Dilema seorang doktor PART I

Physicians' Top 20 Ethical Dilemas
Medscape 2010 Physical Ethics Survey

*Komen dari doktor yang berwarna merah

"I once had a terminal patient who wanted to see his granddaughter before he died, so I prolonged his intravenous therapy for 3 days until she arrived. He died the same night."
"Some families have completely unrealistic expectations, despite my educational efforts. I would give continued care, but not happily."
"I do not have the right to determine futile unless the patient is brain dead. Futility is a matter of opinion. We all will die eventually."
"I would not recommend it if I thought it was futile, but I would give it if that is what the patient or the family wanted."
"Why waste money and time when results are nil?"
"I would do this if I felt it would give the family time to accept the inevitability of death."

"I do not participate in active withdrawal of such intrinsic life-sustaining needs. The family could find another physician if they feel so strongly."
"It depends on what you mean by 'premature.' I would feel differently if death is imminent and there's no hope, and the quality of life is poor rather than if there's no hope but some quality, or if there is some hope but the quality of life is lousy. I'd always try to think, what would the patient want."
"Not if the family insisted, but if the patient insisted on it, I would."
"This is why hospitals have ethics boards. I would refer cases like these to experts."

"I think we do this all the time, with patients coming in with viral urinary tract infections who want antibiotics because they think it is the only thing that will help them."
"Lying to patients about treatments is never OK."
"I'm experienced enough to know that I can't help everyone, and I'm egosyntonic with being the occasional disappointment to my patients."
"A placebo produces a 30% improvement in some studies."
"Why not save money and risk for adverse effects by just prescribing placebos in cases when medications are clearly not indicated?"

"Pain should not be undertreated, and what's the problem with a terminal patient being addicted and comfortable?"
"Pain is undertreated all the time in my city. There is a great deal of fear of the Drug Enforcement Administration and reluctance to use narcotics even when they are indicated. Studies show that addiction is seldom an issue if the pain is real."
"I would never undertreat a patient's genuine pain. I would withhold narcotics from a chronically addicted patient who is presenting with a questionable painful condition (eg, back pain or toothache) and offer nonnarcotic alternatives."
"Having been sanctioned by an out-of-control, vindictive state medical board, such things aren't even in the purview of ethics, but rather a survival mechanism for my ability to continue practicing."

"Most of the time, I tell them exactly as it is; they need to know the truth, and who am I to judge what they should or shouldn't know? However, if the patient is very frail emotionally and physically and has a very supportive family, I may not."
"It's not about hiding information. It's learning how to talk to patients and giving bad news in the best way possible. All the information should be given, but any positive that exists should be also talked about."
"The truth, delivered with compassion, is a gift."
"I think patients deserve total honesty from their physician. They want to know."
"An elderly patient who is senile will not understand, benefit, or prepare, so it is senseless to inform them. However, a family member, next of kin, or whoever is the health proxy will be notified."

"Cover-ups are never OK."
"Everyone makes mistakes, but physicians are punished for their mistakes. I don't believe in covering up information, but in today's litigious society, a simple mistake could cost a physician his or her license."
"The more open the physician is about mistakes, the more acceptable mistakes will be to the patients."
"Why make a mountain out of a molehill if it will cause the patient more emotional upset than simply not saying anything, as long as no physical harm has occurred?"
"Do I balance the potential harm to a patient vs the potential harm to myself in publicly announcing 'a mistake'? Yes."
"I own up to all mistakes I make, but I explain their impact or lack thereof."

"I would, but I would contact an attorney first."
"Yes, but I would tend to seek out advice from a risk manager or more seasoned physician for help in how to reveal the mistake."
"I will reveal any mistakes, especially those that could harm a patient. That is the morally correct thing to do."
"We take an oath to do no harm. Covering up is a form of lying."
"If revealing the mistake won't change the management and it has not yet caused any harm, I think a wait-and-see approach is OK."

"Often, defensive medicine is sloppy medicine. A chart note explaining care is often a better defense."
"Some patients want reassurance, and in some cases, testing helps to prevent further unnecessary medical care."
"Yes, it's acceptable: A jury of 12 men will always be found by an enterprising trial lawyer that will find you guilty of not doing all you could have done."
"We must get away from 'I-did-this-to-protect-myself' medicine. It is costly and exposes the patient to added, unnecessary risks."
"I consider it a criminal act."

"A competent patient who has been adequately medically informed and has a terminal condition that makes his or her life miserable with no chance of cure or amelioration should be allowed to look into all options. We may not agree with it, but we have no right to legislate anyone into intractable suffering."
"Palliative care is one thing, but suicide is not within the scope of acceptable physician behavior."
"I do not believe in assisted suicide, but I do believe in withdrawal of support. If the patient is terminally ill and suffering and there is absolutely no hope to survive, then I withdraw the support (eg, antibiotic treatment, blood testing, or transfusions)."

"As a profession, medicine cannot allow those who are impaired by any reason to expose patients to danger."
"I would not report him to the board, but I would consider talking to a superior. The board is not designed to help, rather to punish and demonstrate their 'value.'"
"I would like to think I would, but it has happened when I did and didn't."
"I would, but only after firm warning that this is my intent and after multiple discussions with this impaired colleague."
"I have done so and consider it an act of love. A year after having done so, the physician and spouse both thanked me."

Jangan fikir nak sedap aje...

Hampir tiap-tiap hari kita dengar kes buang bayi. Sehari tu kadang-kadang lebih dari satu kes. Moral masyarakat kita semakin tenat. Sib baik aku ni jenis 2-3 hari sekali baru selak surat khabar. Tak la rasa sesak nafas dan rimas sangat dengan penyakit ni. Tak dapat tidak aku sebagai mak ni terkena jugak tempias risau tu. Membesarkan anak dalam suasana dunia yang semakin dasyat memerlukan kita perlu memberi perhatian yang berganda kepada anak-anak. Kecik-kecik ni senangla kan. Tutup pintu rumah dia tak keluar. Kalau dah besar tak boleh buat macam tu dah. Lagi plak bila anak dah bersekolah bercampur gaul dengan macam-macam jenis umat manusia. Apa yang aku nampak sejak bergelar mak budak ni hidup asyik risau jek biler fikir pasal anak. Dan aku rasa perasaan itu akan berterusan walaupun anak dah besar panjang, dah keje or dah kawen. risau tu hanya akan lenyap bila mana mata ni tertutup terus=mati.

Aku ni asyik terfikir-fikir kalau ada anak pompuan nanti macam mana. Lagi besar, berat dan dalam kerisauan tu. Menjaga dan mendidik anak perempuan bila dia dah besar remaja mesti sangat mencabar. Takutnya tuhan saja yang tau. Dalam dok risau-risau tu aku pernah terbaca satu entry kat blog mommylyna MSK. Ada sorang tu komen anak laki pon kita kena risau jugak. Kena didik betul-betul supaya tak sesuka hati tebuk anak dara orang. Yup... make sense!!! Besarnya dan beratnya amanah Allah kan. Ya Allah..semoga Engkau melindungi keluarga kami semua dari maksiat dan kemungkaran. Aminnnn..

Lain plak ceritanya di tempat aku..

Tiap-tiap hari masa balik keja nafas aku mesti sesak. Taman perumahan tempat aku menyewa rumah penuh dengan teenagers tak kira laki pompuan berpeleseran sana sini naik motor. Kita yang drive ni plak kena extra careful. Diorang yang naik motor bleh plak bergurau, senda bertempuk tampar, bergelak-gelak dan bersembang-sembang tak hirau orang lain kat jalan tu. Yang paling menyedihkan semua teenagers tu MELAYU!!! Tak dak langsung cina, india or bangsa lain. Haiihhhh... apa nak jadi nih. Kalau alasan nak hilangkan tension dan boring takkan tiap-tiap hari pusing taman tu cuci mata. Kalau nak hilangkan tension dan boring takkan nak berpeleseran macam tu pon berlipstick bagai. Please... Kenapa korang jek macam tu orang lain tak macam tu. Aku memang tak boleh bayangkan anak aku membesar dalam persekitaran yang sangat tidak sihat macam tu. Baik ngadap playstation jek dari merambu macam tu.. Tak dek playstation baca la majalah, novel, surat khabar, surfing internet. Jangan baca majalah or tengok video porno plak. =p Gelap hati tau. Sebab tu la belajar pape pon ilmu payah nak lekat kat dada. Dah macam membebel plak. Serius..aku malu tengok bangsa aku macam tu. Buatlah sesuatu yang membanggakan. Yup..Tak semua macam tu. Tapi kenapa mesti ada yang macam tu??? Aduhai.. tak dapat membayangkan kalau yang merambu tu anak aku. Sakitnyaaa...

Aku nak share sumthing ngan korang. Aku baca ni dari blog suzie. Ori nya dari SINI

Wahai anak-anak dan kawan-kawan sekalian.
Terlajak perahu boleh diundur.
Sesungguhnya perbuatan zina itu satu DOSA BESAR.
Bertaubat lah kepadaNYA sementara pintu itu masih terbuka.

The best thing is JANGAN LANGSUNG MENGHAMPIRI ZINA-
jangan berdua-duaan, pegang-pegang, sentuh-sentuh, kiss-kiss
dan semua yang sewaktu dengannya.
So halalkan semua ni dengan KAWEN!!!!!

Vaksin HPV untuk si gadis 13

Tahun lepas kerajaan telah meluluskan bajet sebanyak RM 150 juta untuk Program Pelalian (Vaksinasi) HPV. Banyak okeh..

Apa itu HPV?

HPV=Human Papiloma Virus. Virus ni lah yang menyebabkan kanser serviks yang telah menjangkiti 1500 wanita Malaysia setiap tahun. (Scary kan??) Kanser serviks merupakan kanser yang ketiga tertinggi yang menjangkiti wanita Malaysia selepas breast cancer dan colorectal cancer (kanser usus).

Peranan Vaksin HPV-mencegah kanser serviks.

Vaksin ni akan di cucuk di lengan sebanyak 3 kali dalam tempoh 6 bulan
Suntikan pertama: tarikh vaksin pertama yang dicucuk di sekolah
Suntikan kedua: 1 bulan selepas suntikan pertama
Suntikan ketiga: 6 bulan dari suntikan pertama

Vaksin dicucuk di lengan la. Yup.. saya dah mention kat atas. Tapi nak mention jugak lagik sebab ada kes sorang budak sekolah ni balik rumah citer kat mak dia cikgu cakap kena cucuk dekat pangkal rahim. WHattttttt???? Sib baik si mak tu nurse. So tau la ada cikgu-cikgu kat sekolah yang salah faham pasal benda ni. Haiihhhh...

Di Malaysia, kerajaan mengambil langkah mewujudkan progam Pelalian HPV bagi mengurangkan kos rawatan kanser serviks untuk 20 tahun akan datang. Rawatan kanser di Malaysia free of charge kalo spital government la. Kalo 20 tahun lagi tatau la FOC ke tak kan. Dan dah tentu 20 tahun lagi kos rawatan berganda-ganda dari sekarang. Jadi langkah pencegahan adalah yang terbaik.

Siapa yang terlibat dalam Program Pelalian HPV?

Untuk yang masih bersekolah-semua gadis yang berada di Tingkatan 1.Tak kisahlah umur dia masa Tingkatan 1 tu berapa tahun. Kalo umur 10 tahun dah masuk Tingkatan 1 bleh jek amek vaksin ni
Yang dah quit sekolah-semua gadis berumur 13 tahun
Gadis-gadis yang berada dalam gologan di atas perlu mendapat kebenaran dari ibubapa/penjaga sebelum cucuk yerr.. Gadis-gadis yang bersekolah mesti cikgu-cikgu korang dah citer pasal program ni. Ibubapa/penjaga tentu dah dapat borang consent untuk sign nak bagi ke tidak anak-anak korang cucuk vaksin ni.
Gadis-gadis yang tidak tergolong di dalam group di atas kalo nak cucuk gak kena pi private hospital/clinic lah yer.

Jakun sekejap...

Last weekend aku pi HOMEDEC 2010 kat PISA Penang. Macam-macam home appliances yang dijual kat pameran tu. Tapi satu benda ni menangkap btol!

EUBIQ GSS SYSTEM

Amendenyer ni? Ini la bendanyer.

Inilah rupa Eubiq GSS System

Eubiq ni adalah plug point moden gitu. Boleh dipasang dimana-mana power source. Yang penting kena ada power track.


Benda panjang dalam gambar di atas adalah power track. Pasang power track kat mana-mana power source (soket) then dah bleh guna. Yang tak bestnya power plug dier mahal. Kalo masa HOMEDEC dalam RM60-RM90 seketul.

Cara-cara nak pasang eubiq system.
Mudah jek kan.
Nak on power pusing jek power plug tu.

Inilah ciri-ciri keselamatan eubiq system. Kalo anak-anak kita korek pon takkan kena renjatan elektrik sebab kawasan yang bleh dimasuki jari tu adalah ruang yang telah dibumikan (btolkah term ni)

Bleh dipasang di dapur.
Kelebihan eubiq adalah ianya hanya perlukan satu power source sahaja
walaupon nak guna power track sepanjang ni. Sangat flekxible sebab power plug tu bleh diubah kedudukan dier sepanjang power track tu.

Dan juga bleh dipasang di atas meja

Atas lantai pon bleh.

Harga??? Di pameran HOMEDEC itu hari untuk power track sepanjang 2.4 meter plus 4 power plug total RM967 . Harga biasa kat luar RM1395. Not bad la kan.

For more info visit these websites

EUBIQ

GSS SYSTEM

Semua gambar dari eubiq.com

Kematian Pertama H1N1 Untuk Tahun Ini

Bahang wabak pandemik influenze H1N1 semakin suam-suam kuku. Walaupon di media iklan peringatan tentang wabak ini sentiasa ada. Namun disebabkan sikap kita yang mudah lupa dan ambil mudah, penularan wabak ini semakin dilupakan. Walaupun telah diingatkan tentang akan datangnya second wave wabak ini namun masyarakat semakin selesa sebab tiada langsung kematian dilaporkan sejak hujung tahun 2009. Dan sesungguhnya aku adalah antara mereka yang semakin lupa tentang bahaya virus itu (dah makin tua kot =p). Dengan selambanya dah lama tak pakai face mask kat tempat keje. Selamba badak bawak Ilham pi tempat-tempat crowded macam pasar tani.

Dan sesungguhnya kenkawan sekalian, virus itu masih bersama kita. Dan tak mustahil dah mutate. Kematian pertama untuk tahun ini dilaporkan berlaku di HUSM. Pesakit muda lagi okeh. Baru 22 tahun. Ok malas nak tulis. Baca kat bawah ni. Aku quote dari website KKM.

Kementerian Kesihatan ingin merujuk kepada beberapa pertanyaan berkaitan kematian jangkitan Influenza A (H1N1) yang berlaku di Hospital Universiti Sains Malaysia(HUSM), Kubang Kerian pada 28 Februari 2010. Mengikut laporan yang diterima daripada pihak HUSM, penyebab kematian kes ini dicatatkan sebagai “Septicemic Shock with Acute Respiratory Distress Syndrome secondary to H1N1 Infection”.

Kes ini adalah seorang wanita berumur 22 tahun, dimasukkan ke HUSM pada 15 Februari 2010 dengan riwayat telah mengalami demam dan batuk selama 8 hari. Kes mula mendapat rawatan di sebuah klinik swasta dan dirujuk terus ke HUSM pada hari yang sama. Kes terus dimasukkan ke wad dan rawatan antiviral influenza A(H1N1) terus dimulakan. Kes disahkan sebagai jangkitan influenza A(H1N1) pada 16 Februari 2010. Akibat komplikasi jangkitan paru-paru, pesakit telah dimasukkan ke Unit Rawatan Rapi(ICU) hospital berkenaan pada 17 Februari 2010. Pesakit meninggal dunia 2 minggu kemudian dengan penyebab kematian dicatatkan sebagai “Septicemic Shock with Acute Respiratory Distress Syndrome secondary to H1N1 Infection”. Walaupun jangkitan influenza A(H1N1) bagi kes ini dikatakan sebagai `secondary’, kejadian kematian ini menunjukkan penularan H1N1 walaupun agak rendah boleh menyebabkan kematian jika rawatan awal tidak ambil.

Oleh itu wahai kenkawan sekalian. Sentiasalah berjaga-berjaga. Langkah-langkah pencegahan sama jugak macam biasa. U all mesti dah tau. Tinggal nak ngan tak nak or jangan jadi macam aku slumber badak. Or consider nak amek vaksin? Bleh klik cni. Aku dah bebel pasal vaksin H1N1 ni kat sini.

Vaksin H1N1.. Perlu ker??

Image dari Google

Menteri Kesihatan kita telah announce tentang vaksin H1N1 sebanyak 300 000 untuk golongan berisiko- ibu mengandung, mereka-mereka yg mempunyai penyakit kronik seperti diabetes dan hypertension, kanak-kanak dan warga emas. Sesetengah klinik kesihatan dah ada vaksin ni.

Peringkat awal vaksin H1N1 telah diberikan kepada seluruh frontliners Malaysia macam doctors, nurses, pharmacist, medical assistants dan lain2 individu yang terlibat dalam bidang kesihatan sejak hujung tahun lepas lagi. Semua petugas kesihatan perlu menandatangani consent untuk mengambil vaksin ni. Yang tak mo amek pon kena sign jugak menyatakan tidak bersetuju untuk ambil. Ada juga terdapat frontliners yang tak mo amek vaksin ni. Antara reasons diorang ialah:

1) Nak observe dulu macam mana reaction staf yang da amek. Nak tengok side effects yg diorang experience. Kebanyakan staf mengalami common side effects macam demam, rasa sakit kat tempat injection, rasa lemah badan, sakit paler, loya dll.

2) Untuk sesuatu produk farmaseutikal berada di pasaran kajian yg diperlukan bukan sehari dua. More than 10 years ok. Sedangkan produk yang dah bertahun-tahun kat pasaran pon kena tarik balik sebab side effects yang baru dikesan. Produk farmaseutikal jugak perlu menjalani beberapa fasa clinical trial sebelum boleh berada di pasaran. Vaksin H1N1 amek masa 6 bulan jek!

3) Reaction atau keberkesanan sesuatu produk tak sama untuk semua orang. Ok untuk ko blom tentu ok untuk ko yg satu lagi. Tak jadi kat ko yg ini blom tentu tak jadi kat ko yg itu. Fisiologi setiap orang berbeza!

Kalau google kat internet macam2 isu pasal vaksin ni dipersoalkan.

1) Halal ke tak vaksin ni?

Kalo vaksin H1N1 brand Pandemrix keluaran GSK insyaAllah halal. Sebab vaksin ni dihasilkan menggunakan medium telur. So kalo sapa alergik telur sah2 tak bleh. Tapi kan yang jadi isu satu lagi vaksin keluaran Baxter. Brand name vaksin tu Celvapan. Kalo ikut leaflet Celvapan dihasilkan melalu Vero cell-continous cell line of mammalian origin. Ada jugak yg cakap porcine base a.k.a khinzir. Yang ni aku tak sure sbb the leaflet cuma mention mammalian origin tapi tak gitau plak binatang apa. Yg aku tau kt Malaysia cuma ada Pandemrix. Tapi korang kena btol2 make sure brand apa sebelum wat decision nak amek. Yer la. Benda2 syubhah ni elok dijauhkan.

2) Kandungan thiomersal yang terdapat di dalam vaksin yang boleh merbahayakan kesihatan?

Thiomersal digunakan di dalam vaksin sebagai pengawet. Ada yg berpendapat kandungan thiomersal ini boleh meningkatkan risiko untuk mendapat kanser. Btol ker? Ini kenyataan yang aku amek dari WHO.

Thiomersal does not contain methyl mercury, which is a naturally-occurring compound and whose toxic effects on humans have been well studied. Thiomersal contains a different form of mercury (i.e. ethyl mercury, which does not accumulate, is metabolized and removed from the body much faster than methyl mercury).

The safety of thiomersal has been rigorously reviewed by scientific groups. There is no evidence of toxicity in infants, children or adults, including pregnant women, exposed to thiomersal in vaccines.

3) Vaksin ni boleh menyebabkan Guillain-Barre Syndrome (GBS) ?

GBS- rapidly developing, immune-mediated disorder of the peripheral nervous system that results in muscular weakness. Most people recover completely but some have chronic weakness. It can develop following a variety of infections, including influenza. In people who have been immunized with available vaccines, the frequency of GBS usually is the same as in unvaccinated people-WHO-

Tahukah korang pada tahun 1976 semasa kempen vaksinasi influenza 10 persons per million vaccinated persons developed GBS (pesal cam ngeri je nih??) Ni yang WHO jawab.

The reason why GBS developed in association with that specific vaccine has never been firmly established. The potential for the development of a similar risk with future vaccines can never be totally excluded. However, pandemic influenza vaccines are manufactured according to established standards, and are similar to recent well-studied influenza vaccines that have shown no association with GBS. Surveillance after vaccines have been sold (post-marketing surveillance) is being conducted to look for potential developments of serious adverse events. Safety monitoring systems are an integral part of strategies for the implementation of the new pandemic influenza vaccines.

4) Cukup ke 1 dos ataupun kena amek 2 doses to boost the immune system?

Immunization experts recommend a single dose of vaccine in adults and adolescents from 10 years of age and above, provided this use is consistent with regulatory authorities' indications. More study is advised on effective dosage regimens for immuno-suppressed persons for whom two doses of vaccine may be needed. Where national authorities have made children a priority for early vaccination, experts are advising one dose of vaccine to as many children as possible over the age of 6 months and younger than 10 years of age. Recommendations on numbers of dosages may need to be adapted rapidly as new data emerges. -WHO-

Menteri Kesihatan memberi jaminan sesungguhnya vaksin ni selamat untuk digunakan. (Kenapa rasa macam tak selamat jek).

Tadi Ketua Jururawat datang. Dia gitau Timbalan Pengarah cakap sapa yang blom amek vaksin H1N1 wajib amek. Biar btol? Pesal nak berwajib2 plak. Dah tu pesal nak sign consent kalo wajib. Aisehhh.. Doakan aku selamat yer..

PERHATIAN: Toner mata yang glamer tu kena tarik dari market..!

Dah lama aku tak masuk website KKM (Kementerian Kesihatan Malaysia) Masa H1N1 tengah gempak 2-3 bulan lepas almost everyday aku godek website KKM ni. Bler da masuk website KKM mesti masuk website pharmacy gak nk tengok latest issue. Tengok2 ada isu yg tersangatlah menarik. Iaitu pasal toner mata yang sangatlah glamer. Cerita pasal produk toner mata ni aku dapat dari website pharmacy KKM. 1st time aku dengar pasal toner mata brand Permata Hijrah ni dari apit. Wife dia, Rose pakai. Diorang cakap berkesan. Pastu ternampak gak dalam berita. Kalo korang antara pengguna toner mata ni better read this entry till the end.

Kalo korang malas baca aku citer serba sedikit pasal hal ni. Kalo korang nak tau sebanyak 27 produk kosmetik telah ditarik balik dari pasaran sebab diorang notify produk ni sebagai produk kosmetik untuk kegunaan luar mata contohnya di lingkaran mata untuk hilangkan kedut atau lingkaran gelap keliling mata. TETAPI.. pengeluar nih telah menggunakan produk keluaran mereka untuk merawat any eye disorders dengan cara menitis ke dalam mata. Kalo korang nak tau, any produk yang digunakan untuk merawat mata yakni memasukkan ubt tersebut ke dalam mata, produk tersebut tidak boleh dinotify sebagai produk kosmetik. Tetapi mestilah dinotify sebagai produk farmaseutikal. Dan bler bercakap pasal produk farmaseutikal lagi banyak lah peraturan dan undang2 yang perlu dipatuhi. Bukan saja untuk ubat titis mata. Ubat titis hidung pon sama jugak dalam kes nih.

27 produk ini tidak lagi boleh diimport, dikilangkan, dijual dan diedar. Pihak berkuasa juga telah mengarahkan semua produk tersebut dikeluarkan dari pasaran. Antara produk yg terlibat:

1. TONER MATA PERMATA HIJRAH AINUN 12.90 SERI MH UMMI SDN BHD

2. TONER MATA PERMATA HIJRAH AINUN 29.90 SERI MH UMMI SDN BHD

3. TONER MATA PERMATA HIJRAH AINUN59.90 SERI MH UMMI SDN BHD

4. PERMATA HIJRAH TONER HIDUNG 9.90 SERI MH UMMI SDN BHD

5. AINUN SYIFA TONER MATA YAMNI INDUSTRIES SDN BHD

6. AINUN TONER MATA AL JABBAR MANUFACTURING SDN. BHD.

7. ANFUN TONER HIDUNG SEDUAN YAMNI INDUSTRIES SDN BHD

8. MAHLIGAI SELASIH TONER MATA YAMNI INDUSTRIES SDN BHD

9. MEDI SUNNAH TONER MATA YAMNI INDUSTRIES SDN BHD

10. PERMATA HIJRAH AINUN TONER MATA YAMNI INDUSTRIES SDN BHD

11. TONER HIDUNG YAMNI INDUSTRIES SDN BHD

12. TONER HIDUNG YAMNI INDUSTRIES SDN BHD

13. TONER HIDUNG ANFUN SYIFA YAMNI INDUSTRIES SDN BHD

14. TONER HIDUNG SEDUAN N YAMNI INDUSTRIES SDN BHD

15. TONER MATA YAMNI INDUSTRIES SDN BHD

16. TONER MATA AINUN SYIFA YAMNI INDUSTRIES SDN BHD

17. TONER MULUT FAHMUN SYIFA YAMNI INDUSTRIES SDN BHD

18. ALKALINE THERAPY PEARL EXTRACT I PERMATA HIJRAHRESOURCES

19. ALKALINE THERAPY PEARL EXTRACT IV PERMATA HIJRAH RESOURCES

20. ALKALINE THERAPY PEARL EXTRACT II PERMATA HIJRAH RESOURCES

21. ALKALINE THERAPY PEARL EXTRACT III PERMATA HIJRAH RESOURCES

22. ALKALINE THERAPY PEARL EXTRACT V PERMATA HIJRAH RESOURCES

23. ALKALINE THERAPY PEARL EXTRACT VI PERMATA HIJRAH RESOURCES

24. AINUN TAHARAH EYE SPRAY NEUTRAL THERAPY I PERMATA HIJRAH RESOURCES

25. AINUN TAHARAH EYE SPRAY NEUTRAL THERAPY II PERMATA HIJRAH RESOURCES

26. AINUN TAHARAH EYE SPRAY DAY & NIGHT I PERMATA HIJRAHRESOURCES

27. AINUN TAHARAH EYE SPRAY DAY & NIGHT II PERMATA HIJRAH RESOURCES

Isu ni kuar kat paper jugak. Check this..

Penglihatan adalah anugerah yang tak ternilai dariNYA...

23/12: Aku shopping kat Carrefour Penang siang tadi.
Ternampak lah booth Permata Hijrah ni kat situ.
Terdapat produk2 yang tersenarai kat atas still dijual kat situ.
Hurmm... Salah siapa??

AKPK: Tentang Duit Kamu dan Hutang Kamu

Hari keempat tersadai di bilik menunggu hubby habis kursus, MHI dah jadi must watch programme aku kat Cameron Highlands ni.

Aku nak share sumthing yg useful. Pernah dengar AKPK??
Iklan AKPK ni selalu jek kuar kat tv. Tapi aku tak pernah amek pusing langsung sehinggalah aku tengok satu slot khas dalam MHI bercerita tentang AKPK. Dengan masa yang sangat banyak untuk surfing internet aku pon godek2 la pasal AKPK. Fyi, AKPK website ni ada dua version. Malay and English.

AKPK atau pun penuhnya Agensi Kaunseling Dan Pengurusan Kredit adalah satu agensi di bawah Bank Negara yang ditubuhkan pada April 2006 bagi menyediakan kaunseling kewangan dan pengurusan hutang kepada mana-mana individu secara percuma. Yupp..!!! Perkhidmatan yang diberikan adalah PERCUMA!!!!

Antara perkhidmatan yang ditawarkan adalah Pendidikan Kewangan, Kaunseling Kewangan dan Pengurusan Kredit. Klik di sini untuk mengetahui dengan lebih lanjut tentang perkhidmatan yang ditawarkan.

One more thing yang menarik yang aku jumpa di dalam web AKPK, diorang ada bagi tips tentang pengurusan kewangan. Antara artikel yang menarik:
1) Hidup Dengan Duit Yang Sedikit
2) Hubungan Anda Dengan Duit
Banyak lagi artikel menarik yang lain yang bleh korang baca di sini.

Till now.. happy reading!!

How To Satisfy Your Fussy Eater

As your child develops, he tends to get more choosy and picky about his food. Your little one may eagerly enjoy carrots one day and then reject them the next. Good news is this is a very normal behaviour and there are things you can do to manage this.

Set the environment
Sometimes, it’s not the food but the setting that makes a child unsettled and therefore fussy. Try to sit and eat together as a family (even though you may have to eat before or after you have fed your little one). This helps to create an environment of family togetherness.

	Set the table with everything before you start your meal so you don’t have to keep leaving the table for things
	Switch off all distractions that are nearby that might make your child want to come down from the high chair
	Create an environment where the family eats together and share special moments
	Lay out special fun cutlery and child proof bowls and plates that will make your child feel special about mealtime. Do not give your child too many utensils in case it becomes a distraction
	Try to include your child in the conversations so that he is encouraged to eat well
	Remember to be a good example for your child and stay at the table throughout!

Creative feeding
Sometimes, the food itself makes your child fussy. Here are other ways that might help your child to eat his meal and vegetables.

	Cut them into smaller sizes. Don’t scare your child with big portions. Prepare them a different way
	Variety! Mince the vegetable with chicken and make a chicken-ball
	Don’t hurry him, especially with new food. Children play with their food because they are children and they are discovering! Don’t make it a bad experience to be at the dinner table
	Let your child get messy. It’s more fun. Perhaps for your sanity, place newspapers on the floor surrounding the meal table and give your child his or her own plate, bowl and spoon
	Eat what you are feeding your child as an example to them
	Again, try not to force your child. While you determine what and when to feed your child, let him or her decide if your little one wants to and how much to eat
	Be practical. If parents through the ages have all been having this challenge, it would be very highly unlikely that you will be the first in history to have the perfect eater.
	“Taugeh” may not be your child’s favourite, but you can make it exciting to discover new foods while sharing mealtimes together.
	Be patient. It may take up to 10 to 15 tries and experimentation for your child to accept new foods or preparations.
	Remember, you were once a child and hated your vegetables too! An article from Nestle

For more information check HERE