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| ### GERIATRIC RESEARCH, EDUCATION AND CLINICAL CENTER    |   |   |   |   |
|                                                          |   |   |   |   |
| ### *Annual Report: Fiscal Year [2007]{.underline}*      |   |   |   |   |
|                                                          |   |   |   |   |
| ######## 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, 2006 through       |   |   |   |   |
| September 30, 2007]{.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 **to ten pages or fewer** the version      |   |   |   |   |
| **SUBMITTED TO VACO** **.**]{.mark}                      |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| **\*[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:** San Antonio GRECC                    |   |   |   |   |
|                                                          |   |   |   |   |
| b.  **Location** *(facility, VISN)*: South Texas         |   |   |   |   |
|     Veterans Health Care System-Audie L. Murphy          |   |   |   |   |
|     Division, VISN 17                                    |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| **2. CONTACT PERSON**                                    |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| a.  **Name:** Mary Anne Svetlik, Ph.D., FACHE            |   |   |   |   |
|                                                          |   |   |   |   |
| b.  **Position:** Administrative Officer, GRECC (182)    |   |   |   |   |
|                                                          |   |   |   |   |
| c.  **Phone, e-mail:** 210-617-5197,                     |   |   |   |   |
|     <Mary.Svetlik@med.va.gov>                            |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| **3. GRECC FOCUS AREA(S)**                               |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| **NOTE:** Please succinctly list your GRECC's Focus      |   |   |   |   |
| Area(s), one per line below. After each focus area       |   |   |   |   |
| listed, please indicate with a check mark (****) which  |   |   |   |   |
| of the research type(s) suitably describes the work      |   |   |   |   |
| conducted (including planning, implementation, analysis, |   |   |   |   |
| and dissemination/publication) within that focus during  |   |   |   |   |
| the Report Year. Add additional lines by positioning     |   |   |   |   |
| your cursor at the lower right side of the table and     |   |   |   |   |
| striking the "Tab" key.                                  |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| **GRECC Focus Area**                                     | * |   |   |   |
|                                                          | * |   |   |   |
|                                                          | 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 | * |   |
|                                                          | * | * | * |   |
|                                                          | * | * |   |   |
+----------------------------------------------------------+---+---+---+---+
| Metabolism/Endocrinology, Nutrition, Oral                | * |   |   |   |
| Health/Dentistry                                         | * |   |   |   |
|                                                          | X |   |   |   |
|                                                          | * |   |   |   |
|                                                          | * |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| Metabolic Diseases, Cognitive/Sensory Impairment, Oral   |   | * |   |   |
| Health/Dentistry                                         |   | * |   |   |
|                                                          |   | X |   |   |
|                                                          |   | * |   |   |
|                                                          |   | * |   |   |
+----------------------------------------------------------+---+---+---+---+
| Functional Status and Ethnicity, Palliative Care, Health |   |   | * |   |
| Care Utilization, and Quality                            |   |   | * |   |
|                                                          |   |   | X |   |
| Assessment                                               |   |   | * |   |
|                                                          |   |   | * |   |
+----------------------------------------------------------+---+---+---+---+
| N/A                                                      |   |   |   | * |
|                                                          |   |   |   | * |
|                                                          |   |   |   | N |
|                                                          |   |   |   | / |
|                                                          |   |   |   | A |
|                                                          |   |   |   | * |
|                                                          |   |   |   | * |
+----------------------------------------------------------+---+---+---+---+

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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 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}. ***                                  |
|                                                                       |
| -   GRECC research expenditure funding for FY'07 totals more than     |
|     \$5.2 million, representing 15.7% of the total research           |
|     expenditures of the South Texas Veterans Health Care System for   |
|     FY'07**.**                                                        |
|                                                                       |
| -   GRECC research staff continues to be very successful in obtaining |
|     grant funding from federal and other sources. In addition, GRECC  |
|     investigators lead a collaborative network of scientists from the |
|     host VAMC and its affiliated University of Texas Health Science   |
|     Center at San Antonio (UTHSCSA). This leadership has resulted in  |
|     the successful recruitment of many internationally renowned       |
|     biomedical gerontologists to both institutions.                   |
|                                                                       |
|     -   GRECC research staff involvement in above has resulted in the |
|         establishment of the Barshop Institute on Longevity and Aging |
|         Studies, with its animal core and researchers from both       |
|         institutions, and most recently the grant award for the NIA   |
|         Intervention Testing Center. Both initiatives serve as        |
|         resources for host VAMC investigators.                        |
|                                                                       |
|     -   The GRECC hosts weekly conferences as Geriatrics &            |
|         Gerontology Grand Rounds for the host VAMC and its            |
|         educational affiliate (UTHSCSA). Attendance includes          |
|         employees from various other services at the host VAMC.       |
|                                                                       |
|     -   The GRECC sponsored three Medical Grand Rounds and two        |
|         Medical Research Conferences for employees, faculty and staff |
|         of the host VAMC and the educational affiliate (UTHSCSA)      |
|         during FY 2007. GRECC research faculty presented at the       |
|         Medical Research Conference. GRECC faculty and trainees       |
|         submitted entries for the Department of Medicine Annual       |
|         Research Day, and Dr. Sara Espinoza won the excellence award  |
|         for clinical research.                                        |
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| 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}. ***                                  |
|                                                                       |
| -   The GRECC held its 28^th^ Annual Conference on Aging, cosponsored |
|     by the VISN, "Geriatric Primary Care: Current Perspectives & New  |
|     Horizons," in August 2007, with broad attendance throughout the   |
|     VISN.                                                             |
|                                                                       |
| -   The GRECC continues to collaborate with the Little Rock GRECC in  |
|     VISN 19 by trading expertise in geriatric dentistry and           |
|     nutrition.                                                        |
|                                                                       |
| -   The GRECC Director has served on the VISN's Research Committee    |
|     since its inception. The committee established a VISN-wide new    |
|     investigator start-up grant program. This program continues to    |
|     fund 2-year research awards to junior investigators at the three  |
|     VAMCs within the VISN.                                            |
|                                                                       |
|     -   GRECC research staff involvement in above has resulted in the |
|         establishment of the Barshop Institute on Longevity and Aging |
|         Studies, with its animal core and researchers from both       |
|         institutions, and most recently the grant award for the NIA   |
|         Intervention Testing Center. Both initiatives serve as        |
|         resources for investigators throughout the VISN.              |
|                                                                       |
| -   The GRECC continues to address the South Texas Veterans Health    |
|     Care System's palliative care program. In FY-07, 20 facility-wide |
|     training sessions were held for host VAMC staff. Educational      |
|     programs are held each year for VISN 17 staff. Sandra             |
|     Sanchez-Reilly, M.D., developed and directs the combined          |
|     consultation service program in geriatrics and palliative care    |
|     for patients at the host VAMC. This ongoing clinical              |
|     demonstration program should result in a model that can be        |
|     replicated at other VAMCs in VISN 17. To that end, the GRECC has  |
|     \"begun the innovative "Palliative Care on the Road" program with |
|     a two-hour videoteleconference in late fall '06, and two day-long |
|     programs on-site at Temple and Dallas VAMCs. More programs are    |
|     planned.                                                          |
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| c.  **GRECC Trend-Setting Innovations since October 1, 2002**: *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. ***                          |
|                                                                       |
| -   GRECC researcher Randy Strong, Ph.D., with UTHSCSA colleagues,    |
|     continues to utilize his \$2.5 million grant from a National      |
|     Institute on Aging (NIA) Intervention Testing Center, one of      |
|     three such U.S. centers established by the NIA to test potential  |
|     therapeutic interventions to slow the aging process (Dr. Randy    |
|     Strong, 2004).                                                    |
|                                                                       |
| -   GRECC researcher Arlan Richardson, Ph.D., continues as director   |
|     of the Barshop Institute on Longevity and Aging Studies, which    |
|     will house an extensive aging and transgenic animal core. The     |
|     Center was built at the UTHSCSA-affiliated Texas Research Park    |
|     and occupied summer 2006 (Dr. Arlan Richardson, 2006).            |
|                                                                       |
| -   In summer FY'07, the GRECC conducted, in conjunction with the     |
|     South Texas Geriatric Education Center (STGEC) at the UTHSCSA,    |
|     the fourth week-long, Interdisciplinary Summer Institute in       |
|     Geriatrics & Gerontology, "G&G 101," for health professionals who |
|     treat elderly veterans in all clinical settings and who have had  |
|     minimal training in geriatrics and gerontology. This 40-hour      |
|     program was digitally videotaped and is available for future      |
|     viewing in FY'07 and '08 (Dr. Michèle Saunders, 2007).            |
|                                                                       |
| -   The GRECC continues to collaborate with the Little Rock GRECC in  |
|     VISN 19 by trading expertise in geriatric dentistry and           |
|     nutrition. Numerous hours have been taped and are available for   |
|     sharing across both VISNs for those employees who are unable to   |
|     view the videoteleconferences (Dr. Michele Saunders, 2006-07).    |
|                                                                       |
| -   Innovative clinical programs include 1) Memory Clinic, a          |
|     multidisciplinary program focusing on the diagnosis and           |
|     management of Alzheimer's disease and related disorders and their |
|     behavioral manifestations; 2) a multidisciplinary Combined        |
|     Consultation Service in Geriatric Medicine and Palliative Care;   |
|     and 3) a multidisciplinary geriatric oncology clinic developed at |
|     the affiliated NIH-designated Cancer Therapy and Research Center. |
|     (Dr. Donald Royall, #1, 2002; Dr. Sandra Sanchez-Reilly, #s2&3,   |
|     2004-2006).                                                       |
|                                                                       |
| -   GRECC staff members are engaged in active discussion with         |
|     industry and the VA Cooperative Studies Program to develop a VA   |
|     multi-center trial of MBX-102, a new glucose-lowering agent, for  |
|     the treatment of VA patients with type 2 diabetes.                |
|                                                                       |
| -   The GRECC began the innovative "Palliative Care on the Road"      |
|     program for VISN 17 with a two-hour videoteleconference in late   |
|     fall '06, and two day-long programs in spring '07 on-site at      |
|     Temple and Dallas VAMCs. More programs are planned.               |
+-----------------------------------------------------------------------+
| **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}.*                                      |
|                                                                       |
| \[Ref: Royall DR, Jai HG, Kellogg DL. Insular Alzheimer's disease     |
| pathology as a cause of "age-related" autonomic dysfunction and       |
| mortality in the non-demented elderly. Medical Hypotheses.            |
| 67(4):747-58, 2007 June\] The investigators found that stroke may not |
| be the only insular pathology with the potential to disrupt autonomic |
| function. This study revealed that Alzheimer's Disease (AD) is        |
| associated with both insular pathology and autonomic dysfunction.     |
| Pre-clinically diagnosed AD is a possible explanation for             |
| fall-related morbidity and mortality in non-demented elderly persons. |
|                                                                       |
| \[Ref: Sanchez-Hidalgo A, Lu Z, Tan D-X, Maldonado MD, Reiter RJ,     |
| Gregerman RI. Melatonin inhibits fatty acid-induced triglyceride      |
| accumulation in ROS 17/2.8 cells: implications for osteoblast         |
| differentiation and osteoporosis. Am J of Physiol Regul Integr Comp   |
| Physiol 292: R2208-15, 2007 March\] This important study reveals that |
| melatonin-fatty acid interrelationship may have implications for bone |
| marrow stomal cell differentiation. Findings indicate that melatonin  |
| may be a regulator of osteoblastic development which impacts the      |
| development of osteoporosis during aging.                             |
|                                                                       |
| \[Ref: Miller RA, Harrison DE, Astle CM, Strong R. An aging           |
| interventions testing program: study design and interim report. Aging |
| Cell 6:565-75, 2007 April.\] The authors examined the use of several  |
| agents to determine which one(s) might reduce mortality and found     |
| that only one, nordi-hydroguiaretic acid (NDGA) significantly reduced |
| mortality in genetically heterogeneous male mice in the last third of |
| their expected life span, as replicated at the four test sites (P =   |
| 0.0004). The runner-up agent, though non-significant, was aspirin (P  |
| = .07).                                                               |
|                                                                       |
| \[Ref: Sanchez-Reilly S, Wittenberg-Lyles EM, Villagran MM. Using a   |
| pilot curriculum in generic palliative care to improve communication  |
| skills among medical students. Am J of Hospital Palliative Care 24:   |
| 131-6, 2007 May.\] Pre- and post-surveys of attitudes of medical      |
| students taking a palliative care elective were evaluated. After the  |
| intervention, students showed improvement in their ability to break   |
| bad news to end-of-life geriatric patients.                           |
|                                                                       |
| \[Ref: Royall DR, Chiodo LK, Mouton C, Polk MJ.\] Cognitive           |
| predictors of mortality in elderly retirees: results from the Freedom |
| House study. Am J of Geriatric Psychiatry 15(3):243-51, 2007 March.\] |
| Right hemisphere dysfunction and impairment on non-verbal drawing     |
| tasks (clock drawing) have been associated with mortality in          |
| conditions such as Alzheimer's disease, stroke and epilepsy. This     |
| study extended the association to "normal" aging. Mortality may be    |
| related to right hemisphere cortical control of autonomic function.   |
| Many non-demented persons who cannot accurately draw a clock may be   |
| identified as being at risk for impairment.                           |
+-----------------------------------------------------------------------+
| **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}.*                                                  |
|                                                                       |
| \[Ref: Kostrominova TY, Pasyk KA, Van Remmen H, Richardson AG,        |
| Faulkner JA.\] Adaptive changes in structure of skeletal muscles from |
| adult SOD1 homozygous knockout mice. Cell Tissue Research             |
| 327:595-605, 2006 November.\] The study found that despite a complete |
| lack of SOD1 activity and the expected vast structural damage caused  |
| by superoxide free-radicals, adaptations in gene and protein          |
| expression that influence skeletal muscle structure and function      |
| minimize damage and preserve the structural integrity of muscles of   |
| adult SOD1 mice.                                                      |
|                                                                       |
| \[Ref: Zhang Y, Padalecki SS, Chaudhuri AR, Richardson AR, et al.\]   |
| Caspase-2 deficiency enhances aging-related traits in mice.           |
| Mechanisms of Aging and Development 128(2):213-221, 2007 February.\]  |
| The investigators found that the deletion of capase-2, an important   |
| component of the intrinsic pathway of apoptosis, enhanced a number of |
| aging-related traits commonly seen in prematurely aging animals. This |
| important study demonstrates for the first time that apoptosis plays  |
| an important role in aging.                                           |
|                                                                       |
| \[Ref: Morrison LJ, Scott JO, Block SD, and the American Board of     |
| Hospice and Palliative Care Medicine Competencies Workgroup:          |
| Sanchez-Reilly S. Journal of Palliative Care 10(2):313-30, 2007.\]    |
| Developing initial competency-based outcomes for the hospice and      |
| palliative medicine subspecialist: phase 1 of the hospice and         |
| palliative medicine competencies project. The workgroup focused on    |
| qualifications (such as those developed in a strong internal medicine |
| program) upon which hospice and palliative medicine (HPM)             |
| competencies could be built. The initial competencies outcomes study  |
| (Part 1) for the HPM subspecialist provides a definition of the       |
| unique competencies of the HPM physician which will form the basis    |
| for developing those competencies in fellowship and other training    |
| programs. The study will evolve into Part 2 which will determine      |
| measurable outcomes for the identified competencies.                  |
+-----------------------------------------------------------------------+
| **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.)*                                         |
|                                                                       |
| -   The GRECC partnered with the STGEC to conduct a unique education  |
|     program in FY07 on Medico-legal Issues in Aging for health care   |
|     professionals and lawyers throughout VISN 17. The program was     |
|     also web-cast live and available for viewing via computer         |
|     nationally and internationally.                                   |
|                                                                       |
| -   The San Antonio GRECC cosponsored \[with the South Texas          |
|     Geriatric Education Center (STGEC)\] the fourth Summer Institute  |
|     in Geriatrics & Gerontology: "G&G 101." This program is           |
|     innovative because it is a 40-hr week-long program, is            |
|     multidisciplinary, and is for health professionals who treat      |
|     elderly veterans in all clinical settings and who have had        |
|     minimal training in geriatrics and gerontology. The program was   |
|     digitally videotaped to be available for future viewing in        |
|     FY'07-08.                                                         |
|                                                                       |
| -   The GRECC uses the facilities of Golden Manor (GM) Jewish Home    |
|     and Services for the Aging, a community health care agency for    |
|     the elderly, as additional clinical sites for joint GRECC and     |
|     STGEC trainees. This is an innovative program because it is       |
|     interdisciplinary in nature and expands the female patient        |
|     population available for trainee education as required by the     |
|     ACGME and other accrediting bodies. Trainee rotations began in    |
|     late FY'05 and are continuing.                                    |
|                                                                       |
| -   The GRECC began the innovative "Palliative Care on the Road"      |
|     program for VISN 17 with a two-hour videoteleconference in late   |
|     fall '06, and two day-long programs in spring '07 on-site at      |
|     Temple and Dallas VAMCs. More programs are planned.               |
+-----------------------------------------------------------------------+
| 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.***   |
|                                                                       |
|     -   DVDs and videotapes are available of the VISN co-sponsored    |
|         24^th^ (Prostate Cancer), 25^th^, 26^th^, 27 ^th^ and 28^th^  |
|         Annual Conferences on Aging ("New Horizons in Geriatric       |
|         Primary Care") for those employees who could not attend.      |
|         Multidisciplinary staff from throughout the VISN, including   |
|         satellite clinics, attended. Attendees evaluated the          |
|         conferences as excellent. This is the first time all five     |
|         previous conferences are available.                           |
|                                                                       |
| -   Forty hours of DVDs and videotapes are available for each of the  |
|     1^st^ through 4^th^ Summer Institutes on Geriatrics and           |
|     Gerontology ("G&G 101"), co-sponsored with the STGEC. This is the |
|     first time all four previous institutes are available.            |
|                                                                       |
| -   Twenty-seven hours of DVDs and videotapes are available of the    |
|     FY'07 GRECC Geriatrics & Gerontology Grand Rounds, for a total of |
|     81 hours for FYs'05 through '07.                                  |
+-----------------------------------------------------------------------+
| c.  **Educational programs offered by your GRECC during the report    |
|     year that were evaluated for impact, as described in              |
|                                                                       |
|   <http://vaww1.va.gov/grecc/docs/2007Measuresinstructions102506.doc> |
|      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 evaluation, including in your   |
|     description of the latter the evaluation methodology, findings,   |
|     and conclusions.   Limit your description of each intervention    |
|     and its evaluation to one-half page.*                             |
|                                                                       |
| -   This new evaluation of educational programs for impact required   |
|     an increase in the time needed to collect program data, with      |
|     inadequate numbers of staff to collect it. Newly funded Geriatric |
|     Education Center staff were volunteered to assist. The first      |
|     program evaluated for impact was the eight-hour 28^th^ Annual     |
|     Conference on Aging, *Geriatric Primary Care: Current             |
|     Perspectives & New Horizons*, on August 24, 2007, with the        |
|     majority of attendees (73 of 105) from the host facility. The     |
|     following topics were presented in the conference: "Early         |
|     Detection of Cancer: A Risk of Ageism in Screening," "The New     |
|     Field of Geriatric Oncology," "Putting Findings from the New      |
|     England Centenarian Study into Practice," "Nonalcoholic Fatty     |
|     Liver Disease: What's Important for the Health Care Provider to   |
|     Know," "Osteoporosis Therapy: The Good, the Bad and the Ugly,"    |
|     "Ethical Issues in End of Life Care," and "Cutting Edge           |
|     Management of Frailty in Geriatric Patients." In addition to the  |
|     usual primary evaluation conducted by the Employee Education      |
|     System staff (numbers of attendees, disciplines, work location,   |
|     profession, quality of presentations, and the like---see          |
|     electronic data base), secondary impact evaluation was conducted  |
|     on a random sample of 25% of the attendees via telephone or       |
|     personal contact three months after the program. All of the       |
|     respondents reported that they now were 1) utilizing clinical     |
|     monitoring of fatty liver disease in veteran patients with        |
|     metabolic syndrome, 2) screening for osteoporosis in older men as |
|     well as post-menopausal women, and 3) considering the limitations |
|     of PSA screening for prostate cancer in older male veterans.      |
|                                                                       |
| -   This new evaluation of educational programs for impact required   |
|     an increase in the time needed to collect program data, with      |
|     inadequate numbers of staff to collect it. Newly funded Geriatric |
|     Education Center staff were volunteered to assist. The second     |
|     program evaluated for impact was the day-long VISN program,       |
|     *Palliative Care on the Road* that had 100% attendance (42) from  |
|     the following VISN 17 medical centers: Temple, Dallas, Bonham and |
|     Waco. The following topics were presented in the conference:      |
|     "Introduction to Palliative Care," "Clinical Criteria for Hospice |
|     Referral," "Symptom Management in Palliative Care," "Restoring    |
|     Balance between Curative and Palliative Care," and "Ethical       |
|     Issues in Palliative Care." In addition to the usual primary      |
|     evaluation conducted by the Employee Education System staff       |
|     (numbers of attendees, disciplines, work location, profession,    |
|     quality of presentations, and the like---see electronic data      |
|     base), secondary impact evaluation was conducted on a random      |
|     sample of 25% of the attendees via telephone or personal contact  |
|     three months after the program. All of the respondents reported   |
|     that they now were 1) more skilled in providing palliative care   |
|     consults, 2) better able to determine appropriate dosage for      |
|     adequate pain control in older veterans, and 3) more skilled in   |
|     conducting family conferences for elderly veterans in palliative  |
|     care.                                                             |
+-----------------------------------------------------------------------+
| **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.                                   |
|                                                                       |
| -   Autonomic Dyscontrol and Very Early Alzheimer\'s Disease. The     |
|     primary goals of this project conducted by Dr. Donald Royall and  |
|     colleagues are to establish specific associations between tests   |
|     of constructional praxis and insular mediated autonomic           |
|     dysfunction in elderly persons at risk for Alzheimer's disease    |
|     (AD). The PI and colleagues have previously observed a specific   |
|     association between right hemisphere visuospatial cognitive tasks |
|     and mortality in non-demented octogenarians. Similar tests        |
|     specifically predict mortality in AD. This study uses functional  |
|     magnetic resonance imaging (fMRI) to determine whether right      |
|     insular blood flow mediates the association between visuospatial  |
|     cognitive measures and measures of autonomic control in           |
|     non-demented octogenarians, free of comorbid cardiovascular       |
|     disease. \[Ongoing\]                                              |
|                                                                       |
| -   Stress-Busting Program for Caregivers of Patients with            |
|     Neurological Diseases. The overall goal of this program is to     |
|     determine the effectiveness of relaxation therapy and stress      |
|     management for caregivers of patients with Alzheimer's disease    |
|     and Parkinson's disease. This is a longitudinal study that        |
|     focuses on teaching relaxation skills to caregivers and           |
|     monitoring the effectiveness using biofeedback parameters,        |
|     immunological parameters, and self-report measures. Follow-up     |
|     studies are performed at two and four months after the completion |
|     of the study. Compliance with the study and follow-up has         |
|     exceeded 95%. \[Ongoing\]                                         |
|                                                                       |
| -   Geriatric-specific Health Care Quality Curriculum in the Clinical |
|     Setting. In late FY04 Dr. Monica Horton was awarded a Geriatric   |
|     Academic Career Award (GACA) from the Bureau of Health            |
|     Professions of the Health Resources and Services Administration   |
|     of the USPHS. Using these funds in FY05, Dr. Horton began         |
|     development and implementation of a geriatric-specific Health     |
|     Care Quality curriculum to apply in direct patient care programs. |
|     Congress cancelled all geriatrics education programs in FY06, but |
|     restored them in FY07; and Dr. Horton was refunded in             |
|     September 2007. She is continuing this activity with these funds. |
|     \[Ongoing\]                                                       |
|                                                                       |
| -   Medical Quality Improvement in the GEM Clinic: Intervention to    |
|     Prevent Emergency Room (ER) Visits and Hospitalizations. Dr.      |
|     Monica Horton is pursuing studies of medical quality improvement  |
|     initiated under a Bureau of Health Professions Geriatric Academic |
|     Career Award (GACA). Providing patients with efficient and        |
|     effective care is a characteristic of the ideal healthcare        |
|     system, as described in the Institute of Medicine report          |
|     "Crossing the Quality Chasm". Ambulatory care sensitive           |
|     conditions are illnesses for which timely treatment in the        |
|     ambulatory care setting would be expected to prevent ER visits    |
|     and hospitalizations. In Dr. Horton's study patients who are      |
|     enrolled in the VA Geriatric Evaluation and Management Clinic     |
|     (GEM) and who have recently been seen in the ER receive a GEM     |
|     intervention consisting of notification of clinic hours or        |
|     clinical telephone access parameters. Congress cancelled all      |
|     geriatrics education programs in FY06, but restored them in FY07; |
|     and Dr. Horton was refunded in September 2007. She is continuing  |
|     this activity with these funds. \[Ongoing\]                       |
|                                                                       |
| -   Longitudinal, Integrated Humanities Curriculum in the Clinical    |
|     Setting. This curriculum has been developed by a GRECC/Extended   |
|     Care clinical investigator, Dr. Sandra Sanchez-Reilly. It         |
|     incorporates a specific longitudinal, integrated humanities       |
|     curriculum with the UTHSCSA Center for Medical Humanities and     |
|     Ethics, strategically designed for the different education levels |
|     of medical students and residents, geriatric fellows and          |
|     interdisciplinary team members. Dr. Sanchez-Reilly began teaching |
|     the curriculum in FY06 and continued it in FY07. \[Ongoing\]      |
|                                                                       |
| -   Combined Consultation Service in Geriatric Medicine and           |
|     Palliative Care. This program has been developed, implemented and |
|     evaluated by Dr. Sandra Sanchez-Reilly, who was awarded a GACA    |
|     for this purpose in late FY'04. This program incorporates the     |
|     humanities curriculum Dr. Sanchez-Reilly is developing with the   |
|     UTHSCSA Center for Medical Humanities and Ethics. The literature  |
|     lacks evidence on the efficacy of combined programs in the areas  |
|     of geriatrics and palliative care. Palliative care programs       |
|     address quality of life issues, but few are specifically related  |
|     to older populations with provision of complementary geriatric    |
|     expertise. Dr. Sanchez-Reilly and colleagues have developed a     |
|     model of care at this VAMC with dual expertise in geriatrics and  |
|     palliative care. The model is being evaluated for its efficacy in |
|     addressing many needs of veteran patients, including pain         |
|     control, end-of-life care in frail patients, management of        |
|     geriatric syndromes such as delirium/acute confusion, and         |
|     functional assessment. Congress cancelled all geriatrics          |
|     education programs in FY06, but restored them in FY07; and Dr.    |
|     Sanchez-Reilly was refunded in September 2007. She is continuing  |
|     this activity with these funds. \[Ongoing\]                       |
|                                                                       |
| -   Care Coordination Program. A Care Coordination Program was        |
|     developed for patients residing at home within VISN 17. The       |
|     program utilizes disease management, care/case management,        |
|     self-management of chronic disease and technology to manage       |
|     veterans who are high users of medical center resources.          |
|     Equipment was placed in patient homes and telemonitoring is       |
|     underway. \[Ongoing\]                                             |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   Multidisciplinary Geriatric Oncology Clinic. Dr. Sandra           |
|     Sanchez-Reilly is expanding the multidisciplinary geriatric       |
|     oncology clinic at the affiliated NIH-designated Cancer Therapy   |
|     and Research Center which was developed partly as a site for      |
|     clinical outcomes research on optimization of oncological care    |
|     for older adults and for the conduct of clinical trials           |
|     specifically designed for the elderly. Currently, patient         |
|     demographic and epidemiological data are being collected. In      |
|     addition, Palliative Care and Geriatrics Fellows began rotations  |
|     in this clinic in FY06 and continued in FY07. \[Ongoing\]         |
|                                                                       |
| -   Interdisciplinary clinical training program in geriatrics at      |
|     Golden Manor Jewish Home and Services for the Aging (GM). Drs.    |
|     Michèle Saunders, Michael Katz, and Sandra Sanchez-Reilly have    |
|     developed an interdisciplinary clinical training program in       |
|     geriatrics at GM in part to meet new ACGME and fellowship         |
|     requirements for more female patients. Interdisciplinary teams of |
|     advanced trainees in geriatrics from the disciplines of medicine, |
|     dentistry, dental hygiene, nursing, PT, OT, social work,          |
|     psychology, and chaplaincy rotate through the site. \[Ongoing\]   |
|                                                                       |
| -   Wound Rounds Tracking Program. GRECC staff and affiliated staff   |
|     have begun a new program to track the progression of wound        |
|     healing in the ECTC using photography. Clinical photographs are   |
|     taken of wounds at each Wound Rounds, entered into the electronic |
|     medical record and assessed to determine if therapies should be   |
|     adjusted. \[Ongoing\]                                             |
|                                                                       |
| -   Assessment of the impact of motorized wheelchair and/or scooter   |
|     prescription and utilization on ADL and IADL is being conducted   |
|     in collaboration with The Scooter Store by Drs. Sara Espinoza and |
|     Helen Hazuda. \[New\]                                             |
+-----------------------------------------------------------------------+
| b.  **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.                    |
|                                                                       |
| -   Autonomic Dyscontrol and Very Early Alzheimer\'s Disease. A       |
|     significant association between asymmetric right insular blood    |
|     flow reductions and orthostasis can be demonstrated. Data suggest |
|     that visuospatial measures also mediate depression's association  |
|     with mortality, and that both the association between depression  |
|     and mortality, and that of visuospatial cognition and mortality,  |
|     are mediated by orthostasis.                                      |
|                                                                       |
| -   Stress-Busting Program for Caregivers of Patients with            |
|     Neurological Diseases. Outcomes of this intervention are assessed |
|     on both short-term and long-term bases using psychosocial         |
|     instruments as well as state-of-the-science technology including  |
|     biofeedback measurements and immune parameters. There were many   |
|     improvements for both spousal and adult children caregivers.      |
|     However, the children caregivers did not improve to the same      |
|     level as the spousal caregivers because they expressed difficulty |
|     in "letting go" of their stress.                                  |
|                                                                       |
| -   Geriatric-specific Health Care Quality Curriculum in the Clinical |
|     Setting. Evaluation is based on assessment of trainee             |
|     performance, trainee evaluation of curriculum, patient            |
|     satisfaction surveys, and improved patient outcomes. \[No         |
|     evaluation data available in FY07\]                               |
|                                                                       |
| -   Medical Quality Improvement in the GEM Clinic: Intervention to    |
|     Prevent Emergency Room (ER) Visits and Hospitalizations. The      |
|     intervention measures used in the study were found to result in a |
|     progressive decline in the number of ER visits. Dr. Horton's      |
|     ongoing research indicates that formation of a quality            |
|     improvement team and selective targeting of older patients        |
|     seeking care in an inappropriate setting will dramatically        |
|     improve the efficacy and cost of health care within the VA.       |
|                                                                       |
| -   Longitudinal, Integrated Humanities Curriculum in the Clinical    |
|     Setting. Evaluation is based on assessment of trainee             |
|     performance, trainee evaluation of curriculum, patient            |
|     satisfaction surveys, and alterations in care of elderly veteran  |
|     patients. FY07 evaluation thus far indicates the trainees found   |
|     the curriculum to be excellent in preparing them to treat elderly |
|     patients.                                                         |
|                                                                       |
| -   Combined Consultation Service in Geriatric Medicine and           |
|     Palliative Care. Evaluation is based on assessment of trainee     |
|     performance, trainee evaluation of rotation, patient satisfaction |
|     surveys, and improved patient outcomes. FY07 evaluation thus far  |
|     indicates the trainees found the curriculum and rotation          |
|     experience to be excellent in preparing them to treat elderly     |
|     patients and provide palliative care when appropriate.            |
|                                                                       |
| -   Care Coordination Program. Evaluation of this program will be     |
|     based on patients' rate of return to the Urgent Care Clinic**.**  |
|     The first patients were enrolled in late FY05 and data is         |
|     currently being collected and will be analyzed. \[No evaluation   |
|     data available in FY07\]                                          |
|                                                                       |
| -   Multidisciplinary Geriatric Oncology Clinic. Currently, patient   |
|     demographic and epidemiologic data are being collected.           |
|     Evaluation of trainee performance is based on assessment of       |
|     trainee performance, trainee evaluation of rotation, patient      |
|     satisfaction surveys, and improved patient outcomes. FY07         |
|     evaluation thus far indicates the trainees found the curriculum   |
|     to be excellent in preparing them to treat elderly patients with  |
|     cancer and patients and their families were extremely satisfied   |
|     with their care. \[No patient outcome data available in FY07\]    |
|                                                                       |
| -   Interdisciplinary clinical training program in geriatrics at GM.  |
|     Evaluation is based on assessment of trainee performance, trainee |
|     evaluation of rotation, and patient satisfaction surveys. Results |
|     of FY07 evaluations show a significant improvement of knowledge,  |
|     attitudes and skills among trainees by the end of the rotation;   |
|     trainees enjoyed the rotation; and the GM residents enjoy working |
|     with the students during their rotations.                         |
|                                                                       |
| -   Wound Rounds Tracking Program. GRECC staff and affiliated staff   |
|     have begun a new program to track the progression of wound        |
|     healing in the ECTC using photography. Clinical photographs are   |
|     taken of wounds at each Wound Rounds, entered into the electronic |
|     medical record and assessed to determine if therapies should be   |
|     adjusted. \[Data was being analyzed towards the end of FY07\]     |
|                                                                       |
| -   A new program began in FY07 to assess the impact of motorized     |
|     wheelchair and/or scooter prescription and utilization on ADL and |
|     IADL is being conducted in collaboration with The Scooter Store   |
|     by Drs. Sara Espinoza and Helen Hazuda. The evaluation will be    |
|     based on assessment of ADL and IADL of elderly veterans before    |
|     and after prescription of a motorized wheelchair and/or scooter.  |
|     \[No evaluation data available in FY07\]                          |
+-----------------------------------------------------------------------+
| c.  **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"):*           |
|                                                                       |
| -   The Combined Consultation Service in Geriatrics and Palliative    |
|     Care has been presented formally at the national level with       |
|     ongoing evaluation and additional discussion for export VISN-     |
|     and/or nation-wide. Export to VISN 17 is underway with the new    |
|     Palliative Care on the Road Program.                              |
|                                                                       |
| -   The Multidisciplinary Geriatric Oncology Clinic at the CTRC       |
|     affiliate also has been presented formally at the national level  |
|     with ongoing evaluation and additional discussion for possible    |
|     export VISN- and/or nation-wide.                                  |
|                                                                       |
| -   Clinical Model for Dementia Assessment. Dr. Royall's dementia     |
|     assessment scales (the Executive Interview \[EXIT25\] and CLOX:   |
|     an executive clock drawing task) have been incorporated into      |
|     numerous longitudinal studies of aging, including the Hispanic    |
|     Established Populations for the Epidemiologic Study of the        |
|     Elderly, the San Antonio Longitudinal Study of Aging, and the     |
|     University of Alabama Longitudinal Study of Aging. These studies  |
|     provide opportunities to extend Dr. Royall's work on executive    |
|     function to community samples. The EXIT25 and CLOX have also been |
|     introduced into clinical trials, which provide the first          |
|     empirical evidence of the potential to reverse executive          |
|     impairments in the elderly. The EXIT25 and CLOX have been         |
|     translated into 14 languages; Dr. Royall has validated a Spanish  |
|     language translation of the CLOX, while Dutch, Hebrew, and        |
|     Mandarin Chinese translations of the EXIT25 have been validated   |
|     by other investigators. In addition, the British Geriatrics       |
|     Society has specifically recommended CLOX for initial dementia    |
|     screening in its most recent evidence-based guidelines, thus      |
|     assuring broad international export of this instrument for use as |
|     a clinical model for dementia assessment. In July 2007, Dr.       |
|     Royall conducted a workshop on the use of these instruments at    |
|     the VAS-COG International Scientific Meeting held in San Antonio, |
|     TX, and cosponsored by the GRECC and the national VHA Employee    |
|     Education System.                                                 |
+-----------------------------------------------------------------------+
| **8. CONSULTATION AND OUTREACH**                                      |
+-----------------------------------------------------------------------+
| NOTE: **Consultation** = GRECC staff going to sites **[within host    |
| VAMC]{.underline}** or having those staff come to the GRECC, to       |
| assist in development of research, education or clinical programs at  |
| those sites. **Outreach** = GRECC staff going to **[non-host VAMC     |
| facilities]{.underline}** or having those staff come to the GRECC (in |
| person or by video or other technology) to assist in development of   |
| research, education or clinical programs at those sites.              |
+-----------------------------------------------------------------------+
| a\. **Current Year Activity Outcomes** *(list up to five examples, up |
| to two lines each; summarize specific outcomes realized from current  |
| year **consultation**, e.g., "Host VAMC instituted a Falls Clinic     |
| after consultation from GRECC staff;" or **outreach**, e.g.,          |
| [X]{.underline} VAMC instituted a Falls Clinic after GRECC outreach   |
| via series of videoconferences):*                                     |
|                                                                       |
| -   The GRECC continues to address the South Texas Veterans Health    |
|     Care System's palliative care program. In FY-07, 20 facility-wide |
|     training sessions were held for host VAMC staff. Attendees found  |
|     the seminars extremely helpful and have implemented screening of  |
|     patients for palliative care consultations.                       |
|                                                                       |
| -   Kerrville Division instituted a patient care screening program    |
|     for palliative care consultations after consultation with the     |
|     GRECC palliative care team. \[Ongoing\]                           |
|                                                                       |
| -   The GRECC began the innovative "Palliative Care on the Road"      |
|     program for VISN 17 with a two-hour videoteleconference in late   |
|     fall '06, and two day-long programs in spring '07 on-site at      |
|     Temple and Dallas VAMCs. More programs are planned.               |
+-----------------------------------------------------------------------+
| b.  **Previous Years' Activities Outcomes** *(list up to five         |
|     examples, up to two lines each; summarize specific outcomes       |
|     realized from previous years' [**consultation** to host           |
|     VAMC]{.underline} or [**outreach** to non-host                    |
|     facilities]{.underline}, where results were first realized in the |
|     current year.)*                                                   |
|                                                                       |
| -   GRECC staff completed editing of 16 hours of dental video for the |
|     curriculum sharing project in dentistry and nutrition with the    |
|     Little Rock GRECC. These edited videos were converted to DVD      |
|     format in FY07 and are now ready for export.                      |
|                                                                       |
| -   Dental staff from the Kerrville VAMC, having completed geriatrics |
|     training, is now fully responsible for the care of their elderly  |
|     nursing home residents; therefore, GRECC dental staff no longer   |
|     has to travel to Kerrville to treat these nursing home patients.  |
|                                                                       |
| -   Because the GRECC AD/EE was officially appointed to both the host |
|     and VISN 17 Education Committees there are now more consultation  |
|     and outreach education programs within the host VAMC and          |
|     throughout the VISN.                                              |
+-----------------------------------------------------------------------+