Evaluating the cost of managing patients with cellulitis in Wales, UK: A 20-year population-scale study

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.

The Lymphatic System, Lymphoedema, and Medical Curricula-Survey of Australian Medical Graduates

The aim of this study was to survey the perceptions of recent (i.e., within the past 12 months) Australian medical graduates regarding (i) their understanding of the lymphatic system and lymphoedema, and (ii) the extent to which the lymphatic system and lymphoedema were covered as part of their medical degree. Medical graduates were invited to participate in a 17-item online survey that asked respondents to rate their level of agreement (using a 5-point Likert scale; higher scores = higher agreement) to statements that explored their understanding and comprehensiveness of their medical degree. Responses to each item were described using n (%). Subscale scores for understanding and medical degree were computed by summing scores of individual items, described using means (SD) and compared by participant characteristics. Medical graduates (n = 230) perceived their understanding of the lymphatic system and lymphoedema to be low, and comprehensiveness of medical curricula specific to the lymphatic system and lymphoedema to be lacking. Subscale scores did not differ by participant characteristics. Improvement of medical graduates understanding of lymphoedema may facilitate greater awareness of lymphoedema, thus optimizing the timeliness of diagnosis and access to treatment.

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.

Challenges and opportunities identified for lymphoedema services in Wales during the COVID-19 pandemic

BACKGROUND

During the COVID-19 pandemic, lymphoedema staff adapted services, providing care remotely, and worked in other NHS sectors. The impact on services and staff must be understood in order to safeguard patient care and foster workforce resilience.

AIMS

To evaluate the experiences of clinical and non-clinical lymphoedema staff in Wales during the COVID-19 pandemic.

METHODS

An anonymous online survey, based on scoping work, was sent out via the Welsh lymphoedema services mailing list.

FINDINGS

71% (68/96) of eligible lymphoedema staff completed the survey. More than half supported lymphoedema services (40/68) with the remaining staff deployed elsewhere. Overall, staff and services felt prepared for new ways of working. Concerns about others and the future burden on services when life returned to normal were reported. Opportunities identified included education initiatives and virtual services.

CONCLUSION

Lymphoedema services were well prepared to deliver virtually, enable effective care and share knowledge. Co-ordinated efforts to uphold patient advocacy will support virtual services to meet their needs.

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.

Interprofessional education (IPE) in clinical practice for pre-registration nursing students: A structured literature review

OBJECTIVES

To explore the experiences of nursing students after clinical IPE activities through a review of contemporary literature then use the context of nursing programmes in Singapore to consider the transferability of the findings.

DESIGN

Structured literature review.

DATA SOURCES

A search of international qualitative literature no older than five years and published in English was conducted on CINAHL, Embase, Medline and Pubmed.

REVIEW METHODS

A systematic and structured approach was guided by Cooper's five-step approach to review the literature. The Critical Appraisal Skills Programme qualitative checklist and the Appraisal of Guidelines Research & Evaluation reporting checklist were used to critically appraise literature in this review.

RESULTS

13 papers were included for qualitative synthesis. The literature most commonly reported that students had a better understanding of professional roles, improved communication and teamwork. In contrast, the most commonly reported negative experience involved some examples of disparity within the team.

CONCLUSION

Overall findings show that positive student experiences outweigh negative ones. Nursing programmes might be able to reap similar outcomes subject to contextual and cultural differences. However, further research is recommended before IPE in clinical practice is implemented in current nursing programmes in the local setting.

Case study: Obesity, genital oedema and lower limb compression bandaging

The purpose of this article is to present an evidence-based rationale for lymphoedema compression bandaging, one aspect of treatment for a patient with complex lower limb lymphoedema. The current health care climate requires treatment decisions to be transparent, based on the best available evidence. The challenge faced by community nurses is to formulate treatment plans which incorporate patients' preferences and best use limited resources provided by clinical environments. The article appraises research in order to formulate a suitable treatment plan and provides discussion and reflection regarding the challenges faced by the nursing profession in achieving evidence-based practice. Evidence-based practice is beneficial in formulating patient-centred and cost-effective treatment plans. Developing competence is not straightforward; however, clinical guidelines can provide much needed guidance.

Development of the lymphoedema genito-urinary cancer questionnaire

The aim of this study was to develop a patient self-report tool to detect symptoms of genital and lower limb lymphoedema in male survivors of genitourinary cancer. The study incorporated the views of patients and subject specialists (lymphoedema and urology) in the design of a patient questionnaire based on the literature. Views on comprehensiveness, relevance of content, ease of understanding and perceived acceptability to patients were collated. The findings informed the development of the next iteration of the questionnaire. The overall view of participants was that the development and application of such a tool was of great clinical value and the Lymphoedema Genito-Urinary Cancer Questionnaire (LGUCQ) has significant potential for further development as a research tool to inform prevalence of this under-reported condition.