What do children who stutter and their parents expect from therapy and are their hopes aligned?

Currently there are few published reports exploring what it is that children and their parents wish to see change or happen as part of therapy. A process of eliciting hopes or expectations for therapy using Solution Focused Brief Therapy (de Shazer, 1985) is routinely used at the Michael Palin Centre (MPC) with children who stutter and their parents. This qualitative study aimed to explore what children who stutter and their parents expect from therapy and whether their hopes are aligned

Perspectives on Therapeutic Progress: 11-14 Year-Olds’ Reflections

AbstractPurposeThis qualitative analysis aimed to understand therapy outcomes from the viewpoint of children who have completed an intensive ten-day stuttering therapy program. There have been reports of quantitative outcomes of stuttering therapy (e.g., changes in stuttering frequency, changes in OASES scores), but there is a gap in the literature regarding children's views on therapeutic progress when provided with open-ended prompts.MethodsSeven children who stutter (mean age = 12;1, range 11;10-14;3), 6 males and 1 female, were prompted to answer the questions “what is going well?” and “what are small signs of progress?”. These questions were answered on the first day of therapy and the last day of therapy (day 10) during individual face-to-face Solution Focused Brief Therapy (de Shazer, 1985) interviews with a skilled clinician. The responses were then phenomenologically analysed to uncover primary categories and subcategories.ResultsPhenomenological analysis revealed that communication abilities, adaptive affective/cognitive status, and adequate social support were the three primary categories that children attributed to “what is going well” at both day 1 and day 10. Changes in communication, adaptive affective/cognitive status, and relaxed bodily state were the three primary categories related to “what are small signs of progress” at both day 1 and day 10.ConclusionsThis insight into how children view their own competency and understand the steps needed to make positive changes is meaningful for clinicians working with children in this age group who stutter in order to inform clinical decision making and guide therapeutic activities. The results implicate the importance of helping children 1) realize positive aspects of the situation and 2) provide specific, detailed accounts of their goals so that goal-directed therapeutic progress can take place

Long-term effect of endothelin receptor antagonism with bosentan on the morbidity and mortality of patients with severe chronic heart failure : primary results of the ENABLE Trials

Objectives: The objective of this clinical trial was to evaluate the long-term effect of endothelin receptor antagonism with bosentan on the morbidity and mortality of patients with severe chronic heart failure. Background: Endothelin may play a role in heart failure, but short-term clinical trials with endothelin receptor antagonists have reported disappointing results. Long-term trials are lacking. Methods: In 2 identical double-blind trials, we randomly assigned 1,613 patients with New York Heart Association functional class IIIb to IV heart failure and an ejection fraction <35% to receive placebo or bosentan (target dose 125 mg twice daily) for a median of 1.5 years. The primary outcome for each trial was clinical status at 9 months (assessed by the hierarchical clinical composite); the primary outcome across the 2 trials was death from any cause or hospitalization for heart failure. Results: Bosentan did not influence clinical status at 9 months in either trial (p = 0.928 and p = 0.263). In addition, 321 patients in the placebo group and 312 patients in the bosentan group died or were hospitalized for heart failure (hazard ratio [HR]: 1.01; 95% confidence interval [CI]: 0.86 to 1.18; p = 0.90). The bosentan group experienced fluid retention within the first 2 to 4 weeks, as evidenced by increased peripheral edema, weight gain, decreases in hemoglobin, and an increased risk of hospitalization for heart failure, despite intensification of background diuretics. During follow-up, 173 patients died in the placebo group and 160 patients died in the bosentan group (HR: 0.94; 95% CI: 0.75 to 1.16). About 10% of the bosentan group showed meaningful increases in hepatic transaminases, but none had acute or chronic liver failure. Conclusions: Bosentan did not improve the clinical course or natural history of patients with severe chronic heart failure and but caused early and important fluid retention