The association between clinical parameters recorded at vet gates during Fédération Equestre Internationale endurance rides and the imminent risk of elimination.

BACKGROUND: Endurance competitions over distances of 80-160 km are required by Fédération Equestre Internationale (FEI) rules to be divided into a number of stages between three and six. These stages are also known as "loops". Veterinary inspections, designed to ensure horse welfare, are conducted at the end of each loop, with details recorded on a separate "vet card" for each horse. OBJECTIVES: To identify risk factors recorded on vet cards that were associated with elimination at subsequent loops. STUDY DESIGN: Retrospective cohort study. METHODS: Data relating to 3213 horse starts worldwide in international (CEI) events during 2014 were analysed. Univariable logistic regression was used to identify risk factors for potential inclusion in a final multivariable logistic regression model. Models were constructed stepwise using backwards-removal and assessed using the Bayesian information criterion. RESULTS: Risk factors were identified, which would allow an "in-ride" risk profile to be constructed for each horse which evolves as the horse progresses through the ride. Some risk factors such as abnormal gait and high heart rate were found to be repeatedly associated with imminent failure to qualify. MAIN LIMITATIONS: This is a relatively small study in terms of cohort size, based on the data that were available at the time of the study. Although comprehensive ride history data were also available for each horse via the main FEI database, training data were not. CONCLUSIONS: By identifying risk factors observed during the veterinary inspections at the end of a loop that are strongly associated with elimination at the end of the next or subsequent loops, these results provide an evidence-base for educational initiatives and regulatory changes that will inform the way veterinary delegates use veterinary inspections to help identify horses at risk of imminent FTQ.

Advanced care planning: a study on home health nurses.

The purpose of this research was to assess home health nurses' (HHNs) knowledge, comfort levels, barriers, and personal participation in advanced care planning (ACP), a practice that recognizes patient preferences for health care treatment. Licensed nurses who identified home care as their primary area of practice (N = 519) were surveyed about their knowledge of laws governing ACP and their perceptions of patients' preferences for ACP. Most respondents were women (97%), and the average age of the respondents was 54 years. Most nurses felt knowledgeable and capable of educating patients on advance directives (ADs), although the nurses' knowledge of laws governing ACP was limited and often inaccurate. Generally, nurses felt comfortable during ACP discussions with patients and families. HHNs perceived patient or family reluctance as the greatest barrier hindering discussions of ACP. No association was found between level of education and whether a nurse had a personal AD. Twenty percent of the nurses had their valid personal AD. A greater knowledge base concerning ACP would facilitate HHN discussions with patients and families. Recognition of patient preferences can be enhanced by understanding and overcoming barriers that hinder discussions of ACP. Educational opportunities focusing on ACP are encouraged for all health care providers.