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Poláková K, Brýdlová H, Uhlíř M, Peřan D, Vlčková K, Loučka M. Calling emergency medical services for terminally ill patients: a qualitative study exploring reasons why informal caregivers make the call. Eur J Emerg Med 2024; 31:195-200. [PMID: 38215271 DOI: 10.1097/mej.0000000000001119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
BACKGROUND Although emergency medical service is focused on providing acute prehospital treatment, it is often used by terminally ill patients and their informal caregivers during the last days of patient's life. Little is known about why they decide to use the emergency medical services. STUDY OBJECTIVE The aim was to explore informal caregivers' motivation and decision-making process for calling emergency medical services for their terminally ill loved ones. METHODS This study used a qualitative design. Data were collected by semi-structured interviews with 31 relatives of 30 patients who used the emergency medical services. Data were analyzed with NVivo software by utilizing principles of thematic analysis. RESULTS Through the analysis, four distinct themes emerged: (1) limited availability of support from health care services; (2) insufficient planning of care; (3) decline in the health of the patient and (4) being lost and desperate. CONCLUSION For informal caregivers, emergency medical services represented an important source of support while caring for their terminally ill loved ones due to the limited availability of other sources of help, including a lack of specialist palliative care providers. Additionally, informal caregivers had limited knowledge of the dying process and used emergency medical services for professional advice.
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Affiliation(s)
- Kristýna Poláková
- Centre for Palliative Care
- Division of Medical Psychology, Third Faculty of Medicine, Charles University
| | | | - Marek Uhlíř
- Centre for Palliative Care
- Prague Emergency Medical Services, Prague
| | - David Peřan
- Centre for Palliative Care
- Emergency Medical Services of the Karlovy Vary Region, Karlovy Vary, Czech Republic
- Department of Anaesthesia and Intensive Care Medicine, Charles University, Third Faculty of Medicine and FNKV University Hospital, Prague, Czech Republic
| | - Karolína Vlčková
- Centre for Palliative Care
- Division of Medical Psychology, Third Faculty of Medicine, Charles University
| | - Martin Loučka
- Centre for Palliative Care
- Division of Medical Psychology, Third Faculty of Medicine, Charles University
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Motlová LB, Vlčková K, Prokešová B, Suchánková E, Štirská L, Janoušková M. "I Didn't Expect to Be So Caught Up in It": a Qualitative Study of Experiences of Medical Students' Volunteering for Ukrainian Refugees. Acad Psychiatry 2023; 47:659-662. [PMID: 37991684 DOI: 10.1007/s40596-023-01903-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 11/04/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE Russia's invasion of Ukraine in February 2022 triggered a huge wave of migration, with thousands of refugees arriving at Prague's Central Station. With no medical service available, medical students started to volunteer and were running an infirmary available around the clock. The research aimed to explore medical students' professional experiences, emotionally challenging situations, and coping strategies in this demanding setting. METHODS The authors used a qualitative analysis of semi-structured in-depth interviews with 19 participants recruited through purposive sampling. Interviews took place between April and May 2022. Data were recorded, transcribed, and processed by using thematic qualitative analysis. RESULTS The research identified five emotionally challenging situations: caring for traumatized refugees, refusal of treatment, disruption of everyday life, independent decision-making, and complexity of voluntary work. Students adopted both adaptive and maladaptive coping strategies for dealing with stress and trauma. Almost half the students reported signs of secondary traumatization and moral distress; however, no one asked for psychological help. CONCLUSIONS Medical school curricula should cover trauma-informed approaches, healthy coping strategies, and destigmatization of psychological problems.
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Affiliation(s)
| | - Karolína Vlčková
- Charles University, Prague, Czech Republic
- Center for Palliative Care, Prague, Czech Republic
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Janoušková M, Vlčková K, Harcuba V, Klučková T, Motlová J, Bankovská Motlová L. The Challenges of Inter-role Conflicts for Peer Support Workers. Psychiatr Serv 2022; 73:1424-1427. [PMID: 35538749 DOI: 10.1176/appi.ps.202100566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The definitions of the roles of peer support workers (PSWs) are unclear, creating one of the main challenges to PSWs' successful involvement in mental health care. In this empirical qualitative study conducted in the Czech Republic, four common roles of PSWs (N=15) were identified: friend, professional, staff member, and expert-by-experience. Conflicts were observed between the roles of friend and professional and between staff member and expert-by-experience. These conflicts may have a detrimental effect on the PSWs' well-being. The authors therefore call on organizations to prioritize regular supervision, team education, clear definition of the PSW position within an organization, and the destigmatization of people with mental illness in mental health services.
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Affiliation(s)
- Miroslava Janoušková
- Third Faculty of Medicine, Charles University (all authors), and Center for Palliative Care (Vlčková), Prague
| | - Karolína Vlčková
- Third Faculty of Medicine, Charles University (all authors), and Center for Palliative Care (Vlčková), Prague
| | - Vojtěch Harcuba
- Third Faculty of Medicine, Charles University (all authors), and Center for Palliative Care (Vlčková), Prague
| | - Tereza Klučková
- Third Faculty of Medicine, Charles University (all authors), and Center for Palliative Care (Vlčková), Prague
| | - Julie Motlová
- Third Faculty of Medicine, Charles University (all authors), and Center for Palliative Care (Vlčková), Prague
| | - Lucie Bankovská Motlová
- Third Faculty of Medicine, Charles University (all authors), and Center for Palliative Care (Vlčková), Prague
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Křemenová Z, Vlčková K. Translation, cultural adaptation, and validation of the Integrated Palliative Outcome Scale-renal (IPOS-r) to Czech. Palliat Care 2022; 21:152. [PMID: 36038854 PMCID: PMC9425933 DOI: 10.1186/s12904-022-01044-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 08/23/2022] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND Patients with advanced kidney disease suffer from burdensome symptoms, which should be assessed by valid and reliable patient-reported outcome measures. This study aimed to provide a translation, cultural adaptation, and validation of the Czech version of the IPOS-r. METHODS The IPOS-r was translated to Czech and culturally adapted using cognitive interviews. During the validation phase, patients and staff in dialysis centres and outpatient renal clinics completed the IPOS-r. Internal consistency was tested with Cronbach's alpha, its reliability via intraclass correlation coefficient for total IPOS-r score, and weighted Kappa (for test-retest and interrater reliability of individual items). Convergent validity was tested with Spearman correlation to Kidney Disease Quality of Life Survey-Short Form 1.2 (KDQOL-SF 1.2). We assessed sensitivity to change using a distribution-based approach. RESULTS Two sets of translators independently performed forward and backward translations of the IPOS-r. Ten patients and ten health care professionals participated in cognitive pre-testing. The sample size for validation included 88 patients (mean age 66 ± SD13.8; 58% men) who were treated with haemodialysis (70.5%), home haemodialysis (5.5%), peritoneal dialysis (3%), and conservative management (21%). Cronbach's alpha was 0.72, and the intraclass correlation was 0.84 for test-retest reliability and 0.73 for interrater reliability. The IPOS-r correlated with KDQOL-SF 1.2 had a rho between 0.4-0.8 for most of the IPOS-r items, showing good convergent validity. The IPOS-r measure is feasible and takes 9 minutes to complete. Patients who reported a change in health status after 1 month demonstrated a total IPOS-r score change of eight points in both positive and negative directions. CONCLUSIONS The process of translation and cultural adaptation of the IPOS-r was successful, and the Czech IPOS-r measure is a valid and reliable tool. The Czech IPOS-r can be used to assess symptoms in patients with advanced chronic kidney disease. TRIAL REGISTRATION GAUK [82121].
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Affiliation(s)
- Zuzana Křemenová
- Third Faculty of Medicine, Charles University in Prague, Prague, Czech Republic. .,Kralovske Vinohrady University Hospital in Prague, Šrobárova 50, 10034, Prague, Czech Republic.
| | - Karolína Vlčková
- First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.,Center for Palliative Care, Prague, Czech Republic
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Loučka M, Vlčková K, Tučková A, Poláková K, Houska A, Matějů M, Donátová Z. Prognostic awareness in advanced cancer patients and their caregivers: A longitudinal cohort study. Psychooncology 2021; 30:1449-1456. [PMID: 33864323 DOI: 10.1002/pon.5704] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/13/2021] [Accepted: 04/13/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The aim of this study was to analyse longitudinal development of prognostic awareness in advanced cancer patients and their families. METHODS This was a longitudinal cohort study, involving 134 adult cancer patients, 91 primary family caregivers and 21 treating oncologists. Key eligibility criterion for patients was life expectancy less than 1 year (estimated by their oncologists using the 12-month surprised question). Structured interviews, including tools to measure prognostic awareness, health information needs, and demographics were conducted face to face or via phone three times over 9 months. Forty-four patients completed all three phases of data collection. RESULTS Only 16% of patients reported accurate prognostic awareness, 58% being partially aware. Prognostic awareness of both patients and family caregivers remained stable over the course of the study, with only small non-significant changes. Gender, education, type of cancer, spirituality or health information needs were not associated with the level of prognostic awareness. Family caregivers reported more accurate prognostic awareness, which was not associated with patients' own prognostic awareness (agreement rate 59%, weighted kappa 0.348, CI = 0.185-0.510). CONCLUSIONS Prognostic awareness appears to be a stable concept over the course of the illness. Clinicians must focus on the initial patients' understanding of the disease and be able to communicate the prognostic information effectively from the early stages of patients' trajectory.
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Affiliation(s)
- Martin Loučka
- Center for Palliative Care, Prague, Czech Republic.,Division of Medical Psychology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Karolína Vlčková
- Center for Palliative Care, Prague, Czech Republic.,Division of Medical Psychology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Anna Tučková
- Center for Palliative Care, Prague, Czech Republic.,Department of Sociology, Faculty of Social Science, Charles University, Prague, Czech Republic
| | - Kristýna Poláková
- Center for Palliative Care, Prague, Czech Republic.,Division of Medical Psychology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Adam Houska
- Center for Palliative Care, Prague, Czech Republic.,Division of Medical Psychology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Martin Matějů
- Department of Oncology, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Zuzana Donátová
- Department of Oncology, First Faculty of Medicine and Thomayer Hospital, Charles University, Prague, Czech Republic
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Čelovská D, Vlčková K, Gonsorčík J. Negative association between lipoprotein associated phospholipase A2 activity and baroreflex sensitivity in subjects with high normal blood pressure and a positive family history of hypertension. Physiol Res 2021; 70:183-191. [PMID: 33676381 DOI: 10.33549/physiolres.934467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The relationship between baroreflex sensitivity (BRS) and inflammatory vascular biomarker Lipoprotein associated phospholipase A2 (Lp-PLA2) in subjects with high normal blood pressure (HNBP, prehypertensives) with a positive family history of hypertension (FHH+) and hypertension history free control subjects (FHH-) was evaluated. A total of 24 HNBP participants (age 39.5 ± 2.5 years, 18 male/ 6 female) were studied. 14 HNBP subjects FHH+ were compared to 10 HNBP participants FHH-, being of similar age and body mass index. BRS (ms/mmHg) was determined by the sequence and spectral methods (five-minute non-invasive beat-to-beat recording of blood pressure and RR interval, controlled breathing at a frequency of 0.33 Hz). Venous blood was analyzed for Lp-PLA2 biomarker of vascular inflammation and atherothrombotic activity. A significant negative correlation between spontaneous BRS obtained by both methods and systolic blood pressure (BP) was present (BRS spect r = -0.54, P<0.001, BRS seq r = -0.59, P<0.001). BRS obtained by sequence and spectral methods were reduced in HNBP FHH+ compared to the group of HNBP FHH- (P = 0.0317 BRS seq, P = 0.0395 BRS spect). Lp-PLA2 was significantly higher in HNBP FHH+ compared to FHH- controls (P<0.05). Lp-PLA2 was negatively correlated with BRS obtained by sequence method (r = -0.798, R2 = 0.636, P<0.001) in the HNBP FHH+ subjects. These findings demonstrate that reduced baroreflex sensitivity, as a marker of autonomic dysfunction, is associated with vascular inflammation, predominantly in otherwise healthy participants with a positive family history of hypertension who could predispose to increased risk of hypertension. We conclude that our transversal study suggests that a lowbaroreflex sensitivity could be an early sign of autonomic dysfunction even in the prehypertensive period, and to corroborate these findings, a longitudinal study is needed.
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Affiliation(s)
- D Čelovská
- Department of Internal Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic.
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Houska A, Tučková A, Vlčková K, Poláková K, Loučka M. Optimal participation in decision-making in advanced chronic disease: perspectives of patients, relatives and physicians. Ann Palliat Med 2021; 10:3951-3959. [PMID: 33691440 DOI: 10.21037/apm-20-2368] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 01/21/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Making decisions about health care issues in advanced illness is difficult and the participation of patients and relatives is essential. Most of the studies on shared decision-making focus on the interaction between patient and physician (dyadic interaction), while the role of relatives in triadic decision-making remains less explored. The aim of the study was to investigate the perceived importance of the role of the patient, the physician and the relative in the decision-making from their respective perspectives. METHODS Patients (n=154) with advanced disease, their relatives (n=95) and physicians (n=108) were asked to rank the importance of their roles on the scale from 0 to 10. Differences between respondent groups were examined by ANOVA. A typology of answers was constructed for dyadic and triadic relations and analyzed by descriptive statistics and the chi-square test. RESULTS Physicians rated the importance of patients' role in decision-making significantly higher [mean 9.31; 95% confidence interval (CI): 9.07-9.55] than did patients themselves (mean 7.85; 95% CI: 7.37-8.32), while patients and relatives rated higher the importance of the physicians' role (mean 9.29; 95% CI: 8.98-9.59 and mean 9.20; 95% CI: 8.96-9.45, respectively) than did physicians themselves (mean 8.35; 95% CI: 0.06-8.65). In the analysis of the patient-physician dyadic interaction, patients ranked their role as equally important (44.1%) or more important (11.2%) than the role of physicians. Physicians (56.5%) thought patients should play a more important role. When relatives were included in the analysis, patients either preferred equal role of the three actors (30.2%) or prioritized the role of the physician and the relatives (16.8%), while physicians and relatives prioritized the role of the patient (54.6% and 29.0%, respectively). All results were statistically significant (P<0.05). CONCLUSIONS Physicians and relatives tend to accentuate the active role of patients, while patients mostly prefer shared decision-making. Physicians seem to underestimate the importance of the role of relatives, compared to patients and relatives for whom the participation of relatives in the decision-making is of greater importance. A triadic decision-making model that acknowledges the importance of all three actors should be implemented in decision-making process in advanced illness.
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Affiliation(s)
- Adam Houska
- Center for Palliative Care, Prague, Czech Republic; st Faculty of Medicine, Charles University, Prague, Czech Republic; rd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Anna Tučková
- Center for Palliative Care, Prague, Czech Republic; st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Karolína Vlčková
- Center for Palliative Care, Prague, Czech Republic; st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Kristýna Poláková
- Center for Palliative Care, Prague, Czech Republic; st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Martin Loučka
- Center for Palliative Care, Prague, Czech Republic; st Faculty of Medicine, Charles University, Prague, Czech Republic
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Vlčková K, Ondrušová L, Vachtenheim J, Réda J, Dundr P, Zadinová M, Žáková P, Poučková P. Survivin, a novel target of the Hedgehog/GLI signaling pathway in human tumor cells. Cell Death Dis 2016; 7:e2048. [PMID: 26775700 PMCID: PMC4816174 DOI: 10.1038/cddis.2015.389] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 11/30/2015] [Accepted: 12/01/2015] [Indexed: 12/12/2022]
Abstract
Survivin, an important antiapoptotic protein, is expressed in tumors, whereas in normal tissues the expression of this protein is extremely low, defining a role for survivin as a cancer gene. Survivin exhibits multifunctional activity in tumor cells. However, why survivin expression is sharply and invariably restricted to tumor tissue remains unclear. Here, we identified 11 putative consensus binding sites for GLI transcription factors in the survivin promoter and characterized the promoter activity. Inhibitors of the Hedgehog/GLI pathway, cyclopamine and GANT61, decreased the promoter activity in reporter assays. ΔNGLI2 (which lacks the repressor domain) was the most potent vector in activating the survivin promoter–reporter. Moreover, GANT61, a GLI1/2 inhibitor, repressed endogenous survivin protein and mRNA expression in most cells across a large panel of tumor cell lines. Chromatin immunoprecipitation showed GLI2 binding to the survivin promoter. The ectopic GLI2-evoked expression of endogenous survivin was observed in normal human fibroblasts. GANT61 decreased survivin level in nude mice tumors, mimicking the activity of GANT61 in cultured cells. The immunohistochemistry and double immunofluorescence of human tumors revealed a correlation between the tissue regions showing high GLI2 and survivin positivity. Thus, these results demonstrated that survivin is a classical transcriptional target of GLI2, a Hedgehog pathway signaling effector. This potentially reflects the high expression of survivin in human tumor cells. As the Hedgehog pathway is upregulated in virtually all types of cancer cells, these findings substantially contribute to the explanation of uniform survivin expression in tumors as a potential target for the development of a more effective treatment of cancers through the inhibition of GLI2 to restrain survivin activity.
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Affiliation(s)
- K Vlčková
- Laboratory of Transcription and Cell Signaling, Institute of Medical Biochemistry and Laboratory Diagnostics, Charles University in Prague, 1st Faculty of Medicine, Prague, Czech Republic
| | - L Ondrušová
- Laboratory of Transcription and Cell Signaling, Institute of Medical Biochemistry and Laboratory Diagnostics, Charles University in Prague, 1st Faculty of Medicine, Prague, Czech Republic
| | - J Vachtenheim
- Laboratory of Transcription and Cell Signaling, Institute of Medical Biochemistry and Laboratory Diagnostics, Charles University in Prague, 1st Faculty of Medicine, Prague, Czech Republic
| | - J Réda
- Laboratory of Transcription and Cell Signaling, Institute of Medical Biochemistry and Laboratory Diagnostics, Charles University in Prague, 1st Faculty of Medicine, Prague, Czech Republic
| | - P Dundr
- Institute of Pathology, Charles University in Prague, 1st Faculty of Medicine and General University Hospital in Prague, Prague, Czech Republic
| | - M Zadinová
- Institute of Biophysics and Informatics, Charles University in Prague, 1st Faculty of Medicine, Prague, Czech Republic
| | - P Žáková
- Laboratory of Transcription and Cell Signaling, Institute of Medical Biochemistry and Laboratory Diagnostics, Charles University in Prague, 1st Faculty of Medicine, Prague, Czech Republic
| | - P Poučková
- Institute of Biophysics and Informatics, Charles University in Prague, 1st Faculty of Medicine, Prague, Czech Republic
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El-Hady HMA, Grünwald A, Vlčková K, Zeithammerová J. Clinoptilolite in Drinking Water Treatment for Ammonia Removal. Acta Polytech 2001; 41. [DOI: 10.14311/192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
In most countries today the removal of ammonium ions from drinking water has become almost a necessity. The natural zeolite clinoptiloliteis mined commercially in many parts of the world. It is a selective exchanger for the ammonium cation, and this has prompted its use in water treatment, wastewater treatment, swimming pools and fish farming. The work described in this paper provides dynamic data on cation exchange processes in clinoptilolite involving the NH4 +, Ca+2 and Mg+2 cations. We used material of natural origin – clinoptilolite from Nižný Hrabovec in Slovakia (particle-size 3–5 mm). The breakthrough capacity was determined by dynamic laboratory investigations, and we investigated the influence of thermal pretreatment of clinoptilolite and the concentration of regenerant solution (2, 5, and 10% NaCl). The concentrations of ammonium ion inputs in the tap water that we used were 10, 5, and 2 mg NH4 + l_1 and down to levels below 0.5 mg NH4 + l_1. The experimental results show that repeated pretreatment sufficiently improves the zeolite’s properties, and the structure of clinoptilolite remains unchanged during the loading and regeneration cycles. Ammonium removal capacities were increased by approximately 40 % and 20 % for heat-treated zeolite samples. There was no difference between the regenerates for 10% and 5% NaCl. We conclude that the use of zeolite is an attractive and promising method for ammonium removal.
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El-Hady HMA, Grünwald A, Vlčková K, Zeithammerová J. Lewatit S100 in Drinking Water Treatment for Ammonia Removal. Acta Polytech 2001; 41. [DOI: 10.14311/186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Ammonium nitrogen is the most important form of nitrogen that can cause excessive algal growth and stimulate eutrophication in surface water. The purpose of this study is to investigate the possibility of removing ammonium from drinking water by means of an ion Exchange process. Polymeric Lewatit S100 material (particle-size 0.3–1.2 mm) was used. The breakthrough capacity was determined by dynamic laboratory investigations and the concentration of regenerant solution (5 and 10 % NaCl) was investigated. The concentration of ammonium ion inputs in the tap water that we used were 10, 5 and 2 mg NH4+ l_1 and down to levels below 0.5 mg NH4 + l_1. The experimental results show that the breakthrough capacity was very small at ammonium concentration 2 mg NH4 + l_1 compared to its breakthrough capacity at ammonium concentration 10 mg NH4 + l_1. There was no difference between regeneration by 10 and 5 % NaCl. We conclude that the use of Lewatit S100 is an attractive and promising method for ammonium concentration greater than 5 mg NH4 + l_1 and till 10 mg NH4 + l_1 .
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