Team Development Measure in Interprofessional Graduate Education: A Pilot Study.

A faculty team developed the 4-week Recovery-Based Interprofessional Distance Education (RIDE) rotation for graduate students in their disciplines. The evaluation team identified the Team Development Measure (TDM) as a potential alternative to reflect team development during the RIDE rotation. The TDM, completed anonymously online, was piloted on the second student cohort (N = 18) to complete the RIDE rotation. The overall pretest mean was 60.73 points (SD = 11.85) of a possible 100 points, indicating that students anticipated their RIDE team would function at a moderately high level during the 4-week rotation. The overall posttest mean, indicating student perceptions of actual team functioning, was 72.71 points (SD = 23.31), an average increase of 11.98 points. Although not statistically significant, Cohen's effect size (d = 0.43) indicates an observed difference of large magnitude. No other published work has used the TDM as a pre-/posttest measure of team development. The authors believe the TDM has several advantages as a measure of student response to interprofessional education offerings, particularly in graduate students with prior experience on health care teams. Further work is needed to validate and extend the findings of this pilot study. [Journal of Psychosocial Nursing and Mental Health Services, 56(4), 18-22.].

Recovery-Based Interprofessional Distance Education (RIDE): Graduate Student Responses.

Graduate student attitudes (n = 28) were assessed before and after participation in interprofessional practitioner education (IPE). Twenty-eight graduate students participated (14 mental health nursing, 6 pharmacy, 4 nutrition, 4 exercise physiology); most had at least some health care experience. Posttest scores indicated gains on a majority of constructs measured. These results suggest that online-blended IPE content yields gains in team skills and attitudes. This study adds to a very small body of literature on IPE in graduate programs. More research is needed in examining online versus face-to-face delivery.

Effect of Adding Online Social Support Tools to an Adult Walking Program: A Pilot Randomized Controlled Trial.

This pilot study examined the efficacy of providing access to online social support tools on adults' step counts during a technology-mediated walking intervention. Sixty-three insufficiently active adults were randomized to a 12-week walking intervention with (SUPPORT) or without (NO SUPPORT) access to online social support tools. Both groups received a pedometer, step goals, and access to relevant websites. The SUPPORT group also received access to online social support tools. A mixed-factor analysis of variance was conducted to examine within- and between-group differences in measures of daily steps, psychosocial indicators, and health. Both groups significantly (p < .05) increased their daily steps over time from baseline by 1,401 (SUPPORT) and 2,461 (NO SUPPORT), with no significant differences between groups. Psychosocial and health improvements were no greater for SUPPORT versus NO SUPPORT. The SUPPORT group's use of the online social support tools was low. Results suggest that giving adults access to online social support tools during a technology-mediated walking program did not lead to an enhanced increase in daily steps versus an identical program without these tools; however, the low use of these tools may have weakened their effect. Future studies should examine SUPPORT versus NO SUPPORT among groups with preexisting social ties.

The Recovery-Based Interprofessional Distance Education (RIDE) Rotation: Content and Rationale.

A faculty team of two psychiatric nurse practitioners, an exercise physiologist, a registered dietician and a pharmacist developed the 8-week Recovery-Based Interprofessional Distance Education (RIDE) rotation for graduate students in the four disciplines. Organizing the RIDE rotation around the recovery model ensured an emphasis upon optimal health and quality of life. RIDE faculty engaged in project planning for several months before the RIDE rotation was offered to students. In this paper, we describe details of the 8-week program. Our next step will be to analyze student feedback and de-identified evaluation data from the first student cohort.

Monitoring capabilities of the Omron HJ-720ITC pedometer.

PURPOSE: The purpose of our study was to examine the monitoring capabilities of the Omron HJ-720ITC pedometer and determine the feasibility of using it in physical activity interventions. METHODS: Using data from an 8-week lifestyle-intervention study, we tested the capabilities of the pedometer for recording physical activity data. Data from a total of 28 subjects were used in our analysis. The total number of patient steps per day was recorded over the duration of an intervention, as well as "aerobic steps per day" (ie, those taken at a cadence of > 60 steps per minute for ≥ 10 consecutive minutes). Daily wear time was computed in order to ascertain participant compliance in wearing the pedometer. In addition, aerobic steps per minute were computed, providing an assessment of activity intensity during continuous walking bouts. RESULTS: Total steps per day and aerobic steps per day increased from baseline assessment to Week 8. Participants exceeded 100 steps/minute for 89% of their aerobic minutes, suggesting that they were in the moderate-intensity range (3-6 metabolic equivalent tasks) when performing continuous bouts of walking (> 10 minutes). CONCLUSION: The new pedometer is a reasonably priced, wearable activity monitor that is feasible for use in clinical and research settings.

Approaches for enhancing the informativeness and quality of clinical trials: Innovations and principles for implementing multicenter trials from the Trial Innovation Network.

One challenge for multisite clinical trials is ensuring that the conditions of an informative trial are incorporated into all aspects of trial planning and execution. The multicenter model can provide the potential for a more informative environment, but it can also place a trial at risk of becoming uninformative due to lack of rigor, quality control, or effective recruitment, resulting in premature discontinuation and/or non-publication. Key factors that support informativeness are having the right team and resources during study planning and implementation and adequate funding to support performance activities. This communication draws on the experience of the National Center for Advancing Translational Science (NCATS) Trial Innovation Network (TIN) to develop approaches for enhancing the informativeness of clinical trials. We distilled this information into three principles: (1) assemble a diverse team, (2) leverage existing processes and systems, and (3) carefully consider budgets and contracts. The TIN, comprised of NCATS, three Trial Innovation Centers, a Recruitment Innovation Center, and 60+ CTSA Program hubs, provides resources to investigators who are proposing multicenter collaborations. In addition to sharing principles that support the informativeness of clinical trials, we highlight TIN-developed resources relevant for multicenter trial initiation and conduct.

The Trial Innovation Network Liaison Team: building a national clinical and translational community of practice.

In 2016, the National Center for Advancing Translational Science launched the Trial Innovation Network (TIN) to address barriers to efficient and informative multicenter trials. The TIN provides a national platform, working in partnership with 60+ Clinical and Translational Science Award (CTSA) hubs across the country to support the design and conduct of successful multicenter trials. A dedicated Hub Liaison Team (HLT) was established within each CTSA to facilitate connection between the hubs and the newly launched Trial and Recruitment Innovation Centers. Each HLT serves as an expert intermediary, connecting CTSA Hub investigators with TIN support, and connecting TIN research teams with potential multicenter trial site investigators. The cross-consortium Liaison Team network was developed during the first TIN funding cycle, and it is now a mature national network at the cutting edge of team science in clinical and translational research. The CTSA-based HLT structures and the external network structure have been developed in collaborative and iterative ways, with methods for shared learning and continuous process improvement. In this paper, we review the structure, function, and development of the Liaison Team network, discuss lessons learned during the first TIN funding cycle, and outline a path toward further network maturity.

Leveraging the Expertise of the CTSA Program to Increase the Impact and Efficiency of Clinical Trials.

Importance: Multicenter clinical trials play a critical role in the translational processes that enable new treatments to reach all people and improve public health. However, conducting multicenter randomized clinical trials (mRCT) presents challenges. The Trial Innovation Network (TIN), established in 2016 to partner with the Clinical and Translational Science Award (CTSA) Consortium of academic medical institutions in the implementation of mRCTs, consists of 3 Trial Innovation Centers (TICs) and 1 Recruitment Innovation Center (RIC). This unique partnership has aimed to address critical roadblocks that impede the design and conduct of mRCTs, in expectation of accelerating the translation of novel interventions to clinical practice. The TIN's challenges and achievements are described in this article, along with examples of innovative resources and processes that may serve as useful models for other clinical trial networks providing operational and recruitment support. Observations: The TIN has successfully integrated more than 60 CTSA institution program hubs into a functional network for mRCT implementation and optimization. A unique support system for investigators has been created that includes the development and deployment of novel tools, operational and recruitment services, consultation models, and rapid communication pathways designed to reduce delays in trial start-up, enhance recruitment, improve engagement of diverse research participants and communities, and streamline processes that improve the quality, efficiency, and conduct of mRCTs. These resources and processes span the clinical trial spectrum and enable the TICs and RIC to serve as coordinating centers, data centers, and recruitment specialists to assist trials across the National Institutes of Health and other agencies. The TIN's impact has been demonstrated through its response to both historical operational challenges and emerging public health emergencies, including the national opioid public health crisis and the COVID-19 pandemic. Conclusions and Relevance: The TIN has worked to reduce barriers to implementing mRCTs and to improve mRCT processes and operations by providing needed clinical trial infrastructure and resources to CTSA investigators. These resources have been instrumental in more quickly and efficiently translating research discoveries into beneficial patient treatments.

Can sedentary behavior be made more active? A randomized pilot study of TV commercial stepping versus walking.

BACKGROUND: There is a growing problem of physical inactivity in America, and approximately a quarter of the population report being completely sedentary during their leisure time. In the U.S., TV viewing is the most common leisure-time activity. Stepping in place during TV commercials (TV Commercial Stepping) could increase physical activity. The purpose of this study was to examine the feasibility of incorporating physical activity (PA) into a traditionally sedentary activity, by comparing TV Commercial Stepping during 90 min/d of TV programming to traditional exercise (Walking). METHODS: A randomized controlled pilot study of the impact of 6 months of TV Commercial Stepping versus Walking 30 min/day in adults was conducted. 58 sedentary, overweight (body mass index 33.5 ± 4.8 kg/m2) adults (age 52.0 ± 8.6 y) were randomly assigned to one of two 6-mo behavioral PA programs: 1) TV Commercial Stepping; or 2) Walking 30 min/day. To help facilitate behavior changes participants received 6 monthly phone calls, attended monthly meetings for the first 3 months, and received monthly newsletters for the last 3 months. Using intent-to-treat analysis, changes in daily steps, TV viewing, diet, body weight, waist and hip circumference, and percent fat were compared at baseline, 3, and 6 mo. Data were collected in 2010-2011, and analyzed in 2011. RESULTS: Of the 58 subjects, 47 (81%) were retained for follow-up at the completion of the 6-mo program. From baseline to 6-mo, both groups significantly increased their daily steps [4611 ± 1553 steps/d vs. 7605 ± 2471 steps/d (TV Commercial Stepping); 4909 ± 1335 steps/d vs. 7865 ± 1939 steps/d (Walking); P < 0.05] with no significant difference between groups. TV viewing and dietary intake decreased significantly in both groups. Body weight did not change, but both groups had significant decreases in percent body fat (3-mo to 6-mo), and waist and hip circumference (baseline to 6-mo) over time. CONCLUSIONS: Participants in both the TV Commercial Stepping and Walking groups had favorable changes in daily steps, TV viewing, diet, and anthropometrics. PA can be performed while viewing TV commercials and this may be a feasible alternative to traditional approaches for increasing daily steps in overweight and obese adults. TRIAL REGISTRATION: This study is registered at ClinicalTrials.gov, NCT01342471.

Using gamification to enhance clinical trial start-up activities.

Background: The Trial Innovation Network (TIN) is a collaborative initiative within the National Center for Advancing Translational Science (NCATS) Clinical and Translational Science Awards (CTSA) Program. To improve and innovate the conduct of clinical trials, it is exploring the uses of gamification to better engage the trial workforce and improve the efficiencies of trial activities. The gamification structures described in this article are part of a TIN website gamification toolkit, available online to the clinical trial scientific community. Methods: The game designers used existing electronic trial platforms to gamify the tasks required to meet trial start-up timelines to create friendly competitions. Key indicators and familiar metrics were mapped to scoreboards. Webinars were organized to share and applaud trial and game performance. Results: Game scores were significantly associated with an increase in achieving start-up milestones in activation, institutional review board (IRB) submission, and IRB approval times, indicating the probability of completing site activation faster by using games. Overall game enjoyment and feelings that the game did not apply too much pressure appeared to be an important moderator of performance in one trial but had little effect on performance in a second. Conclusion: This retrospective examination of available data from gaming experiences may be a first-of-kind use in clinical trials. There are signals that gaming may accelerate performance and increase enjoyment during the start-up phase of a trial. Isolating the effect of gamification on trial outcomes will depend on a larger sampling from future trials, using well-defined, hypothesis-driven statistical analysis plans.

Validation of the Cosmed Fitmate for prediction of maximal oxygen consumption.

The main purpose of this study was to assess the validity of the Cosmed Fitmate (FM) for the prediction of maximal oxygen consumption (VO(2)max). In addition, this study examined whether measuring submaximal VO(2), rather than predicting it, can improve upon the prediction of VO(2)max. Participants for the study were 48 young to middle-age adults (32 men, 16 women), with a mean age of 31 yr. Each participant completed a submaximal and maximal treadmill test on 2 separate occasions. During the submaximal test, VO(2)max was predicted using the FM. This device extrapolates the linear regression relating heart rate (HR) and measured VO(2) at submaximal work rates to age-predicted maximum HR (HR = 220 - age). The criterion measure was obtained using a graded, maximal treadmill test, with VO(2) measured by the Douglas bag (DB) method. There was no significant difference between VO(2)max predicted by the FM and VO(2)max measured by the DB method. The results of this study showed that a strong positive correlation (r = 0.897) existed between VO(2)max predicted by the FM and VO(2)max measured by the DB method, with a standard error of the estimate (SEE) = 3.97 ml·kg(-1)·min(-1). There was a significant difference in VO(2)max predicted by the American College of Sports Medicine (ACSM) metabolic equations and VO(2)max measured by the DB method (p = 0.01). The correlation between these variables was r = 0.758 (SEE = 5.26 ml·kg(-1)·min(-1)). These findings indicate that a small, portable, and easy-to-use metabolic system provides valid estimates of VO(2)max, and improves upon predictive accuracy, compared to using generalized ACSM metabolic equations.

Relationship between leptin, adiponectin, bone mineral density, and measures of adiposity among pre-menopausal Hispanic and Caucasian women.

OBJECTIVE: The purpose of this study was to examine the relationship between fasting serum leptin and adiponectin levels with bone mineral density (BMD) and body composition in pre-menopausal, middle-aged Hispanic and Caucasian women. OBJECTIVE: Participants' (68 Hispanic and 36 Caucasian) BMD and bone mineral content were measured by dual-energy X-ray absorptiometry, and body density was measured by hydrodensitometry. Serum leptin was determined by enzyme immunoassay and adiponectin by ELISA. RESULTS: Hispanic women had significantly higher leptin, BMD, and fat mass (FM), and lower adiponectin than Caucasian women. There was no significant correlation between leptin and BMD for Hispanic or Caucasian women; adiponectin was inversely correlated with BMD in Caucasian women only (p = 0.01). In both Hispanic and Caucasian women, lean body mass and adiponectin best explained the variance in BMD (r(2) = 0.25, p < 0.001). CONCLUSION: These data demonstrate no significant relationship between leptin and BMD of pre-menopausal, middle-aged Hispanic and Caucasian women, and a significant inverse relationship between adiponectin and BMD in Caucasian women. The role of adipocytokines in the regulation of BMD remains inconclusive and may vary across ethnic groups.

Relationship of leptin, resting metabolic rate, and body composition in premenopausal hispanic and non-Hispanic White women.

OBJECTIVE: The purpose was to evaluate the relationships between fasting serum leptin, resting metabolic rate (RMR), and body composition in premenopausal Hispanic and non-Hispanic White (White) women. METHODS: Participants were 67 Hispanic and 43 White women who arrived at the laboratory in a fasted state for measurement of RMR by indirect calorimetry, bone mineral content measured by dual-energy X-ray absorptiometry, and body density measured by hydrodensitometry. Serum leptin levels were determined by EIA. RESULTS: Multiple regression analysis revealed that body mass and lean body mass were the best predictors of RMR. Leptin was not a significant predictor of RMR. CONCLUSION: Further research needs to be done to examine the role of leptin on metabolism, especially in ethnic groups predisposed to development of obesity and related disorders.

Transforming Health Care Through Interprofessional Graduate Education.

PURPOSE: We provide an overview of the Recovery-based Interprofessional Distance Education (RIDE) rotation for graduate students in psychiatric mental health (PMH) nursing, pharmacy, nutrition, and exercise physiology, with faculty from the four professions represented. CONCLUSIONS: Interprofessional education can enhance team concepts in these professions and is viewed positively by students and faculty. PRACTICE IMPLICATIONS: Interprofessional learning opportunities prepare graduates to contribute to team-based care. We urge colleagues to join us in providing meaningful IPE experiences to students at all levels, with the goal of optimizing health care for all persons with mental health treatment needs.

Postprandial walking reduces glucose levels in women with gestational diabetes mellitus.

The purpose of this study was to investigate blood glucose changes, as measured by a continuous glucose monitoring system, that occur in women with gestational diabetes mellitus (GDM) following an acute bout of moderate-intensity walking after consuming a high-carbohydrate/low-fat meal. This study found that moderate-intensity walking induced greater postprandial glucose control compared with sedentary activity and it appears that moderate-intensity activity may be used to reduce postprandial glucose levels in women with GDM.

The effectiveness of walking in preventing cardiovascular disease in women: a review of the current literature.

This paper summarizes research examining the effects of walking on the prevention of cardiovascular disease (CVD) and treatment of CVD risk factors in women. Epidemiological evidence indicates that walking reduces a woman's risk for developing CVD. Walking may lower CVD risk by having beneficial effects on risk factors associated with CVD development. Obesity, dyslipidemia, hypertension, and diabetes can all be positively affected by increased physical activity or, more specifically, increased daily walking in women. With a large number of people living a sedentary lifestyle, it is important to focus on the effects of physical activity options that are both physiologically beneficial and personally appealing and available to the majority of individuals. With studies showing positive results using pedometer- monitored walking to decrease CVD risk, accumulated daily walking as opposed to structured walking activity should also be considered as a viable option in women.

The relationship between daily steps and body composition in postmenopausal women.

PURPOSE: The purpose of this study was to examine the relationship between pedometer-determined physical activity (PA) measured in steps per day and adiposity in postmenopausal women. METHODS: Ninety-three women aged 60.9 +/- 5.8 years participated in the study. Relative body fatness was determined by the measurement of height, body mass, percent body fat, trunk fat, and waist and hip circumference. Each subject wore a pedometer for 14 days after testing to measure daily steps. Correlation coefficients were calculated to examine the relationship between average steps per day and adiposity variables. Subjects were grouped according to PA tertiles. ANCOVA, with age as the covariate, was used to determine whether adiposity varied across activity groups. RESULTS: Significant inverse associations (p < 0.001) were found between average steps per day and all adiposity variables (r ranging from -0.487 to -0.368). Relationships remained significant after controlling for the influence of age and caloric intake. Also, there was a significant difference in adiposity variables among PA tertiles, with higher values found in the less active groups. CONCLUSIONS: We demonstrated that postmenopausal women who take more daily steps have more favorable adiposity profiles. Additionally, the average body mass index (BMI) of the women in the active category (accumulating an average of 10,023 +/- 240 steps per day) was in the recommended range (24.1 +/- 0.9 kg/m(2)).

Effects of a 10,000 steps per day goal in overweight adults.

PURPOSE: This study was designed (1) to examine the effects of a 10,000 steps d(-1) exercise prescription on sedentary, overweight/obese adults, and (2) to examine the effects of adherence on body composition and cardiovascular risk factors. METHODS: Fifty-six overweight/obese adults participated in the study. Body composition and cardiovascular risk factors were determined at baseline, 20 weeks, and 36 weeks. Adherence was defined as averaging > or = 9500 steps d(-1) from week 4 to week 36. RESULTS: 38 participants (68%) wore pedometers daily for 36 weeks and were available for posttesting. Significant improvements were noted in mean values for walking volume (3994 steps x d(-1)), body weight (-2.4 kg), body mass index (-0.8 kg x m(-2)), percentage body fat (-1.9%), fat mass (-2.7 kg), waist circumference (-1.8 cm), hip circumference (-1.9 cm) and high-density lipoprotein (3 mg/dl). The adherers had large improvements in body composition measures, whereas the nonadherers showed little or no change in these variables. DISCUSSION: A 10,000 steps (d(-1) exercise prescription resulted in weight loss over 36 weeks in previously sedentary, overweight/obese adults. Adherence to the step goal had a marked effect on the outcome.

Physical Activity With and Without TV Viewing: Effects on Enjoyment of Physical Activity and TV, Exercise Self-Efficacy, and Barriers to Being Active in Overweight Adults.

BACKGROUND: Physical activity (PA) is enjoyable, but there are barriers to participation. TV viewing is highly enjoyable with limited barriers. Exercising while viewing TV may impact enjoyment, exercise self-efficacy, and barriers to PA, compared with exercising without TV. METHODS: 58 sedentary, overweight adults were randomized to 1 of 2 PA prescriptions: one that increased PA during TV viewing (TV Commercial Stepping), and another that focused solely on PA (Walking). Random effects models tested changes in enjoyment of TV and PA, exercise self-efficacy, and barriers to PA across time (baseline, 3, and 6 months) and PA prescription during a 6-month PA intervention. RESULTS: At baseline, TV was more enjoyable than PA. Over the 6-month intervention, enjoyment of TV viewing did not change, but enjoyment of PA and exercise self-efficacy significantly increased, while barriers to PA significantly decreased for both groups compared with baseline (P < .05). CONCLUSIONS: While enjoyment of TV viewing remained constant, PA became more enjoyable, confidence to exercise increased, and barriers to being active were reduced for previously sedentary adults participating in a behavioral PA intervention. These findings highlight the importance of encouraging inactive adults to engage in some form of PA, whether it occurs with or without TV viewing.

Comparison of walking recommendations in previously inactive women.

PURPOSE: To compare the number of steps accumulated by women instructed to walk 10,000 steps per day (10K group) with those told to take a brisk 30-min walk on most, preferably all, days of the week (30-min group). METHODS: Daily steps were compared for 58 sedentary women (mean age 45.0+/-6.0 yr) randomly assigned to either the 10K or the 30-min group. Subjects wore a sealed pedometer for 2 wk for baseline physical activity assessment. Those averaging 0.05) between the groups for baseline steps. During the intervention, there was a significant difference (P<0.005) between groups in daily steps. The 30-min group walked 8270+/-354 steps per day, and the 10K group walked 10,159+/-292 steps per day. The 30-min group averaged 9505+/-326 steps per day on the days that a 30-min walk occurred, and 5597+/-363 steps per day when no walk occurred (P<0.05). The 10K group averaged 11,775+/-207 steps on days when they walked at least 10,000 steps, and 7780+/-231 steps on days that their target was not achieved (P<0.05). CONCLUSION: Women walk more when told to take 10,000 steps per day compared with those instructed to take a brisk 30-min walk. On days when women took a 30-min walk, their average step count was near 10,000.