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| ### GERIATRIC RESEARCH, EDUCATION AND CLINICAL CENTER                 |
|                                                                       |
| ### *Annual Report: Fiscal Year [2004]{.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}. Report year is from [October 1 through     |
| September 30]{.underline}. This Accomplishments report should be no   |
| more than a [total of ten pages]{.underline}.                         |
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| **GRECC Core Staff** includes **Primary Core**, **Affiliated Core,**  |
| and **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 acquired through     |
| centralized enhancements/awards for programs such as Home-Based       |
| Primary Care, Geriatric Evaluation and Management Program, etc. To be |
| considered Affiliated Core, staff must be organizationally aligned    |
| under the GRECC or specifically identified by the Medical Center as   |
| GRECC-affiliated staff. **Research Core** = Full-or part-time staff   |
| who devote 51% or more of their total time to GRECC research and      |
| whose salaries are supported by research funds (either VA or non-VA). |
| Includes all GRECC staff whose salaries are paid from research funds  |
| (e.g., Associate Investigator, Assistant Research Scientist, Senior   |
| Research Career Scientist; Research Career Scientist, Advanced        |
| Research Career Scientist).                                           |
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| **1. GRECC NAME/LOCATION**                                            |
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| a.  **GRECC Name:** San Antonio GRECC                                 |
|                                                                       |
| b.  **Location** *(facility, VISN)*: South Texas Veterans Health Care |
|     System-Audie L. Murphy Division, VISN 17                          |
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| **2. CONTACT PERSON**                                                 |
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| a.  **Name:** Mary Anne Svetlik, Ph.D., FACHE                         |
|                                                                       |
| b.  **Position:** Administrative Officer, GRECC (182)                 |
|                                                                       |
| c.  **Phone, e-mail:** 210-617-5197, Mary.Svetlik@med.va.gov          |
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| **3. GRECC FOCUS AREA(S)**                                            |
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| **NOTE:** Each problem area should ideally be approached from the     |
| basic biomedical, clinical [and]{.underline} health services research |
| perspectives, as well as from the rehabilitation research perspective |
| where that expertise exists. The number of problem areas should be    |
| limited to one or two. If the focus of research is different for      |
| basic biomedical, clinical, health services and/or rehabilitation     |
| research, there should be no more than a [total]{.underline} of 4     |
| major areas of investigation. Changes to GRECC focus area(s) must be  |
| approved by VACO (114).                                               |
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| a.  **Basic Biomedical**: Metabolism/Endocrinology, Nutrition, Oral   |
|     Health/Dentistry                                                  |
|                                                                       |
| b.  **Applied Clinical**: Metabolic Diseases, Cognitive/Sensory       |
|     Impairment, Oral Health/Dentistry                                 |
|                                                                       |
| c.  **Health Services**: Functional Status and Ethnicity, Palliative  |
|     Care, Health Care Utilization, and Quality Assessment             |
|                                                                       |
| d.  **Rehabilitation**: N/A                                           |
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| **4. ADMINISTRATION**                                                 |
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| a.  **GRECC Impact on Host VAMC in Current Year** *(list up to five   |
|     most important ways in which the GRECC has had specific impact on |
|     host VAMC research, staff education, program evaluation, or       |
|     clinical care improvements for elderly veteran, i.e., how the     |
|     GRECC has "made a difference" in these areas within the entire    |
|     host VAMC; up to five lines each)*:                               |
|                                                                       |
| -   GRECC research expenditure funding for FY'04 totals more than     |
|     \$4.5 million dollars, representing 14% of the total research     |
|     expenditures of the South Texas Veterans Health Care System for   |
|     FY'04**.** Overall, GRECC research funding is \$22.2 million      |
|     dollars.                                                          |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   GRECC research staff continues to be very successful in obtaining |
|     grant funding from federal and other sources. In addition, GRECC  |
|     investigators lead a collaborative network of scientists from the |
|     host VAMC and its affiliated University of Texas Health Science   |
|     Center at San Antonio (UTHSCSA). This leadership has resulted in  |
|     the successful recruitment of many internationally renowned       |
|     biomedical gerontologists to both institutions.                   |
|                                                                       |
|     -   GRECC research staff involvement in above has resulted in the |
|         new Barshop Center on Longevity and Aging Studies with its    |
|         animal core and researchers from both institutions, and most  |
|         recently the grant award for the NIA Intervention Testing     |
|         Center. Both initiatives serve as resources for host VAMC     |
|         investigators.                                                |
|                                                                       |
|     -   The GRECC hosts weekly conferences as Geriatrics &            |
|         Gerontology Grand Rounds for the host VAMC and its            |
|         educational affiliate (UTHSCSA). Attendance includes          |
|         employees from various other services at the host VAMC.       |
|                                                                       |
|     -   The GRECC sponsored two Medical Grand Rounds and one Medical  |
|         Research Conference for employees, faculty and staff of the   |
|         host VAMC and the educational affiliate (UTHSCSA) during      |
|         FY 2004. GRECC research faculty presented the Medical         |
|         Research Conference. Two GRECC trainees were award winners in |
|         the Department of Medicine Annual Research Day.               |
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| b.  **GRECC Impact on VISN in Current Year** *(list up to five most   |
|     important ways in which the GRECC has had specific VISN-wide      |
|     impact on research, education/training, program evaluation, or    |
|     clinical care improvements for elderly veterans, i.e., how GRECC  |
|     participation in VISN-wide activities has "made a difference" in  |
|     these areas within the entire VISN; up to five lines each.* NOTE: |
|     GRECCs are intended and expected to serve as a                    |
|     [regional]{.underline}, and not merely local resource*)*:         |
|                                                                       |
| -   The GRECC held its 25^th^ Annual Conference on Aging, cosponsored |
|     by the VISN, "Geriatric Primary Care: Current Perspectives & New  |
|     Horizons," in August 2004, with broad attendance throughout the   |
|     VISN. Dr. David A. Lipschitz was the keynote speaker. Dr.         |
|     Lipschitz is Professor and Chairman of the Reynolds Department of |
|     Geriatrics at the University of Arkansas for Medical Sciences. He |
|     is the former Director of the GRECC at the Little Rock VA.        |
|                                                                       |
| -   The GRECC is collaborating with the Little Rock GRECC in VISN 19  |
|     by trading expertise in geriatric dentistry and nutrition. The    |
|     first videoteleconference, entitled "Oral Health in Geriatric     |
|     Nutrition," was broadcast across both VISNs. These presentations  |
|     are videotaped for sharing across both VISNs for those employees  |
|     who are unable to view the videoteleconferences.                  |
|                                                                       |
| -   The GRECC Director has served on the VISN's Research Committee    |
|     since its inception. The committee established a VISN-wide new    |
|     investigator start-up grant program. This program continues to    |
|     fund 2-year research awards to junior investigators at the three  |
|     VAMCs within the VISN.                                            |
|                                                                       |
|     -   GRECC research staff involvement in above has resulted in the |
|         new Barshop Center on Longevity and Aging Studies with its    |
|         animal core and researchers from both institutions, and most  |
|         recently the grant award for the NIA Intervention Testing     |
|         Center. Both initiatives serve as resources for investigators |
|         throughout the VISN.                                          |
|                                                                       |
| -   The GRECC continues to address the FY2000-2005 VA Heart of Texas  |
|     Health Care Network Plan's palliative care performance goal.      |
|     Consequently, educational programs are held each year for VISN 17 |
|     staff. Sandra Sanchez-Reilly, M.D., recently joined the GRECC and |
|     Geriatric and Extended Care Product Line to develop and direct    |
|     the combined consultation program in geriatrics and palliative    |
|     care for patients at the host VAMC. She plans to make this        |
|     pioneer program a model that can be replicated at other VAMCs in  |
|     VISN 17.                                                          |
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| c.  **GRECC Trend-Setting Innovations since October 1,                |
|     [1999]{.underline}** *(list up to five most significant GRECC     |
|     research, education or clinical innovations in past five years;   |
|     for each item, provide date, GRECC staff responsible, and up to   |
|     five line description)*:                                          |
|                                                                       |
| -   GRECC researcher Randy Strong, Ph.D., with UTHSCSA colleagues,    |
|     has received a \$2.5 million grant for a National Institute on    |
|     Aging (NIA) Intervention Testing Center, one of three such U.S.   |
|     centers established by the NIA to test potential therapeutic      |
|     interventions to slow the aging process (Dr. Randy Strong, 2004). |
|                                                                       |
| -   GRECC researcher Arlan Richardson, Ph.D., has become director of  |
|     the new Barshop Center on Longevity and Aging Studies, which will |
|     house an extensive aging and transgenic animal core. The Center   |
|     is currently being built at the UTHSCSA-affiliated Texas Research |
|     Park (Dr. Arlan Richardson, 2002-5).                              |
|                                                                       |
| -   In late FY'04, the GRECC conducted, in conjunction with the South |
|     Texas Geriatric Education Center (STGEC) at the UTHSCSA, the      |
|     first week-long, Interdisciplinary Summer Institute in Geriatrics |
|     & Gerontology, "G&G 101," for health professionals who treat      |
|     elderly veterans in all clinical settings and who have had        |
|     minimal training in geriatrics and gerontology. This 40-hour      |
|     program was digitally videotaped and will be available for future |
|     viewing in FY'05 (Dr. Michèle Saunders, 2004-5).                  |
|                                                                       |
| -   The GRECC is collaborating with the Little Rock GRECC in VISN 19  |
|     by trading expertise in geriatric dentistry and nutrition. The    |
|     first videoteleconference, entitled "Oral Health in Geriatric     |
|     Nutrition," was broadcast across both VISNs. These presentations  |
|     are videotaped for sharing across both VISNs for those employees  |
|     who are unable to view the videoteleconferences.                  |
|                                                                       |
| -   Innovative clinical programs include 1) Memory Clinic, a          |
|     multidisciplinary program focusing on the diagnosis and           |
|     management of Alzheimer's disease and related disorders and their |
|     behavioral manifestations; and 2) Combined Consultation Service   |
|     in Geriatric Medicine and Palliative Care, a multidisciplinary    |
|     program that will incorporate the humanities curriculum Dr.       |
|     Sanchez-Reilly is developing with the UTHSCSA Center for Medical  |
|     Humanities and Ethics. (Dr. Donald Royall, 2002; Dr. Sandra       |
|     Sanchez-Reilly, 2004-5).                                          |
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| **5. RESEARCH**                                                       |
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| a.  **Key Findings Published in Current Year -- GRECC Core Staff as   |
|     PI or CO-PI** *(list up to five; for each item provide GRECC Core |
|     Staff name(s), journal reference, and up to five line description |
|     of topic/method/ results/clinical significance; use layperson     |
|     language)*:                                                       |
|                                                                       |
| -   \[Ref: Mahimainathan L. Choudhury GG. Inactivation of             |
|     platelet-derived growth factor receptor by the tumor suppressor   |
|     PTEN provides a novel mechanism of action of the phosphatase.     |
|     Journal of Biological Chemistry. 279(15):15258-68, 2004 Apr       |
|     9*.*\] Dr. Goutam Ghosh Choudhury and colleagues' data provide    |
|     the first evidence that PTEN (mutated in a variety of cancers) is |
|     physically associated with platelet-derived growth factor (PDGF)  |
|     receptor and that PDGF causes its dissociation from the receptor. |
|     These data demonstrate a novel aspect of PTEN function where it   |
|     acts as an effector for the PDGF receptor function and negatively |
|     regulates PDGF receptor activation.                               |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   \[Ref: Lin AL. Johnson DA. Stephan KT. Yeh CK. Salivary secretory |
|     leukocyte protease inhibitor increases in HIV infection. Journal  |
|     of Oral Pathology & Medicine. 33(7):410-6, 2004 Aug.\] Dr.        |
|     Chih-Ko Yeh and colleagues study the influence of salivary        |
|     factors on oral candidal infection in HIV/AIDS patients. Data     |
|     analyses indicate that the salivary concentration of secretory    |
|     leukocyte protease inhibitor is increased in the presence of HIV  |
|     infection even though salivary flow rate is decreased.            |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   \[Ref: Zhao JL. Pergola PE. Roman LJ. Kellogg DL Jr. Bioactive    |
|     nitric oxide concentration does not increase during reactive      |
|     hyperemia in human skin. Journal of Applied Physiology.           |
|     96(2):628-32, 2004 Feb.\] Dr. Dean Kellogg and colleagues note    |
|     that reactive hyperemia normally occurs when blood flow to a limb |
|     is occluded and then restored. Although previous studies          |
|     suggested that nitric oxide, a powerful relaxer of blood vessels, |
|     was important in reactive hyperemia, this study demonstrates that |
|     hyperemia is independent of nitric oxide.                         |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   \[Ref: Liang H. Masoro EJ. Nelson JF. Strong R. McMahan CA.       |
|     Richardson A. Genetic mouse models of extended lifespan.          |
|     Experimental Gerontology. 38(11-12):1353-64, 2003 Nov-Dec.\] Dr.  |
|     Arlan Richardson and colleagues' research goal is to understand   |
|     the role of oxidative stress/damage in aging and age-related      |
|     diseases, such as cancer, etc. One area of study outlined in this |
|     paper is developing and using transgenic and knockout mouse and   |
|     rat models with alterations in the antioxidant defense system to  |
|     study how increased or decreased oxidative damage affects         |
|     survival, age-related pathology, and physiological parameters     |
|     that are markers of physiological aging.                          |
|                                                                       |
| -   \[Ref: Royall DR. Chiodo LK. Executive control and the validity   |
|     of survey data. International Journal of Geriatric Psychiatry.    |
|     19(7):696-8, 2004 Jul.\] Dr. Donald R. Royall and Dr. Laura       |
|     Chiodo studied executive control and the validity of survey data. |
|     They concluded that younger people's perceptions of "harmful"     |
|     aspects of memory screening or medical procedures may not be      |
|     generalizable to the decision-making of executive control         |
|     function (ECF)-impaired elderly persons. Additionally, survey and |
|     other self-reported data may be invalid when obtained from        |
|     executively impaired populations.                                 |
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| b.  **Key Findings Published in Current Year -- GRECC Core Staff as   |
|     Co-Investigators on Projects with Non-GRECC PI (***list up to     |
|     five; for each item provide GRECC Core Staff name(s), journal     |
|     reference, and up to five line description of topic/method/       |
|     results/clinical significance; use layperson language)*:          |
|                                                                       |
| -   \[Ref: Yang H. Shi M. Story J. Richardson A. Guo Z. Food          |
|     restriction attenuates age-related increase in the sensitivity of |
|     endothelial cells to oxidized lipids. Journals of Gerontology     |
|     Series A-Biological Sciences & Medical Sciences. 59(4):316-23,    |
|     2004 Apr.\] Dr. H. Yang and colleagues, including the GRECC's Dr. |
|     Arlan Richardson, assessed the effect of aging and food           |
|     restriction (FR) on endothelial functions, including the release  |
|     of endothelial nitric oxide (NO) and the adhesion of mononuclear  |
|     cells (MNCs) to endothelial cells (ECs). They found that FR       |
|     attenuates an age-related increase in the sensitivity of          |
|     endothelial cells to oxidized low density lipoprotein, which      |
|     might be responsible, at least in part, for the antiatherogenic   |
|     action of FR.                                                     |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   \[Ref: Han ES. Wu Y. McCarter R. Nelson JF. Richardson A.         |
|     Hilsenbeck SG. Reproducibility, sources of variability, pooling,  |
|     and sample size: important considerations for the design of       |
|     high-density oligonucleotide array experiments. Journals of       |
|     Gerontology Series A-Biological Sciences & Medical Sciences.      |
|     59(4):306-15, 2004 Apr. \] Dr. Han and colleagues, including the  |
|     GRECC's Dr. Arlan Richardson, undertook a series of experiments   |
|     to examine issues that directly affect design of gene expression  |
|     studies using Affymetrix GeneChip arrays: probe-level analysis,   |
|     need for technical replication, relative contribution of various  |
|     sources of variability, and utility of pooling RNA from different |
|     samples. They found that replicate chips of the same RNA have     |
|     limited value in reducing variability and that pooling samples is |
|     not advantageous nor disadvantageous.                             |
|                                                                       |
| -   \[Ref: Shinkai RS. Hatch JP. Cornell JE. Yeh CK. Intraoral        |
|     tactile sensitivity in adults with diabetes. Diabetes Care.       |
|     27(4):869-73, 2004 Apr.\] Dr. Shinkai and colleagues, including   |
|     the GRECC's Drs. Chih-Ko Yeh and John E, Cornell, compared the    |
|     intraoral tactile sensitivity (ITS) of diabetic and nondiabetic   |
|     subjects. The effects of age, ethnicity, sex, and intraoral site  |
|     were considered. They found that diabetic and nondiabetic         |
|     subjects showed no significant differences in ITS at any of the   |
|     three test sites and potentially confounding factors were not     |
|     associated with ITS, indicating that diabetes per se may not      |
|     influence ITS.                                                    |
|                                                                       |
| -   \[Ref: Gooch JL. Gorin Y. Zhang BX. Abboud HE. Involvement of     |
|     calcineurin in transforming growth factor-beta-mediated           |
|     regulation of extracellular matrix accumulation. Journal of       |
|     Biological Chemistry. 279(15):15561-70, 2004 Apr 9.\] In this     |
|     study, Dr. Gooch and colleagues, including the GRECC's Dr.        |
|     Bin-Xian Zhang, describe a new pathway for transforming growth    |
|     factor-beta-mediated regulation of extracellular matrix           |
|     accumulation via generation of reactive oxygen species, calcium   |
|     influx, and activation of calcineurin. This study of cellular     |
|     signaling relates to GRECC studies of factors contributing to     |
|     age-related vascular diseases.                                    |
|                                                                       |
| -   \[Ref: McArdle A. van der Meulen J. Close GL. Pattwell D. Van     |
|     Remmen H. Huang TT. Richardson AG. Epstein CJ. Faulkner JA.       |
|     Jackson MJ. Role of mitochondrial superoxide dismutase in         |
|     contraction-induced generation of reactive oxygen species in      |
|     skeletal muscle extracellular space. American Journal of          |
|     Physiology - Cell Physiology. 286(5):C1152-8, 2004 May.\] Dr.     |
|     McArdle and colleagues, including the GRECC's Dr. Holly Van       |
|     Remmen and Dr. Arlan Richardson, tested the hypothesis that,      |
|     after a demanding isometric contraction protocol, the major       |
|     source of superoxide and hydroxyl radical activity in the         |
|     extracellular space of muscles is mitochondrial generation of     |
|     superoxide anions and that, with a reduction in mitochondrial     |
|     superoxide dismutase (MnSOD) activity, concentration of           |
|     superoxide anions in the extracellular space is unchanged but     |
|     concentration of hydroxyl radicals is decreased. Their findings   |
|     suggest that the increase in hydroxyl radical concentration in    |
|     the extracellular space of muscles from wild-type mice after the  |
|     contraction protocol most likely results from degradation of      |
|     hydrogen peroxide generated by MnSOD activity.                    |
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| **6. EDUCATION**                                                      |
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| **NOTE**: Do not list trainee and conference data here. Those data    |
| are reported in the GRECC Electronic Database.                        |
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| a.  **Innovations in Educational Activities Implemented During        |
|     Current Year** (*list up to five; for each item, up to three      |
|     lines on how it is innovative)*:                                  |
|                                                                       |
| -   The San Antonio GRECC cosponsored \[with the South Texas          |
|     Geriatric Education Center (STGEC)\] the first Summer Institute   |
|     in Geriatrics & Gerontology: "G&G 101." This program is           |
|     innovative because it is a 40-hr week-long program, is            |
|     multidisciplinary, and is for health professionals who treat      |
|     elderly veterans in all clinical settings and who have had        |
|     minimal training in geriatrics and gerontology. The program was   |
|     digitally videotaped to be available for future viewing in FY'05. |
|                                                                       |
| -   The GRECC cosponsored, with the STGEC, eight community training   |
|     programs with the Lone Star Chapter of the National Alzheimer's   |
|     Association. These programs were unique because they focused on   |
|     training community practitioners who treat veterans in VA         |
|     contract nursing homes.                                           |
|                                                                       |
| -   The GRECC is collaborating with the Little Rock GRECC in VISN 19  |
|     in a 5-year project to trade expertise in geriatric dentistry and |
|     nutrition. In FY'04, the first videoteleconference, entitled      |
|     "Oral Health in Geriatric Nutrition," was broadcast across both   |
|     VISNs. This project is unique because it involves 2 GRECCs and    |
|     the presentations are being videotaped to be shared across both   |
|     VISNs for those employees who are unable to view the              |
|     videoteleconferences.                                             |
|                                                                       |
| -   The GRECC began discussions in FY'03 with Golden Manor (GM)       |
|     Jewish Home and Services for the Aging, a community health care   |
|     agency for the elderly, regarding an agreement to use GM          |
|     facilities as additional clinical sites for joint GRECC and STGEC |
|     trainees. This is an innovative program because it will be        |
|     interdisciplinary in nature and will expand the female patient    |
|     population available for trainee education as required by the     |
|     ACGME and other accrediting bodies. These discussions reached     |
|     fruition in FY'04.                                                |
|                                                                       |
| -   The GRECC is partnering with the STGEC to conduct a unique        |
|     education program with the Baylor College of Medicine and the     |
|     U.S. Department of Justice to disseminate curriculum in elder     |
|     abuse to health care professionals throughout VISN 17, the GRECCs |
|     and Geriatric Education Centers (GECs) throughout the U.S., and   |
|     to law enforcement throughout the State of Texas. This program is |
|     innovative because elder abuse curriculum has not been            |
|     disseminated before in VISN 17, or nationally to the GRECCs and   |
|     GECs.                                                             |
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| b.  **Exportable Educational Products First Available for             |
|     Distribution in Current Year** *(list up to five most important   |
|     products; for each item, up to three lines summarizing content,   |
|     target audience, format, product evaluation results. Include      |
|     educational products developed in previous years ONLY if this is  |
|     the [first year]{.underline} they have been available for         |
|     distribution)*:                                                   |
|                                                                       |
|     -   Videotapes are available of the 24^th^ Annual Conference on   |
|         Aging for those employees who could not attend the conference |
|         in August 2003. This VISN co-sponsored event was entitled,    |
|         "New Horizons in Geriatric Primary Care." Multidisciplinary   |
|         staff from the following medical centers and satellite        |
|         clinics attended: South Texas Veterans Health Care System,    |
|         Audie L. Murphy Division (host) and Kerrville Division,       |
|         Corpus Christi Satellite Clinic, and Dallas VAMC. Attendees   |
|         evaluated the conference as excellent.                        |
|                                                                       |
| -   [Dental Regulations Compliance Manual for the Nursing Facility,   |
|     2^nd^ Ed.]{.underline} and [Developing a Dental Program for the   |
|     Nursing Facility: A Manual for Dental Office Staff, 2^nd^         |
|     Ed.]{.underline}, are two educational packages that have been     |
|     updated in FY 2003-04 in collaboration with the STGEC and the     |
|     American Society for Geriatric Dentistry. Both packages include   |
|     manuals tailored for the nursing home and dental office,          |
|     respectively, and in-service instructional materials for nurses   |
|     and nursing assistants (slides, audiotapes, videotape in English  |
|     and Spanish, handbook in English and Spanish). This is the first  |
|     year the 2^nd^ Edition is available for distribution.             |
|                                                                       |
| -   Several other products are available, but not for the first time. |
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| **7. NEW CLINICAL MODELS**                                            |
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| **NOTE:** These are new models of care for elderly veterans that the  |
| GRECC is developing and evaluating, in relation to its area(s) of     |
| focus. This is NOT a list of all Geriatrics & Extended Care clinical  |
| programs at the host VAMC.                                            |
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| a.  **New Clinical Models Implemented in Current Year** *(list all    |
|     new clinical models or significant modifications of existing      |
|     models that the GRECC is developing and evaluating. For each      |
|     item, indicate whether [N]{.underline}ew or [O]{.underline}ngoing |
|     in current year; provide up to five line description)*:           |
|                                                                       |
| -   Geriatric-specific Health Care Quality Curriculum in the Clinical |
|     Setting. In late FY'04 Dr. Monica Horton was awarded a Geriatric  |
|     Academic Career Award (GACA) from the Bureau of Health            |
|     Professions of the Health Resources and Services Administration   |
|     of the USPHS. Using these funds in FY'05, Dr. Horton will develop |
|     and implement a geriatric-specific Health Care Quality curriculum |
|     and apply it to direct patient care programs. \[New\]             |
|                                                                       |
| -   Longitudinal, Integrated Humanities Curriculum in the Clinical    |
|     Setting. This curriculum is being developed by a new              |
|     GRECC/Extended Care clinical investigator, Dr. Sandra             |
|     Sanchez-Reilly. It will incorporate a specific longitudinal,      |
|     integrated humanities curriculum with the UTHSCSA Center for      |
|     Medical Humanities and Ethics, strategically designed for the     |
|     different education levels of medical students and residents,     |
|     geriatric fellows and interdisciplinary team members. \[New\]     |
|                                                                       |
| -   Combined Consultation Service in Geriatric Medicine and           |
|     Palliative Care. This program is being developed, implemented and |
|     evaluated by Dr. Sandra Sanchez-Reilly, who was awarded a GACA    |
|     for this purpose in late FY'04. This program will incorporate the |
|     humanities curriculum Dr. Sanchez-Reilly is developing with the   |
|     UTHSCSA Center for Medical Humanities and Ethics. GRECC trainees  |
|     will rotate through the Service. \[New\]                          |
|                                                                       |
| -   Plans are underway to develop a Community Care Coordination       |
|     Program within VISN 17. The program will utilize disease          |
|     management, care/case management, self-management of chronic      |
|     disease and technology to manage veterans who are high users of   |
|     medical center resources. Telehealth equipment is on order and is |
|     expected to arrive in early FY'05. \[Ongoing\]                    |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   During this fiscal year, a new variety of Enhanced Residential    |
|     Care was developed. This program identifies Assisted Living       |
|     facilities for cost-sharing of care between the patient and the   |
|     VA. The patient pays room and board and the VA pays for personal  |
|     care under Homemaker/Home Health Aide funding. This project       |
|     provides an alternative method of appropriate care for veterans   |
|     in a safe environment. Three potential vendors have been          |
|     identified to operate the Assisted Living facilities in federally |
|     leased space. \[Ongoing\]                                         |
+-----------------------------------------------------------------------+
| b.  **Current Year Evaluation Results of New Clinical Models** *(for  |
|     each clinical model listed in 7-a above, indicate whether         |
|     evaluated by [R]{.underline}esearch or [Q]{.underline}uality      |
|     [I]{.underline}mprovement project; up to five lines summarizing   |
|     evaluation outcomes, such as changes in access to care, patient   |
|     functioning, satisfaction, cost-effectiveness, organizational     |
|     changes, etc. Note if no evaluation results in current year for a |
|     particular model)*:                                               |
|                                                                       |
| **NOTE:** Do not list patient service utilization data here. Those    |
| data are reported in the GRECC Electronic Database.                   |
|                                                                       |
| -   Geriatric-specific Health Care Quality Curriculum in the Clinical |
|     Setting. Evaluation is based on assessment of trainee             |
|     performance, trainee evaluation of curriculum, patient            |
|     satisfaction surveys, and improved patient outcomes. \[No         |
|     evaluation data available in FY'04\]                              |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   Longitudinal, Integrated Humanities Curriculum in the Clinical    |
|     Setting. Evaluation is based on assessment of trainee             |
|     performance, trainee evaluation of curriculum, patient            |
|     satisfaction surveys, and alterations in care of elderly veteran  |
|     patients. \[No evaluation data available in FY'04\]               |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   Combined Consultation Service in Geriatric Medicine and           |
|     Palliative Care. Evaluation is based on assessment of trainee     |
|     performance, trainee evaluation of rotation, patient satisfaction |
|     surveys, and improved patient outcomes. \[No evaluation data      |
|     available in FY'04\]                                              |
|                                                                       |
| -   Community Care Coordination Program. Evaluation of this program   |
|     will be based on patients' rate of return to the Urgent Care      |
|     Clinic**.** The first patients are expected to be enrolled in     |
|     early FY'05. \[No evaluation data available in FY'04\]            |
|                                                                       |
| -   Enhanced Residential Care. This program will be evaluated using   |
|     facility and patient satisfaction surveys. \[No evaluation data   |
|     available in FY'04\]                                              |
+-----------------------------------------------------------------------+
| c.  **New Clinical Models Exported in Current 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")*:                                          |
|                                                                       |
| -   No new models exported in FY'04.                                  |
+-----------------------------------------------------------------------+
| **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)*:     |
|                                                                       |
| -   GRECC outreach: implementation by Dentist Fellows in the          |
|     Physician/Dentist Geriatric Fellowship Program at the Dallas VAMC |
|     of GRECC-sponsored dental program in geriatric nursing home.      |
|                                                                       |
| -   GRECC outreach: institution by Little Rock GRECC of               |
|     videoteleconference programs in oral health and nutrition in      |
|     aging.                                                            |
|                                                                       |
| -   GRECC outreach: implementation by Dental Service at Kerrville     |
|     Division of GRECC-sponsored dental program in geriatric nursing   |
|     home.                                                             |
|                                                                       |
| -   GRECC consultation: institution by host VAMC of a new, combined   |
|     consultation service in geriatrics and palliative care.           |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   GRECC consultation: implementation of the GRECC "Stress-busting   |
|     Program" (for caregivers of veteran and non-veteran patients with |
|     Alzheimer's Disease) by host VAMC.                                |
+-----------------------------------------------------------------------+
| b.  **Previous Years' Activities Outcomes** (*list up to five         |
|     examples, up to two lines each; summarize specific outcomes       |
|     realized from previous years' [**consultation** to host           |
|     VAMC]{.underline} or [**outreach** to non-host                    |
|     facilities]{.underline}, where results were first realized in the |
|     current year.)*                                                   |
|                                                                       |
| -   GRECC and Extended Care outreach: institution by the Kerrville    |
|     Division of a fully operational outpatient GEM managed by two     |
|     Geriatrics and Extended Care physicians.                          |
|                                                                       |
| -   GRECC and Extended Care outreach: institution by the Kerrville    |
|     Division of several community residential care programs serving   |
|     25 veterans.                                                      |
|                                                                       |
| -   GRECC outreach: implementation by Temple/Olin E. Teague VAMC of   |
|     GRECC-sponsored dental program in geriatric nursing home.         |
|                                                                       |
| -   GRECC consultation: expansion by host VAMC of the dental program  |
|     in Geriatric Nursing Home Dentistry in the ECTC Dental Clinic.    |
|                                                                       |
| -   GRECC and Extended Care outreach: institution by the Kerrville    |
|     Division of hospice and respite patient care programs.            |
+-----------------------------------------------------------------------+