+-----------------------------------------------------------------------+
| ### GERIATRIC RESEARCH, EDUCATION AND CLINICAL CENTER                 |
|                                                                       |
| ### *Annual Report: Fiscal Year [2008]{.underline}                    |
| *![](media/image1.png){width="1.625in" height="0.2708333333333333in"} |
|                                                                       |
| ######## Part II: Accomplishments                                     |
+-----------------------------------------------------------------------+
| **NOTE:** The **GRECC Annual Report** reflects status and             |
| accomplishments of **[GRECC Core Staff]{.underline} \*** (as defined  |
| below) [only]{.underline}. The **"Report Year"** is from [October 1,  |
| 2007 through September 30, 2008]{.underline}.                         |
|                                                                       |
| You are welcome to use this report format for your own internal       |
| reporting purposes,                                                   |
|                                                                       |
| in which case you may exceed the recommended limits of numbers of     |
| responses and their length                                            |
|                                                                       |
| ("list no more than..." "Describe the three most important..." "limit |
| your response to five lines or fewer")                                |
|                                                                       |
| ***\-\--BUT\--***                                                     |
|                                                                       |
| Please limit up **to ten pages or fewer** the version **SUBMITTED TO  |
| VACO**.                                                               |
+-----------------------------------------------------------------------+
| **\*[GRECC Core Staff ]{.underline}**is limited to either **Primary   |
| Core**, **Affiliated 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.                           |
+-----------------------------------------------------------------------+
| **[IMPORTANT:]{.underline} Throughout this report, please             |
| AVOID/MINIMIZE JARGON. Each response is much more likely to be        |
| included in secondary communications derived from the Annual Reports  |
| if it can be readily understood by a non-technical readership.**      |
+-----------------------------------------------------------------------+
| **1. GRECC NAME/LOCATION**                                            |
+-----------------------------------------------------------------------+
| a.  **GRECC Name:** GRECC, NF/SGVHS, Gainesville, Florida             |
|                                                                       |
| b.  **Location** *(facility, VISN)*: NF/SGVHS, VISN 8                 |
+-----------------------------------------------------------------------+
| **2. CONTACT PERSON**                                                 |
+-----------------------------------------------------------------------+
| a.  **Name:** Ruth Franklin                                           |
|                                                                       |
| b.  **Position:** Administrative Officer                              |
|                                                                       |
| c.  **Phone, e-mail:** (352) 376-1611 Extension 4328                  |
|                                                                       |
| ruth.franklin@va.gov                                                  |
+-----------------------------------------------------------------------+
| +--                                                                   |
| ----------------------------------------------------+---+---+---+---+ |
| | *                                                                   |
| *3. GRECC FOCUS AREA(S)**                           |   |   |   |   | |
| +--                                                                   |
| ----------------------------------------------------+---+---+---+---+ |
| | *                                                                   |
| *NOTE:** Please succinctly list your GRECC's Focus  |   |   |   |   | |
| | A                                                                   |
| rea(s), one per line below. After each focus area   |   |   |   |   | |
| | l                                                                   |
| isted, please indicate with a check mark (****)    |   |   |   |   | |
| | w                                                                   |
| hich of the research type(s) suitably describes the |   |   |   |   | |
| | w                                                                   |
| ork conducted (including planning, implementation,  |   |   |   |   | |
| | a                                                                   |
| nalysis, and dissemination/publication) within that |   |   |   |   | |
| | f                                                                   |
| ocus during the Report Year. Add additional lines   |   |   |   |   | |
| | b                                                                   |
| y positioning your cursor at the lower right side   |   |   |   |   | |
| | o                                                                   |
| f the table and striking the "Tab" key.             |   |   |   |   | |
| +--                                                                   |
| ----------------------------------------------------+---+---+---+---+ |
| | *                                                                   |
| *GRECC Focus Areas**                                | * |   |   |   | |
| |                                                                     |
|                                                     | * |   |   |   | |
| |                                                                     |
|                                                     | R |   |   |   | |
| |                                                                     |
|                                                     | e |   |   |   | |
| |                                                                     |
|                                                     | s |   |   |   | |
| |                                                                     |
|                                                     | e |   |   |   | |
| |                                                                     |
|                                                     | a |   |   |   | |
| |                                                                     |
|                                                     | r |   |   |   | |
| |                                                                     |
|                                                     | c |   |   |   | |
| |                                                                     |
|                                                     | h |   |   |   | |
| |                                                                     |
|                                                     | T |   |   |   | |
| |                                                                     |
|                                                     | y |   |   |   | |
| |                                                                     |
|                                                     | p |   |   |   | |
| |                                                                     |
|                                                     | e |   |   |   | |
| |                                                                     |
|                                                     | * |   |   |   | |
| |                                                                     |
|                                                     | * |   |   |   | |
| +--                                                                   |
| ----------------------------------------------------+---+---+---+---+ |
| |                                                                     |
|                                                     | > | > | > | > | |
| |                                                                     |
|                                                     |   |   |   |   | |
| |                                                                     |
|                                                     | * | * | * | * | |
| |                                                                     |
|                                                     | * | * | * | * | |
| |                                                                     |
|                                                     | B | A | H | R | |
| |                                                                     |
|                                                     | a | p | e | e | |
| |                                                                     |
|                                                     | s | p | a | h | |
| |                                                                     |
|                                                     | i | l | l | a | |
| |                                                                     |
|                                                     | c | i | t | b | |
| |                                                                     |
|                                                     | > | e | h | i | |
| |                                                                     |
|                                                     |   | d | > | l | |
| |                                                                     |
|                                                     | B | > |   | i | |
| |                                                                     |
|                                                     | i |   | S | t | |
| |                                                                     |
|                                                     | o | C | e | a | |
| |                                                                     |
|                                                     | m | l | r | t | |
| |                                                                     |
|                                                     | e | i | v | i | |
| |                                                                     |
|                                                     | d | n | i | o | |
| |                                                                     |
|                                                     | i | i | c | n | |
| |                                                                     |
|                                                     | c | c | e | * | |
| |                                                                     |
|                                                     | a | a | s | * | |
| |                                                                     |
|                                                     | l | l | * |   | |
| |                                                                     |
|                                                     | * | * | * |   | |
| |                                                                     |
|                                                     | * | * |   |   | |
| +--                                                                   |
| ----------------------------------------------------+---+---+---+---+ |
| | 1                                                                   |
| \. Prevention of age-related physical disability    | * | * |   |   | |
| | (                                                                   |
| e.g., exercise, male hormone replacement)           | * | * |   |   | |
| |                                                                     |
|                                                     | x | x |   |   | |
| |                                                                     |
|                                                     | * | * |   |   | |
| |                                                                     |
|                                                     | * | * |   |   | |
| +--                                                                   |
| ----------------------------------------------------+---+---+---+---+ |
| | 2                                                                   |
| \. Prevention and treatment of age-related          | * | * | * | * | |
| | c                                                                   |
| ognitive disability (e.g., stroke, dementia)        | * | * | * | * | |
| |                                                                     |
|                                                     | x | x | x | x | |
| |                                                                     |
|                                                     | * | * | * | * | |
| |                                                                     |
|                                                     | * | * | * | * | |
| +--                                                                   |
| ----------------------------------------------------+---+---+---+---+ |
| | 3                                                                   |
| \. End of life care                                 |   | * | * |   | |
| |                                                                     |
|                                                     |   | * | * |   | |
| |                                                                     |
|                                                     |   | x | x |   | |
| |                                                                     |
|                                                     |   | * | * |   | |
| |                                                                     |
|                                                     |   | * | * |   | |
| +--                                                                   |
| ----------------------------------------------------+---+---+---+---+ |
| | 4                                                                   |
| \. Self-Management of chronic health care           |   | * | * |   | |
| | c                                                                   |
| onditions                                           |   | * | * |   | |
| |                                                                     |
|                                                     |   | x | x |   | |
| |                                                                     |
|                                                     |   | * | * |   | |
| |                                                                     |
|                                                     |   | * | * |   | |
| +--                                                                   |
| ----------------------------------------------------+---+---+---+---+ |
| | 5                                                                   |
| \. Patient safety and healthcare quality            |   | * | * |   | |
| | i                                                                   |
| mprovement                                          |   | * | * |   | |
| |                                                                     |
|                                                     |   | x | x |   | |
| |                                                                     |
|                                                     |   | * | * |   | |
| |                                                                     |
|                                                     |   | * | * |   | |
| +--                                                                   |
| ----------------------------------------------------+---+---+---+---+ |
|                                                                       |
| +------------------------------------------------------------------+  |
| | **4. ADMINISTRATION**                                            |  |
| +------------------------------------------------------------------+  |
| | a.  **GRECC Impact on Host VAMC in Report Year***: list **the**  |  |
| |     **most important ways** in which the GRECC has had specific  |  |
| |     impact on **host VAMC's** research, staff education, program |  |
| |     evaluation, or clinical care improvements for elderly        |  |
| |     veterans (i.e., how the GRECC has "made a difference" in     |  |
| |     these areas within the entire host VAMC) during the Report   |  |
| |     Year. **Please limit your response to [5 or                  |  |
| |     fewer]{.underline} "ways"; and please limit your description |  |
| |     of each of the five "ways" to [five lines or                 |  |
| |     fewer]{.underline}. ***                                      |  |
| |                                                                  |  |
| | **1) Leadership in host VAMC research redesign (research):**     |  |
| | With the recruitment of Paul Hoffman as ACOS for Research, the   |  |
| | NF/SG VAMC is undergoing a complete redesign. Several GRECC      |  |
| | staff serve in leadership roles to facilitate this transition    |  |
| | including Stephen Nadeau, M.D. (Chair); Christy Carter, Ph.D.    |  |
| | serves Chair of the Research and Development (R&D) Committee;    |  |
| | Stephen Borst, Ph.D. is Chair of the IACUC R&D Committees;       |  |
| | Ronald Shorr, M.D., M.S. serves as member of the Budget          |  |
| | Committee.                                                       |  |
| |                                                                  |  |
| | **2) Mandatory Age-Related Competencies Course (staff            |  |
| | education):** All NF/SGVHS staff are required to take the        |  |
| | age-specific competencies course, which was developed by         |  |
| | Constance Uphold, Ph.D., ARNP, FAAN. Topics include age-related  |  |
| | physical cognitive and psychosocial changes. The course is       |  |
| | available in an online format and in a printed poster-format.    |  |
| |  All staff must complete a short post-test to complete the       |  |
| | training.                                                        |  |
| |                                                                  |  |
| | **3) Geriatric training for future NF/SG employees (staff        |  |
| | education):** We offer diverse interdisciplinary activities to   |  |
| | increase the age-specific competencies of students/trainees from |  |
| | various disciplines (e.g., pharmacy, social work, OT, speech     |  |
| | pathology, psychology, nursing, and optometry).  The impact of   |  |
| | these activities is that many of our trainees continue to work   |  |
| | in geriatrics and many become employees and work at our local    |  |
| | facility after graduation.                                       |  |
| |                                                                  |  |
| | **4) Mentoring junior investigators (research):** All GRECC      |  |
| | staff play a major role in research mentorship for NF/SG VAMC    |  |
| | trainees. Rebecca Beyth, MD, MSc, serves as primary HSR & D      |  |
| | mentor for 2 physicians in the medical service; Constance        |  |
| | Uphold, Ph.D., ARNP, FAAN and Ronald Shorr, MD, MS serve as      |  |
| | primary HSR & D mentors to junior investigators in the           |  |
| | RORC-REAP. Nihal Tumer, Ph.D. serves as a BLR & D mentor for 1   |  |
| | physician in the Medical Service and Stephen Nadeau, M.D.,       |  |
| | serves as mentor for several trainees in the Neurology Service   |  |
| | and the BRRC.                                                    |  |
| |                                                                  |  |
| | **5) Improving end-of-life care (staff education):** Dr. Leslye  |  |
| | Pennypacker, MD, played a major role in The End-of-Life Nursing  |  |
| | Education Consortium (ELNEC). ELNEC consists of educational      |  |
| | activities designed for nurses at our facility and includes      |  |
| | family support, pain management, and ethical issues aimed at     |  |
| | improving end-of-life care.                                      |  |
| +------------------------------------------------------------------+  |
| | b.  **GRECC Impact on VISN in the Report Year:** *list **the**   |  |
| |     **most important ways** in which the GRECC has had specific  |  |
| |     impact on the **host** **VISN's** research, staff education, |  |
| |     program evaluation, or clinical care improvements for        |  |
| |     elderly veterans (i.e., how the GRECC has "made a            |  |
| |     difference" in these areas within the entire host VISN)      |  |
| |     during the rating period. **Please limit your response to [5 |  |
| |     or fewer]{.underline} "ways"; and please limit your          |  |
| |     description of each of the five "ways" to [five lines or     |  |
| |     fewer]{.underline}. ***                                      |  |
| |                                                                  |  |
| | **1) Completion of VISN-wide educational needs assessment        |  |
| | (program evaluation):** Constance Uphold, Ph.D. in collaboration |  |
| | with the Miami GRECC developed and implemented a VISN 8          |  |
| | Geriatrics and Aging Needs Assessment for Primary Care           |  |
| | Providers. Providers identified age-related considerations in    |  |
| | drug therapy and Alzheimer's Disease as major areas needing      |  |
| | educational emphasis. Other topics included pain management,     |  |
| | prevention, and arthritis. This will improve content for future  |  |
| | VISN programs in aging.                                          |  |
| |                                                                  |  |
| | **2) Collaboration with VISN facilities and centers              |  |
| | (research):**                                                    |  |
| |                                                                  |  |
| | **2a) VA Caribbean Health System:** Drs. Shorr, Uphold, and a    |  |
| | post-doctoral research fellow, Dr. Ivette Freytes, Ph.D.         |  |
| | presented lectures on aging at the VA Caribbean Healthcare       |  |
| | System. In addition, Dr. Pennypacker provided MICU templates and |  |
| | order sets that we use in terminally ill ICU patients at         |  |
| | NF/SGVHS for use in the VA Caribbean Healthcare System. Finally, |  |
| | we collaborated with clinicians in the VA Caribbean Healthcare   |  |
| | System to use a culturally-sensitive model of care that was      |  |
| | successful in improving prevention of stroke risk factors at the |  |
| | NF/SGVHS.                                                        |  |
| |                                                                  |  |
| | **2b) VISN 8 Patient Safety Center (Tampa):** Dr. Shorr is a     |  |
| | major collaborator with the VISN 8 patient safety center. He     |  |
| | serves on the advisory board, is a co-investigator on research   |  |
| | projects, and serves on the faculty of their annual Falls        |  |
| | conference.                                                      |  |
| +------------------------------------------------------------------+  |
| | c.  **GRECC Trend-Setting Innovations since October 1,           |  |
| |     [2003]{.underline}**: *list **the** **most significant**     |  |
| |     GRECC research, education or clinical innovations in the     |  |
| |     past five years. For each item, provide date or date range,  |  |
| |     GRECC core staff responsible, and a description. **Please    |  |
| |     limit your response to 5 or fewer innovations; and please    |  |
| |     limit each of the five innovation descriptions to five lines |  |
| |     or fewer. ***                                                |  |
| |                                                                  |  |
| | **1) Viral gene delivery systems to study the effects of         |  |
| | age-related gains in adiposity and declining function in rodent  |  |
| | models (Focus area 1) .** Drs. Tumer and Carter are              |  |
| | collaborating with colleagues at UF in developing novel          |  |
| | approaches to age-related obesity and disability. These studies  |  |
| | will help to guide future approaches to the prevention of        |  |
| | hypertension and functional decline in our older veterans, due   |  |
| | to age-related obesity.                                          |  |
| |                                                                  |  |
| | **2) Direct-to-consumer approaches to improve healthcare (Focus  |  |
| | areas 2, 4, 5).** Drs. Beyth, Uphold and Shorr, along with       |  |
| | colleagues in the College of Journalism & Communication at UF,   |  |
| | are developing materials designed to empower patients to "ask    |  |
| | their provider" for evidence-based therapy such as oral          |  |
| | anticoagulation in atrial fibrillation. This approach is         |  |
| | informed by the success of direct-to-consumer (DTC) advertising  |  |
| | of pharmaceuticals.                                              |  |
| +------------------------------------------------------------------+  |
| | **5. RESEARCH**                                                  |  |
| +------------------------------------------------------------------+  |
| | **a. Key Findings Published in the Report Year on projects for   |  |
| | which GRECC Core Staff was PI or Co-PI:\                         |  |
| | ***list **five or fewer;** for each item provide GRECC Core      |  |
| | Staff name(s), journal reference, and description of topic/      |  |
| | method/results/clinical significance. Please limit each response |  |
| | to [5 lines or fewer]{.underline}.*                              |  |
| |                                                                  |  |
| | **1) You T, Sonntag WE, Leng X, [Carter CS.]{.underline}         |  |
| | Lifelong caloric restriction and interleukin-6 secretion from    |  |
| | adipose tissue: effects on physical performance decline in aged  |  |
| | rats. *J Gerontol A Biol Sci Med* Sci. 2007 Oct;62(10):1082-7    |  |
| | (Focus area 1):** We investigated whether caloric restriction    |  |
| | (CR) improves physical performance in a rodent model of aging,   |  |
| | and whether this effect is accompanied with a decrease in        |  |
| | visceral adipose tissue production of proinflammatory cytokines. |  |
| | Compared to AL rats, CR rats had lower fat mass, fat to lean     |  |
| | ratio, adipose tissue secretion of interleukin-6, and            |  |
| | circulating levels of C-reactive protein, and higher physical    |  |
| | performance scores. Therefore, CR may be an effective            |  |
| | intervention for improving functional and inflammatory status    |  |
| | into advanced age.                                               |  |
| |                                                                  |  |
| | **2) [Shorr RI]{.underline}, Mion LC, Chandler AM, Rosenblatt    |  |
| | LC, Lynch D, Kessler LA. Improving the capture of fall events in |  |
| | hospitals: combining a service for evaluating inpatient falls    |  |
| | with an incident report system. *J Am Geriatric Soc.* 2008       |  |
| | Apr;56(4):701-4. (Focus area 5):** We determined the utility of  |  |
| | a fall evaluation service to improve the report of falls in      |  |
| | acute care. Nursing staff were instructed to notify, using a     |  |
| | pager, a trained nurse \"fall evaluator.\" In the 16 nursing     |  |
| | units studied, the percent increase of captured falls using the  |  |
| | combined data sources versus the incident reporting system alone |  |
| | ranged from 13% to 125%. We conclude that incident reports       |  |
| | underestimate both injurious and non-injurious falls in acute    |  |
| | care settings and should not be used as the sole source of data  |  |
| | for research or quality improvement initiatives.                 |  |
| |                                                                  |  |
| | **3) Braun UK, [Beyth RJ]{.underline}, Ford ME, McCullough LB.   |  |
| | Voices of African American, Caucasian, and Hispanic surrogates   |  |
| | on the burdens of end-of-life decision making. *J Gen Intern     |  |
| | Med.* 2008 Mar;23(3):267-74. (Focus areas 3 and 5) :**           |  |
| | End-of-life decisions are frequently made by patients\'          |  |
| | surrogates. Race and ethnicity may affect such decision making.  |  |
| | Few studies have described how different racial/ethnic groups    |  |
| | experience end-of-life surrogate decision making. Regardless of  |  |
| | race/ethnicity, surrogates for seriously ill patients appeared   |  |
| | to experience increased significant, multidimensional burdens of |  |
| | decision making under conditions of uncertainty about a          |  |
| | patient\'s preferences. This aspect of the burden of surrogate   |  |
| | decision making may not be fully appreciated by physicians.      |  |
| |                                                                  |  |
| | []{.mark}                                                        |  |
| |                                                                  |  |
| | **4) [Beyth, R.J.]{.underline}, Wing, K, & Uphold, C.R. (        |  |
| | 2007).  Applying direct-to-consumer marketing techniques to      |  |
| | stroke prevention education.  *Federal Practitioner, 24*(12),    |  |
| | 47-48, 51 (Focus areas 2, 4, and 5).** This describes innovative |  |
| | GRECC work which seeks to empower patients to take a more active |  |
| | role in stroke prevention.                                       |  |
| |                                                                  |  |
| | **Yarrow JF, Conover CF, Purandare AV, Bhakta AM, Zheng N,       |  |
| | Conrad B, Altman MK, Franz SE, Wronski TJ, [Borst                |  |
| | SE]{.underline}. Supraphysiological testosterone enanthate       |  |
| | administration prevents bone loss and augments bone strength in  |  |
| | gonadectomized male and female rats. *Am J Physiol Endocrinol    |  |
| | Metab*. 2008 Nov;295(5):E1213-22 (Focus area 1).** High-dose     |  |
| | testosterone enanthate (TE) may prevent hypogonadism-induced     |  |
| | osteopenia. In males and females, TE increased femoral length    |  |
| | and femoral maximal strength to above that of Sham and           |  |
| | gonadectomy animals while preventing the loss of femoral         |  |
| | stiffness in females. In conclusion, TE administration appears   |  |
| | protective of cancellous bone in male rats and augments cortical |  |
| | bone strength in both sexes.                                     |  |
| |                                                                  |  |
| | []{.mark}                                                        |  |
| +------------------------------------------------------------------+  |
| | **b. Key Findings Published in the Report Year on work in which  |  |
| | GRECC Core Staff served as Co-Investigators to a Non-GRECC PI:** |  |
| | *list **five or fewer**; for each item provide GRECC Core Staff  |  |
| | name(s), journal reference, and description of                   |  |
| | topic/method/results/clinical significance. Please limit each    |  |
| | response to [5 lines or fewer]{.underline}.*                     |  |
| |                                                                  |  |
| | **Xu J, Knutson MD, Carter CS, Leeuwenburgh C. Iron accumulation |  |
| | with age, oxidative stress and functional decline. PLoS ONE.     |  |
| | 2008 Aug 6;3(8):e2865.** Total non-heme iron levels in the       |  |
| | gastrocnemius muscle of AL rats increased progressively with     |  |
| | age. Between 29 and 37 months of age, the non-heme iron          |  |
| | concentration increased by approximately 200% in AL-fed rats.    |  |
| | Increase in non-heme iron and oxidized RNA levels and decrease   |  |
| | in sarcopenia indices were all attenuated in the calorie         |  |
| | restriction (CR) rats. These findings strongly suggest that the  |  |
| | age-related iron accumulation in muscle contributes to increased |  |
| | oxidative damage and sarcopenia, and that CR effectively         |  |
| | attenuates these negative effects.                               |  |
| |                                                                  |  |
| | **Shapiro A, Matheny M, Zhang Y, Tümer N, Cheng KY, Rogrigues E, |  |
| | Zolotukhin S, Scarpace PJ. Synergy between leptin therapy and a  |  |
| | seemingly negligible amount of voluntary wheel running prevents  |  |
| | progression of dietary obesity in leptin-resistant               |  |
| | rats.Diabetes. 2008 Mar;57(3):614-22. Epub 2007 Dec 17.** We     |  |
| | examined whether chronic leptin treatment of diet-induced obese  |  |
| | rats promotes or alleviates the susceptibility to continued      |  |
| | high-fat feeding. Second, we examined if voluntary wheel running |  |
| | is beneficial in reducing the trajectory of weight gain in       |  |
| | high-fat-raised leptin-resistant rats. Chronic leptin treatment  |  |
| | in diet-induced obese rats accelerates dietary obesity. However, |  |
| | leptin combined with wheel running prevents further dietary      |  |
| | weight gain. Thus, this combination therapy may be a viable      |  |
| | anti-obesity treatment.                                          |  |
| |                                                                  |  |
| | **Powers ME, Yarrow JF, McCoy SC, Borst SE. Growth hormone       |  |
| | isoform responses to GABA ingestion at rest and after exercise.  |  |
| | Med Sci Sports Exerc. 2008 Jan;40(1):104-10.** We tested whether |  |
| | GABA ingestion stimulates immunoreactive GH (irGH) and           |  |
| | immunofunctional GH (ifGH) release at rest and that GABA         |  |
| | augments the resistance exercise-induced irGH/ifGH responses in  |  |
| | men. Our data indicate that ingested GABA elevates resting and   |  |
| | postexercise irGH and ifGH concentrations. The extent to which   |  |
| | irGH/ifGH secretion contributes to skeletal muscle hypertrophy   |  |
| | is unknown, although augmenting the postexercise irGH/ifGH       |  |
| | response may improve resistance training-induced muscular        |  |
| | adaptations.                                                     |  |
| |                                                                  |  |
| | **Schulman S, Beyth RJ, Kearon C, Levine MN; American College of |  |
| | Chest Physicians.Chest. Hemorrhagic complications of             |  |
| | anticoagulant and thrombolytic treatment: American College of    |  |
| | Chest Physicians Evidence-Based Clinical Practice Guidelines     |  |
| | (8th Edition). 2008 Jun;133(6 Suppl):257S-298S.** Bleeding is    |  |
| | the major complication of anticoagulant and fibrinolytic         |  |
| | therapy. The criteria for defining the severity of bleeding vary |  |
| | considerably between studies, accounting in part for the         |  |
| | variation in the rates of bleeding reported. Thrombolytic        |  |
| | therapy increases the risk of major bleeding 1.5-fold to         |  |
| | threefold in patients with acute venous thromboembolism,         |  |
| | ischemic stroke, or ST-elevation myocardial infarction.          |  |
| |                                                                  |  |
| | **Strotmeyer ES, de Rekeneire N, Schwartz AV, Faulkner KA,       |  |
| | Resnick HE, Goodpaster BH, Shorr RI, Vinik AI, Harris TB, Newman |  |
| | AB. Diabetes Care. The relationship of reduced peripheral nerve  |  |
| | function and diabetes with physical performance in older white   |  |
| | and black adults: the Health, Aging, and Body Composition        |  |
| | (Health ABC) study. 2008 Sep;31(9):1767-72. Epub 2008.** Poor    |  |
| | peripheral nerve function is prevalent in diabetes and older     |  |
| | populations, and it has great potential to contribute to poor    |  |
| | physical performance. Cross-sectional analyses were done for the |  |
| | Health, Aging, and Body Composition Study participants (aged     |  |
| | 73-82 years). We found that peripheral nerve function accounts   |  |
| | for a portion of worse physical performance in diabetes and may  |  |
| | be directly associated with physical performance in older        |  |
| | diabetic and nondiabetic adults. The impact of peripheral nerve  |  |
| | function on disability should be evaluated in older adults.      |  |
| |                                                                  |  |
| | []{.mark}                                                        |  |
| +------------------------------------------------------------------+  |
| | **6. EDUCATION**                                                 |  |
| +------------------------------------------------------------------+  |
| | **NOTE**: **DO NOT** list trainee and conference data            |  |
| | here**\--**those data are reported in the GRECC Electronic       |  |
| | Database.                                                        |  |
| |                                                                  |  |
| | **NOTE: You may list educational activities here even if they    |  |
| | were supported by funds that qualified for inclusion in the      |  |
| | ePROMISE (RDIS) database if you wish.**                          |  |
| +------------------------------------------------------------------+  |
| | +-------------------------------------------------------------+  |  |
| | | a.  **Innovations in Educational Activities Implemented     |  |  |
| | |     during the Report Year** *(list five or fewer. Please   |  |  |
| | |     limit each item to [5 lines or fewer]{.underline} and   |  |  |
| | |     include clarification of how each activity is           |  |  |
| | |     innovative.)*                                           |  |  |
| | |                                                             |  |  |
| | | **1) Educational activities and collaborations with the     |  |  |
| | | University of Florida, College of Journalism and            |  |  |
| | | Communication to increase professionals understanding of    |  |  |
| | | social marketing theory, implementation science, and        |  |  |
| | | strategies to change patients' and providers' behavior.**   |  |  |
| | | Examples are the following: (1) presentations and           |  |  |
| | | consultation with C. Bennett, MD, PhD, internationally      |  |  |
| | | recognized researcher in behavioral change; (2) Published   |  |  |
| | | article, "Applying direct-to-consumer marketing techniques  |  |  |
| | | to stroke prevention education" in the *Federal             |  |  |
| | | Practitioner, (3)* GRECC audio-conference, entitled         |  |  |
| | | "Activating Patients to Improve Healthcare: Lessons from    |  |  |
| | | Direct-to-Consumer Marketing of Pharmaceuticals," and (4)   |  |  |
| | | oral presentations and poster sessions on implementation    |  |  |
| | | science strategies at professional conferences and          |  |  |
| | | seminars.                                                   |  |  |
| | |                                                             |  |  |
| | | **2) Model to increase GRECC fellows understanding and      |  |  |
| | | excitement of research and academic geriatrics.** Examples  |  |  |
| | | include the following: (1) weekly "VA/UF interdisciplinary  |  |  |
| | | aging and rehabilitation research" seminar series, (2)      |  |  |
| | | bi-weekly brown-bag seminar series "Research Works in       |  |  |
| | | Progress" (3) weekly small group conferences in which the   |  |  |
| | | fellows learn basic research theories and methods,          |  |  |
| | | including "hands-on" experiences using SAS to analyze       |  |  |
| | | datasets, and (4) journal clubs in which the fellows learn  |  |  |
| | | how to critique research manuscripts and how to use         |  |  |
| | | research findings to improve their practice, (5) hands-on   |  |  |
| | | experience of conducting research project in collaboration  |  |  |
| | | with senior researchers, and (5) participation in GRECC     |  |  |
| | | Poster Day.                                                 |  |  |
| | |                                                             |  |  |
| | | **3) Interdisciplinary approaches to increase knowledge of  |  |  |
| | | aging and geriatrics amongst young healthcare               |  |  |
| | | professionals**. We offered a weekly series of              |  |  |
| | | interdisciplinary geriatric conferences. We had several     |  |  |
| | | informal, networking experiences to increase                |  |  |
| | | interdisciplinary dialogue and collaboration, such as the   |  |  |
| | | "Welcome" luncheon and the "pot-luck" dinner outside the    |  |  |
| | | VA. We matched GRECC preceptors with GRECC trainees/fellows |  |  |
| | | to develop and implement a research or education/clinical   |  |  |
| | | project related to geriatrics. Our culminating              |  |  |
| | | interdisciplinary educational activity was the GRECC Poster |  |  |
| | | and Recognition Day.                                        |  |  |
| | |                                                             |  |  |
| | | **4) VA GRECC and University of Florida, Department of      |  |  |
| | | Aging Geriatric Lectures for Anesthesiology Residents.** We |  |  |
| | | collaborated with the UF anesthesiology to present a series |  |  |
| | | of seven lectures (e.g., epidemiology and physiology of     |  |  |
| | | aging, ethical issues related to aging, post-op delirium,   |  |  |
| | | psychosocial aspects of aging) to VA and UF anesthesiology  |  |  |
| | | residents and faculty members. The capstone lecture was a   |  |  |
| | | clinical geriatrics case conference that was led by a       |  |  |
| | | geriatrician and an anesthesiologist. The lecture series    |  |  |
| | | had 321 attendees. The evaluations were positive.           |  |  |
| | +-------------------------------------------------------------+  |  |
| | | b.  **Exportable Educational Products First Available for   |  |  |
| | |     Distribution in Report Year** *List five or fewer of    |  |  |
| | |     the most important products. For each item, limit the   |  |  |
| | |     response to five lines summarizing content, target      |  |  |
| | |     audience, format, and product evaluation plan and       |  |  |
| | |     results. **Include educational products developed in    |  |  |
| | |     previous years ONLY if this is the [first               |  |  |
| | |     year]{.underline} they have been available for          |  |  |
| | |     distribution.***                                        |  |  |
| | |                                                             |  |  |
| | | **1) Online Training: "Successful Dementia Care: Behavioral |  |  |
| | | Management":** This online course is targeted to nursing    |  |  |
| | | assistants, registered nurses, and advanced practice nurses |  |  |
| | | who work in nursing homes and other long-term care          |  |  |
| | | settings. The course is designed to positively change       |  |  |
| | | staff's attitudes about caring for patients with dementia.  |  |  |
| | | The online evaluation survey results demonstrated that this |  |  |
| | | course is understandable and has led to changes in nursing  |  |  |
| | | care.                                                       |  |  |
| | |                                                             |  |  |
| | | **2) Online Mandatory Training: Age-Specific                |  |  |
| | | Competencies**: This online course was revised with new     |  |  |
| | | slides and information and is available for all NF/SGVHS    |  |  |
| | | employees through EES. Based on evaluations, the course     |  |  |
| | | post-test was revised. We are currently working with the    |  |  |
| | | patient education and medical media departments to develop  |  |  |
| | | an additional on-line course and poster for "age-specific"  |  |  |
| | | mandatory training that will be at a lower literacy level   |  |  |
| | | and targeted to auxiliary personnel such as the kitchen and |  |  |
| | | custodial staff.                                            |  |  |
| | |                                                             |  |  |
| | | **3) Spanish-Language Community Reintegration Resource      |  |  |
| | | Guide (funded by two rapid response grants from HSR&D       |  |  |
| | | QUERI) for OEF/OIF veterans and family members living in    |  |  |
| | | Puerto Rico**. Although not specifically targeted to the    |  |  |
| | | aging population, some OEF/OIF veterans are over the age of |  |  |
| | | 50 years and many family members are part of the geriatric  |  |  |
| | | population. We developed and are disseminating an           |  |  |
| | | attractive, culturally relevant booklet/guide written in    |  |  |
| | | Spanish, which included 13 consumer guides, a list of       |  |  |
| | | resources with phone numbers of addresses in Puerto Rico,   |  |  |
| | | and websites for obtaining post-deployment and caregiver    |  |  |
| | | information.                                                |  |  |
| | |                                                             |  |  |
| | | **4) MICU templates and order sets related to Hospice       |  |  |
| | | Care.** We traveled to the VA Caribbean Healthcare System   |  |  |
| | | in San Juan and discussed the MICU-Hospice Model that we    |  |  |
| | | are using at the NF/SG VHS ICU. We disseminated the         |  |  |
| | | template and order sets for hospice care. We plan to        |  |  |
| | | continue this collaboration to improve the end-of-life care |  |  |
| | | that patients receive in the VA Caribbean Healthcare        |  |  |
| | | System.                                                     |  |  |
| | +-------------------------------------------------------------+  |  |
| +------------------------------------------------------------------+  |
| | c.  **Exportable Educational Products First Available for        |  |
| |     Distribution in Report Year** *List five or fewer of the     |  |
| |     most important products. For each item, limit the response   |  |
| |     to five lines summarizing content, target audience, format,  |  |
| |     and product evaluation plan and results. **Include           |  |
| |     educational products developed in previous years ONLY if     |  |
| |     this is the [first year]{.underline} they have been          |  |
| |     available for distribution.***                               |  |
| |                                                                  |  |
| | **1) Online Training: "Successful Dementia Care: Behavioral      |  |
| | Management":** This online course was developed through the      |  |
| | GRECC in collaboration with nursing personnel. The course is     |  |
| | targeted to nursing assistants, registered nurses, and advanced  |  |
| | practice nurses who work in nursing homes and other long-term    |  |
| | care settings. The course is designed to positively change       |  |
| | staff's attitudes about caring for patients with dementia. The   |  |
| | online evaluation survey results demonstrate that this course is |  |
| | understandable and has led to changes in nursing care.           |  |
| |                                                                  |  |
| | **2) Online mandatory training: Age-Specific Competencies**:     |  |
| | This online course was revised with new slides and information   |  |
| | and is available for all NF/SGVHS employees through EES.         |  |
| | Evaluation is completed annually by a subgroup of the NF/SGVHS   |  |
| | education committee. Based on evaluations, the course post-test  |  |
| | was revised. We are currently working with the patient education |  |
| | and medical media departments to develop an additional online    |  |
| | course and poster for "age-specific" mandatory training that     |  |
| | will be at a lower literacy level and targeted to auxiliary      |  |
| | personnel such as the kitchen and custodial staff.               |  |
| |                                                                  |  |
| | **3) Spanish-language community reintegration resource guide for |  |
| | OEF/OIF veterans and family members living in Puerto Rico**. We  |  |
| | received funding from the HSR&D QUERI for two rapid response     |  |
| | projects to improve readjustment of Puerto Rican OEF/OIF         |  |
| | veterans and family members. Although not specifically targeted  |  |
| | to the aging population, our team was cognizant that our many    |  |
| | OEF/OIF veterans are over the age of 50 years and, in the        |  |
| | relatively near future, these older veterans will be considered  |  |
| | part of the geriatric population. Further, the family members    |  |
| | and caregivers of the returning veterans (i.e., mothers,         |  |
| | fathers, grandparents, and siblings) are often older adults. We  |  |
| | developed an attractive, culturally relevant booklet/guide       |  |
| | written in Spanish, which included 13 consumer guides, a list of |  |
| | VA and veteran-related organizations with phone numbers of       |  |
| | addresses in Puerto Rico, and websites for obtaining             |  |
| | post-deployment and caregiver information. The 13 fact sheets    |  |
| | included topics such as improving family relationships, handling |  |
| | stress, reducing "battle-mind" behaviors, and communicating with |  |
| | family members. The guide/booklet is unique in that we used a    |  |
| | community-based participant research to guide our work. To date, |  |
| | there are no Spanish-language, printed educational materials     |  |
| | that address the needs of OEF/OIF veterans and their families.   |  |
| |                                                                  |  |
| | **4) MICU templates and order sets related to Hospice Care.** We |  |
| | traveled to the VA Caribbean Healthcare System in San Juan and   |  |
| | discussed the MICU-Hospice Model that we are using at the        |  |
| | NF/SGVHS ICU. We disseminated the template and order sets for    |  |
| | hospice care. We plan to continue this collaboration to improve  |  |
| | the end-of-life care that patients receive in the VA Caribbean   |  |
| | Healthcare System.                                               |  |
| +------------------------------------------------------------------+  |
| | c\. **Educational programs offered by your GRECC during the      |  |
| | report year that were evaluated for impact both immediately and  |  |
| | at a later time, as described in "FY08Instructions" for          |  |
| | Performance Measure 7.** *Describe at least **TWO**, each of     |  |
| | which had at least 25 participants: one in which the majority of |  |
| | participants was from your GRECC's host facility; and one in     |  |
| | which the majority of participants were from VAs other than your |  |
| | GRECC's host facility. For each, describe the educational        |  |
| | intervention briefly and then the evaluations, including in your |  |
| | description of the latter the evaluation methodologies,          |  |
| | findings, and conclusions. If the second evaluation has not yet  |  |
| | occurred during the report year, describe your plans for it.     |  |
| | Limit your description of each intervention and its evaluation   |  |
| | to one-half page.*                                               |  |
| |                                                                  |  |
| | **1) National Conference: "Interventions to Promote              |  |
| | Independence: New Discoveries in Physical Activity Programs,     |  |
| | Cognitive Training, and Gene Therapy":** This was an             |  |
| | interdisciplinary one-day conference that was held the day       |  |
| | before and in conjunction with the 2008 International Conference |  |
| | of Aging, Disability, and Independence. The conference brought   |  |
| | together six nationally-known researchers and clinicians from    |  |
| | multiple disciplines who focused on interventions to promote     |  |
| | independence in aging. Recent advances in exercise               |  |
| | interventions, cognitive training, and gene therapy were         |  |
| | discussed. The presenters used findings from their ongoing       |  |
| | programs of research to illustrate strategies to improve healthy |  |
| | aging. The audience included 42 participants with over half the  |  |
| | attendees from VAs outside our host VA facility. The             |  |
| | participants completed a paper-and-pencil evaluation survey.     |  |
| | Overall the evaluations were overwhelmingly positive and         |  |
| | indicated that the conference met the objectives, was            |  |
| | informative, and stimulating. The majority of participants       |  |
| | stated that the conference would lead to changes in their        |  |
| | practice. The only negative comments were that the food was too  |  |
| | costly and that there was no food provided during the morning    |  |
| | break. We used a qualitative research approach for the follow-up |  |
| | evaluation. We conducted 6-month post-conference interviews with |  |
| | 3 participants who attended the conference. All of the interview |  |
| | participants stated that the conference had increased their      |  |
| | knowledge about ways to improve independence in older adults.    |  |
| | One participant stated that as a result of listening to the      |  |
| | presentation on cognitive training, she had begun encouraging    |  |
| | family members of older adults who had cognitive impairment to   |  |
| | encourage their loved ones to do mental exercises, such as       |  |
| | cross-word puzzles and simple mathematical games. Another        |  |
| | participant stated that the presentation on the national         |  |
| | research exercise study had led her to consider additional       |  |
| | variables and measures to include in her program of research.    |  |
| | Two of the participants discussed how the presentation on        |  |
| | interventions to reduce body fat and increase physical activity  |  |
| | had changed their own personal behavior in managing their        |  |
| | weight.                                                          |  |
| |                                                                  |  |
| | **2) Whittington Endowed Lecture: "Care of Hospitalized Older    |  |
| | Patients":** Recognizing the need for a model in our facility to |  |
| | improve the care of older patients who are hospitalized in       |  |
| | acute-care settings, we invited C. Seth Landefeld, M.D. to speak |  |
| | in Gainesville and at our VA hospital in Lake City, Florida. Dr. |  |
| | Landefeld presented two lectures, led an informal discussion     |  |
| | group, and consulted with individual clinicians and researchers. |  |
| | The presentations were attended by 84 health professionals and   |  |
| | over half of the attendees were employees outside our local VA   |  |
| | facility. A paper-in-pencil evaluation survey was completed by   |  |
| | the attendees. The evaluations were all positive. Comments from  |  |
| | several participants stated that Dr. Landefeld stimulated them   |  |
| | to consider ways to adapt the model at the local medical         |  |
| | centers. We are in the process of developing follow-up           |  |
| | evaluations using Survey Monkey to survey the GRECC attendees.   |  |
| |                                                                  |  |
| | **3) End-of-Life Nursing Education Consortium (ELNEC):** This    |  |
| | educational activity is an ELNEC training course that is part of |  |
| | a national effort supported by AACN/City of Hope. This           |  |
| | educational activity uses ELNEC materials and nine ELNEC         |  |
| | modules. The training course at our facility includes three      |  |
| | all-day conferences. The goal is to teach a group of             |  |
| | professional nurses to become trainers of the ELNEC curriculum.  |  |
| | Our GRECC in collaboration with other palliative-care            |  |
| | organizations in the area conducted two of the three conferences |  |
| | during 2007-2008. GRECC faculty participated in developing the   |  |
| | conference agenda and evaluation as well as served as speakers   |  |
| | and facilitators of the activity. The first two conferences were |  |
| | attended by 55 people. Most of the attendees were from the local |  |
| | VA or from other local organizations. Topics included            |  |
| | communication, loss, grief, bereavement, and models of           |  |
| | excellence in palliative care. Speakers were multidisciplinary   |  |
| | experts in palliative care. The attendees completed a            |  |
| | paper-and-pencil evaluation. The first conference had            |  |
| | consistently positive evaluations. Comments from this first      |  |
| | conference indicated that some of the speakers did not provide   |  |
| | specific, clinically-relevant information. The surveys for the   |  |
| | second conference were extremely positive and higher than those  |  |
| | of the first conference. Attendees' comments related to second   |  |
| | conference were that more practical, helpful strategies for      |  |
| | end-of-life care were presented. As a follow-up evaluation, we   |  |
| | conducted qualitative interviews with 2 attendees two weeks      |  |
| | after the first conference. These two attendees substantiated    |  |
| | what the written evaluations had highlighted. For example, in    |  |
| | the qualitative interviews both of the attendees stated that the |  |
| | conference was beneficial, but they would have preferred more    |  |
| | content on helpful tips and strategies from improving care at    |  |
| | the bedside. Three to six months after the last conference (in   |  |
| | fiscal year 2008-2009), we plan to do an online follow-up        |  |
| | evaluation using Survey Monkey.                                  |  |
| +------------------------------------------------------------------+  |
| | **7. CLINICAL DEMONSTRATION PROJECTS**                           |  |
| +------------------------------------------------------------------+  |
| | **NOTE:** A clinical demonstration [program]{.underline} is      |  |
| | defined as:                                                      |  |
| |                                                                  |  |
| | -   an ongoing, clinical, cooperative collaboration between the  |  |
| |     GRECC and host VA medical center;                            |  |
| |                                                                  |  |
| | -   that carries out and evaluates assessment strategies,        |  |
| |     management approaches and/or specialized investigations      |  |
| |                                                                  |  |
| | -   of a targeted or focused group of elderly patients           |  |
| |                                                                  |  |
| | -   with the intention that findings will be disseminated for    |  |
| |     the advancement of the field.                                |  |
| |                                                                  |  |
| | A clinical demonstration program is comprised of one or more     |  |
| | clinical demonstration [projects]{.underline}, each of which is  |  |
| | defined as                                                       |  |
| |                                                                  |  |
| | -   a set of one or more clinical activities                     |  |
| |                                                                  |  |
| | -   integrated and coordinated under a specified protocol        |  |
| |                                                                  |  |
| | -   designed to permit evaluation(s) of processes and/or         |  |
| |     outcomes.                                                    |  |
| |                                                                  |  |
| | Evaluation of a clinical demonstration program may be a          |  |
| | comprehensive assessment of the activity and/or the clinical     |  |
| | outcomes.  Alternatively, evaluation may concentrate on a        |  |
| | prioritized and feasible set of more focused or specific,        |  |
| | project-related questions, e.g. related to improved diagnosis,   |  |
| | quality of care, patient satisfaction, drug compliance,          |  |
| | functional status, etc.  Ongoing and subsequent modifications of |  |
| | the care model may also be evaluated as may be the               |  |
| | practicability and outcomes of exporting new clinical models or  |  |
| | variations of models to general care settings and/or smaller,    |  |
| | more resource-limited VA medical centers or outpatient           |  |
| | facilities.                                                      |  |
| +------------------------------------------------------------------+  |
| | a.  **Clinical Demonstration Projects Underway in Report         |  |
| |     Year***: list **all** GRECC Clinical Demonstration Projects  |  |
| |     underway. For each item, indicate whether [N]{.underline}ew  |  |
| |     or [O]{.underline}ngoing in Report Year. You may include up  |  |
| |     to five lines of descriptive text for each Project.\         |  |
| |     *                                                            |  |
| |                                                                  |  |
| | > **NOTE:** The number of Projects listed should be equal to the |  |
| | > number of Clinical Demonstration Projects you have listed and  |  |
| | > named in the GRECC Electronic Database.                        |  |
| |                                                                  |  |
| | -   Intervention to improve care at life's end in VA medical     |  |
| |     centers (Ongoing): We are one of several sites for this      |  |
| |     multi-center HSR&D study using the BEACON order set.         |  |
| |                                                                  |  |
| | -   Web-based information materials for caregivers of veterans   |  |
| |     post stroke (New): This HSR&D funded project will develop    |  |
| |     materials for stroke caregivers and then place them on [My   |  |
| |     HealtheVet]{.mark}.                                          |  |
| |                                                                  |  |
| | -   Evaluation of outcomes from a Gait and Balance Clinic (New): |  |
| |     This VISN 8 funded project will utilize data base analysis   |  |
| |     to assess predictors of outcome in an innovative             |  |
| |     interdisciplinary falls clinic.                              |  |
| |                                                                  |  |
| | -   Home safety assessment utilizing a video camera (Ongoing):   |  |
| |     This VISN 8 funded project will extend previous work by      |  |
| |     comparing home assessment by an occupational therapist with  |  |
| |     that obtained through use of a video camera.                 |  |
| |                                                                  |  |
| | -   Implementing evidence in the detection and treatment of      |  |
| |     post-stroke depression (Ongoing): This HSR&D QUERI funded    |  |
| |     project employs targeted screening to better identify        |  |
| |     depression in stroke patients.                               |  |
| |                                                                  |  |
| | -   Intervention development for shared decision-making in       |  |
| |     stroke prevention (Ongoing): This HSR&D QUERI funded project |  |
| |     involves development of a video with script to aid patients  |  |
| |     with atrial fibrillation to better interact with their       |  |
| |     health provider regarding the decision to anti-coagulate.    |  |
| |                                                                  |  |
| | -   Improved clinical decision-making for stroke prevention      |  |
| |     (Ongoing): This HSR&D QUERI funded project involves use of   |  |
| |     audiotapes or CD's along with a booklet as decision aids for |  |
| |     patients with atrial fibrillation.                           |  |
| +------------------------------------------------------------------+  |
| | **Evaluation of Clinical Demonstration Projects:** *for each     |  |
| | GRECC Clinical Demonstration Project listed in 7a above,         |  |
| | summarize the evaluation activity. If no evaluation results are  |  |
| | available, be explicit as to the focus of the planned            |  |
| | evaluation, and when it is anticipated to occur. If the project  |  |
| | has been completed during the Report Year, provide key findings  |  |
| | and their significance.*\                                        |  |
| | \                                                                |  |
| | **NOTE:** Do not list patient service use data here. Those data  |  |
| | are reported in the GRECC Electronic Database.                   |  |
| |                                                                  |  |
| | -   Intervention to improve care at life's end in VA medical     |  |
| |     centers: This HSR&D study was just reactivated and           |  |
| |     evaluation activities will commence in FY09.                 |  |
| |                                                                  |  |
| | -   Web-based information materials for caregivers of veterans   |  |
| |     post stroke: Interviews with caregivers and clinicians are   |  |
| |     guiding development of materials. After posting of the       |  |
| |     materials on [My HealtheVet]{.mark}, interviews will be      |  |
| |     conducted through: 1. Online survey when people are reading  |  |
| |     the materials; and 2. A telephone survey to obtain outcome   |  |
| |     data from both caregivers and clinicians.                    |  |
| |                                                                  |  |
| | -   Evaluation of outcomes from a Gait and Balance Clinic: A     |  |
| |     database of evaluations and outcomes will be retrospectively |  |
| |     analyzed to assess predictors of good and poor outcomes.     |  |
| |                                                                  |  |
| | -   Home safety assessment utilizing a video camera: The home    |  |
| |     safety recommendations of an occupational therapist making a |  |
| |     home visit will be compared with those made by an            |  |
| |     occupational therapist reviewing a videotape of the home     |  |
| |     shot by the family.                                          |  |
| |                                                                  |  |
| | -   Implementing evidence in the detection and treatment of      |  |
| |     post-stroke depression: Change in depression screening and   |  |
| |     treatment in stroke survivors at 2 intervention sites is     |  |
| |     being compared to the base rate of screening and treatment   |  |
| |     in these 2 sites in the year prior to the study. Data        |  |
| |     collection is ongoing through 6/09.                          |  |
| |                                                                  |  |
| | -   Intervention development for shared decision-making in       |  |
| |     stroke prevention: Interviews of patients with atrial        |  |
| |     fibrillation who are not using anti-thrombotics have been    |  |
| |     qualitatively assessed. Findings from this assessment are    |  |
| |     the foundation for a script and video being developed to     |  |
| |     improve shared decision making.                              |  |
| |                                                                  |  |
| | -   Improved clinical decision-making for stroke prevention:     |  |
| |     Data collection has been completed regarding the perceived   |  |
| |     usefulness of the Atrial Fibrillation Treatment              |  |
| |     Decision-Making Aid.                                         |  |
| |                                                                  |  |
| | -   Results were published in the **[\_\_\_\_\_]{.mark}** of the |  |
| |     Federal Practitioner.                                        |  |
| +------------------------------------------------------------------+  |
| | b.  **New Clinical Models developed at your GRECC that were      |  |
| |     exported in the Report Year** *(list up to five examples, up |  |
| |     to two lines each; provide name of new clinical model, name  |  |
| |     of VA or non-VA facility to which it was exported, and       |  |
| |     method of export, such as "Falls Clinic protocol sent to     |  |
| |     [X]{.underline} VAMC"):*                                     |  |
| |                                                                  |  |
| | -   Gait and Balance Clinic: Information on the practices of     |  |
| |     this clinic was shared with the Bronx VA in 10/07.           |  |
| |                                                                  |  |
| | -   The MICU-Hospice model was exported to the San Juan VAMC and |  |
| |     was presented at the annual meeting of the Gerontological    |  |
| |     Society of America in November 2007.                         |  |
| |                                                                  |  |
| | -   Coordination of care between VA and community partners was   |  |
| |     presented at the West Palm Beach VAMC in April 2008 and Bay  |  |
| |     Pines VAMC in September 2008, during meetings of the Florida |  |
| |     Hospice-Veterans Partnership.                                |  |
| +------------------------------------------------------------------+  |
| | **8. COLLABORATION ACTIVITY**                                    |  |
| +------------------------------------------------------------------+  |
| | NOTE: Increasingly, VACO is seeking to characterize the GRECCs   |  |
| | as not only isolated programs of excellence, but also, as a      |  |
| | group, a potent and effective system for investigating issues,   |  |
| | demonstrating efficacy, and implementing change. In order to     |  |
| | assist the GEC office in building a resource set of examples of  |  |
| | GRECCs working in complementary manners to advance their own     |  |
| | goals and those of the Department, you asked to provide up to    |  |
| | five (5) examples of collaborative activities you have underway  |  |
| | with one or more GRECCs other than your own. If possible, please |  |
| | try to include at least one Clinical Demonstration, one          |  |
| | Education, and one Research example. Be sure to specify the      |  |
| | GRECC or GRECCs with whom you are collaborating; and a           |  |
| | description, limited to 6 or fewer lines, of the collaborative   |  |
| | activity.                                                        |  |
| +------------------------------------------------------------------+  |
| | -   The Gainesville GRECC is a participant in the multi-center   |  |
| |     HSR&D study "Intervention to improve care at life's end in   |  |
| |     VA medical centers," for which the Birmingham GRECC is the   |  |
| |     coordinating center.                                         |  |
| |                                                                  |  |
| | -   We are collaborating with the Miami GRECC in developing      |  |
| |     educational programs for clinicians throughout VISN 8. For   |  |
| |     example, we conducted a VISN 8 Geriatrics and Aging Needs    |  |
| |     Assessment for Primary Care Providers. Based on this needs   |  |
| |     assessment, we offered two lectures on aging and geriatrics  |  |
| |     at the annual VISN 8 Ambulatory Care Forum.                  |  |
| +------------------------------------------------------------------+  |
+-----------------------------------------------------------------------+