June 2018 Volume 10 Issue 6
THE INDEPENDENT VOICE OF PHARMACY
In this issue:
HAYFEVER MEETS ITS
NEWS: Push for HPV vaccine to include boys Page 8
NEWS: Bluefish arrives in Ireland Page 12
More allergy sufferers use Zirtek Allergy Relief in Ireland than any other brand. That’s because it’s a trusted, non-drowsy way to ease the symptoms of hayfever and other allergy symptoms, 24-hours-a-day.1,2
NEWS: How hypertension changed the face of a pharmacy Page 37
With Zirtek Allergy Relief, you’ll also get: High-profile marketing support, including a new website, national television campaign, online advertising and social media Your own point-of-sale material
A range of products suitable for all the family3
Oesteoarthritis Page 41
A heritage and reputation based on reliability and dependability, supported by extensive knowledge and research Round-the-clock, max strength treatment, available in extra-value packs of 30
www.zirtek.ie 1 2 3
FEATURE: Nasal congestion Page 46
Zirtek Usage and Attitude in the ROI report. Does not cause drowsiness in the majority of people. Zirtek is available in liquid formula for ages 2 and upwards, and in tablets suitable for ages 6 and upwards. Zirtek D is suitable for adults and adolescents from 12 years of age and upwards.
Please consult the Summary of Product Characteristics before prescribing, information about this product can be found at www.medicines.ie Further information is available on request from UCB Pharma Ireland Ltd, United Drug House, Magna Drive, Citywest Road, Dublin 24 MA Numbers:
Zirtek 1 mg/ml oral solution: PA 891/8/3, Zirtek Plus Decongestant 5/120mg Prolonged Release Tablets PA 891/8/1, Zirtek Tablets PA0891/008/005
Product licence holder: UCB Pharma Ireland Ltd Classification:
Legal Category: OTC
Zirtek tablets & oral solution: Cetirizine dihydrochloride Zirtek Plus Decongestant prolonged release tablets: Cetirizine dihydrochloride, Pseudoephedrine hydrochloride
Adverse events should be reported to the Health Products Authority at www.hpra.ie or via email to firstname.lastname@example.org Adverse events should also be reported to UCB Pharma Ireland Ltd via email UCBCares.IE@ucb.com
May 2018 UK/18ZI0019
The Irish Pharmacy Awards 2018 – winners Page 48
FEATURE: Infant nutrition Page 70
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Contents Page 5: McKesson and the Irish Heart Foundation join forces
Page 11: IPU Conference Page 23: ‘Design thinking’ needed for pharmacies to meet the needs of their customers in the future
Page 48: The Irish Pharmacy Award winners
PUBLISHER IPN Communications Ireland Ltd. Clifton House, Fitzwilliam Street Lower, Dublin 2 00353 (01) 6690562 MANAGING DIRECTOR Natalie Maginnis email@example.com
COMMERCIAL MANAGER Natalie Millar firstname.lastname@example.org
JOURNALIST Beau Donelly Editorial@ipn.ie PHOTOGRAPHY Aidan Oliver and Stuart Pearson CONTRIBUTORS Kathleen O’Callaghan | John Hogan Dr Deirdre Lundy | Robert McOwan Dr Vicky O’Dwyer | Paul Knox Dr Anne-Marie Tobin
IPN would like to say thanks to the entrants, finalists, winners and sponsors; without whom the event just would not be as special as it has been, every year for the last seven years. Don’t miss our red carpet feature on page 14. One of our award winners, Jack McPolin, has described his journey from locum pharmacist to the owner and MD of a large pharmacy group, one that hopes to expand even further as Smith’s Pharmacy launch their search for new pharmacies to purchase over on page 4.
Page 34: The menopause – a study
SENIOR JOURNALIST Kerry McKittrick email@example.com
The focus of the last month in the world of community pharmacy has been the Irish Pharmacy Awards which took place in the Clayton Hotel, Burlington in Dublin. This edition brings you the highlights of the awards, from the red carpet to the stage and everything in between. Don’t miss the awards pages themselves from page 48, where we pay special tribute to all of the winners and the huge effort it took for them to take home one of the stunning gold trophies.
Page 8: Push for boys to receive HPV vaccine
COMMERCIAL MANAGER Nicola McGarvey firstname.lastname@example.org
Irish Pharmacy IRISH News is circulated PHARMACY to all independent, NEWS multiple and hospital pharmacist, government officials and departments, pharmacy managers, manufacturers and wholesalers. Buyers of pharmacy groups and healthcare outlets. Circulation is free to all pharmacists. Subscription rate for Irish Pharmacy News is ¤60 plus vat per year. 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. has 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 - Reproductive Health 32
In other news this month, we visited the Retail Excellence Retreat and Expo in Dublin to discover that in retail pharmacy there is very much a focus on technology at the moment. Find out more about the first beauty review app that will allow customers to review cosmetics in pharmacies across Ireland. Former CEO of Celesio, Cormac Tobin has also warned of the dangers to pharmacist of ignoring the digital revolution. You can find the full story on page 6. As we come into the summer, skin cancer issues are certainly something to pay attention to. On page 20 Dr Anne-Marie Tobin gives a run-down of the different types of skin cancer, prevention and the warning signs that pharmacists should be looking out for. Dr Tobin is the clinical lead for the National Clinical Programme in dermatology at the Health Service Executive. On page 28 is a must-read for every pharmacist – the beginning of a six-part series on financial planning by Robert McOwan. This week features and overview of the financial lifecycle and how planning ahead will pay dividends in the future. Finally, on page 24 we examine the success of Ireland’s first drive-thru pharmacy, Mulligans of Ardkeen. Purpose built, this pharmacy is a life-line for patients in a hurry, with mobility issues or who simply aren’t feeling very well. Do you have a news tip? Is there a community pharmacy topic you would like to see covered in Irish Pharmacy News? Do you know of someone in your business going that extra mile to promote best practice in Irish pharmacy? Email: email@example.com
Feature - The Menopause
Patient Profiling Improve customer service and patient churn.
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News news brief CORK PHARMACIST HAS REGISTRATION REMOVED
Smith’s look to an expanding future Irish pharmacy chain Smith’s are hoping to expand their business to include their 11th store and beyond after a win at the Irish Pharmacy Awards last month. Pharmacy back in the year 2000. It was working in this first store in Leixlip that Mr McPolin created the business model for what would become an ever-expanding pharmacy group.
A Cork pharmacist who allegedly submitted 669 invalid claims to the Primary Care Reimbursement Scheme in 2013 has been struck off.
“The strategy and business model were developed based around offering great value for money, providing a personal service and a wealth of information to patients,” explained Mr McPolin.
Beatrice Ross owned three pharmacies; one in Fermoy, one in Cahir and one in Adare, and between February and July 2013 appeared to claim prescriptions for herself and her two children to the value of ¤33,000. The claims stopped after initial queries discovered that the quantities and drugs prescribed were not suitable for children. The family doctor said the medicines had not been prescribed by him. The professional conduct committee of the Pharmaceutical Society of Ireland carried out an inquiry after which Ms Ross was found guilty of professional misconduct. Head of Pharmacy at the PCRS, Kate Mulveena told the Professional Conduct Committee that it was "an unusual claiming pattern against one person and that person owned the pharmacy". She said that the amount of medications claimed for was “astronomical”. Following the committee’s guilty verdict, the council of the PSI applied to the High Court to have Ms Ross’ registration cancelled. Ms Ross is a French native who qualified in pharmacy from the University of Caen. All three of her pharmacies have since closed and she is believed to have returned to France. Nevertheless, Mr Justice Kelly was satisfied he had the jurisdiction to cancel her registration.
Jack McPolin, Managing Director, Smith’s Pharmacy Group Owner, managing director and superintendent pharmacist Jack McPolin has been heading the group since his purchase of the first pharmacy nearly 20 years ago. Having worked in Northern Ireland and at Great Ormond Street Hospital in London, Mr McPolin purchased the first Smith’s
In fact, Smith’s are keen to hear from any established pharmacy businesses considering sale, as they continue to look to the future. Mr McPolin said: “The strategic plan for the business is to continue to grow and expand the group through store acquisition and opening of further greenfield sites. I am mainly focused on acquisitions, whether it be acquiring a single pharmacy or a
So successful has the venture been that Jack was named Teva Superintendent Pharmacist of the Year for 2018 at the Irish Pharmacy Awards in Dublin last month. He was very clear that the award was not down to a solo effort. “I was honoured to receive the Irish Pharmacy News, Teva Superintendent Pharmacist of the Year 2018 award. Receiving such a prestigious award brought delight not only to me but to the entire Smith’s Pharmacy team,” he said. “It was a tribute to the entire team as they all made it possible to win the award, without their hard work and commitment to delivering excellent patient care, winning the award and driving the business growth strategy forward would not have been possible.”
Caution urged over breast cancer apps There are currently more than 600 mobile apps aimed at breast cancer patients for iOS and Android – a figure that has risen steadily since 2006. However, the Insight Centre for Data Analytics has discovered that a number of these apps lack sources and references to back up the information they provide. In an article published on IrishHealth.com, the centre has expressed concern over the quality of the apps aimed at breast cancer patients and their health and wellbeing. Among the apps targeted at patients, 30% provided information about disease and treatment, around 20% dealt with disease management and 15% were aimed at prevention and raising awareness. However, less than 20% of these apps listed any sources or references in their descriptions, while over 75% provided no disclaimer about usage.
Now the Smith’s Pharmacy Group has expanded to nine branches in the Republic of Ireland with one, McNally’s Late Night Pharmacy, in Northern Ireland. But they’re not stopping there.
multiple chain of pharmacies as I know Smith’s Pharmacy have the team, systems and processes in place to such a high standard that will facilitate the amalgamation of established pharmacies into the Smith’s Pharmacy group.”
According to research leader, Dr Guido Giunti, of Salumedia Tecnologias in Spain, information is useful “provided it is correct”. “We found that the breast cancer app ecosystem largely consists of start-ups and individual entrepreneurs. Unfortunately, there is no way of telling whether the information contained in the app is reliable. If an app is created by, say, the HSE or the NHS, you know you can trust the information in it, but it may not be as attractive or as user friendly as some of the competition,” he noted. Meanwhile, 10% of the apps were found to include alternative or complementary therapies. This was described as concerning by Estefania Guisado Fernández of the Insight Centre. “When an app from a reputable
medical source sits alongside one about homeopathy for breast cancer, the former risks lending credibility to the latter. Overall, evidence base seems to be lacking in these apps, and in my opinion, it is essential that expert medical personnel be involved in the creation of medical apps,” she insisted. Details of these findings are published in the International Journal of Medical Informatics. The Insight Centre for Data Analytics was established in 2013 by Science Foundation Ireland. It is a join initiative between Dublin City University, the National University of Ireland, Galway, University College Cork, and University College Dublin.
News McKesson Ireland joins forces with the Irish Heart Foundation
Leading healthcare company McKesson Ireland has announced a new charity partnership with the Irish Heart Foundation.
PHARMACISTS PUT PRESSURE ON GOVERNMENT
Pictured at the launch of the new LloydsPharmacy partnership with the Irish Heart Foundation is Ruth Guy, Commercial Director, Irish Heart Foundation, Pat Watt, Director of Sales & Marketing McKesson Ireland and Bernadine Egan, Pharmacy Technician from LloydsPharmacy Blackrock Shopping Centre.
Together, McKesson Ireland and the Irish Heart Foundation will work to increase heart health awareness and encourage positive, preventative steps to a healthy and active lifestyle.
of heart health and the positive and proactive steps we all need to take to safeguard it. This is profoundly important, especially in a time when 10,000 lives are lost a year as a result of heart issues.
As part of the new partnership with the Irish Heart Foundation, LloydsPharmacy stores nationwide will become ‘Heart Health Hubs’ and a number of LloydsPharmacy Pharmacists in each of the stores will receive heart health training, focusing on cardiovascular risk assessments, lifestyle advice, blood pressure and BMI and pulse checks to discover those at risk of atrial fibrillation.
“Crucially for us, there’s real alignment between McKesson Ireland and the Irish Heart Foundation. The Irish Heart Foundation will have access to LloydsPharmacy’s nationwide store network and local communities, and existing LloydsPharmacy customers will be able to get new heart health services in ‘Heart Health Hubs’ from Pharmacists specially trained by the Irish Heart Foundation.
The McKesson Ireland partnership initiatives will focus on fundraising campaigns. These events will take place in LloydsPharmacy’s stores nationwide. Commenting on the new partnership, Pat Watt, Director of Sales & Marketing at McKesson Ireland, said: “McKesson Ireland is proud to partner with the Irish Heart Foundation. Together, our mission will be to raise awareness
“For the next two years, McKesson Ireland and the Irish Heart Foundation will work together across Ireland to help our colleagues and customers understand and monitor their heart health and how to look after it.” Ruth Guy, Commercial Director of the Irish Heart Foundation, said: “The Irish Heart Foundation is thrilled to be partnering with McKesson Ireland. The Heart
Health Hubs will be key in helping people understand the importance of heart health and the very simple steps they can take to reduce their own risk. Through our partnership, we can empower people to live longer, healthier lives together. McKesson Ireland is the leading healthcare company for pharmaceutical distribution. The company delivers accurate and reliable health care services and solutions for pharmacies, hospitals, pharmaceutical companies, and health care facilities. The Irish Heart Foundation, established in 1966, is the country’s leading heart health charity. Every hour someone in Ireland suffers from a stroke. Every day, hundreds of Irish people are diagnosed with heart disease. The lives of these people are often cut tragically short. Many are left disabled. Up to 10,000 die each year, which makes heart disease and stroke the nation’s biggest killer. However, 80% of these deaths are preventable.
Pharmacists have called on the Minister for Health Simon Harris T.D. to change legislation to allow them substitute expensive biological medicines for more cost-effective biosimilars. Representing over 2,000 Irish community pharmacists, the Irish Pharmacy Union (IPU) members at their AGM passed a motion on biosimilars that could potentially save the Exchequer up to ¤800 million over five years. In 2017 the Department of Health held a public consultation on a National Biosimilar Medicines Policy, and the IPU made these proposals in their submission in September 2017. IPU Secretary General Darragh O’ Loughlin pointed out that if the Government had heeded IPU advice at that time and had allowed pharmacists to substitute biological medicines for biosimilars approximately ¤60 million would have been saved to date: “Every week that the Government fails to implement this proposal is costing roughly ¤2 million in potential savings”. He said allowing pharmacists to substitute biological medicines for biosimilars “is the fastest and most effective way to ensure a rapid and meaningful increase in the use of biosimilars”. “There are no clinically meaningful differences between a biosimilar and reference biological medicine and increased use of biosimilars would result in significant savings. Despite this, uptake has been extremely low in Ireland, with biosimilars representing less than 10% market share, which is far below the EU average. “An amendment to the Health (Pricing and Supply of Medical Goods) Act 2013 would allow pharmacists to substitute a biological reference product with a biosimilar, and the IPU is now calling on Minister Simon Harris to legislate for this.” In 2013 pharmacists began facilitating Government policy on the use of generic medication. Consequently, the use of generic medicines in Ireland increased fivefold, saving the State over ¤667 million by the end of 2017. As the experience of generic substitution demonstrated, allowing community pharmacists to substitute is the fastest and most effective way to ensure a rapid and meaningful increase in the usage of biosimilars.
News New app allows users to review and rate beauty products sold in Irish pharmacies A new smartphone app that allows users to review beauty and cosmetic products sold in Irish pharmacies will go live this month. app, including the most searched for and purchased products in different parts of the country, and at different times of the year.
they didn’t actually tell us anything about them. We realised we couldn’t be the only ones with this problem.”
The app is the first of its kind for the cosmetics industry and will function much like TripAdvisor, with users posting reviews and comments online. It was also offer a standalone social media feed, with peer-to-peer posts and commentary.
Co-founder Wendy Slattery, from Leixlip, Co. Kildare, said she decided to build the app due to the lack of credible information about beauty and cosmetic products available online. Ms Slattery and her business partner, her sister Tracy Leavy, struggled to find independent reviews for makeup brushes during a shopping trip.
The app, which can be used by customers across all pharmacies in Ireland, will launch on June 18. There are plans to rollout the platform in the US, Canada, Australia and New Zealand by the end of the year.
From July, Irish pharmacies can sign up to install interactive screens in-store, which customers can use to scan barcodes and access product information. Pharmacies will also be able to buy analytics generated through the
“We were in a shop looking at brushes and there were over 100 on the wall,” she said. “We didn’t know which ones were any good and when I searched online all that came up were e-commerce sites trying to sell us the brushes, but
Independent review platform, The Beauty Buddy, encourages customers to scan the barcodes of more than 30,000 items sold overthe-counter to access product ratings, tutorials, and ingredients.
Wendy Slattery founder of Beauty Buddy
Ms Slattery said the company would maintain its credibility by remaining independent of all beauty and cosmetics brands. “The way social media is going it’s important to have a forum where people can get information that they can trust,” she said. “Our independence is key.”
Times are changing, but there’s a bright future for the pharmacy that adapts Pharmacy owners must break the rules and be willing to reinvent themselves to succeed as retailers, according to a veteran of the community pharmacy industry. Cormac Tobin told the 2018 Retail Retreat and Expo in Dublin last month about the importance of adapting old business models and tapping into digital technologies to maximise growth. "Provided the rule doesn’t put somebody in harm or is unsafe, you should look at the rules and how they’re shackling you,” he said. “The world has changed and all these retailers who changed the world, they didn’t act with yesterday’s limitations or the rules that people applied to their industries.” Mr Tobin, the former head of Celesio UK and Ireland, highlighted the examples of Uber, which disrupted the taxi industry, and Netflix, which was not afraid to overhaul their entire business model. He told the packed auditorium about the importance of embracing new technology and harnessing social media, particularly Instagram, to connect with customers.
them and seduce them, and you must do it every day of the week because there’s another guy trying to steal that. “I worked in the pharmacy industry for years. They’ll always come that was always the model. And they do, some of them do, but the world is changing around us now where customers are actually looking for new routes and new channels and new ways of doing things. So be loyal to your customers, absolutely obsessed.” Former head of Celesio UK, Cormac Tobin The aim for business leaders, he said, should be to achieve a seamless intersection point for their brand between the physical and digital worlds. “Artificial intelligence and machineto-machine communication are the battlegrounds of the future,” Mr Tobin said. "Penetrate the digital world - that’s where the customers live. It’s not just big companies
doing this anymore, it’s little companies.” Mr Tobin also stressed the importance of putting the customer first and cautioned against taking customer loyalty for granted. “You don’t have loyal customers,” he said. “You must be loyal as a company to your customers. You must give them things that entice
Mr Tobin also said it was vital that business owners surrounded themselves with experts in other areas to engage with and capture the imagination of potential customers. “It’s very important in business that we surround ourselves with people with different skills, different competencies, that will actually challenge you, that will frighten you,” he said. “I learnt early on in my career: employ different types of people. I’ve seen the importance of people, talent and leadership.”
News Push for HPV vaccine to include boys Is it ethical to only protect girls from a cancer-causing virus that we know also leads to cancer in boys? In the session, 'Don’t Hesitate, Vaccinate', Dr Murtagh flagged the importance of the medical rationale of vaccinating boys because men also carry the virus and develop HPV-related diseases. The free vaccination program is currently only provided to girls in Ireland. “All the medical data points towards universal vaccination,” she told Irish Pharmacy News after the conference. “When the vaccine was developed it was known that HPV caused cervical cancer so it made sense to only vaccinate girls. Dr Janice Murtagh, Director of Medical Affairs, MSD That question was raised at the annual IPU National Pharmacy Conference in Wexford. At a presentation about the public health impact of immunisation programmes, Dr Janice Murtagh spoke about the role pharmacists play in vaccine confidence. The associate director of medical affairs at pharmaceutical giant MSD, Dr Murtagh raised the example of the HPV vaccine, which protects against the human papillomavirus, a sexually transmitted infection that can cause various cancers in both men and women.
“But as the research around HPV has evolved, we know that not only do boys carry it, but they get HPVrelated cancers, they don’t mount immunity to HPV if they’re infected, and they’re highly exposed to the virus if they leave the community where vaccination rates are high.” HPV causes genital warts and can lead to cervical, vaginal, anal, penile, throat and mouth cancers. The HPV vaccine, which has been given to teenage girls in Ireland since 2010 under a nationally funded, school-based programme, protects against the four strains of the HPV virus that cause most cervical cancers. Australia and the U.S. already administer the HPV vaccine to boys as part of their immunisation
programmes, but Britain and Ireland do not. In the United Kingdom, there have been reports of doctors and health professionals paying for their sons to receive the HPV vaccine privately. In Ireland, sexual health clinics give the HPV vaccine preventatively to men who have sex with men, and it is available to boys if they buy the vaccine from their GP. Following a recommendation from the National Immunisation Advisory Committee, the Health Information and Quality Authority launched an inquiry into whether providing the vaccine to boys was clinically justified and cost-effective. The HIQA aims to publish a draft report in the coming months, with its final recommendations expected to be put to the government before the end of the year. The Irish Cancer Society has also called for government investment to widen the HPV vaccination programme to boys. Donal Buggy, head of services and advocacy, said last year that 335 women and 85 men in Ireland were diagnosed with cancers caused by HPV. “While boys can avail of the HPV vaccine through their GP, for a fee, the Irish Cancer Society believes it is time for the government to invest in the extension of the
national HPV school vaccination programme to boys, so that as many lives as possible can be saved,” he has said. Dr Murtagh said there was no routine screening programmes in place for HPV-related cancers in men, and that their inclusion would increase the overall resilience of the programme. “The only way to actually tackle a circulating pathogen and to try and eliminate it is to vaccinate as many people as possible,” Dr Murtagh said. “In countries where universal vaccination has been in place, there has been a decrease in HPV infection and disease in both boys and girls. The medical data is there, we’re just waiting on the cost-effective analysis locally.” In the meantime, Dr Murtagh said, pharmacists and other health professionals continue to educate patients about the benefits of the HPV vaccine in a bid to counter misinformation spread by anti-vax campaigners. The HSE said every year more than 6500 women were treated for precancer of the cervix, 300 women were diagnosed with cervical cancer, and 90 women died from the disease. Since its introduction, more than 230,000 Irish girls have been fully vaccinated against HPV.
How a young pharmacy group is thriving online Taking a bricks and mortar business online is a daunting process for any shop owner. But as one Donegal pharmacy discovered, the payoff has been worth it. When Paul O’Hea entered the world of e-commerce, he had been running a successful pharmacy for five years but had no online retailing experience. It didn’t deter him. “We thought, if we can sell to people in Cork and Dublin, why can’t we sell to people across Europe?” The Inish Pharmacy director, speaking in May at the Retail Excellence expo, recounted how the company evolved from a traditional drugstore in rural Ireland to leading online pharmacy serving customers across Ireland and in the UK, US, Australia, Canada and Germany.
Beginning with a humble Facebook page in 2012, the company’s website was launched the following year. By the end of 2014, it’s online conversion rate had grown to 5.7 per cent. Since then, Inishpharmacy.com has enjoyed between 50 and 90 per cent revenue growth year on year. The number of countries it ships health and personal care products to has also grown every year. “Once it went live things were never the same again,” Mr O’Hea said. “It can be daunting, and a lot of work, but it’s definitely worthwhile doing.” Key to the online success, Mr O’Hea said, was that the website
replicated the pharmacy’s in-store values: excellent service, care and trust. Mr O’Hea said it was important to have the right infrastructure in place to thrive online, including marketing, warehouse and customer service staff. “Being a small team has its advantages in our ability to react,” he said. In real terms, that means that when customers gave feedback to Inish about wasteful packaging the company quickly adapted. It now uses only recyclable packaging and sustainable packing materials. Mr O’Hea said the single biggest improvement in the online side of the business was seen in 2015,
when it implemented a system integration model. This allowed the company to have more control over what sold online, ensuring it was never out of stock and could always be delivered to customers quickly. It has paid off. The Donegal company, which launched in 2007, has grown to three pharmacies and its online store is complimented by Ebay, Amazon and Google Shopping profiles, which have been effective at driving traffic. Inish has also expanded into social media, where customer service staff engage with clients around the world via Twitter, Instagram and Snapchat.
Enjoy non-drowsy relief from hayfever and other allergies
Medicinal product not subject to medical prescription. Further information available from Rowex Ltd., Bantry, Co. Cork, Ireland Tel No: 027-50077 Fax: 027-50417. PA: 711/088/001, Date of preparation (02-18) CCF No: 20397. Also available in packs of 7.
Always read the leaflet.
IPU Conference IPU Conference looks to the future The Irish Pharmacy Union National Conference discussed biosimilars and the Falsified Medicines Directive. The theme of the threeday conference this year was Community Pharmacy: Driving Healthcare. The event concluded on the Sunday evening with the IPU President’s Dinner and Ball. Naturally, there were several hot topics over the weekend. The Falsified Medicines Directive, GDPR and biosimilars were all prominently discussed. Also, this year there was strong focus on the pharmacy and retail. How to maximise sales within the pharmacy, top tips for the pharmacy and selling and the challenges and opportunities of
running your own business were all titles of seminars throughout the event. David Keyes, Director and Head of Public Affairs, United Drug also gave a presentation on the upcoming trends for community pharmacists, addressing the pharmacy trends for Europe and drug trends. For the first time this year the IPU hosted a CPD session, hosted by Conor Walker, Director of TONiC Consultancy. Mr Walker gave an overview of the PCRS claims process and how to address and avoid rejections.
“We’ve done a lot of training on PCRS reclaims for IPU members over the years and we also run a business that helps pharmacists get money back that they’re owed. We also help them go through, on a month by month basis, to establish if they’ve been underpaid and to help them get that money back,” he explained. Mr Walker continued: “The whole purpose of the talk was to stop people from having rejects – how to process their claims properly. Or to minimise the rejects as much as possible. If you don’t have as many rejects,
then you might be able to spot the bigger areas where you may not know you’re losing money.” All pharmacists who attended sessions will receive a certificate of attendance for their CPD ePortfolio. Also new to the conference this year were the plenary sessions, chaired by IPU Secretary General Darragh O’Loughlin. The speakers brought together IPU members and speakers from throughout the healthcare industry.
Alan Reilly, Head of Information and Technology, IPU
Brody Sweeney Entrepreneur and Founder and Chief Executive of Camile Thai Kitchen
IPU Secretary General Darragh O’Loughlin addressing the Plenary Session
Edward McGettrick MPSI, Senior Medical Advisor, Pfizer Healthcare Ireland
Kathy Maher MPSI
Keith O’Hourihane and Jonathon Morrissey
Demand for dangerous black market steroids soars in Ireland Anabolic steroids made up almost half of all illegal drugs confiscated in Ireland last year, overtaking imports of counterfeit sedatives seized by authorities. Figures from the Health Products Regulatory Authority reveal almost one million doses of illegal prescription medicines were stopped before reaching Irish consumers in 2017, a 40 per cent increase compared to 2016. The state’s medicines watchdog warned of the serious risks that illicit medicines pose to consumers’ health, saying there were no guarantees of the safety or quality of drugs bought outside of the regulated pharmacy setting. A total of 948,915 illegal tablets, capsules and vials were confiscated last year. Anabolic steroids made up 47% of the prescription drugs, while sedatives and erectile dysfunction medicines accounted for 23% and 13%. The seizure figures show an alarming rise in demand for anabolic steroids, which have increased over the past three years from 38,049 to 449,411 dosage units. Over the same period, illegal sedative drugs seized by
authorities have dropped from 726,164 to 222,470. Speaking at the annual Conference of the Irish Pharmacy Union in April, Caitriona O’Riordan said she was alarmed by the volume of anabolic steroids seized, which indicated a rise in demand from consumers wanting to build muscle mass and boost sporting performance. “This is an exceptionally dangerous endeavour,” she said, adding that the side effects from steroid use can include addiction, fatigue, insomnia, decreased sex drive, and psychosis. The conference heard that pharmacists were growing increasingly concerned about the rise in counterfeit and illegal medications in Ireland. Ms O’ Riordan, an IPU executive committee member, told her colleagues that people who ordered medicines online or through other non-official channels were “ignoring” decades of best healthcare practice.
“Medications should only ever be provided by qualified healthcare professionals,” she said. “It is not appropriate and not safe for people to take matters into their own hands.” Ms O’Riordan said the biggest risk of illegal medications was the lack of quality control. “What is most concerning is that there is no way for anyone to know what is in these supposed medications,” she said. “Quite often they have been found to be worthless placebos, meaning genuine health complaints and illnesses go untreated, while in other cases the products contain toxins, harmful levels of active ingredients and even bacterial contamination. “When you get a medicine from your community pharmacy you know this product has been through rigorous testing and quality assurance.” This sentiment was echoed by the Health Products Regulatory Authority. HPRA’s director of compliance, John Lynch, said the year-on-year increase in
illegal drugs being confiscated was “extremely concerning” because it indicated Irish patients were willing to put their health at risk. “It is of continuing concern that members of the public would use potent prescription medicines without medical supervision,” he said. “We know from our investigations and prosecutions that those who seek to profit from illegal medicines have little regard for the health of the end users of the medicines they are supplying.” Mr Lynch said some of the drugs contained different substances to what was advertised, which could cause serious health problems. HPRA works with the Revenue Customs Service and An Garda Síochána, as well as Interpol, in a bid to stem the flow of unauthorised medicines, medical devices and dodgy health products. The regulator prosecuted six cases and issued six separate formal cautions over the past year.
David Keyes, Director & Head of Public Affairs, United Drug
Dr Susan Pike, IPU President Daragh Connolly, Jack Shanahan the recipient of the inaugural IPU President’s Medal with Eliza Shanahan
Attendees at the IPU Plenary Session
News Bluefish break into the Irish market Founded in Sweden in 2005, Bluefish has become the byword when it comes to pharmaceuticals generics in Europe. The company prides itself in managing the full pharmaceutical chain – from the development and manufacture all the way to the successful marketing of generic pharmaceuticals. for the market right now is continuity of supply. We as a company have invested heavily in our stock and we will honour our commitments with customers where we have made commercial agreements. “One of the most important aspects to any business is to deliver on our commitments and our promises so this is goal one for year one. We plan to make doing business easy and transparent. We also plan to join Medicines for Ireland as I feel we need a strong, united association to represent the generics industry,” Mr Hynes concluded.
Keith Hynes, Country Manager Ireland, Bluefish
Already present in 13 countries, the Swedish company has now taken its first steps into the Irish market, with the first office opening in Dublin last month. Keith Hynes, Country Manager Ireland, has been tasked with guiding not only Bluefish’s introduction into the Irish market, but also their expansion. He joined the company last July and since then has been cementing the company’s foundations in Ireland while developing the launch portfolio. Having spent the last 19 years working in Ireland’s pharmaceutical industry. He started his career with GSK, spending six years as a field sales rep in the west of Ireland. Before joining Bluefish he was commercial director of the Actavis generics business unit. “Pharmacy has always interested me,” He said. “In the early days I had a number of different strings to my bow. There was
straight commercial selling but also the softer side, such as detailing brands to the pharmacy assistants early in the morning or at lunch. I would get 10 minutes with them whenever I could. I could cover all aspects of sales within the pharmacy environment.” Although the company only has a staff of three in Ireland, there are plans to expand in sales, marketing and the supply chain over the next 12 months. For this initial period at least, Mr Hynes is under no illusions as to his responsibilities. “My role with Bluefish can be explained quite simply. I am responsible for the business from top to bottom,” he explained. “From sales and marketing to quality. We are a sales and marketing team in Ireland and we use Allphar as our pre-wholesaler. This means all of our stock sits in their central warehouse and we supply full line wholesale through Allphar.”
Brexit and the new Falsified Medicines Directive are both looming on the horizon, but for a European-based company such as Bluefish, concerns are minimal. He said: “These concerns are not huge for Bluefish at the moment. None of our products are manufactured in the UK and none of our products currently have UK marketing authorisation. Our products are supplied and released to our central warehouse in Sweden. Brexit will have a low impact for us.” As far as plans for Bluefish in Ireland go however, Mr Hynes is focused. “We want to strengthen our position in the Irish market. We have had our products on the market in Ireland for over seven years now. Irish pharmacists are used to the Bluefish brand and livery which is of great benefit to us. “One of the biggest challenges
For him, it’s very clear that there are numerous challenges for Bluefish on the Irish market. Firstly, comes low cost medicines 15% of the generic volume market is comprised of products that cost less than 2 Euro. With serialisation in the beginning of 2019 and another round of generic substitution and reference pricing which has just been announced we have big challenges in terms of commercial viability of these products. According to Mr Hynes, Ireland is lagging behind other European countries in its usage of biosimilars with only 11 currently reimbursed by the HSE out of a total of 28 authorised for use in the EU. There are significant savings that can be achieved by removing the current barriers for biosimilars. The generic Industry as a whole needs to join and offer collective solutions instead of targeting categories in isolation. Mr Hynes says: “I like to keep things as simple as possible and a one stop shop for generics and brands alike will not work in the future. The industry needs to join together while also having the voice to articulate our concerns. Combined generic volumes are now over 60% of the total pharmaceutical market and quite simply critical to Irish patients.”
About Bluefish Bluefish Ireland is committed to delivering a first class customer service experience with trust and integrity at the centre of everything we do. The Irish team have an abundance of experience in the industry and are committed to delivering on their commitments. We like to make doing business as simple as possible.
Leading the way to a healthier Future
Bluefish Pharma Ltd.
The Gables, Torquay road, Foxrock, Foxrock Village, D18 A2N7
Awards The Irish Pharmacy
Aine Shine - Supervisory Pharmacist, McCartans Pharmacy and Louise Beegan - Supervisory Pharmacist, Sam McCauleys Pharmacy
Red Carpet Irish Pharmacy News was delighted to welcome more than 600 guests at the Clayton Hotel, Burlington Road, Dublin for the 7th annual Irish Pharmacy Awards. Hosted by comedian and TV presenter Jennifer Zamparelli, 16 awards were handed out on the night to recognise innovation and excellence within the pharmacy sector. A special award was also given for the Pharmaton Peopleâ€™s Pharmacist of the Year. This award was both nominated for and voted by the general public who helped select Joel Duffy as the winner.
Amy Douglas, Carol Traynor, Sally El-Banna, Emily Ashmore, Ola Elgarawany and Emma Clarke Conway
Patrick McCormack, Lorraine McCormack and Cormac Tobin
Jackie Gannon, Gerard Coffey, Jane Brennan, Stephen Brennan, Lora Armstrong and Alan Armstrong, Life Pharmacy Sarah Murphy, Andre Barbosa and Sarah Mollaghan
Elaine O'Shaughnessy, Sinead County, Rimanta Liutkevieiene, Anthony Redmond, Betty McGorman and Dee Farrell - Stacks Careplus Pharmacy Swords
Teresa Heffernan, Avril Farrell, Natalie Kalo and Clare Fitzell - Boots OTC Team
Lisa Walsh, Holly Foster and Shirley O'Neill, Lloyds HQ
Clodagh Hennessy and Karen Kaye - GSK
Dr Cathal Cadogan, Beatriz Hayata, Marion Cullinan and Dr Shane Cullinan
Shane Coy, Orlagh Trainor and Ross McEntegart, Smith's Pharmacies, Dublin
Lorna Havard, Paula Cuddy and Nicola Abbott - Cell Nutrition
Laura Romero, Paulo Iacovelli and Emily Kelly - Lloyds Pharmacy, Ringsend
Susanne Hayes, Lynsey Rigney, Ger Reilly, Jennifer Rigney and Carol Grant, The Village Pharmacy Coolcok
Hickey's Pharmacy Team
News news brief NOTIFICATION PERIOD OF GDP INSPECTIONS INCREASED At present, GDP inspections performed by the HPRA are announced to companies, typically six weeks in advance of the inspection date. Prior announcement of the inspection helps to ensure that companies have the required resources available for the inspection. Despite advance notifications, the scheduling of inspections has become increasingly difficult as an increasing number of companies are requesting the rescheduling or cancellation of inspections at short notice. This results in significant difficulties for the HPRA inspection scheduling team. The rescheduling of inspections reduces the capacity of the inspection team as other inspections cannot be scheduled at short notice to fill the schedule gap created. To address these challenges, the inspection notification period for GDP inspections will be increased. While individual cases may vary, the date of most routine inspections will be notified by email at least eight weeks in advance of the inspection. This will be followed by a more detailed inspection notification containing documentation requests closer to the inspection date. In giving a longer notification period, the HPRA expects that companies will have an increased ability to plan and manage their resources accordingly, such that there should be no requirement to reschedule. It is noted that the rescheduling of some inspections are requested due to absence of key personnel. When notified early, the HPRA will try to accommodate changes to the schedule where at all possible, but companies are reminded that measures should be in place for delegation of duties of key personnel during periods of absence. It is expected that a deputy responsible person has adequate knowledge and oversight of the systems in place such that they can effectively deputise for the responsible person. This includes management of inspections. The HPRA reserves the right to perform unannounced inspections.
Mylan Ireland teams up with Nasal Medical Mylan Ireland and Irish start-up Nasal Medical have signed a deal to distribute nasal filters in over 2,800 pharmacies across the UK and Ireland. Established in 2015, Nasal Medical has been selling its Discreet Snoring Aid in up to 400 pharmacies in Ireland. In partnering with Mylan, Nasal Medical will now increase its distribution footprint to 1,800 pharmacies in Ireland and 1,000 in the UK. The announcement of this distribution partnership coincides with the launch of Nasal Medical’s new allergy nasal filter, which comes to market just in time for this year’s allergy season. According to Allergy Ireland, nearly one in four Europeans suffer from some form of a nose, sinus or chest allergy. In order to provide the best care for customers and patients, Mylan Ireland and Nasal Medical bring this convenient, drug-free and practical nasal allergy filter to the market as an alternative option to antihistamines and sprays. The Allergy Nasal Filter is designed to prevent dust, pollen, dander and mould from entering the nasal cavity. It’s comfortable and discreet and conforms to the contours within the nasal cavity. It is currently on sale in pharmacies nationwide. Commenting on the signing of the deal, Mylan Country Manager, Owen McKeon said: “We are delighted to partner with Nasal Medical, through a deal which exemplifies our commitment to supporting local start-ups. As one of the largest pharmaceutical
Martin O'Connell, Nasal Medical CEO and founder, and Owen McKeon, Country Manager, Mylan Ireland
companies in Ireland, Mylan is always looking to expand our non-pharmaceutical portfolio by actively seeking out the best of indigenous talent and innovation we have here in Ireland.” The deal marks a significant expansion for Nasal Medical, which was established in 2015. The company was founded by Martin O’Connell, an electrical engineer from Co Kerry, and Keith Yeager, a mechanical engineer from New York with experience in designing medical devices. Nasal Medical CEO, Martin O’Connell said: “The partnership
with Mylan is a significant step forward for us. We anticipate this to be the first step in our plan to expand into a worldwide medical device company. With the launch of the Allergy Nasal Filter and the Discreet Snoring Aid firmly underway, we are excited in launching two more products from our portfolio in the coming months. After initial positive results from a sports trial in Dublin City University, we will be launching the Sports Aid which will increase oxygen intake for athletes. The second device, Travel Filter, will help reduce exposure to flus and contaminated air while travelling.”
More education on the supply chain for pharmacists, urges FIP The pharmacist’s role in the supply chain should be strengthened by training and education says a report by the International Pharmaceutical Federation (FIP). The recently released report stresses that inefficient pharmaceutical supply chains are partly to blame for a substantial proportion of the world still being without access to basic live-saving medicines. “The need to ensure effective and safe medicines supply prompted FIP to take a close look at the actual role of pharmacists in pharmaceutical supply chains. This report aims to provide a foundation from which improvements can develop,” said FIP’s Working Group on Pharmacists in the Supply Chain chair Ulf Janzon. The pharmaceutical supply chain encompasses the full-life cycle
of a medicine, from raw material through to use by patients. Through literature and survey data reviews as well as nine country case studies, the working group identified pharmacists as having expertise that is critical to supply chain integrity. The report gives a global overview of the role of pharmacists in different supply chains in low, middle and high income countries, and describes the evolution of supply chains. “The report recognises different levels of maturity of supply systems that could be used as a basis for discussion, particularly in developing countries. It doesn’t aim to describe a single gold standard system, but, rather, it
seeks to highlight that all systems should ensure efficient supply of quality medicines. It also draws attention to the effect of globalisation on the supply chain, which is adding complexities to ensuring appropriate quantities of quality medicines,” Mr Janzon said. He continued: “Pharmacists engaged, or interested in being engaged, in the supply chain may need special courses, which are not always provided by the basic curriculum. For example, these pharmacists often assume leadership roles and so courses in leadership and management should be provided in addition to courses in logistics.”
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Please consult the Summary of Product Characteristics before prescribing, information about this product can be found at www.medicines.ie Further information is available on request from UCB Pharma Ireland Ltd, United Drug House, Magna Drive, Citywest Road, Dublin 24 MA Numbers:
Zirtek 1 mg/ml oral solution: PA 891/8/3, Zirtek Plus Decongestant 5/120mg Prolonged Release Tablets PA 891/8/1, Zirtek Tablets PA0891/008/005
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Zirtek tablets & oral solution: Cetirizine dihydrochloride Zirtek Plus Decongestant prolonged release tablets: Cetirizine dihydrochloride, Pseudoephedrine hydrochloride
Adverse events should be reported to the Health Products Authority at www.hpra.ie or via email to firstname.lastname@example.org Adverse events should also be reported to UCB Pharma Ireland Ltd via email UCBCares.IE@ucb.com
February 2017 UK/16ZI0052
News IPU calls for MDS for the older population The Irish Pharmacy Union has proposed a state-funded Monitored Dosage System (MDS) for the elderly in Ireland.
The aim of the programme is to reduce medication non-adherence which can often lead to hospital stays and trips to an emergency department. Under the IPU’s proposal, polypharmacy patients would be assessed by a pharmacist on their need for the service. The implementation of an MDS would be on a patient-by-patient basis. The pharmacist will establish if there has been previous medicine non-adherence, if the patient is confused about their medication, if they regularly forget to take it or if there is evidence of medical wastage. There are more than 300,000 over
65s in Ireland and it is estimated that 65% of that population suffer from at lease two chronic diseases. A recent study has shown that around 30% of those patients currently being prescribed five or more medicines (polypharmacy) are non-adherent to their medicine regime. This is a figure somewhere between 43,300 and 86,700 patients. The IPU’s proposal that the state should provide an MDS would be employed to promote safe and appropriate medicine usage. Improved medicine adherence would reduce hospital admissions and treatment costs. Medication non-adherence has
also become a key-factor in the decision to move patients into residential care from their own homes. The MDS system is hoped to bring a greater capacity and a better utilisation of hospital time. It’s also thought the system could be of benefit to patients with learning difficulties, mental illness, and dementia. The system is proposed only for those patients who meet the criteria and for whom the system would be a benefit. The pharmacists would have overall responsibility for the safe supply of medicinal products. The cost of this service would be the standard dispensing fee with an additional £3.50 per item to reflect the effort, expertise and input costs required to prepare an MDS prescription. Economics consultancy Salutem has estimated the cost of the scheme to be around ¤45 million a year. However, they also estimate the savings to the HSE would be in the region of ¤70 million thanks to the improvement of medicine non-adherence and the reduction of hospital treatment – provided there is an increase of medicine adherence rates of 20% or more.
Warnings for hay fever and asthma sufferers Hay fever and asthma sufferers are warned to be prepared this summer as pollen counts are on the rise. Both the Irish Pharmacy Union and the Asthma Society have warned hay fever sufferers to be prepared this summer. As many as one in five Irish people suffer from hay fever, also known as allergic rhinitis. From early summer to autumn they can expect to suffer from itchy eyes, running noses, sneezing and coughing thanks to the release of pollen from trees, plants and grasses. Hay fever can have a more serious impact, particularly for over 370,000 sufferers who have also been diagnosed with asthma. Hay fever symptoms can cause asthma to flare up and even escalate. This is a cause for concern when Ireland sees around one death from asthma a week. Dr Marcus Butler, Medical Director of the Asthma Society, said: “Managing asthma becomes more difficult over the summer months as the nice weather brings along a sharp increase in the pollen count. Research suggests that up to 80% of people with
asthma notice a worsening of asthma symptoms due to allergies such as pollen, as an allergic reaction is triggered. I see a drop in asthma control amongst my allergic asthma patients during hay fever season, which leaves them at risk of a more serious asthma attack. It is vital that all asthma patients with pollen or grass allergy have an asthma action plan and prepare for the hay fever season to limit its effects.” There is no cure for hay fever and the symptoms can only be managed, but both the IPU and the Asthma Society have recommended sufferers should take several precautionary measures: • Discussing preventative measures with your pharmacist at the beginning of hay fever season, even before symptoms start to manifest • Avoid working in the garden and mowing grass • Keep windows and doors closed as much as possible
• Wear wraparound sunglasses to protect the eyes • Avoid drying clothes outside For asthmatics experiencing hay fever symptoms, the Asthma Society has recommended the following. • Carry inhalers and medication with you at all times • Measure the pollen count and try to avoid being outdoors on high pollen days • Avoid pets who have been outdoors and may have pollen on their coats • If possible, invest in an air purifier to remove allergens from the air Patients should seek medical advice after any asthma attack, as the occurrence suggests the condition is not under control. Sufferers can keep track of pollen counts by consulting the Met Eireann website or by following the Asthma Society pollen tracker at asthma.ie.
news brief GSK UNVEILS IMPACT AWARDS GSK, one of the world’s leading research-based pharmaceutical and healthcare companies, has unveiled the annual GSK Ireland IMPACT Awards which recognise and reward community-based charities who contribute to the improvement of people’s health and wellbeing in Ireland. The company, which employs 1,700 people across four locations in Ireland, is committed to enabling people to do more, feel better and live longer and the ‘GSK Ireland IMPACT Awards’ are a key element of this mission. This will be the fourth year of the ‘GSK Ireland IMPACT Awards’ and they are an expansion of the global healthcare company’s IMPACT awards programme which has been running in the UK and USA for 20 years. The awards are open to registered charities that are working in a health-related field in Ireland and are at least three years old. Applicants are evaluated using six criteria from which the name ‘IMPACT’ is derived: Innovation, Management, Partnership, Achievement, Community focus and Targeting needs. Up to five winning charities will receive ¤10,000 each in unrestricted funding, while five runner-up charities receive ¤2,000 each. In addition to the prize money, winning charities also receive a specially commissioned video and photography package to help them promote their work. Jacinta Collins, Communications Director for GSK, says: “There are thousands of “unsung healthcare heroes” all over the country that operate with purpose and passion to improve people’s health and wellbeing in their community and GSK wants to ensure they receive the recognition they deserve. Since establishing the initiative in Ireland, we have been truly inspired and moved by our wonderful winners and the huge contribution they are making to Irish health on a daily basis. We have every confidence that this year will be no different and we are really looking forward to reviewing the entries we receive.” The deadline for applications is 5pm Tuesday, 19th June 2018 and interested organisations can apply at ie.gsk.com
Feature Skin Cancer recognition and prevention – the role of the pharmacist By Dr Anne-Marie Tobin Dr Tobin is the Clinical Lead for the National Clinical Programme in Dermatology at the Health Service Executive and a Consultant Dermatologist at Tallaght Hospital. mole or freckle which grows or changes in appearance. Melanomas can occur anywhere on the body, including areas that are protected from the sun. The commonest site for melanoma in women is the lower leg and for men the back. Warning signs of melanoma are summarised in the ABCDE algorithm. Melanomas tend to be •3 Asymmetrical •3 Have an irregular Border •3 Have multiple Colours •3 Have a Diameter > 6 mm •3 Change or Evolve The top risk factors for the development of melanoma are: • Skin phenotype: fair skin and tendency to sunburn (Most Irish people have ‘Fitzpatrick’ skin type I and II which burns easily and tans poorly) • Sun exposure, recreational sun exposure either by sun holidays or sunbeds • Multiple large or unusual shaped moles
Dr Anne-Marie Tobin, consultant dermatologist, Tallaght Hospital
• Family history of melanoma • High socio-economic status
Skin cancer is the most common cancer diagnosed in Ireland, the numbers of skin cancers outnumber all other cancers annually. There are two main types of skin cancer: melanoma and non-melanoma skin cancer. Over 1,000 cases of melanoma are diagnosed annually in Ireland since 2014, this equates to 20 cases per 100,000 population and greater than 10,000 non-melanoma skin cancers. Given the ubiquity of skin cancer it is likely that several of your patients are suffering from skin cancer. Pharmacists are ideally placed to help recognize the signs of skin cancer and also help in prevention as it must be the goal of the health service in reducing this significant burden.
Melanoma: Melanoma is the fourth most common cancer in men (after prostate, lung and colorectal) and also for women (after breast, lung and colorectal (www.ncri. ie). Incidence of melanoma in men has risen by 5% on a yearly basis versus 2.7% per year in females since 2014. Mortality from melanoma is also on the increase and currently approximately 160 deaths occur from melanoma each year, up from under 60 deaths per year in the mid-1990s and from less than 20 deaths per year during the 1950s.
Melanoma arises from melanocytes which are cells derived from the neuroendocrine crest and are situated at the dermo-epidermal junction. Four different subtypes of melanoma exist: • Superficial spreading malignant melanoma • Nodular melanoma • Melanoma arising in lentigo maligna (arising in areas of sun damage) • Acral melanoma (arising on the palms, soles or under the nail plate)
Treatment pathway for melanoma:
Melanomas can arise as a new mole or from a pre-existing
Since 2012 the National Cancer Control Programme
has introduced guidelines for the referral and management of suspected melanomas. All suspicious pigmented lesions should be referred to a consultant dermatologist or plastic surgeon and there are 14 pigmented lesion clinics throughout the country. Most of these clinics operate as ‘See and Treat’ clinics whereby lesions are excised on the same day the patient is seen. All patients diagnosed with a melanoma must be discussed at a Melanoma Multi-Disciplinary Meeting in line with other cancers. The prognosis for patients diagnosed with melanoma is predicated on the Breslow depth which is the thickness of the lesion from the surface of the skin to its deepest point. This reflects the evolution of melanoma where in its early stage it displays radial growth but as the lesions progresses it enters vertical growth. Because melanoma is potentially curable with surgical excision of early, thin lesions, prompt detection, diagnosis, and adequate removal of such lesions are of utmost importance. Non-melanoma skin cancer: Two main types of Non-melanoma skin cancer exist: Basal cell carcinomas and Squamous Cell Carcinomas Basal cell carcinomas: Clinical presentation: Basal cell carcinomas are the most common skin cancer with more than 10,000 cases diagnosed annually in Ireland. They arise on sun exposed sites such as the face, neck. backs of the Hands, forearms. They arise on sun exposed sites such as the face, neck, backs of the hands and forearms. They typically present as small red bumps which are slightly shiny on close observation and enlarge slowly over time. More rarely they can present as a scar-like
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Feature lesion. If large they may ulcerate and bleed. Diagnosing basal cell carcinomas requires experience but a history of a lesion on a sun exposed site that ‘doesn’t go away’ warrants investigation. The top risks for Basal Cell Carcinomas are • Sun exposure: particularly chronic sun exposure in outdoors workers or golfers • Immunosuppressive medications: such as azathioprine, ciclosporin and certain photosensitizing medications • Exposure to ionizing radiation – this is rarely seen nowadays Treatment of Basal Cell Carcinomas: Basal cell carcinomas do not metastasize but grow locally in a ‘dendritic pattern’ that is the extent of the lesion is much greater than what is visible on the skin. Treatment is surgical and because of the increased non-visible margin, they are removed with a margin of 4 – 5mm. Although low risk, these lesions can result in quite large scars and have a significant cosmetic effect. Certain types of basal cell carcinomas and those occurring a special type of surgery known as Moh’s surgery, this is offered in St James’s Hospital and Cork University Hospital. During Moh’s surgery the surgeon checks the specimen as it is removed to ensure margin clearance rather than sending the specimen to the laboratory after excision. Squamous Cell Carcinomas: Clinical Presentation: Squamous cell carcinomas are less numerous than basal cell carcinomas approximately 2,500 are diagnosed annually. Like melanoma they may metastasize and cause approximately 60 deaths annually. Squamous cell carcinoma arise in sun-exposed skin such as the forehead, ears and lips (particularly in smokers). They are often preceded by actinic keratoses (scaly red patches) which are mildly irritating. Squamous cell carcinomas may also arise red fleshy nodules or crusty lesions, they can also be painful and this is a good clinical marker of malignancy.
Risk factors for squamous cell carcinomas (SCC): • UV radiation – chronic UV light exposure is the major pattern, incidence of SCC doubles with every 8 – 10° closer to equator. • Sunbeds – those who visited sunbeds carried twice the risk factor in developing SCC. • Organ transplantation – there is an 18-fold risk in renal transplant patients three to seven years after transplant. The HSE has recently approved reimbursement of sun protection factor for renal transplants who hold a medical card. Treatment of actinic keratosis: Treatment of actinic keratosis may be targeted at individual lesions or where there are a number of lesions. Field therapy is where a whole area such as the forehead or the backs of the hands are treated. Targeted treatments include: • Cryotherapy with liquid nitrogen • Efufix (5-fluorouracil) • Piacto (Ingenol mebutyrate) • Aldara (Imiquimod) • Solaraze (Diclofenac) Field Treatment includes: Efudix (5-fluoruracil)
Photodynamic therapy (5 aminolevulonic acid is applied to the skin as a photosensitizer and then skin exposed either to a light source or daylight). Treatment of squamous cell carcinoma: Treatment of squamous cell carcinoma is surgical with excision margins of 5 mm, this may be followed by radiotherapy to the area if a tumour is incompletely excised or an aggressive tumour. High risk sites are the lips, ears and scalp. Prevention of melanoma and non-melanoma skin cancers: Skin cancer is an increasingly common cancer in Ireland, driven by our fair skin type and increased sun-seeking behaviour. Education of the public regarding sun protection is vital and pharmacists are probably best positioned to offer this advice. The Irish Cancer Society and Irish Skin Foundation promote the five Ss of sun safety as part of the Protect and Inspect Campaign (www.irishskinfoundation.ie) and both provide leaflets and information about sun safety. • Slip on a t-shirt with a collar. • Slop on broad spectrum (UVA/UVB) sunscreen with a sun protection factor (SPF) of at least 30+, with high UVA protection, and water resistance if you intend to swim. In Ireland
SPF is required from April to September even on a cloudy day as there is sufficient UV radiation at ground level to cause damage to the skin. It is also important to remember to use sunscreen on the lips. • Slap on a hat with a wide brim (will cover the ears) • Slide on sunglasses with UV protection. • Seek shade – particularly between 11am and 3pm, when UV rays are strongest. Key groups to target are organ transplant recipients, children, outdoor workers and sports people. Public health measures are also required, for example the provision of areas of shade in playgrounds and schools. And finally, a word on Vitamin D. Vitamin D deficiency is sometimes used as a pretext for sunbathing. Given our fair skin type Vitamin D deficiency is terribly common and rather than sunbathing Irish people should firstly ensure adequate intake of Vitamin D from dietary sources. For more information visit the Irish Cancer Society website at www.cancer.ie. If you have any concerns or questions about any kind of cancer, then you can contact the Cancer Nurseline on 1800 200 700.
News ‘Design thinking’ needed for pharmacies to meet the needs of their customers in the future There is great opportunity for pharmacists to become more innovative and offer their local communities a tailored service to help them stand out from the crowd, the Dublin Chamber of Commerce has said. Chief Executive Mary Rose Burke said while pharmacies would always provide a suite of generic services, the sustainability of the profession rested on their ability to respond to the specific demands of the communities they serve. “It has to start with the pharmacist asking themselves: who is my patient, what are their needs, and how do I meet those needs,” Ms Burke said. “It can’t be based on [the pharmacist] meeting the needs that I want to have in front of me.” Ms Burke served as a judge on the 2018 Irish Pharmacy Awards and is a council member of the Pharmaceutical Society of Ireland. She was the Director of Pharmacy at Boots Ireland when they introduced the morning after pill as a pharmacy service. Prior to 2011, Irish women needed a prescription to access emergency contraception. In a wide-ranging interview, Ms Burke said there were great examples of community pharmacies responding to the needs of their local communities, but more needs to be done to differentiate the country’s more than 1800 pharmacies, which each face unique challenges. “We now have a case where everybody is offering the same services, which is fine, but in terms of differentiating and moving the profession forward you need some element of specialisation and expertise,” she said. “We have to ask who the customer is. Is it a community of young mothers, or a community of older people, or a community that suffers a lot with substance misuse? With that deeper understanding, pharmacists can target their services to meet that need. This not only provides a clear focus on trajectory of growth for their business, it brings them into contact and collaboration with other health professionals.” Ms Burke said a local focus would not only give pharmacies a unique selling point, but also help to firmly embed the business within the
community. “The north inner-city community in Dublin would look very different to the community in Kilmallock in Limerick,” she said. “If you have three care homes in your immediate community then upskilling in the area of elderly medicine and the conditions that the elderly suffer from that’s where real value would be delivered and that’s the only way pharmacy can be sustainable.” She said this level of innovation was evident from some of the contenders for this year’s awards, and commended pharmacists and their teams for engaging with their communities and adding real value. Ms Burke urged pharmacists to draw on other disciplines across the business sphere, such as marketing and statistics, to design services that meet their specific needs of their patients. She said pharmacists should engage with “design thinking,” a business concept employed by some of the world’s most successful companies, which uses creative strategies to identify, explore and understand and ultimately overcome challenges. The essence of design thinking is to start with what future patients and customers of the pharmacy will really want and then to create innovative services that respond to those needs. For example, a decade ago, when home sharing giant Airbnb was a profitless startup, its founders logged onto the website to try and understand why they weren’t making money. They quickly realised it was because photos of the accommodation, mostly shot by users on their smartphones, weren’t good enough. So, they got on a plane, rented a professional camera, and took high-resolution photos of the accommodation themselves. That was the turning point: the revenue came pouring in, and the company is now worth in excess of $2.5 billion. They looked at their business from the viewpoint of the potential customer.
Mary Rose Burke, Chief Executive, Dublin Chamber of Commerce
“Typically, healthcare professionals go through very scientific, academic, vocational-type training that very much focuses on developing a body of knowledge and then putting that knowledge into practice,” Ms Burke said. “There is a risk that sometimes there is an over reliance on the upskilling of clinical knowledge and less of a focus on other skills, these could be communication skills, part of which would be marketing, part of which would be communication to patients, but also building relationships based on mutual respect with other health professionals in the community.” “There’s huge opportunity here, building on the core intellect and proven ability of pharmacists, for building leadership, decision
making, influencing, and communication skills.” Ms Burke said it was vital that pharmacists engaged not only with stakeholders in the industry, but also with experts in other sectors. Sharing knowledge across different sectors and types of business sparked creativity and innovation, she said. “I’ve seen the value of networking in my current role of CEO at the Dublin Chamber and the people who are successful tend to be the people who network: they come out, they listen, they participate and share knowledge and they broaden their engagement outside their own area of expertise. I think there’s a huge opportunity here for pharmacy.”
Driving success at Ireland’s only ‘drive-thru’ Ireland’s one and only drive-thru pharmacy, Mulligans of Ardkeen, Waterford is celebrating its third anniversary this year. Legislation and technology will also eventually catch up, so prescriptions can be administered in a more efficient manner that gets around some of the current obstacles that delay matters. As well as a plan for video-chat options with patients Mulligan will also be rolling out webinars focusing on mum and baby, nutrition, smoking cessation and other advocacy driven concepts. “We can link into the millennial generation by starting out on a connective pathway, over the internet, that discusses topics that start at preconception and leads onto baby development stages and toddler issues,” explains Mulligan. What have been the challenges of the drive-thru concept?
Ronan Mulligan, owner, Mulligan’s Drive-Thru Pharmacy
The 3,000 square foot outlet renowned for its innovative service is also launching more smart ways to ensure a highly efficient, retail business over the next few weeks. Owner Ronan Mulligan is pleased with its progress and how the Drive-Thru element has caught the imagination of his customers in Waterford. “The genesis of the idea was to assist a variety of people who find the hassle of travelling, parking and waiting in a pharmacy an obstacle to shopping,” says Mr Mulligan. “It was originally set up to help people with mobility issues, the old and infirm, parents with babies strapped in seats, oncology patients, as well as the customers who are feeling poorly with the flu or other ailments who simply want to text and collect.” The drive-thru system takes the legwork out of collecting prescriptions and essential drugs for patients. It cuts out the timeconsuming element of looking for a parking space and eliminates the
discomfort of getting out in the cold if you’re sick with a temperature. Mulligan said it had been difficult to find a greenfield site and apply for planning permission for a totally new build that could be specially adapted to facilitate the drive-thru experience, but they were fortunate to discover one in Ardkeen. ON-LINE CHAT APP Recently, Mulligan has updated the website and introduced a new Smart App that facilitates an on-line chat with the pharmacist in the shop. This virtual link to the customer’s home or iphone via technology is all part of the philosophy of reaching-out to the community in Ardkeen. Mulligan explains the new update. “This chat app changes the dynamic between the patient, doctor and the dispensary by giving a consultation and a conversation before the customer has to visit the shop. We also communicate with doctors
and consultants for a clearer view of the patients’ ongoing requirements. We are fortunate to be located very near the local hospital and so many patients can collect their prescriptions on the way home once they have been in contact by text, email or phone or the click and collect option with the doctor.” By clearly identifying the ongoing medical needs of certain patients, Mulligans can ensure they have the right stocks ordered and in supply for their clients. “I think our future success is dependent on creating a different, superior experience for the customer. The electronic advance of technology helps us in that regard. We are going to introduce a video app very soon so we can talk to the patient face to face like in Skype and discuss their particular requests and issues.” This face to face interaction offers a much more personal service and builds up relationships unlike impersonal on-line shopping.
There’s no question that drive-thrus can be challenging, hectic, and sometimes unpredictable. There is always the possibility that a car breaks down outside the hatch or the customer hasn’t ordered the prescription in advance and may have to pull into the waiting bay. The staff working late at Mulligan’s drive-thru have a number of devices for security purposes from using the speaker phone in the hatch until they feel confident about the driver; to high powered CCTV cameras and alarms that are close at hand; car registration recognition. “Fortunately, we have had no incidents as yet,” adds Mulligan. Mulligan’s Ardkeen store also provides additional services such as the Health Room where there is the diabetes blood test; the heart and blood pressure check; cholesterol testing. They also have a dedicated Beauty Room. “We must be the only highly trained professionals who do not charge anything for our professional advice and I think our customers really appreciate that.” Mulligans Pops-Up in Tesco’s As well the Drive-Thru Mulligans
Feeling better already
Pain and fever relief for babies* & children
Easofen for Children Strawberry 100 mg/5 ml Oral Suspension and Easofen for Children Six Plus Strawberry 200 mg/5 ml Oral Suspension. Always read the label. Do not exceed the stated dose. Consult your doctor if there is no improvement. Available in Pharmacy only. Contains maltitol liquid & sodium. Sugar free and colour free. *This product should only be given to infants aged 3â€“6 months who weigh more than 5kg. Clonmel Healthcare Ltd., Waterford Road, Clonmel, Co. Tipperary. Date prepared: December 2017. 2017/ADV/EAS/055 Easofen for Children Strawberry 100 mg/5 ml Oral Suspension and Easofen for Children Six Plus Strawberry 200 mg/5 ml Oral Suspension. Contains maltitol liquid & sodium. Sugar free and colour free. *This product should only be given to infants aged 3â€“6 months who weigh more than 5kg. Retail sale through pharmacies only. A copy of the summary of product characteristics is available upon request. PA 126/60/3-4 PA Holder: Clonmel Healthcare Ltd., Clonmel, Co. Tipperary Date prepared: May 2018. 2018/ADV/EAS/059
Pain and fever relief for & children Children babies* Strawberry
100 mg/5 ml Oral Suspension Six Plus 200 mg/5 ml Oral Suspension
for Children Strawberry
100 mg/5 ml Oral Suspension Six Plus 200 mg/5 ml Oral Suspension
has had another breakthrough by opening in the main Tesco’s store in Waterford. The pharmacy is not physically cut off in a mall but located within the main store. Business has been brisk as customers are more liable to impulse purchase if the pharmacy products are a visible part of their grocery shopping experience.
"There were issues in retail as well - Waterford had a number of large-scale retail projects which, due to the economic crisis, never happened. So, the city had a problem attracting the kind of big name high street stores that Dublin, Cork and Limerick take for granted.
Mulligan says some customers think the pharmacy is actually Tesco’s
“However, the upswing in new indigenous retail shops has restored confidence along with longer opening hours.”
“On a few occasions people inadvertently start putting stuff in their trolleys until we tell them that we are actually an independent shop!” With shoppers tending to shop every day of the week now instead of the old weekly shop the footfall is good, and business is brisk. Mulligan has also been effective in creating more employment opportunities in the city and beyond having opened 17 stores in Waterford, Tipperary and Kilkenny and employing 160 staff. He is keenly aware of the economic slide that Waterford has suffered since the recession. The south-east had Ireland's highest unemployment rate at 19.2% in 2011 - and, while it has dropped substantially in line with Ireland's economic recovery, it remains the highest in the country. “I think the future is now very bright for Waterford for a number of reasons," he said. "The city has struggled over the years with its economic identity and precisely the kind of industries it should be associated with. That is particularly true given the manufacturing industries on which Waterford had depended for so long.
However, things are now on the up for Mulligans, a company ever looking to the future. Mulligan says: "We hope to complete the refurbishment of our existing network of stores by June 2019 involving a ¤2.5 million spend, launch our online offering and are in talks to add up to 10 new stores by 2022/2023 , mostly green fields sites in conjunction with the governments primary initiative in the community, about 25 % of these will be by acquisition. "
Speaking at the opening of the latest Mulligans pharmacy at Tesco in Ardkeen, Cllr. John Cummins said "It is an exciting day for Waterford to see growth in the retail sector and the creation of another 25 jobs for the city. Mulligans Pharmacy is a true family business and a local success story contributing enormously to the local economy since 1957 and helping to shape the landscape of Waterford in doing so". Mulligan agrees. “We are committed to the future of Waterford. We are now a secondgeneration family business and I am optimistic for the future of the business and the future of Waterford in spite of the challenges that we are faced with. We are delighted to have opened new pharmacies in Tesco of Ardkeen and Tesco in Ballybeg recently and creating additional employment of up to 25 new jobs. With 17 stores across the south east and along with our sister companies, Specsavers Waterford and The Hanger Boutique we employ
nearly 200 people there is a lot of opportunity. Our new stores provide exciting opportunities for improving the provision of customer service and customer care and increase the accessibility of health care services in Waterford to all". Mulligans on-line presence is also a key factor in keeping the store in close contact with customers. The Facebook page is very well maintained with daily updates and fun events tied into discreet product promotions. They have make-up demonstration evenings with beauticians like Laura Dempsey who runs masterclasses in cosmetics and dermatological treatments. They also get involved with the local charity runs, the city marathons, the Waterford hospice and connect in a meaningful way with the community. The Drive-Thru was a brave move for Mulligans as it requires a lot of ancillary back-up and support. The system requires essential apps and click and collect technology to keep it up to speed and efficient.
News Category management simplified Category management is sometimes presented as something of a dark art, which it can be, but it is simple enough to implement sound category management practices pragmatically that will increase sales & margins and reduce stock levels. Here are four steps.
displacement method on these, if you emptied that stand on to a standard floor gondola, what proportion of a metre would it take up? Extend the calculations for each department and you will have a total number of linear metres for each department. This shouldn’t take more than an hour or two. The most important thing is that you have calculated how much space is being used by each department.
1)3Space Productivity 2)3Building Product Ranges
b)3Sales per metre
3)3Clearing Excessive Stock
Now the hard work is done, put your yearly sales/margin next to each department. Divide the number of linear metres into the sales to give you sales/margin per metre. Divide this by 52 to get the sales/margin per metre per week.
4)3Controlling the Buying Skipping any of these steps would be counter-productive, so they will need to be implemented properly. 1)3Space productivity
c)3What to do next
a)3First, list all your departments on a sheet down the left. Next, get a measuring tape and measure how many linear metres that you are giving to each department. (A linear metre is a one metre length of a standard floor fixture.) Start with your standard floor fixtures and write in how many metres are being given to each department. If a department is taking up two out of four shelves and a shelf is 0.8 of a metre, then it has 2/4 x 0.8 = 0.4 metres. This is not that hard to do, get someone to help you if needs be. Next start on your wall fixtures, these generally will be higher so they are worth more. If your wall typically has six shelves whereas your floor fixtures have four, then multiply your wall fixtures by 1.5 as they will carry 50% more stock. Finally, you will have miscellaneous fixtures on the floor that will need measuring. Use what is called the
On this sheet here, we can see that our average sales per week per metre is ¤120 per week. That’s now our new yardstick. Look at department four, is that a waste of time? As a minimum it needs to be cut back, and more space given to those departments that are performing better. Department 10 needs more space, are there more ranges that we can buy to expand this space? OTC typically needs to be expanded as much as practicably possible, including out into the front of counter first. Then all the other space is divided up in accordance to its sales or margin contribution. Doing this exercise will release a lot of wasted space into more productive areas and eliminate space that was harbouring overstocks.
Divide this by 52 to get the sales/margin per metre per
Department Department 1 Department 2 Department 3 Department 4 Department 5 Department 6 Department 7 Department 8 Department 9 Department 10
Existing Linear 15.0 24.0 9.3 6.0 3.0 27.0 12.6 3.6 15.0 1.5 117.0
% 13% 21% 8% 5% 3% 23% 11% 3% 13% 1% 100%
Annual Sales 90,000 135,000 90,000 7,500 22,500 146,250 112,500 27,000 67,500 30,000 728,250
% 12% 19% 12% 1% 3% 20% 15% 4% 9% 4% 100%
Sales per Metre per Week 115 108 186 24 144 104 172 144 87 385 120
By John Hogan of Real World Analytics
2)3Building product ranges You now need to select the right products for your store. Do your market research by visiting aspirational pharmacies, attend fairs and review trade publications. Key considerations when building a range are: • Avoid duplication of products that do the same job. This is one of the greatest temptations that a buyer has when reviewing samples from various suppliers. Duplicate products will cause confusion in your range if there are too many similar products. • Have a meaningful range of prices. The number of different prices should reflect the type of merchandise and how wide the range is of the selection. Do not have price points that are slightly different as this will again just confuse the customer. • Avoid using too many suppliers. You will have more strength as a buyer who buys large quantities from one or two suppliers • Make sure that you have the right mix of core lines that are a direct replacement for something sold previously plus newness. • Construct your range carefully from a gross margin point of view. Start with the value lines that are comparable with competitors so that you have a very good value perception. Make sure that that you have a good margin on the balance of the range, where maybe you week. have exclusivity, less of a direct comparison or regular ranges. • If you are looking at reducing your range, use the 80/20 rule, where are the 20% of your products driving 80% of your sales. Do you need to keep anything outside of this list? 3)3Clearing excessive stock Once you have decided what your ranges are, it is important to clear your excess stock. This can either be done in the existing position or brought out to a promotional end. Taking it out to a promotional end I think is better because you can see what the re-laid store will look like much sooner. Stock needs to be reduced to prices where it will
John Hogan, co-founder and chief data scientist, Real World Analytics sell quickly, you do want to turn it into cash. When you keep your stocks tight, you can then take advantage of special buys to give a great perception of value whilst making good margin at the same time. This is a win-win both for you and the customer. 4)3Controlling the buying You need to ensure that the buying is controlled otherwise product that you have delisted and sold at a loss could come back into the store. Ideally, one person will be responsible for reordering, the fewer people involved the better. Systematically ordering at the start of each month is the best option as you will maximise your credit terms whilst ensuring all lines are in stock. Surprising though it may seem, not even best sellers will be in stock in all stores when relying on reps visiting the pharmacy. Finally, beware of multi-buys, they are only good if you can sell them, it is better to negotiate net cost prices and buy what you need. Finally, what’s the payback? We would expect you to trade on: • 7-10 weeks cover on OTC/Vitamins • 25-30 weeks on Beauty/ Skincare • 12-15 weeks on the rest of the Shop. This typically will be a cash boost of ¤20k-40k per pharmacy, not to mention a higher margin and sales.
Ian – there was a pic of this guy in the appointments section of the March edition, can we use that too? I’ve requested jpegs of the butterflies but not sure if I will get them in time. Two pages for this one – 36 and 38
The financial lifecycle of the pharmacist
The Financial Cycle - Float like a In the first of a six-part series, Robert McOwan explores the financial lifecycle of the community Butterfly pharmacist. Using his experience in both the
In the first and of apharmacy six-part sectors series, Robert Robertworks McOwan business as a financial advisor offering both business and personal explores the financial lifecycle of the financial planning. This week he gives an overview of community pharmacist. Using his experience the four stages in a financial lifecycle. in both the business and pharmacy sectors Robert now works as a financial advisor offering both business and personal financial planning. This week he gives an overview of the four stages in a financial lifecycle. Your financial cycle
together without having children.
which is always sensible and
Life choices and wealth are inextricably linked to business and personal ambitions, and great advice to follow; Likewise, a couple who livegoals, career together and have children will “Don’t spend financial aspirations. The achievement of these and the financial result which flows fromeverything them at once” follow another cycle as their financial needs will be different “Now is a good time to save” depends on the financial cycles a person follows during a lifetime of work. from both of the above. “Think about a deposit on
Financial cycles vary. A person who remains single willThese have a different cycle toaahouse” couple who live variances caused by unique personal and/or business “Save an emergency together without having children. Likewise, a couple who live together and have children will fund” follow circumstances drive the need for both business owners and “What about marriage and yet another financial cycle. This cycle variance drives the financial planning need for both business employees to be financially starting a family.” informed and aware of their owners and their employees. Savings & Income Robert McOwan
specific needs as they move through each financial step.
How much to save and where to save are important decisions. For example, if children arrive it distinct time frames. Age Taking a generation couple with as an example, unless their financial cycles are interrupted ansaving as Wealth and thechildren ability would be wise by to start ranges for each financial step The financial circumstances to create positive life choices are the latest estimates of paying for are indicative but not exact unplanned as winning the lottery or inheriting a below smallarefortune, outlined an overviewtheira child who is staying away from inextricablyevent linked tosuch business for everybody, however, the of what may typically happen career progression home in third level education is associated financial challenges livesgrowth, will normally follow in theas to aillustrated couple with children and financial aspirations. This four distinct financial steps as at least ¤12,000 per annum. in each cycle are likely to arise they move through each of the statement is generally true for regardless of the age you begin diagram. Source: DIT Cost of Living Guide steps; unless their life style is people working in all industries, any of the steps. Survey, June 2017. interrupted by an unplanned including the very successful event, such as winning the and dynamic pharmacy sector Step one But these early years of the lottery, death, serious illness, or where business owners are financial cycle are not without Early years: Age 21 to 35 theywith are lucky enoughambitions to inherit provided withstep opportunities Within each there are business and personal goals, career to be achieved risk. In spite of your youth and a small fortune. for revenue growth and Step two energy, death or a sudden illness employeeswealth see opportunities alongside aspirationsGrowth to beyears: realised. How theseStep shape and drive financial needs are canplanning be indiscriminate in their one: Age 36 to 50 for motivational get-up-and-go occurrence. Such things can The early years, age 21-35 discrete questions to be answered at every stage. career progression. Step three cause business failure, loss of During this time you may be all income and maybe erode any The four step financial cycle Consolidation years: taking on the challenge of accumulated assets or savings. Age 51 to 65 starting your own business or be Also intricately connected to This is a financial risk to both very busy building a successful building of a business and Step four is broadly indicative business owners and employees Thethe age range shown for each step but not exact. However, the associated career as an employee. You are a career is a four-step financial as if either happens it can have & freedom: probably working long hours, cycle. These cycles follow a likelyFlight financial challenges are to arise, regardless of the age you arrive at any ofa the steps.impact on the devastating Age 66 and over managing deadlines, delivering logical pattern during our lives financial well-being of a business superior service and meeting the and arrive as individuals acquire or a family. Financial cycle variances Agenew profile: 21 toalongside 35. needs of a growing number of responsibilities Consequently, a top priority in customers. It is also when your Financial cycles vary from financial challenges that must step onelong is to protect income headline income see you to person, to for example a be overcomethis in order ensure Throughout time you willperson be looking build your business ormay career by working hours, as much as possible. A simple have more disposable income at person who remains single will personal success and financial meeting deadlines and delivering superior service growing customers. time younumber may recall of what definition of protection is have different financial needs to awhich well-being during a busy your parents might have said, compared to a couple who live working life. ensuring a capital sum is
TheFloat four-step financial cycle The four steps fall into four like a butterfly
A four-step financial cycle example: A couple with children
Matching four steps to financial cycles.
Age profiles & financial cycles.
It is also when your headline income may provide you with more disposable income and at this time, 28 you may recall what your parents might have said to you; “don’t spend everything at once; now is a
Reminder of Precautions to avoid Photosensitivity Reactions with Fastum Gel (ketoprofen gel) A. Menarini Pharmaceuticals Ireland Ltd. wish to remind healthcare professionals of the necessary precautions to avoid the risk of photosensitivity reactions with Fastum Gel. The European Medicines Agency’s Committee for Medicinal Products for Human Use (CHMP) undertook a safety review of topical ketoprofencontaining medicines in 2010 and recommended that doctors should strictly follow the contraindications when prescribing topical ketoprofen. CHMP also recommended that doctors and pharmacists should inform patients on how to use these medicines appropriately to prevent the occurrence of serious skin photosensitivity reactions. A series of risk minimisation measures for Fastum Gel was agreed with the Health Products Regulatory Authority. The Summary of Product Characteristics and the Patient Information Leaflet were updated accordingly and may be found on www.medicines.ie and www.hpra.ie. Patients should be reminded to wash their hands thoroughly after application of the product and to protect treated areas from sunlight by wearing clothing. They should avoid exposing the treated areas to sunlight, even if cloudy, or UVA from sunbeds or solarium during use and for 2 weeks after discontinuation. In addition they should be advised to avoid using Fastum Gel under occlusive bandages and to discontinue Fastum Gel immediately and contact their doctor should any skin reaction develop, including cutaneous reactions after co-application of octocrylene-containing products. A copy of the patient educational leaflet is available from A. Menarini on 01 284 6744 or 1800 283045 or is available at www.hpra.ie A. Menarini would like to remind healthcare professionals that any suspected adverse reactions associated with the use of Fastum Gel should be reported to the Health Products Regulatory Authority at www.hpra.ie or by calling 01 676 4971. Adverse reactions can also be reported to A. Menarini’s Pharmacovigilance Department on 01 284 6744.
Financial Feature available to maintain lifestyle and income, for a specified period of time, in the event of death or a serious illness. The exact design of such a plan is not a one-sizefits all as people usually have different financial perspectives which need to be assessed carefully before any option could be considered fit for purpose. Step one early years summary When you think about the volatility of life during step one it is probably the most financially and emotionally challenging of all four steps. Typically, this is the time of your life when you start a business, build a career, get married, have children, change your lifestyle, accumulate debt, acquire long term financial commitments and are willing and able to take on new risks and responsibilities. With all of this happening at such a fast pace, itâ€™s also probably a good time to begin having regular financial health check-ups. Step two: growth years, age 36-50 Step one is over, business growth is on target or your career as an employee is trending upwards and on track. Revenue from business and income from employment is increasing. New business is developing, and promotion opportunities are being won and maybe bonuses are being earned. A downside is disposable income may not now not be keeping pace with headline income as the costs associated with children growing up and other major family expenses must be met. However, some changes may occur. For example, the need for saving towards education might reduce or stop. This depends on ages of children, when savings started, how much was saved monthly and are your child or children likely to be away from home during third level education.
when you stop working, for example, a male aged 47 today with 18 years to go before retiring at age 65 can reasonably expect to live for another 18 years after retirement*. A female aged 47 can reasonably expect to live for 21 years afterwards**. *Source: CSO Irish Life Tables 08 July 2015. ** Source: CSO Irish Life Tables 08 July 2015 Currently, apart from any entitlement to a private, public, or state pension, regular income from employment usually stops at the end of cycle three, i.e. at age 65. One way to avoid any income gap at retirement is to save from regular income while working or use your business to create assets and wealth that may be converted into income post retirement. Step two growth years summary Generally speaking, for most people, it is financially steady as you go during step two with no major changes to financial needs. There may be an opportunity to reduce saving for education and it may be an opportune time to start saving towards an income for retirement. You are now looking forward to step three, the consolidation years and hopefully there is less financial risk to worry about and potentially, a gradual increase in discretionary income. Step three: consolidation years age 51-65 Moving into step three can often mean the good news is that the light at the end of the financial tunnel is not the train coming towards you. Some of the motivational reasons for this being the situation can be that one or more of the following statements is true for you; 1. Business is well established. 2. Career is stable and progressive.
Saving for a childâ€™s education takes time. However, if savings start at the birth of a child, there may be enough time to reduce or stop saving before the funds are actually needed.
3. Children are grown up.
Growth years and new priorities
6. Mortgage reducing or fully repaid.
A fast approaching need now is to think about income needs
7. Short term loans not required or minimal
4. Children probably building careers. 5. Children potentially moving into step one of their own financial cycle.
If this is your improving financial situation it is advisable to retain some protection while making your investments work hard and ensuring a plan is in place for a regular income post-retirement. Awareness of what to prioritise is still important as some financial needs may be moving targets and therefore need to be managed wisely to ensure risks are mitigated and any discretionary income is working hard for your benefit. Step three consolidation years summary Planning to ensure income is available after stopping work either as a business owner or an employee is now a priority. Waiting until close to or the end of step three is usually too late for most people. Accumulating assets and wealth to be used to fund post retirement income should ideally happen throughout all of step three and begin in step two whenever possible. Step four flight and freedom aged 66 and over Congratulations, you have built a successful business or career, own a home, maybe collected some savings and assets, raised a family and perhaps helped your children begin step one of the financial cycle. Lifestyle and income protection is no longer a priority, unless there is a need to pay inheritance tax or have a lump sum available in the event of a death or serious illness. You can look back with satisfaction on successfully completing all of the four financial steps which helped ensure your business, family income and lifestyle were always protected; savings were aligned with goals, and the need for an exit strategy, business succession and securing a regular income when you stopped working was achieved on time. In summary, you took responsibility for your financial well-being by having regular financial health check-ups to help with being aware of your financial priorities and needs. All of which has helped you to make the best financial decisions for your business and family throughout your working life.
Step four flight & freedom priorities Taking centre stage now is the need to evaluate all accumulated business and personal wealth, think about how to convert these into assets to provide a regular income, now that you have stopped working and can afford to invest some quality time in hobbies and leisure activities. Summary of the financial cycle In the ideal financial world, everyone in both their business and personal lives, would tick all financial boxes at each of the four steps. However, this is not always possible and while an early start in understanding and prioritising needs usually works best, itâ€™s never too late to take control and make the right financial decisions. The forthcoming articles in the series will provide greater detail on financial awareness for both business owners and employees on each of the steps Acorn Life DAC is regulated by the Central Bank of Ireland. Acorn Life is a 100% Irish owned Life Assurance Company offering protection, savings and investment products designed for the Irish public. Deductions for charges and expenses are not made uniformly throughout the life of the products mentioned above but are loaded onto the early period. This means that if you withdraw from the product in the early period, the practice of front-end loading will impact on the amount of money which you receive, and you may not get back the full amount invested. About the Author Rob McOwan is a Personal Financial Adviser with Acorn Life. He has a strong connection to the Pharma Industry having worked alongside numerous pharmaceutical organizations to assist with the design and launch of key brands. He has significant experiences creating, building, and supporting pharma companies within the Irish and European markets and in his current role is now ideally positioned to present financial advice within the pharmacy industry to owners and employees.
Reproductive health before, during and after pregnancy By Vicky O’Dwyer, MD, MRCPI, MRCOG
Reproductive health is a hot topic this days, particularly as women are waiting later and later to begin their families. Vicky O’Dwyer, locum consultant obstetrician discusses many of the health issues surrounding women and pregnancy.
Dr Vicky O’Dwyer, Consultant Obstetrician
The are a number of recommendations for women who are thinking of conceiving. Firstly it is important to know the fertile window. For women who have a 28-day menstrual cycle the most fertile time is around day 14 when ovulation occurs. Those with a longer cycle should subtract 14 days from the cycle length to calculate the date of ovulation i.e. 35-day cycle, ovulation is day 21. About half of pregnancies are unplanned so women of reproductive age should be taking folic acid. Ideally 400mg folic acid should be taken for 3 months prior to pregnnacy and until 12 weeks gestation. For women who are obese and those with a pre-existing medical condition such as epilepsy 5mg folic acid is recommended to reduce the risk of neural tube defects. Women should be advised to optimise their weight prior to pregnancy to reduce the risk of pregnancy complications. The average BMI of women pregnant in Ireland is in the overweight category and about a third are obese. Pregnancy and weight gain During pregnancy and the postpartum period are unique opportunities to embrace healthy
lifestyle choices including a healthy diet and regular exercise. This is especially important for women who are overweight or obese. Not all hospitals routinely weigh women throughout pregnancy but a Dublin study examined experiences of routine weighing during antenatal care. This study found that women expected to be weighed during pregnancy and postpartum. The benefits included providing reassurance and minimising postpartum weight retention. Gestational weight gain guidelines were published by the Institute of medicine in 2009. These recommendations are based on BMI. They recommended GWG is 12.518kg for women with a normal BMI, 6-11kg for women with an overweight BMI, and 5-9kg for women who are obese. Exercise during pregnancy Both the Royal College of Obstetricians in the UK and American College of Obstetricians have produced recommendations for exercise in an uncomplicated pregnancy. The benefits of exercise in pregnancy include staying fit and healthy, reducing the risk of diabetes in pregnancy and reducing excessive weight gain in pregnancy. Women who haven’t been exercising before pregnancy can still start to exercise, gradually increasing from low to moderate intensity. Women who exercise regularly they continue moderate to high intensity exercise with a few modifications for pregnancy. Ultimately the aim is to do 20-30 minutes of moderate intensity exercise at least three days a week, such as walking, running, swimming, pregnancy yoga or pilates and strength training. As previously mentioned most pregnant women in Ireland are overweight based on their BMI at the first antenatal visit. So how do we prevent excessive GWG and postpartum weight retention? A randomised control
trial examining the effect of a low glycamic index (GI) diet on pregnancy outcomes including gestational weight gain showed that women in the intervention arm gained significantly less weight in pregnancy. Furthermore, they continued this positive lifestyle intervention up to three months postpartum. This resulted in greater weight loss from pre-pregnancy up to three months postpartum than the control group. Encouraging a positive lifestyle change during pregnancy and after requires a multidisciplinary approach including general pracitioners, obstetricians and dieticians. But what is the best forum to deliver this support? A recent study has used positive lifestyle interventions in conjunction with web based technology in an effort to improve pregnancy outcomes for mother and baby by reducing the incidence of gestational diabetes mellitus. The PEARS study, a randomised controlled trial in women with a BMI ≥25kg/ m2 used a healthy lifestyle package including a motivational counselling session to encourage behaviour change, low glycaemic index, nutritional advice and daily physical activity prescription delivered before 18 weeks gestation, as well as a smart phone app to provide ongoing healthy lifestyle advice and support throughout pregnancy. A recent study evaluated an internet based intervention in addition to standard weight loss management strategies to promote postpartum weight loss. The weight loss programme included a recommended calorie intake ranging from 1200 to 1800 calories per day based on study entry weight, with 300 additional calories for mothers who were breastfeeding. Exercise was gradually increased to 30 minutes or more on most days. There was an interactive web based strategy used over a 12-month period which provided weekly lessons
with automated feedback, an online diary, a weight and physical activity tracker, videos, and a message board. Four weekly text messages notified participants of new website content and provided motivation and feedback. Of the 371 participants, those in the intervention arm lost more weight and were more likely to return to pre-pregnancy weight by increasing physical activity and decreasing calorie intake compared with the control group. Weight gain post pregnancy Women who are overweight or obese are at increased risk of pregnancy complications including high blood pressure and diabetes mellitus in pregnancy. They are also more likely to require pregnancy interventions such as induction of labour and caesarean section. For those that develop gestational diabetes mellitus they are given advice regarding diet to ensure good blood sugar control. All these women are seen at six weeks postpartum to check for type 2 diabetes. Even if this is normal these women are at increased risk of developing type 2 diabetes within 10 years. The average woman is beginning pregnancy with a BMI in the overweight category. Retaining gestational weight gain will push some of these women into the obese BMI category. Obesity is associated with adverse health outcomes such as diabetes and cardiovascular disease. It is therefore important that women lose weight postpartum and return to their pre-pregnancy weight. Using diet and exercise interventions with the addition of web-based tools can facilitate this positive lifestyle change and improve long-term health.
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Women’s health and the menopause By Dr Deirdre Lundy GP and sexual/reproductive health co-ordinator for the Irish College of General Practitioners
Originally from the US, Dr Lundy came to Ireland to attend UCD Medical School. She has worked in all of the major family planning clinics in Dublin and is also on staff at the Royal College of Surgeons in Ireland where she introduces patients to the art of interviewing and examining patients with respect and kindness. symptoms such as hot flushes, sweating (especially at night), poor sleep, mood changes and more. Some women are fortunate and don’t experience too much disruption during this time but for others it can be an awful process. Sleep disruption particularly can be devastating and will affect all aspects of wellbeing. The most efficient way to combat disruptive symptoms brought on by menopausal hormonal fluctuations and subsequent decline is to supplement levels with hormone replacement therapy or HRT. In recent years there has been a lot of anxiety over the use of HRT and how it might affect the development of breast cancer, but most of that information was not presented in an accurate way and caused enormous, unnecessary fear. It might be helpful to know where all this furore came from. Dr Deirdre Lundy, GP
The term women’s health is used to refer to aspects of reproductive and sexual health that may affect a woman during the many stages of her life. The most common issues women seek medical advice for include: period problems, contraception, advice and testing for sexually transmitted infections, fertility testing, antenatal care and help with the changes that occur during the menopause. New developments in women’s health happen all the time (it can be a challenge for GPs & pharmacists to keep up to speed) but one of the most welcome developments in the last few years has been the new guidelines and recommendations
Hormone replacement therapy
to healthcare workers about women suffering from menopause symptoms. The menopause The menopause is officially defined from the last day of a woman’s last menstrual period. She is considered postmenopausal when a year of amenorrhoea has passed, but most patients use the term to describe the many months or years during which their body transitions from producing large amounts of reproductive hormone to almost none. Some women start to feel the beginning of this transition with
HRT was prescribed liberally in the western world from the early 1970s and users derived great benefit from it. The situation changed in 2002 however, when a study from the US was published that created concern about a possible link between using HRT and finding breast cancer. The study was called the Women’s Health Initiative (WHI) and it was commissioned by the US government to look at many different aspects of the health of older women. They were particularly keen to see what factors affected heart disease and cancer. The women in the study were almost all over 55 (most participants were in fact in their early 60s) and they were all offered Prempro (double dose Prempak-C). The WHI study
was a double blind randomised control trial with some women on the equine urine Estrogens – with or without medroxyprogesterone acetate – and some on placebo. The rate of unblinding was staggeringly high (almost 50%). In the first five years of the study there was no difference in breast cancer detection in the two groups but after those five years went by, a slight increase was noticed in the number of breast cancers found in the women on the active HRT versus the placebo. This only applied to the MPA using group. The women on plain Premarin had an observed reduction in breast cancer detection. The extra numbers in the Premarin + MPA group were small and there was no suggestion that the HRT was creating new cancers. The actual increase in breast cancers being found was quoted as: “relative risk of 1.26”. That was the official report; this is about the same extra number of breast cancers we see in women who drink one glass of wine a day. The information derived from that study did not suggest or prove that HRT caused breast cancers to develop, only that there was a slight association in some older women over time, but they chose to halt that part of the study until more information was gathered which was sensible. Sadly, things took an unfortunate turn at that stage when some of the authors of the study published a review in the Journal of the American Medical Association without discussing it with some of the other study authors. Their article was worded in a very alarming tone (they continue
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Feature to receive much criticism for this even today). The popular papers picked up their story and we were seeing terrifying headlines saying HRT causes breast cancer but without any actual data to support this. It was so sad for Irish patients during those years. Droves of Irish women, as well as millions of women in the US and Europe, stopped their HRT abruptly. Some were fine, but others got their symptoms back vigorously and were too terrified to seek help. Even when they did ask for advice they didn’t know who to believe. No matter how much we tried to reassure patients about the real relationship between HRT and breast cancer, there were just as many other doctors and pharmacists who hadn’t read all the information and were still warning patients to avoid it at all costs. HRT today Things stayed this way for decades until finally in 2015, the UK ‘s National Institute for Health & Care Excellence (NICE) issued a guidance document on HRT that finally reversed the mood around HRT care. Their review of menopause Care & HRT reaffirmed what menopause doctors had been saying all along; if your patient is suffering and needs HRT to control troublesome menopause symptoms, she should feel confident to use it and you should support her in her choice. They pointed out that most women who need HRT are young (well under the age of the women in the WHI study) and are probably only going to need it for a few years anyway. This has slowly returned to a rising confidence in many GPs about menopause care & HRT prescribing and we have thankfully noticed an increasing number of women willing to talk about their symptoms and seek advice. The Symptoms? Menopause symptoms are varied and there are no blood tests that confirm the diagnosis, so it can be a tricky consultation. In the main, early symptoms include flushes, night sweats and sleep disturbance. Some women are more troubled by emotional and cognitive issues such as low
mood, poor sex drive, irritability or anxiety, poor memory and/or a cloudiness in their thinking. As some women move deeper into the transition, issues concerning declining collagen levels arise, so weakness of the pelvic floor with incontinence can worsen. Skin, hair and nail quality declines as collagen levels drop even further. The elasticity of the vaginal wall usually dis-improves as time goes on and that can make things like exercise and having sex less comfortable for some women. The worst of these symptoms usually tail off by the late 50s but some women continue to have troubles well into their 60s and beyond. HRT will combat most if not all of these symptoms and it is always worth suggesting patients educate themselves before making decisions. Wonderful information can be found for patients and health workers alike on the NICE website. Additionally, some excellent agencies in the UK offer clear advice and information such as. www.womenshealth-concern.org and www. menopausematters.co.uk among others. While HRT is worth considering there are also many non-HRT remedies that NICE and other health agencies recommend. NICE explores other issues around HRT including the slight increased rate of venous thromboembolism seen with the use of oral Estrogens (transdermal preps or the patch are safer for women at risk of deep vein thrombosis) and the need for caution when starting a woman on HRT after more than 10 years of her being estrogen depleted. In this case a menopause expert opinion should be sought as late intervention with estrogen has been shown to cause an increase in cerebro & cardio vascular plaque embolisation and may precipitate an MI or CVA. HRT Alternatives Women who can’t or won’t consider HRT can use over the counter vitamin and mineral supplements to help alleviate symptoms. Some women have tried the alpha agonist
clonidine to help relieve flushes and sweats with good results. Some of the SSRI/SNRI antidepressant medications have been shown to give relief from flushes even when used in very low doses. Mood problems can be helped by these drugs too. Caution must be exercised with some of the SNRIs and SSRIs though, for women on breast cancer therapies. Vaginal moisturisers and lubricants are available that may help improve the symptoms of vaginal dryness and discomfort that plague some women. One alternative that is not recommended though is the use of compounded or bio-identical HRT alternatives. These are hormone containing pellets or creams that are produced in private laboratories and as a result are not subjected to the same quality standardisation as conventional HRT that are pharmacy dispensed. These products are no better than conventional HRT and may in some cases expose the user to much higher levels of hormone than might be necessary so there is a concern about safety. They can also be very expensive with some women paying over ¤100 a month whereas conventional HRT is covered by the medical card and even for private patients rarely costs more than ¤20-30 a month. General advice for women There is a lot more to maintaining good health during the menopause than HRT. It is important to be aware of and take charge of any health issues that might be a problem for women now and later on. Consider treating yourself to a mid-life medical check-up. Mind blood pressure and weight. Eat well and exercise. Don’t smoke or at least cut down - the same goes for alcohol. Consider exploring one of the many different mind-body-spirit therapies that can help improve well-being and contentedness and lastly, perhaps the best advice of all, be more kind to oneself and seek help if needed. Osteoporosis and the menopause Literally meaning porous bone, osteoporosis results in an
increased loss of bone mass and strength. The disease often progresses without any symptoms or pain. Often osteoporosis is not discovered until weakened bones cause painful fractures usually in the back or hips. There is a direct relationship between the lack of oestrogen during perimenopause and menopause and the development of osteoporosis. Early menopause (before the age of 45) and any prolonged periods in which hormone levels are low and menstrual periods are absent or infrequent can cause loss of bone mass. Women over the age of 50 have the greatest risk of developing osteoporosis. In fact, women are four times more likely than men to develop osteoporosis. Women's lighter, thinner bones and longer life spans account for some of the reasons why they are at a higher risk for osteoporosis. Helping to prevent osteoporosis There are multiple ways women can help protect themselves against osteoporosis, including: Exercise - Weight-bearing exercises, done at least three to four times a week, are best for preventing osteoporosis for example: walking, jogging, playing tennis, and dancing. Strength and balance exercises may help with avoiding falls. Supplements - Calcium carbonate and calcium citrate are good forms of calcium supplements. Vitamin D - The body uses vitamin D to absorb calcium. Being out in the sun for a total of 20 minutes every day helps most people's bodies make enough vitamin D. Due to the relative lack of vitamin D-containing foods, supplements of vitamin D are often necessary to achieve an adequate intake, particularly during the winter months. Other preventive steps are limiting alcohol consumption and quitting smoking. Smoking causes the body to make less oestrogen, which protects the bones. Too much alcohol can damage the bones and increase the risk of falling and breaking a bone.
How high blood pressure set one pharmacy on a new path In 2010, pharmacy graduate Jonathon Morrissey set about bringing his grandfather’s rural dispensary into the 21st Century. management, smoking cessation, and an injection service. The pharmacy now hires out three 24-hour blood pressure monitors to up to seven patients a week. Of those, about 70 per cent are referred to their doctor with symptoms of hypertension. Morrissey, the superintendent pharmacist at Marron’s, reels off example after example of how these extra services have benefited his patients. From concerned parents unsure if they should take their children to the doctor with a sore throat, to elderly patients unable to get to an out-of-hours service and in need of a pharmacist to advocate on their behalf. There was the teenage boy with an elevated ABPM reading whose doctor didn’t have a 24-hour monitor. Instead of being referred to a hospital or cardiologist, the boy’s mother was sent to Marron’s, where he was fitted with the monitor, which later confirmed hypertension.
Jonathon Morrissey, Marron’s Pharmacy One of the first things he did when he started working in the family business, Marron's Pharmacy in Clane, Co. Kildare, was introduce free blood pressure monitoring.
consultant confirmed that Morrissey, who has a family history of cardiovascular disease, had hypertension. At the time of diagnosis, he was 28 years old.
In an effort to give patients who recorded elevated readings a clearer picture of their condition, Morrissey soon got hold of a 24-hour ambulatory blood pressure monitor.
Nicknamed the silent killer, high blood pressure affects more than one third of Irish people although many do not know they have it and is a major risk factor for heart disease, vascular disease, and stroke.
He decided to give the machine a test run. “I had noticed that my own blood pressure was often elevated, but I would dismiss it out of hand because we were a busy community pharmacy,” says Morrissey. “When we got the monitor, I ran it on myself.” The results weren’t good. A
Blood pressure monitoring was the first additional service Marron’s offered. But under Morrissey's stewardship, the suite of extended services available to customers has grown to almost two dozen. They include cholesterol and diabetes screening, urinalysis, free ear and throat exams, firstaid training, weight and asthma
Or the person who walked in off the street feeling unwell and whose BP results prompted an immediate doctor’s referral. Such an urgent and dramatic referral is rare. That person ended up in hospital after suffering a bout of stress and anxiety - it wasn’t hypertension, but because of the test they were treated that day. And the 92-year old woman with type-one diabetes who had a suspected UTI but couldn’t be seen by a doctor for five days. A urine sample tested at the pharmacy found it was loaded with Leukocytes, blood and protein: the hallmarks of a kidney infection. The woman was referred to an out-of-hours service right away. “We didn’t get to fill that prescription, but I don't mind that. That's not why we do it,” says Morrissey. “We do it to increase the service to our customers. It was off the back of that case that I realised we might not see all the patients back after we discover the issue. But it gives our patients instant access to information and knowledge.”
The services have also been good for business. Morrissey says many of them took some time to pay off, they have become an extra source of revenue for the pharmacy. The 24-hour blood pressure monitoring costs ¤50, and urinalysis costs ¤10. Sometimes, the pharmacy makes an OTC sale off the back of one of the services, such as a physical examination. “They don’t make a huge amount of money, but some of these people become patients for life,” says Morrissey. “And when they leave they’re happy because they know they’re going to the GP with a genuine reason; they know their throat infection isn’t viral, or they know for certain that they have a kidney infection.” Morrissey believes more Irish pharmacies need to adapt their business models to attract and retain patients. He says they have to become more proactive, rather than reactive, adding that pharmacy is perfectly positioned to give patients better access to crucial services. Importantly, pharmacists can also intervene in instances where people might be avoiding going to the doctor or don’t realise they need to see their GP. Having grown up in the pharmaceutical business, Morrissey never had reason to step foot into another pharmacy before he graduated. When he was studying at the Royal College of Surgeons, he remembers learning about all the additional services pharmacists should offer their patients. “I didn’t know what other pharmacy models looked like,” he said. “When we were told about all the services pharmacies should be doing I thought that was the norm, and when I looked at our own pharmacy, I thought, not only are we not the norm, we are in the dark ages.” Almost a decade on, Morrissey now realises Marron’s wasn’t in the dark ages. It was offering the same service that most other Irish pharmacies did at the time.
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CPD 91: OSTEOARTHRITIS Biography - Paul Knox earned his higher diploma in Community Pharmacy from Cloughjordan Pharmacy with Distinction and started in Coffeys Pharmacy Roscrea in 2013. There he was quickly promoted to Managing Pharmacist before he and his wife Tanya took over the Pharmacy in October 2016. Paul also holds a masters degree from Trinity College Dublin.
Welcome to the Continuing Professional Development Module. CPD is mandatory professional requirements for pharmacists. Journal based education programmes are an important way of keeping up to date with personal clinical and professional development. This module can be used in your personal learning log and can be completed in the magazine or online by completing the reflection questions at the end of the module. You can also track your progress of you development by going to www.pharmacynewsireland.com/cpdtraining where you can register to record your learning.
Reflection - Is this area relevant to my practice? What is your existing knowledge of the subject area? Can you identify any knowledge gaps in the topic area?
Evaluation - How will you put your learning into practice?
origin. Obesity has been associated with OA, especially in women, and particularly in the knee. In fact, more than half the cases of OA can be linked to obesity. A strong genetic component is thought to be present, particularly in women. Heberden’s and Bouchard’s nodes (bony outgrowths at the top of finger and middle of finger resepectively) are three times more common in sisters with OA than in the general population. An inherited defect in type II collagen genes is linked with the development of early onset polyarticular OA.
Have I identified further learning needs?
Planning - Will this article satisfy those knowledge gaps or will more reading be required? What resources are available? Action - After reading the article complete the summary questions at www.pharmacynewsireland. com/cpdtraining and record your learning for future use and assessment in your personal log.
Osteoarthritis is a chronic disease and the most common of all the rheumatological disorders. It typically occurs in people over the age of 60 and is the most common joint problem of this cohort. In the most simple terms, osteoarthritis has been conceptualised in relation to joint degredation and cartilage destruction; rheumatoid arthritis, on the other hand, has been primarily viewed in terms of joint inflammation. However, while degeneration and inflammation may be clearly discernible at the two extremes, there may be a group of patients where differentiation is impossible and a misdiagnosis will have implications for treatment down the line. The comparison of OA and RA will be discussed in a later section but while the latter is seen as an active disease with both an evolving and multidisciplinary treatment approach, there is now a prevaling view that the former is an active disease in its own right with potential for treatment, as opposed to merely the consequence of aging. OA is characterised by deterioration and loss of articular cartilage in articulating joints and hypertrophy of the bones at the articular margins. Its localised form affects 1-2 joints while its generalised form affects three or more joints. It is the most common type of arthritis and is the leading cause of disability and pain in older adults. EPIDEMIOLOGY The prevalence of OA increases with age, being uncommon in those aged less than 45 years with a prevalence of just 2%. This incidence rises to 70% and 60% respectively in women and men over 65 years with the hip, knee and hands being the joints most commonly affected. OA occurs in all populations irrespective of race, climate or geographic location but ethnic origin may contribute to the pattern of the disease – hip manifestations are less common in Chinese and Asians than in those of Western
The exact aetiology is unknown but in basic terms it is believed to result from an imbalance in erosive and reparative processes. The disease process is not a simple wear-andtear mechanism as inflammatory components may also contribute. Anything that alter the microenvironment of the chondrocyte is a factor. This includes congenital joint abnormalities, genetic defects, infectious, metabolic, endocrine, and neuropathic diseases; acute or chronic trauma including fractures. Virtually any disease process that can affect the normal structure and function of hyaline cartilage may be a risk factor for OA. Hyaline cartilage is avascular, aneural, and alymphatic. Chondrocytes divide and increase their rates of both synthesis and degradation, they have the longest cell cycle in the body. They don’t tend to divide unless some change in the microenvironment occurs. Cartilage heal depends on the compression and release of weight-bearing and use. Its primary causes can be codified as follows – • Aging and genetics • Obesity • Inactivity • Trauma • Race • Gender • Systemic disorders - hypertension, diabetes mellitus • Hormonal - oestrogen post menopause; growth hormone in acromegaly PATHOGENESIS OA appears to be the result of a complex system of interacting, mechanical, biologic, biochemical and enzymatic feedback loops and its pathogenesis has been classified into four stages –
1. Initial repair – proliferation of chondrocytes synthesising the extracellular matrix of bone. This involves the mitosis of chondrocyte with increased synthesis of the proteoglycans and type ll collagen with a decrease in concentration of proteoglycans in the immediate neighborhood of the chondrocyte. 2. Early stage OA – degradation of the extracellular matrix as protease enzyme activity exceeds chondrocyte activity. This is characterised by the increased synthesis of bone by osteoblasts in the subchondral bone by intercommunication between chondrocyte and osteoblasts in the subchondral bone cells. With increased bone formation in the subchondral area, physical propierties change, the bone become stiffer, and microfractures occur. With these microfractures comes callus formation and hence more stiffness and further microfractures. 3. Intermediate stage – failure of extracellular matrix synthesis and increased protease activity, further increasing cartilage loss. Increased synthesis of bone by osteoblasts in the subchondral bone by intercommunication between chondrocyte and osteoblasts in the subchondral bone cells. With increased bone formation in the subchondral area, physical propierties change, the bones become stiffer, and microfractures occur. With these microfractures comes callus formation and hence more stiffness and further microfractures. 4. Late stage – extreme of complete loss of cartilage with joint space narrowing (a shown in diagram below). Bony outgrowths (osteophytes) appear at joint margins and there is general bone sclerosis. This mechanism is triggered by extrusion of joint fluid trough the hyaline cartilage clefts into the marrow with fibroblastic, osteoblastic cellular reaction around the synovial fluid. Clinically this stage manifests with pain and reduced joint movement. 5. The gross pathology – roughening or loss of surface of the hyaline cartilage, pitting, and irregularities, resulting in the gross ulceration with a first focal, diffuse area of loss of cartilage surface. There is a subsequent proliferation of new bone, capsule tendon, cartilage, and synovium occur. Deterioration and loss of bearing surface, proliferation of all osteoarticular tissue at the margin of the joints and under the detached joint surface. All cases have active synovial proliferation and synovitis.
CPD 91: OSTEOARTHRITIS
features such as history of trauma; prolonged morning-joint related stiffness (longer than 30 minutes); rapid worsening of symptoms or the presence of a hot swollen joint, may indicate alternative or additional diagnoses. Important differential diagnoses include gout, other inflammatory arthritides e.g. rheumatoid arthritis, septic arthritis, and malignancy. TREATMENT While there is no cure for osteoarthritis the goals of therapy are to • Reduce pain • Increase mobility • Reduce disability • Minimise disease progression • The most modifiable risk factor is obesity The NICE 2018 guidelines for the management of OA has devised a holistic treatment plan for two cohort of patients – 1. Over 45 years and 2. Has activity related joint pain and 3. Has either no morning joint-related stiffness or morning stiffness that lasts no longer than 30 minutes CLINICAL MANIFESTATIONS OA is characterised by joint pain, reduced joint movement, stiffness and joint swelling. The signs and symptoms are dependent on the affected joints – the most commonly affected are the distal interphalangeal, proximal, interphalangeal, and first metacarpophalangeal joints, the knees, hips and the cervical and lumbar spine. Muscle weakness or wasting is also common. Other symptoms are listed below –
compression of nerve roots secondary to proliferative osteochondrophytes, functional compromise of the vertebral artery, neuromyopathy secondary to compresion, spinal cord infarcts or esophageal compression, by anterior bony projection.
• MRI may determine disease progression
The above figure illustrates the multifactorial nature of OA and its treatment. Nothing is as simple as it first appears and what is ostensibly a pain management regimen requires a defter, nuanced, individualised and thorough approach. Co-morbidities must be taken into account, and not all these are physical. Depression and anxiety are associated with chronic pain and disability and any treatment plan should incorporate their treatment or prevention. Patient misconceptions that the disease will progress unchecked and cannot be treated should be challenged. Accurate information should be imparted to the patient on an ongoing basis rather than merely bombarding the patient at the time of information. Treatments evolve, and advancements are made, often quite rapidly, so it’s important that the patient is au fait with any new developments in this regard.
• Blood tests do not diagnose OA but rule out RA, but ESR may be slightly elevated.
Patient self-management and non-pharmaceutical approach
• Synovial fluid aspiration – arthrocentesis may rule out RA and infection. Examinations for crystals should also be conducted to determine if pseudogout is present.
• Weight loss is the obvious, mandatory first step incorporating diet and the next step, exercise.
DIAGNOSIS AND INVESTIGATIONS OA is primarily diagnosed on the clinical presentation. Diagnosis will incorporate – • Client history
1. Insidious onset.
• Physical exam
2. Joint stiffness after mobility.
• X-ray of affected joints – joint space narrowing and osteophyte formation; increased in radiologic density of the subchondral bone; formation of osteochondrophytes at the periphery of joints; formation of pseudocysts in the subchondral bone marrow.
3. Chronic pain; deep, aching which is aggravated by motion or exercise and weather changes (or more pertinently, changes in barometric pressure. The pain is relieved by rest, but night pain accompanied by progressive paresthesia may occur. However, the affected joints may be particularly troublesome after a long period of rest. 4. Pain is usually localised to the affected joint although it may be referred away from its origin (e.g. hip pain may be felt at the knee). 5. Crepitus – a grating sound or sensation with motion. 6. Decreased range of motion. 7. Joint spurs/deformity – enlargement of large joints related to bone overgrowth. 8. Joints are hard and cool on palpitation. 9. Acute episodes of severe synovitis may occur in those who have gout or pseudogout. 10. As ligaments become lax, the joint has increasing instability with more local pain, and clinical appearance of a limp. 11. OA of the cervical and lumbar spine: is common. In the cervical spine the symptoms may be related to radiculitis by
NICE touts a holistic approach to OA and management.
• Serum Hyaluronic acid levels may determine disease severity or predict disease progression • On arthroscopy normal cartilage is smooth, white and glistening, while OA cartilage is yellowed, irregular and ulcerated • The practitioner may employ the WOMAC index (The Western Ontario and Mc Master Universities Osteoarthritis Index) to evaluate and asses the patient. It is a proprietary set of standardised questionnaires to ascertain the condition of patients with OA of the hip and knee including pain, stiffness and physical functioning of the joints. NICE (2018) advocates awareness of atypical
• Exercise, suitable footwear and pacing. Exercise should be viewed as a core treatment irrespective of age, comorbidity, pain severity. Exercise should include local muscle strengthening and general aerobic fitness. The regimens involved should encourage ‘little and often’ physical activity to improve muscle strength and muscle tone. • Rest – 1. Local rest – immobilisation splint or brace 2. Systemic rest – whole body: sleep and naps 3. Psychological rest – stress reduction: to this end assistive devices such as tap turners, walking sticks, door handles etc should make every day tasks less daunting and
CPD 91: OSTEOARTHRITIS
burdensome. The patient should forensically examine every aspect of their day and introduce aids and adjustments to ensure that the disease does not adversely affect their daily routine. Something as simple as wearing slip-on shoes will make it that bit easier to get dressed. The overarching theme is that the patient has acceptance of their condition and is prepared to live with it and adjust their life accordingly. • Physiotherapy – may help patients regain strength and improve range of movement of the affected joints • Alternating heat and cold therapy – the former will improve blood flow to the joint to obtain analgesia, decrease muscle spasm, increase collagen extensibility and accelerate metabolic processes; while the former, in simple terms, reduces swelling, numbs the pain, constricts the blood vessels and blocks nerve impulses to the joint. • Ultrasound – there is accumulating evidence that this technology may be effective in the treatment and management of the osteoarthritis complex . Ultrasound converts electrical energy into an acoustic waveform, which is then converted into heat as it passes through tissues of varying resistance. Therapeutic ultrasound may produce temperature elevations of 4–5 °C at depths of 8 cm. A 2003 study determined that ultrasound was as least as effective as topical ibuprofen and ibuprofen phonophoresis after two weeks of therapy. • Diathermy - A 2011 study evinced beneficial effects of a 433.92 MHz microwave hyperthermia regimen in patients with moderate knee OA to reduce pain and to improve their physical function . • Electrotherapy – Healthcare professionals should consider the use of transcutaneous electrical nerve stimulation (TENS) as an adjunct to core treatment for pain relief according to the NICE guidelines. TENS is a nonpharmacological intervention that activates a complex neuronal network to reduce pain by activating descending inhibitory systems in the central nervous system to reduce hyperalgesia. • Acupuncture – is NOT recommended for the management of OA PHARMACOLOGICAL MANAGEMENT Most patients with OA have pain as a result of the damage to bone and cartilage. In the absence of inflammation, simple analgesia and joint protection are often sufficient. NICE’s guidelines from 2008 remain in situ in this regard pending a full review of evidence of the pharmacological management of OA and a review of the safety of OTC analgesics by the MHRA (Medicines and Healthcare Products Regulatory Agency). A preliminary review by the Guidline Development Group (GDG) on the effectiveness of paracetamol was proffered, and it identified a reduced effectiveness of paracetamol in the management of OA compared with what was previously thought and this should be considered when at the prescribing stage. Its perceived effectiveness notwithstanding, paracetamol (1g QDS regular dosing as opposed to an ‘as required’ dosing) remains as safe and effective as oral NSAIDs in mild
to moderate OA , and would be the first line treatment. A topical anti-inflammatory may be added instead of escalating to oral NSAID or opioids. The latter may be useful if paracetamol and topical NSAIDs are ineffective but the risk benefit ratio should be evaluated especially in elderly patients. Tramadol seems to be the most recommended opioid here. It acts centrally as an opioid agonist which inhibits re-uptake of noradrenaline and serotonin. It has shown to be comparable to ibuprofen in OA and may be used as an adjunct therapy in patients whom are inadequately controlled with NSAIDs. The evidence for use of oral NSAIDs in the management of OA is conflicting. Compared to simple analgesia, NSAID treated patients have significantly reduced pain at rest and on movement. However, other studies have shown that paracetamol and ibuprofen have comparable efficacy in mild to moderate pain with ibuprofen being superior in more severe cased. As such, patients should be initiated on paracetamol before switching to NSAID therapy. NICE makes the distinction between NSAIDS and selective COX-2 inhibitors due to the difference in side effect profile. These drugs can either be substituted or added to a regimen; addition probably being more prudent as it will allow a lower initial dose of the NSAID/COX-2 inhibitor. The first choice in this regard should either be a standard NSAID/COX-2 inhibitor (other than etoricoxib 60mg) and should be prescribed with a proton pump inhibitor. All NSAIDSs/COX-2 inhibitors have analgesic effects of a similar magnitude but vary in their potential GI, liver, and cardio-renal toxicity and these factors must be considered on an individual patient basis. Similar considerations must be taken if the patient requires low dose aspirin. TOPICAL TREATMENTS Topical treatments are particularly useful for patients afflicted with hand and knee OA. Rubefacients should not be offered save for topical capsaicin. The use of the latter in OA is interesting and storied. It was first extracted in impure form in 1816 from the genus Capsicum and was synthesised to its current form in 1930. In the 1960s similar compounds were extracted from chilli peppers that yield a burning sensation when in contact with mucous membranes. The mechanism of action of topical capsaicin has been ascribed to depletion of substance P. However, experimental and clinical studies show that depletion of substance P from nociceptors is only a correlate of capsaicin treatment and has little, if any, causative role in pain relief. Rather, topical capsaicin acts in the skin to attenuate cutaneous hypersensitivity and reduce pain by a process best described as ‘defunctionalization’ of nociceptor fibres. Defunctionalization is due to a number of effects that include temporary loss of membrane potential, inability to transport neurotrophic factors leading to altered phenotype, and reversible retraction of epidermal and dermal nerve fibre terminals. Other topical interventions include lidocaine patches (notwithstanding the difficulty of GP approval for prescribing of same and ambiguity regarding their actual effectiveness). Intra-articular corticosteroid injections should be considered as an adjunct to core treatments for the relief of moderate to severe pain in people with OA. However, intra-articular
hyaluron injections are not recommended. This author has encountered prescriptions for these on a few occasions and the patients received little or no benefit at huge cost. However, the one caveat was that the patients did not experience any relief from the conventional OA treatments either and both patients ultimately underwent total knee arthroplasty. NUTARCEUTICALS Glucosamine and chondroitin, while may give benefit to some patients, are not recommended for the management of OA. Studies conflict as to whether there is any benefit in taking these products. A recent meta-analysis investigating their use in OA concluded that while there may be some symptomatic benefit, there is no evidence that they offer a long-term solution in OA. However, a 2001 study has suggested that glucosamine is as safe and beneficial disease modifying agent in OA . In any event, these products are still prominent and relatively popular with and beneficial to some patients, recommended or not. In many respects, their effectiveness or not highlights the individualised and multifaceted nature of the illness. DISEASE MODIFYING OSTEOARTHRITIS DRUGS The last paragraph mentioned disease modifying drugs. Current OA treatments do not inhibit structural deterioration of the OA joint, the need for this type of treatment is immense. The current definition of a disease-modifying OA drug (DMOAD) is that of a drug that inhibits structural disease progression and ideally also improves symptoms and/or function. There are currently no licensed DMOADs but there are many prospective agents under investigation. The challenge of DMOAD development include the establishment of appropriate preclinical animal models that reflect human OA, the limitations of the current radiographic standard for structural assessment, and the lack of stratification of patients in trials by phenotype or tissue involvement. Furthermore, DMOADs should probably be used in early disease before irreversible molecular and biomechanical pathology is established, as is commonly present at time of diagnosis. They are also likely to be prescribed for considerable, lengthy period of time in an elderly population which demands excellent safety data in a target population with multiple comorbidities and the potential for drug interactions. Potential candidate DMOADs are currently under investigation that either affect or influence the degradation of cartilage and subchondrial bone or structurally modify the latter. Below is a list of potential DMOADs adopted from a 2013 Medicographia paper by AJ Barr xiii • Calcitonin – Calcitonin is responsible for regulating calcium homeostasis and promotes osteoblastic bone formation. It inhibits bone resorption by binding to calcitonin receptors on osteoclasts. Calcitonin, ostensibly, is indicated for the prevention of osteoporosis in postmenopausal women but its inhibition of subchondral bone turnover may be chondroprotective and, therefore, it may inhibit the structural disease progression of OA.
CPD 91: OSTEOARTHRITIS
• Bisphosphonates are frequently used for treating conditions with osteoclastic bone resorption, especially osteoporosis. Increased subchondral bone turnover in OA is integral to the pathogenic process of OA and may be associated with progressive cartilage loss. This disease-specific pathogenic process can be targeted using antiresorptive agents such as bisphosphonates, which hinder the bone remodeling process and could be chondroprotective. Animal models identified a beneficial effect of bisphosphonates in OA through their impact on subchondral bone, which includes inhibition of remodeling and osteophyte formation along with decreased vascular invasion of calcified cartilage. Zoledronic acid is the most proficient in this regard - it improves symptoms and a marker of structural disease progression at the same time, zoledronic acid represents an important prospective DMOAD. • Strontium Ranelate - Strontium ranelate is a drug used in the treatment of osteoporosis with antiresorptive and anabolic effects on the subchondral bone. Strontium ranelate influences bone remodeling through calcium-sensing receptors on osteoclasts and osteoblasts in subchondral bone and by an antiresorptive action via inhibition of osteoclastogenesis. In vitro studies suggest that strontium ranelate has anabolic effects on cartilage by directly promoting the formation of human cartilage matrix. In studies of human osteoporosis, strontium ranelate reduces cartilage degradation markers and inhibits clinical symptoms and radiographic features of spinal OA, indicating its potential as a DMOAD. A double-blind, placebo-controlled, randomized, international 3-year study of knee OA demonstrated a chondroprotective effect and symptomatic improvement in WOMAC index scoring. NICE posits whether ‘cardiovascular concerns will prevent strontium ranelate garnering approval for OA • Fibroblast growth factor 18 - Fibroblast growth factor 18 (FGF-18) is involved in cartilage and bone development during skeletal maturation.52In animal models, it has been shown to promote chondrogenesis, cartilage repair, and subchondral bone remodelling. It represents an important potential DMOAD and is currently undergoing phase 2 clinical trials examining changes in cartilage volume. • Interleukin 1 inhibitors - interleukin 1 (IL-1) has been proposed to be involved in the degradation of articular hyaline cartilage based upon preclinical studies. Inhibition of the enzyme that activates the proinflammatory cytokine IL-1β, interleukin-1 beta-converting enzyme (ICE), has been achieved with a highly selective caspase-1 inhibitor called pralnacasan. In animal models, a reduction in joint damage was demonstrated. However, in human OA, monoclonal antibody IL-1 inhibitors have failed to demonstrate an improvement in symptoms. • Doxycycline - Although there is no evidence to support an infectious etiology in OA, doxycycline has demonstrated potential as a DMOAD based on preclinical data. Possible
mechanisms of action include inhibition of type XI cartilage degradation, inhibition of collagenase activity and a decrease in iNOS mRNA transcription. A randomized, placebocontrolled, double-blind trial of doxycycline of over 30 months that included 431 obese women with unilateral radiographic knee OA reported a small reduction in the rate of JSN in knees with established OA. Doxycycline is not currently recommended for the treatment of OA. • Cathepsin K - Cathepsin K, a cysteine proteinase, appears to play a role in the pathogenesis of OA.57 In preclinical models, cathepsin K inhibition reduced evidence of cartilage degradation.58 It is, therefore, a prospective DMOAD. • Other collagenase inhibitors JOINT SURGERY The pertinent point that the paper also alludes to is that economic and patient factors also come into play here: at what point does surgery up to and including arthroscopy and arthroplasty become a viable option for the patient. There does seem to be a limited therapeutic avenue, notwithstanding the potential novel therapies described above, but patients in chronic pain require a realistic management plan. NICE addresses the referral for surgery and recommends this option when the patient has been offered the core non-surgical treatment options and there is prolonged and established functional limitation and severe pain. The decision should be based on referral thresholds on discussions between patient representatives, referring clinicians and surgeons, rather than using scoring tools for prioritisation. Referral for joint surgery should be considered for people with OA who experience joint symptoms (pain, stiffness, and reduced function) that have a substantial impact on their quality of life and are refractory to non-surgical treatment. Patient factors such as age, sex, smoking or obesity should not impinge on the patient’s right or referral surgery. The following should be considered – • The benefits and risks of surgery and the potential risks of not having surgery • Recovery and rehabilitation issues • The psychological or other effects of having a prosthesis. • Social and care circumstances of patient FOLLOW-UP AND REVIEW Regular reviews should be offered to all patients with symptomatic OA at 6 or 12-month intervals and the reviews should include – • The monitoring of the patient’s symptoms and the real-life impact of the condition on their activities and quality of life; • The monitoring of the long-term course of the condition; • The discussion of the patient’s perception and ownership of their condition. Their personal preferences and ability to access services should be examined;
• The reviewing of their treatment • A forensic scrutiny of their self-management OA AND THE ELDERLY The second cohort described by NICE in its guidelines pertains to ‘very old people’ whom it describes as those above 80 years. While the text highlights the limited data on OA in this cohort, it does highlight its increasing relevance. The population is aging and there is a high incidence of comorbidities in this cohort which in turn may influence or hinder the treatment options. These options should include if not focus on implementing exercise strategies with a reduction in pharmacological therapy where possible. Renal failure, cardiovascular and GI intolerance may limit NSAID usage. Outcome and intervention studies are required for the elderly in whom joint replacement surgery is not an option because of these comorbidities and their inherent risks. TREATING COMMON PRESENTATIONS OF OA ‘FOR WHICH THERE IS LITTLE EVIDENCE’ NICE makes a further distinction for those people who have more than one painful joint – it is common for OA to affect both knees; or one knee and one or more smaller joints such as the base of the thumb or the big toe. The mechanisms that cause pain may differ in people with one affected joint compared to those who have pain in several joints – this may be natural evolution of the condition as pain in one site may lead to increased mechanical stress and over-reliance in the corresponding joint, especially the knee. Almost all trials of treatments for OA focus on a single joint and if a participant has bilateral symptoms or additional symptoms at a different joint site only one ‘index’ joint (the most painful) is assessed. Whether systemic treatments for OA are less effective if a person has more than one painful site, and whether local treatment of one joint (e.g. injection of corticosteroid into the knee) will in turn benefit other sites remains to be seen. NICE recommends that further research be undertaken on OA treatment for sites other than knee or hip such as the first metatarsophalangeal (bunion) joint, mid-foot joints, the ankle or the shoulder. CONCLUSION OA refers to a clinical syndrome of joint pain accompanied by varying degrees of functional limitation and reduced quality of life. It is the most common form of arthritis and one of the leading cause of disability worldwide with the knee, hip, and small hand joints being affected most frequently. While OA is linked to ageing, it is not necessarily caused by this process and the condition does not necessarily deteriorate. There are a number of management and treatment options both pharmacological and non-pharmacological which should be tailored to the individual patient up to and including joint surgery. Further studies are needed on OA in patients with multiple joint involvement as this may alter the effectiveness of interventions. REFERENCES ON REQUEST
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Feature Nasal Drops/Sprays - how they can help ease babies and young children’s congested noses Nasal congestion is the most common symptom of the cold, nasal pollen allergy, or even a change in the weather. No matter how old a child is, breathing difficulties are cause for concern. However, nasal congestion isn’t a cause for concern and is quite common among all age groups. A basic saline spray for children is all that’s needed to treat a stuffy nose. Over-the-counter saline sprays and rinses can help remove pollen from the nasal lining. These sprays can also be used to add moisture if the child’s nose feels dry from winter weather. The symptoms often associated with nasal congestion include: • a blocked and stuffy nose • a runny nose or mucus running down the back of the throat • an irritating, persistent cough caused by excess mucus at the back of the throat • headache • facial pain caused by a blocked nose and blocked sinuses • a loss of smell and taste • temporary partial hearing loss and a crackling sensation in the middle ear • tiredness Studies show that a saline solution restores moisture to dry nasal passages and sinuses, and curbs inflammation of mucous membranes. Whilst it’s possible to make a saline solution at home, it is advisable to recommend an OTC nasal spray to avoid any other infections. An OTC nasal spray is typically made using a salt water solution, and it loosens excess mucus in the nasal passage and moisturizes, making breathing less difficult. Solutions or nasal sprays for children can be easily administered once in four to five hours as and when needed. Most children, irrespective of their age, will not enjoy a spray being squirted into their noses. This is because the nasal passage is connected to the throat and when you use a spray it tends to trickle down to the back of the throat and leaves an
unpleasant taste. Recommend these simple tips to administer the spray to an older child: • Hold the child in a sitting position and support his head using one hand. Use the other hand to squirt the drops into one of the two nostrils. Guide the child to lift or tilt his head backward so that the drops go in. • Allow the spray to work by moistening the entire nasal passage. This can take a few minutes. Once the mucus loosens, help the child to blow their nose. Most over-the-counter saline nasal sprays are isotonic, which means the solution is the same saline concentration as in the body. Hypertonic versions have a higher concentration of salt. Both types are effective for clearing mucus. Saline sprays also help keep the cilia in the nose healthy. Cilia are small hair-like structures that help humidify air to the lungs, trap bacteria to keep them from entering the cells, and aid
sense of smell. By keeping cilia healthy, saline sprays may help treat rhinitis and sinusitis, studies show. Further advice Most doctors suggest the use of a vaporizer or an effective humidifier in the room during bedtime, which naturally increases the amount of moisture in the air. The humidity will help loosen the mucus and clear the nasal passages. Breathing in steam moisturizes the nasal passage and loosens the mucus. Using a humidifier or cold mist vaporizer in the child’s room can help relieve his congestion in a couple of days. Alternatively, parents can steam up the bathroom and let the child sit inside for a few minutes. If the child is four years or above, eucalyptus oil can be helpful, it will produce a cooling sensation and decongest the child’s chest and nose. Just dab on the child’s nose will open up the breathing passage. Consuming warm fluids also help
in decongesting the chest. Make the child some chicken broth or soup. Warm liquids can do wonders in treating a congestion naturally. It also will drive away other symptoms like tiredness and fever. Most paediatricians do not routinely recommend decongestant nasal sprays for younger children. The solution may offer only temporary respite and with prolonged use, the child will suffer from a “rebound” effect whereby the blood vessels will swell up, and the whole area will get blocked, leaving the child more congested and restless. While doctors and researchers are still at loggerheads over the safety of using these drugs for younger children, it is better to be safe than sorry. In short, do not overuse a nasal spray, especially if the child is between 4 and 6. However, it is still suggested that we should limit the use of medicated nasal sprays. Instead, opt for safer and more natural remedies that don’t just alleviate the symptoms, but also relieve discomfort without any side effects.
Awards The Irish Pharmacy
Irish Pharmacy Awards 2018 The seventh annual Irish Pharmacy Awards took place in Dublin last month. The event showcased the extraordinary talent and hard work community pharmacists are undertaking throughout the country with an evening of celebration at the Clayton Hotel, Dublin. The Irish Pharmacy Awards champion excellence in all aspects of the community pharmacy sector and have proven to be an industry highlight, with more than 600 attending the glittering awards ceremony.
With over 1,800 community pharmacies across Ireland, these prestigious awards are certainly an acclaim to be proud of. Finalists were selected from over 100 nominations representing Irelandâ€™s leading multiple and independent community pharmacies, alongside the chief buying and symbol groups, and their individuals and teams nationwide. All of these submissions are testament to the huge efforts community pharmacies and their teams are making to improve patient care. The entries were made towards a total of 17 award categories, reflecting all areas of community pharmacy from business development to innovation, and from self care
to superintendent pharmacist of the year. These awards strengthen the relationship between pharmacists and patients to provide the care and expert advice they deserve. By going above and beyond, pharmacists can help people live well, stay well and get well. Irish Pharmacy Awards winners reflect the industryâ€™s determination to revitalise and enhance their status within the wider healthcare arena. Through the submissions to these awards and the examples of innovation that they demonstrate, pharmacists and their teams can benchmark their business and health and wellbeing practices against their colleagues and the profession in which they operate. Whilst the judging process was extremely difficult, with some strong entries failing to make it to the shortlist, it is important to highlight that it is not just about winners. Everyone who entered this yearâ€™s awards deserves commendation.
Awards The Irish Pharmacy
Clinigen Group Community Pharmacist of the Year 2018
Winner: Mike Walsh, Walsh’s Pharmacy, Fermoy, Co Cork
Jennifer Zamparelli, Mike Walsh of Walsh’s Pharmacy and Anna Ryan, Country Manager, Clinigen Group
“This means everything to me and it means everything for my town as well,” said Mike Walsh after accepting the Clinigen Group Community Pharmacist of the Year Award. “I’d just like to thank my staff; they’re key, they’re the first port of call.”
of clinical and nonclinical competencies and skills, this year’s winner has shown a dedication to his work that has resulted in meaningful improvements in patient care, delivery and services.
This annual award honours community pharmacists who go the extra mile to help the community they serve. Drawing on his wide range
The judges were looking for evidence of high standards and dedication to community pharmacy. They found it in Mike Walsh.
Walsh was honoured for his commitment, not just to his patients, but to his local community. The Fermoy pharmacist has pioneered numerous local initiatives, ranging from mother-andbaby first aid sessions to defibrillator training for GAA club officials to public health talks. Passionate about local causes, Mike advocates for and sponsors 40 initiatives a year.
Anna Ryan, country manager at Clinigen Group, said the company was delighted to sponsor this award. “The work of the community pharmacist has grown so much over the last few years and it’s lovely to see a business from outside of Dublin being recognised for their work,” she told Irish Pharmacy News. “Congratulations to Mike and his team.”
Awards The Irish Pharmacy
The Pharmaton People’s Pharmacist of the Year Award 2018
Winner: Joel Duffy, Markievicz Pharmacy, Sligo Joel Duffy has been chosen as the Pharmaton People's Pharmacist of the Year 2018. The Sligo pharmacist, who was nominated by his local community for his unmatched service and dedication, said he was thrilled to receive the recognition. “We don’t do this job to get awards, but it’s nice all the same to be recognised,” he said. “This award means a lot to me - but it’s all the more special because it was voted for by the public. "It means that wee bit more to me that it came from customers.” One customer who recently recounted their experience with Duffy described how he went above and beyond his call of duty to support her family after her daughter’s cancer diagnosis. Anne Marie Frizzell, whose nine-year-old daughter, Erica, was diagnosed with Burkitt Lymphoma, said Duffy was fantastic. “He explained everything, I could ring him to order things in and it was never a problem,” she said. “He linked with my GP and they got everything in order and sorted out all of the paperwork. It took so much pressure off me and I never felt that nothing was too much for him. He would even ring up when Erica was coming to the end of certain drugs in case I needed to reorder them. The whole team were great, even when Erica came in she was
Jennifer Zamparelli, Joel Duffy of Markievicz Pharmacy and Tanya O’Toole, Consumer Healthcare Manager, Sanofi
welcomed, not patronised. They even got her a little present at Christmas." Award sponsor Tanya O'Toole, Sanofi’s consumer healthcare manager, said this award was close to the company's heart. “For Sanofi this is a really, really special award,” she said.
“This award is the one that lets us understand how important pharmacy is to all of the general public in Ireland. I think it really goes to show that the pharmacist is truly in the heart of the community, and people really are very happy to support their pharmacist and want them to be recognised.
The other finalists in this highly contested category, who were voted for by the public, were Tom Treacy (Treacy’s Pharmacy), Sally El-Banna (Lily’s Pharmacy), and Justin O’Connell (O’Connell’s Pharmacy).
Awards The Irish Pharmacy
McLernon Computers Innovation & Service Development (Independent) Award 2017
Winner: Joanne Sheridan, Staunton’s Link Pharmacy, Co Mayo allowing me to do these events in store.” Award sponsor McLernons Pharmacy Software has long been associated with this particular award. Sales director Robin Hanna told Irish Pharmacy News, Sheridan was a deserving winner. “We think this award is really key because pharmacy is going through such a challenging time,” he said. “It’s a fantastic opportunity to recognise those pharmacists that are taking that extra step just to try to make a difference in the community and in their own pharmacy business.” Sheridan, who believes Irish pharmacies should become more active in health promotion, told Irish Pharmacy News she planned to do events on men’s health, dementia and blindness.
Jennifer Zamparelli, Joanne Sheridan of Staunton’s Link Pharmacy and Robin Hanna, Sales Director, McLernons Pharmacy Software
This award celebrates innovation. Awarded to an individual or teams who have created a breakthrough opportunity for business growth and whose ideas or inventions have improved patient experiences. The judges in this category were looking for examples of pioneering new models or systems that improve pharmacists impact as members of the healthcare team.
Central to this award, is showing a measurable patient benefit to the initiative, which can serve as a template for other pharmacy professionals to follow. Sheridan, of Staunton’s Link Pharmacy in Mayo, was recognised for hosting regular in-store health promotion events, including a three-day Diabetes information and awareness campaign. She also organised for the
pharmacy to partner with the Irish Osteoporosis Society to host an information session about the bone disease, as well as running separate weight management, heart health, cancer and autism information sessions. “I am thrilled!” exclaimed Joanne Sheridan, after accepting the innovation and service development award last month. “I’m delighted that I’ve won, and I want to thank the Staunton’s family for
“I am very passionate about health promotion and I feel that the pharmacy setting is the ideal place to promote healthy living and healthy lifestyles, and educate the public on chronic illnesses,” she said. “I’ve learnt this from my own experience when my daughter was diagnosed with diabetes a few years ago. I realised there was a lot that I didn’t know, and I thought, if I’m a pharmacist and I don’t know then what does the ordinary mum or dad who doesn’t have a scientific background do when they’re faced with something like this?”
Awards The Irish Pharmacy
The Nurofen for Children Baby Health Pharmacy of the Year Award 2018
Winner: Sheena Mitchell, Milltown Totalhealth Pharmacy market, with creativity, flair and evidenced-based research. The award sponsor Will O’Brien, country manager at RB Ireland, congratulated Mitchell on her success. “In our business, we’re very passionate about thinking beyond just medicine and more about our consumers and children themselves,” he said. “With this award, we really bring to life and connect what the pharmacies do on behalf of delivering that message, and Mitchell has done fantastic work delivering a lot of content to parents out there.” The recently relaunched WonderBaba website has become a complete parenting healthcare destination, offering more than 150 helpful articles and a confidential online advice service. Mitchell, a pharmacist, says she will continue to combat misleading and incorrect parenting advice online through her fresh, interactive, evidenced-based website.
Sheena Mitchell of Milltown Totalhealth Pharmacy and Will O’Brien, Country Manager, RB Ireland
For the third year in a row, Sheena Mitchell, of Milltown Totalhealth Pharmacy in Dublin, has taken this prestigious award. Recognised for her innovative work online, Sheena provides tips, advice and support to parents in Ireland and abroad via her popular blog, Wonderbaba.ie.
“It means more than anything to win this award tonight,” she told Irish Pharmacy News. “I am completely overwhelmed.” Mitchell said while she was delighted to receive recognition for her work, she couldn’t have done it without her team. “Obviously, I do a lot
of work online giving one-toone advice, but that follows through with every single team member who make sure we provide a really strong parenting resource.”
Mitchell used her WonderBaba Facebook page to announce the win to her more than 13,000 social media followers: “Thank you so much everyone for your support of the WonderBaba page,” she wrote. “I am more motivated and encouraged [more] than ever to continue to write accessible healthcare information and support for Irish parents!”
The judges believe Mitchell continues to lead the way in the children and baby
Awards The Irish Pharmacy
KRKA Counter Assistant of the Year Award 2018
Winner: Phil Cahill, Adrian Dunne, Trim - The Counter Assistant of the Year Award 2018 goes to Adrian Dunne’s long-time employee Phil Cahill.
Jennifer Zamparelli with winner of the KRKA Counter Assistant of the Year 2018 Award, Phil Cahill, Adrian Dunne, Trim, with sponsor Daniel Byers, KRKA
“This award is everything to me, but it really is all about team Trim,” Phil Cahill told Irish Pharmacy News. “This is deserved by all the girls I work with and all of the people in Trim. It’s so easy to be positive on the counter in Trim because the team behind me are fabulous. We work together, we play together, and we have such good fun.” Informed, alert and impassioned floor-teams are paramount to the successful running of a pharmacy and
counter assistants are very often the first line support that a patient receives. The judges of this award recognised Cahill’s outstanding work ethic, her willingness to go above and beyond her job description, and her genuine desire to make a real difference to her community. Cahill has been in the pharmacy business for more than three decades and her knowledge of the industry is unmatched. Adrian Dunnne
customers adore Cahill - with many popping into the shop just to see her. As for new customers, Cahill always takes the time to make them feel welcome, introducing them to the pharmacist and explaining the borad range of services on offer at the pharmacy. Cahill has a reputation for going the extra mile and is known for taking the time to deliver prescriptions outside of her working hours. This year, the judges felt that Cahill
embodied all the qualities of a great counter assistant. Speaking at the ceremony, award sponsor KRKA said it was delighted Cahill had been recognised for her hard work. “We’ve been sponsoring this award for three years now,” KRKA general manager Daniel Byers said. “Counter assistants tend to be a real focal point, a touch point in pharmacies for customers, and we like to recognise that. A huge congratulations to Cahill as this award is very much deserved.”
Awards The Irish Pharmacy
MRII Pharmacy Representative of the Year Award 2018
Winner: Amanda Quinn MRII, Perrigo
Jennifer Zamparelli, Amanda Quinn, Pharmacy Business Development Manager, Perrigo and Anthony Carroll, MRII President
The finalists for this unique award category were nominated by their community pharmacy customers. As representatives of pharmaceutical and healthcare suppliers across Ireland, the judges were looking for someone who stood out for their work ethic and integrity. Specifically, they were searching for a sales representative who excelled in customer service and showed unrivalled product knowledge.
After an extensive judging process, Amanda Quinn from Perrigo was selected as the winner for consistently achieving excellent results and building strong and lasting relationships with her customers. In Quinn, the judges noted a commitment to excellence, a strong sales record, and a desire to always exceed client expectations. Quinn said “I can’t believe I’ve
won the award and I feel very privileged. Without my team and my valued customers I would never be here. It’s absolutely amazing.” Award sponsor, MRII president Anthony Carroll, said: “We are delighted to support this award. We want to make sure that people who are dealing with customers give 100% all of the time, and Quinn is clearly one of those individuals who gives so much.”
Quinn, a Pharmacy Business Development Manager with Perrigo, joined the industry in 2015 and provides innovative products and educational support to community pharmacies and their patients. “My business ethos is to be as accommodating and supportive as possible to my customers and to deliver a superior quality service,” she said.
Awards The Irish Pharmacy
The GSK Self Care Award 2018
Winner: LloydsPharmacy, Castletroy, Co Limerick
Jennifer Zamparelli, Rebecca Barry, supervising pharmacist and Maria McBreart, pharmacy manager and Bryan Dunne, GSK customer business manager
This award celebrates those who have identified and addressed a need within their community and have created promotions, campaigns or initiatives in response. The judges were looking for evidence of long-term, consistent dedication and outstanding achievements that have led to the advancement of the profession of pharmacy and self-care. Strong character, cumulative professional accomplishments and the ability to properly
represent and model what pharmacy as a profession encompasses.
checks, which revealed 17% of participants suffered from hypertension.
great strides in implementing health promotion across the group.
With increased GP waiting times, the Lloyds team knew many of their customers were not getting their blood pressure checked on a regular basis. The company decided to do something about it.
Accepting the GSK Self-Care Award on behalf of LloydsPharmacy was supervising pharmacist, Rebecca Barry, and manager, Maria McBrearty.
GlaxoSmithKline, which sponsored the award, congratulated LloydsPharmacy on its achievement.
The team ran a public awareness campaign about hypertension in a bid to inform their customers about the benefits of heart health, including free blood pressure
“We didn't expect to win it but it’s absolutely lovely,” said McBrearty. “This is for the team back in the shop,” Barry added. LloydsPharmacy have made
“Selfcare is so important to the pharmacy industry,” GSK customer business manager Bryan Dunne said. “It empowers people to make the right choice, based on the best information. That’s why we were really keen to sponsor this particular award.”
Awards The Irish Pharmacy
FLEXISEQ Innovation & Service Development (Chain) of the Year Award 2018
Winner: Hickey’s Pharmacy they're responding to new or adjusted medicines. The simple, yet highly effective initiative, has improved outcomes for patients, who are better informed and feel more supported by their local pharmacist. Superintendent pharmacist Tom Concannon was thrilled with the win. “This is really good recognition for all the work we do so thank you to everyone involved,” he said. “Thanks to management, who support us and allow us to do all this innovation, and then I’ve got to love all the pharmacists who do so much hard work.” Award sponsor, Flexiseq, said Hickey’s had proven itself as a customer-focused organisation. “This award is really about pharmacy development, and Hickey’s has demonstrated that they are committed to moving the business forward with their customers at the centre of everything they do,” Flexiseq’s Deidre Holden said. “This award is well-deserved and recognises their fantastic achievements.”
Jennifer Zamparelli, Rebecca Maxwell, support pharmacist Amy Flynn, supervising pharmacist, Tom Concannon, superintendent pharmacist, Hickey’s Pharmacy with Deirdre Holden, Sales & Marketing Manager, Pro Bono Bio
Hickey’s Pharmacy has been named the winner of the Innovation and Service Development (Multiple) of the Year Award 2018. This competitive category saw nominees from across the country who are transforming the pharmacy business and paving the way for the future of our industry.
This award celebrates innovation that improves the patient experience. The judges were looking for examples of enthusiasm and commitment that led to the development of a new system which improved pharmacists’ impact in the healthcare system. Hickey’s was recognised for a programme aimed at building
trust between pharmacists and their patients. In a bid to combat the increasingly transactional relationship of dispensing medicine, Hickey’s launched StartRight, a customer care initiative that sees pharmacists make follow-up calls to patients one week after consultations to assess how
With research showing many patients do not take new medicines as prescribed, it makes perfect sense for pharmacists to step up and assist with medication management. Over the next 12 months, this service will result in an additional 10,000 patientpharmacist interactions.
Awards The Irish Pharmacy
The United Drug Business Development of the Year Award 2018
Winner: Kieran’s Avenue Pharmacy, Dundalk Crucially, Kieran’s looked to their internal systems as well as the external ones. They ensured that online orders were dealt with swiftly, accurately and even personally – all orders were accompanied by a note from the pharmacist. Although Kieran’s is a singlestore pharmacy, their website has increased customer loyalty and local employment. The ability to create and innovate were the key markers that judges of the Business Development Award were looking for. And they found it in Kieran’s Avenue. Owner Amy Kieran was delighted with the recognition. “We’re absolutely thrilled to be here tonight and to win the business development award,” she said at the awards ceremony. “We’ve only been in business three and a half years so it’s a real boost and great recognition of all our work.” Patrick Watt, the director of sales and marketing at McKesson Ireland, spoke about the spirit of camaraderie in Irish pharmacy and said he was thrilled to present the award to Kieran’s Avenue Pharmacy.
Presenter Jennifer Zamparelli, Amy Kieran of Kieran’s Avenue Pharmacy and Patrick Watt, Director of Sales & Marketing, McKesson Ireland
This award recognises excellence and innovation in sales, training, recruitment, customer service and product development, all underpinned by a proven ability to monitor performance. Judges were searching for a project that filled a gap in the community,
and evidence that its implementation helped to drive the business forward.
develop a website that would bring the wider community into contact with the business.
Established in 2014, Kieran’s Avenue Pharmacy quickly identified the need to reach out to a wider customer base beyond the immediate community. Kieran’s began to
Their pharmacists underwent specific marketing and online training and the company built a site that retained the feel of a local pharmacy, while also growing its online following.
“This is a great example of innovation and a great example of customer centricity,” he said. “The business results are there to be seen, not just in a commercial sense but also in terms of the impact it has had on customers and patients. Fantastic innovation.”
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Awards The Irish Pharmacy
The Clonmel Healthcare Business Development of the Year Award 2018
Winner: CarePlus Pharmacy Group
Presenter Jennifer Zamparelli, Lee-Ann McCarthy, head of Marketing and Breege McTigue, head of customer engagement, CarePlus Pharmacy with Barry Fitzpatrick, Director of Sales, Clonmel Healthcare
CarePlus Pharmacy has positioned itself as a destination for parents. With an extensive baby range across the national group, the company enlisted experts to complement its offering and upskill front-of-store staff. CarePlus now operates an empowering Mum and Baby training programme, which is spread over three modules and delivered in partnership with resident sleep expert Lucy Wolfe, midwife Dorothy Buck, and the Irish Red Cross, who
deliver paediatric first aid training. The programme is designed to provide dozens of specialist Mum and Baby staff with the tools and product information to deliver expert advice and customer care to expecting and new mums. So far, it has been a major success in store and on social media. CarePlus ticked all the boxes for the judges of this award, who were looking for evidence of a pharmacy chain that displayed success in
product development. This is a business initiative that stands out in its scale, scope and approach.
to our commercial team, to our operations team on the road. I’m delighted for everybody.”
On the night of the awards, head of customer engagement, Breege McTigue, accepted the award on behalf of the CarePlus Pharmacy Group.
Clonmel Healthcare Director of Sales, Barry Fitzpatrick, who presented the award to McTigue, said it was important to champion development and innovation in the industry.
“It’s absolutely fantastic for the team to win the award,” she said. “We’ve put a lot of hard work into our baby category and working with experts in the field. It’s been a huge team effort from customer service,
“We feel it’s always good to sponsor and work with and help new developments,” he said. “It’s all about innovation, and that has clearly been demonstrated by the winners here tonight.”
Awards The Irish Pharmacy
The IPN Community Pharmacy Technician of the Year Award 2018 THE INDEPENDENT VOICE OF PHARMACY
Winner: Lynsey Rigney, The Village Pharmacy
Presenter Jennifer Zamparelli, Lynsey Rigney, pharmacy technician, The Village Pharmacy and Nicola McGarvey, Commercial Manager, IPN
The ever-growing demands on the modern-day pharmacy mean the supporting role of the community pharmacy technician has become so important. The judges in this category were searching for a person who demonstrated a consistent, long-term dedication to pharmacy, and a record of outstanding achievements. Strong character, inspirational leadership, and a champion for pharmacy technicians was found in Lynsey Rigney.
Having started as a Saturday OTC assistant, Lynsey completed her degree with DIT, then continued to gain her pharmacy technician qualification, all while remaining part of the team.
has taken advantage of every training opportunity to extend her knowledge and has brought about real change in store with initiatives such as hypertension awareness evenings.
News. Nicola McGarvey, IPN’s Commercia Manager, said the company was delighted to support the award, which acknowledges the vital importance of pharmacy technicians.
Rigney now takes care of the marketing and social media for the pharmacy and has developed her own specialist area in nutrition and exercise, which she uses to educate and influence not just patients, but her co-workers, too.
Reflecting on her success Rigney said: “It’s a real honour that my boss would nominate me. This means everything to me.”
“Technicians are heralded as the backbone of the dispensary, and Lynsey is certainly the backbone of the Village pharmacy,” said Nicola. “She’s someone who has wholeheartedly embraced the ethos of community pharmacy.”
Dedicated to her job, Rigney
This year the Community Pharmacy Technician Award was a special category, sponsored by Irish Pharmacy
Awards The Irish Pharmacy
Cellnutrition Community Pharmacy Team of the Year Award 2018
Winner: McCartans Allcare Pharmacy, Donaghmede, Co Dublin
The McCartans Pharmacy team with Lorna Howard, National Sales Manager, Cellnutrition (far right)
Dublin’s McCartans Allcare Pharmacy has been named the winner of the Cellnutrition Community Pharmacy Team of the Year Award 2018. This highly competitive category - which received more nominations than any other - celebrates every member of the pharmacy team. From the superintendent pharmacist to the counter staff, McCartans has proven itself as a leader in the field. The key to a successful pharmacy is teamwork. This award recognises the power and potential of a focused and
unified approach to health care initiatives. The judges said McCartans displayed the best combination of team spirit and enhancement of patient care at all levels. The Donaghmede pharmacy has demonstrated excellence in its commitment to innovation, staff development and continual learning. “It’s absolutely amazing to receive this award! Pharmacist manager Kerrie Finnan told Irish Pharmacy News. “I just want to say a massive thank you to all the staff who I work
with because obviously this would not be possible without them. “They are brilliant and they’re the backbone of Donaghmede. Each and every one brings their own individual little spark. They really are the reason why we’ve won this award - they’re just brilliant!” The McCartans team, who provide a one-stop shop in a busy retail area, last year ran several outreach events, including charity fundraisers, a COPD clinic and a breast cancer awareness day.
With a loyal patient base, the pharmacy prides itself on providing a top quality clinical service, regular medication reviews, and unmatched communication - with a smile. The positive team culture at Donaghmede is contagious. Award sponsor, Cellnutrition, congratulated the McCartans team on their win. “These are really prestigious awards and everyone who was nominated was deserving,” said Lorna Howard, Cellnutrition’s national sales manager. “A special congratulations to McCartans!”
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Awards The Irish Pharmacy
The JPA Brenson Lawlor Young Community Pharmacist of the Year Award 2018
Winner: Grace Grimes, Meaghers Pharmacy, Glenview, Dublin she would be retained as a pharmacist – she was the obvious choice. Since then, Grimes has proven herself as a highly-skilled team member, capable of juggling the dayto-day demands of a busy pharmacy with individual patient care. Her innovation has led to several cost and time-saving measures ranging from everything from blister-pack preparation to diabetes management. She constantly searches for new ways to continue her education and has already started management training. In less than two years, Grimes has demonstrated a real flair for the business and is clearly committed to a long career in community pharmacy. IPN caught up with Grimes after she accepted her award. “This is a huge honour,” she said. “I suppose it’s a reflection of everything I try to do in pharmacy, which is to help people, that’s why I started. So it’s really great to be recognised in this way.”
Presenter Jennifer Zamparelli, Grace Grimes, Meaghers Pharmacy and Jason Bradshaw, partner at JPA Brenson Lawlor
Being patient-focused comes easy to Grace Grimes, the winner of this year’s prestigious Young Community Pharmacist award. Grimes is a natural with customers and easily adapts her communication style to fit any situation. She approaches her job with an air of calmness and there can be no doubt
that she thoroughly enjoys her work, always going out of her way to support patients.
the challenge while putting their patients at the heart of everything they do.
Today, young pharmacists are operating in a challenging environment, with more clinical, commercial and regulatory demands placed on them. This award recognises young talent, a rising star in the field, who takes on
The judges singled Grimes out for her excellent communication and leadership skills, and dedication to pharmacy. When Grimes finished her intern year with Meaghers there was no question that
Jason Bradshaw, partner at JPA Brenson Lawlor congratulated Grimes on her win. “We sponsor this award because our main focus in the pharmacy sector is for firsttime buyers,” Bradshaw said. “We want to see pharmacists coming out of college, being able to buy their own pharmacy, so we’re very proud and honoured to be able to present this award.”
Awards The Irish Pharmacy
The IPN OTC Retailer of the Year 2018 THE INDEPENDENT VOICE OF PHARMACY
Winner: Life Pharmacy - OTC
Jennifer Zamparelli, Jane Brennan from Life Pharmacy and Natalie Maginnis, IPN Managing Director
This award recognises pharmacies that are leading the way in the thriving over-the-counter market by investing in specialty products and staff training, all geared towards a better customer experience. Market knowledge, strong displays and effective front of shop marketing strategies are key. The judges of this award were looking for evidence of key promotional activities and staff training that added value for the customer.
The winner, Life Pharmacy, has demonstrated an unrivalled commitment to freeing up pharmacists’ time so they can spend more time focusing on patient service. The company has run extensive staff training initiatives over the past year, equipping all employees with the skills and knowledge to confidently provide professional advice about OTC products. Life Pharmacy has also engaged with its communities to drive health services and, in doing so, has
Accepting the honour, Life Pharmacy’s Jane Brennan said the award was a testament to the company’s dedication to patients.
congratulated Life Pharmacy on its success delivering a best-in-class OTC service. IPN Managing Director, Natalie Maginnis, said the company had implemented a range of great initiatives that all revolved around improving patient care.
“I’m delighted to accept this award on behalf of Life Pharmacy,” Brennan told Irish Pharmacy News. “We worked so hard at building the OTC business and looking after all of our customers.”
“A commitment to providing accurate information and a dedication to fantastic patient support is at the heart of pharmacy, and Life Pharmacy has proven itself as a leader in the industry,” she said.
become a destination for OTC expertise.
Irish Pharmacy News, which sponsored the coveted award,
Awards The Irish Pharmacy
Teva Superintendent Pharmacist of the Year Award 2018
Winner: Jack McPolin, Smith’s Pharmacy Group
Jack McPolin (centre), Paul Neill, Business Unit Manager, Teva (far right) and the Smith's Pharmacy team
Jack McPolin has won the Teva Superintendent Pharmacist of the Year Award 2018. As Superintendent Pharmacist of the rapidly expanding Smith’s Pharmacy Group, McPolin has been the key driver in the business, adapting to embrace the evolving role of community pharmacy.
Superintendent pharmacists have an enormously demanding role, carrying full time responsibility and accountability for their pharmacies whilst being continuously at the forefront of innovation and progression in Irish pharmacy.
Described as driven, innovative, and a natural leader, McPolin has a reputation for going above and beyond for his patients. He epitomises the temperament and values of an effective and forward-thinking superintendent pharmacist.
In McPolin, the judges found a thorough understanding of patient needs, evidence of best practice in delivering professional services, strong leadership skills, the desire to drive the business forward, and a commitment to encouraging staff education.
Speaking at the awards ceremony, McPolin said he was delighted with the win but shared the honour with his dedicated staff. “It’s an honour to win and it’s down to the pharmacy team,” he said. “I couldn’t have done it on my own. I have a wonderful team behind me. We look forward to growing the Smith’s pharmacy business through acquisitions and organic growth in the next 12 months.” McPolin extended his congratulations to all the other finalists in his category, Joanne Kissane (Lloyds Pharmacy),
Dan Burns (Allcare), and Tom Concannon (Hickey’s Pharmacy). Award sponsor, Teva Pharmaceuticals Ireland, said superintendent pharmacists were central to the success of the pharmacy business. “Superintendent pharmacist is a hugely important award,” said Teva Business Unit Manager, Paul Neill. “The role superintendent pharmacists play within pharmacy in shaping and developing the careers of pharmacists that work with them is vitally important.”
Awards The Irish Pharmacy
The Uniphar Fixxa Category Development of the Year Award 2018
Winner: CarePlus Pharmacy
Presenter Jennifer Zamparelli, Jane Bruton, supervising pharmacist and Martina Vengrinova of CarePlus with Sarah Sambrooks, Head of Consumer, Uniphar Group
This award aims to recognise the specialist knowledge and expertise of pharmacies in areas such as first aid, derma skincare or vitamins, minerals and supplements. Judges of this category were looking for an identified need within the pharmacy, followed by details of the project implementation process from conception to resolution. CarePlus was announced as the winner of this year’s Uniphar Fixxa Category
Development Award for its visual merchandising and staff training remedies initiative, which have added value profits, increased productivity and improved customer satisfaction across the group. Collecting the award, Martina Vengrinova, thanked her staff, customers, and suppliers. “We are really delighted to work with you and hopefully our collaboration will improve even more,” she said.
CarePlus was recognised for running staff training workshops, installing OTC Hotspot hubs in-store, and nominating a ‘category champion’ in each pharmacy to oversee the range. The pharmacy was clearly able to demonstrate the benefits of this particular project. Sarah Sambrooks, Head of Consumer for the Uniphar Group said: “Community pharmacists in
Ireland have excellent, well-trained staff. They advise their customers on a daily basis. They provide excellent services like testing and first aid and we want to help them grow those services, grow their sales and provide top quality products. That’s why it’s so important for us to sponsor an award like this.”
Awards The Irish Pharmacy
The Life Pharmacy Student of the Year Award 2018
Winner: Meabh Ryan, School of Pharmacy and Pharmaceutical Sciences, TCD
Presenter Jennifer Zamparelli, Meabh Ryan, TCD pharmacy student and Gerard Coffey, chairman of Life Pharmacy
This award represents the future of the community pharmacy profession in Ireland. The deserving winner was Meabh Ryan, a final year pharmacy student at Trinity College, Dublin.
lot of the work I’ve put in over the last four years has paid off, which really means a lot to me. I would like to say a big congratulations to the other two finalists as well, to Bridget and Faiza.”
“I’m delighted and a bit shocked, to be honest!” said Ryan, after receiving the award. “I’m over the moon! Two years ago I was actually working at this event so it’s a bit different to be holding the award in my hand.
The chairman of Life Pharmacy, Gerard Coffey, said he was delighted to present Ryan with the award. “Students are the future,” he told Irish Pharmacy News. “In Life Pharmacy we see independent pharmacy as the future and we want to support
“This award shows me that a
students at that juncture of their education so that they do realise there is a future for them in pharmacy. “Sponsoring a student award is essential as far as we are concerned.” Ryan has worked in a wide variety of pharmaceutical care settings over the past three years, always seeking to develop her clinical knowledge and learn more about the relationship between pharmacists and patients.
Thanks to experiences at pharmacies in Stephen’s Green, Dundrum Town Centre, and Dun Laoghaire, Ryan has seen first-hand the trust patients put in their pharmacist and the important role pharmacy plays in community healthcare. In addition to attending faculty assemblies and being involved with the student union at TCD, Ryan has set up a dialogue where students are able to discuss their course work.
Feature Infant nutrition and best practice for the first year According to the World Health Organisation (WHO) adequate nutrition during infancy and childhood is essential for growth, health, and development.
Breastfeeding Up to six months of age, breastfeeding is the gold standard for babies, but it can continue beyond two years. Breast milk contains essential fats that are high in energy for growing infants. It also contains the best source of proteins and vitamins for infants. The WHO recommends exclusive breastfeeding for the first six month of an infant’s life. Breastfeeding is good for both mother and baby, helping to protect the infant from infections and disease. It’s a nutrition source that has been specifically designed for the baby and is available whenever needed. Breastfeeding lowers the risk of SIDS, obesity, cardiovascular disease, and childhood leukaemia. Breastfeeding mothers are reported to have lower instances of breast and ovarian cancer, cardiovascular disease, and osteoporosis. Geraldine Cahill, IBCLC, BA C Ed., BA Training, is an
International Board-Certified Lactation Consultant (IBCLC) with Breastfeeding Cork. She gave the following advice for pharmacists when counselling patients on breast feeding; “Pharmacists can be helpful to breastfeeding parents by having access to good resources on which drugs are OK to use whilst breastfeeding. Dr Hale in the US and Wendy Jones in the UK have been at the forefront of work in this area and they both have really good resources. Dr Hale has a book called Medications and Mothers Milk as well as an app for phones and computer – Infant Risk Centre. And Wendy Jones many resources are available through the Breastfeeding Network - http:// www.breastfeedingnetwork. org.uk/ which has a lot of factsheets available. Either will also answer individual queries on their websites. In Ireland the hospitals pharmacy sections will also answer queries for parents and www.breastfeeding.ie is a source of accurate information
on some of the problems that parents might present with such as mastitis or blocked ducts. In my experience the best way a pharmacist can assist in the community is to know the place to get good lactation help. www.alcireland.ie is a good website for information on local International Board-Certified Lactation Consultants and also having information on local meetings and the names of the local breastfeeding counsellors which are very useful for parents. If a pharmacist meets a parent with, for instance, low milk supply, they really should refer that parent to a specialist – an IBCLC so that they can be assisted in getting care that will provide them with a plan to help to solve their problems. These problems which could be stemming from physical problems with either mum or baby, for instance, tongue tie or insufficient Glandular tissue, and there is not just one way to fix the problem.
Another way that pharmacists can be helpful to breastfeeding is to encourage their pregnant clients to find breastfeeding classes so that they are prepared for changes that having a new baby will bring to them. Informing them at this stage of the resources available in their communities is probably the most helpful thing that a pharmacist can do as well as being the resource for having up to date information on medications that are suitable.” Formula Feeding Mothers can’t always breastfeed or sometimes can’t produce enough milk to satisfy all of a baby’s nutritional needs, so another source must be used. Infant formula is the only alternative to breastmilk, either in powder form or ready-mixed. Infant formula should be given up to one year, but follow-on milk is available for children from six months. A standard, whey-based formula will be suitable for most infants
Aptamil Pepti for the effective management of cows’ milk allergy
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Republic of Ireland: www.aptamilhcp.ie Northern Ireland: www.eln.nutricia.co.uk References: 1. Verwimp JJ et al. Eur J Clin Nutr. 1995;49 (Suppl1):S39-S48. 2. Giampietro PG et al. Pediatr Allergy Immunol. 2001;12:83-86. 3. Arslanoglu S et al. J Biol Regul Homeost Agents. 2012;26:49-59. 4. O’ Carroll, E, Redmond, M et al. (2018), A blinded palatability study comparing two extensively hydrolysed infant formula used for the dietary management of Cows’ Milk Allergy in Ireland. The Nutrition Society Advancing Nutritional Science Spring Conference OC18.
IMPORTANT NOTICE: Aptamil Pepti 1 & 2 are foods for special medical purposes for the dietary management of cows’ milk allergy. They should only be used under medical supervision, after full consideration of the feeding options available including breastfeeding. Aptamil Pepti 1 is suitable for use as the sole source of nutrition for infants from birth, and/or as part of a balanced diet from 6-12 months. Aptamil Pepti 2 is suitable for babies over 6 months as part of a mixed diet. 17-026 / March 2018
Feature who are not breastfed. Again here, formula should be used up to six months upon which complementary feeding should begin combined with formula. There are a number of different formulas available for various conditions. Some children may not be able to digest cow’s milk, others may suffer from low-birth weight or have been born premature. Cow’s Milk Allergy (CMA) The most common allergy, up to 7.5% infants will develop a cow’s milk allergy. As most infant formula use cow’s milk or cow’s milk protein, this allergy is common among formula-fed babies. Symptoms include: vomiting, diarrhoea, wheezing and respiratory difficulty, reflux and rashes or hives. Sometimes, if a mother has consumed dairy products, babies can have an allergic reaction to their breast milk, but this is rare. Exclusively breastfed infants have a much lower incidence of CMA. If CMA is suspected, the child’s doctor will advise a substitute, ranging from formulas containing proteins which have been broken down, to formulas that contain no cow's milk protein at all (amino acid-based formulas). Reflux As well as a symptom of an allergy, reflux is a normal occurrence in many babies. It is usually signalled by babies spitting up milk after feeds, difficulty feeding, hiccups, coughing or choking and excessive crying. Reflux is not normally cause for concern if a baby is putting on weight normally, but a healthcare professional should be contacted if the condition develops after six months of age or if the baby vomits blood, has a tender tummy, develops a fever or if the baby arches their back after feeding. As well as a CMA, reflux can be a sign of a blockage in the oesophagus or of gastro-oesophageal reflux disease. Reflux doesn’t usually require treatment but smaller and more frequent feeds, regular burping during feeding and thicker formulas might be recommended. If treatment is required then a doctor may prescribe alginates to form a protective barrier over stomach
contents, or proton pump inhibitors and H2-receptor antagonists to reduce the levels of acids in the stomach. The condition normally resolves itself by the time the infant reaches a year old. Vitamins Breast milk is considered low in vitamin D, and although formula milk and certain cereal-based commercially available baby foods are fortified with small amounts of vitamin D, many infants will continue to be at risk of suboptimal intakes. Infants are viewed as a particularly vulnerable group, and so, following the publication of ‘Recommendation for Vitamin D Supplementation of Infants in Ireland’ by the FSAI in 2007. It is now policy that all infants in Ireland receive 5mg of vitamin D as a vitamin D3 only supplement daily, throughout the first year of life. Suitable vitamin D3 only supplements are now available on the Irish market, thus allowing all infants to be supplemented with an adequate and safe dose of vitamin D. Vitamin A is another important vitamin for babies and young children because it strengthens their immune system, can help their vision in dim light, and maintains healthy skin whilst vitamin C is important for the infant’s general health and
immune system. It may also help their body to absorb iron. Beyond six months The WHO recommends that at six months safe, complementary feeding should begin and be combined with breastfeeding up to the age of two years. Studies have shown that in Ireland, 71% of babies are weaned too early. However, Dr Mary Flynn, chief specialist in Public Health Nutrition at the Food Safety Authority of Ireland (FSAI) advises that parents started to introduce solid food at around six months. “I would say hang on to as close as you can, making sure that the baby is still growing well, but don’t be driving yourself demented,” she said. If a child is showing all the signs of being ready for solid food, or if a healthcare professional advises it, then it’s important to follow that advice. Weaning must take place between the ages of 17 and 26 weeks. An infant’s digestive system is not developed enough to digest solid food before 17 weeks and after 26 weeks milk alone – neither breast nor formula – is not enough to meet a baby’s nutritional needs. The introduction of solid food to a baby’s diet is also an important developmental step.
According to the HSE, signs that an infant is ready to be weaned include: good head control, an interest in other people eating solid food, being able to sit up with support and more interest in milk feeds for a period longer than one week. When weaning starts, babies should be sat upright in a secure high chair or travel chair. Generally, weaning involves the spoon-feeding of mashed or pureed foods – initially with no lumps in the beginning but lumps and more solid foods can be introduced over time. Suggested foods included cereals such as baby rice or porridge; pureed vegetables, fruit and pulses and well-cooked chicken. These are available pre-made or many batch-prepare at home and freeze in portions. Baby should be introduced to one new food at a time with a couple of days in between introductions, in case of a reaction or intolerance to the new food. Solid food should always be given with a spoon, never with a bottle. Studies have shown that babies who are introduced to foods containing gluten after the age of 30 weeks have a greater chance of developing coeliac disease or type-1 diabetes in later life. Therefore, a nutritionally balanced diet should be observed.
of infants experience symptoms of regurgitation1
For bottle-fed infants with frequent regurgitation
a stepped-care approach...
the feeding history.
the feed volumes by trialling smaller, more frequent feeds (while maintaining an appropriate daily total).
a thickened formula.
Clinically proven to reduce infant regurgitation episodes by
Aptamil Anti-Reflux is a thickened formula for the dietary management of reflux and regurgitation in bottlefed babies
AVAILABLE IN RETAIL AND PHARMACY OUTLETS * European Society for Pediatric Gastroenterology, Hepatology, and Nutrition References: 1. Vandenplas Y et al., J Pediatr Gastroenterol Nutr 2015; 61(5): 531â€“537. 2. Wenzl TG et al. Pediatrics 2003;111:e355-9.
IMPORTANT NOTICE: Aptamil Anti Reflux is a food for special medical purposes for the dietary management of frequent reflux and regurgitation. It should only be used under medical supervision, after full consideration of the feeding options available including breastfeeding. Suitable for use as the sole source of nutrition for infants from birth and as part of a balanced diet from 6 months.
FOR HEALTHCARE PROFESSIONAL USE ONLY.
Ireland: www.aptamilhcp.ie Northern Ireland: www.eln.nutricia.co.uk 17-003/February 2018 Photography: All photos are posed by models
What are UTIs? Urinary tract infections are as common as they are uncomfortable, and they can strike any part of your urinary system. • Back pain • Abdominal pain Upper UTI symptoms include: • Fever • Nausea • Vomiting • Diarrhoea For any person experiencing these symptoms where any of the following apply, their GP should be consulted:
The urinary system is made up of four parts: • Kidneys which extract waste from the body and turn it into urine; • Ureters which are tubes that connect the kidneys to the bladder; • The bladder which stores urine;
There are generally two kinds of UTI;
It’s estimated that at least 50% of women will contract a UTI in their lifetime, with 20% experiencing recurring infections. Each reoccurrence of a UTI makes it more likely that another one will be contracted. One in three women will have had an infection by the time they reach 24.
A lower UTI involves the bladder and urethra, usually cystitis (bladder) and urethritis (urethra). These are the most common: An upper UTI involves the kidneys and ureters, these are potentially more serious as they can result kidney damage, but they are rarer than lower UTIs.
UTIs are significantly less common in men although the likelihood increases with age due to problems with the prostate. In men, UTIs can often be a symptom of a more serious underlying condition and consultation with a GP should be sought if a UTI is suspected.
How does it happen?
UTIs are caused when bacteria enter the body through the urethra. Men, women and children can all contract a urinary tract infection, but women are by far the most likely to.
Lower UTI symptoms can include:
• The urethra, the tube that passes urine from the bladder to the penis for men and the vulva for women.
One of the reasons that women contract more infections than men is that their urethras are
considerably shorter and located closer to the anus making it easier for bacteria to travel. In particular, intercourse is one of the ways this transfer occurs – so-called honeymoon cystitis is a common problem for newly sexually active women. Causes of recurrent UTI's also include Chlamydia, Mycoplasm and Kidney stones.
• Cloudy urine • Pain when passing urine • Constant need to urinate and the need to urinate more frequently • Blood in the urine
At the moment, like cranberry tablets, there isn’t much scientific evidence to support this, but these are both popular among those who suffer from regular UTIs. Preventative measures include going to the toilet as soon as you need to and immediately after sex. Good personal hygiene is recommended for all, and for women wiping from front to back to reduce the transfer of bacteria. Tight-fitting undergarments made of synthetic material are also to be avoided. Drinking plenty of water is also thought to flush out the urethra.
• They have diabetes, kidney disease or kidney stones
UTIs and the pharmacist
• They have a weakened immune system due to a pre-existing condition such as HIV or are undergoing treatment such as chemotherapy
Pharmacists are often the first point of enquiry for sufferers of UTIs and therefore should be familiar with the symptoms and be able to advise on over-thecounter preventative remedies and behaviours for UTIs.
• She is or could be pregnant • Persons who are over 65 • They have a catheter or other foreign body in the urethra. Testing UTI testing is done by a urine dip at the GP. Testing is recommended for pregnant women, all men, suspected cases of an upper urinary tract infection and for those with blood in their urine. Treatment and prevention Most UTIs lasting for longer than three days are treated with a short course of antibiotics. It is recommended that for the first presentation of an uncomplicated UTI, narrow-spectrum antibiotics that focus on the bladder such as fosfomycin, nitrofurantoin or trimethoprim. Over the counter remedies include taking concentrated cranberry tablets as they break down to increase the acidity of urine, flushing out the urethra and preventing bacteria growth. D-mannose, a natural sugar that comes in tablet or powder form is recommended by some sufferers as a good preventative measure. It’s thought that it keeps bacteria from sticking to the urethra lining and can’t therefore cause infection.
Urinary tract infections are usually treated with prescription antibiotics and therefore consultation with a doctor is always recommended. Persistent, untreated UTIs must always be referred to a GP as they can, in extreme cases, cause sepsis and kidney failure. When dispensing antibiotics pharmacists can also advise on the importance of finishing the course of treatment, even after symptoms disappear. Patients are likely to seek pharmacist advice regarding the symptoms, treatment, and prevention of UTIs. It is imperative that pharmacists educate patients on behaviours that may help minimize the risk of acquiring a UTI. Recommendations for various preventive agents may be provided, as well. Pharmacists should reinforce the value of each medication used in the treatment of UTIs. Patients who choose OTC medications for analgesic relief should be educated on their lack of antimicrobial activity. Patients receiving antibiotic therapy should receive regular counsel on the importance of completing the entire course of antibiotics, as well potential AEs associated with the medications.
Clonmel Healthcare Introduce A New, Natural Solution to Help Prevent Colds and Infections in Young Children A first for Clonmel Healthcare, Clear Little Noses and Clear Kids Noses is a new product range that helps prevent colds and infections in young children, by cleansing the nasal passage, keeping it free from mucus and limits the occurrence of allergens. The product range is 100% natural and preservative free for relief from stuffed up little noses. Clear Little Noses baby drops are suitable for infants aged over one month, whilst Clear Kids Noses is suitable for children aged over three years. The isotonic sea water nasal cleansing spray (and drops) work to maintain daily nasal hygiene by gently cleansing “nasally” nostrils and preserving the natural balance of the nasal mucosa of the infant/child. Its use improves the evacuation of mucus which ultimately prevents colds and limits the occurrence of allergic symptoms like hay fever. By clearing the child’s nose and allowing them to breathe more freely, this also results in improved sleeping and feeding. Available in pharmacies. Always read the label.
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From the global leaders in natural alternatives comes a new formulation of Cys Control Plus to treat and prevent recurrence of UTI’s. The new 14 sachet pack is the most complete and effective 100% natural treatment for recurring UTI’s thanks to the complementary action of cranberry and D-Mannose on E. Coli. In addition, included in the formulation is heather which contains anti-bacterial properties and promotes the “auto-flush” phenomenon. For further information contact email@example.com
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MyPro Colicare From the Irish owned MyPro family of probiotics comes Colicare. Containing the rare probiotic strain Lactobacillus rhamnosus GG with added sunflower oil (for immunity strengthening and energy boosting), Colicare is clinically proven and documented to be effective in the improvement of the early childhood symptoms of infant colic and to promote a healthy digestive system for baby. For further information contact firstname.lastname@example.org
The mini travel pack contains three of the bestselling products: Wash-Off Facial Cleanser, Deep Cleansing Cloth gently dissolve makeup and impurities leaving skin cleansed and refreshed, the 2 in 1 Day+Night Cream is packed full of nourishing ingredients that will leave skin feeling soft and hydrated home or away.
NEXUS Glucose meters and reagent strips WINDZOR Pharmaceuticals are pleased to announce the launch of the NEXUS range of Blood Glucose monitoring systems, using advanced GDH-FAD enzyme technology.
Swedish Nutra Swedish Nutra is a comprehensive range of all-natural liquid supplements, manufactured in Sweden combining essential nutrients and minerals for optimum health. Now available from Blackhall.
There are three meters in the range. NEXUS Ideal, for patients with dexterity issues, NEXUS Mini-Ultra, very compact, and NEXUS Voice, the talking meter! contact orders@ windzorpharma.com
Important storage update - Ovelle Aqueous cream, Ovelle Silcock's Base and Ovelle Emulsifying Ointment Re: Amendment (S.I. No 80 of 2016) to the regulations of Retail Pharmacy Business Regulations 2008 (S.I No 488 of 2008) requiring pharmacy only medicines. In Response to the implementation of amendment (S.I. No 488 of 2016) to the regulations of Retail Pharmacy Business Regulations 2008 requiring that pharmacy only medicines "are stored in a part of the premise to which the public noes not have access". Ovelle Pharmaceuticals have re-classified all sizes of Ovelle Aqueous Cream, Ovelle Silcock's Base and Ovelle Emulsifying Ointment supplied to the Irish market as cosmetic products, rather than medicinal products with a Product Authorisation Number. As a result of this re-classification ALL Ovelle Aqueous cream Ovelle Silcock's Base and Ovelle Emulsifying Ointment have product labelling that meet the requirements of the Cosmetic Directive (1223/2009) and therefore CAN REMAIN in the part of the pharmacy to which the public has access. We would also like to reassure you that the product formulations have not changed, that we continue to use the highest grade of raw materials and that the products remain pharmacy only.
Don't let urinary problems inconvenience you!
Bio-Kult Pro-Cyan is an advanced triple action formula. Bio-Kult Pro-Cyan contains cranberry extract, two specifically selected live bacterial strains and Vitamin A which contributes to the normal function of the immune system and the maintenance of mucous membranes which can be found lining the urinary tract.
Ask your wholesaler for more information.
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Product News Síle Seoige Launches Marimer nasal spray range Presenter Síle Seoige hosted the Marimer launch at Dublin’s Urchin restaurant. The presenter and Gaeilgeoir was on hand to introduce Marimer, already the number one brand in its field in France, to the Irish press. An all-natural range that promotes good daily nasal hygiene and can help prevent and treat infections, complementing other ENT medications, Marimer is made using seawater harvested daily off the coast of Brittany in France. Síle was joined at the launch by some of Dublin’s leading journalists and bloggers who enjoyed breakfast in the cool surrounds of Urchin’s beach-inspired decor, while learning more about the brand from Tom Murphy, MD of Pamex Limited, who brought the brand to Ireland. Tom describes himself as a man on a mission
to source products from all over the world that will make life more comfortable for people. Marimer certainly ticks this box, allowing users from babies to adults to clear congestion and simply breathe easier. Mayo man Tom enjoyed a great rapport with Síle, with both sharing a love of the West, the sea and using natural products. Síle was delighted to host the launch, saying, ‘As a yoga teacher, I can’t emphasise enough how important breathing well is. I use Marimer Baby Nasal Hygiene on Cathal, my 9-month-old son, and find it very easy to use and super effective. It is also completely safe and natural, both of which are a must for me. It’s now part of our daily routine.”
Pamex launches foot health awareness campaign 50% of the world population is affected by athlete’s foot or fungal nail at least once a year. 27% of world population suffers from nail fungus. 1 in 10 people with Diabetes have foot problems.
Stephanie Roche put her Best Foot Forward to raise awareness of foot health this summer. The campaign was launched today by Pamex,
the Mayo-based distributor of foot health products, Mycosan and Dermatonics Once. Commenting on her most prized
possessions, Stephanie Roche said: “As a sportsperson, I can’t afford any serious issues with my feet that might prevent me from competing at the highest level. I incorporate foot care into my daily routine and make sure when I’m not training that I wear the right footwear and rest my feet when I can. I am a strong believer in prevention being better than cure, so I make sure to get regular physiotherapy, and if I have any issues at all, no matter how small, I seek treatment immediately. I always make sure to have a foot treatment such as Mycosan and Dermatonics Once to hand if required!”
New ‘no sting’ first aid spray from Medicare Fleming Medical, owner of Medicare, Ireland’s number one pharmacy First Aid brand has recently launched its new Medicare Effigerm range of Sprays & Gels. All three products are Antibacterial, Fungal, Viral and kill 99.9% germs. They have been dermatologically tested and are hypoallergenic, free from fragrances & alcohol, preservatives and harmful chemicals – the
amazing thing is that they are as natural as water and so are safe to use in the home. Both the First Aid Spray & Gel products are perfect for cleaning wounds such as Cuts, Scrapes and Scratches. They can also be used in the treatment of Minor Burns, Insect Bites, Minor Eye Irritations and Acne. The Junior Spray is ideal for all children’s needs including Nappy
Rash, Navel & Eye Cleansing, it can be used also for cleaning of Baby Bottles, Soothers, Toys, Breast Pumps and High Chairs. “We are delighted to launch these fantastic innovative products as they are both highly effective for First Aid and are harmless in the home – this makes them perfect for the all the family to use.” Mark Fleming, Fleming Medical
At the launch event, Podiatrist, Aoife Reilly said: “Thousands of Irish people suffer from foot conditions, such as callouses, cracked heels and fungal infections. Often, these conditions can remain hidden throughout the year and only really become obvious or a problem for people as we come into the summer months. Some conditions are merely unsightly or uncomfortable while others can progress to more serious foot health complications if left untreated.” For further information visit, www.pamex.ie.
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ent seasonal ENT infections (cold1, allergic rhinitis …) 126115_Pamex_Marimer_Advert_190x133mm_PRF1.indd 1
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TouchStore Sales Executive
Introduction: TouchStore are currently seeking to hire a sales executive with pharmacy software knowledge along with sales skills to provide advice and support on a range of our products. This would be an ideal position for a pharmacy technician or pharmacist assistant who has experience using TouchStore Rx and is seeking a new challenging position.
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Clinical Profiles THE HIGH COURT (COMMERCIAL) LIFTS EX PARTE ORDER AND REJECTS INTERLOCUTORY INJUNCTION AGAINST EZETIMIBE/SIMVASTATIN GENERIC – CLONMEL HEALTHCARE TO RESTART DISTRIBUTION
Psoriasis affects up to 73,000 people in Ireland. It can cause great physical and psychological burden. Approximately one third of people with psoriasis experience depression and anxiety. Because of the visible nature of the disease, psoriasis can lead to social isolation, due to self-consciousness and low self-esteem.
The High Court (Commercial) has lifted the ex-parte Order granted on April 20, 2018 against Clonmel Healthcare’s cholesterol drug Ezetimibe/Simvastatin Clonmel and rejected the interlocutory injunction after a hearing on April 27, 2018. As a consequence of the court‘s decision Clonmel Healthcare is now again allowed to market and distribute its generic version of MSD’s product Inegy in Ireland.
Commenting on the launch, Professor Brian Kirby, Consultant Dermatologist, St Vincent's Hospital, Dublin said, “The availability of guselkumab provides an important treatment option for people living with psoriasis in Ireland. Clinical studies show that this medicine works by effectively blocking the activity of a protein called IL-23, which is present at increased levels in people with psoriasis. This well-tolerated treatment gives both physicians and patients fresh hope and will significantly decrease the burden of moderate to severe plaque psoriasis”.
“Having carefully considered legal and patent advice before launching our product, we are very pleased with the outcome of the hearing,” says Clonmel Healthcare’s CEO James Hanlon. “We will now continue to supply our customers with our high quality and affordable Ezetimibe/ Simvastatin combination.” Clonmel Healthcare’s Ezetimibe/ Simvastatin Clonmel is sold at a significantly lower price than the original product, thus allowing for substantial cost savings to customers, patients and the Irish Government.
TREMFYA® (GUSELKUMAB) LAUNCHED IN IRELAND TO TREAT MODERATE TO SEVERE PLAQUE PSORIASIS The Janssen Pharmaceutical Companies of Johnson & Johnson today announced that TREMFYA® (guselkumab) has been reimbursed in Ireland for the treatment of adults with moderate to severe plaque psoriasis who are candidates for systemic therapy. Guselkumab is the first biologic to selectively target interleukin (IL)-23, a key protein that initiates a specific immune inflammatory response in psoriasis. Guselkumab can offer patients both effective and sustained control of their disease, with evidence showing superior efficacy compared with a biologic standard of care.
“We at the Irish Skin Foundation welcome this new treatment option for people living with moderate to severe plaque psoriasis. The availability of new and innovative therapies that provide improved efficacy will allow people with psoriasis to get the best results possible from their treatment”, says David McMahon, Head of Advocacy and Communications, Irish Skin Foundation. The HSE decision follows European Commission approval in November 2017, which was based on data from two Phase 3 clinical studies - the VOYAGE 1 and 2 trials. These trials compared guselkumab with placebo and Humira® (adalimumab) and showed high levels of skin clearance after 16 weeks, with at least a 90% reduction in Psoriasis Area and Severity Index score (PASI 90) score in 73.3% and 70.0% of patients receiving guselkumab, compared with 49.7% and 46.8% in patients receiving adalimumab, respectively (P<0.001). Longer term data also demonstrated consistent rates of skin clearance in patients with moderate to severe psoriasis treated with guselkumab through week 100.
The NAVIGATE trial evaluated patients who did not achieve a response of cleared or minimal disease (Investigator’s Global Assessment [IGA] score of 0 or 1) by week 16 when treated with STELARA® (ustekinumab) and were then randomised to either switch to guselkumab or continue on ustekinumab. The guselkumab group had a significantly higher mean number of visits with patients achieving an IGA score of 0 or 1 and at least a 2-grade improvement from week 28 through week 40 (relative to week 16), compared to the ustekinumab group (1.5 vs 0.7; P<0.001). “We are delighted that guselkumab is now available for patients in Ireland,” said Dr Leisha Daly, Country Director, Janssen Sciences Ireland UC. “At Janssen, we are committed to bringing innovative new therapies that help to improve the lives of patients. The availability of guselkumab in Ireland provides an innovative new option to help address the continued needs of people living with plaque psoriasis.” Guselkumab is an injectable treatment for psoriasis and can be self-administered following training. Treatment requires two starter doses, one initially and the other four weeks later, followed by a maintenance dose once every eight weeks (q8w) thereafter.
DUPIXENT® (DUPILUMAB) SHOWED POSITIVE PHASE 3 RESULTS IN ADOLESCENTS WITH INADEQUATELY CONTROLLED MODERATE-TO-SEVERE ATOPIC DERMATITIS A pivotal Phase 3 trial evaluating Dupixent (dupilumab) to treat moderate-to-severe atopic dermatitis in adolescents (ages 12-17) met its primary and key secondary endpoints. In the trial, treatment with Dupixent as monotherapy significantly improved measures of overall disease severity, skin clearing, itching, and certain healthrelated quality of life measures. Dupixent is the first and only biologic to show positive results in this patient population. Patients treated with Dupixent
had significant improvement in disease severity at 16 weeks The primary endpoints were the proportion of patients achieving Investigator's Global Assessment (IGA) score of 0 (clear) or 1 (almost clear) and 75% improvement in Eczema Area and Severity Index (EASI75, co-primary endpoint outside of the U.S.) at 16 weeks. Results included: • 24% of patients who received weight-based dosing of Dupixent every two weeks (200 mg or 300 mg) and 18% of patients who received a fixed dose of Dupixent every four weeks (300 mg) achieved the primary endpoint - clear or almost-clear skin (IGA; score of 0 or 1) - compared with 2% with placebo (p less than 0.0001, and p= 0.0007, respectively). • 41.5% of patients who received Dupixent every two weeks and 38% of patients who received Dupixent every four weeks achieved 75% or greater skin improvement (EASI-75) compared to 8% with placebo (p less than 0.0001). • There was a 66% improvement in the Dupixent every two weeks group and, 65% improvement in the Dupixent every four weeks group in average percent change from baseline in EASI score compared with a 24% improvement in the placebo group (p less than 0.0001). • There was a 48% improvement in the Dupixent every two weeks group and 45.5% improvement in the Dupixent every four weeks group in average percent change from baseline in the pruritus numerical rating scale (NRS) compared with a 19% improvement in the placebo group (p less than 0.0001).
News 40 Years of service to pharmacy honoured Eileen Morrissey, the manager of McCartan’s Pharmacy in Dublin 13, has been honoured with a Lifetime Achievement Award in recognition of a long-running career that has spanned more than four decades. Eileen started working as the manager of the McCartan’s Sutton Cross pharmacy in 1978 - a position she has held ever since. She was presented with the lifetime achievement award last month at a ceremony in store. The award, from Irish Pharmacy
News, celebrates Eileen’s dedication to her work and contribution to the pharmacy sector. Announcing the award, Brian McCartan, owner of the McCartan Pharmacy Group, described Eileen as an irreplaceable member of staff who is dedicated to her customers.
“Eileen is very unassuming and very caring,” Brian said. “She’s always concerned for her patients, always respectful, always keeps their confidence.” Brian said the pharmacy was packed for the award ceremony last month. “A lot of people came down to wish her well on the day,” he said. “Eileen is very much loved and highly respected by the community.” Eileen will continue to manage the busy community pharmacy
Sam Maguire still draws in the crowds More than 100 people flocked to Sheridan’s Pharmacy in Blanchardstown last month when the Sam Maguire Cup was put on display in store. Owner Des Sheridan said there was a lot of excitement among Gaelic football fans and his staff. “It was very popular with the young mothers, and there were a few babies put in the cup,” he said. “It was great - everyone shared it around.” The iconic silver chalice, which is has been presented to the winners of the All-Ireland Senior Football Championship each year since 1928, was on loan to the pharmacy for the day from the Dublin GAA. To celebrate, the pharmacy ran an energy drink tasting stall and gave away free goodie bags to customers, who eagerly posed for photographs with The Sam. Luckily for Des, when it came time to give the cup back, he didn’t have to pry it out of anyone’s hands.
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Appointments Medicines for Ireland has announced the appointment of Mylan Ireland Country Manager, Owen McKeon, as new chairperson of the organisation, taking over from Sandra Gannon (Teva Pharmaceuticals Ireland) and Jeffrey Walsh (Pinewood Healthcare). The appointment will mark the first change in leadership since the organisation’s launch in June 2017. Since its launch, Medicines for Ireland has engaged with the Minister and Department of Health and wider Government on a number of policy issues and has developed long-term road map for the procurement and supply of medicines in Ireland. Key amongst these has been an ambitious and comprehensive National Medicines Strategy. The organisation has been urging Minister Harris to put in place such a blue-print for the long-term procurement, supply and usage of medicines in Ireland.
Edwards Lifesciences has appointed Nathan Tenzer as Plant General Manager in the mid-west of Ireland. Nathan will have responsibility for leading the management and engineering function and delivering on Edwards’ strategic objective to expand its global supply network of delivery components for transcatheter heart valve therapies, where open heart surgery would previously have been the norm. He has worked for Edwards for more than 15 years, honing his experience in engineering, manufacturing, operations and project management in this fast-growing global company. For the past two years, he has held the position of Senior Director of Engineering in an Edwards manufacturing facility near Salt Lake City, Utah. Edwards Lifesciences recently announced the company’s establishment in Ireland, which will over the next several years result in an estimated ¤80m investment and 600 jobs in the Mid-West of Ireland.
Ian Wilson has replaced Peter Surgenor as the new head of Sangers AAH. Ian replaces Peter on his retirement in January of this year. Ian Wilson joins Sangers AAH from the RLC Group, where he had worked as site operations manager. Since graduating with a degree in mechanical and manufacturing systems engineering he has worked across a broad range of sectors. Outside work, Ian is a keen sportsman with interests in cycling, the gym and rugby. He is married with two sons.
News Pharmacy student wins top honour One of pharmacy’s future stars has been awarded Trinity College Dublin Students’ Union Class Rep of the Year 2018. Eimear Garvey from Mullingar is one of two first year pharmacy class reps. She admits to being completely shocked at her win, having had no knowledge that she was even up for nomination. “I had nominated Cathal Hannafin, the other first year class rep for the award and then completely forgot about it.” She explained: “I was concentrating on coursework and exams so when I got a text telling me I had one it was really out of the blue. “it turns out that my entire class has banded together to get as many nominations as possible for me. We’re such a little family but it was a great shock and to be honest I didn’t believe it at first.” Out of 384 nominations Eimear received 60 – more than 15%. According to the TCD Students’ Union, Eimear’s nomination described her dedication, caring nature and her hard work.
“I loved chemistry – from the start it’s been my favourite subject at school. As well as that I wanted to help people. I’m quite an outgoing person so I don’t think I could do something where I was stuck in a lab or behind a desk all day and I love the front-facing aspect of community pharmacy,” she said. Although she hasn’t ruled out hospital pharmacy, it would appear that the first-year student is already carving out a path towards community pharmacy. She spends her weekends as an over-the-counter assistant at Keane’s CarePlus Pharmacy in her hometown of Mullingar. TCDSU Education Officer Alice MacPherson said: “After an extensive review of the nominations, TCDSU was delighted to award Eimear Garvey with the honour.”
The award sees Eimear named as the top class rep in all of Trinity College.
Alice continued: “Class reps are the most important officers of the students’ union. They take care of their classes’ welfare, solve academic issues and create community by organising social events.”
For Eimear, there was a clear choice when it came to studying pharmacy.
As well as the award, Eimear has won herself a ticket to the prestigious Trinity Ball.
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