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Fitness and Nutrition Awards 2019

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A New Golden Age for Medical Herbalism

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A New Golden Age for Medical Herbalism medicine clinic in Singapore. Last year, SLC was recognised in Global Health & Pharma out more about the company’s ethos, culture and imminent future. The alternative medicine sector has flourished on the back of a renewed interest in the greater health and wellness sphere over the last couple of years. People are now actively seeking out healthier, more sustainable, natural alternatives to pharmaceuticals, following in the footsteps of their ancestors hundreds of years ago. Herbal remedies, perhaps too easily dismissed as ‘old wives tales’ are now thoroughly in vogue, their effectiveness reinforced by scientific research. Unlike its popular Chinese variant, Sebastian’s unique take on medical herbalism finds its origins in Classical Europe, through the work of noted

physicians Hippocrates, Galen and Pedanius Dioscorides – an ancient sort of wisdom. Sebastian takes a moment to offer more insight into his work. “My work involves clinical consultations for clients and patients who want to seek alternative treatment or solutions for their health conditions. They are usually mature adults and young families who believe in the natural approach to health and treatment of a variety of diseases – autoimmune, allergies, skin diseases such as eczema and hives, fatigue, heart diseases, hormonal issues, depression and anxiety, to name a few. To this day, Sebastian Liew Centre remains a bastion of medical herbalism, and one of the few centres in Asia

who advocate for a European approach. “My practice is one of a kind in Singapore. Many people in the region are still ignorant of phytomedicine, though many are familiar with traditional Chinese medicine. I try my best to be a healing-centred medical herbalist, always putting my patients’ interests first, and profits second. I also enjoy sharing my experiences and knowledge via my blog, articles, talks and books, so people can have informed choices and an avenue for healthy, effective alternatives.” “I am known to dispense safe, high quality, pharmaceutical grade herbal medicine, health products and supplements, supported by personal coaching and a holistic approach. I am very much known in my circle to

always and constantly be looking for the highest quality products for my clients. I believe my circle of clients and followers also realise I am not a trend follower. I stand for what I believe and stand by what I don’t.” As we come to the close of the interview, Sebastian takes some time to talk about the future of his company. Most notably, 2019 heralds a new product range under the brand name, Leaf to Life, which aims to help others across Asia to benefit from Sebastian’s twenty years of experience in complementary health practices. “We will have a completely new website and social media platform, with the aim to reach out to people across the Asia Pacific. The Leaf to Life brand has a special focus on wholistic aging™, a term I coined to mean a state of wholeness and functional ability in our physical body, mind, and soul. I hope to do more education through Leaf to Life all over Singapore and beyond so that more people will liver a better and healthful lives.”

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Company: Sebastian Liew Centre Pte Ltd Director Name: Sebastian Liew Address: 150, Orchard Road, Orchard Plaza, #07-06, Singapore 238841 Website: http://leaftolife.com.sg Telephone: +65-65389978

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25 x High end hard copies of your fourpage brochure brochure The Consultant Pharmacist: A beacon for change

The Consultant Pharmacist: A beacon for change Leeds Teaching Hospital, discusses how consultant pharmacists can lead the way in ‘medicines Recently, I had a referral to my Advanced Cardiology Medicines Optimisation Clinic from one of our cardiologists to review a patient who had issues with their antihypertensives. After assessing his experience and thoughts about the medicines he was prescribed, it was clear that the patient was not satisfied with his current therapy – seven antihypertensives and no control of his blood pressure. The sad reality is that this can be common place. Pill burden for many patients is high. Many patients are on many medicines and their benefits and effectiveness are not routinely assessed. Medicines need to be optimised to meet the needs of patients, ensure that they are safe, and most importantly efficacious. In this case, we safely took the patient down from seven antihypertensive to three – needless to say, he was very pleased, and his blood pressure was well controlled by rationalising his antihypertensive therapy. A vital part of medicines optimisation is ensuring patients feel listened to and involved in the decision-making process about their conditions and medicines. This is only one snippet of what a consultant cardiology pharmacist does! 2018 saw the National Health Service celebrate its 70th anniversary, and over the last 70 years, while the core values have remained the same, the service

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that it provides and demographic that it treats has evolved dramatically. Over the last century, handwritten prescriptions in Latin have made way for computerised prescriptions dispensed by state-of-the-art machines. A quarter of the population live with a long-term medical condition and up to 50% of medicines prescribed for longterm conditions are not adhered to. The increasing problem of polypharmacy, multimorbidity and a medicated ageing population is driving greater scrutiny around clinical and cost-effectiveness, particularly in the context of widespread healthcare cuts. The modern-day patient requires clinical multidisciplinary teams to collaborate, now more than ever. We must drive best practice in complex care pathways to alleviate the health and economic burden that diseases place on already stretched healthcare systems. As part of my role as a Consultant Pharmacist, this is an area where there is a high expectation. We are responsible for leading the way in ‘medicines optimisation’ to help patients achieve the best outcomes with their treatments through patient and person- centred care. Medicines optimisation is guided by four principles which; recognise the patient experience, establish evidence-based treatment choices, ensure the safe use of medicines, and require medicines

optimisation to be part of routine practice.1 Medicines optimisation drives innovation and ensures that healthcare systems benefit the patients they serve. An example of this can be seen in coronary heart disease, a condition which has, in the past, seen around 40% of patients not adhering to the life-saving therapies prescribed and the delivery of sub-optimal secondary prevention therapy in many cases. Somewhat surprisingly, these issues remained despite multiple national published guidance by National Institute of Healthcare Excellence (NICE), quality standards and technology appraisals aimed at addressing the burden of chronic heart disease. At six weeks post-discharge, we found that over 60% of our patients with myocardial infarction (MI) were not receiving their secondary prevention medicines as recommended by NICE guidelines. Through the application of the principles of medicines optimisation (and medicines adherence), my colleagues and I successfully reengineered the post-MI pathway at our Trust. Based on previous research and audits carried out within our team, the cardiology and pharmacy departments collaborated to establish a post-MI Medicines Optimisation Clinic. Based on our research in medicines adherence, we were able to develop a tool which allows patients to

communicate the barriers that can potentially prevent them from adhering to their medicines – the My Experience of Taking Medicines Questionnaire (MYMEDS). Within the first year, medicines optimisation post-MI were improved significantly with angiotensin converting enzyme (ACE) inhibitors dosing improving from 16% to 74% and beta blockers from 6% to 46%. The new service also created capacity within our cardiology outpatient clinics, which reduced the waiting time to be seen post-discharge by over 50%.3 The outcomes were not only well received by our patients and peers but has now been fully commissioned in Leeds after the first phase of the proof of concept was partially industry funded as part of a joint working agreement. Key to such innovation is reflection. Pausing to think about how a healthcare system should be fulfilling the needs of patients, encourages us as Consultant Pharmacists, with the support of multidisciplinary teams, to take stock and critically assess missed opportunities along the patient journey. The concept of missed opportunities is an important one, and it can often highlight room for improvement in places that a department may feel fairly confident in its performance. Another area that we explored recently with our cardiologists is the prevalence of anaemia among our patients who were admitted with heart failure. Along with a one of our leading heart failure nurses at my hospital in

Leeds, we examined, through a retrospective audit, the prevalence of anaemia and iron studies during the admission of patients with heart failure. This stemmed out of the principles of medicines optimisation, where we need to treat patients holistically. Evidence shows that the prevalence of anaemia and iron deficiency is high among patients with heart failure with detrimental effects on their quality of life and economic impact on the wider health system. While the standards for haemoglobin testing were well adhered to, iron studies were not conducted in hospital as frequently as advised by guidance such as the European Society of Cardiology (ESC) guidance which recommends screening patients with HF for

anaemia and assessing their iron status.4, Anaemia could have many causes and therefore patients should be examined to identify the reason for their anaemia. Patients with iron deficiency as defined by the ESC guidelines should be considered for iron supplementation. Some evidence shows that symptomatic patients with iron deficiency who receive intravenous iron have improvements in symptoms, exercise capacity and quality of life compared to those who are not treated. Our audit showed that there was lack of awareness of the additional investigations that should be undertaken while managing patients with heart failure to reduce missed opportunities and improve outcomes for patients.4 We are

working with our cardiologists to address this.

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As a Consultant Pharmacist, it is not just our role to implement guidelines, but also influence them and share best practice at a national and international level. We ensure that our findings and innovations are disseminated and shared on national and international platforms to raise awareness and enable our peers to translate research into their daily practice.

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Collaboration and multidisciplinary working Patient and person-centred care Data collection to show that interventions work and support any business case submission Ensuring the outcomes measured are relevant and important to patients and the healthcare system in its totality Considering how research can be translated into practice

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Uncovering, implementing and driving best practice is no mean feat, but it is possible. Five learnings that have been central to the advancement of medicines optimisation in the cardiology department at Leeds Teaching Hospitals NHS Trust are:

Underpinning all of these principals is a holistic mindset that sees beyond the symptoms, patient and department before us, but the healthcare community as a whole.

ards 2019 Fitness and Nutri tion Aw

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Q4 2018

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Research, Translation, Commercialisation

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Leading Providers of  Advanced, NaturallyFormulated Pet Products Broadreach Nature + is a market leading, award-winning provider of natural health supplements for pets. Over a number of years they have worked closely with Veterinarians

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First Human Study Capsule to Replace

Safety and Tolerability of RaniPill™ Capsule in Humans Advances Oral Delivery of Injectable Biologic Drugs The first human study of a pill designed to replace injections of biologics is being announced by Rani Therapeutics, the inventor of the RaniPill™ capsule. The human study follows more than 100 animal studies testing the RaniPill capsule’s delivery of drugs such as insulin and Humira into the wall of the small intestine, where Rani has demonstrated 100% equivalence with injections.

BMI with no adverse events. The study showed similar intestinal deployment times for both fasted and fed subjects, indicating that food does not impact the RaniPill capsule’s performance. The next human study will be conducted later this year and will include a drug-filled resorbable needle.

The human study was conducted at a Clinical Research Organization (CRO) in Texas, under the Investigational Review Board (IRB) approval. There were two sub-groups, one cohort was fed and another fasted. Each subject swallowed a drug-free version of the RaniPill capsule. The study, which evaluated the RaniPill capsule platform, focused on safety and tolerability.

This human study builds on Rani’s extensive preclinical porcine and canine studies conducted over five years with 10 molecules, including antibodies, peptides, and proteins. These studies in large animal models have demonstrated delivery equivalent to 3 milligrams (mg) or 3,000 micrograms (µg) of drug and bioavailability that is on par or better than subcutaneous injections. For context, 3,000 µg translates into 80 units of insulin. This dosage covers not only the pre-diabetic patient (300 micrograms) but also patients with more severe chronic diabetes conditions.

The results revealed no sensation of the capsule inflating or deploying, and the successful passing of the remnants. The RaniPill capsule was welltolerated by both male and female adult subjects of similar

“This is a first-of-its-kind innovation that combines a range of disciplines from engineering, chemistry and materials science to anatomy, physiology, and biochemistry to convert injectable drugs into pills,” said Mir Imran,

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Fitness and Nutrition Awards 2019 This is to certify that: Rani’s Chairman and CEO. “The safety and tolerability of the RaniPill capsule in this first human study give us confidence in our platform as we prepare for human testing of the RaniPill capsule with Octreotide (a drug for the treatment of acromegaly) in the coming months.” Rani’s extensive intellectual property portfolio, which includes over 150 patent applications filed and more than 50 patents issued in the U.S., covers important innovations for injecting into the gastrointestinal tract including the stomach and intestines. Dennis Ausiello, M.D., Physician-in-Chief, Emeritus at

Massachusetts General Hospital and Jackson Distinguished Professor of Clinical Medicine at Harvard Medical School and Rani board member added, “The oral delivery of biologics is considered the holy grail of drug delivery. Rani has generated impressive bioavailability data in preclinical testing, while methodically and significantly de-risking its platform. With strong preclinical results and an extensive patent portfolio, Rani is poised to benefit patients across a range of therapeutic areas, including diabetes, psoriasis, Crohn’s disease, rheumatoid arthritis, hemophilia, among others.”

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GHB17002

CALCIVIS Launches its Unique CALCIVIS Imaging System in the United Kingdom -

CALCIVIS, a medical devices company focused on revolutionising the management of tooth decay, has announced the first commercial launch of its unique CALCIVIS imaging system in the United Kingdom (UK). The CALCIVIS imaging system is a sophisticated medical device and consumable combination designed to transform the assessment and management of dental caries and erosion. It involves a unique photoprotein that reacts directly with the calcium ions released from the tooth surface in the early stages of demineralisation. The photoprotein creates a vivid bioluminescence that is captured by the imaging device, providing visual evidence of early signs of decay. The resulting images provide dentists with unique visual information to discuss with their patients in support of their treatment plan.

(p<0.0001) and for sound (healthy) teeth there was 97.8% agreement (p<0.0001). User and patient questionnaires conducted as part of the clinical study showed that dentists found the product easy to use and that there was good acceptance of the CALCIVIS imaging system amongst patients who reported the procedure to be “quick and painless.” Adam Christie, CEO of CALCIVIS, said: “The first commercial launch of the CALCIVIS imaging system is a transformational event for preventive dentistry. We are confident that the availability of this unique system which enables the real-time detection and visualisation of

CALCIVIS has generated positive data from a pivotal clinical study that compared the CALCIVIS imaging system with the current best standard of care in the assessment of active dental demineralisation. Results from the study showed a highly significant level of agreement between the original dentist conducting the clinical assessment and the assessment of an independent dentist using the CALCIVIS imaging system. For teeth with active lesions there was 90.7% agreement

6 GHP / Biotechnology Awards 2018

demineralisation, an early sign of caries and erosion, will speed up the adoption of preventive dentistry in the UK. For the firsttime, dentists will be able to see active tooth demineralisation as it is happening, enabling them to develop a preventive treatment programme that will benefit both dentists and their patients.” He added: “Our confidence in the potential of the CALCIVIS imaging system has been reinforced by the very positive feedback we have seen from both dentists and patients during the product’s beta launch phase. We introduced the product to dental professionals in October last year at the Dental Showcase exhibition in Birmingham and have now created our own UK commercial organisation to

ensure that we can communicate the clear benefits that the CALCIVIS imaging system provides directly to the dental community. We believe its introduction will trigger the greater adoption of preventive dentistry, a more cost-effective approach to dental health that benefits both dentists and their patients.” CALCIVIS plans to launch its unique imaging system in the United States, the world’s largest dentistry market. The Company filed a PMA application with FDA in October 2017. The Company anticipates launching the CALCIVIS imaging system in the US in 2019, subject to the successful review of its PMA by FDA.

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