Impact of hospital characteristics on implementation of a Pediatric Early Warning System in resource-limited cancer hospitals

BackgroundPediatric Early Warning Systems (PEWS) aid in identification of deterioration in hospitalized children with cancer but are underutilized in resource-limited settings. Proyecto EVAT is a multicenter quality improvement (QI) collaborative in Latin America to implement PEWS. This study investigates the relationship between hospital characteristics and time required for PEWS implementation.MethodsThis convergent mixed-methods study included 23 Proyecto EVAT childhood cancer centers; 5 hospitals representing quick and slow implementers were selected for qualitative analysis. Semi-structured interviews were conducted with 71 stakeholders involved in PEWS implementation. Interviews were recorded, transcribed and translated to English, then coded using a priori and novel codes. Thematic content analysis explored the impact of hospital characteristics and QI experience on time required for PEWS implementation and was supplemented by quantitative analysis exploring the relationship between hospital characteristics and implementation time.ResultsIn both quantitative and qualitative analysis, material and human resources to support PEWS significantly impacted time to implementation. Lack of resources produced various obstacles that extended time necessary for centers to achieve successful implementation. Hospital characteristics, such as funding structure and type, influenced PEWS implementation time by determining their resource-availability. Prior hospital or implementation leader experience with QI, however, helped facilitate implementation by assisting implementers predict and overcome resource-related challenges.ConclusionsHospital characteristics impact time required to implement PEWS in resource-limited childhood cancer centers; however, prior QI experience helps anticipate and adapt to resource challenges and more quickly implement PEWS. QI training should be a component of strategies to scale-up use of evidence-based interventions like PEWS in resource-limited settings

Enhancing adsorptive removal of diclofenac from aqueous solution: Evaluating organic and inorganic acid treatment of zeolite

This study examined the adsorption capacity of natural zeolite (ZN) and zeolite treated with citric acid (ZCA) and nitric acid (ZNA) to evaluate their effectiveness in removing the pharmaceutical compound diclofenac (DCF) from water in batch experiments. Fourier Transform Infrared Spectroscopy (FTIR) and textural properties (BET) were used to investigate the changes in zeolite resulting from chemical modifications. The findings demonstrate a significant enhancement in surface area, pore volume, and the presence of acidic sites, resulting in an improved adsorption capacity for DCF. The observed increase in the Si/Al ratio following acid treatment suggests the de-alumination of the zeolite. Results have shown an increase in the percentage of DCF adsorbed to 76.8 % from 11.2 % using nitric acid-treated and untreated zeolites, respectively. In comparison, citric acid zeolite achieves 48.9 %. The adsorption kinetic was assessed using pseudo-first and pseudo-second-order models, and it was observed that the pseudo-second-order provided the best fit for all adsorbents. Furthermore, the BET model exhibited the best fit for the adsorption isotherm data. The maximum adsorption capacities were found to follow the order: ZNA (85.9 mg/g) > ZCA (33.6 mg/g) > ZN (14.4 mg/g). These results indicate that the acidic treatment enhances the adsorption capacity of the zeolite, and nitric acid treatment shows the most significant improvement