condition. Rebecca Billingham, Chair of the British Lymphology Society, also discusses a complex case that shows the difficulties patients face when given their diagnosis and the impact this may have on them and their families. All lymphology societies are invited to include information about their work and forthcoming events within the journal's society update pages. There is much that can be learnt from the experience of others and we are eager to provide a platform for the sharing of information. This launch journal also contains a valuable supplement, The Template for Practice-Compression Hosiery in Lymphoedema, which brings together the technical, scientific and practical issues concerning the effective use of compression hosiery. We very much hope that this journal will be a useful resource and that it contributes to raising the profile of lymphoedema throughout the world. Christine Moffatt Christine is Professor of Nursing at the Centre for Research and Implementation of Clinical Practice (CRICP), Thames Valley University, London	References Latest journal references

What is Lymphoedema? Lymphoedema is a chronic condition that presents with swelling (oedema) of one or more limbs and may involve the trunk. This can also involve the head, neck, the breasts and the genitalia. In essence there is an imbalance between lymph production and lymph absorption. Fluid gathers in the interstitial spaces due to the failure of the lymphatic system to function. There are two types of lymphoedema, primary and secondary. Primary lymphoedema results from abnormalities or malformation of the lymphatic vessels and or lymph nodes. Primary lymphoedema can occur at any age and is usually only confirmed once all possible causes of lymphoedema have been ruled out. Secondary lymphoedema is caused by damage to the lymphatic system resulting in functional deficiency (International Society of Lymphology 2003) The most common form of secondary lymphoedema is caused by filarial infection transmitted by the mosquito. Other key causative factors include, trauma and tissue damage, infection, malignancy, venous disease, inflammation, immobility and factitious injury. Diagnosis involves thorough clinical history taking and physical examination with early identification and initiation of treatment helping to improve long term outcomes. Treatment involves skin care, exercise and movement, and for some patients manual lymphatic drainage may be appropriate. For many patients multilayer compression lymphoedema bandaging will be required. Pivotal to successful treatment is the involvement, education and support of the patient. Long term treatment involves the use of compression hosiery in order to provide high working pressure and low resting pressure to allow lymphatic refill in the limb. As with all compression garments, accurate assessment and fitting of the garments is essential in order to prevent complications and improve lymphatic flow.   Keep reading for: Tissue Viability Remains in the Headlines References that relate to lymphoedema management and treatment Download this newsletter in PDF format Tissue Viability Remains in the Headlines There is renewed concern among many in tissue viability that jobs may still be under threat. Many health boards and trusts are reducing services in an effort to combat recent budget deficits. To add insult to injury, a recent submission from Advanced Medical Solutions to the Health Committee has served only to anger tissue viability nurses and distract attention from the real debate, which is about providing an efficient quality driven service. It would seem that memories are short when it comes to tissue viability services. Ten years ago I was summoned to our Hospital board room and asked to set up a tissue viability service. There was a large budget deficit caused by ad hoc bed rentals and to a lesser extent dressings use. Within 6 months the annual spend of £500,000 on specialised beds and mattresses was cut to £80,000 per year, with no drop in service standards. The use of dressings was tailored using a formulary which was not restrictive but prevented inappropriate use. Staff education, research and audit were also a major part of the role and presenting the findings at relevant conferences was a key part of this work. This is what a modern and efficient NHS is about. Central to all of our work is the prevention and management of patients with pressure ulcers. This has always been viewed as a key indicator of quality care in all care settings and despite growing fears of litigation, it would appear that tissue viability and pressure ulcer prevention are no longer issues for those involved in allocation of NHS resources. In the past I have found that the presence of a tissue viability nurse can ensure that quality of care improves. At the recent Wounds UK Northern Ireland conference, a primary care Tissue Viability Team, consisting of a podiatrist a dietician and a tissue viability nurse, discussed their role in managing complex patients. The description of their work in the community, demonstrated the complexity of the tissue viability problem and how team working can boost the quality of service provided. The predicted increase in the number of elderly patients over the next decade will have a huge impact on the health service and on tissue viability services, providing us with huge challenges. At a time when investment is needed in our service to prepare for this future, it is apparent that the NHS views tissue viability as a 'disposable service'. Unfortunately it will be patients and their relatives who will suffer as a result of these reductions in service.   Keep reading for: Wounds UK Books References that relate to lymphoedema management and treatment Download this newsletter in PDF format Wounds UK Books T'Wound Healing: A systematic approach to wound healing and management' edited by David Gray and Pam Cooper which has recently been reviewed in the Journal of Community Nursing (vol 20, issue 9, pp 44): 'This excellent book is in four chapters based on Applied Wound Management, an emerging system which gives a clear indication of progress, good and bad and which would improve communication between members of a health care team and between different health care teams....... a useful addition to any practitioners collection of reference books.' Marianne Clothier RGN, DN (Dip), BSc (Hons) in Nursing, Aberystwyth For the month of October only this book will be on sale at £15.00, a saving of almost £10 on the recommended price. To purchase this or any other Wounds UK book, go to www.wounds-uk.com   Keep reading for: Events References that relate to lymphoedema management and treatment Download this newsletter in PDF format Events 26th October 2006 - TVS Symposium, London -www.tvs.org.uk 13th-15th November - Wounds UK conference will be held in Harrogate 16 - 19th November - CAWC, Canada -www.cawc.net Keep reading for: References that relate to lymphoedema management and treatment Download this newsletter in PDF format The following references relate to lymphoedema management and treatment: Azurdia RM, Guerin DM, Verbov JL. (1999) Chronic lymphedema and angiosarcoma. Clin Exp Dermatol. 24:270-272 Badger, C. (2000) 'A randomised, controlled, parallel-group, clinical trial comparing multilayer bandaging followed by hosiery versus hosiery alone in the treatment of patients with lymphedema of the limb'. Cancer, 88: 2832-7 British Lymphology Society. (1999a) Chronic Oedema Population and Needs. British Lymphology Society, Caterham, UK. British Lymphology Society. (1999b) Manual lymphatic drainage (MLD) and simple lymphatic drainage (SLD) - guidelines for health professionals. British Lymphology Society, Caterham, UK. Buren JM, Linton C. (2000) The role of exercise in treating lymphedema. Rehabil Manage: Interdisciplinary J Rehabil. 13:26, 28, 30-31. Cefai C., Lund E. (2003) 'The management of acute and recurrent inflammatory episodes in chronic lymphoedema'. British Lymphology Society Newsletter, 36: 13-16. Carter BJ.(1997) Women's experiences of lymphedema. Oncol Nurs Forum. 24:875-882. Hardy D, Taylor J.(1999) Clinical audit. An audit of non-cancerrelated lymphoedema in a hospice setting. Int J Palliative Nurs. 18, 20-27. Ko DS, Lerner R, Klose G, Cosimi AB. (1998) Effective treatment of lymphedema of the extremities. Arch Surg; 133:452­8 Moffatt C. (2000) 'Compression therapy'. Journal of Community Nursing, 14: 26-36. Moffatt C et al (2002) Lymphoedema: An underestimated health problem. British Dermatology, 147, supplement 62, 8 Mortimer PS (2000) ABC of arterial and venous disease Swollen lower limb-2: Lymphoedema BMJ Vol 320 (7248): 1527. Williams A.F. (2003) 'An overview of non-cancer-related chronic oedema - A UK perspective'. WorldWide Wounds Online journal http://www.worldwidewounds.com   Download this newsletter in PDF format