Routine Performance Research Articles

Current Eligibility Requirements for CGM Coverage Are Harmful, Costly, and Unjustified.

Despite ongoing advances in medications, insulin delivery systems, and glucose monitoring technologies, diabetes control remains suboptimal in many individuals with this disease.1 In addition to the clinical consequences resulting from poor control is the ever-increasing financial burden on individuals, health systems, and society.2 In its latest report, the American Diabetes Association (ADA) estimated the total estimated cost of diagnosed diabetes in 2017 to be $327 billion.2 Although the direct cost of treating complications (hospitalizations, emergency room visits, and nondiabetes prescription medications) and the indirect costs associated with lost/reduced productivity account for ∼73.1% of the total diabetes cost, many public and private payers continue to focus much of their cost-cutting efforts on reducing the costs of diabetes supplies, which account for only 1.1% of the total cost. Examples of these questionable efforts can be found in the restrictive eligibility criteria for coverage of continuous glucose monitoring (CGM). Specifically, the requirements are that eligible individuals must have type 1 diabetes (T1D) and be able to document routine performance of at least four fingerstick blood glucose tests per day. The Centers for Medicare and Medicaid Services (CMS) explicitly requires this level of testing for Medicare beneficiaries to qualify for CGM coverage, as do 11 of 36 state Medicaid programs that provide CGM coverage. Requiring documentation of >4 blood glucose tests per day is clearly enigmatic given that the Medicare coverage policy only pays for three test strips per day for insulin-treated beneficiaries. Although Medicare coverage includes both T1D and intensively treated type 2 diabetes (T2D), many state Medicaid programs do not match such coverage. A comprehensive Internet search found that 13 state programs limit CGM use to individuals with T1D and documented history of 4 × /day blood glucose testing (Table 1). Three programs cover both T1D and insulin-requiring T2D but with the minimum blood glucose monitoring restriction. Four programs cover T1D with no blood glucose monitoring restriction, and only one state covers both type 1 and insulin-requiring diabetes with no blood glucose restriction. Eligibility for CGM in the remaining 14 State Medicaid programs is not specified or accessible according to our Internet search. Table 1. Medicaid Coverage for Continuous Glucose Monitoring Use

Performative Achievement of Routine Recognizability: An Analysis of Order Taking Routines at Sushi Bars

AbstractThe concept of performativity, a central theme in routine dynamics research, suggests that a routine does not first exist as a recognizable phenomenon, and then actions are taken subsequently. On the contrary, actions themselves need to achieve the recognizability of the routine. This paper revisits recognizability in light of routine interdependence and materiality. Focusing on order taking routines at sushi bars, the analysis reveals that participants constantly achieve the beginning of a routine performance by drawing on performances of other routines and materiality, both of which are seemingly unrelated to the focal routine. Prior to routine initiation, much material and embodied work is conducted in order to make the routine recognizable. Once initiated, the routine performance makes subtle use of materiality, allowing participants to engage in a seemingly unrelated routine while they remain subordinately attentive to the focal routine. While a routine appears to exist on its own once it is recognized, the achievement of this recognition relies largely on factors that are not part of the routine.

Operability, Acceptability, and Usefulness of a Mobile App to Track Routine Immunization Performance in Rural Pakistan: Interview Study Among Vaccinators and Key Informants.

BackgroundThere has been a recent spate of mobile health (mHealth) app use for immunizations and other public health concerns in low- and middle-income countries. However, recent evidence has largely focused on app development or before-and-after effects on awareness or service coverage. There is little evidence on the factors that facilitate adoption of mHealth programs, which is critical to effectively embed digital technology into mainstream health systems.ObjectiveThis study aimed to provide the qualitative experiences of frontline health staff and district managers while engaging with real-time digital technology to improve the coverage of routine childhood immunization in an underserved rural district in Pakistan.MethodsAn Android-based app was iteratively developed and used for a 2-year period in 11 union councils of the Tando Muhammad Khan district, an underserved rural district with poor immunization coverage in Pakistan. We used iterative methods to examine the (1) acceptability and operability of the app, (2) validity of the collected data, and (3) use of the collected data. In addition, we collected the barriers and enablers for uptake of the mHealth app. Each of these topics was further explored related to changes in work as well as the enabling factors for and barriers to app use. In-depth interviews were conducted with the 26 vaccinators posted in the 11 union councils and 7 purposively selected key informants (government district managers) involved with the Expanded Program for Immunization. Findings were triangulated in line with the three broad research areas.ResultsDigital immunization tracking was considered acceptable by vaccinators and district managers. Real-time immunization data were used to monitor vaccination volume, track children with incomplete vaccinations, develop outreach visit plans, correct existing microplans, and disburse a fuel allowance for outreach sessions. The validity of the app data was perceived to be superior to that of data from manual records. Ease of operability, satisfaction with data, personal recognition, links to field support, and a sense of empowerment served as powerful enablers. Taking twice the time to complete both manual and digital entries and outdated phones over time were considered constraints. An unintended knock-on effect was improved coordination and strengthening of Expanded Program for Immunization review platforms across district stakeholders through digitalized data.ConclusionsEmbedding digital technology into mainstream health systems relies on use by both end users and district stakeholders. Ease of operability, satisfaction with data reliability, personal recognition, links to field support, and empowerment are powerful enablers, whereas improved coordination as a result of easy, transparent data access can be an important by-product of digitalization. Findings are relevant not only for wide-scale implementation of immunization tracking apps in Pakistan but also for informing the use of digital technology for results-based delivery by frontline health workers.

Mastering the analytical process of the Complete Blood Count: how and why?

This is a prospective study realized at the level of the hematology department and blood transfusion center of the University Hospital Center (CHU) of Dr Ben Badis of Constantine and spread out over a period of one year (from January 1st to December 31st). The work focused on the analytical processes mastery of the NFS needs a compulsory step concerning technical and organizational laboratory skills respecting the ISO 15189 laws going through a mastery of support processes (humain resourses, informatics, materials, documents, management) indispensable for the good function of analytic proceedings, a performance evaluation of the hematology analyzer Advia (2120 I and II and 560) and quality control management (intern, extern). The analytic performance evaluation of Advia gives reliable results reproductible and stable for use of the routine automatisation good inter-machine correlation and laboratory performance in terms of the quality extern evaluation with military hospital laboratory.

Absence of DOA Effect but No Proper Test of the Lumberjack Effect: A Reply to Jamieson and Skraaning (2019).

The aim was to evaluate the relevance of the critique offered by Jamieson and Skraaning (2019) regarding the applicability of the lumberjack effect of human-automation interaction to complex real-world settings. The lumberjack effect, based upon a meta-analysis, identifies the consequences of a higher degree of automation-to improve performance and reduce workload-when automation functions as intended, but to degrade performance more, as mediated by a loss of situation awareness (SA) when automation fails. Jamieson and Skraaning provide data from a process control scenario that they assert contradicts the effect. We analyzed key aspects of their simulation, measures, and results which we argue limit the strength of their conclusion that the lumberjack effect is not applicable to complex real-world systems. Our analysis revealed limits in their inappropriate choice of automation, the lack of a routine performance measure, support for the lumberjack effect that was actually provided by subjective measures of the operators, an inappropriate assessment of SA, and a possible limitation of statistical power. We regard these limitations as reasons to temper the strong conclusions drawn by the authors, of no applicability of the lumberjack effect to complex environments. Their findings should be used as an impetus for conducting further research on human-automation interaction in these domains. The collective findings of both Jamieson and Skraaning and our study are applicable to system designers and users in deciding upon the appropriate level of automation to deploy.

Sociomaterial relations and adaptive space in routine performance

This article examines the various processes through which sociomaterial relations constitute the performance of a routine. The study’s theoretical underpinnings are linked to sociomateriality in understanding the dynamics of routine performance. In this study, adaptive space furthers sociomaterial relations and processes, and their dynamics to constitute the routine performance. The findings are based on ethnographic research that was conducted during an international crisis management exercise. The analysis consists of three field episodes that illustrate the different processes in which the sociomaterial matters in routine performance. The article contributes to the theoretical discussion by showing, first, how adaptive space enables going beyond the sociomaterial dualism and transfers the theoretical emphasis to the fluidity and dynamism of these relations. It also draws attention to the sociomaterial processes that constitute the performance of the routine. Third, it further shows how through sociomaterial relations and processes the organizing of professional knowledge co-constitution is performed and managed.

The distribution and use of feedback bulletins among national immunization program management teams in East and Southern Africa.

IntroductionImmunization program monitoring includes numerous activities, some of which include monitoring of vaccination coverage, surveillance performance and epidemiological patterns. The provision of timely, high quality and actionable feedback is an essential component of strengthening health systems. Within the African region of the WHO, various bulletins are produced and disseminated regularly to provide feedback on the performance of immunization programs and vaccine preventable disease control initiatives.MethodsThe 2019 annual national immunization program managers’ meeting for countries in the eastern and southern African subregion was held in Asmara from 18 - 20 March 2019. A survey questionnaire was administered to the participants representing the national programs and in-country partners across the 20 countries.ResultsOn average, the 75 respondents receive 1.8 e-mailed feedback bulletins monthly. Twenty-three (31%) respondents receive 3 or more written feedback bulletins per month, and 72% receive the bulletins regularly. On a scale of 1 - 5 (from lowest to highest), 87% participants rated the relevance of the bulletins they receive at 4 - 5. Only 19% of the respondents responded that the results are discussed within the national immunization program, and 14% stated that action points are generated based on the feedback received. Fifty-nine (79%) respondents want to receive more frequent feedback on routine immunization performance. Among the EPI program managers and the EPI program data managers, the access to these feedback bulletins was quite limited. Even though the primary objective of the bulletins is to initiate discussions and action based on the provided feedback, such discussions do not happen regularly at country level. The programmatic use and advocacy value of the bulletins is not optimal.ConclusionWe recommend integrating program feedback, regularly updating the distribution lists, the additional use of instant messaging platforms for distribution, as well as online posting of the bulletins for wider availability.

Effect of tele-occupational therapy on self-determined routine task performances in a young adult with autism, intellectual disability, and obsessive-compulsive disorder: A case report

A 19-year-old male with autism, intellectual disability (ID), and obsessive–compulsive disorder (OCD) presented with difficulty in self-determined routine task performances. Tele assessment was performed pre- and post-tele-occupational therapy (OT) intervention, using Yale Brown Obsessive–Compulsive Scale (Y-BOCS), Self-Determination Observation Checklist (SDOC), American Institutes for Research Self Determination Scale (AIRSDS) parent and educator form, and Routine Task Inventory-Expanded (RTI-E), to assess compulsive behaviors, self-determination from therapist, parent, and educator perspective, and routine task performances, respectively. Postintervention, favorable improvement was observed for the scores of Y-BOCS (25%), SDOC (therapist 29%), AIRSDS (parent 15% and educator 13%), and RTI-E: Activities of daily living (ADL) (20%), instrumental ADL (10%), communication (8.3%), and work behaviors (16.7%). This case report indicates that OT had a positive effect on the self-determined routine task performances in a young adult with autism, ID, and OCD.

"Door-In to Door-Out" Delay in Patients with Acute ST-Segment Elevation Myocardial Infarction Transferred for Primary Percutaneous Coronary Intervention in a Metropolitan STEMI Network of a Developing Country.

Background Routine performance measures of primary percutaneous coronary intervention (PCI) within an ST-segment elevation myocardial infarction (STEMI) network are needed to improve care. Objective We evaluated the door-in to door-out (DI-DO) delays at the initial hospitals in STEMI patients as a routine performance measure of the metropolitan STEMI network. Patients and Methods We retrospectively analyzed the DI-DO time from 1,076 patients with acute STEMI who were transferred by ground ambulance to a primary PCI center for primary PCI between 4 October 2014 and 1 April 2019. Correlation analysis between DI-DO times and total ischemia time was performed using Spearman's test. Logistic regression analyses were used to find variables associated with a longer DI-DO time. Results Median DI-DO time was 180 minutes (25th percentile to 75th percentile: 120-252 minutes). DI-DO time showed a positive correlation with total ischemia time ( r = 0.4, p < 0.001). The median door-to-device time at the PCI center was 70 minutes (25th percentile to 75th percentile: 58-88 minutes). Multivariate analysis showed that women patients were independently associated with DI-DO time > 120 minutes (odds ratio 1.55, 95% confidence interval 1.03 to 2.33, p = 0.03). Conclusion The DI-DO time reported in this study has not reached the guideline recommendation. To improve the overall performance of primary PCI in the region, interventions aimed at improving the DI-DO time at the initial hospitals and specific threat for women patients with STEMI are possibly the best efforts in improving the total ischemia time.

Comparison of muscle activity, strength, and balance, before and after a 6-month training using the FIFA11+ program (part 2).

Sports injury prevention training programs have been reported to be effective in decreasing the incidence of injuries. The aim of this study was to evaluate the effects of a 6-month training period, using part 2 of the FIFA11+ program (the Fédération Internationale de Football), on the activation and strength of core and lower limb muscles and on static and dynamic balance performance. Case series; level of evidence, 4. Eight college male soccer players, aged mean 20.4 ± 0.5 years old, completed the FIFA11+ program at least three times per week for 6 months. The following variables were measured both before and after the 6-month training program: activities of more than 30 muscles (core and lower limb muscles), measured using the standardized uptake values of 18F-fluorodeoxyglucose on positron emission tomography; isokinetic strength of the knee flexor and extensor and hip abductor muscles, measured at 60° s-1; static balance over a 60-s period, measured using a gravicorder; and dynamic balance, measured using the star excursion balance test. Training improved the activity levels of core (obliquus externus abdominis and erector spinae) and lower limb (tibialis anterior) muscles (p ≤ 0.03), corrected the between-limb difference in the activation of the semimembranosus and improved dynamic balance, with a greater training effect on the nondominant limb (p ≤ 0.02). Training also improved the knee flexor force of the nondominant lower limb (p = 0.02). Routine performance of the FIFA11+ program can improve the activation of core and lower limb muscles, with a concomitant improvement in dynamic balance. These improvements could be beneficial in lowering the risk of sports-related injuries.

The arranged mourning ambience. About the professional production of atmospheres at funeral services

ABSTRACT This paper operationalises the theory of social practices for the specific case of professionally producing and maintaining the atmospheres in Thuringian mourning halls (Germany). Funeral services constitute a complex of social practices, which releases affects. Using the example of consultation with the funeral director and the funeral speech, I demonstrate how actors in the funeral services profession engage in the practice and shape the funeral service’s atmosphere. Likewise, the present paper outlines that these actors are also affected by the complex of practices and their corporeality as well as disturbances. As a consequence, this disrupts routine performance in funeral service.

Emergency Department Evaluation After Conducted Energy Weapon Use: Review of the Literature for the Clinician.

Conductive energy weapons (CEWs) are used daily by law enforcement, and patients are often brought to emergency departments (EDs) for medical clearance. Our aim was to review the medical literature on the topic of CEWs and to offer evidence-based recommendations to emergency physicians for evaluation and treatment of patients who have received a CEW exposure. A MEDLINE literature search from 1988 to 2018 was performed and limited to human studies published from January 1, 1988 to November 1, 2018 written in English with the following keywords: TASER, conductive energy device(s), electronic weapon(s), conductive energy weapon(s), non-lethal weapon(s), conducted energy device(s), conducted energy weapon(s), conductive electronic device(s), and electronic control device(s). Studies identified then underwent a structured review from which results could be evaluated. Two hundred and sixty-three articles on CEWs were screened and 37 appropriate articles were rigorously reviewed. Evaluation and treatment recommendations are presented. These studies did not report any evidence of dangerous laboratory abnormalities, physiologic changes, or immediate or delayed cardiac ischemia or dysrhythmias after exposure to CEW electrical discharges of up to 15s. The current medical literature does not support routine performance of laboratory studies, electrocardiography, or prolonged ED observation or hospitalization for ongoing cardiac monitoring after CEW exposure in an otherwise asymptomatic awake and alert patient.

Snapshot of current carotid artery stenting practice and accreditation in the USA

ObjectiveThe aim of this exploratory study was to compare the performance of carotid artery stenting (CAS) best practices between Intersocietal Accreditation Commission (IAC) accredited facilities and non-accredited facilities certified by...

Detecting deviations from activities of daily living routines using kinect depth maps and power consumption data

There has been an increase in the world’s population of elderly persons who wish to live independently for as long as possible. This paper presents an unsupervised approach to help caregivers detect deviations from daily routines of elderly people living alone via inexpensive minimally intrusive sensors. The approach employs a power sensor to measure household composite power consumption and a small number of Kinect sensors in functional areas of the house to capture depth maps from the occupant’s activities of daily living (ADLs). The ADLs in an unlabelled training dataset are identified based on associating the occupant’s locations with specific power signatures on the power line. This training dataset is processed in order to model key features of ADLs, including the regularity and frequency of important activities. The approach uses a novel data-driven technique to define fuzzy sets over ADL attributes tailored to the occupant’s behaviour patterns. The membership functions of these fuzzy sets are learned based on the data distribution of attributes. A set of fuzzy rules is generated to indicate the occupant’s deviation from the normal routine of ADLs in subsequent data. The outputs of this monitoring system are reports on upward and downward deviations from normal behaviour patterns in the form of both numerical and linguistic information. The assessment of these scores over a long-term can help caregivers detect the warning signs of persistent drifts from the daily routine. As a proof of concept, the proposed monitoring approach was evaluated using two datasets collected from real-life settings. The fuzzy rule set obtained from the output of the proposed membership function generation technique was able to effectively monitor the ADLs of elderly people because it could accurately distinguish periods of deviations from the routine performance of ADLs. Compared to existing monitoring techniques, the proposed method required no prior information about the appliances in use and its output was considered to be more helpful for caregivers. The fuzzy inference system in this approach was found to be robust in regard to errors when identifying ADLs as it could effectively classify normal and abnormal behaviour patterns of the occupant despite errors in the list of the used appliances.

Boosted trees to predict pneumonia, growth, and meat percentage of growing-finishing pigs1.

In pig production, efficiency is benefiting from uniform growth in pens resulting in single deliveries from a pen of possibly all animals in the targeted weight range. Abnormalities, like pneumonia or aberrant growth, reduce production efficiency as it reduces the uniformity and might cause multiple deliveries per batch and pigs delivered with a low meat yield or outside the targeted weight range. Early identification of pigs prone to develop these abnormalities, for example, at the onset of the growing-finishing phase, would help to prevent heterogeneous pens through management interventions. Data about previous production cycles at the farm combined with data from the piglet’s own history may help in identifying these abnormalities. The aim of this study, therefore, was to predict at the onset of the growing-finishing phase, that is, at 3 mo in advance, deviant pigs at slaughter with a machine-learning technique called boosted trees. The dataset used was extracted from the farm management system of a research center. It contained over 70,000 records of individual pigs born between 2004 and 2016, including information on, for example, offspring, litter size, transfer dates between production stages, their respective locations within the barns, and individual live-weights at several production stages. Results obtained on an independent test set showed that at a 90% specificity rate, the sensitivity was 16% for low meat percentage, 20% for pneumonia and 36% for low lifetime growth rate. For low lifetime growth rate, this meant an almost three times increase in positive predictive value compared to the current situation. From these results, it was concluded that routine performance information available at the onset of the growing-finishing phase combined with data about previous production cycles formed a moderate base to identify pigs prone to develop pneumonia (AUC > 0.60) and a good base to identify pigs prone to develop growth aberrations (AUC > 0.70) during the growing-finishing phase. The mentioned information, however, was not a sufficient base to identify pigs prone to develop low meat percentage (AUC < 0.60). The shown ability to identify growth aberrations and pneumonia can be considered a good first step towards the development of an early warning system for pigs in the growing-finishing phase.

Utilidad de la laparoscopia de estadificación frente a la tomografía axial computarizada para detectar metástasis peritoneales en el adenocarcinoma gástrico avanzado

&#x0D; Introducción. El adenocarcinoma gástrico es una de las neoplasias más frecuentes. La tomografía computarizada abdominal con contraste es el método estándar para la estadificación; tiene una sensibilidad del 30 al 73 % y una especificidad del 83 al 100 %. La laparoscopia detecta hasta el 30 % de los casos de enfermedad metastásica que no se haya observado en los estudios de imágenes. En la Clínica Universitaria Colombia se realiza estadificación rutinaria con tomografía y laparoscopia más lavado peritoneal.&#x0D; Objetivos. Determinar la utilidad de la laparoscopia para detectar la carcinomatosis peritoneal en los pacientes con adenocarcinoma gástrico avanzado en un centro de referencia.&#x0D; Materiales y métodos. Se llevó a cabo un estudio descriptivo y retrospectivo, en el cual se analizaron todas las historias clínicas de los pacientes con cáncer gástrico atendidos en la Clínica Universitaria Colombia entre el 2013 y el 2016. Se confrontó el hallazgo de la laparoscopia con el de la tomografía abdominal, buscando falsos negativos para la enfermedad peritoneal.&#x0D; Resultados. Se incluyeron 94 pacientes con adenocarcinoma gástrico. La localización en el cuerpo gástrico fue la más frecuente (47,9 %). La tomografía reportó estadio T3 en el 56,4 %, N0 en el 55,3 % y M0 en el 97,9 % de los casos. La laparoscopia reportó estadio T3 en el 43,6 %, ganglios comprometidos en el 56,4 % y carcinomatosis peritoneal (M1) en el 11,7 %.&#x0D; Discusión. Un radiólogo experimentado detecta una gran proporción de las enfermedades peritoneales, pero la laparoscopia detecta hasta 11 % de aquellas que no son evidentes en los exámenes de imágenes. El lavado peritoneal no prolonga el tiempo quirúrgico ni incrementa la morbilidad, lo cual favorece su realización rutinaria. Se puede recomendar la laparoscopia en aquellos pacientes con resultados tomográficos negativos, evitando la cirugía cuando la neoplasia es irresecable. La laparoscopia tiene un impacto positivo en el manejo integral del cáncer gástrico, acorde con la literatura mundial.

Long-Term Outcomes of Sentinel Lymph Node Biopsy for Ductal Carcinoma in Situ.

The use of sentinel lymph node biopsy (SLNB) for ductal carcinoma in situ (DCIS) is controversial. Using population-cohort data, we examined whether SLNB improves long-term outcomes among patients with DCIS who underwent breast-conserving surgery. We identified 12 776 women aged 67–94 years diagnosed during 2001–2013 with DCIS who underwent breast-conserving surgery from the US Surveillance, Epidemiology, and End Results-Medicare dataset, 1992 (15.6%) of whom underwent SLNB (median follow-up: 69 months). Tests of statistical significance are two-sided. Patients with and without SLNB did not differ statistically significantly regarding treated recurrence (3.9% vs 3.7%; P = .62), ipsilateral invasive occurrence (1.4% vs 1.7%, P = .33), or breast cancer mortality (1.0% vs 0.9%, P = .86). With Mahalanobis-matching and competing-risks survival analyses, SLNB was not statistically significantly associated with treated recurrence, ipsilateral invasive occurrence, or breast cancer mortality (P ≥ .27). Our findings do not support the routine performance of SLNB for older patients with DCIS amenable to breast conservation.

Editorial

Editorial

Denoising and artefact removal for transthoracic echocardiographic imaging in congenital heart disease: utility of diagnosis specific deep learning algorithms.

Deep learning (DL) algorithms are increasingly used in cardiac imaging. We aimed to investigate the utility of DL algorithms in de-noising transthoracic echocardiographic images and removing acoustic shadowing artefacts specifically in patients with congenital heart disease (CHD). In addition, the performance of DL algorithms trained on CHD samples was compared to models trained entirely on structurally normal hearts. Deep neural network based autoencoders were built for denoising and removal of acoustic shadowing artefacts based on routine echocardiographic apical 4-chamber views and performance was assessed by visual assessment and quantifying cross entropy. 267 subjects (94 TGA and atrial switch and 39 with ccTGA, 10 Ebstein anomaly, 9 with uncorrected AVSD and 115 normal controls; 56.9% male, age 38.9 ± 15.6years) with routine transthoracic examinations were included. The autoencoders significantly enhanced image quality across diagnostic subgroups (p < 0.005 for all). Models trained on congenital heart samples performed significantly better when exposed to examples from congenital heart disease patients. Our study demonstrates the potential of autoencoders for denoising and artefact removal in patients with congenital heart disease and structurally normal hearts. While models trained entirely on samples from structurally normal hearts perform reasonably in CHD, our data illustrates the value of dedicated image augmentation systems trained specifically on CHD samples.

Correlation of competition performance with heart rate and blood lactate response during interval training sessions in eventing horses

Objective performance monitoring in eventing horses is rare as the implementation of standardised exercise tests is commonly perceived to interfere with the daily training routine. The validity of performance parameters derived from GPS data, heart rate (HR) and post exercise blood lactate concentration (LAC) measured during usual training sessions should therefore be evaluated. Velocity (V), HR and post exercise LAC recorded during 172 interval training sessions in 30 horses were retrospectively analysed. Linear regression of HR, averaged over retrospectively defined speed ranges, was used to calculate the V at HRs of 150 (V150) and 200 (V200) beats/min. A single exponential regression model, fitted to LAC in relation to HR values from the whole group of horses, was used to predict LAC for each horse’s individual HR value and to calculate the difference between measured and predicted LAC (LACdiff). Recovery HRs were derived from bi-exponential regression of HR decrease after exercise. Results were compared between different stages of training in the same horses and between horses categorised as superior (SP) and average performer (AP) according to their competition performance. V150 and V200 significantly increased with progressing training. SP had higher V150 and V200 values, lower LACdiff values and lower HRs after 1 min of recovery (HRR60s) than AP. Competition performance was positively correlated to V150 and V200 but negatively correlated to LACdiff and HRR60s. Regular monitoring of HR and LAC in response to interval training provided valuable indicators of performance. The results of this study may contribute to an increased applicability of routine performance monitoring in eventing horses.