Re PG opportunities in the UK, I think currently there are still places, but as it has been commented on, many times now in this thread and other related threads, medical graduates are on the increase, domestic and international students, both. Unless PG places are adjusted accordingly, some international students will miss out, in the near future.

It is not difficult if you choose the less popular disciplines......

The uni results help you get good fy rotations......then the consultants' references are all important.....

Like i said, it is possible.....just only if you really want or not.....eg a colleague's daughter rejected a paediatrics rotation for ophthalmology in spore.....she cannot get oph in uk, and there is pressure to complete exams quick and continue to get jobs to qualify for the tier 2 visa.....

is it normal to know almost nothing about opthalmo at this stage? I mean basic things like corneal ulcers, cataracts, glaucoma, conjunctivitis i'm ok with it. I was asked about floaters and had no idea what are those or what they are associated with.

My niece just successfuly completed her pre-clinical studies (5 semesters) at IMU and will proceed to do the clinical part in the UK for 3 yrs to complete her medical degree, as part of the twinning medical program. Unfortunately she will have to wait until August 2013 to commence her study in UK as per the university intake calendar.

Anybody got any idea what will be good for her to do during this '8-month waiting time'? Govt hospitals do not take in medical students as medical assistants. Are there any opportunities for her to work in private hospitals/clinics? I'd appreciate any suggestions.

Mr limeuu, any idea?

This post has been edited by Stamp: Dec 13 2012, 05:04 PM

take a 'gap' year off....well, 9 months off.....go do things she likes/want to do, preferably nothing to do with medicine....believe me, after this, there will be NO time for anything else....

relative got a travel and work visa to oz, and worked in sales....earn some money, and visited several cities...

she plans 'to lepak' for a couple of months but she wants to work in a medical-related field until the time comes for her to continue her medical study.

most likely she'll find work at a private clinic.

Dear medical students/doctors, pls point out the mistake in this discharge note from a peripheral hospital.

Can I admit that I cant comprehend the handwriting much?

ACS is acute cardiac symptom right? so Asp is aspirin? And there's a Perindopril down there?

Side note : Passed year one

This post has been edited by Syd G: Dec 17 2012, 02:00 PM

congrats on passing! ACS = acute coronary syndrome.

at first i thought DOA = dead on arrival. oops.

I can't read the writings, i see aspirin, perindopril and maybe a rosuvastatin? oh gosh.

Yeah, one of the mistakes is the bad hand writing. Doctor's writing supposed to be neat and tidy

This patient was diagnosed with ACS and warded. Upon discharge, he was prescribed the following meds:

T. Perindopril 4mg OD
T. Aspirin 150mg OD
T. Clopidogrel 75mg OD
T. Lovastatin 20mg ON
C. Gemfibrozil 300mg ON
T. Cardiprin 1tab OD
T. Isordil 10mg TDS
S/L GTN 1tab PRN

Now, please find the mistake in this list of drugs.

Double dose aspirin? Cardiprin + Aspirin

Good. Even someone who has just passed first year can pick up the error.

The list of meds was prescribed by a junior MO who has just completed Housemanship. This MO is a graduate of an IPTA which is recognized by Singapore medical council.

I really hope this is an "accidental" or "postcall" mistake. If not the rural folks are in big trouble.

BTW, statin with fibrate is also not a good combination, as it can cause rhabdomyolysis. This combination is only used as second line therapy.

This post has been edited by hypermax: Dec 17 2012, 05:40 PM

yeah but if the TGL levels are really high fibrates should be started along with statins.

Monotherapy is always recommended as the initial therapy. If TG is > 5.7mmol/L at presentation, fibrate is started instead of statin. Combination therapy is only recommended if optimal monotherapy has failed to bring the lipid level down to target lipid goals after 8-12 weeks.

Pls refer below pic for more info (from KKM guideline)



This post has been edited by hypermax: Dec 17 2012, 06:45 PM

It is likely that it is a unintentional mistake (for aspirin and ?cardiprin).
Not sure why gemfibrozil, does it actually really work? Definitely I wont feel comfortable starting them together.
? consider beta blocker in future?
Statin is a must regardless of lipid studies given its role in secondary prevention.
Plavix - did not state the duration? Was PCI done/ BMS/ DES? =D

Such mistake would not be made if there is a pharmacist around checking discharge scripts?

yes but this was a discharge script. the patient might have already been started on initial therapy during admission. no? furthermore it is unclear on how long has the patient been admitted and what other drugs has the patient been taking along with his other test results. IMO besides the duplication of aspirin, its hard to justify whether the script is accurate or not based on present data.

gemfibrozil is to lower TGL levels, beta blockers work on the heart. both drugs work differently and have different mechanisms and different outcomes. u only start statins if patient has a previous cardio/stroke event. if levels all ok then no issue la. but having said that if you get admitted probably got problem liao.

This post has been edited by zstan: Dec 17 2012, 07:23 PM

was looking for beta blockers in the chart and trying to make up what is what. to be honest i've never heard of cardiprin, we just say low dose asp 100mg. but yeah, double prescription seems like an unintentional mistake? (overworked? still, not an excuse).

I'll still put in statins and asp just for prevention, for high risk patients. as far as i know, statins are relatively safe, well, apart from some causing rhabdo, but chances are rather low. and I wouldn't be so sure on prescribing fibrates with statin tgt.

As mentioned, I hope this is an unintentional mistake. If not then I am very worried about the quality of medical education.

yes, agreed with the statin part. Statin should be started regardless of lipid profile post ACS/STEMI. Like you, I am also not comfortable with starting both fibrate and statin.

if I am not mistaken, PCI is not routinely done for ACS. It is however, a gold standard for STEMI. Also, district hospital has no cardiologist, so PCI can't be done.

Well, I am equally surprised that pharmacist didn't pick up the mistakes.

I guess you are confused a little. Let me clarify.

1. The guideline says optimal monotherapy before considering combination. Does 20mg of lovastatin or 300mg of gemfibrozil sound optimal to you? Are you aware of the max dosage for each drug?

2. Date of admission and discharge clearly written on the discharge note. Pls read it carefully.

3. All drugs taken by the patient are on the discharge note (usual practice for hospitals)

4. You dun only start statin post stroke or cardio event (where did you get this fact!?). Statin can be used in simple dyslipidemia as suggested by KKM guideline and guidelines all over the world.

5. tqeh is right on beta blocker for ACS. Beta blocker reduces the myocardial oxygen demand, thus it benefits patients with ACS/STEMI as well as CCF.

I would suggest you do a read through of KKM's guidelines as well as books such as Sarawak Handbook of Medical Emergencies. Are you a doctor btw? If I am not mistaken, you are a pharmacist right?

---

Added on December 17, 2012, 8:38 pmCardiprin is combination of 100mg aspirin and 45mg glycine. It causes less gastrointestinal effect than conventional aspirin.

This post has been edited by hypermax: Dec 17 2012, 08:38 PM

Ah. Wanted to point out statin/fibrates combo but too unsure about that.

Btw what's the reason for the MO to prescribe lovastatin instead of atorvastatin? Am more familiar with the latter since it's.....more famous price? dosage? compliance?

ah my bad then. didn't really check the DOA. so yeah, the fibrates shouldn't be prescribed together with statins. yeap the statin dose is quite low and not maxed out yet. my mistake on part 4. should be referring to high risk patients.