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We present a newly developed methodology using computer-readable fiducial markers to allow images from multiple imaging modalities to be registered automatically. This methodology makes it possible to correlate images from many surface imaging techniques to provide an unprecedented level of surface detail on a nanometre scale that no one technique can provide alone. This methodology provides the capability to navigate to specific areas of interest when transferring samples from machine to machine seamlessly. Then taking data acquired from scanning electron microscope (SEM), secondary ion mass spectrometry (SIMS), x-ray photoelectron spectroscopy (XPS), atomic force microscopy (AFM) and optical inspection tools and combining all the data acquired to then generate a 3D data representative model of a surface., (Copyright © 2021. Published by Elsevier B.V.)

Objective: Delivering a life changing diagnosis can be a distressing experience for patients and a challenging task for professionals. Diagnosis delivery can be especially difficult for individuals with neurodegenerative diseases such as motor neurone disease (MND), multiple sclerosis (MS) and Parkinson's disease (PD). This review aims to scope the literature on doctors' and patients' perspectives on diagnosis delivery for these conditions in order to enhance our understanding in this area and identify potential research gaps., Methods: A scoping review methodology was used, and data were summarised using content analysis., Results: 47 studies fulfilled the inclusion criteria. Studies showed that although patients were generally satisfied with diagnosis delivery, a considerable proportion was still dissatisfied with aspects of the consultation, especially the information and time provided and the doctor's approach. Only six studies addressed doctors' perspectives, which focused more on doctors' practice., Conclusion: There was a significant research gap in professionals' perspectives. The review also found that although basic standards of good practice were being met, a significant proportion of patients were dissatisfied with diagnosis communication., Practice Implications: Professionals delivering such diagnoses need to assess and respond to patients' information needs, provide time for questions and maintain an empathic attitude., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objective To explore the processes by which therapeutic alliance develops in mental health consultations with Sign Language interpreters. Method Semi-structured interviews with 7 qualified interpreters were transcribed and analysed with interpretative phenomenological analysis. Results Two key themes were generated: (1) Nurturing the triangle of care, where the therapeutic process relied on collaboration, continuity, and trust; and (2) Shared vision and knowledge, in which participants felt misunderstood and unsupported; there was a lack of deaf awareness and clinicians appeared to feel deskilled. Conclusions Interpreters should be viewed as valued members of clinical teams and have access to clinical supervision so that they can be supported in interpreting emotional distressing content. Clinicians can aim to be collaborative with interpreters and improve their knowledge of mental health issues that are relevant to deaf people. Practice Implications An aide-memoire of the role and practicalities of working with SL interpreters should be developed and disseminated to relevant services to support collaborative working with clinicians. A core competence in SL interpreter training is reflexivity. This should be embedded in educational curricula and facilitated through clinical supervision. Funding by commissioning services should be subject to services being deaf aware and interpreters being mental health aware., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Introduction: Perceived control is an important concept in understanding adjustment to chronic conditions such as Parkinson's. While generic measures have been used to measure the construct in Parkinson's, no Parkinson's-specific scale currently exists. This study outlines the initial development and further validation of a free-to-use scale, the Parkinson's UK Scale of Perceived Control (PUKSoPC)., Method: Focus groups were used to create items for the new scale. Potential items were then subject to screening for readability and coherence by people affected by the condition. This left 49 items that were then completed, along with other measures, by 231 people with Parkinson's. Exploratory factor analysis then created a 15-item scale with five distinct subscales. This initial structure was then further tested using confirmatory factor analysis with 2032 people with Parkinson's. Structural equation modelling confirmed the acceptability of the total scale and subscale structures., Results: The final scale is concluded to be a psychometrically robust measure of perceived control. It has good face validity, evidence of convergent and criterion (concurrent and divergent) validity, good test-retest reliability and is internally coherent, with a demonstrably solid factor structure. While further testing would be useful to assess the scale's predictive ability, it is currently considered robust enough for more widespread use., Conclusion: The PUKSoPC is an appropriate scale to provide a more comprehensive measure of perceived control. It is preferable to single item, non-validated measures and can provide evidence of perceptions of control across a number of domains important in the measurement of the construct., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objective: To investigate whether and how doctors' attachment styles and emotional intelligence (EI) might influence patients' emotional expressions in general practice consultations., Methods: Video recordings of 26 junior doctors consulting with 173 patients were coded using the Verona Coding Definition of Emotional Sequences (VR-CoDES). Doctors' attachment style was scored across two dimensions, avoidance and anxiety, using the Experiences in Close Relationships: Short Form questionnaire. EI was assessed with the Mayer-Salovey-Caruso Emotional Intelligence Test. Multilevel Poisson regressions modelled the probability of patients' expressing emotional distress, considering doctors' attachment styles and EI and demographic and contextual factors., Results: Both attachment styles and EI were significantly associated with frequency of patients' cues, with patient- and doctor-level explanatory variables accounting for 42% of the variance in patients' cues. The relative contribution of attachment styles and EI varied depending on whether patients' presenting complaints were physical or psychosocial in nature., Conclusion: Doctors' attachment styles and levels of EI are associated with patients' emotional expressions in primary care consultations. Further research is needed to investigate how these two variables interact and influence provider responses and patient outcomes., Practice Implications: Understanding how doctors' psychological characteristics influence PPC may help to optimise undergraduate and postgraduate medical education., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Objective: To investigate the relationship between trainee doctors' attachment style and their performance in qualifying clinical and communication skills assessments., Methods: Participants were 190 undergraduate medical students whose performance was assessed by examiners across two areas (communication and clinical skills) during their qualifying Objective Structured Clinical Examination (OSCE). Simulated patients also rated communication skills. Participants' attachment style was rated across two dimensions, avoidance and anxiety, using the Relationship Questionnaire (RQ)., Results: Lower levels of attachment avoidance and anxiety significantly predicted higher performance in both communication and clinical skills., Conclusion: Trainee doctors' attachment styles are associated with patient communication and clinical performance. Further research is needed to investigate the impact of attachment on consultations between doctors and patients within clinical settings., Practice Implication: Attachment theory can inform our understanding why, for some student doctors, interacting with patients may be particularly challenging and require additional support by medical educators., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Objective: Attachment style and emotional intelligence (EI) have been highlighted as potential factors influencing the variation in medical students' and doctors' patient-provider communication (PPC), particularly in relation to emotive issues. The objective of this review is to systematically review and synthesise the published literature relating to the influence of medical students' and/or doctors' attachment style and EI on their PPC., Methods: Electronic and hand searches were conducted to identify all published literature relating to the aim of the review. Data were narratively synthesised., Results: 1597 studies were identified. 14 were included in the review, of which 5 assessed the influence of attachment style and 9 assessed the influence of EI on PPC. No studies assessed the impact of both attachment style and EI on PPC., Conclusion: Whilst tentative links were found between both PPC and both attachment style and EI, heterogeneity in study design, predictor variables and outcome measures made drawing conclusions difficult., Practice Implications: More research is needed to assess the influence of both attachment style and EI on PPC., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Objective: to establish which kind of physician communicative responses to patient cues and concerns are appreciated by lay people., Methods: A balanced sample (259 people) was recruited in public places to participate in a full day observation of four videotaped standardized medical consultations. In a two-step procedure participants gave their individual quality ratings of the whole consultations and then of a set of four fragments from each consultation. They contained a patient negative emotional expression and the subsequent physician response, according to the VR-CoDES., Results: Higher quality ratings were given to physician responses which provided space to the patient to talk and to the explicit expressions of empathy. The explicit responses were favored above non-explicit responses. Participants' global evaluation of the whole consultation affected their quality assessments of the fragments (halo-effect). In a multivariate model, lay people's background characteristics appeared to be relevant: to be female, of lower educational level and living in Belgium or Italy predicted higher ratings., Conclusions: Providing space to patients is appreciated by all participants, combined with the need for tailor made communication., Practice Implications: To teach physicians listening skills and how to show empathy with distressed patients should be a core element in medical education., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

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., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Objective: To investigate whether different measures of inter-rater reliability will compute similar estimates with nominal data commonly encountered in communication studies. To make recommendations how reliability should be computed and described for communication coding instruments., Methods: The raw data from an inter-rater study with three coders were analysed with; Cohen's κ, sensitivity and specificity measures, Fleiss's multirater κj, and an intraclass correlation coefficient (ICC)., Results: Minor differences were found between Cohen's κ and an ICC model across paired data (largest margin=0.01). There were negligible differences between the multirater estimates e.g. κj (0.52) and ICC (0.53). Sensitivity analyses were in general agreement with the multirater estimates., Conclusion: It is more practical to analyse nominal data with >2 raters with an appropriate model ICC for inter-rater studies, and little difference exists between Cohen's κ or an ICC., Practice Implication: Alternatives to Cohen's κ are readily available, but researchers need to be aware of the different ICC definitions. An ICC model should be fully described in reports. Investigators are encouraged to supply confidence limits with inter-rater data, and to revisit guidance regarding the relative strengths of agreement of reliability coefficients., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

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., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

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., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

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., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

Objective: To investigate whether emotional intelligence (EI) developmental training workshops can lead to increases with the Bar-On Emotional Quotient (EQ-i) total scores., Methods: A pilot study with a quasi-randomised controlled design was employed with self-report assessments conducted at baseline and post-intervention following a 7-month training programme. Medical students based at a UK-based medical school participated in the study, and 36 volunteer students were recruited to the control group with 50 students randomly assigned to receive the intervention. A total of 34 (68%) students in the intervention group attended the first intervention training workshop, 17 (34%) attended the majority of the monthly development sessions and completed the post-intervention assessment. In the control group only one participant did not complete the follow-up assessment., Results: The intervention group had significantly higher EQ-i change from baseline mean scores than the control group. The intervention group mean scores had increased across time, whilst the control group mean scores slightly decreased., Conclusion: The EI developmental training workshops had a positive effect on the medical students in the intervention group., Practice Implications: Further research is warranted to determine whether EI can be a useful measure in medical training, and the concept and measurement of EI requires further development.

Background: We tested whether a brief psychological intervention could prevent anxiety or depressive disorders among newly diagnosed cancer patients., Patients and Methods: Patients free of anxiety or depressive disorder were randomised to receive immediate intervention (start of cancer treatment), delayed intervention (8 weeks after starting treatment) or usual care. They were stratified according to risk of developing anxiety or depressive disorders. Primary outcome was measured using a standardised psychiatric interview to detect any anxiety or depressive disorder at 6 and 12 months following the cancer diagnosis. Analyses used conditional odds logistic regression models adjusting for age, gender, concerns and past history to compare outcome of all intervention patients with usual care., Results: A total of 465 patients were recruited. In all, 313 (79%) of the 397 well enough to be interviewed completed the study. At 12 months, there was no difference between the groups receiving the intervention and usual care [odds ratio (OR) = 0.69, 95% confidence interval (CI) 0.41-1.17, P = 0.17]. In high-risk patients, those who received the intervention were less likely to develop an anxiety or depressive disorder compared with those who received usual care (OR = 0.54, 95% CI 0.29-1.00, P = 0.050). In low-risk patients, there was no difference (OR = 1.50, 95% CI 0.51-4.43, P = 0.47)., Conclusion: A brief intervention, delivered by nonspecialists, promoted adjustment among newly diagnosed cancer patients at high risk of developing anxiety or depressive disorders.

Objective: To identify methods available for sequential analysis of dyadic verbal clinical communication and to review their methodological and conceptual differences., Methods: Critical review, based on literature describing sequential analyses of clinical and other relevant social interaction., Results: Dominant approaches are based on analysis of communication according to its precise position in the series of utterances that constitute event-coded dialogue. For practical reasons, methods focus on very short-term processes, typically the influence of one party's speech on what the other says next. Studies of longer-term influences are rare. Some analyses have statistical limitations, particularly in disregarding heterogeneity between consultations, patients or practitioners. Additional techniques, including ones that can use information about timing and duration of speech from interval-coding are becoming available., Conclusion: There is a danger that constraints of commonly used methods shape research questions and divert researchers from potentially important communication processes including ones that operate over a longer-term than one or two speech turns. Given that no one method can model the complexity of clinical communication, multiple methods, both quantitative and qualitative, are necessary., Practice Implications: Broadening the range of methods will allow the current emphasis on exploratory studies to be balanced by tests of hypotheses about clinically important communication processes.