A Randomized Prospective Study of Lumpectomy Margin Assessment with Use of MarginProbe in Patients with Nonpalpable Breast Malignancies

BACKGROUND: The presence of tumor cells at the margins of breast lumpectomy specimens is associated with an increased risk of ipsilateral tumor recurrence. Twenty to 30 % of patients undergoing breast-conserving surgery require second procedures to achieve negative margins. This study evaluated the adjunctive use of the MarginProbe device (Dune Medical Devices Ltd, Caesarea, Israel) in providing real-time intraoperative assessment of lumpectomy margins. METHODS: This multicenter randomized trial enrolled patients with nonpalpable breast malignancies. The study evaluated MarginProbe use in addition to standard intraoperative methods for margin assessment. After specimen removal and inspection, patients were randomized to device or control arms. In the device arm, MarginProbe was used to examine the main lumpectomy specimens and direct additional excision of positive margins. Intraoperative imaging was used in both arms; no intraoperative pathology assessment was permitted. RESULTS: In total, 596 patients were enrolled. False-negative rates were 24.8 and 66.1 % and false-positive rates were 53.6 and 16.6 % in the device and control arms, respectively. All positive margins on positive main specimens were resected in 62 % (101 of 163) of cases in the device arm, versus 22 % (33 of 147) in the control arm (p < 0.001). A total of 19.8 % (59 of 298) of patients in the device arm underwent a reexcision procedure compared with 25.8 % (77 of 298) in the control arm (6 % absolute, 23 % relative reduction). The difference in tissue volume removed was not significant. CONCLUSIONS: Adjunctive use of the MarginProbe device during breast-conserving surgery improved surgeons’ ability to identify and resect positive lumpectomy margins in the absence of intraoperative pathology assessment, reducing the number of patients requiring reexcision. MarginProbe may aid performance of breast-conserving surgery by reducing the burden of reexcision procedures for patients and the health care system

A review of immediacy and implications for provider&ndash;patient relationships to support medication management

Rebecca J Bartlett Ellis,1 Anna F Carmon,2 Caitlin Pike31Science of Nursing Care, Indiana University School of Nursing, Indianapolis, 2Communication Studies, Indiana University Purdue University Columbus, Columbus, IN, 3IUPUI University Library, Indianapolis, IN,&nbsp;USA Objectives: This review is intended to 1) describe the construct of immediacy by analyzing how immediacy is used in social relational research and 2) discuss how immediacy behaviors can be incorporated into patient&ndash;provider interventions aimed at supporting patients&rsquo; medication management.Methods: A literature search was conducted using Cumulative Index to Nursing and Allied Health Literature (CINAHL), Google Scholar, OVID, PubMed, and Education Resource Information Center (ERIC) EBSCO with the keyword &ldquo;immediacy&rdquo;. The literature was reviewed and used to describe historical conceptualizations, identify attributes, examine boundaries, and identify antecedents and consequences of immediacy.Results: In total, 149 articles were reviewed, and six attributes of immediacy were identified. Immediacy is 1) reciprocal in nature and 2) reflected in the communicator&rsquo;s attitude toward the receiver and the message, 3) conveys approachability, 4) respectfulness, 5) and connectedness between communicators, and 6) promotes receiver engagement. Immediacy is associated with affective learning, cognitive learning, greater recall, enhanced relationships, satisfaction, motivation, sharing, and perceptions of mutual value in social relationships.Conclusion: Immediacy should be further investigated as an intervention component of patient&ndash;provider relationships and shared decision making in medication management.Practice implications: In behavioral interventions involving relational interactions between interveners and participants, such as in medication management, the effects of communication behaviors and immediacy during intervention delivery should be investigated as an intervention component.Keywords: patient&ndash;provider communication, health communications, medication management, patient education, health behavio

Justice in the family firm: An integrative review and future research agenda

To extend the understanding of justice perceptions in family firms, we take stock of the small but growing literature by reviewing notable conceptual and empirical papers published in the last 15 years that put forward research questions, propositions, and hypotheses related to justice perceptions in the family firm context. With the goal of providing a future research agenda, we identify research questions awaiting empirical answers and present potential difficulties in translating conceptual ideas into empirical studies. To capture differences in how the family aspect of a firm may influence justice, we discuss and identify reliable, valid measures of justice-related constructs and family influence