Insufficient Impact: Limited Implementation of Federal Regulatory Changes to Methadone and Buprenorphine Access in Arizona During COVID-19.

Introduction: This study examined the impact of federal regulatory changes on methadone and buprenorphine treatment during COVID-19 in Arizona. Methods: A cohort study of methadone and buprenorphine providers from September 14, 2021 to April 15, 2022 measured the proportion of 6 treatment accommodations implemented at 3 time periods: before COVID-19, during Arizona's COVID-19 shutdown, and at the time of the survey completion. Accommodations included (1) telehealth, (2) telehealth buprenorphine induction, (3) increased multiday dosing, (4) license reciprocity, (5) home medications delivery, and (6) off-site dispensing. A multilevel model assessed the association of treatment setting, rurality, and treatment with accommodation implementation time. Results: Over half (62.2%) of the 74-provider sample practiced in healthcare settings not primarily focused on addiction treatment, 19% practiced in methadone clinics, and 19% practiced in treatment clinics not offering methadone. Almost half (43%) were unaware of the regulatory changes allowing treatment accommodation. Telehealth was most frequently reported, increasing from 30% before COVID-19 to 80% at the time of the survey. Multiday dosing was the only accommodation substantially retracted after COVID-19 shutdown: from 41% to 23% at the time of the survey. Providers with higher patient limits were 2.5-3.2 times as likely to implement telehealth services, 4.4 times as likely to implement buprenorphine induction through telehealth, and 15.2-20.9 times as likely to implement license reciprocity as providers with lower patient limits. Providers of methadone implemented 12% more accommodations and maintained a higher average proportion of implemented accommodations during the COVID-19 shutdown period but were more likely to reduce the proportion of implemented accommodations (a 17-percentage point gap by the time of the survey). Conclusions: Federal regulatory changes are not sufficient to produce a substantive or sustained impact on provider accommodations, especially in methadone medical treatment settings. Practice change interventions specific to treatment settings should be implemented and studied for their impact.

Nothing really changed: Arizona patient experience of methadone and buprenorphine access during COVID.

OBJECTIVE: To understand patient experience of federal regulatory changes governing methadone and buprenorphine (MOUD) access in Arizona during the COVID-19 pandemic. METHODS: This community-based participatory and action research study involved one-hour, audio-recorded field interviews conducted with 131 people who used methadone and/or buprenorphine to address opioid use disorder at some point during COVID (January 1, 2020- March 31, 2021) in Arizona. Transcribed data were analyzed using a priori codes focused on federally recommended flexibilities governing MOUD access. Data were quantitated to investigate associations with COVID risk and services access. RESULTS: Telehealth was reported by 71.0% of participants, but the majority were required to come to the clinic to attend video appointments with an offsite provider. Risk for severe COVID outcomes was reported by 40.5% of the sample. Thirty-eight percent of the sample and 39.7% of methadone patients were required to be at the clinic daily to get medication and 47.6% were at high risk for COVID severe outcomes. About half (54.2%) of methadone patients indicated that some form of multi-day take home dosing was offered at their clinic, and 45.8% were offered an extra day or two of multi-day doses; but no participants received the federally allowed 14- or 28-day methadone take-home doses for unstable and stable patients respectively. All participants expressed that daily clinic visits interrupted their work and home lives and desired more take-home dosing and home delivery options. CONCLUSIONS: MOUD patients in Arizona were not offered many of the federally allowed flexibilities for access that were designed to reduce their need to be at the clinic. To understand the impact of these recommended treatment changes in Arizona, and other states where they were not well implemented, federal and state regulators must mandate these changes and support MOUD providers to implement them.

Ferulización con carillas de composite en pacientes con periodontitis moderada y avanzada: estética y función. Casos clínicos 2ª parte / Splinting with composite veneers in patients with moderate and advanced periodontal disease: aesthetic and function. Cases report. 2nd part

La ferulización en dientes periodontales es el tratamiento de elección en los casos en los que se pretende mejorar la estética y el conforta la masticación ocasionado por la movilidad dentaria, eliminando poco tejido, sin generar mayor sensibilidad y a un “coste muy razonable”. La ferulización con carillas de composite reúne todas estas características (AU)

The splinting in periodontal teeth is the treatment of choice in the cases where the aesthetics and comfort in chewing is intended to be improved by the dental mobility, eliminating little tissue, without generating greater sensitivity at a “very reasonable cost”. The splinting with composite veneers has all these characteristics (AU)

Ferulización con carillas de composite en pacientes con periodontitis moderada y avanzada: estética y función. Casos clínicos. 1ª parte / Splinting with composite veneers in patients with moderate and advanced periodontal disease: aesthetic and function. Cases report. 1st part

La ferulización en dientes periodontales es el tratamiento de elección en los casos en los que se pretende mejorar la estética y el confort ala masticación ocasionado por la movilidad dentaria, eliminando poco tejido, sin generar mayor sensibilidad y a un “coste muy razonable”. La ferulización con carillas de composite reúne todas estas características (AU)

Splinting in peridontal teeth is the treatment of choice in cases for esthetic improvement and increased mastication comfort, produced by dental mobility, without much tissue being eliminated, avoiding the creation of greater sensitivity, and at a “very reasonable cost”. Splinting with compositeveneers meets all these characteristics (AU)

Efeitos da lovastatina na hipercolesterolemia primária / Effects of lovastatin in primary hypercholesterolemia

Lavastatina, um inibidor competitivo da HMGCoA redutase, foi utilizada no tratamento de 26 pacientes portadores de hipercolesterolemia primária, após um período inicial de placebo de 4 semanas. A resposta terapêutica foi analisada durante 11 semanas. As reduçöes do colesteroltotal com 20 e 40 mg/dia foram 17% e 31% e de LDL-C de 24% e 41%, respectivamente. Cinco pacientes mantiveram a dose de 20 mg/dia durante as 12 semanas com reduçöes mais significativas na semana 12 em relaçäo à semana 6. Näo se observou alteraçäo dos níveis de triglicérides, HDL-C e VLDL-C. Comparando-se os dois grupos, isto é, hipercolesterolemia familiar e poligênica, a resposta à droga foi semelhante. Näo ocorreram alteraçöes clínicas ou efeitos colaterais significantes durante o período analisado