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Large gaps in care quality resulting from ineffective communication between health providers, patients, and other health care organizations have been documented. Research suggests that effective, empathic communication positively influences health outcomes. Many studies focused on the assessment of clinicians empathy, while there is still a lack of evidence on the role and level of empathy for public health medical doctors,especially during their postgraduate education. The aim of this study was to assess empathy level of public health residents, and to investigate differences in empathy scores using a validated questionnaire. The Italian version of the Jefferson scale of Physician Empathy was mailed to all the resident doctors of the Italian Schools in Hygiene and Public Health during the month of April 2013. Individual Empathy Scores (IES) were calculated, as well as descriptive statistics for the items and scale levels. The difference in empathy scores according to physician’s gender, age class, career rank, place of residency, work experiences(medical direction vs research career) were examined trough t test or ANOVA as appropriate. 352 out of 402 resident doctors replied the questionnaire(response rate 87%). The mean of IES was 118.5 (SD 13.4; range = 54-140; median = 120). There were no IES differences between career rank (p = 0.3), age class (p = 0.2), and place of residency (p = 0.07), while females had higher IES than males (120.3 vs 114.9; p < 0.01). Physicians who have had experience in healthcare administration reported higher IES compared to those who only performed research activity (120.4 vs 117.1; p = 0.02). In addition the respondent physicians believe that the development of social skills should be promoted with greater attention during the undergraduate education (78%)and during the postgraduate education in public health (65%). Our results show a good level of IES in the public health residents, with some significant differences according to gender and physicians work experience. Furthermore, considering empathy and cultural competence essential for public health professionals in order to provide and manage high quality patient-centred care, the widespread demand for specific training outlined by this survey should be taken into adequate account.

Background: As a consequence of the improvement in survival after solid organ transplantation, to visit transplant recipients with neoplastic and non-neoplastic skin disorders due to immunosuppressive treatment has become common for dermatologists. Methods: Our endpoints were: 1) to investigate the most common skin diseases in a population of transplant recipients; 2) their associations with the type of immunosuppressant or transplant received; and 3) to compare our single center 40-year experience with the literature data. We retrospectively analyzed the clinical details of the adult patients transplanted in the years 1974-2014, visited for consultation at the Unit of Dermatology of our hospital. Results: Pathologic conditions were observed in more than 3/4 of 812 adults during the follow-up (mean 12.1 years): nonmelanoma skin cancers or actinic keratoses were seen in 44.0% (N.=357) of patients, non-neoplastic events in 55.2% (N.=448). Heart transplant had the statistically significant highest rate of NMSC and AK (52.6%, P=0.0352). Patients receiving cyclosporine A developed at least one non-melanoma skin cancer or actinic keratosis in 57.7% of cases (P=0.0001), while tacrolimus showed a lower risk (33%, P=0.0001). Conclusions: As transplant recipients are susceptible to skin changes, especially after immunosuppressant treatments, a dermatological follow-up should be scheduled for each patient.

To our knowledge, there are currently no previous reports that describe this peculiar presentation of AA. Despite its apparently benign clinical features, this variant has a poor outcome. Scalp biopsy is mandatory for a proper diagnosis, and to start an appropriate amd proltherapy as soon as possible.

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Background and aims: Non-invasive methods accurately estimating hepatic venous pressure gradient (HVPG) are un unmet clinical need. Preliminary data suggested that graph analysis of dynamic contrast enhanced ultrasonography (DCE-US) of the liver using a “connectome” approach allows assessment of the liver microcirculatory derangement and mirrors the severity of portal hypertension (Amat-Roldan et al. Radiology 2015). The EC-funded prospective CLEVER study (FP7-IAPP-GA-2013-612273-CLEVER) is aimed at developing a novel automatized software based on DCE-US able to improve prognostication in cirrhosis. First extended results were developed with a Siemens Acuson Sequoia in Barcelona, showing optimal correlation with HVPG. Here we report the adaptation of this CLEVER software to DCE-US videos acquired with ESAOTE MyLab equipments in Bologna to predict HVPG in a population of patients with F≥3 hepatopathy. Method: Ten seconds long videoclip(s) of the right liver lobe were recorded in each patient producing one cycle of microbubble disruption and reperfusion during SonoVue infusion. A total of 90 videos from randomly selected 47 patients were utilized to optimize the autoselection algorithm of the computer among 5models based on platelet count and spleen diameter. Results: Applicability: the CLEVER software was technically able to provide portal pressure estimations from DCE-US in 41/90 videos corresponding to 28/47 patients (59.6%). The Spearman coefficient of correlation between CLEVER values and HVPG was r = 0.585 ( p < 0.001). The CLEVER software was then tested in a separate validation set of 17 technically successful patients, showing a correlation r = 0.701 ( p < 0.002). Conclusion: We developed and validated the DCE-US based CLEVER software which allows an automatic and quantitative non-invasive estimation of portal pressure in patients with CLD. Larger set of patients with precise subgrouping will help improving the non-invasive predictability of portal pressure by DCE-US.

To evaluate improvements during leg training on an isotonic leg extension system, we analyzed the modality of exercise performance by building power-angle curves for each leg. Ten subjects underwent a two-month training protocol on a leg extension device. Maximal theoretical forces were evaluated to set the protocols for each subject. Each training session was monitored in real time by the acquisition of angles and building power-angle curves for each leg during sub-maximal exercise. Maximal theoretical strength, maximal speed values and slopes between the first and last training sessions differed significantly (p