ABSTRACT
The COVID-19 outbreak represented a remarkable challenge in universities and colleges since it forced the transition from a face-to-face model in classrooms and laboratories to a remote, online model using computers, tablets, and cell phones. In Mexico and other Latin American countries, the return to educational activities was a slow-paced process. The lack of presential activities had a deep impact on education, particularly in under- and graduate Chemistry courses, where laboratory work allows students to develop skills and abilities by applying their knowledge to solve experimental problems. As a consequence, institutional and personal efforts were put together to overcome this situation. These efforts led to remarkable experiences and outcomes with high educational value. This work presents experiences and outcomes of the Instrumental Analysis course offered in the Chemistry Clinical Biologist bachelor program throughout three nonconsecutive semesters, each time on different contexts, to describe the challenges faced, and the emerging opportunities from the experience throughout the pandemic. Each experience is described in a case study. Case 1 exemplifies a regular, pre-COVID-19 semester, in 2019, in a fully face-to-face teaching modality. Case 2 describes a semester in the middle of the COVID-19 crisis in 2020, in a 100% online teaching modality. Finally, Case 3 presents a semester with low prevalence of COVID-19 cases, using a hybrid modality, in 2021. Our observations suggest significant differences related to the knowledge integration process when laboratory work was interrupted, and provide evidence about how online activities impacted the learning process in experimental chemistry courses. © 2023 American Chemical Society and Division of Chemical Education, Inc.
ABSTRACT
STATEMENT OF PROBLEM/QUESTION: Despite accounting for only 34% of the population in Austin, Latinx individuals made up 50% of those who tested positive for coronavirus, 54% of COVID-related hospitalizations, and 51% of COVID-related deaths between March and June 2020. Of hospitalized patients, 40% had never seen a primary care physician (PCP), had high rates of previously undiagnosed health conditions and significant health-related social needs (HRSNs). DESCRIPTION OF PROGRAM/INTERVENTION: We implemented an interdisciplinary pilot program at a local academic teaching hospital to improve community outcomes and address HRSNs. The intervention is led by a bilingual community health worker (CHW), and includes discharge follow-up with patients hospitalized with COVID-19. As the pandemic ebbed and flowed across multiple surges, we expanded the intervention to Latinx patients with other complex health conditions. The full sample was included in the analysis. MEASURES OF SUCCESS: This is a mixed-method evaluation, which includes quantitative patient data (n=96), as well as qualitative data from hospital-based, healthcare professionals (n=26) that collaborated with the CHW. Quantitative data includes patient demographics (age, gender, race, education & insurance), HRSNs, community referrals and primary care followup. Qualitative data was collected via focus groups with case managers, hospitalists, residents and palliative care team members. Focus groups were approximately 60 minutes long, and we used content analysis to identify themes. FINDINGS TO DATE: The majority of patients were hospitalized for COVID-19 (n= 67, 70%) while the rest were diagnosed with other acute conditions. Average length of stay (LOS) was 13.8 days and the median LOS was 8 days. Mean age was 50.6 years, 66% of patients were male and 79% spoke Spanish. Half of the patients had less than a high school education, while 20% had more than a high school education. One-third of patients were employed while the rest were either seeking employment (16%) or nonworking (50%). The majority of patients were either uninsured (42%) or had county-based health coverage for the uninsured (30%). The top HRSNs included food (47%), rental assistance (36%) and utility assistance (36%). Almost half of patients attended a follow up with a PCP. Initial qualitative themes fall into three categories: 1) the role of a CHW, 2) the benefits of a CHW in the hospital and 3) growth opportunities. KEY LESSONS FOR DISSEMINATION: This pilot program demonstrated the capacity for CHWs to raise the hospital scope of care, particularly within the context of COVID-19. CHWs are experts in assessing and addressing HRSNs and can provide complementary services to inpatient care teams. CHWs provide culturally appropriate, transitional care to patients with chronic illnesses, which directly addresses the socioeconomic barriers to receiving continuity of care. Additional and diverse funding mechanism are needed to expand the presence of CHWs in hospital settings and increase the capacity to serve more patients.
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STATEMENT OF PROBLEM/QUESTION: The COVID-19 pandemic highlights the disproportionate burden of disease on communities made vulnerable by structural inequities. The pandemic has increased economic hardship, including housing instability, food insecurity and ability to pay bills. Hospitalization for COVID-19 is an opportunity to address unmet healthrelated social needs (HRSNs) and connect patients with community resources. DESCRIPTION OF PROGRAM/INTERVENTION: Community health workers (CHWs) play a critical role in response to public health crises. To address the inequitable burden of COVID-19 on Austin's Latinx population, we implemented a pilot program at an academic hospital where a CHW helps patients navigate care transitions and address unmet HRSNs. The care team referred patients with COVID-19 to the CHW, who met with patients to establish rapport, provide language-concordant communication between the care team and patient/family, deliver health promotion education, and assess HRSNs. MEASURES OF SUCCESS: This includes three typical cases describing key components of the CHW pilot program. CHWs connected patients and families to community resources and facilitated discharge planning and connection with primary care providers. The CHWs continued to follow patients for at least 45 days after discharge to assist with care coordination. We provide qualitative data from patients and healthcare professionals. FINDINGS TO DATE: Patient 1 is a 38-year-old day laborer with hypertension hospitalized with COVID-19 pneumonia. His family of four is undocumented and faced economic insecurity due to loss of work from the pandemic. The CHW assisted with utilities, bills, food and rent through coordination with local organizations to provide direct financial assistance to the family. Patient 2 is a 45-year-old woman with diabetes hospitalized with COVID-19 pneumonia. She is a mother of three children, two with disabilities. In addition to financial insecurity, she identified transportation as a primary HRSN. The CHW arranged financial resources to fix their car, which allowed the family to access school and clinic resources. Patient 3 is a 36-year-old man hospitalized with COVID-19 pneumonia. The CHW connected the family, including three children, with their school social worker, enabling access to financial support for utilities, food and clothes. The CHW arranged free food delivery to their home for four months. The CHW also secured county-based indigent care coverage for the patient, enabling hospital follow-up with a primary care provider. The patient's wife noted, because of the CHW, “We never felt alone” and now feel “capable of navigating a health system that we never felt we had access to.” KEY LESSONS FOR DISSEMINATION: CHWs, as patient advocates and skilled care navigators, build trust, establish longitudinal relationships with patients and address unmet HRSNs that can enable successful care transitions. CHWs can alleviate the disproportionate burden of COVID-19 on individuals with unmet HRSNs. Supporting the work of CHWs within hospital care teams can improve care transitions.
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BACKGROUND: COVID-19 has uniquely impacted the United States due to an under-resourced and over-burdened public health system. As the pandemic has ebbed and flowed across multiple surges, it has profoundly affected healthcare infrastructure. Multiple reports have noted a marked increase in burnout and compassion fatigue among healthcare professionals (HCPs) during COVID-19, which can adversely impact clinical care. However, the majority of studies have focused only on physicians or nurses in international settings;there is very little research on the experiences of HCPs in the U.S. This study explores the impact of a two-year pandemic on HCPs in terms of compassion, burnout and secondary trauma. METHODS: This is a mixed-method assessment of hospital HCPs (n=26) during COVID-19 including case managers, hospitalists, residents and palliative care team members. Quantitative data include HCP demographics (age, gender, race & education) as well as compassion, burnout and secondary trauma as measured by the Professional Quality of Life (ProQOL) Scale. Qualitative data was collected via 60-minute focus groups with HCPs, and content analysis was used to identify themes. RESULTS: Mean age was 35.2 years and 73% identified as female. The majority of HCPs identified as white (n=21) and 20% as Latinx, while one person identified as Black and four as Asian. About one-third of HCPs spoke Spanish. The majority were physicians (n=15, 58%), while three were social workers, three were registered nurses, one was an advanced practice nurse practitioner and one was a chaplain. HCPs had worked in healthcare for amean of 6.8 years (median=3) with a max of 38 years. Compassion, burnout and secondary trauma survey scores fell within the average range across HCPs. However, qualitative interviews identified burnout as a major theme amongst HCPs. Multiple factors associated with burnout were identified, including the unpredictability of COVID-19, high death rates, understaffing, unfilled positions, long working hours, social isolation and the politicization of COVID-19. CONCLUSIONS: Traditional compassion, fatigue and burnout surveys such as the ProQOL may not fully capture the complexities of how COVID-19 has affected healthcare professionals. Our qualitative data provides rich descriptions of compassion fatigue and burnout that were not captured by the survey data. Due to the unpredictable nature of the pandemic, as well as the large swings in hospitalization numbers, it is possible that the survey data did not reflect the level of burnout or compassion fatigue since data was collected at the end of the delta surge. It is also possible that HCPs most affected by secondary trauma or burnout have left the healthcare field, as supported by current literature. Larger scale assessments of healthcare professionals in the U.S. are warranted to further understand the impact of the COVID-19 pandemic on healthcare professionals, organizational factors leading to compassion fatigue or burnout, and potential policy solutions.
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INTRODUCTION: The COVID-19 pandemic and the use of personal protective equipment (PPE) in the healthcare setting provide a unique opportunity to study PPE-associated headaches (PPEAH). SUBJECTS AND METHODS: We conducted an online survey to assess the prevalence and clinical characteristics of PPEAH. The survey was voluntary, anonymous and addressed to medical and non-medical personnel. We used descriptive statistics and univariate and multivariate comparative analyses to identify factors associated with the development of PPEAH and its impact on work capacity. RESULTS: Out of 886 respondents, 88% (780) reported wearing PPE. Most of them were physicians (81%), 52.4% of whom were women. The prevalence of PPEAH was 65.5% (511/780) and 73.8% (377/511) were de novo headaches. PPEAH was acute, oppressive, bifrontal and of moderate intensity, and subsided with the removal of the PPE. Accompanying symptoms were common, and migraine and/or dysautonomic features were highly prevalent. Female sex, age > 40 years, use of PPE > 6 hours/day and the combination of an N95 mask and goggles were associated with the occurrence of PPEAH. There were factors associated with a negative impact on the ability to work because of the PPEAH. DISCUSSION: PPEAH may be a form of external compression headache (ECH); however, it has distinctive features that overlap with other primary and/or secondary headache disorders. CONCLUSIONS: PPEAH is prevalent and impacts on work-related activities. One subgroup presents characteristics not previously described in ECH.
TITLE: Cefalea asociada con el uso de equipo de protección personal durante la pandemia de COVID-19: una encuesta internacional.Introducción. La pandemia de COVID-19 y el uso de equipo de protección personal (EPP) en el entorno de la atención médica brindan una oportunidad única para estudiar la cefalea relacionada con el EPP (CREPP). Sujetos y métodos. Realizamos una encuesta en línea para evaluar la prevalencia y las características clínicas de la CREPP. La encuesta fue voluntaria, anónima y dirigida a personal médico y no médico. Utilizamos estadística descriptiva y análisis comparativos univariados y multivariados para identificar factores asociados con el desarrollo de CREPP y su impacto en la capacidad de trabajo. Resultados. De 886 encuestados, el 88% (780) notificó que usaba EPP. La mayoría eran médicos (81%), un 52,4% mujeres. La prevalencia de CREPP fue del 65,5% (511/780) y el 73,8% (377/511) fueron cefaleas de novo. La CREPP fue aguda, opresiva, bifrontal y de intensidad moderada, y remitía con el retiro del EPP. Los síntomas acompañantes fueron comunes, y las características migrañosas y/o disautonómicas fueron altamente prevalentes. El sexo femenino, la edad > 40 años, el uso de EPP > 6 horas/día y la combinación de mascarilla N95 y gafas se asociaron con la aparición de CREPP. Hubo factores asociados con un impacto negativo en la capacidad para trabajar debido a la CREPP. Discusión. La CREPP podría ser una forma de cefalea por compresión externa (CCE); no obstante, tiene características distintivas que se superponen con otros trastornos de cefaleas primarias y/o secundarias. Conclusiones. La CREPP es frecuente e impacta en las actividades relacionadas con el trabajo. Un subgrupo presenta características no descritas previamente en la CCE.