Bedside Evaluation of Edema

Study Overview
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Brief Summary
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Edema, commonly called swelling, is a common medical condition, with many causes. Clinicians generally find edema by pressing against a patient's skin, usually on the feet or shins, and observing how much dimpling there is in the skin. Most clinicians estimate the amount on a scale of mild to severe, or perhaps state the amount as 1 to 4. There is little agreement between observers, and it is hard to judge different clinicians' use of these scales. The first part of this experiment will demonstrate this inconsistency. After clinicians are shown a new technique for measuring edema, the second part of the study will show more accurate and consistent measurements. This will help clinicians to measure edema better, and to communicate their findings to other clinicians more effectively.

Detailed Description
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The research team will recruit as many clinicians who are conveniently available for the study. Clinicians will include attending physicians from any specialty, residents, medical students, physician assistants, physician assistant students, nurses, certified nurse practitioners, and certified nurse practitioner students. Once patients and clinicians have been recruited, the research team will maintain a list of the patients and a grid of which clinicians are to examine which patients. Each clinician will be given a data collection sheet, listing the patients' room numbers, and a grid for recording results for each of the patient's affected limb(s). The first data collection sheet (before instruction on the quantitative method) will just show a blank free text field so that clinicians can record their results as they normally do. After instruction in the novel quantitative technique, the clinicians will receive another data collection sheet now indicating the intent to have the clinicians record their findings in millimeters. The expectation is that a minimum of 6 examiners will determine the extent of edema on at least 38 limbs. If possible, the research will continue until approximately 100 limbs have been examined by a total of at least 10 to 20 clinicians.

Official Title
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A Simple Technique for Quantitative Evaluation of an Important Clinical Sign

Conditions
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Edema

Intervention / Treatment
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* Procedure: Exam for quantity of edema


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Currently admitted patients Patient who can understand the purpose of the study and sign a consent form Patient has a measurable amount of edema Patient will likely be available during the time the clinicians can examine the patient Exclusion Criteria: Unable or unwilling to sign the consent form No measurable edema Currently in isolation for infection control purposes Patients in the Behavioral Health section of the hospital Maternity patients (due to availability of infant rooming-in) Prisoners Age below 18 years Patients with bilateral lower extremity amputation

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Procedure: Exam for quantity of edema|There is no intervention|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Inter-observer correlation of edema measurement before instruction in novel technique | Observe the variation in edema documentation based on standard examination technique | one day | 
| Inter-observer correlation of edema measurement after instruction in novel technique | Observe the variation in edema documentation based on the novel examination technique | one day |