We asked Dr. Karen Goldstein to tell us about new leadership in this remarkable Durham ESP center and to catch us up about her own research on topics related to patient-centered interventions and healthcare disparities.
Submitted by Karen Goldstein, MD, assistant professor of medicine, general internal medicine
It is an exciting time of growth and change with the Durham Evidence Synthesis Program (ESP). The Durham ESP was formed in 2008 under the leadership of Dr. John W. Williams Jr. as one of four national VA ESP centers funded to conduct high-quality, rapid turn-around evidence synthesis to inform clinical policy. As the director of this program, John brought his expertise in evidence synthesis from his work with AHRQ’s Evidence Practice Centers and the international Cochrane GRADE group. Over the last 11 years, the Durham ESP has completed 31 projects with almost 60 publications. Our projects thrive with the support and participation of Duke faculty who lend their expertise and efforts, many from our own DGIM.
Announcing Gierisch and Goldstein as new co-directors
For the past several years, John has been preparing the Durham ESP for a leadership transition. In October of 2018, John transitioned from his role as Durham ESP Director to become a senior scientific advisor to the program. At that time, Dr. Jennifer Gierisch and I were appointed as Co-Directors of the program. Jennifer has been the Durham ESP Associate Director since 2014 and a co-investigator since 2009. Along with her quantitative skills, she brings her expertise in complex health behavior change, and qualitative methods to the evidence synthesis mix. I have been working on ESP projects since 2015 and have really come to love evidence synthesis methods and the opportunity to think and work broadly across topics and study designs. Thankfully, John is still a very active advisor of our program and is making his methodologic expertise readily available.
Stay tuned for upcoming projects
We are always looking for co-investigators with content area expertise or those who are just interested in how to conduct a high quality systematic review! Our reviews are indexed in PubMed and we usually get at least one, and sometimes more, peer-reviewed publications out of each project. Oh…and we usually have a pretty fun party every time we wrap up a project. Our next project will start on March 1st and will focus on Screening for Male Osteoporosis. Learn more here and sign up if you are interested in joining the team!
Can we stop worrying about gadolinium with our kidney patients?
One of our current projects is a systematic review of the evidence surrounding Nephrogenic Systemic Fibrosis (NSF) among patients with kidney disease. NSF is a rare but devastating complication of gadolinium contrast agents that involves the thickening and fibrosis of the skin and internal organs. It can be fatal and there is no effective treatment. NSF was first recognized in 2006 by the FDA as a complication of gadolinium exposure among patients with kidney disease; thankfully subsequent restrictions have dramatically reduced the incidence of NSF. Recently, there has been a recent movement to liberalize the use of newer linear and macrocyclic gadolinium agents due to a lower associated risk with these formulations. However, there has not been a definitive systematic review. So, our operations partner from the VA Nephrology Field Advisory committee nominated this project to conduct a comprehensive assessment of the evidence of the risk of NSF associated with newer linear and macrocyclic gadolinium agents used as contrast with MRI and MRA imaging studies. This project caught our attention as one that has the potential to impact the care of a large number patients with kidney disease who might be unnecessarily going without critical diagnostic and treatment information.
Our latest publication
Hughes, J.M., Freirermuth, C., Shepherd-Banigan, M., Ragsdale, M., Eucker, S., Goldstein, K.M., Hastings, S.N., Fulton, J., Ramos, K., Alishahi Tabriz, A., Gordon, A.M., Gieirsch, J.M., Kosinski, A., Williams Jr., J.W. (In press). Emergency department interventions for older adults: A systematic review. Journal of American Geriatrics Society.
Does peer support need to be tailored to gender?
I am also currently conducting a pilot study of a peer support intervention that combines peer coaching and reciprocal peer support to promote healthy lifestyle behaviors such as physical activity and healthy eating. In addition to assessing the feasibility and acceptability of this novel intervention, we are assessing whether or not there are gender-specific preferences around this type of intervention that would warrant gender-specific tailoring of the structure or content. So far, recruitment has gone well and we have experienced great patient engagement.