Implementation research protocol on the national community health policy in Guinea: A sequential mixed-methods study using a decision space approach

The overall goal of this study is to explore the rollout of the community health policy in Guinea in the context of decentralization, and the role of decision space (the decision authority, capacities, and accountability of local officials) in explaining gaps between the policy's conceptualization and actual implementation. The implementation research study will employ a sequential explanatory mixed-methods design. The study will be conducted in 27 communes purposefully selected across the country and include communes where the national community health policy is fully, partially, and not yet being implemented. The quantitative component, based on a survey questionnaire and secondary data, will use ordinary least squares (OLS) multiple regression to compare maternal and child health (MCH) coverage indicators according to the level of policy implementation in the commune. An interrupted time series analysis will be conducted to assess changes in routine MCH service delivery indicators associated with implementation of the community health policy, comparing indicators from one year prior to implementation. OLS regression will be conducted to assess the association between decision space and MCH indicators; all analyses will be carried out in Stata. Findings from the quantitative study will be used to inform the key qualitative questions and areas to explore in greater depth, to develop the interview and focus group guides, and to generate an initial codebook. Qualitative data will be double coded in NVivo by two qualitative analysts, and results generated using thematic analysis. Findings from the quantitative and qualitative components will be integrated and triangulated for interpretation and reporting. Findings and recommendations of this study will inform revisions to the National Community Health Policy to improve its rollout and effectiveness.

C-60 The Efficacy of Weighted Blankets for Quantity and Quality of Sleep in Autism Spectrum Disorder: A Meta-Analysis

Objective

A meta-analysis was computed to assess the efficacy of weighted blanket therapy for improving sleep for children with autism spectrum disorder (ASD). Currently, pressure-based therapies are used to reduce ASD-related sensory concerns as well as to facilitate sleep in these patients; however, few studies have substantiated this use.

Data Selection

A search was conducted on EBSCO Host and Wiley in January 2019, using the terms ASD, weighted blanket, sleep, quality, sensory, anxiety, efficacy, and weighted. Salient selection criteria included: standardized pre- and post–treatment measures, randomized groups, and data that permitted calculations of effect sizes. Exclusion criteria included: bias represented and incomplete data due to participant attrition. The search resulted in 12 studies but following exclusion criteria, six remained. Pertinent data extracted included: sample size, number of nights studied, and pre– and post-measure data.

Data Synthesis

The results were obtained by first calculating the cumulative effect size for quantity and quality of sleep independently, and then comparing the effect sizes. Additionally, a funnel plot was used to identify any publication bias. Overall, quantity and quality of sleep had a small effect compared to controls. Further, there was a slightly higher effect for improved quantity over quality of sleep.

Conclusions

The current analysis slightly favors the use of weighted blankets for improved quantity and quality of sleep in those with ASD. A notable consideration is the substantially low number of studies included. Subsequently, the need for additional treatment research is paramount in order to reflect accurate outcomes and hopefully provide relief for patients with ASD.

Laparoscopic lymphocelectomy: a multi-institutional analysis

PURPOSE

Because symptomatic lymphoceles are infrequent, single center studies generally report small numbers of patients. We report a multi-institutional experience with and long-term outcome following laparoscopic lymphocelectomy in 81 patients.

MATERIALS AND METHODS

Data were obtained from 9 institutions at which at least 5 cases of laparoscopic lymphocelectomy had been performed. Baseline patient demographics, operative time and blood loss, special operative adjunct techniques, postoperative course, convalescence, complications and lymphocele recurrence data were collected and analyzed.

RESULTS

A total of 56 men and 25 women with a mean age of 41 years were included in the study. Lymphocele formed after renal transplantation in 78 patients (96%) and after pelvic lymph node dissection in 3 (4%). Average operating time was 123 minutes with a mean blood loss of 43 ml. Omentopexy was performed in 11 cases (13.6%). No intraoperative stenting of the transplant ureter was performed. Intraoperative complications consisted of laryngospasm, bladder injury, inferior epigastric artery injury and mild renal capsule hematoma in 1 patient each. Conversion to open surgery was required for repair of bladder injury in 1, repair of preexisting hernia in 1, unusually thickened lymphocele wall in 1 and inaccessible lymphocele location in 4 cases. Mean time to ambulation and resumption of regular diet was 1 day, and mean hospital stay was 1.5 days. Postoperative complications included trocar site hernia in 1 and urinary retention in 2. Convalescence averaged 2.5 weeks. During a mean followup of 27 months 5 patients (6%) had lymphocele recurrence.

CONCLUSIONS

Laparoscopic lymphocelectomy is safe, minimally invasive and effective. It is an excellent alternative to the conventional open surgical approach.