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Objective: To describe the Emoty-Com training, its impact on medical students’ attitudes towards doctors’ emotions and to explore the association between students’ empathy, emotional intelligence (EI), and attachment style (AS) with post-training performance scores. Methods: The 16-hour Emoty-Com training was delivered to all second-year medical students of Verona and Milan (Italy) Universities. At pre-training, students filled out three questionnaires assessing empathy, AS and EI and responded to three questions on attitudes towards doctors’ emotions in the doctor-patient encounter. The same three questions and a final evaluation test were proposed at post-training. Results: 264 students participated in the study. The training reduced students’ worry about managing emotions during doctor-patient relationships. Gender was associated with specific subscales of empathy, EI, and AS. Final performance scores were associated with students’ attitudes towards emotions but not with empathy, EI, and AS. Conclusion: The Emoty-Com training increased students’ self-efficacy in handling their own emotions during consultations. Students' performance scores were related to their attitude towards doctors’ emotions in clinical encounters. Practice Implications: The Emoty-Com training suggests ways to teach and evaluate emotion-handling skills for medical students. Possible links between empathy, EI, AS, and the attitudes towards doctors’ emotions during the years of education are highlighted.

A multicenter cross-sectional survey study involving four Italian University Hospitals was performed to test the hypothesis that negative affect and positive affect (affective dimensions) mediate the association between risk perception (perceived risk of infection and death; cognitive dimensions) and the feeling of work exhaustion (WE) among obstetrics healthcare providers (HCPs) during the Coronavirus Disease 2019 (COVID-19) pandemic. Totally, 570 obstetrics HCPs were invited to complete the 104-item IPSICO survey in May 2020. A theoretical model built on the tested hypothesis was investigated by structural equation modelling. The model explained 32.2% of the WE variance. Only negative affect mediated the association between cognitive dimensions and WE and also the association between WE and psychological well-being before the pandemic, experiences of stressful events, female gender, and dysfunctional coping. Non-mediated associations with WE were observed for work perceived as a duty, experience of stressful events, support received by colleagues, and the shift strategy. Only previous psychological well-being, support by colleagues, and shift strategies were inversely associated with WE. Based on study results, monitoring negative than positive affect appears superior in predicting WE, with practical implications for planning psychological interventions in HCPs at the individual, interpersonal, and organizational levels.

OBJECTIVE (1) To determine the prevalence and type of depressive symptoms at day-hospital clinical evaluation, before undergoing major surgery in patients diagnosed with pancreatic neoplasm. (2) To analyze the association between depression and sociodemographic, clinical, and psychosocial variables. (3) To understand how coping strategies, perceived social support, and self-efficacy might affect depressive symptoms in this cohort of patients. METHODS Secondary data analysis collected during the baseline phase of a randomized controlled trial performed at the Pancreas Institute of the University Hospital of Verona, Italy, between June 2017 and June 2018. RESULTS 18.5% of pancreatic patients had a PHQ-9 score ≥10 (cut-off). Depressed patients were basically more often female (p = 0.07), younger (p = 0.06), and married/with a partner (p = 0.02). Depression was associated to high trait anxiety (p

Objective: To explore the association of emotional intelligence (EI) and attachment security (AS) with empathy dimensions in medical students by examining the mediating role of EI. Methods: In a cross-sectional design, the Interpersonal Reactivity Index (IRI), the Emotional Quotient Inventory (EQ-i), the Attachment Style Questionnaire (ASQ), and demographic questions were administrated to second-year medical students of two medical schools in Northern Italy. Results: 253 medical students (56.13% female), aged 19–29, participated in this study. AS positively correlated to Empathic Concern (r = 0.17, p = 0.008) and Perspective Taking (r = 0.24, p < 0.001), and negatively to Personal Distress (r = −0.33, p < 0.001). Individuals with the same level of AS and a higher score on EQ-i had a higher score (β = 0.072, p = 0.033) on empathy latent factor (at the basis of Empathic Concern and Perspective Taking) and a lower score (β = −0.290, p < 0.001) on Personal Distress than those with a lower EQ-i score. Conclusion: This study shows that EI completely mediated the relationship between AS and empathy dimensions among medical students. Practice implications: EI training and workshop should be considered when designing educational interventions and programs to enhance empathy and decrease interpersonal distress in medical students.

Academic institutions have shown an increased interest in the so-called third mission to offer an impactful contribution to society. Indeed, public engagement programs ensure knowledge transfer and help to inspire positive public discourse. We aimed to propose a comprehensive framework for academic institutions planning to implement a public engagement intervention and to suggest potential indicators to measure its impact. To inform the framework development, we searched the literature on public engagement, the third mission, and design theory in electronic databases and additional sources (e.g., academic recommendations) and partnered with a communication agency offering non-academic advice. In line with this framework, we designed a public engagement intervention to foster scientific literacy in Italian youth, actively involving them in the development of the intervention. Our framework is composed of four phases (planning/design, implementation, immediate impact assessment, and medium- and long-term assessment). Impact indicators were subdivided into outcome variables that were immediately describable (e.g., changed understanding and awareness of the target population) and measurable only in the medium or long run (e.g., adoption of the intervention by other institutions). The framework is expected to maximize the impact of public engagement interventions and ultimately lead to better reciprocal listening and mutual understanding between academia and the public.

A large body of research suggests that establishing and strengthening patient–provider relationships, characterized by transparency, respect, trust, and empathy, is highly beneficial for patients, their caregivers, and healthcare providers [...]

Given the automatization of care and rationing of time and staff due to economic imperatives, often resulting in dehumanized care, the concept of ‘humanization of care’ has been increasingly discussed in the scientific literature. However, it is still an indistinct concept, lacking well-defined dimensions and to date no literature review has tried to capture it. The objectives of this systematic review were to identify the key elements of humanization of care by investigating stakeholders’ (patients, patients’ caregivers, healthcare providers) perspectives and to assess barriers and strategies for its implementation. We carried out a systematic search of five electronic databases up to December 2017 as well as examining additional sources (e.g., gray literature). Search terms included “humanization/humanisation of care” and “dehumanization/dehumanisation of care”. We conducted a thematic synthesis of the extracted study findings to identify descriptive themes and produce key elements. Of 1327 records retrieved, 14 full-text articles were included in the review. Three main areas (relational, organizational, structural) and 30 key elements (e.g., relationship bonding, holistic approach, adequate working conditions) emerged. Several barriers to implementation of humanization of care exist in all areas. Our systematic review and synthesis contributes to a deeper understanding of the concept of humanization of care. The proposed key elements are expected to serve as preliminary guidance for healthcare institutions aiming to overcome challenges in various forms and achieve humanized and efficient care. Future studies need to fully examine specific practices of humanized care and test quantitatively their effectiveness by examining psychosocial and health outcomes.

ObjectivesDespite growing interest in the second-victim phenomenon and greater awareness of its consequences, there has not been a meta-analysis quantifying the negative impact of adverse events on providers involved in adverse events. This study systematically reviewed the types and prevalence of p

Given the negative impact of adverse events on the wellbeing of healthcare providers, easy access to psychological support is crucial. We aimed to describe the types of support resources available in healthcare organizations, their benefits for second victims, peer supporters’ experiences, and implementation challenges. We also explored how these resources incorporate aspects of Safety I and Safety II. We searched six databases up to 19 December 2019 and additional literature, including weekly search alerts until 21 January 2021. Two reviewers independently performed all methodological steps (search, selection, quality assessment, data extraction, formal narrative synthesis). The 16 included studies described 12 second victim support resources, implemented between 2006 and 2017. Preliminary data indicated beneficial effects not only for the affected staff but also for the peer responders who considered their role to be challenging but gratifying. Challenges during program implementation included persistent blame culture, limited awareness of program availability, and lack of financial resources. Common goals of the support programs (e.g., fostering coping strategies, promoting individual resilience) are consistent with Safety II and may promote system resilience. Investing in second victim support structures should be a top priority for healthcare institutions adopting a systemic approach to safety and striving for just culture.

The COVID-19 outbreak has impacted the wellbeing of people worldwide, potentially increasing maladaptive psychological responses of vulnerable populations. Although young adults with multiple sclerosis (yawMS) might be at greater risk of developing psychological distress linked to the pandemic, they might also be able to adapt to stress and find meaning in adverse life events. The aim of the present study was to explore benefit finding in response to the pandemic in a sample of yawMS. As part of a larger project, data were collected using a cross-sectional, web-based survey. Benefit finding was analysed using a qualitative thematic approach, descriptive and inferential statistics were performed to describe the sample and compare sub-groups. Out of 247 respondents with mostly relapsing-remitting MS, 199 (31.9 ± 6.97 years) reported at least one benefit. Qualitative analysis showed that during the pandemic yawMS found benefits related to three themes: personal growth, relational growth, and existential growth. No differences in benefit finding were found between age sub-groups (18–30 vs. 31–45). Participants reported a wide range of benefits, some of which seem to be specific to MS or the pandemic. Results have been transformed into tips to be introduced in clinical practice to promote resilience in yawMS through meaning making.

BackgroundMultiple sclerosis (MS), the most common neurological disease that causes disability in youth, does not only affect physical functions but is also associated with cognitive impairment, fatigue, depression, and anxiety and can significantly impact health-related quality of life (HRQoL). Since MS is generally diagnosed at a young age—a period of great significance for personal, relational, and professional development—adaptation can become highly challenging. Therefore, enhancing the competence of young people to adaptively cope with these potential challenges is of utmost importance in order to promote their potentialities and talents. It has been shown that psychological interventions targeting MS patients can enhance resilience and HRQoL and that regular physical activity (PA) and social engagement can improve psychological well-being. However, literature on the development of global interventions based on the bio-psycho-social model of the disease is missing. Even less attention has been paid to interventions dedicated to young adults with MS (YawMS) and to the involvement of patients in the development of such programs.AimsIn collaboration with MS patients, this study aims to develop a bio-psycho-social intervention (ESPRIMO) for YawMS, aiming to improve their HRQoL and to explore its feasibility, acceptability, and effects.MethodsTo tailor the intervention to the specific needs of YawMS, “patient engagement principles” will be adopted in the co-creation phase, performing a web survey and focus groups with patients and healthcare professionals. In the intervention phase, a pilot sample of 60 young adults with MS will be enrolled. The co-created intervention, composed of group sessions over a 12-week period, will cover psycho-social strategies and include physical activities. Adopting a longitudinal, pre–post evaluation design, self-report questionnaires measuring HRQoL and other bio-psycho-social features (e.g., resilience, well-being, mindfulness traits, self-efficacy, perceived social support, psychological symptoms, illness perception, committed action, fatigue, attitudes, subjective norms, perceived behavioral control, motivation, perception of autonomy support for PA, barriers and intentions to PA) will be administered, the quantity and quality of PA will be measured, and a questionnaire developed by the authors will be used to evaluate the feasibility and acceptability of the ESPRIMO intervention.

Objective: Recent evidence has demonstrated that the COVID-19 pandemic is taking a toll on the mental health of the general population. The psychological consequences might be even more severe for patients with special healthcare needs and psychological vulnerabilities due to chronic diseases, such as multiple sclerosis (MS). Thus, we aimed to explore the psychological impact of this pandemic and of the subsequent healthcare service changes on young adults with MS living in Italy and to examine their coping strategies and preferences regarding psychological support in the aftermath of the pandemic.Methods: Data were collected using a cross-sectional, web-based survey advertised on social networks. We report both quantitative (descriptive statistics, t-tests, and one-way ANOVA) and qualitative data (inductive content analysis).Results: Two hundred and forty-seven respondents (mean age 32 ± 7 years), mainly with relapsing–remitting MS, from all Italian regions participated. Participants felt more worried, confused, sad, and vulnerable because of the disease “during” the pandemic in comparison to their self-evaluation of the period “before” the COVID-19 outbreak. Similarly, their perception of control over MS decreased “during” the pandemic in comparison to the retrospective evaluation of the period “before” the COVID-19 outbreak (p < 0.01). Canceled/postponed visits/exams were listed as the most frequent MS management changes, with modified/postponed pharmacological treatment representing the most stressful change. Psychological support in dealing with pandemic-related fears and improving MS acceptance and well-being was considered extremely important by almost 40% of the respondents. Different coping strategies were mentioned in the qualitative section of the survey, with social support, hobbies, and keeping busy being the most frequent ones.Conclusions: Considering the enormous impact of the pandemic on young adults with MS, we urge MS clinical centers to implement psychological support programs that address the potentially long-lasting psychological negative impact, thus fostering the therapeutic alliance that is being threatened by the infection prevention measures imposed during the pandemic, and promoting psychological resources for adaptively managing future waves of COVID-19.

The psychological impact of the Covid 19 pandemic on cancer patients, a population at higher risk of fatal consequences if infected, has been only rarely evaluated. This study was conducted at the Departments of Oncology of four hospitals located in the Verona area in Italy to investigate the psychological consequences of the pandemic on cancer patients under active anticancer treatments. A 13-item ad hoc questionnaire to evaluate the psychological status of patients before and during the pandemic was administered to 474 consecutive subjects in the time frame between April 27th and June 7th 2020. Among the 13 questions, 7 were considered appropriate to elaborate an Emotional Vulnerability Index (EVI) that allows to separate the population in two groups (low versus high emotional vulnerability) according to observed median values. During the emergency period, the feeling of high vulnerability was found in 246 patients (53%) and was significantly associated with the following clinical variables: female gender, being under chemotherapy treatment, age ≤ 65 years. Compared to the pre-pandemic phase, the feeling of vulnerability was increased in 41 patients (9%), remained stably high in 196 (42%) and, surprisingly, was reduced in 10 patients (2%). Overall, in a population characterized by an high level of emotional vulnerability the pandemic had a marginal impact and only a small proportion of patients reported an increase of their emotional vulnerability.

In light of the current coronavirus disease 2019 (COVID-19) pandemic and potential future infectious disease outbreaks, a comprehensive understanding of the negative effects of epidemics and pandemics on healthcare workers’ mental health could inform appropriate support interventions. Thus, we aimed to synthesize and quantify the psychological and psychosomatic symptoms among frontline medical staff. We searched four databases up to March 19, 2020 and additional literature, with daily search alerts set up until October 26, 2020. Studies reporting psychological and/or psychosomatic symptoms of healthcare workers caring for patients with severe acute respiratory syndrome, H1N1, Ebola, Middle East respiratory syndrome, or COVID-19 were eligible for inclusion. Two reviewers independently conducted the search, study selection, quality appraisal, data extraction, and synthesis and involved a third reviewer in case of disagreement. We used random effects modeling to estimate the overall prevalence rates of psychological/psychosomatic symptoms and the I2 statistic. We included 86 studies, reporting data from 75,991 participants. Frontline staff showed a wide range of symptoms, including concern about transmitting the virus to the family (60.39%, 95% CI 42.53–76.96), perceived stress (56.77%, 95% CI 34.21–77.95), concerns about own health (45.97%, 95% CI 31.08–61.23), sleeping difficulties (39.88%, 95% CI 27.70–52.72), burnout (31.81%, 95% CI 13.32–53.89), symptoms of depression (25.72%, 95% CI 18.34–33.86), symptoms of anxiety (25.36%, 95% CI 17.90–33.64), symptoms of posttraumatic stress disorder (24.51%, 95% CI 18.16–31.46), mental health issues (23.11%, 95% CI 15.98–31.10), and symptoms of somatization (14.68%, 95% CI 10.67–19.18). We found consistent evidence for the pervasive and profound impact of large-scale outbreaks on the mental health of frontline healthcare workers. As the CO­VID-19 crisis continues to unfold, guaranteeing easy access to support structures for the entire healthcare workforce is vitally important.

Objective: To assess the psychological distress of healthcare providers (HCPs) working in the field of obstetrics during the coronavirus disease 2019 (COVID-19) pandemic and to identify factors associated with psychological distress at the individual, interpersonal, and organizational level.Design: Cross-sectional survey study.Setting: Four University hospitals in Italy.Participants: HCPs working in obstetrics, including gynecologists, residents in gynecology and obstetrics, and midwives.Methods: The 104-item survey Impatto PSIcologico COVID-19 in Ostetricia (IPSICO) was created by a multidisciplinary expert panel and administered to HCPs in obstetrics in May 2020 via a web-based platform.Main Outcome Measures: Psychological distress assessed by the General Health Questionnaire-12 (GHQ-12) included in the IPSICO survey.Results: The response rate to the IPSICO survey was 88.2% (503/570), and that for GHQ-12 was 84.4% (481/570). Just over half (51.1%; 246/481) of the GHQ-12 respondents reported a clinically significant level of psychological distress (GHQ-12 ≥3). Psychological distress was associated with either individual (i.e., female gender, stressful experience related to COVID-19, exhaustion, and the use of dysfunctional coping strategies), interpersonal (i.e., lower family support, limitations in interactions with colleagues), and organizational (i.e., reduced perception of protection by personal protective equipment, perceived delays on updates and gaps in information on the pandemic) factors in dealing with the pandemic.Conclusions: Results confirm the need for monitoring and assessing the psychological distress for HCPs in obstetrics. Interventions at the individual, interpersonal, and organizational level may relieve the psychological distress during the COVID-19 pandemic and foster resilience skills in facing emotional distress.

Background: The health emergency caused by the SarS-Cov-2 pandemic has a strong impact on oncological patients' (pts) life. The purpose of this study is to explore the emotional impact and pts' perception experienced who accessed to our Oncology section at University Hospital and Trust of Verona (Italy) regarding these rules. Method(s): An questionnaire was designed by our Psycho-Oncology service and administered to all pts accessing to our outpatient facilities during a 21-days period (April 9th - April 30th, 2020). Two main areas were investigated: i) organizational aspects and ii) awareness about infection risks, protective strategies, and new rules adopted (14 items, plus demographic data). Percentage of relevant answers to questionnaire items are reported with 95% confidence intervals (95% CI). Result(s): Among 241 respondents, fear of accessing hospital facilities and that chemotherapy treatment could increase the infection risk was reported to be quite high or high in 34% (95% CI: 29-41%) and 27% (95% CI: 21-33%), respectively. Awareness of disease-related risks of infection and strategies to reduce them was "very clear" or "fairly clear" [83% (95% CI: 78-88%) and 93% (95% CI: 90-96%), respectively]. Availability of medical personnel to be contacted while not in hospital was perceived as "very high". Almost all pts felt that organizational measures were clearly expressed (98%, 95% CI: 96-100%) and mainly obtained through the information received at the triage (73%, 95% CI: 67-79%). Overall acceptance of these measures was very high (>70%). Of note, the acceptance of phone-based follow-up and visits were perceived as "not very adequate" or "absolutely not adequate" by 17% (95% CI: 12-22 %) and 18% (95% CI: 13-23%) of respondents, respectively. Conclusion(s): Herein, we report among the first real-life experiences about oncological pts' perception of infection risks and their level of acceptance of protective measures during SarS-Cov-2 pandemic. A timely and thoughtful measures adoption, the coordinated efforts of all figures involved in cancer care and an effective communication strategy to share the necessary risks and sacrifices with pts/caregivers, can lead to effective protection of oncological pts. Legal entity responsible for the study: The authors. Funding(s): Has not received any funding. Disclosure: All authors have declared no conflicts of interest.Copyright © 2020

Objectives Despite the critical need to understand the diverse responses by second victims to adverse events, there has not been a meta-analysis examining coping by second victims. We aimed to analyze the coping strategies applied by second victims in the aftermath of adverse events. Methods We performed a systematic search of nine electronic databases up to October 2018 and screened additional sources, such as gray databases. Two independent reviewers conducted the search, selection process, quality appraisal, data extraction, and synthesis. In case of dissent, a third reviewer was involved to reach consensus. Quantitative studies of the frequency with which coping strategies were applied by second victims were eligible for inclusion. We calculated the overall frequency of coping strategies and I statistic using random effects modeling. Results Of 10,705 records retrieved, 111 full-text articles were assessed for eligibility and 14 studies eventually included. The five most frequent coping strategies were Changing work attitude (89%, 95% confidence interval [CI] = 80-94), Following policies and guidelines more accurately and closely (89%, 95% CI = 54-98), Paying more attention to detail (89%, 95% CI = 78-94) (task oriented), Problem-solving/concrete action plan (77%, 95% CI = 59-89) (task oriented), and Criticizing or lecturing oneself (74%, 95% CI = 47-90) (emotion oriented). Conclusions Second victims frequently used task- and emotion-oriented coping strategies and, to a lesser degree, avoidance-oriented strategies. To better support second victims and ensure patient safety, coping strategies should be evaluated considering the positive and negative effects on the clinician's personal and professional well-being, relationships with patients, and the quality and safety of healthcare.

This study explores whether clinicians or a statistical model can better identify patients at risk of early readmission and investigates variables potentially associated with clinicians' risk judgment. We focus on a total of 142 patients discharged from acute psychiatric wards in the Verona Mental Health Department (Italy). Psychiatrists assessed patients' risk of readmission at 30 and 90 days postdischarge, predicted their postdischarge compliance, and assessed their Global Assessment of Functioning (GAF) score at admission and discharge. Clinicians' judgment outperformed the statistical model, with the difference reaching statistical significance for 30-day readmission. Clinicians' readmission risk judgment, both for 30 and 90 days, was found to be statistically associated with predicted compliance with community treatment and GAF score at discharge. Clinicians' superior performance might be explained by their risk judgment depending on nonmeasurable factors, such as experience and intuition. Patients with a poorer GAF score at discharge and poor assumed compliance were predicted to have a higher risk of readmission.

Background: The health emergency caused by the SarS-Cov-2 pandemic has been strongly impacting on oncological patients’ (pts). The purpose of this study was to explore the emotional impact and perception of cancer pts who received the vaccine against COVID-19 at the University Hospital and Trust of Verona (Italy). Methods: After the first dose of COVID-19 vaccine an anonymously questionnaire was proposed to cancer pts (March-May 2021). The survey investigated anxiety and depression levels using the Hospital Anxiety and Depression Scale (HADS), psychological distress with the Distress Thermometer (DT). Additionally, four specific items regarding the awareness about: i) infection risks, ii) interference with chemotherapy treatment, and iii) adverse effects, were developed. Descriptive analyses were performed. Results: A total of 736 patients (mean age 63 yrs) completed the questionnaire. Breast (23%) and gastrointestinal (40%) were the most represented cancer sites. The majority of pts (65%) reported mild levels of distress (DT ≤4), while moderate (DT 5-7) and severe (DT ≥8) levels were identified in 26% and 9% of participants, respectively. A total of 11% and 8% of pts experienced clinically significant symptoms of anxiety and depression (HADS ≥11), whereas 15% were borderline (HADS score 8-10). Two thirds of pts (67%) thought that the vaccination may reduce the infection risks and 56% felt safer. Overall, 59% of pts did not believe that vaccine-related side effects may interfere with the oncological treatment and 49% considered the vaccination safe. Conclusions: Most cancer pts undergoing COVID-19 vaccination presented mild levels of anxiety, depression and distress. Oncological pts undergoing vaccination felt safe and judged the benefits of COVID-19 vaccination to overweight the potential side effects. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

A culture of safety is important for the delivery of safe, high-quality care, as well as for healthcare providers’ wellbeing. This systematic review aimed to describe and synthesize the literature on patient safety attitudes of the next generation of healthcare workers (health professional students, new graduates, newly registered health professionals, resident trainees) and assess potential differences in this population related to years of study, specialties, and gender. We screened four electronic databases up to 20 February 2020 and additional sources, including weekly e-mailed search alerts up to 18 October 2020. Two independent reviewers conducted the search, study selection, quality rating, data extraction, and formal narrative synthesis, involving a third reviewer in case of dissent. We retrieved 6606 records, assessed 188 full-texts, and included 31 studies. Across articles, healthcare students and young professionals showed overwhelmingly positive patient safety attitudes in some areas (e.g., teamwork climate, error inevitability) but more negative perceptions in other domains (e.g., safety climate, disclosure responsibility). Women tend to report more positive attitudes. To improve safety culture in medical settings, health professions educators and institutions should ensure education and training on patient safety.

There is increasing evidence that psycho-social factors can influence antimicrobial prescribing practice in hospitals and the community, and represent potential barriers to antimicrobial stewardship interventions. Clinicians are conditioned both by emotional and cognitive factors based on fear, uncertainty, a set of beliefs, risk perception and cognitive bias, and by interpersonal factors established through social norms and peer and doctor–patient communication. However, a gap is emerging between research and practice, and no stewardship recommendation addresses the most appropriate human resource allocation or modalities to account for psycho-social determinants of prescribing. There is a need for translation of the evidence available from human behaviour studies to the design and implementation of stewardship interventions and policies at hospital and community levels. The integration of behaviour experts into multidisciplinary stewardship teams seems essential to positively impact on prescribers’ communication and decision-making competencies, and reduce inappropriate antibiotic prescribing.

Despite growing interest in the second-victim phenomenon and greater awareness of its consequences, there has not been a meta-analysis quantifying the negative impact of adverse events on providers involved in adverse events. This study systematically reviewed the types and prevalence of psychological and psychosomatic symptoms among second victims.We conducted a systematic review of nine electronic databases up to February 2017, without restrictions to publication date or language, examining also additional sources (e.g., gray literature, volumes of journals). Two reviewers performed the search, selection process, quality assessment, data extraction, and synthesis. We resolved disagreements by consensus and/or involving a third reviewer. Quantitative studies on the prevalence of psychological and psychosomatic symptoms of second victims were eligible for inclusion. We used random effects modeling to calculate the overall prevalence rates and the I statistic.Of 7210 records retrieved, 98 potentially relevant studies were identified. Full-text evaluation led to a final selection of 18 studies, based on the reports of 11,649 healthcare providers involved in adverse events. The most prevalent symptoms were troubling memories (81%, 95% confidence interval [CI] = 46-95), anxiety/concern (76%, 95% CI = 33-95), anger toward themselves (75%, 95% CI = 59-86), regret/remorse (72%, 95% CI = 62-81), distress (70%, 95% CI = 60-79), fear of future errors (56%, 95% CI = 34-75), embarrassment (52%, 95% CI = 31-72), guilt (51%, 95% CI = 41-62), and sleeping difficulties (35%, 95% CI = 22-51).Second victims report a high prevalence and wide range of psychological symptoms. More than two-thirds of providers reported troubling memories, anxiety, anger, remorse, and distress. Preventive and therapeutic programs should aim to decrease second victims' emotional distress.

The Vase of Flowers is a picture book for preschool children and their mothers who are undergoing chemotherapy treatment, and it is principally aimed to promote their resilient attitude by fostering and facilitating their emotional communication. A report of the National Cancer Institute indicates that about 5% of all cancer diagnoses in the United States is delivered to young people, aged between 15 and 39 years [1]. According to these data, cancer in young women can be considered infrequent, and, consequently, the presence of this health condition/disease in women during the years following their pregnancy is even rarer.

Background In the last years, patients’ empowerment has been increasingly recognized as a crucial dimension of patient-centered healthcare and patient safety. Nevertheless, little work has been done so far in the field of patient safety to investigate strategies for empowering psychiatric patients. Therefore, the aim of this study was to identify, by using focus groups, whether and how psychiatric patients’ empowerment can improve risk management according to the perspective of healthcare providers (HPs). Methods A mixed-method approach composed of a qualitative data collection method (i.e., focus groups) and a quantitative analysis technique (i.e., inductive content analysis) was applied. HPs working in mental health settings shared their perspectives on psychiatric patients’ empowerment in risk management. After the transcription of the audio-taped discussions and the subsequent development of a hierarchical four-level coding system (strategy versus critical issue, thematic area, category, subcategory), two independent raters codified the transcripts and synthesized the content. Absolute frequencies are reported for quantitative data. Results Twelve focus groups consisting of six to ten participants, each with an overall sample size of 95 participants (65 women; average age ± SD 47 ± 9 yrs), were enrolled. A total of 1252 participants’ verbal contributions (i.e., units of analysis) were assessed. Strategies and critical issues (Level 1) were mentioned almost equally (52 and 48%, respectively) by the HPs. Most of the contributions at Level 2 referred to the thematic areas Treatment and Cure (69%) and Emergency Management (21%). In the area Treatment and Cure, the category Therapeutic Compliance (Level 3) was discussed in one third of all contributions. Conclusions Our results suggest that HPs consider patients as crucial partners in risk management and expect them to play a key role in actively enhancing safety. Policy makers should be aware that risk management in mental health settings particularly relies on the therapeutic relationship between HPs and patients. Therefore, allocating sufficient human and financial resources to mental health care aiming to further support the relationship between patients and HPs is of utmost importance. Electronic supplementary material The online version of this article (10.1186/s12913-019-4215-x) contains supplementary material, which is available to authorized users.

Objectives The role of physical activity (PA) in the promotion of mental wellbeing and prevention of psychological disorders in population groups at increased risk for mental health conditions, such as migrant populations, has never been systematically investigated. Methods We conducted a systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Pubmed, Web of Science, SportDiscus. We included randomized (RCTs), controlled clinical trials (CCT), and pre-post intervention studies, that assessed the efficacy of PA interventions in migrants, compared with any types of controls. Results We included 27 studies (4166 participants) (16 RCTs; 2 CCTs; 9 pre-post design) between 1997 and 2020. Meta-analysis showed a significant beneficial effect of PA over control conditions for general functioning (SMD -0.35, 95% CI -0.83 to −0.16; 400 participants), outcome expectancies (SMD -0.78, 95% CI -1.17 to −0.40; 118 participants), self-efficacy/coping (SMD -0.28, 95% CI -0.52 to −0.03; 269 participants), and psychological symptoms (SMD -0.48, 95% CI -0.88 to −0.08; 6 RCTs; 597 participants). Similar findings were produced by pre-post intervention studies (SMD -0.35, 95% CI -0.60 to −0.10; 7 studies; 302 participants). Conclusions Migrant populations may benefit from PA interventions to improve psychological outcomes. Uncertainty remains about the best approach to promote PA in this population, and future research should consider the complex factors that characterize the migration experience.

Considering that radiology is still a male-dominated specialty in which men make up more than two thirds of the workforce, this systematic review aimed to provide a comprehensive overview of the current role of women in radiological imaging, focusing on the main aspects such as career progression, leadership, academic practice, and perceived discrimination. Three electronic databases were searched up to 21 October 2020. To identify additional records, weekly automatic email alerts were set up on PubMed until December 2020 and reference lists of key studies and included papers were screened. Two reviewers independently performed the search, study selection, quality appraisal, data extraction, and formal narrative synthesis. In case of disagreement, a third reviewer was involved. Across the 61 included articles, women worked more often part-time and held fewer positions of power in hospitals, on editorial boards, and at the academic level (associate and full professors). Women were less often in relevant positions in scientific articles, had fewer publications, and had a lower H-index. Discrimination and sexual harassment were experienced by up to 40% and 47% of female radiologists, respectively. Our study highlights that women in radiology are still underrepresented and play a marginal role in the field, struggling to reach top and leading positions.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is giving rise to a relevant impact on the wellbeing and mental health of several Health Care Providers (HCPs) Among HCPs, those who work in the field of obstetrics repre-sent a particular group of HCPs who are susceptible to stressful events, given the stress derived from a physically, emotionally, and intellectually demanding work, the difficulty in reschedul-ing and postponing daily activities during a health emergency, and the special ability to develop personal resilience Based on this background, the aim of the present study is to assess the acute psychological and professional impact of the SARS-CoV-2 outbreak on this group of HCPs at four University Hospitals in Italy (Verona, Roma Policlinico Gemelli, Varese, Brescia) For this purpose, a 104-items survey named Impatto PSicologico Covid in Ostetricia (IPSICO) has been developed and administered with a web-based platform This survey, divided into four sections, will collect demographic data and information about past personal and mental health history, the impact of the epidemic on the personal and professional life, and the outcomes of this health care emergency The results of this survey will help to plan effective strategies in order to face the psychological consequences of possible future new health care emergencies of this type

Seasonal influenza is recognized to be a significant public health problem and a cause of death, especially in fragile persons. In nursing homes (NHs), vaccination for both residents and staff is the best preventive strategy. However, professionals&rsquo, immunization rates are far from reaching the international recommended values. This study aims to describe the adherence and attitudes of NH staff towards flu vaccination and to explore staff hesitancy. A questionnaire was developed based on a literature review and on the 3Cs (confidence, complacency, convenience) of the WHO framework and administered among the staff of four NHs of a province in the northeast of Italy. Results demonstrated a low adherence towards annual vaccination (i.e., only 3% declared getting the flu vaccination each year). Complacency, confidence and convenience all showed a significant impact on the attitude towards vaccination both in univariate and multivariable analysis, with complacency being the most strongly associated area. The area of confidence resulted in strongly challenging factors. Only 24.8% of interviewees appeared trustful towards the efficacy of receiving immunization and 34% declared safety issues. Insights from the study can support the implementation of effective interventions to improve vaccination adherence in NHs. Specifically, increasing complacency by raising awareness related to the risks of influenza appears to be an essential strategy to effectively promote vaccination uptake.

Allogeneic hematopoietic stem cell transplant (HSCT) is a procedure with life-threatening complications that in turn has the potential to cure a significant proportion of patients with otherwise fa...

Good doctor-patient communication may lead to better compliance, higher patient satisfaction, and finally, better health. Although the social variance in how physicians and patients communicate is clearly demonstrated, little is known about what patients with different educational attainments actually prefer in doctor-patient communication. In this study we describe patients' perspective in doctor-patient communication according to their educational level, and to what extent these perspectives lean towards the expert opinion on doctor-patient communication. In a multi-center study (Belgium, The Netherlands, UK and Italy), focus group discussions were organised using videotaped medical consultations. A mixed methods approach was used to analyse the data. Firstly, a difference in perspective in communication style was found between the lower educated participants versus the middle and higher educated participants. Secondly, lower educated participants referred positively most to aspects related to the affective/emotional area of the medical consultation, followed by the task-oriented/problem-focused area. Middle and higher educated participants positively referred most to the task-oriented/problem-focused area. The competency of the physician was an important category of communication for all participants, independent of social background. The results indicate that the preferences of lower educated participants lean more towards the expert opinion in doctor-patient communication than the middle and higher educated participants. Patients' educational level seems to influence their perspective on communication style and should be taken into account by physicians. Further quantitative research is needed to confirm these results.

Background Oncological pts usually experience symptoms that include anxiety, depression and distress. The aim of this preliminary study was to explore the effect of Cognitive-Behavioral-Therapy (CBT) in cancer pts. Methods An open trial evaluated the treatment effects of CBT in breast and lung pts referring to a clinical psychology health service specialized in psycho-oncology. Levels of anxiety and depression were assessed using the validated self-report questionnaires Hospital Anxiety and Depression Scale (HADS), while the distress was evaluated with the Distress Thermometer (DT). The statistical analysis includes the Wilcoxon-Mann-Whitney and the Spearman rank tests. Results At a median follow-up of 6 months, data from 43 pts (88% breast and 12% lung cancer) were prospectively collected (median age: 49 years). At baseline, 62.8% and 44.2% of pts were borderline abnormal for anxiety and depression, while 34.9% and 30.2% reported abnormal levels. All pts presented high levels of distress. A significant correlation between anxiety and depression was observed (rs=0.55; p Conclusions These results highlight the importance of the introduction in clinical routine of validated psychological screening for anxiety, depression and distress as well as psychological intervention, carried out by trained psycho-oncology. Legal entity responsible for the study University of Verona. Funding Has not received any funding. Disclosure E. Bria: Honoraria (self): MSD, AstraZeneca, Celgene, Pfizer, Helsinn, Eli Lilly, BMS, Novartis, and Roche. ; Research grant / Funding (self): AIRC-IG 20583. M. Milella: Honoraria (self): Pfizer, EUSA Pharma, AstraZeneca. S. Pilotto: Honoraria (self): AstraZeneca, Eli Lilly, BMS, Boehringer Ingelheim, Roche, MSD and Istituto Gentili. ; Research grant / Funding (self): AIRC-IG 20583. All other authors have declared no conflicts of interest.

Background The literature shows that the quality of communication is usually determined from a professional perspective. Patients or lay people are seldom involved in the development of quality indicators or communication. Objective To give voice to the lay people perspective on what constitutes ‘good communication’ by evoking their reactions to variations in physician communication. Design Lay people from four different countries watched the same videotaped standardized medical encounters and discussed their preferences in gender-specific focus groups who were balanced in age groups. Setting and participants Two hundred and fifty-nine lay people (64 NL, 72 IT, 75 UK and 48 BE) distributed over 35 focus groups of 6–8 persons each. Main variables studied Comments on doctors’ behaviours were classified by the GULiVer framework in terms of contents and preferences. Results Participants prevalently discussed ‘task-oriented expressions’ (39%: competency, self-confident, providing solutions), ‘affective oriented/emotional expressions’ (25%: empathy, listening, reassuring) and ‘process-oriented expressions’ (23%: flexibility, summarizing, verifying). ‘Showing an affective attitude’ was most appreciated (positive percentage within category: 93%, particularly facilitations and inviting attitude), followed by ‘providing solution’ (85%). Among disfavoured behaviour, repetitions (88%), ‘writing and reading’ (54%) and asking permission (42%) were found. Conclusions Although an affective attitude is appreciated by nearly everybody, people may vary widely in their communication needs and preferences: what is ‘good communication’ for one person may be disliked or even a source of irritation for another. A physician should be flexible and capable of adapting the consultation to the different needs of different patients. This challenges the idea of general communication guidelines.

Objective Although most health care professionals im- or explicitly will assume that they tend to use patient-centered communication strategies, there are reasons to believe that this might not always be a valid assumption. In everyday practice, professionals' own value system is often the dominant steering guide. This Special Issue aims to bring together ongoing research and reflections about the quality of health care communication from the patients' own perspective. In short: what do patients want? Methods This introduction presents a comprehensive overview of the papers in the special issue of Patient Education and Counseling within a framework that describes the collected papers according to the six functions of medical consultations, taking account of the studies' applied methodologies: quantitative versus qualitative. Results Two functions of the medical consultation are strongly represented in the collected papers on the quality of communication from the patients' perspective: ‘fostering the relationship' and ‘information giving'. There is a remarkable difference between the qualiative and quantitative studies, showing that if patients are not limited to prestructured questionnaires but completely free to express themselves, they tend to focus on ‘fostering the relationship' with an emphasis on personal attention, warmth and empathy. Conclusions Patients' needs and preferences for personalized and humane medical care cannot be overestimated. For the rest, patient diversity is striking, showing the limited usefulness of general communication guidelines for the other five functions of the medical consultation. Researchers should be aware that patients' views might be different dependent on the applied methodologies.

Fiorenza Broggi,1 Monica Bomba,1 Michela Rimondini,2 Maura Mutti,1 Sara Pasta,1 Chiara Ricci,1 Luca Tagliabue,1 Silvia Valsecchi,1 Elide Monaco,1 Francesca Neri,1 Silvia Oggiano,2 Renata Nacinovich,1 1Department of Child and Adolescent Psychiatry, San Gerardo Hospital, University of Milano–Bicocca, Monza, 2Department of Clinical Psychology, University of Verona, Italy Abstract: A mindful approach to education and training could improve students’ reflective capacities and have positive effects on clinical practice because it facilitates a helping relationship. The main aims of this study were to investigate whether participation in a mindful-based University training was associated with increases in mindfulness skills as measured by the 5-Facet M Questionnaire, and to present the Italian validation of the questionnaire. Sixty-seven students from the course Neuro and Psychomotor Therapy were enrolled. They filled in the self-administered 5-Facet M Questionnaire before and 1 month after a mindfulness-based training, focused on role-playing and followed by a feedback group discussion. The Italian version of the 5-Facet M Questionnaire had good psychometric properties. The pre- and post-training analysis showed a significant increase in the subscale ‘Observing’. Findings suggest that role-playing and feedback group sessions are valid tools to improve students’ mindfulness skills. Keywords: mindfulness, role play, self-awareness, communication skills, insight, reflective capacities, feedback

Objective The aim of this study is to generate empirically based ‘tips’ from lay people on how medical consultations could become more successful from a patient perspective. Methods 258 Lay people in the United Kingdom, Italy, Belgium and the Netherlands, distributed over 32 focus groups, were invited to formulate ‘tips’ for doctors as well as patients after rating the quality of communication from videotaped consultations and discussing their arguments in focus groups. Results Tips were remarkably similar across the four countries. Most tips reflect the professional literature, such as the importance of nonverbal communication, personal attention and empathy, but also addressed issues as how to deal with new technologies and new accessibility arrangements (triage). The tips were targeted to the consultation itself, its preparation and the aftercare. Tips for doctors were mirrored in tips for patients. Conclusion Lay people seem to be competent in participating in quality-of-care debates. They are well aware of patients’ own responsibilities. Besides, they have clear opinions about novel technology and healthcare arrangements (triage). Practice implications Listening to patients, showing empathy and personal attention seem to have a universal value. Doctors should be trained to practice these behaviors, healthcare managers in involving patients in practice reorganisations.