IPN March 2017

March 2017 Volume 9  Issue 3

THE INDEPENDENT VOICE OF PHARMACY

In this issue: NEWS: Green light for cannabis distribution Page 5

PROFILE: Taking to the road with Dr Michelle Barry Page 9

CONFERENCE: Healthcare Enterprise Alliance event Page 14

CPD: Nutritional Supplements Page 39

FEATURE: Analgesics Market in Ireland Page 58

REPORT: Non-Clinical Business CPD Page 64

Contents Page 4:

Foreword Journalist: Paulie Doyle This month in IPN we’ve witnessed a number of developments for Irish pharmacists, as well as a number of events held specifically for their and allied healthcare professionals benefit.

Cannabis distribution given the green light

The HPRA has released a report that has recommended cannabis based medicines be distributed as treatment for several treatments.

Page 9:

Turn to page 4 for more details.

Dr Michelle Barry talks diabetes, research and education

9

Page12:

With increasing numbers of people presenting to pharmacy with symptoms of food intolerance and allergies, Martin Lynch discusses the most common symptoms patients who present to a pharmacy suffer from, and the benefits pharmacists can glean from purchasing a food allergy intolerance indicator test.

CarePlus continues Ireland expansion

Page 14: Procurement procedures must improve, says Harris

You can read more about this on page 72.

14

Page 44:

Irish Pharmacy Awards 2017 – Have you entered?

PUBLISHER IPN Communications Ireland Ltd. Clifton House, Lower Fitzwilliam Street Dublin 2 00353 (01) 6690562

EDITOR - Kelly Jo Eastwood kjeastwood@hotmail.com

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EDITORIAL DEPARTMENT editorial@ipnirishpharmacynews.ie

COMMERCIAL MANAGER Barry Maguire Barry@ipnirishpharmacynews.ie ADVERTISING MANAGER Nicola McGarvey nicola@ipnirishpharmacynews.ie SALES AND MARKETING Aisling Twomey aisling@ipnirishpharmacynews.ie CONTRIBUTORS Mike Wakeman | Eugene Renehan Rachel Dungan | Martin Healy Roger Meacock DESIGN DIRECTOR Ian Stoddart Design

Regulars

Then on page 14 we look at a conference held by the HEA, in which the potential savings biogeneric drugs could have to the HSE drug budget were discussed. Present at the event was Minister Simon Harris, who stated that EU-wide joint procurement must be something that healthcare services strive towards.

Pharmacist Brian Kearney of Sam McCauley’s in Tralee recently organised an event providing information to the public about women’s health, in which a number of speakers, including Consultant Rheumatologist Dr Muhammad Harron were there to provide their expertise. More information on page 24.

MANAGING DIRECTOR Natalie Maginnis n-maginnis@btconnect.com

ACCOUNTS Jon Dickinson accounts@ipncommunication.com

On pages 9 and 10, we speak with Regional Medical Advisor for Novo Nordisk Doctor Michelle Barry, who travels the country giving healthcare professionals the latest in diabetes research.

Irish Pharmacy IRISH News is circulated PHARMACY to all independent, NEWS multiple and hospital pharmacist, government officials and departments, pharmacy managers, manufactures and wholesalers.

Buyers of pharmacy groups and healthcare outlets.

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All rights reserved by Irish Pharmacy News.

All material published in Irish Pharmacy News is copyright and no part of this magazine may be reproduced, stored in a retrieval system of transmitted in any form without written permission.

IPN Communications Ltd. have taken every care in compiling the magazine to ensure that it is correct at the time of going to press, however the publishers assume no responsibility for any effects from omissions or errors.

Feature: Generics

28

CPD: Nutritional Supplements 39

Save

On page 28 we look at regulations for generic drugs entering the EU market, as well as the state of the Irish generic market.

Eugene Renehan of Meagher’s Pharmacy breaks down some of the products on the Irish market for baby care on page 32.

Analgesics are discussed on page 58, with some information about some of the different medications available to patients, and the analgesics market itself.

This month will also see the OTC and Retail Pharmacy Product awards, which will be held in the Radisson Blue, in Dublin on March 3rd.

These awards act as a celebration and showcase of product innovation, marketing and value to its customers. Recognising the achievements of leading manufacturers and distributors in bringing new products and services to Ireland’s retail pharmacies. The entries received represent those leading the way in innovation.

Feature: Analgesics

58

Business CPD

64

Product Profiles

78

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News news brief PSI HOST PAS INFORMATION EVENTS Next month (March) the Pharmaceutical Society of Ireland (PSI) will host a further six information events aimed to support pharmacists in completing the Pharmacy Assessment System.

Like the events held in October and November 2016, these events will offer practical advice about using the Assessment System.

The events will take the form of short presentations, question and answer sessions and opportunity for one-to-one engagement at the end of the evening. Each session should last approximately 1.5 hours.

The PSI are encouraging pharmacists to register online to attend, and to do so in advance as places will be limited.

The events will be held at: the Newpark Hotel, Castlecomer Rd, Newpark Lower on Tuesday March 7th; Hotel Kilmore, Dublin Road Killygarry, Cavan on March 8h; the Ballina Manor Hotel, The Moy Ridgepool & Salmon Weir, Ballina, on March9th; Casteroy Park Hotel, Dublin Rd, Limerick on March 22nd.

The event to be held in the Clarion Hotel in Dublin is now booked out.

In addition, to help pharmacists keep on track, and support them in completing the Pharmacy Assessment System, the PSI has compiled a suggested completion schedule: It is suggested that pharmacists complete ‘Sale and Supply of Prescription Medicines ‘by March 2017, while ‘Documentation and Record’ keeping should be complete

by April. ‘Premises, Equipment Storage’, as well as Supply of Medicines to Patients in Residential Care Settings’ should be finished by May and June respectively.

Each month an email alert will be sent to supervising pharmacists and pharmacies with the suggested section of the Pharmacy Assessment System that should be completed.

4

Go ahead given for cannabis distribution A report to examine the potential use of cannabis for medical purposes in Ireland was published earlier this month by the Minister for Health Simon Harris, recommending that cannabis based medicines be used for specific medical conditions.

Cannabis for Medical Use – a Scientific Review makes eight recommendations and was compiled for the Minister by the HPRA, the state body that safeguards public health in relation to medicines.

An expert working group, convened by the HPRA, and chaired by Professor Tony O’Brien, Consultant Physician in Palliative Medicine, contributed to the review.

The report found that the scientific evidence supporting the safe and effective use of cannabis products for medical treatment is insufficient and at times conflicting.

Therefore, if a policy decision on access to cannabis for medicinal use is to be made, it advises that this must be controlled and confined to the treatment of specified medical conditions.

The specified medical conditions are: Spasticity associated with multiple sclerosis; Intractable nausea and vomiting associated with chemotherapy; Severe, refractory (treatment-resistant) epilepsy.

The HPRA suggests this would be a significant first step that recognises patient need, whilst providing patient protection through medical consultant

oversight. It recommends that access should only be undertaken within a legislative framework that provides for a central registry for collation of medical information and usage data to ensure accountability, and to inform the future direction of access to cannabis for medical purposes.

According to Dr Lorraine Nolan, Chief Executive of the HPRA, the outcome of the review confirms the many unknowns around the use of cannabis for medical purposes. It also highlights that the medicines’ regulations are not the barrier to cannabis access, as the main barrier is in fact the absence of sufficient scientific evidence-based information supporting cannabis as a treatment.

Dr Nolan said the HPRA recommendations provided for a “progressive first step that ensures safeguards are in place for individual patients and for society.

It is an incremental approach that puts oversight and accountability at the heart of the process. It will also encourage research and facilitate the collection of information to determine the future medical needs for cannabis in Ireland.”

Professor Tony O’Brien, Chairman of the expert working group, confirmed that based on the

available evidence, the working group was pleased to cautiously advise for the restricted use of cannabis products for a limited number of medical conditions.

“Currently, the scientific evidence is insufficient to offer the public the necessary assurances in respect of the medical use of cannabis products across a wider range of possible conditions. This is something that will be kept under review. With regard to the specified medical conditions, the use of cannabis products would be initiated under expert medical supervision on a trial basis, in situations where patients have failed to respond satisfactorily to standard treatment regimes.”

Professor O’Brien also noted that the primary function of the HPRA is to protect and enhance public health and explained that in assessing all health products, the HPRA must have due regard to the well-established authorisation process which is underpinned by scientific data.

Patients accessing cannabis through the programme should be under the care of a medical consultant and medical information and utilisation data should be kept on a central register.

Fleming medical signs ¤1.1m Oman distribution deal Fleming Medical, a key supplier of medical devices has recently signed a distribution agreement with Muscat Pharmacy to distribute its Medicare range of products in Oman.

The deal represents a value of ¤1.1million over the next three years and builds on the company’s strategy to grow its presence in the Middle East.

Fleming Medical was part of an Enterprise Ireland delegation of 20 Irish companies led by Minister for Employment & Small Business, Pat Breen TD that attended Arab Health 2017 in Dubai, the largest healthcare exhibition & medical congress in the Middle East.

appointment of Muscat Pharmacy as our distributor in Oman – we are very excited in seeing our Irish products on the shelves in Omani Pharmacies. This announcement is further strengthening both the

Fleming Medical & Medicare brands on an international stage – we look forward to exploring more new markets in the next few years”.

Founded by MD Mark Fleming 30 years ago in Limerick, the company currently operates successfully in more than 20 countries worldwide, trading in quality healthcare devices and consumables under the Medicare brand, among others.

Mark Fleming, said, “We are delighted to announce our

Mike Hogan, Director MENA Enterprise Ireland, Mr Patrick Hennessy (Ambassador of Ireland to the UAE), Dr Mohammed H. Darwish, Honorary Consul of Ireland to Oman, Mr Pat Breen, Minister for Employment & Small Business, Mohamed taken on the Enterprise Ireland Stand at Arab Health 2017

News Uniphar sells 11 Allcare pharmacies Drug wholesaler Uniphar has completed the sale of 11 Allcare pharmacies, it has been reported.

The company is also in the process of selling sell four more. Last year the company had announced that it was putting the pharmacies on the market.

Its primary competitor in Ireland is McKesson, which also owns the LloydsPharmacy chain of pharmacies, as well as Irish wholesaler United Drug.

Lat month, it was reported in Irish Pharmacy News that LloydsPharmacy and United Drug had announced a ‘joining of operations’, prompting concern from some pharmacists about a potential monopoly being acquired by a small number of companies.

Ger Rabbette, Chief Executive, Uniphar Speaking to the Sunday Independent, Ger Rabbette, Chief Executive of Uniphar said, “We’ve completed the sales of 11 Allcare stores back to the independent pharmacy community, and there are four more deals at an advanced stage.

“As a wholesaler, we think it’s important not to compete with our customers - retail pharmacists in Ireland are facing aggressive competition from the large multiples and especially from the

big international pharmacy chains.

“We don’t think they should have to contend with their wholesaler owning the pharmacy down the street as well… But it’s a key part of the national health infrastructure and makes sure that patients around the country can get the medicines they need when they need them.”

Currently, Uniphar controls roughly 50pc of the Irish drugs wholesale market.

Rabette noted that the pharmaceutical wholesale business was increasingly difficult due to low margins. He also told the paper that the growth opportunities for Uniphar were in its Manufacturer Services division.

“We have already seen significant progress in the businesses such as Star, PharmaSource and Point of Care that provide outsourced or specialist services to pharmaceutical manufacturers in the UK and Ireland.

“The group has ambitious plans to grow the Manufacturer Services division and leverage our strong UK/Ireland market position to build a substantial EU business.”

PSI Request for Nominations - Pharmaceutical Society of Ireland Registrar, Niall Byrne is requesting nominations from pharmacists on the Register of Pharmacists, held by the PSI, who may wish to stand for election for appointment to the PSI Council.

Nomination papers are available by request from the Registrar or are available to download by visiting www.thepsi.ie The closing date for receipt of nomination papers is Wednesday, 22 March 2017 at 12 noon. Nomination papers should be returned to the PSI office at PSI House, 15-19 Fenian Street, Dublin 2, D02 TD72.

The 2017 election for the appointment of pharmacist members to PSI Council is being conducted in accordance with the PSI (Council) Rules 2008 and 2015.

Rose McGrath joins McCartan Group Former Consumer Relationship Director and Wholesale Director at United Drug Rose McGrath has joined the McCartan group as Head of Operations.

“At McCartan’s we are glad to welcome Rose McGrath to our team. Rose has a wealth of experience in the Pharmacy sector,” said pharmacist Eoin McCartan, speaking to Irish Pharmacy News. “Rose will have an integral role in the introduction of new and implementation of any procedures to ensure the smooth operation of the company on a day to day basis.

“Through her role working in United Drug Rose has developed an extensive skill set which will

help drive our business forward.

Already Rose is looking at how we run our business and critically analysing both what we do well and what we could do better.”

Rose added, “I was delighted with the opportunity that Brian McCartan has given me to use my expertise to grow and enhance the McCartan Group. The wonderful experience I have had working with UD and their customers has helped me developed the knowledge and expertise which I hope to bring to the McCartan group.”

Rose Mary McGrath and McCartan’s Pharmacist Eoin McCartan

news brief REDUCTION IN PRESCRIPTION CHARGE FOR OVER 70S The Health (Amendment) Bill has now been brought to Cabinet. The Bill will allow for a reduction in the prescription charge for over-70s from ¤2.50 per item to ¤2, and is expected to proceed quickly through both Houses of the Oireachtas.

However, whilst welcoming the news, the Irish Cancer Society says the Bill doesn’t go far enough and reductions in the prescription charge need to be seen across all patient groups.

In October 2015, the Irish Cancer Society report “The Real Cost of Cancer”, found that, on average, regardless of whether a patient held a medical card or private insurance, the additional cost of cancer was ¤862 a month, at a time when patients were losing an average of ¤1,400 a month in income, through having to leave work or taking reduced hours.

The Society are calling on the Ministers for Health and Public Expenditure and Reform to abolish prescription charges for all medical card holders on a phased basis, beginning with Budget 2018.

Head of Services and Advocacy Donal Buggy said, “While we welcome the proposed move to reduce prescription charges for what is a vulnerable group who make up the majority of cancer patients, we believe action is required that will benefit the entire cancer population.

“The economic rationale no longer exists for prescription charges. We understand that they were introduced at the time of a catastrophic economic crisis, but since the last increase in the charge to ¤2.50, there has been a drop in the number of medical cards, the cost to the state of a medical card has fallen to its lowest point since 2003, the average pharmacy payment per medical card holder has fallen significantly, while the new pricing agreement with the pharmaceutical industry will deliver savings of ¤140m this year alone.”

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News 750 pharmacies take part in IPU’s news brief ‘operation transformation’ ‘GET BREATHLESS FOR COPD’ CYCLE 2017 COPD Support Ireland, in partnership with A. Menarini Pharmaceuticals Ireland, has opened registrations for the second year of the unique ‘Get Breathless for COPD’ event, a two-day challenge to cycle from Galway to Dublin raising vital funds for COPD services.

Supported by a professional crew of guides and support vehicles, the cycle will take place on June 23 and 24 2017, overnighting in the Hudson Bay Hotel in Athlone.

For seasoned cyclists or those just getting into the sport, the 2017 “Get Breathless for COPD” cycle will challenge all participants at an appropriate level. With event capacity increased in 2017, event organisers are hoping to raise in excess of the ¤18,000 raised in 2016.

Last year, Irish cycling legend Sean Kelly was appointed event champion and entertained participants from Galway to Athlone. Details of the 2017 Champion will be announced this Spring.

Keen cyclist, Irish Olympic Team Doctor and Consultant Respiratory Physician at the Mater Hospital Professor Sean Gaine will once again join the cycle, and encourages anyone interested to register, regardless of their experience.

Participants must pay ¤110 to enter the cycle and then raise a minimum of ¤250 for COPD Support Ireland. For each participant that meets the fundraising target, A. Menarini will make an additional donation to COPD Support Ireland.

Francis Lynch, A. Menarini Pharmaceuticals Ireland, said, “We are delighted to once again partner with COPD Support Ireland with the announcement of the second ‘Get breathless for COPD’ cycle, an exciting opportunity to raise awareness levels for COPD in Ireland, and to raise much-needed funds.”

Interest in the event is expected to be even higher than last year, so early registration is encouraged in order to avoid disappointment.

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As part of the Operation Transformation ‘Live Longer, Live Better’ campaign, the Irish Pharmacy Union (IPU) and hundreds of pharmacies around the country offered free blood pressure measurements to the public as part of a programme focusing on Strokes and Heart Attacks.

Almost 750 pharmacies took part, providing blood pressure measurement services and healthcare advice to patients from Thursday 26th January – Thursday 2nd February.

This is the third year that pharmacies have partnered with Operation Transformation to offer the public support in achieving a healthy lifestyle and weight.

On a global scale, the World Health Organisation (WHO) estimates that up to17 million people die every year from cardiovascular disease, representing almost one-third of all deaths globally.

The WHO also estimates that by 2020, heart disease and stroke will become the leading cause of both death and disability worldwide, with the number of fatalities projected to increase to over 20 million a year. The number is expected to increase by another 4 million by 2030.

Pharmacist Daragh Connolly, President of the IPU, said, “As

Daragh Connolly, President, IPU

the most accessible part of the healthcare system, pharmacists are delighted once again to partner with Operation Transformation to promote a healthy lifestyle and encourage members of the public to achieve and maintain a healthy weight.

“Blood pressure is an important

indicator and simple monitoring can play a key role in identifying serious healthcare issues. With the focus on strokes and heart attacks on the show this week, I encourage everyone to visit their nearest participating pharmacy over the next week to talk to their pharmacist and have their blood pressure checked.”

National Standard for Dispensing - Last month, the Health Information & Quality Authority (HIQA) published two national standards aimed at supporting the development of eHealth systems, which can enhance the quality, accessibility and efficiency across all healthcare services through the secure, timely, accurate and comprehensive exchange of clinical and administrative data.

These systems can ultimately lead to the provision of safer, better care.

• National Standard for a Dispensing Note Dataset and Clinical Document Architecture specification available at: https://www.hiqa.ie/publications/national-standard-dispensing-note-including-clinical-documentarchitecture-specifiction • National Standard for a Procedure Dataset including a Clinical Document Architecture specification available at: https://www.hiqa.ie/publications/national-standard-procedure-dataset-including-clinicaldocument-architecture-specification

Re-launch of Linoforce for Irish Market A.Vogel, in association with Wholefoods, has re-launched Linoforce as a pharmacy-exclusive product in the Irish market.

A.Vogel Linoforce, containing Linseed, Senna and Frangula, is a traditional herbal medicinal product for the short term relief of occasional constipation.

Most herbal laxatives are found in tablet form and this can be for a number of reasons.

Many well-known herbal laxatives are reasonably bulky (for example, linseed has a mucilaginous coating that swells in the presence of water) and it is their bulking action in the bowel that prompts the bowel to move.

The feeling of pressure on the bowel wall triggers nerve message that tell the body the bowel is full and needs to empty.

This type of laxative works when someone has hard, dry stools that are small in circumference and make no impact on the bowel wall, which tends to happen when the diet is full of highly processed, refined foods.

The bulking effect will not be had by anything except a physically bulking agent – a tincture cannot have this effect.

Linseed is known to exert its action 12-24 hours after taking it. It must be taken with plenty of water to swell the linseeds.

Maximum results are usually seen after 2-3 days of daily use.

Additionally, some of the herb constituents that affect the bowel do not transfer well into alcohol.

Sennosides A and B, found in senna, are quite large molecules and are not soluable in either water (tisanes or percolates) or tinctures.

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Profile

Taking to the road, in an Advisory role Dr Michelle Barry is a Regional Medical Advisor for Novo Nordisk. Within this remit she travels the country lecturing nurses, consultants, and other medical professionals about the latest in diabetes research, so that they can decide which drugs to provide for their patients. Here, she speaks to Irish Pharmacy News about her role, the latest in diabetes research, her unique position both within the company, and as a medical professional.

Novo Nordisk Novo Nordisk is a global healthcare company with more than 90 years of innovation and leadership in diabetes care. This heritage has given us experience and capabilities that also enable us to help people defeat other serious chronic conditions: haemophilia, growth disorders and obesity.

Headquartered in Denmark, Novo Nordisk employs approximately 40,000 employees in 75 countries, and markets its products in more than 180 countries. Novo Nordisk’s B shares are listed on Nasdaq Copenhagen (Novo-B). It’s ADRs are listed on the New York Stock Exchange (NVO).

Becoming an expert in diabetes research Like many Irish pharmacists, Dr Barry studied abroad, but eventually made her way home.

Discussing how she came to become an expert on diabetes research she says, “I studied in Brighton, and ended up being assigned a final year project about diabetes. I worked away on that and found that I absolutely loved it, and the research that was in it.

“I left Brighton and was in the process of doing my pre-reg, when I received a call offering me a PhD. That was an opportunity that I couldn’t pass up. When I returned I undertook locum work for a while, and was really looking for anything in the area of diabetes that I could get into, because I loved it so much.

Eventually I landed at Novo Nordisk.”

The work being carried by Dr Barry and Novo Nordisk is becoming increasingly important in the context of Irish healthcare.

Diabetes is of growing concern to Irish healthcare professionals.

The prevalence of Type 1 Diabetes, is currently on the rise in Ireland. The International Diabetes Federation Diabetes Atlas (2013) has estimated that there are currently 207,490 people with diabetes in Ireland in the 20 – 79 age group, and that by 2020 there will be 233,000 people with the condition, and by 2030 there would be 278,850 people with the condition.

Novo Nordisk and diabetes research “In diabetes research Novo Nordisk would really be seen as the biggest innovators in the market, they really push the boundaries” she explains.

Dr Barry’s job is unusual for a pharmacist. With Novo Nordisk placing a particular emphasis on medical affairs (the company boasts a global medical affairs team, with Michelle and her manager covering Ireland), she found herself travelling countrywide, lecturing healthcare professionals about the latest in diabetes research, development and science.

“Novo Nordisk is committed to doing everything we can to improve the treatment of diseases. This includes providing as much information as we can to healthcare professionals, healthcare organisations and patients about the proper use of the medicines and delivery systems we manufacture,” a transparency statement on the company’s website reads.

“Collaborations with healthcare professionals and healthcare organisations help us to drive innovation and develop new medicines, enhance quality of health education and identify patient needs…. We believe the transparency of financial relationships between those with whom we collaborate is very important to maintaining trust-based relationships with our patients and the public.”

Dr Michelle Barry

I ask Dr Barry if Novo Nordisk benefit commercially from her role in any way. “I don’t know if commercially there’s an added benefit but there’s certainly a benefit to healthcare professionals from roles like mine existing” she says.

“It’s really important that healthcare professionals understand the science behind the drugs, and ultimately they decide what’s best to prescribe to patients, – you just Provide the data on request. It really is a ‘yes you can or no you can’t.

“My job is to be as unbiased as

possible, I go to a lot of hospitals and simply give them the science: My job is to say ‘you can or cannot use this product in with the licence she says.

“They really drove home, in both of the interviews I did before I got the job, that my role is not promotional, even though Novo Nordisk of course produces its own drugs for diabetes. For instance, if I’m giving a lecture, I’ll always use slides that don’t have any logos or brands. I’m just there to provide the medical science behind a kind of insulin, usually at the request of a group of medical professionals.”

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Profile news brief Creating clarity on how each treatment works DEVELOPMENTS IN DISEASE RESEARCH The Horizon 2020 funded project TrainERS coordinated by NUI Galway, has released new findings on how communication is coordinated between the inside and outside of a cell. The discovery is set to open up new avenues for further research into treatments for Alzheimer’s, cancer and diabetes.

The discovery was made by researchers at the Laboratory of Cell Death Research and Therapy at the University of Leuven in Belgium. TrainERS is being coordinated by Professor Afshin Samali, CÚRAM Researcher and Professor of Biochemistry and Director of the Apoptosis Research Centre (ARC) at NUI Galway. The findings were published in the scientific journal Molecular Cell of which Professor Samali and his colleagues in Belgium are co-authors.

Proteins such as insulin are properly formed in the endoplasmic reticulum (ER), one of the biggest membrane structures in the cell. The ER works like an assembly line and folds the proteins into a three-dimensional shape that is essential for them to function.

When there is a problem in the ‘protein folding assembly line’, the accumulation of misfolded proteins can lead to diseases such as Alzheimer’s, cancer, and diabetes.

PERK, an enzyme known to detect protein folding errors in the cell has now also been revealed to coordinate the communication between the inside and the outside of the cell, and is an essential component of this protein folding factory.

Commenting on the new findings, Professor Afshin Samali of NUI Galway said, “This is an extremely exciting step forward for any researcher involved in understanding the ER stress response mechanistically and quantitatively.”

The project is funded by Research Foundation Flanders (FWO) and by TrainERS, an innovation training network funded by Horizon 2020 and coordinated by CÚRAM at NUI Galway. Alex van Vliet received funding from the Flemish government agency for Innovation by Science and Technology (IWT).

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and where they fit in the treatment cascade is critical for both patient safety and ensuring better outcomes for people with diabetes The latest in research Dr Barry’s employer provides a database of the latest knowledge and research for diabetes, which facilitates her doing her job – the company’s Global Medical Affairs team does all its’ own R&D in Copenhagen, and once a year it will get together and share their knowledge and experience.

“They really help keep me up to date with everything that’s going on,” she continues. “For example, at the end of the month, I have a week of medical training in which I’ll be updated on everything: they’ll dedicate a day or so to almost every topic, or every aspect of the latest research, and they’ll provide you with all the current information. And because they [Novo Nordisk] diabetes, they are really able to focus and provide the most in-depth knowledge possible.”

“Even if I have a medical query that I don’t know the answer to off hand,” she adds, “I can always contact someone in global who would have better access to that knowledge. So, I’m always able to access the information in some way!”

Diabetes research, she explains, is constantly changing, so a strong R&D department like Novo Nordisk’s is absolutely essential.

“I would say that pharmacists are up to their eyeballs with all these new medications that are coming in,” she says.

“And, diabetes itself has changed. For instance, when I was in college, treatment was all about getting levels down. Now, there’s all this new data that says you really shouldn’t be doing that because it’s actually really dangerous, that if they go too low they can affect a patient’s brain, they can go into hypoglycaemia, and now a coma. Driving regulations have even changed to say that they can’t drive if their levels are too low. So, it’s changing all the time.”

Recommending the best medicines She explains that although the cost of a medicine is considered, primarily, she just looks at the efficacy of the medication . “If you it’s a little bit different from some other ailments because you’re on the long-term illness scheme, ,” she says. “Primarily, people are just asking me ‘is there a benefit to this drug?’.

The Long Term Illness Scheme, is a government initiative that ensures that people suffering from certain conditions can get free drugs, medicines and medical and surgical appliances for their treatment. This scheme is administered by the Health Service Executive (HSE), under Section 59 of the Health Act 1970.

“Although, with that said, the subject of cost does come up now more than it used to,” she continues. “But with that said, cost is a much greater factor in somewhere like Britain. If you were in the UK it would be a part of your everyday life, talking about the economics of different drugs – the NHS means that certain drugs are available in certain parts of Britain but not others. Thankfully, it’s not like that here.”

A typical week?

I ask her about what a typical week working as a Regional Healthcare Advisor is like. “Well really, there is no typical week,” she says.

“So, for instance, what I was doing this morning was providing some diabetes nurses with a medical update. I was out in Blanchardstown for an hour a new insulin that’s on the market.

They wanted to know about it because they have patients using it, and they needed to know more about it. So, I designed a talk where I came in, talked for 45 minutes, then took some questions from them.

“Yesterday, I went to see a consultant, hear about research he’d been looking at, Then on Thursday I’m in Galway, so I’m always moving about the place!”

“I like talking to people, being out there and hearing about how patients and healthcare professionals are getting on” she says. “Although I did love research in an academic setting, I much prefer what I’m doing now, because it’s getting to see exactly what’s going on, up close.”

Novo Nordisk and the role of Regional Medical Advisor Novo Nordisk is one of few companies that have full time regional medical advisors, providing unbiased information to Irish healthcare professionals regarding the latest and best care for diabetes.

Speaking to Irish pharmacy News about Dr Barry’s role, Mr Owen Treacy, Country Manager, Novo Nordisk Ireland, said, “the role of Regional Medical has become essential for pharma companies to allow us to deliver high quality training and scientific updates to healthcare professionals and respond to medical enquiries reactively in Ireland. In Novo Nordisk, the area of diabetes is central to our research and development and this is a space which is becoming more and more complex with a greater range treatments now available to the prescriber.

“Creating clarity on how each treatment works and where they fit in the treatment cascade is critical for both patient safety and ensuring better outcomes for people with diabetes. Using a Medical Advisor to communicate information from various research sources allows the clinician, pharmacist or nurse to evaluate the risks and benefits of newer treatment options for their patients.”

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Advertorial Exciting growth for CarePlus Pharmacies as Group continues to expand in Ireland Since opening the first CarePlus Pharmacy in February 2015, Ireland’s fastest growing pharmacy group now operates over 30 branded pharmacies across the country and with aggressive expansions plans, the future looks very bright for the Group.

Tomas Conefrey cuts the ribbon to celebrate a new era in his family pharmacy in Pearse St, Dublin 2

Commenting on the expansion John Carroll, Chief Executive of CarePlus, said “When we started on our CarePlus expansion, we had a very clear strategic vision for the company and that vision is now very much a reality. We have partnered with likeminded pharmacists who share the same passion as we do for pharmacy health care in communities across Ireland.

Our independent pharmacist partners are really seeing the benefit of being part of the CarePlus Group”. Membership benefits of the Group are numerous and include access to a large support office network, improved cash flow, increased access to better purchasing deals, and the security of a unified centralised purchasing system, which would otherwise

12

not be available to independent businesses. “Our model is designed to work in tandem with a pharmacist’s locations’ specific business plan, backed up by a group of pharmacy and retail specialists. We felt that was a better approach than pursuing a co-operative model, which we felt didn’t offer that critical component necessary for a changing competitive landscape”, added Carroll.

At the heart of the CarePlus business philosophy, is the brand embracing a digitally proactive strategy. Pharmacists benefit from various technology systems that enhance and add value to their pharmacy operations and customer service. For pharmacists and their employees TouchPlus - the interactive bespoke ordering

system, together with iGnite, the Groups newest unique business intelligence system, CarePlus targets an improvement through their IT ordering platforms that drives efficiencies in the procurement of ethical, over the counter and front of shop product. Aligned with the Group’s buying differentiation strategy, is the company’s collaboration with Market Hub, which has positioned CarePlus as the first retail group in Ireland and the first pharmacy group in Ireland and the UK, to introduce electronic shelf edge labelling. This unique sector initiative provides pharmacists with labour saving and price accuracy synergies and further shows the commitment that CarePlus has to championing technological advancements in the retail sector, thus allowing

the pharmacist spend more valuable time speaking with customers and patients.

The new CarePlus App which launched in January, has been welcomed by both customers and pharmacists alike, with particularly positive feedback on its ‘order your prescription’ feature. “The take up on the app has been fantastic” according to Technology and Systems Director Finn McCann.

“It provides customers with a quick, easy and convenient service allowing customers to order their prescription without having to go to their pharmacy first. The App allows customers to select their local CarePlus Pharmacy, take a picture of their prescription (together with any notes for the pharmacist) and the prescription will be

dispatched to the pharmacy.

When the prescription is ready for collection, an alert will be sent to the customers’ phone and the transaction is completed on the physical presentation of the script. Not only does this save valuable time for the customer, it’s also beneficial for the pharmacist in that it allows them to timely plan the preparation of medicines for their customer, freeing up time to spend with them when they come to collect their medicine, added McCann.

At the heart of the CarePlus growth strategy is, of course, the pharmacists they work with. Out of the 12 pharmacies planned in the first quarter of this year, two official openings were already celebrated in January, welcoming Tomas Conefrey of Pearse St, Dublin and Aedine Browne of Cootehill, Co. Cavan to the CarePlus family. The Group have just announced further additions to their Primary Care Centre opening programme, with two greenfield sites opened in February, one of which is located near the PCC in Celbridge, Co. Kildare and owned by Pat Mangan. The second is located in the new Mullingar Primary Care Centre, opened by independent CarePlus pharmacist John Keane.

Aedine Browne, her team and customers officially open Browne’s CarePlus in Cootehill, Co. Cavan

We caught up with Independent pharmacist Aedine Browne, who has just opened a CarePlus pharmacy at the same location where her family has served the community in Cootehill for over 40 years. “We are delighted to offer our customers a better retail experience and the new brand and layout of the pharmacy definitely offers them this. I have been delighted with the support offered by CarePlus, from store design and merchandising expertise, to the purchasing and marketing support now at my disposal.”

Similarly, Tomas Conefrey whose family has run the pharmacy on Pearse Street for over 50 years, saw a similar opportunity to modernise his store and offer his customers a better service, which has always been the core focus of his family business. Commenting on the rebrand, Tomas said “I felt it was time for us to move forward and ensure we were providing our customers with a modern and welcoming pharmacy and

Launching electronic shelf edge labeling is John Carroll, Chief Executive, CarePlus; John Keane, Keane’s CarePlus Mullingar; Roy Horgan, CEO, Market Hub

CarePlus delivered on this in every way. They not only changed the layout of the store, they introduced new brands that will appeal more to our customers. Most importantly they took my own views on board and their Head of Store Design, Stephen McKay was very accommodating in this regard.”

The Group has also partnered with baby sleep expert Lucy

Wolfe, providing customers of CarePlus with free advice on getting their babies to sleep well through their hosted ‘baby sleep clinics’. John Carroll is keen on starting conversations with progressive pharmacists. “We believe that we can offer real added value to their business.

That’s not just a soundbite as we understand there is a cohort of pharmacists out there who will want to remain independent and unbranded. By

the same token, there are many unbranded who are thinking about joining a brand, or some who are with the wrong branded partner for their business.

Calling us is a good start in that process”, he says.

For more information about CarePlus Pharmacy, please contact John Carroll on 087 667 2359, Joey McNamara on 086 607 6019 or email us at info@careplus.ie.

13

Report Harris says ultimate goal is EU wide joint procurement Minister for Health Simon Harris has said that European countries must improve procurement procedures, and ultimately strive for joint procurement, if they are to improve the standard of treatment and care available to patients in the next number of decades.

The comment came from the Minister at conference hosted by the Health Enterprise Alliance (HEA) on Wednesday February 8th, in which the potential savings gleaned by the HSE using biosimilar drugs were discussed by the Minster, as well as Sandra Gannon and Dr Paul Cornes of the HEA .

The HEA are a lobby group for the generic drug and biosimilar sector.

“I think it’s important to say at the outset that advances in medicine, particularly in high-tech and innovative medicine have obviously paid a key role in improving the overall health of the population in this country,” said Minister Harris at the beginning of his speech.

“However, this comes at an everincreasing price.”

“The European Union has to start acting together in relation to the purchasing of medicines, and if not in relation to joint procurement, we at the very minimum must start working together in relation to horizon scanning, and in relation to the assessment of new medicines,” the minister said.

L-R: Mr David Delaney, HEA, European Markets Director Mylan; Mr Adrian van den Hoven, Director General, Medicines for Europe; Dr Paul Cornes, NHS Oncologist, Bristol Oncology Centre

“How can it possibly be acceptable to industry - but more importantly from my perspective, to patients - that a new medicine coming on the market will have to go through so many assessment processes from so many different countries before that medicine can become available?” he asked the crowd.

The Minister said the bill for hightech and innovative medicines rose from ¤170 million in 2005 to ¤590 million in the past 12 years, an enormous spike in cost, with the two most popular medicines on the budget costing ¤87 million, and ¤52 million respectively in 2010.

“As expenditure on medicines is expected to continue an upward trajectory in the next number of years, it is absolutely necessary that we consider new ways the ensure that patients have access to new medicines, but access to medicines in an affordable and sustainable manner,” the minister added. “…ultimately the potential for joint procurement do[es] offer the possibility of putting the medicines bill on a sustainable footing right across the EU.” Biosimilars and potential savings While the Minister acknowledged

14

L-R: Mr Owen McKeon, Vice President HEA, Country Manager Mylan; Ms Sandra Gannon, President HEA, General Manager Teva Pharmaceuticals Ireland; Ms Deirdre Kelly HEA, Country Manager Consilient Health; Mr Adrian van den Hoven, Director General, Medicines for Europe. that convincing doctors to prescribe them posed a challenge, he also stated that increasing the use of biosimilars had serious potential at driving down the cost of healthcare in both Ireland and the EU. Biosimilars are a biologic medical product, which are almost biologically identical to an original medicine, which can be made

after the original product’s patent expires. The drugs, advocates say, could potentially save the Irish health service millions of euros.

Ireland has the second worst use of biosimilars in the European Union, with the single biosimilar drug on the Irish market, Benepali, selling only three packs by the end of last year.

Mr Harris also said the Department of Health intended to publish the first national policy on biosimilars at some point in 2017, following the publishing a consultation paper on the potential uses of biosimilar drugs by the HSE in a bid to save money on its budget.

The conference also heard that in March 2016, that IMS Health, a leading provider of global health

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PRESCIBING INFORMATION DIORALYTE™ NATURAL, BLACKCURRANT AND CITRUS, POWDER FOR ORAL SOLUTION Presentation: Sachet containing the active ingredients Sodium Chloride 0.47g, Potassium Chloride 0.30g, Glucose 3.56g and Disodium Hydrogen Citrate 0.53g. Indications: Oral correction of fluid and electrolyte loss and the management of watery diarrhoea in infants, children and adults. Dosage and Administration: Each sachet should be reconstituted in 200ml (approximately 7 fluid ounces) of fresh drinking water. For infants where fresh drinking water is unavailable the water should be freshly boiled and cooled. The solution should be made up immediately before use. If refrigerated, the solution may be stored for up to 24 hours, otherwise any solution remaining an hour after reconstitution should be discarded. The solution must not be boiled after reconstitution. Daily intake may be based on a volume of 150ml/kg body weight for infants and 20-40 mg/kg body weight for adults and children. A reasonable approximation is: Infants – One to one and a half times the usual feed volume. For infants under 12 months, use only under medical advice. Children – One sachet after every loose motion. Adults (including elderly) – One or two sachets after every loose motion. More may be required initially to ensure early and full volume repletion. Contraindications: None known. Warnings and Precautions: The solution must not be reconstituted except with water at the volume stated. Solutions of greater concentration may result in hypernatraemia.

Those of greater dilution may result in inadequate replacement. If there is no improvement within 24-36 hours, consult the physician. If nausea and vomiting are present with the diarrhoea, small but frequent amounts of dioralyte should be drunk at first. No specific precautions are necessary in the elderly. However, caution is required in cases of severe Reference: 1. IMS Health OTC Market Overview, Data on file IE.OTC.14.02.03(1), January 2016 Date of Preparation: March 2016 SAIE.DIO.16.02.0021

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renal or hepatic impairment or other conditions where the normal electrolyte balance may be disturbed. Pregnancy and Lactation: Dioralyte is not contra-indicated in pregnancy or lactation. Interactions and Adverse Effects: None stated. Overdose: In the event of significant overdose, serum electrolytes should be evaluated as soon as possible, correct any abnormalities and monitor levels until return to normal, especially in the very young and in cases of severe hepatic or renal failure. Precautions for Storage: Do not store above 25°C. The reconstituted solution should be used immediately but may be stored for up to 24 hours in a refrigerator at 2-8°C. Marketing Authorisation Holder: Sanofi Ireland Ltd., Citywest Business Campus, Dublin 24. Marketing Authorisation No. PA 540/98/1 (Blackcurrant), PA 540/98/2 (Citrus), PA 540/99/1 (Natural) Legal Category: P Further information: Available from Sanofi Ireland Ltd., Citywest Business Campus, Dublin 24 or contact IEmedinfo@sanofi.com. Please refer to Summary of Product Characteristics which can be found on IPHA at http://www.medicines.ie/ before prescribing. Date of Preparation: January 2016 Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via HPRA Pharmacovigilance, Earlsfort Terrace, IRL - Dublin 2; Tel: +353 1 6764971; Fax: +353 1 6762517. Website: www.hpra.ie; E-mail: medsafety@hpra.ie. Suspected adverse events can also be reported to Sanofi Ireland Ltd. directly by emailing IEPharmacovigilance@Sanofi.com or calling 01 403 5600.

Report news brief ‘EXCITING’ RESEARCH IN TYPE 1 DIABETES A study looking at how to slow down the development of type 1 diabetes has uncovered some “extremely exciting” results, according to researchers.

A drug called GAD-alum has been found to help maintain insulin production in people with newly-diagnosed type 1 diabetes.

While the study only involved six participants, the study team believes their findings could represent a significant research milestone.

Johnny Ludvigsson, senior professor at Link University and principal investigator for the study, said, “The results for these six patients are very promising. Type 1 diabetes usually progresses gradually as the patient loses the ability to produce insulin, but this has not happened in these patients.

“We must follow them for a longer period and we must include more patients before we can say anything about the effectiveness of the treatment, but the results so far are extremely exciting.”

Ludvigsson and colleagues wanted to reduce attacks carried out by the immune system on insulin-producing cells, which causes type 1 diabetes.

The process often increases the presence of antibodies against the body’s own proteins, such as GAD65, in the beta cells.

The GAD-alum drug used in the study was developed based on GAD65, with researchers hoping it would make participants’ immune systems become more tolerant towards the protein.

information, estimated that by 2020, biosimilars have the potential to enter the market for several key biologics that have current sales of ¤40 billion euro. They also estimate that the cumulative potential savings from such drugs to health systems in the five major EU markets as are could be in the range of ¤50 billion euro in aggregate in the next five years and potentially reach as much as ¤100 billion.

“The development of new biosimilar medicines being brought to market is a very opportune moment for Ireland to capitalise on and to deliver better, more cost-effective use of medicines,” he said.

Criticisms of pricing agreement The conference came following statements from the HEA in June criticising the latest pricing agreement agreed by the IPHA as not providing enough savings to the Irish taxpayer and Irish patient.

The group claims such a deal prevents competition, and ultimately stops biosimilars from entering the Irish market.

The Irish Pharmaceutical Healthcare Association (IPHA), which represents the research based pharmaceutical industry in Ireland, has, however, strongly refuted claims by the Healthcare Enterprise Alliance (HEA) that the new pricing Agreement negotiated with the State last summer is not bringing value.

According to Oliver O’Connor, CEO of the IPHA, “The IPHA Agreement is now delivering savings of ¤12 million per month since it started on 1st August – on target for ¤140m in its first year. It is travesty for others to suggest we are not delivering value. There is no evidence that any other Association or other pharmaceutical companies are

Six people aged between 20 and 22, who had been diagnosed with type 1 diabetes six months previously, were given injections of GAD-alum into the groin.

They were also given vitamin D supplements, which have been shown to reduce the immune system’s inflammatory response.

16

Front Row: L-R: Ms Sandra Gannon, President HEA, General Manager Teva Pharmaceuticals Ireland; Mr Adrian van den Hoven, Director General, Medicines for Europe; Ms Deirdre Kelly HEA, Country Manager Consilient Health. Back Row: L-R: Dr Paul Cornes, NHS Oncologist, Bristol Oncology Centre; Dr Sean Barry, Executive Pharmaceutical Assessor Health Products Regulatory Authority; Mr Owen McKeon, Vice President HEA, Country Manager Mylan

L-R: Dr Gavin Jennings, Broadcaster/RTE; Dr Paul Cornes, NHS Oncologist, Bristol Oncology Centre; Ms Sandra Gannon, President HEA, General Manager Teva Pharmaceuticals Ireland; Dr Sean Barry, Executive Pharmaceutical Assessor Health Products Regulatory Authority

The findings showed the natural production of insulin in the participants’ bodies remained at a stable level.

“If these results are confirmed when we test more patients, it would be an extremely important advance,” added Ludvigsson.

L-R: Mr Owen McKeon, Vice President HEA, Country Manager Mylan; Ms Sandra Gannon, President HEA, General Manager Teva Pharmaceuticals Ireland; Ms Deirdre Kelly HEA, Country Manager Consilient Health; Mr Adrian van den Hoven, Director General, Medicines for Europe; Dr Sean Barry, Executive Pharmaceutical Assessor, Health Products Regulatory Authority

delivering savings to the State of anything like this scale. Nor have they set out any plans to do so.”

Minister Simon Harris T.D., Minister for Health; Ms Sandra Gannon, President HEA, General Manager Teva Pharmaceuticals Ireland

“The Agreement we negotiated with the State is delivering a package of measures with the State that will deliver over ¤785 million in savings to the taxpayer

up to 2020. That is the largest ever such package of savings the research-based pharmaceutical has delivered to State…Savings from the entry of biosimilars into Ireland are part of this package and have already started. We estimate that these savings will be over ¤100m.”

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IRE/CA/17-2418

News news brief DIGITAL TECHNOLOGY PARTNERSHIP CarePlus Pharmacy has announced a partnership with Market Hub Technologies, the innovative retail dynamic pricing company with offices in Cork, London and Boston.

The collaboration sees CarePlus become the first retail chain in Ireland and the first Pharmacy group in Ireland and the United Kingdom to introduce digital shelf labelling technology. This will allow CarePlus community pharmacists to manage their products and pricing digitally, by linking on shelf pricing into their point-of-sale (POS) systems.

Electronic labelling allows retailers to ensure price accuracy whilst making the collection, analysis and action of data easy, in order to improve sales and increase efficiency. It also provides consumers with clear and real-time pricing.

CarePlus Pharmacy has seen significant growth over the last two years through the rollout of a franchise-based retail Pharmacy offer that promotes the independence of an individual community pharmacist with the system and structure normally associated with larger multinational chains.

The company is now operating 35 pharmacies nationwide and is due to open a further 30 this year of which 12 locations have been confirmed in 2017.

At the launch of this new digital initiative in the new primary care centre in Mullingar, Chief Executive John Carroll said, “Pharmacy within Ireland has become a competitive arena, and as a Group, our focus is to empower the pharmacists and their employees to become best in class within their locality.

Roy Horgan CEO of MarketHub has said, “We’re delighted to have launched this partnership with such an exciting and dynamic brand as CarePlus Pharmacy. The combination of digital pricing and data analytics service helps retailers to realise the full potential of their stores.

Our partnership with CarePlus ensures we are a step closer to helping the Pharmacy stores with the digital transformation of their traditional physical retail footprint.”

18

Lack of awareness concern in Psoriasis New research launched on February 6th by the More than Skin Deep campaign has revealed that 46% of people with psoriasis have never heard of psoriatic arthritis. Yet, up to 30% of the estimated 73,000 people with psoriasis in Ireland may go on to develop the inflammatory arthritis that can cause pain, swelling and damage to joints.

According to the new research, 87% of people with psoriasis have not received any information on psoriatic arthritis and only 14% responded that they are well informed and know a lot about the condition. However, 90% of people with psoriasis are interested in learning more about the inflammatory joint disease.

Although the symptoms of psoriatic arthritis vary from personto-person, many symptoms are common to other forms of arthritis and include: Thickening, discoloration and pitting of the nails; Stiff, painful, swollen joints.

Psoriatic arthritis typically affects the ankle, knees, toes and lower back; Sausage-like swelling of the fingers or toes; Tenderness or pain where tendons or ligaments attach to bones. This commonly occurs at the heel or the bottom of the foot,

but it can also occur in the elbow; Pain and swelling at the back of the heel; Eye inflammation (less frequent).

“The symptoms of psoriatic arthritis are quite different to those of psoriasis in that it’s a disease of joints rather than a disease of the skin. Those affected will experience swelling, pain and stiffness in the joints and will have difficulty moving their joints, particularly the hands, knees or feet”, said Prof David Kane, Consultant Rheumatologist, Trinity College Dublin, Tallaght Hospital and Beacon Hospital.

“Early diagnosis of psoriatic arthritis is important. If we intervene and treat early we may be able to put the disease into remission and prevent permanent damage to the joints. I encourage

everyone with psoriasis to watch the More than Skin Deep video series to understand the signs and symptoms of psoriatic arthritis so they can be diagnosed and treated early,” he added.

The More than Skin Deep campaign has developed a series of videos that provide information from experts on psoriatic arthritis including the signs and symptoms and how it can be managed.

These videos are available on Arthritis Ireland and Janssen Ireland’s websites.

The videos are presented by Paul Walsh from RTE’s Doctor’s on Call and feature Marion Morrissey, who has psoriatic arthritis, Consultant Rheumatologist, Professor David Kane and Consultant Dermatologist, Dr Anne-Marie Tobin.

GSK holds Barretstown ‘serious fun’ day The GSK “Serious Fun” day was held on February 24th, in celebration of a new €1.2m GSK partnership with the SeriousFun Children’s Network (SFCN), which is represented by Barretstown in Ireland.

To date, GSK have provided over ¤8m in funding to Barretstown which has helped the charity to rebuild the lives of thousands of children who are coping with serious illness and to provide top class family camp facilities, medical assistance and a new hospital outreach programme.

Barretstown was founded by Hollywood actor Paul Newman in 1994 and modelled on his renowned Hole in the Wall Gang Camp in Connecticut, USA. It serves children affected by serious illnesses – primarily cancer and serious blood diseases and their families. Barretstown’s mission is to rebuild the lives of these children and their families. We believe that every child with a serious illness should enjoy their childhood.

The services provided to all of the children and families who come to Barretstown are entirely free of charge, so donations and fundraising efforts are vital for the charity to help more sick children experience the magic of Barretstown each year.

Barretstown is supported by donations and the fundraising efforts of corporate supporters, individuals and community groups.

Aidan Lynch, Vice President & General Manager, GSK, -Dee Ahearn, CEO of Barretstown

GSK runs a number of CSR initiatives with its employees, such as its volunteer programme, which has seen 350 GSK employees giving their time to Barretstown in a variety of ways, such as providing essential business expertise and training to the Barretstown team and acting as chaperones and translators on the camping programmes.

Dee Ahern, CEO of Barretstown, commented, “we have been

working with GSK now for nearly 25 years so we are delighted to announce the next phase of this very unique partnership. Without GSK, Barretstown simply wouldn’t be where we are today.

Our unique partnership with GSK really goes beyond financial support: our camps welcome hundreds of GSK volunteers every year who bring a wealth of expertise, enthusiasm and goodwill to our organisation.”

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IRE/IM/17-2390

Feature Understanding Premenstrual Syndrome PMS (premenstrual syndrome) is a condition that is often poorly understood by patients and their clinicians alike. Indeed, research has only really properly defined the disorder within the past two decades(1). The diagnosis of PMS is based upon the display of a mixture of psychological and somatic symptoms, which manifest themselves in the luteal phase of the menstrual cycle(2,3).

The condition is generally managed in primary care, however it is still debated whether PMS is predominantly psychological or hormonal, and it falls within the remit of gynaecologists or psychiatrists(4). tool. Although the approach of reduction of stress is not evidence based, it does appear to help in ameliorating the symptoms, as do dietary interventions such as control of carbohydrate cravings, limitation of alcohol and reduction of caffeine intake. There are data from nonrandomised trials that exercise also improves PMS symptoms. However, healthcare practitioners in UK have available an algorithm for the management of severe PMS from the Royal College of Gynaecologists(9). This consists of :-

Symptoms experienced by patients with PMS can be wide-ranging and many are reported in the literature(5). They are generally divided into those that are either predominantly psychological in their nature, predominantly physical, or are compound. However, the key discriminator that separates PMS from other disorders, is the pattern of symptom presentation.

Often a PMS patient will experience one or more of these symptoms for up to two weeks before the commencement of menstruation at which point they disappear. This is the differentiating pattern which defines PMS(6).

Hence PMS is characterised by a cyclical symptom fluctuation with symptoms appearing premenstrually, abating with the onset of menses, and reappearing again premenstrually in the next cycle. Generally, diagnosis requires marked premenstrual worsening of at least 5 symptoms that are not exacerbations of other disorders.

• Feeling overwhelmed or out of control • Other physical symptoms (such as headaches, breast tenderness or swelling, joint or muscle pain, bloating, or weight gain) may be experienced.

One of the largest European studies estimated that up to 60% of women of reproductive age suffer with some symptoms of PMS of varying severity and 3–8% suffer so severely that it causes significant impairment to daily life(7).

Aetiology

• Tension, anxiety, mood lability, tearfulness, or persistent irritability

The precise aetiology of PMS remains undetermined. However, a combination of cyclical ovarian activity together with the effect of oestradiol and progesterone on the neurotransmitters serotonin and GABA appear to be key factors. Since PMS is absent before puberty, in pregnancy and after the menopause, this observation supports the theory that cyclical ovarian activity is important. It appears that the rapid fluctuation in oestradiol levels, often occurring premenstrually, postnatally and perimenopausally, and sometimes in the same individual can lead to a series of hormone dependent disorders(8).

• Anger

Management

• Decreased interest in usual activities

The key to effective management of PMS is a correct diagnosis.

This needs to be made by the prospective of logging of symptoms by the patient, ideally over two cycles, since retrospective recall is an ineffective

Symptoms may include the following: • Feeling sad, hopeless, or self-deprecating

• Difficulty concentrating • Feeling fatigued • Changes in appetite

20

• Hypersomnia or insomnia

First line - exercise, cognitive behaviour therapy, vitamin B6, combined new generation oral contraceptive pill; continuous or luteal phase low-dose SSRIs Second line - oestradiol patches plus oral progesterone; higher dose SSRIs continuously or luteal phase Third line - Gonadotrophin releasing hormone (GnRH) analogues plus addback HRT Fourth line - total abdominal hysterectomy and bilateral oophorectomy plus HRT (including testosterone) As a result of these recommendations in the UK 45% of prescriptions of PMS are for psychotropic medications; 21% hormones; 9% vitamins; 9% analgesics and 16% for other medications(7).

Hence, there is a justified role, recommendation and possibly responsibility to use a natural approach and/or dietary interventions as first line strategies in the management of PMS in order to spare the patient the potential side effects and hazards associated with the latter stages of the step-wise approach outlined above. A number of dietary supplement strategies have been assessed in clinical settings over a number of years and found to be beneficial, but few studies have examined the benefits of combining together potentially synergistic natural ingredients(10-28). Therefore we investigated an approach bringing the best evidence together in a single presentation, whilst taking into consideration issues such as delivering a therapeutic dose (hence the exclusion of calcium

and magnesium) and complying with EU legislation regarding potentially active.

The primary objective of the study, which was based on Cleanmarine® For Women, was to evaluate the effectiveness of the formulation for the management of premenstrual syndrome. Primary outcome measure was based upon the scores of the self-assessment questionnaire for PMS symptoms at baseline compared to those at the end of three months. The study was designed as a prospective, open-label evaluation. Each dose of supplement contains thiamine hydrochloride, riboflavin, pyridoxine hydrochloride, vitamin D, with standardised soy isoflavone and rosemary extract in krill oil. 2 capsules were taken daily.

Based upon the global total symptom score at the onset of the trial compared to that of the end of treatment, there was an average 44% improvement-the improvement for individuals ranged from 10% to 80% with no participant failing to report a benefit in global symptom scores. The average reductions in symptoms during the same period were as follows anxiety 38%, bloating, 32%; mood 44%; breast tenderness 51%; skin outbreaks 37%; food cravings 37%; fatigue 25%; forgetfulness 35% ; insomnia 25% and headaches 31%. When the individual scores of those participants experiencing the most severe symptoms were examined, the following reductions in severity experienced by these specific patients were-70% anxiety; 69% bloating; 81%, breast tenderness; 69% skin outbreaks; 59% cravings; 60% fatigue; 77% forgetfulness; 62% insomnia and 70% headache.

Pharmacists can play a part in helping women to manage PMS through advice on lifestyle adjustments and on the use of dietary supplements. Given that nearly all women of child-bearing age have some premenstrual symptoms, especially those between their late 20s and early 40s, there is a growing demand for a PMS category in-store.

Mike Wakeman is a Pharmacist and Healthcare Consultant.

References available on request

National Advertising & PR Campaign March/April 2017

Goodbye PMS “I’ve been taking Cleanmarine® For Women for almost two years now, and it has made a huge difference to my life. PMS days are no more and I feel like my normal, happy self every day!”

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News news brief INTERIM REPORT ON RARE DISEASES Last month saw the publication of the Interim Report on the implementation of the National Rare Disease Plan for Ireland.

The National Rare Disease Plan, originally published in July 2014, provides a policy framework for the diagnosis and treatment of people with rare diseases, of which there are between 5000 and 8000. The plan made 48 recommendations designed to help improve the lives of people affected by rare disease.

An Oversight Group – chaired by the Department – was established to oversee progress with the plan.

In 2016 a number of projects were funded by the State with ¤1.686m, matched by charity funding of ¤1.224m.

The total funding of ¤2.91m is shared between 11 charities.

Six of the 15 projects with a total value of ¤1.1m address rare diseases. The next round of this joint funding initiative will open in autumn 2017. The EU commission now intends to explore the possibility to further strengthen the collaboration between Member States and the Commission in the area of research on rare diseases.

In addition, rare diseases have already been tabled on the agenda for North-South meetings. Therefore, future work to deepen cooperation between both jurisdictions on rare diseases is anticipated.

The establishment of a National Rare Disease Office (NRDO) featured prominently in the recommendations of the Rare Disease plan.

The national office has now been established by the HSE. Its work is currently led by the NCPRD Clinical Lead, Professor Eileen Treacy.

It is, among other functions, providing up-to-date information regarding new treatment and management options, including clinical trials. In addition, the post of Information Scientist for the office is being funded jointly by the HSE and the EU Commission.

22

Minor Ailment Scheme pilot report expected An HSE Report of the pilot Minor Ailment Scheme which ran in several community pharmacies last year is imminent. The three-month pilot ran from June to September, 2016. The report will include the views of pharmacists and GPs in the participating towns, along with feedback from patients who used the service.

The scheme ran in 19 pharmacies in Kells, Co Meath; Roscommon Town; Edenderry, Co Offaly; and Macroom, Co Cork.

The HSE has stated the Report is due early this year.

The aim of the scheme is to relieve GPs of some of the workload associated with the General Medical Services Scheme (GMS).

The Irish Pharmacy Union (IPU) said last year, it is estimated that minor ailments represent 18% of a GPs workload in the UK, costing the NHS some ¤2.5bn a year.

At present, GMS patients present at a GP surgery to obtain a prescription, even when the appropriate treatment is nonprescription medication. The proposed Minor Ailment Scheme will enable medical card patients to receive treatment for minor

ailments free of charge at their local Pharmacy.

In December of last year during an Oireachtas debate, Deputy John Brassil asked the Minister for Health Simon Harris for information on the status of the Government’s plans to expand the role of community pharmacists in managing the health of their patients and in medicine prescription.

Minister Harris was quoted as saying at the time, “In the context of the Programme for Government I am examining the potential for expanding the services that our contracted pharmacists deliver to public patients including in the areas such as vaccination, treatment of minor ailments and supply of emergency contraception.

“A pilot minor ailments project was run earlier this year by the HSE in conjunction with the Irish Pharmaceutical Union where medical card patients were treated for six minor conditions directly by the pharmacist. The outcome of this pilot is being assessed by the HSE.” Commenting on the commencement of the pilot last year, then IPU President Kathy Maher said, “The IPU is delighted that this pilot will commence on the 1st of June. We look forward to working with other healthcare professionals, including GPs, to deliver a service that will not only benefit patients but also reduce the pressure on hard-working local GPs allowing them to focus their valuable time on treating patients with more complex conditions, making better use of their resources.”

Call for Government to break down barriers Boots Ireland has encouraged policy makers to break down the barriers to Pharmacy-delivered smoking cessation support on Ash Wednesday, which was held on 1st March.

By making nicotine replacement therapy (NRT) more easily available at the point of access to smoking cessation support programmes, it will be easier for medical card holders to access the support they need to quit smoking for good.

Over one million people in Ireland, 23% of the population, currently smoke on a daily basis, yet almost 3 in 10 people who smoke have tried to quit in the last year. NRT medication in combination with behavioural support has been found to improve success rates of smoking cessation after six months by 70 – 100%.

Boots Ireland provides smoking cessation support via its Stop for Good service, a free 12 week programme with one-to-one personalised support, to help those who want to quit smoking for good. A review of the service found that;  Two thirds of those using the service (66%) patients feel they are dependent/heavily dependent on cigarettes  57% smoke between 11 and 20 cigarettes per day and the average number of years smoking was 22 years

Paula Reilly, Pharmacist, Boots Ireland  Over a quarter of service users (26%) have a medical card, and 40% of those use NRT  Almost 10% of smokers successfully completed the 12 week programme and quit smoking, with nearly 13% of medical card holders successfully quitting by week 12 The three step programme includes information materials, expert advice tailored for the individual, regular consultations with Boots smoking cessation experts and progress is monitored on a weekly basis in a convenient and accessible setting.

Paula Reilly, Pharmacist, Boots Ireland said, “Those trying to quit smoking have a variety of support options available to them and at Boots, we are committed to helping everyone to quit the habit successfully. For medical card holders, many of whom avail of the Stop for Good service, we want to make it as easy as possible for them to access combined NRT and behavioural support. This will encourage them to stick with the programme and get the help they need to quit smoking for good.”

9:45 - 16:30 9:45 - 16:30

Cork Airport Hotel - Cork

9:45 - 16:30 9:45 - 16:30

Cork Airport Hotel - Cork

News McCauleys prioritise women’s health A Women’s Health and Wellbeing Information Evening for members of the public was recently held by Sam McCauley Chemists, Tralee. of the need for information on various women’s health topics.

Claire McEvoy, Pharmacist Brian Kearney,Christine Foley, Madeleine Kelly, Roisin Donellan, Paula O’Dullivan and Clara Heinrick The event, which was sponsored by healthcare company MSD, was held in the Manor West Hotel, Tralee, on Thursday 26th January, and included an expert discussion around topics such fertility, healthy bones and joints, menopause, polycystic ovary syndrome, as

well as general wellbeing advice, including nutrition, skincare and exercise.

The compere for the evening was Brian Kearney, Supervising Pharmacist in Sam McCauley Chemists, Tralee, who also organised the event in recognition

Drawing in an attendance of over 300 people of all ages, the specialist set of speakers on the evening included Dr Mary McCaffrey Consultant Obstetrician/ Gynaecologist gave an extremely insightful talk on the menopause, polycystic ovary syndrome and fertility; Dr Muhammad Haroon, Consultant Rheumatologist spoke about osteoporosis and arthritis; Corinne Evans, Chartered Physiotherapist spoke about the importance of exercise as an adjunct to a healthy lifestyle; Liadh Fitzgerald, Biomedical Nutritionist spoke about the supplements needed throughout the life of a woman, and Claire McEvoy, makeup artist/skincare analyst who spoke about the skin implications of ageing and offered advice as to the products to target this.

A number of companies also came down on the night to show their support including Revive; Vitabiotics; Lifes2good; Cellnutrition – Quinton; Pharmacare Distribution; Scotia Clinic; Sam McCauleys Chemists; Flexiseq; Forever Living.

Speaking to Irish Pharmacy News, Brian Kearny said, “There was a massive turnout of over 300 people which by far exceeded our expectations. We plan to hopefully run it again next year certainly because the response has been so positive. A lot of people have been enquiring already and we have got very positive feedback from the public”.

“This health promotion event ties in very well with the take control of your health campaign in Sam McCauleys Chemists.”

As one challenging year draws to a close it seems timely to delude ourselves with an illusory crystal ball, to see what the sectors future might hold. Of 1850 stores nationally, 1300 the majority are in the hands of practicing pharmacists and their families.

A few trends are clear in analysing and predicting trends. Management Consultants can run a SWOT analysis of strengths, weaknesses, opportunities and threats. But we as the ones who face the patients - can take stock too.

The rise and consequent fall of chains / groups at the expense of independents has been loudly proclaimed; but reality is not so clear.

There are clear benefits in buying power and the perception of mass brands and marketing, but I believe the best independents will continue to thrive because their values, ethics, flexibility and sheer localness to their ‘locale’ can always win out.

Big UK chains such as Tesco have been given a bloody nose by the Irish market before. This is not the English shires and a one size fits all strategy is often clumsy and unsympathetic. Speaking Irish (or indeed Polish or Portuguese), can be a competitive advantage in certain communities if staff members have fluency and empathy.

The ‘foreign’ chains are often led by ex-supermarket management.

Their profit only culture clashes with pharmacies hybrid model of patient care and ethical professionalism. This dissonance

24

can lead to confrontation with the regulators and indeed their own staff cohorts who vote with their feet to leave.

Independent thinking may be frowned upon by head office as SOP’s can be blunt implements.

A grounded committed local independent can deliver unprecedented service levels because their roots run deep in communities via GAA, soccer or rugby, or through churches or other community involvement.

As long as they can strive to re-invent, refine and reconnect with their locale and their service offering there’s no reason why they cannot continue to prosper.

The new bigger chains have gained the most traction in newer anonymous commuter belts and in shopping centre locations. Their impersonal targets of car driving mums and the ‘worried well’ with social media offers and lost leaders can pick up retail sales.

But it’s a fickle transitory audience, that doesn’t deliver prescription volumes or indeed repeat predictable business.

It can be a little like a trendy night club audience moving onto the next happening hip place.

The rush to the bottom on below cost selling of private prescriptions is a case in point. In attempting

to grab market share it’s an exercise in short termism if there’s little margin or loyalty from a remote commuter, chasing a few euro saving as against the extra time petrol and parking required to gain an illusory saving.

I’ve recently regained some ‘snow bird’ retired civil servants script business who always claimed that their tablets are “cheaper in Spain.”

Inevitably the PCRS cuts have bit so hard on some items that we’re now cheaper in Ireland.

The unforeseen consequence of over-zealous cuts is the re-appearance of parallel exporting from Ireland to Europe as some lines are too cheap here.

My message to independents is to be proud of your personal brand and heritage. Don’t be shy to tell your story and expound your values publicly to your audience and remind your community of your longevity and service continuity.

For example, long associations with sports club shirt sponsorship I believe diversification and sub specialism will continue. Trying to be all things to all people as a generalist is challenging.

In towns, some pharmacies are seen as cosmetic retailers whilst another is seen as the go to for sound advice or procuring difficult

prescriptions others baulk at. I know which camp I’d rather be in!

Advanced services & holistic care will drive change.

Macroeconomic factors are supposedly changing in retailers favour, some positive growth indicators are levelled with wage rises, low interest rates, Brexit fears and uncertainty.

Paradoxically such uncertainty presents opportunity as weak sterling makes bulk importation cheaper on toiletries, which can be passed onto the consumer or to enhance margin.

The threat side looks stacked against all professions with ever increasing regulation and intrusion by state agencies into all aspects of enterprise. The pendulum of excessive regulation will duly swing back when a judge inevitably rules a poor patient outcome was caused by a scared over regulated healthcare professional.

In conclusion I think the future is bright for those smart enough to reinvent whilst still adhering to core service values and ethics. Putting the patient and their needs front and centre not lost in bureaucracy and process.

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Implanon NXT ® Etonogestrel ABRIDGED PRODUCT INFORMATION Refer to Summary of Product Characteristics before prescribing. Presentation: Preloaded applicator with a radiopaque non-biodegradable implant containing 68mg of etonogestrel. Indications: Contraception. Dosage and Administration: One implant should be inserted subdermally after pregnancy has been excluded. Each implant will last for up to 3 years. It is strongly recommended that Implanon NXT should only be inserted or removed by HCPs who have completed training for the insertion and removal technique and where appropriate that supervision be requested prior to insertion or removal. Insertion, removal and replacement instructions must be strictly followed. Contraindications: Active venous thromboembolic disorder, known or suspected sex-steroid sensitive malignancies, presence or history of liver tumours, presence/history of severe hepatic disease with current abnormal liver function tests, undiagnosed vaginal bleeding, hypersensitivity to ingredients. Precautions and Warnings: Risk of having breast cancer diagnosed in users of progestogen-only preparations is possibly similar to the slightly increased risk associated with combined OCs. This may be due to earlier diagnosis, the biological effects of the OC, or a combination of both. Some epidemiology studies have associated combined OC use with an increased incidence of VTE, DVT, PE and ATE, MI and IS Limited epidemiological data do not suggest an increased risk of VTE or ATE in women using the implant; however, there have been post-marketing reports of VTE & ATE. It is recommended to assess risk factors known to increase the risk of VTE & ATE. Caution patients with a history of thromboembolic disorders Remove implant in the event of a thrombosis and prior to long-term immobilisation. Abnormal liver function. Hypertension. Diabetes. Chloasma. HCPs may need to consider earlier replacement of the implant in heavier women. Ectopic pregnancy should be ruled out if a women presents with abdominal pain and amenorrhoea. History during pregnancy or previous use of sex steroids: jaundice and/or pruritis related to cholestasis, gallstone formation, porphyria, SLE, HUS, Sydenham’s chorea, herpes gestation is, otosclerosis, (hereditary) angioedema, anaphylactic reactions. Expulsion may occur if the implant is not inserted correctly or as a consequence of local inflammation. In rare cases the implant may migrate from the insertion site. There have been rare post marketing reports of implants located within the vessels of the arm and the pulmonary artery which may relate to deep insertions or intravascular insertion. Endovascular or surgical procedures may be required for implants that have migrated to the pulmonary artery. If the implant cannot be palpated, it should be localised and removed as soon as medically appropriate. There have been reports of broken or bent implants while in the patient’s arm. Based on in vitro data, when the implant is broken or bent, the release rate of etonogestrel may be slightly increased. This change is not expected to have clinically meaningful effects. When an implant is

removed, it is important to remove it in its entirety. Overdose: Remove previous implant before inserting a new one. There are no data on overdose with etonogestrel. Interactions: Possible interactions with phenytoin, barbiturates, primidone, bosentan, carbamazepine, rifampicin, oxcarbazepine, topiramate, felbamate, ritonavir, efavirenz, bocepravir, nevirapine, griseofulvin strong (eg ketoconazole, itraconazole, clarithromycin) or moderate (eg fluconazole,diltiazem, erythromycin) CYP3A4 inhibitors, ciclosporin, lamotrigine and St John’s Wort (hypericum perforatum). Implanon NXT may also interfere with the metabolism of other drugs - consult their prescribing information for details. Pregnancy and Lactation: Not indicated during pregnancy. Exclude pregnancy prior to insertion. Implanon NXT may be used during lactation, growth and development of the child should be carefully followed. SIDE EFFECTS: Very Common: Vaginal Infection, headache, acne, irregular bleeding, weight increase, breast tenderness and pain. Common: Alopecia, dizziness, depressed mood, affect lability, nervousness, nausea, flatulence, libido decreased, increased appetite, abdominal pain, ovarian cyst, painful menstruation, flu-like illness, pain, fatigue, weight decrease, insertion site pain or reaction and hot flushes. Other less common and rarely reported side effects are listed in the SPC. PACKAGE QUANTITY: Carton box with 1 blister pack. Legal Category: Prescription Medicine. Marketing Authorisation Number: PA 1286/50/1. Marketing Authorisation Holder: Merck Sharp & Dohme Ireland (Human Health) Limited, Red Oak North, South County Business Park, Leopardstown, Dublin 18. Ireland. Date of revision: November 2016. © Merck Sharp and Dohme Ireland (Human Health) Limited 2017. All rights reserved. Further information is available on request from: MSD, Red Oak North, South County Business Park, Leopardstown, Dublin D18 X5K7 or from www.medicines.ie. Date of preparation: February 2017.

Adverse events should be reported. Reporting forms and information can be found at www.hpra.ie Adverse events should also be reported to MSD (Tel: 01-299 8700) References 1. Otero Flores JB et al. Int J Gynecol and Obstet 2005;90:228-33.

2. Implanon NXT Summary of Product Characteristics November 2016.

Red Oak North, South County Business Park, Leopardstown, Dublin D18 X5K7 Ireland

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Zerochol is a Safe and Effective way to lower Cholesterol Coronary heart disease is one of the leading causes of death in Ireland. High cholesterol is one of the main risk factors affecting people of all ages, as it causes fatty deposits to build up in the arteries, making it harder for the heart to pump blood around the body. The Behaviour & Attitudes survey found that Four out of five adults aged over 45 are affected by high cholesterol – and worryingly, two thirds of these cases go untreated.

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in the graph opposite, taking 2 zerochol tablets daily resulted in 12% reduction in total cholesterol and 17% reduction in LDL “bad” cholesterol. Surprisingly, Zerochol increased HDL “good” cholesterol and reduced triglycerides by a massive 17%, another risk factor for heart disease. Overall, the research data showed a much better lipid profile after 3 months.

The study also found that 83% people were satisfied with Zerochol and 98% experienced no side effects.

Further positive results: A separate study involved 55 dyslipedaemic patients treated with cholesterol lowering medication (20mg of atorvastatin per day). These patients could not tolerate higher dose of atorvastatin due to side effects and had LDL levels above target value. Findings: Taking 2 zerochol tablets daily resulted in 18% reduction in total cholesterol and 26% reduction in LDL “bad” cholesterol. Interestingly, plant sterols or stanols in fortified foods don’t appear to affect HDL cholesterol or lower Triglycerides.

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Feature Generic medicines in the EU and Ireland The legal situation regarding authorisation of pharmaceutical products in the EU is complex, with each member state having its own competent authority in addition to the European Medicines Agency [EMA]. The EMA oversees EU-wide authorisation of medicines. to 210 days and, if successful, results in the granting of a marketing authorisation in that Member State.

When the assessment is completed, copies of the report are sent to all Member States.

The Concerned Member States then have 90 days to recognise the decision of the Reference Member State. National marketing authorizations are granted within 30 days after acknowledgement of the agreement.

Decentralised Procedure (DCP) The DCP is like the MRP but the difference lies in that it applies to medicinal products that have not received a marketing authorisation at the time of application.

The EMA defines a generic medicine as: a medicine that is developed to be the same as a medicine that has already been authorised (the ‘reference medicine’). A generic medicine contains the same active substance(s) as the reference medicine, and it is used at the same dose(s) to treat the same disease(s) as the reference medicine. However, the name of the medicine, its appearance (such as colour or shape) and its packaging can be different from those of the reference medicine.

Authorisation of a medicine in the EU can be done in three different ways: the Centralised Procedure [CP], the Decentralised Procedure [DCP] or the Mutual Recognition Procedure [MRP]. Some member states also have their own National Procedures [NP] allowing for a medicine to be authorised by an authority in a specific state.

The Centralised Procedure (CP) Obtaining a marketing authorisation that is valid throughout the EU is done though Centralised Procedure (CP), which came into operation in 1995.

Medicinal products manufactured using biotechnological processes, as well as for orphan medicinal products and for human medicine products containing a new active substance which was not authorised in the Community before 20 May 2004 (date of entry into force of Regulation (EC) No 726/2004) and which are intended for the treatment of AIDS, cancer, neurodegenerative disorder or diabetes, are required to go through the C. CP applications are made to, and approved by, the EMA. Mutual Recognition Procedure (MRP) A medicinal product must have already received a marketing authorisation in one Member State to be eligible for the MRP. For any medicinal products to be marketed in a Member State other than that in which they were first authorised, the MRP must be gone through, and is compulsory.

Any national marketing authorisation granted by an EU Member State’s national authority can be used to support

an application for its mutual recognition by other Member States.

The MRP is based on the principle of mutual recognition, by EU Member States of their respective national marketing authorizations.

An application for mutual recognition may be addressed to one or more Member States. The applications submitted must be identical and each Member State must be notified of them.

As soon as one Member State decides to evaluate the medicinal product (at which point it becomes the “Reference Member State”), it notifies this decision to other Member States (which then become the “Concerned Member States”) to whom applications have also been submitted.

Concerned Member States will then suspend their own evaluations, and await the Reference Member State’s decision on the product.

This evaluation procedure undertaken by the Reference Member State - may take up

With the DCP, an identical application for marketing authorisation is submitted simultaneously to the competent authorities of the Reference Member State and of the Concerned Member States. At the end of the procedure, the product dossier, as proposed by the Reference Member State, is approved. The subsequent steps are identical to the mutual recognition procedure.

As in the US, applicants for a marketing authorisation [MA] for a generic medicine in the EU may submit an abbreviated application. According to Article 10(1) of Directive 2001/83/EC, an applicant for an authorisation to market a generic medicine is not required to provide the results of pre-clinical and clinical trials if it can be demonstrated that the medicinal product is: A generic medicinal product or a similar biological medicinal product of a reference medicinal product, which has been authorised under Article 6 of Directive 2001/83/EC for not less than 8 years.

This type of application refers to information that is contained in the dossier of the authorisation of the reference product. This information is generally not completely available in the public

LOOKING AFTER YOU AND YOURS SINCE 1970 Here’s to the next 40 years, when we look forward to serving patients in Ireland even further.

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Feature domain. Authorisations for generic or similar biological medicinal products are therefore linked to the ‘original’ authorisation. This does not however mean that withdrawal of the authorisation for the reference product leads to the withdrawal of the authorisation for the generic product.

Generic medicine applications typically include chemical-pharmaceutical data and the results of bioequivalence studies, which demonstrate the similarity of the generic product relative to the reference medicine. As stated previously, the tolerance levels involved have been favourably compared to those acceptable for inter-batch variation during production of the originator medicine.

The authorising regulatory agency(ies) is referred to the data that were established in the originator product’s application for authorisation for information concerning the safety and efficacy of the active molecule. This is only possible once the data exclusivity period has expired on the originator product’s dossier.

Most authorizations for generic medicines are granted through the MRP and the DCP. Since the introduction of the DCP, the MRP has mainly been used for extending the existing marketing authorisation to other countries in what is known as the “repeat use” procedure.

EU bioequivalence parameters are like those mandated in the US, requiring that the test and reference products be contained within an acceptance interval of 80.00 – 125.00% of the AUC [area under the concentration time curve], which reflects the extent of exposure, or Cmax, at a 90% confidence interval. European guidelines, however, also provide a tightened acceptance interval of 90.00-111.11% for narrow therapeutic index drugs [NTIDs] as well as different assessment requirements for highly variable drug products [HVDPs].

Overall, both EU and US legislation for the authorisation of generic medicines allow for abbreviated applications to be made in the case of generic medicines. In both jurisdictions, pre-clinical and clinical studies do not have to be performed by the generic medicine applicant, but bioequivalence to the originator or “reference” medicine must be demonstrated.

This abbreviated application process is often quoted as one of the main reasons for the price difference between generic and

originator drugs. However, there is variation in generic medicine prices (e.g., within the single market European Union) unrelated to Research and Development expenditure and greatly influenced by local regulations and reimbursement arrangements that may, in some cases, be disassociated from the costs of manufacture and distribution.

Interviews were semi-structured and included quantitative assessments of opinions using 15 structured questions and a five-point Likert scale response system. Interview transcripts were coded and thematically analysed using NVivo (version 9), for qualitative data. Quantitative data were analysed using SPSS (version 20).

Other important influencers include demand-side pressures (i.e., education, engineering, economics, and enforcement), International Nonproprietary Name (INN) prescribing, and, specifically, reference pricing which have been widely adopted

by European governments.

Results

It is also worth noting that generic medicine pricing is being driven further downwards because of keen competition in this sector.

18% of people expressed the opinion that generics are not as effective as their brand counterparts, and about one-quarter (24 %) believed that generics were of poorer quality than originators. A majority of patients (86 %) were in favour of reference pricing and generic substitution.

There is evidence of European generic medicine manufacturers facing competition from Indian producers, and a now-established practice of discounting prices to Governments. Indeed, experts are now recommending that “European countries must continue learning from each other to fund increased volumes” and so exploit such discounts for bulk purchases. As a result of these and other factors, generic medicines are generally between 20 to 90% cheaper than their originator equivalents which has obvious implications for healthcare costs.

The Irish consumer and generics Are Irish consumers aware how similar generics are to their counterparts?

In June 2013 Ireland introduced generic substitution and reference pricing for the first time, in the hope of benefitting from the costsavings associated with use of generic medicines.

In a 2014 study conducted by the university of Limerick, it was found that a portion of consumers were unaware that generic drugs were almost identical to their counterparts, although those who were aware had confidence in them.

Before the UL study, perceptions of Irish patients towards generic medicines have never been published.

A total of 42 patients were recruited from general practices affiliated with the Graduate Entry Medical School at the University of Limerick and from community pharmacies.

It was found that almost one third, (31 %) of patients had no knowledge whatsoever of generic medicines, while 39 % of were confused at the distinction between the words ‘generic’ and ‘genetic’.

Up to 90 % of patients stated they would take a generic medicine if it were prescribed by their GP, with just 24 % of patients stated that they would prefer a brand or origination medicine.

Approximately 70% of patients believed that generics were a similar quality to their originators, with 29 % holding the view that generics are less expensive due to being of inferior quality than their originators.

50 % stated that they would find out more, and that a leaflet, or some kind of pamphlet with understandable, and accessible information regarding generic medicines useful.

Conclusions of the study Conducted in the time period leading up to the implementation of legislation promoting the use of generic medicines, it highlights variable knowledge about generic medicines among this key stakeholder group.

Although patients are supportive of their more widespread use, concerns regarding safety, clinical effectiveness, and manufacturing quality of generic medicines were identified.

Improvements in the market Since the research was published however, the generics market has improved as Irish consumers have become increasingly aware of their benefits.

Globally, the generic drugs market is expected to grow at a compounded annual growth rate of 10.53% from 2016 through 2020, according to a new report from ReportsnReports.com.

Worldwide, the global generic drugs market is expected to benefit from the patent expiry of drugs worth $150 billion by 2020.

The generic impact on the Irish market has significantly increased over the past number of years.

Many of the molecules/products that are off patent are achieving generic penetration of up to 80% of the original brand’s volumes in the market. Consistent rounds of price modulation have resulted in these products now being equal to the average generic price across Europe, or in some cases lower than our neighbours in the UK. Attention is now moving to the next largest area of savings: Biosimilars. If this is successful not only will we see savings to the exchequer, but careful husbandry of these sophisticated molecules will allow additional patients to be treated and also may permit the use of newer, more expensive biological medicines. In addition, pressure is now being put on the Irish government to fully utilise the availability of Biosimilars as they come off patent. Following a recent conference held in the Royal College of Physicians attended by the Minister for Health, Simon Harris, a commitment was made to further the use of Biosimilars in the next Health Budget.

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Feature

Skin Conditions in Infants / Children and the Pharmacist’s Role Written by Mr Eugene Renehan, Superintendent Pharmacist, Meaghers Pharmacy Group The rise of conditions such as eczema and psoriasis in children is something we cannot ignore in the Pharmacy setting. who are faced with having their child suffering a skin condition.

It is important to educate them on the potential reasons and to reinforce the practical aspects of managing the condition.

Emollients form the basis for managing eczema in general.

During my Pre-Reg. training I was taught to teach the parent four main rules • Remove the trigger Mr Eugene Renehan, Superintendent Pharmacist, Meaghers Pharmacy

• Use cotton where possible

In Ireland, it is now estimated that one in five children in Ireland suffer from a form of eczema with one in 12 continuing with the condition into adulthood. At the frontline of healthcare, we are often the first port of call for parents when it comes to marks or rashes on their children’s skin. As a profession, we have the opportunity to become the point of reference for parents coping with this condition and the responsibility to remain up to date on developments in treatments, both systemic and topical.

• Moisturise, Moisturise, Moisturise.

Eczema in children can be triggered by many common irritants such as soaps, shampoos, fragrances or changes in temperature.

Allergens such as dust, pollens, pets and foods can also lead to flare ups which will be more specific to the particular child.

Stress is also a common cause, ranging from physical stress such as teething or illness, to being anxiety linked as the child grows older.

As the primary point of contact for many patients, it is our duty to reassure and support parents

32

• File down the child’s fingernails

A decade on, the products and treatments available have become more advanced but the practical advice remains just as relevant today.

If you can encourage the parent to identify the irritant or allergen and remove this from the equation it can vastly improve the skin condition.

Many parents are just not aware of the ingredients of so called baby versions of shampoos and soaps which contain astringents

or fragrances which worsen the drying out of the skin. Advising the parent to use cotton or silk to dress, dry or keep the child warm will result in far less irritation on the skin. Specific eczema clothing is now available to order e.g. Clinifast garments which can vastly improve the lifestyle and outcome for the child. Using a simple nail file to smooth the edges of sharp nails will reduce the damage the child does to the skin while scratching and reduces the risk of infection.

Moisturising and washing with an emollient needs to happen at least three times per day.

Parents need to be aware that emollients help to restore the skin barrier, reducing the risk of a flare, and provide additional protection against the irritants and allergens which may trigger the eczema. Soap replacement should also be advised to avoid drying the skin further. It is incumbent on the pharmacist to deliver this message to the parent directly or to sufficiently train the front of counter staff to deliver it on their behalf.

The range of topical emollient products available nowadays is vast. From Aqueous Cream,

Emulsifying Ointment and Silcock’s Base to Aveeno to La Roche Posay the options can be daunting for any parent of a child with a skin condition.

Intervention at this stage by the pharmacist or a trained member of staff can have a massive influence in terms of outcome. Training in DermoSkincare brands is vital for a pharmacy to invest in. GP’s and Dermatologists will write a list of emollients on the back of a prescription leaving the parent looking to the pharmacist for advice on their content and correct usage. For young children I tend to lean towards the La Roche Posay Range who’s Lipikar Products (Syndet and Baume AP+) can be used safely in children 3 months and older. Emollient preference will differ from pharmacist to pharmacist however the common take home message for the parent in every case has to be to use liberally and often.

Steroids are often viewed negatively when it comes to children. There can be a misconception that steroids will make the situation worse, will thin the skin, or are generally

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Find out more at: aptamilhcp.ie Call our freephone: 1800 22 12 34 References: 1. Høst A et al. Arch Dis Child 1999; 81(1):80-4. 2. Verwimp JJ et al. Eur J Clin Nutr. 1995; 49 Suppl 1:S39-48. 3. Giampietro PG et al. Pediatr Allergy Immunol. 2001; 12(2):83-6. 4. Mabin DC et al. Arch Dis Child 1995; 73(3): 208-10.

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Feature dangerous for the child. It is important as pharmacists to have the confidence to reassure the parent that during a flare there is a clinical place for their use. When used correctly side effects of the steroids are less likely to occur. It is better for the parent to treat the eczema with the correct strength and regimen for a short time rather that use steroids that are too weak or not used often enough for a longer time. The pharmacist also has the opportunity to reaffirm the important role of the emollient throughout a flare. The parent must be educated from the beginning not to rely on steroids to treat a flare but rather that good daily care of the skin will reduce the risk of the flare in the first place.

We are also best placed to advise the parent on possible changes to their child’s diet that may help to positively impact

Nappy Rash No1 skin concern for new mums Nappy rash is a common condition thought to affect up to a third of nappy-wearing babies at any given time and frequently causes increased crying, agitation, altered eating and sleeping patterns, which can understandably be distressing for new mums.

Several factors contribute to nappy rash, including moisture, friction, contact with urine and faeces, and, occasionally, microorganisms.

Night time can be the

on the condition. One example would be to introduce oily fish which is rich in Omega 3’s into their diet, or possibly in a supplement form.

Another aspect of our role is to encourage parents to be open with their children as they grow and to explain the condition and address any worries that they may have. It is important to dispel any concerns and to remind sufferers that eczema is not related to poor hygiene and is not contagious. A strong parent-pharmacist relationship will provide an environment where they feel comfortable to ask questions that may not occur to them when meeting their GP. As the child develops, face to face interaction of the pharmacist with both parent and child is important, this will encourage the child to take shared responsibility for the management of their condition.

longest uninterrupted period that the skin is exposed to over-hydration and irritation caused by urine and faeces, and friction.

Margaret Merrigan-Feenan, Clinical Midwife Manager and Parent Education Teacher advises that babies “are more susceptible if they were premature, during teething, after vaccinations, changing from breast to bottle feeding, starting on solids, while on antibiotics or drinking cow’s milk for the first time”.

Prevention is the most effective way to treat nappy rash.

Learning how to manage their condition correctly at an early stage will ensure that they carry the skills forward into adulthood.

Based on current rates it is expected that almost half of the children will carry the skin condition into adulthood. As a consequence of pharmacy intervention now, we will establish the trust of future generations in our profession.

Having the right product knowledge, along with the confidence to deliver that to your patient, is vital when dealing with parents, both first-timers and veterans. We should support, encourage open discussion, make recommendations, and act as a point of reference for new developments in the treatment and management of eczema.

Eugene graduated with a B.Sc. (Pharm.) from TCD and has a Diploma in Leadership and Management.

Having joined Meaghers in 2007. Eugene now oversees a team of 16 pharmacists and the Meaghers Intern Programme.

He is an Accredited Tutor Pharmacist – RCSI /PSI and is a Professional Registration Examination (PRE) Assessor on behalf of Royal College of Surgeons (RCSI). He previously sat on the RCSI National Pharmacy Internship Programme (NPIP) Advisory Group, and is the Community Pharmacy (Groups) appointee for the IIoP Steering Group, as well a Strategic Advisory Board member for the School of Pharmacy Trinity College.

Mr Eugene Renehan is Superintendent Pharmacist for the Meaghers Pharmacy Group.

Babies may need as many as 10 or 12 nappy changes a day when they are young.

New parents should be advised to look for the tell-tale signs that a nappy change is needed and change wet or soiled nappies as soon as possible.

The aim of prevention is to reinforce and support the skin barrier and this starts with good skincare at nappy changing: • Change nappies regularly • Wash and dry the skin thoroughly

• Allow air on the skin • Avoid tight nappies, clothes and plastic pants.

• Use a barrier cream every day to prevent urine or faeces irritating the skin.

When helping parents to choose a topical nappy care product, they should look for one that enhances natural skin protection, maintains optimum moisture levels and does not contain any unnecessary ingredients or potential sensitizers such as fragrances, preservatives and is pleasant to use.

Baby and Child-Specific Products market in Ireland As the Irish economy slowly begins to recover following the crash in 2008, people are once again beginning to spend money, and industry is recovering.

One such is industry is the baby and child-specific product market, which has seen growth in the past few years. Here, Irish Pharmacy News looks at the overall market, what products are selling, as well as what the future holds for baby and childspecific products in Ireland.

Market Trends Research provided by Euromonitor, and commissioned in 2016, has indicated that value sales of baby and child-specific products grew by 2% in current value terms in 2015, with the category rising to ¤42 million.

Growth remains positive in this category as Ireland’s birth rate continues to decline due to families facing some of the biggest challenges brought about by the economic downturn. Many Irish families have mortgages on homes with negative equity and the

introduction of new charges such as property taxes and water charges are compounding their struggles.

This has led to the consistent trading down to private label products, which are more affordable for these consumers.

35

Feature

The 2% current value growth recorded in baby and childspecific products in 2015 was a considerable improvement on the marginally positive current value CAGR registered in the category over the review period.

helped to support value growth in the category. Moreover, parents taking their children abroad on holiday tend to buy sun care products in smaller, more convenient pack sizes before they leave.

While many Irish families continue to struggle, there remain growing numbers of consumers who do not have the financial burdens of those whose houses lost value so quickly after the collapse of the Irish economy.

Baby wipes recorded positive current value growth for the first time in several years in 2015, with 1% growth recorded.

With unemployment levels falling, there are small but growing numbers of young families who are keen to buy the very best for their children and this is why value sales continue to improve in baby and childspecific products.

Baby and child-specific sun care was the fastest growing category in 2015, with current value sales increasing by 5%, albeit from a relatively low base.

Although 2015 was not an overly sunny year and despite volume sales in the category falling, the launch of new sun care products designed specifically for children

36

Volume sales also increased in the category for the first time since 2010, rising by 2% in 2015. The introduction of more natural products such as WaterWipes from Irish Breeze Limited, is helping to drive sales in the category. This launch was backed by a large television campaign in 2015 claiming that these products are the world’s purest baby wipes.

Growing numbers of products are being positioned as specifically for children across numerous beauty and personal care categories, particularly within hair care. Many of these products target children themselves and they tend to have much brighter packaging than baby-specific products.

In contrast to baby specific products, these child-specific products often have enticing scents, typified by Halos n Horns Mango Melon Mayhem.

There is still a notable lack of products for children within, making this category a particularly good opportunity for further segmentation.

Naturally-positioned products remain attractive for most consumers of babyspecific products.

Babyproducts are positioned as being gentler for the delicate skin of babies. Parents want to protect their babies and ensure that they are well looked-after, which makes them more willing to pay extra for products that promise to do so. A wider range of premium baby-specific products is becoming more widely available on retail shelves under brands such as Sophie the Giraffe.

Similarly to sun care, SPF ratings have increased in many baby and child-specific sun care products. There is a growing awareness of the damage that overexposure to the sun can do to delicate skin and parents want

to protect their children by using products with high SPF ratings of least 30, although most of them are rated at least SPF50.

Johnson and Johnson Ireland Ltd was the leading player in baby and child-specific products in 2015 with a value share of 44%. While the company maintains a very strong lead in the category, its overall value sales have been in decline for three years. The company’s strength comes mainly from within baby wipes, where its value share increased to 29% in 2015. Nevertheless, the company sales continue to decline in the more dynamic category of baby and childspecific sun care.

Baby and child-specific products, overall, however, are expected to increase in value at a CAGR of 1% over the forecast period, with sales set to rise to ¤44 million by 2020. Volume sales are likely to continue growing in all baby and child-specific products categories, with the exception of baby and child-specific sun care, due to the unpredictability of the Irish weather.

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CPD 76: NUTRITIONAL SUPPLEMENTS Biography - Roger Meacock has spent the last 10 years working with Quinton Marine Plasma all over Europe and is an authority on everything Quinton. His understanding of the importance of those trace elements that are present in the smallest amounts has developed through witnessing wider ranging and seemingly disproportionate responses to what would conventionally be considered as low doses of those minerals that are better understood. He has a thorough understanding of Quinton Marine Plasma from where it is created and harvested in specific parts the Sea, to how it is packaged in the state of the art pharmaceutical laboratories in Spain and also draws experience from the tens of thousands that are using Quinton Marine Plasma daily all over Europe.

1. REFLECT - Before reading this module, consider the following: Will this clinical area be relevant to my practice.

2. IDENTIFY - If the answer is no, I may still be interested in the area but the article may not contribute towards my continuing professional development (CPD). If the answer is yes, I should identify any knowledge gaps in the clinical area.

3. PLAN - If I have identified a knowledge gap

- will this article satisfy those needs - or will more reading be required?

4. EVALUATE - Did this article meet my learning needs - and how has my practise changed as a result?

Have I identified further learning needs?

Most, if not all people in Ireland are likely to be deficient in minerals and trace elements for the very simple reason that our food no longer contains the same level of nutrients it used to.

There is famous quotation attributed to Nobel Scientist Linus Pauling that every disease can be traced back to a mineral deficiency. Whilst this has been confirmed for some conditions there are many where the role of minerals has not been established, which does not necessarily mean to say they play no part, rather that few diseases are investigated from this perspective.

There are in excess of 200 different cell types in the human body. Despite this, each cell has common elements to them that are required for all cells to function. Every cell has the complete set of chromosomes that code for the entire organism. Every cell has the standard lipid bilayer membrane with the same methods of actively transporting nutrients, hormones and

Disclaimer: All material published in CPD and the Pharmacy is copyright and no part of this can be used within any other publication without the permission of the publishers and author.

5. WHAT NEXT - At this time you may like to record your learning for future use or assessment. Follow the 4 previous steps, log and record your findings.

Nutritional supplements Supplements are a perennial topic with nutritionists claiming that a good healthy diet is sufficient to provide everything we need despite the fact that the vast majority of the population choose not to manage their diet to fit this description. Supplement research is not always straight forward to interpret and gives mixed results that can easily be skewed by trial duration, dose used, compliance, health status of trial subjects, quality of supplement used to name but a few. Pharmacists are likely to be asked for their opinions and recommendations by the public. With such conflicting evidence a new perspective and understanding of the topic can enable Pharmacists to give the best advice to maximise the chances of a positive response, build the trust of their customers and repeat business.

Published by IPN. Copies can be downloaded from www.irishpharmacytraining.ie

other chemicals into the cells and metabolites out. The membranes are semi-permeable to allow free movement of water and passive movement of certain other nutrients too. There are identical active transport mechanisms into and out of the cells. The cells all have mitochondria for cell respiration, endoplasmic reticulum and other organelles. They have nuclei with DNA and RNA for cell division and transcription to generate proteins for structure and enzymes etc. The proportions of these may vary (eg active muscles have more mitochondria) and different cell types may produce more of a certain enzyme, hormone or other product but the processes involved are fundamentally similar.

Healthy cells are the building block to healthy tissues which make up healthy organs. If all the different organs are healthy and well integrated with each other and the organism is appropriately reactive to changes in the environment to enable homeostasis to be maintained then we would consider that individual is healthy. For perfect health to be maintained, everything must continue to function without error. In reality of course we can only aspire to perfection and hope to minimise the inefficiencies and subsequent deterioration that we term ageing.

Any process, whether it is in manufacturing or in our biochemistry is only as good as the weakest link. Those who look after their health in the finest details should in theory maintain better health, provided they don’t let the stress of worrying about it override the benefits of micromanaging their nutrition, exercise and lifestyle!

When it comes to nourishing the cells much is known about how the macronutrients are processed. We know a lot about the

60 Second Summary Supplement research is not always straight forward to interpret and gives mixed results that can easily be skewed by trial duration, dose used, compliance, health status of trial subjects, quality of supplement used to name but a few. Pharmacists are likely to be asked for their opinions and recommendations by the public. With such conflicting evidence a new perspective and understanding of the topic can enable Pharmacists to give the best advice to maximise the chances of a positive response, build the trust of their customers and repeat business.

There are in excess of 200 different cell types in the human body. Despite this, each cell has common elements to them that are required for all cells to function.

According to Nutritionist textbooks 21 minerals and trace elements are recognised as “possibly important” with a few others regarded as being of more minor importance. There is a seeming assumption that those which are present in very low amounts – only a few ppm or even ppb – are therefore of little consequence.

Scientific research has followed a reductionist paradigm where only one variable is altered and the commonest minerals and trace elements have been identified in specific roles in isolation.

According to UK nutrition bible McCance and Widdowson’s The Composition of Foods, there has been a dramatic reduction in the nutritional value of our foods over the past 70 years – and minerals have been hardest hit.

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CPD 76: NUTRITIONAL SUPPLEMENTS reasonable to suggest that the reason for this could well be the lack of one or more trace elements that a single component is reliant on. It is impossible to prove this hypothesis, but it is equally impossible to disprove it too. We must also consider that blood tests don’t always give an accurate representation of what is happening in the cells if a nutrient is taken into a cell by active transport which happens to varying degrees in different tissues.

Using blood concentration levels as an overall indicator are at best only an approximation of cellular levels based on an assumption that there is even diffusion throughout the body and passive, easy movement between body compartments. We know that is not the real situation. Analysis of the main minerals and trace elements in different fluid compartments of the body clearly indicate that minerals and trace elements are actively distributed in different ratios and concentrations.

role of vitamins and the major minerals and trace elements such as those involved in maintaining cell membrane polarisation, muscle contractions and as co-enzymes etc.

According to Nutritionist textbooks 21 minerals and trace elements are recognised as “possibly important” with a few others regarded as being of more minor importance. There is a seeming assumption that those which are present in very low amounts – only a few ppm or even ppb – are therefore of little consequence. It is virtually impossible to study the role of these rare trace elements when they are present as such low levels but it is a dangerous assumption and completely unscientific to consider them any less important. Using an analogy from architecture, there is only 1 key stone in a stone arch yet without it the whole structure will collapse.

We now understand that the minerals and trace elements interact with each other and can either enhance or interfere with the action of another.

The diagram below shows the interactions of just 21 different elements in the body that we know of. There are 78 naturally-occurring nongaseous elements, and it is not unreasonable to consider that if we knew everything about their different roles in the body that there would be similar complex interactions that make the activity every element dependent to some degree on every other element either directly or indirectly.

If we take Calcium as a common example of

an ingredient in many nutritional supplements with the view to help with bone metabolism for example then we can see that there are immediate implications for the action of Phosphorus, Sulphur, Fluorine, Zinc, Magnesium and Manganese. It is impossible to look at any of the other 15 elements and find one that isn’t affected by Calcium supplementation indirectly whether it is 1, 2 or 3 steps removed. It may sound unlikely that supplementation with Calcium alone can have such ramifications of any importance in reality but we also know that Calcium itself doesn’t act in isolation in bone metabolism and requires Vitamin D, K2 and a healthy bone matrix too. If certain Calcium supplements are considered better because they include these Vitamins too then it’s not a far leap, given our understanding of the interactions between all the minerals and trace elements to realise that for truly effective supplementation all the minerals and trace elements should be present in the right proportions. Mineral levels should be therefore be addressed in totality and not singly, or just a few, in isolation.

Scientific research has followed a reductionist paradigm where only one variable is altered and the commonest minerals and trace elements have been identified in specific roles in isolation. Everyday use of restricted mineral and trace element supplements in people are not completely consistent and don’t always conform with the predicted effects. It is entirely

It is entirely reasonable to suppose that the rarer trace elements are also irregularly distributed throughout the body. To therefore assess the levels of minerals and trace elements individually based on a blood sample without any appreciation or understanding of the levels of the rest of the elements is fundamentally flawed. Physical presence does not necessarily equate to physiological presence either if one or more vital trace elements are missing or deficient. ie looking at individual mineral and trace element levels may bear no relation to how that element is functional within the body and at the cellular level.

It is less likely that the more abundant minerals and trace elements are deficient. They tend to be the ones that the body controls much more closely in terms of concentration too. The diagrams above are likely to be far more consistent between individuals than equivalent diagrams looking at trace elements. It also makes more sense that a deficiency or imbalance of a trace element could have a disproportionately larger effect than the equivalent deficiency of an abundant mineral. For example, if a cell is 1ppm under concentration for Na it is unlikely that any difference in cellular activity will be measurable.

If however a trace element that is required at 5ppm is deficient by the same amount, this equates to a 20% drop in concentration. If this trace element is a vital co-factor for an enzyme, or determines the protein structure of a transport molecule into a cell then that cellular activity will be 20% reduced. If the affected function is vital for DNA replication or transcription then it could result in a mutation.

Medicine has largely focussed on biochemistry almost to the exclusion of understanding the role of biophysics. The complexity of biophysics makes this perhaps unsurprising, however our inability to understand, measure and predictably influence this aspect of human biology does not make it any less important.

78 MINERALS AND TRACE ELEMENTS IN EACH AMPOULE Call: 00353 18728314 Email: info@cellnutrition.com Website: www.cellnutrition.com

CPD 76: NUTRITIONAL SUPPLEMENTS Dr. Alfred Pischinger originated the concept of the ‘system of ground regulation’ which identifies the living matrix as an extensive perineural information system composed of microtubes of protein within the extracellular fluid. What was previously known as connective tissue seems to be an omnidirectional communication system between all the tissues, even at the level of the cell. In fact, over the living matrix, each cell knows what another cell is doing.

If the composition of the extra-cellular fluid is deficient and/or its constituents are disproportionate then this vital cellular communication system cannot function optimally. This is different and faster than the anatomically recognised nervous system. It explains why elite athletes can react faster than should be possible based on calculations using known nerve length and speed on conduction for conventionally recognised nerve impulses.

Similarly within the cells, deficiencies and disproportionate concentrations of the minerals and trace elements can interfere with cellular efficiency. When 64 different elements have been identified as being necessary for DNA replication, anything less than the perfect complement of elements will inevitably affect DNA activity. Epigenetic factors are now recognised as being part of the control of DNA expression. The environments of the cell and nucleus will be a part of this determination.

The minerals and trace elements with their individual charge density, micro-currents and effects on determining the structure and activity of proteins including enzymes all contribute to the cellular environment. Putting everything together, it is far too complex to be able to fully calculate or understand all the interactions of all 78 minerals and trace elements.

According to UK nutrition bible McCance and Widdowson’s The Composition of Foods, published under the auspices of the Medical Research Council, Ministry of Agriculture and the Royal Society of Chemistry, there has been a dramatic reduction in the nutritional value of our foods over the past 70 years – and minerals have been hardest hit.

Food can no longer be relied upon to supply all the nutrients, especially those that could potentially have the largest impact on cellular function which are never included in fertilisers because science hasn’t yet recognised their full importance. So how do we ensure correct micronutrient levels?

Minerals and trace elements cannot be absorbed from ground up rock but must first be made bioavailable by the action of other organisms lower down the food chain. Plants can fulfil this function fuelled by photosynthesis and pass them on to herbivores, omnivores and carnivores. Plants cannot make available what is not there.

We are therefore forced to look to the seas but we can no more absorb inorganic minerals and trace elements in sea water than we can from soil and rocks. Sea water supported the emergence of life on earth in hydrothermal vents at the bottom of the sea. These unicellular organisms, it is hypothesised evolved into multicellular organisms that left the sea to populate the land. The unicellular plankton provides the foundation for the entire food chain of the sea.

They are most abundant in certain areas of the ocean where the sea water provides the correct nutrient balance to support them. Fuelled by photosynthesis, phytoplankton performs the same conversion of minerals and trace elements to their bioavailable form as plants do on land.

In 1897 Rene Quinton, a French physiologist and philosopher postulated that the known feeding grounds of fish would contain a source of the correct nutrients and optimally balanced to support more advanced life-forms including humans. He harvested sea water secreted by the phytoplankton and proved that it supported mammalian life by replacing the entire volume of a dog’s blood with this sea water that he had diluted to isotonicity. The dog made a complete recovery and Quinton soon began treating people with amazing results for malnutrition, eczema, psoriasis and the commonest diseases of the early 20th century. One of his contemporary Doctors Jean Jarricot documented thousands of clinical

cases where providing the body with the correct mineral and trace element balance provided it with the resources to recover health. He followed some of his patients for decades in some cases – something largely unheard of in modern research. Quinton was frequently used for its ability to maintain hydration during bouts of dysentery but with modern knowledge no doubt helped establish and support the correct microbiome in the digestive tract.

Such was the success of treatment using Quinton marine plasma as it became known that it was a recognised pharmaceutical in the French Vidal. The concept of Claude Bernard that it is the environment of the cell that dictates health did not gain the same following as Pasteur’s Germ Theory and Quinton, despite innumerable documented successes it lost popularity amongst the newer generations of Doctors and it was no longer financially viable to renew the medical licences held for all the Quinton products. Quinton marine plasma was relaunched as an oral nutritional supplement and is available through Pharmacies as Cellnutrition Quinton Isotonic and Cellnutrition Quinton Hypertonic.

Quinton marine plasma is once again being recognised for its ability to provide all the minerals and trace elements in the correct proportions. It is unique in that due to the activity of the plankton, all 78 naturallyoccurring minerals and trace elements are in 100% bioavailable form. This nutrient-correct

BE PART OF THE MINERAL REVOLUTION Call: 00353 18728314 Email: info@cellnutrition.com Website: www.cellnutrition.com

CPD 76: NUTRITIONAL SUPPLEMENTS 4. The Nutrition Practitioner, Vol 3 Issue 2 (July 2001) 5. Pischinger, Alfred (2007). The Extracellular Matrix and Ground Regulation. Berkeley: North Atlantic Books. pp. Foreword by Hartmut Heine. ISBN 1-55643-688-2 6. Ursell, L. K., Metcalf, J. L., Parfrey, L. W., & Knight, R. (2012). Defining the Human Microbiome.

Nutrition Reviews, 70(Suppl 1), S38–S44. http://doi. org/10.1111/j.1753-4887.2012.00493.x 7. Watts, D. L. Nutrient Interrelationships Minerals - Vitamins - Endocrines. Journal of Orthomolecular Medicine Vol. 5, No. 1, (1990) 8. Radhakrishnan G., Yamamoto M ., Maeda H., Nakagawa A., KatareGopalrao R., Okada H., Nishimori H., Wariishi S., Toda E., Ogawa H., Sasaguri S. Intake of dissolved organic matter from deep seawater inhibits atherosclerosis progression. Biochem Biophys Res Commun. 2009 Sep 11;387(1):25-30 9. Townsend M.S., Fulgoni V.L. 3rd, Stern J.S., Adu-Afarwuah S., McCarron D.A. Low mineral intake is associated with high systolic blood pressure in the Third and Fourth National Health and Nutrition Examination Surveys: could we all be right? Am J Hypertens. 2005 Feb;18(2 Pt 1):261-9.

10. Hwang H.S., Kim H.A., Lee S.H., Yun J.W. Anti-obesity and anti-diabetic effects of deep sea water on ob/ob mice. Mar Biotechnol (NY). 2009 JulAug;11(4):531-9.

11. Kimata H., Tai H., Nakagawa K., Yokoyama Y., Nakajima H,Ikegami Y. Improvement of Skin Symptoms and Mineral Imbalance by Drinking Deep Sea Water in Patients with Atopic Eczema/Dermatitis Syndrome (AEDS) ACTA MEDICA 2002, Vol.45 No.2 12. Garavello W., Romagnoli M., Sordo L., Gaini R.M., Di Berardino C. Hypersaline nasal irrigation in children with symptomatic seasonal allergic rhinitis: A randomised study. Pediatr Allergy Immunol 2003:14:140–143.2003 Blackwell Munksgaard

source is collected, transported and cold microfiltered to pharmaceutical grade. There are no additives and it is not heat-treated as this can produce hydroxyl free radicals that would compromise the benefits. It is checked for microbiology, contamination and radioactivity to ensure it is 100% safe. The Nasal sprays have been approved under EU legislation for treatment of nasal and sinus infections and to maintain their ongoing health. This is best done alongside daily oral hygiene to ensure no reservoir of infection remains.

Recent research into deep sea water, mostly in Japan, has had very encouraging results in cardiovascular health, allergic rhinitis, and skin conditions to name but a few but has had to resort to using much larger volumes (500ml) of sea water in order to achieve the right levels of bioavailability to obtain significant medical results. By sourcing the raw ingredient for Quinton products from the plankton blooms similar results have been achieved historically with considerably smaller volumes.

When provided with all the necessary minerals and trace elements in exactly the right proportions that does not interfere with absorption and utilisation by the cells it enables the cells themselves to determine what and how much of each element they need to make

good and balance their internal environment.

When the internal environment of the cell is optimised, so is cellular function, regardless of where in the body the cell is located. Through optimisation of cell function, Cellnutrition Quinton marine plasma optimises the ability of the body to utilise macronutrients and vitamins too. Research with elite athletes have shown the ability of the body to better hydrate, regulate blood glucose and prevent muscle cramps with reduced injuries.

In over 100 years using Quinton products for many thousands of people, there have been no adverse reactions, other than mild “detoxification” effects and no contraindications. When restoring the internal environment of the cell is showing such wide scale promise and with such a high degree of safety Cellnutrition Quinton is always an option that can improve the health of your customers.

References 1. Baross, J., A. & Hoffman, S., E. Submarine hydrothermal vents and associated gradient environments as sites for the origin and evolution of life. Orig. Life Evol. Biosph.15, 327–345 (1985) 2. Quinton, R. L’Eau de mer, milieu organique, Masson, edition Encre, Paris, (1904).

13. Kimata H., Tai H., Nakajima H. Reduction of Allergic Skin Responses and Serum AllergenSpecific IgE and IgE-Inducing Cytokines by Drinking Deep-Sea Water in Patients with Allergic Rhinitis Otorhinolaryngol Nova 2001;11:302–303 14. Walters C. Minerals for the Genetic Code. 2013 Acres, USA. ISBN 978-0-911311-85-3 Facts/Summary 1. Food grown on the land is known to be deficient in nutrients 2. Cells require a full complement of minerals and trace elements to function correctly 3. Minerals and trace elements interact in a complex and incalculable manner 4. The body can only absorb and utilise minerals and trace elements when presented together in the right proportions and in a bioavailable form.

5. Certain areas of the ocean where plankton flourish have the correct sea water composition that supports the food chain for the entire ocean.

6. The action of the plankton makes the minerals and trace elements bioavailable.

7. Cellnutrition Quinton products contain all 78 minerals and trace elements in the right proportions and fully bioavailable.

8. Cellnutrition Quinton products are cold microfiltered with no additives to pharmaceutical grade for complete safety.

3. Jarricot, J. Le dispensaire marin, un organisme nouveau de puériculture. Paris: Masson. (1921).

78 MINERALS AND TRACE ELEMENTS IN EACH AMPOULE Call: 00353 18728314 Email: info@cellnutrition.com Website: www.cellnutrition.com

Advertorial IndePharm presents its Vision for 2020 and announces new nationwide sponsorship IndePharm, the co-operative group of independent pharmacists, launched its VISION 2020 Strategy at its AGM in early February. The AGM, held in Kilkenny, brought together all Members of the IndePharm family. Outgoing Chairman, Owen Daly, presented VISION 2020 on behalf of the Board. VISION 2020 is IndePharm’s strategy to further grow its business within the Irish pharmacy sector.

Willie Ruane, CEO Connacht Rugby (left) with IndePharm Chairman, Keith Brennan

IndePharm members at their recent AGM in Kilkenny IndePharm plans to significantly increase its network of pharmacies from its existing 52-branded Haven Pharmacy stores over the next few years. This ambitious plan is supported by a detailed programme of member supports and initiatives to further improve buying opportunities; upgrade technology platforms; build the Haven Pharmacy brand to drive enquiries to its digital channels and increase footfall in its pharmacy stores. A cornerstone of the Strategy is attracting new members. A programme to support this goal will be rolled-out later this year. Members unanimously approved the Strategy and sentiment throughout the day was positive and confident.

Following on from the presentation of VISION 2020, Members were introduced to guest speaker Willie Ruane, CEO, Connacht Rugby who entertained the audience with his unscripted, inspirational words outlining

Connacht Rugby’s ‘Grassroots to Green Shirts’ strategy. What was remarkable for Members was the emotional connection from players, coaches, fans and all stakeholders associated with the Connacht Rugby vision of their future.

Members also remarked upon similarities with the IndePharm vision of its co-operative ethos and its desire to make a difference in its community.

Wanting to make a difference complemented the announcement that IndePharm is partnering with Irish Mens Sheds in a multiyear programme to support the Sheds for Life Programme. The announcement was made at the AGM jointly by IndePharm incoming Chairman, Keith Brennan, and Mens Sheds’ CEO Barry Sheridan. Irish Mens Sheds is a registered charity focused on supporting a grassroots network of sheds, workshops and meeting places for men of all ages. There are 350 sheds in 150 towns with

IndePharm Chairman, Keith Brennan (left) with Mens Sheds CEO, Barry Sheridan (right) at the announcement of a new multi-year partnership

10,000 members across Ireland.

Its patron is President Michael D Higgins. Central funding and advisory services will be provided

by IndePharm and this will be supported by Haven Pharmacies in local communities through the promotion of Health and Wellness awareness initiatives. Developing strong local ties with Mens Sheds members and their families will be actively encouraged.

43

Awards The Irish Pharmacy

2017

QuintilesIMS Superintendent Pharmacist of the Year 2017

This Award will be looking to recognise those individuals who are serving as key drivers for the implementation of enhanced and excellent Pharmacy care within the community they serve.

Judges will be looking for applications from those that are focused on establishing a framework for achievement of a high quality, safe and consistent service for the benefits of the patient, as well as facilitating the development of the professional role of the pharmacist.

Judges will be looking for:  An understanding of patient needs when delivering healthcare in the community  Examples of great patient experience and care  Best practice in delivering professional services and patient reviews  Encouragement of staff education in patient health and wellbeing advice  Strong leadership skills with the ability to drive the business forward Innovation and ambition Who Can Enter: All Superintendent Pharmacists working in both the independent and multiple sector Previous Superintendent Pharmacist of the Year Award entrants, including winners How to Enter:

44

MSD Innovation and Service Development (Chain) Award 2017

* Open to all pharmacies with more than 3 stores The MSD Innovation & Service Development Award’s principal aim is to reward innovation within community pharmacy. The judging panel will be looking for ways in which a project is both innovative and successful.

This Award identifies individuals and teams working within multiple community pharmacies in Ireland whose ideas or inventions have, or could lead to, improvement in the patient experience in all areas of care throughout their community.

Applications are sought from those demonstrating clear enthusiasm and commitment to the enhancement of community pharmacy in Ireland, exceptional quality above and beyond what is expected and an ability to overcome challenges in pursuit of goals.

Judges will be looking for:  Activities that may involve pioneering new models or systems that improve pharmacists’ impact as members of the healthcare team ; patient safety and outcomes; patient care in general and other professional development  Development of a system or tool for pharmacy that will directly or immediately impact patient care or the profession and/or serve as an example or template for other pharmacy professionals to follow  Measurable benefits of your initiative. Please use financial data wherever possible (percentages, rations, graphic images etc.), as well as other statistics to show how your project has bought added value, profits, customer satisfaction improvements, productivity increases or any other benefit relevant to this award category.

Who Can Enter: This category is open to all Pharmacists and their teams working within the chain pharmacy sector. Applications can be through nominating an individual or yourself.

Previous Irish Pharmacy Awards Innovation & Service Development (Chain) Award entrants, including winners, are also welcome to submit entries this year.

For an application form please contact Aisling Twomey via email on: aisling@ipnirishpharmacynews.ie or by telephone on +353 1 6690562 or by visiting our website at www.irishpharmacyawards.ie

How to Enter: For an application form please contact Aisling Twomey via email on: aisling@ipnirishpharmacynews.ie or by telephone on +353 1 6690562 or by visiting our website at www.irishpharmacyawards.ie

Deadline for Entries: Wednesday, March 29th, 2017

Deadline for Entries: Wednesday, March 29th, 2017

Awards The Irish Pharmacy

2017

Young Pharmacist of the Year 2017

The Idis Young Community Pharmacist of the Year Award recognises rising talent – those individuals who despite being in the early stages of their pharmacy careers are already demonstrating that they can make a difference to the pharmacy profession and the companies for whom they work and the communities they serve.

This award is open to pharmacists aged up to 30 - at the date of entry submission - who are working within any pharmacy where their involvement has been greater than six months. It is the individual qualities that will be evaluated, rather than those of any of the projects worked on.

Judges will be looking for:

McLernons Innovation & Service Development (Independent) Award

* Open to all pharmacies with less than 3 stores The McLernon Computers Innovation & Service Development Award’s principal aim is to reward innovation within community pharmacy. The judging panel will be looking for ways in which a project is both innovative and successful.

This Award identifies individuals and teams working within independent community pharmacy in Ireland whose ideas or inventions have, or could lead to, improvement in the patient experience in all areas of care throughout their community.

 Judges will want to see effective communication skills with both staff and customers

Applications are sought from those demonstrating clear enthusiasm and commitment to the enhancement of community pharmacy in Ireland, exceptional quality above and beyond what is expected and an ability to overcome challenges in pursuit of goals.

 Demonstration of a commitment to mentoring or other leadership activities

Judges will be looking for:

 Operation within their own pharmacy liaising with key staff members and management and developing key communication skills  A dedication and commitment to furthering the profession into the future Who Can Enter: This category is open to young pharmacists working within both the independent and chain sectors. Applications can be through nominating an individual or yourself.

Previous Irish Pharmacy Awards Young Pharmacist of the Year entrants, including winners, are also welcome to submit entries.

How to Enter: For an application form please contact Aisling Twomey via email on: aisling@ipnirishpharmacynews.ie or by telephone on +353 1 6690562 or by visiting our website at www.irishpharmacyawards.ie

Deadline for Entries: Wednesday, March 29th, 2017

 Activities that may involve pioneering new models or systems that improve pharmacists’ impact as members of the healthcare team; patient safety and outcomes; patient care in general and other professional development  Development of a system or tool for pharmacy that will directly or immediately impact patient care or the profession and/or serve as an example or template for other pharmacy professionals to follow  Measurable benefits of your initiative. Please use financial data wherever possible (percentages, rations, graphic images etc.), as well as other statistics to show how your project has bought added value, profits, customer satisfaction improvements, productivity increases or any other benefit relevant to this award category.

Who Can Enter: This category is open to all Pharmacists and their teams working within the independent sector. Applications can be through nominating an individual or yourself. Previous Irish Pharmacy Awards Innovation & Service Development (Independent) Award entrants, including winners, are also welcome to submit entries this year.

How to Enter: For an application form please contact Aisling Twomey via email on: aisling@ipnirishpharmacynews.ie or by telephone on +353 1 6690562 or by visiting our website at www.irishpharmacyawards.ie

Deadline for Entries: Wednesday, March 29th, 2017

45

A herbal choice for relief of

Constipation Constipation remedies containing herbal ingredients such as linseed, senna and frangula have been used for decades.

Constipation has become an increasingly common problem as our modern-day lifestyle brings on poor eating habits and stress. Linoforce is one of Alfred Vogel's very first remedies. Take 1 level measuring spoonful of Linoforce with a glass of at least 150ml of water at night.

Benefits and features of Linoforce granules: ✓ Relief of constipation ✓ Registered herbal constipation remedy ✓ Contains linseed, senna and frangula – traditionally used as a constipation remedy for many decades.

Exclusive to Pharmacies A.Vogel Linoforce Granules is a supply through pharmacy only product. Product not subject to medical prescription.

Available from:

Linoforce granules A traditional herbal medicinal product for use in the short term relief of occasional constipation exclusively based upon long-standing use. Always read the leaflet.

Linoforce Granules. Active Ingredients: 1 dose contains: 1.76 g of Linseeds, whole, 0.43 - 0.70 g of Senna leaves, comminuted,36 - 58 mg of Frangula bark, comminuted, corresponding to 20.5 mg of hydroxyanthracene derivatives. Indications: Traditional herbal medicinal product for the short term relief of occasional constipation exclusively based on long-standing use. Dosage and administration: Adults, older people and adolescents over 12 years: One level measuring spoon (4.1g), administered in a single dose at night with a glass of water or other liquid. The laxative effect occurs about 6-12 hours after oral administration. Warnings and Precautions: See SPC for full details. Linoforce granules should not be taken ½ to 1 hour before or after intake of other medicinal products. Not be taken by patients suffering from faecal impaction and undiagnosed, acute or persistent gastro-intestinal complaints. Chronic abuse may cause hypokalaemia.

Contraindications: Children under 12 years of age. Do not use in cases of known hypersensitivity to any of the active ingredients, to plants of the Rhamnaceae or Linaceae families or to any of the excipients. Melanorrhoea, potential or existing intestinal blockage (ileus), paralysis of the intestine or megacolon. Abnormal constrictions in the gastro-intestinal tract, with diseases of the oesophagus and cardia. Sudden change in bowel habit that persists for more than 2 weeks, undiagnosed rectal bleeding and failure to defaecate following the use of a laxative. Undesirable effects: Hypersensitivity reactions (pruritus, urticaria, local or generalised exanthema) may occur. The frequency is not known. Meteorism occurring with the use of this product is common. May produce abdominal pain and spasm and passage of liquid stools, in particular in patients with irritable colon. Legal category: P. Registration number: TR 725/6/1 Registration holder: Bioforce (UK) Ltd, 2 Brewster Place, Irvine, Ayrshire KA11 5DD. Date of Preparation: May 2014.

3861

To place an order please contact Wholefoods on 01 6262315.

For technical queries please contact the A.Vogel helpline on 1890 930 070.

Awards The Irish Pharmacy

2017

Johnson & Johnson Pharmacy Team of the Year 2017

GSK Self Care Award 2017

This Award will be given to the community pharmacy team that demonstrates the best combination of team spirit and enhancement of patient care at all levels. The judges will be looking for those who encourage and support each other and those who have collectively demonstrated innovation and forward thinking.

his Award recognises community Pharmacy’s commitment to tackling health inequalities and serves to reward achievement in the development and implementation of health promotion, self-care and community wellbeing strategies/initiatives.

The key to any successful pharmacy is team work and this award recognises the power and potential of a focused and unified approach to health care initiatives. Teams can be based within one organisation or spread over multiple organisations; but they must comprise individuals working towards the same objective or goal.

Judges will be looking for:  How the team has demonstrated their ability to deliver clear benefits to patients; and/or staff members through working together efficiently and effectively  How the team has worked together to achieve its objectives over the past twelve months  Projects that the team has successfully managed which demonstrate excellence in quality, innovation, productivity and prevention  A clear display of the principles underpinning their success as a team Who Can Enter: This category is open to all community pharmacy teams working within both the independent and chain sectors.

Applications can be through nominating an individual or yourself. Previous Irish Pharmacy Awards Community Pharmacy Team of the Year entrants, including winners, are also welcome to submit entries.

It is designed to encourage excellence in the production and dissemination of accessible, well-designed and clinically balanced patient support.

The Award will be presented to the team or individual who can demonstrate a significant positive impact on the experience of those who use Pharmacy services.

This may be through campaigns, promotions or initiatives which have identified a need within the community to address certain health issues.

Judges will be looking for:  Evidence of long-term, consistent dedication and outstanding achievements that have led to the advancement of the profession of pharmacy and selfcare.  Evidence of an individual strong in character, cumulative professional accomplishments and the ability to properly represent and model what pharmacy as a profession encompasses.  Evidence of an understanding the goals of pharmacy, and significantly contributing to how these goals may be achieved.

Who Can Enter: This category is open to all Pharmacists and their teams working within the independent sector. Applications can be through nominating an individual or yourself. Previous Irish Pharmacy Awards Health Promotion entrants, including winners, are also welcome to submit entries this year.

All entries will be judged by an independent panel of experts and the winners will be announced at the Irish Pharmacy Awards on Saturday 20th May 2017 at Clayton Hotel, Burlington Road, Dublin.

How to Enter:

How to Enter:

For an application form please contact Aisling Twomey via email on: aisling@ipnirishpharmacynews.ie or by telephone on +353 1 6690562 or by visiting our website at www.irishpharmacyawards.ie

For an application form please contact Aisling Twomey via email on: aisling@ipnirishpharmacynews.ie or by telephone on +353 1 6690562 or by visiting our website at www.irishpharmacyawards.ie

Deadline for Entries: Wednesday, March 29th, 2017

Deadline for Entries: Wednesday, March 29th, 2017

47

Awards The Irish Pharmacy

2017

RB Nurofen for Children Baby Health Pharmacy Award

This Award celebrates the application of innovation and dedication within the children/baby market in pharmacy.

It will recognise an outstanding pharmacy store, project or initiative where creative thinking, sound research and team working have combined to achieve real service development in this specific area.

Judges will be looking for the store, or team that have pioneered an initiative providing an excellent, compassionate standard of service within the children/ baby market to this patient group.

It might be a model that ensures a high level of continuity of care in this area, or a unique way of working or providing care to this population.

Judges will be looking for:  Clear demonstration of an identified need and personal rationale along with details of the process of implementation from concept to design, planning and results  Evidence will be displayed for plans for further research and development  Evidence of the process by which the project was developed and implemented  Evidence of impact on women and families Who Can Enter: All Pharmacy teams working in both the independent and multiple sectors. Previous Nurofen for Children Baby Health of the Year Award entrants, including winners.

How to Enter: For an application form please contact Aisling Twomey via email on: aisling@ipnirishpharmacynews.ie or by telephone on +353 1 6690562 or by visiting our website at www.irishpharmacyawards.ie

Deadline for Entries: Wednesday, March 29th, 2017

48

Unilever OTC Retailer of the Year Award

* This Award may be entered though individual application or nomination for those pharmacy businesses with more than 4 stores throughout Ireland Customer purchases of OTC products have consistently risen, for many reasons.

The convenience of treating a condition with an OTC product is appealing to the typically busy person, who seeks to avoid a lengthy and expensive GP visit in favour of meeting the demands of home and work. In addition, patients in the information age have an increased level of awareness about health.

The over-the-counter market continues to thrive as manufacturers continue to think of new promotional and packaging ideas and as the general public take a greater interest in their own health and wellbeing. Pharmacies are increasingly witnessing heightened footfall as GP visits decrease.

Pharmacy staff are the focal point for helping customers select appropriate OTC medicines, suggest diagnostic testing and accessory products and must be aware of when to refer individuals to the pharmacist. Knowledge of the market is essential; seasonal products and accessories; the use of displays and front of shop expertise and judges will want evidence of excellent merchandising strategies.

Judges will be looking for:  Demonstration of identifying key promotional opportunities to add value for the customer such as health promotion events and displays  A showing of continuous working with manufacturers and suppliers to plan yearly promotional calendars to meet pharmacy profit goals  Implementation of innovative strategies to competitive pricing  Examples of education for staff on new products and convenyance to customers as to efficacy and usage

Who Can Enter: This category is open to all pharmacy businesses with more than 4 stores in Ireland.

Previous Irish Pharmacy Awards OTC Retailer of the Year entrants, including winners, are also welcome to submit entries this year.

How to Enter: For an application form please contact Aisling Twomey via email on: aisling@ipnirishpharmacynews.ie or by telephone on +353 1 6690562 or by visiting our website at www.irishpharmacyawards.ie

Deadline for Entries: Wednesday, March 29th, 2017

lose weight

NEW

weight loss shake, with NatURallY soURced iNgRedieNts** what is in a Yokebe shake? high quality proteins

Natural honey

the high-quality soy and whey proteins in Yokebe play a significant role, they support muscle mass.

carefully selected vitamins & minerals the B5 and B12 vitamins in Yokebe promote normal energy metabolism, and vitamin B6 promotes normal protein and glycogen metabolism.

the untreated natural honey is delicious and naturally contains enzymes. last but not least, it provides natural flavouring and gives the natural Yokebe taste.

No artifical flavours or flavour enhancers

Choose the right Yokebe diet plan to fit your customers life and support their weight loss goals. Log onto www.yokebe.ie Substituting two daily meals of an energy-restricted diet with meal replacements contributes to weight loss. Substituting one daily meal of an energy restricted diet with a meal replacement contributes to the maintenance of weight after weight loss. The Yokebe diet plan is a calorie-controlled diet which should include other types of low calorie food such as soups, vegetables and fruits. Make sure you drink enough liquid (2L a day). Individual results will vary.

*92% of 47 people agreed. **Protein and honey at natural source

see who #YoUcaNBe with YokeBe

Awards The Irish Pharmacy

2017

IDIS Pharmacist of the Year 2017

KRKA Counter Assistant of the Year Award 2017

Part of the Clinigen Group

The Krka Counter Assistant of the Year Award recognises excellence in knowledge and service to retail customers.

Nominations for the category can be made through self-nomination, by colleagues or by pharmacy business owners.

Judges will be looking to reward outstanding counter assistants, recognising those who go above and beyond their job description and make a real difference to their local community.

Judges will be looking for:  Evidence of the individual’s contribution to the pharmacy business and impact on patient care  Levels of excellence displayed above and beyond that expected from a counter assistant role  Initiatives or innovations that the individual has established or been involved with  Clear evidence of team working and excellent communication between the individual, their peers/ colleagues and their patients and local community Who Can Enter: This category is open to all community pharmacy technicians working within both the independent and chain sectors. Applications can be through nominating an individual or yourself. Previous Irish Pharmacy Awards Counter Assistant of the Year entrants, including winners, are also welcome to submit entries.

The Pharmacist of the Award recognises a community pharmacist who demonstrates leadership and exemplifies the evolution of the pharmacy profession toward an expanded role in health care.

The winner will demonstrate significant contributions to the pharmacy industry overall resulting in meaningful improvements in the quality of patient care and improved delivery models and pharmacy’s role on the health care team.

Applications are invited from both the independent and chain sectors.

Judges will be looking for:  Evidence of long-term, consistent dedication and outstanding achievements that have led to the advancement of the profession of pharmacy and public health.  Evidence of a large variety of skills, attributes and accomplishment.  Evidence of an individual strong in character, cumulative professional accomplishments and the ability to properly represent and model what pharmacy as a profession encompasses.  Evidence of an understanding the goals of pharmacy, and significantly contributing to how these goals may be achieved.

Who Can Enter: This category is open to all counter assistants working within both the independent and chain sectors. Applications can be through nominating an individual or yourself.

Previous Irish Pharmacy Awards Pharmacist of the Year entrants, including winners, are also welcome to submit entries this year.

How to Enter:

How to Enter: For an application form please contact Aisling Twomey via email on: aisling@ipnirishpharmacynews.ie or by telephone on +353 1 6690562 or by visiting our website at www.irishpharmacyawards.ie

Deadline for Entries: Wednesday, March 29th, 2017

50

For an application form please contact Aisling Twomey via email on: aisling@ipnirishpharmacynews.ie or by telephone on +353 1 6690562 or by visiting our website at www.irishpharmacyawards.ie

Deadline for Entries: Wednesday, March 29th, 2017

2017

SUNGLASSES COLLECTION

MaxBlock 100% UVA UVB PROTECTION TM

Sale or Return Available now A better way to market

01 2968080 www.oceanhealthcare.ie

Awards The Irish Pharmacy

2017

Business Development (Independent) Award 2017

Cellnutrition Business Development (Chain) Award 2017

* Open to all pharmacies with less than 3 stores The Business Development (Independent) Award serves to recognise those who have displayed success in terms of sales, training, recruitment, customer service, product development or other areas of business development.

Entries should demonstrate an innovative approach to creating new business, and outline the timescales, objectives and results of the initiative.

Judges will look for a business initiative that stands out in terms of its scale, scope or approach. This award will credit the company that has demonstrated excellent levels of customer service backed by clear standards and adequate monitoring performance.

Judges will be looking for:  Clear demonstration of an identified need and personal rationale along with details of the process of implementation from concept to design, planning and results  Evidence will be displayed for plans for further research and development  Evidence of a sound business plan, sales and marketing strategies

* Open to all pharmacies with more than 3 stores The Business Development (Chain) Award serves to recognise those who have displayed success in terms of sales, training, recruitment, customer service, product development or other areas of business development.

Entries should demonstrate an innovative approach to creating new business, and outline the timescales, objectives and results of the initiative.

Judges will look for a business initiative that stands out in terms of its scale, scope or approach. This award will credit the company that has demonstrated excellent levels of customer service backed by clear standards and adequate monitoring performance.

Judges will be looking for:  Clear demonstration of an identified need and personal rationale along with details of the process of implementation from concept to design, planning and results  Evidence will be displayed for plans for further research and development

 Strong leadership skills with the ability to drive the business forward Innovation and ambition

 Evidence of a sound business plan, sales and marketing strategies

Who Can Enter:

 Strong leadership skills with the ability to drive the business forward Innovation and ambition

This category is open to all Pharmacists and their teams working within the independent pharmacy sector.

Applications can be through nominating an individual or yourself.

Awards Business Development (Independent) Award entrants, including previous winners, are also welcome to submit entries.

How to Enter: For an application form please contact Aisling Twomey via email on: aisling@ipnirishpharmacynews.ie or by telephone on +353 1 6690562 or by visiting our website at www.irishpharmacyawards.ie

Deadline for Entries: Wednesday, March 29th, 2017

Who Can Enter: This category is open to all Pharmacists and their teams working within the chain pharmacy sector.

Applications can be through nominating an individual or yourself. Previous Irish Pharmacy Awards.

Business Development (Chain) Award entrants, including previous winners, are also welcome to submit entries.

How to Enter: For an application form please contact Aisling Twomey via email on: aisling@ipnirishpharmacynews.ie or by telephone on +353 1 6690562 or by visiting our website at www.irishpharmacyawards.ie

Deadline for Entries: Wednesday, March 29th, 2017

53

Awards The Irish Pharmacy

2017

Community Pharmacy Technician of the Year Award 2017

It is evident that pharmacy technicians are playing an increasingly important supporting role as pharmacists are increasingly spending more time with patient consultations and engaging local stakeholders.

The shift in emphasis from dispensing to healthcare provision has meant that the wider pharmacy team has to pull together – pharmacy technicians capture the essence of this in everything that they do.

This Award will recognise the winner’s important contribution to the community pharmacy technician profession. Applications are invited from both the independent and chain sectors.

The judges will be looking for those who can demonstrate promotion of the role of the Pharmacy Technician and those who continue to champion excellence through forward thinking and innovation.

The winners’ achievements will be an inspiration to those pursuing innovative practice; to those striving to raise standards; and to pharmacists who, through their professionalism, provide models for others within pharmacy.

Judges will be looking for:  Evidence of long-term, consistent dedication and outstanding achievements that have led to the advancement of the profession of pharmacy and public health  Evidence of a large variety of skills, attributes and accomplishments  Evidence of an individual strong in character, cumulative professional accomplishments and the ability to properly represent and model what pharmacy technicians as a profession encompasses  Evidence of an understanding the goals of pharmacy, and significantly contributing to how these goals may be achieved

This Award will be presented to those who can demonstrate outstanding contribution to the field of community pharmacy through work outside of the pharmacy business setting.

This may include those working in industry, academia, research & development or for trade and regulatory bodies or within the HSE.

Who Can Enter: This category is open to all community pharmacy professionals.

Applications can be through nominating an individual or yourself.

How to Enter: For an application form please contact Aisling Twomey via email on: aisling@ipnirishpharmacynews.ie or by telephone on +353 1 6690562 or by visiting our website at www. irishpharmacyawards.ie

Deadline for Entries: Wednesday, March 29th, 2017

IPN Pharmacy Representative of the Year Award 2017 This Award category recognises the sales representatives who excel in customer service, knowledge of their product base and commitment to their profession in terms of future growth and development.

The winner of this category must stand out in business ethics and integrity. Judges will be looking for exceptional applicants that show creativity and an inspiring work ethic. Whether it’s interacting with customers, going that extra mile, running new initiatives or training and promotional campaigns, this person will be an integral part of their company’s business.

Judges will be looking for:

Who Can Enter:

 Evidence of a commitment to excellence within your industry

This category is open to all community pharmacy technicians working within both the independent and chain sectors.

Applications can be through nominating an individual or yourself.

 Demonstration of meeting and exceeding client wants and needs

Pharmacy Awards Community Pharmacy Technician of the Year entrants, including previous winners, are also welcome to submit entries.

Who Can Enter:

How to Enter: For an application form please contact Aisling Twomey via email on: aisling@ipnirishpharmacynews.ie or by telephone on +353 1 6690562 or by visiting our website at www.irishpharmacyawards.ie

Deadline for Entries: Wednesday, March 29th, 2017

54

Professional Contribution Award 2017

 A consistent and successful sales record  Evidence of strong leadership and presentation skills

This category is open to all community pharmacy representatives working within the pharmaceutical industry in Ireland. Applications can be through nominating an individual or yourself.

How to Enter: For an application form please contact Aisling Twomey via email on: aisling@ipnirishpharmacynews.ie or by telephone on +353 1 6690562 or by visiting our website at www.irishpharmacyawards.ie

Deadline for Entries: Wednesday, March 29th, 2017

LABORATORY TESTING SERVICE ANAEMIA (Intrinsic Factor IgG) Tests for autoimmune pernicious anaemia.

Differentiates between other forms of vitamin B12 related anaemia.

CANDIDA (Candida albicans IgA/IgG/IgM) An effective test to identify and monitor early stage, ongoing or past occurrence of C. albicans.

COELIAC DISEASE

(tTG IgA/IgG) A convenient and reliable screening method to detect the autoantibodies commonly associated with coeliac disease.

FOOD INTOLERANCE (Food-specific IgG antibodies) FoodPrintÂŽ is an accurate and reliable method to detect adverse reactions to over 200 commonly eaten foods.

GASTRIC ULCER

(Helicobacter pylori IgG) Tests for antibodies against H. pylori, a bacteria that can cause inflammation, ulcers, gastric cancer and gastritis.

HISTAMINE INTOLERANCE (Diamine oxidase (DAO)) A convenient and reliable method to detect circulatory levels of DAO - the enzyme responsible for metabolising histamine.

PARASITES (Microscopic examination) Parasitic infections can be responsible for leaky gut syndrome and the development of food intolerances.

RHEUMATOID ARTHRITIS

(Rheumatoid factor IgA/IgM , CPA) Therapies can dramatically reduce disease progression, so early intervention is important to avoid long-term damage to joints.

THYROID

(TPO antibodies) Helps to confirm autoimmune thyroiditis and is often the only indication of underlying disease.

VITAMIN D

(25-OH Vitamin D) A low level of 25-OH Vitamin D is the most reliable marker of deficiency.

Growing evidence shows a link with many chronic diseases.

All of the above tests are available to the pharmacy.

For details about how you could provide these tests for your customers contact: Fitzwilliam FoodTEST Clifton House Lower Fitzwilliam Street Dublin 2

Tel: 01-4733790 Email: info@fitzwilliamfoodtest.com

www.fitzwilliamfoodtest.com

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Awards The Irish Pharmacy

2017

Irish Pharmacy News - Charity of the Year - Hugh’s House Hugh’s House provides accommodation 365 days a year to the family of children who are long term inpatients of Temple Street and the Rotunda Hospitals. We opened in May 2015 and are located less than 5 minutes walk from both hospitals. Temple Street and the Rotunda hospital manage the referrals to the house.

Ade Stack and Marty Curley

Example of a Hugh’s House Bedroom

When their baby son Hugh was ill in hospital, Ade Stack and Marty Curley were thankful they lived in Dublin. They witnessed the struggles of other families travelling from all over the country to visit their sick children, some of whom were unable to cope financially with the expense of accommodation and meals.

They were devastated when they saw children, especially babies who rarely had visitors because their families lived too far away.

their brothers and sisters. They wanted a place for children who face long journeys for outpatient appointments to have a place to go before they face the long journey home.

Families are under severe pressure with a very ill child being separated at a time when they needed each other the most.

When a child is in hospital, no one can cheer them up or excite them as much as

Hugh’s House provide them a space to spend time as a family, to play, to live and eat together.

Everyone involved helps on a voluntary basis. The house is run by a dedicated team of caring and compassionate volunteers and supporters, without whom we would not be able to offer our families the support and care they need. IPN will be participating directly at Hugh’s House by volunteering our time and urging our readers to do the same.

Everyone can make a difference through

by Donating your time, even three hours would be amazing.

Gifting unwanted household items and children’s toys.

Gift of time from Skilled Trades such as Painters, Decorators, Electricians, Plumbers, Tilers, Carpenters, Cooks, Gardeners If you would like to get involved with your work colleagues to organize a picnic, a BBQ, or come as a team for the day, send us a message on Facebook, Email or use the Contact Page.

Every hour helps.

Book your table at the Awards IPN Communications Ltd. is pleased to announce that the 2017 Irish Pharmacy Awards will take place on Saturday 20th of May at the Clayton Hotel, Burlington. The Irish Pharmacy Awards are designed to highlight the ongoing excellence being carried out in Ireland’s Pharmacy sector. These Awards will honour individuals and teams for their outstanding achievements and recognise those who are driving innovation.

With over 650 expected in attendance - the tables are already selling out!

For more information or to book a table, please contact Aisling Twomey via email on: aisling@ipnirishpharmacynews.ie or by telephone on +353 1 6690562 or by visiting our website at www.irishpharmacyawards.ie

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a Panadol Extr ts le b ta l o m ta er. ard parace relieving pow ared to stand p in a m p o c re n o e h m *W ive up to 30% Soluble can g

Product Information: Please consult the summary of product characteristics for full product information.

Panadol Extra 500mg/65mg Soluble Effervescent Tablets, paracetamol, caffeine. Indications: Relief of mild to moderate pain such as that associated with rheumatism, neuralgia, headache, musculoskeletal disorders, menstrual pain, toothache, fever, symptoms of colds and flu. Dosage: Adults and children 12 years and over: 2 tablets up to 4 times a day.

Max 8 tablets in 24 hours. Do not give to children under 12 years. Minimum dosing interval: 4 hours. Contraindications: Hypersensitivity to paracetamol, caffeine or any of the other ingredients. Precautions: Diagnosed liver or kidney impairment, hereditary sugar intolerance, pregnancy, concurrent use of other paracetamol-containing products, excessive caffeine intake, low sodium diet. Do not exceed the stated dose. Prolonged use except under medical supervision may be harmful. Side effects: All very rare: Hypersensitivity reactions including anaphylaxis and skin rash, thrombocytopenia, angiodema, Stevens-Johnson syndrome, bronchospasm, hepatic dysfunction. Frequency unknown: Nervousness, dizziness.

Overdose: Immediate medical advice should be sought in the event of an overdose, even if symptoms of overdose are not present. Combined with dietary intake, higher doses of caffeine can cause: insomnia, restlessness, anxiety, irritability, headaches, GI disturbances and palpitations. Legal Category: Pharmacy Only. MA Number: PA 678/39/10. MA Holder: GlaxoSmithKline Consumer Healthcare (Ireland) Limited, Riverwalk, CityWest Business Campus, Dublin 24. Text prepared: July 2016. Further information available on request.

Panadol is a registered trade mark of the GSK group of companies. Contains Paracetamol. Always read the label/leaflet.

CHGBI/CHPAN/0057/16

Feature Analgesics in Ireland – Growth and Market Analgesics has grown by 1% in current value terms in 2016 to reach ¤73 million Growth has been slightly slower compared to the review period average. While brand loyalty continues within this category, there has been a growing awareness of generics over the review period.

This awareness has increased due to the introduction of reference pricing by the Health Service Executive (HSE) in June 2013 for all prescription medicines. Consumers since this point have become more aware that generics exist and can be just as effective as their branded counterparts and this has been the case particularly for analgesics.

Aspirin has seen the worst performance in 2016 with it declining by 2% in current value terms. There are a lot of pain relief options in Ireland at present. While aspirin is renowned for its fast-acting pain relief, it has been impacted by both ibuprofen and paracetamol products which are perceived to be more convenient due to their multifunctional pain relief.

Adult ibuprofen is the most dynamic category in 2016 with current value growth of 4%.

Paediatric analgesics has grown by a further 2% in current value terms in 2016. Irish parents have a tendency to self-medicate their children instead of taking them straight to a doctor.

Nurofen continues to drive sales within this category as consumers see it as a well trusted brand. Ibuprofen is perceived by many as a more effective pain reliever compared to acetaminophen as it is faster acting. However, some still have their reservations as it is severe on the stomach, although this is relatively alleviated when taken with food.

Analgesics, commonly known as painkillers, are substances which work in various ways to relieve different types of pain experienced in the body.

Over-the-counter (OTC) analgesics that are generally used by the public are paracetamol, weak opioids such

as codeine, and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and aspirin.

drugs at the lowest rung, to strong opioids.

Opioids and nonopioids

These are the most common type of analgesics on the market, with paracetamol being the most popular. Aspirin and Ibuprofen are also popular non-opioid analgesics.

The type of analgesic given to a patient depends on how severe their pain is, and what other medications they might be on.

The World Health Organisation’s (WHO) ‘pain ladder’ is typically used as the metric for deciding what kind of analgesic should be distributed.

This was created by WHO in 1986 for the management of pain caused by cancer. it is now widely used by medical professionals for the management of all types of pain.

The general principle is to start with first step drugs, and then to climb the ladder if pain is still present. The medications range from common, over-the-counter

Simple non-opioid analgesics

Paracetamol Paracetamol is used for moderate and mild pain.

The mechanism of action of paracetamol is not clearly known. Unlike NSAIDs, however, it has no anti-inflammatory action.

A dose higher than 4,000 milligrams can seriously damage the liver, or even be fatal. For this reason, the amount of paracetamol that can be sold by pharmacists is restricted.

Paracetamol can, however, be sold to the general public without prescription, provided packs contain no more than 32 capsules or tablets.

Aspirin Aspirin is another painkiller popularly used for reliving pain.

Typically, it’s sold over the counter in 300mg tablets and can be taken up to four times a day.

Prescription aspirin can be used to relieve the symptoms of rheumatoid arthritis (arthritis caused by swelling of the lining of the joints), osteoarthritis (arthritis caused by breakdown of the lining of the joints), systemic lupus erythematosus (condition in which the immune system attacks the joints and organs and causes pain and swelling), and certain other rheumatologic conditions (conditions in which the immune system attacks parts of the body).

Non-prescription aspirin is also used to reduce fever, as well

58

Easofen Easofen––for forthe therelief reliefofofpain pain

Easofen Easofen 200mg 200mg film-coated film-coated tablets. tablets.

Easofen Easofen MaxMax Strength Strength 400mg 400mg film-coated film-coated tablets. tablets.

Ibuprofen.

Ibuprofen.

Clonmel Clonmel Healthcare Healthcare Ltd.,Ltd., Waterford Waterford Road, Road, Clonmel, Clonmel, Co. Tipperary.

Co. Tipperary.

A copy A copy of the of summary the summary of product of product characteristics characteristics is available is available on request. on request.

Medicinal Medicinal product product available available for retail for retail salesale through through pharmacy pharmacy only.only.

2016/ADV/IBU/026.

2016/ADV/IBU/026.

DateDate prepared: prepared: February February 20162016

Feature as to relieve mild to moderate pain from headaches, periods, arthritis, colds, toothaches, and muscle aches.

The drug can also be used to prevent heart attacks in people who have had a heart attack in the past, or who are suffering from angina (chest pain that occurs when the heart does not get enough oxygen). Nonprescription aspirin can also be used to reduce the risk of death in people who are experiencing or who have recently experienced a heart attack.

Aspirin is also available in combination with other medications such as antacids, pain relievers, and cough and cold medications.

Ibuprofen Ibuprofen is an anti-inflammatory and typically available over the counter in doses of 200 to 400 milligrams and can be taken up to four times daily. Also available are ibuprofen gels and creams.

It’s one of a group of painkillers called non-steroidal antiinflammatory drugs (NSAIDs) and can be used to ease mild to moderate pain – such as toothache, migraine and period pain, control a high temperature, caused by fever, ease pain and inflammation (redness and swelling) caused by conditions that affect the joints, bones and muscles – such as rheumatoid arthritis and osteoarthritis It can also be used to ease pain and swelling caused by sprains and strains.

The majority of types of ibuprofen can be purchased from supermarkets, general retail outlets or pharmacies.

Some types and pack sizes, however, are only available from pharmacy counters, and some only on prescription.

Ibuprofen can be taken in tablet, capsule, liquid, cream or spray form. In some products ibuprofen is combined with other ingredients, like cold and flu remedies.

Opioid Analgesics Opioid analgesics are prescribed for moderate to severe pain, particularly of visceral origin.

Evidence of efficacy and safety

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is strongest for use in acute pain and cancer-related pain.

They are used as step two and step three of the World Health Organization (WHO) cancer pain ladder. Dependence and tolerance are well-known features with regular use of these drugs, so care must be taken by both the patient and medical professionals.

Some people with chronic non-malignant conditions benefit from analgesic control with opioids, but prescribing should be reviewed regularly.

Codeine Codeine is an opiate used to treat pain, as a cough medicine, and for diarrhoea. It is typically used to treat mild to moderate degrees of pain. Greater benefit may occur when combined with paracetamol (acetaminophen) or a nonsteroidal anti-inflammatory drug (NSAID) such as aspirin or ibuprofen. Evidence does not support its use for acute cough suppression in children or adults.

In Europe, codeine is not recommended as a cough medicine in those under twelve years of age. It is generally taken by mouth. It typically starts working after half an hour with maximum effect at two hours.

The total duration of its effects last for about four to six hours.

The most popular codeinebased OTC analgesic on the market in 2015, and 2016, was Solpadeine, according to IMS.

Tramadol Tramadol is a stronger painkiller than codeine, and enhances serotonergic and adrenergic pathways as well as having an opioid effect. It is used to treat moderate to severe pain.

Adverse effects are like codeine or dihydrocodeine.

The extended-release form of tramadol is for around-the-clock treatment of pain. This form of tramadol is not for use on an asneeded basis for pain.

Patients should never use tramadol if they have used alcohol, sedatives, tranquilizers, or any kind narcotic in recent hours. Abuse of the drug, or misuse of the drug, can be fatal.

Seizures (convulsions) have occurred in some people taking this medicine. Tramadol may be more likely to cause a seizure if you have a history of seizures or head injury, a metabolic disorder, or if you are taking certain medicines such as antidepressants, muscle relaxers, narcotic, or medicine for nausea and vomiting However, a small but growing number of parents are fearful of over medicating their children and are only administering analgesics to their children if they feel they really require it.

Acetaminophen remains the most popular option within paediatric analgesics. However, paediatric ibuprofen has increased in popularity over the

review period and it is almost as popular as acetaminophen products. This is largely due to the growing number of products becoming available and the rise in popularity of the Nurofen brand for both adults and children.

Systemic analgesics products are generally positioned to treat migraines and headaches. Other benefits are generally listed on the back of the product but these are not a key driver of sales.

Topical analgesics/anaesthetic has grown by 3% in current value terms in 2016 with value sales in the category totalling EUR7 million. Growth has remained relatively consistent over the review period due to strong advertising from brands such as Voltarol. Other topical analgesics/anaesthetic products have been and continue to be popular amongst sports teams, particularly freeze and cold products that can treat impact and muscular injuries.

OTC triptans are not available in Ireland without a prescription.

However, there is strong demand for these products with many consumers going across to Northern Ireland where they are available over the counter.

Thus, there have been calls to make these products available without prescription.

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Solpadeine Soluble Tablets (P) contain Paracetamol, Codeine Phosphate Hemihydrate and Caffeine. For the treatment of acute moderate pain not relieved by other analgesics such as paracetamol or ibuprofen alone; for symptoms of headache, including migraine, toothache, backache, common cold, influenza, menstrual pain, muscoskeletal pain. Adults and children 12 years and over: 2 tablets in water three to four times in 24 hours as required; not more frequently than once every four hours. Maximum 8 tablets in 24 hours. Children under 12 years: Not recommended. Do not take for more than 3 days without consulting a doctor. Do not take any other paracetamol or codeine containing products concurrently.

Avoid excessive caffeine intake. Can cause addiction. Use for 3 days only. In case of overdose, seek immediate medical advice, even if the patient feels well. Contraindications: Lactation, acute asthma, known hypersensitivity to ingredients, known CYP2D6 ultra-rapid metabolisers, patients under 18 years who undergo tonsillectomy or adenoidectomy for obstructive sleep apnoea syndrome, rare hereditary fructose intolerance. Precautions: Caution in renal or hepatic impairment, non-cirrhotic alcoholic liver disease, obstructive bowel disorders, previous cholecystectomy, acute abdominal conditions, pregnancy, hypertension, oedema. Interaction with coumarins (including warfarin), domperidone, metoclopramide, colestyramine, monoamine-oxidase inhibitors. Side effects: anaphylaxis, bronchospasm, dependency or worsening of headache following prolonged use, dizziness, GI disturbances, hepatic dysfunction, thrombocytopenia. PA 1186/11/1. MAH: Chefaro Ireland Limited, 1st Floor, Block A, The Crescent Building, Northwood Business Park, Dublin 9. RRP (excl. VAT): 12s €4.99, 24s €7.99, 60s (GMS) €12.15. SPC: www.medicines.ie/medicine/6826/SPC/Solpadeine+Soluble+Tablets. Date of revision: February 2017.

News McLernon’s ongoing support for Hugh’s House Last year, McLernons designated ‘Hugh’s House’ as their chosen charity for the next few years. The choice has relevance, as Hugh’s House was set up by pharmacist Ade Stack and her partner Martin as a place for families to stay who have sick children being nursed in Temple Street and the Rotunda hospitals.

Ade Stack with Team McLernons and the sock monkeys made by Helen which raised over ¤600 for Hugh’s House

Ade and Martin donated a sixbedroom house on Belvedere Place, following the death of their son Hugh, aged just eight months.

This house, and a neighbouring property bought just a few months ago, serves as a home from home for families whose children are in hospital, with many staying for a few months.

The team at McLernons have been involved in several fund-raising opportunities, the first of which was the completion of Ironman 70.3, which was held in Dublin last August. Graham Henderson, the Operations Director, Sandra Morris, our trainer based in the West, and Tim O’Brien, sales executive, trained hard for this challenging relay event which consisted of a 1.9km swim, a 90km cycle and a 21km run, and raised over ¤1200.

Ironman 70.3 (the ’70.3’ relates to the total distance covered in

Robin McLernon, Director at McLernon Computers

62

miles by the competitors) comes to Dublin for only the second time in its history and up to 3000 athletes swam in Dublin Bay, cycled around Dublin and ran through Phoenix Park.

Fundraising After Ade spoke about Hugh’s House at our ‘Connecting the Patient to Pharmacy’ event at the K Club in Kildare in October, everyone at McLernons redoubled their efforts to raise funds for the charity. Helen Taylor from the Training team at McLernons spent the long winter evenings, frantically sewing ‘sock monkeys’, making over 200 and selling these at Christmas Markets. Her hard work raised ¤590 and this was augmented by our Christmas Jumper and Cakes day in December in the Belfast office, where we overdosed on chocolate and donations totalled over £150.

Marty McArdle, McLernon Engineer

The directors of McLernons doubled the funds raised, and in early January we were delighted to honour our pledge to Ade to kit out a laundry room for Hugh’s House – an essential service for families staying away from home with small children. Two washing machines and two tumble dryers have been installed, and we also provided a PC and printer for use by the families.

Down, Team McLernons brought with them boxes of food, trays of buns, toys for the children and got to work, painting two bathrooms and cooking a hot meal for the families to have that evening on their return from visiting their children in hospital. Helen’s sock monkeys made another appearance, with some being left in every room for the brothers and sisters of the sick children.

Volunteering

Hugh’s House has really struck a chord with everyone in McLernons, and a second mini-bus full of volunteers is already lined up for a return trip.

Hugh’s House required extensive work when first purchased by Ade and Martin and the upkeep is ongoing, with the beautiful garden needing lots of green fingers to keep it in good shape, so in late January a mini-bus full of McLernons’ turned up to do whatever work Ade had lined up for them.

Coming from counties as far apart as Cork, Donegal, Dublin and

Melissa Rodgers and Ali Walsh from Training Team

The McLernon team would like to thank Ade for her warm welcome, congratulate her and Martin on their great work and big hearts, and look forward to continued support for Hugh’s House and the families staying there.

Rachael Callan and Jenny Marsden from Training Team

Voltarol® Emulgel® 2% w/w Gel

EXTRA STRENGTH

Voltarol® Emulgel® Extra Strength 2% w/w Gel for the relief of pain and inflammation. Contains diclofenac diethylammonium.

Always read the label / leaflet.

Diclofenac Diethylammonium Product Information: Please consult the Summary of Product Characteristics for full product information.

Voltarol Emulgel Extra Strength 2% w/w Gel (diclofenac). Indications: For the local symptomatic relief of pain and inflammation in trauma of tendons, ligaments, muscles and joints, localised forms of soft tissue rheumatism. Dosage: Adults and adolescents 14 years and over: 2g to 4g of gel, applied topically 2 times daily – morning and evening. It is recommended that treatment to be limited to 7 days. Patients should consult their doctor if the condition does not improve. Contraindications: Patients with or without chronic asthma in whom attacks of asthma, urticaria or acute rhinitis are precipitated by aspirin or other non-steroidal anti-inflammatory agents. Hypersensitivity to diclofenac, acetylsalicylic acid or other non-steroidal anti-inflammatory drugs. Hypersensitivity to any other ingredient of the gel. Use in third trimester of pregnancy, in children and adolescents aged less than 14 years is contraindicated. Warnings and Precautions: Caution with oral NSAIDs as may result in unwanted side effects. Avoid use with other products containing diclofenac. Apply only to intact, non-diseased skin and not to skin wounds or open injuries. It should not be used with occlusion. It should not be allowed to come into contact with the eyes or mucous membranes, and should never be taken by mouth. Application over extensive areas for prolonged periods or application in excess of recommended dosage may give rise to systemic effects.

These include gastrointestinal disturbances and bleeding, irritability, fluid retention, rash, hepatitis, renal dysfunction, anaphylaxis and rarely blood dyscrasias, bronchospasm and erythema multiforme.

Discontinue if rash develops. Use with caution in patients with a history of peptic ulcers, gastrointestinal bleeding, hepatic or renal insufficiency, or bleeding diathesis, or intestinal inflammation. Pregnancy and Lactation: The systemic concentration of diclofenac is lower after topical administration, compared to oral formulations. During the first and second trimester of pregnancy, diclofenac should not be given unless clearly necessary. Only use during lactation on the advice of a health professional. Diclofenac is contraindicated during the third trimester of pregnancy. Should not be applied on the breasts of nursing mothers, nor elsewhere on large areas of skin or for a prolonged period of time. Side effects: Very rare: rash pustular, hypersensitivity (including urticaria), angioedema, asthma, photosensitivity reaction. Rare: Dermatitis bullous. Common: Dermatitis (including contact dermatitis), rash, erythema, eczema, pruritus.

Overdose: The low systemic absorption of topical diclofenac renders overdosage extremely unlikely. MA Holder: GlaxoSmithKline Consumer Healthcare (Ireland) Limited, 12 Riverwalk, CityWest Business Campus, Dublin 24, Ireland. MA Number: PA 678/140/3. Legal Category: Pharmacy only. Text revised: October 2016. Further information available on request.

Trade marks are owned by or licensed to the GSK group of companies.

CHGBI/CHVOLT/0245/16

Business and Management

CPD

This information may be used and collected each month as an ongoing comprehensive programme for management in Pharmacy. The modules are suitable for use by anyone working in community pharmacy wanting to improve their effectiveness as a successful leader and manager for their continuing professional development.

Why CPD? Continuing profession educational development (CPD) is a legal requirement for pharmacists. Journal-based educational programmes are an important means of keeping up to date with professional developments and from a significant element of your CPD

S.T.E.P. into ‘Engagement’ Part 1 - Seek First to Understand Written by Rachel Dungan MPSI ACC Rachel Dungan is creator and facilitator of the L.E.A.D. Online Mastermind Programme which is “a comprehensive, unique and transformational Personal and Professional Development Programme uniquely created for Pharmacists and Pharmacy STEPtheir into ‘Engagement’ Leaders to future-proof career and optimise patient-centred care.

Part 1 – Seek First to Understand and workplace culture. Over the following articles, we will explore each of the S.T.E.P.S. Here is an overview of the Model.

• S – ‘Seek to Understand.’ – In medical terminology, diagnosis comes before dispensing advice.

Be sure that you understand the different perspectives and that you are focused on solving the RIGHT problem.

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1

P – ‘Problem Solve.’ – Once you • T – ‘Then be Understood.’ – have reached agreement on the Once you understand, you can real problem to be solved, you then seek to be understood. If you can brainstorm potential solutions show true care and concern for to resolve it in a mutually the other person’s perspective, it satisfactory way. is more likely that they will try tointo ‘Engagement’ STEP understand you. When both parties S – ‘Safety Net’ – Patient safety Part 1 – Seek First to Understand is our first priority. This stage are fully understand, they workplace culture. Over the following articles, we will explore each of the S.T.E.P.S. Here analyses the proposed solution can work together to discover is an overview of the Model. to identify any potential pit-falls, possible outcomes.

Page

In the Feb issue, Rachel addressed the topic of Treatment Adherence and offered 10 ways to

and reduce stress In the Febengage issue, Rachel addressed effectively with the health challenged personeffectiveness to optimise adherence. the topic of Treatment Adherence in the workplace In the offered next series articles, will continue the focus on Engagement by exploring Five and 10ofways toRachel effectively - recruit colleagues whose S.T.E.P.S to Eliminate Conflict and Create Synergy in thenew Workplace. engage with the health challenged skills and attitudes complement person to optimise adherence. those ofthe the existing team When it comes to engaging others with impact and influence, same principles apply, In the next series of articles, whether your intention is to - resolve a conflict Rachel will continue the focus on - influence a patient to be adherent to their treatment protocol Caveat: Reading these articles Engagement by exploring Five - elicitto a customer’s needs at the OTC counter S.T.E.P.S Avoid Paralysing offer no value and is an interesting - seekand buy-in from your managerin to invest in a staff training initiative Conflict Create Synergy waste of time unless you DO explore ways to increase effectiveness and reduce stress in the workplace the- Workplace. something different as a result of - recruit new colleagues whose skills and attitudes complement those of the existing what you read. Good intentions are Whenteam it comes to engaging others not enough. When applied though, with impact and influence, the - resolve a conflict these principles will have a same principles apply, whether Caveat: Reading these WHATSOEVER and on is a all complete wasteof impact aspects your intention is toarticles offer NO VALUEprofound of time UNLESS you DO something as a result of whatlife, younot read.just Good intentions are not your professionally, but - influence patient to these principles will have a profound impact on all aspects enough.

Whenaapplied though, personally as well. their of be youradherent life, not justtoprofessionally, but personally as well.

The S.T.E.P.S Model provides a treatment protocol The S.T.E.P.S Model provides a simple and effective framework to turn disagreements simple and effective frameworkinto to - elicit a customer’s needs at the positive outcomes and disengaged groups into high performing teams. This article, will focus turn disagreements into positive OTC counter on the foundation “S” in the context of employeeoutcomes engagement,and teamdisengaged performance and groups - seek buy-in from your into high performing teams. This manager to invest in a staff article, will focus on the foundation training initiative “S” in the context of employee - explore ways to increase engagement, team performance

• E – ‘Empathise with Others.’

- Ask questions. Demonstrate a genuine interest by attentively listening to each answer with compassion and curiosity, without judgement. When you put yourself in the other person’s shoes, they become less defensive and more open to collaboration because they feel they have been seen and heard.

•

S – ‘Seek to Understand.’ – In medical terminology, diagnosis comes before dispensing advice. Be sure that you understand the different perspectives and that you are focused on solving the RIGHT problem.

Business and Management

CPD

agrees protocols to follow in worst case scenarios and review procedure and time-lines.

Why is it important to begin with “Seek to Understand” in the STEPS Process?

In all walks of life, including healthcare, people management, training needs analysis and customer engagement, correct diagnosis is a fundamental principle.

In order to Understand, we must first overcome our tendency to half-engage on “auto-pilot”.

We ask questions, but only half listen to the responses, because we have already pre-judged the outcome. Instead of genuinely seeking to understand, instead we 1. Evaluate (we agree or disagree) 2. Probe (we ask leading questions from our own frame of reference) 3. Advise (we give advice based on our own experience) 4. Interpret (we try to figure people out, explain their motives and behaviour based on our own motives and behaviour) The results of NOT Seeking To Understand First include significant employee disengagement.

According to Gallup, in the US, 33% of employees are ‘engaged’ (love their work, enjoy their teams and customers, contribute, have great ideas, believe in the mission, feel their job uses their strengths and they make their organisation and the world better every day).

At the other end, 16% of employees are ‘actively disengaged’. They are actively destructive in the workplace, infecting it with their emotional poison like a virulent virus.

The remaining 51% of employees are not engaged they’re just there.

What is the impact of not fully understanding each employee on workplace morale, commitment, accountability, attendance, punctuality, workplace conflict, patient safety and results? Can you afford this to continue?

These figures indicate that how you communicate has a direct impact on your career, your family life and your relationships.

In fact there is nothing in human relations that you do more than communicate. Relationships are the bedrock of life, personally, professionally, in business.

When they are good they can be fulfilling, nourishing, engaging, enjoyable and a great means of support. At their worst, they can be complicated, messy, frustrating and dysfunctional.

No matter how healthy your relationships are with others right now, there is a good chance

66

that as you move through your personal and professional life you will experience disengagement at some stage, with your children or parents, friends, partner, manager, colleagues at work or customers,.

It is an inevitable part of life.

Engagement is about connection.

We have a need to feel understood by others. We have a need to communicate our hopes, dreams, ideas, desires and needs when necessary. We have a need to be heard. And so does each of your employees, as an individual. Once you understand this, you will seek to understand that person.

compassion and non-judgement so that this awareness and expanded mind-set can spill out to nurture healthy, fulfilling, mutually rewarding and respectful relationships with others.

To illustrate visually the profound impact of Seeking to Understand first, consider the image below.

But consider this. You have spent years learning to read and write and years learning how to speak.

But what about listening? What specific training or education have you had that enables you to listen so that you really, deeply understand another person from THEIR frame of reference?

Seeking to Understand first involves a very deep shift in perspective for almost all of us.

Getting the concept intellectually is the first and easiest step, but be prepared. Knowing and doing can be two very different things!

Although it sounds like a cliché, the starting point for more healthy, skilful engagement is learning how to ‘listen to understand’, because unfortunately, no matter how much we try, we cannot understand another person’s perspective from our own point of view.

Let me share a story of a pharmacy intern who approached me regarding his frustration with an OTC work colleague. I = Intern.

P = Pharmacist.

I: “I can’t understand that girl. I don’t think she respects me.

She won’t listen to me at all.”

P: “Let me restate what you said,” I replied. “You don’t understand her because she won’t listen to you?”

I: “That’s right”, she said.

P: “Let me try again,” I said. “You don’t understand her because she won’t listen to you?”

I: “Yes!,” he replied impatiently.

P: “I thought that to understand another person, you needed to listen to her,” I offered.

I: “Oh!” he said. There was a long pause as the light dawned on a fresh and very new perspective.

It is so easy to get caught up in our own inner story to such a degree that we believe the story we create to be true without even checking it out with the other person!

Therefore, a crucial aspect of work in the Seek to Understand piece is self-discovery. We need to be prepared to explore our own inner world with curiosity,

It requires us to actively engage with what matters most to our employees. When they share their opinions (even ones that appear us as criticism), ask questions and encourage them to elaborate and expand upon their perspectives. Over time, this creates a safe-space for the nub of the issue to emerge and be dealt with. Above all, don’t interrupt.

How many times have you felt disrespected because someone has rudely interrupted your train of thought? For most of us, this is a common occurrence. Effective, compassionate pharmacists listen and don’t interrupt the flow of the dialogue. They embrace two-way communication and are aware that with every interruption comes disengagement. They earn respect from their colleagues and customers by being a patient listener.

Stay focused. Stay in the moment and be respectful of others.

What do you see? Show it to each of your work colleagues. What do they see? An old woman? A young girl? Which perspective is right?

Seeing one can make it very difficult to see the other perspective. And yet both are hidden in plain view!

From a pharmacist perspective, we are all leaders and have a profound ripple effect on our work colleagues and customers, whether or not we are consciously aware of it. Our employees have a strong desire to be understood, to gain feedback and support and to know that their employer genuinely has their best interests at heart.

This builds trust and loyalty.

As a pharmacist, it’s difficult to really know what your employees are thinking about, what’s troubling them or how to help them get out of a performance rut – unless you create dedicated time to really listen to them. This requires you are not only listening with your ears (words and tone), but also with your eyes (body language, facial expressions) and your heart (emotions), and brain (natural behavioural tendencies). Listening should be a full-time job when you consider the uncertainty embedded in the pharmacy workplace and the pace of change.

As pharmacists, we must balance our professional and managerial responsibilities with compassionate attention to our employees’ needs. Being more mindful of our own and other’s stress and tension points (before they impact patient safety and the business) requires us to consciously and consistently create the space to raise our personal leadership skills.

Providing pharmacists with the mind-set, skill-set, actionset, support, structure and accountability to develop conflict resolution and relationship building skills is what 4Front’s Engagement Module of the LEAD Online Mastermind Programme is specifically designed to do.

Employees, customers and patients respect pharmacists that listen, because they know how difficult listening can be. Here are a few statistics that give cause to pause about the importance of effective listening.

• 85% of what we know we have learned through listening • Humans generally listen at a 25% comprehension rate • In a typical business day, we spend 45% of our time listening, 30% of our time talking, 16% reading and 9% writing • Less than 2% of all professionals have had formal education or learning to understand and improve listening skills and techniques Listening to others is a professional responsibility that does not appear explicitly in the pharmacist’s job description. Neither does listening with curiosity and compassion to your inner voice.

However those who seek to understand themselves and others are destined to discover tremendous differences in perception.

You see the old woman. I see the young girl. And both of us can be right!

When you are stressed, you may withdraw and go slower. When I am stressed, I may confront and go faster.

I may find networking and

Share your knowledge Are you an professional with a special area of interest?

Would you like to see your work in print in Ireland's leading pharmacy publication?

The Editorial team at IPN are keen to hear from individuals who may be interested in submitting original articles for publication in the magazine. Whether you are a Pharmacist, Specialist or Industry expert or Business mentor, we want to hear from you .

Your piece can be on a wide variety of topics that would be of developmental and educational value to the IPN readers, for example:

 Educational/CPD articles on a chosen therapeutic area  Case studies  Research/clinical trials  Category management  Business management advice  SOPs  Financial advice  Recruitment/HR  Security  Technology

All enquiries welcome to: editorial@ipnirishpharmacynews.ie or Telephone 01 6690562

Business and Management

CPD

engaging with people all day to be energising.

You may find being alone is what restores your energy.

3. Adopt an attitude of curiosity, compassion and non-judgement. Learn to shift from judgement into curiosity.

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Our perceptions, motivators, values, beliefs, needs and stressors can be vastly different.

And yet, we both have lived with our versions of reality for years, thinking they are “facts” and questioning the competence of anyone who doesn’t “see the facts.”

4. Create a culture where difference is celebrated and change is seen not as a threat but as an opportunity to learn.

Next month, Rachel will continue the focus on Engagement by exploring S.T.E.P 2 of the Five S.T.E.P.S to Avoid Paralysing Conflict and Create Synergy in the Workplace – namely “Then to be Understood”.

Now, with all our differences, we are tasked with working together to manage resources, achieve results and fulfil professional responsibilities. So how do we do it?

You are invited to register NOW for 4Front’s LEAD Engagement CPD training series which Key Dates for your Diary DATE

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The answer is to truly seek to understand first.

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In summary, to Seek to Understand First 1. Develop your skill at asking powerful questions and listening deeply

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Pleaserate ratehow howmuch much you agree with each statement a scale = Disagree; Please you agree with each statement on on a scale of 1ofto15to(15=(1 Disagree; 2= 2= Somewhat 3 =3 Neutral; 4 = 4Somewhat Agree; 5 = Agree) SomewhatDisagree; Disagree; = Neutral; = Somewhat Agree; 5 = Agree).

Statement I understand the aspirations and goals of each of my employees / colleagues I understand the communication style of each employee, and how to adapt mine to make sure my messages have impact.

I have clarified with each person their sense of where the pharmacy has been, where it is now, and where it is going I have clarified with each employee / work colleague exactly what I expect, how he or she is doing, and what he or she can do better.

I schedule regular, informal opportunities to listen to and offer feedback to each employee / work colleague I use a different approach to engage each employee depending on his or her current performance, behavioural style, stresses, strengths and talents I use a variety of different communication styles (e.g., facts, stories, involving, asserting, affirming, sharing a vision) as required to ‘enter the other person’s world’ Each employee would say that I understand and provide the needed resources, training, information, and time for them to succeed.

I frequently acknowledge and recognise each employee for his or her contribution – in ways that matter most to them.

I spend time with each employee to plan for their professional development, and support employees to achieve their professional aspirations.

I actively seek, consider, and act on feedback about how I can be an even better pharmacist and leader.

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1

2

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In summary, to Seek to Understand First 1. Develop your skill at asking powerful questions and listening deeply

4

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Rachel Dungan.is available for one-to-one personal, professional, and medical coaching, For further training options contact Rachel@racheldungan.com or phone/text 086 6025584

Rachel Dungan, The Pharmacist Coach

News Regional Results of the 2014/15 Drugs Survey Minister for Communities and the National Drugs Strategy, Catherine Byrne, TD has welcomed the release of the regional results of the 2014/15 Drug Prevalence Survey. The new Bulletin presents the key findings at a local level from the fourth drug prevalence survey of households

by Regional Drug and Alcohol Task Force (RDATF) in Ireland and Health and Social Care Trust (HSCT) in Northern Ireland. It provides a breakdown of prevalence rates by region for illegal drugs, tobacco, alcohol, sedatives, tranquillisers and anti-depressants and gambling.

The Bulletin indicates that recent and current levels of illegal drug use increased in most Regional Drug and Alcohol Task Force (RDATF) areas between 2010/11 and 2014/15. It also found that cannabis was the most frequently used illegal drug in all RDATF areas in the year prior to the survey and that, after cannabis, ecstasy and cocaine were the most frequently reported illegal drugs for recent use.

the Steering Committee established to oversee that process is at the final stage of its deliberations. I expect to receive its final report by the end of March and I hope to bring my proposals to Government on the new Strategy after that.”

The Chair of the NACDA, Professor Catherine Comiskey, stated, “In examining the regional data, we see that prevalence of illegal drug use varies across RDATF areas.

A comparison of the 2014/15 figures with the 2010/11 figures shows an overall increase in recent and current use of cannabis, ecstasy and anti-depressants for many regions. There are some exceptions, in particular the MidWestern RDATF area, which has seen reductions or similar rates to 2010/11 for recent and current use of cannabis, ecstasy and antidepressants,”

• Prevalence rate for lifetime use of any illegal drug was highest in the East Coast and Northern RDATF areas (both 41%) and lowest in the North Western RDATF (20%).

In welcoming the bulletin, Minister Byrne commented, “The results of the 2014/15 Drug Prevalence Survey will help to strengthen the evidence base of the new National Drugs Strategy. I understand that

The main findings of the Bulletin, which is available on www.nacda. ie, are: Lifetime use

Last year prevalence • Cannabis was the most frequently used illegal drug in all RDATF areas in the year prior to the survey and after cannabis, ecstasy and cocaine were the most frequently reported illegal drugs for recent use.

• Recent use of any illegal drug was highest in the South Western RDATF area (12%) and lowest in the Mid-Western RDATF area (5%).

• Recent use of ecstasy in young adults (aged 15-34) has

increased in all RDATF areas and significantly so in many areas.

The largest increases are seen in the Western and South Western RDATFs. • Recent use of other opiates was highest in the South Western RDATF area (58%) and lowest in the North Eastern RDATF area (35%).

• Recent use of anti-depressants was highest in the South Eastern RDATF area (9%) and lowest in the Mid-Western and North Western RDATF areas (both 4%).

• Recent tobacco use was highest in the South Western RDATF area (35%), followed by the East Coast RDATF area (34%), and lowest in the South RDATF area (28%).

Last month use • Current use of any illegal drugs was also highest in the South Western RDATF area (8%) and lowest in the Mid-Western RDATF area (2%).

• As in previous surveys, males are more likely to take illegal drugs than females, and young adults (15-34) more likely than older adults (35-64).

Medicines information should be included in policy Strategies for medicines information should be included in national medicines policies, say the authors of a new publication released by the International Pharmaceutical Federation (FIP).

“Medicines information: Strategic development” is the first time that the implementation of medicines information, which is key to the safe and effective use of medicines, has been explored at a global level. Medicines information can be inaccurate, overwhelming, biased, unhelpful or simply not well understood. This publication sets out a vision for collaboration and action towards ensuring high quality medicines information around the world, through the use of strategies.

In addition to supporting the responsible use of medicines, the goals of strategic development of medicines information include medication safety and pharmacovigilance, rational prescribing and dispensing, and health literacy. A survey conducted

by an FIP working group, however, indicates that not all countries have national medicines information strategies. The core elements of medicines information strategies and how these strategies can be developed are explained in the document, which also contains experiences of three countries (USA, UK and Finland) where medicines information strategies exist. There is also a section on the development of medicines information as a part of medicines management policies in low-resource settings.

Importantly, “Medicines information: Strategic development” highlights the important contribution of pharmacists: “Pharmacists’ expertise is highly relevant to guiding the development and

implementation of medicines information strategies within national medicines and health policies,” said the publication’s editor Dr Katri Hämeen-Anttila.

“Pharmacy organisations and individual pharmacists have already taken an important role in this area. This document also highlights the way forward for educational organisations for health care professionals and for governments in order to bring the vision of high quality medicines information, for both consumers and health care professionals, to fruition.”

“Medicines information: Strategic development” is available at: http://fip.org/files/ fip/publications/2017-01Medicines-information-strategicdevelopment.pdf

news brief ¤150,000 TO TACKLE GLOBAL HEALTH PROBLEMS CÚRAM Investigator Dr Martin O’Halloran has been awarded a second European Research Council (ERC) grant. ERC grants are Europe’s most competitive and prestigious research funding, and in this case the ¤150,000 award will support the development of a new medical device for the treatment of hypertension (high blood pressure) that can lead to heart disease and stroke.

The project is a collaboration between Investigators Dr Martin O’Halloran and Dr Conall Dennedy at CÚRAM, the Centre for Research in Medical Devices based at NUI Galway. The Investigators aim to bring the novel medical device towards first-in-man trials within the lifetime of the project. Since heart disease and stroke are such major global health problems affecting a large population of patients, the team expect the project to have a very significant societal and economic impact.

The widespread presence of hypertension in European countries is currently 28-44%.

This amounts to between 200 and 327 million Europeans.

Excess production of the hormone aldosterone by the adrenal glands (primary aldosteronism) is the most common endocrine cause and accounts for 8-20% of all hypertension. Current treatment regimens are dissatisfactory and costly, involving either surgery or lifelong drug therapy. Therefore, a costeffective, minimally invasive and definitive management approach for this underlying cause would present a potential cure for an often undiagnosed and unmanaged disease. This is what is being proposed with the new ERC ‘REALTA’ project.

Adds Dr O’Halloran, “The overarching goal is to gather sufficient technical, clinical, regulatory and commercial evidence over the course of the next 18 months to be able to spin-out a company that is attractive to external investors.

Such investment will be required to take the technology through to Food and Drug Administration (FDA) approval and clinical trials.”

Finance

Why your Financial Review Should lead with Protection Colm Moore CFP® is a Certified Financial Planner and principle with Moore Wealth Management. He has been advising pharmacists for 10 years and is very aware of this market and its issues. CFP® is the highest level of education available in Financial services and is recognised worldwide.

There are only 210 independent CFPs regulated to operate in Ireland and if you would like to talk to someone about the issues raised above this is the level of qualification you should seek out.

When having a comprehensive review carried out it should have at it’s core the protection component. It’s foolhardy making sure you have the best pension and investment products if there is no appropriate life and serious illness cover in place. What’s the use in a well-advised pension or investment portfolio that ensures you have a comfortable retirement if you suffer an illness that stops you earning and making that pension contribution. Worse still is if you die leaving a family behind without a lump sum to enable them to continue to maintain the lifestyle you strived to provide for them.

Living Benefits: A proper plan will break your cover down to living benefits and death benefits further divided by those paid personally and those paid for by your business. This is important for tax reasons as you will see later.

Living benefits include serious illness cover and income protection. Serious illness cover is a long-term insurance policy designed to pay a lump sum on the diagnosis of certain life-threatening or debilitating (not fatal) conditions such as a heart attack, stroke, cancer, multiple sclerosis and loss of limbs. The age Group from 50 to 60 accounts for approx.

40% of claims and surprisingly the lower age group 30 to 40 accounts for approximately 30% of claims. The cost of arranging serious illness cover rises dramatically as one gets older so this something that should be addressed sooner rather than later to negate this. As you are aware the chances of getting a serious illness and surviving are much greater than dying due to medical advances. However, these illnesses can leave the sufferer out of work and unable to earn for a long period of time and these polices in conjunction

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with income protection can address that situation.

Income protection covers your most important asset which is your ability to earn. The potential to earn is a direct culmination of years of study, hard work and enterprise on your part. If you can no longer work this is taken away from you. This a benefit that pays up to 75% of your income if you cannot work after a deferred period typically 13-26 weeks up to your chosen retirement age from 55 to 68.

The benefit is payable if you cannot perform your duties as a pharmacist. It does not matter if you could work elsewhere, its specific to your occupation. The premium on this qualifies for corporation tax relief if paid for by the business or 40% tax relief if paid personally. The maximum you can cover is 75% of salary less state disability benefit if you are entitled to it. As most pharmacists are owner directors with 50% or more of the shares in your company you are a Class S PRSI payer and as such would be you would not be entitled to disability benefit (¤198.50 per week).

Company Paid or Personally Paid Cover: A serious illness policy paid for

by the business for the benefit of the owner needs to be set up correctly. The correct way to set this up is with the company as the proposer and the life insured as the owner. There will be benefit in kind on the premium paid but the benefit paid will go directly to you and not to the company. If the policy is not set up this way and the policy pays out to the business this will be treated as non-trading income and taxed at 25% along with normal income tax, USC and PRSI on extraction. If you have a company paid serious illness policy and it’s not set up correctly a ¤100,000 lump sum initially reduces to ¤75,000 and then by nearly 50% with the tax on extraction. The means the benefit you think you have is reduced by over 60%. You could well be paying for cover you will never be able to benefit from.

Personally paid policies under claim pay out a taxable benefit that go to you while company paid polices have the claim paid to the business and are taxed as normal on extraction.

Crucially only polices paid for by your business give you the option to cover your pension premiums. This means not only are you protecting your income you can protect your retirement also and this is where this policy is invaluable in the lifetime of security it can provide.

by nearly 50% with the tax on extraction. The means able to benefit from.

With income protection you can have the premium pa while company paid polices have the claim paid to th option to cover your pension premiums. This means Death Benefit: invaluable in the lifetime This of security it can is simply a cover thatprovide. pays Death Benefit:

out on the death of an individual.

Typically people think this is something that will not happen to them and they discount the possibility. However if you look at the probability figures from the most recent census statistics it shows the chances of one spouse in a couple dying before age 60 and 65 is as below.

This is simply a cover that pays out on the death of an i However if you look at the probability figures from th With income protection you can have the premium paid by follows. your business or personally.

Ages 45 50 55

Die Before 60 10.69% 8.65% 5.39%

Die Before 65 18.41% 16.54% 13.56%

Income Combined Salary (€100k and €30k) Widowers Pension Children’s Benefit (2 Kids) Rental Income Investment Prop Liabilities Tax and PRSI Living Expenses Mortgage Home Mortgage Investment Property Net Surplus/Deficit

Current Cash Flow € 130,000 € € 3,360 € 8,000 € 141,360

Death Of Spouse 1 € 30,000 € 13,177 € 3,360 € 8,000 € 54,537

Death Of Spouse 2 € 100,000 € 13,177 € 3,360 € 8,000 € 124,537

€ € € € € €

€ € € € € €

€ € € € € €

55,200 50,000 12,000 6,000 123,200 18,160

10,235 35,000 6,000 51,235 3,301

48,471 35,000 6,000 89,471 35,066

Note Rate €193.80+ €29.80 Per Qualified Child per week

Assumes 30% deduction on death of one spouse Home loan is cleared

In this instance, you need to work out what impact the death of either spouse will have on the family in the long term and this is done by way of the calculation above. closely at the cover required be on offer for but it’s available reduces to ¤3,301. This is a drop In this you will see that with a This an excellent option or provided.

The most cost in income of ¤14,859 per annum.

45-year-old couple there is a Death of Spouse 1: In this case €100,000 of income is lost but this will be offset by two primary factors. The home mortgagetoday. payment of is €12,000 per annum is no that allows you over time to With this figure quantified we can effective way to cover loans 10.69% chance one will die longer payable as the mortgage protection policy kicked in and the surviving spouse became entitled to the widow’s pension of €13,177 per annum including engage with more advanced tax is with a mortgage protection then look at a recommendation before age 60 and 18.41% dependants pension. Even with this and athat reduction living rather expenses the annualpolicy surpluswhich of €18,160 to €3,301. This is a drop income of €14,859 planning to in pass on your estateper is thereduces cheapest makesinsense than chance of one dying before age annum.

With this figure quantified we can then look at a recommendation that makes sense rather than an arbitrary figure.

With 28 years to retirement at agenot 68 a form of life cover available as the efficiently and means you do an arbitrary figure. With 28 65. This changes a situation that fair assumption would be 28* €14,859 giving a life cover requirement of €416,052 to maintain the lifestyle that is in place. have to worry in the interim. amount covered decreases with years to retirement at age 68 you perceive as happening to the loan. Any other form of cover a fair assumption would be other people to something that Lifemost and financial Seriousadvisers illness cover However you to cannearly also factor that an extra amount included to cover costs of third levelyou education will be is able is notthe necessary unless are which 28* ¤14,859 giving a lifeiscover will happen one in in clients five wishes too important you the andfamily your in a to give methodology appeals to to some while on others will say they and more totoleave an interest onlywant loanthe andabove amount requirement of ¤416,052 of us. you an approximation of. The above family leave it to a loosely be changed.

The stronger positon. That comes down to your own personal preferences premiums are currently at savings the lowest point theytohave ever been mainly due to maintain the lifestyle that and is life covershould assembled bunch of polices with Trying to quantify an appropriate here can lead into thousands in place. price competition in the market place and the drive for market share by the insurers. no plan in place. The cost of amount of cover always seems depending on the term and hasThis reduced tosaving market you can also factor difficult clients untilthis you premiums involved.

Death of for Spouse 2: With instance andHowever it’s not unusual to see, if the second income earner dies the cashflow situation cancover improve. is downdue to the on pressures in the last five years in clients wishes that an extra put maths and behind it.widow’s pension and the reduction in living expenses. the mortgage, thelogic addition of the and any policy taken out before Inheritance Tax Planning and amount is included to cover the Then the calculation becomes this time can likely be replaced Life Cover: costs of third level education surprisingly straight forward. for a lower premium. Speak with which most financial advisers Take the following scenario a Certified Financial PlannerTM In the past when you were will be able to give you an who can guide you in this matter. looking at a large inheritance A Married Couple both 40 approximation of. The above It’s important you deal with tax bill you had the option of with two incomes of ¤100,000 methodology appeals to some someone who is independent taking out a Section 72 policy and ¤30,000 along with rental while others will say they want because if you for example go the proceeds of which were income of ¤8,000. They have two the above amount and more to to a bank they can only offer a exempt from tax if used solely kids, two mortgages and living leave the family in a stronger quote from one provider out of a for the purpose of settling the expenses of ¤50,000 per annum positon. That comes down to market of seven providers. It’s no inheritance tax bill. These whole along with mortgage payments your own personal preferences different than going to the Ford of life polices with reviewable of ¤18,000. They wish to make and life cover premiums are garage and saying what’s the premiums(upwards) which sure that the family is protected currently at the lowest point they best car, you will only get one combine life cover and savings in the event of the death of have ever been mainly due to answer and experience tells me were typically very expensive either spouse. Currently they price competition in the market it won’t be in your best interest. and the promised level of return have mortgage protection on the place and the drive for market on the savings element never home loan. share by the insurers.

Colm Moore Grad Dip, SIA, materialised. Given they quoted ® ® estimated growth rates that were QFA, CFP Colm Moore CFP In this instance, you need to Death of Spouse 2: With is a Certified Financial Planner 6% plus per annum which no work out what impact the death this instance and it’s not and principle with Moore Wealth managed fund can do with any of either spouse will have on the unusual to see, if the second Management. He has been regularity this outcome was not family in the long term and this income earner dies the cashflow advising pharmacists for 10 surprising. However there is a is done by way of the calculation situation can improve. This years and is very aware of this new option on the market place above. is down to the saving on the market and its issues. CFP® is which can address for some mortgage, the addition of the highest level of education Death of Spouse 1: In this what can be a very significant the widow’s pension and the available in Financial services case ¤100,000 of income is figure and a source of worry.

The reduction in living expenses. and is recognised worldwide. lost but this will be offset by policy enacted under section 72 There are only 210 independent two primary factors. The home of the tax code can cover your Mortgage Protection CFPs regulated to operate in mortgage payment of ¤12,000 liability in the event of death but Ireland and if you would like A common issue encountered per annum is no longer payable crucially will refund you 70% of to talk to someone about the in reviews for clients is where as the mortgage protection your premiums after 15 years if issues raised above this is the policy kicked in and the surviving they were sold the wrong type you do not make a claim. This level of qualification your adviser of cover for their loans. This spouse became entitled to the is a policy that will refund a should have. happens most often when the widow’s pension of ¤13,177 per large portion of your premiums bank arranged the cover for annum including dependants if it’s not used. As a concept its them and at the time most pension. Even with this and a goes against the grain of how people were just grateful for reduction in living expenses life companies operate and we the loan and did not look too cannot be sure how long it will the annual surplus of ¤18,160

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In an exact repeat of history, the new generation IgG antibody food intolerance test als received a lukewarm reception when first introduced but this is rapidly changing. The solid science underpinning this test is finally prevailing.

Feature Food Allergies and Intolerance in the pharmacy 5. Diagnosis of Food Intolerance (is not based upon IgG4)

Fitzwilliam FoodTEST was founded by Martin Healy and the company was the first to introduce this new generation IgG Food intolerance Test into Ireland in 1998.

One of the prominent myths circulating is that the test is detecting IgG 4. This is 100

Having worked in professional practice for over thirty having manyscientist know incorrect.

We DO NOT test for IgG 4. We testyears, for IgG 1,2,trained and 3.with Every celebrated teachers, he now brings this unique experience and specialist skill to the that IgG4 is anti-inflammatory and the reason why it should not be used in the test.

Fitzwilliam FoodTEST Group. The group consists of a network of pharmacists, nutritional therapists, doctors and associated health practitioners spread throughout the country.

With increasing numbers ofThe people presenting pharmacy of food intolerance and allergies, diagram below to clearly showswith thatsymptoms antibody IgG1 and 3 are strongly pro-inflammat Martin Healy discusses the most common symptoms patients who present to a pharmacy suffer from, and andglean that from is what our test isachecking for.intolerance indicator test. the benefits pharmacists can purchasing food allergy 1. Introduction Increasing numbers of people are presenting at the pharmacy with: (a) Digestive symptoms (reflux, indigestion, bloating, constipation, irritable bowel). (b) Inflammatory symptoms (rheumatoid arthritis, sinusitis, asthma, eczema, psoriasis).

Increasing numbers of people know that specific foods are exacerbating their symptoms. They are clear about the connection with diet but they find it very difficult to track the specific foods responsible. This is because in the majority of cases, the symptoms do not appear immediately after eating food. People commonly refer to their trigger foods as “food allergy” but this is technically incorrect. This delayed response is mostly describing a “food intolerance” type of reaction.

2. Difference between Allergy and Intolerance Food allergy is an almost immediate reaction to the trigger food. Anaphylaxis is the outstanding and extreme feature of a true food allergy reaction.

In addition to being an almost immediate response to a food consumed, it can be a violent and life threatening event. It can be a medical emergency but thankfully, very few people suffer with true food allergy.

Food intolerance on the other hand is mostly a delayed reaction to foods consumed and can take anything from a few hours to several days for symptoms to manifest. Because of this delayed reaction it is difficult to determine the trigger foods. Food Intolerance is primarily associated with chronic, inflammatory disease.

3. The Allergy Mechanism In cases of allergy, the underlying mechanism involves immunoglobulin E antibodies (IgE) binding to an allergen and then to a receptor on mast cells

72

or basophils where it triggers the release of inflammatory chemicals such as histamine. This leads to the classic symptoms of an allergic reaction, a runny nose and watery eyes, sneezing etc.

detecting IgG4. This is 100% in the intestinal wall are not incorrect. We DO NOT test for cemented as previously thought IgG4. We test for IgG1, 2, and 3. but rather are dynamic structures.

Every scientist knows that IgG4 is Incompetent tight structures cause anti-inflammatory and the reason increased intestinal permeability, why it should not be used in commonly referred to as leaky 6. The Central Mechanism Behind Food Intolerance the test. gut, and can lead to absorption 4. Diagnosis of Allergy of incompletely digested food The diagram above clearly shows proteins and other antigens that The discovery of IgE antibody and that antibody IgG1 and 3 are over-stimulate the immune system the RAST test in 1967 marked a strongly pro-inflammatory and that through the bloodstream.

Emerging shows that most food intolerance (inflammation) and autoimmune turning point inevidence allergy diagnosis. is what our test is checking for.

This test is now used in hospitals People suffering with conditions share a common 6.root centred in the intestines.

Additionallyfood and most The – Central Mechanism and medical clinics throughout intolerance and autoimmune Behind Food Intolerance the world. Interestingly, for several disease appear to have a genetic importantly, the intestinal wall is crucial to this. years after it was first introduced, it Emerging evidence shows susceptibility and issues with received a lukewarm reception. increased intestinal permeability. that most food intolerance The arrival of undigested foods (inflammation) and autoimmune In an exact repeat of history, the in the intestines can further conditions share a common new generation IgG antibody destabilise the gut microbiome root – centred in the intestines. food intolerance test also and lead to a toxic environment.

Additionally and most importantly, received a lukewarm reception The presence of IgG antibodies the intestinal wall is crucial to this. when first introduced but this is is an indicator of gut leakage rapidly changing. The solid Only a single layer of epithelial as a result of this increased science underpinning this test is cells is all that separates the intestinal permeability. finally prevailing. bloodstream from the contents of The diagram top of page 73 the intestines.

This intestinal wall 5. Diagnosis of Food Intolerance (Normal) is one of an intact has the crucial role of allowing (is not based upon IgG4) intestinal wall which does not allow nutrients inside the body while One of the prominent myths any of the gut contents to infiltrate keeping bacteria, toxins and circulating is that the test is wastes outside. The tight junctions into the interior workings of the

The diagram below (Normal) is one of an intact intestinal wall which does not allow any of the gut contents to infiltrate into the interior workings of the body, the blood stream or come into any direct contact with the internal workings of the immune system: 9. Treat the Root Cause of Autoimmune Disease One of the best defences against food intolerance and autoimmune disease is to maintain thriving colonies of healthy gut bacteria and this in turn helps to maintaining a “leak proof” intestinal wall. The first and most important step along this road to maintaining gut health is to avoid food intolerance trigger foods.

The IgG Food Intolerance test is the best way to find your specific intolerance foods. Increasing numbers of scientific publications clearly support the proposed benefits associated with following an elimination diet based upon the IgG test (contact editor for publications).

10. Probiotics Pharmacists are increasingly recommending probiotics to patients following antibiotic therapy. This article supports their use in a wide range of conditions because of the link between gut health and autoimmune disease. body, the blood stream or come immune complexes and / or a are vigorously training and eating Medical investigators throughout five or more eggs for breakfast, into any direct contact with the weakened immune system which the world are now starting to every morning.

You might expect internalAnormal workings of the immune below is unable to clear build-up ofintestinal The diagram shows a the damaged wall and this is a very look clear at the microbiome and the all of these people to show a high system: these immune complexes. mysteries of the gastrointestinal IgG reaction to egg.

The reality is demonstration of “Gut Permeability” where toxins from the gut have made their way into bacterial community, as one of the that the majority of these people The Anormal diagram below 7. Immune System - does fastest moving areas of biology, of the bloodstream.

This diagram also shows the immune system do not showresponding any reaction to to egg.this invasion shows a damaged intestinal not produce IgG antibody to relevance to all branches of human The only people who show a raised medicine. wall and this is a very clear every food by producing IgG antibodies and ultimately these form clusters or “immune complexes”.

IgG antibody reaction to egg are demonstration of “Gut 11. Food Intolerance – Indicator those who are genuinely intolerant Another of the myths circulating is Permeability” where toxins from Test (Cost ¤15) to egg. These are the people who that the Immune system produces the gut have made their way into report feeling dramatically better an IgG antibody response against the bloodstream. This diagram Not everyone has food intolerance having stopped eating egg. any and every food eaten. also shows the immune system issues and as a result, people This again is totally untrue. For responding to this invasion by are sometimes a bit reluctant to 8. Why are these Antibodies countless numbers of people who producing IgG antibodies and purchase one of these complete Attacking Self (autoimmune regularly eat common everyday ultimately these form clusters or food intolerance tests. To disease) foods such as potatoes, rice, “immune complexes”. overcome this problem we have chicken, lamb, beef and drink introduced the Food Intolerance The immune system initially There is a great deal of evidence coffee and tea etc, they do not Indicator Test (¤15). This Indicator produces these auto-antibodies to suggesting that increased produce elevated levels of IgGimmune There is a great deal of evidence suggesting that increased levels of circulating Test scans the blood. It does attack and destroy the undigested levels of circulating immune antibodies against all of these complexes are associated with a variety of diseases in which the complexes, once not tell you which foods you are food proteins and endotoxins complexes aretissues, associated with by activating foods or indeed alland of other the foods intolerant to. It just indicates YES deposited in the cause damage complement effector that have seeped into the blood a variety of diseases in which included in their diet. or NO to the presence of food mechanisms. stream through the porous gut the complexes, once deposited specific IgG antibodies. A patient wall.

However, cross reactions can Another myth is that ifand / in the tissues, cause getting a POSITIVE result can then Symptoms emerge whendamage there is anby overloaded of antigen andcirculating immune complexes occur as the antibody recognises you eat too much of any specific activating complement andwhich otheris unable progress to one of the bigger tests or a weakened immune system to clear the build-up of these immune not only the antigen for which it food, you will produce an elevated effector mechanisms. to find the exact culprit foods. complexes. was originally formed, but also IgG response against that food. other antigens which are very 12. How These Tests Benefit Symptoms emerge when there That is again 100% untrue. I similar. So if the gut antigen and the Pharmacy is an overloaded of antigen and regularly come across people who some body tissue (organ systems)  Increasing numbers of people share some molecules that are very similar, the antibody can begin are requesting this test service from their pharmacy an attack upon these tissues or organs. This phenomenon has  The blood sample used for been observed for a long time. analysis only requires a finger prick sample If there is a homology of over 70% i.e. congruence between various antigens of over 70%, cross reactions can occur. A clinically relevant cross reaction is possible between 40% and 70%.

This is the basis of thyroid and rheumatoid and all other autoimmune disease and coincidentally – IgG based food intolerance

7. Immune System - does not produce IgG antibody to every food

 The service is already working well in several pharmacies nationwide  All tests are CE marked  These tests are processed in laboratories in over 100 countries worldwide  A professional test commission is paid to the pharmacy.

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News AIB host Pharmacy Masterclass with Fitzgerald Power Thursday the 16th of February saw AIB and Fitzgerald Power present a pharmacy masterclass to an audience of over 60 healthcare professionals and pharmacists and in the Tapestry Room, in the Granville Hotel, county Waterford.

Key speakers on the night included Stuart Fitzgerald, Director of Fitzgerald Power Accountants, Alan Ryan, Senior Manager of the Waterford Business Centre, Maree Lyng, Branch Manager AIB Enniscorthy.

Fitzgerald gave a presentation about the history of the Irish Pharmacy Market, which is beginning to experience growth again, and outlined some of the potential opportunities for pharmacist during 2017.

“What we’ve seen is lots of change: The recession brought in the FEMPI act; we’ve seen reference pricing; we’ve seen the introduction of prescription levies,” he said to the crowd. “…The most significant of those changes, is coming around the state scheme of reimbursement. We would estimate that approximately 2.7 billion, has been stripped out of

the sector through FEMPI and reference pricing since 2009. It’s a huge figure, and it’s not always reported accurately in the media.”

Fitzgerald also noted other changes that have happened in the market in the past number of years, including a significant increase in the number of items dispensed in recent years, an improving in retail focus by pharmacists, pressure on retail pharmacies from supermarkets, increases in healthcare services offered in pharmacies, and a better control of costs.

Afterwards, Alan Ryan and Maree Lyng presented the banking opportunities present for pharmacists in the context of a growing and changing marketplace.

More on this in the next issue of Irish Pharmacy News.

Alan Ryan, Maree Lyng and Stuart Fitzgerald

Munchkin White Hot® System Munchkin is powered by clever innovation designed to make parents’ lives easier and more enjoyable. They develop innovative, modern, and credible products for babies and children by thinking of “the little things.”

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The products with this technology include White Hot® Safety Sunblock Shades - indicate when the car is too hot, White Hot® Feeding utensils - indicate when the food is too hot, and a White Hot® Inflatable Bath indicates when the water is too hot for your babies sensitive skin.

Introducing Prince Lionheart EYESLEEP™ The Prince Lionheart EYESLEEP™ takes the science from the Original Slumber Bear®, the innovative Soundbox and encases it in a cute, fun character appealing to child and parent alike.

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IT ALL STARTS WITH SKIN, IT ALL STARTS WITH MUSTELA®

Brought to pharmacies by leading distributor, Graham Anthony Distribution

The richest thermal water for Eczema and other skin irritations Xemose, from thermal water brand Uriage, is a line of new generation emollient care for extreme and long-lasting cutaneous comfort. It is particularly suitable for people who suffer from eczema or other skin irritations.

The Xemose range is the ideal range to use on your skin as the effects of the Xemose range will last all day, providing a nourishing and soothing feeling.

Products from the Xemose range have a triple barrier action for long-lasting relief: Cerasterol 2F restores and reinforces the skin barrier, the TLR2-Regul regulates the innate immune barrier and Uriage Thermal Water re-balances the microbial barrier.

60 YEARS OF DERMATOLOGICAL RESEARCH

Uriage is one of the leading dermo-cosmetic brands on the international market and is now available exclusively in pharmacies nationwide. ® Uriage Thermal Water cannot be compared to others soldWITH in Ireland as MUSTELA , IT ALL STARTS SKIN it’s very different. Uriage is;

THE RICHEST Thermal Water, with the highest concentration of minerals and trace elements. 52 x richer than other Thermal Water available.

THE ONLY Thermal Water which can be use in mucous membranes.

Mustela_PLV_Gamme_1016_EN 150x115.indd 1

| PR SUPPORT | MARKETING | ATTRACTIVE MARGINS | TRAINING Unit 18bPOS Rosemount Business Park Ballycoolin Road Blanchardstown Dublin 11 Dublin, P:01822 Ireland P: 01 822 2711sales@gadistribution.ie E: sales@gadistribution.ie www.gadistribution.ie 2711 Email: www.gadistribution.ie

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News Skincare showcase for pharmacists Leading Irish company Graham Anthony held a day for people to come and see their range of skincare products on February 15th at the Royal Hibernian Academy. The day saw over 100 journalists, pharmacists and other professionals visit, to see for themselves the wide range of products offered by the company.

Speaking to Irish Pharmacy News, Graham Quinn, CEO of Graham Anthony, said, “We wanted to get everyone here together, to let them see exactly what we have on offer, set up a display of all of our units, the different product lines, because everything that we have really does something different.

“By and large when it comes to say, anti-aging cream, people really are aware what they’re looking for, so it’s important that customers are aware of the kind of products we offer, and the ingredients in them.”

“What we’re offering to pharmacists, is the convenience of dealing with a single company.

We offer a selection, so people can get a full drop, but also, we can provide them with the bestsellers in each brand, so it takes maybe two shelves up.

So, for instance, we gave some Uriage products to a pharmacy last year, taking up maybe one or two shelves. Then the product became a bestseller and they decided to go with a full drop.”

Graham was kind enough to give IPN a tour of some of the products offered by the company, which includes Payot, Alpha H, Delarom, IDC, Uriage, Mustela, Fakebake, Goa, Karita, and other leading brands.

IDC “IDC is a leading brand of ours – it has very active ingredients, and the guy who owned the company was a chemist who used to manufacture the raw materials for big companies, but saw that they weren’t putting a lot of the concentrate into the product, so he decided to make his own line. In total, it includes about 29 different products.”

Alpha H “Then we have Alpha H, which is a glycolic acid from Australia, the signature product being the liquid gold, it’s a best seller as well, and they do face peels too.”

76

Graham Quinn, CEO, Graham Anthony

A best seller, it’s Glycolic based formulation works like an ‘overnight facial’ to brighten and revitalize tired and aging skin.

Delarom “This from a man who used to make Decleor, and now he’s sold the company and reinvented the wheel again with an aromatherapy line. It caters to all skin types.”

Infused with organic botanicals, high quality essential oils and advanced patented biotechnology, DELAROM’s efficacy has charmed many loyal followers with its revitalizing fragrance and anti-aging results.

Lorac “This is a French Brand that we’ve only just started with. It’s purely an anti-aging product, and goes for the price of about 40 euros, so it’s very reasonably priced, and effective.”

Feto Haircare “This is another well-known brand. It’s one of the few natural

haircare brands in the world, and it’s in almost every country in the world, and it’s got a full line of colour. It deals with all problems that might happen to the scalp, hair loss, scalp irritation and so on. It’s also in Lloyds in the UK, at the moment.”

SVR “A dermo skincare brand, for skin conditions like dermatitis, eczema, and others, and its’ very reasonably priced, so it’s very good value for customers who want healthier skin.”

Uriage “At the moment, this is our bestselling brand. It’s another dermo skincare brand, and deals with similar skincare conditions.

It’s recently been put into Lloyds in the UK.” Denise Mulcahy, of Mulcahy’s Pharmacy, Cork, who was also in attendance at the event, said, “I really enjoyed today, and it was very informative. I’d stocked Uriage in both of our pharmacies, in the main street,

and the medical centre, and it goes very well, and we were very interested in a lot of the products that we saw today.”

About Graham Anthony The Graham Anthony team offer the complete collaborative opportunity to Beauty salons, Spas, Pharmacies, Colleges, Department Stores and multiple chains in Ireland, as well as UK. They offer: High Quality Brands and Products, Nationwide Training Programs, Excellent Customer Service, Efficient Delivery, Regular visits from Sales Representatives & Promotional Assistance.

Their marketing team actively market brands using a combination of both traditional and digital tools for promotional drives, advertising and range reviews, and use Facebook and other social media channels to market key brands that need to reach targeted audiences.

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BREATHE EASY COMPRESSOR NEBULISER The Medicare Compressor Nebuliser is a robust nebuliser, ideal for home based, frequent usage. This is a highly efficient nebuliser that combines a short inhalation time with efficient medication delivery thanks to a powerful compressor.

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Active Iron

Altavita D3

Carnation Silky Heels

Active Iron is the only formulation which protects the digestive system from the usual problems with iron and helps deliver iron to where it is best absorbed.

A choice of weekly or monthly soft capsules for the prevention of vitamin D deficiency.

Is shaped to fit the contours of your heel for instant removal of hard cracked skin in just a few strokes.

Active Iron is tough on tiredness because it is clinically proven to ensure better absorption of iron. It is kind on you because of its advanced formulation and is gentle enough to be taken on an empty stomach

Consilient Health Ireland are delighted to announce the launch of a range of licensed, oral vitamin D preparations for the prevention and treatment of vitamin D deficiency. Altavita D3 7000 IU and 25000 IU soft capsules will be available in Ireland from March 2017.

The outer surface is designed with thousands of abrasive particles while the inner is constructed in soft foam making the device flexible to use on all areas of the feet.

RRP ¤6.45

Hydrabio Masque

Ostomy Deodouriser

Leading French dermocosmetic brand, BIODERMA, is proud to announce the launch of the NEW Hydrabio Masque.

Specifically formulated for those with dehydrated and sensitive skin, Hydrabio Masque is the gentle moisture-generating mask with the Aquagenium© patent and the sixth product to be added to the Hydrabio range.

Just A Drop Ostomy Deodouriser is ideal for those with ostomy bags, working to eliminate odours in the toilet bowl and safe to use in the pouch.

Each time the pouch is emptied one or two squirts are placed directly in the toilet bowl or inside the ostomy pouch.

Micellar Water Ultra Soothing For sensitive skin Prone to itchy, stinging or prickling sensations is one of three unique formulas, tailored for three different skintypes that combine both water and oil to effectively remove even waterproof make-up.

Safe, effective, non-toxic and easy to use.

Remington Keratin Radiance Sleek & Smooth Brush Smooth hair in minutes. The sleek and smooth brush has three temperature settings to suit all hair types. Designed to retain the natural volume in the hair whilst smoothing it out to perfection, for a naturally straight style with volume.

Yokebe Nutritious, high protein weight loss shake available in three delicious flavours.

Yokebe Active Food is a highly nutritious all-inone weight loss shake with naturally sourced ingredients. A special combination meal replacement of highquality proteins, honey and all the essential vitamins, minerals and macronutrients necessary to help support weight loss in a convenient, tasty format.

NIVEA Intensive Care Hand Cream 75ml NIVEA Intensive Care Hand Cream 75ml, formula with caring almond oil and the unique NIVEA scent provides rich care and intensive nourishment that lasts for 24hours for protected & incredibly soft hands all day long!

Just 75ml in size and enriched with a variety of caring oils, NIVEA’s NEW Hand Creams are the perfect hand bag or gym bag essential to ensure hands stay well protected & irresistibly smooth at all times.

RRP ¤3.39

RRP ¤89.99

Pure Potions Skin Salvation Intensive Moisturising Ointment NEW Product – To be launched at United Drug Trade Fair April 22nd to 25th This salve is an intensive natural moisturiser formulated to maintain supple, hydrated skin as part of a daily skincare regime. Rich and deeply moisturising, Skin Salvation Intensive Moisturising Ointment forms a semi-occlusive barrier which protects the skin from everyday external irritants.

It’s gentle formulation means that it is also suitable for people who may be prone to dry, itchy skin or eczema.

78

• • • • • •

•

naturally rich in EFAs provides intensive hydration fragrance and preservative free free from harmful chemicals 100% natural also suitable for those who may be prone to eczema, psoriasis, dermatitis, skin rash and any sore skin condition suitable for all ages

For more information or samples please contact your Intrapharma Rep

The Apologetic Tooth wants to say “sorry...”

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Always read the label

He knows he sometimes makes your baby cry, so he wants you to know about Nelsons® Teetha® Teething Granules with soothing Chamomilla.

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Homeopathic medicine for teething pain relief.

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Christmas Cosmetic & Gift Trade Fair

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Sunday 21st May 10am - 6pm Monday 22nd May 9am - 8pm Tuesday 23rd May 9am - 6pm

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