RESUMO
Effective training of horses relies on the trainer's awareness of learning theory and equine ethology, and should be undertaken with skill and time. Some trainers, such as Monty Roberts, share their methods through the medium of public demonstrations. This paper describes the opportunistic analysis of beat-to-beat (RR) intervals and heart rate variability (HRV) of ten horses being used in Monty Roberts' public demonstrations within the United Kingdom. RR and HRV was measured in the stable before training and during training. The HRV variables standard deviation of the RR interval (SDRR), root mean square of successive RR differences (RMSSD), geometric means standard deviation 1 (SD1) and 2 (SD2), along with the low and high frequency ratio (LF/HF ratio) were calculated. The minimum, average and maximum RR intervals were significantly lower in training (indicative of an increase in heart rate as measured in beats-per-minute) than in the stable ( p = 0.0006; p = 0.01; p = 0.03). SDRR, RMSSD, SD1, SD2 and the LF/HF ratio were all significantly lower in training than in the stable ( p = 0.001; p = 0.049; p = 0.049; p = 0.001; p = 0.01). When comparing the HR and HRV of horses during Join-up (®) to overall training, there were no significant differences in any variable with the exception of maximum RR which was significantly lower ( p = 0.007) during Join-up (®) , indicative of short increases in physical exertion (canter) associated with this training exercise. In conclusion, training of horses during public demonstrations is a low-moderate physiological, rather than psychological stressor for horses. The physiological stress responses observed within this study were comparable or less to those previously reported in the literature for horses being trained outside of public audience events. Furthermore, there is no evidence that the use of Join-up (®) alters HR and HRV in a way to suggest that this training method negatively affects the psychological welfare of horses.
RESUMO
IMPORTANCE: Though interprofessional bedside rounds have been promoted to enhance patient-centred care for hospitalised patients, few studies have been conducted in adult hospital settings and evidence of impact is lacking. OBJECTIVE: To evaluate the effect of patient-centred bedside rounds (PCBRs) on measures of patient-centred care. DESIGN AND SETTING: Cluster randomised controlled trial involving four similar non-teaching hospitalist service units in a large urban hospital. PARTICIPANTS: Hospitalised general medical patients. INTERVENTION: We assembled working groups on two intervention units, consisting of professionals and patient/family members, to determine the optimal timing, duration and format for PCBR. Nurses and hospitalists rounded together in PCBR using a communication tool to provide a framework for discussion and unit leaders joined PCBR to provide coaching during initial weeks of implementation. MAIN OUTCOMES: Using patient interviews, we assessed preferred and experienced roles in medical decision-making using the Control Preferences Scale, activation using the Short Form of the Patient Activation Measure, and satisfaction. We also compared postdischarge patient satisfaction survey items related to teamwork, involvement in decisions and overall care. We assessed nurses', physicians' and advanced practice providers' (APP) perceptions of PCBR using a survey developed for this study. RESULTS: Overall, 650 patients were approached for structured interview during hospitalisation: 284 were excluded because of disorientation, 54 were excluded because of non-English language, 72 declined to participate and 4 withdrew from the study after enrolment. Interview data were available for 236 (122 control and 114 intervention unit) patients, and postdischarge satisfaction survey data were available for 493 (274 control and 219 intervention unit) patients. We found no significant differences in patients' perceptions of shared decision-making, activation or satisfaction with care. Results were similar in analyses based on whether PCBR had been performed (ie, per protocol). We also found no difference in postdischarge patient satisfaction items. Results were similar in multivariate analyses controlling for patient characteristics and clustering of patients within study units. A majority of nurses (78.6%), but only about half of hospitalist physicians and APPs felt that PCBR improved communication with patients (47.4%). A minority of nurses (46.4%) and physicians and APPs (36.8%) agreed that PCBR had improved the efficiency of their workday. CONCLUSIONS: PCBR had no impact on patients' perceptions of shared decision-making, activation or satisfaction with care. Additional research is needed to identify optimal approaches that can be reliably implemented in hospital settings to improve patient-centred care.
