Apr 18

Don’t just simply order x-rays unless indicated!!

By taqidoc Radiology 2 Comments »

Risk from radiation is a slope, there is no one “cut-off” point below which it is “perfectly safe” – even small radiation doses may have some risk. Therefore, statutory regulations require the dose to be “as low as reasonably achievable”.
Having said that, there is no absolute “legal” limit to the dose a patient can receive – go ahead and order the scan if you think the investigation is medically indicated, and the benefits outweigh the risk.
What then, is the risk, and how do you explain it to patients in layman terms?
Apr 16

Compulsory service for docs cut to two years with immediate effect.

By taqidoc Work 1 Comment »
By NG CHENG YEE

KUALA KUBU BARU: The compulsory service period for medical practitioners has been reduced from three years to two years with immediate effect, said Health Minister Datuk Seri Liow Tiong Lai.

He said this was in accordance with the longer internship training from one year to two years.

“The move to shorten the compulsory service would encourage doctors to remain in the country,” he said, adding that it would indirectly discourage a brain drain.

Liow also announced that Malay­sian doctors working overseas and who had pursued their studies abroad at their own expense were exempted from compulsory service.

“However, they must have documented clinical experience of more than 10 years,” he said at the launch of a healthy lifestyle campaign here yesterday.

Previously, Liow had announced that doctors above 45 years would get total exemption.

For those below 45 years, exemption will be given if they possess a rare sub-specialty as determined by a committee on exemption of compulsory service or if they had served in public or private universities or military hospitals for a continuous period of two years.

Liow also announced that an additional building would be built at the Kuala Kubu Baru Hospital dialysis unit.

“We will also add four more dialysis machines for kidney patients here,” he said.

He said there were currently four dialysis machines servicing 18 patients while 17 others were still on the waiting list.

On Influenza A(H1N1), Liow said 11 cluster cases had been confirmed and noted that the disease is still active in Malaysia.

On dengue fever, Liow said Selangor had recorded the highest number of such cases for 2008 and last year.

“In Hulu Selangor, there were 1,069 cases in 2008, 642 last year and 68 cases until April this year,” he said.

Original source : TheStar

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Apr 13

On call allowances.

By taqidoc Work Comments Off

This form is on call allowance claim form..The rate for specialist,medical officer or house officer for active or passive calls are as follow.

LAMPIRAN A

BORANG EKLWBB

TUNTUTAN BAYARAN ELAUN

Tugas Atas Panggilan Aktif
Pegawai Perubatan, Pegawai Pergigian, PegawaiPerubatan Pakar dan Pegawai Pergigian Pakar yang menjalankan tugas di luar waktu bekerja biasa melebihi 16 jam sehari secara berterusan
…………..

a] Hari bekerja penuh & hari bekerja separuh

 RM150.00 = …………..
………….

b] Hari cuti mingguan & hari cuti am

 RM170.00 = ……………
Tugas Atas Panggilan Pasif
a] Pegawai Perubatan, Pegawai Pergigian,  Pegawai Perubatan Pakar dan Pegawai Pergigian Pakar yang diarah bersedia di rumah dan dipanggil bertugas selama lebih 4 jam pada:
……. - Hari bekerja penuh dan hari bekerja separuh RM90.00 =
…..… - Hari cuti mingguan dan hari cuti umum RM100.00 =
b] Pegawai Perubatan, Pegawai Pergigian,  Pegawai Perubatan Pakar dan Pegawai Pergigian Pakar yang diarah bersedia di rumah dan dipanggil bertugas selama kurang 4 jam atau tidak dipanggil bertugas pada:
…..… - Hari bekerja penuh dan hari bekerja separuh RM50.00 = ………
…..…. - Hari cuti mingguan dan hari cuti umum RM55.00 = ………
Pegawai Latihan Siswazah yang menjalankan tugas di luar waktu bekerja biasa melebihi 16 jam secara berterusan pada:
…….…. a] Hari bekerja penuh dan hari bekerja separuh RM100.00 = ……………
…………. b] Hari cuti mingguan dan hari cuti umum RM110.00 = ……………

Dikemukakan juga dokumen untuk menyokong tuntutan EKLWBB:
i] Jadual Tugas Kerja Di Luar Waktu Bekerja Biasa
ii] Salinan Kad Perakam Waktu / Buku Daftar Kedatangan
Dengan ini saya mengesahkan bahawa Tuntutan Elaun Kerja Di Luar Waktu Bekerja Biasa seperti maklumat yang disediakan adalah betul dan telah dilaksanakan oleh saya.


Tarikh: [Tandatangan Pegawai]

Dengan ini saya mengesahkan bahawa pegawai ini dikehendaki menjalankan tugas lebih masa dan telah menjalankan tugas di luar waktu bekerja biasa seperti tuntutan tersebut. Tuntutan dan dokumen yang disertakan adalah betul.
……..……………………………

Tandatangan Ketua Jabatan

If you read this posting you would also like to read this one: Doctors’ salaries.

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Apr 12

Govt drops compulsory service for docs abroad for more than 10 years.

By taqidoc Work Comments Off 
BY YENG AI CHUN

KUALA LUMPUR: The Government is seeking to woo Malaysian doctors who have been working overseas for more than 10 years to return to country by abolishing the three-year compulsory Government service.

However, Health Minister Datuk Seri Liow Tiong Lai said the new ruling would only be applicable to those who had self-funded their medical studies.

“The Cabinet decided that all Malaysian doctors working overseas for more than 10 years and who self-funded their studies are welcome to return and practice without the compulsory service in Government hospitals.

“This is, however, not for Government sponsored doctors,” he said in a press conference after launching the Healthcare Tourism Congress 2010 at the KLCC Convention centre Monday.

Currently, doctors who return from overseas are required to serve a three-year compulsory Government service.

Only specialists working overseas who are aged 45 years old and above are allowed to return and not serve the Government.

“We will start it this year. We will announce the details later as the Cabinet only made the decision last week,” he said.

Liow explained that the Government targeted doctors who have more than 10 years working experience as they would have a wide expertise and could contribute to the country’s medical sector.

When asked if the Government was forced to take this step because doctors working overseas refused to return because of the three-year compulsory Government service, he replied that the number of doctors trained locally had increased and this had paved the way for the decision.

“One of the factors we have identified is that we are capable of training more doctors in the country. Back in 2001, we could only train about 700 doctors a year, but now, we can train about 3,300 doctors in a year.

“The training has increased and we now have enough doctors to allow self-funded medical students who are working overseas to come back and not serve the compulsory service,” he said.

He said the move was also aimed at attracting more Malaysian specialists working overseas to serve the country.

Liow said that the increasing growth in medical tourism, the high fees foreign patients pay, increased facilities in the private sector and improved medical technology, doctors would be attracted back.

This in return, Liow said would help push the medical industry to greater heights.

“There are a lot of opportunities for Malaysian doctors returning from overseas. A lot of private hospitals are interested in employing them and the Government is willing to accept them if they want to serve us.

“For specialists returning to serve the Government, there are multi-point entries. They should not come in with a rigid pay in mind. We will pay them according to their experience and expertise,” he said.

Original source : The Star

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Apr 11

Your characteristics based on blood group.

By taqidoc behaviour 1 Comment »

Yesterday, I was talking about people’s behaviour and characteristics with a friend. Suddenly, the idea of blood group and people’s characteristics came across my mind. I was thinking how people’s characteristics were related to the blood group…I seached the web and found the table below…

Click on the image above to zoom it in.

Is it really related? I don’t know…It’s up to you to decide.

Have fun analysing your friend..hehe

Apr 09

Using the internet to make self-diagnoses.

By taqidoc Health Comments Off

The internet has become the main self-empowering tool for people nowadays. It enable patients to surf for the information they needed using their browser.

Not to mention, it also helps doctors in diagnosing difficult cases.

There have been a few cases of patients or their relatives successfully using the internet to make rare diagnosis.

Actually it is not as easy as it sounds as symptoms are often common to many illnesses and symptoms by themselves are not the only clue to illnesses.

For example, epigastric pain could symptom of gastritis or maybe symptom of acute pancreatitis and etc.

People tend to forget, in diagnosing a disease, does not mean all depends on just symptoms. There are also clues in other aspect of the history and physical examination which patients often do not appreciate on their own.

That’s why it is uncommon to see patients jumping to conclusions these days after researching their symptom on the net.

A medically trained person would be more accustomed to using these tools which may be helpful in listing differential diagnoses. One should appreciate that diagnoses are not only derived from symptoms but also various aspects of history taking, physical examination and appropriate tests where necessary. At this point in time, the Internet is not going to replace the basic diagnostic work-up.

Patients can and should use the internet to search for information but they should be best guided by their doctor.

Information from the Internet is however useful for patients to help them understand their illnesses. The 15 or even 30 minute consultation with their doctor is often insufficient. How much information can the doctor give in such a limited time? If on the other hand, patients take the trouble to read about their illnesses, the greater understanding will benefit them and help in the management.

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Apr 06

Finally my GATCO sharpening system arrived..

By taqidoc Leisure, Travel 1 Comment »

Bought this GATCO sharpening system from ebay with the price of approximately RM245 which is equal to ~USD40 + delivery USD 40 last March 24. As usual it takes 10 days to reach me.

What is so special about this thing?

Well….

To maintain angle with certain degree while sharpening your knife with sharpening stone seems like impossible….but with this system it can…I never thought I would only take 2 minutes to sharpen my leatherman and spyderco knives …It’s not 2 minutes both…It’s 2 minutes each knive..

I give 5/5 for this sharpening system…

What is this system all about?

GATCO® Edgemate™
Professional Knife Sharpening System

This is the professional knife sharpening system that will sharpen all kitchen, sport, and utility cutlery including knives and cutting tools with serrated blades. Never before has a sharpening system done so much! This specialty product utilizes the GATCO ® exclusive knife clamp/angle guide to insure that all cutting tools can be easily sharpened to a precise razor-like edge.

THIS SYSTEM CONTAINS:

1.Extra-Coarse, Coarse, Medium & Fine sharpening hone

2.Serrated knife sharpening hone

3.Scientifically formulated honing oil

4.Custom carrying case with instructions permanently
affixed to lid

5.GATCO® exclusive knife clamp/angle guide

What can it do?

Sharpens all sizes and types of kitchen, sport, and utility cutlery

SPORT & UTILITY CUTLERY
• Serrated pocket knives
• Plain edge pocket knives
• Serrated sport knives
• Hunting knives
• Skinning Knives
• Tactical Knives
• Survival knives
• Razor knives
• Fillet knives
• Gut hook knives
• Hook bill carpet knives
• Swiss Army knives
• Multi-tool knives

KITCHEN CUTLERY
• Chef’s knives
• Paring knives
• Butchers’ steaking knives
• Serrated bread knives
• Boning knives
• Meat slicing knives
• Serrated utility knives

To know more about this product, you can visit GATCO.

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Apr 04

What exercise is safe during pregnancy?

By taqidoc Gynae and Obstetric Comments Off

According to American Congress of Obstetricians and Gynaecologists pregnant women are recommended to do at least 30 minutes of moderate exercise most days of the week.

Advantages of exercises :

1. prevents excess weight gain.

2. helps or prevents gestational diabetes.

3. being more fit makes labor and recovery a bit easier.

4. helps with the aches and pains of pregnancy and insomnia.

5. helps reduce constipation,bloating and swelling.

6.Increases your energy.

7.Improves your mood.

8.Improves your posture.

9.Helps you sleep better.

It is essential that you check with your doctor before starting an exercise program to make sure that the exercise won’t give a negative impact to your pregnancy.

Should you have been exercising regularly, it is fine to continue it except for contact and extreme sports.

In the 1st trimester you can do whatever exercise you can. In the 3rd trimester, you should focus on non weight-bearing execise like swimming.If you want to know the best exercise that suits you, you can visit ACOG.

Many women find that prenatal yoga and pilates are beneficial during pregnancy. It can ease the labour.

Stop exercising and call your doctor if you get any of these symptoms:

·         Vaginal bleeding

·         Dizziness or feeling faint

·         Increased shortness of breath

·         Chest pain

·         Headache

·         Muscle weakness

·         Calf pain or swelling

·         Uterine contractions

·         Decreased fetal movement

·         Fluid leaking from the vagina

Drink plenty of water and do not overeat. Excessive weight gain can cause labor and health problems to you and your baby.

You can read the original article at CNN health.

Additional reading : American Congress of Obstetricians and Gynaecologists

Mar 29

UD41,UD44,UD48,UD52,UD54 and JUSAs salaries: Just for doctors…

By taqidoc Work 3 Comments »

PENGIRAAN EMOLUMEN DAN ELAUN PEGAWAI PERUBATAN/PAKAR

Emolumen Gred
UD41 UD43/44 UD47/48 UD51/52 UD53/54
Base salary (MINIMUM) RM2,458.39 RM3,028.90 RM4,431.54 RM4,992.31 RM5,258.09
Public service allowance RM 300.00 - - - -
Entertainment allowance - RM 400.00 RM 550.00 RM 600.00 RM 800.00
COLA RM50-150 RM100-300
Housing allowance RM 210.00 RM 400.00 RM 700.00 RM 700.00 RM 900.00
Critical allowance RM 750.00
Specialist allowance - RM1,900.00 RM2,200.00 RM2,300.00 RM2,900.00
TOTAL W/O SPECIALIST ALLOWANCE - RM4,678.90 RM6,531.54 RM7,142.31 RM7,808.09
TOTAL RM3,768.39

(MINIMUM)

 RM6,578.90 RM8,731.54 RM9,442.31 RM10,708.09

PENGIRAAN EMOLUMEN DAN ELAUN PEGAWAI PERUBATAN

(KELULUSAN SARJANA / DIPLOMA KESIHATAN AWAM)

Emolumen Gred
UD41 UD43/44 UD47/48 UD51/52 UD53/54
Base salary (MINIMUM) RM2,458.39 RM3,028.90 RM4,431.54 RM4,992.31 RM5,258.09
Public service allowance RM 300.00 RM 400.00 RM 550.00 RM 600.00 RM 800.00
COLA RM50-150 RM100-300
Housing allowance RM 210.00 RM 400.00 RM 700.00 RM 700.00 RM 900.00
Critical allowance RM 750.00
Public Health allowance RM1,040.00 RM1,120.00 RM1,360.00 RM1,440.00 RM1,760.00
TOTAL RM4,808.39

(MINIMUM)

 RM5,798.90 RM7,891.54 RM8,582.31 RM9,568.09

PENGIRAAN EMOLUMEN DAN ELAUN PEGAWAI PERUBATAN

(KELULUSAN SARJANA/DIPLOMA PENTADBIRAN HOSPITAL)

Emolumen Gred
UD41 UD43/44 UD47/48 UD51/52 UD53/54
Base salary (MINIMUM) RM2,458.39 RM3,028.90 RM4,431.54 RM4,992.31 RM5,258.09
Public service allowance RM 300.00 RM 400.00 RM 550.00 RM 600.00 RM 800.00
COLA RM50-150 RM100-300
Housing allowance RM 210.00 RM 400.00 RM 700.00 RM 700.00 RM 900.00
Critical allowance RM 750.00
Public Health allowance RM 910.00 RM 980.00 RM1,190.00 RM1,260.00 RM1,540.00
TOTAL RM4,678.39

(MINIMUM)

 RM5,758.90 RM7,721.54 RM8,402.31 RM9,348.09

EMOLUMEN DAN ELAUN PAKAR PERUBATAN

GRED KHAS C, B & A

Emolumen Gred
C B A
Base Salary RM6,595.99 RM7,064.26 RM7,766.66
Entertainment allowance RM2,150.00 RM2,650.00 RM3,300.00
Housing allowance RM1,300.00 RM1,600.00 RM2,000.00
Specialist allowance RM2,900.00
Special Incentive allowance RM400.00 RM600.00 RM1,000.00
Maid Allowance RM500.00
Fixed Allowance for Special grade and JUSA post RM810.00 RM1,200.00 RM2,000.00
House repair allowance

( yearly payment )

 RM166.67
TOTAL RM15,822.66 RM16,680.93 RM19,633.33

PENGIRAAN EMOLUMEN DAN ELAUN PEGAWAI PERUBATAN

GRED ( KHAS ) JUSA C, B & A.

Emolumen Gred
C B A
Base Salary RM6,595.99 RM7,064.26 RM7,766.66
Entertainment allowance RM2,500.00 RM3,050.00 RM4,000.00
Housing allowance RM1,300.00 RM1,600.00 RM2,000.00
Special Incentive allowance RM500.00 RM750.00 RM1,250.00
Maid Allowance RM500.00
Fixed Allowance for Special grade and JUSA post RM1,000.00 RM1,500.00 RM2,500.00
House repair allowance

( yearly payment )

 RM166.67
TOTAL RM12,562.66 RM14,630.92 RM18,183.32

Reference : PEMBANGUNAN KERJAYA KKM

For more info : view this!

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Mar 27

Contrast in CT and MR Imaging: Applications and Contraindications.

By taqidoc Radiology Comments Off

WHAT IS CONTRAST AGENT?

A substance placed in the body to increase image differentiation of anatomical structures.
It increases the differentiation between the areas containing contrast media and the areas not containing contrast media.

WHY NEED TO USE CONTRAST AGENT?

1.To better differentiate between anatomical structures.
2.To increase detection of pathology.

CT CONTRAST AGENTS

POSITIVE CONTRAST AGENT:
Iodinated Contrast Media

IODINATED CONTRAST MEDIA – Ionic

High Osmolar Contrast Media (HOCM)
-Composed of salts which dissociate in water into anions (radiopaque) and cations (osmotically active).
-Osmolality up to 5x serum ? toxicity.
-Non-intravascular route – oral / rectal.
-Not for use in subarachnoid space.
E.g. Gastrografin, Urografin, Isteropac

IODINATED CONTRAST MEDIA – Non-ionic

Low Osmolar Contrast Media (LOCM)
-Non-dissociating.
-Only about 2x serum osmolality.
-Less side effects, less nephrotoxic.
E.g. Ultravist, Omnipaque
Iso-osmolar Contrast Media
-Osmolality approximately serum osmolality.
-Preferred in renal impaired patients.
E.g. Visipaque
Oily Contrast Media
-Currently not widely used
-Used for – chemoembolisation
E.g. Lipiodol Ultra Fluid

METHODS OF ADMINISTRATION:

A)Intravenous injection
1.     Highlight blood vessels.

2.    Enhance structure of organs.

3.    Rapidly eliminated by kidneys.

B) Oral administration

C)Rectal administration

For Oral and rectal–>

1.  Highlight gastrointestinal tract in the abdomen and pelvis.

2.  Positive contrast – iodinated CM(Gastrografin)

3.  Negative contrast
– water
– air (CT colonoscopy)

D)Intrathecal injection

E)Intra-articular injection

CONTRAINDICATIONS

Recognizing patients at risk of contrast media reaction

1.Proven/suspected hypersensitivity to iodine

2.Previous severe reaction to contrast media

3.Asthma/significant allergy history

4.Heart disease

5.Infants/children/elderly

6.Liver failure

7.Renal impairment (moderate-severe) – NIDDM on Metformin

8.Myelomatosis

9.Poor hydration

10.Sickle cell anaemia

11.Thyrotoxicosis

12.Pregnancy

13.Phaeochromocytoma

IN THESE GROUPS OF PATIENTS, LOCM SHOULD ALWAYS BE THE CHOICE OVER HOCM!!

Overall incidence of contrast media reactions

HOCM: 5-12%

LOCM: 1-3%

Mortality rates of contrast media reactions

HOCM: approx 1:40,000

LOCM: approx 1: 200,000

Types of Contrast Media Reactions

1. Anaphylactoid (idiosyncratic)

Urticaria, facial & laryngeal oedema, bronchspasm, hypotension – life threatening

2. Non-idiosyncratic

Direct effect on organs (nephrotoxicity, vasovagal attacks, arrythmias, MI)

3. Local reaction

Extravasation, phlebitis

Severity of Contrast Media Reactions

Mild: Hives, flushed feeling, metallic taste, nausea, vomiting

Moderate: Bronchospasm, laryngospasm, hypotension

Severe: Life threatening anaphylaxis

!! REACTION MAY BE DELAYED UP TO 1 WEEK !!

PATIENT PREPARATION

  1. Fasting 4-6 hrs
  2. Steroid cover  – allergy, asthma
  • T. prednisolone 50 mg 13, 7, 1 hr before examination
  • IV hydrocortisone 200mg stat

3. Renal impairment

  • N-acetyl cysteine 600mg the day before and 1 day after examination

MR CONTRAST AGENTS

Paramagnetic / Superparamagnetic
-Causes changes in the local magnetic field
–>shortened T1 relaxation time – increases signal intensity on T1-weighted images
–>shortened T2 relaxation time – decreases signal intensity on T2-weighted images
e.g.Gadolinium-DTPA (Magnevist)


Newer MRI contrast media
1.Liver-specific MRI agents
-Accumulates in the liver
e.g. Resovist, Primovist, MultiHance
2.USPIO (ultrasmall paramagnetic iron peroxide particles)
-Accumulate in macrophages in lymph nodes
-Currently undergoing clinical trials, no FDA approval as yet

COMPLICATIONS

1.Hypersensitivity reaction
2.Nephrogenic systemic fibrosis
-Recently reported serious late adverse reaction of gadolinium-based contrast.
-Seen in patients with renal failure and on dialysis.
-Fibrosis of skin and organs.
-Clinical symptoms developed 2-8 weeks after exposure to gadodiamide.
-Avoid in patient with creatinine clearance <15mL/min.

Source :
Dept of Biomedical Imaging UMMC

CT and MRI for non-radiologist Course

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