Managing Satellite…

Ok, hari ni nak cerita sikit pasal farmasi satelit Hospital Sultanah Aminah JB (dah 3 minggu tertangguh menulis post ni)… 

Farmasi satelit???

Farmasi satelit adalah farmasi yang dilancarkan ke orbit untuk membekalkan ubat-ubat kepada angkasawan di angkasa lepas…

Angkasawan pun perlukan ubat juga... Hehe

Huh? Iye ke?

Tak lah, saje je nak test pengetahuan korang (untuk orang yang tak tahu lah), mostly pembaca blog saya kalau dikalangan student farmasi mesti dah tahu kan …

Farmasi Satelit adalah term yang digunakan untuk merujuk kepada farmasi yang jauh daripada farmasi induk… Biasanya bila hospital akan mewujudkan beberapa Farmasi satelit untuk menyediakan perkhidmatan kepada wad-wad yang jauh daripada Farmasi Induk…

Beban kerja di farmasi satelit juga berbeza diantara satu hospital kepada hospital lain… Bergantung kepada wad yang disservice oleh farmasi tu, jumlah pesakit yang terlibat, dan perkhidmatan yang ditawarkan oleh farmasi satelit itu…

Hospital lain kebanyakannya mungkin ada banyak Farmasi Satelit, tapi di HSA kami cuma ada satu saje, Farmasi Satelit A….

Dalam rotation selama 8 minggu di Farmasi In-patient,PRP HSA akan bertugas selama seminggu (atau mungkin lebih) di farmasi satelit ni…

Saya rasa Farmasi Satelit A di HSA boleh masuk dalam kategori farmasi satelit yang sibuk, beban kerja pun lebih sikit daripada farmasi induk… 

Mostly kerana staf di sini kurang berbanding di farmasi induk… Cuma ada 2 FRP, 3 PPF dan 1PRP (atau 2, bergantung kepada jadual rotation)… Tu belum consider kalau ada staf yang bercuti, lagi busy…

In addition to that, farmasi satelit HSA juga bertanggung jawab utk supply ubat kepada medical ward di HSA… medical ward kan lebih sibuk dan dynamic berbanding surgical ward dan ICU etc (maknanya patient biasanya terima lebih banyak ubat dan patient tak stay lama dalam ward, mungkin akan di discharge selepas sehari dua sebab tak kronik)…

Farmasi Satelit HSA juga banyak menguruskan discharge dispensing dan counselling.. Mungkin kerana agak jauh untuk patient yang discharge untuk mengambil ubat mereka ke Farmasi A+E di bangunan induk…

Discharge counseling... Take your time when counseling elderly patients...

Di Farmasi Induk, kami banyak melakukan berside counselling tapi sedikit je discharge counselling kerana patient prefer ambil sendiri ubat discharge di kaunter Farmasi A+E…

Farmasi Satelit A takde langsung buat bedside counselling sebab kerja yang sedia ada pun dah berlambak kan, so untuk bedside counselling kami akan relay permintaan untuk bedside kaunseling kepada PRP yang jaga wad…

Oh ya, Farmasi Satelit HSA juga takde perkhidmatan dispense DD dan Psikotropik drug… Semua ward kena indent DD daripada Farmasi Induk…

Apart from that, sistem kerja di Farmasi Satelit basically sama je dengan Farmasi Induk… Screening, CDS, filling dan counterchecking semua sama je caranya…

Ok tu je cerita pasal topik yang tak menarik sangat ni… Kawan-kawan di Hospital lain mungkin berbeza sikit perkhidmatan Farmasi Satelit korang kan…

Next post akan bercerita tentang Oncology pharmacist pulak…

Mengantuk selepas makan???

Do you feel sleepy after eating a large/heavy meal? Chances are, you will and I am writing this post to inform you that it is normal to feel so...

I stumbled into this while reading on somnolence... They even have a medical term for this situation, which is Post-prandial somnolence...

Post-prandial somnolence is a state of drowsiness or lassitude following a meal. 

Post-prandial somnolence has 2 components:

- a general state of low energy related to activation of the parasympathetic nervous system in response to nutrients in the gastrointestinal tract, 

- a specific state of sleepiness caused by hormonal and neurochemical changes related to the rate at which glucose enters the bloodstream and its downstream effects on amino acid transport in the central nervous system.

Parasympathetic activation

In response to the arrival of food in the stomach and small intestine, the activity of the parasympathetic nervous system increases and the activity of the sympathetic nervous system decreases.

This shift in the balance of autonomic tone towards the parasympathetic system results in a subjective state of low energy and a desire to be at rest, the opposite of the fight-or-flight state induced by high sympathetic tone. 

The larger the meal, the greater the shift in autonomic tone towards the parasympathetic system, regardless of the composition of the meal.
  

Insulin, large neutral amino acids, and tryptophan  

When foods with a high glycemic index are consumed, glucose is absorbed rapidly from the gastrointestinal tract into the bloodstream, and in individuals with normal carbohydrate metabolism, insulin levels rise concordantly to drive glucose in to the body's tissues and maintain blood glucose levels in the normal range. 

Insulin stimulates the uptake of valine, leucine, isoleucine, and tyrosine into skeletal muscle, but not uptake of tryptophan. 

This lowers the ratio of these large neutral amino acids in the bloodstream relative to tryptophan, making tryptophan preferentially available to the large neutral amino acid transport at the blood-brain barrier. 

Uptake of tryptophan by the brain thus increases. In the brain, tryptophan is converted to serotonin, which is then converted to melatonin. 

Increased brain serotonin and melatonin levels result in sleepiness that has been objectively measured.

Conclusion: 

Feeling sleepy after eating is normal, it does not mean you are an extremely lazy person... However, certain strategies can be used to prevent this sleepiness...

First, don't eat too much (large meal)... Eat small and frequent meals...

Second, avoid high glycemic index food (such as white rice)... 

Third, don't do sleep-inducing activities (such as studying) directly after meal... Do something enjoyable and stimulating such as facebooking, chatting with your friends (online or offline), or solat sunat... Anything to keep you awake until it is not that sleepy anymore (maybe until 30 mins after meal)...

If you have time constrain and do not wish to fall asleep on a certain day, try these strategies... InsyaAllah boleh kut tahan mengantuk tu... hehe

Harry Potter and the Deathly Hallows (Part One)

I went to watch the latest Harry Potter movie today.. 

My comment? 

The movie was good, and for me much better compared to the previous ones...  It was long (2 hours plus) and the scenes were not rushed. (which is good for people like me who have not read the novel).. The storyline was superb... The action scenes were also not bad... 

That's all for my comment on the movie... Let's focus on other  perspectives...

The Harry Potter character and his 2 best friends have grown up so much since their first day at Hogwarths... Gone were the days when they were having fun learning magic in the compound of their school... 

Now it is time to practice those magic for their survival as they are being hunted by the bad guys... If they fail to practice what have been learned before, they'll die...

This kinda make me think about ourselves... 

It is just months away before we leave the comfort of IIUM to start working in hospitals, and yet I am still not confident enough that I can carry all that we have been taught during these few years and apply the right thing at the right time... (Note that I am using I just in case some of us feels that he/she is already prepared...)

If Harry Potter fails to remember the correct spell to do something at a critical time, he/ his friends might be killed, but if we fail to remember something important at a critical time, whose life are we endangering? How many will die (or badly injured) if we are incompetent in our work???

That is a hypothetical question, who knows what will happen in the future... So what I am trying to say is that we should buck up and be ready (as ready as can be)... Like it or not, we will be responsible for other people in the future... 

Maybe those who watch the movie after this can ponder something on this as well... Hehe

Ps: I come to think of this mainly because of the many spells used by the characters in this movie... The right spell need to be used in a specific situation... Kinda like our knowledge right?

Tak nak makan nasi la, nak diet...

gambar nasi yang cam best... huhu

When common people talked about dieting (the lay-man's term for weight management), one of the most common advise that they will give you is to avoid rice and substitute rice with other carbohydrate such as noodles or bread...  

Although many have given testimonials that this practice works, the question remains, is there any scientific evidence to back up this claim? 

During our clinical nutrition attachment to KK Beserah, this topic was raised and the answer provided by the dietitian was that there is no point in replacing rice with bread if you end up eating more bread to satisfy your hunger... 

There is some merit to this answer, this dietitian emphasize more on the portion of the food compared to the type of carbohydrates... This is because it is a well known fact that, there are many of us whose hunger cannot be satisfied with certain carbohydrates... For example, you might often hear something like "Eh, roti je ke, mana kenyang...". 

But still she did not answer the question...

I have read another article in newspaper which divides rice into white rice and brown rice... The article continue to bash white rice as the source of all evil (obesity etc) while promoting brown rice as the better alternative... In the end, it concludes that eating rice is the healthier option due to proteins present in rice etc but suggested people to take brown rice instead of white rice... From my opinion, this article do not give any credit to other carbohydrates, it only present one-sided arguments on rice only...

Then, there is a pamphlet on Glucerna SR formula which I read while doing community pharmacy attachment last semester... It compares different carbohydrates based on their glycemic index... Let me quote some info on glycemic index before I go on any further...     

     The glycemic index (GI) is a ranking of carbohydrates on a scale from 0 to 100 according to the extent to which they raise blood sugar levels after eating. 

     Foods with a high GI are those which are rapidly digested and absorbed and result in marked fluctuations in blood sugar levels. Low-GI foods, by virtue of their slow digestion and absorption, produce gradual rises in blood sugar and insulin levels, and have proven benefits for health. 

     Low GI diets have been shown to improve both glucose and lipid levels in people with diabetes (type 1 and type 2). They have benefits for weight control because they help control appetite and delay hunger. Low GI diets also reduce insulin levels and insulin resistance.

Now, back to the argument rice versus other carbohydrates...  The pamphlet showed that rice have a high glycemic index value compared to noodles, brown rice and some other carbohydrates... Thus, eating rice would cause the blood glucose to spike, make you feel hungry earlier and all the other disadvantages of eating high glycemic index food... 

People who want to lose weight should avoid high glycemic food and substitute them with lower glycemic index food...

Neway, I don't have that pamphlet with me anymore, that is why I stop short of providing any values of glycemic index in the paragraph above... Maybe I'll stop by at the pharmacy to take another pamphlet (someday in the distant future)...

There are a lot more reference on glycemic index of food in the internet but most of them usually contain western food (pasta) instead of Malaysian food (such as noodles etc), thus making comparison can be a bit difficult... 

Furthermore, glycemic index apply to all carbohydrates,  even food with simple sugar like glucose, thus it kinda make the list of glycemic index values into a very long list containing every fruits and products like honey, which actually defeats the purpose of having that index because the long complicated list makes it harder for common people to assess their food themselves...

Conclusion:
Yes, substituting white rice for other low glycemic index food such as brown rice, noodles and whole wheat bread is good for health, especially for those who are trying to lose weight... However, in addition to choosing the better source of carbohydrate, the meal portion should also be followed....  

-end of post-

Ps: I still eat rice.. and also other carbohydrates... Hehe

The good things in life are.... expensive

Korang mesti biasa dengar ayat "the good things in life are free" kan? Sebenarnye saya x bersetuju dengan pernyataan ni, lebih-lebih lagi kalau kita tengok daripada sudut kesihatan... (Tajuk ni juga boleh di generalized kepada topik lain, tapi post ni fokus kepada kesihatan)

Contoh: 

Kalau kita order nescafe O ais kurang manis di kedai-kedai makan, ada beza tak harga dengan nescafe O ais biasa? Takde kan, sama je harga, walaupun kita cuma dapat gula separuh daripada biasa (estimation je)... 

Kalau kita order Nasi putih daging merah, harga pun biasanya sama dengan Nasi goreng daging merah, walaupun nasi tu tak digoreng... Tak adil kan, kita kena bayar harga yang sama untuk produk yang kurang isinya...

Kalau orang yang berkira mesti dia nak pilih nescafe O ais yang manis tu dan makan pulak Nasi goreng daging merah tu... Lagi berbaloi kata diaorang (tanpa mengira kos kalau menghidap penyakit seperti diabetes)...

Contoh-contoh lain:

Roti wholegrain lagi mahal daripada roti biasa... Sayur-sayuran organik berganda-ganda lebih mahal dari sayur biasa... Cereal yang ada buah-buahan kering lagi mahal daripada cereal biasa... Kenny Roger's Roasters mahal berbanding KFC... etc... banyak sangat contoh, cukup dah contoh-contoh ni rasanya untuk bagi korang faham kan...

Semua produk yang baik untuk kesihatan semuanya mahal (refer balik kepada tajuk kat atas)... 

Dari sudut kerajaan, khususnya Kementerian Kesihatan Malaysia, dalam usaha mereka untuk mempromosikan gaya hidup yang lebih sihat (termasuk mengurangkan pengambilan makanan yang kurang lemak, gula, garam), pihak berkuasa sepatutnya menjadikan barangan yang lebih sihat ni harganya lebih berpatutan berbanding barangan yang kurang sihat...

Kalau air kotak soya kurang manis harganya murah sedikit (eg 20 sen murah) daripada air kotak soya yang biasa, mesti lebih ramai pengguna nak beli yang kurang manis tu kan? Dah le baik untuk kesihatan, jimat pulak tu... 

Ini tak, harga barangan yang lagi sihat biasanya sama atau lagi mahal daripada produk yang kurang sihat... Tapi pengguna-pengguna yang sayangkan badan dan keluarga masing-masing masih juga membeli barangan yang mahal nih, walaupun tanpa insentif dari segi kewangan...

Mungkin syor ini sukar diaplikasikan kepada harga kat kedai makan ataupun restoran, tapi, at least, pihak berkuasa harap boleh mempengaruhi pengilang-pengilang untuk menurunkan harga barangan-barangan sihat nih... Bila harga lebih murah, lebih ramai pengguna akan memilih opsyen sihat ini dan dari segi kolektif, masyarakat Malaysia akan lebih sihat...

Apa-apa pun, saya tak rasa harga produk-produk yang lebih sihat ni jadi lebih rendah dalam masa terdekat... Harga barang masih akan kekal tinggi untuk mengambil kesempatan ke atas pengguna yang sanggup berbelanja lebih untuk kesihatan... 

Dari sudut pengguna, berbaloi tak kita berbelanja lebih? Kalau jawapan saya memang berbaloi... Sebab kesihatan memang tak ternilai...

If you found the perfect one...

... never let go.

A customer at a pharmacy once asked me to recommend products to help her acne problems. So, I recommend her 2 products, a topical cream and a soap. She went back to her home, to try those 2 items, and I didn’t meet her for a long long time....

Months later, the same customer came back. She still has the same acne problem and asked me to recommend her products for her problems.

I asked her, did the product helped her previous problem at all? She said that the product helped her a lot. Her pimples reduces in number, and the remaining become dry, hardly visible to the naked eye...

Then, after months of using the product, with hopes that the remaining small dry dots on her face would go away, it didn’t... Her face was smooth, but she wanted more...

She stopped using the products i recommended to her and started to use other skincare products, she tried many other products to eliminate the scar (remains of the pimples) etc.. she failed.

Not only that she failed to reduce the scar, the old acne problem came back. She started having fresh acne on her face... Lots of them...

Ok, the story ends here... Lets discuss the moral of the story...

The moral of the story is... when you found your perfect match, be grateful... That something (or someone) may not be perfect, they might not rise up to your ever increasing expectations but they are compatible with you. You’ll never know if there are other comparable things (or person) out there for you...

To choose a perfect skincare product is sort of like choosing people you wanted in life (eg: friends, spouse, assistants, business partner etc), there are thousands of skincare products available in the market, but not all are suitable for you... In fact, most of them are not suitable for you... They might give you rashes, or pimples or oily skin...

But when you have found the product that is compatible for your skin, don’t give up on it easily... They might not be up to yor expectation, but they prevent pimples, and isn’t that worth something...

I am not saying that there is just one product for everyone in the world, there might be many, but the moment you gave up on the product that suits you, you might end up searching for many years to find another product that suits you (if there is any)...

So be grateful that you have something that suits you... and never let go...

“An original pharmacy-related story by ezud zaliy”... True story ok (mostly), komen je tambah sendiri... Huhu

Diserang orang gila...

Xde kena serang secara fizikal pun, cuma kena terjah (macam dalam tv3 tuh)...

Kejadian ni berlaku semalam je actually... Selesai je makan dan selesai bayar makanan di sebuah kedai makan, bila dah nak naik motor dah, datang sorang pekerja kedai tu panggil saya macam suruh tunggu jap... Kalau daripada gayanya, macam nak cakap kita x bayar lagi untuk makanan je...

Bila dah betul-betul dekat, dia pun start marah-marah... Antara dialog yang saya ingat, "Abang jangan ingat saya x tahu abang cakap saya gila dari sana tadi kan....", bla bla bla... panjang betul mamat ni marah ada r dalam 5 minit kut... ntah apa ntah, pasal dia marah orang ingat dia gila etc (dah lupa r coz panjang sangat)... dalam keadaan emotionally unstable plak tuh, macam bergetar-getar, nampak memang nak mengamuk r...

Untuk mengelak dari sebarang kejadian buruk (seperti kena serang secara fizikal) berlaku, saya pun diam dan dengar je apa yang dia marah-marah tu, xde rasa nak menjawab balik pun... Seram je rasa time tuh...

Actually, sedang blank time tuh sambil berfikir... Sape plak pekerja nih??? Kitorang (saya dan kamil) perasan dia pun tak, inikan pulak nak gi kutuk-kutuk dia... bajet orang xde keje apa... Macam mana plak dia boleh tahu orang kutuk dia gila kalau kita x pernah cakap apa-apa pasal dia pun kan... Adakah ini auditory halucination? Mungkin dia benar-benar "ada masalah"...

Neway, malas nak marah kalau dalam situasi macam nih... Kalau bertengkar dgn orang yang kurang stabil, kita kenalah jangan emotional...

Kalau dari segi professional, mungkin kita boleh rujuk mamat ni untuk mendapatkan khidmat professional, tapi x berani suggest kat dia, takut dia mengamuk terus... huhu...

Memandangkan mamat ni cuma menunjukkan beberapa symptom psikosis, x baik r nak terus cop dia sbg gila kan (tajuk tuh untuk menarik perhatian je)... Mungkin dia betul-betul gila atau mungkin dia ada masalah anger management or maybe mamat ni jenis yang perasan giler yang bajet orang suma cakap pasal dia je... Semua masalah ni pun boleh dapat terapi yang sesuai, mungkin boleh gi jumpa kaunselor UIA kuantan... Huhu

I like to think that he is just perasan giler and not crazy... Yelah, cuak kan kalau ada orang yang "bermasalah" di sekitar kita... But I would definitely avoid going to the restaurant for a few months (or forever)... Memang seram dan suspens...

Rawatan percuma di Hospital Swasta

The ministry of health has recently unveiled a new proposal to upgrade our existing healthcare system in Malaysia... This is just in the discussion stages, it was said that it would take 10 years or more to finally implement the proposals ideally, but the suggestions are really interesting... Here are the summary of the news report from NST...

• 
  
  To ensure all Malaysians get adequate healthcare, wage earners will have to make scheduled monthly contributions to the proposed National Health Financing Scheme. The self-employed, those who have an independent income as well as employers would also have to contribute.
• 
  
  The rate of contributions is expected to be based on wage scales, in which the rich will pay more. The poor will not have to contribute to the scheme but will still be covered.
• 
  
  The government proposes to set up a health financing scheme that will give all Malaysians access to primary healthcare at any public or private clinic for free.The scheme will also look at secondary healthcare coverage and the illnesses and treatments it might be able to cover.
• 
  
  Only workers aged 18 and above with an income that has reached a certain threshold, need to contribute.
• 
  
  Children will be financed by their parents.
• 
  
  The poor and disabled who have no income or whose income does not reach the threshold need not contribute.
• 
  
  For those well-to-do people who wish to stay in a suite rather than a standard room, they will have to pay the difference. The rich will still get to enjoy whatever luxury they want as long as they pay for it. Otherwise, they will get a standard room like everyone else.
• 
  
  To ensure that no one abused the free healthcare provided, patients would have to pay part of the cost (a co-payment) of the drugs and medication prescribed to them. For the poor and less fortunate, the government will take up the copayment.
• 
  
  Strengthening the healthcare system like governance and standards of care
• 
  
  To grant more autonomy to primary healthcare providers in areas like human resource and management
• 
  
  To integrate all public and private clinics so that they are all linked under a common network so that people can access either one
• 
  
  Introduction of the national health insurance under the national health financing scheme.

The minister of health said it was time the government seriously look into this scheme, which was proposed during the Fourth Malaysia Plan (1981-1985) because although Malaysia has an enviable healthcare system among developing countries, it faces several challenges that affect its sustainability.

The benefit of the the scheme are controlled escalating healthcare costs, lets consumers choose to go public or private, offers better quality care, is more effective and efficient, and more viable and sustainable.

Read more: 


Healthcare for free

Kopi buah-buahan

It has been awhile back when i accidentally came across an advertisement for a pre-packed coffee which stated that it's pre-packed coffee product is suitable for diabetes patients because it uses "gula buah"... 

I am still not convinced that it can be consumed by diabetic patients... Thus starting my journey to read more on "gula buah"... When i googled it, I found that fructose is the most common type of sugar present in most fruits... Assuming that the company is referring to fructose, this is what i summarized from wikipedia:

  

Fructose is often recommended for diabetics because it does not trigger the production of insulin by pancreatic ß cells, probably because ß cells have low levels of GLUT-5 (Fructose-only Transporter). 

Fructose has a very low glycemic index of 19 ± 2, compared with 100 for glucose and 68 ± 5 for sucrose. Fructose is also seventy-three percent sweeter than sucrose at room temperature, so diabetics can use less of it. 

Studies show that fructose consumed before a meal may even lessen the glycemic response of the meal. Its sweetness changes at higher temperatures, so its effects in recipes are not equivalent to those of sucrose (i.e., table sugar)

However, all fruits have different contents of fructose, glucose and sucrose, some have more glucose, and some have more fructose... Here are the examples i found comparing sugar content in different fruits:

Sugar content of some common fruits (g/100g)

Fruits	Total Carbohydrates	Total Sugars	Free Fructose	Free Glucose	Sucrose
Apple	13.8	10.4	5.9	2.4	2.1
Apricot	11.1	9.2	0.9	2.4	5.9
Banana	22.8	12.2	4.9	5.0	2.4
Grapes	18.1	15.5	8.1	7.2	0.2
Peach	9.5	8.4	1.5	2.0	4.8
Pineapple	13.1	9.9	2.1	1.7	6.0
Pear	15.5	9.8	6.2	2.8	0.8

The downside is that fructose can only be metabolized in liver (compared to glucose which can be metabolized by almost all types of cells) thus causing liver stress when taken in excess... Other side effects of excess consumption of fructose are diarrhoea, metabolic syndromes, gout etc (read on your own)...

In conclusion, I have found out that fructose is suitable for diabetic patients compared to glucose, however, there are side effects when taken in excess... Therefore, the best solution is not to have diabetes... :)  

ps:This article is written in the assumption that the product I stated earlier contains fructose only... If the product contains glucose and sucrose as well, it should be avoided by diabetes patients...