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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:** Gainesville GRECC                                 |
|                                                                       |
| b.  **Location** *(facility, VISN)*: Malcom Randall VAMC, VISN 8      |
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| **2. CONTACT PERSON (if there are questions about this report)**      |
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| a.  **Name:** Debra A. Newell, PhD (for narrative sections) Thomas    |
|     Mulligan, MD (for electronic database entry)                      |
|                                                                       |
| b.  **Position:** Acting Associate Director, Education/Evaluation;    |
|     GRECC Director                                                    |
|                                                                       |
| c.  **Phone, e-mail:** 352-376-1611 x 6893 Debra.Newell@med.va.gov    |
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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**: Frailty                                     |
|                                                                       |
| b.  **Applied Clinical**: Frailty                                     |
|                                                                       |
| c.  **Health Services**: Frailty                                      |
|                                                                       |
| d.  **Rehabilitation**: Frailty                                       |
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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**)*           |
|                                                                       |
| -   GRECC brought in \$304,000 in education grants (GACA @            |
|     \$60,000/year/5 years; Chapman Education Grant: \$4,000). These   |
|     funds are augmenting the salary of a new GRECC clinician educator |
|     and providing resources for the technology aspects of creating an |
|     online geriatrics curricula. GRECC brought in \$583,700 in new    |
|     research funding in FY2005, with FY2005 research expenditures of  |
|     \$396,300.                                                        |
|                                                                       |
| -   IN FY05 the GRECC hosted the Lecture Series, a Geriatrics update  |
|     conference, 6 Visiting Scholar lectures, a year-long weekly       |
|     Geriatrics conference, a Nursing Assistant empowerment workshop   |
|     (NF/SG system and the Community Colleges \[Lake                   |
|     City/Gainesville\]), and an Interdisciplinary Team Training       |
|     Workshop. Collectively, 1399 hours of geriatrics CE units and an  |
|     additional 1217 hours of geriatrics and gerontology training were |
|     provided to multiple disciplines, including NF/SG system staff /  |
|     trainees, and across VISN 8.                                      |
|                                                                       |
| -   The GEM, which is directed by GRECC staff, and continues to       |
|     sponsor clinical demonstration projects, serves as the primary    |
|     interdisciplinary care training site for trainees and fellows in  |
|     several disciplines at the NF/SG VAMC. Two abstracts from the GEM |
|     are being published -- 1 for the Florida Occupational Therapy     |
|     Association (Home assessment utilizing a video camera), 1 (The    |
|     GEM Card) for GSA.                                                |
|                                                                       |
| -   GRECC provided the only site for training in palliative care      |
|     within the NF/SG system. One of the GRECC Clinical Demonstration  |
|     Projects, the Gait and Balance Clinic, serves as a best practice  |
|     clinical model and also as an interdisciplinary care training     |
|     site. Three abstracts from this clinic were selected for          |
|     presentation at the 2005 meeting of the Gerontological Society of |
|     America (GSA).                                                    |
|                                                                       |
| -   GRECC provided literature and information on the GRECC, geriatric |
|     services, and its education and training programs to all MRVAMC   |
|     staff during the annual Geriatrics resources fair. Two            |
|     educational CDs, entitled ***Optimizing Mental Function in the    |
|     Cognitively Fragile Patient*** and ***Caring for the Older Adult  |
|     IV*** were distributed to staff and community participants.       |
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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**)*           |
|                                                                       |
| -   Colleen Campbell, MSN, ARNP and John Meuleman, MD spoke in 4/05   |
|     at the Tampa VA License Renewal and Geriatrics Conference. Dr.    |
|     Debra Newell was part of the planning committee responsible for   |
|     putting the conference together.                                  |
|                                                                       |
| -   Consistent doses of geriatrics education and training is provided |
|     across most of the fiscal year by the GRECC Lecture Series and/or |
|     GRECC Primary Care Lecture Series. In FY2005, 16 special topics   |
|     in geriatrics lectures and 6 visiting scholar lectures provided   |
|     1080 person hours of geriatrics and geronotology training to VA   |
|     staff across the VISN 8.                                          |
|                                                                       |
| -   The GRECC Actg. Associate Director/EE, GEM Director and Clinical  |
|     Director interact on an ongoing basis with the education leaders  |
|     of the NF/SG OPCs, Tampa VAMC, West Palm Beach VA, Miami VA/GRECC |
|     to develop and provide geriatrics education and training programs |
|     (didactic, web-based) that have reached VA staff across the VISN. |
|     An example of this collaboration is the Dementia educational unit |
|     that is available across the VISN 8 and can be accessed through   |
|     the VISN 8 Directory.                                             |
|                                                                       |
| -   The Gainesville GRECC hosted an interdisciplinary team training   |
|     workshop on August 9, 2005 that included 47 staff from the both   |
|     the Lake City and Gainesville facilities. The workshop spawned    |
|     working groups that are creating goals, recommendations and       |
|     training plans for 3 different areas (for the interdisciplinary   |
|     team) and 3 different areas for nursing. As the groups works      |
|     through the issues, it is anticipated that morale, teamwork and   |
|     quality of patient care will improve.                             |
|                                                                       |
| -   Gainesville GRECC staff, collectively, have presented numerous    |
|     educational abstracts/posters, presented invited lectures and     |
|     lectures for students of various disciplines, and authored 17     |
|     publications, served on 22 committees, and trained 28 (24         |
|     residents, 4 fellows) medical housestaff and 13 trainees          |
|     (multiple disciplines) in Geriatrics in FY2005. These             |
|     involvements serve as springboards for collegial relationships    |
|     across the VISN.                                                  |
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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 Palliative Care Unit (PCU) was started in 2003 as a teaching    |
|     model, utilizing a preexisting GEM Unit team. Medical students    |
|     and Medicine residents provide care jointly on the PCU and GEM ,  |
|     which for both groups of trainees serves as their only experience |
|     on an interdisciplinary care team. The palliative care unit has   |
|     also developed an externship (elective) and a virtual palliative  |
|     care unit (in the ICU) where consultations are provided, as       |
|     appropriate.                                                      |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   Drs. P Scarpace and S Zolothukin prepared a gene construct that   |
|     allows for insertion of the gene for the neuropeptide POMC        |
|     directly into rat brains. (Patent pending; filed 9/13/04). This   |
|     gene delivery vector reduces intra-abdominal fat in a rat model   |
|     of obesity/insulin resistance, and will help us design treatment  |
|     for our aging veteran population.                                 |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   The Brain Rehabilitation Research Center (BRRC) is a VA RR&D      |
|     project designed to study the nature/impact/management of         |
|     cognitive/motor deficits resulting from disease or injury. The    |
|     BRRC was first funded in 1999 and re-funded in 2004. The GRECC    |
|     and BRRC are closely linked through research initiatives and      |
|     collaborative efforts of staff. The early research developed new  |
|     behavioral therapies to re-establish skills and in 2004, the BRRC |
|     hired a neurorehabilitation neurobiologist to move animal studies |
|     to human trials.                                                  |
|                                                                       |
| -   The GRECC sponsored a Post-Discharge Medication Management        |
|     Project for two years. The project targeted older patients "at    |
|     risk" of medication mismanagement after leaving the unit. The     |
|     project staff contacted patients 1-2 weeks after discharge to     |
|     identify any challenges with medications (wrong meds, dosing,     |
|     etc.) The project caught many mismanagement issues and was able   |
|     to make appropriate changes. The project not only benefited       |
|     patients, but also served as a teaching program for rotating      |
|     housestaff and pharmacy residents.                                |
|                                                                       |
| -   The Gait and Balance Clinic demonstration project provided formal |
|     consultation to the Fall Prevention Program in the VISN-8 Safety  |
|     Initiative. The demonstration project has produced new protocols, |
|     multiple articles and presentations at local, regional and        |
|     national conferences. From the consultation to the VISN, it was   |
|     established that each VISN-8 facility would have a coordinator to |
|     run a clinic and evaluate patients at high risk of falling. The   |
|     clinic serves as a training site for GRECC fellows, housestaff    |
|     and multi-discipline trainees.                                    |
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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.)*                                 |
|                                                                       |
| -   [Core staff name]{.underline}: Stephen E. Borst, Ph.D.            |
|                                                                       |
| > [Reference]{.underline}: Borst SE, Conover CF, Bagby GJ.            |
| > Association of resistin with visceral fat and muscle insulin        |
| > resistance. Cytokine. 2005 Oct 7;32(1):39-44.                       |
| >                                                                     |
| > [5-line jargon-free summary]{.underline}: Increased fat within the  |
| > abdominal cavity (visceral fat) is associated with the development  |
| > of type II diabetes and reduced responses to insulin (insulin       |
| > resistance). In this study visceral fat was surgically removed from |
| > insulin-resistant rats, resulting in improved whole-body and        |
| > skeletal-muscle responses to insulin. Improved insulin response was |
| > associated with lowered blood concentration of the hormone          |
| > resistin. Resistin is produced by visceral fat and can impair       |
| > insulin responses.                                                  |
|                                                                       |
| -   [Core staff name]{.underline}: Stephen E. Borst, Ph.D.            |
|                                                                       |
| > [Reference:]{.underline} Borst, S.E. and C.F. Conover (2005)        |
| > High-fat diet reduces insulin responsiveness and increases tissue   |
| > expression of TNF-α. Life Sci. 77(17): 2156-2165.                   |
| >                                                                     |
| > [5-line jargon-free summary]{.underline}: Tumor necrosis factor     |
| > (TNF) is a hormone that is known to play a role in muscle wasting   |
| > and has the ability impair insulin responses in isolated and        |
| > cultured muscle cells. We found that a high-fat diet increases      |
| > obesity, causes insulin resistance and elevates TNF in the muscle,  |
| > but not in the blood. This finding is further evidence supporting   |
| > our hypothesis insulin resistance may be caused by elevated TNF in  |
| > the tissues, not in the blood.                                      |
|                                                                       |
| -   [Core staff name]{.underline}: Thomas Mulligan, M.D.              |
|                                                                       |
| > [Reference]{.underline}: Veldhuis JD, Iranmanesh A, Mulligan T. Age |
| > and testosterone feedback jointly control the dose-dependent        |
| > actions of gonadotropin-releasing hormone in healthy men. J. Clin.  |
| > Endocrinol. Metab. 2005 Jan;90(1):302-9.                            |
| >                                                                     |
| > [5-line jargon-free summary]{.underline}: This paper identifies     |
| > mechanisms causing reduced testosterone secretion in older men. The |
| > hypothalamus secretes gonadotropin releasing hormone (GnRH), which  |
| > stimulates the pituitary to secrete leutinizing hormone (LH), which |
| > in turn stimulates the testes to secrete testosterone. In older     |
| > men, secretion of LH in response to GnRH is delayed and irregular.  |
|                                                                       |
| -   [Core staff name]{.underline}: Nihal Tümer, Ph.D.                 |
|                                                                       |
| > [Reference:]{.underline} Tumer N, Scarpace PJ, Dogan MD, Broxson    |
| > CS, Matheny M, Yurek DM, Peden CS, Burger C, Muzyczka N, Mandel RJ. |
| > Hypothalamic rAAV-mediated GDNF gene delivery ameliorates           |
| > age-related obesity. Neurobiol Aging. \[2005 Jun 15; Epub ahead of  |
| > print\]                                                             |
| >                                                                     |
| > [5-line jargon free summary:]{.underline} This paper indicates      |
| > that  Glial cell line - derived neurotrophic factor (GDNF) injected |
| > into the rat brain partially reverses  age related obesity.         |
| > Mechanisms are involved in both decrease in food intake and         |
| > increase in energy expenditure.                                     |
|                                                                       |
| -   [Core staff name]{.underline}:            Thomas Mulligan, MD     |
|                                                                       |
| > [Reference:]{.underline}         Does Religious Activity Improve    |
| > Health Outcomes: A critical review of the recent literature.  J of  |
| > Sci and Healing. 1(3):186-191. 2005                                 |
| >                                                                     |
| > [5-line jargon free summary:]{.underline}  Religious activity       |
| > likely improves health lifestyle (cessation of smoking and alcohol  |
| > abuse) and may improve outcomes for patients admitted to a CCU or   |
| > women undergoing in vitro fertilization.                            |
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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)*                                  |
|                                                                       |
| -   [Core staff name]{.underline}: Stephen E. Borst, Ph.D.            |
|                                                                       |
| > [Reference]{.underline}: Yimlamai, T., S.L. Dodd, [S.E.             |
| > Borst]{.underline}, and S. Park (2005) Clenbuterol attenuates       |
| > hindlimb unweighting-induced muscle atrophy by reducing the         |
| > activation of the ubiquitin-proteasome pathway. J. Appl. Physiol.   |
| > 99: 71-80.                                                          |
| >                                                                     |
| > [5-line jargon-free summary]{.underline}: Hindlimb unweighting in   |
| > the rat is a model of disuse muscle atrophy and is somewhat         |
| > different than the loss of muscle that occurs with aging.           |
| > Clenbuterol is a drug that can increase muscle mass and we found    |
| > that it can reduce the loss of muscle mass and strength occurring   |
| > with hindlimb is unweighting. Specifically, clenbuterol blocks      |
| > degradation of muscle proteins by blocking the ubiquitin-proteasome |
| > pathway for protein degradation.                                    |
|                                                                       |
| -   [Core staff name]{.underline}: Nihal Tümer, Ph.D.\                |
|     [Reference:]{.underline} Scarpace PJ, Matheny M, Tumer N, Cheng   |
|     KY, Zhang Y.    Leptin resistance exacerbates diet-induced        |
|     obesity and is associated with diminished maximal leptin          |
|     signaling capacity in rats. Diabetologia. 2005 Jun;48             |
|     (6):1075-83.\                                                     |
|     [5-line jargon free summary]{.underline}: This paper indicates    |
|     that rats that are leptin resistant when provided a high fat diet |
|     eat more food then control rats. This data suggest that those     |
|     already obese will gain more weight on a high fat diet then       |
|     compare to those that not obese.                                  |
|                                                                       |
| -   [Core staff name]{.underline}: Nihal Tümer, Ph.D.\                |
|     [Reference:]{.underline} Zhang, Y., Matheny., M. Tümer, N., and   |
|     Scarpace P.J.: Aged-obese rats exhibit  robust responses to a     |
|     melanocortin  agonist  and antagonist  despite  leptin            |
|     resistance *.  Neurobiol Aging*. 25(10):1349-60, 2004.\           |
|     [5-line jargon free summary]{.underline}: Melanocortin agonist, a |
|     hormone like drug, causes weight loss and partially reduces       |
|     adiposity. Mechanisms are involved in both decrease in food       |
|     intake and increase in energy expenditure.                        |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   [Core staff name]{.underline}: Debra A. Newell, PhD               |
|                                                                       |
| > [Reference]{.underline}: Newell D and Beach RE. 2004.               |
| > Implementation and Delivery of an Intergenerational Community       |
| > Learning Experience: The Family Home Visit Program. Gerontology &   |
| > Geriatrics Education; 25(2): 7-26.                                  |
| >                                                                     |
| > [5-line jargon free summary]{.underline}: This paper describes the  |
| > development and implementation of a home visit program designed to  |
| > bring together allied health and medical students to learn about    |
| > the context in which illness and wellness occur for individuals of  |
| > varying ages across the lifespan. The program demonstrated          |
| > successful outcomes for both students and participating families,   |
| > as well as in meeting the curricular outcomes. Although             |
| > orchestrating the program is complex and time intensive, the        |
| > benefits overall to the learning process of students is worthwhile. |
|                                                                       |
| -   [Core staff name]{.underline}: Debra A. Newell, PhD               |
|                                                                       |
| > [Reference]{.underline}: Newell DA, Raji MA, Lieberman SL and Beach |
| > RE. 2004. Integrating Geriatric Content into a Medical School       |
| > Curriculum: Description of a Successful Model. Gerontology &        |
| > Geriatrics Education, Vol. 25(2): 15-32.                            |
| >                                                                     |
| > [5 line jargon free summary]{.underline}: Increasing the geriatric  |
| > content in a medical school curriculum can meet with challenges     |
| > related to competing "specialty" programming, lack of a template    |
| > for infusion and/or creating new curricula, and funding to          |
| > accomplish the task. Key elements for success include institutional |
| > support at the highest level and throughout, one person dedicated   |
| > to orchestrating the efforts, dedicated funding, a specific         |
| > multi-pronged plan for moving forward, and evaluation of progress   |
| > and outcomes.                                                       |
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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):*          |
|                                                                       |
| -   GEM Card (New): To enhance the Medicine residents' understanding  |
|     of an interdisciplinary function-oriented approach, each resident |
|     now uses a GEM patient data card. This parallels their usual ward |
|     card on which they record labs, diagnoses, etc. but also contains |
|     prompts for them to track information on function, rehabilitation |
|     challenges, and geriatric syndromes.                              |
|                                                                       |
| -   GRECC Education staff, in conjunction with the Geriatrics         |
|     Education Group (which includes members from Lake City and        |
|     Gainesville) that the AD/EE chairs, developed a Palliative        |
|     Care/Pain Management mini-fellowship that includes rotational     |
|     experiences in both facilities (Gainesville and Lake City). The   |
|     rotation is targeted for                                          |
|                                                                       |
| -   The Geriatrics Education Group developed a set of Team Training   |
|     Goals and a teaching/evaluation tool to teach residents, fellows  |
|     and multiple disciplines of trainees the most important questions |
|     to ask and information to obtain and track on a patient. This     |
|     tool is also used by team members to report in team and on        |
|     rounds, as well as be completed by faculty to provide objective   |
|     feedback on their team skills and grasp of clinically important   |
|     concepts in the care of patients. This tool complements the GEM   |
|     card.                                                             |
|                                                                       |
| -   The Geriatrics Education Group developed a Palliative Care/Pain   |
|     Management multidisciplinary mini-fellowship for participation by |
|     post-graduate trainees of other GRECC traineeship programs        |
|     (trainees/fellows). The intended late FY 2005 participant ended   |
|     up not participating, thus no evaluation results.                 |
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| 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)*:           |
|                                                                       |
| -   ***Optimizing Mental Function in the Cognitively Fragile          |
|     Patient*** and ***Caring for the Older Adult IV*** are            |
|     interactive educational CDs targeted towards health care          |
|     professionals. These CDs include text, video, pre and post-test,  |
|     supporting documents and has been disseminated locally,           |
|     regionally through the AHECs, to the CBOCs in the NF/SG system    |
|     and internationally at the American Geriatrics Society meeting. A |
|     product evaluation is planned for early FY2006.                   |
|                                                                       |
| -   ***Rehabilitation Consult Card*** and ***Rehabilitation Consult   |
|     Template for CPRS***. These products were developed for           |
|     residents, trainees and fellows in order to facilitate            |
|     appropriate information inclusion in the consult request and to   |
|     facilitate a more efficient consult process. Informal evaluation  |
|     of the two items has met with rave reviews. During the            |
|     development process, the items were so popular that the staff     |
|     insisted on implementing their use prior to incorporation into    |
|     the intended educational unit.                                    |
|                                                                       |
| -   ***Dementia***. This educational program is available throughout  |
|     VISN 8 on a shared education drive. It is targeted towards health |
|     care professionals and includes video and post-test on a secured  |
|     (must log in through VISTA) site. The offering was co-developed   |
|     by the Gainesville GRECC and the West Palm Beach VA.              |
|                                                                       |
| -   A ***16- unit Special Topics in Geriatrics educational program*** |
|     is available in its entirety, or in separate units. These units   |
|     are from the GRECC sponsored CE conferences, targeted towards     |
|     health care trainees and professionals, and include a video (or   |
|     CD version) of the CE program and lecture handouts. Evaluation    |
|     results of the live programming from across the VISN show that 15 |
|     of the 16 programs were rated as very good or excellent.          |
|                                                                       |
| -   ***GEM Card***: This educational tool is targeted towards any     |
|     health care professional or trainee who works with geriatric      |
|     patients in a non-acute setting. This educational tool was        |
|     accepted and posted on the VA Virtual Learning Center website.    |
|     (vaww.va.tov/vlc.htm or www.va.gov/vlc)                           |
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| **7. CLINICAL INNOVATIONS**                                           |
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| **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.                                             |
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| 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)*:                              |
|                                                                       |
| -   Gait and Balance Clinic (Ongoing): This clinic serves as a best   |
|     practice model for education and clinical care and also as a site |
|     of clinical research. In FY05 a new screening system was          |
|     innovated so as to triage patients for either full                |
|     interdisciplinary evaluation or evaluation just by the physical   |
|     therapist.                                                        |
|                                                                       |
| -   Palliative Care Unit (Ongoing): This 6 bed unit innovates by      |
|     being located adjacent to the GEM Unit and utilizing a            |
|     preexisting GEM team with minimal additional resources.           |
|     Palliative care has developed and disseminated standard order     |
|     sets and has also innovated by developing MICU-hospice. In this   |
|     program terminal ICU patients who are best served by remaining in |
|     the ICU receive skilled palliative-oriented care using standard   |
|     order sets.                                                       |
|                                                                       |
| -   Home assessment with a video camera (Ongoing): Because of the     |
|     rural nature of our catchment area, home safety assessment by     |
|     occupational therapists is problematic. The aim of this project   |
|     is to have GEM families take film of the home environment so that |
|     proper equipment can be ordered to maximize function and safety   |
|     in the home.                                                      |
|                                                                       |
| -   Nurse to nurse report tool (New): In FY05 a template was          |
|     developed to enhance communication between nursing units          |
|     transferring patients to the GEM and the GEM nurses. This report  |
|     tool details specific information about the patient's care and    |
|     function and has served to enhance understanding of each          |
|     patient's needs during this critical transition in care.          |
|                                                                       |
|     -   How common is hypogonadism in older male veterans (new):      |
|         Hypogonadism is likely to be very high among older male       |
|         veterans and is likely associated with frailty.  We are       |
|         conducting a cross sectional study of male veterans age \> 65 |
|         years to determine the prevalence of hypogonadism and its     |
|         associated comorbidities.                                     |
|                                                                       |
|     -   Does hormone replacement therapy (TRT) improve physical or    |
|         cognitive function in older hypogonadal older male veterans   |
|         (new):  Based on preliminary data that approximately 50% of   |
|         older male veterans are hypogonadal, we are now conducting    |
|         randomized controlled trials of testosterone and              |
|         dihydrotestosterone (potentially safer than testosterone) in  |
|         older hypogonadal male veterans.  Our hypotheses are that TRT |
|         improves physical function and mood.                          |
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| 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)*                           |
|                                                                       |
| -   Gait and Balance Clinic: There were 1240 visits in FY05, a 69%    |
|     increase from FY04. A current State of Florida grant has enabled  |
|     us to create a patient data base and evaluation of outcomes is    |
|     now ongoing.                                                      |
|                                                                       |
| -   Palliative Care Unit: There were 84 admissions in FY05, with 62   |
|     deaths on the unit and 26 discharges to home or other facilities. |
|     Of the admissions, 53 were from acute care wards, 13 from ICU, 15 |
|     from home, and 3 from another facility. 23% of all inpatient      |
|     deaths occurred on the PCU.                                       |
|                                                                       |
| -   Home assessment utilizing a video camera: The homes of 10 GEM     |
|     patients were evaluated. Appropriate individualized home safety   |
|     equipment was provided for the following areas: 9 bathrooms, 6    |
|     entry ways, and 3 bedrooms. The video assessment saved            |
|     approximately 20 hours travel time for the occupational           |
|     therapists.                                                       |
|                                                                       |
| -   Nurse to nurse report tool: no evaluation results.                |
|                                                                       |
| -   Approximately 50% of older male veterans attending a primary care |
|     clinic are hypogonadal. No other evaluation results.              |
|                                                                       |
| -   No evaluation results.                                            |
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| 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)*:                                               |
|                                                                       |
| -   Gait and Balance Clinic: a presentation on this clinical project  |
|     was made at the annual meeting of the Florida Geriatrics Society  |
|     in 7/05.                                                          |
|                                                                       |
| -   Palliative Care Unit: the palliative care standard order set was  |
|     presented at Medicine morning report at the University of Florida |
|     and plans commenced for the university teaching hospital to begin |
|     use of these orders.                                              |
|                                                                       |
| -   Home assessment utilizing a video camera: a poster presentation   |
|     of this project "Home Safety Assessment Utilizing a Video Camera: |
|     a Pilot Project" was accepted for the Florida Occupational        |
|     Therapy Association's annual conference. The audience was         |
|     comprised of community/academic OTs from Florida.                 |
|                                                                       |
| -   Nurse to nurse report tool: this tool was accepted and posted on  |
|     the VA Virtual Learning Center website.                           |
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| **8. CONSULTATION AND OUTREACH**                                      |
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| **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}**                                         |
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| **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.**   |
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