OLDER ADULTS
Breathing easy with face masks
I strongly encourage all my patients to wear a face covering in public spaces, but some older patients worry that wearing a mask is dangerous because it decreases oxygen levels. What is the evidence on this issue?-C.C., N.C.
To investigate claims circulating on social media that wearing masks leads to hypoxia, researchers conducted a small crossover study in which participants self-measured peripheral oxygen saturation (SpO2) before, while, and after wearing a mask. Recruited from a retirement community, the 25 participants were age 65 or older (mean age, 76.5) with no comorbid cardiac or respiratory disorders that could lead to dyspnea or hypoxia at rest. Those who could not remove a mask without assistance were excluded from the study.
For each participant, the researchers calculated the mean of the three SpO2 readings for each period (before, while, and after wearing the mask). Pairwise comparisons of these values (while versus before, and while versus after) for each participant were also performed. They found that none of the participants' SpO2 fell below 92% while wearing masks and that "the paired mean differences in SpO2 while wearing the mask were minimal when compared with the value before they wore the mask."
The researchers concluded, "These results do not support claims that wearing nonmedical face masks in community settings is unsafe."
Source: Chan NC, Li K, Hirsh J. Peripheral oxygen saturation in older persons wearing nonmedical face masks in community settings. JAMA. 2020;324(22):2323-2324.
CORONASOMNIA
A pandemic of sleeplessness
I work in an outpatient clinic. Although most of the patients I see are in good health overall, many more than usual have been complaining of insomnia. I confess that I have not been sleeping well myself. Is this another byproduct of the COVID-19 pandemic?-L.S., ARIZ.
Increased insomnia during the pandemic, dubbed "coronasomnia" by some sleep experts, has been identified as a significant phenomenon in several recent studies. One study was based on an online questionnaire with a sample of 5,461 Chinese individuals from February 5, 2020, to February 23, 2020. Participants, who included both healthcare workers and members of the general public, were divided into four groups based on their degree of threat from COVID-19. The results showed a significant correlation between the perceived degree of threat from COVID-19 and insomnia, depression, anxiety, and stress. Twenty percent of participants spent more than 1 hour awake in bed. This study was notable for being among the first to document insomnia and psychological symptoms in response to a pandemic and for rating the severity of symptoms according to degree of threat from COVID-19.
Another large-scale cross-sectional international study conducted from March to April, 2020, similarly found that the pandemic has significantly worsened sleep quality across the globe.
Reassure patients that insomnia is not uncommon in these stressful times and encourage them to maintain good sleep hygiene habits. For example:
* maintain a normal daily routine, if possible, including going to bed and getting up at the same time each day.
* avoid looking at tablets, smartphones, and other devices with bright screens at bedtime.
* get some exercise every day, preferably outside in natural light.
* avoid caffeine and alcohol late in the day; both substances disturb normal sleep patterns.
For more information, refer patients to http://www.sleepfoundation.org/insomnia.
Sources: Morin CM, Carrier J. The acute effects of the COVID-19 pandemic on insomnia and psychological symptoms. Sleep Med. [e-pub June 6, 2020] Mandelkorn U, Genzer S, Choshen-Hillel S, et al. Escalation of sleep disturbances amid the COVID-19 pandemic: a cross-sectional international study. J Clin Sleep Med. 2021;17(1):45-53. UC Davis Health. COVID-19 is wrecking our sleep with coronasomnia - tips to fight back. News release. September 23, 2020.
CONFIDENTIALITY
Anonymity required?
A local athlete who is well known in my community successfully underwent an unusual medical procedure to treat a sports injury. The athlete's injury and medical experience were covered extensively in the local press. I would like to write this up as a case study from a nursing perspective and submit it to a nursing journal for publication. Given that the athlete's name and experience are already public knowledge, do I need to disguise the athlete's identity?-C.N., ILL.
Our legal consultant, who is also a nurse-editor, advises caution. Although some details of the case are already "out there," a case study for a professional audience is likely to delve more deeply into clinical circumstances, potentially compromising the athlete's personal health information (PHI). Our consultant advises you to obtain consent from the athlete and to anonymize the name and identifying details unless you have been specifically granted permission to disclose them.
This issue has ethical as well as legal implications. Although the athlete was not your patient, you have a general duty to protect patient privacy. The fact that some information about this person has appeared in the news or social media does not negate your ethical duty to protect a patient's right to privacy.
Finally, you should be aware that journals have rules about privacy, all some variation on, "No identifiable details or photos for persons or institutions without written consent." A journal could face legal liability for publishing someone's PHI without permission. The bottom line: If you do not have written permission, be discreet and change all identifying details.