Optimizing delivery to meet demand for integrative medicine services in an academic hospital setting: A pilot study.

CONTEXT: A rapidly growing body of evidence shows the positive benefits of integrative medicine (IM) services for patients in hospital-based settings. IM therapies, such as acupuncture, massage, meditation and relaxation, and animal-assisted therapy, reduce symptom burden of pain, anxiety, and stress and increase sense of well-being and satisfaction in hospitalized patients. Current challenges facing hospitals are to move beyond proof-of-concept studies and to provide hospital-based IM therapies. OBJECTIVE: The aim of our quality improvement project was to develop, implement, and evaluate a feasible, scalable, hospital-based "best practice" model for increasing demand for IM services and optimizing their delivery. DESIGN: A multidisciplinary team convened to use quality improvement tools to outline a process for providing IM services. SETTING: A large academic medical center in the Midwestern United States. PARTICIPANTS: IM leadership staff, IM providers, nurses, hospital team members, support staff, and quality improvement staff. INTERVENTIONS: After determining baseline levels of demand and service delivery, we sought to (1) increase nursing staff awareness of available IM services; (2) improve communication between IM providers and nurses; and (3) reinforce communication at the level of nurse supervisors, patients, and family members. MAIN OUTCOME MEASURES: We recorded the numbers and types of IM services ordered at baseline and postimplementation and determined the new delivery rate of requested services. RESULTS: We noted an increase in the number of IM orders, percentage of delivered IM services, and percentage of patients who reported that IM services improved their hospital stay.

Therapy Dogs' and Handlers' Behavior and Salivary Cortisol During Initial Visits in a Complex Medical Institution: A Pilot Study.

Therapy dogs provide health benefits for individuals who suffer from illnesses, such as dementia, depression, loneliness, and aggression. Therapy dogs' impact on human health has been thoroughly studied; however, studies on dog welfare have been limited. Additionally, as dogs have evolved with humans, they have learned to read non-verbal social cues. Dogs can read humans' non-verbal body language and can react to their emotions. However, the body language of dogs is poorly understood and can lead to dog owner-directed aggression. Communication plays a vital role to be a cohesive therapy team. The purpose of this study was to assess perceived stress and cortisol concentrations in therapy dogs and their handlers during the first three visits in a hospital setting. Moreover, the study aimed to investigate whether, while in an overstimulating environment, a therapy dog handler can observe his or her dog's body language and correlate such observations to the dog's stress. Nine therapy dog teams from Mayo Clinic's Caring Canine Program participated in this study. A baseline salivary cortisol was collected from the handler and therapy dog each day of the visits. Once the team arrived, a pre-visit salivary cortisol was collected from the handler and therapy dog and, afterward, a post-visit salivary cortisol. Handlers were also asked to fill out a perceived stress survey on their own stress and that of their therapy dogs'. Behavior was documented by a staff member and the handler. For each visit, the therapy dogs were at the hospital on average 47 min and visited with nine people. There was significant correlation (P = 0.02) between the owner's perceived stress of his or her therapy dog and the dog's salivary cortisol concentrations. The handlers noted medium to high stress, and those dogs had higher cortisol concentrations post-visit. There was no significant difference in salivary cortisol for the handler and therapy dog over the course of the three visits and comparing pre- and post-visit. Overall, the dogs displayed mixed behaviors, with the three most reported being panting, lip licking, and yawning. However, salivary cortisol results suggest that the handlers and therapy dogs maintained their welfare state throughout the visits.

The Impact of a 20-Minute Animal-Assisted Activity Session on the Physiological and Emotional States in Patients With Fibromyalgia.

OBJECTIVE: To study the direct physiological and emotional impact of an animal-assisted activity (AAA) session (a form of complementary and integrative medicine) in patients with fibromyalgia (FM). PATIENTS AND METHODS: The study population consisted of 221 participants with FM who were attending Mayo Clinic's Fibromyalgia Treatment Program between August 5, 2017, and September 1, 2018. This was a randomized controlled trial. Participants were randomly assigned to either the treatment group (a 20-minute session with a certified therapy dog and handler) or the control group (a 20-minute session with a handler only). To gain a better understanding of the direct physiological and emotional effects of AAA in patients with FM, we used multiple noninvasive physiologic-emotional biomarkers, including salivary cortisol and oxytocin concentrations, tympanic membrane temperatures, and various cardiac parameters, in addition to standardized pain and mood-based questionnaires. RESULTS: Results show a decrease in heart rate, an increase in heart rate variability, an increase in well-being survey scores, an increase in salivary oxytocin, and subsequent tympanic membrane temperature changes, suggesting that participants in the treatment group were in a more positive emotional-physiologic state as a result of the AAA session compared with the control group. CONCLUSION: Our results suggest that a 20-minute therapy dog visit in an outpatient setting can significantly and positively impact the physical and mental health of patients with FM.

Physiological State of Therapy Dogs during Animal-Assisted Activities in an Outpatient Setting.

Therapy dogs are increasingly being incorporated into numerous clinical settings. However, there are only a handful of studies that have focused on the impact of animal-assisted activity or therapy sessions on the wellbeing of the therapy dogs. Furthermore, these studies show mixed results. The goal of this study was to provide an in-depth picture of the effects of these interactions on the dogs involved by considering multiple physiological measures known to be associated with emotional state (continuous heart rate, heart rate variability, pre- and post-session tympanic membrane temperatures, and salivary cortisol and oxytocin concentrations). Nineteen Mayo Clinic Caring Canine therapy dogs completed five 20-minute animal-assisted activity (AAA) visits each in an outpatient clinical setting (Mayo Clinic Fibromyalgia and Chronic Fatigue Clinic). From a physiological perspective, the dogs showed a neutral to positive response to the AAA sessions. Heart rate (HR) was significantly lower at the end of the session compared with the beginning of the session (F = 17.26, df1 = 1, df2 = 29.7, p = 0.0003). The right tympanic membrane temperature was lower post-session (F = 8.87, df1 = 1, df2 = 107, p = 0.003). All other emotional indicators remained stable between pre- and post-session. These results suggest that the dogs involved were not negatively affected by their participation in the AAA. Moreover, there was some evidence suggesting the dogs may have been in a more relaxed state at the end of the session (lower HR and lower right tympanic membrane temperature) compared to the beginning of the session.

Canine-Assisted Therapy in Hospitalized Patients Awaiting Heart Transplantation.

OBJECTIVES: Patients awaiting heart transplantation can be listed for prolonged periods of time and, as a result, the prevalence of anxiety and depression is high. Our study evaluates the feasibility of canine-assisted therapy (CAT) in this population. METHODS: A prospective, multicenter study was performed on all status 1a patients admitted during a 12-month period to await transplantation. Patients were asked to complete the Generalized Anxiety Disorder 7-item scale and the Patient Health Questionnaire-9 at baseline, week 2, and week 6, and the Perceived Stress Scale at baseline and week 4. At the conclusion of the study, patients completed a questionnaire assessing the overall efficacy of CAT. RESULTS: Baseline measures demonstrated high levels of anxiety, depression, and stress. The complete Generalized Anxiety Disorder 7-item scale (average score 10.9 vs 8; P = 0.14) and the Patient Health Questionnaire-9 (average score 12.3 vs 9.5; P = 0.057) scores decreased from baseline to week 6 and the Perceived Stress Scale (average score 29.8 vs 27; P = 0.16) decreased from baseline to week 4 with trends toward significance. All of the patients perceived CAT as improving the overall quality of hospitalization, would recommend CAT to other patients, and would elect for CAT during subsequent admissions. No infectious concerns were reported. CONCLUSIONS: Anxiety, stress, and depression are prevalent among 1a heart transplantation candidates, and CAT is a welcomed adjunct to the usual medical care in this population.