Evaluation of a technology-assisted enriched environmental activities programme for upper limb function: A randomized controlled trial.

OBJECTIVE: To evaluate the effectiveness and feasibility of an intensive technology-assisted inpatient enriched environmental programme for upper limb function. METHODS: Patients consecutively admitted to the rehabilitation unit randomly allocated to an intervention (enriched environmental programme, n = 46)) or a control group (usual ward activity, n = 46). Assessments were performed at baseline (T0), discharge (T1) and 3 months (T2) using validated measures. RESULTS: At T1, the enriched environmental group showed significant improvement in upper limb func-tion, compared with the control group: Action Research Arm Test (ARAT) "Total" (p = 0.002), and "Grip", "Pinch" and "Gross" subscales (p < 0.05 for all), with small effect size = 0.04-0.16. Most participants in the enriched environmental group had clinically significant improvement > 5.7 points on the ARAT "Total" compared with the control group (83% vs 44%, p < 0.001). Participants in the enriched environmental group were more involved in various forms of activities during waking hours. At T2, despite no significant between-group difference in ARAT scores, the majority of participants in the enriched environmental group maintained the improvement (> 5.7 points) on ARAT "Total" compared with the control group (91% vs 61%, p = 0.001). Both groups improved in other measures at both T1 and T2. CONCLUSION: An enriched environmental programme was feasible and effective in improving upper limb function and increasing the activity of patients during their inpatient subacute care.

Predictors of surgical margin status in breast-conserving surgery within a breast screening program.

BACKGROUND: Breast-conserving surgery (BCS) requires clear surgical margins to minimize local recurrence. We sought to identify groups of patients at higher risk of involved margins who might benefit from preoperative counselling and/or more generous excision at the first operation. METHODS: We reviewed demographic, clinical, radiological and pathological records of all women diagnosed with ductal carcinoma in situ (DCIS) or invasive cancer (IC) through a population-based breast screening program in Melbourne, Australia between 1994 and 2005. RESULTS: A total of 2,160 women were diagnosed with DCIS or IC. We excluded 199 who had mastectomy (TM) as initial procedure or had missing data. Three hundred and thirteen had a diagnostic biopsy. Of 1,648 women who had BCS after a preoperative diagnosis of DCIS or IC, 13.5% had involved margins, 16.6% had close (1 mm) margins. Of the patients, 281/1,648 (17.1%) underwent re-excision, of whom 93 (33.1%) had residual disease identified. Mammographic microcalcifications (P < 0.0001), absence of a mammographic mass (P = 0.002), presence of DCIS (P < 0.0001), high tumour grade (P < 0.0001), large size (P < 0.0001), multifocal disease (P < 0.0001) and lobular histology (P = 0.005) were associated with involved margins. Microcalcifications (odds ratio [OR] 1.97), large size (OR 4.22) and multifocal disease (OR 2.85) were independently associated with involved margins. Residual disease was associated with involved margins (P < 0.0001), presence of DCIS (P = 0.05) and large tumour size (P = 0.01). CONCLUSION: After BCS, patients with mammographic microcalcifications, larger tumour size and multifocal tumours are more likely to have involved margins. Patients with involved margins, large tumour size and/or a DCIS component are more likely to have residual disease on re-excision.