Today, Derek and I have a little toast at home to celebrate the achievement of our dental practice for receiving a SME Award from DHL SCMP Business Annual Award. Three years of continuous refinement and unfaltering belief that if we always put our patient first, all the good things shall follow.
I would like to share, Derek’s speech during the online award ceremony.
” On behalf of @centralsmilehk , we are truly honoured and grateful to the “HK Business Awards”, South China Morning Post and DHL for awarding us the SME Award for 2020. Thank you.
Central Smile was founded just over three years ago. I never could have imagined the opportunities and challenges we have faced over this short period.
Although the name Small and Medium Size Enterprises gives a notion of a “petite” industry. But in fact, SME’s account for almost 50% of total employment in HK. So collectively we are by no means “small”.
There have been obvious challenges for SME’s and government initiatives such as the “Employment Support Scheme” and “SME Loan Guarantee Scheme” have been instrumental in keeping many businesses afloat. We hope such schemes will continue to support local businesses as we overcome this pandemic together.
I am optimistic about our future. As a society, we have faced many challenges before; The Asian Financial Crisis, SARS, social unrest and now COVID. Hong Kongers have always been entrepreneurial, spirited and hard working. Qualities fit for battle hardened society to flourish. There are many opportunities on the horizon and we look forward to expansion possibilities locally and further afield in the Greater Bay Area.
Personally I would like to also take this opportunity to share my gratitude and recognise the people that have been instrumental. Namely my wife @rosannewng, my parents Vivian and Richard Baram, the management team and all team members at Central Smile. Without your help, Central Smile would not be what it is today.
We don’t take this award for granted. It will spur us on. We hope to continue to develop into something we and our society can be proud of.”
#southchinamorningpost #dhlscmpbusinessaward #centralsmile #centralsmilehk #smeaward #2020 #drderekbaram #rosannewong #thankful #blessed
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dental practice management 在 Dr. 林葳牙科診療室 Facebook 的最佳解答
💉服用通血路藥物的病人, 牙科手術前需不需停藥? 💉
☝️首先,我們要了解什麼是通血路藥物。
血液的凝固,需要靠凝血因子與血小板的作用。依照不同的作用原理,可以分為抗血小板藥物與抗凝血劑。
💊抗血小板藥物
作用原理:抑制血小板
常見藥物:阿斯匹靈/伯基(Bokey/Aspirin)、保栓通(Plavix/Clopidogrel)、百無凝(Brilinta/Ticagrelor)…等。
適應症:缺血性腦中風、心肌梗塞…等
💊抗凝血劑
作用原理:抑制凝血因子
常見藥物:可邁丁錠(Coumadin/Warfarin)、普栓達(Pradax/Dabigatran)、拜瑞妥(Xarelto/Rivaroxaban)、艾必克凝(Eliquis/Apixaban)…等。
適應症:靜脈栓塞、心房顫動血栓型中風…等
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✌️牙科手術前需不需要停藥?
過去普遍認為,服用通血路藥物者,狀況允許下最好先停藥一段時間,等凝血功能較為正常,再做牙科手術(Aspirin停7天,wafarin停5天)。但這幾年似乎有越來越多的研究認為不一定要停藥-理由是未停藥的流血風險可能被高估,而停藥的心血管風險則被低估。貿然停藥可能會導致心血管併發症的風險。
💊抗血小板藥物
不停藥:增加的流血風險應該不高,且多半無生命危險。
停藥:增加的血栓風險也應該不高,但有可能致命。
Michael J. Wahl 2014年的文獻回顧,1,282位未停藥的牙科手術患者,只有2.7%需要術後局部止血,較嚴重而無法以局部方式止血者可能只有0.2%[1]。Kovacic 2012年的研究,任何理由停藥造成的血栓機率大約1% [2]。Biondi-Zoccai 2006年的統合分析(meta- analysis),停藥造成的嚴重心血管病變風險可能增加3.14倍(註1),若是裝心臟支架的病人停藥風險則會明顯更高)(註2)[3]。S. Nathwani 2016年在英國牙醫學會的期刊(British Dental Journal)撰文建議,服用抗小板藥物者雖然牙科術後出血風險增加,但多半可經由局部處理安全地止血而不需停藥[4]。
💊抗凝血藥物
停藥造成的栓塞,致命性可能高過未停藥造成的流血,雖然機率都相當低。
Michael J. Wahl 2015年的文獻回顧,5,431位未停藥的患者中,有0.6%無法以簡單的局部方式止血,當中沒有人因失血而死亡;而在2,673位停藥或減量的患者,出現栓塞併發症(embolic complications)的機率0.8%,其中危及性命(fatal event)的機率則為0.2%[5]。2015年的另一篇文獻回顧指出,服用wafarin者若INR在therapeutic range內,牙科手術前應該可以不用停藥[6]。Mariele認為INR = 2.5的狀態最適合牙科手術,Al-Mubarak表示INR < 3,拔牙前不停藥還算安全[7]。INR > 3.0則要小心,不要貿然做侵入性治療。
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👌結論
受限於研究方式以及病人個體的差異,停藥增加的心血管風險、以及不停藥引發的流血風險,難以確切計算機率。然而對於一般的牙科門診手術,多半可以局部方式達到止血。紗布加壓、傷口縫合、止血棉甚至膠原蛋白,都是常見有效的局部止血方式。
由於醫療存在高度差異且需要高度分工、再加上藥物的推陳出新,停藥與否有賴病人、內科醫師、牙科醫師(甚至口腔外科醫師)充分評估與討論。各位病友千萬別未經醫師許可就擅自停藥!
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註1. OR = 3.14 [1.75–5.61], P = 0.0001。嚴格來說odds ratio不能當成是機率, 但為了方便一般民眾理解,故以此解釋。
註2. OR = 89.78 [29.90–269.60]
參考資料:
1. Wahl, M.J., Dental surgery and antiplatelet agents: bleed or die. Am J Med, 2014. 127(4): p. 260-7.
2. Kovacic, J.C., et al., Safety of temporary and permanent suspension of antiplatelet therapy after drug eluting stent implantation in contemporary "real-world" practice. J Interv Cardiol, 2012. 25(5): p. 482-92.
3. Biondi-Zoccai, G.G., et al., A systematic review and meta-analysis on the hazards of discontinuing or not adhering to aspirin among 50,279 patients at risk for coronary artery disease. Eur Heart J, 2006. 27(22): p. 2667-74.
4. Nathwani, S. and K. Martin, Exodontia in dual antiplatelet therapy: the evidence. Br Dent J, 2016. 220(5): p. 235-8.
5. Wahl, M.J., et al., Dental surgery in anticoagulated patients--stop the interruption. Oral Surg Oral Med Oral Pathol Oral Radiol, 2015. 119(2): p. 136-57.
6. Management of Dental Extractions in Patients taking Warfarin as Anticoagulant Treatment A Systematic Review.
7. Al-Mubarak, S., et al., Evaluation of dental extractions, suturing and INR on postoperative bleeding of patients maintained on oral anticoagulant therapy. Br Dent J, 2007. 203(7): p. E15; discussion 410-1.
dental practice management 在 HKU Dry Club Facebook 的最讚貼文
#Dryclub選科攻略
正所謂三歲定八十 三歲嘅你如果有父幹 已經唔使憂 亦唔使睇以下呢個post
但係如果你同千千萬萬既我地一樣只可以靠自己 咁你就要緊貼本會嘅每一個post
事關呢段期間本會將會不停更新大部份u同一啲熱門科嘅重要資訊 包括學科內容 chur嘅程度 性價比 同就業前景等等
除咗被動咁坐係度睇 本會絕對歡迎你inbox/交post/comment/發問 唔怕你9up淨係怕你唔up
雖則呢啲資料只供參考 但係如果你有選擇困難症就要記得follow啦
最後係admin強嘅溫馨小提示:
1. 揀科同揀U同樣咁重要
2. 能力與興趣並重
3. 第時返工食嘅屎係你揀科嘅時候個腦入嘅水
3. 留意各院校男女比例 :o)
唔講咁多廢話 即係嚟第一個post
#HKU #Surveying #001
近排好多人問應唔應該入surveying/乜係surveying/surveying 定archi
我以surv jj 嘅角度分析一下啦
Surv有分幾種 General Practice, Quantity Surveying, Building Surveying, Land Surveying, Property Management, Planning and Development 等等
General Practice (gp) 就係産業測量師。即係689果種 gp 做嘅野其實同地産bba 差唔多 可以做下估價師 幫人估啲物業值幾錢
另外好多gp 其實最終想做嘅都只不過係agent 就係幫地産商賣樓 收commission 當然唔係做普通地産經紀 而你就高級少少 因為你係測量師 所以好多投資者會搵你買樓希望買到回報高嘅樓 而有時我講緊嘅樓唔係4~500呎果啲 而係一橦橦咁賣 commission 可想然知幾咁高 當你做得旺一年賺幾百萬絶對易過食生菜 但provided that 經濟要好 唔好景果時屎都無得你食 所以風險都幾大
Quantity Surveying (qs) 就係工料測量師。即係幫工程控制成本。初入行你會做好多paper work 例如度數 執tender document 格式 等等 但當你考完牌一路做上去就會掂到啲procurement 同 contract嘅野 (因應唔同客人同工程性質會需要不同procurement 方法同不同contract condition 而呢啲factor 會大大影響一單工程嘅cash flow)
而有啲qs 會做埋調解糾紛 亦因為qs 需要好強嘅法律知識所以有好多qs 甚至會做埋律師
Qs 工作好穩定 market 長期缺人 工程好多上哂馬 未來應該都有一排會旺
不過其實一句講哂:qs就係要幫一項工程管所有錢嘅野
Building Surveying (bs) 就相對GP同QS Technical野就會多D既,一個建築測量
師既工作大概係樓宇圖則設計、建築物條例、樓宇勘察、工程合約管理、樓宇結構
等等,但係我都知道一個dse雞都好大機會都唔知呢d係咩黎既。有興趣進一步了解
bs係咩可以睇下呢位人兄寫既一篇文http://viztor0429.mysinablog.com/index.php?op=ViewArticle&articleId=3195677
.而大部係做bs d人grad左之後,其實都係會aim考牌先,考到牌人工實數係幾多就好難講啦,只可以話都叫唔錯啦。
最後我個人覺得相對上理科人係會岩bs多過qs同gp既。
HKU surveying 就教哂 gp qs bs planning. 但本人感覺着重gp 但其實都等於無教過
我覺得Surveying 呢一科係世界上無一個人會有興趣的 而我亦未聽過人講有興趣 通常入唔到medic dental law 就end up 係呢到 如果你唔想入乞食科 高不成低不就 呢科係你無奈嘅選擇
呢科唔係學術科 係專業訓練學科 等將來大家可以做一部專業嘅機器
至於對於而家surveying 收咁高都有人狗衝我真係笑而不語
利申:9up
dental practice management 在 5 Tips for Successful Dental Practice Management - YouTube 的推薦與評價
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