RESUMEN
BACKGROUND: Amid all public health measures to contain COVID-19, the most challenging has been how to break the transmission chain. This has been even more challenging in low- and middle-income countries (LMICs). A public health emergency warrants a public health perspective, which comes down to prevention. Rapid mass testing has been advocated throughout the pandemic as a way to promptly deal with asymptomatic infections, but its usefulness in LMICs is yet to be fully understood. OBJECTIVE: The study objectives of this paper are to (1) investigate the impact of the different rapid mass testing options for SARS-CoV-2 that have been delivered at point of care in LMICs and (2) evaluate the diagnostic safety (accuracy) of rapid mass testing for SARS-CoV-2 in LMICs. METHODS: This review will systematically search records in PubMed, EBSCOhost, Cochrane library, Global Index Medicus COVID-19 Register, and Scopus. Records will be managed using Mendeley reference manager and SWIFT-Review. Risk of bias for randomized controlled trials will be assessed using the RoB 2 assessment tool, while nonrandomized interventions will be assessed using the tool developed by the Evidence Project. A narrative approach will be used to synthesize data under the first objective, and either a meta-analysis or synthesis without meta-analysis for the second objective. Tables, figures, and textual descriptions will be used to present findings. The overall body of evidence for the first objective will be assessed using the Grading of Recommendations Assessment, Development, and Evaluation-Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) approach, and for the second objective using GRADE. RESULTS: The screening of records has been finalized. We hope to finalize the synthesis by the end of February 2023 and to prepare the manuscript for publication by April 2023. The study will be reported in accordance with standard guidelines for the reporting of systematic reviews. Review results will be disseminated through conferences and their peer-reviewed publication in a relevant journal. CONCLUSIONS: This review highlights the role of a preventive approach in infection control using rapid mass testing. It also flags the overriding need to involve users and providers in the evaluation of such tests in the settings for which they are intended. This will be the first review to the best of our knowledge to generate both qualitative and quantitative evidence regarding rapid mass testing specific to LMICs. TRIAL REGISTRATION: PROSPERO CRD42022283776; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=283776. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/41132.
RESUMEN
Background: Mirror neuron system (MNS) consists of visuomotor neurons that are responsible for the mirror neuron activity (MNA), meaning that each time an individual observes another individual performing an action, these neurons encode that action, and are activated in the observer's cortical motor system. Previous studies report its malfunction in autism, opening doors to investigate the underlying pathophysiology of the disorder in a more elaborate way and coming up with new rehabilitation methods. The study of MNA function in schizophrenia patients has not been as frequent and conclusive as in autism. In this research, we aimed to evaluate the functional integrity of MNA and the microstructural integrity of MNS in schizophrenia patients. Methods: We included case-control studies that have evaluated MNA in schizophrenia patients compared to healthy controls using a variety of objective assessment tools. In August 2022, we searched Embase, PubMed, and Web of Science for eligible studies. We used an adapted version of the NIH Quality Assessment of Case-Control Studies tool to assess the quality of the included studies. Evidence was analyzed using vote counting methods of the direction of the effect and was tested statistically using the Sign test. Certainty of evidence was assessed using CERQual. Results: We included 32 studies for the analysis. Statistical tests revealed decreased MNA (p = 0.002) in schizophrenia patients. The certainty of the evidence was judged to be moderate. Investigations of heterogeneity revealed a possible relationship between the age and the positive symptoms of participants in the included studies and the direction of the observed effect. Discussion: This finding contributes to gaining a better understanding of the underlying pathophysiology of the disorder by revealing its possible relation to some of the symptoms in schizophrenia patients, while also highlighting a new commonality with autism. Systematic review registration: PROSPERO identifier: CRD42021236453.
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BACKGROUND: Waiting time can considerably increase the cost to both the clinic and the patient and be a major predictor of the satisfaction of eye care users. Efficient management of waiting time remains as a challenge in hospitals. Waiting time management will become even more crucial in the postpandemic era. A key consideration when improving waiting time is the involvement of eye care users. This study aimed at improving patient waiting time and satisfaction through the use of Plan-Do-Study-Act (PDSA) quality improvement cycles. OBJECTIVE: The objectives of this study were to determine the waiting time and patient satisfaction, measure the association between waiting time and patient satisfaction, and determine the effectiveness of the PDSA model in improving waiting time and satisfaction. METHODS: This was a pre-post quality improvement study among patients aged 19 to 80 years, who are consulting with the Magrabi International Council of Ophthalmology Cameroon Eye Institute. We used PDSA cycles to conduct improvement audits of waiting time and satisfaction over 6 weeks. A data collection app known as Open Data Kit (Get ODK Inc) was used for real-time tracking of waiting, service, and idling times at each service point. Participants were also asked whether they were satisfied with the waiting time at the point of exit. Data from 51% (25/49) preintervention participants and 49% (24/49) postintervention participants were analyzed using Stata 14 at .05 significance level. An unpaired 2-tailed t test was used to assess the statistical significance of the observed differences in times before and after the intervention. Logistic regression was used to examine the association between satisfaction and waiting time. RESULTS: In total, 49 participants were recruited with mean age of 49 (SD 15.7) years. The preintervention mean waiting, service, and idling times were 450 (SD 96.6), 112 (SD 47), and 338 (SD 98.1) minutes, respectively. There was no significant association between patient waiting time and satisfaction (odds ratio 1, 95% CI 0.99-1; P=.37; χ23=0.4). The use of PDSA led to 15% (66 minutes/450 minutes) improvement in waiting time (t47=2; P=.05) and nonsignificant increase in patient satisfaction from 32% (8/25) to 33% (8/24; z=0.1; P=.92). CONCLUSIONS: Use of PDSA led to a borderline statistically significant reduction of 66 minutes in waiting time over 6 weeks and an insignificant improvement in satisfaction, suggesting that quality improvement efforts at the clinic have to be made over a considerable period to be able to produce significant changes. The study provides a good basis for standardizing the cycle (consultation) time at the clinic. We recommend shortening the patient pathway and implementing other measures including a phasic appointment system, automated patient time monitoring, robust ticketing, patient pathway supervision, standard triaging, task shifting, physician consultation planning, patient education, and additional registration staff.
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BACKGROUND: Making testing available to everyone and tracing contacts might be the gold standard to control COVID-19. Many countries including the United Kingdom have relied on the symptom-based test and trace strategy in bringing the COVID-19 pandemic under control. The effectiveness of a test and trace strategy based on symptoms has been questionable and has failed to meet testing and tracing needs. This is further exacerbated by it not being delivered at the point of care, leading to rising cases and deaths. Increases in COVID-19 cases and deaths in the United Kingdom despite performing the highest number of tests in Europe suggest that symptom-based testing and contact tracing might not be effective as a control strategy. An alternative strategy is making testing available to all. OBJECTIVE: The primary objective of this review was to compare mass testing and contact tracing with the conventional test and trace method in the suppression of SARS-CoV-2 infections. The secondary objective was to determine the proportion of asymptomatic COVID-19 cases reported during mass testing interventions. METHODS: Literature in English was searched from September through December 2020 in Google Scholar, ScienceDirect, Mendeley, and PubMed. Search terms included "mass testing," "test and trace," "contact tracing," "COVID-19," "SARS-CoV-2," "effectiveness," "asymptomatic," "symptomatic," "community screening," "UK," and "2020." Search results were synthesized without meta-analysis using the direction of effect as the standardized metric and vote counting as the synthesis metric. A statistical synthesis was performed using Stata 14.2. Tabular and graphical methods were used to present findings. RESULTS: The literature search yielded 286 articles from Google Scholar, 20 from ScienceDirect, 14 from Mendeley, 27 from PubMed, and 15 through manual search. A total of 35 articles were included in the review, with a sample size of nearly 1 million participants. We found a 76.9% (10/13, 95% CI 46.2%-95.0%; P=.09) majority vote in favor of the intervention under the primary objective. The overall proportion of asymptomatic cases among those who tested positive and in the tested sample populations under the secondary objective was 40.7% (1084/2661, 95% CI 38.9%-42.6%) and 0.0% (1084/9,942,878, 95% CI 0.0%-0.0%), respectively. CONCLUSIONS: There was low-level but promising evidence that mass testing and contact tracing could be more effective in bringing the virus under control and even more effective if combined with social distancing and face coverings. The conventional test and trace method should be superseded by decentralized and regular mass rapid testing and contact tracing, championed by general practitioner surgeries and low-cost community services.
