Systematic review: conservative treatments for secondary lymphedema

<p>Abstract</p> <p>Background</p> <p>Several conservative (i.e., nonpharmacologic, nonsurgical) treatments exist for secondary lymphedema. The optimal treatment is unknown. We examined the effectiveness of conservative treatments for secondary lymphedema, as well as harms related to these treatments.</p> <p>Methods</p> <p>We searched MEDLINE^®, EMBASE^®, Cochrane Central Register of Controlled Trials^®, AMED, and CINAHL from 1990 to January 19, 2010. We obtained English- and non-English-language randomized controlled trials or observational studies (with comparison groups) that reported primary effectiveness data on conservative treatments for secondary lymphedema. For English-language studies, we extracted data in tabular form and summarized the tables descriptively. For non-English-language studies, we summarized the results descriptively and discussed similarities with the English-language studies.</p> <p>Results</p> <p>Thirty-six English-language and eight non-English-language studies were included in the review. Most of these studies involved upper-limb lymphedema secondary to breast cancer. Despite lymphedema's chronicity, lengths of follow-up in most studies were under 6 months. Many trial reports contained inadequate descriptions of randomization, blinding, and methods to assess harms. Most observational studies did not control for confounding. Many studies showed that active treatments reduced the size of lymphatic limbs, although extensive between-study heterogeneity in areas such as treatment comparisons and protocols, and outcome measures, prevented us from assessing whether any one treatment was superior. This heterogeneity also precluded us from statistically pooling results. Harms were rare (< 1% incidence) and mostly minor (e.g., headache, arm pain).</p> <p>Conclusions</p> <p>The literature contains no evidence to suggest the most effective treatment for secondary lymphedema. Harms are few and unlikely to cause major clinical problems.</p

Teledermatology reduces the number of patient referrals to a dermatologist

During a two-year study, 505 teledermatology consultations were carried out on 503 patients of 29 participating general practitioners (GPs) in the province of Friesland. One overview and two detail digital photographs of the skin problems were taken on a digital camera and attached to an email message containing standard clinical information. These email messages were sent to a dermatologist, who replied by email after evaluation. After a median follow-up time of 548 days, the GPs were interviewed about the dermatological referrals. The reduction in referrals was 51% (0.95 confidence interval = 47-58%) when the GP had the intention to refer. When the GPs had no intention to refer, there turned out to be a secondary traditional consultation in 17% of cases. The reduction of 51% of referrals after store-and-forward teledermatology consultation was similar to that seen in other studies of videoconferencing. Consultation using digital store-and-forward teledermatology by the GP can halve the number of referrals to a dermatologist for selected patients