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This study aimed to use a coach-led digital health platform to mitigate burnout and enhance wellbeing among hospital workers. Individual interviews were conducted with 11 healthcare workers to explore their experiences of working with a coach through text-based communication on a digital support platform. Interviews were analysed using thematic analysis. Three overarching themes were identified: (1) Human-centred Conversation, Facilitated Awareness, (2) Learning and Growth, (3) Forward Momentum in the pillars of Lifestyle Medicine. Participants had a positive human-centered connection with their coach and felt safe to communicate openly with her via online chat messages. The coach facilitated participants' awareness, learning and growth by helping them to identify the goals they wanted to achieve. Participants experienced forward momentum in the pillars of Lifestyle Medicine, including sleep, relationships, meaning and purpose in life, exercise, eating well, along with reduced loneliness and burnout. This study found that participants can experience an inherently human-centred connection through text-based communication with an online coach. There were some limits to this connection, including individual preferences and beliefs in relation to the digital means of communication. Participants felt connected to their coach and experienced benefits that extended beyond achieving individual goals to improving their lifestyle and wellbeing. [ABSTRACT FROM AUTHOR]

Fieldwork is a core element of health professional and education student training that is often a professional registration and practice requirement. There are many personal, social, and professional factors that impact on students’ fieldwork performance. The impact of professionalism, resilience, and reflective thinking on fieldwork performance is not well described in the literature.

Background: Ireland has among the highest rates of prostate cancer in the EU, primarily due to widespread PSA screening. PSA screening is not recommended for asymptomatic men. Due to the potential for harm to the patient, and the economic and clinical repercussions for the healthcare system caused by inappropriate screening, this study aimed to investigate associations between PSA screening and sociodemographic, lifestyle, and health-related factors in men ≥50 years in Ireland. Methods: A cross-sectional study was completed using data from Wave 4 of The Irish Longitudinal Study on Aging (TILDA), a nationally representative sample of community dwellers ≥ 50 years in Ireland. Participants self-reported having or not having a PSA test to screen for prostate cancer in the previous two years. Variables were entered into a multivariable logistic regression to estimate adjusted odds ratios (OR) for associations between PSA testing and the factors of interest. Results: There were 2,426 male participants, with 68% reporting a PSA test in the previous two years. In adjusted analysis, older age (OR 1.78, 95%CI 1.32-2.31), third level education (OR 1.34, 95%CI 1.07-1.69) and a higher household net income (OR 2.14, 95% CI 1.52-3.02) increased the likelihood of PSA testing. Health-related factors positively associated with PSA testing screening were private health insurance (OR 1.89, 95%CI 1.52-2.35), blood pressure measurement in the previous year (OR 8.80, 95%CI 6.06-12.77) and a positive family history of cancer (OR 1.42, 95%CI 1.13-1.78). Conclusions: High rates of prostate cancer screening are taking place in Ireland, despite the absence of a population-based screening programme. Men of older age, higher socioeconomic status and who demonstrate health-protective-behaviours have an increased risk of PSA screening. This subgroup of the population should be targeted to increase awareness of the potential benefits and harms of PSA testing. Key messages: Rates of PSA screening remain high in Ireland, despite the absence of a population-based screening programme. Increased awareness of the potential harms and benefits of PSA screening is needed. [ABSTRACT FROM AUTHOR]

Teaching and learning calculus are notoriously difficult and the didactic solutions may involve resorting to intuitive but vague definitions or informal gestures offered as proofs. The teaching literature is rife with examples of metaphors, adverb manipulations and descriptions of what happens “just before” the limit. It is then difficult to leave the domain of the mental image, thus losing the training in rigour. The author (with Karel Hrbacek and Olivier Lessmann) has endeavoured a radically different approach with the objective of training students to prove theorems while preserving both intuition and mathematical rigour. Hence we change the mathematical setting rather than the didactic setting. The result (which is a by-product of nonstandard analysis) has been used in several high schools in Geneva – Switzerland – for over ten years.

Background: Contact tracing is a key component in controlling the spread of COVID-19, however little research has focused on learning from the experiences of contact tracing staff. Harnessing learning from those in this role can provide valuable insights into the process of contact tracing and how best to support staff in this crucial role., Methods: Thematic analysis was used to analyse 47 semi-structured interviews conducted with contact tracing staff via telephone or Zoom at three time points in 2021: March, May and September-October., Results: Six themes related to the contact tracing role were identified, including training, workforce culture, systems issues, motivation and support. While initially nervous in the role, participants were motivated to contribute to the pandemic response and believed the role provided them with valuable transferable skills. Participants described the training as having improved over time while desiring more proactive training. Sources of frustration included a perceived lack of opportunity for feedback and involvement in process changes, feelings of low autonomy, and a perception of high staff turnover. Participants expressed a need for improved communication of formal emotional supports. Increased managerial support and provision of opportunities for career advancement may contribute to increased motivation among staff., Conclusions: These findings identify the experiences of contact tracing staff working during the COVID-19 pandemic, and have important implications for the improvement of the contact tracing system. Recommendations based on learning from participants offer suggestions as to how best to support the needs of contact tracing staff during a pandemic response., Competing Interests: A co-author, EMcA, has received funding for a PhD student working with HSE Quality and Patient Safety who conducted literature reviews to inform the contact management programme. Another co-author, ADB, volunteered as a contact tracer during the early stages of the COVID-19 pandemic response. This role was unpaid. We have no other conflicts of interest to disclose. This does not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2024 Fulham-McQuillan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Psychosocial factors have been informally associated with Chronic Spontaneous Urticaria (CSU); however, the relationship between psychosocial factors and CSU remains relatively unexplored in the scientific literature., Objective: This review aims to provide an evaluation of peer reviewed studies exploring psychosocial factors and CSU., Methods: A systematic search was performed over four databases identifying studies exploring psychosocial factors in relation to CSU published between the years 1995 and 2022., Results: Eighteen studies were included for narrative analysis, and 33 psychosocial factors were identified. These were split into two subgroups: psychosocial factors that were associated with CSU symptoms aggravation/onset (n = 20), and psychosocial factors expected to be impacted by CSU symptoms (n = 13)., Conclusion: This review has highlighted a need for more research and interventions to support individuals with psychosocial factors involved in CSU., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: Contact tracing is a key control measure in the response to the COVID-19 pandemic. While quantitative research has been conducted on the psychological impact of the pandemic on other frontline healthcare workers, none has explored the impact on contact tracing staff., Methods: A longitudinal study was conducted using two repeated measures with contact tracing staff employed in Ireland during the COVID-19 pandemic using two-tailed independent samples t tests and exploratory linear mixed models., Results: The study sample included 137 contact tracers in March 2021 (T1) and 218 in September 2021 (T3). There was an increase from T1 to T3 in burnout related exhaustion (p < 0·001), post-traumatic stress disorder (PTSD) symptom scores (p < 0·001), mental distress (p < 0·01), perceived stress (p < 0·001) and tension and pressure (p < 0·001). In those aged 18-30, there was an increase in exhaustion related burnout (p < 0·01), PTSD symptoms (p < 0·05), and tension and pressure scores (p < 0·05). Additionally, participants with a background in healthcare showed an increase in PTSD symptom scores by T3 (p < 0·001), reaching mean scores equivalent to those of participants who did not have a background in healthcare., Conclusions: Contact tracing staff working during the COVID-19 pandemic experienced an increase in adverse psychological outcomes. These findings highlight a need for further research on psychological supports required by contact tracing staff with differing demographic profiles., (© 2023. The Author(s).)

Post-traumatic growth (PTG) research is flourishing across various disciplines; however, it is only emerging in healthcare. Recently, a flurry of studies assessed PTG among healthcare professionals. However, to date, no systematic review has identified the factors that predict their experiences of PTG among healthcare professionals. The current paper aims to address this gap. Of 126 papers, 27 were selected for this systematic review. The analysis identified a range of demographic, individual (work-related and personal), interpersonal and environmental factors that contributed to healthcare professionals' experiences of PTG. Analysis of findings offers a novel perspective on individual factors by dividing them into personal and work-related factors. Results also highlight a variety of psychological interventions that can be used in healthcare to cultivate PTG. In addition, the gaps in current research, implications for further research, policy and practice that can facilitate the experience of PTG among healthcare professionals are discussed., Competing Interests: The authors declare no conflict of interest.

Having psychological safety embedded in preceptorship relationships facilitates positive interpersonal and educational experiences for students. Psychological safety refers to a student's belief as to whether or not it is safe for them to take interpersonal risks, such as asking questions, sharing an idea for improvement or speaking up to maintain patient safety. Having psychological safety leads to collaboration, positive student learning experiences and effective patient care. This article presents key guidelines for preceptors to provide a psychologically safe learning environment for their students. Guidelines fall under four categories 1) before meeting students, 2) first meeting students, 3) continued relationship with students, and 4) general rules. These guidelines are informed by current literature on psychological safety and preceptorship and the author's clinical expertise in nursing preceptorship. We conceptualise psychological safety in a nursing preceptorship for preceptors to denote the experience of inclusivity, empowerment, and well-being of students within the social, cultural and physical clinical learning environment. A crucial attribute to cultivating a psychologically safe environment involves being an accessible and approachable preceptor., (© 2022. The Author(s).)

Background: Given the unprecedented nature of the COVID-19 pandemic, the Irish health system required the redeployment of public sector staff and the recruitment of dedicated contact tracing staff in the effort to contain the spread of the virus. Contact tracing is crucial for effective disease control and is normally carried out by public health teams. Contact tracing staff are provided with rapid intensive training but are operating in a dynamic environment where processes and advice are adapting continuously. Real-time data is essential to inform strategy, coordinate interconnected processes, and respond to needs . Given that many contact tracers have been newly recruited or redeployed, they may not have significant experience in healthcare and may experience difficulties in managing the anxieties and emotional distress of the public. Aim: (i) identify emerging needs and issues and feed this information back to the Health Service Executive for updates to the COVID-19 Contact Management Programme (CMP); (ii) understand the psychological impact on contact tracers and inform the development of appropriate supports. Methods: We will use a mixed-methods approach. A brief online survey will be administered at up to three time points during 2021 to measure emotional exhaustion, anxiety, general health, and stress of contact tracing staff, identify tracing systems or processes issues, as well as issues of concern and confusion among the public. Interviews will also be conducted with a subset of participants to achieve a more in-depth understanding of these experiences. Observations may be conducted in contact tracing centres to document processes, practices, and explore any local contextual issues. Impact: Regular briefs arising from this research with data, analysis, and recommendations will aim to support the work of the CMP to identify problems and implement solutions. We will deliver regular feedback on systems issues; challenges; and the psychological well-being of contact tracing staff., Competing Interests: No competing interests were disclosed., (Copyright: © 2021 O'Donovan R et al.)

Aim: The aim of this study is to understand how the behaviour of focal leaders impacts health care team performance and effectiveness., Background: Despite recent shifts towards more collectivistic leadership approaches, hierarchical structures that emphasize the role of an individual focal leader (i.e., the formal appointed leader) are still the norm in health care. Our understanding of the effect of focal leader behaviours on health care team performance remains unclear., Evaluation: A systematic review was conducted. Five electronic databases were searched using key terms. One thousand forty-seven records were retrieved. Data extraction, quality appraisal and narrative synthesis were conducted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines., Key Issues: Fifty papers met the criteria for inclusion, were reviewed and synthesized under the following categories: task-focused leadership, directive leadership, empowering leadership and relational focused leadership., Conclusions: Categories are discussed in relation to team performance outcomes, safety specific outcomes, individual-level outcomes and outcomes related to interpersonal dynamics. Emerging themes are explored to examine and reflect on how leadership is enacted in health care, to catalogue best practices and to cascade these leadership practices broadly., Implications for Nursing Management: Empowering and relational leadership styles were associated with positive outcomes for nursing team performance. This underscores the importance of training and encouraging nursing leaders to engage in more collaborative leadership behaviours., (© 2021 The Authors. Journal of Nursing Management published by John Wiley & Sons Ltd.)

Healthcare professionals who feel psychologically safe believe it is safe to take interpersonal risks such as voicing concerns, asking questions and giving feedback. Psychological safety is a complex phenomenon which is influenced by organizational, team and individual level factors. However, it has primarily been assessed as a team-level phenomenon. This study focused on understanding healthcare professionals' individual experiences of psychological safety. We aim to gain a fuller understanding of the influence team leaders, interpersonal relationships and individual characteristics have on individuals' psychological safety and their decisions to engage in voice or silence behavior. Thirty-four interviews were conducted with healthcare professionals from across five teams working within an acute, suburban hospital. Hybrid inductive-deductive thematic analysis focused on identifying themes which captured the complexities of individuals' varied experiences of psychological safety. The themes identified were: "Personal Characteristics," "Past Experiences," "Individual Perceptions of Being Valued," and "Judged Appropriateness of Issues/Concerns." These themes are explored within the context of motivating and inhibiting factors associated with the influence of leadership, interpersonal relationships and individual characteristics on experiences of psychological safety and voice behavior. These results extend existing theoretical frameworks guiding our understanding of psychological safety by accounting for the variation in individuals' experiences and studying these significant influences on voice behavior. Important considerations for the development of interventions to enhance psychological safety are discussed., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 O'Donovan, De Brún and McAuliffe.)

Traditional hierarchical leadership has been implicated in patient safety failings internationally. Given that healthcare is almost wholly delivered by multidisciplinary teams, there have been calls for a more collective and team-based approach to the sharing of leadership and responsibility for patient safety. Although encouraging a collective approach to accountability can improve the provision of high quality and safe care, there is a lack of knowledge of how to train teams to adopt collective leadership. The Collective Leadership for Safety Cultures (Co-Lead) programme is a co-designed intervention for multidisciplinary healthcare teams. It is an open-source resource that offers teams a systematic approach to the development of collective leadership behaviours to promote effective teamworking and enhance patient safety cultures. This paper provides an overview of the co-design, pilot testing, and refining of this novel intervention prior to its implementation and discusses key early findings from the evaluation. The Co-Lead intervention is grounded in the real-world experiences and identified needs and priorities of frontline healthcare staff and management and was co-designed based on the evidence for collective leadership and teamwork in healthcare. It has proven feasible to implement and effective in supporting teams to lead collectively to enhance safety culture. This intervention overview will be of value to healthcare teams and practitioners seeking to promote safety culture and effective teamworking by supporting teams to lead collectively.

Background: Clinical guidelines are integral to a general practitioner's decision to refer a paediatric patient to emergency care. The influence of non-clinical factors must also be considered. This review explores the non-clinical factors that may influence general practitioners (GPs) when deciding whether or not to refer a paediatric patient to the Emergency Department (ED)., Methods: A systematic review of peer-reviewed literature published from August 1980 to July 2019 was conducted to explore the non-clinical factors that influence GPs' decision-making in referring paediatric patients to the emergency department. The results were synthesised using a narrative approach., Results: Seven studies met the inclusion criteria. Non-clinical factors relating to patients, GPs and health systems influence GPs decision to refer children to the ED. GPs reported parents/ caregivers influence, including their perception of severity of child's illness, parent's request for onward referral and GPs' appraisal of parents' ability to cope. Socio-economic status, GPs' aversion to risk and system level factors such as access to diagnostics and specialist services also influenced referral decisions., Conclusions: A myriad of non-clinical factors influence GP referrals of children to the ED. Further research on the impact of non-clinical factors on clinical decision-making can help to elucidate patterns and trends of paediatric healthcare and identify areas for intervention to utilise resources efficiently and improve healthcare delivery.

This paper explores the role of evidence and its use in a cluster of Australian community-based child development programs. The paper draws on findings from a 2016-2017 study commissioned by a not-for-profit organization to review their programs' alignment with government evidence-based program expectations. Cunningham and Duffee's (2009) evidence-based practice style typology is utilized to examine how different purposes of use drive styles of and approaches to evidence sourcing, application, and reporting. Perspectives on what constitutes evidence and how such evidence is valued, used, and reported can vary considerably between individual programs, irrespective of enforced standards and expectations. It is argued that a single-dimensional approach to program evidence-based evaluation and reporting is not appropriate and potentially damaging in contexts where community-based programs have different purposes, structures, cultures, and intentions. Given a program's particular evidence-use style, evidence-based criteria, processes, and reporting requirements should be matched accordingly.

Background: Psychological safety allows healthcare professionals to take the interpersonal risks needed to engage in effective teamwork and to maintain patient safety. In order to improve psychological safety in healthcare teams, an in-depth understanding of the complex and nuanced nature of psychological safety is needed. Psychological safety concepts, including voice, silence, learning behaviour, support and familiarity, informed the current study's investigation of psychological safety. This study aims to use a mixed-methods approach to develop an in-depth understanding of psychological safety within healthcare teams and to build on this understanding to inform the development of future interventions to improve it., Methods: Survey, observational and interview data are triangulated in order to develop an in- depth understanding of psychological safety within four healthcare teams, working within one case study hospital. The teams taking part included one multidisciplinary and three unidisciplinary teams. Observational and survey data were collected during and immediately following team meetings. Individual interviews were conducted with 31 individuals across the four teams. Thematic analysis was used to analyse these interviews., Results: Survey results indicated a high level of psychological safety. However, observations and interviews captured examples of silence and situations where participants felt less psychologically safe. Findings from across all three data sources are discussed in relation to voice and silence, learning, familiarity and support., Conclusion: The results of this study provide a detailed description and in-depth understanding of psychological safety within four healthcare teams. Based on this, recommendations are made for future research and the development of interventions to improve psychological safety.

Background: Psychological safety is a dynamic team-level phenomenon which exists when team members believe that it is safe to take interpersonal risks. In healthcare teams, the presence of psychological safety is critical to delivering safe care. Scholars have highlighted a need for alternative measures which compliment survey-based measures of psychological safety in healthcare teams., Methods: The exploratory phase of this study raised concerns about whether current survey measures could provide a sufficient understanding of psychological safety within healthcare teams to inform strategies to improve it. Thus, previously validated psychological safety surveys and a meeting observation measure were adapted for use in healthcare teams. First, two group feedback sessions were held with 22 healthcare professionals, as well as a systematic literature review. Then, the members of eleven healthcare teams in Ireland and The Netherlands (n = 135) took part in the pilot test of the adapted composite measure., Results: The final composite measure has two parts: a team meeting observation measure and an adapted survey. The observation measure has 31 observable behaviours fitting seven categories: voice, defensive voice, silence behaviours, supportive, unsupportive, learning or improvement-oriented and familiarity type behaviours. The survey part consists of 19 items in three sub-dimensions related to; the team leader, other team members and the team as a whole. Three additional items capture the perceived representativeness of the observed team meeting compared to other similar meetings. Final adaptations were made in order to integrate the observation and survey measure., Conclusions: The resulting composite measure combines the strengths of observational and survey measures and is tailored for use in healthcare teams. It is uniquely co-developed with healthcare professionals and grounded in the psychological safety and healthcare literature. This composite measure can enable longitudinal research on psychological safety and inform future research to develop and test interventions to improve psychological safety.

Background: Qualitative self- or parent-reports used in assessing children's behavioral disorders are often inconvenient to collect and can be misleading due to missing information, rater biases, and limited validity. A data-driven approach to quantify behavioral disorders could alleviate these concerns. This study proposes a machine learning approach to identify screams in voice recordings that avoids the need to gather large amounts of clinical data for model training., Objective: The goal of this study is to evaluate if a machine learning model trained only on publicly available audio data sets could be used to detect screaming sounds in audio streams captured in an at-home setting., Methods: Two sets of audio samples were prepared to evaluate the model: a subset of the publicly available AudioSet data set and a set of audio data extracted from the TV show Supernanny, which was chosen for its similarity to clinical data. Scream events were manually annotated for the Supernanny data, and existing annotations were refined for the AudioSet data. Audio feature extraction was performed with a convolutional neural network pretrained on AudioSet. A gradient-boosted tree model was trained and cross-validated for scream classification on the AudioSet data and then validated independently on the Supernanny audio., Results: On the held-out AudioSet clips, the model achieved a receiver operating characteristic (ROC)-area under the curve (AUC) of 0.86. The same model applied to three full episodes of Supernanny audio achieved an ROC-AUC of 0.95 and an average precision (positive predictive value) of 42% despite screams only making up 1.3% (n=92/7166 seconds) of the total run time., Conclusions: These results suggest that a scream-detection model trained with publicly available data could be valuable for monitoring clinical recordings and identifying tantrums as opposed to depending on collecting costly privacy-protected clinical data for model training., (©Rebecca O'Donovan, Emre Sezgin, Sven Bambach, Eric Butter, Simon Lin. Originally published in JMIR Formative Research (http://formative.jmir.org), 16.06.2020.)

Purpose: The current systematic review will identify enablers of psychological safety within the literature in order to produce a comprehensive list of factors that enable psychological safety specific to healthcare teams., Data Sources: A keyword search strategy was developed and used to search the following electronic databases PsycINFO, ABI/INFORM, Academic search complete and PubMed and grey literature databases OpenGrey, OCLC WorldCAT and Espace., Study Selection: Peer-reviewed studies relevant to enablers of psychological safety in healthcare setting that were published between 1999 and 2019 were eligible for inclusion. Covidence, an online specialized systematic review website, was used to screen records. Data extraction, quality appraisal and narrative synthesis were conducted on identified papers., Data Extraction: Thirty-six relevant studies were identified for full review and data extraction. A data extraction template was developed and included sections for the study methodology and the specific enablers identified within each study., Results of Data Synthesis: Identified studies were reviewed using a narrative synthesis. Within the 36 articles reviewed, 13 enablers from across organizational, team and individual levels were identified. These enablers were grouped according to five broader themes: priority for patient safety, improvement or learning orientation, support, familiarity with colleagues, status, hierarchy and inclusiveness and individual differences., Conclusion: This systematic review of psychological safety literature identifies a list of enablers of psychological safety within healthcare teams. This list can be used as a first step in developing observational measures and interventions to improve psychological safety in healthcare teams., (© The Author(s) 2020. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Having psychologically safe teams can improve learning, creativity and performance within organisations. Within a healthcare context, psychological safety supports patient safety by enabling engagement in quality improvement and encouraging staff to speak up about errors. Despite the low levels of psychological safety in healthcare teams and the important role it plays in supporting patient safety, there is a dearth of research on interventions that can be used to improve psychological safety or its related constructs. This review synthesises the content, theoretical underpinnings and outcomes of interventions which have targeted psychological safety, speaking up, and voice behaviour within a healthcare setting. It aims to identify successful interventions and inform the development of more effective interventions., Methods: A key word search strategy was developed and used to search electronic databases (PsycINFO, ABI/Inform, Academic search complete and PubMed) and grey literature databases (OpenGrey, OCLC WorldCat, Espace). Covidence, an online specialised systematic review website, was used to screen records. Data extraction, quality appraisal and narrative synthesis were conducted on identified papers., Results: Fourteen interventions were reviewed. These interventions fell into five categories. Educational interventions used simulation, video presentations, case studies and workshops while interventions which did not include an educational component used holistic facilitation, forum play and action research meetings. Mixed results were found for the efficacy or effectiveness of these interventions. While some interventions showed improvement in outcomes related to psychological safety, speaking up and voice, this was not consistently demonstrated across interventions. Included interventions' ability to demonstrate improvements in these outcomes were limited by a lack of objective outcome measures and the ability of educational interventions alone to change deeply rooted speaking up behaviours., Conclusion: To improve our understanding of the efficacy or effectiveness of interventions targeting psychological safety, speaking up and voice behaviour, longitudinal and multifaceted interventions are needed. In order to understand whether these interventions are successful, more objective measures should be developed. It is recommended that future research involves end users in the design phase of interventions, target both group and organisational levels, ensure visible leader support and work across and within interdisciplinary teams., Prospero Registration Number: CRD42018100659.

Aim: Explore the recent literature to examine the factors that affect safety culture within health care teams., Background: Health care organisations must understand and improve their safety culture. However, safety culture is a complex phenomenon which interacts with a myriad of factors, making it difficult to define, measure and improve., Evaluation: A comprehensive search strategy was used to search four major databases. Peer-reviewed which were published in English between 2006 and 2017 and presented research studies related to safety culture in health care teams were included. A narrative analysis was undertaken., Key Issues: Issues relevant to the definition, measurement and improvement of safety culture, the impact of teamwork and communication on safety culture, the role of leaders and accountability are explored., Conclusion: The above themes inform our understanding of developing, measuring and sustaining safety culture in health care teams. However, further research is warranted to accurately understand how to measure and improve safety culture., Implications for Nursing Management: To support a safety culture, initiatives to facilitate effective communication between nurse practitioners and other health care professionals must be introduced. Nurse managers should adopt leadership strategies that will support nurses' psychological safety and create a just culture., (© 2018 John Wiley & Sons Ltd.)

Background: Collective or shared leadership approaches have been associated with team performance outcomes in several sectors. Based on this evidence, there have been calls for more inclusive approaches to leadership in healthcare settings, but guidance on how to achieve collective leadership is lacking. This study synthesised knowledge of interventions to introduce collectivistic leadership in healthcare settings., Methods: The databases of PubMed, PsychInfo, ABI Inform, Cochrane and CINAHL and three grey literature databases were searched. Studies from any country were included if they reported on the development and evaluation and/or implementation of training/interventions to develop collectivistic leadership and reported individual and/or team-level outcomes. Results were synthesised using a narrative approach., Results: The searches yielded 4448 records of which 21 met the eligibility criteria and were reviewed. Studies used a variety of interventions; eleven employed a team training approach, four described co-leadership, three explored service improvement, two detailed co-design approaches and one described an individual team development intervention. Most demonstrated moderate to good success in enabling collectivistic leadership, with benefits reported in staff engagement, satisfaction, and team performance., Conclusions: Whilst collectivistic leadership interventions have demonstrated positive outcomes, there is a need for more rigor and consistency in the evaluation of interventions aimed at developing collectivistic leadership approaches in health settings.

While co-design methods are becoming more popular in healthcare; there is a gap within the peer-reviewed literature on how to do co-design in practice. This paper addresses this gap by delineating the approach taken in the co-design of a collective leadership intervention to improve healthcare team performance and patient safety culture. Over the course of six workshops healthcare staff, patient representatives and advocates, and health systems researchers collaboratively co-designed the intervention. The inputs to the process, exercises and activities that took place during the workshops and the outputs of the workshops are described. The co-design method, while challenging at times, had many benefits including grounding the intervention in the real-world experiences of healthcare teams. Implications of the method for health systems research are discussed., Competing Interests: The authors declare no conflicts of interest.

Background: Klinefelter's syndrome is a sex chromosome abnormality affecting approximately 1 in 1000 men. There have been suggestions that it is associated with a higher than average prevalence of sexual offending but to what extent does research evidence support this assertion?, Aims: This study aimed to conduct a systematic review of published research to establish the prevalence of sexual offending in men with Klinefelter's syndrome., Method: The databases MEDLINE, PsycINFO and EMBASE were searched from inception until 31 December 2016 by using a range of terms for Klinefelter's syndrome and for sexual offending. All selected papers were examined for quality by using the Strengthening the Reporting of Observational Studies in Epidemiology checklist., Results: We identified 53 relevant papers of which 10 met our inclusion criteria. All but one were prevalence studies conducted in a prison or hospital setting. The one, Danish, register-based cohort study did suggest an increased risk of sex offending among Klinefelter men, probably established before the diagnosis was made and, therefore, any hormone replacement instituted., Conclusion: There is insufficient evidence to date to support concerns about exceptional risk of sex offending among men with Klinefelter's syndrome. Rather, it is arguable that there is a research gap in understanding how the experience of and treatment for their condition may affect them. Copyright © 2017 John Wiley & Sons, Ltd., (Copyright © 2017 John Wiley & Sons, Ltd.)

Introduction: There is accumulating evidence implicating the role of leadership in system failures that have resulted in a range of errors in healthcare, from misdiagnoses to failures to recognise and respond to patient deterioration. This has led to concerns about traditional hierarchical leadership structures and created an interest in the development of collective ways of working that distribute leadership roles and responsibilities across team members. Such collective leadership approaches have been associated with improved team performance and staff engagement. This research seeks to improve our understanding of collective leadership by addressing two specific issues: (1) Does collective leadership emerge organically (and in what forms) in a newly networked structure? and (2) Is it possible to design and implement collective leadership interventions that enable teams to collectively improve team performance and patient safety?, Methods and Analysis: The first phase will include a social network analysis, using an online survey and semistructured interviews at three time points over 12 months, to document the frequency of contact and collaboration between senior hospital management staff in a recently configured hospital group. This study will explore how the network of 11 hospitals is operating and will assess whether collective leadership emerges organically. Second, collective leadership interventions will be co-designed during a series of workshops with healthcare staff, researchers and patient representatives, and then implemented and evaluated with four healthcare teams within the hospital network. A mixed-methods evaluation will explore the impact of the intervention on team effectiveness and team performance indicators to assess whether the intervention is suitable for wider roll-out and evaluation across the hospital group., Ethics and Dissemination: Favourable ethical opinion has been received from the University College Dublin Research Ethics Committee (HREC-LS-16-116397/LS-16-20). Results will be disseminated via publication in peer-reviewed journals, national and international conferences, and to relevant stakeholders and interest groups., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Aim: This study assessed neonatal outcomes following implementation of a structured, practical approach for promotion of breastmilk expression in mothers of very preterm infants., Methods: A multidisciplinary team developed a protocol that focussed on the enhancement of expression of human milk by mothers of very preterm infants. A pre- and poststudy intervention was subsequently performed. The group of infants enrolled in this time period was compared to a pre-intervention group from 2010. Outcomes assessed included breastmilk expression, initiation of feeding, re-attainment of birthweight, attainment of full enteral feeding, the incidence of necrotising enterocolitis (NEC), sepsis and duration of hospitalisation., Results: In total, 82 infants (39,43) were included. While there was no statistically significant difference in earlier initiation of enteral feeding with EBM (median = 2 days) nor earlier achievement of fully enteral feeding (median = 12 days), birthweight was regained earlier in the postintervention cohort (mean = 10.42 days; p = 0.038) and there was a reduced length of stay (mean = 50 days; p = 0.021)., Conclusion: A structured, focussed, multimodal approach to enhance breastmilk production has shown potential for producing positive end outcomes, particularly, a significant reduction in duration of hospitalisation., (©2016 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)