Early initiation of corticosteroids in patients hospitalized with COVID-19 not requiring intensive respiratory support: cohort study

ObjectivesTo determine whether early oral or parenteral corticosteroids compared to no corticosteroids are associated with decreased mortality in patients hospitalized with coronavirus disease 2019 (COVID-19) who are not on intensive respiratory support (IRS) within 48 hours of admission. DesignObservational cohort study SettingNationwide cohort of patients receiving care in the Department of Veterans Affairs, a large integrated US national healthcare system Participants9,058 patients admitted to a Veterans Affairs Medical Center between June 7, 2020-December 5, 2020 within 14-days after SARS-CoV-2 positive test; exclusion criteria include less than a 48 hour stay, receipt of prior systemic corticosteroids, and no indication of acute medical care for COVID-19. Main outcome measure90-day all-cause mortality ResultsOf 9,058 total patients (95% men, median age 71 years, 27% black), 6,825 (75%) were not on IRS within 48 hours. Among the 3,025 patients on no oxygen, 598 (20%) received corticosteroids and 283 (9%) died; of 3,800 patients on low-flow nasal cannula oxygen (NC), 2,808 (74%) received corticosteroids and 514 (13%) died. In stratified, inverse probability weighted Cox proportional hazards models comparing those who did and did not receive corticosteroids, patients on no oxygen experienced an 89% increased risk for 90-day mortality (hazard ratio [HR] 1.89, 95% confidence interval [CI] 1.33 to 2.68); there was weak evidence of increased mortality among patients on NC (HR 1.21, 95% CI 0.94 to 1.57). Results were robust in subgroup analyses including restricting corticosteroids to dexamethasone, and in sensitivity analyses employing different modeling approaches. ConclusionsIn patients hospitalized with COVID-19, we found no evidence of a mortality benefit associated with early initiation of corticosteroids among those on no oxygen or NC in the first 48 hours, though there was evidence of potential harm. These real-world findings support that clinicians should consider withholding corticosteroids in these populations and further clinical trials may be warranted.

Cognitive-Behavioral Skills Building to Alleviate the Mental Health Effects of Bullying Victimization in Youth.

Bullying is a long-standing problem with relatively few intervention options for individual youth who have experienced it and have adverse mental health concerns. Depression, anxiety, and suicidal ideation are major consequences of bullying victimization. Although few evidence-based interventions have been put forth to address bullying victimization at the individual level, cognitive-behavioral therapy (CBT) and cognitive-behavioral skills building (CBSB) have been well researched for mental health concerns in youth. The purpose of the current article is to examine the theoretical framework of cognitive theory for individuals who have experienced bullying. Previous work that has addressed CBT for bullying interventions is described. Specific examples of how CBSB components could be applied to a bullying intervention program for youth are discussed. Ultimately, providing a theoretical framework to address this public health concern sets the stage for future intervention research. [Journal of Psychosocial Nursing and Mental Health Services, 59(5), 15-20.].

Communicating Oncologic Prognosis With Empathy: A Pilot Study of a Novel Communication Guide.

BACKGROUND: Clear communication between patients, families, and health-care providers is imperative to maximize patient outcomes, particularly for patients diagnosed with incurable cancer who require prompt engagement in decision-making. In response to the need to engage in quality patient-centered communication, an interprofessional team, representing medicine, nursing, social work, spiritual care, and clinical psychology, explored extant literature and developed a simple, single-page communication guide that summarizes the prognosis for patients with incurable cancers. The tool was specifically designed to enhance communication for patients, families, and across all members of the treatment and patient support team. PURPOSE: The purpose of this pilot study was to evaluate the impact of the communication guide on patient's accurate understanding of prognosis and the feasibility and acceptability of the intervention. METHODS: The study employed a sequential explanatory mixed-method design. Using pre- and post-tests, participants completed a prognosis and treatment perception survey and were randomized into control or intervention groups based on preference for prognostic information. The oncologist utilized the communication guide with the participants in the intervention group. Finally, 6-week post-test surveys were completed, followed by an exit interview. RESULTS: Key findings revealed participants prefer receiving detailed information about prognosis and have differing perceptions compared to the oncologists. Understandings of prognosis for patients and oncologists became more congruent following use of the communication guide. Participants found the tool useful and helpful. CONCLUSIONS: The communication tool serves as a promising mechanism to enhance patient-centered communication about prognosis for patients with incurable cancer.

The Synergistic Influence of Life Experiences and Cultural Nuances on Development of Depression: A Cognitive Behavioral Perspective.

The synergistic influences of everyday life experiences, societal expectations, and cultural nuances affect a person's ability to successfully manage their life and remain mentally healthy. Persons from culturally and ethnically diverse populations may incur depression when societal expectations and cultural influences are in conflict with each other. Chronic stress, often-referred to as toxic stress, contributes to the development of depression as it is unrelenting, beginning in childhood and continuing into adulthood. This article discusses connections between societal expectations, persons' cultural perspectives as well as the role that these connections may contribute to in the development of toxic stress and depression. Beck's Cognitive Behavioral Theory provides a basis to describe the role that synergistic influences play in development of depression for culturally and ethnically diverse persons.

How culture is assessed in the DSM-5.

Reports regarding the proposed changes in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) indicate there will be expanded and more clearly defined mental health assessment information regarding culture and diversity. This change is in response to the concerns of educators, practitioners, and researchers regarding how culture was prioritized, defined, and assessed within the fourth edition, text revision (DSM-IV-TR) of the manual. The purposes of this article are to discuss (a) how culture was assessed in the DSM-IV-TR; (b) what new assessment cultural factors are proposed for inclusion in the DSM-5; and (c) implications for psychiatric-mental health nursing education, practice, and research based on the inclusion of the proposed cultural assessment changes.

Two sides of the coin: the bully and the bullied.

Bullying has become a worldwide phenomenon that produces serious individual and societal consequences when it is ignored. There are two sides of the coin that require consideration when psychiatric-mental health (PMH) nurses conduct assessments of situations that involve bullying behaviors. Both the bully and the bullied can incur serious, negative, and debilitating psychological effects. In some cases, physical injury and/or death occurs as a result of bullying. Deciphering the biopsychosocial mental health issues associated with bullying is challenging. PMH nurses have the clinical expertise to develop coping interventions and strategies that stop bullying, as well as enhance the mental health and wellness of both those who bully and who are bullied. This article presents PMH nursing biopsychosocial strategies for both sides of the bullying coin. Exemplars are provided to aid implementation of the strategies.

Making the transition from lead poisoning prevention to healthy homes: a qualitative study.

CONTEXT AND OBJECTIVE: The goal of this study was to create a guide for programs considering transition from Lead Poisoning Prevention to Healthy Homes. Healthy Homes programs are comprehensive, focusing on multiple residential housing hazards. This study focused on the Baltimore City Healthy Homes Division, which was selected by the Centers for Disease Control and Prevention to pilot the transition process. DESIGN, SETTING, AND PARTICIPANTS: For this qualitative study, data were collected through interviews with program staff from the Baltimore City Healthy Homes Division and followed up by focus groups with community members who received its services. Grounded theory procedures were used for data analysis. Interviews and focus groups were conducted in Baltimore City near the Health Department. Seventeen interviews were conducted with Baltimore City Healthy Homes Division staff. Three focus groups were held with 3 to 6 community participants in each group. RESULTS: Findings for the study are arranged around an organizational framework for which transition from Lead Poisoning Prevention to Healthy Homes is the central phenomenon. Three general themes emerged: (1) programmatic changes; (2) policy changes; and (3) partnerships. Quotations from participating staff and community members provide supporting evidence for the results. CONCLUSIONS: Findings provide insight into the strengths and challenges of transition for 1 program. The study has implications for change on a national level as programs around the country transition to provide families with comprehensive Healthy Homes services.

Cultural aspects of bipolar disorder: Interpersonal meaning for clients & psychiatric nurses.

Bipolar disorder is a complicated mental illness to diagnose and treat. The symptoms of the disorder cause a multitude of fluctuations in mood and behavior, affecting the way individuals function and interact with others on a daily basis. Individuals diagnosed with bipolar disorder experience symptoms within a framework that is grounded in their cultural beliefs, values, and norms. Culture is a complex and personal biopsychosocial phenomenon that provides meaning within life for an individual, a group, or a community. It is essential that psychiatric-mental health (PMH) nurses understand the role of culture and integrate this knowledge into the biopsychosocial care of clients. The development and maintenance of the interpersonal therapeutic relationship between PMH nurses and their clients requires the use of a cultural framework, which refers to the connection of culture and cultural competence. The purposes of this article are to define culture and the process of cultural competence, provide a brief overview of bipolar disorder, propose the use of a cultural framework for bipolar disorder, and discuss the implications for PMH nurses who care for culturally and ethnically diverse clients.

The state of nursing science - cultural and lifespan issues in depression: part I: focus on adults.

Depression is a devastating disorder, affecting approximately 17 million persons within the United States. The manifestation of depressive phenomena is a complex, dynamic, biopsychosocial process involving lifespan and cultural aspects. Unless appropriately treated, depression persists over time having a significant negative effect on life and increasing the risk of suicide. Psychiatric mental health (PMH) nurses are uniquely positioned to address this epidemic health concern. This manuscript is Part I of the review of current nursing literature on adult depression. This review can be used to enhance PMH nurses' knowledge of current nursing research and their efforts in addressing prevention, early intervention, education and treatment of adults who experience depression.

The state of nursing science--cultural and lifespan issues in depression: part II: focus on children and adolescents.

The manifestation of depressive phenomena is a complex, dynamic biopsychosocial process across cultures and the lifespan. Without appropriate treatment, depression persists and can have significant negative effects on the lives of youth, including an increased risk of suicide. Psychiatric mental-health (PMH) nurses are uniquely positioned to address this health concern. This manuscript is Part II of a review of current nursing literature on culture and lifespan aspects of depression. The review presented in Part II focuses on children and adolescents. This information can be used to enhance PMH nurses' knowledge of current nursing research and their efforts in addressing prevention, early intervention, education, and treatment of youth who experience depression.

The cultural expression of death and dying.

Death and dying are universal experiences for people from all cultural groups. This collective experience is intertwined with issues involving mind, body, and spirit in the context of each person's unique culture. Case managers can be instrumental in teaching other members of the health care team regarding the cultural issues involved in the dying process of terminally ill clients. Successful management of the process for clients and the people important to them requires a culturally competent approach. Moreover, the managers need to understand the cultural process of dying and the death process both for themselves and their clients.