Many scholars now critique successful aging terminology. Nonetheless, there is incomplete analysis of the political motivations behind the development of and/or effects of widespread use of these terms. This article suggests that analysis of the people who developed the terms and the settings within which they work parallels an analysis of the terms themselves and illustrates the continuing negative perception of aging. This study fleshes out a more thorough critique of the sociopolitical contexts surrounding the successful aging paradigm so that it can help renew and expand existing critiques. The authors conclude that researchers need to be wary of adopting successful aging terminology without considering and expanding their understanding of the political motivations and results that accompanies it. New, expanded conceptualizations of successful aging are needed so that socially minded researchers and practitioners of gerontology do not contribute to ageism and discrimination against older adults.

Objective:To assess risk-adjusted outcomes and participant perceptions following a statewide coaching program for bariatric surgeons.Summary of Background Data:Coaching has emerged as a new approach for improving individual surgeon performance, but lacks evidence linking to clinical outcomes.Methods:This program took place between October 2015 and February 2018 in the Michigan Bariatric Surgery Collaborative. Surgeons were categorized as coach, participant, or nonparticipant for an interrupted time series analysis. Multilevel logistic regression models included patient characteristics, time trends, and number of sessions. Risk-adjusted overall and surgical complication rates are reported, as are within-group relative risk ratios and 95% confidence intervals. We also compared operative times and report risk differences and 95% confidence intervals. Iterative thematic analysis of semi-structured interviews examined participant and coach perceptions of the program.Results:The coaching program was viewed favorably by most surgeons and many participants described numerous technical and nontechnical practice changes. The program was not associated with significant change in risk-adjusted complications with relative risks for coaches, participants, and nonparticipants of 0.99 (0.62–1.37), 0.91 (0.64–1.17), and 1.15 (0.83–1.47), respectively. Operative times did improve for participants, but not coaches or nonparticipants, with risk differences of –14.0 (–22.3, –5.7), –1.0 (–4.5, 2.4), and –2.6 (–6.9, 1.7). Future coaching programmatic design should consider dose-complexity matching, hierarchical leveling, and optimizing video review.Conclusions:This statewide surgical coaching program was perceived as valuable and surgeons reported numerous practice changes. Operative times improved, but there was no significant improvement in risk-adjusted outcomes.

Against a backdrop of scant literature on commonalities and differences among diverse groups of menopausal women within the United States, and little attempt by scholars in any country to study the ways in which both privilege and oppression can shape women's ideas and experiences of menopause, in this study, 61 menopausal women of varied racial-ethnic and class locations in a Midwestern state were asked about the different meanings and experiences of menopause. African American women and Chicanas, particularly working-class women, viewed menopause as a positive experience, whereas many middle-class European American women discussed more negative feelings. Women of color were more likely than European Americans to report talking about menopause with same-race, same-sex friends only. While women of color discussed their knowledge of European American women's menopause, the latter lacked knowledge of other women's experiences. Women's lived experiences with privilege and oppression also surfaced in the interviews. The authors argue that when scholars listen to how women discuss menopause experiences, commonalities among women by gender, and differences among women by race, and class are exposed. The presence of racial-ethnic differences in these pilot data suggests the importance of more comparative studies on reproductive aging both in the United States and abroad.

Background Little is known about how individuals in the community who qualify for bariatric surgery perceive it and how this affects their likelihood to consider it for themselves. This study is the first qualitative study of a racially and ethnically diverse cohort to understand perceptions of bariatric surgery. Methods We designed a descriptive study to understand attitudes about bariatric surgery. We interviewed 32 individuals who met NIH criteria for bariatric surgery but have never considered bariatric surgery. We purposively sampled to ensure the majority of participants were non-white. Using an Interpretive Description framework, an exploratory, iterative method was used to code interviews and arrive at final themes. Results Participants self-identified as 88% female, 75% Black, 3% Hispanic, 3% Pacific Islander, and 19% white. Three major themes emerged from our data regarding legitimacy of bariatric surgery. First, participants perceived bariatric surgery to be something commercialized rather than needed treatment. They equated bariatric surgery with “botulism of the lips” or “cool sculpting.” Second, an important contributor to the lack of legitimacy as a medical treatment was that many had not heard about bariatric surgery before from their doctors. Doctors were trusted sources for legitimate information about health. Lastly, conflicting information over bariatric surgery-related diet and weight loss further diminished the legitimacy of bariatric surgery. As one participant reflected about pre-operative weight loss requirements, “[If] I'm going to do that, I might as well just keep losing the weight. Why even go do the surgery?”. Conclusion Though bariatric surgery is a safe, effective, and durable therapy for patients with obesity, the majority of individuals we interviewed had concerns over the legitimacy of bariatric surgery as a medical treatment. Moving forward in reaching out to communities about bariatric surgery, healthcare providers and systems should consider the presentation of information to attenuate these concerns.

Background: The ''surgical personality'' is a mostly negative academic and cultural image of the surgeon as egotistical, paternalistic, and inflexible. Because of this image, surgeons have been viewed as resistant to change and some behaviors, vulnerability, for example, are viewed as ''suspect'' because they seemingly threaten professional competency. We report on exit interviews of surgeons who participated in a coaching program and demonstrate how their narratives challenge the surgical ''personality'' and forge an evolving and more open professional surgical identity. Methods: We interviewed n ¼ 34 bariatric surgeons at the end of a 2-year surgical coaching program. Transcribed interviews were analyzed in NVivo, computer-assisted qualitative data analysis software. Coding of transcripts was approached through iterative steps. We utilized an exploratory method; each member of our team independently examined 3 transcripts to evaluate emergent themes early in the investigation. The team met to discuss our independent themes and develop the codebook collectively. We created a descriptive framework for our first round of coding based on emerging themes and employed an interpretive framework to arrive at our themes. Results: Three major themes emerged from our data. Participants in this study discussed the ways that participation in the coaching program initially conflicted with their identity as a competent professional. Surgeons were acutely aware of how participation might have destabilized their surgical identity because they might be viewed as vulnerable. Despite these concerns about image, surgeons found impetus for improvement because of poor outcome scores or because they desired early career affirmation. Finally, surgeons report that the safe spaces of intentional coaching contributed to their ideas about how surgeons, and ultimately surgery, can change. Conclusions: Participation in a coaching program challenged how surgeons thought of themselves in relationship to social and peer expectations. Our results indicate that surgeons do feel peer and social pressures related to identity but are much more complex and nuanced than has been previously discussed. The safe space of intentional coaching allowed participants to practice vulnerability without the pressures of sometimes caustic professional norms. Participants in this study viewed coaching as the way to improve the culture of surgery.

PurposeThe obesity epidemic poses serious challenges to health equity. Despite bariatric surgery being one of the most effective obesity treatments, utilization remains low. In this context, we explored public perceptions of bariatric surgery, centering voices of Black individuals. Materials and MethodsSemi-structured interviews with individuals who have never considered bariatric surgery with purposive sampling to ensure the majority of participants were Black. Transcripts were iteratively analyzed. We employed an Interpretive Description framework to arrive at a collective description of perceptions of bariatric surgery. Results Thirty-two participants self-identified as 88% female, 72% Black, 3% Hispanic, 3% Pacific Islander, 3% Mixed Race, and 19% White. Participants reported a complex interplay of deeply held, stigmatized beliefs about identity. According to the stigma, persons with obesity lacked willpower and thus were considered devalued. Participants internalized this stigma, describing themselves with words like "glutton," "lazy," and "slack off." Because stigma caused participants to view obesity as resulting from personal failings alone, socially acceptable ways to lose weight were discipline through diet and exercise. Working for weight loss was "self-love, self-discipline, and determination." Thus, bariatric surgery was illegitimate, a "shortcut to weight loss" or "easy way out," since it was outside acceptable methods of effort. Conclusion This qualitative study of community members who qualify for bariatric surgery shows obesity stigma was the main reason individuals rejected bariatric surgery. Obesity was stigmatizing, but undergoing bariatric surgery would further stigmatize individuals. Thus, healthcare providers may be instrumental in increasing bariatric surgery uptake by shifting social discourse from stigmatized notions of obesity towards one focusing on health.

Background: This qualitative research explored the lived experiences of patients who experienced postponement of elective cardiac and vascular surgery due to coronavirus disease 2019 (COVID-19). We know very little about patients during the novel coronavirus pandemic. Understanding the patient voice may play an important role in prioritization of postponed cases and triage moving forward. Methods: Utilizing a hermeneutical phenomenological qualitative design, we interviewed 47 individuals who experienced a postponement of cardiac or vascular surgery due to the COVID-19 pandemic. Data were analyzed and informed by phenomenological research methods. Results: Patients in our study described 3 key issues around their postponement of elective surgery. Patients described robust narratives about the meanings of their elective surgeries as the chance to “return to normal” and alleviate symptoms that impacted everyday life. Second, because of the meanings most of our patients ascribed to their surgeries, postponement often took a toll on how patients managed physical health and emotional well-being. Finally, paradoxically, many patients in our study were demonstrative that they would “rather die from a heart attack” than be exposed to the coronavirus. Conclusions: We identified several components of the patient experience, encompassing quality of life and other desired benefits of surgery, the risks of COVID, and difficulty reconciling the 2. Our study provides significant qualitative evidence to inform providers of important considerations when rescheduling the backlog of patients. The emotional and psychological distress that patients experienced due to postponement may also require additional considerations in postoperative recovery.

Objective: This qualitative study explored the impact of postoperative complications on surgeons and their well-being. Background: Complications are an inherent component of surgical practice. Although there have been extensive efforts to reduce postoperative complications, the impact of complications on surgeons have not been well-studied. Surgeons are often left to process their own emotional responses to these complications, the effects of which are not well characterized. Methods: We conducted 46 semi-structured interviews with a diverse range of surgeons practicing across Michigan to explore their responses to postoperative complications and the effect on overall well-being. The data were analyzed iteratively, through steps informed by thematic analysis. Results: Participants described feelings of sadness, anxiety, frustration, grief, failure, and disappointment after postoperative complications. When asked to elaborate on these responses, participants described internal processes such as feelings of personal responsibility and failure, self-doubt, and failing the patient and family. Participants also described external pressures influencing the responses, which included potential impact to reputation and medicolegal issues. Experience level, type of complication, and the surgeon's individual personality were specific factors that influenced the intensity of these responses. Conclusion: Surgeons' emotional responses after postoperative complications may negatively impact individual well-being, and may represent a threat to the profession altogether if these issues remain inadequately recognized and addressed. Knowledge of the impact of unwanted or unexpected outcomes on surgeons is critical in developing and implementing strategies to cope with the challenges frequently encountered in the surgical profession.