Related Experiment Video
Updated: Sep 17, 2025
08:02
Fecal Glucocorticoid Analysis: Non-invasive Adrenal Monitoring in Equids
Published on: April 25, 2016
9.8K
Understanding Provider-Level Variation in Clinical Practice: A Longitudinal Survey of Corticosteroid Use in Septic
Kanupriya Soni1, Leigh A Bukowski2, Billie S Davis2
1Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA.
CHEST Critical Care
|June 27, 2025
Summary
Intensivist clinicians' risk tolerance influences their decision to use corticosteroids for septic shock. Understanding psychological factors can help standardize ICU practices and improve evidence adoption.
Area of Science:
- Critical Care Medicine
- Medical Psychology
- Health Services Research
Background:
- Practice variation is common in ICUs, especially for treatments with moderate evidence.
- Psychological factors influencing clinician decisions are poorly understood.
- Standardizing practice and accelerating evidence adoption are key goals.
Purpose of the Study:
- To investigate the association between psychological traits and clinical practice patterns in the ICU.
- To determine if individual psychological factors predict intensivist willingness to use corticosteroids for septic shock.
Main Methods:
- Longitudinal questionnaire administered to 201 intensivists from 2018-2021.
- Assessed willingness to treat septic shock with corticosteroids using a clinical vignette.
- Measured psychological traits, including risk tolerance and perceptions of evidence strength and mechanism of action.
- Used multivariate regression to analyze the relationship between psychological factors and treatment decisions.
Main Results:
- Willingness to treat with corticosteroids increased from 15.3% to 24.4% by 2021.
- Higher risk tolerance (OR, 1.34) and perceived strength of evidence (OR, 1.45) were significantly associated with increased willingness to treat.
- Perceived understanding of the mechanism of action and other psychological factors did not correlate with treatment decisions.
Conclusions:
- Individual risk tolerance is a significant factor associated with intensivist willingness to prescribe corticosteroids for septic shock.
- Psychological traits, particularly risk tolerance, may be targets for interventions to standardize practice.
- Further research into psychological determinants of clinical decision-making is warranted to improve evidence-based care in ICUs.
Related Concept Videos
01:26COPD: Management Using Bronchodilators and Corticosteroids
324
Chronic obstructive pulmonary isease (COPD) involves a group of progressive lung disorders characterized by persistent airflow limitation and chronic respiratory symptoms. Asthma-COPD Overlap Syndrome (ACOS), encompassing features of both asthma and Chronic obstructive pulmonary disease (COPD), is a group of progressive lung disorders that includes chronic bronchitis, emphysema, and refractory (non-reversible) asthma. ACOS leads to complex clinical presentations that combine the inflammatory...
324
01:25Antiasthma Drugs: Inhaled Corticosteroids and Glucocorticoids
399
Inhaled corticosteroids (ICS) are anti-inflammatory drugs used primarily in treating persistent asthma and providing long-term maintenance. They target the bronchial mucosa, the lining of the airways, to control inflammation, a critical factor in asthma progression and exacerbation.
ICS work through a multifaceted mechanism of action. They suppress the inflammatory response caused by the proliferation of TH cells. They also reduce the transcription of the IL-2 gene, which is involved in the...
ICS work through a multifaceted mechanism of action. They suppress the inflammatory response caused by the proliferation of TH cells. They also reduce the transcription of the IL-2 gene, which is involved in the...
399
01:21Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids
208
Glucocorticoids, a class of anti-inflammatory drugs, are pivotal in treating moderate to severe Crohn's disease by inducing remission. They exhibit their anti-inflammatory action by inhibiting the production of inflammatory cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-1, and chemokines like IL-8. In addition, they reduce the expression of inflammatory cell adhesion molecules and inhibit gene transcription of nitric oxide synthase, phospholipase A2, cyclooxygenase-2...
208
01:26Nephrotic Syndrome II : Assessment and Medical Management
24
IntroductionNephrotic syndrome is a kidney disorder marked by excessive protein loss in the urine, leading to various systemic complications. This condition often results from damage to the glomeruli—the kidney's filtering units—causing proteinuria, low blood protein levels, and fluid retention. Understanding the assessment, diagnosis, and management of nephrotic syndrome is essential for effective treatment and prevention of further kidney damage.AssessmentPatient History: Document...
24
01:29Acute Kidney Injury III: Clinical Manifestations
101
Acute Kidney Injury (AKI) progresses through distinct clinical phases: the oliguric, diuretic, and recovery phases, each marked by unique manifestations and challenges.Oliguric Phase:The oliguric phase is the initial stage of AKI, typically lasting 10 to 14 days. This phase is marked by a significant reduction in urine output, usually less than 400 mL per day, indicating decreased kidney function. Fluid retention is a prominent feature, leading to symptoms such as edema, hypertension, and...
101
01:17Pericarditis III: Medical Management
30
The primary objectives of managing pericarditis are to determine the underlying cause, provide effective therapy for treatment and symptom relief, and promptly detect signs and symptoms of cardiac tamponade. The following outlines the essential aspects of medical management for pericarditis:ObjectivesDetermine the Cause: Identifying the underlying cause of pericarditis is crucial for targeted treatment. Causes include viral infections, autoimmune diseases, post-cardiac injury syndrome, and...
30