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Abstract
Lymphoedema is a consequence of impaired lymphatic drainage. Available treatment options vary in efficacy and impact on the individual. Whilst all are useful in reducing the extent and impact of lymphoedema, there are confounding factors such as patient compliance, financial and physical costs and unpredictably variable outcomes. There seems to be no single treatment that is affordable, effective and sustainable for patients with lymphoedema. This review introduces the novel idea of a modified hydrocephalus shunt as a surgical alternative to treat (and perhaps prevent) lymphoedema. Hydrocephalus shunts allow cerebrospinal fluid (CSF) to circumvent an obstruction during periods of impaired absorption, removing the build-up of fluid that causes hydrocephalus, working on a low pressure system. Lymphatic pumping pressures in failing arm lymphatics have been recorded as approximately 25 mmHg1. In early stage leg lymphoedema, pressures have been recorded around 70mmHg (diastolic) and 100mmHg (systolic), whilst late stage lymphoedema has been recorded as 20mmHg, though often these lymphatics are very difficult to cannulate. As hydrocephalus shunts work on pressures as low as 15-25mmHg at flow rates as low as 5ml/hr it is plausible that they could be used to facilitate normal flow, but importantly prevent retrograde flow of lymph in failing or failed lymphatics, thereby reducing lymphoedema.

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Abstract
Lymphoedema is complex disorder with high disease morbidity characterised initially by progressive fluid accumulation and subsequently by altered tissue fibrosis and fat deposition. Primary lymphoedema is the result of congenital conditions that affect how lymph vessels are formed, whilst the inciting event in secondary lymphoedema is classically the disruption of normal lymphatic flow in the context of surgery or trauma. In addition to the altered fluid and fat homeostasis, lymphoedema is characterised by immune deficits that typically manifest as an increased susceptibility to infection and altered wound healing in the affected site. In contrast to the common perception of the lymphatics as a passive conduit for fluid, waste products, and immune cells, the altered immune homeostasis in lymphoedema patients suggests that the lymphatics play a more active role in the immune response. Indeed, lymphatic dysfunction appears to be a global phenomenon in all immune-related diseases. In this review, we highlight papers that support an active role for the lymphatics in immunity and link this evidence to the observed deficits in wound healing and immune surveillance present in lymphoedema.

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Introduction
Botanical and other natural products have been used for centuries for medicinal purposes including treating skin lesions and wounds. However, formal research into the efficacy of many traditional remedies is sparse. The Wound Healing and Management (WHAM) Node within the Joanna Briggs Institute (JBI) and Wounds Australia conducts evidence summaries on traditional wound care strategies as a resource for local wound care practitioners and staff and students on exchange programs in developing countries. This paper presents an overview on a number of botanicals used in wound care in countries with limited access to contemporary wound care products. The available evidence on effectiveness and potential adverse events for tea tree oil, turmeric, banana leaves, aloe vera, papaya and calendula used in wound care is presented. There is a need for further good quality research into many of the interventions presented in this review in order to increase the evidence base and understanding of any risks in incorporating natural resources into wound care.

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Abstract
Aim: This study explored the visual anatomical characteristics of the buttock region through use of an interface pressure mapping system to determine the correlation of shape with selected risk factors.
Background: Pressure injuries are a major challenge for health care systems worldwide. Risk assessment tools are limited in predicting pressure injury. Interface pressure mapping systems can potentially map body shape data related to pressure injury risk.
Methods: This work was nested within a larger exploratory study which utilised a randomised controlled design. One hundred and twenty-six patients were recruited at any time during their admission to a public tertiary referral hospital or a community hospital. Equipment including the designated standard hospital mattress and bed, and the Tekscan ClinseatTM pressure mapping system was used to explore the visual anatomical characteristics of patients’ buttock region and the correlation of shape with selected risk factors. Demographic and Waterlow Risk Assessment Tool data were collected.
Results: Five buttock shapes were observed using the interface pressure mapping surface, then categorised into ‘round/square’ and ‘other’ groups. Round and square shapes were significantly associated with higher body mass index and Waterlow Risk Assessment scores.
Conclusions: Visually assessing buttock shape demonstrates potential for identifying pressure injury risk in this region.

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Abstract
ABSTRACT Background: Constructivism theoretical framework was used as the fundamental base in developing a nursing education program. This required education of research assistants employed as outcome assessors for a pressure injury prevention study. Outcome assessors were required to correctly identify pressure injury stages and whether or not a pressure injury developed throughout the project.
Objectives: To evaluate the knowledge developed by outcome assessors as a consequence of engaging in the education program.
Methods: The education program was delivered to 25 outcome assessors across five sites in Australia. A purpose-designed instrument was developed for the education day’s program, which included 27 pre-test and post-test questions. A paired samples t-test was used to compare changes in pre-test and post-test scores.
Results: The success of the education day was highlighted by higher post-test scores, compared with the scores obtained prior to pressure injury education. The combined pre-test score was 13.3 (SD±4.4) compared with a higher post-test score of 21.1 (SD±2.6) (p>0.02).
Conclusion: Through the use of constructivism theoretical educational framework, outcome assessors were able to improve their knowledge about pressure injury assessment and staging. Pre-test scores were lower than post-test scores, indicating increased knowledge as a result of the education session.

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QUESTION
What is the best available evidence on the effectiveness of manual lymphatic drainage (MLD) in managing lymphoedema?

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QUESTION
What is the best available evidence on the effectiveness of laser therapy in managing lymphoedema?

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QUESTION
What is the best available evidence on the effectiveness of complex lymphoedema therapy/complete decongestive therapy in managing lymphoedema?

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