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Lymphoedema Service Update
Gillian McCollum / Pippa McCabe Lymphoedema Clinical Leads
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Belfast Trust
Who are we?
Predominantly outpatient service
3.2 WTE clinical staff
Admin support/therapy assistant just appointed (vacant since Feb 2009)
Clinical Lead coordinates & develops the services in SEB & NWB – 0.5 WTE clinical & 0.5 WTE non clinical
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Belfast Trust
Lymphoedema Specialists
South & East Belfast Service:
Jill Lorimer (0.7 WTE)
Diane Stronge (0.5 WTE)
Louise Kerr (0.5 WTE)
North & West Belfast Service: Emma Christie (0.5 WTE) Tanya Coppel (0.5 WTE)
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Belfast Trust
Where do we see patients?South & East Belfast: Cancer Centre, BCH Holywood Arches Centre Domicillary
North & West Belfast: Ballyowen HC Carlisle HWB Centre Grove HWB Centre Domicillary
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South Eastern Trust
Who are we?Service commenced Feb 2008, consisting of:Pippa McCabe – Clinical Lead (0.8 WTE)Laura Patterson – Lymphoedema Specialist (1.0 WTE)
We also have other lymphoedema trained physiotherapists in the trust who treat specific groups of patients:Janet Gabbey (oncology in-patients)Lesley Nelson (palliative care)
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South Eastern Trust
Where do we see patients?
Ards Community Hospital
Bangor Health Centre (although less regularly)
Marie Curie Centre Belfast
Lagan Valley Hospital Downpatrick – Pound
Lane Health Centre
Ards Community Hospital
Bangor Community Hospital
Ulster Hospital Lagan Valley Hospital Downpatrick Hospital Downshire Hospital
Out-Patients In-Patients
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Specialist palliative care service in the community, NI hospice, Marie Curie & acute oncology service in the cancer centre also treat some lymphoedema patients
Those patients who have chronic skin and/or wound issues may be treated in conjunction with TVN, practice nurses or district nurses
Involve wider multidisciplinary team as necessary – GP, dietician, podiatry, OT etc
Other services
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Who do we see?
Primary lymphoedema patients Congenital abnormality of lymphatic
system Can be hereditary May be associated with a syndrome, for
example:Syndrome Name Age of Onset
Milroy’s Disease Birth/Childhood
Turner’s Syndrome Birth/Childhood
Meige’s Syndrome Puberty
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Who do we see?
Secondary Lymphoedema Patients obstruction or interruption of the lymphatic system by
an external causeTrauma and tissue damage
Lymph node excision
Radiotherapy
Burns
Varicose vein surgery/harvesting
Large/circumferential wounds
Malignant Disease Lymph node mets
Infiltrative Carcinoma
Lymphoma
Pressure from large tumours
Inflammation Rheumatiod Arthritis
Psoriatic arthritis
Dermatitis/eczema
Immobility and dependency
Dependency Oedema
Obesity
Paralysis
Venous Disease Chronic venous insufficiency
Venous ulceration
DVT
Artificial Lymphoedema
Self harm
Low albumin
Infection Cellulitis
Lymphadenitis
Filiariasis
(CREST 2008)
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What services do we provide?
Advice and information on skincare and exercise
Manual Lymphatic Drainage Multi-Layer Lymphoedema Bandaging
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What services do we provide?
Compression Garments Kinesio taping Teach patient & their carers self
management techniques 6 monthly review appointments Access to a quarterly complex clinic with
involvement from dermatology, vascular and palliative care consultants
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Other roles & achievements
Education – trust programme; pre & post graduate training; courses; advice booklets etc
Belfast Trust Lymphoedema Network - partnerships with relevant specialities such as vascular, dermatology, oncology etc
Facilitating implementation of cardiovascular & cancer service framework standards
PR campaign – Belfast Telegraph (Nov 2009) Research Clinical Minimum Data Set Engagement with PPI
For further details see www.lnni.org
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Waiting list
Increase in rate of referral Must meet access targets of 9 weeks Increase in complexity of cases Length of intensive treatment required
varies greatly from 2 weeks – 6 months 6 monthly reviews
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Variety of Lymphoedema Cases
Simple Arm Lymphoedema Complex Leg Lymphoedema
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Concerns & Issues
Major reforms within health service Funding Efficiency savings Recruitment Lack of dedicated treatment space Limited capacity of lymphoedema
service
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Solutions to the issues??
Raise profile of lymphoedema & lobby at Stormont – but need to be realistic
Raise awareness – patient & professional education
Promote early diagnosis & referral → less intensive treatment required for acute stage of condition
Empower patients & their carers to self manage this chronic condition