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Bird Fancier's Lung is a type of hypersensitivity pneumonitis, an immunologically mediated lung disease due to repetitive exposure of air-borne avian antigen. This was first described in 1965 and is known as one of the most common causes of hypersensitivity pneumonitis. This case highlights this underdiagnosed etiology of dyspnea, disease presentation and exposure variability, and methods of diagnosis.COVID-19 is the disease caused by SARS-CoV-2 that portends both a relatively high mortality rate as well as high rate of intensive care admission amongst all age groups; however effective therapy remains poorly characterized. Post-transplant patients are especially high risk and underrepresented in the literature. In these patients, cytokine release may play a significant role in the development of acute respiratory distress syndrome, raising the hypothesis that interleukin-6 inhibitors such as tocilizumab may be of benefit. Here, we describe two high-risk post-transplant patients who were treated with single-dose tocilizumab after intubation for moderate acute respiratory distress syndrome secondary to confirmed COVID-19 infection. Both patients recovered rapidly and were successfully extubated and discharged from the hospital without need for supplemental oxygen shortly thereafter, and their clinical improvement correlated with response in interleukin-6 levels. Tocilizumab appears to hold promise for critically ill COVID-19 patients who require mechanical ventilation when given shortly after intubation.The COVID-19 pandemic first affected Lebanon on February 21st, 2020, and one month later it reached Bcharri, a small remote town in northern Lebanon. When similar rural areas with under-equipped facilities and financial limitations are affected, outcomes could be catastrophic, raising the need for meticulous preparation and rapid response. In our study, we describe the different measures taken to prepare this town for the COVID-19 outbreak, as well as our rapid response after the first case was confirmed. We emphasize the distinctions and the needs of rural areas when facing such threats, and the importance of a proactive community and local initiatives. We also detail our contact tracing strategy and massive testing campaign, as well as our early management of patients infected with COVID-19. We hope that our experience can be reproducible in areas with similar rural settings, during the COVID-19 pandemic and future outbreaks.
It is widely accepted that pain is the most common complaint during invasive nursing procedures, which causes anxiety in patients. The purpose of this study was to determine the effect of family presence on the level of pain and anxiety of patients during invasive nursing procedures in an emergency centre in 2019.

The present non-randomized controlled clinical trial was conducted on 70 patients referred to emergency centre at selected hospital affiliated to Kermanshah University of Medical Sciences, Iran, in 2018, who were selected by convenience sampling method and then randomly assigned into two groups of intervention (even days) and control (odd days). The invasive nursing procedure was performed for the intervention group in the family presence for physical and psychological support and for the control group without the family presence. Data collection tools were the Spielberger State-Trait Anxiety Inventory (STAI) and the Visual Analogue Scale (VAS). SPSS version 23 software was used to compare the mean scores of pain and anxiety using independent
-test.

The mean pain score after the invasive procedure had no significant difference between the intervention group (3.9±1.5) and the control group (4.7±1.9) (P=0.073). In the intervention group, the mean score of anxiety after invasive procedure was significantly lower than before the invasive procedure (P=0.028), whereas the control group showed no change (P=0.556).

The family presence during the invasive nursing procedures reduced the anxiety of patients but had no effect on their pain. Emergency nurses can take advantage of family presence during invasive procedures as a non-pharmacological intervention to reduce patients' anxiety.
The family presence during the invasive nursing procedures reduced the anxiety of patients but had no effect on their pain. Emergency nurses can take advantage of family presence during invasive procedures as a non-pharmacological intervention to reduce patients' anxiety.
A Medical Acute Care Unit (MACU) was established at Chris Hani Baragwanath Academic Hospital (CHBAH) to provide comprehensive medical specialist care to the patients presenting with acute medical emergencies. check details Improved healthcare delivery systems at the MACU may result in shorter hospital stays, better outcomes, and less mortality.

The study's objective was to describe the demographics, diagnoses, disease patterns, and outcomes, including patient's mortality, admitted to the MACU at CHBAH.

Records of 200 patients admitted, between March 2015 to August 2015, to the MACU at CHBAH were reviewed. Patient demographics, diagnosis at admission, duration of stay, and outcomes were documented. Patients transferred to the medical ward, the Intensive Care Unit (ICU), or discharge. The leading causes of mortality were documented.

Of the 200 patients, 59% were females. The patients' mean age was 46 (17.2) years, and the mean duration of stay at the MACU was 1.45 (1.25) days. Non-communicable diseases accounted for dmission to the MACU at CHBAH. During the study period, high rates of case improvement, patient discharge, shorter hospital stay, and less mortality were observed. The leading cause of mortality was sepsis related.
Stroke is one of the leading contributors to morbidity and mortality globally. The incidence of stroke is on the increase in Sub-Saharan countries such as South Africa. As stroke is a time-sensitive condition, emergency medical services (EMS) play an important role in the early recognition of stroke. The telephonic application of the FAST (Face, Arm, Speech, Time) assessment has been suggested to screen patients for stroke, but this is not applied consistently. This study aimed to identify the barriers and facilitators to the telephonic application of the FAST assessment.

This retrospective, exploratory study sampled 20 randomly selected emergency calls to a private EMS in South Africa, with suspected stroke. After verbatim self-transcription, data were analysed using inductive content analysis to identify the barriers and facilitators to the application of the FAST assessment. Results were arranged according to themes.

Results indicated that in 15/20 (75%) of the calls, the FAST assessment was successfully applied. Eight barriers under three themes (practical barriers, emotionality, and knowledge and understanding) and three facilitators under one theme (clear communication) were identified. Most notably, language discordance, lack of empathy and caller frustration featured prominently as barriers while caller cooperation and clear instructions were prominent facilitators.

With the barriers known, methods to address these may be constructed. Additional training and credentialing for call-takers may be a reasonable first step. These lessons can likely be applied to other telephonic acuity and recognition algorithms.
With the barriers known, methods to address these may be constructed. Additional training and credentialing for call-takers may be a reasonable first step. These lessons can likely be applied to other telephonic acuity and recognition algorithms.
Stroke is a public health problem worldwide. Community stroke knowledge is crucial to guide the prevention approach. We aimed to evaluate the level of stroke knowledge among the visitors to Emergency Centres (ECs) in the southern region of Tunisia concerning factors of risk, symptoms, and treatment of stroke.

A multicenter cross-sectional survey about stroke knowledge; conducted in five ECs for 10days. All the visitors to these ECs were invited to participate in this survey. In each center, one investigator had to conduct the questionnaire. We used the stroke knowledge test (SKT).

We enrolled 839 participants aged at 44±7years and with an M/F sex-ratio at 0.9. Relatives and mass media were the most reported sources of information about stroke. In 32.3% of cases, the participants had a university schooling level. The upper quartile had an SKT score of 55% or over (n=247; 29.4%). The SKT score was significantly higher in young, female participants, in rural centers, with a university level of schooling and with no reported chronic diseases. Receiving information about stroke through the medium of television or via relatives was an independent predictor of a high SKT score compared with other knowledge sources.

This study emphasises the urgent need for improving the population's knowledge about stroke in Tunisia. These findings may reflect the lack of government policies for education and training on stroke. A national educating program is necessary to implement to increase stroke knowledge.
This study emphasises the urgent need for improving the population's knowledge about stroke in Tunisia. These findings may reflect the lack of government policies for education and training on stroke. A national educating program is necessary to implement to increase stroke knowledge.
Global usage of educational Emergency Medicine (EM) podcasts is popular and ever-increasing. This study aims to explore the desired content, format and delivery characteristics of a potential educational, context-specific Southern African EM podcast, by investigating current podcast usages, trends and preferences among Southern African EM registrars of varying seniority.

We developed an electronic survey - using a combination of existing literature, context-specific specialist-training guidance, and input from local experts - exploring preferred podcast characteristics among EM registrars from four Southern African universities.

The study's response rate was 75%, with 24 of the 39 respondents being junior registrars. Ninety-four percent (94%) of respondents used EM podcasts as an educational medium 64% predominantly using podcasts to supplement a personal EM study program. The primary mode of accessing podcasts was via personal mobile devices (84%). Additionally, respondents preferred a shorter podcast nd content optimised for both Just-in-Time learning.Research is the search for new, generalisable knowledge (Truth in the Universe) to improve our collective ability to correctly diagnose and treat human suffering. In the formal sense, medical research implies both creating new knowledge, and also disseminating that new knowledge as well as putting it into practice. This is the first paper in this Research Primer. It briefly covers why each emergency physician should know and care about research. The paper reminds us that it does not take a physician to do research, but that it is the practicing physician who best knows what new knowledge is needed at the bedside. It introduces the scope of the other papers included in this special issue. The paper reviews the definitions of research and the scope of research practice in emergency medicine; overviews the hows and whys of research, as well as discusses the research question, study justification, literature search and touching on research design.
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