Cheryl K. Lee, MD, an Assistant Professor of Medicine at Northwestern Feinberg School of Medicine, practices internal medicine and pediatrics at Northwestern Memorial and the Ann & Robert H. Lurie Children's Hospital, both in Chicago, IL. She also serves on the Northwestern Medicine Covid Quality Committee and as core clinical faculty in the Internal Medicine Residency. 
 

Is it fair to say that for hospitalists, the pandemic has been a sobering experience, why so?

Dr. Lee: There are several reasons; one stems from the increasing impact of Covid on children. Early in the pandemic, young children, teens, and young adults were not infected or hospitalized at the rate of older adults.¹ For those of us who care for hospitalized patients, that early finding was somewhat of a relief, knowing at least one portion of the population wasn’t as heavily affected. In fact, I normally split my time as a pediatric and adult hospitalist, and I was reassigned to work full-time in the adult hospital because so few children had been admitted. But all that changed with the arrival of the highly transmissible Delta variant and the loosening of social distancing and masking guidelines and other regulations. The American Academy of Pediatrics² reported that, as of October, 8,364 of every 100,000 children have been infected by Covid, largely driven by  the summer surge. Furthermore, pediatric Covid hospitalizations increased five-fold in August 2021 as compared to the prior 6 weeks. And these numbers likely underestimate the true impact, as several states did not release complete reports and did not account for long-term sequelae from milder infections.

What other issues were far-reaching for hospitalists?

Dr. Lee: Early in 2020, we were scrambling to learn about a novel, deadly, highly transmissible disease. Some groups in our population were experiencing a high fatality rate, and the medical community had no proven treatments. We felt helpless in caring for these patients who pleaded for our help and ultimately died. When data proved that medications like steroids were effective and the vaccines arrived, I had hoped that the pandemic would be ending. But now with the quick dissemination of false information and the evolution of new variants, we are left caring for seriously ill, unvaccinated patients along with younger patients. The heartbreaking thing is that these are largely preventable tragedies now that we have effective vaccines.

What medications have changed the course of Covid in the hospital?

Dr. Lee: Steroids are interesting; they are a good reminder that Covid has different stages and that we should be mindful of how we treat patients within those particular stages. Simply, Covid infection begins with a phase of viral replication characterized by fevers, cough, loss of taste and smell, and gastrointestinal symptoms. In time, this is followed by a second phase of high inflammation and immune response, sometimes causing hypoxemia and respiratory failure. What we know is that steroids such as dexamethasone reduce mortality, but they are only effective during this second phase, and only in those whose oxygen levels are low enough to require oxygen. This was not an intuitive finding, since steroids do not help, and may harm, those with other viral pneumonias, such as influenza. Steroid use in severe, hypoxemic Covid, however, is life-saving and the mainstay of inpatient care which might include antivirals and interleukin-6 inhibitors³ in select patients. As with steroid use in other patients, physicians should watch their Covid patients for hyperglycemia⁴ and delirium. That said, steroids provide a  mortality benefit that strongly supports their continued use -- in tandem with management of those expected side effects. Last, it is important to note that steroid use has been associated with possible harm when given to those with mild Covid,⁵ so its use should be avoided, in light of its expected side effects, unless a patient requires supplemental oxygen.

That said, although steroids can be helpful for our sickest patients, vaccines are the best medicine of all because they can allow patients to avoid hospitalization and death  -- outcomes that far outweigh what steroids or any other medication can do for the gravely ill.

Given the complexity of the evidence surrounding the treatments for Covid in the hospital, no wonder some people are confused about which medicines work.

Dr. Lee: First, let me say that I have yet to encounter a patient or family member whose motivation to ask questions or question a loved one’s treatment wasn’t grounded in concern and fear for their loved one.

What do they ask about?

Dr. Lee: They ask about alternative treatments, anti-parasitics, even vitamins. I agree with them that there is so much out there about Covid that it is difficult for anyone to know what is true or false. I then explain what therapies are proven – medications such as steroids and supportive care such as oxygen and prone positioning. I also review the lack of good evidence for the alternative treatments that they ask about. It is sometimes surprising to folks that all research isn’t conducted with equal rigor, and that false conclusions can be made based on faulty evidence. A good example is how providers used hydroxychloroquine early in the pandemic, but ultimately it didn’t prove to be helpful. Although we are always hopeful and looking for new therapies, I say, those specific alternatives haven’t worked out. And I end with a promise that I will continue to keep up with the literature and let them know when something new does look promising.

Your responses to the above questions prompts this one: How do physicians who are treating Covid-19 stay on top of what is being learned about Covid-19? At last count, there were 191,968 results in PubMed, found using that sole keyword.

Dr. Lee: One of the amazing things about the Covid era is that members of the scientific community dropped everything to research Covid. But on the flip side, there is now a lot of research out there, and it frankly has become difficult to keep up with it. Our hospital system identified a core group of collaborators with backgrounds such as pharmacy, nursing, infectious disease, pulmonary, and hospital medicine to regularly review the evidence and identify anything that has strong enough evidence to change our system’s clinical practice. Furthermore, I regularly tap consultants in various specialties to help me contextualize new research. And I’ve found it helpful to review the living practice guidelines from the Infectious Disease Society of America and the NIH.^3,6

What else has been remarkable about the last 19 months?

Dr. Lee: I have never spent this much time talking with patients and their caregivers. I’ve always been one to talk a lot with families, but it feels like the pandemic has created another level. My guess is that many colleagues are experiencing the same thing. Caring for hospitalized Covid patients is not only intense from a medical standpoint, but also from a psychosocial vantage point. Patients are ill and usually scared, and they are supported by friends and family who are equally afraid for them, who furthermore can’t visit because of isolation needs. And I often forget that, besides Covid, families have gone through immense social and financial changes. Sometimes communication can be fraught because of that stress. I am trying to be mindful that patients and families come into the hospital with a lot of these burdens, so that, if the conversation takes a tense turn, I will try not to take it personally. Some days are harder than others.

What you are describing isn’t necessarily an innate skill.

Dr. Lee: Absolutely. As have many others, our medical school and residency program has been incorporating communication skills into the standard curriculum, analogous to teaching anatomy or heart failure treatments. We are more aware that handling a difficult conversation isn’t an instinctive thing; that it must be modeled and learned. But I was surprised at how communication in a pandemic, when caretakers can’t see their loved ones, is truly a unique challenge. It is challenging for me despite being in practice for several years.

What will happen when the pandemic subsides? How much of the impact of Covid will stay with you, when dealing with a broken leg, or a patient with osteoporosis?

Dr. Lee: There will be lasting effects of this era on the health-care workforce, but I honestly can’t predict how severe that impact will be or how long-lasting. Already we are seeing health-care workers drop out of the workforce, driven by effects of the pandemic itself, increased workload, or being underpaid.⁷ This is occurring alongside a national conversation that cannot agree on life-saving interventions such as vaccines. I worry that the current environment will lead to many more dropping out.

What can hospital administrators do now to put stop gaps in place? What advice would you give to them?

Dr. Lee: Workers in each hospital will have unique needs and stressors, so it makes sense that the first step is to provide an opportunity to make their opinions heard. It may be tempting for hospitals to jump on quick fixes such as offering classes in “resilience training,” but that may not be a data-driven solution, particularly if burnout is being driven by an ever increasing workload.

Cheryl K. Lee, MD, an Assistant Professor of Medicine at Northwestern Feinberg School of Medicine, practices internal medicine and pediatrics at Northwestern Memorial and the Ann & Robert H. Lurie Children's Hospital, both in Chicago, IL. She also serves on the Northwestern Medicine Covid Quality Committee and as core clinical faculty in the Internal Medicine Residency. 
 

Is it fair to say that for hospitalists, the pandemic has been a sobering experience, why so?

Dr. Lee: There are several reasons; one stems from the increasing impact of Covid on children. Early in the pandemic, young children, teens, and young adults were not infected or hospitalized at the rate of older adults.¹ For those of us who care for hospitalized patients, that early finding was somewhat of a relief, knowing at least one portion of the population wasn’t as heavily affected. In fact, I normally split my time as a pediatric and adult hospitalist, and I was reassigned to work full-time in the adult hospital because so few children had been admitted. But all that changed with the arrival of the highly transmissible Delta variant and the loosening of social distancing and masking guidelines and other regulations. The American Academy of Pediatrics² reported that, as of October, 8,364 of every 100,000 children have been infected by Covid, largely driven by  the summer surge. Furthermore, pediatric Covid hospitalizations increased five-fold in August 2021 as compared to the prior 6 weeks. And these numbers likely underestimate the true impact, as several states did not release complete reports and did not account for long-term sequelae from milder infections.

What other issues were far-reaching for hospitalists?

Dr. Lee: Early in 2020, we were scrambling to learn about a novel, deadly, highly transmissible disease. Some groups in our population were experiencing a high fatality rate, and the medical community had no proven treatments. We felt helpless in caring for these patients who pleaded for our help and ultimately died. When data proved that medications like steroids were effective and the vaccines arrived, I had hoped that the pandemic would be ending. But now with the quick dissemination of false information and the evolution of new variants, we are left caring for seriously ill, unvaccinated patients along with younger patients. The heartbreaking thing is that these are largely preventable tragedies now that we have effective vaccines.

What medications have changed the course of Covid in the hospital?

Dr. Lee: Steroids are interesting; they are a good reminder that Covid has different stages and that we should be mindful of how we treat patients within those particular stages. Simply, Covid infection begins with a phase of viral replication characterized by fevers, cough, loss of taste and smell, and gastrointestinal symptoms. In time, this is followed by a second phase of high inflammation and immune response, sometimes causing hypoxemia and respiratory failure. What we know is that steroids such as dexamethasone reduce mortality, but they are only effective during this second phase, and only in those whose oxygen levels are low enough to require oxygen. This was not an intuitive finding, since steroids do not help, and may harm, those with other viral pneumonias, such as influenza. Steroid use in severe, hypoxemic Covid, however, is life-saving and the mainstay of inpatient care which might include antivirals and interleukin-6 inhibitors³ in select patients. As with steroid use in other patients, physicians should watch their Covid patients for hyperglycemia⁴ and delirium. That said, steroids provide a  mortality benefit that strongly supports their continued use -- in tandem with management of those expected side effects. Last, it is important to note that steroid use has been associated with possible harm when given to those with mild Covid,⁵ so its use should be avoided, in light of its expected side effects, unless a patient requires supplemental oxygen.

That said, although steroids can be helpful for our sickest patients, vaccines are the best medicine of all because they can allow patients to avoid hospitalization and death  -- outcomes that far outweigh what steroids or any other medication can do for the gravely ill.

Given the complexity of the evidence surrounding the treatments for Covid in the hospital, no wonder some people are confused about which medicines work.

Dr. Lee: First, let me say that I have yet to encounter a patient or family member whose motivation to ask questions or question a loved one’s treatment wasn’t grounded in concern and fear for their loved one.

What do they ask about?

Dr. Lee: They ask about alternative treatments, anti-parasitics, even vitamins. I agree with them that there is so much out there about Covid that it is difficult for anyone to know what is true or false. I then explain what therapies are proven – medications such as steroids and supportive care such as oxygen and prone positioning. I also review the lack of good evidence for the alternative treatments that they ask about. It is sometimes surprising to folks that all research isn’t conducted with equal rigor, and that false conclusions can be made based on faulty evidence. A good example is how providers used hydroxychloroquine early in the pandemic, but ultimately it didn’t prove to be helpful. Although we are always hopeful and looking for new therapies, I say, those specific alternatives haven’t worked out. And I end with a promise that I will continue to keep up with the literature and let them know when something new does look promising.

Your responses to the above questions prompts this one: How do physicians who are treating Covid-19 stay on top of what is being learned about Covid-19? At last count, there were 191,968 results in PubMed, found using that sole keyword.

Dr. Lee: One of the amazing things about the Covid era is that members of the scientific community dropped everything to research Covid. But on the flip side, there is now a lot of research out there, and it frankly has become difficult to keep up with it. Our hospital system identified a core group of collaborators with backgrounds such as pharmacy, nursing, infectious disease, pulmonary, and hospital medicine to regularly review the evidence and identify anything that has strong enough evidence to change our system’s clinical practice. Furthermore, I regularly tap consultants in various specialties to help me contextualize new research. And I’ve found it helpful to review the living practice guidelines from the Infectious Disease Society of America and the NIH.^3,6

What else has been remarkable about the last 19 months?

Dr. Lee: I have never spent this much time talking with patients and their caregivers. I’ve always been one to talk a lot with families, but it feels like the pandemic has created another level. My guess is that many colleagues are experiencing the same thing. Caring for hospitalized Covid patients is not only intense from a medical standpoint, but also from a psychosocial vantage point. Patients are ill and usually scared, and they are supported by friends and family who are equally afraid for them, who furthermore can’t visit because of isolation needs. And I often forget that, besides Covid, families have gone through immense social and financial changes. Sometimes communication can be fraught because of that stress. I am trying to be mindful that patients and families come into the hospital with a lot of these burdens, so that, if the conversation takes a tense turn, I will try not to take it personally. Some days are harder than others.

What you are describing isn’t necessarily an innate skill.

Dr. Lee: Absolutely. As have many others, our medical school and residency program has been incorporating communication skills into the standard curriculum, analogous to teaching anatomy or heart failure treatments. We are more aware that handling a difficult conversation isn’t an instinctive thing; that it must be modeled and learned. But I was surprised at how communication in a pandemic, when caretakers can’t see their loved ones, is truly a unique challenge. It is challenging for me despite being in practice for several years.

What will happen when the pandemic subsides? How much of the impact of Covid will stay with you, when dealing with a broken leg, or a patient with osteoporosis?

Dr. Lee: There will be lasting effects of this era on the health-care workforce, but I honestly can’t predict how severe that impact will be or how long-lasting. Already we are seeing health-care workers drop out of the workforce, driven by effects of the pandemic itself, increased workload, or being underpaid.⁷ This is occurring alongside a national conversation that cannot agree on life-saving interventions such as vaccines. I worry that the current environment will lead to many more dropping out.

What can hospital administrators do now to put stop gaps in place? What advice would you give to them?

Dr. Lee: Workers in each hospital will have unique needs and stressors, so it makes sense that the first step is to provide an opportunity to make their opinions heard. It may be tempting for hospitals to jump on quick fixes such as offering classes in “resilience training,” but that may not be a data-driven solution, particularly if burnout is being driven by an ever increasing workload.

Cheryl K. Lee, MD, an Assistant Professor of Medicine at Northwestern Feinberg School of Medicine, practices internal medicine and pediatrics at Northwestern Memorial and the Ann & Robert H. Lurie Children's Hospital, both in Chicago, IL. She also serves on the Northwestern Medicine Covid Quality Committee and as core clinical faculty in the Internal Medicine Residency. 
 

Is it fair to say that for hospitalists, the pandemic has been a sobering experience, why so?

Dr. Lee: There are several reasons; one stems from the increasing impact of Covid on children. Early in the pandemic, young children, teens, and young adults were not infected or hospitalized at the rate of older adults.¹ For those of us who care for hospitalized patients, that early finding was somewhat of a relief, knowing at least one portion of the population wasn’t as heavily affected. In fact, I normally split my time as a pediatric and adult hospitalist, and I was reassigned to work full-time in the adult hospital because so few children had been admitted. But all that changed with the arrival of the highly transmissible Delta variant and the loosening of social distancing and masking guidelines and other regulations. The American Academy of Pediatrics² reported that, as of October, 8,364 of every 100,000 children have been infected by Covid, largely driven by  the summer surge. Furthermore, pediatric Covid hospitalizations increased five-fold in August 2021 as compared to the prior 6 weeks. And these numbers likely underestimate the true impact, as several states did not release complete reports and did not account for long-term sequelae from milder infections.

What other issues were far-reaching for hospitalists?

Dr. Lee: Early in 2020, we were scrambling to learn about a novel, deadly, highly transmissible disease. Some groups in our population were experiencing a high fatality rate, and the medical community had no proven treatments. We felt helpless in caring for these patients who pleaded for our help and ultimately died. When data proved that medications like steroids were effective and the vaccines arrived, I had hoped that the pandemic would be ending. But now with the quick dissemination of false information and the evolution of new variants, we are left caring for seriously ill, unvaccinated patients along with younger patients. The heartbreaking thing is that these are largely preventable tragedies now that we have effective vaccines.

What medications have changed the course of Covid in the hospital?

Dr. Lee: Steroids are interesting; they are a good reminder that Covid has different stages and that we should be mindful of how we treat patients within those particular stages. Simply, Covid infection begins with a phase of viral replication characterized by fevers, cough, loss of taste and smell, and gastrointestinal symptoms. In time, this is followed by a second phase of high inflammation and immune response, sometimes causing hypoxemia and respiratory failure. What we know is that steroids such as dexamethasone reduce mortality, but they are only effective during this second phase, and only in those whose oxygen levels are low enough to require oxygen. This was not an intuitive finding, since steroids do not help, and may harm, those with other viral pneumonias, such as influenza. Steroid use in severe, hypoxemic Covid, however, is life-saving and the mainstay of inpatient care which might include antivirals and interleukin-6 inhibitors³ in select patients. As with steroid use in other patients, physicians should watch their Covid patients for hyperglycemia⁴ and delirium. That said, steroids provide a  mortality benefit that strongly supports their continued use -- in tandem with management of those expected side effects. Last, it is important to note that steroid use has been associated with possible harm when given to those with mild Covid,⁵ so its use should be avoided, in light of its expected side effects, unless a patient requires supplemental oxygen.

That said, although steroids can be helpful for our sickest patients, vaccines are the best medicine of all because they can allow patients to avoid hospitalization and death  -- outcomes that far outweigh what steroids or any other medication can do for the gravely ill.

Given the complexity of the evidence surrounding the treatments for Covid in the hospital, no wonder some people are confused about which medicines work.

Dr. Lee: First, let me say that I have yet to encounter a patient or family member whose motivation to ask questions or question a loved one’s treatment wasn’t grounded in concern and fear for their loved one.

What do they ask about?

Dr. Lee: They ask about alternative treatments, anti-parasitics, even vitamins. I agree with them that there is so much out there about Covid that it is difficult for anyone to know what is true or false. I then explain what therapies are proven – medications such as steroids and supportive care such as oxygen and prone positioning. I also review the lack of good evidence for the alternative treatments that they ask about. It is sometimes surprising to folks that all research isn’t conducted with equal rigor, and that false conclusions can be made based on faulty evidence. A good example is how providers used hydroxychloroquine early in the pandemic, but ultimately it didn’t prove to be helpful. Although we are always hopeful and looking for new therapies, I say, those specific alternatives haven’t worked out. And I end with a promise that I will continue to keep up with the literature and let them know when something new does look promising.

Your responses to the above questions prompts this one: How do physicians who are treating Covid-19 stay on top of what is being learned about Covid-19? At last count, there were 191,968 results in PubMed, found using that sole keyword.

Dr. Lee: One of the amazing things about the Covid era is that members of the scientific community dropped everything to research Covid. But on the flip side, there is now a lot of research out there, and it frankly has become difficult to keep up with it. Our hospital system identified a core group of collaborators with backgrounds such as pharmacy, nursing, infectious disease, pulmonary, and hospital medicine to regularly review the evidence and identify anything that has strong enough evidence to change our system’s clinical practice. Furthermore, I regularly tap consultants in various specialties to help me contextualize new research. And I’ve found it helpful to review the living practice guidelines from the Infectious Disease Society of America and the NIH.^3,6

What else has been remarkable about the last 19 months?

Dr. Lee: I have never spent this much time talking with patients and their caregivers. I’ve always been one to talk a lot with families, but it feels like the pandemic has created another level. My guess is that many colleagues are experiencing the same thing. Caring for hospitalized Covid patients is not only intense from a medical standpoint, but also from a psychosocial vantage point. Patients are ill and usually scared, and they are supported by friends and family who are equally afraid for them, who furthermore can’t visit because of isolation needs. And I often forget that, besides Covid, families have gone through immense social and financial changes. Sometimes communication can be fraught because of that stress. I am trying to be mindful that patients and families come into the hospital with a lot of these burdens, so that, if the conversation takes a tense turn, I will try not to take it personally. Some days are harder than others.

What you are describing isn’t necessarily an innate skill.

Dr. Lee: Absolutely. As have many others, our medical school and residency program has been incorporating communication skills into the standard curriculum, analogous to teaching anatomy or heart failure treatments. We are more aware that handling a difficult conversation isn’t an instinctive thing; that it must be modeled and learned. But I was surprised at how communication in a pandemic, when caretakers can’t see their loved ones, is truly a unique challenge. It is challenging for me despite being in practice for several years.

What will happen when the pandemic subsides? How much of the impact of Covid will stay with you, when dealing with a broken leg, or a patient with osteoporosis?

Dr. Lee: There will be lasting effects of this era on the health-care workforce, but I honestly can’t predict how severe that impact will be or how long-lasting. Already we are seeing health-care workers drop out of the workforce, driven by effects of the pandemic itself, increased workload, or being underpaid.⁷ This is occurring alongside a national conversation that cannot agree on life-saving interventions such as vaccines. I worry that the current environment will lead to many more dropping out.

What can hospital administrators do now to put stop gaps in place? What advice would you give to them?

Dr. Lee: Workers in each hospital will have unique needs and stressors, so it makes sense that the first step is to provide an opportunity to make their opinions heard. It may be tempting for hospitals to jump on quick fixes such as offering classes in “resilience training,” but that may not be a data-driven solution, particularly if burnout is being driven by an ever increasing workload.

Key clinical point: Enucleation of submucous uterine fibroids (UF) under hysteroscopy can be achieved by a modified resectoscopic slicing using a bipolar loop, which appeared safe and faster compared with classical resectoscopic myomectomy.

Major finding: Mean operation time (22.9 minutes vs 38.9 minutes; P < .001) and volume of mean distending media (1,495.6 mL vs 2,393.1 mL; P < .001) were significantly shorter in the modified vs classical resectoscopic slicing group. The classical group witnessed 3 cases of fluid overload and 1 case of uterine perforation, whereas none of these postoperative complications occurred in the modified technique group.

Study details: Findings are from a retrospective study including 55 women with submucous UFs, of which 19 women underwent modified resectoscopic slicing and 36 women underwent the classical resectoscopic myomectomy.

Disclosures: This study was funded by Shanghai Municipal Health Commission, China. The authors declared no conflict of interests.

Source: Zhang W et al. Front Surg. 2021 Nov 10. doi: 10.3389/fsurg.2021.746936.

Key clinical point: Enucleation of submucous uterine fibroids (UF) under hysteroscopy can be achieved by a modified resectoscopic slicing using a bipolar loop, which appeared safe and faster compared with classical resectoscopic myomectomy.

Major finding: Mean operation time (22.9 minutes vs 38.9 minutes; P < .001) and volume of mean distending media (1,495.6 mL vs 2,393.1 mL; P < .001) were significantly shorter in the modified vs classical resectoscopic slicing group. The classical group witnessed 3 cases of fluid overload and 1 case of uterine perforation, whereas none of these postoperative complications occurred in the modified technique group.

Study details: Findings are from a retrospective study including 55 women with submucous UFs, of which 19 women underwent modified resectoscopic slicing and 36 women underwent the classical resectoscopic myomectomy.

Disclosures: This study was funded by Shanghai Municipal Health Commission, China. The authors declared no conflict of interests.

Source: Zhang W et al. Front Surg. 2021 Nov 10. doi: 10.3389/fsurg.2021.746936.

Key clinical point: Enucleation of submucous uterine fibroids (UF) under hysteroscopy can be achieved by a modified resectoscopic slicing using a bipolar loop, which appeared safe and faster compared with classical resectoscopic myomectomy.

Major finding: Mean operation time (22.9 minutes vs 38.9 minutes; P < .001) and volume of mean distending media (1,495.6 mL vs 2,393.1 mL; P < .001) were significantly shorter in the modified vs classical resectoscopic slicing group. The classical group witnessed 3 cases of fluid overload and 1 case of uterine perforation, whereas none of these postoperative complications occurred in the modified technique group.

Study details: Findings are from a retrospective study including 55 women with submucous UFs, of which 19 women underwent modified resectoscopic slicing and 36 women underwent the classical resectoscopic myomectomy.

Disclosures: This study was funded by Shanghai Municipal Health Commission, China. The authors declared no conflict of interests.

Source: Zhang W et al. Front Surg. 2021 Nov 10. doi: 10.3389/fsurg.2021.746936.

Key clinical point: Rates of reintervention were similar, and the risk for major adverse events was lower with thermal ablative methods vs myomectomy for treating uterine fibroids (UF), suggesting that thermal ablative methods were not inferior to myomectomy for treating UFs.

Major finding: The reintervention rate was not significantly different between thermal ablative treatment and myomectomy in randomized controlled trials (RCTs; P = .094) and observational studies (P = .16). The risk for major adverse events was significantly lower with thermal ablative methods (risk ratio, 0.111; 95% CI, 0.070-0.175). The pregnancy rate was not significantly different between the groups (P = .796).

Study details: Findings are from a meta-analysis of 10 observational studies and 3 RCTs including 4,205 patients who underwent thermal ablative methods or myomectomy for the treatment of UFs.

Disclosures: This study did not report any source of funding. The authors declared no conflict of interests.

Source: Liang D et al. Int J Hyperthermia. 2021 Nov 1. doi: 10.1080/02656736.2021.1996644.

Key clinical point: Rates of reintervention were similar, and the risk for major adverse events was lower with thermal ablative methods vs myomectomy for treating uterine fibroids (UF), suggesting that thermal ablative methods were not inferior to myomectomy for treating UFs.

Major finding: The reintervention rate was not significantly different between thermal ablative treatment and myomectomy in randomized controlled trials (RCTs; P = .094) and observational studies (P = .16). The risk for major adverse events was significantly lower with thermal ablative methods (risk ratio, 0.111; 95% CI, 0.070-0.175). The pregnancy rate was not significantly different between the groups (P = .796).

Study details: Findings are from a meta-analysis of 10 observational studies and 3 RCTs including 4,205 patients who underwent thermal ablative methods or myomectomy for the treatment of UFs.

Disclosures: This study did not report any source of funding. The authors declared no conflict of interests.

Source: Liang D et al. Int J Hyperthermia. 2021 Nov 1. doi: 10.1080/02656736.2021.1996644.

Key clinical point: Rates of reintervention were similar, and the risk for major adverse events was lower with thermal ablative methods vs myomectomy for treating uterine fibroids (UF), suggesting that thermal ablative methods were not inferior to myomectomy for treating UFs.

Major finding: The reintervention rate was not significantly different between thermal ablative treatment and myomectomy in randomized controlled trials (RCTs; P = .094) and observational studies (P = .16). The risk for major adverse events was significantly lower with thermal ablative methods (risk ratio, 0.111; 95% CI, 0.070-0.175). The pregnancy rate was not significantly different between the groups (P = .796).

Study details: Findings are from a meta-analysis of 10 observational studies and 3 RCTs including 4,205 patients who underwent thermal ablative methods or myomectomy for the treatment of UFs.

Disclosures: This study did not report any source of funding. The authors declared no conflict of interests.

Source: Liang D et al. Int J Hyperthermia. 2021 Nov 1. doi: 10.1080/02656736.2021.1996644.

Key clinical point: Hysteromyoma enucleation performed simultaneously during the cesarean section (C-section) is safe without any surgical complications in pregnant women with anterior uterine fibroids (UF).

Major finding: The operation time (median, 83.3 minutes vs 72.5 minutes; P = .04) and postoperative hospital stays (median, 3.6 days vs 3.2 days; P = .01) were slightly longer in the group of patients whose UFs were removed by C-section incision vs those who were operated traditionally by an incision through the serous layer. Pre- and postoperative hemoglobin level, intraoperative bleeding, frequency of blood transfusion, postpartum hemorrhage, and fever were similar between both groups, with no postoperative complications observed in either group.

Study details: Findings are from a retrospective analysis of 90 pregnant women with anterior UFs who underwent hysteromyoma enucleation simultaneously during C-section.

Disclosures: This study was funded by the Fujian Provincial Maternity and Children’s Hospital Science Foundation. The authors declared no conflict of interests.

Source: Dai Y et al. BMC Pregnancy Childbirth. 2021 Nov 3. doi: 10.1186/s12884-021-04226-1.

Key clinical point: Hysteromyoma enucleation performed simultaneously during the cesarean section (C-section) is safe without any surgical complications in pregnant women with anterior uterine fibroids (UF).

Major finding: The operation time (median, 83.3 minutes vs 72.5 minutes; P = .04) and postoperative hospital stays (median, 3.6 days vs 3.2 days; P = .01) were slightly longer in the group of patients whose UFs were removed by C-section incision vs those who were operated traditionally by an incision through the serous layer. Pre- and postoperative hemoglobin level, intraoperative bleeding, frequency of blood transfusion, postpartum hemorrhage, and fever were similar between both groups, with no postoperative complications observed in either group.

Study details: Findings are from a retrospective analysis of 90 pregnant women with anterior UFs who underwent hysteromyoma enucleation simultaneously during C-section.

Disclosures: This study was funded by the Fujian Provincial Maternity and Children’s Hospital Science Foundation. The authors declared no conflict of interests.

Source: Dai Y et al. BMC Pregnancy Childbirth. 2021 Nov 3. doi: 10.1186/s12884-021-04226-1.

Key clinical point: Hysteromyoma enucleation performed simultaneously during the cesarean section (C-section) is safe without any surgical complications in pregnant women with anterior uterine fibroids (UF).

Major finding: The operation time (median, 83.3 minutes vs 72.5 minutes; P = .04) and postoperative hospital stays (median, 3.6 days vs 3.2 days; P = .01) were slightly longer in the group of patients whose UFs were removed by C-section incision vs those who were operated traditionally by an incision through the serous layer. Pre- and postoperative hemoglobin level, intraoperative bleeding, frequency of blood transfusion, postpartum hemorrhage, and fever were similar between both groups, with no postoperative complications observed in either group.

Study details: Findings are from a retrospective analysis of 90 pregnant women with anterior UFs who underwent hysteromyoma enucleation simultaneously during C-section.

Disclosures: This study was funded by the Fujian Provincial Maternity and Children’s Hospital Science Foundation. The authors declared no conflict of interests.

Source: Dai Y et al. BMC Pregnancy Childbirth. 2021 Nov 3. doi: 10.1186/s12884-021-04226-1.

Key clinical point: Robotic single-port myomectomy (RSPM) using the da Vinci SP surgical system for treating symptomatic fibroids was a feasible surgical procedure and could solve many of the ergonomic problems associated with single-port laparoscopic myomectomy (SPLM).

Major finding: Conversion to SPLM, multiport laparoscopic myomectomy, or laparotomy was not required in women with less than 7 resected fibroids (maximal diameter <10 cm) and those with at least 7 resected fibroids (maximal diameter of resected fibroids ≥10 cm). Minor postoperative complications like fever, transient ileus, and transfusion were observed in 15 women, which could be resolved by conservative treatment.

Study details: Findings are from a prospective observational study including 69 women with symptomatic fibroids who underwent myomectomy, of which 61 women underwent RSPM.

Disclosures: The study did not report any source of funding. The authors declared no conflict of interests.

Source: Lee JH et al. J Obstet Gynaecol Res. 2021 Oct 23. doi: 10.1111/jog.15076.

Key clinical point: Robotic single-port myomectomy (RSPM) using the da Vinci SP surgical system for treating symptomatic fibroids was a feasible surgical procedure and could solve many of the ergonomic problems associated with single-port laparoscopic myomectomy (SPLM).

Major finding: Conversion to SPLM, multiport laparoscopic myomectomy, or laparotomy was not required in women with less than 7 resected fibroids (maximal diameter <10 cm) and those with at least 7 resected fibroids (maximal diameter of resected fibroids ≥10 cm). Minor postoperative complications like fever, transient ileus, and transfusion were observed in 15 women, which could be resolved by conservative treatment.

Study details: Findings are from a prospective observational study including 69 women with symptomatic fibroids who underwent myomectomy, of which 61 women underwent RSPM.

Disclosures: The study did not report any source of funding. The authors declared no conflict of interests.

Source: Lee JH et al. J Obstet Gynaecol Res. 2021 Oct 23. doi: 10.1111/jog.15076.

Key clinical point: Robotic single-port myomectomy (RSPM) using the da Vinci SP surgical system for treating symptomatic fibroids was a feasible surgical procedure and could solve many of the ergonomic problems associated with single-port laparoscopic myomectomy (SPLM).

Major finding: Conversion to SPLM, multiport laparoscopic myomectomy, or laparotomy was not required in women with less than 7 resected fibroids (maximal diameter <10 cm) and those with at least 7 resected fibroids (maximal diameter of resected fibroids ≥10 cm). Minor postoperative complications like fever, transient ileus, and transfusion were observed in 15 women, which could be resolved by conservative treatment.

Study details: Findings are from a prospective observational study including 69 women with symptomatic fibroids who underwent myomectomy, of which 61 women underwent RSPM.

Disclosures: The study did not report any source of funding. The authors declared no conflict of interests.

Source: Lee JH et al. J Obstet Gynaecol Res. 2021 Oct 23. doi: 10.1111/jog.15076.

Key clinical point: Transendometrial myomectomy (TEM) could be more advantageous than conventional myomectomy (CM) for uterine fibroids (UF) in cesarean section (C-section) for its shorter operation time and lesser adhesion scores.

Major finding: The mean duration of surgery (50.5 minutes vs 63.6 minutes; P = .001) and adhesion scores were significantly lower (0.58 vs 1.76; P = .001) in the TEM than CM group; however, length of hospital stay, procedure-related hemoglobin difference, blood transfusion requirement, and postoperative fever were similar in both groups.

Study details: Findings are from a retrospective study including 93 patients with intramural UFs and underwent myomectomy during C-section. CM and TEM were performed in 52 and 41 patients, respectively.

Disclosures: This study did not report any source of funding. The authors declared no conflict of interests.

Source: Karaca SY et al. Eur J Obstet Gynecol. 2021 Oct 21. doi: 10.1016/j.ejogrb.2021.10.019.

Key clinical point: Transendometrial myomectomy (TEM) could be more advantageous than conventional myomectomy (CM) for uterine fibroids (UF) in cesarean section (C-section) for its shorter operation time and lesser adhesion scores.

Major finding: The mean duration of surgery (50.5 minutes vs 63.6 minutes; P = .001) and adhesion scores were significantly lower (0.58 vs 1.76; P = .001) in the TEM than CM group; however, length of hospital stay, procedure-related hemoglobin difference, blood transfusion requirement, and postoperative fever were similar in both groups.

Study details: Findings are from a retrospective study including 93 patients with intramural UFs and underwent myomectomy during C-section. CM and TEM were performed in 52 and 41 patients, respectively.

Disclosures: This study did not report any source of funding. The authors declared no conflict of interests.

Source: Karaca SY et al. Eur J Obstet Gynecol. 2021 Oct 21. doi: 10.1016/j.ejogrb.2021.10.019.

Key clinical point: Transendometrial myomectomy (TEM) could be more advantageous than conventional myomectomy (CM) for uterine fibroids (UF) in cesarean section (C-section) for its shorter operation time and lesser adhesion scores.

Major finding: The mean duration of surgery (50.5 minutes vs 63.6 minutes; P = .001) and adhesion scores were significantly lower (0.58 vs 1.76; P = .001) in the TEM than CM group; however, length of hospital stay, procedure-related hemoglobin difference, blood transfusion requirement, and postoperative fever were similar in both groups.

Study details: Findings are from a retrospective study including 93 patients with intramural UFs and underwent myomectomy during C-section. CM and TEM were performed in 52 and 41 patients, respectively.

Disclosures: This study did not report any source of funding. The authors declared no conflict of interests.

Source: Karaca SY et al. Eur J Obstet Gynecol. 2021 Oct 21. doi: 10.1016/j.ejogrb.2021.10.019.

Key clinical point: Relugolix monotherapy effectively reduced menstrual blood loss associated with uterine leiomyomas (UL) along with an acceptable tolerability profile.

Major finding: Between weeks 6 to 12, the proportion of patients with pictorial blood loss assessment chart score of less than 10 was higher in relugolix 40 mg (difference vs placebo [D], 83.3%), 20 mg (D, 42.6%), and 10 mg (D, 20.8%) treatment arms (all P < .001). Treatment-emergent adverse events were mostly mild/moderate but were more frequent in relugolix arm (85.4%-96.4%%) vs placebo (70.2%).

Study details: Findings are from a phase 2 trial, including 216 premenopausal women with UL who were randomly assigned 1:1:1:1 to receive relugolix 10 mg, 20 mg, 30 mg, 40 mg, or placebo.

Disclosures: This study was funded by Takeda Pharmaceutical Company. The lead author reported receiving consultancy fees from Takeda Pharmaceutical Company, and other authors reported being current/former employees of the company.

Source: Hoshiai H et al. BMC Womens Health. 2021 Oct 28. doi: 10.1186/s12905-021-01475-2.

Key clinical point: Relugolix monotherapy effectively reduced menstrual blood loss associated with uterine leiomyomas (UL) along with an acceptable tolerability profile.

Major finding: Between weeks 6 to 12, the proportion of patients with pictorial blood loss assessment chart score of less than 10 was higher in relugolix 40 mg (difference vs placebo [D], 83.3%), 20 mg (D, 42.6%), and 10 mg (D, 20.8%) treatment arms (all P < .001). Treatment-emergent adverse events were mostly mild/moderate but were more frequent in relugolix arm (85.4%-96.4%%) vs placebo (70.2%).

Study details: Findings are from a phase 2 trial, including 216 premenopausal women with UL who were randomly assigned 1:1:1:1 to receive relugolix 10 mg, 20 mg, 30 mg, 40 mg, or placebo.

Disclosures: This study was funded by Takeda Pharmaceutical Company. The lead author reported receiving consultancy fees from Takeda Pharmaceutical Company, and other authors reported being current/former employees of the company.

Source: Hoshiai H et al. BMC Womens Health. 2021 Oct 28. doi: 10.1186/s12905-021-01475-2.

Key clinical point: Relugolix monotherapy effectively reduced menstrual blood loss associated with uterine leiomyomas (UL) along with an acceptable tolerability profile.

Major finding: Between weeks 6 to 12, the proportion of patients with pictorial blood loss assessment chart score of less than 10 was higher in relugolix 40 mg (difference vs placebo [D], 83.3%), 20 mg (D, 42.6%), and 10 mg (D, 20.8%) treatment arms (all P < .001). Treatment-emergent adverse events were mostly mild/moderate but were more frequent in relugolix arm (85.4%-96.4%%) vs placebo (70.2%).

Study details: Findings are from a phase 2 trial, including 216 premenopausal women with UL who were randomly assigned 1:1:1:1 to receive relugolix 10 mg, 20 mg, 30 mg, 40 mg, or placebo.

Disclosures: This study was funded by Takeda Pharmaceutical Company. The lead author reported receiving consultancy fees from Takeda Pharmaceutical Company, and other authors reported being current/former employees of the company.

Source: Hoshiai H et al. BMC Womens Health. 2021 Oct 28. doi: 10.1186/s12905-021-01475-2.

Key clinical point: Patients with moderate-to-severe plaque psoriasis who respond inadequately to ustekinumab should preferably be switched to brodalumab rather than guselkumab.

Major finding: Patients with an inadequate response to ustekinumab who switched to brodalumab vs guselkumab had higher Psoriasis Area Severity Index (PASI) 100 response rate at week 36 (40.3% vs 20.0%; P < .001) and PASI 90 response rate at weeks 12 (62.7% vs 48.1%; P = .002) and 36 (63.7% vs 51.1%; P = .004).

Study details: This matching-adjusted indirect comparison study employed data for patients with moderate-to-severe plaque psoriasis who responded inadequately to ustekinumab and switched to receive brodalumab (n=121) in AMAGINE-2 and -3 and or to receive guselkumab (n=135) in NAVIGATE, phase 3, trials.

Disclosures: The study was supported by LEO Pharma A/S. P Hampton and M Augustin declared receiving research/educational grants, consultation/speaker honoraria, and/or travel expenses and serving as an advisory board member or clinical trial participant for various companies, including LEO Pharma. E Borg is a current employee and JB Hansen is a former employee of LEO Pharma.

Source: Hampton P et al. Psoriasis (Auckl). 2021 Nov 3. doi: 10.2147/PTT.S326121.

Key clinical point: Patients with moderate-to-severe plaque psoriasis who respond inadequately to ustekinumab should preferably be switched to brodalumab rather than guselkumab.

Major finding: Patients with an inadequate response to ustekinumab who switched to brodalumab vs guselkumab had higher Psoriasis Area Severity Index (PASI) 100 response rate at week 36 (40.3% vs 20.0%; P < .001) and PASI 90 response rate at weeks 12 (62.7% vs 48.1%; P = .002) and 36 (63.7% vs 51.1%; P = .004).

Study details: This matching-adjusted indirect comparison study employed data for patients with moderate-to-severe plaque psoriasis who responded inadequately to ustekinumab and switched to receive brodalumab (n=121) in AMAGINE-2 and -3 and or to receive guselkumab (n=135) in NAVIGATE, phase 3, trials.

Disclosures: The study was supported by LEO Pharma A/S. P Hampton and M Augustin declared receiving research/educational grants, consultation/speaker honoraria, and/or travel expenses and serving as an advisory board member or clinical trial participant for various companies, including LEO Pharma. E Borg is a current employee and JB Hansen is a former employee of LEO Pharma.

Source: Hampton P et al. Psoriasis (Auckl). 2021 Nov 3. doi: 10.2147/PTT.S326121.

Key clinical point: Patients with moderate-to-severe plaque psoriasis who respond inadequately to ustekinumab should preferably be switched to brodalumab rather than guselkumab.

Major finding: Patients with an inadequate response to ustekinumab who switched to brodalumab vs guselkumab had higher Psoriasis Area Severity Index (PASI) 100 response rate at week 36 (40.3% vs 20.0%; P < .001) and PASI 90 response rate at weeks 12 (62.7% vs 48.1%; P = .002) and 36 (63.7% vs 51.1%; P = .004).

Study details: This matching-adjusted indirect comparison study employed data for patients with moderate-to-severe plaque psoriasis who responded inadequately to ustekinumab and switched to receive brodalumab (n=121) in AMAGINE-2 and -3 and or to receive guselkumab (n=135) in NAVIGATE, phase 3, trials.

Disclosures: The study was supported by LEO Pharma A/S. P Hampton and M Augustin declared receiving research/educational grants, consultation/speaker honoraria, and/or travel expenses and serving as an advisory board member or clinical trial participant for various companies, including LEO Pharma. E Borg is a current employee and JB Hansen is a former employee of LEO Pharma.

Source: Hampton P et al. Psoriasis (Auckl). 2021 Nov 3. doi: 10.2147/PTT.S326121.

Key clinical point: Patients with psoriasis exhibit significantly lower levels of salivary cortisol despite having higher psychological stress levels, suggesting the existence of an impaired cortisol response to stress.

Major finding: Although patients with psoriasis vs controls had a significantly higher Perceived Stress Scale score (17.2±0.6 vs 15.1±0.8; P = .0289), their salivary cortisol levels were significantly lower (9.6±0.5 vs 14.0±1.1 nmol/L; P < .001).

Study details: This was a cross-sectional study including 126 adult patients with plaque psoriasis who had not received systemic anti-psoriasis therapy since at least 6 months and 116 healthy adult controls.

Disclosures: The study was supported by Fondazione Cariplo. P Gisondi and G Girolomoni declared serving as consultants or speakers for various organizations.

Source: Gisondi P et al. J Pers Med. 2021 Oct 23. doi: 10.3390/jpm11111069.

Key clinical point: Patients with psoriasis exhibit significantly lower levels of salivary cortisol despite having higher psychological stress levels, suggesting the existence of an impaired cortisol response to stress.

Major finding: Although patients with psoriasis vs controls had a significantly higher Perceived Stress Scale score (17.2±0.6 vs 15.1±0.8; P = .0289), their salivary cortisol levels were significantly lower (9.6±0.5 vs 14.0±1.1 nmol/L; P < .001).

Study details: This was a cross-sectional study including 126 adult patients with plaque psoriasis who had not received systemic anti-psoriasis therapy since at least 6 months and 116 healthy adult controls.

Disclosures: The study was supported by Fondazione Cariplo. P Gisondi and G Girolomoni declared serving as consultants or speakers for various organizations.

Source: Gisondi P et al. J Pers Med. 2021 Oct 23. doi: 10.3390/jpm11111069.

Key clinical point: Patients with psoriasis exhibit significantly lower levels of salivary cortisol despite having higher psychological stress levels, suggesting the existence of an impaired cortisol response to stress.

Major finding: Although patients with psoriasis vs controls had a significantly higher Perceived Stress Scale score (17.2±0.6 vs 15.1±0.8; P = .0289), their salivary cortisol levels were significantly lower (9.6±0.5 vs 14.0±1.1 nmol/L; P < .001).

Study details: This was a cross-sectional study including 126 adult patients with plaque psoriasis who had not received systemic anti-psoriasis therapy since at least 6 months and 116 healthy adult controls.

Disclosures: The study was supported by Fondazione Cariplo. P Gisondi and G Girolomoni declared serving as consultants or speakers for various organizations.

Source: Gisondi P et al. J Pers Med. 2021 Oct 23. doi: 10.3390/jpm11111069.

Key clinical point: Given the chronic nature of the disease, antipsoriasis biologics are associated with low median persistence, which is relatively high for interleukin inhibitors vs tumor necrosis factor inhibitors and may change over time.

Major finding: Overall, the median persistence was 23.8 months (95% CI, 21.6-26.2), longest for ustekinumab (49.3 months [95% CI, 38.0-59.1]) and shortest for etanercept (16.3 months [95% CI, 14.5-19.0]). An approximately 50% decrease in the median persistence for ustekinumab, from 62.3 (95% CI, 45.6-∞) months to 32.7 (95% CI, 21.2-49.3) months, occurred between 2010-2011 and 2014-2016.

Study details: The data come from a retrospective cohort study consisting of 2,292 adult patients with psoriasis who had received at least 1 biologic between 2010 and 2018.

Disclosures: The study was sponsored by LEO Pharma. Levin L-Å declared receiving consulting fees from various sources including LEO Pharma, and some of the authors are employees of LEO Pharma.

Source: Schmitt-Egenolf M et al. Dermatol Ther (Heidelb). 2021 Oct 14. doi: 10.1007/s13555-021-00616-7.

Key clinical point: Given the chronic nature of the disease, antipsoriasis biologics are associated with low median persistence, which is relatively high for interleukin inhibitors vs tumor necrosis factor inhibitors and may change over time.

Major finding: Overall, the median persistence was 23.8 months (95% CI, 21.6-26.2), longest for ustekinumab (49.3 months [95% CI, 38.0-59.1]) and shortest for etanercept (16.3 months [95% CI, 14.5-19.0]). An approximately 50% decrease in the median persistence for ustekinumab, from 62.3 (95% CI, 45.6-∞) months to 32.7 (95% CI, 21.2-49.3) months, occurred between 2010-2011 and 2014-2016.

Study details: The data come from a retrospective cohort study consisting of 2,292 adult patients with psoriasis who had received at least 1 biologic between 2010 and 2018.

Disclosures: The study was sponsored by LEO Pharma. Levin L-Å declared receiving consulting fees from various sources including LEO Pharma, and some of the authors are employees of LEO Pharma.

Source: Schmitt-Egenolf M et al. Dermatol Ther (Heidelb). 2021 Oct 14. doi: 10.1007/s13555-021-00616-7.

Key clinical point: Given the chronic nature of the disease, antipsoriasis biologics are associated with low median persistence, which is relatively high for interleukin inhibitors vs tumor necrosis factor inhibitors and may change over time.

Major finding: Overall, the median persistence was 23.8 months (95% CI, 21.6-26.2), longest for ustekinumab (49.3 months [95% CI, 38.0-59.1]) and shortest for etanercept (16.3 months [95% CI, 14.5-19.0]). An approximately 50% decrease in the median persistence for ustekinumab, from 62.3 (95% CI, 45.6-∞) months to 32.7 (95% CI, 21.2-49.3) months, occurred between 2010-2011 and 2014-2016.

Study details: The data come from a retrospective cohort study consisting of 2,292 adult patients with psoriasis who had received at least 1 biologic between 2010 and 2018.

Disclosures: The study was sponsored by LEO Pharma. Levin L-Å declared receiving consulting fees from various sources including LEO Pharma, and some of the authors are employees of LEO Pharma.

Source: Schmitt-Egenolf M et al. Dermatol Ther (Heidelb). 2021 Oct 14. doi: 10.1007/s13555-021-00616-7.