UCAPAN DASAR YDP - AGM PPFM 2011

MESYUARAT AGUNG DWI TAHUNAN PERSATUAN PENOLONG PEGAWAI FARMASI

DI HOTEL THE KATERINA, BATU PAHAT JOHOR PADA 17-18 JUN 2011

DISAMPAIKAN OLEH, GANESAN G.NARAYANAN, NYDP PPFM.

Terima kasih Saudara / Saudari Pengerusi Majlis

SALAM SEJAHTERA, SELAMAT PETANG DAN SALAM SATU MALAYSIA,

· Yang Berbahagia Dr.Salmah bt Bahri, Pengarah Amalan & Perkembangan BPF KKM mewakili Pengarah Kanan Perkhidmatan Farmasi Malaysia

· Yang Berusaha Puan Rosidah bt Md.Din, Timb.Pengarah Kesihatan Negeri (F) Bhg Perkhidmatan Farmasi Negeri Johor

· Yang Berusaha Puan Siti Hanidah bt Maksom, Ketua Pegawai Farmasi, Perkh.Farmasi, Pejabat Kesihatan Bt.Pahat

· Yang Berusaha En.Zaini b Tahir, Ketua Peg.Farmasi, Jabatan Farmasi Hospital Batu Pahat

· Yang DiHormati, En.Muhammad b Awang, Ketua Profesion Penolong Pegawai Farmasi Malaysia

· Yang Dihormati rakan seperjuangan Presiden dan Exco Kebangsaan Pembantu Farmasi Kerajaan Malaysia Barat.

· Yang DiHormati, Pengerusi JK Penganjur , Pn.Samidah bt Rahmat

· Ahli-Ahli Majlis Tertinggi Kebangsaan, ahli-ahli, para Pen.Pegawai Farmasi Malaysia dan para hadirin dan hadirat yang saya hormati sekelian

Tuan-tuan dan Puan-puan sekelian,

1. Terlebih dahulu marilah kita panjatkan kesyukuran kepada tuhan yang maha esa di atas limpah kurnianya sehingga membolehkan kita dapat bersama-sama pada petang yang mulia ini. Saya juga ingin mengambil kesempatan untuk menyampaikan salam daripada YDP En.Lee Kim Huat kepada Yg Bhg Dr.Salmah, Dif2 jemputan dan semua para hadirin sekelian serta memohon maaf bagi pihak beliau di atas keuzuran beliau menghadiri majlis ini. Saya selaku NYDP mewakili Persatuan Penolong Pegawai Farmasi ingin merakamkan setinggi-tinggi penghargaan dan ucapan terima kasih kepada Yg Berbahagia Dr.Salmah di atas kesudian beliau hadir dan merasmikan Mesyuarat Agung Dwi Tahunan PPFM bagi tahun 2011/2013. Ucapan terima kasih juga saya tujukan kepada semua dif-dif jemputan yang dimuliakan di atas kesudian melapangkan masa untuk ke Majlis ini. Tidak dilupakan juga saya ucapkan terima kasih kepada semua perwakilan dan para hadirin yang datang dari segenap sudut di Malaysia ini. Selamat datang, salam sejahtera dan salam satu Malaysia.

Tuan-tuan dan Puan-puan sekelian,

2. Bagi pihak Persatuan, saya juga ingin mengucapkan syabas dan tahniah kepada Pengerusi Jawatankuasa Penganjur Puan Samidah Rahmat dan semua Ahli Jawatankuasa Penganjur di atas usaha gigih menjadikan Malam Mesra ini malam yang penuh bermakna dan juga syabas di atas usaha mengelolakan Persidangan yang bakal diadakan esok. Untuk pengetahuan Tuan-tuan dan Puan-puan sekelian, Persatuan kita telah masuk tahun ke 37 umurnya sehingga hari ini. Namun masih ramai yang keliru akan peranannya serta juga peranan Kesatuan.

Bagi ahli-ahli baru ingin saya perjelaskan peranan Persatuan. Persatuan adalah komited kepada aspek profesionalsima Penolong Pegawai Farmasi, pembangunan profesional dan CPD, pendidikan, berkongsi pengetahuan, respon kepada keperluan ahli-ahli , membantu untuk profesion mencapai dan kekal dalam satu standard yang relevan dan menyokong kepada peranan atau “expanded & extended roles” Penolong Pegawai Farmasi.

Tuan-tuan dan Puan-puan sekelian,

3. Sebagai penjawat awam kita perlulah sentiasa mengambil tahu sebarang maklumat terkini dari Kementerian dan Kerajaan Malaysia serta bersedia untuk berubah dan mengikuti perkembangan semasa dan terkini. Ekoran itu, saya amat tertarik dengan ucapan YAB Perdana Menteri dalam Majlis Perdana Perkhidmatan Awam ke 11 di PICC pada 9 Mac 2010 yang lalu dan menyeru semua Penolong Pegawai Farmasi merenung kembali kepada amanat beliau dalam ucapan tersebut. Ingin saya mengupas beberapa petikan ucapan YAB Perdana Menteri yang memfokuskan kepada pembaharuan dalam sektor awam dengan menggariskan Lapan Tonggak Perdana dan dalam ucapan tersebut beliau menyebut : “mahu tidak mahu para penjawat awam mesti berfikir di luar lingkungan kotak. (Think out of the box). Saya tidak mahu budaya “automation’’ menjadi satu hakikat kehidupan dalam sektor awam. Kita seharusnya berfikiran kritis dan konstruktif dalam menunaikan tanggungjawab dan amanah dengan mencari penyelesaian-penyelesaian kreatif dan inovatif di luar kelaziman”. Ini ditujukan kepada semua penjawat awam. YAB juga menyentuh Lapan Tonggak Perdana iaitu 4 Tonggak Utama (The Four Pillars) dan 4 Tonggak Nilai untuk kecermerlangan perkhidmatan awam dan pembangunan Negara.

4. THE FOUR PILLARS

Tiang Utama Pertama :

Gagasan 1Malaysia: Rakyat Didahulukan Pencapaian Diutamakan - Tonggak pertama ini menyentuh aspek perpaduan nasional yang kita sedia maklum. Dalam gagasan ini juga diujudkan sebanyak 50 Klinik 1 Malaysia.

Tiang Utama Kedua:

Program Transformasi Kerajaan(GTP) – Ia adalah mencerminkan satu kerajaan yang lebih responsive terhadap aspirasi dan prihatin kepada denyut nadi rakyat. Seperti yang sering disebut, era kerajaan mengetahui segala-galanya sudah berakhir. Jadinya, kerajaan perlu bersifat sebagai pemudahcara dan bukannya “absolute arbiter of wisdom”.

Tuan-Tuan dan Puan-Puan, dalam aspek ini ia mengingatkan semua penjawat awam yang mana Pen.Pegawai Farmasi juga sebagai penjawat awam, harus memenuhi minda mereka dengan ilmu yang “uptodate” dan mahir dalam komunikasi, sentiasa kreatif, inovatif serta sentiasa peka kepada perubahan, bersedia berubah dan effisien sebelum menghadapi pelanggan yang kebanyakannya “educated”.

Tiang Utama Ketiga dan Ke Empat adalah dua prakarsa penting ekonomi iaitu Model Baru Ekonomi (NEM) dan Rancangan Malaysia Kesepuluh (RMK10). YAB Perdana Menteri menerangkan untuk mencapai cita-cita nasional bagi menjadi sebuah negara maju yang berpendapatan tinggi, memerlukan kita keluar dari perangkap atau kepompong paradigma. “Kita tidak boleh takut atau bimbang untuk melaksanakan pembaharuan dan penambahbaikan kerana jika kita mengambil sikap suka melewatkan apa yang perlu diubati dengan segera hanya kerana kita kuathir terhadap kesakitan yang bakal ditempuhi dek kerana rawatan tersebut, maka kita sebenarnya sedang mendedahkan diri untuk ditimpa bencana yang lebih serius.”

YAB Perdana Menteri juga mahukan lebih diberi perhatian kepada ehwal ‘’continuing education’’, ‘’skills upgrading”, “succession planning” dan ‘’career advancement’’ para penjawat awam.

Yang Bhg Dr, Tuan-tuan dan Puan-puan sekelian,

5. Pihak Persatuan sentiasa menerima berbagai-bagai pertanyaan dan desakan dari para ahli iaitu Penolong Pegawai Farmasi yang sentiasa dahagakan ilmu dan pembangunan karier. Saban hari pertanyaan diajukan kepada Persatuan untuk membawa masalah pembangunan pendidikan dan karier PPF. Persatuan amatlah berharap Bahagian Perkhidmatan Farmasi khasnya dan Kementerian Kesihatan Malaysia amnya akan memberi lebih ruang dan peluang kepada Penolong Pegawai Farmasi untuk memajukan diri dalam karier dan penambahan ilmu bagi memantapkan perkhidmatan penjagaan farmaseutikal sebagaimana yang disebutkan oleh YAB Perdana Menteri dalam petikan ucapan yang saya sampaikan tadi iaitu continuing education, skills upgrading dan career advancement.

Tuan-tuan dan Puan-puan sekelian,

6. Persatuan Pen.Pegawai Farmasi amat berterima kasih kepada Bhg Perkhidmatan Farmasi KKM di atas sokongan dan kelulusan mengadakan Pos Basik pertama. Persatuan juga amat bersyukur dan mengucapkan penghargaan di atas sokongan Bhg Perkhidmatan Farmasi kerana memberi peluang dalam memperkembangankan skop perkhidmatan atau “expanded scope” dengan melibatkan para PPF dalam peranan baru iaitu Program Terapi Methadone.

Persatuan juga sangat mengharapkan PPF diberi juga peluang dalam lain-lain skop baru seperti MTAC Athma, Perkhidmatan Nasihat Ubat-Ubatan, HMR, Stor Integrasi (Bhg Ubat), Unit Penguatkuasaan dan lain-lain Unit baru yang difikirkan sesuai untuk tugas Teknikal dan bekerja dalam satu pasukan. Dengan penambahan aktiviti baru, akan juga memberikan lebih ruang kepada Pegawai Farmasi dengan memberi lebih tumpuan kepada bidang klinikal dan membantu mempertingkat tahap kesihatan pesakit. Perkara ini telah terbukti berjaya apabila satu Inovasi perkhidmatan di lakukan di USA yang memenangi Award oleh sekumpulan Ahli Farmasi dan Pharmacy Technician pada tahun 2006 di mana kumpulan ini mencipta satu inovasi. Petikan dari Medscape: “New York (MedscapeWire) Dec 13 — Five teams of pharmacists and certified pharmacy technicians were declared the winners of this year's Innovations in Pharmaceutical Care Award on December 4th at the American Society of Health-System Pharmacists (ASHP) Midyear Conference in Las Vegas, Nevada.

Winners included a team at Duke University Medical Center that reengineered pharmacy work functions to allow pharmacists more time to focus on patient care. Another winning team, from North Mississippi Medical Center - Department of Pharmacy Services, uses a certified pharmacy technician in the medication error tracking and reporting process, giving pharmacists and other health professionals more time to implement new patient care programs.

Tuan-Tuan dan Puan-Puan,

7. Bagi meningkatkan mutu, imej dan moral Profesion, Persatuan berharap para Penolong Pegawai Farmasi di dedahkan dan dilibatkan dengan Health System Research secara menyeluruh serta sebagai sesuatu yang harus di galakkan di setiap negeri. Penglibatan PPF dalam HSR akan meningkatkan tahap dan moral profesion di samping membantu Bhg.Perkhidmatan Farmasi dalam semua aktiviti sebagai satu pasukan.

8. Sebagai “Benchmark” profesion ini, jika kita perhatikan di luar Negara contohnya United Kingdom, Pharmacy Technician mempunyai Journal sendiri dan hasil kajian mereka di terbitkan dalam majalah journal 4 kali setahun (februari, april, julai, oktober) melalui Association of Pharmacy Technician, UK (Aptuk- http://www.aptuk.org). Peranan mereka diiktiraf oleh Royal Pharmaceutical Society of Great Britain dan didaftarkan di bawah Akta Farmasi di sana seterusnya menjadikan profesion tersebut dikawal dan di “Regulate”. Keadaan yang sama juga di USA (NPTA, PTCB) dan Kanada (CAPT).

Tuan-tuan dan Puan-puan sidang hadirin sekelian,

9. Persatuan dimaklumkan PPF juga akan di daftarkan dalam masa terdekat ini dan bersyukur sekiranya ia menjadi kenyataan. Pendaftaran ini adalah sesuatu yang dinanti-nantikan oleh semua ahli-ahli dan Penolong Pegawai Farmasi baik dalam kerajaaan atau Institusi swasta. Pendaftaran ini akan menjadikan profesion ini lebih dihormati, menaikkan imej dan moral, mudah dikawal, dan memotivasikan semua Penolong Pegawai Farmasi. Motivasi dan kepuasan dalam tugas (Motivation and Job Satisfaction) adalah amat penting sekali dalam kerja seharian. Ini disokong dalam buku Ronald L.Pardee (1990) yang menyebut “ Motivation is such an important element in improving work productivity”. Beliau juga menyebut “one major means of increasing an employee’s level of intrinsic motivation is through changing the work itself or called Job Enrichment (Herzberg, 1976) . Job enrichment is a critical element of Quality Of WorkLife (QWL). Dengan mewajibkan pendaftaran ini secara tidak langsung juga akan menaikkan imej, motivasi dan moral profesion serta mengelak dari pengambilan Penolong Pegawai Farmasi yang tidak bertauliah terutamanya di sektor swasta serta juga penggunaan gelaran jawatan yang tidak standard atau disalah gunakan oleh mereka yang tidak layak atau tidak bertauliah.

Yang Berbahagia Dr, Tuan-tuan dan Puan-puan,

10. Pendidikan adalah elemen paling penting dalam mana-mana profesion bagi melahirkan anggota yang bermutu, berkualiti dan berilmu. Justeru itu semua Penolong Pegawai Farmasi adalah di sarankan melibatkan diri dalam mana-mana peluang kursus atau memohon mendapatkan kursus contohnya Kursus Intan yang boleh dipohon melalui Online. Persatuan berharap semua PPF tidak menolak peluang sekiranya ditawarkan kerana dimasa akan datang PPF perlu memenuhi mata CPD minima 40 untuk memperolehi PTK aras 4 berpandukan kepada kriteria yang ditetapkan.

11. Dalam aspek latihan pulak, Persatuan berharap bilangan Pengajar perlu di tambah bagi melahirkan lebih ramai graduan-graduan di Institusi latihan KKM iaitu KSKB. Pihak Persatuan juga dimaklumkan sehingga kini bilangan Pengajar masih tidak mencukupi dan keadaan ini akan menjadi lebih kritikal apabila Kolej Sains Kesihatan baru yang bakal beroperasi iaitu KSKB Ulu Kinta pada tahun 2012. Pengambilan Tenaga Pengajar amatlah memerlukan kelayakan sewajarnya. Kualiti pendidikan harus di pelihara dan di kawal sebaiknya. Bagi memenuhi keperluan tenaga pengajar dalam subjek teknikal dan farmaseutik, Persatuan juga ingin mencadangkan sekiranya dapat di jalankan Top-Up Degree 2 tahun dalam bidang Pharmaceutical Science atau Pharmaceutical Technology seperti yang di jalankan di UK dan USA serta juga Teaching Methodology untuk pembangunan karier PPF. Pemilihan dan tawaran perlulah kepada mereka yang benar-benar layak dan cemerlang serta berpengalaman. Bagi memelihara kualiti Diploma Farmasi di IPTA, KSKB dan IPTS, persatuan juga bersetuju proses pengambilan pelajar, kurikulum pendidikan dan mutu pengajaran di pantau supaya negara dapat melahirkan graduan yang berkualiti dan bermutu. Bagi mata pelajaran klinikal, seharusnya Kolej mempunyai para Pensyarah yang berpengalaman luas dalam bidang teknologi farmasi serta berpengetahuan dalam Teaching Methodology. Kita tidak sama sekali mahu mana-mana Institusi pendidikan yang seolah-olah menjual Diploma kepada pelajar semata-mata inginkan perniagaan di Institusi tersebut dengan tidak menggagalkan pelajar yang lemah dan tidak kompeten. Dan bagi mereka yang benar-benar cemerlang dan layak pula, Persatuan merasakan mereka harus di beri peluang untuk sambung belajar Ijazah Farmasi dengan sekurang-kurangnya CGPA 3.5 setelah menghabiskan 3 tahun di dalam Diploma dan mereka ini tidak seharusnya diletakkan setaraf dengan pelajar Foundation, Matrik yang hanya belajar setahun tanpa pengetahuan asas dalam bidang Farmaseutikal serta pengalaman.

Mungkin bagi pelajar-pelajar Foundation/Matriks/ STPM harus diletakkan kelayakan minima CGPA 3.8 tetapi bukan pelajar lulusan Diploma Farmasi. Bagi mereka yang telah berkhidmat 5 tahun dan ke atas pengalaman harus menjadi ukuran dalam penentuan kelayakan dan pengetahuan yang diperolehi haruslah mendapat pengiktirafan. Persatuan berharap golongan ini mendapat peluang menyambung pelajaran ke Ijazah Farmasi dengan kelayakan CGPA minima 3.0. Biarlah Universiti yang menentukakan samada mereka layak mendapat Ijazah atau tidak melalui peperiksaan yang dijalankan dan jika mereka tidak kompeten, sudah tentu mereka akan di gagalkan.

Tuan-tuan dan Puan-puan sekelian,

12. Perubahan drastik yang bakal berlaku selepas pendaftaran perkhidmatan Penolong Pegawai Farmasi, memerlukan komitmen jitu dari semua. Penolong Pegawai Farmasi haruslah bersedia untuk berubah (Ready To Change). Dunia bergerak dengan begitu pantas, begitu juga bidang farmaseutikal dan penyampaian kesihatan. Kita tidak boleh leka dan berpuashati dengan apa yang diterima sebaliknya berusaha memberi dan sentiasa proaktif serta bersikap positif. Mereka yang bersikap negative akan ketinggalan dalam arus pembangunan ini.

13. Yang Bhg Dr, Dif-dif jemputan, Tuan-tuan dan Puan-puan sekelian, pihak Persatuan ingin merakamkan ribuan terima kasih kepada Bhg.Perkhidmatan Farmasi di atas sokongan dan keprihatinan yang di berikan dalam semua tuntutan oleh pihak Persatuan. Pewujudan Jawatankuasa Teknikal Pen.Pegawai Farmasi Malaysia adalah sebagai bukti keperhatinan dan perhatian yang diberikan oleh Dato Pengarah Kanan Perkhidmatan Farmasi ke atas profesion ini. Untuk pengetahuan semua Penolong Pegawai Farmasi, Jawatankuasa ini telah di ujudkan pada tanggal 16 November 2009 sebagai mesyuarat yang pertama di adakan. Ahli-ahli nya adalah terdiri dari Para Pegawai Kanan Bhg.Perkhidmatan Farmasi, Exco Persatuan dan Exco Kesatuan. Tujuan di ujudkan JK ini adalah untuk membincangkan semua hal-hal berkaitan profesion, merancang latihan yang perlu dan sesuai seluruh Negara termasuk untuk PPF sektor swasta, pelaksanaan mata CPD/PTK, penetapan tanda aras korikulum Diploma dan Pos Basik mengikut keperluan semasa dan perancangan keperluan sumber manusia. Oleh yang demikian jika ada sebarang masalah dari ahli-ahli, bolehlah disalurkan melalui Persatuan atau Kesatuan berpandukan isu yang berkaitan untuk dibawa berbincang dalam mesyuarat ini.

14. Sebelum saya mengakhiri ucapan ini, saya menyeru kepada semua Penolong Pegawai Farmasi yang belum lagi menjadi ahli supaya berbuat demikian. Marilah sama-sama kita menjadi ahli Persatuan dan Kesatuan. Kekuatan organisasi ini adalah ditangan anda. Kita memerlukan ahli yang aktif dan pemimpin-pemimpin muda yang boleh mengambil alih kepimpinan sedia ada. Berapa lama lagi kita boleh mengharapkan Ahli Majlis – Ahli Majlis Tertinggi senior yang telah begitu lama menyumbangkan tenaga iaitu hampir 30 tahun. Mereka sebenarnya ingin berehat tetapi kita ketandusan kepimpinan sebenarnya. Kepada PPF baru, anda boleh lawati laman web Persatuan: ww.ppfmy.com untuk berinteraksi sesama PPF atau bersama Ahli Majlis Tertinggi dalam chatbox atau juga dalam forum.

15 Sebelum saya menamatkan ucapan ini, izinkan saya sekali lagi mengucapkan jutaan terima kasih kepada Yg Bhg Dr.Salmah bt Bahri kerana sudi hadir bersama kita dan merasmikan majlis ini. Ucapan terima kasih juga saya tujukan kepada semua Dif-dif jemputan, para hadirin sekelian dan khasnya kepada AJK Penganjur yang bertungkus lumus bekerja menjayakan Majlis dan persidangan ini. Bagi pihak Persatuan, saya ingin mengucapkan jutaan terima kasih kepada Kerajaan Negeri Johor yang sudi memberi sumbangan dalam majlis malam mesra, juga kepada syarikat-syarikat farmaseutikal, wakil-wakil negeri, Ahli Majlis – Ahli Majlis Tertinggi, orang perseorangan yang sudi memberikan derma, tenaga, buah fikiran dan material bagi menjayakan majlis ini.

Akhir sekali saya bagi pihak Ahli Majlis ingin mengucapkan ribuan terima kasih di atas kepercayaan para perwakilan kepada kami untuk menerajui Persatuan penggal ini.

Kemaafan dipohon sekiranya terdapat kesilapan dan kelemahan sepanjang kepimpinan ahli majlis sesi 2009-2011.

“KESILAPAN ITU DARI MANUSIA, KESEMPURNAAN ADALAH DARI TUHAN “

Saya sudahi dengan dua rangkap pantun

Dari Perlis ke Batu Pahat

Singgah di Tapah Berhenti Makan

Para hadirin kelihatan Hebat

Semuga bergembira menikmati hidangan

Bunga Dedap di Atas Para

Anak Dusun Pasang Pelita

Kalau Tersilap Tutur Bicara

Jemari Disusun Maaf Dipinta

Sekian, terima kasih. Selamat malam dan selamat bersidang.

Ganesan G.Narayanan

Naib Yang DiPertua

Persatuan Penolong Pegawai Farmasi Malaysia

UCAPAN PENGHARGAAN

TERIMA KASIH KEPADA SEMUA AHLI-AHLI PERSATUAN DI ATAS KEPERCAYAAN YANG DIBERI DAN UNDIAN KEPADA SAYA SERTA PEMILIHAN SAYA SEBAGAI YDP YANG BARU UNTUK PERSATUAN PENOLONG PEGAWAI FARMASI MALAYSIA SESI 2011-2013.

PERSATUAN KOMITED UNTUK BERJUANG DAN MENJALANKAN SEMUA TANGGUNGJAWAB DAN "TASK" DEMI KEMAJUAN PROFESION PEN.PEGAWAI FARMASI YANG DI CINTAI.

TERUSKANLAH SOKONGAN DAN KEMPENLAH AHLI-AHLI BARU UNTUK MENGUATKAN LAGI PERSATUAN INI.

TERIMA KASIH.

ANJAKAN PARADIGMA DAN TRANSFORMASI - PPF

Kepada semua PPF Malaysia,

Sudah sampai masanya untuk kita mengatur langkah untuk melonjak ke satu paradigma baru dalam pembangunan profesion Penolong Pegawai Farmasi yang kita sayangi.

Perjuangan yang retorik oleh organisasi mewakili profesion ini sudah dimakan zaman. Tidak lagi sesuai untuk zaman sekarang yang penuh dengan teknologi tinggi dan tahap penyampaian kesihatan yang dinamik, sentiasa bergerak pantas dan desakan yang tinggi terhadap kualiti. Kita masih lagi dengan usaha-usaha lama dengan permohonan untuk kelulusan uniform, elaun-elaun, dan mengekori semua apa yang diperolehi oleh lain-lain paramedik anak emas kementerian.

Kita harus bersedia untuk berubah (ready for change). Ujudkan satu identiti baru yang kukuh dengan menjadikan profesion ini satu aset yang penting kepada perkhidmatan farmasi dan kementerian. Jangan sekali-kali hanya mengharapkan nasib dari usaha lain-lain paramedik sahaja. Bagaimana?

Inilah pertanyaan yang akan timbul dari kita semua...

Masalah kita yang paling besar ialah sokongan dari bahagian perkhidmatan farmasi sendiri. Sekiranya kita mendapat sokongan baik, profesion ini boleh meneruskan satu agenda baru dan 'transform' kepada tahap baru dalam perkhidmatan penjagaan kesihatan bidang farmasi.

Wahai PPF sekelian, untuk meletakkan kita dalam peta seangkatan dengan lain-lain paramedik dan mengelakkan dari profesion ini pupus satu hari kelak dengan pembanjiran pegawai-pegawai farmasi di segenap sudut institusi kesihatan, semua PPF harus bersedia untuk belajar dan belajar. Tanamkan ilmu dalam aspek farmakologi, klinikal, QAP, inovasi, libatkan diri dalam pembangunan, sentiasa berfikiran positif, berkhidmat dengan kualiti dan yang paling penting melibatkan diri dalam kajian atau jalankan satu kajian dalam kumpulan setiap 1 atau 2 tahun sekali.

Dengan penglibatan dalam Health System Research, akan menaikkan martabat profesion ini ke tahap baru dalam sistem perkhidmatan kementerian kesihatan dan barulah profesion ini akan dipandang tinggi oleh ketua-ketua perkhidmatan di setiap PTJ. Buat masa sekarang kebanyakan aktiviti Inovasi, QAP, KMK dan lain-lain dijalankan oleh Jururawat, PPKP PPP, Jurupulih Anggota dll. Memang ada juga PPF yang jalankan aktiviti ini tetapi sangat sedikit.

Selain ini saya berpendapat satu perubahan besar perlu di lakukan kepada keseluruhan organisasi perkhidmatan farmasi untuk profesion kita dengan mengujudkan dua jawatan sokongan baru iaitu Pembantu Farmasi U3 (sama taraf seperti PPK U3) yang mana adalah sama dengan negara Ireland yang mempunyai Pharmacy Aides. Tugas mereka adalah seperti PPK dalam unit farmasi tetapi dengan kursus khas berkhaitan ubat yang basik sahaja selama 6 bulan.

Satu lagi jawatan yang perlu di ujudkan ialah Pharmacy Technologist U41 (Teknologis Farmasi) yang berkelulusan Ijazah teknologis Farmasi atau Ijazah Sains farmaseutikal (sama seperti di USA).

Dengan ini profesion kita tidak perlu di jadikan kumpulan bersepadu. Yang mempunyai diploma menjadi PPF, Ijazah menjadi Teknologis Farmasi, dan yang ada degree in Pharmacy menjadi Pharmacist.

Kewujudan Teknologis Farmasi yang memiliki kepakaran teknikal (TPN, CDR, TDM, Logistik Management) boleh meningkatkan kualiti perkhidmatan Jabatan Farmasi kerana para Pegawai Farmasi dapat menumpukan perhatian penuh kepada tugas klinikal kepada pesakit dan berganding bahu dengan doktor untuk membantu pesakit-pesakit dalam rawatan harian.

Ia terpulang kepada nama yang hendak diberikan untuk Teknologis Farmasi U41 samada Pegawai Teknikal Farmasi U41 atau Teknologis Farmasi U41. Dalam tahap ini sebagai sokongan kita kepada para Pegawai Farmasi, profesion mereka juga harus di naikkan kepada UF41 (sebagaimana para doktor naik kepada UD41) dan gred mula gaji juga harus dinaikkan supaya jawatan gred profesional mereka terpelihara juga. Mereka juga harus di naikkan taraf kepada "Clinical Specialist Pharmacist" dalam bidang-bidang yang berkaitan samada Onkologi Specialist, Cardiology Specialist dan sebagainya. (seperti di UK)

Dengan erti kata lain perkhidmatan farmasi akan mempunyai 4 jawatan utama iaitu Pegawai Farmasi UF41-Jusa A, Teknologis Farmasi U41-U54, Pen.Pegawai Farmasi U29-U40, Pembantu Farmasi U3-U14.

Sebagai expanded role untuk PPF, tugas-tugas di stor harus di berikan kepada kita dalam hal-hal perolehan ubat-ubatan dan Pen.Pegawai Tadbir (Stor) serta Pem.Tadbir hanya mengendalikan Non-Drug sahaja. Ketua unit di pejabat stor harus di serahkan kepada Teknologis Farmasi U41 yang mahir dalam hal-hal logistik kerana dalam ijazah mereka subjek logistik management adalah salah satu subjek penting. (lesen pemborong boleh di berikan kepada Ketua di unit stor ini atau sebaliknya mengikut undang-undang.

Dengan kaedah ini skop perkhidmatan Pen.Pegawai Farmasi boleh di kembangkan dan di hargai serta di hormati oleh semua pihak. Secara tak langsung ini juga akan menaikkan moral semua PPF amnya kerana peluang untuk naik ke gred U41 akan terbuka luas melalui pembelajaran ke Ijazah Sains Farmaseutikal dan Ijazah Teknologis Farmasi. (kursus ini ada di jalankan di UK dan USA).

* Artikel ini hanyalah satu nukilan serta sambungan "mimpi indah" yang direka oleh saya untuk tatapan semua semoga mendapat petunjuk yang positif untuk masa depan kita bersama. Sekian.

Ganesan G.Narayanan

Klinik Kesihatan Taiping

PHARMACY TECHNICIAN SERVICE INNOVATION

Kepada semua PPF Malaysia,

Sila baca artikel di bawah berkaitan Inovasi Perkhidmatan di antara Pharmacist dan Pharmacy Technician di USA di mana "expanded role" di berikan kepada Pharmacy Technician oleh Pharmacist di sana supaya semua Pharmacist dapat menumpukan dan meningkatkan perhatian kepada aktiviti "Patient Care" serta clinical duty. Delegasi perkhidmatan adalah sangat penting dalam membina satu "Positive Team Work" di antara Pegawai Farmasi dan Penolong Pegawai Farmasi dan semua Pegawai Farmasi Malaysia harus mempunyai sikap profesional seperti di New York ini dengan memberi peluang dalam expanded role serta mencipta inovasi perkhidmatan dengan tujuan murni supaya para pelanggan atau pesakit mendapat manfaat kesihatan yang maksima. Sila baca...

Winners of Innovations in Pharmaceutical Care Award Announced

New York (MedscapeWire) Dec 13 — Five teams of pharmacists and certified pharmacy technicians were declared the winners of this year's Innovations in Pharmaceutical Care Award on December 4th at the American Society of Health-System Pharmacists (ASHP) Midyear Conference in Las Vegas, Nevada.

Winners included a team at Duke University Medical Center that reengineered pharmacy work functions to allow pharmacists more time to focus on patient care. Another winning team, from North Mississippi Medical Center - Department of Pharmacy Services, uses a certified pharmacy technician in the medication error tracking and reporting process, giving pharmacists and other health professionals more time to implement new patient care programs.

The award, founded in 1998 by the Pharmacy Technician Certification Board (PTCB), recognizes innovations in pharmaceutical care by teams of pharmacists and certified pharmacy technicians in any practice setting. Each of the five winning teams received a cash award of $1,000 to be shared equally by the pharmacist and certified pharmacy technician and a framed certificate to be displayed in their respective practice settings.

"We take great pride in the Innovations Award Program," said Melissa M. Murer, RPh, PTCB Executive Director. "Efforts to enhance patient care, reduce medication errors and manage patient's chronic diseases serve as best practices for the over 70,800 certified pharmacy technicians nationwide."

IS ACETAMINOPHEN HARMFUL IN CHILDREN?

William F. Balistreri, MD

Authors and Disclosures

Posted: 01/20/2011

Does therapeutic dosing of acetaminophen in children pose a risk for liver injury?

Response from William F. Balistreri, MD Dorothy M. M. Kersten Professor of Pediatrics, University of Cincinnati College of Medicine; Medical Director, Liver Transplantation Program, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio

Acute hepatotoxicity as a result of acetaminophen overdose in children is well known and is most often the result of "therapeutic misadventure" -- when the administered dose exceeds the weight-based recommended dose.^[1] In 2009, the US Food and Drug Administration held an advisory committee meeting to address the problem of liver injury from the use of acetaminophen in both over-the-counter (OTC) and prescription products.^[2] Effective strategies were developed to prevent unintentional overdoses by caregivers and unsupervised ingestion by children. The advisory committee recommended increased restrictions on the use of acetaminophen to protect people of all ages from potential hepatotoxicity.

However, as the question above indicates -- concern remains that liver injury may occur with therapeutic acetaminophen dosing. Case reports suggest that this phenomenon may occur, but few reports contain sufficient data to support the probable causal relationship. In addition, the impact of chronic exposure to this drug, which is widely used in children, is not known. This issue was recently addressed in 2 separate studies:

First, a systematic review of the medical literature (62 studies that enrolled 32,414 children) was carried out to determine the rate at which liver injury was reported for children who were prescribed therapeutic doses of acetaminophen (defined as <>[3] Lavonas and colleagues found that hepatotoxicity after therapeutic dosing of acetaminophen in children was rarely reported in these defined-population studies. They concluded that individual susceptibilities in drug response and toxicity may occur with the use of acetaminophen. The study was somewhat hampered by the fact that they reviewed previously published studies that were not expressly designed to systematically collect laboratory measurements that would detect liver injury. Because few children in these studies received exactly 75 mg/kg/d of acetaminophen, and many received the drug for short periods, this review had limited power to detect infrequent hepatotoxicity associated with longer therapy and/or maximal therapeutic dosing.

Second, a focused study emerging from a multicenter study group examined characteristics and outcomes of children with acute liver failure (ALF) to determine the potential role of chronic acetaminophen exposure.^[4] The biochemical profiles of children with ALF who had chronic exposure to acetaminophen were unique. They were characterized by lower serum bilirubin and higher peak alanine aminotransferase levels than patients with ALF who did not have acetaminophen exposure. The outcomes of these children were also worse than for those with single toxic exposure to acetaminophen.

The bottom line is that pediatric care providers must continue to educate parents and patients about the safe use of acetaminophen, including informing them about the widespread incorporation of acetaminophen into many OTC products and prescription pain medications. Ongoing studies will help determine the factors that may contribute to individual susceptibilities to acetaminophen-induced liver injury. These observations should lead to safer use of the drug and hopefully to preventive efforts to reduce exposure.

References

1. Heubi JE, Barbacci MB, Zimmerman HJ. Therapeutic misadventures with acetaminophen: hepatoxicity after multiple doses in children. J Pediatr. 1998;132:22-27.
2. FDA. Acetaminophen and Liver Injury. Available at: http://www.fda.gov/forconsumers/consumerupdates/ucm168830.htm Accessed December 29, 2010.
3. Lavonas EJ, Reynolds KM, Dart RC. Therapeutic acetaminophen is not associated with liver injury in children: a systematic review. Pediatrics. 2010;126:e1430-1444.
4. Leonis MA, Alonso EM, Im K, Belle SH. Chronic acetaminophen exposure in pediatric acute liver failure. Hepatology. 2010;52:1037A. Abstract 1495A.

Cholesterol is Your Friend, Not Your Enemy

Dear readers,
Check this comments by Dr.Mercola who is an osteopathic physician with vast experience in finding long-term solutions for patients who suffer from chronic illnesses using natural medicines.

Dr. Mercola, the New York Times best-selling author, has helped countless people to reach their health and weight loss goals. An osteopathic physician, board certified in family medicine, Dr. Mercola is passionate about empowering people to take control of their health using solely natural means.

Dr. Mercola’s natural health Web site, www.Mercola.com, has been the most visited natural health site on the Internet, with over 12 million page views every month. More than 1 million people subscribe to Dr. Mercola’s free e-mail newsletter, which has been in circulation since 1998

If you decide to take cholesterol-lowering drugs instead of addressing the underlying problem, you are not only stopping your body’s natural healing process, you are exposing yourself to drugs that are loaded with side effects -- not the least of which is depleting your body of Coenzyme Q10, which leads to fatigue, muscle weakness, soreness and ultimately heart failure.

DR.MERCOLA'S COMMENT :

When I first started practicing in the mid-80s, after finishing my residency program, I was already very interested in preventive medicine and checked cholesterol levels on nearly every patient I saw. A large number of people, I found, had elevated levels of cholesterol. But surprisingly, a fair number of them took their results back to their previous doctors (since I was the new kid on the block, no doubt) who reassured them their levels were normal.

Well, the problem was that the ranges of “normal” were, and still are, very misleading as they are a measure of what’s average -- based on mostly sick people.

It’s important to realize that there’s a big difference between average and healthy cholesterol levels. It’s very similar to what we’re now seeing with vitamin D levels.

Today, however, with respect to cholesterol, the pendulum has shifted the opposite way with ever lower levels of cholesterol being recommended, primarily due to the significant influence of the drug industry.

Profit, Not Health, is the Driving Factor Behind Current Cholesterol Recommendations

The pharmaceutical industry quickly realized what an enormous market they could capture with cholesterol lowering drugs. And they could do this very effectively with a drug that you’d have to take for years on end, and which, for the most part, wasn’t toxic or dangerous enough to kill you quickly.

Cholesterol lowering drugs (statins) now generate profits to the tune of tens of billions of dollars a year.

They were also able to leverage their marketing efforts by selecting experts in the medical community, and appointing them to government panels that make recommendations adopted by nearly the entire medical and health community.

On the last U.S. government's National Cholesterol Education Program panel there were nine physicians, and eight of them had clear, direct ties to the drug industry. Specifically to companies that make these kinds of drugs. As a result, the panel revised the national guidelines, advising those at risk for heart disease to attempt to reduce their LDL (bad) cholesterol to very, very low, levels.

Before 2004, a 130 LDL cholesterol level was considered healthy. The updated guidelines, however, recommended levels of less than 100, or even less than 70 for patients at very high risk.

In order to achieve these outrageous and dangerously low targets, you typically need to take multiple cholesterol-lowering drugs. So the guidelines instantly increased the market for these dangerous drugs.

Please understand that you have not been told the whole truth about cholesterol. Rather what you’re getting from most conventional health practitioners is little more than cleverly distorted marketing.

Cholesterol is Not the Evil Villain You’ve Been Led to Believe

Cholesterol is essential and crucial for a wide variety of vital functions in your body.

It’s an integral part of your cell membranes, and it’s also the precursor (the raw material) your body uses to make your steroid hormones – one of which is vitamin D. Your skin contains cholesterol, and when UVB rays from the sun hits your skin it converts that form of cholesterol to vitamin D3, which is then transported to your blood. Your body then further converts it into the active form of vitamin D.

But that’s not all. When your cholesterol levels go too low, a host of negative events occur in your body.

The Risks of Low Cholesterol

Cholesterol also essential for optimal brain health. It helps in the formation of your memories and is vital for neurological function. In fact, low cholesterol has been linked to a variety of neurological problems, including memory loss.

Having too little of this beneficial compound also:

• Increases your risk of depression
• Can increase your risk of suicide
• May lead to violent behavior and aggression
• Increase your risk of cancer and Parkinson’s disease

What is Too High?

Personally, I believe anything above 330 is likely too high. But another powerful way to determine if you’re at risk from abnormal cholesterol metabolism is to check your ratio of HDL, or “good” cholesterol, and your total cholesterol.

Your HDL percentage is a very potent heart disease risk factor.

Simply divide your HDL level by your cholesterol. That percentage should ideally be above 25 percent. Typically, the higher the better, as there are no known side effects of having too high good cholesterol.

If your ratio falls below 15-20 percent you are at high risk, and below 10 percent, it’s a significant indicator of risk for heart disease.

How to Safely and Effectively Treat High Cholesterol

Fortunately, there are simple, basic strategies that can help you regulate your cholesterol.

First, please realize that simply lowering your dietary cholesterol intake is not an effective primary strategy.

Why?

Because 75 percent of your cholesterol is produced by your liver, which is influenced by your insulin levels. Therefore, if you optimize your insulin levels, you will also regulate your cholesterol levels.

One of the most powerful ways you can do that is by exercising, and paying attention to the foods you eat. Foods that increase your insulin levels will also contribute to high cholesterol by making your liver produce more of it.

Here are my primary recommendations for safely lowering and regulating your cholesterol levels:

1. Get an appropriate amount of exercise.
2. Reduce, with the plan of eliminating, grains and sugars in your daily diet.
3. Eat the right foods for your nutritional type.
4. Eat a good portion of your food raw.
5. Make sure you’re getting plenty of high-quality, animal-based omega3-fats. I prefer those from krill oil.
6. Avoid excessive smoking and alcohol.
7. Address your emotional challenges.

I’ve treated between 20-30,000 patients, and I’ve only found about five people who were unable to respond to the recommendations I’ve given here. In these cases they likely had a condition called familial hypercholesterolemia.

It is extremely rare, affecting about one in 1,000 people who are on cholesterol lowering medication, but for those there may actually be some benefit to taking a statin drug.

Some have asked me about taking red rice extract, and there is some confusion on that issue. Please understand that red rice extract is also a statin drug, with the same exact mechanism of action as other statins, even though it’s available over the counter.

My Neighbor's Cholesterol Challenge Nearly Killed Him

On June 5 my old next door neighbor gave me a call and asked me if we could play tennis. We used to play regularly before I moved two years ago. He used to beat me in straight sets even though he was 70 years old, he was very good in placing the ball.

Well when we played this time it was a bit different in that he was much slower and I could easily hit balls straight past him. This time I won in straight sets. Sure he was two years older and 72 now but that could not possibly account for his decreased playing level.

After our match he explained that he was tired all the time now because his doctors put him on Zocor. Foolishly they never put him on ubiquinol This should be medical malpractice. In his case the statin drug completely devastated my neighbor's health. His energy level and quickness had been radically reduced.

Fortunately he was open to trying the ubiquinol and going on some vitamin D. I am hoping he will beat me in straight sets the next time we play.

What You Must Know if You Chose to Take Cholesterol Medication

If you chose to continue taking statin drugs, then it’s vital that you understand the mechanism of action of these drugs.

They typically work by reducing an enzyme in your liver, which not only reduces the production of cholesterol, but it also reduces the production of coenzyme Q10. When you lower the production of coQ10, you increase your risk of a variety of different health problems.

Premature aging is one primary side effect of having too little coQ10 because this essential vitamin recycles other antioxidants, such as vitamin C and E.

CoQ10 deficiency also accelerates DNA damage. Therefore, it is absolutely vital to supplement with coQ10 if you’re taking a statin drug. Unfortunately, many doctors fail to inform their patients of this fact.

If you’re over 40, I would highly recommend taking a reduced form of coenzyme Q10 called ubiquinol, because it’s far more effectively absorbed by your body.

Cholesterol is such an important issue, surrounded by so much confusion that I’m offering my Special Report on this topic FREE to all my readers. Simply click this link to download this in-depth report.

GO TO :
http://mercola.fileburst.com/PDF/Cholesterol_SpecialReport.pdf

Cholesterol Homeostasis

David E Cohen, MD, PhD
Director, Harvard-MIT Division of Health
Sciences and Technology
Associate Professor of Medicine and
Health Sciences and Technology
Harvard Medical School
Boston, MA

Introduction

Cholesterol is an essential component of cell membranes and is also the precursor of steroid hormones, bile acids, and vitamin D.¹ Cholesterol is synthesized by virtually all cells in the body but cannot be catabolized. Therefore, complex metabolic pathways involving biosynthesis, absorption, distribution, and elimination are involved in maintaining cholesterol homeostasis.²

This selective review will cover the principal metabolic pathways involved in cholesterol homeostasis.

• Cholesterol Biosynthesis
• Intestinal Elimination and Absorption
• Hepatic Regulation
• Cholesterol Production and Secretion by the Liver
• Cholesterol Uptake by the Liver
• Conclusion

Cholesterol Biosynthesis

Cholesterol is synthesized by virtually all cells in the body.³

Because of its critical role in maintaining cell membrane structure and function, cells sense and control cholesterol levels. The ratio of cholesterol to other lipids (mostly phospholipids) in the cell's plasma membrane is tightly controlled. Imbalance in these lipids can trigger the cellular synthesis of cholesterol.⁴

De novo synthesis is the major contributor to the body pool of cholesterol. Each day about 800 mg of cholesterol is synthesized, 90% of which is produced in extrahepatic tissues.^5,6

In addition to synthesis, stored cholesterol can be redistributed to the cell's plasma membrane or cells can import cholesterol from plasma low-density lipoproteins (LDL).^3,4,7

Removal of cholesterol: Excessive amounts of cholesterol can destroy cellular membrane function.² Cholesterol is returned from tissues to the liver through a pathway known as "reverse cholesterol transport."^3,5

The principal mechanism for removal of excess cholesterol from extrahepatic tissues is the efflux of cholesterol from cellular plasma membranes to high-density lipoproteins (HDL).³

HDL particles take up cholesterol, transferring some of it to other plasma lipoproteins, or HDL can deliver cholesterol directly back to the liver via specialized receptors that take it up for processing and/or elimination.³

Summary: In extrahepatic tissue, cholesterol homeostasis is maintained by a balance of de novo synthesis, use of stored cholesterol, importation of cholesterol (via LDL), and removal of excess cholesterol (via HDL).

John Dietschy, MD
Professor of Internal Medicine
Division of Digestive and Liver Diseases
University of Texas Southwestern
Medical School
Dallas, TX

Intestinal Elimination and Absorption

Diet contributes to intestinal cholesterol content and it accounts for approximately a quarter of the total. The source of most intestinal cholesterol is bile.^3,5

Cholesterol loss: While the liver secretes an average of 1200 mg/day of biliary cholesterol into the small intestine, and the average Western diet contributes another 400 mg for a total of 1600 mg/day, only about half of this cholesterol is absorbed. It should be noted that there is marked variability in absorption among individuals. The remaining cholesterol in the intestinal lumen is eliminated from the body.^3,8

Additionally, most bile acids (produced in the liver by conversion of cholesterol) are recycled to the liver, but some are eliminated by fecal excretion, which represents a source of cholesterol loss from the body amounting to about 400 mg/day. Therefore, coupled with the loss of 800 mg/day of dietary and free cholesterol in bile, the total loss of cholesterol is about 1200 mg/day.³

Absorption of cholesterol: Enterocytes within the small intestine are responsible for the packaging of absorbed cholesterol and triglycerides into Apo B–containing lipoprotein particles, chylomicrons (CM).^3,9

Chylomicrons deliver triglycerides to peripheral tissues, becoming smaller as they give up their triglycerides. The resultant particles, chylomicron "remnants" (CMR), contain remaining triglycerides and intestinally absorbed cholesterol. Nearly all of these particles are rapidly taken up by the liver, where the intestinally derived triglycerides and cholesterol are stored or packaged into other lipoproteins.^3,10,11

Summary: The intestine contributes to cholesterol homeostasis through the absorption of dietary and biliary cholesterol, which adds to the body pool, and the elimination of unabsorbed free cholesterol from bile, which depletes the body pool.

In addition, a portion of cholesterol-derived bile acids are not re-absorbed from the intestine, and this also represents a loss of cholesterol from the body.

Hepatic Regulation

The liver is the principal regulator of lipid metabolism.¹² The liver synthesizes cholesterol, packages it into lipoproteins for distribution to the tissues, receives it from intestinal lipoprotein remnants as well as from plasma lipoprotein remnants, and receives it as excess cholesterol from the tissues.⁶

The liver eliminates cholesterol^3,13 by converting it into bile acids, some of which are excreted via the intestine, and by secreting it unchanged into the bile, where about half of this cholesterol is subsequently lost by fecal elimination.³

John Dietschy, MD
Professor of Internal Medicine
Division of Digestive and Liver Diseases
University of Texas Southwestern
Medical School
Dallas, TX

Cholesterol Production and Secretion by the Liver

De novo synthesis: The liver contributes relatively little cholesterol to the total body pool, synthesizing only about 10%.^5,6

Secretion of lipoproteins: In order to ensure a continuous supply of fatty acids for delivery to muscle tissue at times when dietary triglycerides are low or nonexistent (such as during a fast), the liver assembles and secretes a triglyceride-rich Apo B–containing lipoprotein, very low-density lipoprotein (VLDL).

VLDL also contains some cholesterol, which the liver contributes from its own cholesterol pool.³

Generation of Apo B remnants: As VLDL gives up its triglyceride to the tissues, the particles become smaller and proportionally more cholesterol is contained within their cores. When about 50% of the triglyceride content of these particles has been transferred, and Apo E is acquired from HDL, the particles convert to VLDL remnants (VLDLR) and approximately half of these are taken up by receptors in the liver. Those that remain in circulation continue to give up triglyceride, and as they become smaller they convert into another remnant lipoprotein, intermediate-density lipoprotein (IDL).³

Generation of LDL: About half of these remnant IDL particles are taken up by receptors in the liver, but those that are left continue to give up triglyceride and also take on cholesterol from HDL particles via the action of cholesteryl ester transfer protein (CETP) in the process of reverse cholesterol transport. Through this process, these remnant particles eventually acquire enough cholesterol that it becomes the principal lipid contained within their cores.³

As IDL continues to give up triglycerides, and acquire more cholesterol from HDL via CETP, IDL particles transfer Apo E to HDL, eventually leaving only a single protein on their surface (Apo B-100). At this point, these particles have completed their conversion to low-density lipoproteins (LDL).³

CETP action can increase plasma LDL concentrations by assisting the remnant IDL particles in acquiring cholesterol from HDL. As detailed above, some of these IDL particles are converted into cholesterol-rich LDL particles.³

LDL is the principal cholesterol-carrying lipoprotein in circulation, accounting for 65% to 75% of total cholesterol in the plasma. If cells in the periphery need to import cholesterol, they can do so by upregulating LDL receptors that will bring these particles into the cell, releasing unesterified cholesterol from their core for use or storage. The liver can also take up LDL particles via LDL receptors.^3,14

LDL particles that are not taken up by extrahepatic cells (or cleared by the liver) remain in the plasma, where they have a half-life of 2 to 4 days—significantly longer than that of other lipoproteins such as chylomicron and VLDL remnants that have a half-life of approximately 30 minutes.³


Cholesterol Uptake by the Liver

The liver receives intestinally derived cholesterol via chylomicron remnants, and as discussed above, cholesterol is also returned to the liver via remnant lipoproteins derived from VLDL (VLDLR, IDL, and LDL). Additionally, some excess extrahepatic cholesterol is returned directly via HDL particles.³

Apo B remnants assist HDL in reverse cholesterol transport: As mentioned previously in the "Cholesterol Biosynthesis" section, HDL particles transfer some of the excess cholesterol taken up from peripheral cells to other circulating lipoproteins, specifically remnant Apo B–containing lipoproteins (VLDLR, IDL, and LDL).³

CETP facilitates the transfer of cholesteryl esters from HDL particles to these Apo B remnants, thus increasing the cholesterol concentration in the cores of these particles. In this way, the remnant Apo B lipoproteins assist in reverse cholesterol transport by carrying cholesterol acquired from HDL back to the liver.^3,13

CETP also transfers triglycerides from the Apo B remnant particles to HDL. This helps to increase size and buoyancy of the HDL particles, making them more efficiently hydrolyzed by hepatic lipase, thus facilitating the uptake of HDL by the liver. As a result, plasma HDL concentrations can fall.^13,15

Clearance of LDL: The liver expresses about 70% of the body's LDL receptors, which are upregulated if hepatic cellular concentrations of cholesterol fall. By upregulating the LDL receptors, the liver accelerates the uptake of LDL, increasing the importation of cholesterol, thus restoring hepatic cholesterol concentration while at the same time effectively clearing these lipoproteins from the plasma. Because of its ability to express so many LDL receptors, the liver is the principal remover of LDL particles from the plasma.^3,5

Summary: The liver maintains cholesterol homeostasis by synthesizing cholesterol, regulating its distribution to tissues via lipoproteins, and taking up cholesterol from intestinal lipoproteins (CMR), plasma lipoprotein remnants (VLDLR, IDL, LDL), and HDL.

Additionally, the liver is capable of eliminating cholesterol, either by converting it into bile acids or excreting it unchanged into the bile.


Conclusion

Complex metabolic pathways have evolved to maintain cholesterol homeostasis across the body.²

The principal pathways of biosynthesis, intestinal elimination and absorption, and hepatic regulation of lipoproteins act interdependently to maintain the body's cholesterol pool.

The intestine, the liver, and diet contribute to the cholesterol pool.

The intestine absorbs dietary and biliary cholesterol, but perhaps more significantly, it absorbs only about half of the cholesterol presented to it, and since some of this cholesterol was contributed from bile (recycled from the liver cholesterol pool), the intestine is a source of cholesterol loss from the body pool.

Additionally, bile acids, produced from cholesterol, also recycle between the liver and intestine, and some are eliminated by the intestine.

The liver maintains cholesterol homeostasis by synthesizing cholesterol, regulating its distribution to tissues via lipoproteins, and taking up cholesterol from intestinal lipoproteins, plasma lipoprotein remnants, and HDL.

Thus, both the liver and the intestine participate in complex, interdependent processes involved in cholesterol homeostasis.

Next Article: The Biology of Atherosclerosis: The Initiating Process »

References

1. O'Keefe JH Jr, Cordain L, Harris WH, Moe RM, Vogel R. Optimal low-density lipoprotein is 50 to 70 mg/dl: lower is better and physiologically normal. J Am Coll Cardiol. 2004;43(11):2142-2146.
2. Weber LW, Boll M, Stampfl A. Maintaining cholesterol homeostasis: sterol regulatory element-binding proteins. World J Gastroenterol. 2004;10(21):3081-3087.
3. Cohen DE, Armstrong EJ. Pharmacology of cholesterol and lipoprotein metabolism. In: Golan DE, Tashjian AH Jr, Armstrong EJ, Armstrong AW, eds. Principles of Pharmacology: The Pathophysiologic Basis of Drug Therapy. 2nd ed. Philadelphia, PA: Lippincott, Williams and Wilkins; 2007:417-438.
4. Lange Y, Ye J, Steck TL. How cholesterol homeostasis is regulated by plasma membrane cholesterol in excess of phospholipids. PNAS. 2004;101(32):11664-11667.
5. Turley SD, Dietschy JM. The intestinal absorption of biliary and dietary cholesterol as a drug target for lowering the plasma cholesterol level. Prev Cardiol. 2003;6(1):29-33,64.
6. Dietschy JM. Theoretical considerations of what regulates low-density-lipoprotein and high-density-lipoprotein cholesterol. Am J Clin Nutr. 1997;65(suppl 5):1581S-1589S.
7. Brown MS, Goldstein JL. A receptor-mediated pathway for cholesterol homeostasis. Science. 1986;232(4746):34-47.
8. Burnett JR, Huff MW. Cholesterol absorption inhibitors as a therapeutic option for hypercholesterolaemia. Expert Opin Investig Drugs. 2006;15(11):1337-1351.
9. Davis HR Jr, Zhu LJ, Hoos LM, et al. Niemann-Pick C1 Like 1 (NPC1L1) is the intestinal phytosterol and cholesterol transporter and a key modulator of whole-body cholesterol homeostasis. J Biol Chem. 2004;279(32):33586-33592.
10. Mamo JC, Wheeler JR. Chylomicrons or their remnants penetrate rabbit thoracic aorta as efficiently as do smaller macromolecules, including low-density lipoprotein, high-density lipoprotein, and albumin. Coron Artery Dis. 1994;5(8):695-705.
11. Pal S, Semorine K, Watts GF, Mamo J. Identification of lipoproteins of intestinal origin in human atherosclerotic plaque. Clin Chem Lab Med. 2003;41(6):792-795.
12. Shepherd J. The role of the exogenous pathway in hypercholesterolaemia. Eur Heart J Suppl. 2001;3(suppl E):E2-E5.
13. Scapa EF, Kanno K, Cohen DE. Lipoprotein metabolism. In: Rodés J, Benhamou J-P, Blei AT, et al, eds. The Textbook of Hepatology: From Basic Science to Clinical Practice. 3rd ed. Oxford, UK: Blackwell; 2007:133-141.
14. Goldstein JL, Brown MS. Molecular medicine. The cholesterol quartet. Science. 2001;292(5520):1310-1312.
15. Jansen H, Verhoeven AJM, Sijbrands EJG. Hepatic lipase: a pro- or anti-atherogenic protein? J Lipid Res. 2002;43(9):1352-1362.

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 !