ABSTRACT
Methods: A survey was designed using Survey Monkey to query faculty regarding measures of stress and burnout related to both remote teaching and on campus teaching. A fivepoint Likert scale was used to garner respondents' reactions to 21 closed ended questions. The anonymous, confidential survey link was sent by email to faculty at three chiropractic programs. Respondents were instructed to reflect on March 2020 to March 2021 when completing the survey. Results: The survey request yielded 36 respondents. The majority of respondents, 66%, worked partially at home and partially on campus, while 26% worked entirely from home and 8% entirely on campus. In addition to work responsibilities, 31% of respondents were educating children at home. Nearly 2/3 of respondents (61%), indicated that they did not stop working at the end of the workday and 47% indicated that they felt stressed at work. However, 72% of respondents indicated that they were able to create a productive learning environment for students. While only 17% of respondents agreed that working with students remotely was energizing, most (70%) did not feel students blamed them for issues experienced during remote learning. Background: The purpose of this study was to examine the effect of moving to emergency remote teaching due to the COVID-19 pandemic on chiropractic college faculty. The job of a faculty member has always included demands. Stress can lead to occupational burnout, defined by the World Health Organization (WHO) in 2019 as “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed.” Conclusion: Chiropractic faculty variably experienced stress during the height of the COVID-19 pandemic. This may be due to working remotely and an absence of separation of home and work life. Despite the stressors felt surrounding teaching and work, faculty created a positive learning environment for students.
ABSTRACT
BACKGROUND Platypnea orthodeoxia syndrome (POS) presents with positional dyspnea and hypoxemia defined as arterial desaturation of at least 5% or a drop in PaO2 of at least 4 mmHg. Causes of POS include a variety of cardiopulmonary etiologies and has been reported in patients recovering from severe COVID-19 pneumonia. However, clinical presentation and outcomes in a patient with multiple interrelated mechanisms of shunting has not been documented. CASE REPORT An 85-year-old man hospitalized for hypertensive emergency and severe COVID-19 pneumonia was diagnosed with platypnea orthodeoxia on day 28 of illness. During his disease course, the patient required supplemental oxygen by high-flow nasal cannula but never required invasive mechanical ventilation. Chest imaging revealed evolving mixed consolidation and ground-glass opacities with a patchy and diffuse distribution, involving most of the left lung. Echocardiography was ordered to evaluate for intracardiac shunt, which revealed a patent foramen ovale. Closure of the patent foramen ovale was not pursued. Management included graded progression to standing and supplemental oxygen increases when upright. The patient was discharged to a skilled nursing facility and his positional oxygen requirement resolved on approximately day 78. CONCLUSIONS The present case highlights the multiple interrelated mechanisms of shunting in patients with COVID-related lung disease and a patent foramen ovale. Eight prior cases of POS after COVID-19 pneumonia have been reported to date but none with a known patent foramen ovale. In patients with persistent positional oxygen requirements at follow-up, quantifying shunt fraction over time through multiple modalities can guide treatment decisions.