'I felt like I'd lost control of everything': An exploration of metacognition and masculinity in men experiencing suicidality.

BACKGROUND: Seventy-five per cent of UK suicides are completed by men, and associated masculinity beliefs are well researched. The self-regulatory executive functioning (S-REF) model of distress is governed by metacognitive beliefs about mental processes, such as worry and rumination. Little is known about metacognition in male suicidality and how these processes interact with masculinity beliefs, suicidal ideation and behaviour. AIMS: To identify which aspects of the S-REF model were present in a sample of men experiencing suicidality, and to consider how these processes interact with masculinity beliefs, suicidal ideation and behaviour. METHOD: Fifteen men experiencing suicidal ideation or behaviour were recruited from a home-based treatment team. Semi-structured interviews and self-report measures were administered to identify metacognitive processes and masculinity beliefs. Interviews were analysed using the framework approach. RESULTS: The S-REF model was identified across three super-ordinate themes; 'the cognitive attentional syndrome (CAS) and maladaptive coping', 'metacognitive beliefs about worry, uncontrollability and danger' and 'consequences'. Thirteen sub-ordinate themes included processes such as 'worry' and 'rumination', metacognitive beliefs such as 'worrying helps me avoid problems' and 'worry is dangerous for me' and emotional consequences such as 'overwhelm', 'emasculation' and 'escape'. CONCLUSION: Perseverative thinking and erroneous metacognitive beliefs were associated with reduced functioning, which was incompatible with masculinity beliefs about leadership and strength, and suicide was considered as re-establishing control. Further research into metacognitive processes in male suicidality would enhance theoretical understanding.

Broad Responses and Attitudes to Having Music in Surgery (The BRAHMS Study): An Australia and Aotearoa New Zealand Perspective.

Background: Surgery is a stressful exercise, and the experience of occupational stress may have impacts on surgical performance, and surgeon well-being. Music is played in operating theatres (OTs) throughout the world, and while it may improve surgical performance, and reduce clinician stress within the OT, concerns exist over its distracting and noise-creating properties. Methods: In this prospective observational study, between May to August 2022, Vascular, General and Paediatric surgeons and registrars in Australia and Aotearoa New Zealand (AoNZ) responded to a survey investigating the way they use music, and their perceptions and attitudes towards its effect on the OT environment. Binomial logistic regression and Chi squared tests of association were performed, accepting p < 0.05 as significant. Results: In this cohort of 120 surgeons, 45 % were vascular specialists, 30 % were female and 59 % were consultant surgeons. The most commonly preferred music genres were easy listening and pop. Over 75 % of surgeons enjoyed having music in their OTs with the majority reporting it improved their temperament, how mentally fatiguing a procedure felt and how anxious or stressed they felt. Vascular surgeons were more likely to believe music had a positive influence on communication than their general and paediatric surgery colleagues (p < 0.01). Registrars had significantly higher odds of believing music had a positive effect on their temperament, and how stressed and anxious they felt when operating, when compared to consultants (p < 0.05). Conclusions: This study provides a window into the surgeons' use of and attitudes towards intra-operative background music and its effect on stress and cognitive load in Australia and AoNZ. While overall, music is viewed positively by this cohort, there was some difference seen across specialties and level of experience. Further subjective and objective data in this field may provide useful information to guide hospital policy and inform pathways for clinician wellbeing.

The effect of background music on stress in the operating surgeon: scoping review.

BACKGROUND: Despite the ubiquitous sounds of music playing in operating theatres (OTs) around the world, the effect that music has on intraoperative clinician stress is ill-defined. In the present scoping review the aim was to map the available evidence for the effect of background music in the OT on the experience of stress in the operating surgeon. METHODS: The present review was conducted in accordance with the PRISMA Protocols for Scoping Reviews. Using Embase, MEDLINE, and the Cochrane databases, peer-reviewed research studies reporting the effect of intraoperative background music on an outcome measure of clinician stress or respondent perceptions on this effect were included. RESULTS: A total of 4342 studies were screened and 15 studies met the inclusion criteria, of which 10 were interventional studies, and five were observational survey-based studies. Of the 10 interventional studies, four showed reduced anxiety and mental workload scores with music, although only two demonstrated a significant improvement in a physiological outcome. The survey-based studies generally reported a positive perception among surgeons and theatre staff towards the effect of music on OT stress. CONCLUSION: While there is generally a positive perception towards intraoperative music and surgeon stress, there are few objective physiological and psychological data to support this. Studies were varied in their design. The present review can be used to guide future experimental, observational, and mixed-method research on this topic.

Validation of the Korean Version of the Positive and Negative Sleep Appraisal Measure (PANSAM) as a Tool for Evaluating Dysfunctional Beliefs about Sleep among the General Population.

We explored the reliability and validity of the Korean version of the Positive and Negative Sleep Appraisal Measure (PANSAM) scale using pre-existing sleep-related questionnaires among the general population. Through an online survey, data from 400 South Korean participants were collected from 10 to 18 January 2022. Symptoms were measured with the PANSAM, Insomnia Severity Index (ISI), the 16-item Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS-16), the Glasgow Sleep Effort Scale (GSES), and the discrepancy between desired time in bed and the desired total sleep time (DBST) index. The four PANSAM subscales were reliable and valid tools for measuring individuals' dysfunctional beliefs about sleep. A confirmatory factor analysis revealed that the full-scale and four-factor model showed a good fit. The full scale and each subscale were significantly correlated with ISI, DBAS-16, and GSES scores. The DBST index was significantly correlated with Subscales 2 and 3. In conclusion, the Korean version of the PANSAM scale and its four subscales can be applied when clinicians measure dysfunctional beliefs regarding sleep among the general population in South Korea. The PANSAM should be explored among other clinical groups to elucidate its applicability as a trans-diagnostic tool while conducting cognitive behavioral therapy for insomnia.

The positive and negative sleep appraisal measure: Towards a clinical validation of sleep spectrum cognitions.

BACKGROUND: Sleep disturbance is considered a transdiagnostic process due to high comorbidity with mental health difficulties. In particular, sleep disturbances are a feature of mood disorders. To advance transdiagnostic psychological interventions targeting sleep, the Positive and Negative Sleep Appraisal Measure (PANSAM) was developed. The PANSAM is a theory-driven measure based on an Integrative Cognitive Sleep Model and proposes that positive and negative sleep appraisals for excessively long and short sleep durations play a key role in the development of insomnia, hypersomnia, and reduced need for sleep. This study evaluated clinical validity of this new measure. METHODS: Participants were those who met bipolar at risk criteria and bipolar diagnoses (bipolar spectrum group) (N = 22), major depressive disorder (unipolar depression group) (N = 18), and a nonclinical group (N = 22). To compare against previous insomnia and bipolar disorder relevant research, administered measures included the Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS) and the Hypomanic and Positive Predictions Inventory (HAPPI). RESULTS: Analysis of variance (ANOVA) tests revealed that the clinical groups scored significantly higher on the PANSAM. The same was shown for the DBAS and HAPPI. Post hoc analyses showed that the PANSAM scale and subscales had significant correlations with all clinical measures. Effect sizes are reported due to sample size limitations. CONCLUSION: This study has initially validated the PANSAM with clinical populations and highlighted its applicability to a transdiagnostic approach.

The development of a theoretically derived measure exploring extreme appraisals of sleep in bipolar disorder: a Delphi study with professionals.

BACKGROUND: Sleep and mood are known to be linked and this is particularly evident in people with a diagnosis of bipolar disorder (BD). It has been proposed that psychological interventions improving sleep can be a pathway for improving mood. In order for a psychological sleep intervention to be appropriate, the common cognitive processes maintaining the range of sleep disturbances need to be investigated. AIM: This study aimed to explore and identify expert consensus on positive and negative sleep appraisals in the context of low and high mood states, using the Integrative Cognitive Model as a theoretical guide. METHOD: A Delphi approach was utilized to allow clinical and research professionals, with experience in the field of BD, to be anonymously consulted about their views on sleep appraisals. These experts were invited to participate in up to three rounds of producing and rating statements that represented positive and negative sleep appraisals. RESULTS: A total of 38 statements were developed and rated, resulting in a final list of 19 statements that were rated as 'essential' or 'important' by >80% of the participants. These statements represent the full range of extreme sleep appraisals this study had set out to explore, confirming the importance of better understanding and identifying positive and negative sleep cognitions in the context of high and low mood. CONCLUSION: The statements reviewed in this study will be used to inform the development of a sleep cognition measure that may be useful in cognitive therapy addressing sleep disturbances experienced along the bipolar spectrum.

An alternative to standard lumpectomy: a 5-year case series review of oncoplastic breast surgery outcomes in a Canadian setting

Background: Oncoplastic surgery (OPS) is becoming the new standard of care for breast-conserving surgery (BCS). It has become increasingly popular in Europe; however, it has not yet been widely accepted in North America. This study aims to describe the experience with OPS at a Canadian tertiary care centre. Methods: This study is a retrospective case series consisting of consecutive OPS cases at a single Canadian centre, the Royal Victoria Regional Health Centre in Barrie, Ontario, between 2009 and 2015. Results: A total of 275 women who consecutively underwent OPS were included. The average size of the tumour was 17 mm (standard deviation [SD] 13 mm; range 0­110 mm). The average specimen weight was 155 g (SD 146 g; range 15­1132 g). Invasive ductal carcinoma was the most common diagnosis (237 patients, 86.2%), followed by ductal carcinoma in situ (18 patients, 6.6%) and then invasive lobular carcinoma (15 patients, 5.5%). A positive margin was recorded in 37 (13.5%) patients. Immediate postoperative complications included seroma and edema (32.7%), wound infection (13.1%), hematoma (8.7%) and delayed wound healing (6.5%). A delay to adjuvant therapy due to postoperative complications occurred in 7 of 217 (3.2%) patients. The median follow-up was 18 months. There were local and distant recurrences in 9 (3.3%) and 2 (0.7%) patients, respectively. Overall survival was 99.3%. Conclusion: The findings of this study are comparable to results in the literature on OPS and demonstrate that OPS is an attractive alternative to standard lumpectomy for Canadian general surgeons who treat breast cancer.

Contexte: La chirurgie oncoplastique (COP) est en passe de devenir la nouvelle norme pour la chirurgie conservatrice du sein (CCS). Elle est de plus en plus populaire en Europe, mais elle n'a pas encore été largement adoptée en Amérique du Nord. Cette étude vise à décrire l'expérience d'un établissement de soins tertiaires au Canada en matière de COP. Méthodes: Cette étude repose sur une série rétrospective de cas de COP dans un établissement canadien, le Centre régional de santé Royal Victoria de Barrie, en Ontario, entre 2009 et 2015. Résultats: En tout, 275 cas consécutifs de COP ont été inclus. La taille moyenne des tumeurs était de 17 mm (écart-type [É.-T.] 13 mm; éventail 0­110 mm). Le poids moyen des spécimens était de 155 g (É.-T. 146 g; éventail 15­1132 g). Le diagnostic le plus fréquent était le carcinome canalaire invasif (237 patientes, 86,2 %), suivi du carcinome canalaire in situ (18 patientes, 6,6 %), puis du carcinome lobulaire invasif (15 patientes, 5,5 %). Une marge positive a été enregistrée chez 37 patientes (13,5 %). Parmi les complications postopératoires immédiates, mentionnons sérome et oedème (32,7 %), infection de plaie (13,1 %), hématome (8,7 %) et retard de cicatrisation de la plaie (6,5 %). Un retard du traitement adjuvant dû à des complications postopératoires est survenu chez 7 patientes sur 217 (3,2 %). Le suivi médian a été de 18 mois. On a noté des récurrences locales et à distance chez 9 (3,3 %) et 2 (0,7 %) patientes, respectivement. La survie globale a été de 99,3 %. Conclusion: Les conclusions de cette étude se comparent aux résultats recensés dans la littérature au sujet de la COP et démontrent que cette dernière est une solution de rechange attrayante à la tumorectomie standard pour les chirurgiens généraux qui soignent le cancer du sein au Canada.

Thoracic spondylodiscitis presenting as abdominal pain.

A 42-year-old woman presented to our hospital with weeks of worsening pain around her lower ribs. Preceding this, she was managed in primary care with anti-inflammatory drugs and physiotherapy for presumed costochondritis. Assessment in accident and emergency suggested a tender right upper quadrant with fever and neutrophilia. A surgical review of the patient was requested to assess for cholecystitis or delayed pancreatitis. On direct questioning, the patient's back pain was the predominating symptom with no neurological deficit. To assess for delayed pancreatitis, CT imaging was obtained, demonstrating unremarkable intra-abdominal organs. There was also the incidental finding of thickened prevertebral soft tissues anterior to T9 and T10 vertebrae, with vertebral endplate irregularity locally. Subsequent MRI demonstrated typical appearances of infective spondylodiscitis at this level. The patient made a good recovery with intravenous antimicrobials. This case highlights how vertebrodiscitis can present insidiously and unexpectedly, manifesting as abdominal pain.