The use of therapeutic untruths by learning disability nursing students

Background: The use of therapeutic untruths raises a number of ethical issues, which have begun to be explored to some extent, particularly in dementia care services, where their use has been found to be high. Little is known, however, about their use by health professionals working in learning disability services. Research question: The study aimed to explore the frequency of use of therapeutic untruths by student learning disability nurses, and by their colleagues; how effective the students perceived them to be as a means of responding to behaviours that challenge; and their level of comfort with using them. Research design: A correlational design was used to gather data from an online version of the Best Interest Scale, adapted for a learning disability context. Participants were 30 learning disability student nurses (female = 28, ages 18–48 years, M = 26.8, standard deviation = 7.3) studying at a university in the North-East of England. Ethical considerations: The study was reviewed and received ethical approval from the first author’s university ethics committee. Findings: Overall, 96% of participants reported using therapeutic untruths. ‘Omission’ was the most frequently used type of therapeutic untruths, the most effective and the type that the students felt most comfortable using. Frequency of use of therapeutic untruths correlated significantly and positively with perceived effectiveness and the level of comfort that the students felt when using them, for all types of therapeutic untruths. Conclusion: The use of therapeutic untruths by the student nurses was consistent with that found in research in dementia care services in the United Kingdom and abroad. Further research to explore the generalisability of the results to the wider context of learning disability services is needed. The study highlights that there may be a need for more formal guidance and educational input to student nurses in the use of therapeutic untruths with people with a learning disability

The postnatal support needs of mothers with an intellectual disability

OBJECTIVE: there is growing evidence that many parents with intellectual disabilities can parent successfully when given adequate support. This paper aims to explore the postnatal care experiences of mothers with an intellectual disability. DESIGN: a qualitative design was used and data were collected using a semi-structured interview format and analysed using Interpretative Phenomenological Analysis. SETTING: the study took place in community settings in Scotland. PARTICIPANTS: six mothers with intellectual disabilities were interviewed about their experiences. MEASUREMENTS AND FINDINGS: two super-ordinate themes are discussed with accompanying subthemes: challenges of providing support and how support was delivered. KEY CONCLUSIONS: the mothers valued formal postnatal care, but this was secondary to informal support. How mothers perceived the support impacted on its effectiveness and building effective relationships with professionals presented challenges. IMPLICATIONS FOR PRACTICE: the study suggests the structure and quality of the wider support networks of mothers with an intellectual disability are central and should be taken account of by professionals. Providing information and advice in ways that validates the mother's role is also important, particularly as the mother's perception of how help is given can impact on the degree to which mothers engage with professional

MAGNITUDE ESTIMATION: AN APPLICATION TO FARMERS' RISK-INCOME PREFERENCES

Magnitude estimation, a technique developed by psychology for obtaining ratio scaled values, was used to derive risk-income preferences of ninety-one central Indiana farmers. Both variability-income and bankruptcy-income measures were developed and related to farmers' socio-economic attributes. Wealth and education had limited effects compared with off-farm employment, percent debt and expected levels of income, percent debt and net worth growth. Magnitude estimation provided reliable estimates of preferences. Farmers gave greater importance to the bankruptcy-income measure of risk-income preferences, but only a small portion of the variation of either measure could be explained.Farm Management, Risk and Uncertainty,

Update on the treatment of gastrointestinal stromal tumors (GISTs): role of imatinib

In the last decade a tremendous amount has been learned about the biology and treatment of gastrointestinal stromal tumor (GIST). Imatinib mesylate has revolutionized the treatment of metastatic GIST. In addition, the role of imatinib in localized GIST has gained much interest and may improve patient outcomes. Additionally, research efforts aimed at understanding the biology and the molecular heterogeneity of GIST both at initial presentation and at the time of resistance to imatinib, has helped guide rational approaches to treatment as well as future efforts aimed at treating imatinib-resistant GIST

Exercise and diet in the management of nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver condition worldwide, and is projected to become the leading cause for liver transplantation in the United States as early as 2020. The mainstay of treatment remains lifestyle modification with diet and exercise recommendations, as although some pharmacological treatments such as glitazones and Vitamin E have shown benefit, there are concerns regarding long term safety. The evidence base for dietary interventions in NAFLD such as the Mediterranean diet, omega-3 polyunsaturated fatty acids and coffee is mainly derived from observational data with questionable validity. Where trials exist, they have shown benefit for surrogate outcomes such as hepatic steatosis and insulin resistance, but no trials have been conducted with salient clinical outcomes such as reduction in progression to chronic liver disease. Benefit in surrogate outcomes has also been seen for aerobic, anaerobic and combined modality exercise but it remains unclear if one type is superior. Furthermore, a reduction in sedentary time appears equally important. To provide a sound evidence base for lifestyle recommendations to people with NAFLD, longer duration trials of standardized dietary or exercise interventions, and testing various doses, types and with liver related outcomes, are essential

Aristotle and the Eternal Caterpillar.

Design arguments are arguments from apparent purposiveness to the conclusion that there is an intelligent deliberating being who planned the order in the world. Socrates and Plato put such arguments. Empedocles, Democritus and Epicurus argue that all such purposiveness, except for the action of intelligent beings like humans or gods, is only apparent. We point out that both camps share the common assumption that all cases of working for the sake of something involve intelligent deliberation. Using Aristotle, we argue that this assumption is false. Unintelligent creatures can act for the sake of something. We use this argument and Aristotle’s further remarks to also argue that this shows that if there were a designer of the universe which acted for the sake of producing living things, it might well be an unintelligent designer, like an eternal caterpillar

A phase I, multicenter, open-label, first-in-human study of DS-6157a in patients with advanced gastrointestinal stromal tumor

PURPOSE: To evaluate DS-6157a, an antibody-drug conjugate targeting G protein-coupled receptor 20 (GPR20), in gastrointestinal stromal tumors (GIST). PATIENTS AND METHODS: In this phase I multicenter, open-label, multiple-dose study, patients with previously treated advanced GIST received intravenous DS-6157a on Day 1 of 21-day cycles, with a starting dose of 1.6 mg/kg. The primary objective evaluated the safety and tolerability of DS-6157a, while determining dose-limiting toxicity (DLT) and the MTD. Secondary objectives included plasma pharmacokinetics parameters, plasma antidrug antibodies (ADA), and efficacy. RESULTS: A total of 34 patients enrolled. DS-6157a was well tolerated, with DLTs in 4 patients (11.8%) at doses of 6.4 mg/kg, 9.6 mg/kg, and 12.8 mg/kg; the MTD was determined to be 6.4 mg/kg. Treatment-emergent adverse events (TEAE) grade ≥3 occurred in 17 patients (50.0%), including decreased platelet count (23.5%), anemia (20.6%), decreased neutrophil count (14.7%), and decreased white blood cell count (11.8%). Four patients (11.8%) experienced serious adverse events related to DS-6157a. Six patients died with 5 due to disease progression and 1 due to DS-6157a-related TEAE. Tumor shrinkage was observed in 7 patients (20.6%), and 1 patient (2.9%) achieved a partial response. Plasma concentrations and exposure of intact DS-6157a, DXd, and total anti-GPR20 antibody all demonstrated a dose-dependent profile. No treatment-emergent ADAs were observed. CONCLUSIONS: Targeting GPR20 with DS-6157a was tolerated in patients with advanced GIST with tumor shrinkage demonstrated in KIT/PDGFRA wild-type GIST. However, the study did not proceed further due to lower efficacy outcomes than anticipated