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We examine the effect of the Medicaid expansion in 2014 under in the Patient Protection and Affordable Care Act on emergency department (ED) utilization and ED admission rates (fraction of ED visits that lead to hospital admission) during the first 3 postexpansion years (2014 to 2016).

We compared ED utilization and ED admission rates in 151 EDs in 14 expansion states with those in 376 EDs in 14 nonexpansion states, using difference-in-differences methods with data from 3 national emergency medicine groups from 2013 to2016.

In expansion states, the volume of Medicaid-paid ED visits increased 49% (95% confidence interval 34% to 65%), and the volume of uninsured visits decreased 44% (95% confidence interval -52% to -34%) relative to that of nonexpansion states. Both effects on payer mix leveled off during 2015. There was no significant relative change in overall ED utilization or overall ED admission rates in expansion versus nonexpansion states during the study. However, relative ED admission rates for uine in ED admission rates in expansion states among the uninsured may reflect a selection effect in which, among newly Medicaid-eligible persons, sicker persons were more likely to enroll than healthier ones.

In many cases, emergency department (ED) care leads to investigations for which there are not final results at patient disposition. The follow-up for these test results pending at discharge, most commonly final diagnostic imaging reports and microbiology cultures, is a significant safety concern for patients and a medicolegal risk for ED practitioners. Our objective is to perform a systematic review of the literature and report on the structure and outcomes of existing ED quality assurance processes to address these test results pending at discharge.

We searched for studies that reported processes to ensure follow-up of test results pending at discharge for patients discharged from ED settings in 6 relevant databases, from inception to June 11, 2019. We appraised the quality of each study and extracted characteristics of the quality assurance process being discussed, as well as its influence and outcomes, cost, and feasibility.

We identified 17,862 studies, and 17 met our criteria for inclusion. Four major processes were identified to improve the follow-up of test results pending at discharge only nurses or clerks involved, physician-driven process, direct patient contact, and pharmacist-led process. The 5 recommendations generated by our literature review included dedicating staff to the quality assurance process, protecting their quality assurance time from clinical duties, ensuring electronic medical record integration, encouraging collaboration among health care disciplines, and engaging patients.

A variety of quality assurance processes have been described to follow up on ED test results pending at discharge, and we provided recommendations to improve patient care. All ED leaders should consider implementing these according to their local context.

A variety of quality assurance processes have been described to follow up on ED test results pending at discharge, and we provided recommendations to improve patient care. All ED leaders should consider implementing these according to their local context.Close observation and rapid escalation of care is essential for obstetric patients with COVID-19. The pandemic forced widespread conversion of in-person to virtual care delivery and telehealth was primed to enable outpatient surveillance of infected patients. We describe the experience and lessons learned while designing and implementing a virtual telemonitoring COVID-19 clinic for obstetric patients. All patients with suspected for confirmed COVID-19 were referred and enrolled. Telehealth visits were conducted every 24 to 72 hours based on the severity of symptoms and care was escalated to in person when necessary. The outcome of the majority (96.1%) of telehealth visits was to continue outpatient management. With regard to escalation of care, 25 patients (26.6%) presented for in person evaluation and five patients (5.3%) required inpatient admission. A virtual telemonitoring clinic for obstetric patients with mild COVID-19 offers an effective surveillance strategy as it allows for close monitoring, direct connection to in person evaluation, minimization of patient and provider exposure, and scalability.Aneurysmal bone cysts are rare benign bone lesions. Location in the sacrum is unusual. click here Symptoms are nonspecific. After an injury, pain develops and complications of adjacent structures can be triggered by the associated oedema. Radiological presentation is usually characteristic but must be confirmed by biopsy and a differential diagnosis must be made with other tumours. Treatment in long bones is based in curettage and refill with bone replacement material. In the sacrum, neurological complications can develop with selective arterial embolisation being an alternative in their management. We describe the case of a 71-year-old male patient with sacral aneurysmal bone cysts and a history of chronic lymphoid leukaemia and benign prostatic hyperplasia. The report includes the clinical presentation, imaging findings and outcome after treatment with selective arterial embolisation. This case highlights the therapeutic options and difficulties encountered in the management of these lesions when located in the sacrum, which complicates their usual treatment. Selective arterial embolisation is a therapeutic option in patients with sacral aneurysmal bone cysts, allowing less aggressive treatments and favourable results.

It has been established that the genomic background of Mycobacterium tuberculosis may influence disease progression, in particular for the Beijing family and the Latin American and Mediterranean (LAM)/RD

strains. The purpose of this study was to evaluate the prevalence of the LAM/RD

genotype in cases of tuberculosis from Mexico and their drug susceptibility profile.

Two hundred eighteen M. tuberculosis isolates were screened by 43-spacer spoligotyping. The LAM/RD

genotype was confirmed by multiplex PCR, and the drug susceptibility testing was carried out in solid Löwenstein-Jensen media.

Among the LAM strains identified, 24 (63.1%) were confirmed as M. tuberculosis RD

. All RD

strains shared the RD174 deletion, that was associated with isoniazid resistance (p=0.0264).

We documented for the first time the isolation of the LAM/RD

genotype in pulmonary cases of tuberculosis in Mexico, and we found resistance to the first-line anti-tuberculosis drug isoniazid in these strains.

We documented for the first time the isolation of the LAM/RDRio genotype in pulmonary cases of tuberculosis in Mexico, and we found resistance to the first-line anti-tuberculosis drug isoniazid in these strains.