Developing a midwifery service task list for Chinese midwives in the task-shifting context: a Delphi study

ObjectiveTo develop and validate a midwifery-led task list in the task-shifting context.DesignAn extensive literature review followed by a two-iterative Delphi survey.SettingTwenty university hospitals, three non-university hospitals and four university colleges from nine provincial regions of China.ParticipantsPurposive non-probability sampling of a national panel of experts in maternal healthcare, obstetrics, nursing and midwifery. Experts in the panel were asked to rate each midwifery service item regarding importance, feasibility and advancement on a 5-point scale, in order to determine those best suited for midwifery-led practice in China.ResultsTwo rounds of Delphi surveys were completed before consensus was achieved, with effective response rate ranging from 96.4% (27/28) to 100% (27/27), indicating a high positive coefficient of the experts. The authority coefficient of experts was 0.882, indicating the high reliability of this study. The Kendall harmony coefficient (W) in the two rounds of consultations was 0.196 (p<0.001) and 0.324 (p<0.001), respectively. A detailed, three-level midwifery-led task list was developed, including 3 domains of midwifery practice (first-level indicators), 13 types of task (second-level indicators) and 58 midwifery service items (third-level indicators). The 3 domains of midwifery practice involved the appropriate scope of practice for Chinese midwives, including antenatal care, intrapartum care and postnatal care. The 58 service items embraced core components of caring task in the Chinese midwifery profession.ConclusionThis study outlines the first midwifery-led task list that defines clearly the Chinese midwives’ scope of practice. It will provide a foundational framework for future midwifery practice in China and abroad, and can be used to inform the design of midwifery-led task shifting interventions in various maternity settings.

Energy Idle Aware Stochastic Lexicographic Local Searches for Precedence-Constraint Task List Scheduling on Heterogeneous Systems

The use of parallel applications in High-Performance Computing (HPC) demands high computing times and energy resources. Inadequate scheduling produces longer computing times which, in turn, increases energy consumption and monetary cost. Task scheduling is an NP-Hard problem; thus, several heuristics methods appear in the literature. The main approaches can be grouped into the following categories: fast heuristics, metaheuristics, and local search. Fast heuristics and metaheuristics are used when pre-scheduling times are short and long, respectively. The third is commonly used when pre-scheduling time is limited by CPU seconds or by objective function evaluations. This paper focuses on optimizing the scheduling of parallel applications, considering the energy consumption during the idle time while no tasks are executing. Additionally, we detail a comparative literature study of the performance of lexicographic variants with local searches adapted to be stochastic and aware of idle energy consumption.

Apps to Teach Social Skills to Individuals with Autism Spectrum Disorder: A Review of the Embedded Behaviour Change Procedures

Social skill interventions have become increasingly popular in recent times, as well as the use of technology to deliver and aid interventions for the autism spectrum disorder (ASD) population. Little research exists on the use of apps to teach social skills to individuals with ASD, in particular the behaviour change procedures that exist within apps. The current review examines the behaviour change procedures that exist within apps according to the Behavior Analyst Certification Board Task List, 5th Edition. A total of 15 apps were included within this review. Results indicate that a variety of behaviour change procedures exist within apps. However, the quality of apps and the number of behaviour change procedures vary across app developers.

Distributed task allocation with critical tasks and limited capacity

This paper considers the task allocation problem under the requirement that the assignments of some critical tasks must be maximized when the network capacity cannot accommodate all tasks due to the limited capacity for each unmanned aerial vehicle (UAV). To solve this problem, this paper proposes an extended performance impact algorithm with critical tasks (EPIAC) based on the traditional performance impact algorithm. A novel task list resizing phase is developed in EPIAC to deal with the constraint on the limited capacity of each UAV and maximize the assignments of critical tasks. Numerical simulations demonstrate the outstanding performance of EPIAC compared with other algorithms.

100 Use of the PHQ-2 as a Depression Screening Tool to Meet BQUIP Guidelines

Introduction In 2015, the Burn Quality Improvement Program (BQUIP) guidelines were established with recommendations for systematic screening of Major Depressive Disorder at all verified burn centers. Our level one trauma center rolled out a program to screen all patients entering the burn service starting in June 2018. After a year of collecting data, we have been able to evaluate the program and make recommendations for other burn centers. Methods All patients admitted to the inpatient burn service who were over 12 years of age were screened by bedside nurses using the 2-item Patient Health Questionnaire (PHQ-2). Exclusion for screening included those who were intubated and sedated and/or not alert or oriented. A reminder automatically popped up in the nursing task list in the electronic medical record until it was given, or patient was coded as not appropriate for screening. Results A total of 509 patients were admitted to the Burn Service between June 2018 and May 2019. Of those, 40 were identified as not being appropriate for screening due to inability to regain consciousness, and 116 (24%) were not screened for unknown reasons. The remaining patients, 353 (77%) were screened with the PHQ-2 and 94% of these patients were screened on the same day of admit. Of the patients screened, 28 (8%) scored above the clinical cut-off for probable depression (PHQ-2 ³ 3) and 265 (75.1%) did not endorse any symptoms on the PHQ-2. Of the 28 that screened positive, 16 (57.1%) received psychological services. Of those that did not receive psychology services, the majority were admitted for less than 3 days (n=10, 76.9%). Conclusions In the first year of the program the vast majority of eligible patients were able to be screened by nursing staff with a 2-item measure. A 77% screening rate is high for a trauma setting. This success is likely due to the automation of the task in the electronic medical record, the ease of use of the PHQ-2 and the dedication of the nursing staff. The 8% rate of a positive screen is higher than the general population (4%) but a similar rate to what is reported in the literature of burn survivors who are 5- and 10-years post burn injury. Given that most patients were screened within 24 hours of admission, we are capturing depressive symptoms that predate the injury. We know that depression can impair burn recovery (e.g., affect participation in therapy, impede wound healing) and lead to poorer long-term outcomes. Systematic screening of depressive symptoms upon admission will allow us to intervene earlier and potentially reduce barriers to optimal recovery. We will be discussing utilization of resources for providing inpatient services to patients with a positive screen.

Quality improvement report: setting up a hospital at night service, limitations of bleep filtering and using an electronic task management system

The ‘hospital at night’ concept was developed at a joint conference of the London Deanery and Clinical Staff in 2002, as an issue for education and service provision. At the start of the project, our trust had issues with both the structure of the hospital at night handover and the working practices overnight. The vision was to improve team working out of hours, expedite review of sick patients and reorganise care to seek a reduction in bleeps to medical junior doctors overnight in a way that all patients had access to the right person with the right skills for their needs at the right time. The hospital at night project at our hospital was started in 2019 by a multidisciplinary working group. We tried bleep filtering for 4 months and this was later followed on by the development of an electronic out of hour’s task list as part of our hospital at night set-up. The bleep analysis data showed an improved distribution of workload but the process was dependent on individuals. The electronic task management system was built in pre-existing online software. The system helped prioritise and review tasks requested by nurses on medical wards. But it was not without its limitations. We worked with the local information technology (IT) team to improve speed and proposed developing an IT solution that is fast and not desktop based to ensure tasks can be assigned and viewed while on the go. The project was overall a success as it demonstrated positive feedback from junior doctors, improved perception of teamwork and ability to take rest breaks. It also demonstrated a drop in ward-based cardiac arrest rates. The hospital at night project at our trust remains a work in progress, but a lot of positive changes have been delivered.