Dying is the Most Grown-Up Thing We Ever Do: But Do Health Care Professionals Prevent Us from Taking It Seriously?

This paper takes a somewhat slant perspective on flourishing and care in the context of suffering, death and dying, arguing that care in this context consists principally of ‘acts of work and courage that enable flourishing’. Starting with the perception that individuals, society and health care professionals have become dulled to death and the process of dying in Western advanced health systems, it suggests that for flourishing to occur, both of these aspects of life need to be faced more directly. The last days of life need to be ‘undulled’. Reflections upon the experiences of the author as carer and daughter in the face of her mother’s experience of death are used as basis for making suggestions about how care systems and professionals might better assist people in dealing with ‘the most grown up thing’ humans ever do, which is to die.     

Methylmalonic aciduria and propionic acidaemia studied by proton nuclear magnetic resonance spectroscopy

Proton nuclear magnetic resonance spectroscopy has been used to monitor changes in urinary metabolites in a patient with propionic acidaemia over a period of 10 months and in a patient with methylmalonic aciduria over a period of 11 days. Results could be obtained within 5-10 min of sample receipt. In the spectra on the patient with propionic acidaemia not only could fluctuations in 3-hydroxypropionate and propionylglycine excretion be followed, but also variations in creatine, glycine and betaine, which were often present at millimolar concentrations. The patient with methylmalonic aciduria had an acute episode of severe ketoacidosis during which the glycine excretion fell but creatine excretion rose and then fell on recovery from the episode. The changes in the creatine excretion may reflect disorders in intracellular energy supply. Nuclear magnetic resonance is a powerful technique for monitoring metabolic perturbations in the organic acidurias in 'real-time', allowing the planning and evaluation of therapy.     

Abnormal Tc-99m MAA accumulation

Image findings are described in two patients who received radiochemically impure Tc-99m MAA radiopharmaceutical preparations. The cases are completely separate and show clinically the presence of hydrolyzed-reduced technetium (TcO2) in a radiopharmaceutical product.     

Obtaining Unbiased Estimates of Tagging SNP Performance

The use of tagging SNPs (tSNPs) as a cost‐effective means of capturing genetic diversity is widespread. However, the quality of the tSNPs selected is dependent on the initial sample in which they are characterized. If the initial marker set is too sparse the tSNPs chosen will capture less information than a naïve analysis suggests. A simple method has been proposed that should provide a better estimate of the performance of tSNPs. It is shown here that this approach is both unbiased and accurate, even for small numbers of typed markers. The effect of unknown phase is also investigated and it is shown that, excepting very small samples, this has little effect on the accuracy of the method.     

Mother and clinician experiences of a trial of a video feedback parent–infant intervention for mothers experiencing difficulties consistent with ‘personality disorder’: A qualitative interview study

Objectives

We explored mothers' and clinicians' experiences of a video feedback intervention adapted for perinatal ‘personality disorder’ (VIPP-PMH) and the acceptability of a randomised controlled trial (RCT) examining its effectiveness.

Design

In-depth qualitative interviews with participants from a two-phase feasibility study of the VIPP-PMH intervention. Participants were mothers experiencing enduring difficulties in managing emotions and relationships, consistent with a ‘personality disorder’, and their 6- to 36-month-old children.

Methods

Forty-four qualitative interviews were conducted, including all nine mothers receiving VIPP-PMH during the pilot phase, 25 of the 34 mothers participating in the RCT (14 allocated to the VIPP-PMH arm and 9 from the control arm), 11 of the 12 clinicians delivering VIPP-PMH and one researcher. Interview data were thematically analysed.

Results

Mothers described feeling motivated to take part in the research and understood the need for randomisation. Research visits were largely experienced positively, with some suggestions for improvement in questionnaire timing and accessibility. Almost all mothers initially felt anxious about being filmed, but reported positive experiences of the intervention, particularly valuing its non-judgemental, positive and child-focussed nature, their supportive relationship with the therapist and the insights they gained on their child.

Conclusions

The findings indicate the likely feasibility and acceptability of undertaking a future definitive RCT of the VIPP-PMH intervention in this population. In designing a future trial, a positive and non-judgemental therapeutic relationship will be important to allay mothers' anxieties about being filmed, and careful consideration should be given to the timing and accessibility of questionnaires used.