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

    Abutineh, Farris / Graetz, Dylan E / Muniz-Talavera, Hilmarie / Ferrara, Gia / Puerto-Torres, Maria / Chen, Yichen / Gillipelli, Srinithya R / Elish, Paul / Gonzalez-Ruiz, Alejandra / Alfonso Carreras, Yvania / Alvarez, Shillel / Arce Cabrera, Daniela / Arguello Vargas, Deiby / Armenta Cruz, Miriam / Barra, Camila / Calderon Sotelo, Patricia / Carpio, Zulma / Chavez Rios, Mayra / Covarrubias, Daniela /
    de Leon Vasquez, Lucy / Diaz Coronado, Rosdali / Fing Soto, Ever Amilcar / Gomez-Garcia, Wendy / Hernandez, Cinthia / Juarez Tobias, María Susana / Leon, Esmeralda / Loeza Oliva, Jose de Jesus / Mendez, Alejandra / Miller, Kenia / Montalvo Cozar, Erika / Negroe Ocampo, Natalia Del Carmen / Penafiel, Eulalia / Pineda, Estuardo / Rios, Ligia / Rodriguez Ordonez, Esperanza / Soto Chavez, Veronica / Devidas, Meenakshi / Agulnik, Asya

    Frontiers in oncology

    2023  Volume 13, Page(s) 1122355

    Abstract: Background: Pediatric 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 ... ...

    Abstract Background: Pediatric 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.
    Methods: This 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
    Results: In 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.
    Conclusions: Hospital 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.
    Language English
    Publishing date 2023-05-03
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2649216-7
    ISSN 2234-943X
    ISSN 2234-943X
    DOI 10.3389/fonc.2023.1122355
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Evaluation of factors leading to poor outcomes for pediatric acute lymphoblastic leukemia in Mexico: a multi-institutional report of 2,116 patients.

    Moreira, Daniel C / González-Ramella, Oscar / Echavarría Valenzuela, Maite / Carrillo, Angela K / Faughnan, Lane / Job, Godwin / Chen, Yichen / Villegas, Cesar / Ellis Irigoyen, Andrea / Barra Urbays, Rosario / Ramírez Martinez, Maribel / Altamirano Alvarez, Eduardo / León Espitia, José Antonio / López Facundo, Norma Araceli / Colunga Pedraza, Julia Esther / Reyes Gutierrez, Flor de María / Aguilar Román, Ana Berenice / Tamez Gómez, Edna Liliana / Portillo Zavala, Claudia Selene /
    Negroe Ocampo, Natalia Del Carmen / Pulido Sanchez, Sandra Guadalupe / Cortés Alva, Deyanira / Casillas Toral, Paola / Salas Villa, Karime / Mendoza Sánchez, Patricia Judith / Pérez Alvarado, Carlos / Tamayo Pedraza, Gabriela / González Zamorano, Margarita / Ávila Alba, José Manuel Ricardo / Becerril Becerril, Jocelyn / Ramírez Durán, Hernán / Sandoval Cabrera, Antonio / Pineda Gordillo, Adolfo / de la Rosa Alonso, Dora Iveth / Mejía Marín, Leonardo Javier / Benítez Can, Leslie de Los Ángeles / Gutiérrez Martinez, Itzel / Jiménez Osorio, Mariana Isabel / Echeandia, Naomi / Casillas, Erika / Guerrero-Gomez, Karla / Devidas, Meenakshi / Friedrich, Paola

    Frontiers in oncology

    2023  Volume 13, Page(s) 1255555

    Abstract: Background and aims: Pediatric acute lymphoblastic leukemia (ALL) survival rates in low- and middle-income countries are lower due to deficiencies in multilevel factors, including access to timely diagnosis, risk-stratified therapy, and comprehensive ... ...

    Abstract Background and aims: Pediatric acute lymphoblastic leukemia (ALL) survival rates in low- and middle-income countries are lower due to deficiencies in multilevel factors, including access to timely diagnosis, risk-stratified therapy, and comprehensive supportive care. This retrospective study aimed to analyze outcomes for pediatric ALL at 16 centers in Mexico.
    Methods: Patients <18 years of age with newly diagnosed B- and T-cell ALL treated between January 2011 and December 2019 were included. Clinical and biological characteristics and their association with outcomes were examined.
    Results: Overall, 2,116 patients with a median age of 6.3 years were included. B-cell immunophenotype was identified in 1,889 (89.3%) patients. The median white blood cells at diagnosis were 11.2.5 × 10
    Conclusion: Outcomes in this multi-institutional cohort describe poor outcomes, influenced by incomplete and inconsistent risk stratification, early toxic death, high on-treatment mortality, and high CNS relapse rate. Adopting comprehensive risk-stratification strategies, evidence-informed de-intensification for favorable-risk patients and optimized supportive care could improve outcomes.
    Language English
    Publishing date 2023-09-18
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2649216-7
    ISSN 2234-943X
    ISSN 2234-943X
    DOI 10.3389/fonc.2023.1255555
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Effect of paediatric early warning systems (PEWS) implementation on clinical deterioration event mortality among children with cancer in resource-limited hospitals in Latin America: a prospective, multicentre cohort study.

    Agulnik, Asya / Muniz-Talavera, Hilmarie / Pham, Linh T D / Chen, Yichen / Carrillo, Angela K / Cárdenas-Aguirre, Adolfo / Gonzalez Ruiz, Alejandra / Garza, Marcela / Conde Morelos Zaragoza, Tania Maria / Soberanis Vasquez, Dora Judith / Méndez-Aceituno, Alejandra / Acuña-Aguirre, Carlos / Alfonso-Carreras, Yvania / Alvarez Arellano, Shillel Yahamy / Andrade Sarmiento, Leticia Aradi / Batista, Rosario / Blasco Arriaga, Erika Esther / Calderon, Patricia / Chavez Rios, Mayra /
    Costa, María Eugenia / Díaz-Coronado, Rosdali / Fing Soto, Ever Amilcar / Gómez García, Wendy Cristhyna / Herrera Almanza, Martha / Juarez Tobías, Maria Susana / León López, Esmeralda Mercedes / López Facundo, Norma Araceli / Martinez Soria, Ruth Angelica / Miller, Kenia / Miralda Méndez, Scheybi Teresa / Mora Robles, Lupe Nataly / Negroe Ocampo, Natalia Del Carmen / Noriega Acuña, Berenice / Osuna Garcia, Alejandra / Pérez Alvarado, Carlos M / Pérez Fermin, Clara Krystal / Pineda Urquilla, Estuardo Enrique / Portilla Figueroa, Carlos Andrés / Ríos Lopez, Ligia Estefanía / Rivera Mijares, Jocelyn / Soto Chávez, Verónica / Suarez Soto, Jorge Iván / Teixeira Costa, Juliana / Tejocote Romero, Isidoro / Villanueva Hoyos, Erika Elena / Villegas Pacheco, Marielba / Devidas, Meenakshi / Rodriguez-Galindo, Carlos

    The Lancet. Oncology

    2023  Volume 24, Issue 9, Page(s) 978–988

    Abstract: Background: Paediatric early warning systems (PEWS) aid in the early identification of clinical deterioration events in children admitted to hospital. We aimed to investigate the effect of PEWS implementation on mortality due to clinical deterioration ... ...

    Abstract Background: Paediatric early warning systems (PEWS) aid in the early identification of clinical deterioration events in children admitted to hospital. We aimed to investigate the effect of PEWS implementation on mortality due to clinical deterioration in children with cancer in 32 resource-limited hospitals across Latin America.
    Methods: Proyecto Escala de Valoración de Alerta Temprana (Proyecto EVAT) is a quality improvement collaborative to implement PEWS in hospitals providing childhood cancer care. In this prospective, multicentre cohort study, centres joining Proyecto EVAT and completing PEWS implementation between April 1, 2017, and May 31, 2021, prospectively tracked clinical deterioration events and monthly inpatient-days in children admitted to hospital with cancer. De-identified registry data reported between April 17, 2017, and Nov 30, 2021, from all hospitals were included in analyses; children with limitations on escalation of care were excluded. The primary outcome was clinical deterioration event mortality. Incidence rate ratios (IRRs) were used to compare clinical deterioration event mortality before and after PEWS implementation; multivariable analyses assessed the correlation between clinical deterioration event mortality and centre characteristics.
    Findings: Between April 1, 2017, and May 31, 2021, 32 paediatric oncology centres from 11 countries in Latin America successfully implemented PEWS through Proyecto EVAT; these centres documented 2020 clinical deterioration events in 1651 patients over 556 400 inpatient-days. Overall clinical deterioration event mortality was 32·9% (664 of 2020 events). The median age of patients with clinical deterioration events was 8·5 years (IQR 3·9-13·2), and 1095 (54·2%) of 2020 clinical deterioration events were reported in male patients; data on race or ethnicity were not collected. Data were reported per centre for a median of 12 months (IQR 10-13) before PEWS implementation and 18 months (16-18) after PEWS implementation. The mortality rate due to a clinical deterioration event was 1·33 events per 1000 patient-days before PEWS implementation and 1·09 events per 1000 patient-days after PEWS implementation (IRR 0·82 [95% CI 0·69-0·97]; p=0·021). In the multivariable analysis of centre characteristics, higher clinical deterioration event mortality rates before PEWS implementation (IRR 1·32 [95% CI 1·22-1·43]; p<0·0001), being a teaching hospital (1·18 [1·09-1·27]; p<0·0001), not having a separate paediatric haematology-oncology unit (1·38 [1·21-1·57]; p<0·0001), and having fewer PEWS omissions (0·95 [0·92-0·99]; p=0·0091) were associated with a greater reduction in clinical deterioration event mortality after PEWS implementation; no association was found with country income level (IRR 0·86 [95% CI 0·68-1·09]; p=0·22) or clinical deterioration event rates before PEWS implementation (1·04 [0·97-1·12]; p=0·29).
    Interpretation: PEWS implementation was associated with reduced clinical deterioration event mortality in paediatric patients with cancer across 32 resource-limited hospitals in Latin America. These data support the use of PEWS as an effective evidence-based intervention to reduce disparities in global survival for children with cancer.
    Funding: American Lebanese Syrian Associated Charities, US National Institutes of Health, and Conquer Cancer Foundation.
    Translations: For the Spanish and Portuguese translations of the abstract see Supplementary Materials section.
    MeSH term(s) Child ; Humans ; Male ; Child, Preschool ; Adolescent ; Clinical Deterioration ; Cohort Studies ; Prospective Studies ; Latin America/epidemiology ; Neoplasms/therapy ; Hospitals
    Language English
    Publishing date 2023-07-08
    Publishing country England
    Document type Multicenter Study ; Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 2049730-1
    ISSN 1474-5488 ; 1470-2045
    ISSN (online) 1474-5488
    ISSN 1470-2045
    DOI 10.1016/S1470-2045(23)00285-1
    Database MEDical Literature Analysis and Retrieval System OnLINE

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