Words count in psychotherapy: Differentiating language characteristics of cognitive behavioral therapy and focal psychodynamic therapy for anorexia nervosa.

It is generally assumed that psychodynamic therapy and cognitive behavioral therapy (CBT) differ in terms of applied techniques and processes. To date, however, little is known about whether and how such differences can actually be observed at a basic linguistic level and in what the two treatment approaches differ most strongly (i.e., how psychodynamic and CBT therapists differ in what they actually say word-by-word in therapy sessions). Building on theoretical models and previous research that used observer ratings, we formulated specific hypotheses regarding which word categories psychodynamic and CBT therapists who treat patients with an eating disorder should differ in. To investigate these hypotheses, we used verbatim transcripts from 297 therapy sessions of a randomized controlled trial in which patients with anorexia nervosa (n = 88) received either focal psychodynamic therapy (FPT) or CBT. These transcripts were then examined using computerized quantitative text analysis. In line with our hypotheses, we found that CBT therapists overall spoke more than their FPT counterparts and that they used more words related to eating. Also in line with our hypotheses, FPT therapists used more words related to social processes. Contrary to our expectations, CBT therapists did not show a stronger focus on the future but talked more about emotions than FPT therapists. The latter effect, however, appears to be driven by a stronger focus on positive emotions. These findings suggest that computerized quantitative text analysis can differentiate meaningful language characteristics of CBT and FPT on spoken-word level and that it holds potential as a tool for researchers and therapists. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A Randomized Trial of Autologous Chondrocyte Implantation Versus Alternative Forms of Surgical Cartilage Management in Patients With a Failed Primary Treatment for Chondral or Osteochondral Defects in the Knee.

BACKGROUND: There are limited randomized controlled trials with long-term outcomes comparing autologous chondrocyte implantation (ACI) versus alternative forms of surgical cartilage management within the knee. PURPOSE: To determine at 5 years after surgery whether ACI was superior to alternative forms of cartilage management in patients after a failed previous treatment for chondral or osteochondral defects in the knee. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: In total, 390 participants were randomly assigned to receive either ACI or alternative management. Patients aged 18 to 55 years with one or two symptomatic cartilage defects who had failed 1 previous therapeutic surgical procedure in excess of 6 months prior were included. Dual primary outcome measures were used: (1) patient-completed Lysholm knee score and (2) time from surgery to cessation of treatment benefit. Secondary outcome measures included International Knee Documentation Committee and Cincinnati Knee Rating System scores, as well as number of serious adverse events. Analysis was performed on an intention-to-treat basis. RESULTS: Lysholm scores were improved by 1 year in both groups (15.4 points [95% CI, 11.9 to 18.8] and 15.2 points [95% CI, 11.6 to 18.9]) for ACI and alternative, with this improvement sustained over the duration of the trial. However, no evidence of a difference was found between the groups at 5 years (2.9 points; 95% CI, -1.8 to 7.5; P = .46). Approximately half of the participants (55%; 95% CI, 47% to 64% with ACI) were still experiencing benefit at 5 years, with time to cessation of treatment benefit similar in both groups (hazard ratio, 0.97; 95% CI, 0.72 to 1.32; P > .99). There was a differential effect on Lysholm scores in patients without previous marrow stimulation compared with those with marrow stimulation (P = .03; 6.4 points in favor of ACI; 95% CI, -0.4 to 13.1). More participants experienced a serious adverse event with ACI (P = .02). CONCLUSION: Over 5 years, there was no evidence of a difference in Lysholm scores between ACI and alternative management in patients who had previously failed treatment. Previous marrow stimulation had a detrimental effect on the outcome of ACI. REGISTRATION: International Standard Randomised Controlled Trial Number: 48911177.

Separation of monomeric and dimeric phenolic compounds in lignosulphonate lignin on different stationary phases using ultrahigh-performance supercritical fluid chromatography.

Lignin is a promising renewable resource and its valorization could help to reduce our dependency on fossil carbon resources. Especially the production of small molecular weight and economically valuable compounds, such as vanillin, are of interest. A good separation of the sample components is crucial for a confident identification of compounds in complex sample mixtures using for instance mass spectrometry. In this work, the resolving power and selectivity of five different stationary phases for ultrahigh-performance supercritical fluid chromatography were studied for the class separation of lignin monomers (LMs) and dimers (LDs). A separation of LMs and LDs will help to identify such compounds in complex technical lignin samples. It could be shown that stationary phases with both hydrogen-bonding acceptor and donator groups offer high overall resolving power, while π-π-interactions are advantageous for the separation of the two compound classes. An almost complete separation combined with an improved overall resolving power was achieved with the 1-aminoanthracene stationary phase, which offers both hydrogen-bonding interactions and π-π-interactions.

No effect of very brief exposure to masked food pictures on fear of food in anorexia nervosa.

OBJECTIVE: Very brief exposure to masked images of spider stimuli can facilitate approach behaviour towards spiders in fearful subjects. We hypothesized that a similar effect might occur for fear of food in patients with anorexia nervosa (AN), possibly offering a new treatment approach, with advantages over other methods of food exposure. METHODS: Patients with AN (n = 60) were randomly assigned to one of three experimental conditions and received a single session of exposure to either masked and very briefly presented food images, clearly visible food images, or masked non-food images (i.e. household items). Effects of the three exposure conditions on fear of food and food avoidance were examined. RESULTS: Contrary to our expectations, very brief food cue exposure was not superior to the control conditions regarding fear of food and approach behaviour towards food immediately after the intervention and body mass index four weeks later. CONCLUSION: This finding suggests important differences between fear of food in AN and specific phobias such as fear of spiders. The absence of an effect reveals limitations of the very brief exposure method, which might be better suited for evolutionarily relevant threat stimuli.

Minimally Invasive and Open Distal Chevron Osteotomy for Mild to Moderate Hallux Valgus.

BACKGROUND: Minimally invasive surgical (MIS) techniques are increasingly being used in foot and ankle surgery but it is important that they are adopted only once they have been shown to be equivalent or superior to open techniques. We believe that the main advantages of MIS are found in the early postoperative period, but in order to adopt it as a technique longer-term studies are required. The aim of this study was to compare the 2-year outcomes of a third-generation MIS distal chevron osteotomy with a comparable traditional open distal chevron osteotomy for mild-moderate hallux valgus. Our null hypothesis was that the 2 techniques would yield equivalent clinical and radiographic results at 2 years. METHODS: This was a retrospective cohort study. Eighty-one consecutive feet (49 MIS and 32 open distal chevron osteotomies) were followed up for a minimum 24 months (range 24-58). All patients were clinically assessed using the Manchester-Oxford Foot Questionnaire. Radiographic measures included hallux valgus angle, the intermetatarsal angle, hallux interphalangeal angle, metatarsal phalangeal joint angle, distal metatarsal articular angle, tibial sesamoid position, shape of the first metatarsal head, and plantar offset. Statistical analysis was done using Student t test or Wilcoxon rank-sum test for continuous data and Pearson chi-square test for categorical data. RESULTS: Clinical and radiologic postoperative scores in all domains were substantially improved in both groups (P < .001), but there was no statistically significant difference in improvement of any domain between open and MIS groups (P > .05). There were no significant differences in complications between the 2 groups ( > .5). CONCLUSION: The midterm results of this third-generation technique show that it was a safe procedure with good clinical outcomes and comparable to traditional open techniques for symptomatic mild-moderate hallux valgus. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Third-generation minimally invasive correction of hallux valgus: technique and early outcomes.

PURPOSE: There is growing evidence supporting minimally invasive surgical (MIS) techniques for correction of symptomatic hallux valgus. The aim of this study was to present a hybrid third-generation technique and assess the safety and efficacy from the first 45 procedures. METHODS: Forty-five consecutive feet underwent a third-generation MIS distal chevron osteotomy with a minimum six month follow-up (range six to 17 months). This technique uses both first- and second-generation techniques plus a distal chevron osteotomy and screw for improved control and stabilisation of the metatarsal head. All patients were clinically assessed using the Manchester-Oxford Foot Questionnaire (MOXFQ). Radiographic measures included hallux valgus angle (HVA), intermetatarsal angle (IMA), first metatarsal length and overall toe length. RESULTS: There were significant improvements in all three domains of the MOXFQ (p <0.001). There was also significant improvement in all radiographic parameters (p < 0.001). Mean HVA decreased from 30.54° to 10.41°, and the mean IMA decreased from 14.55° to 7.11°. Shortening of the first metatarsal had no effect on clinical outcomes. There was a very low rate of complications. CONCLUSION: The short-term results of this third-generation technique show that it is a safe procedure with good clinical outcomes and compares favourably with earlier techniques.

On the source and scope of priming effects of masked stimuli on endogenous shifts of spatial attention.

Unconscious stimuli can influence participants' motor behavior as well as more complex mental processes. Previous cue-priming experiments demonstrated that masked cues can modulate endogenous shifts of spatial attention as measured by choice reaction time tasks. Here, we applied a signal detection task with masked luminance targets to determine the source and the scope of effects of masked stimuli. Target-detection performance was modulated by prime-cue congruency, indicating that prime-cue congruency modulates signal enhancement at early levels of target processing. These effects, however, were only found when the prime was perceptually similar to the cue indicting that primes influence early target processing in an indirect way by facilitating cue processing. Together with previous research we conclude that masked stimuli can modulate perceptual and post-central levels of processing. Findings mark a new limit of the effects of unconscious stimuli which seem to have a smaller scope than conscious stimuli.

Masked stimuli modulate endogenous shifts of spatial attention.

Unconscious stimuli can influence participants' motor behavior but also more complex mental processes. Recent research has gradually extended the limits of effects of unconscious stimuli. One field of research where such limits have been proposed is spatial cueing, where exogenous automatic shifts of attention have been distinguished from endogenous controlled processes which govern voluntary shifts of attention. Previous evidence suggests unconscious effects on mechanisms of exogenous shifts of attention. Here, we applied a cue-priming paradigm to a spatial cueing task with arbitrary cues by centrally presenting a masked symmetrical prime before every cue stimulus. We found priming effects on response times in target discrimination tasks with the typical dynamic of cue-priming effects (Experiments 1 and 2) indicating that central symmetrical stimuli which have been associated with endogenous orienting can modulate shifts of spatial attention even when they are masked. Prime-Cue Congruency effects of perceptual dissimilar prime and cue stimuli (Experiment 3) suggest that these effects cannot be entirely reduced to perceptual repetition priming of cue processing. In addition, priming effects did not differ between participants with good and poor prime recognition performance consistent with the view that unconscious stimulus features have access to processes of endogenous shifts of attention.

A comparison of the readability of two patient-reported outcome measures used to evaluate foot surgery.

Measuring the outcome of surgical intervention is an integral part of modern-day healthcare provision. The increasing requirement to monitor patient-reported outcomes highlights the need for patients to be able to read and understand health outcomes questionnaires. The present study compared the readability of 2 commonly used, validated, foot surgery outcome questionnaires (the Foot Health Status Questionnaire and the Manchester-Oxford Foot Questionnaire) using the Flesch Reading Ease score and the Flesch-Kincaid grade level score. The Manchester-Oxford Foot Questionnaire had a significantly greater (p < .003) score for reading ease and a significantly lower reading grade score (p < .005) than the Foot Health Status Questionnaire. These findings suggest the Manchester-Oxford Foot Questionnaire is a more suitable instrument in terms of readability and comprehension for a greater proportion of the population undergoing hallux valgus surgery.

Time course of free-choice priming effects explained by a simple accumulator model.

Unconscious visual stimuli can be processed by human observers and modulate their behavior. This has been shown for masked prime stimuli that influence motor responses to subsequent target stimuli. Beyond this, masked stimuli can also affect participants' behavior when they are free to choose one of two response alternatives. This finding demonstrates that an apparently free-choice between alternative behaviors can be subject to influences that are outside of awareness. We report three experiments which exhibit that the temporal dynamic of free-choice priming effects corresponds to that of forced-choice priming effects. Forced-choice priming effects were relatively robust against variations of prime stimuli but sensitive to physical features of target stimuli. Free-choice priming effects, in contrast, depended largely on the stimulus-response compatibility of the prime. A simple accumulator model which accounts for forced-choice response priming can also explain free-choice priming effects by the assumption that unconscious stimuli can initiate motor responses when participants are engaged in a speeded choice-reaction time task. According to our analyses free-choice priming results from a response selection mechanism which integrates conscious and unconscious information from external, stimulus driven sources and also from internal sources.

The economic cost of posterior capsule tear at cataract surgery.

PURPOSE: To estimate the direct financial burden to healthcare purchasers of a posterior capsule tear (PCT) during cataract surgery. METHODS: A retrospective data analysis of cataract surgeries was performed. Patients who had surgery in the 2-year period from April 2005, with a maximum follow-up, to April 2009 were identified. Patients previously under review for ocular comorbidity apart from cataract were excluded. Each case with PCT was matched with an uncomplicated cataract operation performed on the same list by the same grade of surgeon. For both groups, we extracted details of all additional subsequent visits and interventions. Data on the cost of visits and procedures were provided by the Department of Health. We then compared this data between groups. RESULTS: A total of 100 patients with PCT were matched with 100 controls. The preoperative parameters of the two groups were similar. The cases required a median of 3 (mean 3.6, range 0-24) additional postoperative visits compared with 0 (mean 0.19, range 0-8) for controls, with a median duration of follow-up of 74 (mean 129.5, range 6-1316) days for cases compared to 21 (mean 26.1, range 0-308) days for controls (p=0.000). The average cost of extra visits was £ 475.0 (SD £ 697.8) for cases and £ 69.2 (SD £ 51.0) for controls (p<0.001). CONCLUSIONS: Based on the National Health Service national tariff, a PCT during cataract surgery results in significant additional financial cost to healthcare purchasers. A full cost analysis would be required to estimate the additional cost of a PCT for the healthcare provider.

Prospective review of medium term outcomes following interpositional arthroplasty for hammer toe deformity correction.

BACKGROUND: Hammer toe is a common lesser toe deformity that is usually found to affect the second toe. A number of procedures have been applied in its surgical management with varying results but there is still no consensus on the best technique. MATERIALS AND METHOD: We prospectively reviewed a consecutive series of patients treated with interpositional arthroplasty, early mobilisation and with a minimal follow up of 6 months. We measured outcome using the Manchester Oxford foot and ankle questionnaire and a global impression of change score. RESULTS: There was a high level of satisfaction with the resulting pain relief and the type of footwear worn thereafter. We had no complications in terms of infection or chronic pain. There were no early recurrences within our follow up period. CONCLUSIONS: Overall we demonstrate good to excellent results with this surgical tactic allowing pain relief, early mobilisation and a low risk of infection.

Outcomes after the Stainsby procedure in the lesser toes: an alternative procedure for the correction of rigid claw toe deformity.

Clawing of the digits is a deformity seen both in patients with and without rheumatoid arthritis, resulting in pain and deformity in the forefoot. After failure of conservative treatment, the Stainsby procedure is one surgical option for severe clawing and metatarsalgia in both rheumatoid and nonrheumatoid feet. Results from the originating authors (G.D. Stainsby and P.J. Briggs) are consistent and reliable; however, there is little material outside of the originating center. This article reviews our experience in the Western Sussex Hospitals NHS Trust. Sixteen consecutive patients who underwent Stainsby procedure between 2006 and 2009 were reviewed. All operations were performed by a single consultant surgeon, the senior author (S.P.). All patients were scored using the Manchester Oxford Foot and Ankle score preoperatively and postoperatively. Minimum follow-up was 6 months, with a mean follow-up of 14 months. Significant improvements in all scores were seen postoperatively. Walking scores dropped from a mean of 22 preoperatively to 12.7 postoperatively (p = 0.007). Pain scores dropped from a mean of 13.3 to 7.1 (p = 0.001). Social scores dropped from a mean 11 to 6 (p = 0.001). Overall patient satisfaction was high. The Stainsby procedure has been shown to improve function and reduce pain in patients from its originating center in both rheumatoid and nonrheumatoid feet. This study demonstrates this simple technique is reproducible and effective in reducing morbidity.

A comparative study of radiation dose and screening time between mini C-arm and standard fluoroscopy in elective foot and ankle surgery.

BACKGROUND: Mini C-arm devices have gained popularity in extremity surgery. There is little evidence of the benefits of this technique in the clinical setting of foot and ankle surgery. We used dose area product (DAP) to compare radiation usage between mini C-arm and standard fluoroscopy. METHODS: We prospectively reviewed 127 cases requiring intra-operative screening during elective foot and ankle surgery. RESULTS: Mini C-arm was used in 55 patients and standard fluoroscopy in 72 patients. There was a statistically significant reduction in mean DAP using the mini C-arm, 3.46 Gy cm² vs 7.43 Gy cm² (P=0.0013). There was no difference in screening time. The annual saving from using the mini C-arm could be £9391, saving the total cost of the device over 5 years. CONCLUSION: The mini C-arm reduces radiation risk and costs when compared to standard fluoroscopy. We recommend its regular use in foot and ankle surgery.

Prospective assessment of dorsal cheilectomy for hallux rigidus using a patient-reported outcome score.

Compared with other surgical procedures for hallux rigidus, dorsal cheilectomy involves relatively less bone removal, maintains joint motion, and leaves the potential for further salvage surgery. The Manchester-Oxford Foot and Ankle Questionnaire (MOXFQ) has a maximum score of 64 (worst foot health) and has been endorsed by the British Foot and Ankle Society to measure surgical outcome. We prospectively assessed patient-reported outcomes after dorsal cheilectomy for hallux rigidus using the MOXFQ. Patients were deemed suitable for dorsal cheilectomy if they had painful restriction of terminal dorsiflexion, with absence of pain in the mid-range of passive movement, and radiographic evidence of dorsal osteophytosis. Twenty-five patients with a mean age of 62 years (range, 39-80 years), including 17 (68%) women, underwent dorsal cheilectomy for hallux rigidus. The mean preoperative MOXFQ score was 33.0 (95% confidence interval = 27.4-38.6), and, at a mean of 17 months (range, 9-27 months) follow-up, the mean postoperative score was 9.6 (95% confidence interval = 6.0-13.2). Eighty-four percent of patients experienced clinically significantly improved walking domain, 68% in the social domain, and 59% in the pain domain of the MOXFQ. Four patients failed cheilectomy, including 3 who subsequently underwent arthrodesis for persistent pain and 1 who experienced no improvement in any domain of the MOXFQ. This prospective study provided further evidence of the success of dorsal cheilectomy as a treatment for hallux rigidus and demonstrated the potential usefulness of the MOXFQ in assessing surgical outcomes in foot surgery.

The pivot shift test is of limited clinical relevance in the arthritic anterior cruciate ligament-deficient knee.

The pivot shift test is used to assess the integrity of the anterior cruciate ligament (ACL). This test has been shown to be highly sensitive in detecting instability in knees with complete ACL rupture. However, in the presence of osteoarthritis, the rotation and subluxation required for the pivot shift to be effective can be limited and therefore is likely to impact upon the reliability of this test. We performed the pivot shift test on 50 patients, under general anesthesia, prior to total knee replacement and then recorded the integrity of the ACL intraoperatively. This allowed us to assess the accuracy of this test in the presence of significant osteoarthritis. Of the 50 knees tested, none had a positive pivot shift test preoperatively; however, 14% of the knees included in the study had a completely ruptured ACL. This gives a sensitivity of 0% and a specificity of 1% for the pivot shift test for ACL ruptures in the presence of established osteoarthritis. We conclude that the pivot shift test may not be a reliable test for ACL function in the presence of symptomatic arthritis of the knee.

How accurate is Whiteside's line as a reference axis in total knee arthroplasty?

There is an increasing focus on the precision with which prostheses in the knee are inserted with advent of computer assisted surgery. Much attention has been paid to the differences between this and conventional alignment jig techniques. Both techniques however rely on accurate identification of bony morphology and utilising this information to correctly orientate the prosthesis. Correct rotational alignment of the femoral prosthesis in total knee arthroplasty is important for correct patella tracking, patellofemoral joint contact forces, varus-valgus positioning in flexion, correct rotational alignment of the tibia in extension and the avoidance of anterior femoral notching. Whiteside's line is considered to be perpendicular to the epicondylar axis and therefore a reliable axis of reference. A cadaveric study was performed to assess the reliability and reproducibility of Whiteside's line in 50 cadaveric distal femora. Our results have shown that Whiteside's line is perpendicular to the epicondylar axis in the majority of cases (mean of 91 degrees). However the variation of values about the mean (range 80-102 degrees), and a SD of 4.7 degrees suggests that this should not be used alone as a rotational assessment guide. Rotation should ideally be checked against several axes to avoid errors in rotation positioning of the femoral prosthesis.

Surgical reconstruction of severe patellofemoral maltracking.

Dysfunction of the patellofemoral mechanism presents in many ways. Results from different realignment procedures show great variability in patient outcome. A surgical technique is presented that attempts to correct all the abnormalities of patellofemoral maltracking. The procedure consists of a lateral release, a vastus medialis (obliquus) tendon advancement, and a tibial tubercle transfer. Along with being moved medially, the tubercle also is moved distally to correct patella alta and elevated anteriorly to reduce patellofemoral joint reaction forces. One hundred seven knees in 84 patients were reviewed. Fifty-five percent of patients had frank dislocation. The remaining patients had anterior knee pain and had abnormal patella tracking on examination. The mean followup was 5.6 years. Seventy-nine percent of patients had a good to excellent functional outcome and 84% of patients stated they would have the operation again. Two patients with marked generalized ligamentous laxity had recurrent dislocation of the patella.