Catherine Tuppo

Self-Care Status, Symptom Burden, and Reported Infections in Individuals With Lower-Extremity Primary Lymphedema

PURPOSE The purposes of this study were (a) to evaluate self-care, symptom burden, and reported infections among individuals with lower-extremity primary lymphedema; (b) to examine the differences in self-care, symptom burden, and reported infections between individuals with unilateral and those with bilateral lower-extremity primary lymphedema; and (c) to examine the associations among self-care status, symptom burden, and reported infections in individuals with lower-extremity primary lymphedema. DESIGN A secondary data analysis was used. Data were collected from a cross-sectional survey study supported by the National Lymphedema Network from March 2006 through January 2010. The surveys were available both online and in hard copy in order to increase accessibility. METHODS Descriptive statistics were conducted and associations between variables were assessed using Mann-Whitney tests and chi-square tests of independence. Multiple logistic regression was used to test for associations while controlling for potentially confounding variables. FINDINGS A total of 803 participants reported having lower-extremity primary lymphedema. The majority of the participants were female (82.9%), White (74.2%), and from the United States (90.7%). Approximately two thirds of the respondents conducted some home daily lymphedema self-care. Over half of the respondents reported experiencing symptom burden and 44.8% reported at least one episode of infection. Compared to individuals with unilateral lower-extremity primary lymphedema, individuals with bilateral lower-extremity lymphedema were more likely to conduct skin care (p = .004), use alternative medications (p = .005), more frequently reported symptoms (p < .05), and more likely to report at least one episode of infection (p = .002). Respondents who reported use of compression garments also were less likely to have self-reported pain (p = .002), poor range of motion (p = .026), and numbness (p = .001). Participants who reported exercising also were less likely to have self-reported pain (p = .003). Participants who reported at least one episode of infection also reported experiencing more symptoms (p < .001). CONCLUSIONS Individuals with lower-extremity primary lymphedema experienced substantial symptom burden and infection episodes. Significant associations were identified among self-care, symptom burden, and reported infections. CLINICAL RELEVANCE The findings support the need for clinicians to educate patients with lower-extremity primary lymphedema regarding the importance of self-care, symptom management, and infection control. It is critically important for clinicians to evaluate symptom burden and reduce infections in individuals with lower-extremity primary lymphedema.

Predictors of a successful medical weight loss program

BACKGROUND Many practices are creating weight loss programs, in preparation for bariatric surgery or for patients who wish to lose weight without surgery. Preoperative weight loss may be associated with improved postoperative weight loss and resolution of co-morbidities. The aim of this study is to investigate the success of a preoperative weight loss program at a single institution and the variables associated with success in weight loss. METHODS We enrolled patients in a once monthly multidisciplinary preoperative weight loss program and evaluated % total weight lost over the 6-month program for primary and for revisional bariatric surgical patients. Demographic characteristics, weight, program related factors, and co-morbidities were recorded. One-way ANOVA and multiple linear regression models were carried out to assess variables. Parameter estimates of multiple linear regression models were reported. Statistical significance was set at .05 and analysis was done using SAS 9.3. RESULTS A total of 133 patients enrolled and completed the program over a period of 14 months. Only 50.8% of the patients lost weight with average weight loss of .1±4.0 lbs. Patient׳s sex, insurance, psychiatric history, co-morbidities, referral status, or type of counseling had no significant effect on weight loss (P>.05). Patients between 30 and 50 years old on average were more successful in losing weight (P = .018). Patients considering revisional surgery were less successful preoperatively compared to first time candidates (P = .0007). CONCLUSION Patients between 30 and 50 years of age, first time surgical candidates, and those with higher weights may be more successful in losing weight in a preoperative bariatric weight loss program.

Factors Associated with Reported Infection and Lymphedema Symptoms among Individuals with Extremity Lymphedema.

Purpose: This study aimed to examine factors associated with reported infection and symptoms among individuals with extremity lymphedema. Design: A cross‐sectional study was used. Methods: Data were collected from a survey supported by the National Lymphedema Network from March 2006 through January 2010. A total of 1837 participants reported having extremity lymphedema. Logistic regression analyses were used. Findings: Factors associated with reported infection among individuals with extremity lymphedema included male gender, decreased annual household income, decreased self‐care, self‐report of heaviness, and lower extremity as opposed to upper extremity. Factors associated with symptoms included infection, decreased self‐care, lower knowledge level of self‐care, decreased annual household income, and presence of secondary lower extremity lymphedema. Conclusions/Clinical Relevance: Select factors of income, self‐care status, and site of lymphedema were associated with increased occurrence of infection and symptoms among individuals with extremity lymphedema. Longitudinal studies are needed to identify risk factors contributing to infections and symptoms in individuals with lymphedema.