Using behavioral economics to promote advanced directives for end of life care: a national study on message framing.

Advance directives (AD) are a crucial method for individuals to communicate their directions regarding medical decisions to their families and health care professionals when they are no longer able to make these decisions for themselves. However, not many individuals have an AD. We present the results of a survey-based experiment on how message framing (positive, negative and social norm) in educational videos affects (a) the individual's decision to acquire more information about an AD and (b) the change in stated likelihood of obtaining an AD. Our message framing is centered on the family burden aspect of end-of-life care. We also survey participants about which type of framing they view as more persuasive in terms of obtaining an AD. We find that participants who watched the negative framed video were more likely to request more information about ADs. However, for those who had not sought information on ADs prior to the study, positive framing has a small positive impact on the approximate change in stated likelihood of obtaining an AD. On average, positive framing is perceived as more convincing to obtain an AD. Ranking the positive framed video as first or second in terms of convincingness is correlated with self-reported creation of an AD, whereas ranking the negative framed video as first or second is correlated with not creating an AD.

A Model for Osteonecrosis of the Jaw with Zoledronate Treatment following Repeated Major Trauma.

This study aims to develop a reproducible rat model for post-traumatic bisphosphonate-related osteonecrosis of the jaw (BRONJ). In our previous studies using dental extraction as an inducing factor, only 30%-60% of zoledronate-treated animals fulfilled the definition of clinical BRONJ. We modified the zoledronate regimen and introduced repeated surgical extraction to illicit quantifiable BRONJ in all animals. Eighty retired-breeder female Sprague-Dawley rats were divided between the treatment (i.v. zoledronate; 80 µg/kg/week for 13 weeks) and control (saline) groups. On week 13, the left mandibular first molar was surgically extracted, followed by the second molar a week later. Animals were euthanized at 1-week, 2-weeks, and 8-weeks following extraction. The occurrence and severity of BRONJ were scored in each animal based on gross and MicroCT analysis. Parameters of bone formation and osteoclast functions at the extraction site were compared between groups. All zoledronate-treated animals developed a severe case of BRONJ that fulfilled the clinical definition of the condition in humans. Osteoclast attachment continued to be defective eight weeks after stopping the treatment. There were no signs of kidney or liver toxicity. Our data confirmed that repeated surgical extraction (major trauma) by itself consistently precipitated massive bone necrosis in ZA-treated animals, eliminating the need to induce pre-existing infection or comorbidity. These results will be the basis for further studies examining the in-vivo pathogenesis and prevention of BRONJ.

Healthy fish consumption and reduced mercury exposure: counseling women in their reproductive years.

OBJECTIVE: To provide family physicians with a practical, evidence-based approach to counseling women about healthy fish eating. SOURCES OF INFORMATION: MEDLINE was searched for articles published between 1999 and 2008. Most studies described in this article provide level II or III evidence. MAIN MESSAGE: Fish is an important component of a healthy diet for women in their reproductive years owing to the beneficial effects of omega-3 fatty acids on the neurologic development of the fetus. However, some fish species contain considerable methylmercury, which crosses the placenta and has harmful effects on neurobehavioural development. As many jurisdictions have issued fish consumption advisories, which can be confusing, women would benefit from individualized assistance from a trusted source, their family physicians, to clarify the risks and benefits of eating fish. CONCLUSION: We recommend that family physicians counsel women in their reproductive years about healthy choices regarding fish in their diet, and provide appropriate resources.