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.
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.
Background Vision 2020: The Right to Sight, was one potential way to deal with the barriers surrounding cataract surgery and improve access to eye care. To this effect, the Magrabi International Council of Ophthalmology (ICO) Cameroon Eye Institute (MICEI) has performed more than 1000 sight-restoring cataract surgeries among patients referred from outreach camps. However, quite a good number of patients diagnosed with cataracts during community screening camps fail to present for surgery. This study sought to explore some of the challenges to accepting cataract surgery among community-diagnosed patients with cataract, patients operated for cataract, and community members. Objective The study objective was 5-fold: (1) to assess the level of awareness about cataract and available treatment, (2) to explore barriers to cataract surgery uptake, (3) to assess people’s perception about the outcome of cataract surgery, (4) to understand people’s perception about free cataract surgery, and (5) to explore reasons for outright refusal of cataract surgery. Methods This was a focused ethnographic study from December 2018 through February 2019 in 3 different communities of the Center Region of Cameroon, in which patients with cataract were diagnosed. The study sample was composed of patients operated for cataract, those diagnosed with cataract, key informants, and community members. Focus group discussions (FGDs), personalized in-depth interviews, and a short demographic questionnaire were used to collect data. Data were analyzed using a Microsoft Excel spreadsheet and Stata 14 (StataCorp). Data were presented using tabular and graphical methods. Results A total of 29 subjects (19 men) with a mean age of 54.5 (SD 14.5) years took part in the study. The most prominent barriers to cataract surgery were found to be cost (25/29, 86%) and fear of surgery (17/29, 59%). It was also noted by 41% (12/29) of subjects that those who do not take up cataract surgery turn to traditional medicine. Other barriers included the lack of awareness of available treatment (6/29, 21%), no perceived need (5/29, 17%), cultural beliefs and superstition (4/29, 14%), and negligence (4/29, 14%). Conclusions We found cost (25/29, 86%) and fear (17/29, 59%) to be the main barriers. Belief in traditional medicine and superstition were the main drivers of fear. The implementation of a tiered pricing system, counseling training for key informants, incentives for the referral of patients with cataract, mass media engagement, advocacy, training and active involvement of traditional doctors as key informants, acquisition of a 4×4 outreach van, and motorbikes for camp organizers were some of the recommendations based on our results.
BACKGROUND Making testing available to everyone and tracing contacts might be the gold standard towards the control of COVID19. Many countries including the UK have relied on symptom-based test and trace in bringing the coronavirus pandemic under control. The effectiveness of a test and trace strategy based on symptoms has been questionable, for failing to meet testing and tracing needs. This is further exacerbated by it not being delivered at point-of-care, leading to rising cases and deaths. Rising COVID-19 cases and the death toll in the UK amid performing the highest number of tests in Europe are suggestive of the fact that symptom-based test and trace might not be effective as a control strategy. An alternative strategy is making testing available to all. This study evaluated the effectiveness of mass testing and contact tracing in the suppression of COVID-19 compared to conventional Test and Trace in the UK. OBJECTIVE The primary objective was to compare mass testing and contact tracing with test and trace in the control of community spread of SARS-CoV-2 infections. The secondary objective was to determine the proportion of asymptomatic cases of SARS-CoV-2 reported during mass testing interventions. METHODS English literature was searched in 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. The tabular and graphical methods were used to present study findings. RESULTS The literature search yielded 286 articles from Google Scholar, 20 from Science Direct, 14 from Mendeley, 27 from Pubmed and 15 through manual search. Altogether 35 articles were included, making a sample size of close to a million participants. This review found a 76.9% (95% CI: 46.2–95.0, P = .09) majority vote in favour of the intervention under the primary objective. The overall proportion of asymptomatic cases among those tested positive and tested sample populations under the secondary objective was 40.7% (95% CI: 38.8–42.5) and 0.01% (95% CI: 0.010–0.012) respectively. CONCLUSIONS There was a very 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. Conventional test and trace should be superseded by decentralised and regular mass rapid testing and contact tracing, championed by GP surgeries and low-cost community services.services
BackgroundMirror 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.MethodsWe 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.ResultsWe 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.DiscussionThis 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 registrationPROSPERO identifier: CRD42021236453.
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