CDC: ER visits not going down since ACA implementation

Says Dr. Paolo:

“ER visits have gone up or stayed the same since the implementation of the ACA.  This should come as no surprise and we have discussed the various reasons for this trend and its likely confutation for the foreseeable future.  Providing insurance to all is a (necessary) and key component of health-care reform but it does not provide health-care or access to all but serves as purely a financial protective device.  Until this country addresses its primary care erosion and access for patients to their providers (mental, dental, and medical) your job will continue to be difficult, busy, and the de facto primary care system for vast swaths of the county.  Be proud of this fact but work like hell to change it because this system and your job, honorable as it is, is completely unsustainable.”

CDC Report:

Article at


NEJM: One-Year Risk of Stroke after Transient Ischemic Attack or Minor Stroke

Via Gary Johnson

Not a controlled study, but evidence that prompt evaluation of TIA reduces morbidity….

One-Year Risk of Stroke after Transient Ischemic Attack or Minor Stroke
Amarenco, Pierre et al.
N Engl J Med 2016; 374:1533-1542
April 21, 2016
[Full Text PDF]

Journal Club Articles for 4/27/16

Note: Full text links work on campus or when connected to Upstate’s network via VPN. If you need help retrieving the full text, please contact David Rothman.

External Validation of the STONE Score, a Clinical Prediction Rule for Ureteral Stone: An Observational Multi-institutional Study
Wang, Ralph C. et al.
Annals of Emergency Medicine , Volume 67 , Issue 4 , 423 – 432.e2
[PDF Full Text]

CURB-65 Performance Among Admitted and Discharged Emergency Department Patients With Community-acquired Pneumonia
Sharp, Adam L. et al.
Academic Emergency Medicine, Volume 23, Issue 4, 400-405
[PDF Full Text]