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                  <text>Dominio científico: Coronavirus</text>
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                <text>COVID19: A Systematic Approach to Early Identification and Healthcare Worker Protection</text>
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                <text>Xuezhong Liu, Kun Zhang, Yu Zhao, Carlos del Rio, Bing Chen, Sylvia Daunert, Jin-Fu Xu, Jialin Liu, Guoyou Qin, Susan H. Blanton, Yilai Shu, Joshua M. Hare, Dushyantha T. Jayaweera, Yixiang Huang, Chong Cui, Paul E. Farmer, Eric Nisenbaum, Michael Hoffer, Fred Telischi, Bhavarth Shukla, Savita G. Pahwa</text>
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                <text>The COVID-19 outbreak spread rapidly throughout the globe, with worldwide infections and deaths continuing to increase dramatically. To control disease spread and protect healthcare workers, accurate information is necessary. We searched PubMed and Google Scholar for studies published from December 2019 to March 31, 2020 with the terms “COVID-19,” “2019-nCoV,” “SARS-CoV-2,” or “Novel Coronavirus Pneumonia.” The main symptoms of COVID-19 are fever (83–98.6%), cough (59.4–82%), and fatigue (38.1–69.6%). However, only 43.8% of patients have fever early in the disease course, despite still being infectious. These patients may present to clinics lacking proper precautions, leading to nosocomial transmission, and infection of workers. Potential COVID-19 cases must be identified early to initiate proper triage and distinguish them quickly from similar infections. Early identification, accurate triage, and standardized personal protection protocols can reduce the risk of cross infection. Containing disease spread will require protecting healthcare workers.</text>
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                <text>DOI: 10.3389/fpubh.2020.00205</text>
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                <text>Frontiers in Public Health</text>
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                <text>Frontiers Media S.A.</text>
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                <text>Public aspects of medicine</text>
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                <text>Pharmacological treatment of COVID-19: lights and shadows</text>
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                <text>Nicola Facciolongo, Francesco Menzella, Mirella Biava, Chiara Barbieri, Francesco Livrieri</text>
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                <text>At the end of December 2019, a novel coronavirus, the severe acute respiratory syndrome coronavirus 2, caused an outbreak of pneumonia spreading from Wuhan, Hubei province, to the whole country of China and then the entire world, forcing the World Health Organization to make the assessment that the coronavirus disease (COVID-19) can be characterized as a pandemic, the first ever caused by a coronavirus. To date, clinical evidence and guidelines based on reliable data and randomized clinical trials for the treatment of COVID-19 are lacking. In the absence of definitive management protocols, many treatments for COVID-19 are currently being evaluated and tested worldwide. Some of these options were soon abandoned due to ineffectiveness, while others showed promising results. The basic treatments are mainly represented by antiviral drugs, even if the evidence is not satisfactory. Among the antivirals, the most promising appears to be remdesivir. Corticosteroids and tocilizumab seem to guarantee positive results in selected patients so far, although the timing of starting therapy and the most appropriate therapeutic schemes remain to be clarified. Efficacy of the other drugs is still uncertain, and they are currently used as a cocktail of treatments in the absence of definitive guidelines. What will represent the real solution to the enormous problem taking place worldwide is the identification of a safe and effective vaccine, for which enormous efforts and investments are underway.</text>
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                <text>Pneumonia, corticosteroids, coronavirus, biologics, antivirals, severe acute respiratory syndrome</text>
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                <text>DOI: 10.7573/dic.2020-4-6</text>
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                <text>Drugs in Context</text>
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                <text>BioExcel Publishing Ltd</text>
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                <text>Therapeutics. Pharmacology</text>
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                <text>Robert J. Katzer</text>
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                <text>DOI: 10.5811/westjem.2020.3.47298</text>
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                <text>Western Journal of Emergency Medicine</text>
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                <text>Medicine, Medical emergencies. Critical care. Intensive care. First aid</text>
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                <text>The Appropriate Use of Testing for COVID-19</text>
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                <text>Tony Zitek</text>
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                <text>Many public officials are calling for increased testing for the 2019 novel coronavirus disease (COVID-19), and some governments have taken extraordinary measures to increase the availability of testing. However, little has been published about the sensitivity and specificity of the reverse transcriptase-polymerase chain reaction (RT-PCR) nasopharyngeal swabs that are commonly used for testing. This narrative review evaluates the literature regarding the accuracy of these tests, and makes recommendations based on this literature. In brief, a negative RT-PCR nasopharyngeal swab test is insufficient to rule out COVID-19. Thus, over-reliance on the results of the test may be dangerous, and the push for widespread testing may be overstated.</text>
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                <text>DOI: 10.5811/westjem.2020.4.47370</text>
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                <text>Western Journal of Emergency Medicine</text>
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                <text>Medicine, Medical emergencies. Critical care. Intensive care. First aid</text>
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                  <text>Dominio científico: Coronavirus</text>
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                <text>Healthcare Ethics During a Pandemic</text>
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                <text>Kenneth V. Iserson</text>
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                <text>As clinicians and support personnel struggle with their responsibilities to treat during the current COVID-19 pandemic, several ethical issues have emerged. Will healthcare workers and support staff fulfill their duty to treat in the face of high risks? Will institutional and government leaders at all levels do the right things to help alleviate healthcare workers risks and fears? Will physicians be willing to make hard, resource-allocation decisions if they cannot first husband or improvise alternatives? With our healthcare facilities and governments unprepared for this inevitable disaster, front-line doctors, advanced providers, nurses, EMS, and support personnel struggle with acute shortages of equipment—both to treat patients and protect themselves. With their personal and possibly their family’s lives and health at risk, they must weigh the option of continuing to work or retreat to safety. This decision, made daily, is based on professional and personal values, how they perceive existing risks—including available protective measures, and their perception of the level and transparency of information they receive. Often, while clinicians get this information, support personnel do not, leading to absenteeism and deteriorating healthcare services. Leadership can use good risk communication (complete, widely transmitted, and transparent) to align healthcare workers’ risk perceptions with reality. They also can address the common problems healthcare workers must overcome to continue working (ie, risk mitigation techniques). Physicians, if they cannot sufficiently husband or improvise lifesaving resources, will have to face difficult triage decisions. Ideally, they will use a predetermined plan, probably based on the principles of Utilitarianism (maximizing the greatest good) and derived from professional and community input. Unfortunately, none of these plans is optimal.</text>
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                <text>Introduction: On March 10, 2020, the World Health Organization declared a global pandemic due to widespread infection of the novel coronavirus 2019 (COVID-19). We report the preliminary results of a targeted program of COVID-19 infection testing in the ED in the first 10 days of its initiation at our institution. Methods: We conducted a review of prospectively collected data on all ED patients who had targeted testing for acute COVID-19 infection at two EDs during the initial 10 days of testing (March 10–19, 2020). During this initial period with limited resources, testing was targeted toward high-risk patients per Centers for Disease Control and Prevention guidelines. Data collected from patients who were tested included demographics, clinical characteristics, and test qualifying criteria. We present the data overall and by test results with descriptive statistics. Results: During the 10-day study period, the combined census of the study EDs was 2157 patient encounters. A total of 283 tests were ordered in the ED. The majority of patients were 18–64 years of age, male, non-Hispanic white, had an Emergency Severity Index score of three, did not have a fever, and were discharged from the ED. A total of 29 (10.2%) tested positive. Symptoms-based criteria most associated with COVID-19 were the most common criteria identified for testing (90.6%). All other criteria were reported in 5.51–43.0% of persons being tested. Having contact with a person under investigation was significantly more common in those who tested positive compared to those who tested negative (63% vs 24.5%, respectively). The majority of patients in both results groups had at least two qualifying criteria for testing (75.2%). Conclusion: In this review of prospectively collected data on all ED patients who had targeted testing for acute COVID-19 infection at two EDs in the first 10 days of testing, we found that 10.2% of those tested were identified as positive. The continued monitoring of testing and results will help providers understand how COVID-19 is progressing in the community.</text>
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                <text>DOI: 10.5811/westjem.2020.3.47348</text>
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                <text>As of March 30 th, 2020 there were 161,807 total cases and 2,953 total deaths of SARS-CoV-2 in the United States, with the number of cases expected to rise. Other than supportive care, there are no SARS-CoV-2 specific treatments available for patients discharged from the emergency department (ED) or those admitted to the hospital. In addition, there are no vaccines available to protect our at-risk healthcare workers. The National Institutes of Health is conducting a Phase 1 clinical trial to evaluate for a potential vaccine and the recipients have started to receive the investigational vaccine. 2 We present a brief overview of the potential prophylactic and treatment agents under investigation, some which could be initiated in the ED if proven effective.</text>
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                <text>DOI: 10.5811/westjem.2020.3.47328</text>
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                <text>Western Journal of Emergency Medicine</text>
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                <text>The maintenance of well-being, healthcare, and social connection is crucial for older adults (OA) and has become a topic of debate as much of the world faces lockdown during the coronavirus disease 2019 (COVID-19) pandemic. OAs have been advised to isolate themselves because they are at higher risk for developing serious complications from severe acute respiratory syndrome coronavirus. Additionally, nursing homes and assisted-living facilities across the country have closed their doors to visitors to protect their residents. Mobile technology such as applications (apps) could provide a valuable tool to help families stay connected, and to help OAs maintain mobility and link them to resources that encourage physical and mental well-being. Apps could address cognitive, visual, and hearing impairments. Our objective was to narratively summarize 15 apps that address physical and cognitive limitations and have the potential to improve OAs’ quality of life, especially during social distancing or self-quarantine.</text>
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                <text>Introduction: As of April 5, 2020, the World Health Organization reported over one million confirmed cases and more than 62,000 confirmed coronavirus (COVID-19) deaths affecting 204 countries/regions. The lack of COVID-19 testing capacity threatens the ability of both the United States (US) and low middle income countries (LMIC) to respond to this growing threat, The purpose of this study was to assess the effectiveness through participant self-assessment of a rapid response team (RRT) mobile laboratory curriculum Methods: We conducted a pre and post survey for the purpose of a process improvement assessment in Angola, involving 32 individuals. The survey was performed before and after a 14-day training workshop held in Luanda, Angola, in December 2019. A paired t-test was used to identify any significant change on six 7-point Likert scale questions with α&lt; 0.05 (95% confidence interval). Results: All six of the questions – 1) “I feel confident managing a real laboratory sample test for Ebola or other highly contagious sample;” 2) “I feel safe working in the lab environment during a real scenario;” 3) “I feel as if I can appropriately manage a potentially highly contagious laboratory sample;” 4)“I feel that I can interpret a positive or negative sample during a suspected contagious outbreak;” 5) “I understand basic Biobubble/mobile laboratory concepts and procedures;” and 6) “I understand polymerase chain reaction (PCR) principles” – showed statistical significant change pre and post training. Additionally, the final two questions – “I can more effectively perform my role/position because of the training I received during this course;” and “This training was valuable” – received high scores on the Likert scale. Conclusion: This Angolan RRT mobile laboratory training curriculum provides the nation of Angola with the confidence to rapidly respond and test at the national level a highly infectious contagion in the region and perform on-scene diagnostics. This mobile RRT laboratory provides a mobile and rapid diagnostic resource when epidemic/pandemic resource allocation may need to be prioritized based on confirmed disease prevalence.</text>
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          <element elementId="40">
            <name>Date</name>
            <description>A point or period of time associated with an event in the lifecycle of the resource</description>
            <elementTextContainer>
              <elementText elementTextId="25242">
                <text>2020</text>
              </elementText>
            </elementTextContainer>
          </element>
          <element elementId="43">
            <name>Identifier</name>
            <description>An unambiguous reference to the resource within a given context</description>
            <elementTextContainer>
              <elementText elementTextId="25243">
                <text>DOI: 10.5811/westjem.2020.4.47385</text>
              </elementText>
            </elementTextContainer>
          </element>
          <element elementId="48">
            <name>Source</name>
            <description>A related resource from which the described resource is derived</description>
            <elementTextContainer>
              <elementText elementTextId="25244">
                <text>Western Journal of Emergency Medicine</text>
              </elementText>
            </elementTextContainer>
          </element>
          <element elementId="45">
            <name>Publisher</name>
            <description>An entity responsible for making the resource available</description>
            <elementTextContainer>
              <elementText elementTextId="25245">
                <text>eScholarship Publishing, University of California</text>
              </elementText>
            </elementTextContainer>
          </element>
          <element elementId="38">
            <name>Coverage</name>
            <description>The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant</description>
            <elementTextContainer>
              <elementText elementTextId="25246">
                <text>Medicine, Medical emergencies. Critical care. Intensive care. First aid</text>
              </elementText>
            </elementTextContainer>
          </element>
        </elementContainer>
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