Page 1

July 2019 Volume 11  Issue 7 PHARMACYNEWSIRELAND.COM


In this issue:

Free your customers from the symptoms of hayfever

NEWS: Expanded role for Pharmacy calls Page 5

PROFILE: Lion Hearted – Fiona Roche re-opens family business Page 9

Zirtek Allergy Relief helps to relieve the symptoms of hayfever and urticaria Zirtek Plus Decongestant delivers all the allergy relief of Zirtek with an added decongestant

REPORT: eMental Health Special Report Page 19

RETAIL: Innovation at REI Retreat Page 23




Zirtek IE

Travel Vaccinations Page 45

Feel free to place an order with your local rep or customer service team: Call: Email:


01 463 2424 cs.pemberton@united-drug.com

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. Legal Category: OTC. Classification: 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 Regulatory Authority at www.hpra.ie or via email to medsafety@hpra.ie Adverse events should also be reported to UCB Pharma Ireland Ltd via email UCBCares.IE@ucb.com Zirtek Allergy Relief is available in liquid formula for ages 2 and upwards, and in tablets suitable for ages 6 and upwards. Zirtek Plus Decongestant is suitable for adults and adolescents from 12 years of age and upwards. May IE-P-ZI-ALY-1900033

Consumer Headache presents Pharmacist opportunity Page 50

AWARDS: Profiling the Winners Page 52

The 2020

PHARMACY Show Date for your Diary Date: Sunday 19th & Monday 20th April 2020 Venue: Citywest Convention Centre, Dublin 24

For further information, please contact:

Laura Payne

Brand and Trade Marketing Manager, United Drug Email: pharmacyshow@united-drug.com Mobile: 087 383 2297

A McKesson Company




Page 6: Pharmacy Regulator publishes Annual Report

The statistics to support what has long been argued, are in. Members of the public are increasingly more likely to attend their pharmacist before they go to their GP and want their pharmacist to be able to do more for them, according to new research launched by the Irish Pharmacy Union (IPU).

Page 9: Fiona Roche on re-establishing the family business

The results of a survey, commissioned by the IPU and carried out by Behaviour and Attitudes, shows that over 90% are in favour of their pharmacist being able to prescribe some medicines for minor ailments; 90% would like to see the pharmacy offering services such as blood pressure monitoring and cholesterol testing; and 94% trust the professional advice they receive from the pharmacist.

Page 26: Pharmacy embraces JAM initiative


Page 19: eMental Health Brenson Lawlor the next big thing? Special Report

IPU Secretary General, Darragh O’Loughlin, says the untapped potential in the pharmacy sector creates “a tremendous opportunity for the healthcare system as a whole, but Government must take action. The services we can provide in Irish pharmacies are, due to many years of government inaction, not as complete as they should be,” he has stated.

Box Advert Apr 2019.pdf



Turn to page 5 for the full story.

Page 23: Retail Excellence Retreat 2019

Fiona Roche is one pharmacist who believes fervently in the profession, and its worth. Showing fierce determination as someone who clearly likes a challenge, Fiona recently went back to her roots and re-opened the family pharmacy in Blacklion, Greystones. On page 9, we speak to her about the history of the store and opportunities for the future.

Are You Thinking of Selling Your Pharmacy? Page 72: Coverage from the Cosmetic Association Trade Show


The Pharmaceutical Society of Ireland have also published their Annual Report, highlighting an extensive programme of work across registration, pharmacy practice development, query and complaint management as well as other regulatory efforts. The details are on page 6 of our July bumper issue but interestingly the report shows that the number of pharmacies in Ireland grew last year to 1,945.

PUBLISHER: IPN Communications Ireland Ltd. Clifton House, Fitzwilliam Street Lower, Dublin 2 00353 (01) 6690562 MANAGING DIRECTOR Natalie Maginnis n-maginnis@btconnect.com

Fitting when you take into account the new store openings we have featured this month, from Cara Pharmacy expanding into the Dublin and Cork areas, to Oonagh O’Hagan opening the ninth Meaghers Pharmacy.

EDITOR Kelly Jo Eastwood: 00353 (87)737 6308 kelly-jo@ipn.ie

JPA Brenson Lawlor88has over 30 years’ experien advising pharmacy owners and will help you to maximise your return. We also carry our monthly feature offerings, giving our readers some vital insights into category managing your pharmacy for the Back to School, Headache and Rosacea consumers, amongst Irish Pharmacy others. Following on from our excusive report in the June 2019 News is IRISH issue on pharmacies now offering travel vaccines, our Continuing PHARMACY circulated to all NEWS Lawlor Brenson Box Advert Apr article 2019.pdf 10/04/2019 Professional Development this month1serves for some independent, thought-provoking reading. multiple Pharmacists and academics

ADVERTISING DIRECTOR Debbie Graham: 00353 (87) 288 2371 debbie@ipn.ie CONTRIBUTORS Alan Moran Dr Conal Twomey

in Ireland.

DESIGN DIRECTOR Ian Stoddart Design

Happy Reading and Happy Summer.

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 or 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.


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Telephone Jason Bradshaw or Padraic onof 01-6689760 Are YouFerguson Thinking Selling Your Pharmacy? Contact Us Today for a Free Consultation jason@brensonlawlor.ie JPA Brenson Lawlor has over 30 years’ experience advising Telephone Jason Bradshaw or pharmacy owners and will help padraic@brensonlawlor.ie Padraic Ferguson on 01-6689760 IrishPharmacyNews







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Targeting NAFLD in Pharmacy There is a silent epidemic of Non-Alcoholic Fatty Liver Disease (NAFLD) in Ireland. People with type 2 diabetes, obesity and/or high cholesterol are at greater risk of developing this disease, which, if left undiagnosed and untreated, may lead to cirrhosis of the liver. International Clinical Practice Guidelines recommend that people with type 2 diabetes should be screened for NAFLD however NAFLD is not routinely checked in Type 2 diabetes patients in Ireland. International NASH Day took place on Wednesday 12th June, and was a day of action to raise awareness about NAFLD and its most progressive form NASH, with events featuring informative and educational on-site screening activities in several cities/countries at the same time.

To mark International NASH Day and to raise the much needed awareness, Meaghers Pharmacy Group in collaboration with Professor Suzanne Norris (Liver Wellness® and St. James’s Hospital) held Ireland’s first Pharmacy-led “Diabetes Liver Screen” Initiative. Patients of Meaghers Pharmacy Group with type 2 diabetes were invited to participate in this screening initiative. Diabetes Liver screening took place at dedicated Meaghers Pharmacy Stores over

four different dates throughout June. Oonagh O’Hagan, Managing Director of Meaghers said, “Meaghers Pharmacy Group are delighted to offer this service to our customers and help create much needed awareness around NAFLD in Ireland. As a Pharmacy group, we always strive to deliver excellence in customer care whilst putting our patients first so we jumped on the opportunity to champion this healthcare initiative with Professor Suzanne Norris.”

Alison reaches for Pharmacy Books Keane’s CarePlus Pharmacy Primary Care Centre in Mullingar recently bid farewell to Dispensary Manager Alison McKeon, who is heading off to study Pharmacy. Pharmacist John Keane said, “We are all extremely proud of Alison and wish her the very best for the next five years of study.”

Dispensary Manager Alison McKeon is pictured with John Keane, Pharmacist, Keane’s CarePlus PCC before heading off to study Pharmacy at RCSI

Boots display Profit Growth The Irish arm of Boots has reported pre-tax profits of €24.1 million in 2018, it has been reported. According to the Irish Independent, the group’s recent accounts show that its profits rose by 2% in the 12 months ending August 2018. The company said it delivered its strong performance as a result of new store openings, good retail trading and strong pharmacy volumes. Boots added that its performance was partially offset by the impacts of the snow and storms at the beginning of the year.

“We are delighted to have had another good year of growth for Boots Ireland, delivering both revenue and profit growth,” Bernadette Lavery, Managing Director, said. "Since our first store opening in 1996, we have grown our footprint


in Ireland and we now employ over 2,000 colleagues. We continue to build on recent progress and invest in retail pharmacy in Ireland, rolling out new pharmacy services and new beauty content.” Last year, Boots operated 87 stores across Ireland, with staff costs totalling ¤65 million.

Eligibility & Reimbursement Service The HSE recently published the Primary Care Eligibility & Reimbursement Service (PCERS) Strategic Plan 2019-2021 which aims to improve the PCERS service offering in line with the Sláintecare vision. Public access to all of the HSE’s centralised schemes such as the GMS (General Medical Services), Drugs Payment Scheme (DPS) and the Long Term Illness (LTI) scheme will be enhanced, and the centralisation of the Maternity & Infant Scheme and reimbursement for the Primary Childhood Immunisation (PCI) scheme within the PCERS is planned. The number of people with eligibility under the various primary health schemes is approximately 3.6 million and the PCERS also has accountability for almost ¤2.738 billion (17% of 2019 national health budget), which positions the service to the forefront of healthcare delivery within the HSE. In developing the plan, the HSE’s PCERS engaged with a wide range of customers and stakeholders and sought feedback via a major customer survey, with over 1,090 respondents, which provided valuable insights and key contributions to the development of the Strategy. Speaking about the Strategic Plan, HSE Assistant National Director with the Primary Care Eligibility & Reimbursement Service, Anne Marie Hoey said, “To fulfil the overarching PCERS vision - ‘to be an excellent and responsive public service’ requires continuous innovative and adaptive ways of doing business with the varied range of customers and stakeholders that engage with our services. These demands challenge all functions of the PCERS to provide ever-more effective and efficient approaches to serve our customers and stakeholders. This strategy drives our choices and enables us to prioritise our efforts. I expect this plan will build lasting value for all who interact and indeed depend on us, as a health service provider of scale, within in the wider public sector.”

News Grant now available A new grant to help pharmacists highlight potential weaknesses in their country’s pharmacy system and to combat these weaknesses has been announced by the Community Pharmacy Section (CPS) of the Federation of International Pharmacists (FIP). As part of the National Pharmacy Champions for Change grant, pharmacists are asked to participate in an electronic survey (in English or Spanish) that will be used to collect responses, which will be evaluated by international pharmacy leaders within the CPS, in collaboration with FIP’s Pharmacy Practice Research Special Interest Group, to select a winner. The winner will be announced at the CPS Steering Committee meeting on 24 September at FIP’s 79th World Congress of Pharmacy and Pharmaceutical Sciences in Abu Dhabi, UAE. The grantee will be given the opportunity to communicate his or her vision for change through a one-hour webinar hosted by the CPS. ¤1.4m for Breast cancer Research Two RCSI researchers have been granted emerging investigator awards by the Health Research Board (HRB). The awards, which total a combined ¤1.4 million, will fund research that will look at breast cancer risk factors and clinical guidelines. The grants were awarded to Dr Barbara Clyne, Postdoctoral Researcher and Honorary Lecturer in the Department of General Practice and Dr Maeve Mullooly, Research Fellow in the Division of Population Health Sciences. The work led by Dr Mullooly will examine breast cancer risk factors, with particular focus on a risk factor known as mammographic breast density (MBD). The research led by Dr Clyne will aim to develop a toolkit to help the development of Irish national clinical guidelines. The toolkit will equip members of National Clinical Guideline Development Groups on how to select the best approaches to evidence synthesis.


Expanded role calls for Pharmacy Irish people are increasingly more likely to attend their pharmacist before they go to their GP and want their pharmacist to be able to do more for them, according to new research. The results of a survey, commissioned by the Irish Pharmacy Union (IPU) and carried out by Behaviour and Attitudes, was launched at an IPU event on the future of pharmacy. The survey shows that: • 70% will talk to their pharmacist first, ahead of visiting their GP; • 94% are in favour of their pharmacist being able to prescribe some medicines for minor ailments; • 90% would like to see the pharmacy offering services such as blood pressure monitoring and cholesterol testing; and • 94% trust the professional advice they receive from their pharmacist. IPU Secretary General, Darragh O'Loughlin, says the untapped potential in the pharmacy sector creates “a tremendous opportunity for the healthcare system as a whole, but Government must take action.”

“The services we can provide in Irish pharmacies are, due to many years of government inaction, not as complete as they should be. When we compare the successful pharmacy sectors of Canada, New Zealand and the UK, we see a range of other initiatives that could be rolled out in Ireland. These include provision of oral contraceptives and increasing the range of vaccines available in our pharmacies. Last month the Minister for Health committed to the IPU that he would work with us to realise some of these improvements. We welcomed this commitment and are eager to get started on the promised engagements.” There are around 78 million visits to Irish pharmacies each year, and roughly 1.6 million adults have been in a pharmacy in the last week, accounting for 44% of the population. This jumps to 81% who have visited in the last month. Nearly half of the adult population lives within one kilometre of a pharmacy (47%), and 87% live within five kilometres of a pharmacy. Nearly nine in ten

(88%) people say the pharmacist is available at a time that suits them, while only half (52%) say the same of GPs. Speaking about the research, Larry Ryan of B&A said, "It is clear that Irish consumers feel very positive about the service they receive in the pharmacy sector. 98% of us rate the professional service we receive as very good or quite good. Very few industries could boast similar satisfaction levels.” Mr O'Loughlin says more needs to be done by Government to support the pharmacy sector in future, in order to improve levels of patient care within the health system: “Delivering care at the lowest level of complexity is the stated aim of Sláintecare. Within the pharmacy sector, we have almost 1,900 pharmacies nationwide ready and waiting to contribute to this. We hope that in the upcoming discussions the Minister shares our ambition and puts flesh on the bones of his recent commitments, because empowering pharmacists to practise to full scope will be a win-win for everyone.”

Adrian Dunne Group celebrate 20 Years The Adrian Dunne Pharmacy Group, which has 12 stores across Ireland, recently celebrated 20 years of being in business. The Group opened their first store in Whitehall in 1999. They marked the milestone with a birthday bash in House, Leeson Street on Saturday 15th June with staff from all branches, and head office, in attendance. “To every single Adrian Dunne Pharmacy employee, I can’t thank you enough on our 20th birthday for your endless compassion and dedication to our customers,” said Managing Director Adrian Dunne.

Adrian Dunne, Managing Director of the Adrian Dunne Pharmacy Group pictured 20 years ago inside the Adrian Dunne Whitehall store when it first opened and pictured celebrating the Group's 20th Birthday celebrations




Pharmacy retains Public trust The PSI, the pharmacy regulator, has published its Annual Report for 2018, and it highlights an extensive programme of work across registration, pharmacy practice development, query and complaint management as well as other regulatory efforts to assure public trust in pharmacy through effective regulation.

PSI Annual Report 2018

Key Facts and Figures

Assuring trust in pharmacy though effective regulation PSI Registers 2018

6,246 pharmacists registered


pharmacists aged < 45 years

Complaints and Fitness to Practise


formal complaints received about pharmacists/pharmacies


fitness to practise inquiries held

PSI Annual Report is available at www.psi.ie

Additionally, a number of significant development projects have been progressed during the year including the revision of the Code of Conduct for pharmacists and an ambitious digital transformation programme that will streamline how pharmacists and pharmacies interact with PSI, while also improving how PSI monitors and assesses risks. High Trust Levels During the year, 298 new pharmacists were added to the register of pharmacists in Ireland. A total of 6,246 pharmacists were registered to work in Ireland as of December last year. The number of pharmacies in Ireland also grew last year to 1,945 (up from 1,931 in 2017). Marking the publication of the report, Niall Byrne, Registrar and Chief Officer, said that feedback from the public continues to reflect a high level of trust in pharmacists, and patients’ frequent interaction with pharmacy services across the country, which currently amount to over two million visits to pharmacies every month. Mr Byrne highlighted the


new pharmacists added to the PSI Register


registered pharmacies


of new pharmacists are female


registered pharmaceutical assistants

Continuing Professional Development

96% of the 1,246 pharmacists selected for ePortfolio Review met the standards 134 pharmacists selected for Practice Review - 100% competence demonstrated


regional seminars with superintendent pharmacists to collaborate on our work public consultations to inform our work

considerable progress made in 2018 on PSI’s review of the Code of Conduct for pharmacists. The Code sets out the principles and ethical standards that govern pharmacists in their practice of their profession. The new Code, which is fundamentally about supporting pharmacists to practice their profession to the highest standard, is due to take effect later in 2019. CPD Success Rates The report also notes the positive results of pharmacists’ commitment to continuing professional development (CPD). There was a 100% pass rate amongst the 134 pharmacists selected for practice review during 2018. In addition, over 1,000 pharmacists submitted CPD portfolios for review, the vast majority of whom met the standards required. CPD became mandatory for pharmacists in 2016. “The public must have confidence in the quality and safety of the pharmacy services that they receive,” says Mr Byrne. “The PSI believes in a collaborative approach to the effective and


Minister Simon Harris has appointed ten members to the PSI Council. The new appointments are Roy Hogan, Mark Jordan, Professor Brian Kirby, RCSI, and Geraldine Crowley, HSE. Fintan Foy, Graham Knowles, Ann Sheehan, and Paul Turpin have been re-appointed as public interest appointees, alongside pharmacists Muireann Ní Shuilleabháin a nd Joanne Kissane following their re-election. Governance and oversight of the PSI, as well as a statutory judicial role, is provided by the 21-member Council. All Council members are appointed to the pharmacy regulator by the Minister for Health to act in the best interest of patients and public in the promotion of safe, appropriate pharmacy care and services. The PSI Council has also elected a new President, Joanne Kissane, and a new VicePresident, Michael Lyons, at its meeting on Thursday, 20 June.

Collaboration and Engagement


Latest PSI Appointments

appropriate regulation of pharmacy services. We were delighted with the positive and open discussions with superintendent pharmacists that took place around the country last year, where we explored how we could collaborate better with the retail pharmacy sector around our shared patient safety objectives. These meetings have informed our important work during the year on the development of Governance and Accountability Standards for pharmacies, a project that is continuing into 2019. “We are committed to building an organisation that is agile and high performing. As part of this, we are investing in a new digital platform to make it easier for pharmacists and pharmacy businesses to interact with us, from registering to sharing information, as well as improving how we assess, monitor and respond to safety and quality risks.” As with many public bodies, the PSI was involved in Brexit-related work during 2018, engaging with the Department of Health, and with the pharmacy regulators in Great Britain and Northern Ireland.

Joanne Kissane was first appointed to the PSI Council in 2015. She graduated from the School of Pharmacy, Trinity College, Dublin in 2000. She is the Head of Operational Excellence for LloydsPharmacy Ireland Limited, and previously held the role of Superintendent Pharmacist for the group. She holds a Masters in Quality and Safety in Healthcare Management from the Royal College of Surgeons in Ireland. Michael Lyons is a dual qualified pharmacist and barrister, he received a Master of Pharmacy degree from the University of Kent in 2011. He began his pharmacy career as a support pharmacist in Cork and Dublin. Michael was called to the Irish Bar in 2016 after attaining a Barrister-at-Law degree at the Honorable Society of Kings Inns, Dublin. Michael opened a new retail pharmacy business in Co. Cork in August 2016 and is the superintendent pharmacist. Michael has been a PSI Council member since 2017.



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Free your customers from the symptoms of hayfever Zirtek Allergy Relief helps to relieve the symptoms of hayfever and urticaria Zirtek Plus Decongestant delivers all the allergy relief of Zirtek with an added decongestant



Zirtek IE

Feel free to place an order with your local rep or customer service team: Call: Email:

01 463 2424 cs.pemberton@united-drug.com

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. Legal Category: OTC. Classification: 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 Regulatory Authority at www.hpra.ie or via email to medsafety@hpra.ie Adverse events should also be reported to UCB Pharma Ireland Ltd via email UCBCares.IE@ucb.com Zirtek Allergy Relief is available as an oral solution for 2 years of age and upwards and in tablets suitable for 6 years of age and upwards. Zirtek Plus Decongestant is suitable for adults and adolescents from 12 years of age and upwards.

Cetirizine dihydrochloride Always read the label For further advice please consult your GP or Pharmacist

June IE-P-ZI-ALY-1900047

Roche’s recapture the pharmacy pride I am impelled, not to squeak like a mouse, but to roar like a lion out of pride in my profession. John Steinbeck

For Pharmacist Fiona Roche the analogy is a fitting one. This year, her passion for her profession, alongside historic family values, saw her re-open the much-loved Roche’s Pharmacy (now renamed Fiona Roche Pharmacy) business in Blacklion, Greystones. To take on a challenge in the face of adversity, displaying fearlessness in every sense of the word, can be best described as having a lion heart. As with so many of life’s big gearshifts, Fiona’s decision to re-launch the pharmacy earlier this year, was made for her, when the previous tenants, Allcare, left on shockingly short notice. One night of brainstorming later, and the old pharmacy team was back together. We spoke to Fiona about reminiscing, re-grouping and re-entering a profession her whole family and community in Blacklion, has a passion for. Fiona’s father, the late Charlie Roche opened the original shop on January 11th, 1974, fulfilling at the time, a lifelong ambition to open his own community pharmacy. Charlie had previously trained under his uncles in the famous Roche Pharmacy chain, which were located on O’Connell Street in Donnybrook and across Dublin in the 1950’s. Greystones was a very different place in 1974 and the pharmacy started as a tiny shop in Blacklion, with the family living in the accommodation behind it. Gradually, over the years it expanded to encompass the living area. Keeping with Tradition With her mother being a Doctor, it wasn’t long before Fiona caught the healthcare bug, studying Pharmacy in Trinity and qualifying in 1984. A year later Fiona travelled to Australia, where she spent five years working in both large community pharmacies and within hospitals specialising in oncology and maternity units.

Fiona Roche


Fiona Roche Pharmacy staff Sharon Corcoran and Rebecca Burke

Former staff Rita O'Brien , Elizabeth Hayden and Karen O'Reilly

Fiona Roche’s Pharmacy conferring ceremony. Pictured are Charlie Roche’s Uncle, Tony Roche M.P.S.I, Fiona Roche, BScPharm M.P.S.I. her father Charlie Roche F.P.S.I and her mother, Dr Paddy Roche

decided to vacate and merge with another pharmacy in the town. Left with a vacant premises yet knowing the pharmacy market had changed dramatically since I had last owned a pharmacy I had a bit of a dilemma. However after a few sleepless nights I realised I had to go with my gut and get back where I belonged - in my own pharmacy. “I contacted all my old staff to see what they were up to and who was in a position to join me and set about ‘Getting the Band Back Together.’ “I also contacted some old and new suppliers and started the process of setting up shop again. “Having received the keys back on March 30th, 2019 we opened the doors on April 12th. It was a marathon effort, but with team work and I’m sure, quite a lot of help from my late father, everything fell into place and we were up and running.” New Challenges

“It was unique, working with both start of – and end of – life patients, but the work experience I obtained whilst in Australia was a real education for me,” Fiona reflects. On her return, Fiona spent a year working between John Holly’s Pharmacy in Wicklow and in Blacklion with her father until he passed on the pharmacy baton to her completely.

“I began working full-time in Blacklion and commenced a project of building a clinic onto the back of the pharmacy to increase the footfall in the area,” Fiona adds. “This has been a great success as it makes it a centre for all healthcare needs within the community.”

immersed herself in family for the next few years. From 2006 until recently, she worked locum cover for various pharmacies in North Wicklow and thoroughly enjoyed being back in the dispensary.

In 2005, and for personal reasons, Fiona decided to sell the pharmacy business and

Fiona continues, “The new owners leased the premises but then last March suddenly


Marathon Efforts

In an environment of increasing public expectations, workforce pressures, and significant scientific and technological advances, the role of the pharmacist is changing and will continue to change alongside the needs and expectations of patients or service users. Change is ever present. There are a lot more services available through pharmacies

Fiona Roche, Proprietor, Fiona Roche Pharmacy

these days. Support for understanding and taking medication well, sexual health, substance misuse, amongst many other things, are available today through community pharmacies. What have been the biggest changes Fiona has witnessed “Pharmacy has changed an incredible amount in the past 14 years, I often feel it is like running a different type of business altogether,” she says. “However, my business will always remain the same focusing on my patients and my staff and creating a great healthcare and retail experience whilst also keeping a happy workplace. “I am working here as well, so I want a nice work environment for myself.” Fiona has also encountered her share of challenges to date. “The biggest challenge I have is with prescription pricing. To be honest, it exasperates me that we are healthcare professionals and yet we don’t even get a mark-up on the medicines we dispense. “My father was a Past President of the Irish Pharmacy Union; when they were negotiating contracts having no mark-up and a fee on GMS was paired with having a mark-up on the other schemes. “Who else runs a business where they sell stock with zero mark-up? The Value of Pharmacy “I am also shocked at how pharmacists are selling themselves short with regard to how little they charge to administer a vaccine. With the costs of training and insurance amongst others, how does this low price make any business sense?” Just this month, research commissioned by the IPU has shown that the public are increasingly more likely to attend their pharmacist before they

go to their GP and want their pharmacist to be able to do more for them. This is something Fiona is passionate about. “Community pharmacists are a vital cog in the healthcare machine. It is therefore hugely important that we recognise our own self-worth and receive acknowledgement for the services we provide. As a profession, pharmacy can have a tendency to under-sell our value. This is especially true when discussing and negotiating professional fees. “I like being a Pharmacist, in the community - giving personalised healthcare to people with whom I build a relationship. “I am a very good pharmacist, I love what I do; what I offer is based on my education and continued education in many areas. “The main difference in what I did before compared to what I am doing currently, is that I now behave more like a retailer and run a pharmacy with a health, gift and beauty shop in the front. “I am sorry that Irish pharmacy has followed the US model rather than the European model. “When I was a child, my father’s pharmacy was a centre for health and he focused on medicines and healthcare. This is what I wanted when I decided to become a pharmacist and it is what I did until I sold in 2005. “Now, it is a different ball game and I am a retail outlet with different challenges. Focusing on the dispensary is not enough anymore. But it must be said that I am completely embracing this

whole new career and enjoying every bit of it. “Helping the community; whether it is with their minor ailments, or in giving educated advice when necessary. this is what I love and I am happy for people to call on me. “I have also found that, at a local level, there is huge support for independent local pharmacists. People really like the personal touch and when you employ locals, support local clubs, schools and charities, the community really appreciate it. “There is a great feeling of personal satisfaction in the job when you feel you have something to contribute to your own community which can help people live a happier and healthier life.” And thankfully, as Fiona Roche relaunches the family’s muchloved Blacklion pharmacy, this smart cookie has our caffeine lifeline sorted. Yep, Fiona Roche Pharmacy will have a coffee machine ust inside the door. For anyone who might not be able to live without their java fix for more than 5 minutes.

“Helping the community; whether it is with their minor ailments, or in giving educated advice when necessary. this is what I love and I am happy for people to call on me”




Pharmacy Crime Siege Continues Crime levels towards community pharmacy continue to rise, as was recently reported by the Irish Pharmacy Union. robbery at Medipharm, South Great George’s Street. Detective Garda Joseph Heafey told Tony McGillicuddy BL, prosecuting, that on the date in question Duffy ran into the shop and shouted at a male employee to open the till.

Irish Pharmacy News has learned this month of at least two attacks. In the first, Gardaí in Santry received a report of a theft from a pharmacy of a large quantity of cosmetic products.

Items recovered included makeup, moisturising creams, fake tan, sun cream and sunglasses.Two people were arrested and charged with the initial theft and are now before the courts.

As part of the investigation Gardaí based in Santry, assisted by the Divisional Search Team and Ballymun Drugs Unit carried out a search of a house in the Crumlin area and recovered in excess of ¤8,000 of stolen cosmetic products.

Meanwhile, a man who stabbed a pharmacy employee with a screwdriver during a failed robbery has been jailed for 14 months. Brendan Duffy (45) of Ballyfermot Avenue, Ballyfermot, Dublin pleaded guilty at Dublin Circuit Criminal Court to attempted

The man closed the till instead and Duffy squared up to him. The man swung a punch at the accused, Duffy punched him in return and they began a struggle during which the man was knocked onto a display case. Duffy then took a screwdriver out of his pocket saying “I’ll kill you”. He swung the screwdriver at the man and stabbed him in his arm, before running out of the pharmacy and down the street. In March of this year, the Irish Pharmacy Union (IPU) Crime Survey revealed that pharmacies across the country are under siege due to the high levels of crime they are subject too. Three quarters of all pharmacies have been the victim of at least one crime over the past twelve months, with the majority of these (81%) experiencing multiple incidents.

The IPU has called for more resources to be made available to tackle crime in the community or warned that these high levels of crime will continue. President of the IPU, Daragh Connolly, voiced concern at the findings of this year’s survey, “Ireland’s pharmacies are at the centre of communities nationwide, it is unacceptable that they are persistently subjected to high levels of crime. This is a threat that cannot be ignored any longer. The Gardaí need to be tasked with tackling this issue and be given the resources required to do so in a meaningful way. “Shoplifting continues to be the most prevalent crime against pharmacies. Fake tan is the single most commonly stolen item (50%) along with other cosmetics and perfume. Meanwhile, almost a quarter of pharmacies (24%) have had cash taken. What is undoubtedly the most sinister and concerning crime example is the high level of thefts of medicines. 17% of pharmacies have had controlled or prescribed drugs stolen in the past year.”

Allcare and Glanbia Ireland join forces Glanbia Ireland has chosen Allcare Pharmacy as its partner for its community pharmacy based alongside the popular Glanbia Agribusiness and Countrylife store in Campile, County Wexford. Bernie Morris of Campile Allcare Pharmacy and senior executives of Allcare and Glanbia cut the ribbon to officially open the new pharmacy

for the growth of our business. We have a long-standing and successful pharmacy business in Campile and we’re confident that working with Allcare will futureproof our growth.”

The decision followed thorough due diligence to find the most suitable partner.

said Robert Kehoe, Operations Manager (East), Glanbia Agribusiness.

“When considering potential partners for our pharmacy in Campile, Allcare stood out to us,”

“We have been particularly impressed with their capabilities, expertise and long-term vision


A planned rebrand of the pharmacies is expected over the coming weeks. In attendance at the formal opening of the pharmacy was Siobhán Talbot, Group Managing Director at Glanbia; Jim Bergin, Chief Executive Officer at Glanbia Ireland; Martin Keane, Group Chairman at Glanbia and Dermot Ryan, Managing Director of Retail Services at Uniphar.

The community pharmacy unveiled its new look at an opening event attended by more than 100 local residents, players from the Wexford hurling team and senior executives from both companies.

“From the first day we spoke with Glanbia, it was clear that we shared a culture that combined rock-solid fundamentals with a strategic vision that emphasised innovation and the importance of community,” said Alan Carroll, Franchise Relationship Manager with Allcare Pharmacy.

Following the acquisition of the Bradley’s group of pharmacies, Allcare is now the largest Irishowned pharmacy brand with nearly 100 pharmacies located in communities across Ireland.

“Allcare matches their needs through our expertise and scale. These are based on key areas of our business including dispensary, retail, digital, marketing and business insights.”



Nine’s the Magic Number for Meaghers Nine is the magic number as Meaghers Pharmacy Group opened their latest store in Churchtown. The occasion was marked with a series of launch events including the Skin School, held with the Skin Nerd Joanne Rock and a wellness event. Meaghers Pharmacy Group was first opened in Baggot Street in 1921 and operated by the Meagher family. In 2001, Oonagh O’Hagan, who had served her Pre-Reg year under the guidance of Pierce Meagher, purchased the store from the Meaghers family. Based on its reputation as a community pharmacy, it was important for Oonagh to retain the name Meagher’s Pharmacy. Over the next 15 years, seven more Meagher’s Pharmacies followed in Ranelagh Village, Sandford Road Ranelagh, Glenview Tallaght, Castletymon Tallaght, Barrow Street, the Mater Hospital and Kinvara Park, Navan Road. Last month saw the opening of the 9th Meaghers Pharmacy location in Churchtown in Dublin 14.

Meaghers 9th Pharmacy, Churchtown

Meaghers Managing Director Oonagh O'Hagan and Jennifer Rock, the Skin Nerd

Today, Meaghers Pharmacy Group is one of Dublin's leading pharmacy groups and employ over 100 staff. Meagher's pride itself on delivering a personal and professional service to the local community in which it serves.

Pharmacy support for Dementia Claire O'Neill, Pharmacist, and Louise O'Brien, Corporate Social Responsibility Manager, both from Boots Retail Ireland with Fiona Foley at the launch of the Dementia: Understand Together campaign, pictured at the campaign’s National Partner Forum 2019, which took place in Kilmainham, Dublin, recently. The HSE-led campaign, in partnership with The Alzheimer Society of Ireland and Genio, is supported by more than 40 national partners. Organisations from various sectors shared their experiences of taking action to change the culture around dementia. It’s estimated that 11 people develop dementia every day in Ireland with over half a million families affected by the condition. For information on how individuals, businesses and organisations can help create communities that are supportive and inclusive of people with dementia and their families, visit www.understandtogether.ie/ get-involved. Claire O'Neill, Pharmacist, Louise O'Brien, Corporate Social Responsibility Manager, both from Boots Retail Ireland with Fiona Foley, Co-ordinator, Dementia: Understand Together


Diary Date The Pharmaceutical Managers’ Institute will be holding a Breakfast Briefing on Thursday, October 21ST, 2019 in the Clayton Hotel, Liffey Valley. Paul Reid New Director General of the HSE will give a brief on what is currently happening within the HSE, the plans for the coming 12 months and the challenges facing them. Visit www.thepmi.com for more information.



PrEP to be made available in Community Pharmacy Minister for Health Simon Harris and Minister for Health Promotion Catherine Byrne have committed to implementing a PrEP HIV prevention programme later this year, following the formal advice from the Health Information and Quality Authority (HIQA) that such a programme would be safe, effective and cost saving. Taoiseach Leo Varadkar, Minister for Health Simon Harris and Minister for Health Promotion Catherine Byrne

Welcoming the advice from HIQA, Minister Harris said, "We want to reduce the number of new HIV diagnoses in Ireland. Increasing the availability of PrEP will help us to do so. This report not only confirms that PrEP can help to prevent HIV amongst those who are high risk, it also shows how a PrEP programme could save money. “My Department and the HSE will fully consider the advice from the HIQA report as we continue to plan for implementation of a programme later this year. I note HIQA's advice in the report on the need to invest in our sexual health services so we can deliver a high quality, holistic programme. Sexual health is a priority focus for me and Minister Byrne, and we want to deliver a world-class PrEP programme.” A PrEP programme involves the pre-emptive use of antiretroviral medication to prevent HIV infection, within a holistic service which includes regular monitoring and testing, as well as advice and counselling on safer sex practices. Similar programmes have recently been introduced in a number of other countries. The health technology assessment (HTA) report from HIQA found that PrEP is safe and highly effective at preventing HIV in people at substantial risk, and also finds

that the introduction of a PrEP programme would be cost-saving. HIV Fast Track The news was welcomed by Teva Pharmaceuticals Ireland. In December 2017, Teva was the first company to launch a generic version of the medication (Emtricitabine/Tenofovir disoproxil Teva). Not only did the entry of a generic into the Irish market lead to a more affordable price for PrEP, it also expanded patient access by making it available through community pharmacy for the first time. Almost two years on, PrEP is now available in community pharmacies across the Republic of Ireland subject to a doctor’s prescription. However, PrEP is currently not reimbursed by the HSE and must be paid for privately by patients, thereby excluding patients dependent on the GMS or Drug Payments Schemes. This most recent decision will now change that. Paul Neill, Teva’s Generics Director, commenting on the announcement notes, “Making PrEP publicly available represents a landmark decision in reducing new HIV infections in Ireland. “Up to this point, access to PrEP for Irish patients has been restricted and based


on their capacity to pay. This announcement will hopefully end that inequality. Access to PrEP will now be based on need rather than financial means. “The decision is also an important statement on the value of preventative healthcare versus after-the-fact treatment. At a time of stretched health budgets, when our health services have so many competing priorities, medicines such as PrEP can make a huge contribution to keeping people healthy and in reducing healthcare costs.” Meanwhile, Ireland has signed up to a global initiative, which is aimed at boosting HIV prevention and treatment and reducing stigma. The HIV Fast Track Cities initiative is a global partnership between almost 300 cities in collaboration with the Joint United Nations Programme on HIV/AIDS and the International Association of Providers of AIDS Care (IAPAC) and was launched in Paris in 2014. Taoiseach Leo Varadkar along with Minister Harris and Minister Byrne, in signing up, also announced funding of ¤450k to kick-start the initiative in Ireland. This funding will support community HIV awareness and testing in Dublin, Cork, Limerick and Galway, as well as a national stigma reduction

“Under the HIV Fast Track Cities initiative we will further expand community HIV testing and raise awareness about the benefits of treatment. We're backing this up with real money” Taoiseach Leo Varadkara campaign, to be delivered by the HSE Sexual Health and Crisis Pregnancy Programme with HIV organisation partners in each city. Simon Harris said reducing the number of new HIV diagnoses in Ireland remains a priority focus for him as Minister for Health. "Sexual health is one of our key priorities under Healthy Ireland. The aim of the Fast Track Cities initiative is to boost current HIV prevention and intervention work. Minister for Health Promotion Catherine Byrne adds, “Ireland's participation in the Fast Track Cities initiative reinforces our commitment to stepping up our response to HIV. We want to break down the stigma around HIV and make information, testing and treatment easily accessible, particularly for at-risk groups. I am delighted that we could secure the additional funding to make this happen and to advance the work of our National Sexual Health Strategy. This initiative will further strengthen the partnership between the HSE, NGOs and local partners in Dublin, Cork, Limerick and Galway, which is key to tackling HIV in the community.”

PrEP (Pre-Exposure Prophylaxis) can protect against HIV and makes sex safer for adults at high risk of infection*.

Emtricitabine/Tenofovir disoproxil Teva 200/245mg Film-coated Tablets Further information is available on request, in the SmPC or from your doctor or pharmacist.

Teva Pharmaceuticals Ireland Digital Office Centre Swords, Suite 101 - 103, Balheary Demense, Balheary Road, Swords, Co Dublin, K67E5AO, Ireland. Freephone: 1800 - 201 700 | Email: info@teva.ie | Web: www.teva.ie | www.hpra.ie Contact your local Teva representative for more details. Prescription only medicine *when used in combination with safer sex practice

Date of preparation: June 2019 Job code: IE/GEN/19/0020



Cara Pharmacy on expansion trail At the end of May this year, the Cara Pharmacy Group officially opened the door of its first Dublin store, located on Pottery Road Dun Laoghaire. Canice and Ramona Nicholas, Company Directors/Pharmacists, Cara Pharmacy Group

All of the pharmacy’s favourite brands arrived to be part of the fun on the day. There was a demonstration of the Skin Nerd’s cult product the Cleanse Off Mitt and Karen from Declare Skincare joined the team to give customers a sophisticated skin analysis using a hi-tech Dermotricos Skin Analysis Machine. Ronan from Spotlight teeth whitening was happy to talk to customers about the benefits of Spotlights products, and Vichy demonstrated their latest product offerings for the crowd. Revive Active were also present and perked up all the customers with samples of their products. Marissa Carter of Cocoa Brown mingled with the crowd and greeted customers, and after a thoughtful and heartfelt speech to congratulate Ramona and Canice on the opening of the group’s first store in the capital, Marissa revealed to the crowd exclusive details of her extremely exciting new makeup collection Carter Beauty, which Cara Pharmacy are delighted to announce will be sold in 8 stores across the country. Formerly the healthcare division of Hayes Conyngham and Robinson (HCR), Abbey was set up in 2009 following the sale of HCR to Boots. The business specialises in providing outsourcing pharmacy services to nursing homes, long-term care institutions and hospitals. The group, which employs 85 people, operates outlets in Dún Laoghaire in Dublin and in Bishopstown, Cork.

The new Cara Pharmacy, Dublin The premises, formerly Abbey Healthcare, were acquired by the group in 2017, and after months of preparation, hard work and remodelling Ramona and Canice along with the team invited customers to celebrate the newest addition to the Cara family with them. It was the Group’s acquisition of Abbey Healthcare that brings the Group to Dublin, and which will

also see them open stores in Cork. This was an exciting development for the Cara Brand, which will forecast employee numbers to increase from 160 to 245 and one that takes them nationwide. The doors opened at the Pottery Road store for a special champagne breakfast hosted for local businesses and to introduce the local community to Cara.


Speaking on behalf of the Cara Pharmacy, Ramona Nicholas said at the time, “We have been searching for the correct site for expansion into Dublin for quite some time now, and we see Abbey Healthcare as the perfect acquisition. It is a great fit for us both in terms of location but also an amazing chance for us to develop our skills in the service of Nursing Homes. We look forward to continuing to provide the excellent service Abbey Healthcare has been providing over the years. Moving to Cork also makes us a national brand and through the statistics on our online shop, we believe our brand will continue to grow there also.”

Hepatitis C ‘ghosts’ immune system Scientists from Trinity College Dublin have discovered how the highly infectious and sometimes deadly Hepatitis C virus (HCV) “ghosts” our immune system and remains undiagnosed in many people. HCV’s main route of transmission is via infected blood but over the past 40 years it has accidentally been given to many patients across the world via infected blood products. The virus replicates particularly well in the liver, and the damage it causes makes it a leading cause of liver disease worldwide. While the majority of HCV infections are now treatable with new medicines, early detection would avoid the damaging progression to liver disease. Therefore, a group of scientists led by Assistant Professor in Immunology at Trinity, Nigel Stevenson, set out to understand how the virus avoids being discovered for months after infection. Under normal circumstances, our cells communicate with each other with molecules called cytokines, which work by activating specific cascades of other molecules within our cells called signalling pathways. These cytokines and their signalling pathways trigger the expression of hundreds of molecules within our cells to increase inflammation and anti-viral activity. This immune response is capable of killing and clearing the viral infection for our cells and bodies. Uncontrolled inflammation would be dangerous, however, so to ensure our immune response to infection is appropriately regulated, several cytokine signalling pathways are controlled by immune regulators called “Suppressor Of Cytokine Signalling (SOCS)”. After a period of time following an initial response, pro-inflammatory cytokine signalling pathways are shut down by SOCS. The Trinity scientists found that HCV “ghosts” our immune response, by triggering our own SOCS regulators; a specific part of the virus is responsible for increasing a specific SOCS molecule, in both liver and immune cells.



Cleary’s Pharmacy go JAM friendly A Skibbereen pharmacy has signed up to a new initiative to ensure customers with special needs, autism or communication difficulties have their needs met. The roll out of the JAM card initiative is being sponsored by McLernons. Cleary’s Pharmacy in Skibbereen is now JAM friendly

CVD among leading causes of death Heart disease and stroke were among the leading causes of death in 2018, according to the latest data from the Central Statistics Office (CSO). The CSO Vital Statistics Yearly summary 2018, found that cancer, diseases of the respiratory system, heart disease and stroke were responsible for almost three in four deaths last year.

Dan Cleary Pharmacy on the town’s main street has become a JAM card friendly business which allows people with special needs to discreetly flag that they need ‘Just A Minute’ when in customer service situations, through information on a small plastic card. The social innovation was set up in 2012 by the NOW Group, an organisation that supports people with learning difficulties and autism into employment. It was their service users who said they would like a discreet way of telling people that sometimes they need a little extra time and patience.

A JAM card is a small plastic card, about the size of a credit card, which on one side says ‘Just A Minute’ and on the other side allows the holder to choose their own message e.g: ‘I have autism/ Asperger's, I have dementia/ memory problems’ which they can present to staff members. McLernons Show Support McLernons are supporting JAM card training in every customer’s pharmacy in Ireland. Managing Director Keith McLernon says, “The JAM Card is a fantastic initiative which has already gained great traction since its launch a

few months ago. As a company, McLernons are always keen to help support our customers look after their patients and sponsorship of the JAM Card and picking up the cost of the training makes perfect sense to us. We are delighted to be sponsoring the roll out of the JAM card throughout community pharmacies in Ireland.” McLernons are sponsoring JAM Card e-learning for all their customers in Ireland, north and south, for up to three members of staff. The training is a multiple choice questionnaire of 15 questions, and you get 3 attempts to pass. Anyone interested in getting involved in this initiative is asked to email ‘JAM@mclernons.com’ with the names of their three members of staff and Anne Marie or Helen will be in touch with a link to the email addresses needed for the training.

World No Tobacco Day Marked There are now approximately 80,000 fewer smokers in Ireland than there were three years ago. This is one of the statistics to be revealed with the publication of the 2018 Annual Report on the Tobacco Free Ireland Action Plan. Marking World No Tobacco Day, Minister for Health Simon Harris and Minister of State with responsibility for Health Promotion Catherine Byrne welcomed the publication. A high-level action plan for Tobacco Free Ireland was published in March 2015 and one of these actions committed the Department of Health to publish an annual report on the implementation of the plan. Speaking, Minister Harris said, “Ireland continues to play a proactive role in the global fight against the burden of tobacco use. In recognition of this role, Ireland has been chosen as the host of the next World Conference

on Tobacco or Health in 2021, the premier conference on tobacco related issues. “One of the strengths of Tobacco Free Ireland is its collaborative approach across governmental and non-governmental sectors to tackle tobacco use and the results of that collaboration are evident in the progress made across all the recommendations in Tobacco Free Ireland. “We continue to make steady progress in the fight against tobacco consumption, but we still have significant work to do. I believe working with our European colleagues will help us in this regard and assist us in making a real and substantive


change to the health and wellbeing of the country.” The 2018 Annual Report outlines several key achievements in 2018, including: • the successful bid to host the World Conference on Tobacco or Health in 2021, • the establishment of a multidisciplinary guideline development group to develop national clinical practice guidelines for diagnosis and treatment of tobacco addiction, • engagement with the Central Statistics Office in relation to the inclusion of a question on smoking in Census 2021.

Overall there was a total of 31,116 deaths registered in 2018, of which 15,967 were male and 15,149 were female. The 2018 total is 2.1% higher than in 2017 when 30,484 deaths were registered. Heart disease and stroke recorded by the CSO as “diseases of the circulatory system,” accounted for 8,938 or 28.7% of all deaths. Cancer was responsible for 29.6% or 9,198 deaths while diseases of the respiratory system accounted for 4,165 or 13.4% According to the report “The leading cause of death in 2018 varied widely by age group. Among those aged from 15 to 34 years, external causes of death including accidents, suicide and other ranked first (265 deaths). Among individuals aged 35-74, cancers were the leading cause while for those aged 75 and older, it was diseases of the heart and arteries.” Of the 8,938 lives lost to heart disease and stroke in 2018, 4,140 were due to ischaemic heart disease and 1,680 to cerebrovascular disease or stroke. Of the 4,140 lives lost to ischaemic heart disease the cause of death in 1,740 people was “acute myocardial infarction” also known as a heart attack. More men died from heart attack in 2018 compared to women with the data showing that acute myocardial infarction was the cause of death for 1,048 men compared to 692 women. At 31,116 the total number of deaths registered in 2018 is 10.4% higher than in 2008 when 28,192 deaths were registered. There were 25,633 deaths of persons aged 65 and over registered in 2018 and this accounts for over four-fifths of all deaths registered in 2018.

Embracing eMental Health A solution to Ireland’s Mental Health crisis?


ental health problems cost the Irish economy over ¤8.2 billion annually, according to the latest OECD report.

Ireland has one of the highest rates of mental health illness in Europe, ranking joint third out of the 36 countries surveyed in the annual Health at a Glance report. Some 18.5% of the Irish population was recorded as having a mental health disorder, such as anxiety, bipolar, schizophrenia, depression, or alcohol or drug use, in 2016. Rates of depression were also well above the European average for both men and women in Ireland. With such shocking statistics, it makes sense that the HSE has been looking into solutions to long-term problems such as high

waiting lists and costs which are spiralling Ireland into a mental health crisis.

deliver new and innovative mental health services effectively,” he said at the time.

Speaking last year at the launch of a report on eMental health funded by Mental Health Reform and the HSE,Minister of State for Mental Health Jim Daly announced that the HSE are rolling out an eMental health strategy to address the mental health services staff shortage.

E-mental health is the use of information and communication technologies (ICT) to support and improve mental health, including the use of online resources, social media and smartphone applications.

“We are living in a rapidly changing world and an age of information, where technology plays a significant role in our everyday lives. As reports like this emphasise, such technology also provides us with opportunities to

Greater use of information and technology could help us address some of the resource challenges within this field. Many believe that E-mental health also has the potential to support cultural transformation and a move towards a social model of health,

by empowering service users to exercise greater choice and control and to manage their own conditions more effectively. But how can healthcare professionals in Ireland, including community pharmacists, make the most of opportunities offered by e-mental health to not only improve efficiency, but also to transform the nature of mental healthcare itself? In this Special Report, Irish Pharmacy News explores the concept in more detail. We also take a look at how mental health providers and others are already embracing e-mental


with the pervasiveness of the internet, smart-phones and other technologies. The report also clearly states that e-Mental Health is not a panacea. Care and consideration is required in the design and delivery of services, and it is imperative that the services offered are clinically appropriate.

Dr Shari McDaid, Director, Mental Health Reform health to bring about change. The OECD report shows that some 28% of Irish children aged between 11 and 15 years reported being bullied in school, while 14% were cyberbullied. These figures were close to the EU average. The report makes the case for giving greater priority to mental health across Europe, where one in six people – 84 million – had a mental health issue in 2016. More than 84,000 deaths in EU countries were attributed to mental illness or suicide in 2015. The economic and social costs of mental illness are substantial, the report points out, amounting to more than 4% of GDP or over ¤600 billion in direct and indirect costs across Europe. eMental Health – A Solution? In May of last year, Mental Health Reform and HSE published a report on eMental health prepared by WRC director Kevin Cullen, an expert on technological innovation in health and social care.1 As the report notes, eMental Health provides considerable potential for an improved service offering in Mental Health services (MHS) and offers opportunities to provide information, supports and treatment to people with mental health issues and the wider population. The MHS working model of eMental Health is underpinned by a tiered approach to provision, including: extensive web enabled information, dynamic signposting and supports for the wider population; enhanced supports such as Instant Messaging / SMS / Live chat / Telephone support for those with greater need; and finally online counselling and potentially tele-psychiatry for those with greatest need. Shari McDaid is Director with Mental Health Reform, which as an organisation has a strong interest in exploring the potential of digital technology within the mental health sphere. An example of this is their participation in the eMEN Interreg project. The e-Mental Health innovation

and transnational implementation platform North West Europe (eMEN) project is a six-country European Union partnership aiming to improve mental health in Europe through increased use of eMental Health interventions. She says, “Our aim in participating in eMEN is to enable stakeholders to develop a shared understanding of the role of digital technology within the mental health system. This means engaging with all stakeholders, from people who may use eMental Health apps and family members/carers to clinicians and service providers (both statutory and non-statutory). Digital technology may benefit individuals with mental health difficulties in a variety of ways, including helping provide wider access to services, empowering service users, and therapeutic innovation. There are also possible risks to using digital technology, especially in a field where 'talking therapies', as well as human and social support more generally, are so important.” Many Opportunities The report considers eMental health applications that may be helpful for the large numbers of people with common mental health conditions, as well as applications relevant for people with more severe and enduring conditions. Current evidence and practice suggests that eMental health offers considerable potential, and some fields of application are already quite mature. eMental health applications can help to empower people with mental health conditions to engage more effectively in their recovery through self-help, access to peer support, and new ways to participate in jointly managing treatment and recovery pathways with clinicians. They can also help mental health services to address the large treatment gaps that prevail for common mental health conditions as well as the current limitations on effective continuity of care for people with enduring conditions. More generally, traditional service models need to evolve in appropriate ways alongside the major societal trends associated


Face-to-face therapy and in-person support will continue to remain centrally important. eMental health is not designed to act as a replacement for these forms of support, but provides opportunities for innovation and service improvement. Ensuring user choice is important - some may prefer to access services in eMental health mode, others will prefer more traditional approaches; and provision of services through eMental health must target it towards those for whom it is clinically appropriate. Developments in Ireland In March this year, the Mental Health Reform eMEN team in Ireland presented an overview of recent developments in the eMEN project and the eMental health field more generally at the Trinity Health and Education International Research Conference in Ireland. One of the significant features is the coming-together, in various ways, of ‘top-down’ and ‘bottom-up’ developments. eMEN has actively supported developments at both levels, and especially in fostering cross-linkages between them through information exchange, awareness-raising, stakeholder consultations, and other activities. From the ‘top-down’ perspective, initiatives by the Department of Health and the Minister with responsibility for mental health are being implemented through pilots in the Health Service Executive (HSE) mental health services at primary and secondary care levels. A number of these are building on more ‘bottom-up’ initiatives by third sector mental health organisations that have begun to provide eMental health services on their own initiative (including online counselling, online CBT programmes, and other applications). A role for community pharmacies? Next month’s issue of Pharmacy News Ireland will look at the role of community pharmacies in mental health and the opportunities for utilisation of eMental health in this context. Cullen K (2018) eMental Health State-of-theart & Opportunities for Ireland. Report funded by Mental Health Reform and HSE. Available at: https://www.mentalhealthreform.ie/ wp-content/uploads/2018/10/eMental-HealthState-of-the-art-Opportunities-for-Ireland-FullReport.pdf 1

Mental Health Commission People with serious mental illness have a high risk of heart disease yet a new report has found that people in long term psychiatric care in Ireland are not adequately monitored for serious physical illnesses, including cardiovascular disease. The report, ‘Physical Health of People with Severe Mental Illness’, found that people with severe mental illness in Ireland were being denied access to essential physical healthcare services, which the Mental Health Commission said it believed was, “both discriminatory and a breach of human rights.” For the report Dr Susan Finnerty, Inspector of Mental Health Services, reviewed the physical healthcare and monitoring of 100 residents in 10 mental health in-patient continuing care centres in 2018. Several risk factors which affect the physical health of people with severe mental illness include higher levels of smoking, lower levels of exercise, and obesity, which may be caused by the medication used to treat their psychiatric illness. According to the report, antipsychotic medication, which is used to treat people with serious mental illness, “adds to the burden of long-term physical illness mediated by iatrogenic weight gain, hyperlipidaemia and diabetes.” Adults with diabetes are also at an increased risk of dying from heart disease or stroke. People on anti-psychotic medication for serious mental illness need regular monitoring to check for a number of things including weight, blood pressure and lipids or cholesterol levels, they also require regular electrocardiograms or ECGs to monitor their hearts. Dr Finnerty said, “These findings are of serious concern and show that residents in long-term care in mental health inpatient units are not adequately monitored for serious physical illness which they have a higher risk of developing than the general population.” The Mental Health Commission has written to the HSE seeking an action plan to address the concerns raised in the report.

Dr Conal Twomey, Psychologist in Clinical Training, UCD

We (Still) Need to Talk Dr Conal Twomey, Psychologist in Clinical Training looks at the challenges within online mental health services and examines the potential towards therapeutic gains with minimal therapist involvement. Despite robust evidence for its effectiveness, psychological therapy remains difficult to access in Ireland, mainly because our mental health services are under-resourced. A potential way to increase access is to deliver therapeutic content remotely, in online self-help programmes that involve minimal therapist input and can be worked through at one’s own pace, 24 hours a day, in the privacy of one’s own home. Most existing online self-help programmes are based around the principles of cognitive behaviour therapy (CBT), a ‘gold standard’ therapy that focuses on changing unhelpful patterns of thinking and behaviour associated with emotional problems. CBT is highly structured, and this facilitates its delivery in self-help format; indeed, self-help CBT books have been in wide circulation since the 1970s. The advent of the Internet in 1990s provided an opportunity to provide CBT self-help materials online, in ‘computerised CBT’ (cCBT) programmes. cCBT has been extensively researched over the last two decades. A consistent positive finding is that adults with common mental health problems who fully engage with cCBT are likely to experience a reduction in symptoms of low mood and anxiety. There is less evidence for children and adolescents, but findings are also largely positive for this age group.

There is a major issue with cCBT however, and it concerns dropout. According to a recent review of the literature, about a quarter of people who are offered cCBT refuse the intervention, and about a third of people who begin a course of cCBT do not complete it. A similar picture emerged in my own experience with a randomised control trial of the MoodGYM cCBT programme in six Irish mental health services: 24% of contacted service users declined participation, and 57% of service users dropped out of the MoodGYM treatment condition before the trial ended.1 There is also the issue of guidance. In general, unguided (purely self-help) cCBT programmes are far less effective than cCBT programmes provided with regular guidance. The former are also hampered by higher dropout rates than the latter. Guided cCBT comes in various guises; for example, the therapist meeting with the service user before and after completion of the cCBT programme, email or telephone guidance, or the delivery of cCBT in groups/classes.The presence of such guidance has many advantages: it can lead to greater motivation and adherence, it allows the service user to ask for assistance, and it preserves some level of therapeutic relationship – a vital ingredient in standard psychotherapy. Importantly, guided cCBT also allows the service user to apply the learning of cCBT to one’s own life in the company of


a qualified professional. It can therefore lead to a personalised experience, or a feeling that the cCBT programme is of direct relevance to one’s own life. It is paradoxical that while cCBT increases access through the delivery of therapeutic content online, it requires regular clinician guidance to be reliably effective and to minimise dropout. A balancing act of sorts is therefore required for its roll-out to make sense from an efficiency perspective: compared with standard therapy, there should be less input from the clinician (in order to cut down waiting list times); however, there needs to be sufficient regular guidance to facilitate a personalised experience for the service userwithin the context of a therapeutic relationship. Whether this balancing act is worth the effort is questionable: why risk the potential downgrading of therapeutic experience for the sake of minimally increasing access and efficiency? Another way to approach this conundrum is to not provide cCBT in place of pre-existing evidence-based interventions; rather, cCBT could be provided as an additional intervention option that some service users may wish to avail of before, during, or after, the receipt of usual care. This approach would maintain service quality, while providing the minority of service users who are likely to fully engage with

cCBT with the chance to benefit from it. It would also give service users greater choice in their care; for example, some may choose cCBT over standard therapy due to the greater privacy it provides. In a similar vein, cCBT might be well-placed as a population-level intervention, available to all in work, educational and clinical settings, as well as the on the Internet more generally. The Australian National University provides a list of evidence-based cCBT programmes, some of which can be accessed free-of-charge (https://beacon.anu.edu.au/). On a final note, an interesting recent development has emerged in the cCBT field: the advent of tailored cCBT programmes. Content here is tailored to individual preferences - unlike previous ‘one-size-fits-all’ cCBT programmes - and specific content is displayed based on the answers that users provide to certain questions. Through this tailoring of content, a personalised experience may be provided, and this may facilitate the application of learning directly to one’s life. My colleagues and I recently conducted a meta-analysis on a German tailored cCBT programme called Deprexis.2 Results were promising: dropout was relatively low (26%) and the programme was effective in the reduction of depressive symptoms. Although still in their infancy, tailored cCBT programmes could have the potential to maintain therapeutic gains with minimal therapist involvement, a goal that most cCBT programmes have so far failed to achieve. References 1. Twomey, C., O’Reilly, G., Byrne, M., Bury, M., White, A., Kissane, S., McMahon, A. & Clancy, N. (2014). A randomised controlled trial of the computerised CBT Programme, MoodGYM, for public mental health service users waiting for interventions. British Journal of Clinical Psychology, 53 (4), 433-450. 2. Twomey, C., O’Reilly, G. & Meyer, B. (2017). Effectiveness of an individually-tailored computerised cognitive behavioural therapy programme (Deprexis) for depression: metaanalysis. Psychiatry Research, 256, 371-377.



Change and Innovation on the Retail Agenda Retail Excellence made the call-to-action at its Annual Retail Retreat & Expo, where 2,000 retailers from around the country gathered this week to attend the industry’s biggest conference. Peter Maher, Chief Operations Officer, Fergus Nugent MPSI, McCauley Pharmacist, Jackie Kelly, Trading Director, Chris McCallum, Retail Supervisor of Mahon Point Store and Richie Patton, Chief Financial Officer

“With customers increasingly shifting their spending online, it is no longer enough for a bricks-andmortar store to be just a transactional venue. Instead, it must now serve as a brand-building environment in which customers can have special, in-person experiences that can’t be replicated in digital channels” Peter Maher, Chief Operations Officer, McCauley Health & Beauty Pharmacy

Speaking at the event were Jackie Kelly, Trade Director and Peter Maher, Chief Operations Officer, both with McCauley Health & Beauty Pharmacy who gave delegates an overview as to the pharmacy group’s new format. On taking delegates through the journey of how McCauley’s reinvented the brand, Peter said “We have reinvented our brand to get closer to what our customers want and need, in order to build a future ready pharmacy brand. “Our brand is steeped in 66 years of heritage, founded in 1953, but we recognised that we needed to move forward. Who we are is still core to our brand and we have not moved away from our traditional values. However the role of the store has changed. “With customers increasingly shifting their spending online, it is no longer enough for a bricks-and-mortar store to be just a transactional venue. Instead,

McCauley Health & Beauty Pharmacy new-look layout



News Hundreds of pharmacies attended the Retail Retreat, and benefitted from the full range of presentations on the future of retail

this Friday, we want to seize the opportunity for candidates and those who will go on to become elected representatives to recognise that our biggest sectoral employer is at a turning point.

it must now serve as a brandbuilding environment in which customers can have special, in-person experiences that can’t be replicated in digital channels.” Bringing Concepts to Life In addressing bringing a logo concept to life, Peter added, “Our new experiential stores embrace a huge range of services, including leading edge hair salon and extension expert Ceira Lambert, digital photo centres, premium cosmetics and perfumery, beauty salons, and expanded healthcare services, all this in addition to the core pharmacy traditional services provided by experienced friendly McCauley pharmacy team.” So how did they get there? One route was via listening to their customers. “Research told us our

customers want to do more than just buy products in stores. We designed the strategy with them at the heart of it,” Peter said. They engaged with a brand strategist to create a new identity and the next step was in bringing this to life which they did by working with design experts in proposing the new shop layouts. “It’s a big year for us at the all-new McCauley Health & beauty Pharmacy, with enormous change and innovation on the way,” said Jackie. “Many may have heard of agile build,” she continued. “This is an approach widely used in technology developments. We are taking an agile, customer-centric approach to format re-design. We are doing this because it is quicker

and less expensive and yields faster returns on investment. “Our strategy going forward will be to focus on continually making one-off, high impact changes rather than store-wide remodels, which means we can keep our fingers on the consumer pulse and adapt quickly to evolving consumer needs. “We have had to tailor our store fronts in the shopping streets of local towns, retail parks and shopping centres but also we have tailored the services we provide, offering a unique mix of trusted pharmacist expertise giving personalised experiences that will be meaningful to secure customer loyalty.” Get Real on Retail Retail Excellence, Ireland’s largest retail representative body has called on politicians and candidates for the local and European electionsto ‘get real on retail’. Speaking at the annual Retail Retreat on Tuesday 21st May, Joe Barrett, COO of Applegreen PLC and Chairperson of Retail Excellence said, “Looking ahead to the local and European elections

Emma McCormack, Retail Manager, Dundrum, Sharen McCabe, Managing Director, Elaine O’Neill, Superintenent Pharmacist and Lisa Byrne, Superintendent Pharmacist, all from McCabes Pharmacy Group


“Retailers across Ireland are faced with rising costs of doing business including the crisis in public liability insurance, rent, rates, wage increases as well as the costs associated with preparing for Brexit.” Retail Excellence is calling for local authorities and European elected representatives to step up their support to the retail industry by committing to specific measures. “At local level, we’re looking for local authorities to roll out rate breaks to retailers, to attract the most innovative and successful retailers into town centres. “We want our newly elected Irish MEPs to champion the cause of Irish online retailers and work on initiatives and new directives that promote business as well as protecting consumer interests. “Specifically, there are opportunities to assist Irish online retailers to secure much-needed European funding for eCommerce training. Retailers should continue to be in the vanguard of campaigning for urban renewal projects, breathing new life into our towns and cities. We are asking for a town revival investment fund to be established, financed from European funding, that can target towns in trouble. “As one of the top five business lobby groups in Ireland, the Retail Excellence Public Affairs team continues to fight for retailers through our engagement with policymakers and stakeholders. We have asked our members to use every opportunity to promote retail interests when engaging with candidates in the final days of this campaign and beyond the 24th May. A strong retail industry is vital for the future of our villages, towns & cities, Retailers want to play their part but it’s time decision-makers support Ireland’s largest industry in a more meaningful way.”



Mahon Point Pharmacy ¤150,000 makeover McCauley Health and Beauty Pharmacy has reopened the doors of its newly renovated store in Mahon Point Shopping Centre, following a €150k investment.

Pharmacist, Fergus Nugent MPSI shows a customer around the new McCauley Health and Beauty Pharmacy at Mahon Point

The relaunch is part of an ongoing ¤3.5m investment programme by the Company on re-branding, re-locations and store refreshes throughout 2019 as the business pursues an ambitious growth strategy to double in size within five years. Commenting, company CEO, Tony McEntee, said, “The revamp in Mahon Point is part of our plan to enhance our offering and create a

great new in-store experience for our patrons. This rejuvenation is in conjunction with our continued commitment to excellent patient care, which the McCauley brand is famous for. The new additions to the store will allow us to do so and provide our customers with access to an extensive range of new, innovative products and services. This investment will also allow McCauley to remain the trustworthy and familiar

The Pharmacy team at McCauley Health & Beauty Pharmacy, Mahon Point with Pharmacist Fergus Nugent, M.P.S.I, centre

community pharmacy where you will find experts in front of and behind the counter. We want to remain at the heart of Ireland's communities where we can provide local people with expert health and beauty advice and refurbishments like Mahon Point help us to achieve this goal.” In addition to the full range of services already on offer at the pharmacy, the newly refurbished

store has introduced a range of services that will be of benefit to the local community including medication management and blood pressure monitoring as well as the flu vaccine. Health and wellbeing will also be top of the agenda, with the new-look store carrying a significantly enhanced and more extensive range of wellness products for customers to avail of.

Pharmacist shortages debated in the Dail The reported shortage of community pharmacists in Ireland issue was brought before the Dail recently, as Deputy Thomas P. Broughan asked the Minister for Health the steps he is taking to address it. The Deputy also asked for a report on the Minister’s plans to involve local pharmacies in the delivery of primary care services. Responding, Minister Harris stated formal consultation within this area will be continuing this year. “I wish to advise the Deputy that the employment of community pharmacists is a commercial matter for the pharmacy sector and my Department has no role in this area,” he said.

“The Deputy will be aware that the Programme for a Partnership Government contains a commitment to expand the role of community pharmacy in managing patient health, and this is an issue I intend to progress. “Work has been done in recent years on wider healthcare roles for pharmacies, including the Pharmaceutical Society of Ireland’s Future Pharmacy report, concerning expansion of professional pharmacy practice. It

is clear from this and other work that there is potential to increase the range of publicly funded health services delivered through community pharmacy. Important new services, in influenza vaccination and emergency contraception, have already been introduced. “To be funded by the taxpayer, new public health services in community pharmacy, as elsewhere, should improve health outcomes and provide

value for money and benefits for patients. Any new or transferred services should be based on sound evidence with matching improvements in governance and administration. “I recently met with the Irish Pharmacy Union (IPU) and I attended their conference in Galway and these and other issues were discussed in both forums. It is my intention that further consultation will be carried out in 2019,” the Minister concluded.




Men on the Move Evaluation As part of Men’s Health, the Men on the Move Evaluation Report has been launched, a male focused wellness programme, which was developed and evaluated to identify how best to engage men in their health and wellbeing through physical activity. The report was commissioned by the HSE to investigate how Local Sports Partnerships together with the HSE and partners could use physical activity as a hook for engaging with men about their health and wellbeing. This evaluation report highlights how the men who successfully engaged in a 12 week physical activity programme reduced their weight and improved their overall health and wellbeing. As a result, the HSE is currently increasing the roll out of the Men on the Move programme in conjunction with Local Sports Partnerships (LSPs) and Sport Ireland to twelve local authority areas and a training programme is being rolled out to support LSPs to deliver on this programme.

Male obesity has more than tripled since 1990 with currently, just 30% of men in Ireland being of ‘normal’ weight. Notably, central or abdominal obesity, which is more specific to men, is linked to a higher risk of cardiovascular and metabolic disease, and some cancers. The Healthy Ireland Survey 2016 found that over 60% of male respondents aged 35-54 years wanted to increase their physical activity levels. Strong evidence shows that physical activity promotes health and wellbeing and offers critically important protection against many of these chronic conditions (Source: RCPI). The HSE funded Men on the Move programme evaluation study sought to compare the health related outcomes of those who

took part in the programme and those who had yet to take part in the programme. For the purposes of the study, the programme was initially delivered in eight local authority areas, culminating in a celebratory 5km event in each county. Participants were evaluated at baseline and twelve weeks and followed up at twentysix weeks and fifty-two weeks. Findings indicate the strong positive value the Men on the Move programme has to the health and wellness of those involved both in the short and longer term. Body weight, BMI and waist circumference were reduced with significant health related risk reduction as a result. Dr Paula Carroll Principal Investigator says, “It’s evident that

Men On the Move appealed to many men in this study and their consistent engagement yielded many significant health and social benefits. Through increasing their aerobic fitness and reducing their waste circumference in particular, cardiovascular disease risk was reduced by between 8 and 20%. Most importantly, men reported that they had fun while participating. Allowing men to participate at their own pace among a group of male peers in their local community created a goodenvironment where they could learn about physical activity and health and achieve things they never thought they could do. It’s absolutely fantastic that the HSE and Sport Ireland are supporting the national roll out of this programme for the benefit of all men in Ireland.”

Training Academy on the road Fleming Medical, Ireland's number one first aid supplier to Irish Pharmacies had its Training Academy on the road again recently in four locations, namely Sligo, Donegal, Athlone and Dublin. Each training day consisted of two workshops; in the morning an OTC first aid workshop was delivered by the Irish Red Cross and covered key topics such as sprains/ strains, bleeding, choking and recovery position, while in the afternoon the advanced woundcare workshop was delivered by Mary Martin, Woundcare Education Consultant. Mary covered topics such as the wound healing process and the right dressing for the right wound. Commenting on the Training Academy, Kieran Quinn, Training Manager with Fleming Medical said, “We were delighted with the strong turnout at each of our workshops recently, we believe that training and product knowledge are essential for pharmacists & OTC teams in the first aid category.”

Pictured above are those who attended the Fleming Medical Training Academy. Pictured left is Barretstown Med Shed


Fleming Medical will hold a second series of training workshops in the Autumn at various locationsaround the country, for information/ registration please e-mail kieran@flemingmedical.ie. Barretstown‘Med Shed’ set for another Season Since 2010, Fleming Medical has been donating medical supplies to Barretstown’s onsite Med Shed. The “Med Shed” is the camp's

Medical Centre, it is designed to be a sheltering, friendly environment to provide care for minor injuries, general paediatric problems, and administer oral medications including oral chemotherapy, IV push chemotherapy and factor infusions. Barretstown rebuilds the lives of children affected by childhood cancer and their families through a medically endorsed, activity-based programme. Volunteer doctors and nurses from around the world join Eimear Kinsella, Nursing & Family Liaison Director and for each session during the summer. Mark Fleming, MD of Fleming Healthcare says, “We are delighted to again donate to the Med Shed at Barretstown, the work that Eimear and the team do there is fantastic, it’s hard to believe we have been working with the team for the last nine years.” Eimear Kinsella, Nursing & Family Liaison Director adds, “Having this donation for the Med Shed is great help for us here in Barretstown as we get geared up for the summer - we really appreciate the annual donations from Mark and all at Fleming Medical.”

BE HEAD LICE-FREE in time for back-to school

Eliminates head lice & eggs Detects & prevents infestation Hygienic & mess-free As easy as combing

Available in Store

Visible Results after treatment

THE HEAD LICE LIFE CYCLE Eggs hatch into nymphs

DAY 0 Eggs

Nymphs mature into adults

DAY 10 Nymphs

DAY 20 Adults

An adult female louse can lay up to 200 eggs in her lifetime! The head lice life span is approximately 30 days.

THE 4-STEP TREATMENT GUIDE DETECTION Check the hair and scalp for any signs of head lice, nymphs, eggs or red sores.

Use the V-Comb to check

ELIMINATION Use the V-Comb to remove adult head lice, nymphs and live eggs.

Comb daily for 1 to 3 days

BREAK THE CYCLE Comb for possible missed eggs, newly hatched nymphs or new head lice.

Comb on the 7th day



Check with the V-Comb again for possible new lice picked up from others.

Use once per week if needed

Educating pharmacy on the Back to School Market


s summer comes to a close, there is always a lot to be done to get kids ready to go back to school. Parents can help their kids have a great school year by making sure they are healthy and ready to learn, because healthy students are better learners.

However, getting kids ready to start the school year involves more than finding the perfect backpack, buying school supplies, and shopping for new clothes. It means safeguarding their health so they’ll be physically ready for the challenges. For community pharmacists, the event leads to opportunities for effective front of shop category management. Now is the time for retail pharmacies to get ready for the onslaught of pharmacy needs that crop up among their younger patients as they return to school. Children, ‘tweens, and teens cannot be underestimated, and need to be treated with importance. Pharmacists have a key role to play in advising the younger generation on how to take medications and how to stay away from toxic medications. Back to school is an opportune time to enhance that discussion.

Providing customers with easy to navigate back-to-school sections in community pharmacy, with relevant point of sale and prominent window displays during August and September, will help remind parents and carers that preparation is key when it comes to the management of back-toschool self-treatable conditions. In addition, many parents worry about whether they should keep their children at home or send them to school when they are ill. Pharmacy teams should be prepared to ask appropriate questions and offer advice to help them to make that decision. For example, does the child seem well enough to carry out the usual day-to-day activities they would at school, or is their condition serious or contagious enough to be passed on to classmates or teachers? Helping people to make such decisions will add to their self care skills and knowledge for managing coughs and colds.


Highlighting the availability of products, giving advice for back to school ailments and communicating the principles of self care to parents is an important service that community pharmacy offers families as the first port of call. From head lice and rotavirus, to stomach upsets and cold/ flu symptoms, there are many self-treatable conditions that can hit families hard when September comes. Consider these commonly presented concerns when thinking about your front of shop and category management within the community pharmacy. Head Lice While several health concerns come to the forefront as students head back to their classrooms, head lice seems to top the list at most pharmacies. Head lice are tan to grayishwhite, 6-legged, wingless insects

typically measuring 2 mm to 3 mm in length, or about the size of a sesame seed. Because lice crawl and do not jump, head-to-head contact is the primary route of transmission. Once on the scalp, lice attach eggs to the base of hair shafts a few millimeters from the scalp surface. Once laid, eggs hatch within 9 to 12 days, and the resulting nymph matures into an adult louse over the subsequent 9 to 12 days, for a full reproductive cycle of approximately 3 weeks’ duration. Typical signs of head lice are usually itchiness on the scalp, around the ears and the back of the neck. However, some people may experience no symptoms at all. Because lice eggs are located on hair shafts approximately 4 mm from the scalp, it is often easier to identify eggs by searching at the back of the hairline, where they are

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most visible. Research suggests that wetting hair before combing improves diagnostic reliability. There are several methods that can be recommended for managing a head lice infestation. Pharmacy teams should help customers choose the most appropriate product for their child because not all treatments will be suitable for everyone. Understanding a person’s preference, medical and drug history, the product’s active ingredient, how the active ingredient works, how the product should be used and if anything has been tried previously will allow pharmacists and pharmacy staff to recommend and help parents choose the right head lice product. Mechanical removal involves systematically combing the whole head of wet hair with a detection comb to remove the lice. The comb must be cleaned after each pass through the hair to remove lice and eggs, which is best done by wiping it on clean white paper or cloth. The process must be repeated every few days for two weeks. Products containing dimeticone or isopropyl myristate kill the lice through physical action. Dimeticone coats the surfaces of head lice and suffocates them, while isopropyl myristate dehydrates head lice by dissolving their external wax coating. The advantages of these products are that they are easy to apply, they have few side-effects, are odourless or have only a faint perfume, and the head lice are unlikely to become resistant to them. Instructions must be followed exactly otherwise the treatment won’t work. Some of these products don’t kill louse eggs either, so it is vital that the treatment is repeated after a week to kill any lice that have hatched since the first application. Many parents are looking for allnatural remedies, so it would be wise for pharmacies to stock up on both traditional and alternative choices. It’s also important to alert parents to this topic, as they need to be inspecting their children for ticks and lice and so whilst stocking up on head lice products, education shouldn’t be missed. Make sure head lice products are prominently displayed, along with educational brochures. Remind parents that their children should not share hats and also point out places where lice can be contracted.

Sports, Allergies & First Aid

Heavy bleeding

Partner Inequalities

The sun may still be out, and September historically sees some of our sunniest weather, so children will be out playing sports during school. This increases the risk of not only sports-related injuries but also exposure to allergens.

 Use sterile gloves G Apply direct pressure to wound, using a clean absorbent pad

Therefore it is important to have a healthy supply of allergy products on hand, such as nasal sprays and antihistamines. Exercise-induced asthma can also surface and so pharmacies should advise on the importance of having a rescue inhaler on hand, both at home and in school. This is expecially true for children ages 4 to 9.


A new study from Empathy Research, commissioned by MSD Ireland, has revealed a range of stark inequalities among male and female partners as 9 in 10 Irish women shoulder the burden of care for sick children. The research revealed insights into the attitudes and impact that chickenpox has within Irish households. According to the nationally representative survey, 72% of parents with dependent children claim that their household has been impacted by the Varicella Zoster Virus or Chickenpox.

Sports-related injuries will also be common and so ensure your pharmacy is stocked with a ready supply of external analgesics and hot and cold treatments. First aid is easy to learn, easy to remember and easy to do. Pharmacists have the opportunity not only to demonstrate how easy first aid is, but also to advocate for the public to learn more themselves It’s important that pharmacy staff keep up to date with first aid training, including administration of adrenaline/ epinephrine auto-injector COMMON TIPS Cuts and grazes  Wash and dry hands; put on sterile gloves  Clean minor cut/graze under running water or saline solution to remove dirt. Don’t wash a wound that’s bleeding heavily  Pat dry with sterile dressing or clean, lint-free material  Cover with sterile adhesive dressing  Don’t remove embedded objects – get medical treatment Burns/scalds  Cool the burn under cold running water for at least 10 minutes.  Cover burnt skin with cling film or clean plastic bag  Treat pain with analgesics  Any burn larger than a postage stamp, or a deep burn, needs medical attention

 Elevate limb to slow bleeding  Bandage pad in place  Seek medical help

Infections The threat of infections cannot be minimised. Pharmacies should ramp up their supply of antibiotics at this time of year. Children get back together and start spreading infections so the use of antibiotics is expected to increase. Common infections presenting to the pharmacy in September will be dermatologic infections, such as ringworm and athlete’s foot, as well as eye, ear, nose and throat infections. It’s important to communicate to younger customers the importance of taking their antibiotics as they are prescribed. It’s especially important that children between the ages of 4 and 12 are given the proper instruction with their parents at their side. Empowering the children and their caregiver can help increase compliance. Most ear infections clear up within a couple of days. Paracetamol or ibuprofen (appropriate for the child's age) can be used to relieve pain and high temperature. Do not give aspirin to children under 16 years old. Antibiotics are usually only needed if symptoms persist or are particularly severe. Sore throat symptoms are easily recognised. The throat hurts and is irritated, swollen, or scratchy. Pain increases when sufferers swallow. They may also have tenderness in their neck. Strep throat is an infection caused by a type of bacteria (group A streptococcus). Strep bacteria cause almost a third of all sore throats. Strep throat usually needs treatment with antibiotics. With the proper medical care and plenty of rest and fluids most kids get back to school and play within a few days. Symptoms of strep throat include:


• sore throat

 Cool area with ice pack wrapped in towel or cold compress

• fever

 Arnica cream/gel may help bruising heal faster

• red and swollen tonsils • painful or swollen neck glands

The research also revealed that when it comes to the primary care giver, inequalities exist amongst Irish female and male parents when it comes to taking days off work to care for a sick child. 9 in 10 Irish women claim to be the primary care-giver at home when a child falls ill, compared to only 28% of men, with 56% of women claiming they are more likely to take days off work when their children are ill instead of their partners. The impacts of chickenpox go beyond just the physical symptoms with almost 2 in 5 (37%) parents claiming that they were forced to take between four to six days off work when their child(ren) got chickenpox. Almost a quarter (23%) of parents were forced to take as many as seven days or more off work. According to latest CSO figures, the average daily income per person is ¤146.37. This translates to a loss of over ¤878 for the majority of Irish households as a result of chickenpox and almost ¤1,025 per household for the 23% of parents that are forced to take seven days off work. Almost 9 in 10 (86%) of adults claim to be aware of the risks and complications associated with chickenpox, with 1 in 6 (16%) claiming to be very aware. While incidences of risks are low among parents surveyed, the complications arising from chickenpox, in some cases can be life changing. Of those surveyed, 13% claim that their child had been impacted by complications of chickenpox. There is no cure for chickenpox. The virus usually clears up by itself without any treatment. However, there are ways of easing the itch and discomfort. Although preventative measures exist for chickenpox, almost two thirds of parents with dependent children (64%) claim that they are not aware or not sure of how they could protect their child(ren) against chickenpox.


Priority Health Irish mothers are prioritising their children’s health over their own according to a new survey by Pregnacare. The fact that 92% of mums say their children come first won’t be a surprise to anyone, as mums tend to focus on the needs of their baby as soon as they arrive into the world. However, Pregnacare has teamed up with Aoife Hearne, mum of three and dietitian to ensure mums also look after themselves and have all the nutrients they need to remain healthy and strong post-pregnancy to look after their little ones. Interestingly, the Pregnacare survey showed that Vitamin B12 was the one nutrient that respondents were most unaware they needed an extra amount of. In fact, one fifth (20%) of mums say they didn’t realise it was important to increase your intake of Vitamin B12 in a bid to help combat tiredness and fatigue. And, with 63% of respondents saying that tiredness was the most challenging aspect of their pregnancy, it is important that women get enough Vitamin B12 during pregnancy.

Kids who do have strep throat might get other symptoms within about 3 days, such as: • red and white patches in the throat • trouble swallowing • a headache • lower stomach pain • general discomfort, uneasiness, or ill feeling • loss of appetite • nausea • rash Strep throat is very contagious. Anybody can get it, but most cases are in school-age kids and teens. Infections are common during the school year when big groups of kids and teens are in close quarters. Children who present with a scaly

round patch on the side of their scalp or elsewhere on their skin, and they seems to be losing hair in the same area of the scalp, the problem may be the contagious infection known as ringworm or tinea. This disorder is caused not by worms but by a fungus. Scalp ringworm often is spread from person to person, sometimes when sharing infected hats, combs, brushes, and hair clips. The first signs of infection on the body are red, scaly patches. They may not look like rings until they’ve grown to half an inch in diameter, and they generally stop growing at about 1 inch. A child may have just one patch or several. These lesions may be mildly itchy and uncomfortable. Scalp ringworm starts the same way the body variety does, but as the rings grow, the child may lose some hair in the infected area.


Certain types of scalp ringworm produce less obvious rings and are easily confused with dandruff or cradle cap. Cradle cap, however, occurs only during infancy. A single ringworm patch on the body can be treated with an overthe-counter cream. A small amount is applied two or three times a day for at least a week, during which time some clearing should begin. If there are any patches on the scalp or more than one on the body, or if the rash is getting worse while being treated, refer to their GP. Tinea pedis (athlete’s foot), corporis, cruris and manuum can all be successfully managed with over-the-counter products. Topical formulations include creams, sprays or powders. In most instances, treatment with a cream will be appropriate. Tinea capitis requires systemic therapy and if this is suspected patients should be referred to their GP.

For many women, intakes of magnesium, zinc, copper and potassium can often be below ideal levels too, meaning many are at risk of not meeting the increased vitamin and mineral requirements during or after pregnancy. While a healthy balanced diet will supply all of these vitamins and minerals, choosing a pregnancy specific multivitamin and mineral supplement, such as Pregnacare, can help boost dietary intake and ensure that mum and baby are receiving everything they need. This ties in with the Pregnacare survey results, which shows that 72% of mums say they took supplements while trying to become pregnant, with most opting for Pregnacare Conception, and this increased to 93% saying they took supplements when they were pregnant for the benefit of their baby and themselves. Once baby arrived, however, this figure reduced, with 65% saying they continued taking supplements after the birth of their baby, indicating that mum puts baby first as soon as they are born.

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8 7 6+

Lets Kids be Kids Paracetamol

Calpol Six Plus 250mg/5ml Oral Suspension, Calpol Six Plus 250mg/5ml Sugar/colour Free Oral Suspension and Calpol Six Plus Fastmelts 250mg Orodispersable Tablets. Calpol Six Plus 250mg/5ml Oral Suspension, Calpol Six Plus Sugar / Colour Free Oral Suspension contains Paracetamol 250 mg per 5 ml. Calpol Six Plus Fastmelts 250mg Orodispersable Tablets: Each orodispersable tablet contains 250mg paracetamol PHARMACEUTICAL FORM: Oral Suspension. Orodispersable Tablets Therapeutic indications: Calpol Six Plus 250mg/5ml Oral Suspension, Calpol Six Plus Sugar / Colour Free Oral Suspension is indicated for the symptomatic relief of headache, migraine, neuralgia, toothache and teething pains, sore throat, influenza, feverishness and feverish colds. . Calpol Six Plus Fastmelts are indicated for the treatment of mild to moderate pain such as headache, teething pain and sore throat, and as an antipyretic (e.g. fever associated with colds and flu). Calpol Six Plus 250mg/5ml Oral Suspension, Calpol Six Plus 250mg/5ml Sugar/colour Free Oral Suspension: Child’s Age

How Much

How often (in 24 hours)

6 – 8 years

One 5 ml spoonful (large end)

4 times

8 – 10 years

One 5.0 ml spoonful (large end) and one 2.5ml spoonful (small end)

4 times

10 – 12 years

Two 5 ml spoonfuls (large end)

4 times

12 – 16 years

Two – three 5ml spoonfuls (large end)

4 times

Adults and children over 16 years

Two – four 5ml spoonfuls (large end)

4 times

Calpol Six Plus Fastmelts 250mg Orodispersable Tablets Dosage: Child’s Age

How Much

How often (in 24 hours)

6 – 9 years

1 tablet

4 times

9 – 12 years

2 tablets

4 times

12 – 16 years

2 to 3 tablets

4 times

Adults and children over 16 years

2 to 4 tablets

4 times

Adults and children over 16 years

Two – four 5ml spoonfuls (large end)

4 times

Children under 6 years: Calpol Six Plus Suspension and Calpol Fastmelts are not suitable for administration to children under 6years of age. Renal impairment: It is recommended, when giving paracetamol to patients with renal impairment, to reduce the dose and to increase the minimum interval between each administration to at least 6 hours unless directed otherwise by a physician. Patients should be advised to contact their healthcare professional before use. Hepatic impairment: In patients with hepatic impairment or Gilbert’s Syndrome, the dose should be reduced or the dosing interval prolonged. Patients should be advised to contact their healthcare professional before use. The Elderly: Experience has indicated that normal adult dosage is usually appropriate. However, in frail, immobile, elderly subjects or in elderly patients with renal or hepatic impairment, a reduction in the amount or frequency of dosing may be appropriate. For certain patient groups, a reduced maximum daily dose should be considered: Patients who are underweight (for adults, those under 50kg), Chronic alcoholism, Dehydration, Chronic malnutrition. These patients should be advised to contact their healthcare professional before use. Contra-indications: Hypersensitivity to the active substance or to any of the excipients. Calpol Six Plus Fastmelts are contra-indicated in patients with phenylketonuria Special warnings and precautions for use: Paracetamol should be administered with caution under the following circumstances: Hepatic impairment, Chronic alcoholism, Renal impairment (GFR≤50ml/min), Gilbert’s Syndrome (familial non-haemolytic jaundice), Concomitant treatment with medicinal products affecting hepatic function, Glucose-6-phosphate dehydrogenase deficiency, Haemolytic anaemia, Glutathione deficiency, Dehydration, Chronic malnutrition, Patients who are underweight (for adults, those under 50 kg), Elderly. In general, medicinal products containing paracetamol should be taken for only a few days without the advice

of a physician or dentist and not at high doses. If high fever or signs of secondary infection occur or if symptoms persist for longer than 3 days, a physician should be consulted. Prolonged or frequent use is discouraged. Patients should be advised not to take other paracetamol containing products concurrently. Taking multiple daily doses in one administration can severely damage the liver; in such cases medical assistance should be sought immediately. Serious skin reactions such as acute generalized exanthematous pustulosis (AGEP), Stevens - Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN), have been reported very rarely in patients receiving paracetamol. Patients should be informed about the signs of serious skin reactions and use of the drug should be discontinued at the first appearance of skin rash or any other sign of hypersensitivity. Calpol Six Plus: Contains sucrose and sorbitol. Patients with rare hereditary problems of fructose intolerance, glucose-galactose malabsorption or sucrose-isomaltase insufficiency should not take this medicine. Contains sunset yellow (E110) which may cause allergic reactions. Contains methyl parahydroxybenzoate (E218) which may cause allergic reactions (possibly delayed). Calpol Six Plus SF/CF: Contains 2.04g Maltitol and 1.4g Sorbitol per 5ml Patients with rare hereditary problems of fructose intolerance should not take this medicine. May have mild laxative effect. Calorific value 2.3kcal/g maltitol and 2.6 kcal/g sorbitol. Methyl and propyl parahydroxybenzoates may cause allergic reactions (possibly delayed). Undesirable effects: Paracetamol has been widely used and, when taken at the usual recommended dosage, side effects are mild and infrequent and reports of adverse reactions are rare. Skin rash and other allergic reactions occur rarely. Most reports of adverse reactions to paracetamol relate to overdosage with the drug.Isolated cases of thrombocytic purpura, haemolytic anaemia and agranulocytosis have been reported. Chronic hepatic necrosis has been reported in a patient who took daily therapeutic doses of paracetamol for about a year and liver damage has been reported after daily ingestion of excessive amounts for shorter periods. A review of a group of patients with chronic active hepatitis failed to reveal differences in the abnormalities of liver function in those who were long-term users of paracetamol nor was the control of the disease improved after paracetamol withdrawal. .Low level transaminase elevations may occur in some patients taking labelled doses of paracetamol; these are not accompanied with liver failure and usually resolve with continued therapy or discontinuation of paracetamol. Nephrotoxic effects following therapeutic doses of paracetamol are uncommon. Papillary necrosis has been reported after prolonged administration. System Organ Classification (SOC) Blood and lymphatic system disorders

Immune system disorders Hepatobilary disorders Skin and subcutaneous tissue disorders

Renal and urinary disorders Investigations

Frequency category

Adverse Event Preferred Term

Not known

Thrombocytopenic purpura

Not known

Haemolytic anaemia

Not known


Not known

Anaphylactic reaction IRE/CA/18-3235(2)



Not known

Hepatic necrosis

Not known

Liver injury



Not known


Not known

Pruritic rash


Nephropathy toxic

Not known

Renal papillary necrosis

Not known

Transaminases increased

MAH: Johnson & Johnson (Ireland) Ltd Airton Road, Tallaght, Dublin 24, Ireland. PA No. PA 330/17/2, PA 330/17/3, PA 330/17/5 Date of revision of text: March 2019. Product Not subject to medical prescription. Full prescribing information available upon request from Johnson & Johnson (Ireland) Ltd.


Magnifying the Management & Treatment for Warts P

harmacists are likely to encounter patients seeking advice on the best self-care and self-treatment options for common warts and plantar warts (verrucae). Warts are classified as non-cancerous viral infections of the epidermis and mucous membranes that are caused by the human papilloma virus (HPV). At any given time, warts affect approximately 7% to 10% of the population. Warts and verrucae are both caused by the Human Papilloma Virus (HPV). Certain types of HPV have an affinity for certain body locations, for example hands, face, anogenital region and feet. Types and Appearance Most people will have warts at some time during their life. However, they are more common in school children and teenagers than in adults. It is estimated that 4-5% of children and adolescents will have them.

develop on the hands of people who are regularly in contact with raw meat, fish or poultry for long periods of time. However, this type is rare. Warts can look different depending on where they appear on the body and how thick the skin is. There are several different types of warts. The more common types include:  common warts  plantar warts (verrucae)  plane warts

Warts are uncommon in babies and occur in equal numbers between males and females.

 filiform warts

People who have an increased risk of developing warts include those with weak immune systems, for example, following treatment for cancer or due to an illness such as HIV and AIDS, and those who have had an organ transplant. Around 50% of people who have had a kidney transplant develop warts within five years.

 mosaic warts

A type of wart that is known as a 'butcher's wart' can sometimes

 periungual warts

 whether they have rubbed or knocked the wart Warts are very contagious. The skin cells in warts release thousands of viruses, which means that close skin-to-skin contact can pass on the infection. It is also possible for the infection to be transmitted indirectly from an object, such as a towel, or by contact with a contaminated surface, such as the surface surrounding a swimming pool. It can take weeks, or even months, for a wart or verrucae to appear after someone has caught the infection. Verrucae

 the strain (type) of HPV that is responsible for the wart

Plantar warts are found on the weight bearing areas of the sole and heel. Their appearance is different from the rest of the body owing to constant pressure imparted to the sole of the foot, causing the lesion to be pushed inwards.

 factors such as whether the sufferers has a weakened immune system

Pressure of the nerve pain causes considerable pain and patients often complain of pain when

The appearance of each type of wart will depend on several factors:  where it is located on the body

walking. Tiny black dots that characterise verrucas are the thrombosed capillaries. This may not be visible until the hardened skin is shed away. They are distinguishable from corns as they have a whitened appearance and remain soft. Corns appear as hard corns (top of toes) or soft corns (between toes). Callouses appear as flattened, yellow white thickened skin and are common on the balls of the foot. Like warts, they are 1cm in diameter and can occur singly or in crops. Most pharmacies now have a consultation room. These should be utilised for performing examinations, allowing the patient to feel at ease, reduce embarrassment at the counter and make it more comfortable to remove clothing, if this is necessary. Examinations can be performed in the consulting room without the need for any specialised equipment, however on occasions a magnifying glass may be useful.


Distribution of warts is generally asymmetric, and lesions are often clustered or may appear in a linear configuration due to scratching. Treatment Goals Treatment goals for warts include effective removal that produces no scarring and prevents reoccurrence or spreading to other areas of the body or to another person. Certain patients, including those with diabetes, peripheral vascular disease, and immunodeficiency disorders, as well as those on immunosuppressive agents, should never attempt to use these products unless they have been referred to their GP. Prior to recommending the use of products for self-treatment of warts, pharmacists should always make sure that self-treatment is appropriate. Since warts are contagious, patients should be advised to wash their hands before and after having direct contact with the wart to guard against transmission of warts to other areas of the body or to other people. In addition, patients should be reminded to use a separate towel for drying the area that contains the wart to prevent warts from spreading to other areas of the body. Patients should also be warned not to manipulate the wart in any way. If plantar warts are present on the bottom of the foot, patients should make sure the wart is covered when walking barefoot. Pharmacists should always stress the importance of using wart treatments properly and note that they must be used for the duration indicated in their instructions in order to be completely effective. Patients should be told that perceptible results are typically observed within the first or second week of therapy and that complete wart removal typically occurs within 4 to 12 weeks of starting therapy. Patients should be encouraged to seek medical care therapy if the wart remains after 12 weeks of therapy or if there are signs of infection, swelling, pain, or irritation. Salicylic Acid Products Products that can be used for self-treatment of common or plantar warts include plaster/ pad vehicles that contain salicylic acid, collodion-like vehicles that contain salicylic acid and karaya gum–glycol vehicles that contain salicylic acid. Prior to recommending the use of these products, it is critical that pharmacists determine whether self-treatment is appropriate, first ruling out patients with any contraindications relevant to the use of salicylic acid. Other exclusions for self-treatment of warts include painful plantar warts, warts that occur extensively on 1 area of the body, and warts that

occur on the face, fingernails, toenails, or genitalia. Patients with these types of warts should be referred to a dermatologist for further treatment. In addition, topical salicylic acid should not be used on irritated or infected skin. Poor methodology is the reason why treatment sometimes fails. Compliance with treatment has also been identified as a limiting factor in the cure rate for warts and verrucae. The affected area should be hydrated first by soaking in warm water for five minutes before application of a product containing salicylic acid. It is very important in the management of warts and verrucae that good skin is protected. This can be achieved by applying petroleum jelly eg Vaseline on the surrounding skin followed by application of treatment on wart or verrucae. Cryotherapy Products These are best for warts on hands. Cryotherapy has been used for several years and it used to freeze the wart. OTC products, marketed as home cryotherapy treatments, are available for home use. In offering guidance, patients should be advised to always adhere to the directions provided with these products, since improper use can cause damage to adjacent unaffected areas of the skin. Warts typically fall off 10 days after the application of the cryotherapy agent. A persistent wart can only be treated 3 times using these products. Formaldehyde is used for the

treatment of verrucae. It is an irritant so is less suitable on hands. However, the thickened layer of skin on feet protects against this irritant. It is a gel formula. Glutaraldehyde is also used for treatment of verrucae and should be used twice daily. It is available in 5% and 10% percent strengths. It should not be used for anogenital warts only verrucae. It stains skin brown, although this is reversible. Different Diagnosis Warts and verrucas are not difficult to diagnose in the pharmacy. However, pharmacists must be able to recognise other similar conditions that look like warts and verrucae. These could include: • Flat warts • Molluscum contagiosum • Corns/calluses • Basal cell papilloma (seborrheic wart) • Basal cell carcinoma Referral to another healthcare professional should be made in the following cases: • Anogenital warts • Multiple and widespread warts • Lesions presenting on the face • Patients >50yrs presenting for the first time • Diabetic patients • Bleeding/itching warts • Changing shape/colour

Key Facts • Warts typically appear on the fingers, hands and around the nails • Warts and verrucae are both caused by the Human Papilloma Virus • They are more common in school children and teenagers and are uncommon in babies • Plantar warts are found on the weight bearing areas of the sole and heel • Treatment should be stopped if skin shows signs of infection or inflammation • Those with a wart lasting more than 12 weeks post treatment, or recurrence of a wart, should be referred to their GP • Warts are very contagious and can be spread through direct or indirect contact via contaminated surfaces

• If not resolved within three months




The End of support for Windows 7 – what this means for your pharmacy Tuesday 14th January 2020 is an important date for all pharmacies who use Windows 7 systems – and for McLernons customers we estimate that there are as many as 2200 Windows 7 systems in operation. From 14th January next year all updates, features and support will come to an end for Windows 7 users. Keith McLernon, Managing Director, McLernons “When an operating system (OS) enters it’s ‘End of Support’ phase, it is increasingly vulnerable to security risks. Where that OS is hosting personal data or is connected to a network where the processing of personal data occurs, it can pose a threat to the confidentially, integrity and availability of that personal data for which the business is responsible.” He added, “Article 32 of the General Data Protection Regulation tasks businesses that process personal data with implementing appropriate technical and organisational measures to ensure a level of security appropriate to the risk. A business should consider several factors when assessing their security of processing:

Every Microsoft product has a lifecycle and as new products come on-stream to replace previous versions, those older products move towards a phase where complimentary support in the form of security patches and features updates will no longer be provided. Upgrade McLernons have been in touch with their customers over the past year to advise our customers about this withdrawal of extended support for Windows 7. If you are currently using Windows 7we strongly recommend that you upgrade to Windows 10 so that you can continue to run your business with a supported operating system which will continue to receive security updates.

• The current state-of-the-art solution that is available; • The costs of implementing the new solution; • The nature, scope, context and purposes of processing that the business carries out; • The potential risks to the rights and freedoms of individuals (should their personal data be compromised).” “For those maintaining or working towards certifications such as ISO 27001, it will be a requirement to ensure that the business takes account of end of support periods for the software that they use.” “Additionally, the GDPR ensures that every business that falls in scope of the regulation needs to consider the threat that unpatched and potentially vulnerable operating systems pose to the

Data Protection Consequences There are also a number of Data Protection consequences for those Data Controllers (pharmacy) who continue to use Windows 7 systems when they are no longer being supported by Microsoft. David O’Sullivan, the McLernons’ Data Protection Officer, outlined these issues.


personal data that those systems process and to take appropriate measures to mitigate the risks.” Office 365 Keith McLernon, Managing Director of McLernons added, “For those running Office 2010, support is ending 13th October 2020. With an Office 365 subscription, managed by McLernons, you’ll always have access to the latest versions of Office at no additional charge. You’ll get the latest and greatest features without having to uninstall and reinstall Office on your computers. In addition Microsoft is constantly making upgrades to features across programs – you’ll get access to those, too. “Older versions of Office such as Office 2007, Office 2003 and Office XP are not certified compatible with Windows 10. Support for these versions expired October 2017, April 2014 and July 2011 respectively. We believe there are over 300 installations of these unsupported versions of Office within our customers’ community pharmacies.” Microsoft There is a huge information about the end of support for Windows 7 on their website, https://www.microsoft.com/en-us/ microsoft-365/windows/end-ofwindows-7-support, which details your upgrade options and has a small business checklist which may be of use. The team at McLernons strongly urge that you contact our helpdesk on 1890 886001 to find out how many Windows 7 systems are operating in your business and obtain advice on how to upgrade to Windows 10.

What is the difference between Windows mainstream support and extended support? For the first five years or so of a Windows system Microsoft provide mainstream support, where the security updates are provided, new releases are issued and bugs are fixed. After this period the product is downgraded to ‘extended’ support, with no new features though bug fixes, etc will be issued. This is the period that Windows 7 is currently in. What does end of support mean for me? After January 14, 2020, if your PC is running Windows 7, it will no longer receive security updates and Microsoft customer service will no longer be available to provide Windows 7 technical support. It is vital to the running for your business and your dispensing system that you upgrade to a modern operating system such as Windows 10, which can provide the latest security updates to help keep you and your data safer. Can I upgrade my existing PC to Windows 10? To take advantage of the latest hardware capabilities, we recommend moving to a new PC with Windows 10. What happens if I continue to use Windows 7? You can continue to use Windows 7, but after support has ended, your PC will become more vulnerable to security risks and viruses. Windows will continue to start and run, but you will no longer receive software updates, including security updates, from Microsoft. Will Internet Explorer still be supported on Windows 7? Support for Internet Explorer on a Windows 7 device will also be discontinued on January 14, 2020. As a component of Windows, Internet Explorer follows the support lifecycle of the Windows operating system it’s installed on. See Lifecycle FAQ – Internet Explorer for more information.


Microsoft will stop supporting Windows 7 from 14 January 2020, which is just over six months away!

This means: • No more security updates • Other software companies will stop supporting it too • New hardware may not work We would strongly recommend all our customers still using Windows 7 to speak to us immediately about upgrading their software and moving to a new PC with Window 10. Failure to do so could mean that your dispensing system slows down or fails to work completely From 18th April you will have started to see pop-up notices on Windows 7 machines advising that all support will end in January. Failure to upgrade will mean using a system that is more and more vulnerable to security risks. New technology will improve your efficiency and reduce your risks. We can help you make a decision. Ask any of our McLernons team today.



McCabes Pharmacy publish sunscreen research A recent survey conducted by McCabes Pharmacy found that only 12.3% of people knew that UVB rays burn skin and UVA rays age skin, while 15.5% said they only vaguely knew the difference between both types of radiation. Sharen McCabe, Managing Director, McCabes Pharmacy Group

adds, "As well as using a broadspectrum sunscreen that protects skin from UVA and UVB rays, use wide-brimmed hats, sunglasses and sun-protective clothing to avoid sunburn.” Sunscreen should be applied 20 to 30 minutes prior to direct sun exposure and re-applied generously every two to three hours while in the sun for maximum protection. Sunscreen should not be applied to babies until they are at least six months old. Before this age, keep the infants in the shade and dress them in light-weight clothing.

However, a fifth (20.9%) of those that took part in the study mistakenly believed the opposite was true, while 51.3% confessed to not knowing at all.

Therefore, I advise sunscreen to be worn to sun-exposed sites all-yearround, especially on the face, ears and backs of the hands throughout the winter," Dr Nicola Ralph added.

Reportedly, overexposure to UV radiation is the cause of nearly 90% of melanomas. It can also lead to sunburn, prickly heat, rashes, and rosacea.

Previous research found that regular sunscreen application can reduce the occurrence of melanoma by 50–73%. It's important to choose a sun cream that protects skin from both types of UV rays.

According to Dr Nicola Ralph, consultant dermatologist at Blackrock Clinic, UVB is most intense in Ireland from May to October but UVA radiation is present all year round. "Technically the only month in Ireland when UV radiation is not strong enough to cause sun damage to the skin is January.

Advice for Customers Sunscreen bottles should be stickered with the date of initial use, as these types of products usually expire within one-two years of opening. Lisa Byrne, Superintendent Pharmacist with McCabes

Dr Nicola Ralph adds, "Ideally introduce the idea of applying sunscreen regularly to children from a young age so that they associate it with a routine and are less against having it applied as they grow older. "Avoid having children in direct sun between 10am and 2pm especially when UV radiation is most intense." However, the use of sun cream combined with excessive sweating can block the sweat gland pores, and cause highly itchy heat rashes, also known as prickly heat. Pharmacists should suggest antihistamine tablets, calamine lotion or hydrocortisone cream. However, not all of these options are suitable for children or pregnant women. The data was gathered in May 2019 via an online survey among 1,000 people living in Ireland.

United Drug 2020 Pharmacy Show The United Drug 2020 Pharmacy Show will take place on Sunday 19th and Monday 20th April, 2020 in the Citywest TheConvention 2020 Centre, Dublin 24.


For further information please contact Laura Payne, Brand and Trade Marketing Manager, United Drug via email at: pharmacyshow@united-drug.com or via telephone on: 087 383 2297


Date for your Diary

¤11.7m in confiscated travel items New research commissioned by Sudocrem has revealed that Irish people have lost ¤11.7 million in confiscated items whilst travelling with carry-on bags in the past year. The research, launched as part of Sudocrem’s ‘Life’s Little Travel Emergencies’ campaign, found that deodorants were the most confiscated item at airport security (36%), followed by body lotions and shampoos (30%), hand, face and eye cream (23%) and perfume (22%). Whether planning a fun city break or a lush retreat this Summer, packing a bag for the trip can be a stressful experience and as Sudocrem’s research demonstrates, Irish people are getting caught out last minute at airport security. Sudocrem wants to help the Irish nation pack smarter and lighter this Summer, with the ideal travel companion - a smaller, more convenient 15g pot for Life’s Little Emergencies – which is the perfect size to fit in to travel bags to soothe and protect skin, on the go. Speaking about the launch of Sudocrem’s ‘Life’s Little Travel Emergencies’ campaign, Yvonne Neeson, Senior Product Manager at Teva, said, “Sudocrem, the antiseptic healing cream has been soothing Irish families since 1931 and we’re always looking for new ways to take care of Irish families’ skin. Our portable, little 15g Sudocrem pot makes it easy to carry around, making it the perfect travel companion for the whole family, tackling any little emergencies when on the go.” As part of the ‘Life’s Little Travel Emergencies’ campaign Sudocrem have compiled some helpful tips and a travel checklist, which aims to make planning your next trip a much more enjoyable experience. Developed by Dublin pharmacist Thomas Smith, the award-winning Sudocrem formula is available from independent pharmacies, major pharmacy chains, supermarkets and selected department stores nationwide.



LloydsPharmacy partner with Irish Heart Foundation As new research reveals that people do not get their blood pressure checked regularly LloydsPharmacy is raising awareness of heart health and the positive and proactive steps we all need to take to safeguard it. Mary-Anne Sweeney, Head of Corporate Partnerships at the Irish Heart Foundation and Pat Watt Director of Sales & Marketing at McKesson Ireland Over ¤30,000 has be raised by LloydsPharmacy and its customers in aid of the Irish Heart Foundation In a recent Blood Pressure Awareness survey carried out by LloydsPharmacy it was found that nearly 40% of people haven't had their blood pressure measured in over six months or more. As part of its charity partnership with the Irish Heart Foundation, 60 LloydsPharmacy's are now Heart Health Hubs, focusing on cardiovascular risk assessments, lifestyle advice and blood pressure checks. In previous months, LloydsPharmacy has worked on

various initiatives with the Irish Heart Foundation including the provision of CPR training for Pharmacists and Pharmacy staff at the 13th Annual Pharmacy Show, in partnership with United Drug, Irelands largest pharmaceutical distributor. Those who attended the training received practical CPR training and information about how to use an automated external defibrillator (AED), allowing them to spread awareness of life-saving skills at a local level across Ireland. Speaking on the partnership so far, Pat Watt Director of Sales & Marketing at McKesson Ireland said; “We're proud to partner with such a fundamentally important Irish charity as the Irish Heart Foundation. The work done by the Irish Heart Foundation is not only commendable but necessary to prevent heart health issues and spread positive awareness across the nation.”

New research into Vitamin D A major new research programme is to investigate the vitamin D levels and bone health of Irish people. Professor J. Bernard Walsh, TCD

Health and Osteoporosis Unit at MISA, the researchers are looking forward to sharing the results of their findings ‘in due course'. Meanwhile, it was revealed that over a quarter of adults aged 50+ are deficient in vitamin D according researchers from TCD who announced their findings last month.

A team from the Mercer Institute for Successful Ageing (MISA) at St James's Hospital and Trinity College Dublin (TCD) will analyse around 10,000 blood samples from people of all ages, in order to better understand the vitamin D levels of the Irish population. The results will be released later this year in a bid to raise awareness of the importance of vitamin D to bone health.

Vitamin D is known to have a key role in bone health. The main source of it is ultraviolet B (UVB) radiation from the sun - this is why it is known as the ‘sunshine vitamin'. However this can be affected by factors such as cloud cover and seasons. "The study will focus on identifying the factors that contribute to the very low vitamin D levels that we see in a significant number of patients of all ages," explained Helena Scully, a bone research fellow at MISA. According to Professor J. Bernard Walsh, of TCD and the Bone


Over half (57%) had inadequate serum vitamin D levels, of which 26% were classed as vitamin D deficient. Vitamin D has a known role in bone health, with growing evidence for beneficial effects on muscle strength and other non-skeletal outcomes. Better understanding of factors that contribute to vitamin D deficiency is needed to identify people most at-risk. Determinants of deficiency identified in this new study were female gender, advanced age (80+ years), smoking, non-white ethnicity, obesity and poor self-reported health. Researchers therefore identified a profile of older people more likely to be at risk of vitamin D deficiency. Being of a healthy

weight, retired, engaging in regular vigorous physical activity, vitamin D supplement use, sun travel in past 12 months and summer season were positive determinants, and therefore potentially protective factors against vitamin D deficiency in older people. The findings were based on 6004 midlife and older adults, living at Northern latitudes (England, 50-55oN) derived from the English Longitudinal Study of Ageing (ELSA). Since UVB radiation (sunlight) is a known determinant of vitamin D status, this was investigated. Interestingly, residents in the South of England had a reduced risk of deficiency, compared with the North, even after adjustment for socioeconomic and other predictors of vitamin D status. This new research demonstrates that vitamin D deficiency is prevalent in older adult populations living at Northern latitudes and highlights the importance of public health strategies throughout midlife and older age to achieve optimal vitamin D status.

3 Reasons to choose ® to choose 3 Reasons Fresubin 2kcal Crème ® Fresubin 2kcal Crème compared to competitors compared to competitors


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Wild Strawberry If you would like to order samples, please use: Web: www.fresubinsamples.ie Email:enquiries.ireland@fresenius-kabi.com Phone: +353 (0)1 841 3030 Fresenius please Kabi Ireland 1. Fresenius-Kabi Data 2016 (available on request) If you would like to order samples, use: Unit 3B, Fingal Bay Business Park Web: www.fresubinsamples.ie Email:enquiries.ireland@fresenius-kabi.com Phone: +353 (0)1 841 3030 Date of preparation: April 2019 Balbriggan, Co. Dublin, K32 X065, Ireland Phone: +353 (0) 1 841 3030 Email: FK-enquiries.Ireland@fresenius-kabi.com Fresenius Kabi Ireland www.fresenius-kabi.com/ie Unit 3B, Fingal Bay Business Park Balbriggan, Co. Dublin, K32 X065, Ireland

Job code: EN/Fres.014.19 1. Fresenius-Kabi Data 2016 (available on request) Date of preparation: April 2019

Continuing Professional Development


CPD 104: TRAVEL VACCINATIONS This module is suitable for use by community pharmacists as part of their Continuing Professional Development. After reading this module, in the magazine or online, complete the post-test on our website at www.pharmacynewsireland.com and include in your personal CPD ePorfolio.

Author: Alan Moran is Managing Director of Hibernian Healthcare who have been PSI accredited training providers for pharmacist vaccination and injectible medicines since 2011. His company has also developed a 25 module travel healthprogramme built by pharmacists for pharmacists.

Travel Health in Pharmacy – the next frontier! 60 Second Summary If you currently provide a flu/shingles/ pneumococcal service, you will already have set up all of the infrastructure and SOPs to provide a safe service. Travel Health consultations will take longer – maybe 20-40 minutes to cover all of the vaccines and advice you want to give your patients. There may be different routes available to you to conduct the vaccination service. This may be through online doctor consultations or perhaps a regulated service may be put in place similar to the current flu /shingles / pneumococcal vaccines. One of the key aspects to providing a travel health service is to ensure that the patient is offered the right vaccines for their individual circumstances. But how do you do that? The National Immunisation Guidelines are a useful source of information and their two UK based guides to selecting vaccines – NaTHNaC and Fit for Travel (which is recommended by HSE). Cholera is caused by the bacteria Vibrio cholera. It is transmitted by the faecaloral route, usually through ingestion of contaminated water and occasionally food (usually shellfish). Symptoms may be mild or asymptomatic in healthy patients. Mild illness can last a few weeks. In over 50% of severe cases, patients can die within a few hours if untreated. Tick-Borne Encephalitis (TBE) is a viral infection that affects the central nervous system. It is caused by the tick-borne encephalitis virus (TBEV) and is endemic in most of the southern, non-tropical Eurasian forest belt. There are many good sources of travel advice including the HSE and Fit for Travel (NHS). Your patients will appreciate the advice as much as the vaccines and medication you offer.

Pharmacists who are eagerly looking forward to providing travel health services in their pharmacies are rightly looking at how best to provide a service their patients will value. The current position at the time of writing is that certain vaccines are provided on a “supply and administer” basis covered by legislation. So, what would a typical Travel Health service look like in your pharmacy? We will look at: • Is there really a need for travel health services? • Is travel health a good fit for your pharmacy? • Risk assessment - assessing what vaccines a patient might need • Some topical diseases which are vaccine preventable • Advising the patient on how to stay well when they travel

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? 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. Evaluation - How will you put your learning into practice? Have I identified further learning needs? Published by IPN. Copies can be downloaded from www.irishpharmacytraining.ie Disclaimer: All material published is copyright, no part of this can be used in any other publication without permission of the publishers and author.

Why vaccinate in the first place? You’ll be well aware of the social media frenzy around vaccines which has become a polarising feature of life in any setting where people’s health is a topic. We’re now seeing the return of measles to areas where it was rarely seen. However, the World Health Organisation and every national and international health authority strongly advises vaccination as a public health necessity and there are many safety studies available to back up this advice. HSE recommends vaccine schedules appropriate for Ireland and these include many of the travel vaccines we’ll address later. Is travel health a good fit for your pharmacy? If you currently provide a flu/shingles/ pneumococcal service, you will already have set up all of the infrastructure and SOPs to provide a safe service. Travel Health consultations will take longer – maybe 20-40 minutes to cover all of the vaccines and advice you want to give your patients. They will want your recommendations on bug sprays and creams as well as other preventatives and we will address this later too.

Setting up the service So, to set up your pharmacy for travel health consultations, it would be useful to at a minimum do the following: • Look at your SOPs and make sure you’ve covered all of the additional services you’ll be offering • Read up on the vaccines and make sure you’re ready to answer questions • Make sure you can order all of the vaccines through your regular suppliers • Have supplies of travel vaccine records available (the little yellow books are ideal for patients to carry with them) • Print off advice leaflets in advance to cover all of the topics • Plan a dummy run to go through a full consultation

CPD 104: TRAVEL VACCINATIONS • The level of risk of malaria prophylaxis and the differences between medication recommended for their area of travel • The level of risk of non-vaccine preventable diseases and preventative action that can be taken by the traveller for self-protection • What travel health advice has been discussed - bite prevention, water purification and hydration, first aid kits, travellers’ diarrhoea, altitude sickness etc. The RA form is designed to allow for recording of any vaccines that are identified as required and those administered. This can become part of the patient record and will be stored according to the information governance protocols of your pharmacy. Which diseases are vaccine preventable? It is now not a given that people in the developed world will have had a full course of childhood vaccines. We won’t go into detail here but a starting point for all travellers is that they may need to have cover against: • Tuberculosis • Diphtheria, tetanus, whooping Cough (Pertussis), Haemophilus influenzae b, polio, hepatitis B There may be different routes available to you to conduct the vaccination service. This may be through online doctor consultations, or a regulated service may be put in place similar to the current flu /shingles / pneumococcal vaccines. In any event, you’ll have either a prescription following a video doctor consultation or you’ll be able to supply and administer travel vaccines under legislation. If you’re using a video doctor service, you will have a script and the doctor will have carried out the risk assessment and prescribed appropriate vaccines and anti malarials. If you are completing the risk assessment, you’ll be asking the questions and making the recommendations! We’ll address that and then we’ll look at a couple of the weird and wonderful diseases. Risk Assessment – what are the right vaccines for your patient? One of the key aspects to providing a travel health service is to ensure that the patient is offered the right vaccines for their individual circumstances. But how do you do that? The National Immunisation Guidelines are a useful source of information and their two UK based guides to selecting vaccines – NaTHNaC and Fit for Travel (which is recommended by HSE). There are two elements to this part of the process – risk assessment and risk management. If you are carrying out a risk assessment, you should follow a format which covers • Patient details • Contact information • Medical history • Current medication • History of allergies, allergic responses

• History of fainting or needle phobia • Any mental health issues • Knowledge of any previous travel vaccinations given and dates • Special conditions, e.g. Pregnancy, seizure disorders, immunocompromised • Trip details • Destination, country (region/province, city/town) • Length of stay • Accommodation • Purpose of visit (Visiting Friends & Relations / business /holiday/backpacking/adventure / overseas aid work) • Activities This will provide a picture of the patient and the risks they will potentially face. Obviously, a mature traveller visiting a relation in a big city has a different risk profile to a young lone traveller visiting jungles and engaging in high risk activities. Following the completion of the first part of the risk assessment (RA) form by the patient, the risk management part is completed in consultation with the patient. This is the where the pharmacist, using the defined reference sources, explains the risks of each disease to the patient and assesses their risk according to the information supplied. At this stage, the information on the RA should include the following: • The level of risk to the patient during their travel from vaccine preventable diseases and whether they require a primary or booster course

• Pneumococcus • Meningococcus • Rotavirus • Measles, mumps, rubella There are many vaccine preventable diseases but we’re just going to look at three – Cholera, Japanese Encephalitis and Tick-borne Encephalitis. CHOLERA Background 1871 saw the first worldwide pandemic of cholera originating from the Ganges Delta in India. Several more global pandemics followed killing millions of people. Cholera is now a widespread disease in Africa and Asia. African countries account for 96% of these cases, particularly Democratic Republic of Congo, Liberia, Mozambique, Somalia and Uganda.  WHO estimate 1.4 – 4.3 million cases and 28,000 – 142,000 deaths worldwide every year  Treatment of cholera with oral rehydration salts will successfully treat 80% of cases  75% of cases will be asymptomatic  The incubation period of cholera is 2 hours to 5 days Cholera is caused by the bacteria Vibrio cholera. It is transmitted by the faecaloral route, usually through ingestion of contaminated water and occasionally food (usually shellfish). Outbreaks of cholera are associated with poor sanitation and unclean drinking water and therefore are most prevalent in low-resource countries in Africa (accounts for >96% of cases annually) and Asia.

CPD 104: TRAVEL VACCINATIONS Symptoms Symptoms may be mild or absent in healthy patients. Mild illness can last a few weeks. In over 50% of severe cases, patients can die within a few hours if untreated. Symptoms include sudden onset of profuse watery diarrhoea with nausea and vomiting. In severe cases patients become extremely dehydrated with electrolyte imbalance and circulatory collapse. Risk The risk of cholera to most travellers is extremely low. For most travellers vaccination against cholera is not necessary, as precautions regarding food and water hygiene are enough. Travellers should be aware of the necessity to drink clean water and avoid poorly cooked seafood in areas where outbreaks have occurred. Travellers should be advised how to treat diarrhoea with hydration and rehydration salts. Travellers such as relief workers or those who may have limited access to medical services and who may be exposed to insanitary living conditions are advised to receive cholera vaccine.



Japanese encephalitis (JE) is a viral disease causing encephalitis - inflammation of the brain.

Less than 1% of people infected with JE virus develop clinical disease. The incubation period is 5–15 days. Acute encephalitis is the most commonly recognised clinical manifestation of JE virus infection, but mild non-specific flu-like symptoms, such as fever and headache may occur. More severe illness is characterised by rapid onset of fever, headache, stiff neck, generalised weakness, flaccid paralysis and disorientation (the symptoms typical of encephalitis). Seizures are common, especially among children. The illness can progress to coma, seizures, spastic paralysis and death in approximately 20–30% of severe cases.

 The World Health Organisation estimates 68 000 cases and 13 600 – 20 4000 deaths worldwide every year.  Japanese encephalitis is endemic in at least 24 countries.  1 in 250 infections will result in severe illness.  Approximately 20–30% of severe cases will be fatal.  30–50% of survivors of severe infection will experience permanent neurological symptoms. Japanese encephalitis (JE) is a viral, mosquitoborne disease caused by a Flavivirus (the Japanese Encephalitis Virus – JE virus). JE virus is found predominantly in South-East Asia and the Indian subcontinent, with the highest incidence in rural areas. JE is transmitted to humans from animals and birds via mosquitoes. Pigs and wading birds, such as herons, are the principle hosts of the JE virus. Mosquitoes feed on these hosts, predominantly between the hours of dusk and dawn, and become infected with JE virus. JE cannot be transmitted from human to human, is seasonal and usually peaks in summer and autumn. Global incidence of JE is currently unknown. Each year more than 3 billion people in endemic countries are at risk of JE infection. It is estimated that 68,000 clinical cases of JE occur annually in 24 endemic countries in South-East Asia and the Western Pacific, with China (excluding Taiwan) accounting for 50% of cases.

An estimated 30–50% of patients who survive severe JE infection may suffer permanent intellectual, behavioural, psychiatric or neurological problems. Risk Children and elderly are most commonly affected by the JE virus, with 75% of cases occurring in children aged 0–14 years. Most JE cases are asymptomatic, resulting in widespread under reporting of the disease. Advice Travellers staying for a month or longer in endemic rural regions should be advised on the safe and effective vaccines available to prevent disease. All travellers to JE-endemic areas should take precautions to avoid mosquito bites to reduce the risk for JE, particularly in the evenings when mosquitoes are most active. TICK-BORNE ENCEPHALITIS Background Tick-Borne Encephalitis (TBE) is a viral infection that affects the central nervous system. It is

caused by the tick-borne encephalitis virus (TBEV) and is endemic in most of the southern, non-tropical Eurasian forest belt. Since the 1930s, TBE has been a major public health problem in central Russia. Austria began vaccinating against TBEV in 1972 and has implemented a universal, annual, national vaccination campaign since 1980.  Around 10,000 to 12,000 cases of tick-borne encephalitis are reported globally each year.  The incubation period can be between 2 and 28 days.  The primary vaccination schedule for the tickborne encephalitis vaccine consists of 3 doses. The virus infects small mammals, domestic livestock, deer, and some birds which all form part of the life cycle of the virus and maintains the reservoir of the disease in a locality. Ticks are found in forest fringes, forest glades, riverside meadows, marshland, parks, and gardens. They tend to reside on ground level vegetation, on the underside of foliage, from where they can be brushed onto clothing. TBEV is transmitted to humans via the bite of an infected Ixodes tick. The virus can also be transmitted through ingestion of unpasteurised milk from infected animals, but this is not common. Symptoms Two thirds of cases are asymptomatic. The median incubation period is 8 days but can be between 2 and 28 days. The disease develops in two stages, with a symptom-free interval between the two stages. The first stage lasts between 1 and 8 days and is characterised by non-specific flu-like symptoms such as fever, fatigue, headache and muscle pain.

CPD 104: TRAVEL VACCINATIONS • Food and Water safety - some nasty conditions can be contracted from unsanitary food and water • Insect and animal bites - avoiding bites and treating them if they occur are key to reducing the risk of many diseases • Jet lag - there are several practical things that can be done to reduce the effects • Travelling with long term medical conditions - you have many patients on treatment for these types of conditions and you can help them prepare to ensure they have continuity of supply and can store their medication safely while they travel • Motion sickness - you can advise on different types of preventive medications and devices to prevent travel sickness ruining a holiday • Sexual health - many travellers seem unaware of the higher risks of STDs in certain countries and your advice could be vital in preventing a serious problem

The symptom-free period lasts between 1 and 20 days. One third of patients progress to this stage.

• Insect repellents such as DEET and Picardin® can be applied to skin, socks and outer clothes.

The second stage begins with a sudden rise in temperature and:

• Avoid consumption of unpasteurised dairy products in areas of risk.

• Meningitis (50% of cases)

• In tick-infested areas, trousers should be tucked into socks to prevent ticks from crawling up the legs. Clothing can be treated with permethrin to kill ticks on contact. Some protection against TBE is provided by covering arms, legs and ankles.

• Menigoencephalitis (40% of cases) • Meningoencephalomyelitis (10% of cases) 40% of patients who progress to the second stage develop long-term neurological conditions and require extended rehabilitation. Risk Most infections occur as a result of tick bites associated with outdoor activities in forested areas (e.g. hiking). Most cases occur from April to November, with peaks in early and late summer when ticks are active. The incidence and severity of disease are highest in people aged ≥50 years. Infection is more common in males. TBE is prevalent in most or parts of Austria, Germany, southern and central Sweden, France (Alsace region), Switzerland, Norway, Denmark, Poland, Croatia, Albania, the Baltic states (Estonia, Latvia and Lithuania), the Czech and Slovak Republics, Hungary, Russia (including Siberia), Ukraine, some other countries of the former Soviet Union, and northern and eastern regions of China. No cases of tick-borne encephalitis have been notified to the Health Protection Surveillance Centre (HPSC) to date. Advice Travellers to endemic areas should be given the following advice: • If possible, avoid known heavily tick-infested areas of the forest and woodlands during the spring, summer, and autumn.

• Check for ticks regularly; common areas for ticks to attach are at the hairline, behind the ears, elbows, backs of knees, groin and armpits. Larval forms of Ixodes ticks are difficult to see (they can be the size of a freckle or speck of dirt). Adult ticks which have fed may be the size of a coffee bean. • Remove ticks as soon as possible by using a pair of fine tipped tweezers. The tick should be grasped close to the skin and steadily pulled out, being careful not to crush the tick’s body or squeeze the stomach contents into the site of the bite. • Seek medical advice if any signs of illness occur within 28 days of a tick bite. “Staying Well” – what advice should you give your patients? There are several ways you can help your patients to stay well while they travel abroad. Clearly, visiting your aunt in Bournemouth for a long weekend carries less risk than a month trekking across the rainforests of Borneo and your advice needs to be tailored depending on other risk factors such as age and activities to be undertaken. Some aspects you might consider advising on are: • First Aid - what equipment and precautions the traveller should put in place

• Sun protection - the prevalence of skin cancers is rising and there is no reason for anyone not to be prepared to stay safe in the sun • Travellers’ Diarrhoea - this could ruin a holiday and you can help with advice on how to minimise the risk and to deal with it if it happens There are many good sources of travel advice including the HSE and Fit for Travel (NHS). Your patients will appreciate the advice as much as the vaccines and medication you offer. So, is travel health the right fit for your pharmacy? There are many areas of primary care where you make a huge difference for your patients. So many of them travel to far flung places without taking precautions and you can definitely help prepare them with the right advice and appropriate medications. You might have to listen enviously while one of your patients tells you about their trip of a lifetime but they’ll know they’ve chosen the right service when you help them travel well and stay well when they get there! REFERENCES National Immunisation Guidelines for Ireland: https://www.hse.ie/eng/health/immunisation/ hcpinfo/guidelines/ SI 449 2015: http://www.irishstatutebook.ie/ eli/2015/si/449/made/en/pdf NHS Scotland: https://www.fitfortravel.nhs.uk/ home https://www.hse.ie/eng/health/az/t/travelhealth/preventing-illness-and-infection-whileabroad.html

in the ongoing battle against serious childhood diseases.


Consumer Headache is a Pharmacists’ Opportunity


eadaches are among the most common disorders of the nervous system. On a global level, it is estimated that the prevalence of headache disorder in adults is 47%. A proper treatment of headaches requires training of pharmacy staff, careful diagnosis and recognition of the condition, appropriate treatment, simple changes in lifestyle and consumer education. According to Euromonitor, analgesics for pain relief, particularly from tension and headaches means that analgesics are in strong demand. “Analgesics retail current value sales increase by 2% to reach ¤76 million in 2018. The fact that consumers are leading busier and more stressful lives helps to boost sales growth,” says a Euromonitor Analyst. Their latest report, ‘Analgesics in Ireland 2019’ states that, “Analgesics will continue to be in strong demand, with consumers leading busier and more stressful lifestyles, and seeking analgesics for pain relief, particularly from tension and headaches. More active consumers are also likely to require more pain relief for injuries. That being said, growth is likely to be marginally slower compared to the review period due to an expected fall in unit prices as a result of competition from generics. Innovation has slowed, with consumers expected to

see little difference between branded products and their generic counterparts. “Topical analgesics and adult ibuprofen will be the fastest growing areas as demand continues to increase for these products. While sales of adult ibuprofen will remain robust, sales growth for paediatric alternatives is expected to remain slow as consumers are uncertain about giving their children strong pain relief. “There is likely to be increased competition across the area over the forecast period. With the approach of external factors such as Brexit, it is likely that many Irish pharmaceutical manufacturers will have robust plans in place to ensure their profits are not impacted. Fewer brands from the UK may be seen on Irish shelves if a hard Brexit occurs and tariffs are imposed on goods coming from the UK into the EU. “Private label and generics continue to aggressively compete


for value share. Manufacturers such as Clonmel Healthcare and Pinewood Healthcare Group are bringing out their own ranges of pain relief products by competing on price with larger brands such as Nurofen and Panadol.” Pharmacists are often on the front lines of care for migraine patients seeking relief from their headaches and are often in a position to direct the initial care and education for these patients. The importance of a thorough understanding of migraine and its management is essential for pharmacists, because as many as 57% of patients self-treat migraine headaches, and inappropriate use of OTC analgesics can increase the risk of medication overuse headaches (MOHs). By advising, educating, and instructing patients in the appropriate use of OTC analgesics in migraine, the pharmacist can be a valuable addition to the management team for this chronic disorder. Having the knowledge

of how and when to use the OTC therapies and when to recommend further evaluation is important when interacting with headache patients seeking advice. Migraine Headaches Migraine headaches are the most common vascular headache type and have a significant impact on quality of life. It is the most common headache disorder which sufferers will present with to their local pharmacy or GP. The World Health Organisation (WHO) Global Burden of Disease (GBD) Studies have recently ranked migraine as the second highest cause worldwide of years lost due to disability (YLD). Migraine is the leading cause of YLD in the age group 15-49 years. YLD is considered to be the most appropriate measure of disability in non-fatal medical conditions. It is estimated that there are currently more than a billion people with migraine on the planet and there are approximately 600,000 to

700,000 people in the Republic of Ireland with this condition. The WHO estimates that 10% 14% of global population have migraine. Migraine patients may experience episodic or chronic symptoms, and the latter is usually associated with the most significant disability. There is often a component of overuse of painkillers or analgesics (medication overuse) in patients with more chronic symptoms. Furthermore, there is an increased risk of certain medical comorbidities in patients with chronic migraine including depression, anxiety, fibromyalgia and obesity. What is Migraine? The majority of migraine sufferers have Migraine without Aura. The most common symptoms of Migraine without Aura are: Intense throbbing headache, usually on one side of the head, worsened by movement and lasting from 4-72 hours. The most common symptoms of migraine without aura include intense throbbing headache, usually on one side of the head, worsened by movement; nausea, sometimes vomiting; sensitivity to light, sensitivity to noise and stiffness of the neck and shoulders. Migraine with Aura refers to a range of neurological disturbances that occur before the headache begins, usually lasting about 20-60 minutes. About 20% of people with migraine experience ‘aura’ in addition to some or all of the symptoms of migraine without aura. The disturbances are usually visual, for example blind spots, flashing lights and/or zig-zag patterns. About 1% of migraineurs experience migraine aura without ever having a headache. The most common symptoms of migraine aura are visual disturbances such as blind spots and flashing lights. Chronic migraine occurs in people with more than fifteen headache days per month over a three month period of which more than eight are migrainous and for whom medication overuse headache has been ruled out as a potential cause. Chronic migraine is treated with many of the acute medications used for episodic migraine but most chronic migraine sufferers will need to access a migraine preventative to improve their long term outcomes. New Daily Persistent Headache (NDP) can occur at any age from childhood through to the 70’s. It usually begins one day and despite lifestyle and dietary adaptations and medical intervention, sufferers cannot seem to stop this headache occurring. Sometimes the person has suffered a cold or viral infection

or there has been a particularly stressful event in their lives. Some people also report the onset of NDP after they underwent a surgical procedure. But equally there can be no obvious trigger or triggering event.

common cause of disability in women aged between 15-49 years. This can be the most demanding time of women's lives, both personally and professionally,” says Dr Mary Kearney, GP and co-author of the guide.

Many NDP sufferers can also suffer from migraine like symptoms and others experience tension type headaches. They must experience daily headaches continuously for at least 3 months before they can be diagnosed with New Daily Persistent Headache.

“There is hope for migraine sufferers and new treatments are becoming available. Because headache is so common (90% of the population), people can often misunderstand that there are very serious forms of migraine.”

Category Management The headache and migraine category lends itself perfectly to facilitating an intervention by medicines counter assistants or pharmacists, something you just can’t get from supermarket shelves.

The Irish College of General Practitioners' guide highlights • Important symptoms in the assessment of any headache • Acute treatment of migraine • When to start preventative treatment, and recommended dosages for medication.

"By advising, educating, and instructing patients in the appropriate use of OTC analgesics in migraine, the pharmacist can be a valuable addition to the management team for this chronic disorder. Having the knowledge of how and when to use the OTC therapies and when to recommend further evaluation is important when interacting with headache patients seeking advice." Once a diagnosis is made, pharmacists should have in mind the range of options for non-drug, rescue and prevention available in-store. If there is diagnostic uncertainty, treatment failure or analgesic dependence, pharmacy staff should know when to refer. Category display should always be clear and the pain relief category should be divided by brand and active ingredient to help customers navigate the fixture easily, with behind-the-counter brands clearly signposted and staff on hand to give pain advice and information. Relevant POS materials can also help customers make an informed choice at the point of purchase. The Irish College of General Practitioners has, earlier this year, published a Migraine Quick Reference Guide. “Migraine can cause very significant disability. After back pain, it is the second most

Deputy Maria Bailey TD, who is a migraine sufferer, says, “Migraine whilst not curable can be managed successfully. Diaries are a crucial component to understanding triggers, lifestyle and type of migraine. With the right combination of treatment, and tailored lifestyle for a specific patient it can ease the debilitating effects of migraine for some, there are many options of treatments available and it can take time to find what works best for them.” Future Treatments According to the ICGP, ‘There is a clear clinical need for specific acute and preventative migraine treatments. The most promising new preventative treatments are the calcitonin gene-related peptide (CGRP) monoclonal antibodies, which have been developed after significant research which started in 1985 in Sweden. It is known that CGRP levels are raised in migraine

patients, and it is believed that the CGRP system plays a fundamental role in the migraine attack. CGRP is one of the most potent naturally occurring vasodilators. Four different CGRP agents have been developed by five pharmaceutical companies. They bind to CGRP molecule or its receptor. The first commercially available CGRP drug (erenumab) has recently been licenced in the US and Europe. ‘Cost and access to these new treatments in Ireland are going to be the most significant going forwards. Never the less, the future for those with migraine is brighter now than ever,’ the ICGP states. Migraine and Holidays As everyone’s thoughts turn to the summer holidays, for those who suffer from migraine there will always be the fear of it lingering, ready to pounce. According to the Migraine Association of Ireland, there are some tips which pharmacists can advise sufferers about before they travel to help combat holiday migraine. Routine: Sufferers should stick to their routine on holiday as much as possible; getting up, eating and sleeping at the same time as usual. Those travelling abroad could bring an extra watch set to Irish time, which will help them figure out when to do things they would normally do at home. Medication: Advise patients to bring all their medication with them. Some countries require people to also bring their prescriptions, so make sure they are also packed. For those bringing extra medication, advise they don’t keep it all in one bag in the event a bag gets lost or stolen. Their GP may be able to provide them with a short note explaining their need for their medication. This will help if they need added medication, to see a GP abroad or for customs. Travel: Advise patients to take a look at the website of their particular carrier, be it airplane, ship, etc., and check if they have anything that might make their migraine risk worse – like strong LED lighting. Advise them beforehand about medication or alternative treatments for motion sickness. Some people may benefit from taking an antihistamine before boarding the plane, as this can help with both pressure in the ears and head, may help sufferers sleep, and might reduce the symptoms of jet-lag – always double check their migraine medication though as some antihistamines work differently than others and some migraine medications already contain antihistamines.




Members of the Community Pharmacy Team of the Year, McCauley Health & Beauty Pharmacy, Tralee, Paula O’Sullivan, Roisin Donnellan, Luke O’Shea, Christine Foley, Alison O’Brien, Chloe Goulding and Brian Kearney with their finalist certificate and Trophy

Working Together in Creating Results IPN & 4Front Community Pharmacy Team of the Year - Winners As Henry Ford once said, “Coming together is a beginning. Keeping together is progress. Working together is success.” This adage rings true for the OTC team at McCauley Health & Beauty Pharmacy in Manor West Tralee, and their dedication, innovation and progress was deservedly recognised with the title Community Pharmacy Team of the Year 2019 at the recent Irish Pharmacy Awards. The OTC team in McCauley Chemists Tralee is a group of highly motivated and dedicated staff who endeavour daily to provide the best possible service to their customers. Many of the staff members have been with

the pharmacy since its opening in 2002 and they are steadfast in their commitment to quality patient care. Each team member brings their own skills and creativity to their roles and working together they are the perfect amalgam for success. Supervising Pharmacist of the OTC team is Brian Kearney, himself no stranger to success having previously won the Community Pharmacist of the Year accolade. He is hugely proud of the team as he reflects, “Each member of the team in Tralee recognise the importance of ‘team playing’ the end result is always more important to them than any individual glory. They motivate each other and applaud one


another’s success. There is a fantastic atmosphere in store which has been commented on by customers.” Routinely Working Hard The OTC team in Tralee work within a routine. There is a daily counter rota as customer service is always the primary priority. The team work together to ensure that adequate time and cover is afforded to each project whilst also ensuring that customers are given full attention at all times. It is important to the team in Tralee that each team member feels valued and everybody has an input and there is a fantastic diversity of skill and strengths within it. This translates in their work and has

resulted in numerous successful events and customer initiatives. Brian continues, “There is no team more committed to the promotion of healthcare than the OTC team here. We have worked tirelessly to grow the pharmacy business through initiatives targeted at educating and engaging with customers on health issues.” One of their most recent successful events was a healthcare seminar organised by the team entitled ‘Women’s Health and Wellbeing for All Ages’ The discussion covered topics such as fertility, Polycystic Ovary Syndrome, menopause, nutrition, cardiac health, skin health and even make-up tips.

There was immense work put into arranging the event. The team knew that this would attract a large number of attendees and decided to arrange sponsorship of the event in order to ensure they could deliver the best possible service. They sought to co-ordinate with some expert guest speakers and engaged numerous representatives of various vitamin products to have stands on the night. The team arranged spot prizes and hampers to be given out on the night to further enhance the experience for those who attended. The event was extremely successful with almost 300 people in attendance. It was widely complimented and the effort put in to its success was very clear to all. It resulted in the recruitment of many more customers who have since become regulars of the pharmacy. It also boosted the pharmacy profile with numerous articles appearing in local newspapers reporting the success of the evening. It was a testament to the teamwork and coordinated effort of the staff in McCauley, Tralee. Innovative Thinking Recently the McCauley Health & Beauty Pharmacy Group developed an App to streamline the delivery of quality patient care to customers. The App allows patients to log on and order repeat prescriptions, view their medical history and engage with the pharmacist in a more efficient manner. Each pharmacy was allocated a target of patient activations. The team in Tralee really got behind this and immediately became familiar with the App and its various benefits. They wore McCauley App badges and highlighted its launch in store with large posters, leaflets and balloons. They started to promote the APP to customers and guided them in how to use it. The team in Tralee exceeded their original target and currently have the second highest number of app activations in the McCauley group. This is due in no small part to the determination of the team. Smoking cessation promotion is a huge passion for the team in Tralee. The McCauley group recently launched a Smoking Cessation club which offers an incentive to those on NRT. This encourages customers to continue on their wellness plan. The team in Tralee used this as an opportunity to increase NRT sales and promoted the Loyalty Club in-store. They also utilised the in-store Smokelyser device which tests for the presence of carbon monoxide

in the breath. This allowed customers to physically see the reduction in CO in their system as they continued on their smoking cessation plan. The team in Tralee are avid charity supporters and utilise every opportunity they can to arrange and participate in events to raise funds and awareness for various charities. One of the charity collections which was particularly close to the hearts of the team in Tralee was that for the Irish Lung Foundation. One of the team members has a family member who suffers from Sarcoidosis and they are therefore an avid supporter of this fantastic charity. The team in Tralee decided to arrange a fundraising event through a Christmas Wrapping Service and worked tirelessly to raise as much money as possible. The total amount raised was a phenomenal ¤1885. This was a testament to the hard work put in by the team and their success at working together to achieve a common goal. Enthusiasm & Motivation In order to provide customers with the best possible service it is important to foster an atmosphere of enthusiasm and motivation. The team in Tralee are very mindful of this and recognise the need to maintain this environment. They set goals daily in order to boost productivity and carefully track their results in order to remain driven.

The new McCauley Health & Beauty Pharmacy App

for one another gives them enhanced determination to see their colleagues succeed. They are hugely supportive of one another and work together for the betterment of the pharmacy. In any pharmacy it is important that the needs of the customer are prioritised over any task. The OTC team are hugely attentive to this and always ensure that the customer remains their top priority. They are committed to providing the best customer service in every situation and have attended numerous training courses to remain abreast of this. They pride themselves on their commitment to excellence and customers have often commented on how they go above and beyond their expectations. Brian continues, “It is important that a team knows and values the different skills sets that each member brings. The team here in Tralee is a blend of talents where each member is encouraged to give as much input as possible. This promotes a great atmosphere in store, ensures maximum

productivity and allows for a great in store experience for customers. “The team members all possess excellent communication skills. They communicate in an open, honest manner. This is vital for an effective team. They are reliable, dependable and constantly go the extra mile in their duties. They always put the team objectives before their own. “The team have an almost encyclopaedic product knowledge and frequently attend training courses to remain updated. This commitment to educating themselves to enhance their performance is a testament to their dedication in their roles.” The McCauley OTC Team in Tralee are extremely creative and work constantly to come up with new and different ways to boost sales and increase productivity. They are hugely adaptable and will often take responsibility for duties not even in their job description in order to complete tasks. Always mindful of goals and how best to achieve them.

They recognise and applaud their successes both within the team and individually. The team leader, Christine Foley, is a fantastic leader and gives the group great direction. She recognises the need for positive re-enforcement and frequently gives the team constructive feedback in order to motivate them further. The OTC team are a very tight-knit group. Their mutual respect Supervising Pharmacist Brian Kearney with a customer conducting a Blood Pressure check


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Shahid Ayub Muhammad, Hazel O’Rourke, Nicole Geraghty, Aidene Brown, Audrey Donegan and Anna Jurak

Innovation in Raising Awareness KBC Business Banking Innovation & Service Development (Chain) Award - Winners To raise awareness of melanoma in Ireland and to encourage a life-long habit among Irish people of regularly checking their moles, Boots Ireland introduced, in conjunction with ScreenCancer UK, an innovative mole scanning service in ten Boots Ireland pharmacies nationally in April 2018. This innovative offering led to the team being presented with the KBC Business Banking Innovation & Service Development Award 2019. Melanoma Awareness The burden of disease and the low level of awareness on how it can be detected were the primary considerations supporting a move

towards a pharmacy-led innovation in the area of pigmented lesion assessment. There were a number of significant points which supported the decision to progress with the Boots Mole Scanning Service. These included; • Skin cancers are the most commonly diagnosed cancers among Caucasian populations; • The bulk of skin cancer is made up of non-melanoma skin cancer (NMSC) of which basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are the most common. These are generally less serious than

melanoma which accounts for 9% of the skin cancer diagnoses in Ireland annually. BCC and SCC are more common in older (70+) adults with melanoma typically presenting earlier (1/3 of females and 1/5 of males with melanoma were diagnosed before age 50); • Malignant melanoma is among the most common cancers in Ireland. There are just over 1,000 new cases of malignant melanoma in Ireland diagnosed in Ireland each year.Ireland has the highest mortality rate from melanoma in Europe; • As malignant melanoma has the potential to spread to other sites in the body, early detection of

the disease is vital as it is more difficult to cure if spread has occurred. Increased accessibility of specialist support for assessment of lesions could lead to earlier referral to secondary care for diagnosis and treatment; • Provision of lifestyle advice (sun safety messages) can help patients to understand the benefits of self-checking their moles, and how they can take appropriate lifestyle steps to benefit their health. Scanning Services The Boots Mole Scanning Service allows people aged 18 and over to have their moles or pigmented


lesions scanned using a specialist device called a SIAscope. The pharmacy colleague then asks the patient a series of questions about their lesion and the consultation record plus the scan is then assessed by a dermatology specialist. All patients who avail of the service receive a personalised report indicating the findings of the assessment, as well as information reminding the patient to regularly check their moles, to have them reviewed by a healthcare professional if there are any changes and to follow the principles of sun safety at all times. While the service doesn’t provide a diagnosis of skin cancer, ScreenCancer dermatology specialists analyse the moles or lesions to help identify any suspicious characteristics that might need further investigation. Should a suspicious lesion be identified, the individual is contacted by a member of the Screen Cancer team and referred to their doctor or specialist for follow-on treatment. The objectives of this initiative were varied. 1. Create a mole scanning service based on international evidence and best practice and with the patient as its focus 2. Identify a suitable partner to collaborate with to ensure a high quality of service provision 3. Design and deliver a comprehensive training programme for Boots pharmacy staff to ensure service was delivered to the highest standard 4. Work with external stakeholders to raise the profile of the service and thus improved community awareness of and engagement with both the service and the sun safety messages aligned with it

In collaboration with ScreenCancer UK a comprehensive training programme, including competency assessment and authorisation on successful completion, was developed and delivered to selected Boots pharmacy teams A range of external stakeholders were approached to highlight availability of the service both medical and non-medical. Investment was made in a marketing campaign (internal and external) to drive awareness of the service. Coverage was secured in national and regional print media, on 6 regional radio stations, and across a range of digital platforms with a reach of almost 700,000 people achieved. Positive patient experience of the service post implementation led to a case study in the Irish Independent for further reach Strategic planning of pharmacy locations to support nationwide access and service materials were developed to highlight this message. Items such as the leaflet that provides advice on checking moles using the ABCDE rule and hints and tips on sun safety are available to all patients free of charge (no participation in the service is required). Follow up of all patients is part of the service; analysis has shown that the service has been successful in identifying cases of malignant melanoma as well as other skin conditions requiring referral for assessment and treatment. Experience in project management of the Boots Mole Scanning Service partnership has highlighted the following key elements for successful service roll out: • Seek to understand the needs of the local community - are there gaps in service provision? what are the needs of patients?

5. Increase the accessibility and availability of specialist support in pigmented lesion assessment in primary care

• Identify suitable partner and agree ways of working to ensure service will be provided to high standard on both sides

6. Encourage self-checking of moles and awareness of sun safety measures

• Develop an evidence based service model and associated Standard Operating Procedures, training materials and patient facing materials (e.g. consultation record forms, service leaflets)

7. Support the earlier detection of suspected skin cancers with the aim of ensuring quicker access to treatment in secondary care A detailed review of the available technology, clinical assessment tools and national/international guidance and policy to support service delivery was undertaken. Relevant external stakeholders within the Irish health service were also consulted. A suitable partner with relevant specialist dermatology expertise and experience in service delivery* was identified – ScreenCancer UK

• Ensure pharmacists and pharmacy teams are trained to the highest standard and that competence is assessed via knowledge checks and consultation skills assessments • Focus on consultation and communication skills is essential • Engage your pharmacy teams – bring people together for a live training day and explore the pertinent issues in detail, this


is a complement to distance learning training and is crucial for engagement and buy in • Develop a robust customer engagement plan across multiple platforms – in-store, online, social media, radio, TV • Work with key stakeholders to maximise expertise and reach Susan O’Dwyer is Pharmacy Development and Strategy Manager with Boots Ireland. She says, “In Ireland, national health policy is focussed on keeping people well and where illness occurs treating people in the most appropriate setting for their needs and as close to their home as possible. The rising incidence rates of melanoma in Ireland, coupled with the comparatively high mortality rate, mean that services that can support earlier detection of melanoma are needed. Provision of accessible services in the community setting can support this ambition and is the reason that we choose to launch the Boots Mole Scanning Service. “At Boots we have created a bespoke training programme to support our teams to take a specialist image of the suspicious lesions and to accurately record a patient history for assessment by the dermatology specialist. Images are transmitted securely for assessment and patient results are provided promptly. As a result, using innovative teledermatology techniques and harnessing the power of digital solutions to provide greater access to clinical specialists, we have introduced a service that is unique to the Irish

pharmacy market. “Our pharmacy teams have embraced the service and value the role they play in delivering a service that patients are both grateful for and complementary of. Provision of advanced services such as the Mole Scanning Service provide our teams with further opportunity to positively impact the health and wellbeing of their patients which they find satisfying. Our teams have refreshed their knowledge on sun safety and have been able to impart this to the many patients that visit their pharmacy, whether they avail of the service or not. This has valuable public health implications and is a real strength of the initiative. Raising awareness of the importance of sun safety has been a real team effort, from the events delivered in Boots Wexford, to the regional radio coverage in the Boots Castlebar area and the national TV segment where Donal O’Sullivan, pharmacist in our Boots Macroom branch spoke about the importance of regularly checking moles and raised awareness of the service.” We feel that the innovative use of technology and digital solutions to facilitate more accessible care, the focus on designing and delivering a high quality, professional service, the execution of a very strong engagement plan at both national and regional levels and the wonderful patient testimonials mean that the Boots Mole Scanning Service is very deserving recipient of this award.



The team at Keane’s CarePlus Mullingar with Pharmacy Manager Robert Keane, winners of the Sudocrem Children Baby Health Pharmacy of the Year Award 2019

Keen on Baby Care – Double Award Win Sudocrem Children Baby Health Pharmacy of the Year - Winner Keane’s CarePlus Pharmacy scooped a double at the Irish Pharmacy Awards, and one of their awards on the night was for the Sudocrem Children Baby Health Pharmacy of the Year Award. For parents, particularly those with their first child, raising a baby can be a daunting task. For young families, the team at Keane’s take pride in having the knowledge, experience and training to look after them. Keane’s CarePlus pharmacies in Mullingar serves the local community across three different locations across the town. Their pharmacies have been caring for the local community for over 10

years, having first opened its doors in 2008. Pharmacy Manager Robert Keane says, “Upon opening, we have gained a strong reputation for providing high levels of patient care. This has been recognised nationally through awards such as retail excellence Ireland, midlands customer excellence awards and the prestigious Irish Pharmacy Awards. “As a family owned, independent pharmacy with a large cohort of patients within the infant category, winning this award means a lot to us. We like to ensure we are looking after this group of patients and looking after them well, so


to be recognised for this is a great achievement for the entire pharmacy team. “These awards are a huge asset to the community pharmacy industry, showcasing excellence. It is fantastic for us to be seen as at the forefront of care. We are very honoured to be involved and to have won here tonight.” Diverse Communities Mullingar, with a population of over 20,000 people has a broad and diverse community. Caring for patients of all ages — from newborn babies right up to the elderly. Mullingar has a young an emerging

population with many of patients being young families or couples embarking on the road of starting and planning for a family. Robert adds, “As a family run business we believe it is so important that young families and babies are cared for with services and initiatives in place to support these patients. “Mullingar Regional Hospital is the main maternity and paediatric unit for the region. Two of our pharmacies are within walking distance of the hospital and we are the initial port of call for parents whilst in and also upon discharge of hospital. Through the years we have developed a strong relationship with both the maternity

and paediatric units in providing out of hours assistance for patients upon discharge.” Over the years, the pharmacy team have set up their very own baby club which provides parents with help and guidance for the first year of their infant`s life. This club has a monthly newsletter emailed directly to the parents providing them with up to date information on a wide range of relevant topics. The club which has proved popular, provides a baby box with products for parents to bring home and try for themselves on ailments such as nappy rash, teething and infantile eczema. They also regularly run free mother and baby events in the community such as first aid in the home, baby massage and sleep regulation for infants and recently hosted the well renowned sleep specialist Lucy Wolfe attracting in over 100 new mothers with their babies to the event. “We listen to mums and strive to further advance our talks and knowledge for all young parents within our local community,” Robert says. Cultivating a Reputation “Many of our staff have their own children and are fully trained on advising patients on child related topics. By running successful baby events this has allowed us to cultivate a reputation of offering excellent customer services. We believe we are trusted as is our advice within the community. We offer a free baby weighing service. This popular service allows parents to weigh their baby for the first months of life at a time that suits them in a calm environment. This has allowed us to develop strong rapport and trust with young mothers in particular being at hand to assist with weighing their baby and also providing advice pertaining to ailments such as teething, vaccinations, constipation in the process “We also have given back to the community. Our close working relationship with hospital staff inspired our staff to hold an event that raised much-needed funds for the local Special Baby Care Unit at Mullingar Hospital. “Frequent contact with public health nurses and staff from the maternity department in the hospital led our pharmacies to stock specialised items such as products for premature babies and to manufacturing a specialised nappy cream. Our close links with the local maternity unit and community practice nurses has allowed us to identity the needs of our

Caption Pharmacy Manager Robert Keane, Keane’s CarePlus Pharmacy, Mullingar

community. Most recently we have rolled out a new service in providing a breast pump rental service for breastfeeding mums. This pump allows new breastfeeding mothers who may have difficulty in breastfeeding to avail of a hospital style breast pump. More so all staff across the three stores are trained in providing advice to new mothers at a time that is crucial for both mammy and baby.”

developed a reputation for offering high levels of customer service and care. This reputation extends to the families and carers of babies and young children. As a family run pharmacy that employs many parents of young children, the knowledge available comes from both learnt and individual personal experiences. This experience has enabled customers to trust their recommendations and advice over the past number of years.

Over the years, The Keane’s CarePlus pharmacies have seen an increase in customers presenting to the pharmacy for medication and other healthcare products related to baby care. Additionally, they have been able, through excellent service, to retain these customers on a long term basis.

Robert adds, “The group has been proactive in adjusting to the needs of young families by extending opening hours to meet demand. Our Green Road location has extended its opening hours until 9pm and expanded to opening on Sundays. These adjustments were requested by customers, in particular those with young families to meet their demands, especially if their child became sick in the evenings or the weekend.

Following the events that took place over 2018, increases in sales related to baby and child care have increased as a result. Facings of baby products, across all three stores, have expanded to cater for the increase in demand. Pharmacies within close proximity to Mullingar Regional Hospital have moved to stock specific products that are recommended by pre- and post-natal departments. The increased demand from young families on pharmacy services was a key reason for the extension of their opening hours also, recognising that operating a late night service until 9pm augmented the out of hours Midoc service. This service has now been further extended to allow for Sunday openings, a day where there is a limited pharmacy service within the town.

event in conjunction with the Red Cross provided attendees with life saving information on CPR and what to do in other emergencies that may occur in the home. “As a company, this particular cohort of patients is a key focus and has led to successful growth over the past number of years. We look forward to seeing this section of our company grow and to caring for more parents and their families as they grow older.”

“Furthermore, the range of products available to purchase in our pharmacies has also grown. Planograms were adapted to enable more stock onto our shelves and to introduce new ranges. This was seen at our Primary Care Centre pharmacy where the baby section was increased by 50%. “Events organised to help parents with baby sleep patterns was invaluable to parents that were struggling to find the right routines. Lucy Wolfe’s roadshow was extremely successful and was attended by over 150 parents and their children. Similarly, the first aid

Looking after the younger generation is hugely important to Keane’s CarePlus Pharmacy, Mullingar

Keane's CarePlus pharmacies in Mullingar has served the local community with medication and professional advice for over 10 years. In this time, the group has




Pharmacist and Owner Juan Jose Del Alamo pictured with Remedi Pharmacy staff alongside Pharmacy Manager and Director, Aneta Walczynska

Going for Gold at Remedi Pharmacy GSK Self-Care Award - Winner Dublin-based Remedi IFSC Pharmacy were recognised for their work and dedication, receiving the GSK Self-Care Award, 2019. In the face of rising costs and ageing populations, many people are themselves seeking more control over every aspect of their lives, including their health. There is a growing awareness of the need for preventable health, and consumers are driving a move towards self-care. The pharmacy team at Remedi IFSC has built slowly over the last number years. As the team increased in size, they were able to undertake more ambitious

projects, which had a positive impact on wellbeing of their community. Pharmacy Manager and Director, Aneta Walczynska explains, “As a team, we managed to undertake and implement number of projects in different areas. They were challenging but had a positive effect on our local community and their health and wellbeing.” Irish Pharmacy News takes a closer look at some of the most successful ones. “At Remedi Pharmacy, we believe strongly that change should be driven from within the community that we are serving,” Aneta


says. “This year, we started our collaboration with local football club. As their official sponsor, we can participate in the events, get information about their performance and, what’s more important, be part of the community. We share information about the club and encourage young people to participate in physical activity. We also provide training and first aid supplies for the club.” One Stop Shop Remedi Pharmacy is a medium size pharmacy localised in the heart of IFSC in Dublin 1. Aneta and the team aim to be a one stop shop for all

pharmaceutical and cosmetic needs of their customers. “We are located in a busy area with medical centre and two dental practices at our doorstep. We provide extensive range of healthcare and beauty services including makeup and lash applications, the newest additions to our offering. “Due to our unique location, the community we serve is extremely diverse. It consists of local population and working professionals who attend our pharmacy but reside elsewhere. Patients living locally are in majority medical card holders of mixed age, who grow up in the

Pharmacist and Owner Juan Jose Del Alamo in dispensary.

• Increase the ease of access to our Healthcare Services • Organising special events that highlights the self – care message in a professional yet enjoyable environment. “Our goals were to create safe and professional environment, where customers can feel confident and their needs answered. We decided to bring some of our services outside the pharmacy and to reach our community. Finally, we identified the need to use our social platforms to educate and promote self-care services.” Education Campaigns In order to educate customers about self-care and its importance, the Remedi team ran a number of campaigns aimed at the local community. In February, they organised allergy and anaphylaxis seminar for the local college. Around 50 staff and students attended and in March they organised a Ladies Evening in celebration of International Women’s Day. During the event, attendees got an opportunity to avail of free health checks, chat to Uriage skincare experts about self management of skin conditions and get their scalp assessed by in house trichologist. area and have strong sense of loyalty and community. On the other hand, individuals working within IFSC area are mostly private patients, with diverse background and nationality. “Because of our unique position within the community, we were able to identify their need for self-care services. GP practices are under enormous amount of pressure to accommodate the needs of our growing community and for some patients the cost of the service may also be an issue. We realised that we can close this gap by providing professional services of the highest standards.” The team identified a number of self-care services required, that go beyond buying over-the-counter medicines. Aneta continues, “Self-care services provided by us should start with preventing ill health, including the actions taken to maintain both physical and mental health. Secondly, we should be able to provide care for minor ailments, managing long-term

conditions and maintaining health after an acute illness. “As a team we agreed that selfcare is also about empowering patients and the public to take more control over their lives. To do so we must not only provide the services but also give our community necessary knowledge about self-care, where possible.” Once the need for self-care services within our community was identified, they decided to set goals in order to meet those needs and made the choice to concentrate on the following areas: • Public health, disease and lifestyle advice • Advice and information about medicines for minor and chronic conditions • Advice on managing long-term conditions • Promoting self-care and healthy lifestyle within the community • Providing number of Healthcare Services in and out of the pharmacy

In January this year the pharmacy took part in new Concept Launch by Johnson & Johnson- featured in IPN News (February issue). Company representative Ann Marie was on hand to provide advice to those who are interested in quitting and patients already in the process. It was a new and exciting concept and it was well received by the customers. “Our pharmacist is always available to provide advice on health conditions, medication use and minor conditions. The newest information campaign undertaken by our Pharmacy and led by pharmacist is Asthma Awareness and Inhaler Technique consultations. Pharmacist advises patients on how to respond to asthma attack, inhaler and medication management and life changes that can help the symptoms. She also demonstrates the most effective inhaler technique.

them to manage common conditions by themselves without putting additional stress on GPs and hospitals. Example include our Allergy and Anaphylaxis provided to NCI college. We noticed that there is a gap between patients and healthcare professionals and projects like those help to close this gap. It allows us to improve customer knowledge and wellbeing, establish pharmacies as first place of contact in case of healthcare issues. “The principles of health screening are well established with a number of health parameters being successfully screened internationally including blood pressure, cholesterol, and obesity / weight. We engage actively in number of screening programmes. We managed to provide Corporate Health checks to around 200 employees last year. This was a convenient service, as we were able to reach the community in their workplace and in cooperation of their employers. Additionally, it was completely free of charge for the employees and they could book it at the most convenient time for themselves, without the need of leaving the building. Considering today’s busy work environment and hectic schedules, this type of service answers directly to our customers changing needs. Remedi team was able to reach individuals who would never be able to avail of free health check anywhere else. Feedback received by our staff was hugely positive. In addition, the campaign itself gave the patients better understanding of self- care in general and range of services that can be obtained in the local pharmacy without GP referral. This continues to have a positive effect on our community as we see increase in the number of customers obtaining these services in our pharmacy. It allows us to detect chronic illnesses early and helps the patients to manage their condition long term.” It was through this work in driving the self-care agenda amongst their community which led the judges to awarding them the GSK Self-Care title for 2019, in recognition of their hard work and dedication.

“Some of the information projects we are currently putting into place are customer educational programmes, that give patients more knowledge and will allow




“Our staff have been fantastic in growing the number of customers who sign up by reminding them of the benefits and exclusive offers available through Loyalty for Life. It’s another way of generating conversation and making them aware that we appreciate their custom” Paddy Colleran, Colleran Life Pharmacy, Charlestown

Mairead Reen, Reen’s Life Pharmacy

Pharmacy Loyalty for Life Clonmel Business Development (Chain) Award 2019 - Winner Life Pharmacy Group’s innovative programme, Loyalty for Life, saw them win the Clonmel Healthcare Business Development (Chain) Award 2019. It is estimated to be 5-6 times more expensive to build a longterm relationship with a new customer than to cultivate the loyalty of an existing customer. Knowing this, Life Pharmacy identified an opportunity to focus on customer retention by implementing a customer loyalty programme. Life Pharmacy’s loyalty programme – Loyalty for Life – allows the group to identify repeat customers and reward them for their continued business. Due to the constant competition in retail services and rapid growth in the pharmacy industry, Life Pharmacy saw the

need to implement a system to recruit and retain customers across its stores. Loyalty for Life rewards customers by offering 1% back on all front of counter purchases. To encourage use of the service, Life incentivises consumer activity through special offers. These include discounts, competitions and entries into draws when visitors swipe their loyalty card. The result has been a sharper competitive edge in this thriving but challenging environment. Life Goals In order to effectively develop Loyalty for Life, a project manager and support team were appointed to oversee the implementation and development of the system across all of the pharmacy


stores. Meeting weekly to provide progress updates in the lead-up to the launch, several teams in the business were involved to ensure its implementation ran smoothly. The main objectives of Loyalty for Life were six-fold: • Reward loyal customers by offering 1% back on purchases and other monthly incentives. • Retain customers by strengthening the customer relationship. • Recruit new customers and convert higher footfall into sales. • Increase frequency of customer visits by communicating monthly loyalty offers and promotions. • Increase overall sales for group,

footfall, spend and average transaction value per customer. • Increase brand awareness and create stronger social interactions. Tailoring Need Gerard Coffey, Chairman of the Life Pharmacy Group explains, “Loyalty for Life currently has a database of over 48,000 customers actively using a Loyalty for Life card. This is after only nine months in operation across the Life Pharmacy group and is rising month-by-month. Right now, 36% of front of counter sales are swiped with a Loyalty Card, allowing pharmacies to give back to customers 36% of the time.” The Loyalty for Life system provides detailed analysis of the

Life Pharmacy’s Loyalty for Life which won the Clonmel Healthcare Business Development (Chain) Award 2019 The benefits of signing up to Loyalty for Life are considerable. Customers receive points back on all front of counter purchases. Upon registration, customers are awarded 200 points (€2) and a further 200 points on their birthdays. Aside from building up points, loyalty customers receive special discounts, offers and entries to prize draws on a monthly basis. The service is also very convenient for the customer as the store can use their phone number to identify their account and add points. That means there’s no issue even when they forget their card.

buying behaviours of the people and communities in which Life pharmacies operate. This allows for the creation of bespoke promotional offers and the targeting of customers according to their preferred methods, i.e. email, text message or post. Each pharmacy can also create “clubs”within their communities. The aim of these clubs is to target specific groups by creating segmented database cohorts which then allows pharmacies to tailor their communications, offers and discounts to each group. For example, members of a local GAA club could be given a 10% discount on front of counter purchases. The success of Loyalty for Life lies in allowing pharmacies to reach customers in new ways and to build stronger connections

with them while also rewarding them for their custom. Paddy Colleran is a Pharmacist and owner of Colleran Life Pharmacy in Charlestown, County Mayo. He told us, “The system has brought huge advantages to my store and other individual community pharmacy members who offer Loyalty for Life ascustomers feel more valued in response to the benefits they receive.” “This is reflected in the figures over the past nine months which show the average transaction value of a Loyalty for Life customer is 50% greater than that of a non-Loyalty for Life customer. Not only that, but repeat custom is also higher among card holders.”

“Our staff have been fantastic in growing the number of customers who sign up by reminding them of the benefits and exclusive offers available through Loyalty for Life”, says Colleran. “It’s another way of generating conversation and making them aware that we appreciate their custom.” Teamwork Loyalty for Life has drawn on all team members in the Life support office as well as across member pharmacies. According to Coffey, the commercial and marketing teamswork each month to offer the most exciting promotions and competitions for Loyalty for Life customers while territory managers regularly share success stories in their efforts to increase uptake.

relationships between all of the teams,” says Coffey.“We will continue to use Loyalty for Life to give back to our customers and reward their loyalty to our pharmacies. Importantly, we also want to encourage healthy behaviour by rewarding customers for using health services like our blood pressure checks and smoking cessation.” “The ultimate goal is to strengthen our relationships, to express our appreciation for customer loyalty and to provide them with the best possible customer service.”public health issues has led to great feedback from our customers and many regular new customers being wholly impressed.” The final say goes to Samantha, “Within our community in Enfield we have spent a lot of time finding out the needs of our customers, researching what they require from us as their local pharmacy and then establishing an enhanced range of services in-house. I am delighted to receive this award; these awards as a whole serve as an ideal way to applaud pharmacists, their teams and technicians.”

“The success of Loyalty for Life is due to the close working




“Samantha has exceeded our expectations with what she has brought to the team. With the basics of being a diligent, hard-working team player covered in little time she reinvented our whole approach to improving our customer relations and providing great services to our clientele. She quickly came to grips with our working model and slowly started to introduce improvements to our dispensary which have greatly benefited the whole team.” Pharmacist, John O’Shaugnessy

Samantha Jones, Keane’s CarePus Pharmacy, Enfield, Pure Pharmacy Recruitment Community Pharmacy Technician of the Year Winner

Driving Improvements in Pharmacy Pure Pharmacy Recruitment Community Pharmacy Technician of the Year - Winner Keane’s CarePlus Pharmacy scored a double victory at the recent national Irish Pharmacy Awards, scooping two awards in demonstration of excellence within their profession. It was Samantha Jones of Keane’s CarePlus Enfield who kicked off the wins, taking home the Pure Pharmacy Recruitment Community Pharmacy Technician of the Year Award. Samantha joined the pharmacy team at Keane’s CarePlus Enfield in February 2018 and, quite literally, hit the ground running. Described by her team members as an integral part of the pharmacy, Samantha has brought much more to the Keane’s table than just serving customers.

Pharmacist John O’Shaugnessy says, “Samantha has exceeded our expectations with what she has brought to the team. With the basics of being a diligent, hard-working team player covered in little time she reinvented our whole approach to improving our customer relations and providing great services to our clientele. She quickly came to grips with our working model and slowly started to introduce improvements to our dispensary which have greatly benefited the whole team.” It has been her approach to completing quality work in a timely manner which has allowed for more time to be spent with customers explaining medicines and discussing their concerns. She has organised the workplace to


greater utilise the pharmacy team’s time and, in so doing, indirectly improved the working relations between all staff. “We have a small pharmacy team with a moderately busy dispensary but what has really driven our business in the previous year is our attention to our customers, old and new, as well as the many new services Samantha has introduced and facilitated. She has purchased, trained and advertised for many new services that all members of the pharmacy feel is improving our business and level of care to our customers. She has introduced monthly information nights based around feedback from our customer surveys (which Samantha created and implemented) which have

really improved our reputation as a service and information-driven clinical setting,” John adds. Adapting Roles Samantha has been qualified as a technician since 2004 and since then has undertaken different roles in the community setting, always improving on her knowledge and expertise as well as creating the persona of a very effective team member who knows how to run a pharmacy on all levels. She has most recently undertaken a Business Management Diploma through the IPU Academy to further her knowledge in this field which will only lead to greater developments in the pharmacy as she introduces beneficial changes

Samantha Jones, Keane’s CarePus Pharmacy, Enfield, Pure Pharmacy Recruitment Community Pharmacy Technician of the Year Winner

and she has co-written many new Standard Operating Procedures to help train her fellow staff members on new innovations and improvements.

based on knowledge gathered and the information made available to her through this course. John continues, “In the past year we have seen a great improvement in how our dispensary is being run. Most of this is attributed to Samantha and how she manages the dispensary. Her attention to detail and hard work has ensured we have a highly functioning dispensary and the administrative material is always in good order.” Samantha has greatly enhanced the role of pharmacy technician and put a strong emphasis on promoting public health through the pharmacy by undertaking promotional campaigns based around the long term illness scheme and its associated medical conditions. She has formulated a monthly structure whereby all the dispensary work is completed well in advance where possible so that the pharmacists can all focus on the promotion of public health through information nights where she organises guest speakers from all aspects of clinical care. Some of these have included a first aid event, a diabetes information night, a mental health awareness talk among others. These events take considerable time and effort to organise with Samantha liaising with the appropriate clinical experts, often qualified HSE employees. Another event held for Family Carer's Ireland involved Samantha

orchestrating a charity bingo night which raised nearly ¤2000. This event was held locally and a lot of work was required to set it up. Samantha took the lead and planned out precisely what was needed for it to be a success. This not only boosted the awareness of the charity but also improved their own reputation within the community. All of these contribute to show that Samantha is an excellent pharmacy technician as well as being a forward-thinking member of staff. Since joining the team Samantha has only enhanced its abilities to perform all the relevant roles necessary. She has great knowledge off all aspects of the pharmacy as a whole notably the running of a busy dispensary but also purchasing and the administrative side of it. Samantha's addition to the team came at a very important time when they were deciding to implement some pharmacy services into the daily routine and she has introduced the following;  otoscopy and throat screening for possible ear or throat infections,

“The services, clinics, consultations and evening information events that Samantha has organised throughout the year have really benefited our customers and we have received great feedback in relation to these. It has lifted the status of the pharmacy to being an excellent service provider within the community with many of our customers availing of our services, some of which we provide free of care. This has also boosted the footfall in the pharmacy and increased our sales of servicerelated products, e.g. Active Iron for people with low iron levels.

 BMI assessments,  full health screenings,  ECG screenings,  Iron level testing. “These new services that Samantha has orchestrated have greatly benefited our business and boosted the team's confidence in providing solutions to, and information for, customers ailments,” says John. Improving the Pharmacy “Before Samantha started with us in February 2018 we had a fully functioning pharmacy with regards to providing strong basic healthcare. Since she started we have really improved as a healthcare provider, implementing fantastic changes and new ideas. “In the dispensary Samantha has incorporated time-saving and money-saving techniques to improve the functionality for all staff members. Our dossette box patients now have their medicines ready and sectioned off for collection without needing to order in advance. The PCRS payments for the months since Samantha has started have been consistently higher than the national average

“As Supervising Pharmacist I have really enjoyed working with Samantha for the last year. She does an excellent job as a technician and incorporates many other aspects of the developing pharmacy services into her role. “She really hit the ground running when she started here and bought into the development of the pharmacy into a finely tuned business with a good mission statement to become a leading healthcare provider. “The innovations she has made and the general promotion of public health issues has led to great feedback from our customers and many regular new customers being wholly impressed.” The final say goes to Samantha, “Within our community in Enfield we have spent a lot of time finding out the needs of our customers, researching what they require from us as their local pharmacy and then establishing an enhanced range of services in-house. I am delighted to receive this award; these awards as a whole serve as an ideal way to applaud pharmacists, their teams and technicians.”

 flu vaccination services,  24 hour blood pressure monitoring,  cholesterol screening,  urinalysis screening,  cardiovascular assessments,


Your patients wouldn’t apply 60% of their lipstick. Why would they only clean 60% of their teeth? Recommend TePe to get them to 100% clean

A standard toothbrush only cleans up to 60% of the tooth surface. TePe Interdental Brushes have a unique neck design and range of sizes to get your patients’ teeth and gums 100% clean. They’re also the most widely available brushes in the UK - making the healthy choice the easy choice. No wonder 94% of dental hygienists recommend them*. Visit tepe.co.uk for more information *Source: A survey of dental hygienists in the UK, Eaton et al. (2012)

Topic Team Training – Halitosis A community pharmacy environment that fosters teamwork ensured high levels of consumer satisfaction. This series of articles is designed for you to use as guide to assist your team in focusing on meeting ongoing CPD targets and to identify any training needs in order to keep the knowledge and skills of you and your team up to date. Consider:  Are the team trained in all OTC treatments available in the suitability to each patient group?  Is my team educated in offering preventative advice such as for those with dry mouth?  How much do I know about the available research and guidance about poor oral health, hygiene and chronic conditions such as diabetes?  Are my staff aware of which customers to refer to the pharmacist, dentist or GP?  Is my team aware of effective tooth brushing techniques? Key Points: Check your pharmacy team are aware and understand the following key points:  Effective oral hygiene strategies such as teeth brushing and flossing  The wider range of oral health conditions such as peridonitis  The impact halitosis on work and lifestyle The below information, considerations and checklist provides support to enable you to run a team training session and identify opportunities for learning within the topic of halitosis. Halitosis (bad breath) is estimated to be the third most frequent reason for patients to seek dental care, following tooth decay and gum disease. Pharmacists are ideally placed to promote oral health and provide patients with advice on the prevention and management of halitosis. Bad breath can be the result of numerous things, but it’s usually caused by poor oral hygiene. Approximately 90% of all cases of halitosis are directly related to poor hygiene. Prevention of halitosis involves the removal of plaque and the prevention of calculus formation. Patients with severe cases of halitosis or those with an unidentifiable cause should be referred to a dentist for further evaluation. Persistent bad breath can sometimes be a sign of gum disease. Occasionally, bad breath can occur following an infection or illness, or as a result of taking certain types of medication. Other medical conditions that cause bad

breath include infections in the throat, nose or lungs; sinusitis; bronchitis; diabetes; or liver or kidney problems. Diet can have a significant impact on their oral health. Crash dieting, fasting and low-carbohydrate diets can have nasty side-effects on breath due to acetone caused by ketosis, or an excess of protein in the diet producing volatile sulphur compounds in the breath. Certain types of food can also feed the bacteria in the mouth that cause bad breath. Hard sweets are a major culprit. Those who suffer with dry mouth and need saliva stimulation throughout the day should avoid ‘breath mints’, which may contain sucrose or glucose, and use alternatives that are sugar-free. Smoking quickly dries out the mouth and introduces nicotine and tar, which contribute to making an even more complex unpleasant odour and also adhere to the teeth, causing discolouration. For customers who do smoke but want to mask bad breath, recommend an alcohol-free mouthwash to kill bacteria, because anything containing alcohol will dry the mouth even more.

Pharmacists are in a crucial position to increase awareness regarding the benefits of good oral health care and to emphasise the importance of adhering to a daily preventive oral care regimen, as well as being a source of information for patients on the selection and proper use of these OTC oral hygiene care products.

 When to refer to the dentist

Through routine monitoring, pharmacists have a vital role in recognising patients who may be susceptible to dental problems associated with the use of some pharmacologic agents and certain medical conditions.

 Ensure efficient sign posting to further help and advice or reputable sources for oral hygiene

Pharmacists should always refer patients to seek advice from a dental professional when warranted. Because many medications can cause varying degrees of adverse dental effects, such as tooth discoloration, abnormal bleeding, or inflammation of the gum tissue, pharmacists also can use patient education sessions as an opportunity to remind them about the importance of adhering to good daily oral hygiene practices as a means of reducing or preventing further complications and ensuring that patients understand the proper use of oral hygiene products.

 The structure of the teeth and gums  The causes of halitosis Actions:  Include POS with associated condition treatments such as sensitive teeth, gum disease or mouth ulcers

 Those suffering from halitosis may feel self conscious and embarrassed. Ensure there is a discreet area in which staff can assist with advice and product selection  Keep products merchandised together, along with related products such as toothpaste/ brushes and mouthwash, to help build sales  Ensure the team are able to communicate lifestyle advice on combating halitosis  Train the team to meet all the above considerations Learning www.dentalhealth.ie – Dental Health Foundation in Ireland





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Could we predict Seizures before they Happen? A new study has found a pattern of molecules that appear in the blood before a seizure happens. This discovery may lead to the development of an early warning system, which would enable people with epilepsy to know when they are at risk of having a seizure. Researchers at FutureNeuro, the SFI Research Centre for Chronic and Rare Neurological Diseases, hosted at RCSI led the study, which is published in the current edition of the Journal of Clinical Investigation (JCI). FutureNeuro and RCSI researchers have discovered molecules in the blood that are higher in people with epilepsy before a seizure happens. These molecules are fragments of transfer RNAs (tRNAs), a chemical closely related to DNA that performs an important role in building proteins within the cell. When cells are stressed, tRNAs are cut into fragments. Higher levels of the fragments in the blood could reflect that brain cells are under stress in the build-up to a seizure event.

Dr Marion Hogg, FutureNeuro investigator, Honorary Lecturer at RCSI

Using blood samples from people with epilepsy at the Epilepsy Monitoring Unit in Beaumont Hospital, Dublin and in a similar specialist centre in Marburg, Germany, the group found that fragment levels of three tRNAs 'spike' in the blood many hours before a seizure. “People with epilepsy often report that one of the most difficult aspects of living with the disease is never knowing when a seizure will occur,” said Dr Marion Hogg, FutureNeuro investigator, Honorary Lecturer at RCSI, and the study’s lead author. “The results of this study are very promising. We hope that our tRNA research will be a key first step toward developing an early warning system.”

Approximately 40,000 people in Ireland have epilepsy and one-third of those do not respond to current treatments, meaning they continue to experience

seizures. The World Health Organisation (WHO) estimates that more than 50 million people worldwide have epilepsy.

Give pharmacists access to patient records

Uniphar holds VMS training events

Legislative support from member states is needed to enable pharmacists to take fuller responsibility for ensuring that when a patient uses a medicine, it will not cause harm, the Federation of International Pharmacists (FIP) has told ministers.

Pharmacy staff from across Ireland travelled to Dublin and Cork to attend expert-led vitamins, minerals and supplements product training hosted by Uniphar. The free sessions offered key information on AYA, Nature’s Aid, Revive Active and Zest Active. More than 170 staff from community pharmacies attended the events, making them the most popular to date.

In a statement at the World Health Assembly in Geneva, Switzerland, FIP explained to ministers that granting pharmacists access to patients’ medication histories would enhance responsibility and enhance patient safety. “Pharmacists are the experts in medicines. We can ensure safety throughout the medication process, from the moment a medicine reaches the patient, through administration, treatment monitoring and follow up, to safe disposal,” said FIP’s YPG project co-ordinator Sherly Meilianti. Ms Meilianti told the assembly that, in many countries, pharmacists

provide medication reconciliation services that optimise medicationrelated care, while minimising risks and preventing errors. FIP is working with the WHO and healthcare professional organisations on the implementation of the 3rd Global Patient Safety Challenge. “Pharmacists are the experts in medicines. We can ensure safety throughout the medication process, from the moment a medicine reaches the patient, through administration, treatment monitoring and follow up, to safe disposal,” says a statement. “In many countries, pharmacists provide medication reconciliation services that optimise medicationrelated care, while minimising risks and preventing errors. However, legislative support from Member States is needed to enable pharmacists to take fuller responsibility for ensuring that when a patient uses a medicine, it will not cause harm. Granting pharmacists access to patients’ medication histories, for example, would enhance responsibility.”

Berniece and Tegan O'Riordan from Bradley's Killarney with Shauna O'Sullivan from O'Reilly's Allcare Fermoy

Rachel Armstrong, Beverley Rowlands and Barbara O'Sullivan from Good's Life Pharmacy Kimmage





Asthma Management – Wrong and Failing Asthma Society of Ireland says “we are getting asthma management wrong – structurally, it revolves solely around the asthma patient in crisis and fails in creating long-term control” New research published by the Asthma Society of Ireland, confirms the enormity of the asthma burden and contains, for the first time, up-to-date figures on the number of people affected by asthma in Ireland. Easing the Economic Burden of Asthma – The Impact of a Universal Asthma SelfManagement Programme1 is the first prevalence and impact assessment of asthma since 2001 and confirms the national economic burden of the chronic disease to be ¤472 million per year. The research supported by a grant from GSK Ireland. Previous estimates into the large-scale impact of asthma on the Irish healthcare system under-estimated the number of people with asthma in Ireland. ¤102 million is lost each year in potential savings and action

is now needed if we are to turn around patient care and reduce the economic impact. Associated Costs Of the total annual ¤472 million economic strain, the cost of hospitalisations, emergency department visits and GP consultations accounted for 57% of total direct costs. In 2017, there was an estimated 2.4 million and 625,000 GP and Practice Nurse consultations for asthma respectively. There was also a significant burden in the hospital setting with an estimated 421,000 and 133,000 Specialist and Emergency Department visits respectively, along with almost 8,000 hospital admissions. Speaking at the launch, CEO of the Asthma Society of Ireland, Sarah O’Connor, said, “The reality


2.4m €1,242 1 5 in

The number of asthma GP consultations annually.

The annual average cost of asthma per patient.

110 113 40,593 nd in

Proportion of children who experience asthma at some stage in their life.


The number of children registered under the Asthma Cycle of Care programme.

Proportion of children who currently have asthma.


Proportion of people in Ireland currently have asthma.



Ireland had the second highest rate of asthma hospital discharges in Western Europe in 2016.

890,000 14 one Four Average number of school days missed every year due to asthma.

seven Average number of work days missed every year due to asthma.

The number of people in Ireland who experience asthma at some stage of their life.


Compared to 14 other European countries: Ireland had the highest death rate from asthma in 2015.

every six days

The frequency at which people are dying as a result of their asthma.


How often someone in Ireland visits an Emergency Department with asthma.

million 8,000 The amount asthma costs the state per annum.



The number of asthma admissions to hospital every year.

of asthma for our health system and our patients is made crystal clear from this research. It tells us that we are getting asthma management wrong – structurally, it revolves solely around the asthma patient in crisis and fails in long-term control. “We can see Emergency Department visits and hospital admissions. We can see that, in comparison to other countries in Western Europe, Ireland has the poorest mortality outcome from asthma and one of the highest asthma hospitalisation rates. We can quantify how many GP and nurse consultations are involved at primary care level. Uncontrolled asthma costs the individual and the state - research shows that 60% of Irish people with asthma do not have it controlled. Sadly, at present, six people in Ireland die every six days as a result of their asthma. “This research highlights the value of a universal asthma selfmanagement programme at the macro-level, showing the benefits for the healthcare system, the cost savings and efficiencies and the potential impact of the measure as a whole.” Minimal Intrusion Marcus Butler, Medical Director of the Asthma Society of Ireland and Associate Professor, UCD/ Consultant Respiratory Physician, St Vincent’s University Hospital adds, “Everyday in Ireland, children and adults are being treated in emergency departments and out-of-hours GP practices up and down the country for uncontrolled asthma symptoms, when they should instead be facilitated in getting on with their lives with minimal intrusion from what is largely a very treatable condition. International data has suggested that there is substantial global variation in the economic burden of asthma over time, in addition to the ultimate and most tragic cost of asthma, asthma-related death, a largely preventable catastrophic event. “Asthma death rates are falling in many developed countries, but alarmingly, they appear to be rising in Ireland. This research contends that a national selfmanagement programme for all

asthma patients, irrespective of age, has a high likelihood of substantial cost savings, not to mention the precious safeguarding of human life and wellbeing that underpins all of our efforts in the asthma community.” The research is being fully supported by a grant from GlaxoSmithKline. Following a formal tender process, Salutem Insights, a specialised Irish health economics consultancy, were selected to undertake the study. Salutem Insights carried out a similar study on the Cost of Diabetes in Ireland which has been used to advocate for change in how Type II diabetes is managed in Ireland. Headline Results Meanwhile, GlaxoSmithKline and Innoviva, Inc. have announced headline results from the pivotal phase III CAPTAIN2 study of oncedaily single inhaler triple therapy Fluticasone furoate/umeclidinium/ vilanterol: (FF/UMEC/VI) compared to Relvar Ellipta (FF/VI), in the treatment of patients living with uncontrolled asthma. The study met its primary endpoint, demonstrating a statistically significant 110mL improvement in lung function (measured by change from baseline in trough FEV1 at 24 weeks of treatment) for FF/UMEC/ VI 100/62.5/25mcg (p<0.001, 95% CI: 66-153 mL) compared with Relvar 100/25mcg and a statistically significant 92mL improvement in trough FEV1 for FF/UMEC/VI 200/62.5/25mcg versus Relvar 200/25mcg (p<0.001, 95% CI: 49-135 mL). The key secondary endpoint was annualised rate of moderate/ severe exacerbations for FF/ UMEC/VI (100/62.5/25 and 200/62.5/25) versus Relvar (100/25 and 200/25) and demonstrated a 13% (95% CI: -5.2 to 28.1) reduction in exacerbations, however this was not statistically significant. Therefore, all subsequent analyses were considered descriptive. Clinical trials.gov - https:// clinicaltrials.gov/ct2/show/ NCT02924688 2


Trade Show

Cosmetic Association 2019 Trade Fair One of the best trade shows in recent times was experienced in the RDS in May of this year. Starting on Sunday 19th May 2019, and finishing up on Tuesday evening 21st at 6pm. Visitors were very happy with the presentations and selection of products and the high standard of all the stands. The exhibitors pulled out all the stops with regards to dressing their stands and the compliments from the buyers were very encouraging. New members brought excitement to the show and they were very happy with their experience. The new products presented were welcomed very well by the buyers and some of the exhibitors were overwhelmed with the success of the event. “It is taking most buyers two days to get the full value out of the event. With in excess of 70 exhibitors taking part, you just have to give it your full attention. “We are preparing for next year already. We organise the largest event, under one roof, for the pharmacy sector in both jurisdictions. We hope you will continue to support us in future years,” said the event organiser Jo Somerville, Managing Director of The Cosmetic Association.

1 2

3 4 1. Anne Cowley, Product Manager and Tiarnan Crowe, Key Accounts Manager, both with Uniphar 2. Ian McDonald, Business Development Executive, Darrin Mullins, Business Development Executive, Ciaran O’Doherty, Category Manager, Olwyn Hanson, Sales Merchandiser and Samantha Ryan-Doyle, Visual Merchandiser, all from Uniphar Group 3. Yvonne Quigley, Area Sales Manager, United Drug, Maura Cronin, Sales Representative, United Drug and Johnny Murphy, Head of Consumer Health, A.Menarini



4. John Tooher, Sales Representative, Fran Wern and Ciaran Branagan, Key Account Manager, all from United Drug 5. Alan Bennett, Business Development Manager – Photo, Uniphar


A unique range of Italian emollients and cleansers, which includes products developed for eczema, dermatitis, baby care, dry and sensitive skin.

All products are dermatologically tested

Distributed by: A.Menarini Pharmaceuticals Ireland Ltd, Castlecourt, Monkstown Farm, Monkstown, Glenageary, Co. Dublin. www.relife.ie IE19019 IR-REL-22-2019 Date of item April 2019


Trade Show









1. Annette Norton, Commercial Director, Geraldine Kerrigan and Olwen Mooney, Sales Representatives, Sam McLernons 2. Linda McNamee, Managing Director, Bellamianta Tan and Jane O’Connor Managing Director, Roc Ronoco 3. The team from Brandshapers, Sharon Cahill, Key Account Manager, Siobhan Quirke, Sales Representative, Joanne Watson, Sales Representative, Michelle Carr, Brand Executive and Liam Dooley, Commercial Manager 4. John Doherty, Co-owner and Rachel O’Gorman, Powder n’ Pout Cosmetics 5. Niamh Hogan, CEO, Holos Skincare 6. John Lalor, Munster Area Manager, Andra Rooney, Account Executive, Darragh Broderick, Area Sales Manager, Kevin Barry, National Sales Manager, Tanya McGuirk, Account Executive, all from Revive Active 7. BPerfect Just James MUA 8. Darren Kennedy of Kennedy & Co, Karoline Kelly, Head of Sales and John Meany O’Brian, Owner & Director, both from Eurosales International


Trade Show










1. The Allegro team, Maeve Healy, Nicola Delaney, Fiona Wilkes, Paul Finnegan, Pharmacy Channel Manager and Jennifer Byron 2. The team that make the Cosmetics Show happen - Jo Somerville, Kevin Gaul 3. Kingsley Lewis, Business Sales Executive and Paul Daly, Pharmacy Representative, both from Fannin 4. David O’Mahony, and Paul O’Neill, Sales Director, both from the Cosmetics Alliance 5. Anne Cowley, Product Manager, Uniphar and Tara O’Brien, PR & Marketing Manager, Carter Beauty 6. Ann Kavanagh, Brand Manager, United Drug, Norma Beggs, Cofri Cosmetics, Yvonne Quigley, Area Sales Manager, United Drug 7. Tina Buckley, Sales & Marketing Manager, Tanya Keegan, Sales Representative, Tracey Carey, Sales Representative, Stephanie Carson, Marketing, Graham Anthony 8. Liam Heavy, National Key Account Manager, Green Angel, Melissa Plunkett, Cosgraves Pharmacy Monkstown and Tom Gilsenan, Sales Representative, Green Angel


The Faces of Rosacea: Triggers to Treatments


osacea's symptoms can cause patients embarrassment, which pharmacists can help relieve with important treatment information. Rosacea is a chronic disorder of the facial skin that is often characterised by flare-ups and remissions. According to the recently updated standard classification of rosacea, the presence of persistent facial redness or, less commonly, phymatous changes where the facial skin thickens is considered diagnostic of the disorder. Additional major signs include bumps (papules) and pimples (pustules), flushing, visible blood vessels (telangiectasia) and certain ocular manifestations. The presence of two or more major features independent of the diagnostic signs is also considered diagnostic of rosacea, and secondary signs and symptoms include burning or stinging, swelling and dry appearance. In around half of rosacea patients, the eyes are also affected, including visible blood vessels on the eyelid margin and a bloodshot appearance, as well as inflammation and growth of fibrous tissue. Burning, stinging, light sensitivity and the sensation of a foreign object may also occur, as well as conjunctivitis, inflammation of oil glands at the rim of the eyelids (blepharitis) and crusty accumulations at the base of the eyelashes. Severe cases of this condition, known as ocular rosacea, can result in loss of visual acuity.


can spread beyond the cheeks and nose to the back, chest, and ears, and the skin usually is very sensitive. The condition involves more than redness, however, it occurs in 4 subtypes, though many patients have 2 or more types: • Erythematotelangiectatic rosacea is distinguished by flushing, redness, and visible blood vessels. Central flushing and redness are prominent, and skin may appear swollen or burn and sting. Dryness, roughness, or scaling also may occur. Diffuse vascular erythema (flushing) is rosacea’s most common symptom. • Papulopustular rosacea manifests as redness, swelling, and acne like breakouts that may come and go, usually developing where the skin is most reddened. Burning, sensitive, or stinging skin with visibly broken blood vessels is the hallmark. Plaques or raised patches also may appear on the face. • The rare phymatous subtype sebaceous gland hypertrophy usually develops after another rosacea subtype. Skin thickening occurs most often on the nose (sometimes called rum or whiskey nose, though alcohol is not a factor) but can also affect the cheeks, chin, ears, and forehead.

In some patients, especially in men, the nose may become enlarged from the development of excess tissue. This is the condition that gave comedian W.C. Fields his trademark red, bulbous nose.

• Ocular rosacea causes red, irritated eyes with swollen lids that can resemble sty formation. Eyes may be bloodshot or watery and feel dry and gritty. Blurry vision and light sensitivity may occur.

Rosacea begins with a tendency to blush or flush easily. Redness

Chronic and progressive, rosacea can create self-esteem issues and

social anxiety. Many sufferers worry that the condition will worsen or cause irreversible disfigurement. A recent National Rosacea Society (NRS) survey found that highly successful medical treatment for rosacea often has a major positive impact on patients’ lives. In the survey of 1,044 rosacea patients, around 76% of all respondents saw at least some improvement in their skin after receiving treatment. Among those patients, 40% said that treatment had improved their psychological well-being, 35% said their social well-being had improved, and 31% saw improvement in their occupational well-being. When the signs and symptoms of rosacea are virtually eliminated, however, the improvement in patients’ lives is often dramatic. “Recent studies of the burden of disease in rosacea have found that it can deeply impact a patient’s quality of life due to its effects on facial appearance and confidence,” says Dr Hilary Baldwin, Associate Professor of Dermatology at Rutgers Robert Wood Johnson Medical School. “The results of this survey suggest that, on the flip side, achieving clear skin through new advances in medical therapy has the potential to greatly improve a rosacea patient’s personal wellbeing in many ways.” Treatment Goals Effective treatment along with changes in lifestyle can help to control and manage the discomfort of rosacea and bring rosacea into total remission. Just as there is no cure for the common cold, there is no cure for rosacea, which will appear again as the body is stressed and worn with time. In the treatment of rosacea to goal is to create or gain a reduction in redness not simply achieve a one-time temporary fix. The desire to control the cause of rosacea requires an effort to produce results.

Rosacea is considered more of an immune system condition rather than a bacterial condition. The proper treatment for rosacea needs to address the cause and symptoms of rosacea and a drier skin; redder skin surface is among those symptoms. There are two ways to relieve skin dryness - replace moisture loss internally and replace moisture loss externally. The skin is the body's largest single organ and controls the function of acting as a protective barrier for all other organs. Increasing water intake will replace moisture loss to the entire body as well as to the skin. Applying soothing oil to the skin will add in replacing moisture loss at the skin's surface. Avoid anti-aging and anti-wrinkle creams as these will actually cause more skin dryness. At the Pharmacy Pharmacists should monitor concurrent medications carefully. Calcium channel blockers may enhance or induce symptoms, and some antihypertensives may reduce symptoms and are sometimes used off-label to treat rosacea. Anecdotal evidence indicates that beta-blockers, clonidine, naloxone, ondansetron, and selective serotonin reuptake inhibitors may reduce flushing. A number of other drugs cause flushing and may exacerbate rosacea. Advise patients to avoid benzoyl peroxide, glycolic acid, propylene glycol, and topical retinoids. Rosacea patients use a large assortment of OTC skin care products, including mild cleansers, moisturisers, and sunscreens. Sunscreen is a critical component of skin care because sun exposure triggers rosacea flare-ups. Those with erythematotelangiectatic and papulopustular rosacea should look for mild OTC cleansers and moisturisers to self-treat burning, dryness, itching, stinging, and tightness.

Rosacea and dry skin commonly exist together. It may be that the treatments used to address the symptoms of rosacea caused the dry skin condition or dry skin may have contributed to the rosacea and possibly caused it to worsen.

Recommend products that contain just cetyl alcohol, glycerol monostearate, mineral oil, petrolatum, preservative, stearic acid, thickeners, and water. Recommend non–soapbased surfactants and synthetic detergents with low to neutral pH.

Many skin treatments are too drying causing the skin to develop small surface fissures of cracks which allow moisture to escape from beneath the surface of the skin causing skin redness, itchy and irritation. In its early stages, a lot of people mistake their rosacea symptoms for acne and thus reach for their standard over the counter acne medication. Acne medications work by drying the skin to reduce oil and hindering the growth of bacteria which is a component of acne.

Individuals who experience rosacea tend to use prescription products just to treat flare-ups and rely on OTC products for long-term control. Millions of patients would benefit from prescription drug treatment. Management strategies must be tailored to specific symptoms, and often, periods of trial and error are needed. Pharmacists also must consider rosacea’s psychological and psychosocial impact and suggest stepping up treatment when flareups occur.


sufferers change the soap or cleanser they are using to clean their face. Facial scrubs and exfoliating treatments are often too harsh for the more sensitive rosacea affected skin. Using a clean damp wash cloth as skin is cleansed will be just as effective without the harsh chemicals that are so damaging to the skin.

Lifestyle Factors Drink some water. Water flushes toxins form the body, reduces skin dryness which often occurs as a side effect of rosacea treatments. Water also aids in regulating the core body temperature to keep the skin from becoming flushed or heated. Advise on trying substituting one coffee, tea or soda a day with a glass of water and drink a glass of water either with each meal or before each meal. Again over a weeks' time observe the difference in rosacea symptoms. Learn to manage stress. Stress is a normal aspect of daily life. Stress can be a positive influence providing an adrenaline rush improving focus, sharpening the senses in a dangerous situation, or increase ambition and enthusiasm. Stress poorly managed can be overwhelming. The body reacts to stress with a rush of heat to

the skin or flushing, it alters the immune system and may cause indigestion, nausea, constipation or diarrhea. The skin may break out in hives, a rash or redness very similar to an allergic reaction. Managing stress is the ability to slow down, to step back, take a deep breath and accept that some things are out of our control. Stimulants causing vascular dilation can result in a spike in facial redness, stress, and an increase in oil secretin through the pores causing pimples and clogged pores. An example of these stimulants would be excess sugar from processed foods, cigarettes, sweets, caffeinated beverages or energy drinks, alcohol, beer or sodas. The soap used to cleanse the face can have an effect on rosacea. Deodorant soaps can actually increase facial redness, dryness and skin irritation. Suggest

Facial massage can reduce inflammation and facial swelling. Facial massage done properly can improve circulation, and skin tone. Hair sprays, styling gels, and conditioners can cause the skin to break out of become flakey or red along the hairline. Advise on bathing or showering in a moderate temperature below 98.6 F. at the very warmest down to roughly 75 F as the lowest will provide less redness of the skin. And obviously between 75 and 85 F. would be most ideal. Rosacea symptoms may result from food allergies. Usually the central portion of the patient's face becomes red with a butterfly pattern of redness. And it is believed that it is not really an allergy but the body becoming overly acidic with too many acid foods and not enough alkaline foods and not enough alkaline water.

are comfortable is a simple way of thinking of when to exercise and at the most comfortable temperatures. Or early AM and late PM after work. Exposure to bacteria from fabrics that come in contact with the face can result in facial redness and pimples. These would include bed linens, pillows, face cloths and towels used in bathing. Bacteria can survive for quite some on these surfaces and be transferred onto the skin from contact. Even a hairbrush, makeup applicators or facial brushes can harbor and transfer bacteria to the skin. These items should be changed frequently. Proper weight management. Excess weight overloads the heart resulting in increased facial redness and difficulty in breathing deeply which results in less oxygen in the blood, more stress to the body and impaired immune system function. Eat many small meals instead of three large meals to help reduce rosacea related redness. Prescription and over the counter medications can result in skin redness, rashes, hives and sun sensitivity. Pharmacists and pharmacy staff should be aware of the possible side effects and advise sufferers on how to prevent them when taking any medication.

Exercise to relieve stress. Exercise at temperatures that

Know the Triggers



In addition to medical therapy, rosacea patients can improve their chances of maintaining remission by identifying and avoiding lifestyle and environmental factors that may trigger flare-ups or aggravate their individual conditions. Identifying these factors is an individual process, however, because what causes a flare-up for one person may have no effect on another.

• Liver • Yogurt • Sour cream • Cheese (except cottage cheese) • Chocolate • Vanilla • Soy sauce • Yeast extract (bread is OK) • Vinegar • Eggplant • Avocados • Spinach • Broad-leaf beans and pods, including lima, navy or pea • Citrus fruits, tomatoes, bananas, red plums, raisins or figs • Spicy and thermally hot foods • Foods high in histamine

• Saunas

To the right are lists of common rosacea trigger factors that may affect various individuals. The first was compiled from patient histories, and the second lists results of a patient survey by the National Rosacea Society. Neither list necessarily includes everything that may cause a flare-up, but they may be helpful in determining trigger factors for those presenting to the pharmacy. Patients should be encouraged to keep a diary of daily activities or events and relate them to any flare-ups they may experience. The following list was compiled from patient histories by Dr Jonathan Wilkin and produced by the National Rosacea Society.

Beverages • Alcohol, especially red wine, beer, bourbon, gin, vodka or champagne • Hot drinks, including hot cider, hot chocolate, coffee or tea

• Hot baths • Simple overheating • Excessively warm environments

Weather • Sun • Strong winds • Cold • Humidity

Drugs • Vasodilators • Topical steroids

Medical conditions • Frequent flushing

Emotional influences

• Menopause

• Stress • Anxiety

• Chronic cough

Skin care products • Some cosmetics and hair sprays, especially those containing alcohol, witch hazel or fragrances • Hydro-alcoholic or acetone substances • Any substance that causes redness or stinging


• Caffeine withdrawal syndrome

Physical exertion • Exercise • "Lift and load" jobs

News New Appointment

United Drug would like to announce the appointment of Laura Payne in the role of Brand & Trade Marketing Manager for the United Drug Wholesale Division.


Diabetes Test comes to Market

Having previously held Marketing positions with Pfizer Healthcare Ireland, Clonmel Healthcare and Roche Products (Ireland) Limited, Laura brings a wealth of industry experience to her new role.

Sugar, as everyone knows, is sticky. Too much in the blood and it'll bind to plasma proteins like albumin, or to the haemoglobin in the red blood cells. Fortunately, they get recycled and replaced every few months. However, glucose also binds to long-lived tissues like nerve cells or kidney cells, where damage can accumulate for decades.

Nutricentric Healthcare has been trialling this new test since the start of this year and is now available to pharmacists and alloed healthcare practitioners concerned with blood glucose managementThe test is certified by NGSP, the international accreditation body which decides if a test is suitable for diagnosis of prediabetes or diabetes.

The HbA1c test measures the proportion of the haemoglobin that has sugar attached. As haemoglobin stays in circulation for about three months, the test is equivalent to doing thousands of the "normal" blood sugar tests over that period. In other words, it won't be distorted by what someone ate yesterday or whether they had breakfast.

The test is available as test strips and a special glucometer. The meter has 2 testing ports, one for standard blood glucose testing and the main one for HbA1c. For more information contact: peter@nutricentric.com

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Aof Sleep Disorders T

here's a reason why sleep deprivation is classified as a form of torture and is a common strategy employed by religious cults.

They force prospective members to stay awake for extended periods to reduce their subjects' decision making ability and make them more open to persuasion. In fact, prolonged sleep deprivation is an especially insidious form of torture because it attacks the deep biological functions at the core of a person’s mental and physical health. It is less overtly violent than cutting off someone’s finger, but it can be far more damaging and painful if pushed to extremes.

Researching the Problem According to Awake, a recent RTÉ documentary on the issue, more than 40% of people in Ireland notch up a bare six hours’ sleep or less on an average weeknight. Around 27% of people use alcohol to help them sleep, while 18% use sleeping tablets. Insomnia is a particularly common problem with up to 15% of people suffering from the condition which leads to difficulty in falling asleep or staying asleep. It seems people continually subject themselves to sleep deprivation, even though, according to the World Health

Organisation, adults generally need between seven and nine hours’ sleep a night

heart attack or stroke within 10 years than those who slept and woke at the same times every day.

 Difficulty in maintaining sleep, waking up for more than 30 minutes during the night

A study published in the US last year on sleep patterns, suggested that a regular bedtime and wake time are just as important for heart and metabolic health among older adults.

Irregular sleepers were also more likely to report depression and stress than regular sleepers, both of which are connected to heart health.

 Having sleep disturbed more than 3 nights per week

In a study of 1,978 older adults, researchers at Duke Health and the Duke Clinical Research Institute found that people with irregular sleep patterns weighed more, had higher blood sugar, higher blood pressure, and a higher projected risk of having a



Common Sleep Disorders

Insomnia can be indicated if an individual presents to the pharmacy reporting two or more of the following:  Taking more than 30 minutes to fall asleep

 Significant impairment of daytime functioning, such as fatigue, mood disturbances, due to lack of sleep The duration of insomnia is the most important guide to treatment. Currently it is classified into three types; Transient: Lasts two or three days and is typically due to extraneous factors such as noise

Short-term: Lasts up to three weeks and is typically due to emotional trauma or physical illness and Chronic: Can be defined as insomnia on most nights, for three weeks or more. Over-the-counter sleep aids are widely available. Common choices and the potential side effects include: • Diphenhydramine (Benadryl, Aleve PM, others). Diphenhydramine is a sedating antihistamine. Side effects might include daytime drowsiness, dry mouth, blurred vision, constipation and urinary retention. • Doxylamine succinate (Unisom SleepTabs). Doxylamine is also a sedating antihistamine. Side effects are similar to those of diphenhydramine. • Melatonin. The hormone melatonin helps control natural sleep-wake cycle. Some research suggests that melatonin supplements might be helpful in treating jet lag or reducing the time it takes to fall asleep, although the effect is typically mild. Side effects can include headaches and daytime sleepiness. • Valerian. Supplements made from this plant are sometimes taken as sleep aids. Although a few studies indicate some therapeutic benefit, other studies haven't found the same benefits. Valerian generally doesn't appear to cause side effects. Over-the-counter sleep aids might help temporarily, but lifestyle changes are usually the best approach for chronic insomnia. Many sufferers can adopt effective self care techniques such as avoiding smoking, avoiding drinking alcohol, tea or coffee at least 6 hours before bedtime. Obstructive Sleep Apnoea Obstructive Sleep Apnoe (OSA) means losing the ability to breathe freely. It happens over and over while asleep. It is caused by a narrow, floppy throat. Most people who have sleep apnoea snore too. The period when the sleeper has

trouble breathing ends with them waking up. This arousal is often very brief with no memory of it. But arousing over and over like this disrupts sleep and causes excessive tiredness during the day. According to the World Health Organization, an estimated 100 million individuals worldwide have some degree of OSA. Left untreated, OSA can lead to a myriad of serious health consequences, including increased mortality and an increased incidence of hypertension, stroke, heart failure, coronary artery disease, cardiac rhythm problems, type 2 diabetes, gastroesophageal reflux disease, nocturnal angina, hypothyroidism, or neurocognitive difficulties. Although OSA commonly affects middle-aged men, especially those who are overweight, it is important to note that OSA can affect anyone at any age regardless of weight. Chronic snoring is the hallmark symptom associated with OSA. Although loud, disruptive snoring is observed in 85% of OSA cases, not everyone who snores has OSA. Other classic OSA signs and symptoms experienced during sleep include choking or gasping for breath and pauses in breathing. Patients may also have nocturia and difficulty staying asleep. Unfortunately, because the patient is often unaware of the condition, OSA frequently goes unrecognised until another individual witnesses symptoms. Diagnosing OSA is often a difficult task because of the patient’s unawareness and the variations in presentation. There are treatments that work. These include weight loss, cutting down on alcohol, dental devices and continuous positive airway pressure (CPAP) therapy. Snoring Snoring is a common problem. It affects up to 40% of men and 20% of women on a regular

basis. It gets worse with age and weight gain. Someone who snores can disturb their partner's sleep. Snoring occurs when the flow of air from the mouth or nose to the lungs is disturbed during sleep, usually by a blockage or narrowing in the nose, mouth, or throat (airway). This condition causes the tissues of the airway to vibrate and knock against the back of the throat, resulting in a noise that can be soft, loud, raspy, harsh, hoarse, or fluttering. As well, many regular snorers also have OSA. A variety of factors can contribute to a patient's likelihood of developing a tendency to snore. Gender is one of them. Age also plays a role; snoring occurs most often in middle- aged people. One study showed that the risk of snoring among men increases until ages 50 to 60, then decreases afterwards. Heredity, being overweight or obese, and jaw abnormalities also can cause snoring. Smoking is another risk factor. Although some of these factors cannot be overcome, a person can take several steps to alleviate the condition. If a snorer is overweight, for example, losing weight can help reduce the narrowing of the airway and possibly diminish or eliminate snoring. Patients should be encouraged to sleep on their sides instead of their backs, and to get an adequate amount of sleep each night, to help lessen snoring. Also, it has been suggested that the use of alcohol and certain sedating medications may make snoring worse, so patients should be advised to use them sparingly. Anti-snoring devices can help prevent snoring. Those whose snoring is mainly coming from their nose, may benefit from using nasal strips or nasal dilators. Nasal strips are small pieces of self-adhesive tape that are similar in appearance to sticking plasters which are placed on the outside of the nose. The strip pushes the nostrils apart, which

can help prevent them narrowing during sleep. A nasal dilator is a plastic or metal device that looks a bit like a nose ring. Those goes inside the nose before going to sleep and pushes nostrils apart. If the snoring is mainly coming from the mouth, patients may benefit from chin strips or a vestibular shield. Chin strips help stop the mouth falling open while they sleep. A vestibular shield is a plastic device that is similar in appearance to a boxer's gum shield. It fits inside the mouth, blocking the flow of air. This forces individuals to breathe through their nose which may prevent them from opening their mouth and snoring. If the snoring is mainly due to the base of the tongue vibrating, a mandibular repositioning splint (MRS) (also known as a mandibular advancement device) may be recommended. A MRS is similar to a vestibular shield, but rather than keeping the mouth closed it is designed to push the jaw and tongue forward. This will increase the space at the back of the throat and reduce the narrowing of theairway that is causing the tongue to vibrate, resulting in snoring. For those whose snoring is not causing them any health problems but is annoying their partner, ear plugs during the night may be a cheap and effective way of resolving the issue. Restless Legs Syndrome People with restless legs syndrome have uncomfortable feelings in the legs. The only way they can stop these is to move their legs. How severe it is tends to vary over the day. The worst time is from the evening through to the early hours of the morning. For some people, it can make their sleep a lot worse. Sometimes it is caused by the body not having enough iron. Patients often describe uncomfortable sensations in

the legs as burning, pins and needles, electric shocks, itching, “things crawling under the skin,” “soda bubbling in the veins,” or throbbing. Some describe these sensations as being painful as well. In the majority of cases, there’s no obvious cause of restless legs syndrome. Mild cases of restless legs syndrome that aren’t linked to an underlying health condition may not require any treatment, other than making a few lifestyle changes, such as: • adopting good sleep habits – for example, following a regular bedtime ritual, sleeping regular hours, and avoiding alcohol and caffeine late at night • quitting smoking • exercising regularly during the daytime If symptoms are more severe, patients may need medication to regulate the levels of dopamine and iron in the body. If restless legs syndrome is caused by iron deficiency anaemia, iron supplements may be all that’s needed to treat the symptoms. Dopamine agonists may be recommended for those experiencing frequent symptoms of restless legs syndrome.

Sleep talking, sleepwalking Sleepwalking, also known as somnambulism, is a parasomnia that tends to occur during arousals from slow-wave sleep. It most often emerges in the first third or first half of the sleep period when slow-wave sleep is more common. Sleepwalking consists of a series of complex behaviours that culminate in walking around with an altered state of consciousness and impaired judgment. Before walking the person often sits up in bed and looks about in a confused manner with eyes wide open. Sometimes the person immediately gets up and walks or even bolts from the bed running. The sleepwalker can be hard to awaken. Once he or she is awake, the person often is confused and has little recall of the event. The sleepwalking may end suddenly, sometimes in unusual or inappropriate places. In other cases the person may return to bed and continue sleeping without ever becoming alert. Sleep talking is a common sleep disorder that is classified as an isolated symptom. It can arise during any stage of sleep and can occur with varying levels of comprehensibility. The sleep talker tends to be unaware of the problem, but loud and frequent talking can disturb the sleep of the bed partner.

Because parasomnias often occur in healthy people, treatment for sleepwalking tends to be unnecessary. Sleepwalking that emerges in childhood often resolves as the child grows older. Treatment may be necessary if the sleepwalking persists into adulthood and involves behaviours that are potentially dangerous. A change in medication may be required if sleepwalking results from using a drug. Most often this rare side effect occurs when patients fail to follow the instructions for taking their medication. Common mistakes include combining a medication with other drugs or with alcohol, taking the wrong dose, or taking the medication at the wrong time. Role of the Pharmacist It has been established that getting adequate sleep each night is a vital component to maintaining a healthy lifestyle. Being chronically sleep deprived can not only increase the risk of developing chronic disease states, such as diabetes, depression, cardiovascular disease, and others, it can also impact neuropsylogical disorders including acute manifestations, such as increased nightmares. It is important for patients to utilise the role of the community pharmacy in managing their sleep disorders to ensure they are getting the proper rest they

need. Pharmacists can play an important role in championing optimal sleep health. While not everyone has easy access to a specialised sleep disorder centre, most have access to a pharmacy. Pharmacists can decipher what treatment strategies are appropriate for their struggling patients and can recommend any alternative options that are available. It is important for pharmacists to be aware which drugs have the potential to disrupt sleep, and when discussing sleep problems with a patient finding out about their current medication is vital. When offering advice, patients should be reminded that OTC sleeping aids are indicated for short-term use and should only be taken for 7 to 10 days, unless otherwise directed by their GP. Pharmacists should always refer patients with chronic insomnia when warranted and thoser electing to use OTC sleep aids should be advised of the potential adverse effects, drug interactions, contraindications, and precautions associated with these products. When patients find themselves in this aggravating situation of losing sleep, confiding in a pharmacist will help them improve their outcomes. Together, a solution for their sleep disorder can be found, and patients can be on their way to nights full of peaceful rest.

News Men urged to start health journey at their pharmacy Pharmacists are calling on all men to use Men’s Health Week as the impetus to start addressing their health challenges: “Why not start your new health journey today by going into your local pharmacy, and begin to address some of the niggles that may have been bothering you for years?” says Tomás Conefrey, a local community pharmacist and member of the Irish Pharmacy Union (IPU). Tomás Conefrey, pharmacist, Conefrey’s Pharmacy and IPU member

Mr Conefrey adds, “Men’s health challenges don’t just affect men themselves: they have an impact on families, friendship networks, personal finances, workplaces and health services. However, too often, we men put off tackling


these issues, and imagine they can wait until we have more time on our hands. Lots of serious health conditions, such as high blood pressure, diabetes and heart disease, can be helped by a healthy lifestyle, and by reducing alcohol intake and quitting smoking. Your local pharmacist can offer advice on all of this in a private consultation room. Pharmacy staff are well positioned to talk to men about their health needs, explore possible options and, when necessary, suggest that they may need to seek further expert assistance.” The Irish Pharmacy Union is encouraging men to utilise the convenience of their local

pharmacy during Men’s Health Week 2019. “Everyone is being encouraged during this Men’s Health Week to ‘Take the Time and Make the Time’ to do something realistic and practical that will make a positive difference to the health of both themselves, and the men and boys that they have influence over. Your local pharmacy is a great place to start”, concluded Mr Conefrey. Men’s Health Week (10 -16 June) is co-ordinated in Ireland by the Men’s Health Forum in Ireland. Find out more about Men’s Health Week at www.mhfi.org/mhw/ mhw-2019.html on Facebook at MensHealthWeek, and on Twitter @MensHealthIRL.

Product News




Clonmel Healthcare is delighted to announce the launch of Febuxostat Clonmel 80mg and 120mg Film-coated Tablets.

Clonmel Healthcare is delighted to announce the launch of Solifenacin Clonmel 5mg and 10mg Film-coated Tablets.

Febuxostat Clonmel 80mg is indicated for the treatment of chronic hyperuricaemia in conditions where urate deposition had already occurred (including a history, or presence of, tophus and/or gouty arthritis) in adults.

Solifenacin Clonmel is indicated in adults for symptomatic treatment of urge incontinence and/or increased urinary frequency and urgency as may occur in patients with overactive bladder syndrome.

Along with the above, Febuxostat Clonmel 120mg is also indicated for the prevention and treatment of hyperuricaemia in adult patients undergoing chemotherapy for haematologic malignancies at intermediate to high risk of Tumour Lysis Syndrome (TLS). Full prescribing information is available on request or alternatively please go to www.clonmel-health.ie. Product is subject to medical prescription.

Full prescribing information is available on request or alternatively please go to www.clonmel-health.ie. Product is subject to medical prescription. Please contact Clonmel Healthcare on 01-6204000 if you require any additional information. PA 126/288/001-002. PA Holder: Clonmel Healthcare Ltd., Clonmel, Co. Tipperary. Date prepared: June 2019. 2019/ADV/SOL/079H

Please contact Clonmel Healthcare on 01-6204000 if you require any additional information. PA 126/295/001-002. PA Holder: Clonmel Healthcare Ltd., Clonmel, Co. Tipperary. Date prepared: June 2019. 2019/ADV/FEB/078H

The Taste of

Now available


SOLIFENACIN SUCCINATE ROWEX 5MG & 10MG FILM-COATED TABLETS Solifenacin succinate Rowex 5mg & 10mg Film-Coated Tablets SOLIFENACIN SUCCINATE Solifenacin succinate Rowex Ltd. is pleased to announce the launch of Solifenacin succinate Rowex. Press Release: Press Release: Solifenacin succinate Rowex 5mg & 10mg Film-Coated Tablets Solifenacin succinate Rowex 5mg & 10mg Film-Coated Tablets Solifenacin succinate Solifenacin succinate AG 20/06/19 Press AGRelease: 20/06/19

AGRowex 20/06/19 Ltd. is pleased to announce the launch of Solifenacin succinate Rowex.

AG 20/06/19

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Solifenacin 5mg FilmPacks POM PA0711/280/001 5390387221019 €13.56 BRAND NAME STRENGTH PACK Packs LEGAL PA NUMBER BARCODE5390387221019 TRADE Solifenacin 5mg POM PA0711/280/001 succinate Rowex Coated of 30FilmPRICE succinate Rowex Coated SIZE of CATEGORY 30 Tablets Tablets Packs Solifenacin 5mg FilmPOM PA0711/280/001 5390387221019 €13.56 Solifenacin succinate 10mg Packs of 30POM PA0711/280/002 5390387221101 €17.23 RowexFilmCoated Solifenacin 10mg POM PA0711/280/002 5390387221101 succinate Rowex Coated Tablets of 30 Film- Packs succinate Rowex Coated of 30 Tablets Tablets Solifenacin 10mg Film- Packs POM PA0711/280/002 5390387221101 €17.23 succinate Rowex

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Medicinal product subject to medical prescription. Further information and SPC are available from the Marketing Authorisation Holder: Rowex Ltd., Bantry, Co. Cork, P75 V009 Contact your Valeo Healthcare Sales Freephone: 1800 304 400 Fax: 027 50417 Rep or Head Office on 01 405 1500MedicinalMedicinal product subject to medical prescription. Further information andand SPCSPC product subject to medical prescription. Further information E-mail: rowex@rowa-pharma.ie Medicinal product subject to medical prescription. Further information available from thefrom Marketing Authorisation Holder: Rowex Ltd., Bantry, Co.Co. and SPC are available the Marketing Authorisation Holder: Rowex Ltd., Bantry, for more information.are areP75 available from the 304 Marketing Authorisation Holder: Rowex Ltd., Bantry, Co. Date ofV009 preparation: (06-19) CCF No: 22236 Cork, P75Cork, V009 Freephone: 1800 400 Fax: 027 50417 Freephone: 1800 304 400 Fax: 027 50417 Cork,rowex@rowa-pharma.ie P75 V009 Freephone: 1800 304 400 Fax: 027 50417 E-mail: E-mail: rowex@rowa-pharma.ie E-mail: rowex@rowa-pharma.ie

of preparation: (06-19) 22236 Date ofDate preparation: (06-19) CCFCCF No: No: 22236 Date of preparation: (06-19) CCF No: 22236


That Enstilar moment ®

calcipotriol/betamethasone dipropionate CUTANEOUS FOAM

Discover what the foam spray Enstilar can do for your plaque psoriasis patients


Extraordinary Delivery Visit www.enstilar.ie Abbreviated Prescribing Information for Enstilar ® (calcipotriol/ betamethasone) 50 micrograms/g + 0.5 mg/g cutaneous foam. Please refer to the full Summary of Product Characteristics (SmPC) (www.medicines.ie) before prescribing. Indication: Topical treatment of psoriasis vulgaris in adults. Active ingredients: 50 µg/g calcipotriol (as monohydrate) and 0.5 mg/g betamethasone (as dipropionate). Dosage and administration: Apply by spraying onto affected area once daily. Recommended treatment period is 4 weeks. The daily maximum dose of Enstilar should not exceed 15 g, i.e. one 60 g can should last for at least 4 days. 15 g corresponds to the amount administered from the can if the actuator is fully depressed for approximately one minute. A twosecond application delivers approximately 0.5 g. As a guide, 0.5 g of foam should cover an area of skin roughly corresponding to the surface area of an adult hand. If using other calcipotriol-containing medical products in addition to Enstilar, the total dose of all calcipotriol-containing products should not exceed 15 g per day. Total body surface area treated should not exceed 30%. Safety and efficacy in patients with severe renal insufficiency or severe hepatic disorders have not been evaluated. Safety and efficacy in children below 18 years have not been established. Shake the can for a few seconds before use. Apply by spraying, holding the can at least 3 cm from the skin, in any orientation except horizontally. Spray directly onto each affected skin area and rub in gently. Wash hands after use (unless Enstilar is used to treat the hands) to avoid accidentally spreading to other parts of the body. Avoid application under occlusive dressings since systemic absorption of corticosteroids increases. It is recommended not to take a shower or bath immediately after application. Contraindications: Hypersensitivity to the active substances or any of the excipients. Erythrodermic and pustular psoriasis. Patients with known disorders of calcium metabolism. Viral (e.g. herpes or varicella) skin lesions, fungal or bacterial skin infections, parasitic infections, skin manifestations in relation to tuberculosis, perioral dermatitis, atrophic skin, striae atrophicae, fragility of skin veins, ichthyosis, acne vulgaris, acne rosacea, rosacea, ulcers and wounds. Precautions and warnings: Adverse reactions found in connection with systemic corticosteroid treatment, e.g. adrenocortical suppression or impaired glycaemic control of diabetes mellitus, may occur also during topical corticosteroid treatment due to systemic absorption. Application under occlusive dressings should be avoided since it increases the

systemic absorption of corticosteroids. Visual disturbance may be reported with systemic and topical corticosteroid use. If a patient presents with symptoms such as blurred vision or other visual disturbances, the patient should be considered for a referral to an ophthalmologist for evaluation of possible causes which may include cataract, glaucoma or rare diseases such as central serous chorioretinopathy (CSCR) which have been reported after use of systemic and topical corticosteroids. Application on large areas of damaged skin, or on mucous membranes or in skin folds should be avoided since it increases the systemic absorption of corticosteroids. Due to the content of calcipotriol, hypercalcaemia may occur. Serum calcium is normalised when treatment is discontinued. The risk of hypercalcaemia is minimal when the maximum daily dose of Enstilar (15 g) is not exceeded. Enstilar contains a potent group III-steroid and concurrent treatment with other steroids on the same treatment area must be avoided. Skin on the face and genitals are very sensitive to corticosteroids. Enstilar should not be used in these areas. Instruct the patient in the correct use of the product to avoid application and accidental transfer to the face, mouth and eyes. Wash hands after each application to avoid accidental transfer to these areas. When lesions become secondarily infected, they should be treated with antimicrobiological therapy. However, if infection worsens, treatment with corticosteroids should be discontinued. When treating psoriasis with topical corticosteroids, there may be a risk of rebound effects when discontinuing treatment. Medical supervision should therefore continue in the post-treatment period. Long-term use of corticosteroids may increase the risk of local and systemic adverse reactions. Treatment should be discontinued in case of adverse reactions related to long-term use of corticosteroid. There is no experience with the use of Enstilar in guttate psoriasis. During Enstilar treatment, physicians are recommended to advise patients to limit or avoid excessive exposure to either natural or artificial sunlight. Topical calcipotriol should be used with UVR only if the physician and patient consider that the potential benefits outweigh the potential risks. Enstilar contains butylhydroxytoluene (E321), which may cause local skin reactions (e.g. contact dermatitis), or irritation to the eyes and mucous membranes. Pregnancy and lactation: There are no adequate data from the use of Enstilar in pregnant women. Enstilar should only be used during pregnancy when the potential benefit justifies the potential risk. Caution should be exercised when prescribing Enstilar to women who breast-feed. The patient should be instructed not to use Enstilar on the breast when breast-feeding.

Side effects: There are no common adverse reactions based on the clinical studies. The most frequently reported adverse reactions are application site reactions. Uncommon (≥1/1,000 to <1/100): Folliculitis, hypersensitivity, hypercalcaemia, skin hypopigmentation, rebound effect, application site pruritus, application site irritation. Not known frequency: Hair colour changes. Calcipotriol: Adverse reactions include application site reactions, pruritus, skin irritation, burning and stinging sensation, dry skin, erythema, rash, dermatitis, psoriasis aggravated, photosensitivity and hypersensitivity reactions, including very rare cases of angioedema and facial oedema. Systemic effects after topical use may appear very rarely causing hypercalcaemia or hypercalciuria. Betamethasone: Local reactions can occur after topical use, especially during prolonged application, including skin atrophy, telangiectasia, striae, folliculitis, hypertrichosis, perioral dermatitis, allergic contact dermatitis, depigmentation and colloid milia. When treating psoriasis with topical corticosteroids, there may be a risk of generalised pustular psoriasis. Systemic reactions due to topical use of corticosteroids are rare in adults; however, they can be severe. Adrenocortical suppression, cataract, infections, impaired glycaemic control of diabetes mellitus, and increase of intra-ocular pressure can occur, especially after long-term treatment. Systemic reactions occur more frequently when applied under occlusion (plastic, skin folds), when applied on large areas, and during long-term treatment. Precautions for storage: Do not store above 30°C. Extremely flammable aerosol. Pressurised container. May burst if heated. Protect from sunlight. Do not expose to temperatures exceeding 50°C. Do not pierce or burn, even after use. Do not spray on an open flame or other ignition source. Keep away from sparks/open flames. No smoking. Legal category: POM. Marketing authorisation number and holder: PA 1025/5/1. LEO Pharma A/S, Ballerup, Denmark. Last revised: August 2018. Further information can be found in the Summary of Product Characteristics or from: LEO Pharma, Cashel Road, Dublin 12, Ireland. e-mail: medical-info.ie@leo-pharma.com ® Registered trademark MAT-18143 V2

Date of preparation: August 2018.

Reporting of Suspected Adverse Reactions Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via HPRA Pharmacovigilance, Earlsfort Terrace, Dublin 2, Tel: +353 1 6764971, Fax: +353 1 6762517, Website: www.hpra.ie, e-mail: medsafety@hpra.ie Adverse events should also be reported to Drug Safety at LEO Pharma by calling +353 1 4908924 or e-mail medical-info.ie@leo-pharma.com


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IPN 2019 July  

July 2019 - Irish Pharmacy News

IPN 2019 July  

July 2019 - Irish Pharmacy News