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This article discusses the adaptations and possible transformations in ELT during and post COVID-19 times. The traditional focus for ELT is often a narrow perspective on teaching methodology, epitomized by the "3 Ps” in ELT-Present, Practice, Produce. We argue for a realignment of focus to "People, Places, and Purposes” in ELT and a focus on addressing social issues. We frame our discussion on the notion of being ultra-social and illustrate the creativity and adaptability in language use during the pandemic. Questioning the deeply held assumptions in ELT, we propose transformative action on social issues: speaking, shifting boundaries and sustainability. © 2023, Association for the teaching of English as a Foreign Language in Indonesia. All rights reserved.
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Background: Nirmatrelvir/ritonavir (NMV/r), a preferred antiviral for high-risk outpatients with COVID-19, is associated with major drug-drug interactions (DDIs). Given the lack of DDI data with short course ritonavir (RTV), initial NMV/r product information was extrapolated from chronic, full dose RTV use. In Jan 2022, DDI experts from the University of Liverpool (UoL), NIH COVID-19 Guidelines Panel, and Ontario Science Table (OST) contributors established a global collaboration to address DDI challenges limiting NMV/r use in real-life settings. We report how safe, pragmatic, and consistent resources were developed to support NMV/r prescribing, and the utilization of these resources globally. Method(s): The 3 teams met monthly to discuss DDIs, review NMV/r DDI literature, and achieve consensus on recommendations. Additional experts were invited as needed. Metrics from the UoL DDI checker guided review of most searched DDIs overall and by severity. 2022 usage metrics for each DDI guide were collected. Differences in recommendations between initial DDI guides and product information were compared. Result(s): In 2022, 12 meetings were convened. Each team's DDI guide was revised and expanded (Table 1). To factor in the lower RTV dose and shorter treatment duration, some recommendations differed from product information. Drug categories that required the most discussion and revision included: anticoagulants (ACs), immunosuppressants, calcium channel blockers. NMV/r accounted for 85% of queries on the UoL site. NMV/r DDI guidance was the most viewed page of the NIH guidelines and among the OST ID/clinical care Science Briefs. Top searched drugs on the UoL site with serious DDIs were certain ACs and statins. Utilization of DDI guides was not limited to in-country resources: 51% and 7% of UoL queries came from the USA and Canada, respectively. NIH users followed links to the UoL and OST sites 161,478 and 37,619 times, respectively. Conclusion(s): Significant efforts have been made by the 3 teams to provide upto-date, complementary DDI guidance. Usage metrics confirm the demand for DDI guidance during the pandemic. Cross-utilization of the DDI guides confirms the need for consistency. DDI recommendations were more permissive than initial product information, expanding clinicians' ability to prescribe NMV/r. DDI guidance for ACs and immunosuppressants was particularly challenging. During drug development, complex interactions likely to be encountered in target populations should be addressed.
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INTRODUCTION: Infection control measures introduced during the COVID-19 pandemic present myriad challenges to end-of-life (EOL) care beyond restricted hospital visiting hours. The objective of this analysis was to understand the effect of infection control measures on bedside care for dying patients in a study embedded in an evaluation of the 3 Wishes Project. We hypothesized diverse effects from clinicians' perspectives. METHODS: Using a mixed-methods design, we enrolled patients with a ≥95% probability of dying in hospital, or plans were to withdraw life support on 3 hospital wards. Clinicians who cared for these patients were purposively sampled 2-10 weeks postmortem for an audio-recorded interview;data were analyzed by conventional content analysis. RESULTS: In total, 45 patients were enrolled in the ICU (n=34);COVID-19 ward (n=7), or medical step-down unit (n=4) from March 16-July 1, 2020. Of 236 terminal wishes elicited, 99% were implemented. During their hospital stay, 32 (71%) patients had ≥1 family member visit in the patient's room, outside the room, or at the outdoor window. At the time of death, 20 (44%) patients had family members at the bedside (none had COVID-19). Perspectives from 45 clinicians (16 nurses, 10 physicians, 8 residents, and others) highlighted several changes to physical aspects of EOL care during the pandemic. Patients with COVID-19 are cohort and/or isolated. Care for patients with and without COVID-19 is clustered to preserve personal protective equipment (PPE), thereby modifying the number and nature of bedside conversations, and physical aspects of care by some healthcare professionals. PPE, including gowns, masks, face shields, and gloves hinder visual and tactile aspects of care, precluding lip reading, covering facial expressions, interfering with natural tactile manifestations of concern. Many wishes were targeted at reducing patient isolation. Beyond task-oriented aspects of care, infection control strategies affect both verbal and non-verbal communication, including expressing and detecting emotion. CONCLUSIONS: Care for patients with and without COVID-19 is affected by infection control measures necessary during the pandemic, which modify many aspects of end-of-life care.
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INTRODUCTION: Restricted visiting hours during the COVID-19 pandemic are common. We hypothesized that clinicians would be distressed caring for patients at the end of life (EOL) related to visiting restrictions, as assessed in our pandemic-specific study to evaluate whether the 3 Wishes Project is feasible and valuable for dying patients. METHODS: In an embedded mixed-methods study from March16-July 1, 2020, we enrolled patients with a ≥95% probability of death or plans to withdraw life support. Clinicians and families elicited and implemented ≥3 final wishes/patient. We recorded patient characteristics and clinician demographics. We purposively sampled clinicians who cared for these patients for interviews 2-10 weeks postmortem;transcripts were analyzed using a qualitative descriptive approach. RESULTS: For 45 enrolled patients, 236 wishes were elicited. Overall, 5.2 (2.1) [mean (SD)] wishes/patient were implemented;50 (21%) by families. Most patients (32, 71%) had family visits during their hospital stay (in the patient's room, outside the room, or at the outdoor window). At the time of death, a family member was present with 20 (44%) patients. We interviewed 45 diverse clinicians with 13.7 (11.5) years of experience. Clinicians discussed operationally challenging dimensions of visiting restrictions related to the timing, duration, number, and purpose of visitors;different policies across units;variable implementation of the same policy;and policies shifting during the pandemic. Clinicians experienced moral distress caused by limited family companionship for patients. Emotions evoked included heartbreak, concern, devastation, frustration, and helplessness. This prompted professional coping strategies such as peer support;story-telling;informal debriefing;family advocacy;initiating research on this issue;and more intentional acts of compassion by creating meaningful wishes to personalize EOL care without family presence. CONCLUSIONS: Clinicians experienced both first-hand and vicarious distress when caring for dying patients during the pandemic related to visiting restrictions. The 3 Wishes Project provided a framework for empowering clinicians to provide humanistic EOL care for patients who were separated from their families.