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Background: Young adults are the most likely age group to be uninsured and have the highest prevalence of substance abuse, motor vehicle accidents, and sexually transmitted diseases, yet little is known about their use of ambulatory care. Objective: To characterize ambulatory care of young adults. Design: Cross-sectional data from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. Setting: Community and hospital-based clinics. Patients: Nonpregnant young adults age 20 to 29 years. Measurements: Ambulatory care utilization, types of visits, and preventive care. Results: Insured young adults had more visits (2.16 [95% Cl, 2.14 to 2.19] annual visits per capita) than those without insurance (0.59 [CI, 0.54 to 0.67] annual visits per capita). Young men utilized ambulatory medical care less than adolescents age 15 to 19 years or older adults age 30 to 39 years (1.10, 1.65, and 1.73 annual visits per capita, respectively) and had lower rates of utilization than young women (1.10 vs. 2.31 annual visits per capita). Young black and Hispanic men had considerably fewer annual visits per capita (0.75 and 0.65, respectively) than did young white men (1.21). Young men had nearly one half the preventive care visits compared with male adolescents or older men (0.11, 0.24, and 0.19 annual visits per capita, respectively) and less than one quarter the visits compared with young women (0.11 vs. 0.48 annual visits per capita). Only 30.6% of visits by young adults included any preventive counseling, and few encounters included counseling directed toward injury prevention (2.4%), mental health (4.1%), or sexually transmitted diseases (2.7%). Limitation: School-based clinics were not included, and counseling may be underreported. Conclusion: Young adults use less ambulatory medical care relative to other groups and infrequently receive preventive care directed at the greatest threats to their health. Efforts to ensure appropriate preventive care are needed. Primary Funding Source: None.

Patients who undergo a percutaneous liver biopsy as outpatients should be monitored closely for the development of complications. A percutaneous liver biopsy is a procedure used to diagnosis patients with suspected liver disease or to plan their treatment. This procedure was first used in the late 1800s by a German physician. It did not gain widespread acceptance until after the development of a safer technique in 1957. Physicians first started performing the percutaneous liver biopsy on an outpatient basis in 1966. Patients who undergo a liver biopsy as outpatients are closely monitored for the first six hours following the procedure. A research study found that 3% of patients who underwent a liver biopsy as outpatients developed complications. The complication rate among outpatients may vary depending on the technique used to do the biopsy. Outpatients in more advanced stages of liver disease may have a higher risk of complications than other patients.

* Objective: To determine the safety of outpatient liver biopsies by analyzing the outcome of patients hospitalized for complications. * Design: Retrospective review. * Setting: Large clinic referral center. * Patients: All patients admitted after outpatient liver biopsy at the Mayo Clinic from 1 April 1989 to 1 April 1991. * Results: During this period, 405 outpatients underwent biopsy. Of the 405 patients, 13 (3.2%) were admitted with complications after biopsy. Five patients (38%)were admitted with persistent localized pain, five (38%) with orthostatic hypotension, one (8%) with both pain and hypotension, one (8%) with peritoneal signs, and one (8%) with lightheadedness but no orthostatic changes. All complications were noted within 3 hours after the biopsy. Bleeding, potentially the most serious complication, was radiographically defined in 5 of the 13 patients (38%) admitted. Only two patients, however, required blood transfusions. No patient required invasive management such as surgery or chest tube placement. The average length of the hospital stay was 1.5 days. * Conclusion: Complications after outpatient liver biopsy occur early and rarely require invasive management. Outpatient liver biopsy is safe when done on carefully selected patients in a setting that provides close observation for at least 3 hours after liver biopsy. Annals of Internal Medicine. 1993;118:96-98., Most patients who undergo a percutaneous liver biopsy as an outpatient do not develop any serious complications. A percutaneous liver biopsy is a diagnostic procedure performed on patients suspected of having different types of liver disorders. Among 405 outpatients who underwent a liver biopsy, 13 (3%) were admitted to the hospital after developing complications. Of the patients who developed complications, five (38%) were suffering from localized pain, five (38%) from low blood pressure, one (8%) from localized pain and low blood pressure, one (8%) from lightheadedness and one (8%) from other types of symptoms. All of the patients developed complications within three hours of undergoing a liver biopsy. Two patients received a blood transfusion, and two required treatment with narcotics. None underwent an invasive procedure such as surgery or chest tube placement.