Is aspirin taken at night time better than morning?

Recently a friend of mine asked about whether is it rationale to change aspirin recommendation to be taken at night than morning? What do you think :

"Aspirin taken at bedtime compared with on awakening significantly diminished 24-hour plasma renin activity and excretion of cortisol, dopamine, and norepinephrine in 24-hour urine. Decreased activity of these pressor systems forms a biologically plausible explanation for the finding that aspirin at night may reduce blood pressure, whereas aspirin at morning does not. "

Snoep JD, Hovens MMC, Pasha SM, et al. Time Depedent Effects of Low-Dose Aspirin on plasma renin activity, aldosterone, cortisol and catecholamine.Hypertension 2009; 54: 1136.

"This prospective trial documents a significant administration time-dependent effect of low-dose ASA on BP in untreated hypertensive patients. The timed administration of low-dose ASA could provide a valuable approach, beyond the secondary prevention of cardiovascular disease, in the added BP control of patients with mild essential hypertension. "

Hermida RC, Ayala DE, Calvo C, et al. Aspirin Administered at Bedtime, But Not on Awakening, Has an Effect on Ambulatory Blood Pressure in Hypertensive Patients. Journal of the American College of Cardiology. 2005; 46: 975-83

& you may check out these 2 sites more for information :

Commentary from Yip HL et al, based on a reply from Kriszbacher I et al on the possible of aspirin for stroke prevention taken in the evening? http://stroke.ahajournals.org/cgi/content/full/35/12/2760

Snoep JD et al. Time Depedent Effects of Low-Dose Aspirin on plasma renin activity, aldosterone, cortisol and catecholamine.Hypertension 2009; 54: 1136. & Commentary from Black HR on this article,published in Medscape Cardiology: Available online http://www.medscape.com/viewarticle/716196

PRP Posting

Congratulations to all B106!! Now that it is over and done, the next big thing after convocation (the attire/shoes hunting, booking of hotels/plane tics for family etc.) and perhaps, graduation trip, at this juncture in your life is none other than the provisionally registered pharmacist (PRP) placement location.


By now, the uni would have gotten you all to fill up the necessary forms and what awaits you all is the SPA interview. My seniors had told me that whatever state you fill (for your posting) in the previous forms are not that important, it is THE FORM which you will be filling in during the day of SPA interview that counts...so you do have some time to think about it before your interview.


Now the interview is just a formality but a grand senior had told me that a few friends of hers failed the interview. They were asked 'if we send you to sabah/sarawak, would you go?' and they answered 'no'. My senior's reasoning is that the gov is trying to see if we 'menurut perintah'so probably the political-correct-cum-neutral answer is 'I will go but I will be sad that I am leaving my parents in my home state'. (Disclaimer: I am no HR manager in the gov sector)

For fledgling pharmacists in overseas who would like to practise their PRP year (known as 'pre-reg' in UK) back home, do visit HERE as my friend ka keat has put up a comprehensive guide on PRP application.


But I digressed. Back to the posting location; after the spa interview, we will be placed by KKM to a particular STATE, the exact hospital which we will be posted to lies on the Jabatan Kesihatan Negeri (JKN) of the particular state. If you are placed in a certain state, (based on past examples), you will most likely be in the state for some time as cross-state transfer is very difficult indeed and you need really valid reason or strong cable.


I am sure as resourceful as all bpharmers are (thanks to all the portfolios and PBLs)*cough*, you all would have done or must be doing your 'research' and are pondering over factors like:
-the love for clinical (hospital) or bureau?

-higher allowance for those who from west malaysia who get placed in east malaysia (but higher chances of getting smaller districts in east malaysia in 2nd year)


You should MAXIMISE your chances of getting what you what by being willing to 'compromise'; you probably would like to consider putting other state in the THREE choices that you have instead of filling them up with hospitals/institutions in kl/selangor (if you are from kl/selangor)


When I filled up my choice, I did it based on probability. If you look at the Second Schedule of your Registration of Pharmacists Act 1951, there is a list of premises that you can be posted to. There are 13 premises (10 hosps, bureau, bhg farmasi, cawangan penguat kuasa farmasi) in Selangor, 3 in WP Kuala Lumpur (I didn't know then that HKL is a 'separate entity', so in actual fact only Hosp Putrajaya and cawangan penguat kuasa farmasi fall under WP Kuala Lumpur).


Although there are hospitals like Hosp Tg. Karang, Kuala Kubu Baru, Banting and Sabak Bernam in Selangor, based on probability, Selangor is still the sensible choice (to me). At that time, I was thinking, how 'ngam' can it be, right? So I bit the bullet and never did take the middle ground.


I was posted to Hosp. Sabak Bernam (the furthest hosp in Selangor!!). Now, here are the probably-not-so-known-facts to you all: a prp who is posted to district hospitals like Hosp Sabak Bernam, Hosp Banting will get to do their clinicals in Hosp Klang or Hosp Selayang! So if you get the place, don't think you will be missing out and quickly appeal for placement at another state. And as most seniors who get postings out of their home states will tell you, after some time, you will see past all the initial frustrations/disappointments.......


To me, getting over the posting (for those who do not get what they want) is indeed like the Kubler-Ross Model: 5 Stages of Grief

1. Denial
'This can't be happening to me..... (name of state), I am not 'related' to it in any way (not even my parents' hometown)'


2. Anger
'Why me? It is not fair!!' 'He/she who................(fill in the blanks yourself) get that but I get this?'


3. Bargaining
'I'd rather be in that hospital in (name of state) although it is very hot!!'
'I don't mind working in (name of state) as I love the food there!'


4. Depression
[Thankfully, so far there is nobody that I know of who was in this stage]


5. Acceptance
'It is going to be alright. It is just one year'
'At least I get to come back on weekends'


So to bite the bullet or not to? to have a soft landing or not to? Please analyse the market yourself....the rumoured rough numbers of frps leaving gov service, the number of fresh graduates like you all going into the job market, any shortage in a certain state, the number of ppl with cables..... At the end of the day, there is just so much we can do, but we should still maximise our chance nonetheless. Wherever you may be, do keep an open mind and embrace your profession with passion=)

Immunosuppressant for Renal Transplant : Update & Summary

As a special offer to whoever viewing this blog, again, "Immunosuppressant for Renal Transplant : Update & Summary", is available upon your request to :

1. bpharmer05@gmail.com

OR

2. dmcancw@yahoo.com, direct to me, Mai. I will then send to you after receiving your email.

I guess we will be happy to share the knowledge from any institution. If you want to post up anything or any information, u can email to us the content.

also, if u do come across any issue that you would like us to look into, u may also email to us. we will try our best to dig n to response to u, as soon as possible.

=) Mai

How Should I Respond to an Angry Client?

All of us once-awhile, will have to deal with some angry client, whether the public, nurses or doctors. Here is an article extracted from Medscape, from Bonnie L. Senst, MS, RPh Clinical Assistant Professor, University of Minnesota College of Pharmacy, Minneapolis, Minnesota; Director, Allina Pharmacy Practice, Allina Hospitals and Clinics, Minneapolis, Minnesota. (published 08/04/2010)

Some basic principles of communication can help ease an otherwise tense interaction. As the angry person explains his or her problem or need, it is very important to listen attentively. Do not interrupt, or you may escalate his or her anger. The book Crucial Confrontations discusses the need to dissipate the emotion before you can address the content of the argument. The author lists several things that you should not do:

• Don't get hooked. Don't allow yourself to become angry in response.
• Don't try to "one up" the other person. Stay focused on the central problem, and don't introduce your own problems.
• Don't patronize. Telling people to calm down only throws gas on the flames.

Once the client's anger is de-escalating and you get an opportunity to respond, acknowledge the complaint and say that you are sorry. Ask for additional details or suggestions for an acceptable resolution of the problem. Be sure to keep a positive attitude. Show the client that you are intent on solving his or her problem. Describe what steps you will take and follow through on your commitments. Thank the individual, and encourage him or her to let you know if any other issues arise in the future.

Some people believe that saying "I'm sorry" is admitting guilt and therefore have suggested the alternative term "I regret..." Quint Studer, founder of the Studer Group, an outcomes-based healthcare consulting firm, maintains that saying you are sorry does not mean you are admitting a mistake. He suggests using such phrasing as "I am sorry you are disappointed" or "I am sorry that we are not meeting your expectations."

Suggested Reading (along with the article)

• Clark PA, Malone MP. Making it Right: Healthcare Service Recovery Tools, Techniques, and Best Practices.Marblehead, MA:HCPro, Inc.; 2005.
• Baker SK, Bank L. I'm Sorry to Hear That: Real Life Responses to Patients' 101 Most Common Complaints About Health Care. Gulf Breeze, FL:Fire Starter Publishing; 2008.
• Diering SL. Love Your Patients! Improving Patient Satisfaction with Essential Behaviors that Enrich the Lives of Patients and Professionals. Nevada City, CA: Blue Dolphin Publishing; 2004.

Also available from http://www.medscape.com/viewarticle/719548?src=mp&spon=30&uac=102525PG (Accessed 15/4/2010)