Background Burnout, stress and anxiety have been identified as areas of concern for informal caregivers and health professionals, particularly in the palliative setting. Meditative interventions are gaining acceptance as tools to improve well-being in a variety of clinical contexts, however, their effectiveness as an intervention for caregivers remains unknown. Aim To explore the effect of meditative interventions on physical and emotional markers of well-being as well as job satisfaction and burnout among informal caregivers and health professionals. Design Systematic review of randomised clinical trials and pre–post intervention studies with meditative interventions for caregivers. Data sources PubMed, EMBASE, CINAHL and PsycINFO were searched up to November 2013. Of 1561 abstracts returned, 68 studies were examined in full text with 27 eligible for systematic review. Results Controlled trials of informal caregivers showed statistically significant improvement in depression (effect size 0.49 (95% CI 0.24 to 0.75)), anxiety (effect size 0.53 (95% CI 0.06 to 0.99)), stress (effect size 0.49 (95% CI 0.21 to 0.77)) and self-efficacy (effect size 0.86 (95% CI 0.5 to 1.23)), at an average of 8 weeks following intervention initiation. Controlled trials of health professionals showed improved emotional exhaustion (effect size 0.37 (95% CI 0.04 to 0.70)), personal accomplishment (effect size 1.18 (95% CI 0.10 to 2.25)) and life satisfaction (effect size 0.48 (95% CI 0.15 to 0.81)) at an average of 8 weeks following intervention initiation. Conclusions Meditation provides a small to moderate benefit for informal caregivers and health professionals for stress reduction, but more research is required to establish effects on burnout and caregiver burden.

Patients with glioblastoma (GBM), the most common primary brain tumor in adults, have a median survival of about one year. In 2005, Stupp et al 1 published the results of a randomized controlled clinical trial in GBM demonstrating a significant survival benefit by adding temozolomide (TMZ) to radiation. In this study, patients with newly diagnosed GBM were treated with low dose temozolomide daily during radiation therapy (termed "concurrent treatment") followed by six monthly cycles of TMZ administered five days out of every 28 ABSTRACT: Introduction: Chemoradiotherapy followed by monthly temozolomide (TMZ) is the standard of care for patients with glioblastoma multiforme (GBM). Case reports have identified GBM patients who experienced transient radiological deterioration after concurrent chemoradiotherapy which stabilized or resolved after additional cycles of adjuvant TMZ, a phenomenon known as radiographic pseudoprogression. Little is known about the natural history of radiographic pseudoprogression. Methods: We retrospectively evaluated the incidence of radiographic pseudoprogression in a population-based cohort of GBM patients and determined its relationship with outcome and MGMT promoter methylation status. Results: Out of 43 evaluable patients, 25 (58%) exhibited radiographic progression on the first MRI after concurrent treatment. Twenty of these went on to receive adjuvant TMZ, and subsequent investigation demonstrated radiographic pseudoprogression in 10 cases (50%). Median survival (MS) was better in patients with pseudoprogression (MS 14.5 months) compared to those with true radiologic progression (MS 9.1 months, p=0.025). The MS of patients with pseudoprogression was similar to those who stabilized/responded during concurrent treatment (p=0.31). Neither the extent of the initial resection nor dexamethasone dosing was associated with pseudoprogression. Conclusions: These data suggest that physicians should continue adjuvant TMZ in GBM patients when early MRI scans show evidence of progression following concurrent chemoradiotherapy, as up to 50% of these patients will experience radiologic stability or improvement in subsequent treatment cycles. RÉSUMÉ: Étude de population sur la pseudoprogression après la chimioradiothérapie dans le glioblastome multiforme. Introduction : Le traitement standard du glioblastome multiforme (GBM) est la chimioradiothérapie suivie de l'administration mensuelle de témozolomide (TMZ). Certains cas de patients atteints de GBM, qui ont présenté une détérioration radiologique transitoire après la chimioradiothérapie qui s'est stabilisée ou s'est résorbée après des cycles additionnels de TMZ, un phénomène connu sous le nom de pseudoprogression radiologique, ont été rapportés. Méthodes : Nous avons évalué rétrospectivement l'incidence de la pseudoprogression radiologique chez une cohorte de patients atteints de GBM tirée de la population et nous avons déterminé sa relation avec le résultat du traitement et avec l'état de méthylation du promoteur MGMT. Résultats : Vingt-cinq des...

While dementia severity was associated with greater likelihood of having documented any AD, almost 4 in 10 residents with dementia lacked any AD. Effective outreach may focus efforts on subgroups with lower odds of any AD or living wills, including non-white, less educated, and unmarried NH residents. A greater understanding of how such factors impact care planning will help to address barriers to patient-centered care for this population.

While OPP, delivery, and utilization continue to represent challenges to health care access in many LMICs, the inclusion of surgery in many UHC policies sets an important precedent in addressing a growing global prevalence of surgically treatable conditions. Barriers to access, including inequalities in financial protection in the form of high OPP, remain a fundamental challenge to providing surgical care in LMICs.

logistic regression to identify factors associated with ER use.Results. Mean age of participants was 60, 65% were black, 61% had multimorbidity, 57% were functionally impaired, and 85% scored <27 on the MOCA. At baseline, 52% reported pain, 53% experienced physical distress, 37% reported psychological distress, and 46% reported loneliness. At 6 months, 44% used the ER; 21% visited multiple times. Factors associated with ER use included pain (p<0.001), functional impairment (p¼0.02), loneliness (p¼0.04), multimorbidity (p¼0.006), and safety concerns (p¼0.002). After adjustment, pain (p¼0.02) and safety concerns (p¼0.04) remained associated with ER use.