BMJ Learning Module
In response to requests from members to raise awareness of lymphoedema with GPs and other doctors, the Lymphoedema Support Network commissioned BMJ Learning to produce an online teaching aid to assist in the recognition and diagnosis of lymphoedema and chronic oedema, onward referral and to highlight how GPs can assist in the management of their patients’ condition.
The BMJ learning module is now live and completely free to all healthcare professionals. If you are a healthcare professional and would like to complete the module, you need to register with BMJ Learning by following this link. If you are a patient/carer, do encourage your GP/nurse/healthcare professional to complete the module.
The two medical professionals involved in the production of the module were Professor Peter Mortimer MD, FRCP, Professor of Dermatological Medicine at the Royal Marsden and St George's Hospitals, and the UK’s leading lymphoedema authority, Dr Graham Easton, MSc MRCGP MAcadMEd, Deputy Director of Primary Care Education Faculty of Medicine, Imperial College London, Charing Cross Campus. They both recommend that healthcare professionals, and doctors in particular, complete the module as part of their Continuing Professional Development. Professor Mortimer comments:
"Doctors in general have difficulty diagnosing and treating lymphoedema but this need not be so. Contrary to what used to be taught there is no clinically significant venous reabsorption and it is the lymphatic that is (in the steady state) responsible for draining tissue fluid. This means that all chronic peripheral oedema indicates lymphatic failure. Tissue fluid is produced by (blood) vascular filtration and then drained by the lymphatic. A clinical approach to a chronically swollen foot or leg i.e. present for more than 3 months should consider a failure of lymph drainage first. A typical lymphoedema will exhibit certain characteristic signs such as thickened skin and subcutaneous tissues e.g. a positive Kaposi-Stemmer sign. Many forms of chronic oedema result from increased vascular filtration overwhelming the capacity of the lymphatic to drain it. This can be seen with higher venous pressures e.g. DVT, varicose veins, heart failure; low plasma proteins and inflammation. Over time such an increased lymph load can undermine the lymphatic vessels leading to a permanent lymphoedema in the same way that heart failure occurs with hypertension.
Investigation of lymphoedema is by lymphoscintigraphy – a positive scan has 100% sensitivity for impaired lymph drainage. Treatment of lymphoedema involves exercise and compression.
In summary chronic oedema is best considered lymphoedema with or without reasons for increased (blood) vascular fluid filtration."
Dr Easton’s perspective can be read in this article.
BMJ Learning Module update
Between 15th December 2011, and 15th February 2012 1,520 healthcare professionals completed the module!!!
Thanks to the BMJ Learning team, we have received accurate figures on the number of healthcare professionals, who in the main, are doctors and physicians, who have, so far, completed the module. We have also received over 580 reviews, the majority of which, have been extremely positive, with very few expressing a negative comment.
BMJ Learning module reviews:
“This was incredibly useful, I now feel more empowered to help patients with this problem that I previously shrugged my shoulders for.”
“Very useful, it’s a topic which every GP should do”
“This was a well presented module. Once the mechanisms, physiology and anatomy of the lymphatic system was explained everything else falls neatly into place”
“Good module, did learn a lot, this will help to nurse patients with swollen limbs, knowledge will also give me the confidence to insist on further treatment and investigations for patients.”
“Good, useful module, every GP should do it.”
“It will help me to recognise and refer patients”
“This has given me a much more structured approach to assessing chronic oedema and given me insight into the problem of chronic oedema and recurrent cellulitis. It also highlighted the importance of dealing with the underlying problem to prevent the lymphatic system from being overwhelmed and developing a chronic problem which may then be difficult to treat.”
“Excellent module. I didn't know whether it would be relevant to me, however having read it I wish I had done so earlier. Will definitely feel more confident dealing with swelling from now on.”
“I am caring for a patient, at present, with severe lymphoedema of both legs. This has given me a much better understanding of her condition.”
“Brilliant, unfortunately also made me feel like a dinosaur; basic physiology understanding has changed since I was at med school. Gulp. Makes the whole heart failure / diuretic / ca++ channel blocker thing suddenly obvious. Thanks very much, I actually enjoyed that.”