The Penn Medicine COVID-19 Therapeutics Committee-Reflections on a Model for Rapid Evidence Review and Dynamic Practice Recommendations During a Public Health Emergency

The Penn Medicine COVID-19 Therapeutics Committee-an interspecialty, clinician-pharmacist, and specialist-front line primary care collaboration-has served as a forum for rapid evidence review and the production of dynamic practice recommendations during the 3-year coronavirus disease 2019 public health emergency. We describe the process by which the committee went about its work and how it navigated specific challenging scenarios. Our target audiences are clinicians, hospital leaders, public health officials, and researchers invested in preparedness for inevitable future threats. Our objectives are to discuss the logistics and challenges of forming an effective committee, undertaking a rapid evidence review process, aligning evidence-based guidelines with operational realities, and iteratively revising recommendations in response to changing pandemic data. We specifically discuss the arc of evidence for corticosteroids; the noble beginnings and dangerous misinformation end of hydroxychloroquine and ivermectin; monoclonal antibodies and emerging viral variants; and patient screening and safety processes for tocilizumab, baricitinib, and nirmatrelvir-ritonavir.

“Let Me Show You How I Think About This Problem…”: Impactful Nuances of Shared Medical Decision-Making

Shared decision-making is a key component of patient-centered care. In this clinical vignette, we illustrate the value of bringing patients into the clinical thought process as part of shared decision-making.

Partners in Narrative: Empowering Patient-Physician Partnerships in the Electronic Health Record

Amidst the chorus of valid laments about the electronic health record (EHR) are voices calling our attention to its potential to enhance transmission of information, patient communication, and decision-making. Herein, we propose ideas which, in addition, may enhance the potential of physicians and patients to become better at storytelling through the EHR. Clinicians can partner with patients to create meaningful, personalized narratives which restore inclusivity and patient agency to the EHR.

From Surveys to Skill Sets: Improving Patient Experience by Supporting Clinician Well-Being

Sharing patient satisfaction survey results is not ideal as a stand-alone motivator for clinician behavior change. Rather, this is best combined with efforts to support clinician well-being by offering protected time to improve our communication skills, along with our ability to effectively process feedback.

Creating Virtual Presence During a Pandemic

This article describes ways in which telemedicine has reshaped the doctor-patient relationship, and how we may face the challenge of maintaining a clinician's presence in the virtual environment.

Pictures

This article talks about an elderly patient named June and how her photos gave the author, a physician, a newfound insight. They remind him of the essential humanity in all patients, which sometimes just lies beneath a tarnished exterior. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Nurturing a Caring Connection in an Opioid Epidemic

The current national opioid crisis poses challenges to the physician–patient relationship. This vignette describes a patient scenario which served as a personal reminder of how the physicians caring role must remain the highest priority while trying to address prescribing concerns.

Acetyl-CoA decarbonylase/synthase complex from Archaeoglobus fulgidus

The acetyl-CoA decarbonylase/synthase (ACDS) multienzyme complex catalyzes the reversible cleavage and synthesis of acetyl-CoA in methanogens. This report of the enzyme complex in Archaeoglobus fulgidus demonstrates the existence of a functional ACDS complex in an organism that is not a methanogen. The A. fulgidus enzyme complex contained five subunits of 89, 72, 50, 49.5, and 18.5 kDa, and it catalyzed the overall synthesis of acetyl-CoA according to the following reaction: CO2 + 2 Fdred(Fe2+) + 2 H+ + CH3 - H4SPt + CoA <==> acetyl-CoA + H4SPt + 2 Fdox(Fe3+) + H2O where Fd is ferredoxin, and CH3-H4SPt and H4SPt denote N5-methyl-tetrahydrosarcinapterin and tetrahydrosarcinapterin, respectively.