Publications by authors named "Karen Goldstein"
Pregnancy Outcomes of Women Veterans with Autoimmune Disease.
Womens Health Rep (New Rochelle)
September 2024
Article Synopsis
- Women Veterans (WV) have unique risk factors for autoimmune diseases (AID) that can lead to pregnancy complications.
- A study identified 25 WV with AID, finding that conditions like inflammatory bowel disease, psoriasis, and undifferentiated connective tissue disease were the most common.
- The research revealed 44% of these women faced pregnancy complications, with a significant number not using VA health services for care during their pregnancies.
Article Synopsis
- Pregnant women veterans can develop serious health problems like high blood pressure or diabetes that may increase their risk of heart disease later in life, but many don’t know this.
- A study interviewed 28 women veterans about their experiences with these issues and found that there are gaps in their medical records, which can lead to confusion about what to do to stay healthy after pregnancy.
- Many women face challenges like money issues and family responsibilities that make it hard for them to follow health advice to reduce their heart disease risk.
Women are the fastest growing population among Veterans and have substantial risk factors that increase their likelihood for developing cancer. To ensure that the Department of Veterans Affairs Veterans Health Administration (VHA) offers the best possible cancer care to women Veterans, it established the Breast and Gynecologic Oncology System of Excellence (BGSoE) in 2021. The BGSoE offers telehealth oncology services and a comprehensive cancer navigation program.
View Article and Find Full Text PDFArticle Synopsis
- Women Veterans represent the fastest-growing demographic within the VA Health Care System, with breast cancer being the most prevalent cancer among them, highlighting the need for improved cancer care tailored to their unique needs.
- The inaugural 2023 VA Women's Cancer Research Conference gathered experts to enhance breast cancer research, focusing on improving referral patterns and genetic testing for women Veterans.
- Surveyed attendees identified five key research priorities for enhancing cancer care, which include improving treatment quality, molecular testing, risk assessment, and building strategic partnerships.
Background: Women are the fastest growing veteran group in the US and the number of women veterans (WVs) with cancer is rising; however, little is known about this population. Cancer care for WVs is complex and it is essential to understand their unique needs and care coordination challenges to provide evidence-based care. The purpose of this review is to map the quantity, distribution, and characteristics of literature describing cancer and its treatment among WVs.
View Article and Find Full Text PDFObjectives: This review examines health care team-focused interventions on managing persistent or recurrent distress behaviors among older adults in long-term residential or inpatient health care settings.
Methods: We searched interventions addressing health care worker (HCW) knowledge and skills related to distress behavior management using Ovid MEDLINE, Elsevier Embase, and Ovid PsycINFO from December 2002 through December 2022.
Results: We screened 6,582 articles; 29 randomized trials met inclusion criteria.
Article Synopsis
- A study of pregnant veterans using VA care found high rates of cesarean sections, with significant occurrences among racial/ethnic minoritized groups, particularly in the southern U.S.
- Interviews with 27 BIPOC veterans revealed that many had previous cesarean sections, with over 60% requesting labor after cesarean but often facing refusals or complications that led to repeated surgeries.
- Key issues identified included feelings of reduced maternal agency due to treatment differences, a lack of information in birthing decisions, and highlighting the potential benefits of VA-funded doula care for improving support and autonomy during labor.
Article Synopsis
- - The study analyzed video-based primary care usage among over 5.3 million Veterans from April 2020 to March 2022, revealing that 32% of women and 18.6% of men utilized this service.
- - It found that gender influenced the likelihood of using video care, with men displaying stronger associations related to various demographic and clinical factors, while women’s associations always matched men in direction but varied in strength, particularly for Black Veterans.
- - Overall, there were fewer disparities in video care adoption between genders, and little difference in how frequently either gender used the service, indicating opportunities to enhance the effectiveness of video visits for all Veterans.
Background: Older adults are frequently hospitalized. Family involvement during these hospitalizations is incompletely characterized in the literature.
Objective: This study aimed to better understand how families are involved in the care of hospitalized older adults and develop a conceptual model describing the phenomenon of family involvement in the care of hospitalized older adults.
Article Synopsis
- The study aimed to evaluate the prevalence of maternal chronic hypertension (MCH) among Veterans and assess blood pressure control before pregnancy as well as medication management during pregnancy.
- About 8% of Veterans with documented pregnancies had MCH, with a significant portion showing uncontrolled blood pressure, particularly in those with chronic kidney disease and diabetes.
- The findings suggest a need for improved interventions to manage MCH and preconception blood pressure to ensure better health outcomes during pregnancy.*
Objective: To evaluate the impact of physical rehabilitation interventions, supplemented with one or more adherence-enhancing components, on outcomes among adults with hip or knee osteoarthritis or chronic lower back pain.
Design: Primary literature search from inception of each database to July 27, 2021, guided by relevant search terms and keywords to search titles and abstracts. All articles meeting eligibility criteria were included for data abstraction.
Genomic classifiers and prognosis of localized prostate cancer: a systematic review.
Prostate Cancer Prostatic Dis
January 2024
Background: Refinement of the risk classification for localized prostate cancer is warranted to aid in clinical decision making. A systematic analysis was undertaken to evaluate the prognostic ability of three genomic classifiers, Decipher, GPS, and Prolaris, for biochemical recurrence, development of metastases and prostate cancer-specific mortality in patients with localized prostate cancer.
Methods: Data sources: MEDLINE, Embase, and Web of Science were queried for reports published from January 2010 to April 2022.
Background: Equitable sex- and gender-based representation in clinical trials is an essential step to ensuring evidence-based care for women. While multi-institutional actions have led to significant improvements in the inclusion of women in trials, inequity persists in areas like sex-neutral cancers and cardiovascular disease. We sought to identify strategies described or evaluated to boost the inclusion of women in clinical trials.
View Article and Find Full Text PDFPurpose: In 2020, Congress passed legislation to establish the national Veterans Child Care Assistance Program (VCAP) targeting eligible veterans receiving care through the Veterans Health Administration (VA). This needs assessment describes the childcare needs of veteran caretakers of young children and explores the implications of inadequate childcare on health care engagement.
Methods: Survey data were collected from 2,000 VA users with dependent children; data were analyzed using standard descriptive statistics.
Introduction: Women experience numerous barriers to patient-centered health care (e.g., lack of continuity).
View Article and Find Full Text PDFObjectives: In this pragmatic clinical trial, the primary objective is to increase access to behavioral treatment of urinary incontinence (UI) for women Veterans by comparing the effectiveness of two virtual care delivery modalities.
Methods: Veterans Affairs (VA) clinical sites in AL, GA, NC will virtually randomize 286 women Veterans with UI (ie, stress, urge, or mixed). We will compare the effectiveness of our mHealth UI application (MyHealtheBladder) to a single VA Video Connect (VVC) session delivered by trained UI providers.
Objective: To assess factors influencing Veterans' decisions to initiate physical therapy (PT) after referral for low back pain (LBP) or knee osteoarthritis (OA).
Design: Qualitative study using individual semistructured telephone interviews.
Setting: Durham Veterans Health Administration Health Care System.
Purpose: As the largest integrated health care system in the United States, the Veterans Health Administration (VA) is a leader in telehealth-delivered care. All 10 million Veterans cared for within the VA are eligible for telehealth. The VA cares for approximately 46,000 Veteran patients with newly diagnosed cancer and an estimated 400,000 prevalent cases annually.
View Article and Find Full Text PDFBackground: Obtaining comprehensive family health history (FHH) to inform colorectal cancer (CRC) risk management in primary care settings is challenging.
Objective: To examine the effectiveness of a patient-facing FHH platform to identify and manage patients at increased CRC risk.
Design: Two-site, two-arm, cluster-randomized, implementation-effectiveness trial with primary care providers (PCPs) randomized to immediate intervention versus wait-list control.