ADVERSE DRUG EVENTS REPORTING RESOURCE CENTRE

Although prescription drugs must meet certain safety standards before they are approved for the market, unexpected adverse drug events (ADEs) can occur after a drug is used in a larger population over a longer period of time. Voluntary reporting of ADEs is thus a vital component of drug safety. Unfortunately, many ADEs are never reported, often because they were not recognized as safety problems, or because a healthcare professional was unfamiliar with the reporting process. In order to address this important public health problem, Medscape developed this collection of educational programs, news articles, and tools to promote better understanding of ADEs and to facilitate more regular and complete ADE reports.

CME on this Topic

From Medscape Internal Medicine > Staying Well With Sandra Fryhofer, MD

Rethinking Calcium: Bone Health or Heartache?

Sandra A. Fryhofer, MD

Authors and Disclosures

Posted: 10/25/2010

Sandra A. Fryhofer, MD Clinical Associate Professor of Medicine, Emory University School of Medicine, Atlanta, Georgia; Past President, American College of Physicians, Philadelphia, This issue of "Staying Well" focuses on rethinking calcium recommendations. In the past, calcium concerns have focused on bone health and on how to get enough calcium. Adequate calcium intake recommendations developed by the Food and Nutrition Board at the Institute of Medicine say that children and teens 18 years of age or younger need 1300 mg daily, and adult men and women 19 to 50 years of age need 1000 mg daily. After age 50 years, the Institute of Medicine recommends even more calcium, and daily adequate intake increases to 1200 mg.[1,2] Now, a study in BMJ raises concern that supplemental calcium may have an inadvertent adverse outcome: It could hurt your heart.[3]

Calcium and Heart Woes

In this meta-analysis of 15 randomized blinded placebo-controlled trials. Dr. Mark Bolland from the University of Auckland in New Zealand and colleagues evaluated calcium supplement use (at least 500 mg daily) in more than 12,000 patients older than 40 years of age. The findings were surprising: The pooled results linked calcium supplement intake to a significant 30% increased risk for heart attack. A tendency to increased risk for stroke and sudden death was also seen, but this result was not significant. Of note, cardiovascular outcomes were not a primary endpoint in any of the individual trials. Proposed mechanisms for the higher risk include increased blood coagulability and decreased blood vessel compliance due to calcium buildup in the arterial wall. On the basis of these findings, the authors postulate that treating 1000 people with calcium for 5 years would prevent 26 fractures but cause an additional 14 heart attacks.^[3]

This is not the first time that Dr. Bolland has studied calcium intake and cardiovascular outcomes. Two years ago, results of a randomized placebo-controlled study of 1471 postmenopausal women were published that linked calcium supplements with greater cardiovascular risk.^[4] That 2008 study by Bolland and colleagues was included in their 2010 meta-analysis.

No Trials of Calcium Plus Vitamin D Were Included

The type of calcium supplement did not seem to matter, but the current meta-analysis looked at calcium supplements alone. Researchers did not include any trials looking at calcium plus vitamin D.

An accompanying BMJ editorial questions the role of calcium in bone health in reducing fractures. It even goes so far as to say that only patients with osteoporosis who are also taking medication for it should take calcium supplements, alone or with vitamin D ,and calls for further research on calcium supplement safety and efficacy.^[5]

The Women's Health Initiative evaluation of combined calcium and vitamin D found no effect on heart attack and stroke.^[6] A recent systematic review in Annals of Internal Medicine suggests that moderate to high doses of vitamin D may reduce cardiovascular risk, whereas calcium alone had no significant effect.^[7]

Back to Basics: Incorporating Adequate Calcium Into the Diet

This study has me rethinking how I talk to patients about calcium. Use of calcium supplements may be problematic from a cardiovascular standpoint. What about dietary calcium? The verdict from previous studies is good: No increased cardiovascular risk is linked to higher intake of dietary calcium.^[3] Adequate calcium intake recommendations refer to total daily intake; it does not mean the extra amount of calcium that should be added, but that's often what happens. Incorporating dietary calcium rather than taking supplements is a better way to meet adequate calcium intake recommendations.

Calcium Content of Foods: My Favorite Lists

When talking to patients about dietary calcium, it helps to have a calcium food content list. My favorite patient-friendly list of the calcium content of selected foods is in the patient education section of the UCSF Medical Center Website.^[8] It separates the calcium content of foods into the categories dairy, vegetables, fruits, legumes, grains, nuts and seeds, fish, and other (blackstrap molasses). A list on the Harvard University Health Services Website is also handy: It is only 2 pages long and includes calorie contents.^[9] The most comprehensive list of the calcium content of foods can be found on the US Department of Agriculture's Website, but at 25 pages, it is too long to download and hand out to patients.^[10]

Dietary Calcium Intake: Start With Dairy

If the goal is to consume 1000 mg calcium daily and you take in 3 servings of dairy and soy, you're almost there. For example:^[8]

• Milk (1 cup [8 oz]): 300 mg calcium
• Plain low-fat yogurt (1 cup [8 oz]): 400 mg
• Cheese (1 oz of cheddar or mozzarella): 200 mg
• Calcium-fortified soy milk (1 cup [8 oz]) 400 mg

Dietary Calcium Intake: Beyond Dairy

Encourage patients to go beyond dairy and incorporate vegetables, fruits, legumes, grains, nuts and seeds, and fish as dietary calcium sources. (Table).

Table. Nondairy Sources of Dietary Calcium^[8]

Vegetables	Acorn squash (1 cup): 90 mg Arugula (1 cup): 125 mg Broccoli (1 cup): 180 mg Chard or okra (1 cup): 100 mg Kale, raw (1 cup ): 55 mg Spinach, cooked (1 cup): 240 mg
Fruits	Figs, dried uncooked (1 cup): 300 mg Calcium-fortified orange juice (1 cup [8 oz]): 400 mg
Nuts	Sesame seeds, whole roasted (1 oz): 280 mg Almonds (1 oz): 80 mg
Fish	Canned mackerel (3 oz): 250 mg Sardines (3 oz): 370 mg
Other	Blackstrap molasses (1 tbsp): 135 mg

Rethinking Calcium Recommendations: Balancing Benefits and Minimizing Risks

Here's how I am rethinking what I tell my patients.

1. For bone health, I will still encourage adequate calcium intake, along with vitamin D, 1000 IU. Don't forget the "D."
2. I will spend more time talking to patients about dietary sources of calcium and discourage immediately turning to a calcium supplement.
3. Calcium supplements should be used to help patients attain total recommended intake, not to augment daily intake. (I prefer calcium citrate.)
4. This new study focuses on heart risks, but don't forget about kidney stones. Unlike supplements, dietary calcium is less likely to trigger stone formation.^[11]

So, add some figs and a spoonful of almonds to your salad, and also sprinkle on some sesame seeds. This new study is another reminder that too much of a good thing may be bad for you, even calcium.

References

1. Dietary Supplement Fact Sheet, Calcium: health professional fact sheet. Available at:http://ods.od.nih.gov/factsheets/Calcium_pf.asp Accessed September 22, 2010.
2. Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington, DC: National Academies Press; 1997.
3. Bolland MJ, Avenell A, Baron J, et al. Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ. 2010; 341:c3691.
4. Bolland M, Barber P, Doughty R, et al. Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial. BMJ. 2008;336:262-266. Abstract
5. Cleland JG, Witte K, Steel S. Calcium supplements in people with osteoporosis. BMJ. 2010;341:c3856.
6. Hsia J, Heiss G, Allison M, et al; Women's Health Initiative Investigators. Calcium/vitamin D supplementation and cardiovascular event. Circulation. 2007;115:846-854. Abstract
7. Wang L, Manson JE, Song Y, Sesso HD. Systematic review: vitamin D and calcium supplementation in prevention of cardiovascular events. Ann Intern Med. 2010;153:315-323.
8. USCF Medical Center. Calcium content of selected foods. USCF Medical Center Website. Available at:http://www.ucsfhealth.org/adult/edu/calciumContent/index.html. Accessed September 24, 2010.
9. Harvard University Health Services. Calcium content of common foods in common portions. Harvard University Health Services website. Available at:http://huhs.harvard.edu/assets/File/OurServices/Service_Nutrition_CalciumContentOfCommonFoods.pdf. Accessed September 24, 2010.
10. USDA US Department of Agriculture. National Nutrient Database for Standard Reference, Release 20. Calcium, Ca mg Content of Selected Foods per Common Measure, sorted alphabetically. Available at:http://www.nal.usda.gov/fnic/foodcomp/Data/SR20/nutrlist/sr20a301.pdf Accessed September 24, 2010.
11. Worcester EM, Coe FL. Clinical practice: calcium kidney stones. N Engl J Med. 2010;363:954-963.

BSc (Honours) Pharmaceutical and Health Sciences

Attention to all Assistant Pharmacist of Malaysia,

University of Nothingham, Malaysia is offering a new programme for qualified candidates and pharmacy personels. Those who are keen to do a degree courses can enroll and contact the person as given below. This will be also an opportunity for those who are planing to become a Tutors at private Pharmacy Colleges and continue for further developments in career as lecturers. In governments colleges, the pharmacy board had change the qualification of tutors to Degree in Pharmacy Only. So its difficult for all Assistant Pharmacist in Malaysian governments Institution to becomes tutors unless you have a degree in pharmacy. But you may try this course and becomes a tutors, scientist, reseachers on drugs.

BSc (Honours) Pharmaceutical and Health Sciences
The Pharmaceutical and Health Sciences programme is a full-time degree studied over three years leading to the award of a BSc single honours degree. All three years of the course are taught at the University of Nottingham Malaysia Campus by our experienced academic staff in the School of Pharmacy. In addition to the staff based permanently at the Malaysia Campus you will also be taught by visiting academics from Nottingham’s UK Campus and senior representatives of the Pharmaceutical Industry in Malaysia and South East Asia. Programme structure Year One During the first year teaching will concentrate on the fundamentals of the main areas of the course which are Pharmaceutics, Pharmaceutical & Medicinal Chemistry, Physiology & Pharmacology and Microbiology. Year Two In the second year you will consolidate the main topics taught in year one and start to explore these subjects in the context of industrial pharmacy and healthcare in general. Year Three The final year builds upon the basic pharmaceutical science foundation and also sees the introduction of a selection of optional modules including some in the field of business and entrepreneurship to meet the needs of employers in the Pharmaceutical and Healthcare sectors. Crucially, a semester-long research project allows the student to develop scientific research and data analysis skills in an area of their choosing. Career opportunities Pharmaceutical scientists are central to the discovery and development of new drug entities, formulation science and the design of novel drug delivery systems and therapeutics. With their training and skills, graduates from the BSc in Pharmaceutical and Health Sciences would be well placed to pursue careers in the pharmaceutical and biotechnology industries as researchers, scientists or indeed as academics in higher education. There would also be scope for graduates to enter employment in medicines sales & marketing, scientific writing and other appointments which require a general science background. Contact Master of Pharmacy (MPharm) For further details of our undergraduate MPharm course, please contact: Dr Ting Kang Nee Tel: +603 8924 8209 Email: pharmacy.enquiries@nottingham.edu.my BSc (Honours) Pharmaceutical and Health Sciences For further details of the BSc (Honours) course, please contact: Dr Nashiru Billa Tel: +603 8924 8211 Email: pharmacy.enquiries@nottingham.edu.my BEST OF LUCK !

How to Protect Yourself from these Five Pervasive Toxins

Good day to all Readers,

I was quite busy lately and didnt have much time to post new articles. Today i received email from Dr.Mercola. This is one of the articles from the famous Dr.Mercola. Read this !

Posted By Dr. Mercola | August 25 2010

A growing body of research links five of the most commonly used chemicals in the world to a host of ailments, including cancer, sexual problems and behavioral issues. Here's what CNN suggests you can do about them:

1. BPA — Bisphenol A

   BPA is used to make lightweight, clear, heat-resistant plastic. It's also used in epoxy resins.

   A growing body of research suggests that BPA poses a potential cancer risk and may disrupt the extremely sensitive chemical signals in your body called the endocrine system.

   To avoid it, buy stainless steel bottles and glass food storage containers. Switch to fresh or frozen vegetables instead of canned. If you buy plastic, check for the number on the bottom — if there is a number 7, assume the container contains BPA unless it explicitly says otherwise.

2. Phthalates

   This family of chemicals softens plastics. Phthalates are considered endocrine disrupters. Research has also shown phthalates disrupt reproductive development. Avoid shampoos, conditioners and other personal care products that list "fragrance" as an ingredient.

3. PFOA — Perfluorooctanoic acid (also called C8)

   PFOA is used to make Teflon and other nonstick and stain- or water-repellent products. PFOA causes cancer and developmental problems. You can reduce your potential exposure by using stainless steel or cast iron cookware. If you use nonstick cookware, do not overheat it — this releases toxic gas.

4. Formaldehyde

   Formaldehyde is an ingredient in resins that act as a glue in the manufacture of pressed wood products. It is a known human carcinogen, causing cancers of the respiratory or gastrointestinal tract.

   Buying furniture free from formaldehyde eliminates much of the exposure you face from the chemical. If you have wood products containing formaldehyde, increase ventilation, reduce humidity with air conditioning or dehumidifiers and keep your home cool.

5. PBDEs — Polybrominated diphenyl ethers

   PBDEs are a group of chemicals used as flame retardants. Toxicology tests show PBDEs may damage your liver and kidneys and affect your brain and behavior. Try to find products without PBDE flame retardants and be sure to sweep up dust.

Sources:

CNN May 31, 2010

Dr. Mercola's Comments:

Thanks to the spoils of the industrial revolution, your body is now home to a growing cocktail of chemicals.

Intermingling with your red and white blood cells, your endocrine system, brain, tissues and other organs are chemicals used to make epoxy resins, non-stock cookware, flame-resistant upholstery and plastic -- clearly substances that have no business taking residence in a living, breathing creature such as yourself.

Your Body Probably Contains Over 200 Chemicals

A typical American comes in regular contact with 6,000 chemicals and an untold number of potentially toxic substances on a less frequent basis. There are about 75,000 chemicals regularly manufactured and imported by U.S. industries, so you could potentially be exposed to any number of them.

Given the vast amounts of chemicals in the environment, it's not too surprising that the CDC's Fourth National Report on Human Exposure to Environmental Chemicals found an average of 212 chemicals in Americans' blood or urine.

Likewise, an Environmental Working Group study found that blood samples from newborns contained an average of 287 toxins, including mercury, fire retardants, pesticides, and Teflon chemicals, and this is from exposures they received before birth.

When it comes to the potentially hazardous chemicals you and your family are exposed to as you go about your daily lives, it can easily feel overwhelming. There are chemicals literally everywhere, but rather than feeling burdened by the thought I encourage you instead to focus on simple steps you can take to reduce your risk.

A good starting point, as CNN as suggested above, is to focus on avoiding some of the most pervasive, and most toxic, chemicals that are virtually guaranteed to be in your home right now.

Five Top Common Chemicals to Avoid …

The five chemicals listed by CNN are definitely worthy of eliminating from your life as much as possible, and given that they are among the most widely used chemicals around, doing so will make a serious positive impact on your chemical exposure.

They gave a great summary above, but I'll touch on them again briefly here:

• BPA: BPA is one of the world's highest production-volume chemicals and is widely used in the production of plastics, canned foods and soda cans, food packaging, baby bottles and toys and more.

  The chemical can lead to heart disease, diabetes and liver problems in adults, and previous research has linked BPA to serious developmental and reproductive problems.

  You can find 10 tips to minimize your BPA exposure here.

• Phthalates: Phthalates, or "plasticizers," are a group of industrial chemicals used to make plastics like polyvinyl chloride (PVC) more flexible and resilient. They're also one of the most pervasive of the endocrine disrupters.

  These chemicals have increasingly become associated with changes in development of the male brain as well as with genital defects, metabolic abnormalities and reduced testosterone in babies and adults.

  You can help reduce your exposure by using the tips in this past article.

• PFOA: Teflon-coated cookware is the primary source of dangerous perfluorinated chemicals (PFOAs). Teflon pans quickly reach temperatures that cause the non-stick coating to begin breaking down, releasing toxins that have been linked to cancer, birth defects and thyroid disease into the air in your kitchen.

  I highly recommend you throw away this type of non-stick cookware immediately and replace it with either ceramic or glass. My personal choice is ceramic cookware, because it's very durable and easy to clean, and there's absolutely no risk of exposure to harmful chemicals.

• Formaldehyde: Formaldehyde, most commonly known as embalming fluid, serves a number of purposes in manufactured products. It is actually frequently used in fabrics to give them a variety of "easy care properties" as well as being a common component of pressed-wood products.

  Formaldehyde has been shown to cause cancer in animals, and may cause cancer in humans. Other common adverse health effects include fatigue, skin rashes, and allergic reactions. Choosing all natural materials for your clothing and furniture can help cut down on your exposure.

• PBDEs: These flame-retardant chemicals have been linked to altered thyroid levels, decreased fertility and numerous problems with development when exposure occurs in utero. PBDEs are commonly found in household items like upholstery and television and computer housings. Fortunately, several states now ban the use of PBDEs, so there is some progress toward reducing exposure.

  Another common source of PBDEs is your mattress, and since you can spend up to a third of your life in bed, this is a significant health concern. Mattress manufacturers are not required to label or disclose which chemicals their mattresses contain. Look for 100 percent wool, toxin-free mattresses.

  Another viable option is to look for a mattress that uses a Kevlar, bullet-proof type of material in lieu of chemicals for fire-proofing. Stearns and Foster uses this process for their mattresses, which is sufficient to pass fire safety standards.

What Else Can You do to Reduce Unnecessary Chemical Exposure to Your Family?

Rather than compile an endless list of what you should avoid, it's far easier to focus on what you should do to lead a healthy lifestyle with as minimal a chemical exposure as possible:

1. As much as possible, buy and eat organic produce and free-range, organic foods to reduce your exposure to pesticides and fertilizers.
2. Rather than eating conventional or farm-raised fish, which are often heavily contaminated with PCBs and mercury, supplement with a high-quality purified krill oil, or eat fish that is wild-caught and lab tested for purity.
3. Eat mostly raw, fresh foods, steering clear of processed, prepackaged foods of all kinds. This way you automatically avoid artificial food additives, including dangerous artificial sweeteners, food coloring and MSG.
4. Store your food and beverages in glass rather than plastic, and avoid using plastic wrap and canned foods (which are often lined with BPA-containing liners).
5. Have your tap water tested and, if contaminants are found, install an appropriate water filter on all your faucets (even those in your shower or bath). My personal favorite, and the one I personally use, is a high-quality reverse osmosis (RO) filter. You just need to add a few minerals back to the water, but RO reliably removes virtually every possible contaminant that could be in the water.
6. Only use natural cleaning products in your home.
7. Switch over to natural brands of toiletries such as shampoo, toothpaste, antiperspirants and cosmetics. The Environmental Working Group has a great safety guide to help you find personal care products that are free of phthalates and other potentially dangerous chemicals. I also offer one of the highest quality organic skin care lines, shampoo and conditioner, and body butter that are completely natural and safe.
8. Avoid using artificial air fresheners, dryer sheets, fabric softeners or other synthetic fragrances.
9. Replace your Teflon pots and pans with ceramic or glass cookware or a safe nonstick pan.
10. When redoing your home, look for "green," toxin-free alternatives in lieu of regular paint and vinyl floor coverings.
11. Replace your vinyl shower curtain with one made of fabric, or install a glass shower door.

It is important to make these positive and gradual steps toward decreasing your chemical risk through healthy lifestyle choices. While you make the switch to remove and reduce chemicals around your home, remember that one of the ways to significantly reduce your toxic load is to pay careful attention to what you eat.

Organically-grown, biodynamic whole foods are really the key to success here, and, as an added bonus, when you eat right, you're also optimizing your body's natural detoxification system, which can help eliminate toxins your body encounters from other sources

Advanced SystemCare Pro | Advanced Care Professional | Advanced System Clean | System Care Pro Review

Hi everyone,

Today i installed this software to my 2 notebook and PC. Its really a great software that do wonders in one click! My notebook now run faster than before ! Why not try and download now for free !

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INFO TERKINI MESYUARAT TEKNIKAL PPF MSIA BIL 01/2010

Salam Sejahtera dan Salam Satu Malaysia semua PPF!

Berikut adalah ringkasan maklumat terkini hasil dari Mesyuarat Teknikal PPF Kebangsaan Bil 01/2010 di IbuPejabat Bhg Perkhidmatan Farmasi, Petaling Jaya yang diadakan pada hari ini 15 Julai jam 8.30pg - 1.00 tgh.

1. Akta baru Farmasi - disediakan melalui penggabungan 4 akta lama serta penambahbaikan akan di satukan sebagai satu akta baru. Dalam akta baru ini turut dimasukkan profesion Pen.Peg.Farmasi dan akan dibentangkan di Parlimen pada Oktober 2010. Ini bermaksud semua PPF baik swasta dan kerajaan wajib mendaftar untuk menjalankan tugas atau "practice" profesion tersebut. Satu majlis telah di tubuhkan iaitu Majlis Farmasi (Pharmacy Council) untuk melakukan aktiviti pendaftaran tersebut dan bukan Lembaga Farmasi.

2. Norma perjawatan baru telah di sediakan mengikut aktiviti di institusi masing-masing (maklumat terperinci akan di upload kemudian) dan jika berpandukan norma baru tersebut, KKM memerlukan sebanyak 4085 PPF di Hospital dan 5681 PPF di Kesihatan (tidak termasuk BIRO) Buat masa ini kita ada sebanyak 3431 PPF di KKM (termasuk BIRO). Jumlah keperluan PPF ialah 9766 tidak termasuk PPF BIRO. (Data untuk BIRO belum diperolehi).
Projection pengeluaran PPF = 1500 setahun. (23 Kolej swasta dan KSKB).

2.1. Unjuran Keperluan PPF di Kesihatan :
Pesakit Luar + Pengurusan Stor / Pentadbiran /Kualiti
Klinik Jenis 1 = 32 PPF + 2 PPF
Klinik Jenis 2 = 26 PPF + 2 PPF
Klinik Jenis 3 = 20 PPF + 2 PPF
Klinik Jenis 4 = 12 PPF + 1 PPF
Klinik Jenis 5 = 4 PPF + 1 PPF
Klinik Jenis 6 = 3 PPF + 1 PPF

2.2. Unjuran Keperluan PPF Hospital
Outpatient & Ambulatory Pharmacy - Processing&Filling = 1PPF : 50 Rx
InPatient Care (24 hrs) - Unit Dose Med Supply = 1PPF : 50 Rx
Internal Audit - 1 PPF per 5 wards
Stock Management - 1 PPF / Substore
Pre-Packing (Supervising Activity) - 1 Hospital : 3 PPF
TPN (Preparation) - 1 PPF / 10 bags
CDR (Preparation) - 1 PPF / 6 Preparations
IV AdMixture - 1 PPF / 10 Preparations
(Bilangan PPF akan berbeza mengikut jenis Hospital - Hospital Besar, Hospital Pakar Utama, Hosp Pakar Kecil, Hospital Daerah Tanpa Pakar)

3. Klinik Methadone - PPF juga telah di masukkan dalam program ini sebagai support staff.

4. Cadangan-cadangan semasa mesyuarat :
4.1 Extended Role - peranan baru PPF di Stor Integrasi dalam skop ubatan sahaja.
4.2 Permohonan jawatan U40 di tiap JKN dan bukan saja Hosp Besar.
4.3 Permohonan jawatan U36/U38 ditiap Pej.Kesihatan Daerah.
4.4 Cadangan Pos Basik baru untuk semua PPF Kes dan Hospital - Logistic Mx & Counter Mx
4.5 Permohonan skim baru "Pharmacy Aides" menggantikan PRA
4.6 Mohon di adakan bengkel dalam sebarang penyediaan kertas kerja dan beri sedikit peruntukkan kpd Ketua Profesion PPF untuk menjalankan bengkel tersebut
4.7 Sabah mohon tambah ahli mesyuarat - Persatuan PPF Sabah (Majlis setuju 1 PPF)
4.8 Mohon kursus-kursus dan attachment di luar negara melalui BPF KKM
4.9 Mohon Klinik 1Malaysia di beri pos sekurang-kurangnya 2 PPF

Sekian buat sementara waktu. Saya akan update lagi lebih maklumat dalam artikel akan datang.

Terima kasih dan salam 1Malaysia

PERKEMBANGAN TERKINI KERJAYA PPF

Berita baik kepada semua Pen.Pegawai Farmasi Malaysia !!!

Bahagian Perkhidmatan Farmasi KKM telah membuat "Penyenaraian" semua PPF dari swasta selepas mendapat feedback dari Institusi swasta bilangan Pen.Pegawai Farmasi/Pharmacy Assistant/Dispenser/Peg.Dagang/Pharmacy Technician yang berkhidmat sekarang.

Tujuannya ialah untuk menjalankan aktiviti Pendaftaran serta memperoleh "Annual Practicing Certificate" (APC) atau Practicing Certificate (PC). Menurut Timb.Pengarah Pengurusan Farmasi KKM dalam Persidangan PPF Kebangsaan di Cam.Highland 12 Julai 2010, AKTA FARMASI baru akan di bentangkan di Parlimen pada bulan Oktober 2010.

Sekiranya Akta tersebut di luluskan, semua Pen.Pegawai Farmasi, Pembantu Farmasi / Pharmacy Assistant (Swasta), Pharmacy Technician, Dispenser adalah wajib mendaftarkan profesion mereka untuk "Practice" tugas tersebut. Kegagalan mendaftar akan mengakibatkan mereka di denda atau di dakwa.

Ini bererti profesion PPF selepas ini akan di kawal dan di lindungi. Kualiti pendidikan Diploma Farmasi juga akan di pantau supaya menepati tahap pendidikan, dan tidak semua Kolej boleh menjalankan sewenang-wenangnya program Diploma Farmasi ini.

Buat masa ini terdapat 23 Institusi Pengajian Tinggi Swasta yang menawarkan program Diploma Farmasi di seluruh Malaysia. Hanya 5 Institusi sahaja di iktiraf MQA.

Adalah di harapkan dengan kelulusan Akta baru ini akan memberikan satu wajah baru dan perkembangan profesion ke tahap yang lebih tinggi seperti yang kita impi-impikan selama ini.
Moral profesion juga secara tidak langsung akan naik dan di hormati.

Sekian, semoga semua ini menjadi kenyataan selepas Oktober ini.

1ST ASSIST. PHARMACIST TECHNICAL COMMITTEE MEETING

To all Malaysian Assist.Pharmacist,

I will be attending the 1st Assist.Pharmacist Technical Committee meeting at our HQ-Pharmacy Services Division, MOH on 15th July 2010.

If you have anything to raise regarding our profession, please email me at : pfganesh@gmail.com or you can call me also at 012-5172500.

May this meeting will be our first step towards our developments. Together we pray for it !

Ganesan
Senior Assist.Pharmacist
Taiping Health Clinic

Diclofenac: Similar CV Risk to Rofecoxib in Healthy People

Dear readers,
Its shocking to know that the drug we've been using everyday in our life has this potential. This article was taken from MEDSCAPE.COM
This article is intended for primary care clinicians, cardiologists, rheumatologists, orthopaedists, and other specialists who prescribe NSAIDs to adults.

The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care.
Authors and Disclosure

From Heartwire CME
Diclofenac: Similar CV Risk to Rofecoxib in Healthy People CME/CE

News Author: Lisa Nainggolan
CME Author: Charles P. Vega, MD

Authors and Disclosures

June 14, 2010 — The first study to examine the cardiovascular risk associated with nonsteroidal anti-inflammatory drugs (NSAIDs) in healthy individuals has found increased morbidity and mortality with diclofenac, rofecoxib (Vioxx, Merck), and high doses of ibuprofen [1]. Naproxen, in contrast, has a safer cardiovascular risk profile, say Dr Emil Loldrup Fosbøl and colleagues in their paper published online June 8, 2010 in Circulation: Cardiovascular Quality and Outcomes.

The increased cardiovascular morbidity and mortality seen with diclofenac, which is similar to that observed with rofecoxib--a drug that was withdrawn from the market in 2004 because of poor cardiovascular safety--is particularly concerning, Fosbøl told heartwire .

Patients and clinicians need to know that [diclofenac] increases the risk of cardiovascular adverse events.

"We've been so much focused on the newer COX-2 inhibitors, but the primary message concerns diclofenac, because there is so much evidence now that this is also a problem; it has been shown quite extensively in many reports. Diclofenac has been used for almost 50 years and is available over the counter [OTC] in many countries, which I think is irrational. This is a major public-health concern, and patients and clinicians need to know that this drug increases the risk of cardiovascular adverse events. "

Also worrying is the fact that the results were dose-dependent, and diclofenac is more often used in high doses compared with other NSAIDs, say Fosbøl and colleagues. "Our results suggest that naproxen could be a safer alternative when NSAID treatment is required," they state.

Large Study, Covering Entire Population of Denmark

The researchers used a nationwide cohort of healthy individuals over the age of 10 in Denmark, made possible by the fact that all residents have a unique personal number, which enables linkage of administrative registries on an individual level. They identified more than 2.5 million people who claimed at least one prescription for NSAIDs from 1997 to 2005; after applying selection criteria regarding comorbidity and concomitant pharmacotherapy, they included just over one million individuals in the analysis.

Ibuprofen was the only nonaspirin NSAID that could be purchased OTC in Denmark during the study period, but it was available only in low doses (200 mg) and in limited quantities, say the researchers. In addition, the system in Denmark would ensure that those requiring higher doses of ibuprofen would have financial incentive to obtain a prescription from their doctor, so OTC NSAID use is unlikely to have had a significant influence on the results, they point out.

Prescription use of the nonselective NSAID diclofenac and the selective COX-2 inhibitor rofecoxib was associated with an increased risk of cardiovascular death (odds ratio 1.91 and 1.66, respectively), with a dose-dependent increase in risk.

Our results further strengthen the association between NSAID use and cardiovascular risk by demonstrating effects on all cardiovascular outcomes.

There was a trend for an increased risk of fatal or nonfatal stroke associated with ibuprofen treatment (OR 1.29), but naproxen was not associated with increased cardiovascular risk (OR for cardiovascular death 0.84).

Although rofecoxib was withdrawn in 2004, another COX-2 inhibitor, celecoxib (Celebrex, Pfizer), is still available. But Fosbøl et al say they were unable to draw any firm conclusions about the cardiovascular safety of celecoxib in this study because the analysis is based on few events, especially at higher doses. The results of the ongoing Prospective Randomized Evaluation of Celecoxib Integrated Safety vs Ibuprofen and Naproxen (PRECISION) trial should shed more light on the risks and benefits of this drug, they say.

They also showed that all NSAIDs except for celecoxib were linked to a substantial increase in risk of serious bleeding, a well-known adverse effect of NSAIDs "that needs to be kept in mind."

Dr Florian Krötz (University Hospital Munich, Germany), who has recently published a review on the risk of MI associated with diclofenac [2] but was not involved with this study, told heartwire : "Concerning diclofenac and rofecoxib, I agree with the increased risk of CV death that the authors find."

However, a "major weakness" of such observational trials is the problem of correlating doctors' certificates on causes of death with numbers of prescriptions, he says. And it is unknown whether the individuals have actually taken these drugs or whether they had cardiovascular risk factors or even any history of CV disease. "As such, I think such studies must be interpreted with great caution," Krötz commented.

Fosbøl et al acknowledge these shortcomings of their trial but note that it also has its strengths, including the size and completeness of data, covering the entire population of Denmark, and the fact that two independent and different statistical approaches were employed to examine the relationship between exposure to NSAIDs and the chosen outcomes.

First Study to Show NSAIDs Affect All Cardiovascular Outcomes

The study was also the first to look at quite specific cardiovascular end points rather than just MI or MI and overall death, says Fosbøl. No previous study has reported results on specific end points such as fatal/nonfatal stroke or coronary death combined with nonfatal MI.

"Therefore, our results further strengthen the association between NSAID use and cardiovascular risk by demonstrating effects on all cardiovascular outcomes."

Population of NSAID Initiators and Sex-, Age- and Time-Matched Controls of Non-NSAID Initiators: Hazard Ratios for Specific Causes of Death Associated With Exposure Stratified According to Daily Dosagea
Drug (mg/day) CV death Coronary death or nonfatal MI Fatal or nonfatal stroke
Ibuprofen
Any use 0.88b 1.31b 1.47b
<1200 0.79b 1.24b 1.39b
>1200 1.63b 1.94b 2.22b
Diclofenac
Any use 1.20b 1.83b 2.00b
<100 0.80 1.39b 1.33c
>100 1.46b 2.10b 2.41b
Rofecoxib
Any use 1.64b 1.84b 1.12
<25 1.60b 1.82b 1.10
>25 2.77c 2.36 1.79
Celecoxib
Any use 1.24 1.44b 1.27
<200 1.19 1.44c 1.16
>200 1.51 1.49 1.95
Naproxen
Any use 0.86 0.78 1.54b
<500 0.84 0.69c 1.55c
>500 0.92 1.22 1.48

a. Compared with no use (HR=1.00)

b. p<0.05

c. p<0.01

Fosbøl says the findings underline the fact that individual NSAIDs have different degrees of cardiovascular safety, so doctors should always make an individual assessment of cardiovascular risk and carefully consider the balance between benefit and risk before starting therapy with any NSAID.

Also, because adverse CV events observed were dose dependent, it is important that NSAIDs are prescribed at the lowest possible dose for the shortest period of time, he adds. He and his colleagues were not able to examine duration of use with regard to cardiovascular risk in this study, but will do so in a future analysis, he says.

The authors declare that they have no disclosures.

References

1. Fosbøl EL, Folke F, Jacobsen S, et al. Cause-specific CV risk associated with NSAIDs among healthy individuals. Circ Cardiovasc Qual Outcomes 2010; DOI:10.1161/CIRCOUTCOMES.109.861104. Available at: http://circoutcomes.ahajournals.org.
2. Krötz F, Struthmann L. A review on the risk of myocardial infarction associated with the NSAID diclofenac. Cardiovasc Hematol Disord Drug Targets 2010; 10:53-65. Abstract

Clinical Context

The use of the COX-2 inhibitor rofecoxib has been associated with a significant increase in the risk for cardiovascular disease, and a study by Solomon and colleagues, published in the April 22, 2008, issue of Circulation, examined whether another COX-2 inhibitor, celecoxib, was also associated with cardiovascular risk. Researchers pooled data from 6 randomized trials of celecoxib and found a significant 60% increase in the risk for a combined cardiovascular endpoint associated with the use of celecoxib. However, the 400-mg daily dose of celecoxib was not associated with a higher risk for cardiovascular disease, and the rate of cardiovascular events related to the use of celecoxib was most pronounced among patients at high baseline cardiovascular risk.

The risk for cardiovascular disease may not be limited to COX-2 inhibitors; other NSAIDs have also been implicated. The current study uses a large patient database to examine this issue.
Study Highlights

* Researchers queried patient databases in Denmark for information pertaining to events between 1997 and 2005. Specifically, researchers examined a national mortality registry and a national database of inpatient admissions. They also examined a national database of prescriptions, which offers virtually complete prescription data across Denmark.
* The study group was aged 10 years or older in 1997. The main study outcome was the relationship between NSAID use and the risks for cardiovascular outcomes, which were defined by cardiovascular death, MI, and stroke. Researchers also examined rates of bleeding associated with NSAIDs.
* The study analysis adjusted for age, sex, and calendar year.
* The study cohort consisted of 1,028,437 apparently healthy individuals with a median age of 39 years; 58% of subjects were men.
* 44.7% of study subjects had an NSAID prescription claim; 2204 individuals died during treatment with an NSAID during the study period.
* The use of diclofenac and rofecoxib were associated with a higher risk for cardiovascular death (OR, 1.91 and 1.66, respectively). There was a dose-response effect in the risk for cardiovascular death associated with these medications.
* In contrast, ibuprofen, celecoxib, and naproxen were not associated with a higher risk for cardiovascular death.
* However, the use of ibuprofen (OR, 1.52), diclofenac (1.82), and rofecoxib (1.72) increased the risk for coronary death or nonfatal MI.
* The use of ibuprofen and naproxen were associated with an elevated risk for stroke.
* Overall, naproxen was associated with the lowest cardiovascular risk for the different NSAIDs examined.
* All NSAIDs, except celecoxib, were associated with a higher risk for fatal or nonfatal major bleeding. The risk of bleeding was dose dependent.
* Slightly more than half of individuals who died during NSAID treatment died of noncardiovascular causes. However, NSAIDs were not associated with a higher risk of dying of causes other than cardiovascular causes.

Clinical Implications

* A previous study evaluating randomized trial data found a significant increase in the risk for cardiovascular disease associated with the use of celecoxib. This risk was most pronounced in higher doses and among patients with a higher baseline cardiovascular risk profile.
* The current study demonstrates that NSAIDs can increase the risk for cardiovascular disease. Rofecoxib and diclofenac were particularly associated with a higher risk for cardiovascular outcomes, whereas naproxen had a safer cardiovascular risk profile.

Reaching Out to an Impaired Physician

MEDSCAPE PHARMACIST

Joseph R. Yancey, MD, CPT, MC; Harry D. McKinnon Jr., MD, LTC (Ret.), MC

Authors and Disclosures

Posted: 04/29/2010; Family Practice Management. 2010;17(1):27 © 2010 American Academy of Family Physicians

Abstract and Introduction

Abstract

Effectively addressing a colleague's impairment requires care, planning and courage.

Introduction

Imagine that you are a family physician in a small, private group practice where for 10 years you've practiced with a colleague we' ll call Dr. D. Dr. D's responsibilities are similar to your own and include both outpatient medicine in your practice and inpatient medicine at three local community hospitals. He has earned a reputation as a superb physician and eager team player. However, in recent months, colleagues and staff have expressed concern to you about behavioral and personality changes in Dr. D. He has become confrontational about trivial things and is increasingly withdrawn. You witness him yelling at a member of the nursing staff over a minor issue. When you approach Dr. D, he is dismissive and states that he is "just stressed out."

Health care providers and behavioral health professionals have made great effort to characterize psychiatric illnesses such as addiction and depression as diseases rather than as moral failings. Nevertheless, physicians who suffer from such illnesses often have difficulty acknowledging that they are susceptible, while in fact addiction and depression are as common in health care providers as in the general population.^[1,2] In addition, other mental illness – such as dementia, bipolar disorder or a personality disorder – or physical injury can lead to an inability to safely perform one's duties as a health care provider.^[3]

Any health condition that could interfere with a health care provider's judgment or other faculties needed as a clinician is referred to as impairment. An impaired physician may have deleterious effects on his or her patients and medical group. As a colleague of an impaired physician, you face a tough moral question: What is my responsibility? The importance of intervening with a struggling colleague cannot be overstated. This article offers advice that may enable you to address the situation productively.

Epidemiology

Not only are physicians as likely to suffer from the spectrum of addictive disorders as the general population,^[1] but it has also been suggested that psychosocial factors which influence people to choose the medical profession are also associated with addiction.^[4] Alcohol, the most commonly abused drug in the United States, is used more frequently by medical professionals than by the general population, although the prevalence of alcohol use among medical professionals is thought to be similar to the prevalence among others of similar socioeconomic status. Physicians as a group are less likely than the overall population to abuse "street" drugs but are more likely to abuse prescription drugs and narcotics, to which they have ready access through self-prescribing or through prescriptions from colleagues. Differences in access to specific drugs are also thought to create variances in drug use among different specialties. Anesthesiologists are more susceptible to narcotic dependence, while emergency medicine physicians are thought to be more prone to illegal drug addictions. Psychiatrists are more likely to abuse prescription mood-altering substances.^[1]

Depression is as common in physicians as in the general population. Gender differences in the prevalence of depression are also similar between physicians and the general population, with 12 percent prevalence for male physicians and 19.5 percent prevalence for female physicians. Suicide rates are higher for physicians than for the general population, and suicide is a disproportionately high cause of mortality in physicians, particularly among female physicians.^[2]

It should be mentioned that data regarding rates of addiction and mental illness are collected by survey or from physicians' health programs. Self-reporting bias in surveys is likely to produce underestimation of the prevalence of impairment. Information from physicians' health programs will not include impaired physicians who are not being treated or those who have sought treatment without informing their health program. Thus, it is difficult to find reliable figures on physician impairment.

Confrontation

The staff has noticed that Dr. D is working very unusual hours. Rumors are swirling that he and his wife are having problems at home. Patient complaints about Dr. D have increased. Many say that he seems tired, constantly distracted and uninterested in conversation. A member of the hospital nursing staff reluctantly mentions to you that she smelled alcohol on his breath.

Most people would agree that it is difficult to confront someone who is impaired. The level of denial, especially for addicts who work in health care, can be surprising and challenging.^[5] The level of importance that is placed on work by those in the health professions is often very high; as a result, social, financial and interpersonal decay often occur before the addiction interferes with the job. Dr. D's wife and children are likely to have suffered the effects of his illness long before you noticed it at work. By the time a physician's job performance is impaired, the disease is often getting out of control.^[6]

If Dr. D is truly under the influence of alcohol at work, then his patients' safety is being compromised. Even if he has made no overt error, the patient-physician relationship is harmed by his impairment. A physician is less likely to recognize mental illness in a patient while suffering from one himself.^[2] Colleagues of the impaired physician suffer from increased workloads and a negative work environment. In the event of a malpractice suit, colleagues should expect legal scrutiny, particularly if they knew about the physician's impairment and did not intervene.^[4]

The first approach to Dr. D in the scenario described might be a simple personal communication. A genuine expression of concern – just asking "How are you?" – is a good start, but the denial that comes with impairment often limits the question's effectiveness.^[7] Most experts recommend a more formal group process known as an intervention. The purpose of an intervention is to present the evidence of impairment to the impaired person in a controlled setting in the hopes of being able to convince him or her to accept help. Participation from co-workers and family members is encouraged, and if possible someone who is experienced with interventions should be present to facilitate the communication. A physicians' health program is a good place to look for a facilitator; contact information for each state's program can be found at the Federation of State Physicians' Health Programs. It is important that those conducting the intervention be prepared to help the impaired physician get treatment immediately following the discussion, including transfer to an inpatient facility as appropriate. Finally, individuals involved in the intervention must establish and clearly communicate consequences for rejecting help, such as suspension of clinic or hospital privileges, a report to the state licensing board and even separation from a spouse.^[5] Without the threat of consequences, an impaired colleague is less likely to accept help and patient safety remains compromised. (See additional suggestions for interventions in the box below.)

Treatment

Dr. D's condition has grown more serious. There are increasing absences from the clinic, more adverse confrontations with staff and more patient complaints. Nurses in the hospital have been paging you to correct some of his erroneous written orders. As a result, you and your partners decide to do an intervention. You anonymously contact your state's physician health program to find someone to assist you with the intervention. After meeting with the intervention expert and conducting a rehearsal, you select a date and time for the intervention. Dr. D enters the meeting to find you, the expert, his wife, two other physicians who know him well and the head nurse for the clinic. Each attendee calmly presents evidence to Dr. D about his impairment, detailing his absences, his behavior at home and at work, and his errors. At the end of the presentation, Dr. D is silent and appears angry. The intervention expert then presents Dr. D with his options: either he reports to an inpatient facility immediately for evaluation and treatment or he will be terminated from the practice and have his hospital privileges suspended. The practice will also file a formal complaint regarding Dr. D to the state medical board if he refuses treatment. Dr. D chooses to report to treatment and boards a plane that evening with bags that his wife has already packed.

Increased awareness of substance abuse among health care professionals in recent years has contributed to an increased emphasis on identification and reporting of concerns as well as on the establishment of monitoring and assistance programs.^[8] The Joint Commission has recently insisted that "medical staffs implement a process to identify and manage matters of individual physician health that is separate from the medical staff disciplinary function."^[9] In addition to local committees at the hospital or medical school level, nearly all 50 states have established programs for identifying and monitoring the impaired physician. These programs are typically composed of an addiction medicine specialist, a psychiatrist and legal counsel. Their overall goal is to provide guidance and resources focusing on the education, rehabilitation and post-treatment monitoring of the impaired physician. The process should not be considered punitive in nature; it is important to treat these physicians as patients rather than criminals. Acceptance and willingness to participate in treatment may depend on this approach.

A treatment plan should be established only after completion of a comprehensive evaluation. The ideal components of a successful treatment program for physicians include these: immediate intervention, evaluation and triage to an appropriate facility, uninterrupted therapy and family involvement followed by rapid re-entry into practice, close monitoring and a contingency plan.^[10] The evaluation should include identification of any comorbid psychiatric or medical diagnoses that may influence treatment success. Once the initial evaluation is completed, efforts should focus on designing a treatment program best for the individual. Most substance abuse programs include detoxification, rehabilitation, ongoing group therapy and attendance at 12-step meetings such as Alcoholics Anonymous or Narcotics Anonymous.^[8] In addition, the Caduceus Society offers a support program especially for recovering health care providers. Many physicians will require inpatient treatment because of the severity of their dependence.^[5]

Treatment does not end with discharge from an inpatient program. The ultimate treatment goals are abstinence and successful return to practice, so it is imperative that a realistic and comprehensive outpatient program be initiated immediately upon discharge. Once physicians have completed the inpatient program and demonstrated commitment to an outpatient treatment plan, consideration should be given to returning them to practice. It is common to have the physician sign a contract detailing the expectations for continued recovery and professional conduct.^[13] In many cases, the contract specifies that failure to adhere to its specific conditions will result in a report to the state licensing board for public citation or potential suspension of license. Periodic monitoring is an integral part of outpatient treatment, and although the specific requirements may vary, the duration is typically no less than five years.^[8] Inclusion of family members has been shown to produce better outcomes in the treatment and rehabilitation process.^[11,12]

Outcomes

The majority of physicians will return to practice, and prognosis for recovery is better than among the general population.^[5] A 2008 British Medical Journal article discussing physicians monitored by several state physician health programs shows that 78.7 percent of monitored physicians were licensed and working five years after admittance to a program.^[14] It may be necessary to modify the work environment for some physicians by decreasing stress levels and restricting access to certain drugs. A factor that may be important to a successful return to practice is the possibility that relapse will entail financial, personal and professional losses. Modifiable factors that contribute to relapse include failure to understand and accept illness, continued denial, a dysfunctional family, poor mechanisms to cope with stress, overconfidence, poor relationship skills, shame and guilt.^[15,16] Nonmodifiable factors that are associated with relapse are a strong family history of addiction and the use of strong opioids with a coexisting psychiatric disorder.^[17] The struggle with addiction is often lifelong, and success typically depends on the level of support in both personal and professional settings.

As for Dr. D, he reported to an inpatient treatment facility for addictive disorders that specializes in physician impairment. His practice agreed to pay the required $35,000 for treatment with the understanding that Dr. D will repay the practice over time. Upon admission, a physician presented him with a treatment plan contract, which he signed. A full psychiatric evaluation revealed that he was suffering from depression as well as alcohol dependence. A physician at the center monitored his treatment and started him on a selective serotonin reuptake inhibitor for his depression. He attended twice-daily meetings similar to those of Alcoholics Anonymous. After six weeks of intensive rehabilitation, Dr. D returned home with a plan for continued monitoring.

A few days after returning home, Dr. D returned to work. His partners were eager to see him return, both from collegial concern and because they had been sharing his workload during his treatment period. He admitted that returning to work was awkward, but that everyone had been supportive. His reintegration at home was not as smooth. The pain of past events proved too much for Dr. D's marriage, and his wife filed for divorce. He continues to be monitored by a physician outside the practice and submits to unannounced monthly urine drug testing per his treatment contract. His patients remain unaware of his treatment, having been told only that Dr. D had a prolonged illness.

Rosiglitazone, Ticagrelor, Dabigatran All Up for FDA Review

Dear readers,

Here are some very good article from Medscape.

www.medscape.com

Shelley Wood

Authors and Disclosures

June 10, 2010 (Gaithersburg, Maryland) — So much for the dog days of summer: three of the most closely watched drugs in recent memory are now scheduled to go before their respective FDA advisory panels in the next few months.

First up is the much-anticipated two-day rosiglitazone (Avandia, GlaxoSmithKline) discussion. As previously predicted by heartwire , the rosiglitazone panel meeting will take place July 13–14 and will be a joint meeting of the Endocrinologic and Metabolic Drugs and the Drug Safety and Risk Management advisory committees. According to the FDA's calendar posting, the committees will review results from the Rosiglitazone Evaluated for Cardiac Outcome and Regulation of Glycemia in Diabetes (RECORD) trial, as well as observational data, health-claims data, and a meta-analysis of controlled clinical trials. The FDA also plans to present its meta-analysis of several trials of pioglitazone (Actos, Takeda Pharmaceuticals) to help panel members understand the relative risk and benefits of the two market-approved thiazolidinediones.

Rosiglitazone was first approved by the FDA in 1999, but concerns over its risk/benefit profile have led to mounting calls to stop the ongoing comparator trial addressing cardiovascular safety, TIDE, and to pull the drug from the US market.

Two weeks later, ticagrelor (Brilanta, AstraZeneca) makes its debut before the Cardiovascular and Renal Drugs Advisory Committee, July 28. As previously reported by heartwire , ticagrelor first set chins wagging at the European Society of Cardiology (ESC) 2009 meeting with the presentation of the phase 3 PLATO results, showing that the new, twice-daily, oral antiplatelet agent reduced the rate of MI/stroke/CV death in ACS patients, as compared with clopidogrel. PLATO data resurfaced in late-breaking clinical-trial sessions for at least two additional meetings, where additional subset analyses were presented. AstraZeneca submitted its new drug application for ticagrelor to the FDA last November.

Next up is dabigatran (Pradax, Boehringer Ingelheim). While the drug is not formally scheduled in the confirmed FDA advisory committee calendar, heartwire has learned that dabigatran will be the focus of the September meeting of the Cardiovascular and Renal Drugs Advisory Committee. A date of September 17 is listed in the tentative calendar but may still change. The FDA publishes a Federal Register notice 15 days in advance of each upcoming advisory committee meeting to formally announce the drug being discussed and will not currently confirm or deny the topic of the September meeting.

As reported by heartwire , dabigatran jostled for the limelight with ticagrelor at ESC 2009, where the RE-LY results were first presented showing that the new oral anticoagulant dosed at 150 mg twice a day reduced the annualized risk of the primary end point--stroke, peripheral embolic events, and the risk of hemorrhagic stroke--compared with warfarin, without increasing the risk of bleeding. Subsequent analyses were presented at the 2010 International Stroke Congress and AHA 2009 meetings. The drug is already approved for venous thromboembolism (VTE) prevention during hip- and knee-replacement surgery in the European Union and Canada.

Dabigatran is one of several new anticoagulants in late-stage testing, hoping to become the number-one warfarin competitor and obviate the need for cumbersome INR testing.

Each FDA meeting will be covered in depth by heartwire ; receive up-to-the-minute updates on how the meetings are progressing by following theheart.org on twitter.

MALAM MESRA PPF MALAYSIA

Semua Pen.Pegawai Farmasi adalah dijemput menghadiri malam mesra PPF 2010 di Hotel Flemington, taiping (kawasan Lake Garden).

Bayaran adalah sebanyak RM50.00 seorang dan tambahan RM40.00 jika membawa pasangan atau anak. Penginapan di Hotel RM118.00 twin sharing.

Aktiviti : Live band, Permainan, cabutan bertuah dll...

RESEARCH ON JOB SATISFACTION AND QUALITY OF WORK LIFE

Dear Assistant Pharmacist,

I am planning to conduct a research on the profession focusing on job satisfaction and the quality of working life. To run a comprehensive research nationwide, we need a good team to conduct the research. The research will be done accordance to the guidelines prepared by CRC, Ministry Of Health Malaysia.

In Malaysia, never before such a research been carried out nationally. It is very important to conduct the research because as we all know Assistant Pharmacist were the last to get anything among all paramedics, no career pathway to degree, highest stress at work (evidence supported by a researcher from HKL, Ruhana 2005) and also a Study On Job Satisfaction Among Assistant Pharmacist Working In Ipoh General Hospital 2009 (not publish yet).

Due to the limitation in previous research, it is appropriate a comprehensive study should be carried out throughout Malaysia to prove the actual working conditions and the quality of work life.

To all my friends who are interested, please contact me at : 012-5172500

We are also planning to propose a White Paper On Assistant Pharmacist In Malaysia.
Through the white paper, our ministry can get more data, information's and true picture of the conditions of all Assistant Pharmacist in Malaysia.

MAY GOD BLESS ALL !

Ganesan

I HAVE A DREAM

"I have a dream that one day this nation will rise up and live out the true meaning of its creed: "We hold these truths to be self-evident: that all men are created equal."
- MARTIN LUTHER KING JR

In one of his last speeches, King reminded his audience that "in the final analysis, God does not judge us by the separate incidents or the separate mistakes that we make, but by the total bent of our lives."
(My most admired and respected Politician/Leader in this world... and its truely happen now!)

To all my Assistant Pharmacist , brothers and sisters,

I have a dream too, that one day, God will open their heart and eyes.. we will be noticed, our cries will be heard...our hunger and thirst of getting further education in this field will be rewarded...we will sit in same par with other paramedics...given important role in patient care and pharmaceutical care together with Profesionals and other paramedics...our education system will be better and have more Pharmacy Collegeous...we will have enough lecturers and more students which will fill all the vacancy in Malaysia...that our welfare will be taken care by those with noble and good heart... Belief me.. one day it will happen.

Dear friends, by looking ahead and following the progress of Pharmacy Technologist /Technicians profesion developments in western and USA, there is a very positive momentums and scenarios. We can see they already have a Pharmacy Certification Board , Code Of Ethics, Registration Of Pharmacy Technician/Technologist, Compulsory Competency Examination (every 2 years), Post Basic Courses, Technical Specialist Courses, Certification Examinations with Badges - Certified Pharmacy Technician Badge.. Proper Uniforms with corporate image...etc.

This will happen one day. There are alot of very nice and good people in Management. So dont blame everyone just because of one or two blacksheeps. Good moment will arise for our profesion. Just be strong, patient as we always do...and belief.

Association and Union will play their part. Lets all give a full support to this organisations and keep praying.

GOD BLESS ALL PPF MALAYSIA !

MY FAVOURATE QUOTES :

* Love begins by taking care of the closest ones
- Mother Theresa

We ourselves feel that what we are doing is just a drop in the ocean. But the ocean would be less because of that missing drop" - Mother Theresa

"Anyone who has never made a mistake has never tried anything new - Albert Einstein

Learn from yesterday, live for today, hope for tomorrow. The important thing is not to stop questioning - Albert Einstein

A RIVER OVER A RIVER IN GERMANY !

Have you ever seen a Water Bridge over a river?......... Pretty Cool !

Even after you see it, it is still hard to believe! Water Bridge in Germany . What a feat! Six years, 500 million euros, 918 meters long........now this is engineering! This is a channel-bridge over the River Elbe and joins the former East and West Germany, as part of the unification project. It is located in the city of

Magdeburg, near Berlin. The photo was taken on the day of inauguration.
To those who appreciate engineering projects, here's a puzzle for you armchair

engineers and physicists.
Did that bridge have to be designed to withstand the additional weight of ship

and barge traffic, or just the weight of the water?

Answer:
It only needs to be designed to withstand the weight of the water!
Why? A ship always displaces an amount of water that weighs the same as the ship,
regardless of how heavily a ship may be loaded