ContextThe Controlled Drugs (CD) (Supervision of Management and Use) Regulations 2013 lays out the legislation for monitoring of the management and use of CDs.1 Inaccurate counting and poor record ...keeping of CDs can reduce staff time for patient facing activities.2 It is a national recommendation that visual inspections of stock balance should happen in various time points: periodic volume checks and checks to confirm the balance on completion of a bottle.3 Due to the patient population, a large proportion of the CDs stocked in the Trust are liquid preparations designed for multiple small volume administration. CD discrepancies contribute to over 100 Datix incident reports annually. This is largely due to volume lost during manual manipulation of bottle for dosing and weekly physical measurements undertaken by staff as per the Trust policy. It is estimated that approximately one hour of nursing time per ward/Theatre per week were taken away from clinical care for CD checks. It also introduces contamination risk due to decanting, as well as generating plastic waste associated with volume checking. To mitigate the risk, the Trust’s Medicines Safety Committee (MSC) benchmarked liquid preparations volume checks against other paediatric centres. It was found that most did not undertake routine or physical measurements. Following a Care Quality Commission’s CD National Group recommendation to consider using a calibrated bottle to aid visual inspection and accurate management3, liquid CD rulers with volume increments were explored. CD rulers allow for a volume measurement to be approximated without the need of decanting the bottle. Following MSC’s approval, the implementation of the liquid CD rulers was introduced. Ward stock lists were reviewed, and the manufacturers and brands of each liquid CD preparation was compiled into a database. Training sessions (both virtual and face-to-face) for pharmacy and nursing staff were delivered and facilitated over a period of three months, prior to implementation. The Trust CD policy was updated, and a local guidance developed, with all eventualities covered. This change in practice was communicated via email, nurse practice educators’ network, and the Trust’s medicine safety newsletter. The guidance was updated and uploaded onto the Pharmacy intranet webpage and put up in the clinical areas as a visual aid.Lessons LearnedThe successful introduction of CD rulers have been well received across the Trust. The implementation required extensive support from the Trust’s educational and pharmacy team. Feedback sessions were carried out post implementation and suggestions were used to update the guideline. Although there are financial implications, there has been a reduction in the number of CD discrepancies-related incidents. They have simplified and sped up CD checks and prevent the risks of spillage, contamination, and wastages. However, they cannot be used for opaque bottles and are tailored specifically to that drug, strength, manufacturer, and pack size, giving less flexibility in response to drug contract changes/shortages. A 6-month surveillance will be conducted to fully assess and review this change in practice.ReferencesThe Controlled Drugs (Supervision of Management and Use) Regulations 2013. No. 373. Part 2. Regulation 12. Available at The Controlled Drugs (Supervision of Management and Use) Regulations 2013 (legislation.gov.uk) Accessed 10 June 2022.Care Quality Commission’s (CQC’s) Controlled Drugs National Group. Sub-Group Newsletter – April 2021. Issue number 11. Available at https://content.govdelivery.com/accounts/UKCQC/bulletins/2d6cbb6 Accessed 05 August 2021.National Institute for Health and Care Excellence (NICE). Controlled drugs: safe use and management (NG46). April 2016.
Background and Aims
Type 2 diabetes is an important risk factor for nonalcoholic fatty liver disease (NAFLD) and advanced fibrosis. Current international guidelines recommend the use of noninvasive ...tests as initial assessments for NAFLD, but the role of noninvasive tests as monitoring tools has not been established. We aimed to study the role of transient elastography as a monitoring tool in patients with type 2 diabetes.
Approach and Results
We recruited patients with type 2 diabetes without viral hepatitis or excessive alcohol intake from a complication screening facility in Hong Kong in 2013‐2014 and repeated the assessments in 2016‐2018. The primary endpoint was an increase of liver stiffness measurement (LSM) to ≥10 kPa. The secondary endpoint was the change in the controlled attenuation parameter (CAP). A total of 611 patients with type 2 diabetes and a valid LSM (mean age, 57.7 ± 10.9 years; 342 men 56.0%) were included in this study (568 also had a valid CAP). Overall, there was moderate correlation between the baseline and follow‐up LSM (r = 0.689, P < 0.001). Among 487 patients with a baseline LSM <10 kPa, 21 (4.3%) had a follow‐up LSM ≥10 kPa. Baseline body mass index, alanine aminotransferase (ALT), and ∆ALT were independent factors associated with LSM increase. Among 124 patients with a baseline LSM ≥10 kPa, 70 (56.5%) had a follow‐up LSM <10 kPa. Among 198 patients with a CAP <248 dB/m at baseline, 103 (52.0%) had a CAP increased to ≥248 dB/m.
Conclusions
The prevalence and incidence of NAFLD in patients with type 2 diabetes are high. Although advanced fibrosis is common in this population, few patients progress to advanced fibrosis in 3 years. Future studies should define the optimal surveillance interval in patients with diabetes.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Recently, a group of hepatologists proposed to rename non-alcoholic fatty liver disease (NAFLD) as metabolic associated fatty liver disease (MAFLD) with modified diagnostic criteria. We aimed to ...study the impact of the new definition on the epidemiology of fatty liver disease.
We randomly selected 1013 adults from the Hong Kong census database for clinical assessment, proton-magnetic resonance spectroscopy, and transient elastography. Five hundred sixty-five subjects without fatty liver at baseline underwent follow-up assessment. MAFLD was diagnosed as intrahepatic triglyceride content (IHTG) ≥5% and the presence of overweight/obesity, diabetes, or two other metabolic risk factors, with and without concomitant liver diseases. The diagnosis of NAFLD required the exclusion of concomitant liver diseases; metabolic factors were not considered.
The population prevalence of MAFLD and NAFLD was 25.9% (95% CI 23.2-28.7%) and 25.7% (95% CI 23.1-28.5%), respectively. Among 277 subjects with IHTG ≥5%, 247 (89.2%) fulfilled both the definitions of MAFLD and NAFLD. Fourteen subjects (5.1%) had IHTG ≥5% but did not meet the metabolic criteria of MAFLD. The incidence of MAFLD was 2.8 per 100 person-years at a median interval of 47 months (range 34-60 months). Among 78 subjects with incident NAFLD, 59 (75.6%) met the criteria of MAFLD; only one of the latter, a regular drinker, had liver stiffness ≥10 kPa.
The new definition of MAFLD does not significantly change the prevalence compared with NAFLD, but it may reduce the incidence by 25%. People with hepatic steatosis but not fulfilling the definition of MAFLD unlikely have significant liver disease.
BackgroundThe establishment of the GOSH Medicines Safety Committee (MSC) in 2020 have seen all medicines-related incidents and medicine-related risks in the Trust and Directorate’s risk registers ...being reviewed collectively. Medication-related safety alerts and incidents are shared via the Medicines Matter newsletters to promote Trust learning. In November 2020, it was raised that both methotrexate 2.5 mg and 10 mg tablets are routinely being dispensed for non-haematological/oncological patients which is against national recommendation1. To mitigate the risk, MSC worked with speciality teams (Dermatology, Gastroenterology and Rheumatology) which had resulted in the proposal and implementation of switching all existing non-haematological/oncological patients to 2.5 mg tablets and initiate new patients on only 2.5 mg tablets. The switch has been promoted via the April 2021 newsletter and Specialist Pharmacists assisted the corresponding teams with the switch. All teams reported the completed switch by May 2021. An audit was carried out 2 months post-implementation to assess the success of the switch.MethodDispensing reports for methotrexate 10 mg tablets were compiled between 1st June to 31st July 2021 (post-implementation) and included in the audit. Prescribing indications for 10 mg tablets were reviewed to assess the appropriateness of using these tablets.Target100% of patients dispensed 10 mg tablets were for haematological/oncological indications.Results100% of patients dispensed 10 mg tablets during the investigated period were for haematological/oncological indications.DiscussionThe success of this project proven effective and positive relationship the MSC has with speciality teams to address medicine-related issues and the newsletter continued to act as an effective communication to promote and raise medicine safety issues. This change in practice has addressed the potential harm resulting from errors and unsafe practice, provide standardisation and help avoid unintended medication discrepancies which affect patients across transitions of care. An annual surveillance will be conducted to ensure continued compliance with this new practice.
Based on the L2 Motivational Self System (L2MSS), influences of second language (L2) learners’ performed and self-perceived proficiency on their intended efforts toward L2 learning were evaluated ...with regard to their ideal L2 self and ought-to L2 self. The participants were young Chinese language learners. A total of 121 grade-six ethnic minority students in Hong Kong took proficiency tests in listening and reading comprehension, rated their own Chinese proficiency, and responded to a L2MSS questionnaire. The results of structural equation modeling show that: (1) the students’ self-perceived proficiency was substantially related to their performances, and the influence of performed proficiency on the L2 selves was mediated by self-perceived proficiency; (2) the influence of self-perceived proficiency on the ideal self was substantial, and that on the ought-to self was limited and negligible; and, (3) it was primarily through the mediation of the ideal self that self-perceived proficiency affected intended learning efforts and further achievement in proficiency. The findings suggest a critical role played by the students’ self-perceived proficiency: it is a mediator of the influence of actual proficiency to motivation and a constituent part of the ideal self, which, in turn, promotes proficiency through intended efforts.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Medicines form the largest group of interventions used in children and young people. It also accounts for the highest number of clinical errors. A newsletter ‘Medicines Matter’ designed to support ...good use of medicines within the Trust was introduced in October 2019 and published monthly by Pharmacy. The newsletter, intended to be read by all healthcare professionals, highlights issues and provides updates on all aspects of medicines management. The contents of the newsletter includes incident examples, along with tips in mitigation, new drugs approved by the Drugs & Therapeutic Committee, new resources, MHRA drug safety update, drug shortages, practice and governance issues.A feedback survey was conducted to evaluate its’ effectiveness as a communication forum as well as staff’s views of it. A survey with 9 questions was circulated with the July 2020 edition and answers were collected until September 2020. Sixteen staff members completed the survey where nursing staff dominated (69%), followed by allied health professionals (25%) and medical staff (6%). 80% of participants read every or most issues with the remaining reading some issues. All participants rated the newsletter as good or very good and useful or very useful where at least 60% of the respondents were interested in each of the topics within the newsletter. The content was found to be engaging (53%), educational (80%), informative (100%), fun-to-read (33%) and a quick reference to changes that are happening (7%). A larger percentage (60%) of participants did not know where to find the newsletter and a suggestion were made to include some medication-related success stories and addition of hyperlinks to new resources available. One participant found the layout and format slightly disorientating but the overall response was positive. The feedback suggests that the newsletter provides a good platform to deliver up-to-date information and key communication across the organisation.
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•Indirect non-contact bioleaching of waste lithium ion batteries was investigated.•Batch leaching at ambient temperature only facilitated low leach yields (<10%).•Sequential batch ...leaching improved yields to 50–80 % depending on metal and lixiviant.•Leach yields were further improved by amendment with 100 mM H2SO4.•Preliminary technical and economic feasibility of this method was demonstrated.
Applying biohydrometallurgy for metal extraction and recovery from mixed and polymetallic wastes such as electronic waste is limited due to microbial inhibition at low pulp densities and substrate (iron and sulfur) limitation. Here, we investigated the application of indirect non-contact bioleaching with biogenic ferric iron and sulfuric acid to extract metals from lithium-ion battery (LIB) waste. Results showed that although a single leach stage at ambient temperature only facilitated low leach yields (<10%), leach yields for all metals improved with multiple sequential leach stages (4 × 1 h). Biogenic ferric leaching augmented with 100 mM H2SO4 further enabled the highest leach yields (53.2% cobalt, 60.0% lithium, 48.7% nickel, 81.8% manganese, 74.4% copper). The proposed use of bioreagents is a viable and a more environmentally benign alternative to traditional mineral processing, which could be further improved by appropriate pre-treatment of the LIB waste.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
The reciprocal influences between the development of Chinese-as-a-second-language (CSL) listening and reading comprehension among young learners in Hong Kong were evaluated using a 2-year, three-wave ...longitudinal design. A total of 129 senior primary CSL students were assessed using listening and reading comprehension tests at the end of grades 4, 5, and 6. An autoregressive, cross-lagged model was specified, and it accounted for a substantial portion of variance (more than 60%) in the two comprehension abilities by grades 5 and 6. Path analysis showed that the two comprehension abilities facilitated each other’s development across the years: on controlling for their respective strong autoregressive effects, the two comprehension abilities predicted a unique, substantial variance portion of each other every year. In addition, based on previous studies conducted on readers of both alphabetic languages and Chinese, this study argues the following points: (1) the development of CSL students’ reading comprehension is constrained by their listening comprehension, and (2) the acquisition of Chinese literacy skills may promote students’ listening comprehension by enhancing their linguistic knowledge and awareness.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, ODKLJ, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Ovarian clear cell carcinoma (OCCC) is a type of epithelial ovarian cancer that is strongly associated with endometriosis, resistance against conventional chemotherapy and thus poorer prognosis. The ...expression of inhibitory member of the ASPP family proteins (iASPP) and Polo‐like kinase (PLK)1 were significantly higher in OCCC compared to benign cystadenomas and endometriosis. Both protein expressions were found to correlate with chemoresistance in patients with OCCC while high iASPP expression alone was significantly associated with a poor patient survival. The growth of OCCC cell lines, OVTOKO and KK, were inhibited after iASPP silencing. Such effect was related to senescence triggering as evidenced by increased SA‐β‐Gal staining and p21WAF1/Cip1 expression. Moreover, knockdown of iASPP induced PLK1 downregulation, whereas either genes’ silencing sensitized the cells in response to cisplatin treatment. More prominent apoptosis was induced by cisplatin in OCCC cells after the knockdown of either iASPP or PLK1 as evidenced by the formation of more cleaved caspase 3. Heightened chemosensitivity to cisplatin after iASPP knockdown was further demonstrated in in vivo xenograft model. Additionally, both iASPP and PLK1 were shown to regulate autophagic flux as the induction of LC3B‐II and LC3 puncta were much less in OCCC cells with either knockdown. Importantly, inhibition of autophagy also enhanced chemosensitivity to cisplatin in OCCC cells. These findings strongly imply that iASPP and PLK1 affect the chemoresistance of OCCC via the regulation of autophagy and apoptosis. Both iASPP and PLK1 can be potential therapeutic targets for treating OCCC in combination with conventional chemotherapy.
What's new?
Compared to other ovarian cancer histotypes, ovarian clear cell carcinoma (OCCC) is highly resistant to conventional chemotherapeutic agents. While mechanisms remain unclear, OCCC chemoresistance likely is linked to elevated expression of iASPP, an inhibitory member of the otherwise apoptosis‐stimulating ASPP protein family. Here, expression of both iASPP and polo‐like kinase 1 (PLK1) was correlated with OCCC chemoresistance, while high iASPP expression alone was associated with poor survival in OCCC patients. Sensitivity to cisplatin increased in vitro and in vivo following iASPP knockdown. Further in vitro studies demonstrated a critical role for iASPP and PLK1 in the maintenance of autophagy.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
This study examines the development of the reading comprehension of young learners of Chinese as a second language (CSL) in Hong Kong, with reference to the Simple View of Reading model. The model ...postulates that reading comprehension is a product of decoding and linguistic comprehension. A sample of 121 ethnic minority senior primary students was assessed with Chinese decoding, listening, and reading comprehension tests at grades 4 and 6. The students showed a statistically significant improvement in attainment across the comprehension tests over the years. Results from structural model analysis showed that the students' grade-4 Chinese decoding competence, a latent variable with Chinese character recognition and orthographic knowledge as indicators, was a strong predictor of their reading comprehension attainment by grade 4 and its progress by grade 6, controlling for the influence of listening comprehension at both grades. The findings suggested that acquiring fluent Chinese character recognition skills that build on good orthographic knowledge is crucial for young CSL learners' reading performance. This is argued to have clear implications for implementing a curriculum that better supports students' progress in Chinese literacy.
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BFBNIB, NUK, PILJ, SAZU, UL, UM, UPUK
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