Does Personality Matter? Perceptions and Experiences of Introverts and Extraverts as General Surgeons.

PHENOMENON: Medical educators increasingly recognize both the challenges introverts, compared to extraverts, may face in medical training and the unique strengths they bring to practice. However, few researchers have examined in-depth how introverts and extraverts truly experience training and practice, particularly in specialties like surgery that tend to value qualities (e.g., dominance and assertiveness) typically associated with extraverts. This study aimed to explore the perceptions and experiences of individuals with both personalities within the field of general surgery. APPROACH: Using a constructivist grounded theory approach, six general surgeons and 10 general surgery residents who identified as introverted, extraverted, or ambiverted were recruited from two Canadian tertiary care hospitals to participate in semi-structured interviews. Data collection and analysis occurred iteratively, and data were analyzed using open, selective, and thematic coding. Constant comparison allowed us to make sense of the similar and dissimilar views that emerged from each interview. FINDINGS: Irrespective of their personalities, participants voiced two general patterns of responses. Some participants believed that "personality doesn't matter": that both introverted and extraverted practice styles were equally viable and neither introverts nor extraverts would find surgical training more challenging than the other (culture of equality). However, others believed that "personality matters," emphasizing that surgeons should be dominant and aggressive leaders. Only those who believed "personality matters" felt that introverts sometimes needed to act more extraverted in order to succeed in surgical training (culture of hierarchy). Similar numbers of introverts and extraverts adhered to each viewpoint. INSIGHTS: Our qualitative approach allowed us to draw meaning from the complex subjective experiences of our research participants. Our findings suggest that two competing cultures (equality and hierarchy) co-exist within the field of surgery and that trainees, depending on which culture they adhere most to, will or will not "adapt" their personalities to the workplace. These findings deepen our understanding of the nuances of surgical culture and have important implications for how we select candidates based on personality.

Angels of Courage: The Experiences of Mothers Who Have Been Bereaved by Suicide.

Despite the increasing number of people being bereaved by suicide, little is understood concerning the experiences of those bereaved by suicide as they struggle to make sense of a loved one's death. The current study explored the experiences of four mothers who had been bereaved by suicide and the role of support groups in the meaning-making process following bereavement by suicide. Participants were interviewed and transcribed interviews were then analysed from an interpretative phenomenological perspective. Four main themes were identified: Continuing role of the mother; A never-ending quest; Finding sanctuary; and Rising up from the ashes. These themes relate to a range of emotions following bereavement by suicide, the meaning-making process, the social context and the role of the support group. Clinical implications are discussed in relation to these findings.

A Qualitative Systematic Review of the Bereavement Process Following Suicide.

Despite the fact that a large number of people are bereaved by suicide each year, the experiences of those bereaved by suicide are poorly understood. It has been suggested that a contributing factor in relation to this lack of understanding has been the use of quantitative methods, which may not be sensitive to the bereavement process and its thematic content. Therefore, the current article outlines a systematic review of 11 qualitative studies that address issues related to the bereavement process following suicide. The results indicate that those bereaved by suicide encounter a range of difficult feelings following suicide including blame, guilt, and emptiness and that these feelings are affected by participants' ability to make meaning of the event. The meaning-making process is a complex one that occurs within a difficult social context in which both those bereaved by suicide and members of the wider community struggle to interact with each other in a beneficial way. Clinical implications of these findings are discussed.

Assessing physical function after completing a supervised education and exercise program in adults with type 2 diabetes and exploring exercise motivation at one-year follow up: A case series study.

BACKGROUND: Exercise programs for adults with type 2 diabetes (T2D) improve glycemic control and physical function. However, diabetes complications, disability, and motivation pose challenges for exercise participation. OBJECTIVE: The purpose of the study was to: 1) measure change in fasting blood glucose, blood pressure, anthropometrics (i.e. BMI and waist circumference), and physical function (i.e. endurance, agility and balance, upper and lower-body strength and flexibility) after completing an eight-week education and exercise program for adults with T2D; and 2) explore the experience of exercise continuation in people living with T2D at one-year follow-up. METHODS: A mixed methods case series design was conducted. Participants were ≥ 18 years and had a clinical diagnosis of T2D (glycated hemoglobin (A1C) ≥ 6.5%). Participants completed two one-hour exercise sessions and one one-hour education session per week for eight weeks. Blood glucose, blood pressure, body mass index (BMI), waist circumference, and physical function were measured at baseline and after completing the program. Follow-up telephone interviews were conducted at one, six, and 12-months and thematic analysis was employed to analyze interviews. RESULTS: Twelve participants completed the program. Clinically significant improvements were observed for waist circumference, systolic blood pressure, six-minute walk test (6MWT), timed up-and-go test (TUG), 30-second chair stand test (CST) and arm curls. Three themes emerged from the interviews that described participant reflections and experiences with a supervised education and exercise program for management of their T2D: 1) medical management; 2) lifestyle management; and 3) finding what works. Conclusion: Supervised programming improves physical function and may mitigate disability. Physiotherapists are qualified to assess and treat physical function through education and exercise.

Health Care Providers' Perspectives on Promoting Physical Activity and Exercise in Health Care.

Health care providers (HCPs) are entrusted with providing credible health-related information to their patients/clients. Patients/clients who receive physical activity and exercise (PAE) advice from an HCP typically increase their PAE level. However, most HCPs infrequently discuss PAE or prescribe PAE, due to the many challenges (e.g., time, low confidence) they face during regular patient care. The purpose of this study was to ascertain HCPs' perspectives of what could be done to promote PAE in health care. HCPs (n = 341) across Nova Scotia completed an online self-reflection survey regarding their current PAE practices and ideas to promote PAE. The sample consisted of 114 physicians, 114 exercise professionals, 65 dietitians, and 48 nurses. Quantitative textual analysis (frequency of theme ÷ number of respondents) was performed to identify common themes to promote PAE in health care. In the pooled sample, the primary theme cited was to increase the availability of community programs (24.1% of respondents), followed by more educational opportunities for providers (22.5%), greater promotion of PAE from HCPs (17.1%), reducing financial barriers experienced by patients/clients (16.3%), and increasing availability of qualified exercise professionals (15.0%). Altogether, increased PAE education and greater availability of affordable community PAE programs incorporating qualified exercise professionals, would reduce barriers preventing routine PAE promotion and support the promotion of PAE in Nova Scotia.

Exercise is Medicine Canada workshop training improves physical activity practices of physicians across Canada, independent of initial confidence level.

BACKGROUND: Educational workshops help physicians (MDs) include physical activity and exercise (PAE) content in more patient appointments. It is unclear if MDs with varying degrees of confidence discussing PAE with their patients equally benefit from such training. We evaluated whether MDs' initial confidence affects the impact of an educational PAE workshop. METHODS: MDs (n = 63) across Canada completed self-reflection questionnaires initially and 3-months following a PAE workshop. MDs were divided into low-confidence [confidence score (out of 100%): <40%; n = 21], medium-confidence (40-60%; n = 19) and high-confidence (>60%; n = 23). RESULTS: PAE counselling confidence increased in all groups (relative increase: Low=~40%, Medium=~20%, High=~10%). Training increased the low-confidence group's knowledge, awareness of guidance/resources and perception of their patients' interest in lifestyle management (~30% change; all p < 0.001). Compared to baseline, a greater proportion (all p < 0.001) of MDs reported prescribing exercise at 3-month follow-up in each of the low-confidence (10% to 62%) medium-confidence (16% to 89%) and high-confidence (57% to 87%) groups. CONCLUSION: PAE training favorably improved MDs' confidence, perceived impact of many barriers and the proportion of MDs prescribing exercise, at each level of confidence. An educational workshop particularly assisted MDs with low-confidence (i.e., those who needed it the most) integrate PAE into their practice.

CONTEXTE: Les ateliers éducatifs aident les médecins (MD) à inclure un contenu sur l'activité physique et l'exercice (PAE) dans un plus grand nombre de consultations auprès de leurs patients. On ne peut établir clairement si les médecins, avec divers degrés de confiance en soi pour discuter de l'activité physique et de l'exercice avec leurs patients, bénéficient tous également d'une telle formation. Nous avons évalué si la confiance en soi initiale du médecin influence les effets d'un atelier éducatif sur l'activité physique et l'exercice. MÉTHODES: Des médecins (n = 63) de partout au Canada ont rempli des questionnaires d'introspection au départ et trois mois après un atelier sur l'activité physique et l'exercice. Les médecins ont été divisés selon un niveau de confiance faible [score d'auto-efficacité (sur 100 %) : < 40 %; n = 21], moyen (40 - 60 %; n = 19) et élevé (> 60 %; n = 23). RÉSULTATS: L'auto-efficacité de services de consultation en matière d'activité physique et d'exercice a augmenté dans tous les groupes (augmentation relative : faible = ~40 %, moye n = ~20 %, élevé = ~10 %). La formation a augmenté les connaissances, la sensibilisation aux conseils/ressources et la perception de l'intérêt de leurs patients dans la gestion du style de vie dans le groupe à faible niveau de confiance (changement d'environ 30 %; tous p < 0,001). Par rapport à la valeur initiale, une plus grande proportion (tous p < 0,001) des médecins ont indiqué prescrire de l'exercice au suivi de trois mois dans chacun des groupes avec un degré de confiance faible (10 % à 62 %), moyen (16 % à 89 %) et élevé (57 % à 87 %). CONCLUSION: La formation sur l'activité physique et l'exercice a amélioré la confiance en soi des médecins, les effets perçus de nombreux obstacles et la proportion de médecins prescrivant de l'exercice, à chaque degré de confiance. Un atelier éducatif a aidé plus particulièrement les médecins avec un faible degré de confiance (c.-à-d., ceux qui en avaient le plus besoin) à intégrer l'activité physique et l'exercice dans leur pratique.

Oxygen hypothesis of polar gigantism not supported by performance of Antarctic pycnogonids in hypoxia.

Compared to temperate and tropical relatives, some high-latitude marine species are large-bodied, a phenomenon known as polar gigantism. A leading hypothesis on the physiological basis of gigantism posits that, in polar water, high oxygen availability coupled to low metabolic rates relieves constraints on oxygen transport and allows the evolution of large body size. Here, we test the oxygen hypothesis using Antarctic pycnogonids, which have been evolving in very cold conditions (-1.8-0 degrees C) for several million years and contain spectacular examples of gigantism. Pycnogonids from 12 species, spanning three orders of magnitude in body mass, were collected from McMurdo Sound, Antarctica. Individual sea spiders were forced into activity and their performance was measured at different experimental levels of dissolved oxygen (DO). The oxygen hypothesis predicts that, all else being equal, large pycnogonids should perform disproportionately poorly in hypoxia, an outcome that would appear as a statistically significant interaction between body size and oxygen level. In fact, although we found large effects of DO on performance, and substantial interspecific variability in oxygen sensitivity, there was no evidence for sizexDO interactions. These data do not support the oxygen hypothesis of Antarctic pycnogonid gigantism and suggest that explanations must be sought in other ecological or evolutionary processes.

Exercise is Medicine Canada physical activity counselling and exercise prescription training improves counselling, prescription, and referral practices among physicians across Canada.

Exercise is Medicine Canada (EIMC) is an initiative that promotes physical activity (PA) counselling and exercise prescription within health care. The purpose of this study was to compare physicians' perceptions and practices around PA counselling and exercise prescription following EIMC training. Physicians (n = 46) from 7 different provinces completed questionnaires initially and 3 months following an EIMC workshop. Three months after intervention, physicians reported greater confidence compared with baseline for providing physical activity and exercise (PAE) information to patients (79% vs 55%; p < 0.001), assessing patients' PAE (69% vs 44%, p = 0.005), answering patients' PAE questions (78% vs 54%, p < 0.001), providing PAE advice (71% vs 43%, p < 0.001), and identifying which patients would benefit from referral to qualified exercise professionals (77% vs 52%, p = 0.002). At follow-up, physicians reported PA prescription barriers as less impactful (out of 4; all p < 0.05), including perceived patients' lack of interest (2.75 to 2.25), lack of available resources (2.59 to 2.00), and lack of time (2.41 to 2.14). The proportion of physicians providing written exercise prescriptions increased from 20% to 74%. This study suggests that the completion of a 1-day EIMC workshop increases physicians' confidence, knowledge, and counselling behaviours of physicians in prescribing PAE.

Emergency Department use of Apneic Oxygenation Versus Usual Care During Rapid Sequence Intubation: A Randomized Controlled Trial (The ENDAO Trial).

OBJECTIVES: Desaturation leading to hypoxemia may occur during rapid sequence intubation (RSI). Apneic oxygenation (AO) was developed to prevent the occurrence of oxygen desaturation during the apnea period. The purpose of this study was to determine if the application of AO increases the average lowest oxygen saturation during RSI when compared to usual care (UC) in the emergency setting. METHODS: A randomized controlled trial was conducted at an academic, urban, Level I trauma center. All patients requiring intubation were included. Exclusion criteria were patients in cardiac or traumatic arrest or if preoxygenation was not performed. An observer, blinded to study outcomes and who was not involved in the procedure, recorded all times, while all saturations were recorded in real time by monitors on a secured server. Two-hundred patients were allocated to receive AO (n = 100) or UC (n = 100) by predetermined randomization in a 1:1 ratio. RESULTS: A total of 206 patients were enrolled. There was no difference in lowest mean oxygen saturation between the two groups (92, 95% confidence interval [CI] = 91 to 93 in AO vs. 93, 95% CI = 92 to 94 in UC; p = 0.11). CONCLUSION: There was no difference in lowest mean oxygen saturation between the two groups. The application of AO during RSI did not prevent desaturation of patients in this study population.

Source attribution and credibility of health and appearance exercise advertisements: relationship with implicit and explicit attitudes and intentions.

The relationship of attributed source (commercial or nonprofit) and credibility of exercise advertisements to explicit and implicit exercise-related attitudes and intentions was examined. Male and female participants (N = 227) were randomly assigned to watch health or appearance-related advertisements and then completed an implicit attitudes task and questionnaires. Health advertisements and those attributed to a nonprofit source were rated more credible. Appearance condition participants who attributed the advertisement to a nonprofit source also rated the advertisement as more credible. Participants who rated a commercial advertisement as credible reported higher implicit instrumental attitudes. Implications for exercise promotion are discussed.

Implementation of resources to support patient physical activity through diabetes centres in Atlantic Canada: the effectiveness of toolkit-based physical activity counselling.

OBJECTIVE: The purpose of this study was to determine the effectiveness of toolkit-based physical activity counselling on physical activity and exercise participation of type 2 diabetes patients attending diabetes centres in Atlantic Canada. METHODS: Patients with type 2 diabetes (n=198) were recruited to a quasiexperimental study comparing the effectiveness of counselling by persons trained to use a physical activity and exercise resource manual (i.e. toolkit) vs. a standard of care counselling situation. Effectiveness was assessed through questionnaires completed by patients, and clinical data were extracted from patient charts before and 6 months after a single appointment with a diabetes educator. Primary outcome measures were patient self-reported physical activity and exercise levels, efficacy perceptions and mean glycated hemoglobin. RESULTS: There were no significant differences in primary outcomes over time. Subanalyses of the toolkit-counselled patients revealed a significant interaction for moderate-to-vigorous physical activity (MVPA [p<0.0001]), whereby patients who were not meeting Canadian Diabetes Association guidelines for physical activity at baseline (i.e. <150 MVPA a week; n=44) increased physical activity (from 20±23 to 120±30 minutes) and patients who were active at baseline (i.e. >150 MVPA a week; n=22) decreased physical activity (from 444±32 to 161±41 minutes) at 6 months. CONCLUSIONS: A single counselling appointment using the toolkit did not elicit significant changes in physical activity or clinical outcomes measured 6 months later when compared with standard care condition; however, increased physical activity was observed for patients who were inactive at baseline. Repeated counselling or more intensive strategies may be required to increase patient physical activity levels and produce clinical outcomes.

Implementation of resources to support patient physical activity through diabetes centres in Nova Scotia: the effectiveness of enhanced support for exercise participation.

OBJECTIVE: The purpose of this study was to determine the effectiveness of enhancing support for physical activity counselling and exercise participation at diabetes centres in Nova Scotia on physical activity and exercise behaviours and clinical outcomes in patients with type 2 diabetes mellitus. METHODS: In all, 180 patients at 8 diabetes centres participated in this observational study. A range of enhanced supports for exercise were offered at these centres. A kinesiologist was added to the diabetes care team to primarily provide extra physical activity counselling and exercise classes. Patient physical activity and exercise levels, efficacy perceptions and mean glycated hemoglobin (A1C) were evaluated at baseline and 6 months. We compared changes in these variables for patients who participated in the enhanced supports versus patients who did not. RESULTS: Participants who attended exercise classes (n=46), increased moderate physical activity by 27% and doubled resistance exercise participation (1.0±1.8 to 2.0±2.1 days per week) whereas those who did not attend exercise classes (n=49) reduced moderate physical activity by 26% and did not change resistance exercise participation (interactions, p=0.04 and p=0.07, respectively). Patients who received resistance band instruction (n=15) from a kinesiologist had reductions in A1C (from 7.5±1.4 to 7.1±1.2; p=0.04), whereas other subgroups did not have significant changes in A1C. CONCLUSIONS: Offering enhanced support for exercise at diabetes centres produced improvements in physical activity and exercise in type 2 diabetes patients. Resistance band instruction from a kinesiologist combined with participating in a walking and resistance training program improved glycemic control, which underscores the importance of including exercise professionals in diabetes management.

Physical activity and nutrition among youth in rural, suburban and urban neighbourhood types.

OBJECTIVES: Physical activity and nutrition are essential to healthy living and particularly important during youth, when growth and development are key. This study examined rates of physical activity (PA) and diet quality (DQ) among youth in grades 7 to 9 in Halifax, Nova Scotia, during the 2008/09 school year and tested differences among students in rural, urban and suburban neighbourhood types of high and low socio-economic status (SES). METHODS: Youth in grades 7 through 9 (aged 12-16; 53% male) from six schools (N=380), stratified by neighbourhood type (urban, suburban, rural) and SES, wore accelerometers for up to 7 days (mean=4.14, standard deviation=1.49) and completed a nutritional survey. RESULTS: The findings suggest important differences in PA and DQ across SES and neighbourhood type. Specifically, rates of moderate to vigorous physical activity among youth from schools in lower socio-economic areas were higher in urban than in suburban or rural settings. Furthermore, DQ was better among youth in higher than in lower socio-economic urban settings. CONCLUSIONS: Understanding these differences in PA and DQ across rural, urban and suburban environments of high and low SES may highlight subgroups and targeted geographic areas for the design of interventions to improve rates of PA and health nutrition.