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Background: The Emoty-Com training is a 16 hours-course based on interactive teaching to increase communication and emotion-handling skills for medical students. The study aimed to describe the Emoty-Com training impact on medical students’ attitudes towards patients’ emotions and to explore the association between students’ empathy, emotional intelligence (EI), attachment style (AS) and attitudes with post-training performance scores. Methods: The Emoty-Com training was delivered to all second-year students of Medicine and Surgery Schools in Verona and Milan (Italy) Universities. Empathy, AS and EI were assessed at pre-training; attitudes towards emotions in the doctor-patient encounter were assessed at pre-training and post-training; at post-training, a final test evaluating the knowledge acquired during the training was administered. Findings: The Emoty-Com training increased the relevance attributed to doctor emotional involvement, at least by male students, and students’ perception of self-efficacy in handling their own emotions during a consultation. Students with higher final test scores were those with less perceived self-efficacy in dealing with patients’ emotions before the training, while students with lower final scores were those who tended to give scarce importance to doctors' emotions in the clinical encounter after the training. Discussion: In contrast with previous literature, the relationship between AS, EI, empathy, and communication skills measured by the final test was not confirmed. Students' acquired knowledge resulted related to their attitude towards emotions, which should be considered in adapting future training to the specific needs of medical students.

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.

Internet eXchange Points (IXPs) serve as landmarks where many network service providers meet to obtain reciprocal connectivity. Some of them, especially the largest, offer route servers as a convenient technology to simplify the setup of a high number of bi-lateral peerings. Due to their potential to support a quick and easy interconnection among the networks of multiple providers, IXPs are becoming increasingly popular and widespread, and route servers are exploited increasingly often. However, in an ever-growing level of market competition, service providers are pushed to develop concerns about many aspects that are strategic for their business, ranging from commercial agreements with other members of an IXP to the policies that are adopted in exchanging routing information with them. Although these aspects are notoriously sensitive for network service providers, current IXP architectures offer no guarantees to enforce the privacy of such business-critical information. We re-design a traditional route server and propose an approach to enforce the privacy of peering relationships and routing policies that it manages. Our proposed architecture ensures that nobody, not even a third party, can access such information unless it is the legitimate owner (i.e., the IXP member that set up the policy), yet allowing the route server to apply the requested policies and each IXP member to verify that such policies have been correctly deployed. We implemented the route server and tested our solutions in a simulated environment, tracking and analyzing the number of exchanged control plane messages., QC 20180207

Il terapista della neuro e psicomotricità dell’età evolutiva,si trova ad operare in un setting terapeutico-riabilitativo,in cui lo spazio della comunicazione è basato principalmente su un linguaggio non verbale; deve pertanto essere formato nel percorso universitario a riconoscere sul piano emozionale e sensoriale i linguaggi non verbali che utilizza quotidianamente con il bambino: losguardo, la mimica, la postura, il gesto, il tono e verbali:la voce, la prosodia, il tono, il contenuto e la loro sintonianella comunicazione. Per relazionarsi correttamente con il paziente il terapista deve imparare ad agire in modo consapevole e attento durante la sua attività clinica quotidiana; è quindi importante una formazione che parta dal poter essere osservato e dal poter osservarsi nella pratica terapeutico riabilitativa e un feedback sulla stessa fatto da un supervisore esterno. Questa formazione deve attuarsi attraverso un cammino lento nel tempo e nello spazio, nella sicurezza e nel rispetto delle possibilità personali. In questo lavoro si vuole valutare l’efficacia di un intervento formativo integrato composto da: role play, feedback individuale, discussione in gruppo nel Corso di Laurea in Terapia della Neuro e Psicomotricità dell’ Età Evolutiva.

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

Internal routing inside the network of an Internet Service Provider (ISP) affects the performance of lots of services that the ISP offers to its customers and is therefore critical to adhere to Service Level Agreements (SLAs), achieve a top-quality offer, and earn revenue. Existing technologies (most notably, MPLS) offer limited (e.g., with RSVP-TE), tricky (e.g., with OSPF metrics), or no control on internal routing paths. Recent research results address these shortcomings, but miss a few elements that would enable their application in an ISP's network. We introduce a new control plane, based on pathlet routing (Godfrey et al., 2009) [2], designed to operate in the network of an ISP and offering several nice features: it enables steering of network paths at different levels of granularity; it is scalable and robust; it supports independent configuration of specific network regions and differentiation of Quality of Service (QoS) levels; it can nicely coexist with other control planes and is independent of the data plane used in the ISP's network. Besides formally introducing the messages and algorithms of our control plane, we propose an experimental scalability assessment and comparison with OSPF, conducted in the simulation framework OMNeT++., QC 20180207

Internal routing inside the network of an Internet Service Provider (ISP) affects the performance of lots of services that the ISP offers to its customers and is therefore critical to adhere to Service Level Agreements (SLAs), achieve a top-quality offer, and earn revenue. Existing technologies (most notably, MPLS) offer limited (e.g., with RSVP-TE), tricky (e.g., with OSPF metrics), or no control on internal routing paths. Recent research results address these shortcomings, but miss a few elements that would enable their application in an ISP's network. We introduce a new control plane, based on pathlet routing (Godfrey et al., 2009) [2], designed to operate in the network of an ISP and offering several nice features: it enables steering of network paths at different levels of granularity; it is scalable and robust; it supports independent configuration of specific network regions and differentiation of Quality of Service (QoS) levels; it can nicely coexist with other control planes and is independent of the data plane used in the ISP's network. Besides formally introducing the messages and algorithms of our control plane, we propose an experimental scalability assessment and comparison with OSPF, conducted in the simulation framework OMNeT++. © 2014 Elsevier B.V. All rights reserved.

Internal routing inside an ISP network is the foundation for lots of services that generate revenue from the ISP's customers. A fine-grained control of paths taken by network traffic once it enters the ISP's network is therefore a crucial means to achieve a top-quality offer and, equally important, to enforce SLAs. Many widespread network technologies and approaches (most notably, MPLS) offer limited (e.g., with RSVP-TE), tricky (e.g., with OSPF metrics), or no control on internal routing paths. On the other hand, recent advances in the research community are a good starting point to address this shortcoming, but miss elements that would enable their applicability in an ISP's network. We extend pathlet routing by introducing a new control plane for internal routing that pursues the following qualities: it is designed to operate in the internal network of an ISP; it enables fine-grained management of network paths with suitable configuration primitives; it is scalable because routing changes are only propagated to the network portion that is affected by the changes; it supports independent configuration of specific network portions without the need to know the configuration of the whole network; it is robust thanks to the adoption of multipath routing; it supports the enforcement of QoS levels; it is independent of the specific data plane used in the ISP's network; it can be incrementally deployed and it can nicely coexist with other control planes. Besides formally introducing the dissemination mechanisms and algorithms of our control plane, we propose an experimental validation in the simulation framework OMNeT++ that we use to assess the effectiveness and scalability of our approach., QC 20180207

Introduction: Studies on patient involvement show that physicians make few attempts to involve their patients who ask few questions if not facilitated. On the other hand, the patients who participate in the decisionmaking process show greater treatment adherence and have better health outcomes. Different methods to encourage the active participation during oncological consultation have been described; however, similar studies in Italy are lacking. The aims of the present study are to (1) assess the effects of a preconsultation intervention to increase the involvement of breast cancer patients during the consultation, and (2) explore the role of the attending companions in the information exchange during consultation. Methods and analysis: All female patients with breast cancer who attend the Oncology Out-patient Services for the first time will provide an informed consent to participate in the study. They are randomly assigned to the intervention or to the control group. The intervention consists of the presentation of a list of relevant illnessrelated questions, called a question prompt sheet. The primary outcome measure of the efficacy of the intervention is the number of questions asked by patients during the consultation. Secondary outcomes are the involvement of the patient by the oncologist; the patient's perceived achievement of her information needs; the patient's satisfaction and ability to cope; the quality of the doctor-patient relationship in terms of patientcenteredness; and the number of questions asked by the patient's companions and their involvement during the consultation. All outcome measures are supposed to significantly increase in the intervention group. Ethics and dissemination: The study was approved by the local Ethics Committee of the Hospital Trust of Verona. Study findings will be disseminated through peer-reviewed publications and conference presentations.

Background: The project GULiVer explores how lay people in Belgium (Gent), the Netherlands (Utrecht), the UK (Liverpool) and Italy (Verona) evaluate physicians’ communicative skills. The aims are to present the study design and to assess the quality of collected data. Methods: In each centre one out of two sets of four videotaped consultations involving medical students with varying communication skills were shown to eight lay panels of six to nine participants each (n = 259). The selection of lay participants was stratified by gender and age in order to obtain a heterogeneous sample. Background characteristics included socio-demographics, participants’ general physical (COOP-WONCA) and mental health (GHQ), communication preferences (QUOTE-com) and trust in doctors (TMP). Participants were asked to give quantitative and qualitative evaluations of the student doctors’ performance in a mixed-methods design. Quality assessment of the collected data and protocol adherence of the four centres was carried out by Generalized Linear Model (GLM). Results: The overall sample comprised 259 participants. Participants were equally distributed among the centres and balanced in terms of age, gender and OSCE scenario, confirming the quality of collected data. Conclusion: The study design and the applied procedures will ensure a great richness of data allowing a wider European perspective on lay persons’ views, assessed both individually and through focus group discussion.

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.

Objective To describe the methodological procedures of a multi-centre focus group research for obtaining content categories also suitable for categorical statistical analyses. Methods Inductive content analyses were performed on a subsample of 27 focus groups conducted in three different countries, the Netherlands (Utrecht), the UK (Liverpool) and Italy (Verona). The analyses of the subsample of focus group discussions were performed in five steps: (1) independent development of content categories in each of the participating centres, (2) obtaining consensus categories, (3) creation of a manual with coding rules and defining criteria for categories and subcategories, (4) assessment of inter-rater reliability to identify unreliable categories to be revised, and (5) repetition of inter-rater reliability assessment. Results The resulting coding system considers five areas: non verbal communication, process oriented expression, task oriented or problem focused expressions, affective or emotional expressions, and physician's personal characteristics. It contains 12 categories of acceptable inter-rater reliability and 41 subcategories. Conclusion The coding procedures show how focus group data, obtained in an international multi-centre study can be analysed in a systematic way combining scientific rigour with the richness of data obtainable from qualitative methodologies. Practice implication The applied procedures may be helpful for multi-centre focus group research on other topics.

Objective To present the Verona Coding Definitions of Emotional Sequences (VR-CoDES CC), a consensus based system for coding patient expressions of emotional distress in medical consultations, defined as Cues or Concerns. Methods The system was developed by an international group of communication researchers. First, consensus was reached in different steps. Second, a reliability study was conducted on 20 psychiatric consultations. Results A Cue is defined as a verbal or non-verbal hint which suggests an underlying unpleasant emotion that lacks clarity. A Concern is defined as a clear and unambiguous expression of an unpleasant current or recent emotion that is explicitly verbalized with or without a stated issue of importance. The conceptual framework sets precise criteria for cues and concerns and for whom (health provider or patient) elicits the cue/concern. Inter-rater reliability proved satisfactory (agreement 81.5%, Cohen's Kappa 0.70). Conclusion The VR-CoDES CC will facilitate comparative research on provider–patient communication sequences in which patients express emotional distress. Practice implications The VR-CoDES CC may be used to help clinicians in recognizing or facilitating cues and concerns, thereby improving the recognition of patients’ emotional distress, the therapeutic alliance and quality of care for these patients.

Objective To present a method to classify health provider responses to patient cues and concerns according to the VR-CoDES-CC (Del Piccolo et al. (2009) [2] and Zimmermann et al. (submitted for publication) [3]). The system permits sequence analysis and a detailed description of how providers handle patient's expressions of emotion. Methods The Verona-CoDES-P system has been developed based on consensus views within the “Verona Network of Sequence Analysis”. The different phases of the creation process are described in detail. A reliability study has been conducted on 20 interviews from a convenience sample of 104 psychiatric consultations. Results The VR-CoDES-P has two main classes of provider responses, corresponding to the degree of explicitness (yes/no) and space (yes/no) that is given by the health provider to each cue/concern expressed by the patient. The system can be further subdivided into 17 individual categories. Statistical analyses showed that the VR-CoDES-P is reliable (agreement 92.86%, Cohen's kappa 0.90 (±0.04) p < 0.0001). Conclusion Once validity and reliability are tested in different settings, the system should be applied to investigate the relationship between provider responses to patients’ expression of emotions and outcome variables. Practice implications Research employing the VR-CoDES-P should be applied to develop research-based approaches to maximize appropriate responses to patients’ indirect and overt expressions of emotional needs.

Contains fulltext : 51590.pdf (publisher's version ) (Closed access), OBJECTIVE: To provide psychometric characteristics of the Italian language version of the OPTION scale and descriptive statistics on patients' involvement. The OPTION scale assesses the extent to which clinicians involve patients in therapeutic decisions. The English language version has a Cohen's kappa score for individual items ranging from 0.45 to 0.98 and an intraclass correlation coefficient (ICC) for the total score of 0.77. METHODS: Six male GPs provided 235 audiotaped consultations with consecutive patients who had attended for a new illness episode over a 2-month period. Thirty interviews were rated by two raters to assess inter- and intra rater as well as test-retest reliability of the Italian language version of the OPTION scale. Based on the whole sample, Cronbach's alpha and an exploratory factor analysis were performed to assess internal validity and to determine factor loadings. RESULTS: Cohen's kappa values were comprised between 0.29 and 0.73, the ICC at test and retest was 0.85 and 0.81 and Cronbach's alpha 0.82. The ratings for each OPTION item showed a skewed distribution: the majority of scores (>70%) were between 0 (behaviour absent) and 2 (minimum skill level). CONCLUSION: The reliability indices were satisfactory and similar to those reported for the original OPTION. PRACTICE IMPLICATIONS: OPTION can be used for both teaching purposes and research, as well as for future cross-national comparisons.