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      Worldwide assessment of healthcare personnel dealing with lymphoedema

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          Abstract

          Background

          Lymphoedema is a pandemic with about 250 million people suffering from this condition worldwide. Lymphatic diseases have considerable public health significance, but yet few professionals are specialised in their management causing a substantial burden on health resources.

          Aims and objectives

          This study aims to give an overview of the approximate number of medical professionals, professional societies, institutions and companies dealing with lymphoedema in various countries. Concepts of improvement for current human resources are considered.

          Methods

          An online database analysis (Google search engine and PubMed) was carried out for each country of the world. Additionally, relevant congress participant lists as well as member lists of significant medical societies and reports of the World Health Organisation were analysed.

          Results

          Overall distribution of tertiary level professionals specialised in this field is heterogenous. A decrescent gradient of professionals can be seen between developed and developing countries and between urban and rural areas. Countries in general do not seem to have yet met the current demand for specialists at tertiary level in this field.

          Conclusions

          This study intends to draw attention to the current medical coverage gaps due to a low number of lymphoedema specialists at tertiary level. It wishes to start a discussion about structured reimbursement and certification of knowledge and skills that are essential incentives for experts to act as multiplicators and change the lack of care in the mid-term. Current fail prescriptions and evitable disability and sick certificates represent a high financial burden that could be reinvested in a correct management. Policy makers must focus in the two above mentioned essential measures. Medical training and the consequent development of the industry will then naturally take place, as it was the case for other professional groups in the past.

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          Most cited references49

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          Primary health care delivery models in rural and remote Australia – a systematic review

          Background One third of all Australians live outside of its major cities. Access to health services and health outcomes are generally poorer in rural and remote areas relative to metropolitan areas. In order to improve access to services, many new programs and models of service delivery have been trialled since the first National Rural Health Strategy in 1994. Inadequate evaluation of these initiatives has resulted in failure to garner knowledge, which would facilitate the establishment of evidence-based service models, sustain and systematise them over time and facilitate transfer of successful programs. This is the first study to systematically review the available published literature describing innovative models of comprehensive primary health care (PHC) in rural and remote Australia since the development of the first National Rural Health Strategy (1993–2006). The study aimed to describe what health service models were reported to work, where they worked and why. Methods A reference group of experts in rural health assisted in the development and implementation of the study. Peer-reviewed publications were identified from the relevant electronic databases. 'Grey' literature was identified pragmatically from works known to the researchers, reference lists and from relevant websites. Data were extracted and synthesised from papers meeting inclusion criteria. Results A total of 5391 abstracts were reviewed. Data were extracted finally from 76 'rural' and 17 'remote' papers. Synthesis of extracted data resulted in a typology of models with five broad groupings: discrete services, integrated services, comprehensive PHC, outreach models and virtual outreach models. Different model types assume prominence with increasing remoteness and decreasing population density. Whilst different models suit different locations, a number of 'environmental enablers' and 'essential service requirements' are common across all model types. Conclusion Synthesised data suggest that, moving away from Australian coastal population centres, sustainable models are able to address diseconomies of scale which result from large distances and small dispersed populations. Based on the service requirements and enablers derived from analysis of reported successful PHC service models, we have developed a conceptual framework that is particularly useful in underpinning the development of sustainable PHC models in rural and remote communities.
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            The life and times of ivermectin - a success story.

            Since its introduction more than 20 years ago, ivermectin has proved to be one of the most successful therapeutic drugs in veterinary medicine, as well as the basis of one of the most successful public-health programmes of the past century. The drug arose from a unique international collaboration between the public and private sectors. The development process also incorporated the world's first and largest drug-donation programme and involved a unique association between governments, non-governmental organizations and industry. The drug is now being used, free of charge, in two global disease-elimination programmes that are benefiting millions of the world's poorest people.
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              Recent progress in the treatment and prevention of cancer-related lymphedema.

              This article provides an overview of the recent developments in the diagnosis, treatment, and prevention of cancer-related lymphedema. Lymphedema incidence by tumor site is evaluated. Measurement techniques and trends in patient education and treatment are also summarized to include current trends in therapeutic and surgical treatment options as well as longer-term management. Finally, an overview of the policies related to insurance coverage and reimbursement will give the clinician an overview of important trends in the diagnosis, treatment, and management of cancer-related lymphedema.
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                Author and article information

                Contributors
                henrikeschulze@hotmail.de
                m.nacke.1@research.gla.ac.uk
                gutenbrunner.christoph@mh-hannover.de
                catarina.hadamitzky@gmail.com
                Journal
                Health Econ Rev
                Health Econ Rev
                Health Economics Review
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                2191-1991
                16 April 2018
                16 April 2018
                2018
                : 8
                : 10
                Affiliations
                [1 ]ISNI 0000 0000 9529 9877, GRID grid.10423.34, Clinic of Rehabilitation Medicine, Hannover Medical School, ; Carl-Neuberg-Straße 1, 30625 Hannover, Germany
                [2 ]ISNI 0000 0000 8821 5196, GRID grid.23636.32, Cancer Research UK, Beatson Institute, ; Glasgow, UK
                [3 ]Practice for Lympho-Vascular Diseases, Bahnhofstraße 12, Hannover, Germany
                Article
                194
                10.1186/s13561-018-0194-6
                5901432
                29663122
                af11d4a9-75ac-408f-8f49-09d4ce845033
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 1 October 2017
                : 3 April 2018
                Funding
                Funded by: European Union
                Award ID: 527658-LLP-1-2012-1-DE-ERASMUS-ESMO
                Award Recipient :
                Categories
                Research
                Custom metadata
                © The Author(s) 2018

                Economics of health & social care
                lymphology,lymphoedema,lymphatic diseases,medical healthcare resources,medical education

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