Cosmetic Medicines Ordering, Storage, Supply and Incident Reporting

Posted on July 15, 2019 in Uncategorized

This article gives an overview of the systems and processes that must be followed by cosmetic clinics when supplying prescription medicines.

A prescription medicine or drug legally requires a qualified doctor, dentist, nurse or pharmacist to write a prescription for a named patient. The list of drugs and prescribing qualifications may vary in different countries.

A cosmetic clinic must ensure that all medicines are ordered, stored and supplied within the legislative and other relevant pharmaceutical guidelines available.

Therefore ordering, storage and supply of medicines for use within the practice must be undertaken according to appropriate procedures and guidelines to ensure all relevant legislation and pharmaceutical information is adhered to.

Any medicines stored within a typical cosmetic clinic are those used for aesthetic purposes, this includes drugs such as Botox ® and Hyaluronidase. These must be stored according to manufacturer’s guidelines in a locked refrigerator or locked cabinet as appropriate. The temperature of the refrigerator should be monitored and documented daily. If the temperature is found to be outside the recommended range the pharmacy supplier must be informed as soon as possible and if necessary the medicines are returned to the supplier and a new supply obtained.

Supply of Medicines and Maintaining Patient Records for Cosmetic Clinics

The Medical Practitioner is responsible for maintaining a record of medicines obtained from the supplier for use during treatment. A copy of the prescription is retained in the patient’s notes and the following information is noted in the Medicines IN register. The Medical practitioner must include the following details:

– the name of the medicine (generic)

– the dose provided by the pharmacy

– the amount provided by the pharmacy

– the format of the medicine (oral I IM etc)

– the batch numbers and expiry dates

The Medical Practitioner is responsible for ensuring that details of the medicines administered are recorded in the patient notes, including:

– the name of the medicine (generic)

– the dose provided

– the route of administration

– the batch number and expiry date of the medicine

– the date and time of administration

The Medical Practitioner must also document in the Medicines OUT register the name of the patient the medicine was administered to and the date and time of administration. This will ensure an audit trail is available for each practitioner.

All medicines not used or expired must be returned to the pharmacy.

In conclusion only a medical professional should be accepted on a cosmetic training course. This will ensure all practitioners have experience with the use of prescription only medicines and record keeping. The medical practitioner who facilitates a cosmetic intervention should be a qualified doctor, dentist, nurse or pharmacist. These specialists have the prerequisite medical experience plus understand their legal and ethical requirements in prescribing, dispensing and administration of such drugs.

Any errors with the medication must be recorded and reported.

Reporting a Medication Incident

A cosmetic clinic must ensure that all medication incidents follow local legislative and other guidelines for your country of practice. The following is based on the UK CQC guidelines.

All practitioners involved with medication prescribing, dispensing or administration must be aware of the procedures to be followed in the event of a medication error or near miss.

Medication errors or near misses will occur despite having risk procedures in place, and all personnel involved in medication prescribing, dispensing or administration are at risk of being involved an error or a near miss. Because of this, comprehensive reporting of all medication incidents is crucial to enable the organisation to learn from mistakes and improve practice wherever possible.

All incidents involving medication prescribing, dispensing or administration, ‘near misses’ and serious drug reactions must be documented on the Incident Report Form. A medication error is a preventable incident or omission that results in an increase in the risk of patient harm. A ‘near miss’ is a medication error that is discovered before it reaches the patient, thus preventing harm to the patient.

What to Report

The following are some of the issues that require an incident report:

– incorrect dose administered (both over and under dosing)

– incorrect route of administration

– incorrect rate of administration

– incorrect drug administered

– administration to the wrong patient

– failure to document administration in the patient’s medical notes

– administration of an expired drug

– prescribing errors

– incorrect labels

– allergies not recorded

– serious adverse effects including allergic reactions

Near Misses will also be recorded on the Incident Report form.

How to Report Medication errors

Medication errors involving administration to a patient will be documented in the patient’s notes. The Medical Practitioner should inform the patient.

The incident should be documented fully before the end of the day. This report form must be completed by the Medical Practitioner and given to the Practice Manager without delay.

Follow Up Procedures for Medication Errors

A follow-up is undertaken by the Medical Practitioner to ensure the safety of the patient. If necessary the patient must be referred to the nearest Emergency department for further review. The Practice Manager must undertake an investigation into the event ensuring a statement is taken from those involved.

The incident must be discussed at the next Clinical Governance meeting and an action plan developed to aim to prevent recurrence; this may include further training for the personnel involved.

Any severe medication incident must be reported to the within 24 hours of it occurring.

I hope you enjoyed the article. For more information about medicines and their regulations you can check with the Department of Health and MRHA in the UK. In the USA please refer to The Food and Drug Administration (FDA).

How to Study for and Pass the Internal Medicine Boards

Posted on July 14, 2019 in Uncategorized

As the ABIM internal medicine certification exam approached, we received a large number of emails from our subscribers asking for suggestions on the best way to study for the boards. The truth is there is no one path to success though there are certainly ways to increase your likelihood of passing. Regardless of whether you are preparing for board certification or trying to achieve maintenance of certification (MOC), the best tried and true overall method is to “study early and study often.” Below we lay out possible strategies and tactics (in no particular order) for passing the ABIM board exam:

1. Know the basics of the internal medicine board exam

This is obvious but a lot of people simply don’t review this prior to starting their exam preparation and instead rely on their ABIM study source of choice to provide the information.

  • Review the ABIM exam blueprint and understand the topics covered on the exam
  • A large percentage (33%) of the exam is comprised of Cardiovascular Disease, Gastroenterology, and Pulmonary Disease
  • Over 75 percent are based on patient presentations – most take place in an outpatient or emergency department; others are primarily in inpatient settings such as the intensive care unit or a nursing home.
  • While it’s not a big part of the exam, be prepared and expect to interpret some pictorial information such as electrocardiograms, radiographs, and photomicrographs (e.g., blood films, Gram stains, urine sediments).

2. Use the in-training exam as a starting gauge

If you are a resident, the Internal Medicine in-training exam is a good starting point to see where you stand. It’s simply that – a barometer of where you stand. It will give you an idea where you may be weak and where you may be pretty strong. It will also give you an idea of how you compare with your peers. Don’t alter your ABIM study plan simply based on it but it does give you an early metric of the areas you need to focus on.

3. Get a study guide to prepare for the ABIM exam

It’s important to have a good study guide that is tailored for the exam. Some of the more popular and effective guides we’ve come across are the MedStudy Internal Medicine Board Review books and Harrison’s Principles of Internal Medicine Board Review.

4. Join a study group

Study groups, if utilized properly, are particularly effective because they allow you to learn from your colleagues and other exam takers. Oftentimes, people will form study groups with their colleagues (ideally limited to 3-4 people) at their residency program. Tactics to use in ABIM study groups may include:

  • Focus on a new internal medicine category by week. For example, focus one week on cardiology and the next on pulmonary care. The exam can be broken into a dozen or so categories (see the ABIM exam blueprint). The majority of the subspecialty questions on the Internal Medicine board exam will focus on cardiology, gastroenterology, and pulmonary care. However, do not neglect the other areas as the ABIM wants to ensure that internists have a broad base of medical knowledge.
  • Test each other with internal medicine questions you have written yourself. We are firm believers in the philosophy that the best way to learn is to teach. If you help others learn, your knowledge of medical concepts will be greatly strengthened.

We recognize that joining a study group is often not feasible – especially for those no longer in residency programs where everyone is preparing the boards. Fortunately, we live in a digital age where being part of a study group is much easier. You can connect with colleagues through Skype, Google hangout or a number of other channels. One of our favorite approaches is to remain informed and learn through the power of social media – in particular Twitter. In a previous post, we highlighted excellent Twitter handles to follow for ABIM exam review as you prepare for certification. If Twitter is not your cup of tea, you can also connect with colleagues through the Knowmedge ABIM community on Google+. Regardless of what approach you decide, studying alongside others preparing for the same exam is a great motivational tool for success.

5. Get a question bank that fits your personal needs

What is the value of an Internal Medicine question bank? This is a discussion near and dear to our heart, of course. Question banks have become a popular tool because they bring together a lot of material in a question format and help create a test taking environment. There are a lot of question banks to choose from – so what should you look for in an ABIM qbank?

  • High quality ABIM-style questions in a format similar to the exam: The exam is mostly filled with clinical vignettes and has straightforward questions as well. At a minimum, your ABIM exam question bank should have both of these types of questions. Quantity is important – but the quality of the questions and explanations is much more important.
  • Detailed explanations that review why the incorrect choices were wrong: A question bank that does not provide you detailed explanations is probably not worth the money and time spent. As you review questions, you will inevitably get some wrong – your choice of ABIM question bank should detail why your choice is incorrect and the reasoning behind the correct choice.
  • Ability to track your personal performance: Your choice of ABIM qbank should be able to tell you your performance overall and by category. Most – not all – question banks provide you a dashboard broken down by category. The Knowmedge question bank has gone an additional step to break the categories into subcategories as seen on the ABIM exam blueprint. This allows you to review your strengths and weaknesses at a granular level. Knowing you are weak at cardiovascular disease is great – knowing you are weak at arrhythmia questions is more valuable.
  • Add-ons – Notes, Lab values, Highlighting: Depending on how you study, these may be valuable features.

ABIM exam questions straight talk:

  • No question bank – not MKSAP, not Knowmedge, not any – knows what will be on the actual ABIM exam. Based on the ABIM Blueprint, you can make assumptions on what are the most high-yield areas to study. The point of a question bank is not to give you the exact questions that will be on the exam – it is to hopefully teach you concepts you may see on the exam and how to reason through what you don’t know immediately.
  • High-quality ABIM exam review questions can be found in many places – question banks are not the only place. There are study guides, books, and even free sources. So don’t simply base your decision on question bank on the questions. In addition to the quality of the questions, what truly differentiates one ABIM exam question bank from another is whether it will truly help you build a broad base of knowledge and help you retain information for the exam. If you are not comfortable reading a bunch of text – it won’t matter how great the questions are. If you are not an audio-visual learner, the Medstudy or Knowmedge videos won’t do anything for you (As clarity, the Knowmedge qbank contains text and audio-visual explanations for this exact reason). If you are an “old-fashioned” learner that prefers printouts – USMLEWorld is definitely not for you – those who have used them are well aware their software will block you from taking print screens or copying of their content. In short… don’t follow the herd – each one of us learns differently and you need to pick the best method for you.

6. Consider whether a review course is right for you

There are pros and cons to taking a review course for your ABIM exam prep. The pros are that it gives you a serious dose of review in a short period of time. It gets you focused if you weren’t focused and some courses are absolutely excellent – we know some internists are ardent supporters of some of the professors that teach these courses. The three most popular independent courses we are aware of are:

  • Awesome Review by Dr. Habeeb Rahman – The best known and most popular independent course. Dr. Rahman has a very unique style of teaching and accompanies his lectures with his own videos. During this six day course (Sunday – Friday), Dr. Rahman provides students his own set of notes and questions to practice.
  • iMedicineReview by Dr. Shahid Babar – This three day course (Friday, Saturday, Sunday) course comes with a set of 1,500 review questions.
  • Unique Course by Dr. Satish Dhalla – A six day course (Monday – Friday) taught by one of the Top Internists in the Nation as selected by U.S. News

The cons of a review course are that they are expensive (Often over $1,000 plus hotel stay) and can be inconvenient to travel to and from. Regardless of whether you attend a review course or not, it cannot replace the pre and post-course study time that is needed. It is complementary to study time and does not replace it.

7. Review our suggested ABIM test taking strategies

The ABIM exam questions are not intended to trick you – they are intended to challenge your knowledge and ability to bring together your understanding of many different concepts and topics. Below are some of the tactics you can use as you are practicing questions and/or taking the actual ABIM exam:

  1. For clinical vignettes, read the question (last line) first and then go back and read the scenario. This way you’ll know what to look for as you are reading the scenario.
  2. Try to answer the question even before seeing the answer choices.
  3. Pay attention for keywords that can clue you in on an etiology or physical exam.
  4. Watch for key demographic information – Geography, ethnicity, gender, age, occupation.
  5. The ABIM test is not intended to be tricky but we are all human so we miss keywords sometimes – such as “least likely” – pay attention to these.
  6. If you are challenged by a longer clinical vignette, note the key items and develop your own scenario – this may trigger an answer.
  7. Most internists we’ve spoken with say time is generally not an issue – but be aware that it is a timed exam and that you have approximately two minutes per question.

We cannot stress enough the mantra “study early and study often.” The exam is challenging but it can be conquered with diligence and proper preparation.

8. Understand and be prepared for ABIM test day

  • Be prepared and confident. No matter how you have chosen to study, on test day – confidence is critical!
  • Get a good night’s rest – last minute cramming and staying up late is only going to stress you out more.
  • Get there early – don’t risk getting caught in traffic. It’s much better to be a little early than be aggravated in traffic.
  • Take an extra layer of clothing. The last thing you want to do is be uncomfortable and cold because someone decided to turn on the air conditioner too high.
  • Test day is long! Be mentally prepared for it. From registration to the optional survey at the end, the day will be 8-10 hours long (depending on whether you are certifying for the first time or taking the maintenance of certification exam).
  • Keep some power snacks with you to take during break time.
  • Review the ABIM exam day schedule so you know exactly what to expect.

That’s a basic overview of how to study for and pass the ABIM board exam. As mentioned, there is no secret sauce or method to this – you simply need to have a broad base of knowledge. There is no substitute for studying early and studying often! If you are preparing for the ABIM Boards, we wish you well – we’re here to help so let us know if you have any questions! Happy studying!

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Living Life Medicine – Pharmaceutical Free – Part II

Posted on July 12, 2019 in Uncategorized

Living Life Medicine/Pharmaceutical Free sounds like an oxymoron-doesn’t it? To some it is-to others it will seem redundant, because millions of people throughout the world are living Medicine/Pharmaceutical Free. How can that be?-Every one gets sick-you might say. Yes, occasionally, people need remedies because they are sick, however, there are a plethora of natural remedies.

The five most common uses of prescription drugs are for Depression, Antibiotics, Menopause, High Blood Pressure and Ulcers.

Through illness your body is working to get your attention. Every malady or pain-either physical or mental is your body’s way of communicating what it needs.

Depression Remedies:

St. John’s Wort,

St. John’s Wort (Hypericum perforatum in Latin), the most frequently used natural remedy for depression, is a long-living plant with yellow flowers. It contains many chemical compounds. Some are believed to be the active ingredients that produce the herb’s effects, including the compounds hypericin and hyperforin. Alternative Medicine Review 1998 (Feb); 3 (1): 18-26

Hypericum (St. John’s Wort) has been favorably compared to numerous antidepressant drugs, the studies having revealed equivalent results and a much more favorable incidence of side effects. Studies have also demonstrated its efficacy in treating seasonal affective disorder.

Kava: The kava root is ground to a powder, and it has a brownish color. The brownish powder is then mixed with water and drank as a beverage, without being fermented. Extracts from the kava root are placed in capsules and sold as kava or kava kava. Additional herbs and nutrients involved in relaxation include 5-HTP, ashwagandha, passionflower, and valerian. Users report the following results:

o A state of relaxation, without feeling drugged
o Muscle tension is reduced
o Peaceful and contentment
o More sociable in the right company
o Mild euphoria, occasionally
o Mental alertness is often not effected, except on high doses
o Initial alertness followed by drowsiness which comes on after a few hours, can be taken in the evening, a few hours before bedtime

SAMe: SAMe (S-adenosylmethionine) is not an herb or a hormone. It’s a molecule that all living cells, including our own, produce constantly. How does extra SAMe improve a person’s mood? Researchers have identified several possibilities. Normal brain function involves the passage of chemical messengers between cells. SAMe may enhance the impact of mood-boosting messengers such as serotonin and dopamine-either by regulating their breakdown or by speeding production of the receptor molecules they latch on to. SAMe may also make existing receptors more responsive. In 1994 Dr. Giorgio Bressa, a psychiatrist at the University Cattolica Sacro Cuore in Rome, pooled results from a dozen controlled trials and found that “the efficacy of SAMe in treating depressive syndromes… is superior [to] that of placebo and comparable to that of standard… antidepressants.”

Depression is anger held inside–Hypnosis has proven to be highly effective in uncovering the core issue of the person’s anger and helping them to resolve it.

Antibiotics: Excessive use of antibiotics breeds antibiotic-resistant bacteria-germs that are immune to antibiotics! Amoxicillin also destroys large numbers of protective “good” bacteria that reside in your intestine, making you more vulnerable to other infections. A recent article in the American Medical Association Journal reported that probiotics might actually protect against many infections. Gary W. Elmer,pH.D., of the University of Washington, Seattle, reports that probiotics greatly reduce the risk of gastrointestinal and vaginal infections.

Instead of using antibiotics, which have a plethora of side effects use, Probiotics, Garlic, Echinacea and Goldensea are highly effectivel.

Menopause:

Menopause is the stopping of periods or menses. The average age is 52, however, menopause can occur in the 30’s or 60’s. The perimenopausal or menopause phase in a woman’s life can be dramatic or quite simple – it is different for every woman – but every woman does stop having periods.

The most effective natural remedies include: Flaxseed, Red Clover, Vitamin E, citrus Bioflavonoids, Vitamin A, or Beta Carotene, B-Vitamins, Black Cohash, Chasteberry (Vitex Agnus Castus) Evening Primrose oil. Altering your diet in small ways can have the greatest positive effect on your body. Include plenty of low-fat, high-fiber foods and soy in your diet.

High Blood Pressure:

Recent studies have uncovered many factors associated with high blood pressure including-stress, unresolved anger, a high sodium or salt diet, overweight, and unhealthy lifestyles.

Hyperexol, a combination of several herbs, is proven to be successful and goes to the cellular level to lower your blood pressure levels. It contains all-natural ingredients, in their purest form, that are essential to making it gentle and effective, unlike prescription drugs that have harmful side-effects, Hyperexol has been shown to have no negative side effects. A partial list of the ingredients are: Calcium, Garlic, Selenium, Allium Sativas, Potassium, Hawthorn Berry Powder, Capsicum Frutescenes, Crataegu Ocycantha, Magnesium, Vitamin C, and Pyridoxine HCL

Since stress is part of high blood pressure, emotional and spiritual healing with a holistic health care provider is paramount.

Ulcers: Gastric Ulcers form when the mucus lining of the stomach loses its ability to repel stomach acids. The acids, which digest food, begin to digest your stomach instead. If the ulcer forms at the top of the small intestine, it’s a duodenal ulcer.

For temporary relief of gastric ulcer pain, activated charcoal is effective, says, Agatha Thrash, M.D., a medical pathologist and co-founder and co-director of Uchee Pines Institute, a natural healing center in Seale, Alabama.

Other remedies include: Flower Remedy/Essence Therapy, Food Therapy, Hydrotherapy, Reflexology, Relaxation and Meditation, Sound Therapy, Vitamin and Mineral Therapy.

When you neglect your mind, body and spirits’ needs sooner or later, your body breaks down, and you experience the pain-diagnosed as migraine headaches, MS, lupus, fibromyalgia, chronic fatigue, cancer, diabetes, high blood pressure, TMJ, PMS and the list goes on.

The purpose of this article is to direct you to the realization that you are activated from within; that life and healing come from within; and ultimately that the maintenance of health is superior to the treatment of disease.

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Doctor Reviews – A Topnotch Source For Finding Quality Medical Referrals

Posted on July 8, 2019 in Uncategorized

If you are wondering how to go about finding the best physician for your medicinal needs, then look no further than doctor reviews. The days of pestering friends and family for recommended practitioners are in the past, as the most efficient way to find professional care is much simpler. By utilizing the handy online database of doctor reviews from certain websites, you search will be completed without any trouble and in a short amount of time.

Most care-seeking patients might not think to consult the information super highway for their medical needs, but in fact, this is the best source available. After providing a small amount of personal information and a few mouse clicks, you will have located the provider of quality health care that you need.

The reasons for using this search strategy are many, but perhaps one of the best is because it is totally private. By going online and reading what other, former patients of a particular physician have to say about his or her practice, you can find the information you need without having to ask anyone in person. For instance, what if you have a medical condition that is of a sensitive subject matter and you would prefer to talk about it as little as possible? After all, medicine should be a totally confidential matter that is shared between patient and doctor.

The requirements for using this method are simple enough, as you only need access to a computer and the internet. For a lot of us, this will be possible without leaving your own home. What is even better is that it will likely require little of your time to find what you are looking for. Searching through doctor reviews can be done as you take care of other daily internet tasks, such as checking or writing emails.

The advantages continue to stack up for this great way to find health care, so more and more people are using it. This translates into more and more reviews and ratings to help make your decision easier. The more reviews there are for a particular, the more reliable the general consensus of the individual’s practice. This can make a difference between paying a lot for sub-par treatment or receiving the topnotch care you deserve and require.

Do yourself a tremendous favor and start looking today and find out what everyone is talking about when they mention how fast and efficient the use of doctor reviews are. These sites are trustworthy and can be accessed instantly. After you try this procedure, you will never go back to bothering friends and family about who to seek treatment from, as you will know that the internet is so much faster and reliable. To start, all you need to supply is type of clinician or treatment you are seeking and then enter your city’s name. In no time at all, you will be privy to all of the most reliable, locally accessible doctors near you.

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