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| ### GERIATRIC RESEARCH, EDUCATION AND CLINICAL CENTER    |   |   |   |   |
|                                                          |   |   |   |   |
| ### *Annual Report: Fiscal Year [2007]{.underline}*      |   |   |   |   |
|                                                          |   |   |   |   |
| ######## Part II: Accomplishments                        |   |   |   |   |
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| **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:** St. Louis GRECC                      |   |   |   |   |
|                                                          |   |   |   |   |
| b.  **Location** *(facility, VISN)*: VAMC St. Louis,     |   |   |   |   |
|     VISN 15 Heartland Network, Kansas City, MO           |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| **2. CONTACT PERSON**                                    |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| a.  **Name:** H. James Armbrecht, PhD/Linda M. Smith     |   |   |   |   |
|                                                          |   |   |   |   |
| b.  **Position:** Assoc Director,                        |   |   |   |   |
|     Evaluation/Administrative Officer, GRECC             |   |   |   |   |
|                                                          |   |   |   |   |
| c.  **Phone, e-mail:** <James.Armbrecht@va.gov>.         |   |   |   |   |
|     314-894-6510 <smith.linda@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 |   |   |   |
|                                                          | * |   |   |   |
|                                                          | * |   |   |   |
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|                                                          | > | > | > | > |
|                                                          |   |   |   |   |
|                                                          | * | * | * | * |
|                                                          | * | * | * | * |
|                                                          | 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 | e | t |
|                                                          | e | i | r | i |
|                                                          | d | n | v | o |
|                                                          | i | i | i | n |
|                                                          | c | c | c | * |
|                                                          | a | a | e | * |
|                                                          | l | l | s |   |
|                                                          | * | * | * |   |
|                                                          | * | * | * |   |
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|                                                          |   |   |   |   |
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|                                                          |   |   |   |   |
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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}. ***                                  |
|                                                                       |
| -   Pain Improvement Initiative                                       |
|                                                                       |
| -   VA Assisted Living and VA contract Assisted Living staff received |
|     21 hours of CEU training on non-pharmacologic treatment of pain.  |
|                                                                       |
| -   VA SLUMS exam was adapted to the CPRS for all clinics to use.     |
|                                                                       |
| -                                                                     |
|                                                                       |
| -                                                                     |
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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}. ***                                  |
|                                                                       |
| -   Major research component and developed utilizable screening       |
|     questionnaires.                                                   |
|                                                                       |
| -   VA SLUMS was introduced to staff at all VISN 15 facilities.       |
|                                                                       |
| -                                                                     |
|                                                                       |
| -                                                                     |
|                                                                       |
| -                                                                     |
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| 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. **Please limit your         |
|     response to 5 or fewer innovations; and please limit each of the  |
|     five innovation descriptions to five lines or fewer. ***          |
|                                                                       |
| **1. SLUMS - Morley JE, Tumosa N, Perry HM -- 09/02 is consistently   |
| updated to incorporate and utilize the most recent research and       |
| medical information.**                                                |
|                                                                       |
| **2. SNAQ -- Morley JE 09/05**                                        |
|                                                                       |
| **3. Disaster Planning -- Morley JE, Tumosa N -- 09/02**              |
|                                                                       |
| **4. Development of an antisense to treat** Alzheimer's Disease --    |
| Banks WA, Kumar VB, Armbrecht HJ, Farr S -- 09/03                     |
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| **5. RESEARCH**                                                       |
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| **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}.                                       |
|                                                                       |
| -   [Treatment of Alzheimer\'s Disease.]{.underline} Overproduction   |
|     of amyloid beta protein (ABP) is thought to be the immediate      |
|     cause of Alzheimer\'s disease. As a result many drugs are being   |
|     developed that target ABP. We tested an IgM class of antibody     |
|     that binds very well to ABP and found that it could cross the     |
|     blood-brain barrier (BBB) and reverse learning impairments in a   |
|     mouse model of Alzheimer\'s disease, the SAMP8 mouse.             |
|     *Reference*: **Banks, W.A.**, **Farr, S.A.,** **Morley, J.E.,**   |
|     **Wolf**, **K.M.,** Geylis, V. and Steinitz, M. Anti-amyloid beta |
|     protein antibody passage across the blood-brain barrier in the    |
|     SAMP8 mouse model of Alzheimer\'s disease: An age-related         |
|     selective uptake with reversal of learning impairment. [Exp.      |
|     Neurol.]{.underline} 206: 248-56, 2007.                           |
|                                                                       |
| -   [Tissue deposition of a colon carcinogen increases with           |
|     age]{.underline}. The age-related increase in cancer may be       |
|     associated with altered metabolism and deposition of common       |
|     carcinogens. This study showed that the renal deposition of a     |
|     colon carcinogen found in well-done meat increased with age in    |
|     rats. There was no change in carcinogen metabolism. This suggests |
|     that therapies aimed at reducing carcinogen binding by tissues    |
|     from older animals may reduce exposure. *Reference*: **Armbrecht, |
|     H.J.**, Lakshmi, V.M., Wickstra, J., Hsu, F.H., and **Zenser,     |
|     T.V**. Metabolism of a heterocyclic amine colon carcinogen in     |
|     young and old rats. [Drug Metabolism and Disposition]{.underline} |
|     35:633-639, 2007.                                                 |
|                                                                       |
| -   [Lipid peroxidation in brain during aging in the                  |
|     senescence-accelerated mouse (SAM).]{.underline} The study        |
|     examined brain tissue of SAMP8 mice at 2, 4, 12 and 18 months of  |
|     age and determined that several lipid indices associated with     |
|     oxidative stress are altered in aged SAMP8 mice. *Reference*:     |
|     Petursdottir, A.L., **Farr, S.A., Morley, J.E., Banks, W.A.**,    |
|     and Skuladottir, G.V. Lipid peroxidation in brain during aging in |
|     the senescence-accelerated mouse (SAM). [Neurobiol.               |
|     Aging]{.underline}*. 28*:1170-1178, 2007.                         |
|                                                                       |
| -   [Inflammation plays a role in many diseases associated with       |
|     aging]{.underline}. Nitric oxide, an inflammatory component,      |
|     mediates formation of an N-nitroso derivative of the colon        |
|     carcinogen 2-amino-3-methylimidazo\[4,5-*f*\]quinoline (IQ). We   |
|     used                                                              |
|                                                                       |
|    2-(4-carboxyphenyl)-4,4,5,5-tetramethylimidazoline-1-oxyl-3-oxide, |
|     which oxidizes nitric oxide to nitrogen dioxide radicals, as a    |
|     tool to investigate if these radicals potentiation nitrosation.   |
|     Results are consistent with nitrogen dioxide radicals (or a       |
|     reactive nitrogen oxygen species like these radicals)             |
|     potentiating IQ oxidative nitrosylation. *Reference*: **Lakshmi,  |
|     V.M.** and **Zenser, T.V.**                                       |
|     2-(4-Carboxyphenyl)-4,4,5,5-tetramethylimidazoline-1-oxyl-3-oxide |
|     potentiates nitrosation of a heterocyclic amine carcinogen by     |
|     nitric oxide. [Life Sci]{.underline}. 80: 644-649, 2007.          |
|                                                                       |
| -   [The effects of high fat diets on the blood-brain barrier         |
|     transport of leptin: failure or adaption]{.underline}? Obese mice |
|     have impaired transport of leptin into the brain. Leptin signals  |
|     the body that it is full. These mice not only have impaired       |
|     transport, but impaired learning and memory associated with the   |
|     elevated transport, which has been linked to elevated             |
|     triglycerides. *Reference*: **Banks, WA, Farr SA, and Morley,     |
|     JE**. The effects of high fat diets on the blood-brain barrier    |
|     transport of leptin: failure or adaption? [Physiol.               |
|     Behav]{.underline}*. 28*: 244-248, 2006.                          |
|                                                                       |
| -                                                                     |
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| 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}.                                                   |
|                                                                       |
| -   [Parathyroid hormone (PTH) stimulation of renal production of     |
|     active vitamin D declines with age.]{.underline} Decreased levels |
|     of the active form of vitamin D (1,25(OH)~2~D) may contribute to  |
|     age-related bone loss. The capacity of PTH to stimulate renal     |
|     production of 1,25(OH)~2~D declines with age in the rat. This     |
|     lack of PTH stimulation is mimicked by treatment of cultured      |
|     renal tubular cells with hydrogen peroxide. This suggests that an |
|     age-related increase in oxidative stress could contribute to the  |
|     decreased actions of PTH. *Reference:* **Armbrecht, H.J.**,       |
|     Boltz, M.A., Ritter, C.S., and Brown, A.J. Parathyroid hormone    |
|     stimulation of the renal 25-hydroxyvitamin D-1α-hydroxylase --    |
|     Effect of age and free radicals. [J. Steroid Biochem. and Mol.    |
|     Biol]{.underline}. 103:330-333, 2007.                             |
|                                                                       |
| -   [Drug Delivery to the Brain: Treatment of Mucopolysaccharidosis   |
|     (Sly Syndrome).]{.underline} Mucopolysaccharidoses occur in       |
|     children born without the enzymes that breakdown                  |
|     mucopolysaccharides (MPS) in the body. We showed that             |
|     epinepherine can induce the BBB MPS transporter, which is lost    |
|     soon after birth, and make it active again. This leads to two     |
|     major conclusions: 1) Arenergic agents may be useful in the       |
|     treatment of mucopolysaccharidoses; 2) A new approach to drug     |
|     delivery to the brain may be manipulating the expression of       |
|     endogenous transporters. reference ayama, A., Grubb, J.H.,        |
|     **Banks, W.A.**, Sly, W.S. Epinephrine enhances lysosomal enzyme  |
|     delivery across the blood-brain barrier by up-regulation of the   |
|     mannose 6-phosphate receptor. [Proc. Natl. Acad. Sci.             |
|     USA.]{.underline} 104: 12873-78, 2007.                            |
|                                                                       |
| -   [Insulin Resistance Syndrome (IRS) and Disability in the          |
|     Elderly.]{.underline} Insulin resistance syndrome occurs when     |
|     blood glucose is normal, but insulin levels in blood are          |
|     elevated. We found that 20-25% of female residents in a nursing   |
|     home population have IRS. This was associated with a higher       |
|     percent of fat and an altered clearance of insulin from the body. |
|     An inflammatory cytokine, tumor necrosis factor, was elevated in  |
|     IRS and its levels correlated with those of insulin, suggesting   |
|     it may be a major mediator of this condition. *Reference*:        |
|     **Banks, W.A.**, Willoughby, L., Thomas, D., **Morley, J.E**.     |
|     Insulin resistance syndrome in the elderly: Assessment of         |
|     functional, biochemical, metabolic, and inflammatory status.      |
|     [Diabetes Care]{.underline} 30:2369-2373, 2007.                   |
|                                                                       |
| -   [Identification of a natural metabolite of dopamine involved in   |
|     Parkinson's disease.]{.underline} DOPAL, an aldehyde metabolite   |
|     of dopamine, was shown to be the most potent inducer of           |
|     aggregation of alpha-synuclein in dopamenergic neurons of the     |
|     substantia nigra in Parkinson's disease. DOPAL caused the         |
|     aggregation both in vivo and in vitro. This observation suggests  |
|     that monoamine oxidase inhibitors that inhibit the formation of   |
|     DOPAL from dopamine may be helpful in preventing such             |
|     aggregation. *Reference*: Burke, W.J., **Kumar, V.B.**, Pandey,   |
|     N., Panneton, W.M., Gan, Q., Franko, M.W., O'Dell, M., Li, S.W.,  |
|     Pan, Y., Chung, H.D., Galvin, J.E. Aggregation of alpha-synuclein |
|     by DOPAL, the monoamine oxidase metabolite of dopamine. [Acta     |
|     Neuropathologica]{.underline} In press, 2007.                     |
|                                                                       |
| -   [Regulation of Insulin Transport into the Brain.]{.underline}     |
|     Almost nothing is known about the BBB insulin transporter or what |
|     regulates it. We have grown brain endothelial cells, the cells    |
|     that comprise the BBB and contain the transporter, with or        |
|     without two types of major supporting cells, pericytes and        |
|     astrocytes. We found that pericytes, but not astrocytes, were key |
|     to maintaining the ability of the endothelial cells to transport  |
|     insulin. Loss of pericyte function, therefore, may be related to  |
|     the development of glucose intolerance/diabetes after brain       |
|     injury. *Reference*: Nakaoke, R., Verma, S., Niwa, M., Dohgu, S., |
|     **Banks, W.A.** Glucose-regulated blood-brain barrier transport   |
|     of insulin: Pericyte-astrocyte-endothelial cell cross talk.       |
|     [International Journal of Neuroprotection and                     |
|     Neuroregeneration]{.underline} 3:195-200, 2007.                   |
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| **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.                                          |
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|                                                                       |
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| 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.)*                                         |
|                                                                       |
| -   *Aging Successfully* Fall 2006, Vol XVI, No. 5: Geriatrics is a   |
|     Team Sport. This 24-page issue concentrated on educating          |
|     healthcare professionals and patients about how to participate in |
|     teams that optimizes the patient's care through care that         |
|     concentrates on treating the patient, rather than on specific     |
|     conditions and diseases. A total of 30,000 were distributed,      |
|     approximately 8000 to VA employees and patients.                  |
|                                                                       |
| -   *Aging Successfully* Spring 2007, Vol XVII, No. 1. Diabetes       |
|     Mellitus. This 24-page issue discusses causes, classification,    |
|     and management of diabetes in elderly patients. It also           |
|     introduces the concept of mental status becoming the 6^th^ vital  |
|     sign in medical care of our veterans. Forty thousand copies were  |
|     printed and 15,000 of them were distributed to VA clinics         |
|     nationwide for provider and patient education.                    |
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| 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.***   |
|                                                                       |
| -   Poster: Fifteen thousand copies of a poster on Diabetes and Aging |
|     was distributed to all VA hospitals nationwide and to and all     |
|     CBOCs in VISN 15 for use by both providers and patients. The      |
|     poster shows the change in the prevalence of diabetes mellitus    |
|     (DM) between 1980 and 2003. It also illustrates the causes of DM  |
|     in older persons. Medications appropriate to older patients were  |
|     also listed and commented upon.                                   |
|                                                                       |
| -   The book *Geriatric Nutrition* (CRC Press) was printed. It        |
|     provides a state-of-the-art review of current nutritional         |
|     thinking. It includes a scientific review of nutritional          |
|     requirements, new clinical assessments of nutrition in elderly    |
|     patients and ideas on management of under nutrition in nursing    |
|     home and assisted living environments.                            |
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| 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.*                                                                |
|                                                                       |
| -   MAJORITY OF PARTICIPANTS FROM HOST FACILITY: A total of 82 VA     |
|     employees (63 from the Host facility) were given a                |
|     train-the-trainer program to teach health care professionals how  |
|     to create emergency preparedness kits that was light, compact and |
|     specific for older adults. The kits consisted of a small satchel, |
|     a flashlight, a photo album (to store copies of prescriptions,    |
|     insurance cards, contact phone numbers, insurance cards,          |
|     evacuation plans, contact phone numbers and family pictures), a   |
|     pill box for current medications, and a pamphlet introducing the  |
|     FEMA website on emergency preparedness. Trainees were taught what |
|     other items should be added to the kit to make is customized to   |
|     patients with specific ailments and conditions. Upon completion   |
|     of the training each trainee received two complete kits, one to   |
|     use as an example during their subsequent training sessions of    |
|     other healthcare providers and the other to be given to a         |
|     disadvantaged older person whom they deemed at risk in an         |
|     emergency. Each participant was contacted by me through Outlook   |
|     at 3 months post training in order to enumerate their training    |
|     successes. At the end of 3 months all of the trainees had given   |
|     their extra kit to an elderly person who was at risk. None of     |
|     them had done any training in emergency preparedness. Barriers to |
|     providing training included lack of money to purchase kit         |
|     contents, lack of commitment or permission from supervisors, lack |
|     of time to provide the training, and lack of time on the part of  |
|     their colleagues to receive training. A total of 5trainees        |
|     indicated that they planned to provide training in the making of  |
|     emergency preparedness kits within the following 3 months.        |
|     Another e-mail to the participants at 6-months post training      |
|     showed that an unexpectedly large number of trainees (19) had     |
|     provided training to seniors in their community (one at the WMCA, |
|     1 at Lodge, 5 at their churches, and 6 more had shown the kits to |
|     family members) and another 6 had shown their kits to interested  |
|     co-workers. A follow-up e-mail to those 19 inquired as to why     |
|     they had done the training, especially since many of them had not |
|     indicated any plans to do so 3 months prior. In 3 cases, the      |
|     training had been planned 3 months in advance; in the remaining   |
|     cases, these trainers had been victims of week-long power outages |
|     in the St Louis Metropolitan region in January, 2006; just 3      |
|     months after their training. They indicated that they or the      |
|     elderly persons they had given their extra kits to had used their |
|     kits during the forced evacuation of their homes during the power |
|     outage. The demonstrated usefulness of the kits prompted them to  |
|     share the information with others.                                |
|                                                                       |
| -   MAJORITY OF PARTICIPANTS FROM NON-HOST FACILITY: A Pain           |
|     Improvement Program was developed for interdisciplinary           |
|     healthcare teams in VA or VA-contract nursing homes. A total of   |
|     12 nursing homes participated (with a total of 56 participants).  |
|     The training session consisted of three sessions. The first       |
|     session reviewed commonly used assessments and introduced some    |
|     that were developed specifically for non-communicative patients.  |
|     The concept of the pain team was introduced. The second session   |
|     consisted of lectures on non-pharmacological approaches to pain   |
|     control. Guest lectures included information from therapists,     |
|     pharmacists, physicians, and nurses and the roles they play in    |
|     their nursing home's pain team. The final session consisted of    |
|     lectures from pain victims and round table discussions of patient |
|     dignity and quality of life. Both before and after the 3-month    |
|     training session, each nursing home was asked to randomly select  |
|     30 patients to determine their level of pain and their            |
|     perceptions about how well their pain was being managed. The pain |
|     surveys were distributed by the GRECC in person but were mailed   |
|     directly to the State Alliance for Pain Improvement in Madison,   |
|     Wisconsin.\                                                       |
|     The surveys were analyzed and pre and post training results were  |
|     compared. Results in 9 of the 12 nursing homes indicated that a   |
|     decreased percentage of patients reported being in pain and felt  |
|     that their pain needs were not being met. Two nursing homes       |
|     showed no change in the level of perceived pain in their          |
|     patients. One nursing home has not yet submitted the completed    |
|     post assessments.                                                 |
|                                                                       |
| -                                                                     |
+-----------------------------------------------------------------------+
| **[7. CLINICAL DEMONSTRATION                                          |
| PROJECTS\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.underline}** |
|                                                                       |
| **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.                                   |
|                                                                       |
| -                                                                     |
|                                                                       |
| -   GRECC Diabetes Education Clinic -- "Frequent Flyer Program" is    |
|     ongoing.                                                          |
|                                                                       |
| -   Saint Louis University Mental Status -- "SLUMS" is ongoing        |
|                                                                       |
| -   Simplified Nutrition and Appetite Questionnaire -- "SNAQ" is      |
|     ongoing.                                                          |
|                                                                       |
| -                                                                     |
+-----------------------------------------------------------------------+
| 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.                    |
|                                                                       |
| -   Diabetes Education -- Patients were provided education classes on |
|     nutrition, exercise and diet. As a result, patients were able to  |
|     keep their diabetes and insulin usage better controlled. This     |
|     resulted in fewer visits to the GRECC Primary Care Clinic and     |
|     closer management of the patients.                                |
|                                                                       |
| -   SLUMS - Pre-screening document used to identify cognitive         |
|     impairment and aid physicians as to whether or not to pursue      |
|     further testing in diagnosing dementia. The results aided in      |
|     identifying early cognitive problems which can oftentimes be      |
|     treated with medication and the data compiled with specific       |
|     outcomes to be used in future research and treatment.             |
|                                                                       |
| -   SNAQ -- A four question screening tool that can aid the physician |
|     in predicting future weight loss in elderly patients placing them |
|     at greater risk of death. Use of this screening tool will help    |
|     with early diagnosis, proven effective 88% of those completing    |
|     the questionnaire.                                                |
|                                                                       |
| -                                                                     |
|                                                                       |
| -                                                                     |
+-----------------------------------------------------------------------+
| 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"):*           |
|                                                                       |
| -   Non pharmacological approaches to pain management, exported to 11 |
|     VISN 15 contract assisted living sites and 1 nursing home care    |
|     unit at VAMC Jefferson Barracks.                                  |
|                                                                       |
| -                                                                     |
|                                                                       |
| -                                                                     |
|                                                                       |
| -                                                                     |
|                                                                       |
| -                                                                     |
+-----------------------------------------------------------------------+
| **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.              |
+-----------------------------------------------------------------------+
| b.  **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):*     |
|                                                                       |
| -   Outreach: 11 VISN 15 contract assisted living facilities          |
|     incorporated non-pharmacological treatment protocols for patients |
|     in pain after training from GRECC staff. On site training was     |
|     provided by: Dr.'s Hajjar, Kevorkian, Morley and Tumosa.          |
|                                                                       |
| -   Consultation by GRECC staff was provided to staff at the VAMC     |
|     Jefferson Barracks NH staff and contract assisted living          |
|     facilities for non-pharmacological treatment of pain is ongoing   |
|     via telephone conference and consultation as required.            |
|                                                                       |
| -   Adoption of VA SLUMS by 29 non host VAMC's.                       |
|                                                                       |
| -   SLUMS was adopted by VA Central Office for nationwide use in      |
|     CPRS.                                                             |
|                                                                       |
| -                                                                     |
+-----------------------------------------------------------------------+
| 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.)*                                                   |
|                                                                       |
| -                                                                     |
|                                                                       |
| -   Disaster Planning for the Elderly: VA employees at John Cochran   |
|     and Jefferson Barracks Divisions are using and creating emergency |
|     kits for distribution and use during 3 regional power outages in  |
|     NOV'06 through FEB'07.                                            |
|                                                                       |
| -                                                                     |
|                                                                       |
| -                                                                     |
|                                                                       |
| -                                                                     |
+-----------------------------------------------------------------------+