tag:blogger.com,1999:blog-22987189002661114812024-02-07T14:38:20.871+08:00*** I am who I am ***生一念好心,结一分好缘HYYhttp://www.blogger.com/profile/16141502157494340810noreply@blogger.comBlogger64125tag:blogger.com,1999:blog-2298718900266111481.post-28794519587007995582014-10-19T14:28:00.001+08:002014-10-19T14:28:08.318+08:00Drug drug interaction<div style="text-align: justify;">
My friend, XY is a counsellor. She has a client who was taking Valdoxan (agomelatine) and Seroquel (Quetiapine) for depression. Recently her client was stress and smoke marijuana / cannabis at the same time. XY asked whether there are any drug-drug interaction among these 3 drugs and can that cause panic attack in her client? </div>
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Identify drug-drug interaction on a prescription is also one of the job of pharmacist. 90% of the time, drug-drug interaction was not significant and thus do not require any adjustment but just closer monitoring. However, sometime, drug-drug interaction require some of the drugs on the prescription to be changed to a safer alternative.</div>
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A check on agomelatine showed that this drug is available in Malaysia. It is a melatonin type of antidepressant from Servier company. It is often used as 25mg once daily at bedtime. As it is a CYP1A2 substrate, the drug is not suitable to be co-administered with flucoxamine and ciprofloxacin, which are potent CYP1A2 inhibitor. </div>
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There are few drug interaction checker available online and on mobile apps. The reliable one include www.drugs.com, MIMS gateway and Micromedex drug interaction checker. Upon entering the 3 drugs in the checker found that interaction exist between quetiapine and cannabis. Using both agents together increase sedation, drowsiness and dizziness. The patient will also not able to concentrate and has trouble making judgment. Panic attack is not listed in it and may require further search on certain case reports or other literature. </div>
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Pharmacists often overlook drug-drug interaction due to lack of knowledge and not familiar with the prescribed medications. Regular updates on drugs, using interaction checker and create pop-up messages in the computer system will help us in identifying these interaction.</div>
HYYhttp://www.blogger.com/profile/16141502157494340810noreply@blogger.com0tag:blogger.com,1999:blog-2298718900266111481.post-71183801744053059572014-08-02T16:51:00.002+08:002014-10-24T23:57:06.904+08:00当药剂师进军饮食业<br />
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<span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; line-height: 150%; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: SimSun; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">静脉营养 (Parenteral Nutrition)是把一种特别配置的营养液,透过管子从血管(静脉)输送全身的营养補助法。由于营养液不是透过嘴巴进入身体,无须经过咀嚼和肠胃的消化,因此也称作肠外营养。</span><span style="font-size: 14pt; line-height: 150%;"><o:p></o:p></span></div>
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<span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; line-height: 150%; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: SimSun; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">我们每天所吃的食物都必须经过肠胃的消化和吸收,才能转换成身体所需的能量。举个例子,米饭中的碳水化和物,肉类中的蛋白质,食物中的油脂;都必须转换成葡萄糖(</span><span style="font-size: 14pt; line-height: 150%;"><span style="font-family: Calibri;">glucose</span></span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; line-height: 150%; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: SimSun; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">),氨基酸(</span><span style="font-size: 14pt; line-height: 150%;"><span style="font-family: Calibri;">amino
acids</span></span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; line-height: 150%; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: SimSun; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)和脂肪酸(</span><span style="font-family: Calibri;"><span style="font-size: 14pt; line-height: 150%;">fatty acid</span><span lang="EN-US" style="font-size: 14pt; line-height: 150%; mso-ansi-language: EN-US;">s</span></span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; line-height: 150%; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: SimSun; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)才能被身体所吸收和使用。因此,一旦肠胃功能出现问题,并在超过七天都无法进食,我们就必须通过其他途径去供应病人身体所需的能量。这些病人包括:患有肠癌的病人,因为肿瘤太大而造成肠阻塞;一些因为早产而体重过轻,并还无法用母乳喂养的婴儿;患有溃疡性结肠炎的病人;一些肠胃功能正常,但是却营养不良,并需要进行各项治疗和手术的癌症病人等等。</span><span style="font-size: 14pt; line-height: 150%;"><o:p></o:p></span></div>
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<span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; line-height: 150%; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: SimSun; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">医院里提供静脉营养的服务,通常是由一队称为营养支持小组(</span><span style="font-size: 14pt; line-height: 150%;"><span style="font-family: Calibri;">nutrition support team</span></span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; line-height: 150%; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: SimSun; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)的医务人员所负责。小组里有医生,药剂师,护士和营养师。药剂师主要的职责包括负责营养液的调配与供应。静脉营养所使用的营养液究竟是何方神圣?其实营养液的包装,类似我们在路边摊向小贩购买的汽水;</span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; line-height: 150%; mso-ansi-language: EN-US; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: SimSun; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">那种</span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; line-height: 150%; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: SimSun; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">装入塑胶袋,用塑胶绳绑起一角,并在另一角插入吸管的包装饮料。只是,其分别在于路边摊的饮料是喝进肚子,经过消化才能转换成葡萄糖被吸收。可是营养液却是直接输入静脉,并含有能够直接被人体使用的多种营养元素:如葡萄糖,蛋白质,脂肪酸</span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; line-height: 150%; mso-ansi-language: EN-US; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: SimSun; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,</span><span lang="ZH-CN" style="font-size: 14pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="font-family: Calibri;"> </span></span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; line-height: 150%; mso-ansi-language: EN-US; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: SimSun; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">电解质(</span><span lang="EN-US" style="font-size: 14pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="font-family: Calibri;">electrolytes</span></span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; line-height: 150%; mso-ansi-language: EN-US; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: SimSun; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)</span><span lang="EN-US" style="font-size: 14pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="font-family: Calibri;">, </span></span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; line-height: 150%; mso-ansi-language: EN-US; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: SimSun; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">矿物质</span><span lang="EN-US" style="font-size: 14pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="font-family: Calibri;">(minerals)</span></span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; line-height: 150%; mso-ansi-language: EN-US; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: SimSun; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,微量元素(</span><span lang="EN-US" style="font-size: 14pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="font-family: Calibri;">trace
elements</span></span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; line-height: 150%; mso-ansi-language: EN-US; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: SimSun; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">),</span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; line-height: 150%; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: SimSun; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">无需像其他食物般需要经过冗长的消化过程。</span><span style="font-size: 14pt; line-height: 150%;"><o:p></o:p></span></div>
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<span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; line-height: 150%; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: SimSun; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">市面上有两种商业配方的三合一和二合一包装营养液供医务人员选购。但是,当病人的情况比较特殊,或当商业配方不适合,就需要人工配置处方的营养液。药剂师就是负责按照医疗团队所定下的处方,根据病人的身高体重,体内电解质,肾脏和肝脏功能等等,计算出病人所需的卡路里和其他营养,混合原料并包装。我们必须在特别的配置室里(</span><span style="font-size: 14pt; line-height: 150%;"><span style="font-family: Calibri;">clean room</span></span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; line-height: 150%; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: SimSun; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)穿上类似太空装,将原料以特定的排列混合。由于营养液是直接透入血管,所以其制作过程非常严谨,以便降低微生物,细菌和毒素的污染,并确保混合后营养液的安全和稳定性。</span><span style="font-size: 14pt; line-height: 150%;"><o:p></o:p></span></div>
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<span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; line-height: 150%; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: SimSun; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">尽管静脉营养補助法有许多好处,能帮助病人在短期内取得所需的能量,但它从来都不是提供营养的最佳途径,家属不应要求医生为病人输入营养液。如果病人情况允许,医疗团队通常都会先通过插管直达肠胃的方法,把流质食物送入病人肠胃(管灌,</span><span style="font-size: 14pt; line-height: 150%;"><span style="font-family: Calibri;">tube feeding</span></span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; line-height: 150%; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: SimSun; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)或鼓励病人口服食物(</span><span style="font-size: 14pt; line-height: 150%;"><span style="font-family: Calibri;">oral
feeding</span></span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; line-height: 150%; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: SimSun; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。因为这种经过消化系统的方法更符合人的生理状态,而保护肠胃功能。</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhH8qJEFaAATiUw9qeu0T41X92G_dPQOBDeEvKg2potLiPeTHXi00y2o1wWgNW3rah9xevCdXt2fCwfIMweCVT7TktYb3ytcegWuE7NHXL6MPP8VwBhdHt4lxj4sJPVdWVUxClwfJthKoE/s1600/TPN+article_oriental+daily.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhH8qJEFaAATiUw9qeu0T41X92G_dPQOBDeEvKg2potLiPeTHXi00y2o1wWgNW3rah9xevCdXt2fCwfIMweCVT7TktYb3ytcegWuE7NHXL6MPP8VwBhdHt4lxj4sJPVdWVUxClwfJthKoE/s1600/TPN+article_oriental+daily.jpg" height="155" width="320" /></a></div>
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HYYhttp://www.blogger.com/profile/16141502157494340810noreply@blogger.com0tag:blogger.com,1999:blog-2298718900266111481.post-49275774789839330462014-04-08T23:01:00.001+08:002014-08-02T17:22:48.521+08:00孕妇可以吃药吗?<span lang="ZH-CN" style="font-family: SimSun; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: SimSun; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><span lang="ZH-CN" style="font-family: SimSun; mso-bidi-font-family: SimSun;"><span style="font-family: Times New Roman;">
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<span lang="ZH-CN" style="font-family: SimSun; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: SimSun; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><span lang="ZH-CN" style="font-family: SimSun; mso-bidi-font-family: SimSun;"><span style="font-family: Times New Roman;"><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; mso-bidi-font-family: SimSun;">每一个准妈妈的怀孕历程都不同。有的和平时一样,</span><span lang="ZH-CN" style="font-family: "Arial","sans-serif"; font-size: 14pt;"> </span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; mso-bidi-font-family: SimSun;">就像美国一个距离预产期两个星期的孕妇竟然还能挺着大肚子举重。</span><span lang="ZH-CN" style="font-family: "Arial","sans-serif"; font-size: 14pt;"> </span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; mso-bidi-font-family: SimSun;">可是有的孕妇却在怀孕期间吃尽了苦头,身体不断出状况。而在怀孕期间生病能吃药吗?</span><span lang="ZH-CN" style="font-family: "Arial","sans-serif"; font-size: 14pt;"> </span><span style="font-family: "Arial","sans-serif"; font-size: 14pt;"><o:p></o:p></span><br />
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<span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; mso-bidi-font-family: SimSun;">其实,并不是所有的药物都对胎儿有害。根据世界卫生组织网站</span><span style="font-family: "Arial","sans-serif"; font-size: 14pt;">2014</span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; mso-bidi-font-family: SimSun;">年</span><span style="font-family: "Arial","sans-serif"; font-size: 14pt;">1</span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; mso-bidi-font-family: SimSun;">月的资料显示,每</span><span style="font-family: "Arial","sans-serif"; font-size: 14pt;">33</span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; mso-bidi-font-family: SimSun;">个婴儿当中,有一个会患有先天性疾病或身体缺陷。药物所导致</span><span lang="ZH-CN" style="font-family: "Arial","sans-serif"; font-size: 14pt;"> </span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; mso-bidi-font-family: SimSun;">的先天性异常只占了少数一部分。其他因素如营养不良,遗传,传染病,化学品,高剂量辐射,烟,酒和环境等因素其实更为普遍。而这当中有一半以上都很难找出</span><span lang="ZH-CN" style="font-family: "Arial","sans-serif"; font-size: 14pt;"> </span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; mso-bidi-font-family: SimSun;">具体的原因。</span><span lang="ZH-CN" style="font-family: "Arial","sans-serif"; font-size: 14pt;">
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<span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; mso-bidi-font-family: SimSun;">为了孕妇的安全,不同国家把药物在怀孕期间分类的方法都不同。我国根据美国食品和药物管理局</span><span style="font-family: "Arial","sans-serif"; font-size: 14pt;"> (FDA) </span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; mso-bidi-font-family: SimSun;">的标准,把药物分类成</span><span style="font-family: "Arial","sans-serif"; font-size: 14pt;">A,
B, C, D, X </span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; mso-bidi-font-family: SimSun;">五个等级。</span><span style="font-family: "Arial","sans-serif"; font-size: 14pt;">A</span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; mso-bidi-font-family: SimSun;">和</span><span style="font-family: "Arial","sans-serif"; font-size: 14pt;">B</span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; mso-bidi-font-family: SimSun;">级的药物一般都可安全使用,</span><span style="font-family: "Arial","sans-serif"; font-size: 14pt;">C</span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; mso-bidi-font-family: SimSun;">和</span><span style="font-family: "Arial","sans-serif"; font-size: 14pt;">D</span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; mso-bidi-font-family: SimSun;">级的药物则可能会对胎儿造成损害,可是却对孕妇的病况有益。而</span><span style="font-family: "Arial","sans-serif"; font-size: 14pt;">X</span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; mso-bidi-font-family: SimSun;">级的药品属于怀孕中禁止被使用的药物如</span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; mso-ansi-language: EN-US; mso-bidi-font-family: SimSun;">口服</span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; mso-bidi-font-family: SimSun;">暗疮药</span><span lang="EN-US" style="font-family: SimSun; font-size: 14pt; mso-ansi-language: EN-US; mso-bidi-font-family: SimSun;">isotretinoin</span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; mso-bidi-font-family: SimSun;">。</span><span lang="ZH-CN" style="font-family: "Arial","sans-serif"; font-size: 14pt;"> </span><span style="font-family: "Arial","sans-serif"; font-size: 14pt;"><o:p></o:p></span><br />
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<span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; mso-bidi-font-family: SimSun;">除了药物的等级,其他因素如药物的剂量,持续服用的时间和在哪一个怀孕周期服用都会对胎儿有影响。在卵子受精后</span><span style="font-family: "Arial","sans-serif"; font-size: 14pt;">20</span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; mso-bidi-font-family: SimSun;">至</span><span style="font-family: "Arial","sans-serif"; font-size: 14pt;">55</span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; mso-bidi-font-family: SimSun;">天,或停经后</span><span style="font-family: "Arial","sans-serif"; font-size: 14pt;">5</span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; mso-bidi-font-family: SimSun;">至</span><span style="font-family: "Arial","sans-serif"; font-size: 14pt;">10</span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; mso-bidi-font-family: SimSun;">周是胎儿器</span><span lang="ZH-CN" style="font-family: "Arial","sans-serif"; font-size: 14pt;">
</span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; mso-bidi-font-family: SimSun;">官成型期</span><span style="font-family: "Arial","sans-serif"; font-size: 14pt;">
(organogenesis) </span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; mso-bidi-font-family: SimSun;">。在这时期,孕妇不应擅自服药。有的时候,同样的一种药物在怀孕早期的和晚期会带来不同的影响。</span><span lang="ZH-CN" style="font-family: "Arial","sans-serif"; font-size: 14pt;"> </span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; mso-ascii-font-family: Arial; mso-bidi-font-family: Arial; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Arial;">比如在怀孕早期,孕妇并不适合服用有</span><span lang="EN-US" style="font-family: SimSun; font-size: 14pt; mso-ansi-language: EN-US; mso-bidi-font-family: SimSun;">pseudoephedrine</span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; mso-ansi-language: EN-US; mso-bidi-font-family: SimSun;">成分的</span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; mso-ascii-font-family: Arial; mso-bidi-font-family: Arial; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Arial;">感冒药。但是在怀孕晚期如果短暂如一至两天使用却可以被接受。</span><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 14pt; mso-ansi-language: EN-US; mso-fareast-font-family: SimSun; mso-fareast-theme-font: minor-fareast;"><o:p></o:p></span><br />
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<span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; mso-bidi-font-family: SimSun;">孕妇也不应擅自停药。如果在怀孕前就患有慢性疾病如高血压,糖尿病,癫痫,气喘等,此类疾病如果控制不当所带来的不良影响远比服用药物还来得高。</span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; mso-ansi-language: EN-US; mso-bidi-font-family: SimSun;">举个例子,许多常见的</span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; mso-bidi-font-family: SimSun;">高血压药物如</span><span lang="EN-US" style="font-family: SimSun; font-size: 14pt; mso-ansi-language: EN-US; mso-bidi-font-family: SimSun;">perindopril, losartan</span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; mso-ansi-language: EN-US; mso-bidi-font-family: SimSun;">等并不适合在怀孕期使用,必须得换成另一种药物。患有高血压的准</span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; mso-bidi-font-family: SimSun;">妈妈不应擅自停药,而应在计划怀孕前就咨询医生或药剂师,她们所服用的药物是否适合?</span><span lang="EN-US" style="font-family: SimSun; font-size: 14pt; mso-ansi-language: EN-US; mso-bidi-font-family: SimSun;"><o:p></o:p></span><br />
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<span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; mso-bidi-font-family: SimSun;">其他怀孕期常见的疾病如孕吐,感冒,胃灼热,便秘,痔疮,头疼,</span><span lang="ZH-CN" style="font-family: "Arial","sans-serif"; font-size: 14pt;"> </span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; mso-bidi-font-family: SimSun;">妊娠期糖尿病和高血压,有许多</span><span style="font-family: "Arial","sans-serif"; font-size: 14pt;">A</span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; mso-bidi-font-family: SimSun;">和</span><span style="font-family: "Arial","sans-serif"; font-size: 14pt;">B</span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; mso-bidi-font-family: SimSun;">级的药物可以使用。比如</span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; mso-ansi-language: EN-US; mso-bidi-font-family: SimSun;">发烧</span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; mso-bidi-font-family: SimSun;">药</span><span lang="EN-US" style="font-family: SimSun; font-size: 14pt; mso-ansi-language: EN-US; mso-bidi-font-family: SimSun;">paracetamol,</span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; mso-ansi-language: EN-US; mso-bidi-font-family: SimSun;">感冒药</span><span lang="EN-US" style="font-family: SimSun; font-size: 14pt; mso-ansi-language: EN-US; mso-bidi-font-family: SimSun;">loratadine,</span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; mso-ansi-language: EN-US; mso-bidi-font-family: SimSun;">咳嗽药</span><span lang="EN-US" style="font-family: SimSun; font-size: 14pt; mso-ansi-language: EN-US; mso-bidi-font-family: SimSun;">diphenhydramine,</span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; mso-ansi-language: EN-US; mso-bidi-font-family: SimSun;">胃药</span><span lang="EN-US" style="font-family: SimSun; font-size: 14pt; mso-ansi-language: EN-US; mso-bidi-font-family: SimSun;">ranitidine</span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; mso-ansi-language: EN-US; mso-bidi-font-family: SimSun;">,</span><span lang="EN-US" style="font-family: SimSun; font-size: 14pt; mso-ansi-language: EN-US; mso-bidi-font-family: SimSun;">antacids</span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; mso-ansi-language: EN-US; mso-bidi-font-family: SimSun;">和胰岛素等等。</span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; mso-bidi-font-family: SimSun;">孕妇可向医生或药剂师询问药物的等级并商量到底她们的情况是否该服药。</span><span lang="EN-US" style="font-family: SimSun; font-size: 14pt; mso-ansi-language: EN-US; mso-bidi-font-family: SimSun;"><o:p></o:p></span><br />
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</span></span>HYYhttp://www.blogger.com/profile/16141502157494340810noreply@blogger.com0tag:blogger.com,1999:blog-2298718900266111481.post-87737316507058587972014-04-08T22:54:00.002+08:002014-08-02T17:24:03.905+08:00旅游六大常用药品<span lang="ZH-CN" style="font-family: SimSun; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: SimSun; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><span style="font-family: Times New Roman;">
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<span class="shorttext"><span lang="ZH-CN" style="color: #222222; font-family: SimSun; font-size: 14pt; line-height: 115%; mso-bidi-font-family: SimSun;">旅</span></span><span class="shorttext"><span lang="ZH-CN" style="color: #222222; font-family: SimSun; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-font-family: SimSun;">行是一个让身心充电的好方法。不管您是独自上路还是全家老少一齐出动,请记得携带一些简单的药品以备不时之需。以下是六种</span></span><span class="shorttext"><span lang="ZH-CN" style="color: #222222; font-family: SimSun; font-size: 14pt; line-height: 115%; mso-bidi-font-family: SimSun;">旅游常用药品供大家参考。</span></span><span class="shorttext"><span style="color: #222222; font-family: SimSun; font-size: 14pt; line-height: 115%; mso-bidi-font-family: SimSun;"><o:p></o:p></span></span></div>
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<span style="color: #222222; font-family: SimSun; font-size: 14pt; line-height: 115%; mso-bidi-font-family: SimSun;">1<span lang="ZH-CN">)感冒药</span><o:p></o:p></span></div>
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<span lang="ZH-CN" style="color: #222222; font-family: SimSun; font-size: 14pt; line-height: 115%; mso-bidi-font-family: SimSun;">感冒病毒容易在人潮多和空气不流通的地方传播。除此以外,面对大幅度气候及温度转换也会容易让人患上感冒。备有退烧药如</span><span style="color: #222222; font-family: SimSun; font-size: 14pt; line-height: 115%; mso-bidi-font-family: SimSun;"> paracetamol,<span lang="ZH-CN">能有效退热和减轻咽喉不适。令外,</span>
antihistamines<span lang="ZH-CN">能舒缓流鼻水和<span class="shorttext">打喷嚏等症状。</span></span><span class="shorttext"><o:p></o:p></span></span></div>
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<span class="shorttext"><span style="color: #222222; font-family: SimSun; font-size: 14pt; line-height: 115%; mso-bidi-font-family: SimSun;">2<span lang="ZH-CN">)口服补液盐</span><o:p></o:p></span></span></div>
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<span class="shorttext"><span lang="ZH-CN" style="color: #222222; font-family: SimSun; font-size: 14pt; line-height: 115%; mso-bidi-font-family: SimSun;">如果不慎吃了不卫生的食物而导致轻微的腹泻和呕吐,及时补充口服补液盐,</span></span><span class="shorttext"><span style="color: #222222; font-family: SimSun; font-size: 14pt; line-height: 115%; mso-bidi-font-family: SimSun;">oral rehydration salt<span lang="ZH-CN">能帮助补充身体流失的盐分和水分。此外,一些能吸附毒素的药品如</span>charcoal<span lang="ZH-CN">和</span>smectites<span lang="ZH-CN">,和减少肠胃蠕动的药品如</span>loperamide <span lang="ZH-CN">和</span>atropine
diphenoxylate <span lang="ZH-CN">能暂停腹泻的症状,都是不错的旅游良伴。</span><o:p></o:p></span></span></div>
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<span class="shorttext"><span style="color: #222222; font-family: SimSun; font-size: 14pt; line-height: 115%; mso-bidi-font-family: SimSun;">3<span lang="ZH-CN">)胃药</span><o:p></o:p></span></span></div>
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<span class="shorttext"><span lang="ZH-CN" style="color: #222222; font-family: SimSun; font-size: 14pt; line-height: 115%; mso-bidi-font-family: SimSun;">品尝美食是旅途中不可或缺的。</span></span><span class="shorttext"><span lang="ZH-CN" style="color: #222222; font-family: SimSun; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-font-family: SimSun;">如果吃了太多辛辣,煎炸和油腻的食物,再加上因为赶路而没有定时进食,经常会引起消化不良,造成上腹部疼痛及不适。这时候胃药如小包装方便携带的液状</span></span><span class="shorttext"><span lang="EN-US" style="color: #222222; font-family: SimSun; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-font-family: SimSun;">antacids,</span></span><span class="shorttext"><span lang="ZH-CN" style="color: #222222; font-family: SimSun; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-font-family: SimSun;">或者胃片能帮助减少疼痛。其他口服胃药如</span></span><span class="shorttext"><span lang="EN-US" style="color: #222222; font-family: SimSun; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-font-family: SimSun;">ranitidine, famotidine </span></span><span class="shorttext"><span lang="ZH-CN" style="color: #222222; font-family: SimSun; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-font-family: SimSun;">药效持续时间较长,适合</span></span><span class="shorttext"><span lang="ZH-CN" style="color: #222222; font-family: SimSun; font-size: 14pt; line-height: 115%; mso-bidi-font-family: SimSun;">旅途使用。 </span></span><span class="shorttext"><span style="color: #222222; font-family: SimSun; font-size: 14pt; line-height: 115%; mso-bidi-font-family: SimSun;"><o:p></o:p></span></span></div>
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<span class="shorttext"><span style="color: #222222; font-family: SimSun; font-size: 14pt; line-height: 115%; mso-bidi-font-family: SimSun;">4<span lang="ZH-CN">)过敏药</span><o:p></o:p></span></span></div>
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<span class="shorttext"><span lang="ZH-CN" style="color: #222222; font-family: SimSun; font-size: 14pt; line-height: 115%; mso-bidi-font-family: SimSun;">若旅途中接触一些新物品,如穿戴新饰品或者碰触动植物而出现皮肤红肿,可以口服</span></span><span class="shorttext"><span style="color: #222222; font-family: SimSun; font-size: 14pt; line-height: 115%; mso-bidi-font-family: SimSun;">antihistamines<span lang="ZH-CN">和擦上消炎药膏如</span>hydrocortisone<span lang="ZH-CN">。</span><o:p></o:p></span></span></div>
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<span class="shorttext"><span style="color: #222222; font-family: SimSun; font-size: 14pt; line-height: 115%; mso-bidi-font-family: SimSun;">5<span lang="ZH-CN">) 晕车药</span><o:p></o:p></span></span></div>
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<span class="shorttext"><span lang="ZH-CN" style="color: #222222; font-family: SimSun; font-size: 14pt; line-height: 115%; mso-bidi-font-family: SimSun;">感觉晕头转向,随即伴有噁心和呕吐的症状不只发生在车里,也常见于其他交通工具如飞机,船和火车上。旅客可在乘搭交通工具半小时前服用</span></span><span class="shorttext"><span style="color: #222222; font-family: SimSun; font-size: 14pt; line-height: 115%; mso-bidi-font-family: SimSun;">dimenhydrynate <span lang="ZH-CN">和</span>meclozine <span lang="ZH-CN">等药品以避免不适。只是此类药物能导致昏昏欲睡。</span><o:p></o:p></span></span></div>
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<span class="shorttext"><span style="color: #222222; font-family: SimSun; font-size: 14pt; line-height: 115%; mso-bidi-font-family: SimSun;">6<span lang="ZH-CN">) 外用药品(外用止痛药,</span></span></span><span class="shorttext"><span lang="ZH-CN" style="color: #222222; font-family: SimSun; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-font-family: SimSun;">驱蚊剂,</span></span><span class="shorttext"><span lang="ZH-CN" style="color: #222222; font-family: SimSun; font-size: 14pt; line-height: 115%; mso-bidi-font-family: SimSun;">防</span></span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; line-height: 115%; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: SimSun; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">晒霜)</span><span class="shorttext"><span style="color: #222222; font-family: SimSun; font-size: 14pt; line-height: 115%; mso-bidi-font-family: SimSun;"><o:p></o:p></span></span></div>
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<span class="shorttext"><span lang="ZH-CN" style="color: #222222; font-family: SimSun; font-size: 14pt; line-height: 115%; mso-bidi-font-family: SimSun;">外用止痛药如含有</span></span><span class="shorttext"><span style="color: #222222; font-family: SimSun; font-size: 14pt; line-height: 115%; mso-bidi-font-family: SimSun;">ketoprofen,diclofenac <span lang="ZH-CN">成分的药膏和贴片能减轻因常久保持同一坐姿或步行太多而引起的肩膀酸痛和肌肉疼痛。此类外用的止痛药</span></span></span><span class="shorttext"><span lang="ZH-CN" style="color: #222222; font-family: SimSun; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-font-family: SimSun;">不逊于口服止痛药,而且能够避免口服止痛药所带来的胃痛和胀气等不适。另外,若到郊外露营或者郊游要避免被蚊虫叮咬,</span></span><span class="shorttext"><span lang="ZH-CN" style="color: #222222; font-family: SimSun; font-size: 14pt; line-height: 115%; mso-bidi-font-family: SimSun;">旅客们可穿上长袖衣裤并在衣服上喷上</span></span><span class="shorttext"><span lang="ZH-CN" style="color: #222222; font-family: SimSun; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-font-family: SimSun;">驱蚊剂。药剂行出售的驱蚊剂琳琅满目,而且多由天然的植物制作而成。最后,</span></span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; line-height: 115%; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: SimSun; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">防晒霜能够保护我们的皮肤免受紫外线的伤害。出门时记得在半小时前擦上,并在太阳曝晒下每两个小时内重复使用。</span><span lang="EN-US" style="color: #222222; font-family: SimSun; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-font-family: SimSun;"><o:p></o:p></span></div>
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<span class="shorttext"><span lang="ZH-CN" style="color: #222222; font-family: SimSun; font-size: 14pt; line-height: 115%; mso-bidi-font-family: SimSun;">以上所列的药品,纯属参考。旅客们也须记得携带日常服用的</span></span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; line-height: 115%; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: SimSun; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">其他慢性疾病药物。如果发现自身或</span><span class="shorttext"><span lang="ZH-CN" style="color: #222222; font-family: SimSun; font-size: 14pt; line-height: 115%; mso-bidi-font-family: SimSun;">旅伴的</span></span><span lang="ZH-CN" style="font-family: SimSun; font-size: 14pt; line-height: 115%; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: SimSun; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">症状在服用药物后没有改善,并有加剧的象征,请即刻到邻近的医院就医。</span><span style="font-size: 14pt; line-height: 115%;"><o:p></o:p></span></div>
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HYYhttp://www.blogger.com/profile/16141502157494340810noreply@blogger.com0tag:blogger.com,1999:blog-2298718900266111481.post-86772100379720083362014-02-18T22:37:00.002+08:002014-02-18T22:49:55.008+08:00How far can clinical pharmacists go?I have been working as a clinical pharmacist for 3 years plus. The daily job of a clinical pharmacist including following doctor's ward round, answering drug related enquiries, examining medication charts, elicit patient's medication history, counsel patients who need to be started on new devices or new drugs and dispensing the discharge medications to the ward patients. We also work in an ambulatory clinic such as warfarin medication adherence clinic (MTAC), diabetic clinic, chronic kidney disease clinic, methadone clinic, respiratory clinic and etc.<br />
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It has been a while since I feel that working as a ward pharmacist is "looking good but going nowhere". Reading articles from David Gibson at <a href="http://www.pjonline.com/clinical-pharmacist/2014_feb/piece_of_the_jigsaw">http://www.pjonline.com/clinical-pharmacist/2014_feb/piece_of_the_jigsaw</a> makes me wonder how far can a clinical pharmacist go in the future and whether the profession as clinical pharmacists will disappear in the near future. <br />
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In view of we are trained as pharmacists, we deal with medications and not diagnosing patients. Although in recent years, there are guides and books coming out in the US to teach pharmacist in physical examination of patients, what has been provided in the university or workplace is still not adequate to replace an actual diagnosis. Our recommendation rely very much on the doctor's diagnosis. The management plan can be not working not that our recommendation is inappropriate, but it is just because the diagnosis is wrong.<br />
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An experience doctor who know how to diagnose usually will know how to manage the patients and how to monitor the result after the management was perform on the patient. Maybe what we do was just fine-tuning on dosing, and selection of certain drugs, but In view of the increasing in numbers of specialists with so many different types of sub-specialty, consultants, are the clinical pharmacist actually redundant??? Where are the clinical pharmacists heading to? What are we trying to achieve? Is it necessary that we go through the training by doctors to understand the patients more? If we really go through doctor's training, then why don't we change our title to doctor???HYYhttp://www.blogger.com/profile/16141502157494340810noreply@blogger.com0tag:blogger.com,1999:blog-2298718900266111481.post-1066841337917810502013-12-19T23:08:00.000+08:002014-04-08T22:59:17.458+08:00Liver abscessThere is this Indian uncle who had admitted to my ward complaining of fever for 3 days and worsening abdominal pain for 1 week. Patient is an alcoholic. Initially he was suspected to have acute calculus cholecystitis and meliodosis. However, CT scan showed that he actually had liver abscess. (a pus filled cavity in the liver). <br />
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His blood culture and sensitivity taken on admission showed present of Enterobacter Sakazakii. As there is multiple loculi, and the size of each of the loculus was small, there is no indication for surgical drainage of the abscess. Therefore the surgeons plan to start on conservative management, which is starting antbiotics treatment. So, for how long should we give the antibiotics???<br />
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There are 3 types of liver abscess, namely pyogenic, amebic and also fungal liver abscess. In this article, lets discuss pyogenic and amebic liver abscess. Pyogenic abscess is usually present as multiple loculi on the CT scan and commonly cause by gram negative enteric organism such as Klebsiella pneumonia, Enterobacteriacae, enterococcus, anaerobics. On the other hand, amebic liver abscess is usually present as single loculus caused by parasite Entamoeba histolytica. The antibiotics required for this 2 types are different. <br />
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Patient in this case received antibiotics (IV cefoperazone 1g BD and IV metronidazole) for 5 days and later discharge with Tab cefuroxime 250mg BD and Tab metronidazole 400mg TDS for 6 weeks. The careless houseman in charge only prescribed 1 week antibiotics for him. Luckily the error was later amended after being informed by us. (this HO did not even show a slight appreciation!!!!! OMG, seriously beh tahan with her "DO I CARE" face. Can't she just say THANK YOU???)<br />
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Come back to the case, the national antibiotics guidline in Malaysia back in 2008 is not clear... The guideline only mentioned that patient should be treated until clinical improvement achieved. In pyogenic liver abscess, the choice of IV antibiotics include:<br />
IV Ampicilin + IV Metronidazole + IV Gentamicin, x 2 weeks (Effective but resistant toward ampicilin increased and Gentamicin may cause nephrotoxicitiy)<br />
or <br />
IV Ampicillin/sulbactam alone x 2 weeks. (metronidazole may be added if cant rule out amebic)<br />
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Then, the alternative agents include:<br />
IV 3rd gen cephalosporin + IV Metronidazole x 2 weeks or <br />
IV ciprofloxacin + IV Metronidazole x 2 weeks.<br />
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For amoebic liver abscess, IV metronidzole 500mg TDS may be started for 10 days and Tab Tinidzole 2g OD for 3-5 days.<br />
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Then from Sanford guideline, pyogenic liver abscess may be treated with:<br />
IV metronidazole + (IV ceftriazone or IV ciprofloxacin or IV Pip/Tazo or IV Amp/Sulbactam)<br />
and amebic liver abscess with metronidazole, however the duration was not mentioned.<br />
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A search on the total duration of antibiotics patient should received is unclear and inconclusive. The suggested duration include IV antibiotics for 2 to 3 weeks followed by oral anitbiotics for 3 to 12 weeks. The common practice in Hospital Selayang as informed by one of the doctor is IV antibiotics for 2 weeks followed by 6 weeks oral antibiotics. <br />
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In the Malaysia ICU antibiotic guideline, pyogenic liver abscess required 6 weeks of oral antibiotics while amebic liver abscess only require 7 to 10 days of therapy followed by a luminal agent for gut colonisation. Suggested regimen for those who is hemodynamically unstable are:<br />
IV Pip/Tazo + IV metronidazole ---- prefered<br />
IV Cefepime + IV metronidazole ---- prefered <br />
IV Meropenem + IV metronidazole ---- alternative<br />
IV Imipenem/Cilastatin + IV metronidazole ---- alternative<br />
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Then for those who is hemodynamically stable are:<br />
IV Ceftriaxone + IV metronidazole<br />
IV Pip/Tazo + IV metronidazole<br />
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The SD number for patient is SD330816 for future reference. <br />
<br />HYYhttp://www.blogger.com/profile/16141502157494340810noreply@blogger.com0tag:blogger.com,1999:blog-2298718900266111481.post-61594878639042892622013-12-18T23:31:00.002+08:002014-04-08T22:59:48.420+08:00Onychomycosis (Nail infection)My doctor asked me regarding the choice of drug in onychomycosis (nail fungal infection) today. She informed that patient's condition was severe and topical antifungal did not help and oral antifungal may be needed in this patient.<br />
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Itraconazole can be use in this kind of patient. The dose and duration for this infection is very unique and it worth to be keep in mind. <br />
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1. For onychomycosis which involve fingernail only: <br />
200mg BD x 1 week, then off for 3 weeks, followed by 200mg BD for another week.<br />
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2. For onychomycosis which involve toenail (Trichophyton rubrum or T. mentagrophytes): <br />
200mg BD x 12 consecutive weeks<br />
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3. For onycomycosis (toenails with or without fingernail involvement): <br />
200mg OD x 12 weeks OR 200mg BD x 1 week, repeat 1 week course twice with 3 week off time between each course.<br />
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HYYhttp://www.blogger.com/profile/16141502157494340810noreply@blogger.com0tag:blogger.com,1999:blog-2298718900266111481.post-77563753338203102072013-12-18T23:00:00.001+08:002014-04-08T22:59:55.154+08:00Myasthenia gravis<div style="text-align: justify;">
Today we had pharmacist round in the medical ward. We had reviewed 2 patients in the medical ward. The first patient is a 78 years old Malay female who was admited for myasthenia gravis (MG) and later progress to myasthenia crisis. Patient was presented with dysphagia, ptosis, diplopia and fatigue. She was also diagnosed with new onset of atrial fibrillation, with existing hypertension and hyperlipidemia. </div>
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Patient was treated with tab pyridostigmine 30mg TDS for MG. and later the dose was increased to 60mg TDS. At the same time she was also given IVIG infusion 20g OD for 5 days. (0.4g/kg/day). Patient responded to the treatment. However, she still has dysphagia upon review. After IVIG infusion was completed, Tab prednisolone 50mg OD (1mg/kg) was later started for MG and there is plan to initiate immunosuppressant such as Azathioprine or cyclosporine in this patient. These medications are usually required for lifelong unless the culprit organ of secreting antibody has been removed. In the ward, patient's hypertension was also treated with tab amlodipine 10mg OD and her lipid profile showed that total cholesterol was 6 and the LDL was 5.01, as a result, tab simvastatin 20mg was later increased to 40mg ON. </div>
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Important point of myasthenia gravis include this is an autoimmune disease. Usually affecting voluntary muscle and may cause severe fatigue and respiratory distress. The common cause influde hyperactive thymus. Thymus is an organ that we used during childhood to produce T-lymphocytes, but the organ became dormant in adulthood. However in MG, the thymus gland is hyperactive and this required removal of thymus if the condition was severe.</div>
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Questions raised during the round included why treatment was not initiated for atrial fibrillation. Suggestions was made to score the patient according to CHA2DS2-VASc score and assess the bleeding risk according to HAS-BLED. I score the patient myself. Total CHA2DS2-VASc score: 4, patient is a candidate for anticoagulation and should be counselled on starting warfarin.</div>
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C-Chronic heart failure history - 0/1</div>
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H-Hypertension history - 1/1</div>
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A-Age>75 - 2/2</div>
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D-Diabetes mellitus - 0/1</div>
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S-Stroke history - 0/2</div>
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V-Vascular disease history - 0/1</div>
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A-Age 65 to 74 - 0/1</div>
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Sex-Female - 1</div>
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H-Hypertension history</div>
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A-Age>65, alcohol usage history</div>
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S-Stroke history</div>
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B-Prior major bleeding history</div>
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L-Labile INR</div>
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E-Medication usage predispose to bleeding.</div>
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D-Renal / liver disease</div>
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HAS-BLED score was 2: hypertension and age. The risk is low. If AF is confirmed, suggestion should be made to start warfarin.</div>
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Questions raised also include should the simvastatin be discontinued as simvastatin may cause muscle weakness and further worsen patient's condition. I suggested that simvastatin may be continued for short period of time and to monitor her condition and only discontinued when patient showed symptoms of muscle weakness again.</div>
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A list of drugs which should be used cautiously in patient with MG as these medications may worsen patient's symptoms upon using was also mentioned. This include phenytoin, beta blocker, loperamide, aminoglycoside, tetracycline, sulfonamide, fluoroquinolone, colistin, Quinidine, CCB. Further list can refer to</div>
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<a href="http://www.google.com/url?sa=t&rct=j&q=&esrc=s&frm=1&source=web&cd=1&ved=0CCoQFjAA&url=http%3A%2F%2Fwww.myasthenia.org%2FLinkClick.aspx%3Ffileticket%3DJuFvZPPq2vg%253D&ei=ErWxUs-NC8eHrQfolIDwDA&usg=AFQjCNF---Bkimg54LK4kCXHNP9yf40qRg&sig2=MtfZTA5OkgTD4AEn_aNGEQ">http://www.google.com/url?sa=t&rct=j&q=&esrc=s&frm=1&source=web&cd=1&ved=0CCoQFjAA&url=http%3A%2F%2Fwww.myasthenia.org%2FLinkClick.aspx%3Ffileticket%3DJuFvZPPq2vg%253D&ei=ErWxUs-NC8eHrQfolIDwDA&usg=AFQjCNF---Bkimg54LK4kCXHNP9yf40qRg&sig2=MtfZTA5OkgTD4AEn_aNGEQ</a></div>
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We then proceed to the next patient in the ward next door. </div>
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HYYhttp://www.blogger.com/profile/16141502157494340810noreply@blogger.com0tag:blogger.com,1999:blog-2298718900266111481.post-68863563076218916842013-11-09T11:22:00.002+08:002014-04-08T23:00:15.834+08:00Gold Coast Itinerary<span style="line-height: 115%;"><span style="font-family: Calibri;"><span style="font-size: large;">Gold Coast in
5 Days – Itinerary<o:p></o:p></span></span></span><br />
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<span style="font-family: Calibri;"><b style="mso-bidi-font-weight: normal;"><span style="line-height: 115%;">1/11/13 Friday:</span></b><span style="line-height: 115%;"> </span></span><span style="font-family: Calibri;"><span style="line-height: 115%;">Malaysia to Gold Coast (940pm flight)</span></span></div>
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<span style="font-family: Calibri;"><b style="mso-bidi-font-weight: normal;">2/11/13 Saturday</b>:
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<span style="font-family: Calibri;">750 am: Touch down
at Coolangatta airport<o:p></o:p></span><br />
<span style="font-family: Calibri;">Rent a car and drove from
airport to Surfer paradise </span><br />
<span style="font-family: Calibri;">Reach Capricorn One: 198 Ferny Avenue, Surfers Paradise <o:p></o:p></span><br />
<span style="font-family: Calibri;">Gold Coast Theme Park---- Sea world </span><br />
<span style="font-family: Calibri;">(book ticket online $75 for 3 theme parks unlimited entry till 2014)</span><br />
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<span style="font-family: Calibri;">Australian Outback
Spectacular Show (730pm) --- dinner provided</span></div>
<span style="font-family: Calibri;"><b style="mso-bidi-font-weight: normal;"></b></span><br />
<span style="font-family: Calibri;"><b style="mso-bidi-font-weight: normal;">3/11/13</b> <b style="mso-bidi-font-weight: normal;">Sunday</b>: <o:p></o:p></span><br />
<span style="font-family: Calibri;">Tamborine Wine
Tasting (930am to 430pm) $125/pax </span><br />
<span style="font-family: Calibri;">Lunch in DeliVino cafe</span><br />
<span style="font-family: Calibri;">Dinner at Cavill Avenue (la piatto pizza)</span><br />
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<span style="font-size: 8pt;"><o:p><span style="font-family: Calibri;"> </span></o:p></span></div>
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<span style="font-family: Calibri;"><b style="mso-bidi-font-weight: normal;">4/11/13 Monday</b>
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<span style="font-family: Calibri;">Gold Coast Theme Park :</span><br />
<span style="font-family: Calibri;">Morning: Warner Bros Movie world </span><br />
<span style="font-family: Calibri;">After lunch: Wet n Wild Water World</span><br />
<span style="font-family: Calibri;">Australia fair shopping center</span><br />
<span style="font-family: Calibri;">Dinner: Red rooster</span></div>
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<span style="font-family: Calibri;"><b style="mso-bidi-font-weight: normal;">5/11/13 Tuesday</b>
: </span><br />
<span style="font-family: Calibri;">Brisbane Day trip (drove from surfers paradise to Brisbane)</span><br />
<span style="font-family: Calibri;">Miramar River Cruise to Lone Pine Koala Sanctuary ($68 round trip)</span><br />
<span style="font-family: Calibri;">Gallery of modern art </span><br />
<span style="font-family: Calibri;">Gathering with friends</span></div>
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<o:p><span style="font-family: Calibri;"></span></o:p> </div>
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<span style="font-family: Calibri;"><b style="mso-bidi-font-weight: normal;">6/11/13 Wednesday</b>: </span><br />
<span style="font-family: Calibri;">Walk and photo session at the beach of surfers paradise</span><br />
<span style="font-family: Calibri;">Breakfast at ocean avenue</span><br />
<span style="font-family: Calibri;">Movie world AGAIN</span><br />
<span style="font-family: Calibri;">Harbour town factory outlet </span><br />
<span style="font-family: Calibri;">Surfer paradise beach front night market</span><br />
<span style="font-family: Calibri;">Gold Coast</span><span style="font-family: Calibri;"> to
Malaysia (945pm flight)</span></div>
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<o:p><span style="font-family: Calibri;"> </span></o:p></div>
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<span style="font-family: Calibri;"><b style="mso-bidi-font-weight: normal;">7/11/13 Thursday: </b></span></div>
<span style="font-family: Calibri;">Arrive at Malaysia
(405am) </span><o:p><span style="font-family: Calibri;"> </span></o:p>HYYhttp://www.blogger.com/profile/16141502157494340810noreply@blogger.com0tag:blogger.com,1999:blog-2298718900266111481.post-9612254852877127492012-07-21T11:32:00.001+08:002012-07-21T11:32:46.719+08:00Translation: Who had ruined the pharmacy profession?<br />
Author: Xiao huang<br />
Source: Sin Chew daily 20.7.2012<br />
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Please refer to the original article if you have any queries. This translation is only based on my personal understanding from the article.<br />
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<span style="font-family: Calibri;">I just hand in my resignation letter before I wrote this
article, telling the government hospital that I had worked for a few years:
Let’s not meet again. I still remembered how I had struggled to enter the
University for Pharmacy Degree 8 years ago. 8 years had passed, now I can only
sigh and wonder why am I so determined to get into the profession way back then.
<o:p></o:p></span></div>
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<span style="font-family: Calibri;">The public thinks that Pharmacist
is a good profession; however, this is not the truth. <span style="mso-spacerun: yes;"> </span>In the government hospital, our status is
worse than doctors and nurses, and always become the “punching bag” of
specialists, nurses and patients. It is the pharmacists’ fault not able to give
full supply of 3 to 6 months medications for patients with chronic diseases. It
is also our fault to provide generic medications rather than branded
medications. Besides that, we often sneer by the senior doctors or even junior
doctors when we try to provide recommendation on patients’ management and
patients rolled their eyes on our suggestions.<o:p></o:p></span></div>
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<span style="font-family: Calibri;">Talking about the wages and
welfare, pharmacists in the government hospitals are just like an illegitimate
child. We do not have overtime allowance for the 24hours and weekend extended
services. It is very common that the manpower in the government hospital is always
insufficient and we have to do multitasking & “one man show”. Amidst all this,
we still try to do our best. However, the officers in the health ministry are
always eyeing on our RM700 critical allowance, using cost cutting as an excuse to
try to abolish this allowance. On the other hand, when all other government
servants are allowed to take up part time job as long as they get approval from
their supervisor and their part time job does not affect the daily job;
pharmacists in the government hospitals are not allowed to have a part time
job.<span style="mso-spacerun: yes;"> </span>Dear fellow officers, do you intend
to force the pharmacists in government sector to quit?<span style="mso-spacerun: yes;"> </span>5 years ago, when there were not enough
pharmacists in the government sectors, the government enforce 4 years compulsory
service. As a result, we chose to stay back to service in the government.<span style="mso-spacerun: yes;"> </span>After 5 years, the government informed us
that the private sectors need more pharmacists, so they have shortened the
compulsory service. The government cannot afford our salary? <span style="mso-spacerun: yes;"> </span>Or there is really a better offer in the
private sector? We feel that the government is taking advantage on us.<o:p></o:p></span></div>
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<span style="font-family: Calibri;">In the private hospital, the
status of the pharmacists is worse than the medical assistants. Private
hospitals only employed pharmacists to fulfil the requirement set by the
ministry of health. Only 4 pharmacists are employed in a medium sized private
hospital. Is that sufficient? Low wages and welfare, long working hours, the
effort that they put in is incompatible with the salary that they get. Who will
understand the actual situation facing by pharmacists in the private sectors
despite their glamorous status? Besides that, the pharmaceutical companies and
factories employed the pharmacists just for their licence. In academic and
research field, the role of pharmacists are still very important. However, how
long can they survive when they are marginalized by the government?<o:p></o:p></span></div>
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<span style="font-family: Calibri;">The community pharmacy which is
more related to our daily life and better known by the public has also come to
a miserable situation. With the mushrooming of chain pharmacies, independent
pharmacies are struggling on whilst at death’s door. Even the multilevel marketing
companies want to have a share in the business. Pharmacies are supposed to sell
medications and supplements. However, the pharmacies now are similar to the
grocery shops where the toiletries, cosmetics and even junk food filled up most
of the space in the shops, especially in those pharmacy shops own by the
multilevel marketing company. This type of business operation is insulting the
pharmacists’ profession. In order to survive, each pharmacy used various methods
to attract customers, from the basic customer service to the discounting price
war and misuse of certain medications. Is this healthy? Or are we massacring
each other?<o:p></o:p></span></div>
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<span style="font-family: Calibri;">Next, is the medical revolution
proposed under 1 care national healthcare system benefitting our nation or it
is just another white elephant project? First of all, the retired government
servants can seek treatment in the government hospitals and get their
prescriptions filled in the pharmacies appointed by the government, and payment
will be given to these pharmacy shops via the appointed contractors. Why the patients
can only get their prescriptions filled in certain pharmacies? Why there is a
need to pay these pharmacies via certain appointed contractors? Why can’t the
government hospitals purchase these medications to supply to the retired
government servant? Why do we need such a big project? Since the government
sectors are notorious for “fishing culture” we all understand what is happening
here. On the other hand, 1 care system proposed dispensing separation, to
return the dispensing right to pharmacists and at the same time privatised the
government pharmacies. However, there are rules that medications can only be
supplied by certain companies. This proposal is only using dispensing
separation to support the clique. The assistance provided by the government had
made certain bumi companies to monopolize the market. Do we need more of these
companies? This policy is definitely going to bring the pharmacy profession to
a dead end. <o:p></o:p></span></div>
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<span style="font-family: Calibri;">To sum it up, who created the
current situation of the pharmacy profession? Who had ruined the registered
pharmacists’ professional status? The answers are as follow. Firstly, there is
not much restriction in approving more private colleges to set up pharmacy
courses, which causes the overload of pharmacist graduates. It is difficult to
control the quality of the curriculum of each college and therefore the qualities
of the graduates are also uneven. <span style="mso-spacerun: yes;"> </span>When
there are too many pharmacy graduates enter the job market, the government
sectors cannot absorb all of them and the supply of pharmacy graduates are also
way more than the demand in private sectors. As a result, the bubbling of the
pharmacy profession begins. Unemployment, low income, selling medications in
black market, giving discounts in order to survive all begins. Where this profession
with hundreds and thousands of years stands?<o:p></o:p></span></div>
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<span style="font-family: Calibri;">Secondly, allowing doctors to
dispense medications. <span style="mso-spacerun: yes;"> </span>The pharmacists
are not needed when this policy remains. Dispensing separation would allow the
maximization of professional knowledge of pharmacists in improving patient’s
management. The pharmacists then have a role to monitor doctor’s management.
Also, the dispensing right must be built on the zero benefits of doctors,
pharmacists and pharmaceutical companies and it is important that doctors and
pharmacists have their own role. The dispensing separation is the right way to
go in the future and the dispensing right must be slowly return to pharmacists.
<o:p></o:p></span></div>
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<span style="font-family: Calibri;">Thirdly, the prices of medications
are not controlled. If the 1care system is enforced, the government should set
the maximum price or strictly control the price of medications in the market.
This is easier for the enforcement sectors to monitor the market and it can
also avoid the misuse of medications and the selling of adulterated medications
to the public due to vicious competitions. When these problems arise, the
patients and consumers are going to suffer in the end. The pharmacy profession
needs a healthier environment to survive.<o:p></o:p></span></div>
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<span style="font-family: Calibri;">Number four will be the
professional qualifications. This problem hit the retail pharmacies the most.
All of the retail pharmacies must be owned by pharmacists rather than
businessmen without professional background. At the same time, the multilevel
marketing companies should be restricted to setup more pharmacies which sell other
more of other non medictations. Government should also provide monetary
assistance to those pharmacists who wish to open their own shops.<o:p></o:p></span></div>
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<span style="font-family: Calibri;">Each healthcare professional have
their own roles in building a healthy healthcare system. There is not a single
profession can be replaced. In order for the pharmacists’ profession to have a
brighter future, we must control the setup of the pharmacy degree, implementing
the dispensing separation system and strictly control the pricing of
medications and recognized the professional qualifications. Please return a
healthier surviving environment and the pride to the profession. <o:p></o:p></span></div>
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<br /></div>HYYhttp://www.blogger.com/profile/16141502157494340810noreply@blogger.com9tag:blogger.com,1999:blog-2298718900266111481.post-77010388785788828652012-03-27T15:46:00.003+08:002012-03-27T16:36:46.173+08:00HangZhou, Shanghai, SuZhou 8 days 7 night tour<div style="font-family: Georgia, serif; font-size: 100%; "><span><b>HangZhou, Shanghai, SuZhou 8 days 7 night tour Itinerary </b></span></div><div style="font-family: Georgia, serif; font-size: 100%; "><span><br /></span></div><span style="font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal; font-size: 100%; ">19.3.12 HangZhou</span><div style="font-family: Georgia, serif; font-size: 100%; "><ol><li><span>Arrived at HangZhou Xiaoshan International airport</span></li><li><span>Check in at WuShanYi international youth hostel</span></li><li><span>He Fang street </span><span lang="ZH-CN" style="font-size:10.0pt;font-family: 宋体;mso-ascii-font-family:Calibri;mso-bidi-font-family:宋体;mso-ansi-language: EN-US;mso-fareast-language:ZH-CN;mso-bidi-language:AR-SA;mso-bidi-font-weight: bold">河坊街</span></li><li><span>Wu Shan square </span><span lang="ZH-CN" style="font-size:10.0pt;font-family: 宋体;mso-ascii-font-family:Calibri;mso-bidi-font-family:宋体;mso-ansi-language: EN-US;mso-fareast-language:ZH-CN;mso-bidi-language:AR-SA;mso-bidi-font-weight: bold">吴山广场</span></li></ol><div><span>20.3.12 Shanghai</span></div></div><div style="font-family: Georgia, serif; font-size: 100%; "><ol><li><span>HangZhou railway station: HangZhou - Shanghai G train (RMB76)</span></li><li><span>Shanghai blue mountain youth hostel </span></li><li><span>Visiting factory (Kai Shing's business partner)</span></li><li><span>Huangpu riverside <span lang="ZH-CN" style="font-size:10.0pt;font-family: 宋体;mso-bidi-font-family:宋体;mso-ansi-language:EN-US;mso-fareast-language:ZH-CN; mso-bidi-language:AR-SA">黄浦江</span><span lang="ZH-CN" style="font-size:10.0pt; font-family:"Calibri","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-bidi-font-family:"Times New Roman";mso-ansi-language:EN-US;mso-fareast-language: ZH-CN;mso-bidi-language:AR-SA"> &</span> The Bund </span><span lang="ZH-CN" style="font-size:10.0pt;font-family: 宋体;mso-bidi-font-family:宋体;mso-ansi-language:EN;mso-fareast-language:ZH-CN; mso-bidi-language:AR-SA">外滩</span></li><li><span><span style="font-family: Georgia, serif; font-size: medium; ">Shanghai Nanjing Road Pedestrian Street (shopping) </span></span> <span lang="ZH-CN" style="font-size:10.0pt;font-family: 宋体;mso-ascii-font-family:Calibri;mso-bidi-font-family:宋体;mso-ansi-language: EN-US;mso-fareast-language:ZH-CN;mso-bidi-language:AR-SA;mso-bidi-font-weight: bold">上海南京路步行街</span></li></ol><div><span style="font-family: Georgia, serif; ">21.3.12 Shanghai</span></div></div><div style="font-family: Georgia, serif; font-size: 100%; "><ol><li><span>Expo (China pavillon) <span lang="ZH-CN" style="font-size:10.0pt;font-family: 宋体;mso-ascii-font-family:Calibri;mso-bidi-font-family:宋体;mso-ansi-language: EN-US;mso-fareast-language:ZH-CN;mso-bidi-language:AR-SA;mso-bidi-font-weight: bold">上海世博</span>----- Closed for maintenance. =(</span></li><li><span>Oriental pearl TV tower (RMB 120) observation platform </span> <span style="font-family: 宋体; font-size: 13px; ">东方明珠塔</span></li><li><span style="font-family: 宋体; font-size: 13px; "><span style="font-family: Georgia, serif; font-size: medium; ">Yu garden <span lang="ZH-CN" style="font-size:10.0pt;font-family: 宋体;mso-ascii-font-family:Calibri;mso-bidi-font-family:宋体;mso-ansi-language: EN-US;mso-fareast-language:ZH-CN;mso-bidi-language:AR-SA;mso-bidi-font-weight: bold">豫园</span> & Tea performance (Cheated by 2 school girls) =(</span></span></li><li><span style="font-family: 宋体; font-size: 13px; "><span style="font-family: Georgia, serif; font-size: medium; ">Chenghuangmiao commercial centre </span></span><span style="font-family: 宋体; font-size: 10pt; ">城隍庙商业中心</span></li><li><span style="font-family: 宋体; font-size: 13px; "><span style="font-family: Georgia, serif; font-size: medium; ">People square </span></span><span lang="ZH-CN" style="font-size:10.0pt;font-family: 宋体;mso-ascii-font-family:Calibri;mso-bidi-font-family:宋体;mso-ansi-language: EN-US;mso-fareast-language:ZH-CN;mso-bidi-language:AR-SA;mso-bidi-font-weight: bold">人民广场</span></li><li><span>Shanghai centre Theatre: <span style="font-family: 宋体; font-size: 10pt; ">上海商城剧院 </span></span><span>Acrobatic show (RMB200)</span></li></ol><div><span>22.3.12 SuZhou one day tour</span></div></div><div><ol><li style="font-family: Georgia, serif; font-size: 100%; "><span>ShangHai HongQiao railway station: Shanghai G train - SuZhou (RMB40) </span></li><li style="font-family: Georgia, serif; font-size: 100%; "><span>The Lingering garden </span> <span lang="ZH-CN" style="font-size:10.0pt;font-family: 宋体;mso-ascii-font-family:Calibri;mso-bidi-font-family:宋体;mso-ansi-language: EN-US;mso-fareast-language:ZH-CN;mso-bidi-language:AR-SA;mso-bidi-font-weight: bold">留园</span></li><li style="font-family: Georgia, serif; font-size: 100%; "><span><span style="font-family: Georgia, serif; font-size: medium; ">The Tiger Hill Scenic Region </span></span><span lang="ZH-CN" style="font-size:10.0pt;font-family: 宋体;mso-ascii-font-family:Calibri;mso-bidi-font-family:宋体;mso-ansi-language: EN-US;mso-fareast-language:ZH-CN;mso-bidi-language:AR-SA;mso-bidi-font-weight: bold">虎丘</span></li><li><span ><span style="font-family: Georgia, serif; font-size: 16px; ">SuZhou railway station: SuZhou - Shanghai </span></span></li></ol><div style="font-family: Georgia, serif; font-size: 100%; "><span style="font-family: Georgia, serif; ">23.3.12 HangZhou</span></div></div><div style="font-family: Georgia, serif; font-size: 100%; "><ol><li>Shanghai HongQiao railway station: Shanghai G train- Hangzhou </li><li><span>Impression West Lake show (RMB240) </span><span lang="ZH-CN" style="font-size:10.0pt;font-family: 宋体;mso-ascii-font-family:Calibri;mso-bidi-font-family:宋体;mso-ansi-language: EN-US;mso-fareast-language:ZH-CN;mso-bidi-language:AR-SA;mso-bidi-font-weight: bold">印象西湖秀</span></li></ol><div><span style="font-family: Georgia, serif; ">24.3.12 HangZhou</span> </div></div><div style="font-family: Georgia, serif; font-size: 100%; "><ol><li><span>West Lake Tour </span><span lang="ZH-CN" style="font-size:9.0pt;font-family: 宋体;mso-bidi-font-family:宋体;mso-ansi-language:EN-US;mso-fareast-language:ZH-CN; mso-bidi-language:AR-SA">租船游西湖</span></li><li><span>West lake lake cruise (RMB 480/boat) passed by </span><span lang="ZH-CN" style="font-size:9.0pt;font-family: 宋体;mso-bidi-font-family:宋体;mso-ansi-language:EN-US;mso-fareast-language:ZH-CN; mso-bidi-language:AR-SA">雷锋塔 </span></li><li><span>Broken bridge with snow <span lang="ZH-CN" style="font-size:9.0pt;font-family: 宋体;mso-bidi-font-family:宋体;mso-ansi-language:EN-US;mso-fareast-language:ZH-CN; mso-bidi-language:AR-SA">断桥</span><span lang="ZH-CN" style="font-size:10.0pt;font-family: 宋体;mso-bidi-font-family:宋体;mso-ansi-language:EN-US;mso-fareast-language:ZH-CN; mso-bidi-language:AR-SA"><span lang="ZH-CN" style="font-size: 10pt; ">残</span>雪</span>& BaiTi</span></li><li><span>Three pools mirroring the moon </span><span lang="ZH-CN" style="font-size:9.0pt;font-family: 宋体;mso-bidi-font-family:宋体;mso-ansi-language:EN-US;mso-fareast-language:ZH-CN; mso-bidi-language:AR-SA">三潭印月</span></li><li><span>Solitary hill </span><span lang="ZH-CN" style="font-size:10.0pt;font-family: 宋体;mso-bidi-font-family:宋体;mso-ansi-language:EN-US;mso-fareast-language:ZH-CN; mso-bidi-language:AR-SA">孤山</span></li><li><span>YueFei tomb (RMB25) </span><span lang="ZH-CN" style="font-size:9.0pt;font-family: 宋体;mso-bidi-font-family:宋体;mso-ansi-language:EN-US;mso-fareast-language:ZH-CN; mso-bidi-language:AR-SA">岳庙</span></li><li><span>Lingyin temple (RMB45) </span><span lang="ZH-CN" style="font-size:9.0pt;font-family: 宋体;mso-bidi-font-family:宋体;mso-ansi-language:EN-US;mso-fareast-language:ZH-CN; mso-bidi-language:AR-SA">灵隐寺 </span></li><li><span lang="ZH-CN" style="font-size:9.0pt;font-family: 宋体;mso-bidi-font-family:宋体;mso-ansi-language:EN-US;mso-fareast-language:ZH-CN; mso-bidi-language:AR-SA"><span style="font-family: Georgia, serif; font-size: medium; ">PingHuQiuYue </span></span><span lang="ZH-CN" style="font-size:10.0pt;font-family: 宋体;mso-bidi-font-family:宋体;mso-ansi-language:EN-US;mso-fareast-language:ZH-CN; mso-bidi-language:AR-SA">平湖秋月</span></li></ol><div><span>25.3.12 WuZhen </span></div></div><div style="font-family: Georgia, serif; font-size: 100%; "><ol><li><span>WuZhen one day tour (RMB 125)</span></li></ol><div><span>26.3.12 HangZhou </span></div></div><div style="font-family: Georgia, serif; font-size: 100%; "><ol><li><span>Going back Malaysia</span></li></ol></div>HYYhttp://www.blogger.com/profile/16141502157494340810noreply@blogger.com0tag:blogger.com,1999:blog-2298718900266111481.post-31755238116416310052012-01-04T20:51:00.003+08:002014-04-08T22:59:17.462+08:00AVMLLS is a 27years old lady with arteriovenous malformation at her right hand. It is a congenital disease where the patient's artery connected directly to the vein without passing the capillaries. This abnormal connection is fragile and will bleed easily. During admission, she was bleeding profusely and her hemoglobin level dropped to a dangerous 4g/L (normal is about 10-12g/L) <div><br /></div><div>This is my first time seeing a life blood spurting artery. Upon opening the bandage on the right hand, her blood spurt out like a burst pipe and the site still continue to bleed even the doctor apply direct pressure and inflated the blood pressure hand cuff to reduce blood flow to the site. I was just standing right beside the young girl staring at the blood... IT IS SO SCARY. The blood current is so strong. It is just like the garden host that started splashing without control but this time, it is blood coming out from it rather than water. </div><div><br /></div><div>The surgeon looks so relax!!! I was pretending to be calm too. With my heart start pumping like mad and blood gushing to my face, I actually still able to talk to the patient and try to divert her attention. This is so unbelievable. Mr C just do a few stitches on the patient hand, and the wound stop bleeding. It is so amazing. The girl was then send to the operation theater for a proper procedure. Wish the girl will be fine. </div><div><br /></div><div>Getting treatment in a government funded hospital is really depend on luck. If the patient is lucky and met some senior and experienced doctors like Mr C, I will be sure that they had done a lot of good deed in the past. The society nowadays judge the success of one person based on the car they are driving and the house they are staying. In order to support their status and their luxurious lifestyle, many doctors nowadays use their knowledge to earn money. I sincerely wish Mr C always healthy and happy. Hope he will have a long age and to safe more people. </div>HYYhttp://www.blogger.com/profile/16141502157494340810noreply@blogger.com0tag:blogger.com,1999:blog-2298718900266111481.post-54015018855196757912011-08-16T22:40:00.002+08:002014-08-02T17:27:54.031+08:00成大事必备9种能力、9种手段、9种心态<span class="Apple-style-span" style="background-color: white; color: #333333; font-family: 宋体, Tahoma, 'Trebuchet MS', Arial, serif; font-size: 14px; line-height: 22px;"></span><br />
<span class="Apple-style-span" style="background-color: white; color: #333333; font-family: 宋体, Tahoma, 'Trebuchet MS', Arial, serif; font-size: 14px; line-height: 22px;"><div style="margin: 10px 0px 20px; padding: 0px;">
一:<strong>沉稳</strong></div>
<div style="margin: 10px 0px 20px; padding: 0px;">
(1)不要随便显露你的情绪。
<br />(2)不要逢人就诉说你的困难和遭遇。
<br />(3)在徵询别人的意见之前,自己先思考,但不要先讲。
<br />(4)不要一有机会就嘮叨你的不满。
<br />(5)重要的决定儘量有别人商量,最好隔一天再发佈。
<br />(6)讲话不要有任何的慌张,走路也是。</div>
</span><span class="Apple-style-span" style="background-color: white; color: #333333; font-family: 宋体, Tahoma, 'Trebuchet MS', Arial, serif; font-size: 14px; line-height: 22px;"><div style="margin: 10px 0px 20px; padding: 0px;">
二:<strong>细心</strong></div>
<div style="margin: 10px 0px 20px; padding: 0px;">
(1)对身边发生的事情,常思考它们的因果关係。
<br />(2)对做不到位的执行问题,要发掘它们的根本癥结。
<br />(3)对习以为常的做事方法,要有改进或优化的建议。
<br />(4)做什麼事情都要养成有条不紊和井然有序的习惯。
<br />(5)经常去找几个别人看不出来的毛病或弊端。
<br />(6)自己要随时随地对有所不足的地方补位。</div>
</span><span class="Apple-style-span" style="background-color: white; color: #333333; font-family: 宋体, Tahoma, 'Trebuchet MS', Arial, serif; font-size: 14px; line-height: 22px;"><div style="margin: 10px 0px 20px; padding: 0px;">
三:<strong>胆识</strong></div>
<div style="margin: 10px 0px 20px; padding: 0px;">
(1)不要常用缺乏自信的词句
<br />(2)不要常常反悔,轻易推翻已经决定的事。
<br />(3)在眾人争执不休时,不要没有主见。
<br />(4)整体氛围低落时,你要乐观、阳光。
<br />(5)做任何事情都要用心,因为有人在看著你。
<br />(6)事情不顺的时候,歇口气,重新寻找突破口,就结束也要乾净俐落。</div>
</span><span class="Apple-style-span" style="background-color: white; color: #333333; font-family: 宋体, Tahoma, 'Trebuchet MS', Arial, serif; font-size: 14px; line-height: 22px;"><div style="margin: 10px 0px 20px; padding: 0px;">
四:<strong>大度</strong></div>
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(1)不要刻意把有可能是伙伴的人变成对手。
<br />(2)对别人的小过失、小错误不要斤斤计较。
<br />(3)在金钱上要大方,学习三施(财施、法施、无畏施)
<br />(4)不要有权力的傲慢和知识的偏见。
<br />(5)任何成果和成就都应和别人分享。
<br />(6)必须有人牺牲或奉献的时候,自己走在前面。</div>
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五:<strong>诚信</strong></div>
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(1)做不到的事情不要说,说了就努力做到。
<br />(2)虚的口号或标语不要常掛嘴上。
<br />(3)针对客户提出的“不诚信”问题,拿出改善的方法。
<br />(4)停止一切“不道德”的手段。
<br />(5)耍弄小聪明,要不得!
<br />(6)计算一下產品或服务的诚信代价,那就是品牌成本。</div>
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六:<strong>担当</strong></div>
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(1)检讨任何过失的时候,先从自身或自己人开始反省。
<br />(2)事项结束后,先审查过错,再列述功劳。
<br />(3)认错从上级开始,表功从下级啟动
<br />(4)著手一个计画,先将权责界定清楚,而且分配得当。
<br />(5)对“怕事”的人或组织要挑明瞭说。
<br />(6)因为勇於承担责任所造成的损失,公司应该承担</div>
</span><span class="Apple-style-span" style="background-color: white; color: #333333; font-family: 宋体, Tahoma, 'Trebuchet MS', Arial, serif; font-size: 14px; line-height: 22px;">成大事的<strong>九种手段</strong></span><br />
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<span class="Apple-style-span" style="background-color: white; color: #333333; font-family: 宋体, Tahoma, 'Trebuchet MS', Arial, serif; font-size: 14px; line-height: 22px;"></span><br />
<span class="Apple-style-span" style="background-color: white; color: #333333; font-family: 宋体, Tahoma, 'Trebuchet MS', Arial, serif; font-size: 14px; line-height: 22px;"><div style="margin: 10px 0px 20px; padding: 0px;">
1、<strong>敢於决断</strong>--克服犹豫不定的习性</div>
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很多人之所以一事无成,最大的毛病就是缺乏敢於决断的手段,总是左顾右盼、思前想后,从而错失成功的最佳时机。成大事者在看到事情的成功可能性到来时,敢於做出重大决断,因此取得先机。</div>
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2、<strong>挑战弱点</strong>--彻底改变自己的缺陷</div>
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人人都有弱点,不能成大事者总是固守自己的弱点,一生都不会发生重大转变;能成大事者总是善於从自己的弱点上开刀,去把自己变成一个能力超强的人。一个连自己的缺陷都不能纠正的人,只能是失败者!</div>
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3、<strong>突破困境</strong>--从失败中撮成功的资本</div>
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人生总要面临各种困境的挑战,甚至可以说困境就是“鬼门关”。一般人会在困境面前浑身发抖,而成大事者则能把困境变为成功的有力跳板。</div>
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4、<strong>抓住机遇</strong>--善於选择、善於创造</div>
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机遇就是人生最大的财富。有些人浪费机遇轻而易举,所以一个个有巨大潜力的机遇都悄然溜跑,成大事都是绝对不允许溜走,并且能纵身扑向机遇。</div>
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5、<strong>发挥强项</strong>--做自己最擅长的事情</div>
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一个能力极弱的人肯定难以打开人生局面,他必定是人生舞臺上重量级选手的牺牲品;成大事者关於在自己要做的事情上,充分施展才智,一步一步地拓宽成功之路。</div>
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6、<strong>调整心态</strong>--切忌让情绪伤害自己</div>
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心态消极的人,无论如何都挑不起生活和重担,因为他们无法直面一个个人生挫折,成大事者则关於高速心态,即使在毫无希望时,也能看到一线成功的亮光。</div>
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7、<strong>立即行动</strong>--只说不做,徒劳无益</div>
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一次行动胜过百遍心想。有些人是“语言的巨人,行动的矮子”,所以看不到更为实际现实的事情在他身上发生;成大事者是每天都靠行动来落实自己的人生计画的。</div>
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8、<strong>善於交往</strong>--巧妙利用人力资源</div>
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一个人不懂得交往,必然会推动人际关係的力量。成大事者的特点之一是:善於靠借力、借热去营造成功的局势,从而能把一件件难以办成的事办成,实现自己人生的规划。</div>
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9、<strong>重新规划</strong>--站到更高的起点上</div>
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人生是一个过程,成功也是一个过程。你如果满足于小成功,就会推动大成功。
<br />成大事者懂得从小到大的艰辛过程,所以在实现了一个个小成功之后,
<br />能继续拆开下一个人生的“密封袋”。</div>
</span>From: <a href="http://www.12sharing.com/note/?p=2082">http://www.12sharing.com/note/?p=2082</a><br /></div>
HYYhttp://www.blogger.com/profile/16141502157494340810noreply@blogger.com0tag:blogger.com,1999:blog-2298718900266111481.post-53826022140155154312011-03-21T23:48:00.002+08:002011-03-21T23:54:58.459+08:00[None]NAC may be able to reduce contrast induced nephropathy but holiday is not really effective in reducing work induced STRESSopathy.. <div><br /></div><div>Question: Where is the source of the problem? </div><div><br /></div><div>a) The diagnosis is incorrect? </div><div>b) The treatment regimen is incorrect? </div><div>c) The dose or duration of treatment is too short? </div><div>d) None of the above, the problems lies in the patient herself.</div>HYYhttp://www.blogger.com/profile/16141502157494340810noreply@blogger.com0tag:blogger.com,1999:blog-2298718900266111481.post-73255780285390775652010-09-23T22:29:00.002+08:002010-09-23T22:40:56.753+08:00Shisha<div>Something to share:</div><div><br /></div><div><div>This Shisha smoking is also known as narghile, hookah and goza. It was originated in Persia and India and has been used for 4 centuries. </div></div><div><br /></div><div>I was first introduced to shisha in a mamak shop in Kelantan (surprisingly), then later found out that there is a shop in Sunway which even sell the colourful nice water pipe which used for shisha smoking. </div><div><br /></div><div>Shisha is equivalent to cigarette smoking. A single session of this waterpipe smoking deliver the same amount of tar as a pack of cigarettes. Shisha also contain nicotine, carbon monoxide, benzene, toluene, arsenic, lead, formaldehyde and carcinogens. </div><div><br /></div><div>So for those who think that it is safe, think twice. It is as bad or even worst compare to the normal cigarettes...</div><div><br /></div><div>Ref:</div><a href="http://www.medscape.com/viewarticle/727687?src=mp&spon=30&uac=101775CT">http://www.medscape.com/viewarticle/727687?src=mp&spon=30&uac=101775CT</a>HYYhttp://www.blogger.com/profile/16141502157494340810noreply@blogger.com2tag:blogger.com,1999:blog-2298718900266111481.post-61870662688924501012010-04-16T10:38:00.001+08:002010-04-16T10:43:29.263+08:00Taiwan 2010<b>Day 1: 8.4.2010</b><br />1. 抵达台湾桃园机场<div>a. 乘搭统联客运到高铁站<br />b. 乘搭台湾高铁(桃园 机场----> 台北车站)</div><div><br /></div><div>2. 住宿: 新驿旅店 City Inn (台北怀宁街7号)www.gocityinn.com</div><div><br />3. 新光三越大厦</div><div><br />4. 台北车站地下街</div><div>a. 早午餐: NY Begel (京都地下车站购物中心)</div><div><br />5. 阳明山</div><div>a. 竹子湖<br />b. 海芋花园<br />c. 小油坑</div><div><br />6. 晚餐: 台大牧场 (寿喜锅) www.mo-mo.com.tw (台北罗斯福路四段68号3F)</div><div><br />7. 逛罗斯福路周边<br />a. 师大路夜市<br />b. 公馆夜市 (红豆饼,青蛙撞奶)</div><div><br /><br /><b>Day 2: 9.4.2010 (宜兰一日一夜游)</b><br />1. 早餐: 摩斯汉堡 (Mos Burger)</div><div><br />2. 台北火车站 (台北---->罗东) </div><div>a. 自强号: 1小时16分: NT$239</div><div><br />3. 国立传统艺术中心<br />a. 传统小吃坊 (猪血糕,红花香肠,冰沙,豆花,蜜饯)<br />b. 民艺街 (传统街屋)<br />c. 传习街( 工艺传习所)<br />d. 临水街</div><div>e. 文昌祠戏台(昆曲:弄水袖,唱曲子,动扇子 & 西游记剧场)</div><div><br />4. 住宿: 葛瑞丝民宿Grace Home stay (宜兰县罗东镇四维路152巷7号)<br />a. http://blog.pixnet.net/gracepark<br />b. www.gracepark.tw</div><div><br />5. 罗东运动公园</div><div><br />6. 罗东夜市 (葱油饼,龙风卷,包心粉园,花生雪糕,糕渣,卜肉,糖葫芦,当归羊肉羹)</div><div><br />7. 罗东弈顺轩(奶冻卷,新鲜muachi)<br /><br /></div><div><br /><b>Day 3: 10.4.2010 (花莲二日一夜游)</b><br />1. 早餐: Grace home stay</div><div><br />2. 罗东火车站(罗东---->花莲)<br />a. 自强号: 56分: NT$205<br />b. 租车(二日)<br />c. 花莲市美食[博爱街165号 (五霸包心粉圆焦糖锉冰), 扁食(混沌), 卤鸭胗]</div><div><br />3. 鲤鱼潭(划船, 漫游鲤鱼山步道)</div><div><br />4. 午餐: 红瓦屋:_老地方文化美食餐厅 (传统阿美族餐厅) Cifadahan café</div><div>a. http://www.cifadahan.58168.net<br />b. 吴郭鱼石煮 (以槟榔叶编织成器皿,置入鱼肉,加上盐巴,生姜,米酒, 以湿地自然涌泉为汤底, 陆续加入烧热的石头,最后放入湿地野菜), 紫米饭,烤山猪肉,野菜,芦笋</div><div><br />5. 东海岸游车河<br />a. Cliff house拍照留念</div><div><br />6. 住宿:法喜民宿</div><div><br />7. 晚餐: 陈记状元粥铺 (状元粥, 红豆牛奶甜点,芝麻饼)</div><div><br />8. 自强夜市(棺材板,炭火烤肉串,米粉梗,杏仁红豆汤,西饼,烤玉米)</div><div><br /><br /><b>Day 4: 11.4.2010 (花莲二日一夜游)</b><br />1. 早餐: 法喜民宿”幸福”套餐</div><div><br />2. 太鲁阁国家公园</div><div>a. 东西横贯公路牌坊<br />b. 宁安桥<br />c. 燕子口<br />d. 九曲洞步道<br />e. 慈母桥<br />f. 天祥庙</div><div><br />3. 花莲火车站(花莲---->台北)<br />a. 午餐 (铁路便当: 排骨,酸菜,卤蛋,豆干,白饭,腌萝卜,芥菜)</div><div><br />4. 住宿: 新驿旅店</div><div><br />5. 博爱路相机街</div><div><br />6. 西门耵<br />a. 红楼剧场<br />b. 西门耵服饰街<br />c. 诚品116<br />d. 万年商业大楼<br />e. 美食(阿宗面线,青蛙下蛋,珍珠奶茶,KFC 蛋塔,鹅肉,卤肉饭,米粉汤)</div><div><br /><br /><b>Day 5: 12.4.2010 (九份一日游)</b><br />1. 台北火车站(台北---->瑞芳)<br />a. 莒光号: 50分钟, NT$125</div><div><br />2. 逛瑞芳老街<br />a. 早餐: 泡芙 & 芝士火腿蛋糕 from 花莲<br />b. 牛肉面,番薯,龙凤卷</div><div><br />3. 乘搭基隆客运到金瓜石站<br />a. 黄金神社<br />b. 眺望茶壶山<br />c. 阴阳海</div><div><br />4. 九份<br />a. 九份老街<br />b. 升平戏院<br />c. 美食: 赖阿婆芋圆,盐酥菇,田螺,烤鳗鱼,鱼丸汤</div><div><br />5. 台北市林夜市 (豪大炸鸡排,蜜汁鸡排. 臭豆腐,当季水果,油饭,螃蟹羹,锉冰)</div><div><br />6. 住宿: 新驿旅店<br /><br /><br /><b>Day 6: 13.4.2010 (台北市 & 淡水一日游)</b><br />1. 龙山寺<br />2. 中正纪念堂<br />3. 国家戏剧院<br />4. 台北101 (板南线市政府站)<br />5. 纽约纽约购物中心<br />6. 诚品书城信义旗舰店<br />7. 静思书轩<br />8. 淡水河岸<br />9. 淡水老街 (美食: 阿给小吃,鱼酥,阿婆铁蛋,珍珠包,铁塔:炸薯片)<br />10. 渔人码头: 情人桥<br />11. 住宿: 新驿旅店<br /><br /><b>Day 7:</b><br />1. 乘搭台湾高铁(台北车站---->桃园 )<br />2. 回家<br /></div>HYYhttp://www.blogger.com/profile/16141502157494340810noreply@blogger.com0tag:blogger.com,1999:blog-2298718900266111481.post-62864965655406681142010-01-10T13:46:00.003+08:002010-01-10T14:39:11.647+08:002010 wishesIt is the 10th day of 2010... <br /><br />When the holiday mood gradually faded and washed out from the mind, when we just set some resolutions which yet to be implement, the news of churches being burnt down shocked the Malaysians. <br /><br />I am shocked with what had actually happened to our country. This is the 2nd time the places of worship had been brutally vandalized by a small group of irresponsible people. First the buffalo head was being thrown into a Hindu temple, now they set fire on churches, what is next? The Buddhist temple? <br /><br />This is a multiracial country. Race issue is like a time bomb. It is set everywhere and explosions will happen anywhere & anytime if we are not careful with what we say and what we do. Lets condemn those who act without thinking. <br /><br />Burning down churches would not resolved the matters. For those who are not satisfied with the courts decision, this is not the correct way of expressing your disappointment or anger. So are these people trying to tell the world that Muslims or Islams teaching are so violent? and they will destruct everything which is not in line with them?<br /><br />Send those people who involved with arson attack to jail. Find out those people. Why when there are witnesses come forward to help in investigations that the police are still not able to find any suspects? <br /><br />Donating RM500,000 may be a good move to help in cooling down the issue for a while. In order to prevent things from happen again, our "great leaders" must really do something. They must have a broad and open minded to embrace and absorb all culture and be fair to every race in this country...<br /><br />We still have 355 days to go as 2010 just started. Lets do something to help in succeeding the 1Malaysia concept. Lets forget about the color of the skin. We may have a different flesh color, but always remember that the color of blood of every human are same....HYYhttp://www.blogger.com/profile/16141502157494340810noreply@blogger.com2tag:blogger.com,1999:blog-2298718900266111481.post-74886932707550129672009-11-12T22:33:00.002+08:002009-11-12T23:23:51.469+08:00BMSBMS stands for balance medication sheets. It is a letter issued by my hospital pharmacy department to remind patients to collect their balance medications at certain date...<br /><br />In government hospitals or clinics, the doctors usually see patients with chronic diseases once in every 2 months or sometime up to 9 months. SO within the 1st and the next appointment, patient will usually continue on their medications and they have to collect their medications in the pharmacy department. <br /><br />If they are in the private hospitals, usually they can collect all of their medications in one go. However, in the government setting, with the increasing number of patients and the limited budget to buy drugs, we always control our supply by issuing out a BMS to the patient to ask them to come back to collect the balance and at the same time check their compliance on those medications. <br /><br />Towards the end of the year, we are issuing out a lot of BMS, to almost every patient and at a very near date... For example if the doctor prescribed 6 months medications, we can only supply 1-2 months supply, some even only 2 weeks supply. This means that we have to see the patient VERY VERY often to refill their prescriptions. <br /><br />Refilling prescriptions at this speed----once every 2 weeks or once a month for a 6months prescriptions is tiring. It is very inefficient and lowering the compliance of patients on their medications. Although no actual statistic had been published on the percentage of patient coming back to collect their balance med, it will definitely not be 100%...<br /><br />For patients who are not considerate, they will make a lot of noise and complaining that the government servants are not efficient and we are cold blood. I do not blame them. If I were the patient, I will also be very frustrated to come back and collect medications so often and each time when I come back, I have to purposely take leave, spend money on transport, waste time on waiting, sigh... such a miserable life. <br /><br />However, I must say something on behalf of my department. We are also human and we feel sympathy on the patients who have to keep coming back for their medications, especially the elderly and those who stays very far from the hospital. Everyday we are trying very hard to ensure that the supply of the medications are sufficient. But with the increasing numbers of patients who transfer from private to government hospitals due to economic downturn and the H1N1 flu outbreak last 2 months and without extra money given to the pharmacy department, what can we do? We got no money to buy and can only borrow a small amount from other hospitals when the medication finish. I especially feel sad for my colleagues who work in the store who have to keep calling to beg for drugs from other hospital...<br /><br />I strongly agree with a comment published in the STAR paper from an Ipoh pharmacist.<br /><br />"I can confidently say that government pharmacy departments are at a breaking point whereby in many cases the money has already run out"<br /><br />"Therefore I urge our Prime Minister and health minister to look into this urgent matter. Maybe instead of spending money to open 50 1Malaysia clinics, the allocation can be used to meet public demand for medications"<br /><br />In my opinion, it is really time to consider to increase the payment to receive treatments in the government hospital and make sure that only those hardcore poor citizens enjoy free treatments. For those who are "not so poor" they can at least pay for their medications, at least 20% of medications they received. This can also make sure that wastage of medications lowered. When one have to fork out money to pay, they will then appreciate how much had the government done on providing the almost free healthcare treatment to the public. We are all tax payers. I do not wish the money which I contribute to the country continue to use to support some rich people.....HYYhttp://www.blogger.com/profile/16141502157494340810noreply@blogger.com0tag:blogger.com,1999:blog-2298718900266111481.post-17994564786842073872009-11-01T10:22:00.002+08:002009-11-01T10:55:06.069+08:00PanicI was hopping that I can finish the trainee life asap. But now when it is all over, I felt uneasy and suddenly do not know what to do with my life. <br /><br />The one year of PRP turns out to be a calm and steady path. But when everything turns out to be too smooth, it just doesn't seems right... It is a very difficult feeling to be explain by words. <br /><br />Most of my best friends and colleagues were posted to the east Malaysia or cities in the northern states to continue their government service. The ministry of health people seems to be to tired with all of us. Non of the appeal to stay back in the hometown were accepted and all of them just suddenly dissapear from my life. We don't even hav a proper farewell gathering before they leave. It is all too sudden, and I think I am still not used to it until now. <br /><br />It is 2 weeks from the day I reported to my workplace. It is glad to know that I can continue to work in the same place, staying in the comfort zone and ignoring the world outside. BUT these voices in my brain telling me to get out from the place I am familiar with and get out from my parent's house I had stayed for 25 years had grew stronger and stronger. I will ended up having schizephrenia if I still live my life like this. <br /><br />what I am suppose to do????????????????????????????????HYYhttp://www.blogger.com/profile/16141502157494340810noreply@blogger.com0tag:blogger.com,1999:blog-2298718900266111481.post-79366720282575806312009-08-20T22:38:00.005+08:002009-08-20T23:53:36.259+08:0015malaysia short filmWatch this:<br /><br /><a href="http://15malaysia.com/">www.15malaysia.com</a><br /><br />The most hilarious Potong saga, the meningful chocolate and many more to come<br /><br />If you like Yasmin Ahmad, watch this:<br /><br /><a href="http://www.youtube.com/watch?v=dP-j6vUGwK4&feature=related">http://www.youtube.com/watch?v=dP-j6vUGwK4&feature=related</a>HYYhttp://www.blogger.com/profile/16141502157494340810noreply@blogger.com1tag:blogger.com,1999:blog-2298718900266111481.post-2859441994728298042009-07-26T17:14:00.003+08:002009-07-26T17:20:02.892+08:00Rest in peaceI do not know Teoh Boon Hock until he appeared on the front page of the newspaper, lying dead at the premises of the Malaysian Anti corruption commission (MACC). I was so shock that this is actually happening in Malaysia, where somebody walks into a government building alive but come out as a dead body. I began wondering whether this place that I stayed is still the Malaysia I know. Can I still stay in this piece of land??? I felt sorry for this young man, his fiancée and his family members. Hope he will rest in peace and the next life he will not be born in Malaysia. <br /><br /> I voted for the opposition in 308 elections, not hopping to change the BN government but just to tell BN I am not satisfied with what they are doing and hope that there is a stronger opposition which can counter check the current government. With the new opposition government formed less than a year and was probe by the anti corruption body, I was quite disappointed and I really hope they are not equally as dirty as their former counterparts. However, what are the interrogation method the anti corruption officers used until a young man was dead not even after 1 day of going into their building? <br /><br /> This is so scary. When a Mongolian woman died bombing by the former armies, an Indian boy died in a police station during interrogation, can anyone that we know found dead the next day they went into a government building? If someone wishes you to die the next day, will you just vanish into the thin air without leaving any remaining? We really want to know what is actually happening in this country. <br /><br /> For Dato Seri Najib, our beloved prime minister, I hope he can really sit down discuss with his cabinet members to let the Royal Comission of Inquiry investigate the cause of dead of Teoh. All we want is just the truth of what had actually happened on 16.7.09 in the MACC premise. Whether or not Teoh had commited a crime, he is not supposed to die this way. If he was really murdered, let the murderers face the justice. Let’s be focus and put away all the political differences and the racial divide. This is human life. He was dead and will never come back again. Give us the answers we want. I just hope that this will just not turned out to be an unresolved case, and later become the most mysterious case in Malaysia for the past 52 years.HYYhttp://www.blogger.com/profile/16141502157494340810noreply@blogger.com0tag:blogger.com,1999:blog-2298718900266111481.post-80567881614394164562009-04-19T17:11:00.003+08:002009-04-19T17:18:37.738+08:00Autopsy<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiknZ74qVyD_dOHAOb7lWbCXmF0-77RWm5r4RSzTtsETFGFpj4tTeN3LtplRVLzdbztUauEBK85KmKMUYkGNMZMb_HX_6btxMBrh1eLjAJeDbLeTmzeIVT-jcav8GSRIcQjjh-abSn-LzU/s1600-h/IMAG0046.jpg"><img id="BLOGGER_PHOTO_ID_5326328037691263250" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 320px; CURSOR: hand; HEIGHT: 240px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiknZ74qVyD_dOHAOb7lWbCXmF0-77RWm5r4RSzTtsETFGFpj4tTeN3LtplRVLzdbztUauEBK85KmKMUYkGNMZMb_HX_6btxMBrh1eLjAJeDbLeTmzeIVT-jcav8GSRIcQjjh-abSn-LzU/s320/IMAG0046.jpg" border="0" /></a><br />Having flu? take a capsule of Carinox. Pseudoephedrine + Loratadine<br /><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiRutcRo6cgCLw-nhl8836B_6l3hyIxjpgSC-JVc0dqGbOsjkJ7rgYD65Dpb_ecwUUWz5P4HvnGkwMuFD-V_gFiHo4LMYKvECCoOcfgSRipIf6JuRZKw7m6WbzdgtXqm3cchW0cT5rIJ4Y/s1600-h/IMAG0049.jpg"><img id="BLOGGER_PHOTO_ID_5326328191327036290" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 320px; CURSOR: hand; HEIGHT: 240px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiRutcRo6cgCLw-nhl8836B_6l3hyIxjpgSC-JVc0dqGbOsjkJ7rgYD65Dpb_ecwUUWz5P4HvnGkwMuFD-V_gFiHo4LMYKvECCoOcfgSRipIf6JuRZKw7m6WbzdgtXqm3cchW0cT5rIJ4Y/s320/IMAG0049.jpg" border="0" /></a><br />Nice from outside. Not much different from other products.<br /><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQmy6kbgfTDhs6_mQU-cC6Q9X_HoPCgR_GR8qt9K-5Fb7y59FdNdnyMi2v2y5gcEfyJU6gqJpgn-ymA_vlOiGjwbiMnmn5Toh_An5RhUnPWgKXvRykdBtT7h8Ap_vOwxlOwfTyEQujtmI/s1600-h/IMAG0051.jpg"><img id="BLOGGER_PHOTO_ID_5326328338911915074" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 320px; CURSOR: hand; HEIGHT: 240px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQmy6kbgfTDhs6_mQU-cC6Q9X_HoPCgR_GR8qt9K-5Fb7y59FdNdnyMi2v2y5gcEfyJU6gqJpgn-ymA_vlOiGjwbiMnmn5Toh_An5RhUnPWgKXvRykdBtT7h8Ap_vOwxlOwfTyEQujtmI/s320/IMAG0051.jpg" border="0" /></a><br />Walaoeh... Another Malaysia Boleh product.HYYhttp://www.blogger.com/profile/16141502157494340810noreply@blogger.com0tag:blogger.com,1999:blog-2298718900266111481.post-47046096420284178392009-04-03T23:35:00.001+08:002009-04-04T00:14:43.962+08:00Looking good but going nowhereA doctor asked me the other day, whether I feel frustrated when dispensing. After study so hard for 4 years, I am just dispensing at the counter... <br /><br />I had mixed feeling when she said that. I told her we are doing many things besides dispensing. Things like TDM, TPN, clinical stuff, controlling stocks, counter checking prescriptions, providing drug information, monitored drug therapy for specific patients and etc.These are important... The doctor doesn't seems to listen. She just shrug her shoulder.<br /><br />The public sees pharmacist = dispenser. They do now know what are the pharmacist doing. So are many doctors. They thought we are just taking "gaji buta" and sit there doing nothing. They do not see the importance of our job. Without pharmacist, many doctors' license will kena suspend... I am serious.<br /><br />Healthcare professionals work as a team. The main purpose in the end of the day is to provide good patient care and let them recover from their illness asap. <br /><br />Dispensing is crucial and it is part of patient care. Pharmacist prepare reliable medications and distribute them to patients, counseling patients about their prescription drugs and how to best use them. I think ensure that the patients are taking medication are as important as writing a precription. <br /><br />Furthermore, in the ward, clinical pharmacists participate in drug selection, drug Regimen, develop and implement pharmaceutical therapeutic plans, document it and follow-up of outcomes... Since malaysia just start to have pharmacist ward round with doctors, I understand many doctors just cant get used to it. But just remember that we are not finding fault or try to challenge any decisions. We are just there to help. Lets us work hand in hand to provide a better healthcare service for the public.HYYhttp://www.blogger.com/profile/16141502157494340810noreply@blogger.com1tag:blogger.com,1999:blog-2298718900266111481.post-8598358115339005502009-02-10T20:43:00.003+08:002009-02-10T21:58:40.040+08:00Slumdog MillionaireSlumdog Millionaire, one of the best movie I watched recently. <br /><br />The story is about an 18 years old Indian boy. Jamar Malik, an orphan who grew up without proper education and lived in the slum area, won "Who wants to become the millionaire". The movie tells us his adventurous and sad childhood, and how he came to know all the answers in the game which arouse suspicions and led to the accusation of him cheating.<br /><br />After watching this movie, I am glad that I am a normal people, not rich, not poor, never worry about will there be any food to eat tomorrow, can sleep comfortably every night, have eyes to see beautiful and ugly things in life, have parents who still treat me like chidren, having a good job and many great friends. <br /><br />I used to say that our life are in our hand. However, as I grow older, I sort of believe that our destiny are somehow written. What we done in the past made the unique life we had today and what we did now affecting our future. Are we actually controlling our live or it is our live which control us? <br /><br />Jamal Malik unfortunate life experiences coincidentally enabled him to know the answer to each question. It is like news last month regarding the pilot who saved the lives of the passangers. When you read about the history of the pilot, it is as if his whole life is preparing him to face the challenge in the plane crashed incident. Same case as Jamal Malik, where his whole childhood is preparing him to become a millionaire. <br /><br />A great movie at the beginning of this not so good 2009. Strongly recommend to watch. Let us ignore our frog MP, pariah government, lowsy economy and all the unhappy events in life. Sees obstacle as opportunities and live life to the fullest.HYYhttp://www.blogger.com/profile/16141502157494340810noreply@blogger.com0tag:blogger.com,1999:blog-2298718900266111481.post-30643686850742865382008-12-20T17:01:00.003+08:002008-12-20T17:10:42.881+08:00Good old days<a href="http://www.youtube.com/watch?v=VipsmMgeuH4">Video---AMIGO</a><br /><br />Video created by Seng yeong "dai ka jie"<br />Missed B104ian...<br />All the best to all of my friends.<br />Wish all of you always happy and healthy.<br />Hope we can still remember each other many many years from now.HYYhttp://www.blogger.com/profile/16141502157494340810noreply@blogger.com0