Rationale:Little is known about how physicians develop their beliefs about new treatments or update their beliefs in the face of new clinical evidence. These issues are particularly salient in the context of the COVID-19 pandemic, which created rapid demand for novel therapies in the absence of robust evidence.Objective: To identify psychological traits associated with physicians' willingness to treat with unproven therapies and willingness to update their treatment preferences in the setting of new evidence in the context of COVID-19. Methods:We administered a longitudinal e-mail survey to United States physicians board-certified in intensive care medicine in April and May, 2020 (phase one); and October and November, 2020 (phase two). We assessed five psychological traits potentially related to evidence-uptake: need for cognition, evidence skepticism, need for closure, risk tolerance, and research engagement. We then examined the relationship between these traits and physician preferences for pharmacological treatment for a hypothetical patient with severe COVID-19 pneumonia.Results: There were 592 responses to the phase one survey, conducted prior to publication of trial data.At this time physicians were most willing to treat with macrolide antibiotics (50.5%), followed by antimalaria agents (36.1%), corticosteroids (24.5%), antiretroviral agents (22.6%), and angiotensin inhibitors (4.4%). Greater evidence skepticism (relative risk, RR=1.40, 95% CI: 1.30 -1.52, p<0.001), greater need for closure (RR=1.19, 95% CI: 1.06 -1.34, p=0.003), and greater risk tolerance (RR=1.17, 95% CI: 1.08 -1.26, p<0.001) were associated with an increased willingness to treat; while greater need for cognition (RR: 0.85, 95% CI: 0.75 -0.96, p=0.010) and greater research engagement (RR=0.91, 95%
In the United States, liberals and conservatives disagree about facts. To what extent does expertise attenuate these disagreements? To study this question, we compare the polarization of beliefs about COVID-19 treatments among laypeople and critical care physicians. We find that political ideology predicts both groups’ beliefs about a range of COVID-19 treatments. These associations persist after controlling for a rich set of covariates, including local politics. We study two potential explanations: a) that partisans are exposed to different information and b) that they interpret the same information in different ways, finding evidence for both. Polarization is driven by preferences for partisan cable news but not by exposure to scientific research. Using a set of embedded experiments, we demonstrate that partisans perceive scientific evidence differently when it pertains to a politicized treatment (ivermectin), relative to when the treatment is not identified. These results highlight the extent to which political ideology is increasingly relevant for understanding beliefs, even among expert decision makers such as physicians.
Background Podiatrists independently manage diabetic foot ulcers (DFU), often complicated by diabetic foot infections (DFIs). The prevalence of DFU is 40 - 60% and guidelines vary in their recommendations for DFI, creating a target for antimicrobial stewardship. However, the prevalence and appropriateness of antibiotics prescribed by podiatrists has not been reported. We describe both variables among patients with DFU in a podiatry clinic. Methods We conducted a retrospective chart review of all consecutive patients > 18 years of age with DFUs, infected or not, who had at least one visit to the UPMC Mercy Wound Clinic (Pittsburgh, PA) in 2020. We defined severity of infection using the PEDIS score and diagnosis of osteomyelitis (OM) (Figure 1). We collected data on antibiotics prescribed by podiatry in the clinic or by any provider during a hospitalization for DFI. Figure 2 shows our appropriateness criteria. Figure 1:Stratification of Severity of Diabetic Foot InfectionFigure 2:Criteria for Appropriateness of Antibiotic Use in Diabetic Foot Ulcers Results Of 72 patients with DFU, 32 (44.4%) received an antibiotic. Compared to those who did not receive antibiotics, patients who did were more likely male (86.2% vs. 63.6%), had a higher PEDIS score (2.03 vs. 1.49), and were more frequently diagnosed with OM (71.9% vs. 26.8%). (Table 1). Table 2 shows the most common antibiotics. Among the five patients with no to mild infection, none received appropriate treatment (Table 3). Two patients in that category received IV antibiotics (when hospitalized for DFI), and neither received an Infectious Diseases (ID) consult. The other three were considered inappropriate due to durations > 7 days. The mean length of treatment for patients with mild infection was 12.6 (4.56). The two patients with moderate infection who received antibiotics had “inappropriate” courses; however, both had complicated Staphylococcus aureus bacteremia, and therefore 4-6 weeks courses were justified. All 12 inappropriate courses in severe infections were due to courses > 42 days. Conclusion Prescription of antibiotics among patients with DFU was common. Our findings suggest potential targets for antimicrobial stewardship: unnecessarily long courses an IV antibiotic use in patients with mild or no infection. Our criteria can be refined to recognize situations in which prolonged therapy may be justified, and larger studies are warranted. Disclosures All Authors: No reported disclosures.
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