The Lymphoedema Genitourinary Cancer Questionnaire in urology follow‐up clinics

Is the Lymphoedema Genitourinary Cancer Questionnaire (LGUCQ) useful to men treated for genitourinary cancer through facilitating symptom disclosure? Lymphoedema can be debilitating and progressive and its association with bladder, prostate, testicular and penile cancer, either as a consequence of treatment or progressive disease is well recognized. However, lymphoedema is generally unrecognized during follow‐up. Research on genitourinary cancer‐related lymphoedema is sparse with a lack of reliable prevalence figures. A lack of empirical understanding of the experiences of these men led to the development of the LGUCQ, a simple two‐sided tool to facilitate self‐reporting of symptoms and difficulties associated with lymphoedema. Related pilot work suggests that written self‐report tools enable men to disclose more sensitive information than they would verbally. However, the LGUCQ had not been formally evaluated in an uro‐oncology department to identify the benefits from the perspective of the patients and health professionals. Thematic analysis of completed LGUCQs and interviews with patients and staff were performed. Emergent themes included the perceived barriers to symptom disclosure, the LGUCQ as facilitator and pragmatic addition, the support needs of patients and health professionals and refinements required for roll out. Issues limiting identification of lymphoedema within uro‐oncology services existed. Findings suggest the inclusion of the LGUCQ within uro‐oncology clinics could lead to earlier identification of lymphoedema. Patients could identify genital oedema problems with the LGUCQ increasing prompt and accurate disclosure and normalizing the experience

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

Millennial scale control of European climate by the North Atlantic Oscillation from 12,500 BP: the Asiul speleothem record

Contemporary climate in Europe is strongly influenced by the North Atlantic Oscillation (NAO), the atmospheric pressure dipole between Iceland and the Azores1. Under positive NAO conditions winter storm tracks associated with the Atlantic Westerly Jet (AWJ) migrate northwards, leading to wetter and warmer winter conditions in north-western Europe and dry conditions in southern Europe; including the Iberian Peninsula. Under the negative NAO phase, storm tracks weaken and shift southwards reversing the pattern1. Existing proxy records of the NAO suggest that this atmospheric process only began to dominate European climate at approximately 8000 years BP, related to the final breakup of the Laurentide ice shelf2. However, here we present evidence of precipitation changes from a high-resolution speleothem δ18O record from northern Iberia, which indicates NAO-like forcing extending throughout the Holocene and into the Younger Dryas (YD) at 12,500 years BP. These variations in precipitation delivery relate to an underlying millennial scale cycle in NAO dynamics. The speleothem δ18O is strongly correlated to existing records of North Atlantic Ocean ice rafted debris (IRD)3, indicating an NAO-like connection with oceanic circulation during the Holocene2. These large-scale atmospheric processes have dramatically influenced the delivery of precipitation to northern Iberia and may have played a decisive role in environmental and human development in the region, throughout the Holocene

Receiving end of life care at home: experiences of the bereaved carers of cancer patients cared for by health care assistants

First paragraph: Many terminally ill cancer patients and their families prefer for death to occur at home rather than in an institution where the majority of care falls to the patient’s family and friends. As death approaches caring can become an increasing burden for the patient’s informal carers. This issue has long been recognized by health care professionals and also in current policy for end of life care, with the End of Life Care Strategy for England (DH, 2008) highlighting the need for community services to enable home death by supporting both patient and their family carers. Basic nursing, social and respite home care has frequently been provided by basically trained, unqualified nursing staff, including auxiliary nurses and health care assistants (HCA). Whilst increasing research has been undertaken into the needs of family carers (Stajduhar et al, 2010; Funk et al 2010), relatively little has focused on the care HCAs deliver (Herber & Johnston 2012) and very few studies have explored the experience of bereaved family carers of patients who have received such services

North Atlantic forcing of moisture delivery to Europe throughout the Holocene

Century-to-millennial scale fluctuations in precipitation and temperature are an established feature of European Holocene climates. Changes in moisture delivery are driven by complex interactions between ocean moisture sources and atmospheric circulation modes, making it difficult to resolve the drivers behind millennial scale variability in European precipitation. Here, we present two overlapping decadal resolution speleothem oxygen isotope (δ18O) records from a cave on the Atlantic coastline of northern Iberia, covering the period 12.1–0 ka. Speleothem δ18O reveals nine quasi-cyclical events of relatively wet-to-dry climatic conditions during the Holocene. Dynamic Harmonic Regression modelling indicates that changes in precipitation occurred with a ~1500 year frequency during the late Holocene and at a shorter length during the early Holocene. The timing of these cycles coincides with changes in North Atlantic Ocean conditions, indicating a connectivity between ocean conditions and Holocene moisture delivery. Early Holocene climate is potentially dominated by freshwater outburst events, whilst ~1500 year cycles in the late Holocene are more likely driven by changes internal to the ocean system. This is the first continental record of its type that clearly demonstrates millennial scale connectivity between the pulse of the ocean and precipitation over Europe through the entirety of the Holocene

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