Persuading physicians to test their patients' level of kidney functioning: the effects of message frame and point of view.

A two-part field experiment was conducted to determine the effects of message frame (gain vs. loss) and point of view (personal vs. impersonal) on physicians' intentions and behavior to test their patients' level of kidney functioning. One hundred and fifty-one physicians returned a survey that accompanied one of four different experimental cover letters or a generic control letter. One hundred and twelve (74%) of these physicians also completed and returned a follow-up survey sent approximately 4 months later. Physicians who received a letter (vs. the generic-letter control group) believed their patients were more susceptible to kidney disease, believed that kidney disease had more severe consequences, and also demonstrated greater intentions and behavior to test their patients' level of kidney functioning. Additionally, there was a significant frame by point of view interaction effect, in that physicians receiving the gain-framed personal letter or the loss-framed impersonal letter demonstrated greater intentions and behavior than physicians receiving other versions of the letter. These results extend the theoretical scope of the EPPM by suggesting that threat to other can motivate behavior change, and also can have significant practical application for the development of messages targeting physicians.

Bisphosphonate-induced osteonecrosis of the jaw.

OBJECTIVE: To review the risk of osteonecrosis of the jaw associated with bisphosphonates. DATA SOURCES: A MEDLINE search (1966-January 2007) and a search of International Pharmaceutical Abstracts (1970-January 2007) were conducted to identify relevant literature. Additional references were reviewed from selected articles. STUDY SELECTION AND DATA EXTRACTION: Articles related to bisphosphonate-induced osteonecrosis of the jaw were reviewed and summarized. Inclusion criteria required that articles be either case studies or case series that were reporting actual cases linking osteonecrosis of the jaw with bisphosphonate use. Articles that addressed sites of osteonecrosis not involving the jaw, teaching cases (fictitious patients), and a retrospective claims analysis paper were excluded from consideration. DATA SYNTHESIS: Bisphosphonates have recently been linked to osteonecrosis of the jaw, with the greatest incidence seen with the intravenous preparations zoledronic acid and pamidronate. Osteonecrosis refers to death of a part of the bone, resulting in decreased bone density. Although the majority of occurrences have been associated with the intravenous bisphosphonates, oral bisphosphonates have also been implicated. Other risk factors noted from reported cases include dental extraction or trauma to the jaw exposing part of the bone. It is difficult to determine an exact incidence of osteonecrosis of the jaw in the general population of patients prescribed bisphosphonates; however, the incidence in cancer patients is approximately 6-7%. CONCLUSIONS: Although discontinuation of intravenous bisphosphonates in cancer patients has been recommended, stopping oral bisphosphonates prior to dental work cannot be universally endorsed at this time, since it is unknown whether this is effective in reducing the risk of osteonecrosis of the jaw. Treatment of this condition is not well established; therefore, efforts should be directed toward prevention. Pharmacists may further counsel patients to practice good oral hygiene and regularly follow up with their dentist during therapy. Current evidence suggests limited surgical debridement with systemic and local antibiotics as treatments.

Safety of COX-2 inhibitors in asthma patients with aspirin hypersensitivity.

OBJECTIVE: To review the safety of cyclooxygenase-2 (COX-2) inhibitors in asthma patients with aspirin hypersensitivity. DATA SOURCES: Clinical studies were identified using MEDLINE (1966-September 2002). Key search terms included cyclooxygenase inhibitors, aspirin, asthma, and hypersensitivity. English-language articles were identified and included. References from the identified articles were also reviewed. DATA SYNTHESIS: The literature provides information regarding the safety of COX-2 inhibitors in asthma patients with aspirin-exacerbated respiratory disease (AERD). The mechanism of AERD involves inhibition of cyclooxygenase, particularly COX-1. Inhibition of COX-1 causes an increased production of certain inflammatory mediators, which results in the reactions seen with AERD. Considering this mechanism, COX-2 inhibitors may be an alternative to aspirin or nonsteroidal antiinflammatory drugs (NSAIDs) in a patient with AERD. This article analyzes 4 studies to evaluate the safety of COX-2 inhibitors in this population. RESULTS: The 4 studies evaluated included a total of 172 patients with AERD. All patients included demonstrated intolerance to aspirin or NSAIDs and tolerated the selective COX-2 inhibitor administered. CONCLUSIONS: COX-2 inhibitors provide a potentially safe alternative for treatment of inflammatory conditions in patients with AERD.