Research Spotlight

Wolk, C.B., Alter, C.L., Kishton, R., Rado, J., Atlas, J.A., Press, M.J., Jordan, N., Grant, M., Livesey, C., Rosenthal, L.J. and Smith, J.D. (2021). “Improving Payment for Collaborative Mental Health Care in Primary Care.” Med Care 59(4): 324-326.

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BACKGROUND: There is strong evidence supporting implementation of the Collaborative Care Model within primary care. Fee-for-service payment codes, published by Current Procedural Terminology in 2018, have made collaborative care separately reimbursable for the first time. These codes (ie, 99492-99494) reimburse for time spent per month by any member of the care team engaged in Collaborative Care, including behavioral care managers, primary care providers, and consulting psychiatrists. Time-based billing for these codes presents challenges for providers delivering Collaborative Care services. OBJECTIVES: Based on experience from multiple health care organizations, we reflect on these challenges and provide suggestions for implementation and future refinement of the codes. CONCLUSIONS: Further refinements to the codes are encouraged, including moving from a calendar month to a 30-day reimbursement cycle. In addition, we recommend payers adopt the new code proposed by the Centers for Medicare and Medicaid Services to account for smaller increments of time.

Alam, A., Mancini, D. and Hall, S. (2021). “Should Withdrawal Of Care Be Listed As A Cause Of Death?” Ann Thorac Surg Mar 19;S0003-4975(21)00534-8. [Epub ahead of print].

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In the latest INTERMACS report we were encouraged to read that despite the heart failure community implanting left ventricular assist devices (LVAD) in a sicker patient population, survival continues to improve. However, the frequent adverse events and the primary cause of death remain concerning. Major bleeding and infection continue to lead the adverse events profile with a declining rate of strokes. Interestingly, the report does not track incidence of right sided heart failure which had been included in prior annual INTERMACS reports. Furthermore, the report concludes that “withdrawal of care” is now the leading cause of death. [No abstract, excerpt from article].

Alam, A., Kobashigawa, J., Milligan, G.P. and Hall, S.A. (2021). “Evolution of Testing for Allograft Rejection After Orthotopic Heart Transplantation Without the Evolution of Guidelines and a Proposal for the Multidisciplinary Health-Team Approach.” Am J Cardiol Mar 19;S0002-9149(21)00254-X. [Epub ahead of print].

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Acute allograft rejection remains among the most common causes of morbidity and mortality, especially in the first year following orthotopic heart transplant with roughly 25% of patients having at least 1 episode of allograft rejection within this time period. Despite its prevalence and substantial clinical significance, accurate diagnosis often proves elusive. Endomyocardial biopsy (EMB) remains the gold standard in diagnosis of acute rejection,2 despite its inherent limitations of sampling bias, subjectivity, and false negatives are well known. This has prompted the use of an expanding array of diagnostic modalities such as cardiac magnetic resonance imaging, gene expression profiling, donor-derived cell free DNA (dd-cfDNA), and more recently, microarray biopsy technology known as the Molecular Microscope Diagnostic System (MMDx). Recommendations on the utility of some of these tests were provided in the latest guidelines on care of the heart transplant recipient published by the International Society of Heart and Lung Transplant in 2010, however, as the field has rapidly evolved, so must our approach to the care of these patients. [No abstract; excerpt from article].

Liu, S., Kramer, P. and Tao, F. (2021). “Editorial: Mechanisms of Orofacial Pain and Sex Differences.” Front Integr Neurosci 15: 599580.

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Orofacial pain comprises multiple pain conditions that affect oral, head, face, and neck area. Such pain can be divided into different types based on its origin, including neuropathic, musculoskeletal, neurovascular, psychogenic, and idiopathic pain. Patients with orofacial pain often show sex differences with high prevalence in women. However, mechanisms underlying orofacial pain conditions and their sexual dimorphism remain elusive. With obvious differences in anatomical structures, gonadal hormones, and immune responses between males and females, it is proposed that these factors contribute to sexual dimorphism in orofacial pain. In the Special Research Topic entitled “Mechanisms of Orofacial Pain and Sex Differences,” we collected six relevant articles. These studies provide new insights into understanding orofacial pain and may aid target identification for future development of sex-specific therapies for orofacial pain.[No abstract; excerpt from article].

Scherer, M.D., Barmak, B.A., Özcan, M. and Revilla-León, M. (2021). “Influence of postpolymerization methods and artificial aging procedures on the fracture resistance and flexural strength of a vat-polymerized interim dental material.” J Prosthet Dent Mar 29;S0022-3913(21)00099-8. [Epub ahead of print].

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STATEMENT OF PROBLEM: The influence of postpolymerization methods and artificial aging procedures on the fracture resistance and flexural strength of additively manufactured interim polymers remains unclear. PURPOSE: The purpose of this in vitro study was to evaluate the effect of the conditions (dry and water- and glycerin-submerged) and time (25, 30, 35, 40, and 45 minutes) of postpolymerization methods with and without artificial aging procedures on the fracture resistance and flexural strength of an additively manufactured interim material. MATERIAL AND METHODS: Bar specimens (25×2×2 mm) were manufactured from an interim resin (NexDent C&B MFH N1) with a 3-dimensional printer (NexDent 5100) as per the manufacturer’s recommendations. Three groups were created based on the postpolymerization condition: dry (D group) and submerged in a container with water (W group) or glycerin (G group) inside the ultraviolet polymerization machine (LC-3DPrint Box). Each group was divided into 5 subgroups (D1 to D5, W1 to W5, and G1 to G5) depending on the polymerizing time (25, 30, 35, 40, and 45 minutes) (n=20). Each subgroup was divided into nonaged and aged subgroups. The aged groups were treated in a mastication simulator. Fracture strength was measured on a universal testing machine. The flexural strength was calculated as per International Organization for Standardization (ISO) 10477-2018. The Kolmogorov-Smirnov test demonstrated that data were normally distributed. The 3-way ANOVA test was used to analyze the data (α=.05). RESULTS: A significant main effect was found on the fracture strength analysis for each of the 3 factors: postpolymerization condition (F[2, 449]=81.00, P<.001), treatment duration (F[4, 449]=2.84, P=.024), and aging procedure (F [1, 449] =7.62, P=.006). The only significant 2-way interaction was between postpolymerization condition and treatment duration (F[8, 449]=3.12, P=.002). Furthermore, a significant main effect was found on the flexural strength for each of the 3 factors including postpolymerization condition (F[2, 449]=82.55, P<.001), treatment duration (F[4, 449]=2.85, P=.024), and artificial aging procedure (F[1, 449]=6.72, P=.010). The only significant 2-way interaction was between postpolymerization condition and treatment duration (F[8, 449]=3.33, P=.001). Dry postconditions at 25 minutes and nonaged procedures obtained the significantly highest fracture resistance and flexural strength values. CONCLUSIONS: Postpolymerization conditions and duration time affected the fracture resistance and flexural strength of the additively manufactured interim material assessed. Artificial aging procedures significantly decreased the fracture resistance and flexural strength of the additively manufactured interim dental material.