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| ### *GRECC Annual Report: Fiscal Year [2005]{.underline}*             |
|                                                                       |
| ######## Part II: Accomplishments                                     |
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| This GRECC Annual Report covers [October 1, 2004-September 30,        |
| 2005]{.underline}: **the "Report Year"**.                             |
|                                                                       |
| This GRECC Annual Report reflects status and accomplishments of       |
| [**GRECC Core Staff \***only]{.underline}.                            |
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| **\*[GRECC Core Staff ]{.underline}**is limited to either **Primary   |
| Core**, **Affiliate Core**, or **Research Core**:                     |
|                                                                       |
| -   **Primary Core =** positions authorized by the original GRECC     |
|     allocation plus any addition in ceiling from VA Central Office    |
|     specifically designated for GRECC.                                |
|                                                                       |
| -   **Affiliated Core** = Staff who work full- or part-time in        |
|     [direct support]{.underline} of the GRECC's research, education   |
|     or clinical activity.                                             |
|                                                                       |
|     -   May be either "contributed" by the VA Medical Center or       |
|                                                                       |
|     -   May have been acquired through centralized                    |
|         enhancements/awards for programs\                             |
|         (e.g., Home-Based Primary Care, Geriatric Evaluation and      |
|         Management Program, etc.)                                     |
|                                                                       |
|     -   To be considered Affiliated Core, staff must be               |
|         organizationally aligned under the GRECC or specifically      |
|         identified by the Medical Center as **"GRECC-affiliated       |
|         staff."**                                                     |
|                                                                       |
| -   **Research Core** = Full-or part-time staff who devote 51% or     |
|     more of their total time to GRECC research and whose salaries are |
|     supported by research funds (either VA or non-VA). Includes all   |
|     GRECC staff whose salaries are paid from research funds, e.g.:    |
|                                                                       |
|     -   Associate Investigator                                        |
|                                                                       |
|     -   Assistant Research Scientist                                  |
|                                                                       |
|     -   Senior Research Career Scientist                              |
|                                                                       |
|     -   Research Career Scientist                                     |
|                                                                       |
|     -   Advanced Research Career Scientist.                           |
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| **1. GRECC NAME/LOCATION**                                            |
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| a.  **GRECC Name:** Little Rock GRECC                                 |
|                                                                       |
| b.  **Location** *(facility, VISN)*: CAVHS, VISN 16                   |
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| **2. CONTACT PERSON (if there are questions about this report)**      |
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| a.  **Name:** Kay Guthrie                                             |
|                                                                       |
| b.  **Position:** Administrative Officer                              |
|                                                                       |
| c.  **Phone, e-mail:** 501-257-5547, GUTHRIE.BKAY@med.va.gov          |
|                                                                       |
| d.                                                                    |
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| **3. GRECC FOCUS AREA(S)**                                            |
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| GRECCs are required to conduct research in a basic biomedical area,   |
| an applied clinical area, and either a health services or             |
| rehabilitation topic. The number of specific research foci in each    |
| perspective should be limited to two or fewer.                        |
|                                                                       |
| Please enter a succinct phrase that best characterizes the focus      |
| area(s) recognized for your GRECC in the first two and either the     |
| third or fourth (or both) category below:                             |
|                                                                       |
| **a. Basic Biomedical**:                                              |
|                                                                       |
| Cellular and Molecular Biology of Aging                               |
|                                                                       |
| Alzheimer's Disease                                                   |
|                                                                       |
| **b. Applied Clinical:** Nutrition, Exercise and Metabolism in the    |
| Elderly                                                               |
|                                                                       |
| **c. Health Services**: Outcomes research                             |
|                                                                       |
| **d. Rehabilitation**: Functional rehabilitation                      |
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| **4. ADMINISTRATION**                                                 |
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| a.  **GRECC Impact on Host VAMC in Report Year**\                     |
|     *(list the most important ways in which the GRECC has had         |
|     positive impact on the host VAMc\--i.e., how the GRECC has "made  |
|     a difference"locally. **Please limit your response to five ways   |
|     or fewer.** Please be as succinct as possible but specify the     |
|     GRECC contribution, what the impact was and whom it benefited,    |
|     where it occurred, and why it was important. **Please limit the   |
|     description of each bullet item to 5 lines or fewer**)*           |
|                                                                       |
| -   The GRECC has 54 funded research projects that amount to more     |
|     than \$9 million in research funding during last FY. This         |
|     represented over \$3.9 million in VERA funding. The GRECC staff   |
|     also provided numerous research mentoring experiences for         |
|     post-doctoral fellows, students, junior faculty, and staff from   |
|     other services and published 50 journal articles.                 |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   GRECC modified, printed, laminated and distributed Geriatric      |
|     Assessment Pocket Guides to Fellows, medical students, and        |
|     clinical staff to make geriatric information instantly available. |
|     A pocket guide developed by the Falls nurses was prepared,        |
|     printed and laminated by the GRECC and distributed throughout     |
|     CAVHS.                                                            |
|                                                                       |
| -   During FY05, 107 health professionals at the CAVHS participated   |
|     in on-site in-services provided by GRECC and 390 attended HR      |
|     training provided by the GRECC Education Specialist. One hundred  |
|     twenty-four CAVHS employees earned 248 CE hours by completing     |
|     tapes on geriatric topics developed by the GRECC and the Arkansas |
|     Geriatric Education Center. Nine individuals accessed the new     |
|     on-line feature of completing tests, evaluations, and participant |
|     profiles through the website.                                     |
|                                                                       |
| -   During the last year, the GRECC initiated several clinical        |
|     demonstration and quality of care assessment projects. Clinical   |
|     evaluations are ongoing on memory loss with aging in patients     |
|     with PTSD, emotional memory dysfunction in aging veterans with    |
|     PTSD; and telehealth video-to-video assessment of behavioral      |
|     status of geriatric veterans.                                     |
|                                                                       |
| -   In close collaboration with the Geriatrics and Extended Care      |
|     Service, the GRECC continues to be a major provider of clinical   |
|     teaching opportunities for medical students (all third-year       |
|     medical students have a mandatory Geriatrics rotation through the |
|     North Little Rock Division clinical programs), medical and family |
|     practice residents, geriatric fellows (with 6 first-year fellows  |
|     in AY 04/05 and 1 fellow in the Special Fellowship Program in     |
|     Advanced Geriatrics (SFPAG) in AY 04/05), and allied health       |
|     students (nurses, pharmacists, and occupational therapists)       |
|     through the GRECC Expansion Traineeships. The Geriatric Clerkship |
|     for the 3^rd^ year medical students continues to be rated in the  |
|     top 50% of all 3^rd^ year clinical rotations. All GRECC           |
|     physicians are active clinically and participate in all aspects   |
|     of the teaching program.                                          |
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| b.  **GRECC Impact on VISN in Report Year** *\                        |
|     (list the most important ways in which the GRECC has had positive |
|     impact on the host VISN\-- i.e., how the GRECC has "made a        |
|     difference "regionally. **Please limit your response to five ways |
|     or fewer.** Please be as succinct as possible but specify the     |
|     GRECC contribution, what the impact was and whom it benefited,    |
|     where it occurred, and why it was important. **Please limit the   |
|     description of each bullet item to 5 lines or fewer**)*           |
|                                                                       |
| -   During FY05, 147 health professional employees of VISN 16         |
|     attended live video teleconferences and 151 people attended       |
|     on-site programs conducted at VAMCs in New Orleans, Jackson and   |
|     Houston. Faculty for these programs were GRECC core employees as  |
|     well as the Little Rock wound care nurse. Six tapes of geriatric  |
|     topics were used in Shreveport for CE credit.                     |
|                                                                       |
| -   Dr. Chernoff is a member of the VISN 16 Geriatrics and Extended   |
|     Care committee as a representative from the GRECC.                |
|                                                                       |
| -   In addition to the on-site training, the GRECC continues to work  |
|     in close collaboration with all of the other facilities within    |
|     our VISN to provide training, assistance with clinical program    |
|     development and to foster new collaborative research initiatives. |
|     A young geriatrician from OKC spent several days with GRECC       |
|     investigators to learn about exercise and aging to better develop |
|     her own research initiative. We implemented a VTC research        |
|     conference within VISN 16.                                        |
|                                                                       |
| -   Dr. Sullivan is a member of the VHA/VACO Geriatrics Task Force as |
|     a representative from the GRECC and VISN 16. Through this Task    |
|     Force, the GRECC has taken a very active role in a national       |
|     effort to incorporate geriatrics into the planning and            |
|     implementation of Advance Clinic Access as there was previously   |
|     no input from geriatrics into this initiative. In collaboration   |
|     with Dr. Sullivan, Dr. Carmen Arick and Dr. Ronni Chernoff serve  |
|     on the VHA G&EC Planning Committee for Geriatric Primary Care     |
|     Advanced Clinic Access (aka Open Access) to accomplish this goal  |
|     and to promote the adoption of open access principle within       |
|     geriatric clinic programs throughout the VISN. This program has   |
|     been put on hold due to lack of EES funding.                      |
|                                                                       |
| -   Dr. Chernoff served on a planning committee to develop and        |
|     implement a training program to define and establish new GEMS     |
|     that was held in May at AGS for practitioners in VISNs 7 & 8.     |
|     Based on availability of future funds, there may be a broader     |
|     audience in the future.                                           |
|                                                                       |
| -   The GRECC developed a telehealth initiative in G&EC that is being |
|     re-evaluated for funding by the VISN as part of the VISN          |
|     telehealth program. As part of this initiative, the GRECC         |
|     proposed assessing the use of telehealth technology to focus on   |
|     improving medication compliance in older patients, especially     |
|     during the critical period of medication titration.               |
|                                                                       |
| -   The GRECC coordinated post-hurricane (Katrina and Rita) CNH       |
|     patient recovery efforts in collaboration with the office of Home |
|     and Community-Based Care                                          |
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| c.  **GRECC Trend-Setting Innovations since October 1,                |
|     [2000]{.underline}** *(list the most significant research,        |
|     education or clinical innovations originating in your GRECC in    |
|     the past five years. Please limit your response to five           |
|     innovations or fewer. For each item, succinctly describe the      |
|     innovation, specify the time frame of its earliest impact, whom   |
|     it benefited, where it occurred, and why it was important.        |
|     **Please limit the comments concerning each innovation to 5 lines |
|     or fewer**)*:                                                     |
|                                                                       |
| -   A self-study program in geriatrics was developed collaboratively  |
|     by the GRECC and the Arkansas Geriatric Education Center. Since   |
|     October, 2000, 15 VA health professionals have enrolled in this   |
|     self-study. It is composed of 4 mandatory modules including       |
|     coaching/mentoring training, 2 out of 4 elective modules and 10   |
|     hours of a mentored clinical experience. This is innovative since |
|     participants can complete the program at their own pace and       |
|     select individualized relevant clinical experiences. The program  |
|     awards 105.5 CE hours for nurses and 88 hours for other health    |
|     professionals. Since its inception, 3 additional elective modules |
|     have been created. Program completers can elect to do one of the  |
|     new modules for additional CE credits.                            |
|                                                                       |
| -   Between January 2000 and February 2003 while Dr. Sullivan was the |
|     Acting ACOS Geriatrics and Extended Care, the GRECC helped to     |
|     establish and expand the outpatient GEM program at the CAVHS.     |
|     This program is uniquely structured in that the GRECC clinicians  |
|     run the memory disorders evaluation component of the program,     |
|     provide consultation and evaluation for endocrine and cardiac     |
|     problems, and handle much of the caseload. The clinic is also     |
|     unique in that it is open to all older veterans (not just the     |
|     highly complex patient), there is a strong emphasis on health     |
|     promotion and exercise, and all referrals remain within the       |
|     geriatrics primary care program after completing the GEM          |
|     evaluation. Over 5200 uniques were registered in the geriatrics   |
|     primary care program.                                             |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   Nicoll, JAR, Mrak RE, Graham DI, Stewart J, Wilcock G, MacGowan   |
|     S, Esiri MM, Murray LS, Dewar D, Love S, Moss T, **Griffin WST**: |
|     Association of Interleukin-1 Gene Polymorphisms with Alzheimer's  |
|     disease.  Ann Neurol 2000;47:365-368 -- This seminal paper found  |
|     further evidence to indicate that disregulated inflammation may   |
|     be an important factor leading to Alzheimer's disease as had been |
|     suggested by previous work in Dr. Griffin\'s laboratory.  The     |
|     study found that persons with a particular form of a gene for     |
|     IL-1 produced more of this inflammation-associated cytokine and   |
|     were ten times as likely to develop Alzheimer's compared to       |
|     individuals with other forms of the gene.  In other studies, Dr.  |
|     Griffin's lab showed higher concentrations of the products of     |
|     these genes in Alzheimer brains and identified links between      |
|     these                                                             |
|                                                                       |
| inflammatory mediators and abnormal behavior of nerve cells and       |
| other brain components.  These studies have engendered a growing      |
| debate about the role of inflammation-associated genes in the         |
| pathogenesis of Alzheimer's disease.                                  |
|                                                                       |
| -   Slotnick S, Moo L, Kraut M, Lesser R, **Hart J**: Thalamic        |
|     modulation of cortical rhythms during semantic memory recall in   |
|     humans. **P[\<\<]{.mark}N[\>\<]{.mark}A[\>\>]{.mark}S             |
|     ([\<\<]{.mark}USA[\>\>]{.mark})**, 99(9): 6440-6443, 2002 (as     |
|     well as **JOCN,** 14:24-36, 2002; **JOCN,** 14:37-47, 2002;       |
|     **JINS,** 9:1031-1040, 2003). They found that one memory concept  |
|     (e.g., a dog) if often stored as separate memory components       |
|     (e.g., bark, head, fur, pet) distributed throughout the brain and |
|     the thalamus synchronizes the neural activity of all the parts of |
|     the brain that store each of these memory components. It is hoped |
|     that eventually it will be possible to develop more focused       |
|     therapeutic interventions to address memory loss in the elderly,  |
|     whether mild (e.g., "senior moments") or more severe (e.g.,       |
|     Alzheimer's disease).                                             |
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| **5. RESEARCH**                                                       |
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| a.  **Most Noteworthy Findings Published in Report Year by GRECC Core |
|     Staff as PI or CO-PI\                                             |
|     ***(Please list five or fewer. For each noteworthy finding,       |
|     include the GRECC Core Staff name(s), journal reference, and a    |
|     JARGON-FREE description of the finding and its clinical or other  |
|     significance. Please limit your description of each noteworthy    |
|     finding to five lines or fewer.)*                                 |
|                                                                       |
| -   **Bodenner DL**, Medhi M, **Evans WJ, Sullivan DH**, Liu H,       |
|     Lambert CP. Effects of megestrol acetate on pituitary function    |
|     and end-organ hormone secretion: A post hoc analysis of serum     |
|     samples from a 12-week study in healthy older men. Am J Geriatr   |
|     Pharmacother 3:160-167, 2005. Megestrol acetate (MA) is a         |
|     synthetic progestin commonly used to promote weight gain in       |
|     malnourished older individuals. However, its use is controversial |
|     because of its side-effects. The purpose of this study was to     |
|     examine the effect of MA on pituitary function and end-organ      |
|     hormone secretion in older men. After receiving the standard dose |
|     of 800 mg MA PO QD for 12 weeks, TSH, ACTH, LH, cortisol and      |
|     testosterone levels were profoundly suppressed in all             |
|     individuals. FSH and free T4 were unchanged. These results        |
|     confirm those from our prior studies that indicate MA is a        |
|     powerful corticosteroid agonist that causes profound suppression  |
|     of other hormones, particularly the anabolic hormones. We         |
|     recommend further study of this drug before its continued         |
|     widespread use can be advocated.                                  |
|                                                                       |
| -   **Sullivan DH**, Liu LJ, Roberson PK, Bopp MM, Rees JC. Body      |
|     Weight Change and Mortality in a Cohort of Elderly Patients       |
|     Recently Discharged from the Hospital. J Am Geriatr Soc.          |
|     2004;52:1696-701. Although there is a very high prevalence of     |
|     severe protein-energy undernutrition among older patients at      |
|     hospital discharge, it is not known how many of these patients    |
|     eventually replete their deficits and whether so doing is         |
|     associated with a better prognosis. To investigate this issue,    |
|     660 randomly selected elderly hospitalized patients were          |
|     comprehensively evaluated at discharge and then prospectively     |
|     followed for an average of 6 years. Weights were recorded from    |
|     all hospital or clinic visits beginning the year before admission |
|     through to the study end. Contrary to what was expected, a        |
|     U-shaped association between weight change and mortality was      |
|     observed. Those who were relatively weight stable (+-1 kg/y) had  |
|     the lowest mortality (28%). Compared with this group, the         |
|     adjusted relative risks (ARR) of death for those who either       |
|     gained or lost \>3 kg/y was \>3.5 (\~3.6 for each group,          |
|     P\<0.01). In order to better understand these findings, further   |
|     studies are needed to determine the long-term changes in body     |
|     composition that occur in older adults after serious illness.     |
|     Until then, clinicians should examine their older patients        |
|     carefully when they begin to either gain or lose weight.          |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   **Sullivan DH**, Nelson CL, Klimberg VS, Bopp MM. Nightly Enteral |
|     Nutrition Support of Elderly Hip Fracture Patients: A Pilot       |
|     Study. J Am Coll Nutr. 2004;23:683-91. Protein-energy             |
|     undernutrition is a serious problem among older patients          |
|     undergoing surgical repair for an acute hip fracture. There is a  |
|     direct association between the severity of nutritional deficits   |
|     and the risk of adverse clinical outcomes in this population. The |
|     purpose of this randomized controlled trail was to validate the   |
|     findings from a prior pilot study that reported improved          |
|     postoperative survival with nutrition support. The results were   |
|     negative. The study found that there was no difference between    |
|     the treatment and control groups in the rate of postoperative     |
|     life-threatening complications or mortality within six months     |
|     subsequent to surgery. There was also a higher rate of            |
|     tube-related problems than encountered in the pilot study. The    |
|     pilot study was conducted on one ward and involved a highly       |
|     trained nursing staff whereas the larger study was conducted in   |
|     multiple hospitals. This suggests that tube feedings are possibly |
|     effective when used appropriately, but this is difficult to       |
|     achieve in the real world. Further study is needed.               |
|                                                                       |
| -   Zhang X, Azhar G, Zhong Y, **Wei JY**. A novel protein found to   |
|     be a modulator of serum response factor regulation of its target  |
|     genes. J Biol Chem. 2004 Dec 31;279(53):55626-32. Epub 2004       |
|     Oct 18. We have identified a protein that binds to and modulates  |
|     a transcription factor called serum response factor (SRF), which  |
|     is important in the regulation of a number of heart muscle genes. |
|      This protein may also have a role in modulating other genes, and |
|     that possibility is currently undergoing further evaluation.      |
|                                                                       |
| -   Liu L, Li Y, Van Eldik LJ, **Griffin WS, Barger SW**.             |
|     S100B-induced microglial and neuronal IL-1 expression is mediated |
|     by cell type-specific transcription factors. J Neurochem. 2005    |
|     Feb;92(3):546-53.  Two molecules elevated in Alzheimer disease    |
|     brains are 'S100B' and the inflammatory 'interleukin-1 (IL-1)'.   |
|     We examined genetic mechanisms through which S100B causes an      |
|     elevation of IL-1beta. The cellular molecules that mediate this   |
|     cause and effect relationship were found to be different in nerve |
|     cells (neurons) versus non-neuronal cells.                        |
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| b.  **Most Noteworthy Findings Published in Report Year -- GRECC Core |
|     Staff as Co-Investigators on Projects with Non-GRECC PI\          |
|     ***(Please list five or fewer. For each noteworthy finding,       |
|     include the GRECC Core Staff name(s), journal reference, and a    |
|     JARGON-FREE description of the finding and its clinical or other  |
|     significance. Please limit your description of each noteworthy    |
|     finding to five lines or fewer)*                                  |
|                                                                       |
| -   Carroll C, Fluckey JD, Williams RH, Sullivan DH, Trappe TA. Human |
|     soleus and vastus lateralis muscle protein metabolism with an     |
|     amino acid infusion. Am J Physiol Endocrinol Metab                |
|     288:E479-E485, 2005. The calf muscles, compared with the thigh,   |
|     are less likely to hypertrophy in responsive to resistance        |
|     exercise (RE). We evaluated the change in the rate of protein     |
|     synthesis post-exercise in the soleus (S) compared to the vastus  |
|     lateralis (VL) and the effect of amino acid infusions on these    |
|     rates. We found that the amino acid infusions stimulated protein  |
|     synthesis to a greater extend in the VL compared to S. It was     |
|     also found that the S contained more total and phosphorylated     |
|     eukaryotic translational initiation factor 4E-binding protein-1   |
|     which may account for the differences in muscle responsiveness    |
|     identified. This study serves as the foundation for more in-depth |
|     investigators of the anabolic control factors in muscle.          |
|                                                                       |
| -   Richards, K.C., Beck C., O'Sullivan P., Shue, V.M.. (2005) Effect |
|     of individualized social activity on sleep in nursing home        |
|     residents with dementia.  *J Am Geriatric Soc.* 53(9), 1510-1517. |
|     Sleep is severely disturbed in nursing home residents with        |
|     dementia and the consequences are serious: difficulty             |
|     concentrating and remembering, anxiety, depression, poor quality  |
|     of life, weakened immunity, and risk of falls. The purpose for    |
|     this randomized controlled trial of 147 such residents was to     |
|     determine if increased daytime social activities improved their   |
|     sleep. Those in the daytime social activities group had           |
|     significant reductions in daytime napping, fell asleep faster at  |
|     night, and awakened in the middle of the night less often when    |
|     compared to the control group. Increased daytime social           |
|     activities improve sleep in nursing home residents with dementia  |
|     without the dangerous side effects of medications.                |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   Wainwright MS, Craft JM, **Griffin WST**, Marks A, Pineda J,      |
|     Padgett KR, Van Eldik, LJ 2004 Increased susceptibility of S100B  |
|     transgenic mice to perinatal hypoxia-ischemia. Ann Neurol         |
|     56:61-67.  We demonstrated the possibility that S100B serves as a |
|     driving function for promoting neuropathological changes in the   |
|     head trauma stroke model and by analogy in head trauma.           |
|                                                                       |
| -   Liu H, Liu K, **Bodenner DL** *The Estrogen Receptor Inhibits     |
|     Interleukin-6 Gene Expression by Disruption of  NF-KB             |
|     Transactivation*.  Cytokine 2005 31 (4) 251-257.  Interleukin-6   |
|     (IL-6) is involved in many inflammatory diseases including        |
|     Paget's disease, osteoporosis, heart disease and many forms of    |
|     cancer.  We demonstrate that the estrogen receptor directly       |
|     interferes with a regulator of the expression of a factor called  |
|     NF-KB, which in turn downregulates IL-6.                          |
|                                                                       |
| -   [Thal DR, Schultz C, Botez G, Del Tredici K, Mrak RE, **Griffin   |
|     WST**, Wiestler OD, Braak H, Ghebremedhin                         |
|     E.](http://www.ncbi.nlm.nih.gov/entrez/query.fcg                  |
| i?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15885064&query_hl=1) |
|     2005 The impact of argyrophilic grain disease on the development  |
|     of dementia and its relationship to concurrent Alzheimer\'s       |
|     disease-related pathology. Neuropathol Appl Neurobiol. 31:270-9.  |
|     In this report, we show the impact of comorbid brain conditions   |
|     that contribute to the development of Alzheimer dementia          |
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| **6. EDUCATION**                                                      |
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| a.  **Innovations in Educational Activities Implemented During Report |
|     Year**\                                                           |
|     (*Please list up to five. For each, describe the innovation and   |
|     the context in which it was innovative. Please limit your         |
|     description of each innovation to five lines or fewer):*          |
|                                                                       |
| -   The Eugene Towbin Honorary Lecture for the Geriatric Medicine     |
|     Update series continues in February. This is an innovative way to |
|     honor someone who was so essential to the concept and development |
|     of the GRECC program. The speaker was Dr. Sue T. Griffin for a    |
|     program that addressed new advances in the diagnosis and          |
|     treatment of Alzheimer's Disease.                                 |
|                                                                       |
| -   Pilot testing Geriatric Self-Study program for CNAs; participants |
|     are from the Jackson VAMC. This program is a patient-focused      |
|     version of a self-study (AR-GEMS) written at an appropriate       |
|     reading level for paraprofessionals. Use of this type of program  |
|     for CNA training is very unique.                                  |
|                                                                       |
| -   Broadcast live video teleconferences to VISN 16 facilities on     |
|     Vision Conditions in Older Adults, Diagnosis and Management of    |
|     Arthritis, Sleep Behavior Challenges in Older Adults, and         |
|     Bioterrorism Preparedness. These topics are important, relevant   |
|     information disseminated widely throughout VISN 16; offers CE     |
|     without travel.                                                   |
|                                                                       |
| -   Enrolled health care practitioners in AR-GEMS (geriatrics         |
|     self-study program) training to staff at Fayetteville, Jackson,   |
|     and Muskogee VAMCs; this program allows individual participants   |
|     to complete several mandatory modules including a clinical        |
|     observation and coaching and mentoring workshop in Little Rock    |
|     and select from several elective modules that best meets their    |
|     learning needs. Innovation is the individualization of the        |
|     program.                                                          |
|                                                                       |
| -   Established an on-line Post-test, Evaluation and Participant      |
|     Profile option for health practitioners who have viewed one of    |
|     the tapes we have exported to VISN 16 facilities. Individuals can |
|     view the program locally and then log on to do the tests,         |
|     evaluations, and profiles; if they pass the test and complete the |
|     other forms, they can print their CE certificate of completion    |
|     with the CE hours immediately from the website.                   |
+-----------------------------------------------------------------------+
| b.  **Exportable Educational Products First Available for             |
|     Distribution in Report Year**\                                    |
|     *(Please list your most important products. Please limit to five. |
|     Your description of each item should succinctly summarize the     |
|     content, target audience, format, and product evaluation results  |
|     if any. You may include products developed in prior years ONLY IF |
|     THIS IS THE FIRST YEAR they have been available for distribution. |
|     Please limit each description to five lines or fewer)*:           |
|                                                                       |
| The following (3) videotapes require evaluations from each viewer as  |
| well as review from accrediting organizations from which CE credit is |
| approved.                                                             |
|                                                                       |
| -   CARDIOVASCULAR DISEASE IN OLDER ADULTS -- a 100 minute videotape  |
|     derived from a live video teleconference for health professionals |
|     that featured Dr. Jeanne Wei and other cardiologists; the topics  |
|     covered include coronary artery disease, congestive heart         |
|     failure, etiologies of myocardial ischemia, and appropriate       |
|     treatments for older adults. This is available on VHS tape or DVD |
|     with printed handout materials; it is approved for 2 hours of CE. |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   REHABILITATION EXERCISE -- a 100 minute program for health        |
|     professionals that reviews the role of exercise in rehabilitation |
|     for older adults. Topics include strength training and resistive  |
|     exercise, range of motion and restorative exercise, aquatic       |
|     exercises and tai chi with demonstrations of use of equipment and |
|     exercise and discussion of the benefits of these rehabilitation   |
|     techniques. This is available on VHS tape or DVD with printed     |
|     handout material; it is approved for 2 hours of CE.               |
|                                                                       |
| -   NUTRITIONAL CHALLENGES IN OLDER ADULTS -- a 100 minute program    |
|     that features Dr. Ronni Chernoff (Little Rock) and Dr. Michele    |
|     Saunders (San Antonio GRECC) as well as a UAMS faculty person in  |
|     speech pathology. It is targeted for health professionals and     |
|     covers changes in nutrient requirements and ability to obtain     |
|     nutritious foods, oral health challenges and their impact on      |
|     nutrition, and swallowing disorders in older adults. This is      |
|     available on VHS tape or DVD with printed handout material; it is |
|     approved for 2 hours of CE.                                       |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   LAMINATED GERIATRIC ASSESSMENT POCKET GUIDES AND FALLS PREVENTION |
|     POCKET GUIDES were produced this year in collaboration with the   |
|     Sepulveda GRECC and the Little Rock VA Falls nurses. These are    |
|     designed for physicians and APNs and fit easily into a lab coat   |
|     pocket. They are given to 3^rd^ year medical students, fellows,   |
|     and clinical staff as a tool in their clinical practice. These    |
|     have been disseminated to VISN 16 facilities. All scales used in  |
|     this pocket guide have been validated.                            |
+-----------------------------------------------------------------------+
| **7. CLINICAL INNOVATIONS**                                           |
+-----------------------------------------------------------------------+
| **NEW DEFINITION:** A "Clinical Innovation" is an untested,           |
| GRECC-initiated clinical effort that ideally is related to one of the |
| GRECC's research foci. A Clinical Innovation may be a wholly original |
| clinical program or an original aspect of or variation on an          |
| established program. A Clinical Innovation must incorporate an        |
| evaluation plan for assessing the innovation's efficacy so that, if   |
| the innovation is demonstrated to be an improvement over an existing  |
| approach to care, there is a basis on which it can be exported for    |
| implementation elsewhere.                                             |
+-----------------------------------------------------------------------+
| a.  **Clinical Innovations Underway in Report Year**\                 |
|     *(list all Clinical Innovations underway during the report year.  |
|     For each, indicate whether the innovation is [N]{.underline}ew or |
|     [O]{.underline}ngoing in the report year. Please describe each    |
|     innovation in five lines or fewer)*:                              |
|                                                                       |
| -   **Telehealth Assessment:** Our geriatric assessment was performed |
|     using vided-to-video assessment of behavioral and cognitive       |
|     status. Technology was available to perform port-to-port          |
|     tele-video interaction between an experienced masters level       |
|     speech pathologist and a patient at a remote site.                |
|     Neurobehavioral tests were chosen that are typically used in      |
|     geriatric assessment. (ongoing)                                   |
|                                                                       |
| -   **Memory Assessment in Elderly Veterans**. There are few          |
|     physiological markers that can aid in diagnosing and predicting   |
|     memory difficulties in normal aging, mild cognitive impairment,   |
|     and dementia (includes Alzheimer's Disease). We are assessing     |
|     whether EEG can be used to objectively measure physiological      |
|     markers of brain activity associated with memory loss and/or      |
|     predict a susceptibility to future memory dysfunction. (new)      |
|                                                                       |
| -   **Cognitive Decline In Older Veterans with PTSD:** The            |
|     neuropsychological testing battery was verified as an effective   |
|     instrument in a limited cohort and will now be administered this  |
|     year to a larger cohort of aging PTSD patients for more           |
|     definitive assessment. (ongoing)                                  |
|                                                                       |
| -   **Threatening Memories in the Elderly**: We are assessing how     |
|     previous threatening memories experienced during military         |
|     deployment are now being triggered as veterans age resulting in   |
|     distressing recall of traumatic events. We are using EEG          |
|     paradigms to assess who is at risk for these emotional memory     |
|     triggers. (new)                                                   |
+-----------------------------------------------------------------------+
| b.  **Evaluation Results of Clinical Innovations listed in the        |
|     preceding box\                                                    |
|     ***(for each clinical innovation listed in 7-a above, summarize   |
|     evaluation outcome(s) identified in the report year, in five      |
|     lines or fewer. Please specify "no evaluation results" for any    |
|     innovation for which that is the case)*                           |
|                                                                       |
| -   **Telehealth Assessment of Behavioral and Cognitive Status in the |
|     Elderly:** Demonstrated that, given the video telehealth          |
|     equipment available, there is a core set of behavioral tests that |
|     can be reliably administered via video in the elderly. There were |
|     also specific tests that could not be reliably administered by    |
|     video due to deafness/hearing loss in the patients and/or         |
|     technical sound limitations of the equipment.                     |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   **Memory Assessment in Elderly Veterans**. There are few          |
|     physiological markers that can aid in diagnosing and predicting   |
|     memory difficulties in normal aging, mild cognitive impairment,   |
|     and dementia (includes Alzheimer's Disease). We are assessing     |
|     whether EEG can be used to objectively measure physiological      |
|     markers of brain activity associated with memory loss and/or      |
|     predict a susceptibility to future memory dysfunction. No         |
|     evaluation results are available as this project has just been    |
|     initiated.                                                        |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   **Cognitive Decline In Older Veterans with PTSD:** The            |
|     neuropsychological testing battery was verified as an effective   |
|     instrument in a limited cohort. In this cohort, the original      |
|     neuropsychological battery was evaluated and was focused down to  |
|     those tests sensitive for determining memory decline reported by  |
|     the patients. This targeted battery will now be administered this |
|     year to a larger cohort of aging PTSD patients for more           |
|     definitive assessment.                                            |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   **Threatening Memories in the Elderly:** No evaluation results    |
|     are available as this project has just been initiated.            |
+-----------------------------------------------------------------------+
| c.  **Clinical Innovation Exported in Report Year**\                  |
|     *(Please list up to five examples. In three lines or less for     |
|     each example, name or describe the innovation, identify the name  |
|     of the VA or non-VA facility to which it was exported, and the    |
|     method of export)*:                                               |
|                                                                       |
| -   **Telehealth** initiative results are under review for            |
|     publication. In addition, a proposal to expand this initiative is |
|     being re-reviewed at the VISN level. Exporting of results is      |
|     pending this review.                                              |
|                                                                       |
| -   **Memory Assessment in Elderly Veterans:** This has not been      |
|     exported as the study is presently being conducted with           |
|     evaluation and exporting to follow.                               |
|                                                                       |
| -   **Cognitive Decline In Older Veterans with PTSD:** The present    |
|     study is being performed, this year, with results to be exported  |
|     following this study.                                             |
|                                                                       |
| -   **Threatening Memories in the Elderly:** The present study is     |
|     being performed, this year, with results to be exported following |
|     this study.                                                       |
+-----------------------------------------------------------------------+
| **8. CONSULTATION AND OUTREACH**                                      |
+-----------------------------------------------------------------------+
| **DEFINITIONS:**                                                      |
|                                                                       |
| **"Consultation"** for this section of the report has occurred when   |
| GRECC staff has materially assisted in the development of a non-GRECC |
| research, education or clinical program **[within the host            |
| VAMC.]{.underline}**                                                  |
|                                                                       |
| **"Outreach"** for this section of the report has occurred when GRECC |
| staff has materially assisted in the development of a non-GRECC       |
| research, education or clinical program **[at a facility other than   |
| the host VAMC.]{.underline}**                                         |
+-----------------------------------------------------------------------+
| **Note:**                                                             |
|                                                                       |
| **for the 2005 Annual Report,**                                       |
|                                                                       |
| **Consultation and Outreach activity**                                |
|                                                                       |
| **will NOT be reported here.**                                        |
|                                                                       |
| **It will be reported via the Electronic Annual report Data Base.**   |
+-----------------------------------------------------------------------+