Use of a digital step counter improved mobility in women at high risk for thromboembolic events after a cesarean delivery, based on data from a randomized trial of 215 patients.

“Patient immobility after surgery is associated with an increased risk of VTE [venous thromboembolism], whereas adequate mobility offers the benefits of enhanced bowel movement resumption and decreasing hospitalization length,” wrote Hadas Ganer Herman, MD, of Tel Aviv University, and colleagues.

In a study published in Obstetrics & Gynecology, the researchers randomized 108 women to a personalized feedback program using pedometers to promote mobility after cesarean delivery; 107 served as controls. Patient demographics and intrapartum experiences, including age, body mass index, and gestation week at delivery, were similar between the groups, as were postpartum complications and the use of analgesics.

Patients who used the pedometers took significantly more steps, compared with controls (5,918 vs. 4,161, P < .001). In addition, women in the pedometer group reported improved physical and mental postpartum recovery and higher levels of satisfaction with their delivery experience, the researchers noted.

The study findings were limited by several factors including potential selection bias among patients who completed the full follow-up, as well as the effect of preset visits from the research team during the study and lack of blinding of the participants. In addition, data on thromboembolic events after hospital discharge were available only through patient phone calls, the researchers noted.

“Our trial is notable for its novelty in exploring an intervention to improve postcesarean delivery mobility, using an objective means of digital step counters,” and for focusing on high-risk patients of clinical interest, Dr. Herman and associates wrote.

Larger studies are needed to explore interventions to improve mobility after cesarean deliveries, they emphasized. However, “because the integration between technology and medicine has continued to evolve and has successfully been proven for additional patient care issues in obstetrics, the current trial offers a basis for interpretation, with the possible use of low-cost interventions such as smart phone applications in maternity wards and simple digital feedback.”

“VTEs are still among the leading causes of maternal morbidity and mortality with peak incidence in the immediate postpartum period,” Martina L. Badell, MD, of Emory University, Atlanta, said in an interview. “As the age and body mass index of our pregnant patients continues to increase, focused attention to prevent VTEs in high-risk populations is very important.”

Dr. Badell said that pedometers are a feasible strategy “provided there is funding available to pay for and provide them.” Pedometers “don’t cause pain/discomfort and can be easily worn and reused. If the hospital isn’t able to provide them, however, then cost could be a barrier to high-risk women using pedometers in the immediate postpartum period.”

“The take-home message is that wearing a pedometer is a simple, low-risk strategy to encourage increased ambulation in a high-risk postpartum population with good patient satisfaction,” Dr. Badell said. The next step for research in this area “is to determine how many steps during the immediate postpartum period is optimal to reduce not only VTE risk, but potentially other postoperative markers such as pain and infection,” she added. Another research question is whether “focused feedback-based pedometers during the prolonged postpartum period result in improved weight loss.”

The researchers had no relevant financial disclosures. Dr. Badell said she had no relevant financial disclosures.

SOURCE: Herman HG et al. Obstet Gynecol. 2020 May 7. doi: 10.1097/AOG.0000000000003879.

Use of a digital step counter improved mobility in women at high risk for thromboembolic events after a cesarean delivery, based on data from a randomized trial of 215 patients.

“Patient immobility after surgery is associated with an increased risk of VTE [venous thromboembolism], whereas adequate mobility offers the benefits of enhanced bowel movement resumption and decreasing hospitalization length,” wrote Hadas Ganer Herman, MD, of Tel Aviv University, and colleagues.

In a study published in Obstetrics & Gynecology, the researchers randomized 108 women to a personalized feedback program using pedometers to promote mobility after cesarean delivery; 107 served as controls. Patient demographics and intrapartum experiences, including age, body mass index, and gestation week at delivery, were similar between the groups, as were postpartum complications and the use of analgesics.

Patients who used the pedometers took significantly more steps, compared with controls (5,918 vs. 4,161, P < .001). In addition, women in the pedometer group reported improved physical and mental postpartum recovery and higher levels of satisfaction with their delivery experience, the researchers noted.

The study findings were limited by several factors including potential selection bias among patients who completed the full follow-up, as well as the effect of preset visits from the research team during the study and lack of blinding of the participants. In addition, data on thromboembolic events after hospital discharge were available only through patient phone calls, the researchers noted.

“Our trial is notable for its novelty in exploring an intervention to improve postcesarean delivery mobility, using an objective means of digital step counters,” and for focusing on high-risk patients of clinical interest, Dr. Herman and associates wrote.

Larger studies are needed to explore interventions to improve mobility after cesarean deliveries, they emphasized. However, “because the integration between technology and medicine has continued to evolve and has successfully been proven for additional patient care issues in obstetrics, the current trial offers a basis for interpretation, with the possible use of low-cost interventions such as smart phone applications in maternity wards and simple digital feedback.”

“VTEs are still among the leading causes of maternal morbidity and mortality with peak incidence in the immediate postpartum period,” Martina L. Badell, MD, of Emory University, Atlanta, said in an interview. “As the age and body mass index of our pregnant patients continues to increase, focused attention to prevent VTEs in high-risk populations is very important.”

Dr. Badell said that pedometers are a feasible strategy “provided there is funding available to pay for and provide them.” Pedometers “don’t cause pain/discomfort and can be easily worn and reused. If the hospital isn’t able to provide them, however, then cost could be a barrier to high-risk women using pedometers in the immediate postpartum period.”

“The take-home message is that wearing a pedometer is a simple, low-risk strategy to encourage increased ambulation in a high-risk postpartum population with good patient satisfaction,” Dr. Badell said. The next step for research in this area “is to determine how many steps during the immediate postpartum period is optimal to reduce not only VTE risk, but potentially other postoperative markers such as pain and infection,” she added. Another research question is whether “focused feedback-based pedometers during the prolonged postpartum period result in improved weight loss.”

The researchers had no relevant financial disclosures. Dr. Badell said she had no relevant financial disclosures.

SOURCE: Herman HG et al. Obstet Gynecol. 2020 May 7. doi: 10.1097/AOG.0000000000003879.

Use of a digital step counter improved mobility in women at high risk for thromboembolic events after a cesarean delivery, based on data from a randomized trial of 215 patients.

“Patient immobility after surgery is associated with an increased risk of VTE [venous thromboembolism], whereas adequate mobility offers the benefits of enhanced bowel movement resumption and decreasing hospitalization length,” wrote Hadas Ganer Herman, MD, of Tel Aviv University, and colleagues.

In a study published in Obstetrics & Gynecology, the researchers randomized 108 women to a personalized feedback program using pedometers to promote mobility after cesarean delivery; 107 served as controls. Patient demographics and intrapartum experiences, including age, body mass index, and gestation week at delivery, were similar between the groups, as were postpartum complications and the use of analgesics.

Patients who used the pedometers took significantly more steps, compared with controls (5,918 vs. 4,161, P < .001). In addition, women in the pedometer group reported improved physical and mental postpartum recovery and higher levels of satisfaction with their delivery experience, the researchers noted.

The study findings were limited by several factors including potential selection bias among patients who completed the full follow-up, as well as the effect of preset visits from the research team during the study and lack of blinding of the participants. In addition, data on thromboembolic events after hospital discharge were available only through patient phone calls, the researchers noted.

“Our trial is notable for its novelty in exploring an intervention to improve postcesarean delivery mobility, using an objective means of digital step counters,” and for focusing on high-risk patients of clinical interest, Dr. Herman and associates wrote.

Larger studies are needed to explore interventions to improve mobility after cesarean deliveries, they emphasized. However, “because the integration between technology and medicine has continued to evolve and has successfully been proven for additional patient care issues in obstetrics, the current trial offers a basis for interpretation, with the possible use of low-cost interventions such as smart phone applications in maternity wards and simple digital feedback.”

“VTEs are still among the leading causes of maternal morbidity and mortality with peak incidence in the immediate postpartum period,” Martina L. Badell, MD, of Emory University, Atlanta, said in an interview. “As the age and body mass index of our pregnant patients continues to increase, focused attention to prevent VTEs in high-risk populations is very important.”

Dr. Badell said that pedometers are a feasible strategy “provided there is funding available to pay for and provide them.” Pedometers “don’t cause pain/discomfort and can be easily worn and reused. If the hospital isn’t able to provide them, however, then cost could be a barrier to high-risk women using pedometers in the immediate postpartum period.”

“The take-home message is that wearing a pedometer is a simple, low-risk strategy to encourage increased ambulation in a high-risk postpartum population with good patient satisfaction,” Dr. Badell said. The next step for research in this area “is to determine how many steps during the immediate postpartum period is optimal to reduce not only VTE risk, but potentially other postoperative markers such as pain and infection,” she added. Another research question is whether “focused feedback-based pedometers during the prolonged postpartum period result in improved weight loss.”

The researchers had no relevant financial disclosures. Dr. Badell said she had no relevant financial disclosures.

SOURCE: Herman HG et al. Obstet Gynecol. 2020 May 7. doi: 10.1097/AOG.0000000000003879.

Combination therapy with relugolix, an investigational oral gonadotropin-releasing hormone antagonist, estradiol, and norethindrone acetate effectively preserved bone mineral density (BMD) in two replicate phase 3 studies enrolling women with heavy menstrual bleeding associated with uterine fibroids.

The BMD findings, released ahead of the study’s scheduled presentation at the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists, build upon previously reported positive primary endpoint data from the LIBERTY 1 and LIBERTY 2 studies. ACOG canceled the meeting and released abstracts for press coverage.

The developer of the drug, Myovant Sciences, plans to submit a new drug application to the Food and Drug Administration for approval of the single-tablet combination therapy for women with uterine fibroids, according to Albert Liao, the company’s director of corporate communications.

The two multinational LIBERTY studies randomized women who had a monthly menstrual blood loss volume of at least 80 mL in two consecutive cycles (or 160 mL in one cycle) in a 1:1:1 ratio to one of three groups: relugolix combination therapy for 24 weeks (once-daily relugolix 40 mg plus estradiol 1.0 mg plus norethindrone acetate 0.5 mg); relugolix alone (40 mg once daily) for 12 weeks followed by relugolix combination therapy for 12 weeks; or placebo for 24 weeks.

In October 2019 at the American Society for Reproductive Medicine Scientific Congress, investigators reported that 73% of women receiving combination therapy in the LIBERTY 1 trial achieved a menstrual blood loss of less than 80 mL and a 50% or greater reduction from baseline over the last 35 days of treatment, compared with 19% in the placebo group. The mean percent reduction in menstrual blood loss from baseline at week 24 was 84% for combination therapy and 23% for placebo.

Earlier in 2019, Myovant Sciences announced that, in the LIBERTY 2 study, 71% of women receiving combination therapy met the primary endpoints, compared with 15% in the placebo group. The reduction in menstrual blood loss in this study’s combination therapy arm was also 84%, according to a company press release from June 2019.

Each of the two clinical trials enrolled upwards of 380 women.

The new abstract released for press coverage by ACOG and published in Obstetrics & Gynecology reports that women receiving relugolix combination therapy in the LIBERTY 1 and LIBERTY 2 studies had a mean change in lumbar spine BMD of –0.36% and –0.13%, respectively, from baseline to 24 weeks. Percent change in lumbar spine BMD in the delayed combination therapy groups (12 initial weeks of relugolix monotherapy) was –1.82% and –2.12%. In the placebo groups, the change was 0.05% and 0.32%.

Michael R. McClung, MD, who is the lead author of the abstract and was scheduled to present the findings at the ACOG meeting, said in an interview that the slight decreases in lumbar spine BMD with combination therapy were noted largely at week 12 and are “clinically insignificant in my opinion.” BMD by dual-energy x-ray absorptiometry was assessed at weeks 12 and 24.

“There was no further increase [after week 12] and [in some patients] there was even a return to baseline,” said Dr. McClung, of the Oregon Osteoporosis Center in Portland.

The safety and efficacy of longer-term treatment with relugolix combination therapy has been investigated thus far through an open-label extension study that brought the treatment period to 52 weeks. The 1-year data has been positive and will be presented or published soon, said Mr. Liao. In addition, a “second, 52-week randomized withdrawal study has been designed to provide 2-year safety and efficacy data … and to evaluate the need for maintenance therapy.”

It’s important, Dr. McClung said, “for clinicians to be confident that BMD loss is prevented or minimized with longer-term relugolix combination therapy since treatment for uterine fibroids is not a short-term proposition. Given the stability of BMD values between weeks 12 and 24 in the LIBERTY studies, I’d anticipate that we will see stable values with longer-term treatment.”

Dr. McClung disclosed that he has served as a consultant/advisory board member and speaker for Amgen and a consultant/advisory board member for Myovant. Several of his coauthors disclosed employment and ownerships interests in Myovant.

SOURCE: McClung MR et al. Obstet Gynecol. 2020 May. doi: 10.1097/01.AOG.0000662944.34860.b4.

Combination therapy with relugolix, an investigational oral gonadotropin-releasing hormone antagonist, estradiol, and norethindrone acetate effectively preserved bone mineral density (BMD) in two replicate phase 3 studies enrolling women with heavy menstrual bleeding associated with uterine fibroids.

The BMD findings, released ahead of the study’s scheduled presentation at the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists, build upon previously reported positive primary endpoint data from the LIBERTY 1 and LIBERTY 2 studies. ACOG canceled the meeting and released abstracts for press coverage.

The developer of the drug, Myovant Sciences, plans to submit a new drug application to the Food and Drug Administration for approval of the single-tablet combination therapy for women with uterine fibroids, according to Albert Liao, the company’s director of corporate communications.

The two multinational LIBERTY studies randomized women who had a monthly menstrual blood loss volume of at least 80 mL in two consecutive cycles (or 160 mL in one cycle) in a 1:1:1 ratio to one of three groups: relugolix combination therapy for 24 weeks (once-daily relugolix 40 mg plus estradiol 1.0 mg plus norethindrone acetate 0.5 mg); relugolix alone (40 mg once daily) for 12 weeks followed by relugolix combination therapy for 12 weeks; or placebo for 24 weeks.

In October 2019 at the American Society for Reproductive Medicine Scientific Congress, investigators reported that 73% of women receiving combination therapy in the LIBERTY 1 trial achieved a menstrual blood loss of less than 80 mL and a 50% or greater reduction from baseline over the last 35 days of treatment, compared with 19% in the placebo group. The mean percent reduction in menstrual blood loss from baseline at week 24 was 84% for combination therapy and 23% for placebo.

Earlier in 2019, Myovant Sciences announced that, in the LIBERTY 2 study, 71% of women receiving combination therapy met the primary endpoints, compared with 15% in the placebo group. The reduction in menstrual blood loss in this study’s combination therapy arm was also 84%, according to a company press release from June 2019.

Each of the two clinical trials enrolled upwards of 380 women.

The new abstract released for press coverage by ACOG and published in Obstetrics & Gynecology reports that women receiving relugolix combination therapy in the LIBERTY 1 and LIBERTY 2 studies had a mean change in lumbar spine BMD of –0.36% and –0.13%, respectively, from baseline to 24 weeks. Percent change in lumbar spine BMD in the delayed combination therapy groups (12 initial weeks of relugolix monotherapy) was –1.82% and –2.12%. In the placebo groups, the change was 0.05% and 0.32%.

Michael R. McClung, MD, who is the lead author of the abstract and was scheduled to present the findings at the ACOG meeting, said in an interview that the slight decreases in lumbar spine BMD with combination therapy were noted largely at week 12 and are “clinically insignificant in my opinion.” BMD by dual-energy x-ray absorptiometry was assessed at weeks 12 and 24.

“There was no further increase [after week 12] and [in some patients] there was even a return to baseline,” said Dr. McClung, of the Oregon Osteoporosis Center in Portland.

The safety and efficacy of longer-term treatment with relugolix combination therapy has been investigated thus far through an open-label extension study that brought the treatment period to 52 weeks. The 1-year data has been positive and will be presented or published soon, said Mr. Liao. In addition, a “second, 52-week randomized withdrawal study has been designed to provide 2-year safety and efficacy data … and to evaluate the need for maintenance therapy.”

It’s important, Dr. McClung said, “for clinicians to be confident that BMD loss is prevented or minimized with longer-term relugolix combination therapy since treatment for uterine fibroids is not a short-term proposition. Given the stability of BMD values between weeks 12 and 24 in the LIBERTY studies, I’d anticipate that we will see stable values with longer-term treatment.”

Dr. McClung disclosed that he has served as a consultant/advisory board member and speaker for Amgen and a consultant/advisory board member for Myovant. Several of his coauthors disclosed employment and ownerships interests in Myovant.

SOURCE: McClung MR et al. Obstet Gynecol. 2020 May. doi: 10.1097/01.AOG.0000662944.34860.b4.

Combination therapy with relugolix, an investigational oral gonadotropin-releasing hormone antagonist, estradiol, and norethindrone acetate effectively preserved bone mineral density (BMD) in two replicate phase 3 studies enrolling women with heavy menstrual bleeding associated with uterine fibroids.

The BMD findings, released ahead of the study’s scheduled presentation at the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists, build upon previously reported positive primary endpoint data from the LIBERTY 1 and LIBERTY 2 studies. ACOG canceled the meeting and released abstracts for press coverage.

The developer of the drug, Myovant Sciences, plans to submit a new drug application to the Food and Drug Administration for approval of the single-tablet combination therapy for women with uterine fibroids, according to Albert Liao, the company’s director of corporate communications.

The two multinational LIBERTY studies randomized women who had a monthly menstrual blood loss volume of at least 80 mL in two consecutive cycles (or 160 mL in one cycle) in a 1:1:1 ratio to one of three groups: relugolix combination therapy for 24 weeks (once-daily relugolix 40 mg plus estradiol 1.0 mg plus norethindrone acetate 0.5 mg); relugolix alone (40 mg once daily) for 12 weeks followed by relugolix combination therapy for 12 weeks; or placebo for 24 weeks.

In October 2019 at the American Society for Reproductive Medicine Scientific Congress, investigators reported that 73% of women receiving combination therapy in the LIBERTY 1 trial achieved a menstrual blood loss of less than 80 mL and a 50% or greater reduction from baseline over the last 35 days of treatment, compared with 19% in the placebo group. The mean percent reduction in menstrual blood loss from baseline at week 24 was 84% for combination therapy and 23% for placebo.

Earlier in 2019, Myovant Sciences announced that, in the LIBERTY 2 study, 71% of women receiving combination therapy met the primary endpoints, compared with 15% in the placebo group. The reduction in menstrual blood loss in this study’s combination therapy arm was also 84%, according to a company press release from June 2019.

Each of the two clinical trials enrolled upwards of 380 women.

The new abstract released for press coverage by ACOG and published in Obstetrics & Gynecology reports that women receiving relugolix combination therapy in the LIBERTY 1 and LIBERTY 2 studies had a mean change in lumbar spine BMD of –0.36% and –0.13%, respectively, from baseline to 24 weeks. Percent change in lumbar spine BMD in the delayed combination therapy groups (12 initial weeks of relugolix monotherapy) was –1.82% and –2.12%. In the placebo groups, the change was 0.05% and 0.32%.

Michael R. McClung, MD, who is the lead author of the abstract and was scheduled to present the findings at the ACOG meeting, said in an interview that the slight decreases in lumbar spine BMD with combination therapy were noted largely at week 12 and are “clinically insignificant in my opinion.” BMD by dual-energy x-ray absorptiometry was assessed at weeks 12 and 24.

“There was no further increase [after week 12] and [in some patients] there was even a return to baseline,” said Dr. McClung, of the Oregon Osteoporosis Center in Portland.

The safety and efficacy of longer-term treatment with relugolix combination therapy has been investigated thus far through an open-label extension study that brought the treatment period to 52 weeks. The 1-year data has been positive and will be presented or published soon, said Mr. Liao. In addition, a “second, 52-week randomized withdrawal study has been designed to provide 2-year safety and efficacy data … and to evaluate the need for maintenance therapy.”

It’s important, Dr. McClung said, “for clinicians to be confident that BMD loss is prevented or minimized with longer-term relugolix combination therapy since treatment for uterine fibroids is not a short-term proposition. Given the stability of BMD values between weeks 12 and 24 in the LIBERTY studies, I’d anticipate that we will see stable values with longer-term treatment.”

Dr. McClung disclosed that he has served as a consultant/advisory board member and speaker for Amgen and a consultant/advisory board member for Myovant. Several of his coauthors disclosed employment and ownerships interests in Myovant.

SOURCE: McClung MR et al. Obstet Gynecol. 2020 May. doi: 10.1097/01.AOG.0000662944.34860.b4.

Two reports of chilblain-like lesions in children suspected of having COVID-19 in Spain and Italy have been published, joining other recent reports of such cases in the United States and elsewhere.

These symptoms should be considered a sign of infection with the virus, but the symptoms themselves typically don’t require treatment, according to the authors of the two new reports, from hospitals in Milan and Madrid, published in Pediatric Dermatology.

In the first study, Cristiana Colonna, MD, and colleagues at Hospital Maggiore Polyclinic in Milan described four cases of chilblain-like lesions in children ages 5-11 years with mild COVID-19 symptoms.

In the second, David Andina, MD, and colleagues in the ED and the departments of dermatology and pathology at the Child Jesus University Children’s Hospital in Madrid published a retrospective study of 22 cases in children and adolescents ages 6-17 years who reported to the hospital ED from April 6 to 17, the peak of the pandemic in Madrid.

In all four of the Milan cases, the skin lesions appeared several days after the onset of COVID-19 symptoms, although all four patients initially tested negative for COVID-19. However, Dr. Colonna and colleagues wrote that, “given the fact that the sensitivity and specificity of both nasopharyngeal swabs and antibody tests for COVID-19 (when available) are not 100% reliable, the question of the origin of these strange chilblain-like lesions is still elusive.” Until further studies are available, they emphasized that clinicians should be “alert to the presentation of chilblain-like findings” in children with mild symptoms “as a possible sign of COVID-19 infection.”

All the patients had lesions on their feet or toes, and a 5-year-old boy also had lesions on the right hand. One patient, an 11-year-old girl, had a biopsy that revealed dense lymphocytic perivascular cuffing and periadnexal infiltration.

“The finding of an elevated d-dimer in one of our patients, along with the clinical features suggestive of a vasoocclusive phenomenon, supports consideration of laboratory evaluation for coagulation defects in asymptomatic or mildly symptomatic children with acrovasculitis-like findings,” Dr. Colonna and colleagues wrote. None of the four cases in Milan required treatment, with three cases resolving within 5 days.

Like the Milan cases, all 22 patients in the Madrid series had foot or toe lesions and three had lesions on the fingers. This larger series also reported more detailed symptoms about the lesions: pruritus in nine patients (41%) and mild pain in seven (32%). A total of 10 patients had systemic symptoms of COVID-19, predominantly cough and rhinorrhea in 9 patients (41%), but 2 (9%) had abdominal pain and diarrhea. These symptoms, the authors said, appeared a median of 14 days (range, 1-28 days) before they developed chilblains.

A total of 19 patients were tested for COVID-19, but only 1 was positive.

This retrospective study also included contact information, with one patient having household contact with a single confirmed case of COVID-19; 12 patients recalled household contact who were considered probable cases of COVID-19, with respiratory symptoms.

Skin biopsies were obtained from the acral lesions in six patients, all showing similar results, although with varying degrees of intensity. All biopsies showed features of lymphocytic vasculopathy. Some cases showed mild dermal and perieccrine mucinosis, lymphocytic eccrine hidradenitis, vascular ectasia, red cell extravasation and focal thrombosis described as “mostly confined to scattered papillary dermal capillaries, but also in vessels of the reticular dermis.”

The only treatments Dr. Andina and colleagues reported were oral analgesics for pain and oral antihistamines for pruritus when needed. One patient was given topical corticosteroids and another a short course of oral steroids, both for erythema multiforme.

Dr. Andina and colleagues wrote that the skin lesions in these patients “were unequivocally categorized as chilblains, both clinically and histopathologically,” and, after 7-10 days, began to fade. None of the patients had complications, and had an “excellent outcome,” they noted.

Dr. Colonna and colleagues had no conflicts of interest to declare. Dr. Andina and colleagues provided no disclosure statement.

SOURCES: Colonna C et al. Ped Derm. 2020 May 6. doi: 10.1111/pde.14210; Andina D et al. Ped Derm. 2020 May 9. doi: 10.1111/pde.14215.

Two reports of chilblain-like lesions in children suspected of having COVID-19 in Spain and Italy have been published, joining other recent reports of such cases in the United States and elsewhere.

These symptoms should be considered a sign of infection with the virus, but the symptoms themselves typically don’t require treatment, according to the authors of the two new reports, from hospitals in Milan and Madrid, published in Pediatric Dermatology.

In the first study, Cristiana Colonna, MD, and colleagues at Hospital Maggiore Polyclinic in Milan described four cases of chilblain-like lesions in children ages 5-11 years with mild COVID-19 symptoms.

In the second, David Andina, MD, and colleagues in the ED and the departments of dermatology and pathology at the Child Jesus University Children’s Hospital in Madrid published a retrospective study of 22 cases in children and adolescents ages 6-17 years who reported to the hospital ED from April 6 to 17, the peak of the pandemic in Madrid.

In all four of the Milan cases, the skin lesions appeared several days after the onset of COVID-19 symptoms, although all four patients initially tested negative for COVID-19. However, Dr. Colonna and colleagues wrote that, “given the fact that the sensitivity and specificity of both nasopharyngeal swabs and antibody tests for COVID-19 (when available) are not 100% reliable, the question of the origin of these strange chilblain-like lesions is still elusive.” Until further studies are available, they emphasized that clinicians should be “alert to the presentation of chilblain-like findings” in children with mild symptoms “as a possible sign of COVID-19 infection.”

All the patients had lesions on their feet or toes, and a 5-year-old boy also had lesions on the right hand. One patient, an 11-year-old girl, had a biopsy that revealed dense lymphocytic perivascular cuffing and periadnexal infiltration.

“The finding of an elevated d-dimer in one of our patients, along with the clinical features suggestive of a vasoocclusive phenomenon, supports consideration of laboratory evaluation for coagulation defects in asymptomatic or mildly symptomatic children with acrovasculitis-like findings,” Dr. Colonna and colleagues wrote. None of the four cases in Milan required treatment, with three cases resolving within 5 days.

Like the Milan cases, all 22 patients in the Madrid series had foot or toe lesions and three had lesions on the fingers. This larger series also reported more detailed symptoms about the lesions: pruritus in nine patients (41%) and mild pain in seven (32%). A total of 10 patients had systemic symptoms of COVID-19, predominantly cough and rhinorrhea in 9 patients (41%), but 2 (9%) had abdominal pain and diarrhea. These symptoms, the authors said, appeared a median of 14 days (range, 1-28 days) before they developed chilblains.

A total of 19 patients were tested for COVID-19, but only 1 was positive.

This retrospective study also included contact information, with one patient having household contact with a single confirmed case of COVID-19; 12 patients recalled household contact who were considered probable cases of COVID-19, with respiratory symptoms.

Skin biopsies were obtained from the acral lesions in six patients, all showing similar results, although with varying degrees of intensity. All biopsies showed features of lymphocytic vasculopathy. Some cases showed mild dermal and perieccrine mucinosis, lymphocytic eccrine hidradenitis, vascular ectasia, red cell extravasation and focal thrombosis described as “mostly confined to scattered papillary dermal capillaries, but also in vessels of the reticular dermis.”

The only treatments Dr. Andina and colleagues reported were oral analgesics for pain and oral antihistamines for pruritus when needed. One patient was given topical corticosteroids and another a short course of oral steroids, both for erythema multiforme.

Dr. Andina and colleagues wrote that the skin lesions in these patients “were unequivocally categorized as chilblains, both clinically and histopathologically,” and, after 7-10 days, began to fade. None of the patients had complications, and had an “excellent outcome,” they noted.

Dr. Colonna and colleagues had no conflicts of interest to declare. Dr. Andina and colleagues provided no disclosure statement.

SOURCES: Colonna C et al. Ped Derm. 2020 May 6. doi: 10.1111/pde.14210; Andina D et al. Ped Derm. 2020 May 9. doi: 10.1111/pde.14215.

Two reports of chilblain-like lesions in children suspected of having COVID-19 in Spain and Italy have been published, joining other recent reports of such cases in the United States and elsewhere.

These symptoms should be considered a sign of infection with the virus, but the symptoms themselves typically don’t require treatment, according to the authors of the two new reports, from hospitals in Milan and Madrid, published in Pediatric Dermatology.

In the first study, Cristiana Colonna, MD, and colleagues at Hospital Maggiore Polyclinic in Milan described four cases of chilblain-like lesions in children ages 5-11 years with mild COVID-19 symptoms.

In the second, David Andina, MD, and colleagues in the ED and the departments of dermatology and pathology at the Child Jesus University Children’s Hospital in Madrid published a retrospective study of 22 cases in children and adolescents ages 6-17 years who reported to the hospital ED from April 6 to 17, the peak of the pandemic in Madrid.

In all four of the Milan cases, the skin lesions appeared several days after the onset of COVID-19 symptoms, although all four patients initially tested negative for COVID-19. However, Dr. Colonna and colleagues wrote that, “given the fact that the sensitivity and specificity of both nasopharyngeal swabs and antibody tests for COVID-19 (when available) are not 100% reliable, the question of the origin of these strange chilblain-like lesions is still elusive.” Until further studies are available, they emphasized that clinicians should be “alert to the presentation of chilblain-like findings” in children with mild symptoms “as a possible sign of COVID-19 infection.”

All the patients had lesions on their feet or toes, and a 5-year-old boy also had lesions on the right hand. One patient, an 11-year-old girl, had a biopsy that revealed dense lymphocytic perivascular cuffing and periadnexal infiltration.

“The finding of an elevated d-dimer in one of our patients, along with the clinical features suggestive of a vasoocclusive phenomenon, supports consideration of laboratory evaluation for coagulation defects in asymptomatic or mildly symptomatic children with acrovasculitis-like findings,” Dr. Colonna and colleagues wrote. None of the four cases in Milan required treatment, with three cases resolving within 5 days.

Like the Milan cases, all 22 patients in the Madrid series had foot or toe lesions and three had lesions on the fingers. This larger series also reported more detailed symptoms about the lesions: pruritus in nine patients (41%) and mild pain in seven (32%). A total of 10 patients had systemic symptoms of COVID-19, predominantly cough and rhinorrhea in 9 patients (41%), but 2 (9%) had abdominal pain and diarrhea. These symptoms, the authors said, appeared a median of 14 days (range, 1-28 days) before they developed chilblains.

A total of 19 patients were tested for COVID-19, but only 1 was positive.

This retrospective study also included contact information, with one patient having household contact with a single confirmed case of COVID-19; 12 patients recalled household contact who were considered probable cases of COVID-19, with respiratory symptoms.

Skin biopsies were obtained from the acral lesions in six patients, all showing similar results, although with varying degrees of intensity. All biopsies showed features of lymphocytic vasculopathy. Some cases showed mild dermal and perieccrine mucinosis, lymphocytic eccrine hidradenitis, vascular ectasia, red cell extravasation and focal thrombosis described as “mostly confined to scattered papillary dermal capillaries, but also in vessels of the reticular dermis.”

The only treatments Dr. Andina and colleagues reported were oral analgesics for pain and oral antihistamines for pruritus when needed. One patient was given topical corticosteroids and another a short course of oral steroids, both for erythema multiforme.

Dr. Andina and colleagues wrote that the skin lesions in these patients “were unequivocally categorized as chilblains, both clinically and histopathologically,” and, after 7-10 days, began to fade. None of the patients had complications, and had an “excellent outcome,” they noted.

Dr. Colonna and colleagues had no conflicts of interest to declare. Dr. Andina and colleagues provided no disclosure statement.

SOURCES: Colonna C et al. Ped Derm. 2020 May 6. doi: 10.1111/pde.14210; Andina D et al. Ped Derm. 2020 May 9. doi: 10.1111/pde.14215.

As the COVID spring progresses, the days before the pandemic may seem like a dream: Practices were open, waiting rooms were full of unmasked people, and PPE was plentiful.

Medscape’s latest physician survey, conducted from Oct. 4, 2019, to Feb. 10, 2020, shows what dermatology looked like just before the coronavirus arrived.

Back then, it turns out, earnings were down. Average compensation reported by dermatologists dropped from $419,000 in 2019 to $411,000 this year, a 1.9% decrease. Average income for all specialists was $346,000 in this year’s survey – 1.5% higher than the $341,000 earned in 2019, Medscape reported.

Prospects for this year of the pandemic are not better. “Specialists are currently having more troubles than [primary care physicians] because they’re dependent on elective cases, which can’t be directly addressed by telemedicine,” Joel Greenwald, MD, the CEO of Greenwald Wealth Management in St. Louis Park, Minn., told Medscape.

Despite the drop in earnings, 65% of dermatologists said that they were fairly compensated, which is more than the 61% who expressed that opinion in 2015 and more than 22 of the 29 specialties included in this year’s survey, Medscape noted.

Dermatologists (76%) were just below the average for all physicians (77%) when asked if they would choose medicine again, but they were near the top when asked if they would choose the same specialty (95%). Only orthopedics (97%) and oncology (96%) were higher, the survey data show.

The biggest problem area for dermatologists, by a small margin, is difficult patients. The most challenging part of their job, according to 24% of those responding, is “dealing with difficult patients,” with 23% choosing “having so many rules and regulations.” Among all physicians, rules/regulations was the leading choice with 27% of the vote, Medscape said.

The survey respondents were Medscape members who had been invited to participate. The sample size was 17,461 physicians, and compensation was modeled and estimated based on a range of variables across 6 years of survey data. The sampling error was ±0.74%.

rfranki@mdedge.com

As the COVID spring progresses, the days before the pandemic may seem like a dream: Practices were open, waiting rooms were full of unmasked people, and PPE was plentiful.

Medscape’s latest physician survey, conducted from Oct. 4, 2019, to Feb. 10, 2020, shows what dermatology looked like just before the coronavirus arrived.

Back then, it turns out, earnings were down. Average compensation reported by dermatologists dropped from $419,000 in 2019 to $411,000 this year, a 1.9% decrease. Average income for all specialists was $346,000 in this year’s survey – 1.5% higher than the $341,000 earned in 2019, Medscape reported.

Prospects for this year of the pandemic are not better. “Specialists are currently having more troubles than [primary care physicians] because they’re dependent on elective cases, which can’t be directly addressed by telemedicine,” Joel Greenwald, MD, the CEO of Greenwald Wealth Management in St. Louis Park, Minn., told Medscape.

Despite the drop in earnings, 65% of dermatologists said that they were fairly compensated, which is more than the 61% who expressed that opinion in 2015 and more than 22 of the 29 specialties included in this year’s survey, Medscape noted.

Dermatologists (76%) were just below the average for all physicians (77%) when asked if they would choose medicine again, but they were near the top when asked if they would choose the same specialty (95%). Only orthopedics (97%) and oncology (96%) were higher, the survey data show.

The biggest problem area for dermatologists, by a small margin, is difficult patients. The most challenging part of their job, according to 24% of those responding, is “dealing with difficult patients,” with 23% choosing “having so many rules and regulations.” Among all physicians, rules/regulations was the leading choice with 27% of the vote, Medscape said.

The survey respondents were Medscape members who had been invited to participate. The sample size was 17,461 physicians, and compensation was modeled and estimated based on a range of variables across 6 years of survey data. The sampling error was ±0.74%.

rfranki@mdedge.com

As the COVID spring progresses, the days before the pandemic may seem like a dream: Practices were open, waiting rooms were full of unmasked people, and PPE was plentiful.

Medscape’s latest physician survey, conducted from Oct. 4, 2019, to Feb. 10, 2020, shows what dermatology looked like just before the coronavirus arrived.

Back then, it turns out, earnings were down. Average compensation reported by dermatologists dropped from $419,000 in 2019 to $411,000 this year, a 1.9% decrease. Average income for all specialists was $346,000 in this year’s survey – 1.5% higher than the $341,000 earned in 2019, Medscape reported.

Prospects for this year of the pandemic are not better. “Specialists are currently having more troubles than [primary care physicians] because they’re dependent on elective cases, which can’t be directly addressed by telemedicine,” Joel Greenwald, MD, the CEO of Greenwald Wealth Management in St. Louis Park, Minn., told Medscape.

Despite the drop in earnings, 65% of dermatologists said that they were fairly compensated, which is more than the 61% who expressed that opinion in 2015 and more than 22 of the 29 specialties included in this year’s survey, Medscape noted.

Dermatologists (76%) were just below the average for all physicians (77%) when asked if they would choose medicine again, but they were near the top when asked if they would choose the same specialty (95%). Only orthopedics (97%) and oncology (96%) were higher, the survey data show.

The biggest problem area for dermatologists, by a small margin, is difficult patients. The most challenging part of their job, according to 24% of those responding, is “dealing with difficult patients,” with 23% choosing “having so many rules and regulations.” Among all physicians, rules/regulations was the leading choice with 27% of the vote, Medscape said.

The survey respondents were Medscape members who had been invited to participate. The sample size was 17,461 physicians, and compensation was modeled and estimated based on a range of variables across 6 years of survey data. The sampling error was ±0.74%.

rfranki@mdedge.com

Obstetrician/gynecologists reported making $308,000 between Oct. 4, 2019, and Feb. 10, 2020, which is slightly below middle among the specialties included in Medscape’s Physician Compensation Report 2020.

Male ob.gyns. made more than $50,000 more than female ob.gyns. a year ($338,000 vs. $286,000), and men make up 64% of ob.gyn. respondents. This occurs although male and female ob.gyns. reported working about the same hours per week (40.2 vs. 39).

The average incentive bonus for ob.gyns. was about $44,000, which is on the low side among specialties included in the report. Although 42% of ob.gyns. achieve 100% of this bonus and 17% achieve 76%-99% of their bonus, slightly less than a quarter (22%) achieve only 25% or less.

About 51% of ob.gyns. reported feeling fairly compensated, which put them in the bottom fifth of the 29 specialties asked that question.

Among ob.gyns., 38% reported that gratitude and relationships with patients is the most rewarding part of their job, while 20% said that helping others or being good at what they do is the most rewarding aspect of their job. About even proportions of ob.gyns. complained that the most challenging part of their job is dealing with EHRs (18%), working long hours (17%), or navigating rules and regulations (16%).

The data in the Medscape report were gathered before COVID-19 had really taken hold in the United States – before states began issuing stay-at-home orders and before practices began implementing their own precautions. Although in the best interest of patients and providers, switching to telemedicine, eliminating most elective procedures, and making other changes to improve safety will have significant financial consequences. It is unclear at this time how this ongoing pandemic will affect physician compensation and income.

The survey respondents were Medscape members who had been invited to participate. The sample size was 17,461 physicians, and compensation was modeled and estimated based on a range of variables across 6 years of survey data. The sampling error was ±0.74%.

cpalmer@mdedge.com

Obstetrician/gynecologists reported making $308,000 between Oct. 4, 2019, and Feb. 10, 2020, which is slightly below middle among the specialties included in Medscape’s Physician Compensation Report 2020.

Male ob.gyns. made more than $50,000 more than female ob.gyns. a year ($338,000 vs. $286,000), and men make up 64% of ob.gyn. respondents. This occurs although male and female ob.gyns. reported working about the same hours per week (40.2 vs. 39).

The average incentive bonus for ob.gyns. was about $44,000, which is on the low side among specialties included in the report. Although 42% of ob.gyns. achieve 100% of this bonus and 17% achieve 76%-99% of their bonus, slightly less than a quarter (22%) achieve only 25% or less.

About 51% of ob.gyns. reported feeling fairly compensated, which put them in the bottom fifth of the 29 specialties asked that question.

Among ob.gyns., 38% reported that gratitude and relationships with patients is the most rewarding part of their job, while 20% said that helping others or being good at what they do is the most rewarding aspect of their job. About even proportions of ob.gyns. complained that the most challenging part of their job is dealing with EHRs (18%), working long hours (17%), or navigating rules and regulations (16%).

The data in the Medscape report were gathered before COVID-19 had really taken hold in the United States – before states began issuing stay-at-home orders and before practices began implementing their own precautions. Although in the best interest of patients and providers, switching to telemedicine, eliminating most elective procedures, and making other changes to improve safety will have significant financial consequences. It is unclear at this time how this ongoing pandemic will affect physician compensation and income.

The survey respondents were Medscape members who had been invited to participate. The sample size was 17,461 physicians, and compensation was modeled and estimated based on a range of variables across 6 years of survey data. The sampling error was ±0.74%.

cpalmer@mdedge.com

Obstetrician/gynecologists reported making $308,000 between Oct. 4, 2019, and Feb. 10, 2020, which is slightly below middle among the specialties included in Medscape’s Physician Compensation Report 2020.

Male ob.gyns. made more than $50,000 more than female ob.gyns. a year ($338,000 vs. $286,000), and men make up 64% of ob.gyn. respondents. This occurs although male and female ob.gyns. reported working about the same hours per week (40.2 vs. 39).

The average incentive bonus for ob.gyns. was about $44,000, which is on the low side among specialties included in the report. Although 42% of ob.gyns. achieve 100% of this bonus and 17% achieve 76%-99% of their bonus, slightly less than a quarter (22%) achieve only 25% or less.

About 51% of ob.gyns. reported feeling fairly compensated, which put them in the bottom fifth of the 29 specialties asked that question.

Among ob.gyns., 38% reported that gratitude and relationships with patients is the most rewarding part of their job, while 20% said that helping others or being good at what they do is the most rewarding aspect of their job. About even proportions of ob.gyns. complained that the most challenging part of their job is dealing with EHRs (18%), working long hours (17%), or navigating rules and regulations (16%).

The data in the Medscape report were gathered before COVID-19 had really taken hold in the United States – before states began issuing stay-at-home orders and before practices began implementing their own precautions. Although in the best interest of patients and providers, switching to telemedicine, eliminating most elective procedures, and making other changes to improve safety will have significant financial consequences. It is unclear at this time how this ongoing pandemic will affect physician compensation and income.

The survey respondents were Medscape members who had been invited to participate. The sample size was 17,461 physicians, and compensation was modeled and estimated based on a range of variables across 6 years of survey data. The sampling error was ±0.74%.

cpalmer@mdedge.com

As the COVID-19 spring progresses, the days before the pandemic may seem like a dream: Practices were open, waiting rooms were full of unmasked people, and personal protective equipment was plentiful.

Medscape’s latest physician survey, conducted from Oct. 4, 2019, to Feb. 10, 2020, shows what pediatrics looked like just before the coronavirus arrived.

Back then, earnings were up. Average compensation reported by pediatricians was up from $225,000 in 2019 to $232,000 this year, a 3.1% increase. Average income for all primary care physicians was $243,000 in this year’s survey – 2.5% higher than the $237,000 earned in 2019, Medscape reported.

Prospects for the next year, however, are grim. “We found out that we have a 10% salary decrease effective May 2 to Dec. 25. Our bonus will be based on clinical productivity, and since our numbers are down, that is likely to go away,” a pediatric emergency physician told Medscape.

Before the pandemic, 53% of pediatricians said that they were fairly compensated, right between internists at 52% and family physicians at 54% and in the middle of the overall specialty pack, which ranged from nephrology at 44% to oncology, emergency medicine, and radiology at 67%, the survey data show.

Primary care physicians and specialists were nearly equal in hours spent seeing patients each week – 37.6 for primary care and 38.0 for specialists – but family physicians and internists both averaged more hours than pediatricians doing paperwork and administration each week, at 15.9 and 18.5 versus 14.7, respectively, Medscape said.

Pediatricians (38%) were more likely than the average physician (27%) to say that “gratitude/relationships with patients” was the most rewarding part of their job, and less likely to say that “having so many rules and regulations” was the most challenging part (22% vs. 26%), according to the survey.

When asked if they would choose medicine again, 78% of pediatricians said yes, just above the 77% for all physicians. Pediatricians, however, were much more likely (83%) to say they would choose the same specialty, compared with family physicians (70%) and internists (66%), Medscape found.

The survey respondents were Medscape members who had been invited to participate. The sample size was 17,461 physicians, and compensation was modeled and estimated based on a range of variables across 6 years of survey data. The sampling error was ±0.74%.

rfranki@mdedge.com

As the COVID-19 spring progresses, the days before the pandemic may seem like a dream: Practices were open, waiting rooms were full of unmasked people, and personal protective equipment was plentiful.

Medscape’s latest physician survey, conducted from Oct. 4, 2019, to Feb. 10, 2020, shows what pediatrics looked like just before the coronavirus arrived.

Back then, earnings were up. Average compensation reported by pediatricians was up from $225,000 in 2019 to $232,000 this year, a 3.1% increase. Average income for all primary care physicians was $243,000 in this year’s survey – 2.5% higher than the $237,000 earned in 2019, Medscape reported.

Prospects for the next year, however, are grim. “We found out that we have a 10% salary decrease effective May 2 to Dec. 25. Our bonus will be based on clinical productivity, and since our numbers are down, that is likely to go away,” a pediatric emergency physician told Medscape.

Before the pandemic, 53% of pediatricians said that they were fairly compensated, right between internists at 52% and family physicians at 54% and in the middle of the overall specialty pack, which ranged from nephrology at 44% to oncology, emergency medicine, and radiology at 67%, the survey data show.

Primary care physicians and specialists were nearly equal in hours spent seeing patients each week – 37.6 for primary care and 38.0 for specialists – but family physicians and internists both averaged more hours than pediatricians doing paperwork and administration each week, at 15.9 and 18.5 versus 14.7, respectively, Medscape said.

Pediatricians (38%) were more likely than the average physician (27%) to say that “gratitude/relationships with patients” was the most rewarding part of their job, and less likely to say that “having so many rules and regulations” was the most challenging part (22% vs. 26%), according to the survey.

When asked if they would choose medicine again, 78% of pediatricians said yes, just above the 77% for all physicians. Pediatricians, however, were much more likely (83%) to say they would choose the same specialty, compared with family physicians (70%) and internists (66%), Medscape found.

The survey respondents were Medscape members who had been invited to participate. The sample size was 17,461 physicians, and compensation was modeled and estimated based on a range of variables across 6 years of survey data. The sampling error was ±0.74%.

rfranki@mdedge.com

As the COVID-19 spring progresses, the days before the pandemic may seem like a dream: Practices were open, waiting rooms were full of unmasked people, and personal protective equipment was plentiful.

Medscape’s latest physician survey, conducted from Oct. 4, 2019, to Feb. 10, 2020, shows what pediatrics looked like just before the coronavirus arrived.

Back then, earnings were up. Average compensation reported by pediatricians was up from $225,000 in 2019 to $232,000 this year, a 3.1% increase. Average income for all primary care physicians was $243,000 in this year’s survey – 2.5% higher than the $237,000 earned in 2019, Medscape reported.

Prospects for the next year, however, are grim. “We found out that we have a 10% salary decrease effective May 2 to Dec. 25. Our bonus will be based on clinical productivity, and since our numbers are down, that is likely to go away,” a pediatric emergency physician told Medscape.

Before the pandemic, 53% of pediatricians said that they were fairly compensated, right between internists at 52% and family physicians at 54% and in the middle of the overall specialty pack, which ranged from nephrology at 44% to oncology, emergency medicine, and radiology at 67%, the survey data show.

Primary care physicians and specialists were nearly equal in hours spent seeing patients each week – 37.6 for primary care and 38.0 for specialists – but family physicians and internists both averaged more hours than pediatricians doing paperwork and administration each week, at 15.9 and 18.5 versus 14.7, respectively, Medscape said.

Pediatricians (38%) were more likely than the average physician (27%) to say that “gratitude/relationships with patients” was the most rewarding part of their job, and less likely to say that “having so many rules and regulations” was the most challenging part (22% vs. 26%), according to the survey.

When asked if they would choose medicine again, 78% of pediatricians said yes, just above the 77% for all physicians. Pediatricians, however, were much more likely (83%) to say they would choose the same specialty, compared with family physicians (70%) and internists (66%), Medscape found.

The survey respondents were Medscape members who had been invited to participate. The sample size was 17,461 physicians, and compensation was modeled and estimated based on a range of variables across 6 years of survey data. The sampling error was ±0.74%.

rfranki@mdedge.com

COVID-19 has changed many things in the medical landscape as practices have closed, many physicians are transitioning to telemedicine, and EDs struggle to provide safe environments for their employees.

Medscape’s latest physician survey, conducted from Oct. 4, 2019, to Feb. 10, 2020, illustrates what rheumatology looked like just before the coronavirus arrived.

Rheumatologists saw a small increase in average salary in 2020, rising from $259,000 in 2019 to $262,000, an increase of 1.16%. In comparison, average income for all specialists was $346,000 in this year’s survey, up by 1.5% from the $341,000 earned in 2019, Medscape reported. Male rheumatologists earned significantly more than women at $288,000 versus $240,000.

Prospects for next year, however, are grim. “We found out that we have a 10% salary decrease effective May 2 to Dec. 25. Our bonus will be based on clinical productivity, and since our numbers are down, that is likely to go away,” a pediatric emergency physician told Medscape.

Before the pandemic, 55% of rheumatologists felt they were fairly compensated. This was about average among the 29 specialties included in the survey, which ranged from nephrology at 44% to oncology, emergency medicine, and radiology at 67%.

Rheumatologists were more likely than the average physician to report that “having so many rules and regulations” was the most challenging part of their job, according to the survey. A similar number of rheumatologists said that “gratitude/relationships with patients” was the most rewarding part of the job at 27%.

When asked if they would choose medicine again, 79% of rheumatologists said yes, slightly more than the 77% for all physicians; 81% said that they’d choose rheumatology again.

The respondents were Medscape members who had been invited to participate. The sample size was 17,461 physicians, and compensation was modeled and estimated based on a range of variables across 6 years of survey data. The sampling error was ±0.74%.

lfranki@mdedge.com

COVID-19 has changed many things in the medical landscape as practices have closed, many physicians are transitioning to telemedicine, and EDs struggle to provide safe environments for their employees.

Medscape’s latest physician survey, conducted from Oct. 4, 2019, to Feb. 10, 2020, illustrates what rheumatology looked like just before the coronavirus arrived.

Rheumatologists saw a small increase in average salary in 2020, rising from $259,000 in 2019 to $262,000, an increase of 1.16%. In comparison, average income for all specialists was $346,000 in this year’s survey, up by 1.5% from the $341,000 earned in 2019, Medscape reported. Male rheumatologists earned significantly more than women at $288,000 versus $240,000.

Prospects for next year, however, are grim. “We found out that we have a 10% salary decrease effective May 2 to Dec. 25. Our bonus will be based on clinical productivity, and since our numbers are down, that is likely to go away,” a pediatric emergency physician told Medscape.

Before the pandemic, 55% of rheumatologists felt they were fairly compensated. This was about average among the 29 specialties included in the survey, which ranged from nephrology at 44% to oncology, emergency medicine, and radiology at 67%.

Rheumatologists were more likely than the average physician to report that “having so many rules and regulations” was the most challenging part of their job, according to the survey. A similar number of rheumatologists said that “gratitude/relationships with patients” was the most rewarding part of the job at 27%.

When asked if they would choose medicine again, 79% of rheumatologists said yes, slightly more than the 77% for all physicians; 81% said that they’d choose rheumatology again.

The respondents were Medscape members who had been invited to participate. The sample size was 17,461 physicians, and compensation was modeled and estimated based on a range of variables across 6 years of survey data. The sampling error was ±0.74%.

lfranki@mdedge.com

COVID-19 has changed many things in the medical landscape as practices have closed, many physicians are transitioning to telemedicine, and EDs struggle to provide safe environments for their employees.

Medscape’s latest physician survey, conducted from Oct. 4, 2019, to Feb. 10, 2020, illustrates what rheumatology looked like just before the coronavirus arrived.

Rheumatologists saw a small increase in average salary in 2020, rising from $259,000 in 2019 to $262,000, an increase of 1.16%. In comparison, average income for all specialists was $346,000 in this year’s survey, up by 1.5% from the $341,000 earned in 2019, Medscape reported. Male rheumatologists earned significantly more than women at $288,000 versus $240,000.

Prospects for next year, however, are grim. “We found out that we have a 10% salary decrease effective May 2 to Dec. 25. Our bonus will be based on clinical productivity, and since our numbers are down, that is likely to go away,” a pediatric emergency physician told Medscape.

Before the pandemic, 55% of rheumatologists felt they were fairly compensated. This was about average among the 29 specialties included in the survey, which ranged from nephrology at 44% to oncology, emergency medicine, and radiology at 67%.

Rheumatologists were more likely than the average physician to report that “having so many rules and regulations” was the most challenging part of their job, according to the survey. A similar number of rheumatologists said that “gratitude/relationships with patients” was the most rewarding part of the job at 27%.

When asked if they would choose medicine again, 79% of rheumatologists said yes, slightly more than the 77% for all physicians; 81% said that they’d choose rheumatology again.

The respondents were Medscape members who had been invited to participate. The sample size was 17,461 physicians, and compensation was modeled and estimated based on a range of variables across 6 years of survey data. The sampling error was ±0.74%.

lfranki@mdedge.com

As the COVID spring progresses, the days before the pandemic may seem like a dream: Practices were open, waiting rooms were full of unmasked people, and PPE was plentiful.

Medscape’s latest physician survey, conducted from Oct. 4, 2019, to Feb. 10, 2020, shows what pulmonology and critical care looked like just before the coronavirus arrived.

Back then, earnings were up. Average compensation reported by pulmonologists was up from $331,000 in 2019 to $342,000 this year, a 3.3% increase. For intensivists, earnings rose from $349,000 to $355,000, or 1.7%. Average income for all specialists was $346,000 in this year’s survey – 1.5% higher than the $341,000 earned in 2019, Medscape reported.

Prospects for the next year, however, are grim. “We found out that we have a 10% salary decrease effective May 2 to Dec. 25. Our bonus will be based on clinical productivity, and since our numbers are down, that is likely to go away,” a pediatric emergency physician told Medscape.

One problem area for intensivists, even before the pandemic, was paperwork and administration. Of the 26 specialties for which data are available, critical care was highest for amount of time spent on paperwork, at 19.1 hours per week. Those in pulmonary medicine spent 15.6 hours per week, which also happened to be the average for all specialists, the survey data show.

Both specialties also ranked high in denied/resubmitted claims: Intensivists were fourth among the 27 types of specialists with reliable data, with 20% of claims denied, and pulmonologists were tied for eighth at 18%, Medscape said.

Only 50% of pulmonologists surveyed said that they were being fairly compensated, putting them 26th among the 29 specialties on that list. Those in critical care medicine were 13th, with a 59% positive response, Medscape reported.

In the end, though, it looks like you can’t keep a good pulmonologist or intensivist down. When asked if they would choose medicine again, 83% of pulmonologists said yes, just one percentage point behind a three-way tie for first. Intensivists were just a little further down the list at 81%, according to the survey.

The respondents were Medscape members who had been invited to participate. The sample size was 17,461 physicians, and compensation was modeled and estimated based on a range of variables across 6 years of survey data. The sampling error was ±0.74%.

rfranki@mdedge.com

As the COVID spring progresses, the days before the pandemic may seem like a dream: Practices were open, waiting rooms were full of unmasked people, and PPE was plentiful.

Medscape’s latest physician survey, conducted from Oct. 4, 2019, to Feb. 10, 2020, shows what pulmonology and critical care looked like just before the coronavirus arrived.

Back then, earnings were up. Average compensation reported by pulmonologists was up from $331,000 in 2019 to $342,000 this year, a 3.3% increase. For intensivists, earnings rose from $349,000 to $355,000, or 1.7%. Average income for all specialists was $346,000 in this year’s survey – 1.5% higher than the $341,000 earned in 2019, Medscape reported.

Prospects for the next year, however, are grim. “We found out that we have a 10% salary decrease effective May 2 to Dec. 25. Our bonus will be based on clinical productivity, and since our numbers are down, that is likely to go away,” a pediatric emergency physician told Medscape.

One problem area for intensivists, even before the pandemic, was paperwork and administration. Of the 26 specialties for which data are available, critical care was highest for amount of time spent on paperwork, at 19.1 hours per week. Those in pulmonary medicine spent 15.6 hours per week, which also happened to be the average for all specialists, the survey data show.

Both specialties also ranked high in denied/resubmitted claims: Intensivists were fourth among the 27 types of specialists with reliable data, with 20% of claims denied, and pulmonologists were tied for eighth at 18%, Medscape said.

Only 50% of pulmonologists surveyed said that they were being fairly compensated, putting them 26th among the 29 specialties on that list. Those in critical care medicine were 13th, with a 59% positive response, Medscape reported.

In the end, though, it looks like you can’t keep a good pulmonologist or intensivist down. When asked if they would choose medicine again, 83% of pulmonologists said yes, just one percentage point behind a three-way tie for first. Intensivists were just a little further down the list at 81%, according to the survey.

The respondents were Medscape members who had been invited to participate. The sample size was 17,461 physicians, and compensation was modeled and estimated based on a range of variables across 6 years of survey data. The sampling error was ±0.74%.

rfranki@mdedge.com

As the COVID spring progresses, the days before the pandemic may seem like a dream: Practices were open, waiting rooms were full of unmasked people, and PPE was plentiful.

Medscape’s latest physician survey, conducted from Oct. 4, 2019, to Feb. 10, 2020, shows what pulmonology and critical care looked like just before the coronavirus arrived.

Back then, earnings were up. Average compensation reported by pulmonologists was up from $331,000 in 2019 to $342,000 this year, a 3.3% increase. For intensivists, earnings rose from $349,000 to $355,000, or 1.7%. Average income for all specialists was $346,000 in this year’s survey – 1.5% higher than the $341,000 earned in 2019, Medscape reported.

Prospects for the next year, however, are grim. “We found out that we have a 10% salary decrease effective May 2 to Dec. 25. Our bonus will be based on clinical productivity, and since our numbers are down, that is likely to go away,” a pediatric emergency physician told Medscape.

One problem area for intensivists, even before the pandemic, was paperwork and administration. Of the 26 specialties for which data are available, critical care was highest for amount of time spent on paperwork, at 19.1 hours per week. Those in pulmonary medicine spent 15.6 hours per week, which also happened to be the average for all specialists, the survey data show.

Both specialties also ranked high in denied/resubmitted claims: Intensivists were fourth among the 27 types of specialists with reliable data, with 20% of claims denied, and pulmonologists were tied for eighth at 18%, Medscape said.

Only 50% of pulmonologists surveyed said that they were being fairly compensated, putting them 26th among the 29 specialties on that list. Those in critical care medicine were 13th, with a 59% positive response, Medscape reported.

In the end, though, it looks like you can’t keep a good pulmonologist or intensivist down. When asked if they would choose medicine again, 83% of pulmonologists said yes, just one percentage point behind a three-way tie for first. Intensivists were just a little further down the list at 81%, according to the survey.

The respondents were Medscape members who had been invited to participate. The sample size was 17,461 physicians, and compensation was modeled and estimated based on a range of variables across 6 years of survey data. The sampling error was ±0.74%.

rfranki@mdedge.com

The punch biopsy revealed dense lymphoid hyperplasia consistent with pseudolymphoma. The punch biopsy sample underwent notable immunohistochemical analysis to exclude lymphoma and was remarkable for a polyclonal set of B and T lymphocytes in a benign ratio, without epidermotropism.

Pseudolymphoma is an inflammatory response often induced by an arthropod bite, or occasionally, medication. Both T cell predominant and B cell predominant pseudolymphoma occur. Most present as a 5- to 30-mm pink papule on the head. They are rare below the waist and more common in young adults.

Basal cell carcinoma (BCC) is such a common diagnosis for a novel pink neoplasm on the face of an older adult that it is easy to forget the many other rare tumors and benign lesions (such as this one) present this way. An expanded differential diagnosis included cutaneous lymphoma, amelanotic melanoma, and granulomatous rosacea.

In this case, dermoscopy of the lesion (shown above) also was of limited help because BCC features of arborized vessels and shiny white lines were evident. There was a lack of more specific dermoscopic features such as spoke wheel–like structures, leaflike structures, or blue clods. This lack of more specific features might be the subtle clue to think beyond BCC when approaching the diagnosis. The history of rapid change was somewhat atypical for a BCC, which tends to grow more slowly. Patient history about the timing of facial lesions can be poor, but this patient’s history fit the ultimate diagnosis well.

This patient was treated with a superpotent topical steroid, clobetasol ointment 0.05% bid for 3 weeks. As a general rule, use of such a strong steroid is avoided on the face because of the risk of steroid atrophy, but in the case of pseudolymphoma or lymphoma, an exception is allowed. An alternative would be intralesional triamcinolone at a 5 to 10 mg/mL concentration. At follow-up 6 weeks later, the lesion was completely resolved.

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Photos and text for Photo Rounds Friday courtesy of Jonathan Karnes, MD (copyright retained). Dr. Karnes is the medical director of MDFMR Dermatology Services, Augusta, ME.

The punch biopsy revealed dense lymphoid hyperplasia consistent with pseudolymphoma. The punch biopsy sample underwent notable immunohistochemical analysis to exclude lymphoma and was remarkable for a polyclonal set of B and T lymphocytes in a benign ratio, without epidermotropism.

Pseudolymphoma is an inflammatory response often induced by an arthropod bite, or occasionally, medication. Both T cell predominant and B cell predominant pseudolymphoma occur. Most present as a 5- to 30-mm pink papule on the head. They are rare below the waist and more common in young adults.

Basal cell carcinoma (BCC) is such a common diagnosis for a novel pink neoplasm on the face of an older adult that it is easy to forget the many other rare tumors and benign lesions (such as this one) present this way. An expanded differential diagnosis included cutaneous lymphoma, amelanotic melanoma, and granulomatous rosacea.

In this case, dermoscopy of the lesion (shown above) also was of limited help because BCC features of arborized vessels and shiny white lines were evident. There was a lack of more specific dermoscopic features such as spoke wheel–like structures, leaflike structures, or blue clods. This lack of more specific features might be the subtle clue to think beyond BCC when approaching the diagnosis. The history of rapid change was somewhat atypical for a BCC, which tends to grow more slowly. Patient history about the timing of facial lesions can be poor, but this patient’s history fit the ultimate diagnosis well.

This patient was treated with a superpotent topical steroid, clobetasol ointment 0.05% bid for 3 weeks. As a general rule, use of such a strong steroid is avoided on the face because of the risk of steroid atrophy, but in the case of pseudolymphoma or lymphoma, an exception is allowed. An alternative would be intralesional triamcinolone at a 5 to 10 mg/mL concentration. At follow-up 6 weeks later, the lesion was completely resolved.

‌

Photos and text for Photo Rounds Friday courtesy of Jonathan Karnes, MD (copyright retained). Dr. Karnes is the medical director of MDFMR Dermatology Services, Augusta, ME.

The punch biopsy revealed dense lymphoid hyperplasia consistent with pseudolymphoma. The punch biopsy sample underwent notable immunohistochemical analysis to exclude lymphoma and was remarkable for a polyclonal set of B and T lymphocytes in a benign ratio, without epidermotropism.

Pseudolymphoma is an inflammatory response often induced by an arthropod bite, or occasionally, medication. Both T cell predominant and B cell predominant pseudolymphoma occur. Most present as a 5- to 30-mm pink papule on the head. They are rare below the waist and more common in young adults.

Basal cell carcinoma (BCC) is such a common diagnosis for a novel pink neoplasm on the face of an older adult that it is easy to forget the many other rare tumors and benign lesions (such as this one) present this way. An expanded differential diagnosis included cutaneous lymphoma, amelanotic melanoma, and granulomatous rosacea.

In this case, dermoscopy of the lesion (shown above) also was of limited help because BCC features of arborized vessels and shiny white lines were evident. There was a lack of more specific dermoscopic features such as spoke wheel–like structures, leaflike structures, or blue clods. This lack of more specific features might be the subtle clue to think beyond BCC when approaching the diagnosis. The history of rapid change was somewhat atypical for a BCC, which tends to grow more slowly. Patient history about the timing of facial lesions can be poor, but this patient’s history fit the ultimate diagnosis well.

This patient was treated with a superpotent topical steroid, clobetasol ointment 0.05% bid for 3 weeks. As a general rule, use of such a strong steroid is avoided on the face because of the risk of steroid atrophy, but in the case of pseudolymphoma or lymphoma, an exception is allowed. An alternative would be intralesional triamcinolone at a 5 to 10 mg/mL concentration. At follow-up 6 weeks later, the lesion was completely resolved.

‌

Photos and text for Photo Rounds Friday courtesy of Jonathan Karnes, MD (copyright retained). Dr. Karnes is the medical director of MDFMR Dermatology Services, Augusta, ME.

The Food and Drug Administration has expanded the approved indication for atezolizumab (Tecentriq) in patients with non–small cell lung cancer (NSCLC).

Atezolizumab is now approved as first-line monotherapy for adults with metastatic NSCLC whose tumors are EGFR and ALK wild-type but have high PD-L1 expression (PD-L1 stained ≥50% of tumor cells or PD-L1 stained tumor-infiltrating immune cells covering ≥10% of the tumor area).

The FDA also approved the VENTANA PD-L1 (SP142) Assay as a companion diagnostic to identify patients with NSCLC who are eligible for treatment with atezolizumab.

The drug was evaluated in the IMpower110 trial (NCT02409342), which enrolled patients with stage IV, PD-L1–positive (tumor cells [TC] ≥1% or immune cells [IC] ≥1%) NSCLC who had received no prior chemotherapy for metastatic disease.

The patients were randomized to receive atezolizumab at 1,200 mg every 3 weeks (n = 286) or platinum-based chemotherapy (n = 263), which consisted of carboplatin or cisplatin with either pemetrexed or gemcitabine, until disease progression or unacceptable toxicity.

Overall survival was superior in the atezolizumab arm, but only among patients with high PD-L1 expression (TC ≥50% or IC ≥10%). The median overall survival was 20.2 months among PD-L1–high patients in the atezolizumab arm and 13.1 months among PD-L1–high patients in the chemotherapy arm (hazard ratio, 0.59; P = .0106). There was no significant difference in overall survival between the treatment arms for patients in the other two PD-L1 subgroups – TC ≥5% or IC ≥5% and TC ≥1% or IC ≥1%.

Serious adverse events occurred in 28% of patients receiving atezolizumab. The most frequent of these were pneumonia (2.8%), chronic obstructive pulmonary disease (2.1%), and pneumonitis (2.1%). Fatal adverse events in the atezolizumab arm included unexplained death, aspiration, chronic obstructive pulmonary disease, pulmonary embolism, acute myocardial infarction, cardiac arrest, mechanical ileus, sepsis, cerebral infraction, and device occlusion (one patient each).

For more details on atezolizumab, see the full prescribing information.

The FDA has granted the approval of atezolizumab to Genentech and the approval of the VENTANA PD-L1 (SP142) Assay to Ventana Medical Systems.

The Food and Drug Administration has expanded the approved indication for atezolizumab (Tecentriq) in patients with non–small cell lung cancer (NSCLC).

Atezolizumab is now approved as first-line monotherapy for adults with metastatic NSCLC whose tumors are EGFR and ALK wild-type but have high PD-L1 expression (PD-L1 stained ≥50% of tumor cells or PD-L1 stained tumor-infiltrating immune cells covering ≥10% of the tumor area).

The FDA also approved the VENTANA PD-L1 (SP142) Assay as a companion diagnostic to identify patients with NSCLC who are eligible for treatment with atezolizumab.

The drug was evaluated in the IMpower110 trial (NCT02409342), which enrolled patients with stage IV, PD-L1–positive (tumor cells [TC] ≥1% or immune cells [IC] ≥1%) NSCLC who had received no prior chemotherapy for metastatic disease.

The patients were randomized to receive atezolizumab at 1,200 mg every 3 weeks (n = 286) or platinum-based chemotherapy (n = 263), which consisted of carboplatin or cisplatin with either pemetrexed or gemcitabine, until disease progression or unacceptable toxicity.

Overall survival was superior in the atezolizumab arm, but only among patients with high PD-L1 expression (TC ≥50% or IC ≥10%). The median overall survival was 20.2 months among PD-L1–high patients in the atezolizumab arm and 13.1 months among PD-L1–high patients in the chemotherapy arm (hazard ratio, 0.59; P = .0106). There was no significant difference in overall survival between the treatment arms for patients in the other two PD-L1 subgroups – TC ≥5% or IC ≥5% and TC ≥1% or IC ≥1%.

Serious adverse events occurred in 28% of patients receiving atezolizumab. The most frequent of these were pneumonia (2.8%), chronic obstructive pulmonary disease (2.1%), and pneumonitis (2.1%). Fatal adverse events in the atezolizumab arm included unexplained death, aspiration, chronic obstructive pulmonary disease, pulmonary embolism, acute myocardial infarction, cardiac arrest, mechanical ileus, sepsis, cerebral infraction, and device occlusion (one patient each).

For more details on atezolizumab, see the full prescribing information.

The FDA has granted the approval of atezolizumab to Genentech and the approval of the VENTANA PD-L1 (SP142) Assay to Ventana Medical Systems.

The Food and Drug Administration has expanded the approved indication for atezolizumab (Tecentriq) in patients with non–small cell lung cancer (NSCLC).

Atezolizumab is now approved as first-line monotherapy for adults with metastatic NSCLC whose tumors are EGFR and ALK wild-type but have high PD-L1 expression (PD-L1 stained ≥50% of tumor cells or PD-L1 stained tumor-infiltrating immune cells covering ≥10% of the tumor area).

The FDA also approved the VENTANA PD-L1 (SP142) Assay as a companion diagnostic to identify patients with NSCLC who are eligible for treatment with atezolizumab.

The drug was evaluated in the IMpower110 trial (NCT02409342), which enrolled patients with stage IV, PD-L1–positive (tumor cells [TC] ≥1% or immune cells [IC] ≥1%) NSCLC who had received no prior chemotherapy for metastatic disease.

The patients were randomized to receive atezolizumab at 1,200 mg every 3 weeks (n = 286) or platinum-based chemotherapy (n = 263), which consisted of carboplatin or cisplatin with either pemetrexed or gemcitabine, until disease progression or unacceptable toxicity.

Overall survival was superior in the atezolizumab arm, but only among patients with high PD-L1 expression (TC ≥50% or IC ≥10%). The median overall survival was 20.2 months among PD-L1–high patients in the atezolizumab arm and 13.1 months among PD-L1–high patients in the chemotherapy arm (hazard ratio, 0.59; P = .0106). There was no significant difference in overall survival between the treatment arms for patients in the other two PD-L1 subgroups – TC ≥5% or IC ≥5% and TC ≥1% or IC ≥1%.

Serious adverse events occurred in 28% of patients receiving atezolizumab. The most frequent of these were pneumonia (2.8%), chronic obstructive pulmonary disease (2.1%), and pneumonitis (2.1%). Fatal adverse events in the atezolizumab arm included unexplained death, aspiration, chronic obstructive pulmonary disease, pulmonary embolism, acute myocardial infarction, cardiac arrest, mechanical ileus, sepsis, cerebral infraction, and device occlusion (one patient each).

For more details on atezolizumab, see the full prescribing information.

The FDA has granted the approval of atezolizumab to Genentech and the approval of the VENTANA PD-L1 (SP142) Assay to Ventana Medical Systems.