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From our Newsletter

This page is dedicated to providing you with the latest articles from our lymphoedema newsletter. We hope that you find the news interesting and useful. Please share this page with your colleagues.

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Functional Zones

Introducing a new clinical publication supporting the use of JOBST® Elvarex® custom-fit, flat-knit compression garments, with knee and elbow functional zones used to enhance patient choice, garment suitability and potential for improved quality of life.

Lymphoedema management consists of volume reduction, addressing shape distortion and improvement of skin condition. Treatment consists of a two-phase approach, comprising an intensive and maintenance phase. The maintenance stage of treatment or self-care consists of skin care, exercise and compression garments.

The case studies demonstrate how knee and elbow functional zones enhance patient choice, garment suitability and potential for improved quality of life.

To read more about how JOBST Elvarex functional zones might benefit you and your patients please click here.



Optomising Concordance with Compression Hosiery in the Community Setting

This article provides an interesting platform for the debate surrounding concordance with compression hosiery. It suggest that practitioners should avoid blaming patients for not adhering to treatments. The potential factors that may impact upon patient concordance are seen as more relevant when set against holistic considerations. These include seven relevant factors:

  1. Pain
  2. Constriction
  3. Choice / acceptability
  4. Loss of control
  5. Mobility / dexterity
  6. Cognitive ability
  7. Application / removal

These are not exhaustive factors, but they offer further thoughts in this area, and provide possible reasons as to why a patient may be concordant or non-concordant. These areas could be addressed through education (staff / patients), leading towards greater knowledge and understanding, but also competence.

Reference: Anderson, I. (2015) Optimising concordance with compression hosiery in the community setting. BJCN, 20(02), pp.67-72

Nursing Associates (England)

Nursing Associates (NA) is a new support role for registered nurses in the delivery of care to patients’. The Willis Report (2015) recommended multiple routes into nursing, which has led to the creation of this role. The two-year program will lead to an expanded nursing role, when compared to a Healthcare Assistant, and will be regulated by the Nursing and Midwifery Council (NMC).

When launched there were 2,000 Student Nursing Associates (SNA) in 11 pilot sites. Now there are a further 1,000 SNA’s who started in April 2017 at twenty-four additional pilot sites. The educational programs for NA’s are delivered in partnership with universities and the NHS, and are set against an agreed educational curriculum.  The pilot sites will form part of an overall evaluation of the viability of the NA role with Health Education England (HEE).  If the NA role remains viable, it will complement the current route into nursing via university education, and the new higher education apprenticeship scheme.

To find out more please click here.

UCLan Course: Introduction to Chronic Oedema Management

Starting January 2018, the University of Central Lancashire is running the Advanced Certificate in Introduction to Chronic Oedema Management, designed to enhance the student’s capacity to manage lymphoedema in the clinical setting. The course leader is Justine Whitaker, Senior Lecturer at UCLan. For more details click here or email: healthcpd@uclan.ac.uk or telephone 01772 893839.

Highlights of this year's BLS Conference

The 2017 BLS Conference kicked off in style at new venue Yarnfield Park, with Sunday ‘Introduction to Lymphoedema  Workshops’ for community practitioners, to help raise awareness and understanding of this chronic condition. Guest speakers Professor Vaughan Keeley and Dr Sharaf  Eldin, presented on obesity and the importance of skin care. The workshops proved a success with more than 100 Community Nurses, Podiatrists, Tissue Viability Nurses and Leg Ulcer Nurses in attendance.

The following two day event delivered extensive education to clinical lymphoedema professionals, including a presentation by Justine Whittaker on Lymphoedema Management at Night: Views from Lymphoedema Patients in 5 Countries, sharing the impact on patient’s lymphoedema and limb volumes when night compression is used.

Professor Peter Mortimer was awarded the ‘Lifetime Achievement Award’ for this outstanding contribution to lymphoedema over the years and was on site to promote his new book ‘Let’s Talk Lymphoedema’.

Diagnosis of Upper-Quadrant Lymphoedema Secondary to Cancer

This clinical practice guideline from the American Physical Therapy Association (APTA) commissioned the writing of an evidence-based guideline for secondary lymphedema.  The goals within its development focused on the ability to 1) describe evidence-based diagnostic methods and criteria for cancer-related Secondary Upper Quadrant Lymphoedema (SUQL), 2) identify gaps in the research for the diagnosis of cancer-related SUQL, 3) create reference publications for identifying best practice related to diagnosis of SUQL. The guideline located a number of research articles that considered the multiple methods of diagnosis from 3D camera to bioimpedance analysis (BIA) as examples.  It was suggested that not one tool was seen to be absolutely accurate, or reliable, in all stages of lymphoedema. However, it was suggested BIA could be used in the diagnosis of subclinical or mild stages, whilst tape measure could be used in moderate to severe stages as examples.  There are noted limitations, such as search strategy dates, and the publication of research studies outside these dates.  However, it provides a useful reference and insight into an area that is developing in both innovation and reliability.

Author: Levenhagen, K., Davies, C., Perdomo, M

Reference:  Levenhagen, K., Davies, C., Perdomo, M. (2017) Diagnosis of Upper-Quadrant Lymphedema Secondary to Cancer: Clinical Practice Guideline From the Oncology Section of APTA. Physical Therapy, 97(7):pp729–45. https://doi.org/10.1093/ptj/pzx050

Self-measurement of upper extremity volume in women post-breast cancer: reliability and validity study

The aim of this cross-sectional study was to assess the reliability and accuracy (validity) of self-measurement (tape measure).  The 17 women who participated in this study, were measured in their clinic on day one and then day ten, through the use of water displacement and tape measure. The participants were educated/trained to perform self-measurement under supervision, and then performed self-measurement by themselves on day seven. The results suggest  that the use of self-measurement was reliable and valid. However, the study has limitations in terms of study design and sample size, which limits application, but adds further knowledge in this area.

Author: Mori T, Lustman A, Katz-Leurer

Reference: Mori T, Lustman A, Katz-Leurer M. Self-measurement of upper extremity volume in women post-breast cancer: reliability and validity study. Physiother Theory Pract. 2015;31:283–287.


Improving patient concordance in lymphoedema management with SoftFit technology

Lymphoedema and chronic oedema patients are cared for by all members  of the community nursing team. With limited knowledge and understanding of  how to improve the condition, nurses feel under immense pressure in caring  for their patients. This article includes four case studies in which lymphedema  patients were prescribed JOBST® Elvarex® or JOBST® Elvarex® Soft custom-fit, flat-knit graduated compression garments with the addition of SoftFit which proved to provide greater comfort to the patient. All four case studies indicate that wear time and concordance is improved by the addition of this new technology. SoftFit is a unique system of silicone yarns knitted into the inner welt of the compression garment.

Author: Dawn Heal, Lymphoedema Nurse Specialist, The Hampshire Lymphoedema Clinic, Basingstoke

Publishing Journal: British Journal of Community Nursing

For more information about the benefits of SoftFit and to read the full article, please click here or click here to send us an email.

Penile Reconstruction for a Case of Genital Lymphoedema Secondary to Proteus Syndrome

Primary lymphoedema is a complicated area however our understanding is developing as a result of genetic research. Proteus syndrome is considered to be a mosaic syndrome that can affect skin, bones, muscles, fatty tissues and blood and lymphatic vessels. Penile lymphoedema, secondary to Proteus syndrome, is considered to be a rare manifestation. This case report focuses on a 16 year old male undergoing surgery as result of penile oedema. This report is a an interesting case on an area that is considered rare and may not be observed by many lymphoedema practitioners.

To read the full article please click here.

Author: Ashouri, F., Manners, J., Rees, R.
Publishing Journal: ISRN Urology

Motivational interviewing: Experiences of primary care nurses trained in the method

Motivational interviewing (MI) is a technique that has gained prominence due to its perceived success within behavioural change and the focus upon the patient. This person-centred counselling approach was explored within this qualitative study. The study explored the experiences of primary care nurses trained in the technique and its application within the primary care setting. The study applied a number of approaches in gathering and analysing data (semi-structured interviews/content analysis). The themes generated centred on the mutual benefits in facilitating work with patients in need of lifestyle change. However, it also noted that resistance to change, time, support and interest were reasons for not using MI. This approach has the potential to be a beneficial tool when we consider patients who are non-concordant and who may require to be empowered, alongside the nurse.

To link to the full article visit Athens access or NHS library services.

Author: Ostlund, A., Wadensten, B., Kristofferzon, M., Haggstrom, E.
Publishing journal: Nurse Education In Practice

Sensitivity and Specificity of the Toe-Brachial Index for Detecting Peripheral Arterial Disease

The assessment of the arterial system, to establish if peripheral arterial disease is present, has a number of challenges, especially when oedema is present.

The use of ankle brachial pressure index (ABPI) is challenging with those patients diagnosed with lymphoedema / chronic oedema.  This study’s aim was to assess the sensitivity / specificity of toe brachial pressure index (TBPI) compared to ABPI.  It focused on known populations in which an ABPI accuracy would be challenged, such as the elderly, diabetic and those with renal disease.  The results of the study (119 participants) indicates a difference, with TBPI sensitivity (71%) and specificity (78%) compared to an ABPI sensitivity (45%) and specificity (93%).  The study indicates that TBPI has a role within arterial assessment when used in specific populations.

Reference: Tehan, et al. (2015). Sensitivity and Specificity of the Toe-Brachial Index for Detecting Peripheral Arterial Disease. Journal of Ultrasound in Medicine, 34(10), pp

To find out more click here.

Evidence Summary; Managing Lymphoedema: Low Level Laser Therapy

Low level laser therapy (LLLT) has been used to treat wounds and accelerate wound healing and a summary from Wounds Australia supports LLLT being used in the management of lymphoedema. The summary reviewed recent research studies which indicate LLLT has benefits in volume reduction for those diagnosed with upper limb breast cancer related lymphoedema, pain reduction and improvement in limb mobilisation. The most appropriate regime for LLLT is unclear but suggests greater benefits when LLLT is combined with compression therapy and MLD.

Reference: Haesler, E. (2015) Evidence Summary; Managing lymphoedema: Low level laser therapy

To find out more click here.

Study Finds First Possible Drug Treatment for Lymphoedema

A study led by the Rockson Lab, Stanford University School of Medicine, USA has resulted in the discovery of a potential new drug treatment for lymphoedema. The study is the collaboration between two labs, looking at two different diseases, and uncovered for the first time the molecular mechanism responsible for triggering lymphoedema, as well as a potential drug for inhibiting this process.

To learn more about the study please click here.

Footless Tights for the Management of Lipoedema

As per the Best Practice Guidelines for the Management of Lipoedema (1), custom-fit, flat-knit garments may allow more accurate fitting and accommodate uneven or distorted limb shapes better than circular-knit garments (1). If there is no oedema and no risk of oedema in the feet, footless garments can be prescribed (1). BSN medical is pleased to announce that a new style ‘thigh high footless’ is now available on Drug Tariff for both JOBST Elvarex and JOBST Elvarex Soft. This can be combined with the current ‘body bandage style’ already listed on the Drug Tariff to create ‘footless tights’. For more information, please click here.

(1) Source: Best Practice Guidelines: The Management of Lipoedema. London: Wounds UK, 2017.

June is Lipoedema Awareness Month. For helpful advice and information about lipoedema visit Lipoedema UK.

Compression Where You Need it Just Got Easier with Bellisse® and JOBST® JoViPads

Now Available

BSN medical is committed to ensuring clinicians have the products they need to manage lymphoedema / chronic oedema.

BSN medical is pleased to announce the launch of Bellisse and JOBST JoViPads a new ready-to-wear compression garment and pad range that enables you to address lymphoedema, in many areas of the body, including the head and neck, genital and breast / chest.

Bellisse is exclusively distributed by JOBST and is a medical compression garment that:

  • Helps to reduce discomfort
  • Provides gentle, even compression around the torso
  • Facilitates drainage of excess lymphatic fluid from the breast and chest-wall area
  • Offers support and compression following surgery
  • Can be used in combination with JOBST JoViPads

JOBST JoViPads offers a number of solutions to help target and address areas of stubborn oedema and fibrotic tissues and can be used in combination with compression bandaging, wrap compression systems and compression garments.

To find out more please click here.

NEW Compression Therapy Catalogue OUT NOW!

Our popular BSN medical Compression Therapy catalogue has been updated and now includes our very latest product additions and some user-friendly features to support ease of navigation and use.

Available in hard copy and digital format. To view our digital catalogue click here or to order a printed catalogue click here.

A Gripping New Idea

SoftFit technology is a new and unique benchmark standard in the treatment of lymphoedema / chronic oedema. Armsleeve and knee high styles of our leading flat-knit, custom-fit brands, JOBST® Elvarex® and JOBST® Elvarex® Soft, are now available with the additional option of SoftFit technology. This unique system of silicone yarns, knitted into the inner welt (knitted top band area of the garment) provides more gentle, seamless friction on the skin which means there is no cutting in and less slipping down, even when moving about. SoftFit is fully reimbursable and available on the Drug Tariff. 

BLS - Call for Abstracts

The oral presentation of abstracts and the display of posters detailing work done by both members and non-members is a key element in the exchange of good practice at the British Lymphology Society Conference.

Abstracts for oral and poster presentations may be submitted on the following:

  • Research studies
  • Clinical audits
  • Case reports
  • Service developments / educational initiatives including user involvement
  • Literature reviews

The deadline for abstracts is 26th May 2017. To find out how to submit click here.

The 7th International Lymphoedema Framework (ILF) Conference

This year's ILF Conference is being held in Siracusa, Italy from the 21st - 24th June. The programme is packed with key speakers and topics that we are sure will have enormous appeal to those healthcare professionals managing all aspects of care for lymphoedema, chronic oedema and lipoedema patients. We are excited to hear that Karen Morgan, National Lymphoedema Education and Research Lead in Wales has been accepted to present the findings of the ‘On the Ground Education' and the development of the 'Chronic Oedema Wet Leg Pathway' programme that took place in South Wales. To find out more about this conference click here.

JOBST® FarrowWrap Drug Tariff Range Expanded

BSN medical is pleased to announce that the JOBST FarrowWrap Drug Tariff range is now expanded to include the gauntlet.

We believe the addition of the gauntlet onto the Drug Tariff will be welcome news to healthcare professionals and patients. It can also be combined with the JOBST FarrowWrap armpiece, which is already fully reimbursable on the Drug Tariff.

Best Practice Guidelines for Lipoedema

BSN medical is proud to be a corporate sponsor of the ‘Best Practice Guidelines for the Management of Lipoedema’ produced by Wounds UK. These guidelines were produced by expert clinicians involved in the treatment of lipoedema from all around the UK, and who are passionate about improving awareness and care of patients with lipoedema. The guidelines highlight the need for compression therapy in the treatment of lipoedema and lipo-lymphoedema patients, and also post-liposuction.

To read the guidelines click here.

Lymphoedema Courses Now Available

You can find out which education route is right for you with the University of Glasgow. One of their lymphoedema courses might be what you are looking for to develop new skills and knowledge in lymphoedema management. 

To find out more please click here.

3rd Advanced Lymphoedema Specialist Event

Thank you to all the delegates that attended BSN medical’s 3rd Advanced Lymphoedema Specialist Event at the Park Regis Hotel in Birmingham this week. This engaging event included the launch of the revolutionary new JOBST® Relax custom-fit compression garment range for the management of lymphoedema at night and the delegates received a technical presentation from the designer of the product. This was preceded by an informative presentation from Justine Whitaker on the ‘Lymphoedema management at night: views from patients across five countries’ study that was published in the BJCN in October 2016 and provides an insight and understanding into the use of night-time compression in the management of lymphoedema from a patient perspective. Rebecca Elwell’s early product evaluation feedback on the use of JOBST Relax on two patients prompted lots of discussion. In support of the BLS Lymphoedema Awareness Week and the launch of this product, all delegates participated in ‘the big shleep over’ in their JOBST Relax garment, which provided valuable feedback in the management of lymphoedema.

Please click here to learn more information on JOBST Relax and click the clinical tab to read the article.

Dorset Lymphoedema Steering Group Event

A “Chronic Oedema Awareness Day” was held this week to help educate and raise awareness of lymphoedema / chronic oedema in the community, with a focus on; management of obesity-related chronic oedema, the compression garment choices available on FP10 and the local referral pathway.

The day was supported and sponsored by BSN medical Lymphoedema Development Manager Joe Emms and Account Manager Simon Rowles.

Genetics and Lymphoedema

The future of genetics is an evolving story, with new techniques that enable manipulation of DNA, and whether they may serve as a progressive means in re-writing this story.  However, genetics can be a confusing subject to navigate.  This comment piece summarises some of the key terms used within genetics, historical developments and how these relate to lymphoedema.

To find out more please click here.

References: Cooper, G. (2017) Genetics and lymphoedema: a future yet to be fully discovered. British Journal of Community Nursing, 22(1), pp. 646–648

Lymphoedema Awareness Week Begins!

The second day of the annual British Lymphology Society (BLS) Lymphoedema Awareness Week begins and many events are taking place up and down the country.

Today is also recognised as International Lymphoedema Awareness Day and around the world events are taking place to support awareness, research and education. 'Choose your Walk' is being supported by BSN medical USA. It follows on from the good work at last years event which featured Kathy Bates and friends, the well-known actress who lives with lymphoedema following breast cancer. To find out more click here.

To assist in raising lymphoedema awareness, BSN medical is dedicating a  newsletter to lymphoedema, with information that you will find interesting, as well as feedback on local awareness events. To keep up-to-date with the BLS activities please visit their website, click here.

BLS Conference 2017

The BLS has confirmed that Yarnfield Park Training and Conference Centre in Stone, Staffordshire is the new venue to host this two-day event.

Date for your diary: 1st - 3rd October

For further conference details and to submit an abstract click here.

What are the perceived barriers that prevent patients with lymphoedema from continuing optimal skin care?

Patient concordance and its impact upon treatment / management options is an area that creates debate amongst healthcare professionals and therapists.  This qualitative study focuses on the patient experience and how they live with lymphoedema.  It also considers how a patient feels about the need and therapeutic benefit in relation to skin care, and why they appear to be non-concordant. The results of this study recommend patients education and support to help influence patient understanding of the consequences of secondary complications and exacerbations of symptoms when skin care is not maintained.

To find out more please click here.

Reference: James, S. (2011) What are the perceived barriers that prevent patients with lymphoedema from continuing optimal skin care?', Wound Practice & Research, 19(3): 152-157. 

Commissioning Guidance for Lymphoedema Services for Adults Living With and Beyond Cancer

The political and economic environment has led to NHS service provision coming under greater scrutiny.  England has yet to develop national standards regarding the provision and structure of lymphoedema services.  However, work in London has led to a PAN London commissioning document that may have importance and impact beyond the capital.

This commissioning guidance document focuses on services for people with lymphoedema as a result of cancer treatment and sets out what a good service looks like, including patients with primary or secondary lymphoedema. This document which was endorsed last year by the Cancer Commissioning Board, provides a compelling account and strong economic reasoning to why there is a need to improve services.

To find out more please click here.

A review of the evidence for adjustable compression wrap devices

Adjustable compression wrap devices (ACWD) are a recognised effective treatment solution in the treatment of lymphatic and venous conditions.  This evidence review considers the clinical efficacy and the economic implications surrounding ACWD and concludes that claims against cost savings are compelling, alongside scope for improved quality of life for patients.

There is also recognition that further clinical research needs to be carried out in this area to better understand the long term nature of this treatment option.

To find out more please click here.

Reference: Williams, A. (2016) A review of the evidence for adjustable compression wrap devices ACWD

New Developments in Clinical Aspects of Lymphatic Disease

Research in lymphoedema is gaining pace and so is our understanding of the lymphatic system.  This article discusses some new developments in the understanding of the lymphatic system and its major functions. You can also read about the developments in understanding genetics related to primary lymphoedema. This clinical investigation concludes that more work needs to be carried out in this area. The hope is that with these developing technologies, in lymphatic science, there will be meaningful advances in the future.

To find out more please click here.

Reference: Mortimer, P., Rockson, S. (2014) New development in clinical aspects of lymphatic disease.  The Journal of Clinical Investigation. 124(3), pp.915-921

The Foeldi College in the UK

The Foeldi College, established in the 1980's, is one of the world's leading training providers for lymphoedema management and delivers exceptional levels of theoretical and practical based training.

In 2017 the Foeldi College is again coming to the UK with an educational programme covering basic, full therapy, and review courses in manual lymphatic drainage (MLD) / decongestive lymphatic therapy (DLT).

For more information on these courses and how to register please click here.

BLS - New Updated Guidelines

The BLS has recently issued updates to two key documents, supporting members with revised cellulitis guidelines and the benefits of using Amoxicillin over Flucloxacillin for the treatment of cellulitis in lymphoedema patients.

These documents are available in the members area of the BLS website www.bls.com or simply by clicking on the link below.

National Lymphoedema Conference 2017

We are pleased to announce that BSN medical will be attending the National Lymphoedema Conference in London on the 2nd March 2017.

The focus of the event is “Considering the physical and psychological impact of lymphoedema”.

Now in its fourth year and with the full backing of the British Lymphology Society (BLS) and Lipoedema UK, this conference benefits from a very strong and enticing programme aimed at attracting Lymphoedema Clinical Nurse Specialists, Community Nurses and Nurse Specialists interested in new and progressive treatments in lymphoedema management. The British Journal of community Nursing (BJCN) have partnered with the BLS for this conference to ensure current topics are incorporated into the programme, making it fresh and up-to-date. Speakers include Alex Munnoch, Jane Wigg, Denise Hardy and Dr Karen Robb.

Manual lymphatic drainage (MLD) for lymphoedema following breast cancer

This systematic review undertaken by the Cochrane collaboration, was to assess the efficacy and safety of MLD in treating breast cancer related lymphoedema (BCRL). The review searched a number of databases which resulted in six studies being reviewed. The studies looked at MLD and compression treatments. The results of the review suggest MLD is safe and may offer greater benefit in addition to compression treatments, particularly when treating mild to moderate BCRL. Trials with an armsleeve had volumetric inconsistencies therefore further research is required. Despite these inconsistences 60-80% of participants felt better (reduction in pain and heaviness) regardless of which treatment was received. Additional outcomes are also included within this study and it is worth reading the full systematic review.

To find out more please click here.

References: Manheimer, E et al. (2015) Manual lymphatic drainage for lymphoedema following breast cancer (Review). London: Cochrane database.

Associations between the treatment and outcomes of patients with upper and lower limb lymphoedema in Japan: a cross-sectional observational study

This cross-sectional study took place in Japan with the objective of examining the association between lymphoedema treatments and outcomes. Lymphoedema outpatient clinics were the setting with a total of 170 patients participating in the study.  Data collection involved medical records, physical assessments and interviews. Results from the study suggest that secondary lymphoedema was present in 92.9%, with 53.8% of this figure represented by lower limb conditions.  Patients using compression garments were 2.85 times more likely to be satisfied with their treatment compared to those not using compression garments (p<0.01).   Patients receiving simple lymphatic drainage (SLD) exhibited a greater level of satisfaction compared to those not in receipt of SLD (p<0.01). It was also noted that patients quality of life (QOL) was higher in those receiving complete decongestive therapy (CDT) compared to those not in receipt of CDT.

To find out more please click here.

References: Luchi, T. et al (2015)Associations between the treatment and outcomes of patients with upper and lower lymphoedema in Japan: A cross-sectional observational study. London: International Journal of Nursing Studies, 52, pp.913-919.


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