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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:** Little Rock                          |   |   |   |   |
|                                                          |   |   |   |   |
| b.  **Location** *(facility, VISN)*: CAVHS, VISN 16      |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| **2. CONTACT PERSON**                                    |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| a.  **Name:** Kay Guthrie                                |   |   |   |   |
|                                                          |   |   |   |   |
| b.  **Position:** AO                                     |   |   |   |   |
|                                                          |   |   |   |   |
| c.  **Phone, e-mail: (501) 257-5547                      |   |   |   |   |
|     <guthrie.bkay@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 | * |   |
|                                                          | * | * | * |   |
|                                                          | * | * |   |   |
+----------------------------------------------------------+---+---+---+---+
| **Cellular and Molecular Biology of Aging; Alzheimer's   | * |   |   |   |
| Disease**                                                | * |   |   |   |
|                                                          | X |   |   |   |
|                                                          | * |   |   |   |
|                                                          | * |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| **Nutrition, Exercise and Metabolism in the Elderly**    |   | * |   |   |
|                                                          |   | * |   |   |
|                                                          |   | X |   |   |
|                                                          |   | * |   |   |
|                                                          |   | * |   |   |
+----------------------------------------------------------+---+---+---+---+
| **Clinical Outcomes Research**                           |   |   | * |   |
|                                                          |   |   | * |   |
|                                                          |   |   | X |   |
|                                                          |   |   | * |   |
|                                                          |   |   | * |   |
+----------------------------------------------------------+---+---+---+---+
| **Functional rehabilitation**                            |   |   |   | * |
|                                                          |   |   |   | * |
|                                                          |   |   |   | X |
|                                                          |   |   |   | * |
|                                                          |   |   |   | * |
+----------------------------------------------------------+---+---+---+---+
| **4. ADMINISTRATION**                                    |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| a.  **GRECC Impact on Host VAMC in Report Year***: list  |   |   |   |   |
|     **the** **most important ways** in which the GRECC   |   |   |   |   |
|     has had specific impact on **host VAMC's** research, |   |   |   |   |
|     staff education, program evaluation, or clinical     |   |   |   |   |
|     care improvements for elderly veterans (i.e., how    |   |   |   |   |
|     the GRECC has "made a difference" in these areas     |   |   |   |   |
|     within the entire host VAMC) during the Report Year. |   |   |   |   |
|     **Please limit your response to [5 or                |   |   |   |   |
|     fewer]{.underline} "ways"; and please limit your     |   |   |   |   |
|     description of each of the five "ways" to [five      |   |   |   |   |
|     lines or fewer]{.underline}. ***                     |   |   |   |   |
|                                                          |   |   |   |   |
| -   The GRECC has 37 funded research projects that       |   |   |   |   |
|     amount to more than \$6 million in research funding  |   |   |   |   |
|     during last FY. This represented over \$2 million in |   |   |   |   |
|     VERA funding. The GRECC staff also provided numerous |   |   |   |   |
|     research mentoring experiences for post-doctoral     |   |   |   |   |
|     fellows, students, junior faculty, and staff from    |   |   |   |   |
|     other services and published 53 journal              |   |   |   |   |
|     articles/book chapters/books.                        |   |   |   |   |
|                                                          |   |   |   |   |
| ```{=html}                                               |   |   |   |   |
| <!-- -->                                                 |   |   |   |   |
| ```                                                      |   |   |   |   |
| -   During FY07, 14 CAVHS employees participated in live |   |   |   |   |
|     video teleconference programs and 84 attended        |   |   |   |   |
|     continuing education symposia offered by the GRECC.  |   |   |   |   |
|                                                          |   |   |   |   |
| -   During the last year, the GRECC initiated 3 clinical |   |   |   |   |
|     demonstration and quality of care assessment         |   |   |   |   |
|     projects -- Geriatric Sleep Study, Vitamin D         |   |   |   |   |
|     Deficiency and Hospital at Home evaluation.          |   |   |   |   |
|                                                          |   |   |   |   |
| -   In close collaboration with the Geriatrics and       |   |   |   |   |
|     Extended Care Service, the GRECC continues to be a   |   |   |   |   |
|     major provider of clinical teaching opportunities    |   |   |   |   |
|     for medical students (all third-year medical         |   |   |   |   |
|     students have a mandatory Geriatrics rotation        |   |   |   |   |
|     through the North Little Rock Division clinical      |   |   |   |   |
|     programs), medical and family practice residents,    |   |   |   |   |
|     geriatric fellows (with 4 first-year fellows in AY   |   |   |   |   |
|     06/07 and 2 fellows the in the Special Fellowship    |   |   |   |   |
|     Program in Advanced Geriatrics (SFPAG) in AY 06/07), |   |   |   |   |
|     and allied health students (nurses, pharmacists, and |   |   |   |   |
|     occupational therapists) through the GRECC Expansion |   |   |   |   |
|     Traineeships. The Geriatric Clerkship for the 3^rd^  |   |   |   |   |
|     year medical students continues to be rated in the   |   |   |   |   |
|     top 20% of all 3^rd^ year clinical rotations. Number |   |   |   |   |
|     range CHAPTERAll GRECC physicians are active         |   |   |   |   |
|     clinically and participate in all aspects of the     |   |   |   |   |
|     teaching program.                                    |   |   |   |   |
|                                                          |   |   |   |   |
| -   Dr. Sullivan and all of the other GRECC senior       |   |   |   |   |
|     investigators serve as mentors and preceptors to     |   |   |   |   |
|     multiple post-doctoral fellows and junior staff. Of  |   |   |   |   |
|     particular importance, we were one of only a few     |   |   |   |   |
|     facilities throughout the country to have filled     |   |   |   |   |
|     two, Special Fellowship in Advanced Geriatrics       |   |   |   |   |
|     (SFPAG) positions this year. The focus of this       |   |   |   |   |
|     fellowship is to develop future leaders in           |   |   |   |   |
|     geriatrics within the VA.                            |   |   |   |   |
|                                                          |   |   |   |   |
| -   Collaborated with PM&RS to develop and evaluate a    |   |   |   |   |
|     proposal to establish a local MOVE exercise          |   |   |   |   |
|     initiative within CAVHS                              |   |   |   |   |
|                                                          |   |   |   |   |
| -   Coordinated with CAVHS G&EC Committee to develop     |   |   |   |   |
|     policy to transition patients seamlessly between     |   |   |   |   |
|     Services                                             |   |   |   |   |
|                                                          |   |   |   |   |
| -   Developed a committee that evaluated and then        |   |   |   |   |
|     implemented changes that brought CAVHS into          |   |   |   |   |
|     compliance with the new VA privacy and data security |   |   |   |   |
|     mandates                                             |   |   |   |   |
|                                                          |   |   |   |   |
| -   The CBT sleep disorders clinic was exported to GEC   |   |   |   |   |
|     at the CAVHS. Dr. Richards left before it could be   |   |   |   |   |
|     disseminated to other facilities.                    |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| 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}. ***                     |   |   |   |   |
|                                                          |   |   |   |   |
| -   During FY07, 33 health professional employees of     |   |   |   |   |
|     VISN 16 attended live video teleconferences          |   |   |   |   |
|     (Alexandria, Houston, Jackson, Muskogee); 16 health  |   |   |   |   |
|     professionals from other VAMCs within VISN 16        |   |   |   |   |
|     attended the LR GRECC audioconference (Jackson,      |   |   |   |   |
|     Biloxi, Houston, Oklahoma City, Shreveport and       |   |   |   |   |
|     Fayetteville); and 6 people from VISN 16 attended    |   |   |   |   |
|     continuing education programs.                       |   |   |   |   |
|                                                          |   |   |   |   |
| -   Dr. Chernoff is a member of the VISN 16 Geriatrics   |   |   |   |   |
|     and Extended Care committee as a representative from |   |   |   |   |
|     the GRECC.                                           |   |   |   |   |
|                                                          |   |   |   |   |
| ```{=html}                                               |   |   |   |   |
| <!-- -->                                                 |   |   |   |   |
| ```                                                      |   |   |   |   |
| -   In the last year, the GRECC has continued to play a  |   |   |   |   |
|     major role in helping to shape VISN policies         |   |   |   |   |
|     regarding Geriatrics and Extended Care. Working      |   |   |   |   |
|     closely with Dr. Enderle (VISN 16 CMO), we           |   |   |   |   |
|     facilitated the first annual face-to-face strategic  |   |   |   |   |
|     planning meeting of the VISN G&EC Leadership         |   |   |   |   |
|     Committee in conjunction with our Best Practices     |   |   |   |   |
|     conference in April, 2007.                           |   |   |   |   |
|                                                          |   |   |   |   |
| ```{=html}                                               |   |   |   |   |
| <!-- -->                                                 |   |   |   |   |
| ```                                                      |   |   |   |   |
| -   LR GRECC worked with the VISN and New Orleans to     |   |   |   |   |
|     develop the foundation for a Hospital at Home        |   |   |   |   |
|     program and other innovative clinical demonstration  |   |   |   |   |
|     programs and have established appropriate outcomes   |   |   |   |   |
|     and monitoring plans for these programs.             |   |   |   |   |
|                                                          |   |   |   |   |
| ```{=html}                                               |   |   |   |   |
| <!-- -->                                                 |   |   |   |   |
| ```                                                      |   |   |   |   |
| -   Dr. Sullivan is a member of the VHA/VACO GEM         |   |   |   |   |
|     Training Task Force as a representative from the     |   |   |   |   |
|     GRECC and VISN 16. Through this Task Force, the      |   |   |   |   |
|     GRECC has taken a very active role in a Number range |   |   |   |   |
|     CHAPTERnational effort to incorporate geriatrics     |   |   |   |   |
|     into the planning and implementation of Advance      |   |   |   |   |
|     Clinic Access as there was previously no input from  |   |   |   |   |
|     geriatrics into this initiative.                     |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| c.  **GRECC Trend-Setting Innovations since October 1,   |   |   |   |   |
|     [2002]{.underline}**: *list **the** **most           |   |   |   |   |
|     significant** GRECC research, education or clinical  |   |   |   |   |
|     innovations in the past five years. **[For each      |   |   |   |   |
|     item, provide date or date range, GRECC core staff   |   |   |   |   |
|     responsible, and a description.]{.underline}**       |   |   |   |   |
|     **Please limit your response to 5 or fewer           |   |   |   |   |
|     innovations; and please limit each of the five       |   |   |   |   |
|     innovation descriptions to five lines or fewer. ***  |   |   |   |   |
|                                                          |   |   |   |   |
| -   In close collaboration with the VISN 16 leadership,  |   |   |   |   |
|     the GRECC has established several ongoing Clinical   |   |   |   |   |
|     Demonstration Projects including the Hospital at     |   |   |   |   |
|     Home program at New Orleans and the multiphase       |   |   |   |   |
|     initiative designed to address the epidemic of       |   |   |   |   |
|     hypovitaminosis D among older veterans. Prior        |   |   |   |   |
|     initiatives lead to the development of more          |   |   |   |   |
|     effective clinical strategies for evaluating and     |   |   |   |   |
|     treating sleep disorders in older veterans and the   |   |   |   |   |
|     need to monitor for cognitive decline in older       |   |   |   |   |
|     veterans with PTSD. Responsible persons: **Drs.      |   |   |   |   |
|     Sullivan, Kortebein, Bodenner, Richards, Hart.**     |   |   |   |   |
|                                                          |   |   |   |   |
| -   Introductory course in geriatrics for Surgical       |   |   |   |   |
|     Residency students. Responsible person: Dr. **Ronni  |   |   |   |   |
|     Chernoff**. This course was developed for general    |   |   |   |   |
|     surgery residents and is a mandatory part of their   |   |   |   |   |
|     orientation. It is 8-9 hours of fundamentals in      |   |   |   |   |
|     geriatrics needed for surgeons to better care for    |   |   |   |   |
|     elderly patients. The course is taught by the        |   |   |   |   |
|     staff/faculty from the GRECC and Geriatrics and      |   |   |   |   |
|     Extended Care                                        |   |   |   |   |
|                                                          |   |   |   |   |
| -   GRECC research has been very innovative in           |   |   |   |   |
|     developing strong intra- and                         |   |   |   |   |
|     inter-service/department collaborations involving    |   |   |   |   |
|     basic, clinical and health services researchers      |   |   |   |   |
|     which has resulted in 3 program projects, a large VA |   |   |   |   |
|     outcomes study, and multiple other research projects |   |   |   |   |
|     and a strong emphasis on translational research.     |   |   |   |   |
|     **Drs. Sullivan, Kortebein, Bodenner, Griffin, Reis, |   |   |   |   |
|     Evans, Barger and Wolfe.**                           |   |   |   |   |
|                                                          |   |   |   |   |
| -   Under Dr. **Ronni Chernoff**'s leadership, the GRECC |   |   |   |   |
|     developed an innovative state and VISN-wide          |   |   |   |   |
|     education program for health professionals in        |   |   |   |   |
|     geriatrics This program used many strategies         |   |   |   |   |
|     including continuing education seminars, live        |   |   |   |   |
|     interactive video teleconferences, self-study        |   |   |   |   |
|     programs, printed and syllabus materials; faculty    |   |   |   |   |
|     training seminars which have lead to undergraduate   |   |   |   |   |
|     course development; an educational newsletter;       |   |   |   |   |
|     clinical training experiences; mentoring             |   |   |   |   |
|     experiences; and an informational website. Much of   |   |   |   |   |
|     this activity was funded by the Arkansas Geriatric   |   |   |   |   |
|     Education Center grant (Chernoff PI).                |   |   |   |   |
|                                                          |   |   |   |   |
| -   **Dr. Ronni Chernoff** received a contract from HRSA |   |   |   |   |
|     to write a White Paper on Clinical Nutrition         |   |   |   |   |
|     Education and Training in the Health Professions     |   |   |   |   |
|     which will be used for policy initiatives if Title   |   |   |   |   |
|     VII funding is restored. This was a                  |   |   |   |   |
|     multi-disciplinary panel of experts reviewing the    |   |   |   |   |
|     existing educational opportunities in geriatric      |   |   |   |   |
|     nutrition across selected health professions and     |   |   |   |   |
|     making recommendations for future funding            |   |   |   |   |
|     opportunities. Drs. Sullivan (Little Rock,), Sanders |   |   |   |   |
|     (San Antonio), and Robbins (Madison) were other      |   |   |   |   |
|     GRECC representatives on this committee.             |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| **5. RESEARCH**                                          |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| **a. Key Findings [Published in the Report               |   |   |   |   |
| Year]{.underline} 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}.   |   |   |   |   |
|                                                          |   |   |   |   |
| -   **Kortebein P (co-PI, & GRECC Core)**, **Ferrando A, |   |   |   |   |
|     Lombeida J, Wolfe RR,** **Evans WJ** **(PI, & GRECC  |   |   |   |   |
|     Core)**. Effect of ten days of bed rest on skeletal  |   |   |   |   |
|     muscle in healthy older adults.  JAMA,               |   |   |   |   |
|     297(16):1772-4, 2007. Healthy older adults remained  |   |   |   |   |
|     in bed for 10 days continuously. Pre- and post bed   |   |   |   |   |
|     rest values for skeletal muscle protein synthesis,   |   |   |   |   |
|     DEXA and knee extension strength were reported;      |   |   |   |   |
|     these older adults lost almost 1 kg of lean tissue   |   |   |   |   |
|     from the lower extremities while protein synthesis   |   |   |   |   |
|     declined 30%, and strength 15%. These findings       |   |   |   |   |
|     indicate that healthy older subjects are more        |   |   |   |   |
|     sensitive to bed rest inactivity than younger        |   |   |   |   |
|     subjects.                                            |   |   |   |   |
|                                                          |   |   |   |   |
| ```{=html}                                               |   |   |   |   |
| <!-- -->                                                 |   |   |   |   |
| ```                                                      |   |   |   |   |
| -   **Number range CHAPTERSullivan DH**, Roberson PK,    |   |   |   |   |
|     Smith ES, Price JA, Bopp MM: Effects of Muscle       |   |   |   |   |
|     strength training and megesterol acetate on          |   |   |   |   |
|     strength, muscle mass, and function in the frail     |   |   |   |   |
|     elderly. *J Am Geriatr Soc* 55:20--28, 2007. This    |   |   |   |   |
|     was a blinded randomized controlled trial that       |   |   |   |   |
|     evaluated the effects of muscle strength training    |   |   |   |   |
|     alone or in combination with megesterol acetate on   |   |   |   |   |
|     strength, muscle mass, and function in frail older   |   |   |   |   |
|     adults recuperating from illness-induced functional  |   |   |   |   |
|     loss. The results indicate that megesterol acetate   |   |   |   |   |
|     blunts the beneficial effects of exercise, probably  |   |   |   |   |
|     as a result of the drug's strong glucocorticoid      |   |   |   |   |
|     properties.                                          |   |   |   |   |
|                                                          |   |   |   |   |
| -   **Bodenner DL**, Spencer H, Riggs AT, Van Vleet J,   |   |   |   |   |
|     Strunk B, Hughes, T. A retrospective study of the    |   |   |   |   |
|     association between megestrol acetate administration |   |   |   |   |
|     and mortality among nursing home residents with      |   |   |   |   |
|     clinically significant weight loss. *American        |   |   |   |   |
|     Journal of Geriatric Pharmacotherapy* 5(2): 137-146, |   |   |   |   |
|     2007 June. This study demonstrates that megestrol    |   |   |   |   |
|     acetate is ineffectual in promoting weight gain in   |   |   |   |   |
|     nursing home residents that have lost significant    |   |   |   |   |
|     weight. It may actually increase mortality.          |   |   |   |   |
|                                                          |   |   |   |   |
| -   Chen Y, Bodles AM, McPhie DL, Neve RL, Mrak RE,      |   |   |   |   |
|     **Griffin WS**. 2007 APP-BP1 inhibits Abeta42 levels |   |   |   |   |
|     by interacting with Presenilin-1.  Mol Neurodegener  |   |   |   |   |
|     2:3, 1-12. This project details interactions between |   |   |   |   |
|     two key players in Alzheimer pathogenesis that may   |   |   |   |   |
|     provide insight into the normal regulation of the    |   |   |   |   |
|     principle component in beta-amyloid plaques in       |   |   |   |   |
|     Alzheimer\'s disease.                                |   |   |   |   |
|                                                          |   |   |   |   |
| -   Mao X, Yang SH, Simpkins JW, **Barger SW**. 2007.    |   |   |   |   |
|     Glutamate receptor activation evokes                 |   |   |   |   |
|     calpain-mediated degradation of Sp3 and Sp4, the     |   |   |   |   |
|     prominent Sp-family transcription factors in         |   |   |   |   |
|     neurons. J Neurochem. 100:1300-14. This project      |   |   |   |   |
|     provides details of an impact of glutamate-receptor  |   |   |   |   |
|     activation on molecular events connected to gene     |   |   |   |   |
|     expression unique to neurons of the central nervous  |   |   |   |   |
|     system.                                              |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| **b. Key Findings [Published in the Report               |   |   |   |   |
| Year]{.underline} 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}.*        |   |   |   |   |
|                                                          |   |   |   |   |
| -   Ayyadevara S, Dandapat A, Singh SP, Siegel ER,       |   |   |   |   |
|     **Shmookler Reis RJ**, Zimniak L, Zimniak P.  Life   |   |   |   |   |
|     span and stress resistance of *Caenorhabditis        |   |   |   |   |
|     elegans* are differentially affected by glutathione  |   |   |   |   |
|     transferases metabolizing 4-hydroxynon-2-enal.       |   |   |   |   |
|     ***Mech. Aging Devel.*** 128:196--205, 2007.   Epub  |   |   |   |   |
|     Dec 8, 2006. (Dr. Zimniak was PI and **RJSR** was    |   |   |   |   |
|     coinvestigator for this project.)  This report       |   |   |   |   |
|     identifies glutathione transferases metabolizing     |   |   |   |   |
|     4-hydroxynon-2-enal in the nematode, which are (or   |   |   |   |   |
|     are not) contributors to longevity and resistance to |   |   |   |   |
|     oxidative stress                                     |   |   |   |   |
|                                                          |   |   |   |   |
| -   Szumska D, Beneš H, Kang P, Weinstein RS, Jilka RL,  |   |   |   |   |
|     Manolagas S, **Shmookler Reis RJ**.  A Novel Locus   |   |   |   |   |
|     on the X Chromosome Regulates Post-Maturity Bone     |   |   |   |   |
|     Density Changes in Mice.  ***Bone*** 40:758-766.     |   |   |   |   |
|     Epub Dec 18, 2006. This research describes a novel   |   |   |   |   |
|     X-chromosome locus governing bone mineral density    |   |   |   |   |
|     (BMD) in mice.  Its relevance to human clinical care |   |   |   |   |
|     hinges on an earlier paper from the Shmookler Reis   |   |   |   |   |
|     group (Parsons *et al.*, ***Hum Mol Genet*** 2005,   |   |   |   |   |
|     14:3141--3148), defining a human X-chromosome locus  |   |   |   |   |
|     (and identifying the gene responsible), which        |   |   |   |   |
|     modulates BMD in postmenopausal women.  The search   |   |   |   |   |
|     for that human locus was guided by the mouse mapping |   |   |   |   |
|     described in the present paper, which continues by   |   |   |   |   |
|     providing detailed characterization of the effects.  |   |   |   |   |
|                                                          |   |   |   |   |
| ```{=html}                                               |   |   |   |   |
| <!-- -->                                                 |   |   |   |   |
| ```                                                      |   |   |   |   |
| -   Johnson SK, **Dennis RA**, Barone GW, Lamps LW, and  |   |   |   |   |
|     RS Haun.  (2006)  Differential Expression of         |   |   |   |   |
|     Insulin-like Growth Factor Binding Protein 5 in      |   |   |   |   |
|     Pancreatic Adenocarcinomas: Identification Using DNA |   |   |   |   |
|     Microarray.  Molecular Carcinogenesis.  45:814-827.  |   |   |   |   |
|     GRECC Core staff Richard A Dennis worked as a        |   |   |   |   |
|     co-investigator to Non-GRECC PI Randy S Haun on a    |   |   |   |   |
|     project using gene expression data to diagnose       |   |   |   |   |
|     pancreatic cancer.  This is clinically significant   |   |   |   |   |
|     because this cancer is often detected at advanced    |   |   |   |   |
|     stages and has a very poor prognosis.                |   |   |   |   |
|                                                          |   |   |   |   |
| -   Hamid Z. Riggs A. Spencer T. Redman C. **Bodenner    |   |   |   |   |
|     D**. Vitamin D deficiency in residents of academic   |   |   |   |   |
|     long-term care facilities despite having been        |   |   |   |   |
|     prescribed vitamin D. *Journal of the American       |   |   |   |   |
|     Medical Directors Association. 8(2):71-5, 2007 Feb.* |   |   |   |   |
|     This study evaluated nursing home residents for      |   |   |   |   |
|     vitamin D deficiency in homes covered by UAMS        |   |   |   |   |
|     physicians. The study is unique in that it           |   |   |   |   |
|     demonstrated that a very large minority were still   |   |   |   |   |
|     vitamin D deficient despite being prescribed vitamin |   |   |   |   |
|     D.                                                   |   |   |   |   |
|                                                          |   |   |   |   |
| -   Raj, D., Oladipo, E.A., Dominic, E.A., Boivin, M.,   |   |   |   |   |
|     McClelland, S., **Wolfe, R.R.**, **Ferrando, A.A.**  |   |   |   |   |
|     Amino acid repletion does not improve protein        |   |   |   |   |
|     synthesis efficiency during hemodialysis. American   |   |   |   |   |
|     Journal of Physiology Endocrinology and Metabolism   |   |   |   |   |
|     292(6):E1534-42, 2007.  Use of exogenous amino acids |   |   |   |   |
|     during hemodialysis does not offset loss of protein. |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| **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]{.underline}** *(list five or    |   |   |   |   |
| fewer. Please limit each item to [5 lines or             |   |   |   |   |
| fewer]{.underline} and include clarification of how each |   |   |   |   |
| activity is innovative.)*                                |   |   |   |   |
|                                                          |   |   |   |   |
| -   Started building linkages between our education and  |   |   |   |   |
|     clinical demonstration project initiatives that      |   |   |   |   |
|     allow us to use the clinical demonstrations as a     |   |   |   |   |
|     forum for educating other healthcare professionals   |   |   |   |   |
|     about clinical issues, principles of quality         |   |   |   |   |
|     improvement, and scientific principles. As an        |   |   |   |   |
|     example, providing education to allied healthcare    |   |   |   |   |
|     students and externs from Pharmacy, Dietetics, and   |   |   |   |   |
|     Nursing regarding Vitamin D and the application of   |   |   |   |   |
|     scientific principles to population screening and    |   |   |   |   |
|     patient treatment while eliciting the support of the |   |   |   |   |
|     students in helping to implement the project.        |   |   |   |   |
|                                                          |   |   |   |   |
| -   VHS tapes have been provided to VISN 16 facilities;  |   |   |   |   |
|     we have instituted an innovative approach to         |   |   |   |   |
|     post-tests, evaluations, participant profiles and CE |   |   |   |   |
|     certificates by putting these all on-line so         |   |   |   |   |
|     participants can get their CE credits immediately    |   |   |   |   |
|     after viewing a program.                             |   |   |   |   |
|                                                          |   |   |   |   |
| ```{=html}                                               |   |   |   |   |
| <!-- -->                                                 |   |   |   |   |
| ```                                                      |   |   |   |   |
| -   As part of our SFPAG fellowship training program,    |   |   |   |   |
|     developed collaboration with the College of Nursing  |   |   |   |   |
|     to establish opportunities for the fellows to        |   |   |   |   |
|     receive training and field experience in qualitative |   |   |   |   |
|     research. The collaboration has already produced     |   |   |   |   |
|     positive results; one fellow developed a qualitative |   |   |   |   |
|     research study and was successful in applying for    |   |   |   |   |
|     pilot grant funding to support the project.          |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| **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.***                                         |   |   |   |   |
|                                                          |   |   |   |   |
| -   VHS/DVD program on Sleep Disorders in Older Adults   |   |   |   |   |
|     developed for health professionals. Speakers include |   |   |   |   |
|     Dr. Kathy Richards (Sleep and Movement Disorders),   |   |   |   |   |
|     Dr. David Davila (Sleep Disordered Breathing in the  |   |   |   |   |
|     Elderly), and Dr. Cathy Cole (Sleep and Cognition in |   |   |   |   |
|     Older Adults). This program was distributed to VISN  |   |   |   |   |
|     16 facilities and is approved for 2 hours of         |   |   |   |   |
|     continuing education.                                |   |   |   |   |
|                                                          |   |   |   |   |
| -   VHS/DVD program on Arthritis in Older Adults         |   |   |   |   |
|     developed for health professionals. Speakers include |   |   |   |   |
|     Dr. Hugo Jasin (Approach to the Elderly Patient with |   |   |   |   |
|     Arthritis), Dr. Richard Zuniga (Treatment of         |   |   |   |   |
|     Rheumatoid Arthritis in the Elderly Population),     |   |   |   |   |
|     Angela Campbell, PT (Rehabilitation Approaches for   |   |   |   |   |
|     the Older Adult with Arthritis). This program was    |   |   |   |   |
|     distributed to all VISN 16 facilities and is         |   |   |   |   |
|     approved for 2 hours of continuing education.        |   |   |   |   |
|                                                          |   |   |   |   |
| -   VHS/DVD program on Hypertension & Stroke developed   |   |   |   |   |
|     for health professionals. Speakers were Dr. James    |   |   |   |   |
|     Schmidley (Stroke, Stroke Mechanisms & Hypertension) |   |   |   |   |
|     and Dr. Sarkis Nazarian (Medical Prevention and      |   |   |   |   |
|     Treatment of Stroke). This program was distributed   |   |   |   |   |
|     to all VISN 16 facilities and is approved for 2      |   |   |   |   |
|     hours of continuing education. (This program was     |   |   |   |   |
|     supported through a grant from Novartis              |   |   |   |   |
|     Pharmaceuticals)                                     |   |   |   |   |
|                                                          |   |   |   |   |
| -   VHD/DVD program on Advances in the Treatment of      |   |   |   |   |
|     Osteoporosis developed for health professionals. The |   |   |   |   |
|     speaker was Dr. Donald Bodenner (Antiresoprtives v   |   |   |   |   |
|     Anabolic Agents in the Treatment of Osteoporosis).   |   |   |   |   |
|     This talk was supplemented with a previously taped   |   |   |   |   |
|     segment 'Common Fractures Resulting from             |   |   |   |   |
|     Osteoporosis' by Dr. Randy Bindra. The program was   |   |   |   |   |
|     partially supported through an educational grant     |   |   |   |   |
|     from Novartis Pharmaceuticals, was distributed to    |   |   |   |   |
|     all VISN 16 facilities and approved for 2 hours of   |   |   |   |   |
|     continuing education.                                |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| c\. **Educational programs offered by your GRECC during  |   |   |   |   |
| the report year that were evaluated for impact, as       |   |   |   |   |
| described in                                             |   |   |   |   |
| <http://vaw                                              |   |   |   |   |
| w1.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.*                    |   |   |   |   |
|                                                          |   |   |   |   |
| -   An audioconference on Nutrition and Wound Healing    |   |   |   |   |
|     was offered in February, 2007. More than 51% of the  |   |   |   |   |
|     239 attendees were from VAs other than Central       |   |   |   |   |
|     Arkansas Veterans Healthcare System. A program       |   |   |   |   |
|     evaluation was completed by at least 50% of the      |   |   |   |   |
|     attendees. Since the program was sponsored by the    |   |   |   |   |
|     GRECC and the EES, we only received an evaluation    |   |   |   |   |
|     report. As far as the AD/EE is aware, there was no   |   |   |   |   |
|     follow-up evaluation conducted.                      |   |   |   |   |
|                                                          |   |   |   |   |
| -   In FY 07, there were no programs offered where 51%   |   |   |   |   |
|     of the attendees were from the host VA. However,     |   |   |   |   |
|     more than 50% of the attendees at any GRECC          |   |   |   |   |
|     co-sponsored program completed follow-up             |   |   |   |   |
|     evaluations. Prior to this fiscal year, the GRECC    |   |   |   |   |
|     had an education specialist who planned and          |   |   |   |   |
|     implemented programs for this facility. It is        |   |   |   |   |
|     anticipated that this will occur in FY 2008 with the |   |   |   |   |
|     addition of an education specialist position in the  |   |   |   |   |
|     GRECC.                                               |   |   |   |   |
|                                                          |   |   |   |   |
| -   Follow up evaluations will begin with FY 07          |   |   |   |   |
|     Nutrition and Aging program and be reported in the   |   |   |   |   |
|     FY 08 annual report.                                 |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| **7. CLINICAL DEMONSTRATION PROJECTS**                   |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| a.  **Clinical Demonstration Projects [Underway in       |   |   |   |   |
|     Report Year]{.underline}***: 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.                       |   |   |   |   |
|                                                          |   |   |   |   |
| -   Geriatric Sleep Clinic: Studies have shown that      |   |   |   |   |
|     cognitive behavioral therapy (CBT) for insomnia is   |   |   |   |   |
|     at least as effective as pharmacologic treatment,    |   |   |   |   |
|     does not have its undesirable side effects, and      |   |   |   |   |
|     works longer. In FY2006, Dr. Kathy Richards began    |   |   |   |   |
|     work on a clinical demonstration project to          |   |   |   |   |
|     implement CBT principles in outpatient geriatric     |   |   |   |   |
|     practice. The project was designed to have three     |   |   |   |   |
|     phases: a Pilot Test of CBT Manualized Treatment     |   |   |   |   |
|     Protocols and Templates, Implementation of           |   |   |   |   |
|     APN-Managed CBT for Geriatric Insomnia Clinic at     |   |   |   |   |
|     CAVHS, and, Dissemination of Strategies, Materials,  |   |   |   |   |
|     and Outcomes to the VISN and throughout the VA.      |   |   |   |   |
|     Before she left the VA to take a new position in     |   |   |   |   |
|     Philadelphia, Dr. Richards implemented the first two |   |   |   |   |
|     phases of the project. (new-closed)                  |   |   |   |   |
|                                                          |   |   |   |   |
| -   Hospital at Home -- New project initiated in         |   |   |   |   |
|     Spring 2007. The GRECC is providing expertise for    |   |   |   |   |
|     the evaluative component of this project that is     |   |   |   |   |
|     examining an early discharge hospital at home model  |   |   |   |   |
|     that is being implemented at the New Orleans VA.     |   |   |   |   |
|     (new)                                                |   |   |   |   |
|                                                          |   |   |   |   |
| -   Evaluation and treatment of hypovitaminosis D --New  |   |   |   |   |
|     project initiated Spring 2007. This project is       |   |   |   |   |
|     evaluating how effectively a clinic-based screening  |   |   |   |   |
|     and treatment protocol for hypovitaminosis D in      |   |   |   |   |
|     older veterans can be implemented in primary care    |   |   |   |   |
|     outpatient clinics. Outcomes to be evaluated will    |   |   |   |   |
|     include percentage of the target population that is  |   |   |   |   |
|     successfully screened (i.e., Vit D level obtained),  |   |   |   |   |
|     the percentage of screened individuals with low      |   |   |   |   |
|     levels that are started on therapy, and the          |   |   |   |   |
|     percentage of treated patients that are successfully |   |   |   |   |
|     repleted. (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.           |   |   |   |   |
|                                                          |   |   |   |   |
| -   **Geriatric Sleep Clinic Study**: Dr. Richards       |   |   |   |   |
|     adapted standardized sleep assessments and           |   |   |   |   |
|     manualized treatment protocols from efficacy studies |   |   |   |   |
|     conducted by Ken Lichstein, PhD. Using these         |   |   |   |   |
|     materials, she successfully established a weekly     |   |   |   |   |
|     Geriatric Insomnia Clinic. Once this clinic was      |   |   |   |   |
|     well-established, she developed education materials  |   |   |   |   |
|     and competencies for APNs on sleep assessment,       |   |   |   |   |
|     manualized treatment protocols, and application of   |   |   |   |   |
|     medical record templates for assessment, management, |   |   |   |   |
|     and follow-up of geriatric insomnia. Dr. Richards    |   |   |   |   |
|     used the training materials to educate an APN whom   |   |   |   |   |
|     she trained to take over the clinic. Assessment of   |   |   |   |   |
|     the first 20 referrals identified improvement in     |   |   |   |   |
|     self-report measures of sleep quality and quantity,  |   |   |   |   |
|     and daytime alertness. Dr. Richards left the VA      |   |   |   |   |
|     before Phase 3 of this project could be implemented. |   |   |   |   |
|                                                          |   |   |   |   |
| -   **Hospital at Home**: This project just began        |   |   |   |   |
|     enrolling patients on October 1, 2007; we will be    |   |   |   |   |
|     meeting monthly via teleconference to discuss        |   |   |   |   |
|     progress and problems, and approximately quarterly   |   |   |   |   |
|     in-person evaluations will be performed. Depending   |   |   |   |   |
|     upon patient participation, evaluations will be done |   |   |   |   |
|     semi-annually or annually. Specific outcome measures |   |   |   |   |
|     and the strategies for their measurement are         |   |   |   |   |
|     currently being refined and tested.                  |   |   |   |   |
|                                                          |   |   |   |   |
| ```{=html}                                               |   |   |   |   |
| <!-- -->                                                 |   |   |   |   |
| ```                                                      |   |   |   |   |
| -   **Vitamin D**: This is a multi-phase project. In     |   |   |   |   |
|     phase 1 we confirmed that \>68% of older veterans    |   |   |   |   |
|     have subnormal vitamin D levels. In phase 2, which   |   |   |   |   |
|     is ongoing, we are testing the efficacy (i.e.,       |   |   |   |   |
|     success when implemented by GRECC personnel) of a    |   |   |   |   |
|     treatment protocol to replenish low vitamin D        |   |   |   |   |
|     levels. This phase should be completed in December   |   |   |   |   |
|     2007/January 2008; depending upon the results, the   |   |   |   |   |
|     next phase may start shortly thereafter. The focus   |   |   |   |   |
|     of this latter phase will be to evaluate the         |   |   |   |   |
|     effectiveness of a protocol to train clinicians to   |   |   |   |   |
|     screen all of their patients and to successfully     |   |   |   |   |
|     implement treatment when indicated. Simultaneously,  |   |   |   |   |
|     we will evaluate patient compliance and treatment    |   |   |   |   |
|     success. Subsequent phases will be implemented based |   |   |   |   |
|     on initial program outcomes.                         |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| 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 **Hospital at Home** project was initiated at    |   |   |   |   |
|     New Orleans. We are working with other VISNs (e.g.   |   |   |   |   |
|     Hawaii) to promote efforts to implement at           |   |   |   |   |
|     additional sites.                                    |   |   |   |   |
|                                                          |   |   |   |   |
| -   The **CBT sleep disorders clinic** was exported to   |   |   |   |   |
|     GEC at the CAVHS. Dr. Richards left before it could  |   |   |   |   |
|     be disseminated to other facilities.                 |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| **8. CONSULTATION AND OUTREACH**                         |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| **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):*         |   |   |   |   |
|                                                          |   |   |   |   |
| -   Collaborated with PM&RS to develop and evaluate a    |   |   |   |   |
|     proposal to establish a local MOVE exercise          |   |   |   |   |
|     initiative within CAVHS                              |   |   |   |   |
|                                                          |   |   |   |   |
| -   Coordinated with CAVHS G&EC Committee to develop     |   |   |   |   |
|     policy to transition patients seamlessly between     |   |   |   |   |
|     Services                                             |   |   |   |   |
|                                                          |   |   |   |   |
| -   Developed a committee that evaluated and then        |   |   |   |   |
|     implemented changes that brought CAVHS into          |   |   |   |   |
|     compliance with the new VA privacy and data security |   |   |   |   |
|     mandates                                             |   |   |   |   |
|                                                          |   |   |   |   |
| -   In the last year, the GRECC has continued to play a  |   |   |   |   |
|     major role in helping to shape VISN policies         |   |   |   |   |
|     regarding Geriatrics and Extended Care. We           |   |   |   |   |
|     facilitated VISN 16 G&EC leadership meeting in       |   |   |   |   |
|     conjunction with our Best Practices conference in    |   |   |   |   |
|     April.                                               |   |   |   |   |
|                                                          |   |   |   |   |
| -   Collaborated with New Orleans G&EC Service to        |   |   |   |   |
|     develop the foundation for the Hospital at Home      |   |   |   |   |
|     initiative                                           |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| 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.)*                                              |   |   |   |   |
|                                                          |   |   |   |   |
| -   The GRECC has successfully implemented numerous      |   |   |   |   |
|     VISN-wide clinical, education, and research          |   |   |   |   |
|     initiatives. In FY06, we sponsored a highly          |   |   |   |   |
|     successful VISN-wide Geriatrics and Extended Care    |   |   |   |   |
|     leadership conference that was the first step in     |   |   |   |   |
|     implementing the VISN Geriatric & EC Matrix concept  |   |   |   |   |
|     and began the process of short-term policy           |   |   |   |   |
|     implementation and long-term planning for Geriatrics |   |   |   |   |
|     and EC. The conference was rated as highly           |   |   |   |   |
|     successful by VISN and local leadership and the      |   |   |   |   |
|     other attendees. This leadership and collaboration   |   |   |   |   |
|     lead to the development of the VISN 16 G&EC Matrix   |   |   |   |   |
|     which was adopted and funded by the VISN. Dr David   |   |   |   |   |
|     Bass has been hired as the VISN 16 Geriatrics and    |   |   |   |   |
|     Extended Care Manager. Per request from the VISN, we |   |   |   |   |
|     now sponsor an annual VISN 16 GEC leadership         |   |   |   |   |
|     conference and business meeting.                     |   |   |   |   |
|                                                          |   |   |   |   |
| -   At the request of the VISN, Dr. Sullivan organized   |   |   |   |   |
|     and chaired an advisory committee to examine the     |   |   |   |   |
|     VISN policies regarding medical management of        |   |   |   |   |
|     dementia in FY06. The result was a decision memo     |   |   |   |   |
|     (authored by Dr. Sullivan) advising the VISN as to   |   |   |   |   |
|     the most cost-effective approach to treatment. The   |   |   |   |   |
|     major recommendations were rapidly adapted and have  |   |   |   |   |
|     resulted in significant cost savings to the VISN     |   |   |   |   |
|                                                          |   |   |   |   |
| -   The GRECC serves as a local (facility), VISN, and    |   |   |   |   |
|     national resource. Our business plan was developed   |   |   |   |   |
|     in collaboration with local and VISN leadership and  |   |   |   |   |
|     included multiple initiatives that have already been |   |   |   |   |
|     approved for funding by the VISN. The plan links to  |   |   |   |   |
|     and supports local, VISN, and National strategic     |   |   |   |   |
|     goals.                                               |   |   |   |   |
|                                                          |   |   |   |   |
| ```{=html}                                               |   |   |   |   |
| <!-- -->                                                 |   |   |   |   |
| ```                                                      |   |   |   |   |
| -   Established VISN-wide GRECC monthly clinical         |   |   |   |   |
|     research conference -- have had great interest by    |   |   |   |   |
|     several facilities, especially Oklahoma City. We     |   |   |   |   |
|     have overcome the obstacle of outdated equipment at  |   |   |   |   |
|     our facility with a VISN purchase of a new Polycom   |   |   |   |   |
|     system for this purpose.                             |   |   |   |   |
|                                                          |   |   |   |   |
| -   Our success in clinical demonstrations is reported   |   |   |   |   |
|     above in the Clinical Demonstration section          |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+