Spirometry services in England post-pandemic and the potential role of AI support software: a qualitative study of challenges and opportunities.

BACKGROUND: Spirometry services to diagnose and monitor lung disease in primary care were identified as a priority in the NHS Long Term Plan, and are restarting post-COVID-19 pandemic in England; however, evidence regarding best practice is limited. AIM: To explore perspectives on spirometry provision in primary care, and the potential for artificial intelligence (AI) decision support software to aid quality and interpretation. DESIGN AND SETTING: Semi-structured interviews with stakeholders in spirometry services across England. METHOD: Participants were recruited by snowball sampling. Interviews explored the pre- pandemic delivery of spirometry, restarting of services, and perceptions of the role of AI. Transcripts were analysed thematically. RESULTS: In total, 28 participants (mean years' clinical experience = 21.6 [standard deviation 9.4, range 3-40]) were interviewed between April and June 2022. Participants included clinicians (n = 25) and commissioners (n = 3); eight held regional and/or national respiratory network advisory roles. Four themes were identified: 1) historical challenges in provision of spirometry services; 2) inequity in post- pandemic spirometry provision and challenges to restarting spirometry in primary care; 3) future delivery closer to patients' homes by appropriately trained staff; and 4) the potential for AI to have supportive roles in spirometry. CONCLUSION: Stakeholders highlighted historic challenges and the damaging effects of the pandemic contributing to inequity in provision of spirometry, which must be addressed. Overall, stakeholders were positive about the potential of AI to support clinicians in quality assessment and interpretation of spirometry. However, it was evident that validation of the software must be sufficiently robust for clinicians and healthcare commissioners to have trust in the process.

Associations between two nursing workload scales and the cost of intensive care unit nursing staff: A retrospective study of one Belgian hospital.

AIMS: The aim of this study was to assess associations between a general nursing funding scale and an intensive care unit specific nursing workload scale and the cost of nursing staff. BACKGROUND: Nurse staffing represents the most important cost in the intensive care unit, so it is essential to evaluate it accurately. In addition, the assessment of nursing workload is important for the daily management of the intensive care unit and to ensure quality of care. METHODS: This was a retrospective and quantitative study carried out in the intensive care unit of a Belgian hospital. The extraction of data from the Nursing Activities Score and the Minimum Hospital Summary Nursing Dataset were carried out during 2 periods of 15 days, from 1 June 2018 to 15 June 2018 and from 1 September 2018 to 15 September 2018. RESULTS: A total of 234 patients were included in the study. A total of 773 Nursing Activities Score and Minimum Hospital Summary Nursing Dataset recordings were analyzed in the study per intensive care unit day. A strong correlation was observed between Nursing Activities Score and Minimum Hospital Summary Nursing Dataset for the entire intensive care unit stay with a rho (95% CI) of .88 (0.83-.93); however, the correlation was moderate per intensive care unit day with a rho of .51 (0.45-0.57). A strong association was observed between the Minimum Hospital Summary Nursing Dataset and the Nursing Activities Score with the costs of intensive care unit nurses with a rho (95% CI) of .78 (0.72-0.86) and .74 (0.65-0.84), respectively. CONCLUSIONS: A general nursing funding scale in Belgium was strongly correlated with the nursing workload for the whole intensive care unit stay, but this correlation was moderate per intensive care unit day. In contrast, both scales showed a good correlation with intensive care unit nursing costs. IMPLICATIONS FOR NURSING MANAGEMENT: In Belgium, a general funding scale for nurses does not allow for an assessment of the nursing workload in the intensive care unit. The Nursing Activities Score is strongly correlated with the cost of nursing staff in the intensive care unit. The authors recommend that the Belgian authorities carry out this type of study in several intensive care units in the country and eventually replace the general funding scale for nurses with the Nursing Activities Score.

The gender division of paid work over family formation: Variation by couples' migration background.

Although the gender gap in labour force participation has narrowed considerably in many European countries, life course scholars have shown that the transition to parenthood exacerbates gender inequality in couples' division of paid work. Hitherto, variation by migration background has received limited attention in research on the effect of parenthood on couples' gender division of paid work. This is remarkable given that such heterogeneity is theoretically informative on differential interconnectedness of life course events, but may also inform policy makers on the life course transitions that induce migrant-native differentials in women's labour force participation. This study adopts a life course perspective and uses longitudinal microdata from Belgian social security registers to examine variation in couples' gender division of paid work around family formation by migration background. Taking into account couples' migration background - by considering the origin group and migrant generation of both partners - we identify four patterns of gender dynamics around family formation in couples where at least one partner is of migrant origin. These four patterns emerge from (dis)similarities with native couples with respect to their pre-birth division of paid work on the one hand and their changes in this division around family formation on the other hand. These results highlight that combining an account of couples' division of paid work prior to the birth of a first child with a perspective focussing on how the division of paid work changes around family formation is necessary for a thorough understanding of variation by migration background.

Measuring the nursing workload in intensive care with the Nursing Activities Score (NAS): A prospective study in 16 hospitals in Belgium.

PURPOSE: The evaluation of nursing workload is a common practice in intensive care units (ICUs). It allows the calculation of an optimal nurse/patient ratio (N/P) which is a major challenge to ensuring the quality of care while controlling the costs of health care. The objectives of this study were, therefore, to evaluate the N/P ratio and to study nursing activities in intensive care in French-speaking Belgium. METHODS: The Nursing Activities Score (NAS) was prospectively recorded by shift for two periods of one month each in 16 French-speaking Belgian hospitals for a total of 316 ICU beds in 24 ICUs. RESULTS: We included 3377 patients in the study, of which 64% were medical (versus surgical). The results for 24-hour NAS (68.6%) were significantly different from the NAS per shift (Morning: 61.3%, Afternoon: 58.4%, Night: 55.0%). Outliers were significantly more prevalent among men and patients who died and outliers had longer stays in the ICU. Finally, mobilization-positioning and clinical-administrative tasks took, on average, more time for nurses in the ICU. CONCLUSIONS: There is a significant difference in N/P ratio between the Belgian regulation (1/3) and the one calculated by the NAS (1/1.5). A systematic objective assessment of shift workload should be done to avoid N/P ratio differences in intensive care.