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June 2019 Volume 11  Issue 6 PHARMACYNEWSIRELAND.COM

THE INDEPENDENT VOICE OF PHARMACY

Winners' Edition

In this issue: NEWS: Pharmacy can be the shopfront of Sláintecare Page 5

NOW AVAILABLE IN

IRELAND

PERSPECTIVES: Focus in Pharmacy at National Conference Page 9

OUR SOLUTION TO YOUR SENSITIVE SKIN

INNOVATION: McCauleys open Flagship Store Page 12

REPORT: Vaccination Training goes Online Page 21

CPD: Managing Rheumatoid Arthritis Page 49

AWARDS:

Golden Cross Pharma

Email: kurt.lowell@gmail.com

Excellence Winners of 2019 Irish Pharmacy Awards Page 54


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3

Contents

Foreword

Page 4: Ridiculous red tape to blame for shortages

This June issue of Irish Pharmacy News is a full one, with in-depth features looking at skin care, male and female health, an exclusive report on the future of online vaccination training and brings you the latest developments within the sector. The failure as yet, for any expansion to the role of the pharmacists in Ireland, was just one of the topics debated at the recent IPU Annual Conference held in Galway.

Page 6: Next stage of High Tech Hub Page 12: McCauley Health & Beauty Pharmacy opens Flagship store

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Page 16: Brenson Medicines Pricing future looks very different

The IPU stated it is eagerly awaiting the commencement of negotiations with the Minister for Health so that a greater role for pharmacists in the implementation of Sláintecare can be realised. Each year in Ireland there are nearly 78 million visits to community pharmacies, making pharmacists the most accessed healthcare professionals in Ireland.

Speaking at the 2019.pdf conference, IPU Vice President Hanly, said, Lawlor Box Advert Apr 1Eoghan 10/04/2019 “Three years ago we welcomed the Government’s commitment to expand the role of pharmacists. We have consistently put forward proposals that would help alleviate current primary healthcare deficits, offer significant savings and efficiencies to the health service. While many of our proposals have been met with apathy from the Department of Health, we continue to be enthusiastic about the additional contribution we could make and hopeful that Sláintecare will provide an opportunity for progress.”

Page 22: Online Vaccinations Training – Exclusive Report

Are You Thinking of Selling Your Pharmacy? Page 54: Irish Pharmacy Awards 2019 – The Winners

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

Turn to page 9 for the full story.

Another key issue discussed at the conference, was pharmacy staff shortages. Sheila O’Loughlin, Pharmacist and member of the IPU Employee Pharmacy Committee (EPC), outlined some of the main findings of a new Behaviour & Attitudes report commissioned by the IPU, Perspectives of Community Pharmacy. Sheila also stated that the problem could become a ‘critical’ one, adding that the burden of excessive bureaucracy and unnecessary regulation was identified as a major frustration, particularly for younger pharmacists.

MANAGING DIRECTOR Natalie Maginnis n-maginnis@btconnect.com

“The report found that excessive red tape, bureaucracy and administration is one of the biggest drawbacks to a career in community pharmacy. The research shows that this is making it difficult to attract new graduates into the community pharmacy sector and to retain pharmacists in their current roles,” she said.

JPA Brenson Lawlor54has over 30 years’ experien advising pharmacy owners and will help you to maximise your return. EDITOR Kelly Jo Eastwood: 00353 (87)737 6308 kelly-jo@ipn.ie

In other news, the pinnacle of the community pharmacy calendar – the

2019 Irish Pharmacy Awards – took place last month, recognising the Irish Pharmacy excellence and dedication of 16 community pharmacists, pharmacy staff News is IRISH PHARMACY and businesses. Over 650 attended on the night honour and applaud11:18 circulated to all NEWS Lawlor Box Advert Apr 2019.pdf Brenson 1 to 10/04/2019 independent, these inspirational and deserving professionals and teams. multiple Pharmacists and academics Turn to page 54 for all the coverage and further details of who took home in Ireland.

ADVERTISING DIRECTOR Debbie Graham: 00353 (87) 288 2371 debbie@ipn.ie CONTRIBUTORS Dr Maria Benito

DESIGN DIRECTOR Ian Stoddart Design

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.

a prestigious award.

Regulars

Contact Us Today for a Free Consultation PHARMACYNEWSIRELAND.COM

@Irish_PharmNews

FEATURE: ORAL HEALTH

P26

FEATURE: MALE & FEMALE HEALTH

P35

CPD: RHEUMATOID ARTHRITIS

P49

PRODUCT PROFILES

P98

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

C

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CM

MY

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you to maximise your return. CMY

jason@brensonlawlor.ie padraic@brensonlawlor.ie

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www.brensonlawlo www.brensonlawlor.ie


4

News

‘Ridiculous’ Red Tape to Blame for Pharmacist Shortages A shortage of community pharmacists could become a critical problem for Irish healthcare the Irish Pharmacy Union (IPU) has warned. At the IPU’s National Pharmacy Conference, the burden of excessive bureaucracy and unnecessary regulation was identified as a major frustration, particularly for younger pharmacists. Sheila O'Loughlin, IPU Employee Pharmacy Committee

half of pharmacists now believe the sector is over-regulated which is creating constant pressure. “Ireland produces some of the most qualified pharmacists in the world”, according to Ms O’ Loughlin, “and yet our system is content to consign them to a career of administration. Expert healthcare professionals are being hamstrung by meaningless paperwork and excessive bureaucracy.”

research shows that this is making it difficult to attract new graduates into the community pharmacy sector and to retain pharmacists in their current roles.

Sheila O’ Loughlin, Pharmacist and member of the IPU Employee Pharmacy Committee (EPC), outlined some of the main findings of a new Behaviour & Attitudes report commissioned by the IPU, Perspectives of Community Pharmacy. “The report found that excessive red tape, bureaucracy and administration is one of the biggest drawbacks to a career in community pharmacy. The

“The areas identified as the biggest concerns include the additional burden of dealing with the HSE PCRS and its attendant paperwork and the pressure of ensuring compliance with regulatory guidelines. “We all recognise the importance of checks and balances, and safety is something a pharmacist would never compromise. However, 98% of pharmacists state that they are required to spend too much time on paperwork, which means time away from our patients. Almost

The impact upon the profession is becoming profound Ms O’Loughlin continued. “Fewer and fewer pharmacists now say they would recommend community pharmacy to a student today. We are therefore calling on the Regulators, particularly the HSE PCRS and Pharmaceutical Society of Ireland (PSI), to work with us to review and reduce the level of unnecessary bureaucracy foisted on community pharmacists. “Doing so will signal a commitment to would-be community pharmacists, that their role does matter as a key professional in the healthcare service and not just a quasi-administrative role, which involves frustrating hours chasing paperwork and complying with unnecessary bureaucracy”, concluded Ms O’ Loughlin.

Boots Stores face Threat of Closure Boots’ American parent company is reportedly planning to put more than 200 stores under review for possible closure over the next two years. Walgreens Boots Alliance (WBA), which owns the high street chemist and American pharmacy chain Walgreens have said that a ‘significant number’ of stores were likely to be closed, although it remains unclear if any Irish stores will be affected. Sources say some of the impacted stores would close at the end of their leases while others in towns with two or Boots would be closed as part of consolidation efforts ahead of time. Where possible, staff would be redeployed to an area’s existing or new store, they added. WBA said last month that it was

undertaking a review of Boots ‘focusing on low-performing stores and opportunities for consolidation’, but declined to specify how many stores it would consider for closure. In a statement to Irish Pharmacy News, a Boots UK spokesperson said, “We currently do not have a major programme envisaged, but as you'd expect we always review underperforming stores and seek out opportunities for consolidation. As is natural with a business of our size, we have stores opening, closing and relocating on a regular basis, but we have had around

PHARMACYNEWSIRELAND.COM

2,500 stores open for several years now. “In fact we’re investing in our stores – last year, we completed a huge merchandising project to update our self-selection cosmetics areas in 2,200 of our stores. “We have recently announced the planned opening of a new flagship store in Covent Garden, London and the reinvention of our beauty business in 24 stores across the UK. “We are being realistic about the future and that we will need to be agile to adapt to the changing landscape.”

Pharmacy Vaccine Amendment An amendment to the legislation which provides for the provision of vaccinations and emergency medicines by pharmacists (SI449/2015) came into effect in December 2018. The amendment has introduced changes to allow pharmacists to administer certain vaccinations and emergency medicines through new routes of administration, and/or in accordance with national guidelines, where the relevant training has been completed. The amendment has introduced changes which include allowing: • Herpes Zoster vaccine for injection to be administered by intramuscular or subcutaneous injection • Pneumococcal Polysaccharide vaccine solution for injection to be administered by intramuscular or subcutaneous injection • Naloxone nasal spray to be administered The amendment also allows for Epinephrine (adrenaline) injection and Salbutamol 100mcg multi dose inhaler to be administered in accordance with the Summary of Product Characteristics (SmPC) of the product or relevant national guidelines. In light of the changes introduced, the Naloxone training programme will be updated to include intranasal administration. The PSI is liaising with the HSE and IIOP in relation to the programme update and the updated programme will be available in due course. Pharmacists must undertake updated training in order to be able to administer Naloxone intranasally. All pharmacists must have up to date training, in the relevant route of administration, in order to deliver vaccination and emergency medicines services. Pharmacists who have undertaken the current training for the delivery of Herpes Zoster vaccination, Pneumococcal Polysaccharide vaccination, Adrenaline injection and Salbutamol are not required to repeat or undertake additional training to facilitate the changes in the legislation. Pharmacists must make themselves aware of the new provisions of the legislation, in the context of the medicines, SmPcs and national guidelines.


News Use and Learn Extension The Falsified Medicines Directive safety feature requirements came into effect on 9th February. During this time, the system in Ireland has been in ‘use and learn’ phase to ensure the continuity of safe supply of medicines to patients while all parties gained a better understanding of the new system. The national Safety Features Oversight Group comprising the Irish Medicines Verification Organisation (IMVO), the Department of Health, the Health Products Regulatory Authority (HPRA), the Pharmaceutical Society of Ireland (PSI), the Health Service Executive (HSE) and the Private Hospitals Association (PHA) has been closely monitoring progress since go live on 9th February. Taking all factors into account, the group has decided that the use and learn period will be further extended until 9th September 2019 to allow additional time for the system to stabilise. The situation will be reviewed again at that stage. Progress: Significant progress has been made on several fronts since 9th February: • The vast majority of pharmacies, hospitals and wholesalers have registered with IMVO and are connected to the national system • Between 50,000 and 60,000 thousand scans are taking place daily in Irish pharmacies, hospitals and wholesalers and this number is growing week on week • Barcode data for over 100 million packs has been uploaded to the national system by manufacturers. The number of packs bearing 2D barcodes in pharmacies will increase over the coming weeks and months as these packs work their way through the supply chain • Extensive analysis of alerts is taking place across Europe, resulting in greater understanding of their root causes and the rollout of initiatives to reduce the number of alerts being generated.

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Pharmacy - the ‘Shopfront of Sláintecare’ Minister for Health Simon Harris has committed to delivering a new contract with pharmacists and moving beyond FEMPI in a way that will see an increased investment in pharmacy services. Minister for Health Simon Harris and President of the IPU Daragh Connolly

Addressing the delegates at the Irish Pharmacy Union’s (IPU) National Pharmacy Conference, the Minister said, “There are undoubtedly opportunities for community pharmacy contractors in the next decade and I look forward to engaging with the IPU to enhance the delivery of primary care services through community pharmacy.” In his address Minister Harris outlined, “The role community pharmacy plays in delivering health services to our citizens is a vital one. Expansion of community pharmacy services is an important part of better primary care provision.” He stated his strong desire to work with pharmacists and to see negotiations swiftly concluded to ensure that pharmacists move past FEMPI and he committed to providing investment to expand the role of pharmacies in primary care.” Referring to the IPU’s repeated calls for implementation of a Minor Ailment Scheme, Minister Harris said that such schemes are proven to work. He went on to say there was no need for any more pilots and that a wider implementation was required.

A Minor Ailment Scheme would allow medical card holders to receive treatment for a number of specified ailments directly from their local community pharmacy, in a timely manner, without the need for an unnecessary visit to the GP. Pharmacists have consistently called for improved accessibility of contraception for women. This includes the provision of oral contraceptives (the pill), without prescription and without charge. The Minister echoed this ambition and committed to working with pharmacists to achieve this in the coming months. Minister Harris concluded by complimenting the role of

pharmacists and said “in towns and villages throughout this country, you can be the shopfront of Sláintecare.” Welcoming the Minister’s commitment, President of the IPU Daragh Connolly, said, “The IPU and our members strongly welcome Minster Harris’s clear commitment to begin a process that will bring about reform, modernisation and contractual overhaul for community pharmacy similar to his engagement with GPs. This will move the delivery of community healthcare to “higher terrain” that will ultimately bring huge benefits to patients and our communities.”

Solid Quarter for Pharmacy in Retail A new report shows that the value of retail sales rose by 4.7% in the first quarter of the year, boosted by a mild winter and early spring weather. The Grant Thornton Retail Excellence Retail Productivity Review, said there was a ‘modest uptick’ in consumer confidence coming off the back of some respite from Brexit uncertainty. The first quarter represented a solid quarter for the pharmacy sector with strong January sales. Retail Excellence Ireland said the main driver in the supermarkets and convenience stores sector continues to be competitive action with the battle for market share between multiples very intense and the slower but continuing growth of discounters also contributing to downward pressures.

A buoyant economy has been good news for the convenience sector, which is also in growth, it added. Retail Ireland noted that beauty categories were strong across Valentine's Day. But seasonal healthcare was soft with the exception of hay fever, which saw an early boost due to milder weather. Commenting on the report for Q1 2019, Group CEO of Retail

Excellence David Fitzsimons, said, “Quarter 1 2019 proved relatively robust, that said it is set against a weak Q1 2018 when severe weather events negatively impacted retail sales. “The Health Store sector enjoyed a very productive quarter, principally due to consumer bulk buying of food supplements in anticipation of a VAT increase from 0% to 23%. There was significant acceleration in online shopping over the period.”

PHARMACYNEWSIRELAND.COM


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News

Next Phase of High Tech Hub The next phase of the High Tech Hub was due to roll out at the start of this month (1st June). This will include Rheumatology, Dermatology and Gastroenterology. IVF, PAH and Cystic Fibrosis medicines are currently ordered through the Hub. In the case of three products – Idebenone (Raxone®) and Ataluren (Translarna®), which have been available through the Hub since 1 May, and Dimethyl Fumerate (Skilarence®), which will be included for ordering through the Hub from 1 June – the HSE is adopting a zero tolerance approach. If prescriptions for these products are not generated through the Hub, the medicine cannot be ordered by the pharmacy and the High Tech fee cannot be claimed. Prescribers must input prescriptions for these products directly on to the High Tech Hub to ensure the patients meet the reimbursement criteria.

The HSE has advised us that they have engaged with the relevant consultant prescribers in relation to this and that the prescribers are aware of the requirement to input prescriptions for these products directly onto the High Tech Hub. High Tech prescription forms generated on the Hub are prefaced by ‘HTH’. For Skilarence, a High Tech Hub prescription only needs to be generated on the Hub for newly initiated patients. The contact details for the High Tech Hub are pcrs.hitech@hse.ie / 01 864 7135. The FAQs and User Guide are

available on the Help section of the High Tech Hub. Patients with concerns can contact the HSE at hselive@hse.ie or phone 041 685 0300 or 1850 241 850. No doubt there will be some problems with the change to these services from 1 June. If you have any questions or comments on centralisation of the LTI Scheme or on the High Tech Hub, contact Derek or Aoife in the Contract Unit on aoife.garrigan@ipu.ie or call 01 406 1557. They will be raising all issues and concerns with the HSE in order to have them resolved.

Pharmacists demand reversal in FEMPI cuts The future of pharmacies in communities across Ireland will be threatened if the Government does not urgently begin the process of reversing deep cuts inflicted as part of the Financial Emergency Measures in the Public Interest Act (FEMPI). Minister for Health Simon Harris

“Irish pharmacists have experienced a decade-long decline in resources for providing services on behalf of the State. The HSE PCRS statistics for 2009 to 2017 show that pharmacy output and efficiency have increased, as the costs of medicines reimbursed to pharmacies has reduced by almost 36% per item. Meanwhile, there has been a 17% drop in the fees paid per item and the average annual fee amount paid to each pharmacy has fallen by nearly a fifth (18%). Between 2009 and 2018 FEMPI cuts removed ¤1.5 billion in revenue from the pharmacy sector. “We have, of late, seen an increasing number of business failures in pharmacy as the increasing cost base cannot be accommodated within the shrinking resources that are made available. This was the message delivered to Minister Simon Harris as he attended the Irish Pharmacy Union's National Pharmacy Conference in Galway. Speaking in advance of the conference, President of the Irish Pharmacy Union (IPU) Daragh Connolly, said, "We're delighted that Minister Harris is attending this year's conference. This will allow Minister Harris to experience the enthusiasm of Ireland's 1,900 community pharmacists. We are ambitious for the role of Pharmacies in primary care and want to do

more to alleviate the pressure on other areas in the health service and our patients nationwide. “However, Minister Harris will also hear a growing sense of frustration and disappointment that FEMPI cuts have yet to be reversed for pharmacists. We now approach the third anniversary of when the Government's own review recommended fees to pharmacists be re-examined. To date, nothing has happened, and we cannot tolerate the laissez-faire approach being taken any longer.

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“Pay has rightly been restored for public servants and most recently for GPs, in return for vital modernisation and service reform. Pharmacy services must not be forgotten or starved of resources any longer. The FEMPI reversal must be started immediately to ensure we keep pharmacies at the heart of the community providing a vital service to patients and the public. We expect urgent engagement from the Department of Health on this matter and look forward to engaging with them in a constructive fashion.”

Worrying Health Trends Research by Behaviours & Attitudes into the health of the Irish population highlights some worrying trends, including that 13% of all adults take no exercise at all per week, 45% have suffered from a serious medical condition in the last 12 months, while 21% have suffered stress or depression. To that end, Irish Life has announced the launch of MyLife, the first healthcare app in Ireland that empowers all people to monitor and improve their own Health Score. The innovative app measures overall health, encouraging an individual to make positive lifestyle changes to improve their Health Score. MyLife encourages users to select and set a fitness, nutrition or lifestyle goal each month. People will earn points when they engage with the app and complete their goal, track their exercise, get sufficient sleep, answer the Health Coach’s questions and track their weight. Commenting on the launch, Professor Niall Moyna, of the Centre for Preventive Medicine at Dublin City University says, “We are living in an era of healthcare where the role of the patient has evolved, empowered by the rapid adoption of digital health technologies. It’s well known that individuals who take charge of their health and actively participate in decisions about healthcare delivery have better health outcomes.” He continued, “Many medical conditions result from poor lifestyle choices including inactivity, smoking, inadequate sleep and excessive alcohol consumption. Empowering and enabling the individual creates an engaged patient which is a positive move in the right direction. In short - those who think they have no time for exercise will sooner or later have to find the time for illness.” The MyLife app is free to download on the App Store or the Google Play Store for all Apple and Android devices. The app has been developed in partnership with dacadoo.


Hi Tech Portfolio ANTI-BACTERIAL AGENT

NEUTROPENIA

Linezolid

Accofil ▼

600 mg x 10 Film Coated Tablets

30 MU/0.5 ml Solution for Injection / Infusion in Pre-Filled Syringe x 5

Linezolid

ANTI-FUNGAL AGENT

Voriconazole Accord Voriconazole

50 mg x 28 Film Coated Tablets 200 mg x 28 Film Coated Tablets

ANTI-VIRAL AGENT

Valganciclovir Valganciclovir

450 mg x 60 Film Coated Tablets

Filgrastim

48 MU/0.5 ml Solution for Injection / Infusion in Pre-Filled Syringe x 5

Pelgraz ▼ Pegfilgrastim

6 mg Solution for Injection in Pre-Filled Syringe x1

PULMONARY ARTERIAL HYPERTENSION

Granpidam Sildenafil

20 mg x 90 Film Coated Tablets

ONCOLOGY AGENT

Bicalutamide IMMUNOSUPPRESSANT

Mycophenolate Mofetil Accord

Mycophenolate Mofetil 250 mg x 100 Capsules 500 mg x 50 Film Coated Tablets

HIV-1 INFECTION AND HEPATITIS B INFECTION

Tenofovir disoproxil Tenofovir disoproxil

245 mg x 30 Film Coated Tablets

HEPATITIS B INFECTION

Entecavir (Actavis) Entecavir

0.5 mg x 30 Film Coated Tablets

Bicalutamide

50 mg x 28 Film Coated Tablets

Capecitabine Accord Capecitabine

150 mg x 60 Film Coated Tablets 300 mg x 60 Film Coated Tablets 500 mg x 120 Film Coated Tablets

Imatinib Accord Imatinib

100 mg x 60 Film Coated Tablets 400 mg x 30 Film Coated Tablets

Temozolomide Accord Temozolomide

5 mg x 5 Hard Capsules 20 mg x 5 Hard Capsules 100 mg x 5 Hard Capsules 140 mg x 5 Hard Capsules 180 mg x 5 Hard Capsules 250 mg x 5 Hard Capsules

Further information is available on request from Accord Healthcare Ireland Ltd, Euro House | Euro Business Park | Little Island | Cork | T45 K857 | Ireland. Tel: 021-461 9040 or from the SmPC available on www.accord-healthcare.ie Products subject to prescription. Supply through pharmacies only. Marketing Authorisation Holder for Actavis products Actavis Group PTC ehf, Reykavikurvegi, 76-78, 220 Hafnarfjordur, Iceland and for Accord products Accord Healthcare Limited, Sage House, 319 Pinner Road, North Harrow, Middlesex HAI 4HF, United Kingdom.

Date of Preparation: September 2018 UK&IE/HiT/0002/10-17a


Maximising Pharmacy

9

Pharmacy Promises must be followed by Action A commitment within the Programme for Government to expand the healthcare role of the pharmacist within two years, has not been delivered, according to the Irish Pharmacy Union (IPU). The IPU is eagerly awaiting the commencement of negotiations with the Minister for Health so that a greater role for pharmacists in the implementation of Sláintecare can be realised. Eoghan Hanley, IPU Vice-President

“Experience from other countries has proven that allowing pharmacists to practise to full scope delivers better patient outcomes. Pharmacists should be empowered to take pressure off other parts of the healthcare system, including GPs and hospitals, by providing accessible health care to people in their own communities.” Eoghan Hanley, IPU Vice-President

Each year in Ireland there are nearly 78 million visits to community pharmacies, making pharmacists the most accessed healthcare professionals in Ireland. The IPU has welcomed the fact that the Sláintecare Action Plan 2019, published in March, proposes to involve pharmacists in developing more local services, however, action over words is now required. Speaking at the IPU National Pharmacy Conference in Galway, IPU Vice President Eoghan Hanly, said, “Three years ago we welcomed the Government’s commitment to expand the role of pharmacists. We have consistently put forward proposals that would help alleviate current primary healthcare deficits, offer significant savings and efficiencies to the health service. While many of our proposals have been met with apathy from the Department of Health, we continue to be enthusiastic about the additional contribution we could make and hopeful that Sláintecare will provide an opportunity for progress. Hope on Promises Speaking at the IPU Conference Minister Harris stated his strong desire to work with pharmacists

and to see negotiations swiftly concluded to ensure that pharmacists move past FEMPI and to providing investment to expand the role of pharmacies in primary care. Mr Hanly welcomed these commitments stating, “We appreciate the Minister’s renewed ambition and hope that finally promises are followed by actions. We are, as we have always been, enthusiastic to work with Government to implement real and relevant improvements in primary healthcare. “Experience from other countries has proven that allowing pharmacists to practise to full scope delivers better patient outcomes. Pharmacists should be empowered to take pressure off other parts of the healthcare system, including GPs and hospitals, by providing accessible health care to people in their own communities.” According to Mr Hanly, allowing pharmacists to provide healthcare has been proven to pay dividends. “Since Irish pharmacists first started vaccinating in 2011, flu vaccine deliveries have increased overall by 48%. Pharmacists now represent 15% of all flu vaccinations, with a 99% public satisfaction rate. This is why

we have repeatedly proposed widening the range of vaccines that pharmacists can supply and administer to include vaccination against meningococcal disease, tetanus and hepatitis A and B, as well as travel vaccines. “Since July 2017, we have been proposing the introduction of nicotine replacement therapy and smoking cessation counselling for medical card holders. In the UK, the NHS has promoted similar community pharmacy-based smoking cessation services and has achieved meaningful quit rates. Despite the anti-smoking rhetoric from Government, our proposal had no response. Capacity Crisis “In response to the capacity crisis in general practice, the IPU has long advocated for a Minor Ailment Scheme. This would allow medical card patients to receive treatment for common illnesses directly from their local community pharmacy without the need for a visit to the GP. Our research estimates that full implementation of a comprehensive Minor Ailment Scheme would save 950,000 GP consultations in a single year. Following a successful pilot in 2016 we are still awaiting action from the Department of Health.”

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Maximising Pharmacy Members of the Panel Discussion on Sláintecare

Aileen Bryson, Deputy Director and Practice and Policy Lead for the Royal Pharmaceutical Society (RPS) in Scotland

Minister Harris said that such schemes are proven to work adding that there is no need for any more pilots and that a wider implementation is required. Mr Hanly argued that allowing women to access contraception direct from pharmacies, without the requirement for prescription, should be included in the Sláintecare implementation. “There is a strong demand for pharmacists to provide contraception and this is a service we are keen to make available. HSE research has found that 47% of women would prefer to access contraception through a pharmacy. We understand an expert review of access to contraception is currently underway and so are hopeful that progress can be made.” He concluded, stating that there was “no shortage of ambition in the pharmacy sector. This is combined with a strong desire to innovate for our patients and deliver a primary care system for all. We hope the government shares our ambition and desire and takes immediate steps to expand the scope of pharmacists, which is a win-win for everyone.”

Maximising Potential The Irish Pharmacy Union annual National Pharmacy Conference this year was titled 'Community Pharmacy: Maximising Our Potential' which focused on the necessity for the community pharmacy profession to develop a broader scope of practice in the future and to be fully engaged in the wider health system. The conference heard from a range of speakers on the development of pharmacy services and the challenges currently being faced by the sector. Other speakers included Dr Ross T. Tsuyuki, Professor and Chair, Department of Pharmacology, Faculty of Medicine and Dentistry, University of Alberta; Margaret Wing, CEO, Alberta Pharmacists' Association (RxA); and Terence A. Maguire, Pharmacist and Honorary Senior Lecturer, School of Pharmacy, Queen’s University Belfast. Also joining the IPU’s busy agenda was Laura Magahy, Executive Director at Sláintecare, for the Panel Discussion on the Saturday afternoon of the conference, titled, Sláintecare – the Future Shape

PHARMACYNEWSIRELAND.COM

of Healthcare. Joining her in the discussion was IPU President Daragh Connolly, Terence A. Maguire and Aileen Bryson, Deputy Director and Practice and Policy Lead for the Royal Pharmaceutical Society (RPS) in Scotland. The conference concludes with community pharmacists from across the country debating motions on a wide range of topics relating to pharmacy services and improving access to healthcare. Motions debated at the conference included: • “That this AGM commends the Sláintecare Programme for engaging with the IPU to explore the healthcare role of the pharmacist and looks forward to the expansion of pharmacy services as part of reforming and modernising healthcare in Ireland.” • “That this AGM calls on the HSE PCRS and the PSI to review and reduce the level of unnecessary bureaucracy they foist on community pharmacists which risks exacerbating the exodus of young pharmacists from the profession.”

• “That this AGM calls upon the Minister for Health, following the recent agreement with General Practitioners, to immediately commence substantive talks with the IPU to reverse FEMPI as it applies to community pharmacy contractors.” Development of Primary Care Minister Harris recently addressed the House on a range of important developments within primary care. Within his address the Minister said he was looking forward to sitting down with pharmacists' representative organisation, the Irish Pharmaceutical Union, IPU, to negotiate a new pharmacist contract. “I addressed the IPU conference in Galway,” he confirmed. “We will sit down with pharmacists to examine how they can play a greater role in the provision of healthcare, as is their wish, and how the Government can invest in the pharmacy network.” He added, “As many Deputies will be aware, the reality is that our primary and community care system, as currently configured, is ill-equipped to play the role we all know it should play, and must


11 play, if we are to respond to the healthcare challenges of the 21st century. “Our population is not only growing but is becoming older, and we face a growing prevalence of chronic disease. Our current hospital-centric model of care, which has its roots in responding to accidents and episodic diseases, simply cannot respond efficiently and effectively to meet the health needs of our population.

Daragh Connolly, President, Darragh O’Loughlin, Secretary General, both IPU with Minister for Health Simon Harris

“It is for this reason the expansion of community and primary care is at the heart of the Sláintecare vision, and it is important to recognise the progress that has been made in delivering on that vision. “April was a significant month in clearly signalling that we are serious about radically changing how the health system works. The month saw three important achievements, namely, securing agreement on GP contractual reform, publishing the national oral health policy and introducing a series of measures to enable more people to access affordable healthcare. “The development of a new, modernised contract for the provision of general practitioner services was always going to be a significant element in facilitating a move to primary-care-centred health services. The agreement reached with the Irish Medical Organisation, IMO, has the potential to be a landmark moment for health reform and I was delighted to see it win the support of 95% of members of the IMO in a recent ballot.

Seamus Ruane, who spoke about increasing your wellbeing at work

Margaret Wing, CEO, Alberta Pharmacists' Association (RxA)

“For the first time, we will see the delivery in a primary care setting of structured care on a large scale for patients with chronic conditions. More than 400,000 medical card and GP visit card patients with chronic illnesses such as diabetes, asthma, chronic obstructive pulmonary disease and heart disease will benefit from new and improved chronic disease management.” Fianna Fáil Deputy John Brassil replied, “The message from Fianna Fáil is clear: robust and active primary and community care plays an essential role in enhancing health outcomes and limiting costs. A strong primary and community care system will be invaluable for preventing the development of conditions that could ultimately require acute hospital care. It will also provide a suitable environment to enable earlier discharges from hospital. From the patient's perspective, it helps to enhance quality of life

and reduce the undue stress of admission to hospital. “Unfortunately, the Government's record on primary care leaves much to be desired. “The Minister rightly referred to e-health and e-prescribing. As he knows, I am a practising pharmacist and have an interest in the area but, as I informed him at

the meeting of the Joint Committee on Health last week, pharmacists are underused. In countries such as Canada, pharmacists provide a much greater role and are an invaluable addition to primary care services. As well as the unwinding of measures under the Financial Emergency Measures in the Public Interest, FEMPI, Acts relating to GPs, which I welcome, I look

forward to the same happening for pharmacists and to the Minister engaging with the pharmacy sector to allow it to deliver its full potential on issues such as the minor ailment scheme and the provision of contraception. “I look forward to a new contract and pharmacists playing a much more progressive role.”

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McCauley Pharmacy opens flagship store McCauley Health and Beauty Pharmacy has opened the doors of its newly renovated flagship store in Navan Town Centre, following a €700k investment.

Antimicrobial stewardship in the Community The Health Information and Quality Authority (HIQA) has published a health technology assessment recommending that, as part of the wider effort to improve antimicrobial stewardship in Ireland, a carefully managed and monitored pilot programme of C-reactive protein point-of-care testing (CRP POCT) in primary care settings be considered. Ireland has a high rate of antibiotic prescribing in patients presenting to primary care with acute respiratory tract infections (RTIs). Inappropriate antibiotic consumption is associated with increased antimicrobial resistance, causing increased illness and death from bacterial infections. CRP POCT is used to measure the level of C-reactive protein in a person’s blood, which can be used as an indicator of bacterial infection. Clinical trials have demonstrated that the use of CRP POCT in primary care settings to inform antibiotic prescribing for acute RTIs leads to a significant reduction in antibiotic prescribing without compromising patient safety.

Tony McEntee, CEO McCauley Health & Beauty Pharmacy, Noelle Coyne, Pharmacy Store Manager McCauley Health & Beauty Pharmacy, Navan with Peter Maher, Chief Operations Officer

The new-look store, which employs 25 people alongside a further six staff at the McCauley Medical Centre in Navan town, will be officially opened by fashion and lifestyle entrepreneur Suzanne Jackson. The launch was part of an ongoing ¤3.5m investment programme by the pharmacy group 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 on the launch of the new flagship store, CEO of McCauley Pharmacy, Tony McEntee, said, "This is an exciting day for McCauley Pharmacy as we officially launch our new flagship store in Navan Town Centre. We look forward to continuing to serve the people of Navan and offering them the great level of service and care they are accustomed to, with the additional benefit of being able to avail of

the most extensive and innovative ranges of products and services. This customer care and innovation was synonymous with the founder of this pharmacy, John Nolan, continued by his son Conor and is now being further enhanced by the McCauley acquisition and investment. "Even though we have a fresh look, the important things aren't changing. We're still the trustworthy and familiar community pharmacy where you will find experts in front of and behind the counter. It is our mission to be at the heart of Ireland's communities, providing expert health and beauty advice for total wellbeing. I believe that mission will help us achieve our goal of becoming Ireland's largest and most valued pharmacy network." In addition to the full range of services already on offer at the pharmacy, the newly refurbished and extended store has

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introduced a range of services that will be of benefit to the local community in Navan including medication management and blood pressure monitoring as well as the flu vaccine. Health and wellbeing will also be top of the agenda, with newlook store carrying a significantly enhanced and more extensive range of wellness products for customers to avail of. The McCauley Navan Town Centre store will additionally carry extensive beauty ranges in store, including Benefit, Bare Minerals and Stila. The revamped pharmacy will also carry an excellent electrical range, as well as photo services and products. The launch of the new look store in Navan precedes the relaunch of the newly renovated McCauley Health and Beauty Pharmacy store in Mahon Point Shopping Centre, Cork.

An estimated 2.4 million prescriptions are issued for respiratory tract infections in Ireland each year – a number that could be halved if GPs used CRP POCT and were also provided with training directed at facilitating conversations with their patients about appropriate antibiotic prescribing. HIQA’s Chief Scientist, Dr Conor Teljeur, says, “The use of CRP POCT in primary care settings to inform antibiotic prescribing for acute respiratory tract infections may lead to a significant reduction in antibiotic prescribing without compromising patient safety. The adoption of CRP POCT would also have organisational implications for general practices in terms of impact on patient flow, the need for quality assurance, and potential displacement of activity through longer consultation times for patients who undergo the test. “A carefully managed and monitored pilot programme or partial roll-out of CRP POCT offers the best prospect to evaluate a CRP POCT programme and establish whether a national roll-out is advisable.”


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Continuous Improvement for Pharmacy The International Pharmaceutical Federation (FIP) and Pharmapod have signed a partnership to offer an infrastructure for effective incident management and continuous quality improvement for pharmacists internationally. FIP CEO Catherine Duggan, FIP President Dominique Jordan, Pharmapod CEO Leonora O'Brien, Pharmapod Pharmacy Director Dan Burns and (standing) Pharmapod Sales Manager David Coleman

The partnership agreement was signed at the 1st FIP Regional Conference for the Eastern Mediterranean in Amman, Jordan on April 25th. Medication errors are a significant global problem, impacting millions of lives daily. In response to the World Health Organisation’s Patient Safety Challenge to reduce these errors by 50% over the next five years, pharmacists as medication experts are taking a lead role in developing and adopting effective solutions to improve processes across the healthcare system and prevent patient harm. Pharmapod are driving worldwide change in patient safety with its Global Learning Health System. This is an award-winning, professionally-led solution

which has rolled out across pharmacies, hospitals and longterm care facilities internationally – for example, it is the mandated system for the largest medication safety program of its kind in Canada, involving over 4,500 pharmacies. The system helps drive improvements in quality and efficiencies in process, which are demonstrable and measurable for healthcare professionals. In addition to incorporating artificial intelligence tools such as machine learning into its technology, Pharmapod are now also connecting experts in medication safety internationally through establishing national response teams in each country to analyse the medication error data and develop improvement strategies.

“The shared aims and goals of our two organisations provide the perfect environment to formalise existing collaborations and joint working, which is an important step forward for Pharmapod and FIP, now and in the future. Having two international organisations working in mutually beneficial and positive ways provides an excellent framework for similar collaborations at local levels, which we will both support and encourage through our agreed work programmes in FIP Education, specifically our Workforce Development Hub,” said FIP CEO Catherine Duggan. Pharmapod CEO Leonora O’Brien adds, “Being a pharmacist myself, it is a particular honour to collaborate with FIP and contribute to our profession. Pharmacists in every country provide an extraordinary service to their public. By harnessing technology we can strengthen communications across the profession, helping pharmacists share their expertise and accelerate improvements in practice.”

Cosmetic Association 2019 Trade Fair One of the best trade shows in recent times was experienced in the RDS last month (May). 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. Next month’s issue of Irish Pharmacy News will carry full coverage of the event.

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Jo Sommerville, Managing Director and Kevin Gaul, Area Manager, The Cosmetic Association

Health Inequalities in Children Health inequalities emerge in children as young as three years of age in Ireland with those from more disadvantaged backgrounds more likely to be overweight or obese, a new study has revealed. For the research scientists at Trinity College Dublin (TCD), analysed data on body mass index (BMI) from 41,399 children measured over time in three European countries – Ireland, the UK, and Portugal – using the mother’s highest level of education as a marker of socio-economic position. The research revealed that while there were no differences in BMI between children in infancy, differences in BMI emerged by pre-school age (3-5 years) with children whose mothers has attained primary and secondary education gaining body mass at a faster rate compared with children whose mothers were educated to third level. These differences continued to widen as the children aged in all three countries. In general, the research found that children whose mothers were educated to primary level were more likely to be overweight or obese compared with children whose mothers had attained third level or university education. According to the authors, this is a worrying trend as children who are obese in early life are more likely to maintain this status into adolescence and adulthood, increasing their risk for chronic conditions later in life. Dr Cathal McCrory, Professor of Psychology at TCD and lead author of the paper said, “They are quite literally carrying a heavier burden of disease from much earlier in life. These findings reinforce the necessity of challenging the childhood obesity epidemic at early ages as these patterns are difficult to change once they have become entrenched. Urgent government action is now required to understand the material, social, and structural barriers that contribute to these stark socio-economic differences in obesity risk.”


Reminder of Precautions to avoid Photosensitivity Reactions with Fastum Gel (ketoprofen gel) A. Menarini Pharmaceuticals Ireland Ltd. wish to remind healthcare professionals of the necessary precautions to avoid the risk of photosensitivity reactions with Fastum Gel. The European Medicines Agency’s Committee for Medicinal Products for Human Use (CHMP) undertook a safety review of topical ketoprofencontaining medicines in 2010 and recommended that doctors should strictly follow the contraindications when prescribing topical ketoprofen. CHMP also recommended that doctors and pharmacists should inform patients on how to use these medicines appropriately to prevent the occurrence of serious skin photosensitivity reactions. A series of risk minimisation measures for Fastum Gel was agreed with the Health Products Regulatory Authority. The Summary of Product Characteristics and the Patient Information Leaflet were updated accordingly and may be found on www.medicines.ie and www.hpra.ie. Patients should be reminded to wash their hands thoroughly after application of the product and to protect treated areas from sunlight by wearing clothing. They should avoid exposing the treated areas to sunlight, even if cloudy, or UVA from sunbeds or solarium during use and for 2 weeks after discontinuation. In addition they should be advised to avoid using Fastum Gel under occlusive bandages and to discontinue Fastum Gel immediately and contact their doctor should any skin reaction develop, including cutaneous reactions after co-application of octocrylene-containing products. A copy of the patient educational leaflet is available from A. Menarini on 01 284 6744 or 1800 283045 or is available at www.hpra.ie A. Menarini would like to remind healthcare professionals that any suspected adverse reactions associated with the use of Fastum Gel should be reported to the Health Products Regulatory Authority at www.hpra.ie or by calling 01 676 4971. Adverse reactions can also be reported to A. Menarini’s Pharmacovigilance Department on 01 284 6744.


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Future of Medicines Pricing – will be different

World No Tobacco Day

The future of medicines pricing and supply will be radically different to what has gone before - and all stakeholders, especially industry and the State, must be ready to embrace change, the Irish Pharmaceutical Healthcare Association (IPHA), representing pharmaceutical innovators, has told a conference hosted by the National Centre for Pharmacoeconomics (NCPE).

Every year, on 31 May, the World Health Organisation (WHO) and global partners celebrate World No Tobacco Day (WNTD). In 2019, WNTD will focus on "tobacco and lung health".

Aidan Lynch, President, IPHA

all of these combined will not cover the cost of new medicines. In many cases, these are old technologies. Their patents have yielded returns that have been invested in creating new innovative medicines that more than likely are not going to be in primary care but in specialty medicine. The old will not fully compensate for the new,” he added.

In a significant policy speech delivered at the NCPE event in Dublin Castle, Aidan Lynch, IPHA’s President, said “the pace of pharmaceutical innovation means that the pricing and supply agreements of the past will not work for the future.” “The funding requirement to support the introduction of new medicines is going to be greater than the opportunity to save on older medicines,” said Mr Lynch. “Interchangeability and reference pricing will continue to yield savings but on a diminishing basis. Realignment will realise savings in July. The biosimilars policy, once rolled out, will bring about some efficiencies. However,

The industry’s four-year agreement with the State on pricing and supply of medicines expires next summer. IPHA has called for a mind-shift in how medicines spending is considered - from “a cost to be written off” to an “investment in outcomes”. “We need to find new ways of measuring value and outcomes. We must think differently, innovate and work together, sharing information and knowledge. If we are to be consistent from an industry perspective, we should not expect the HSE to pay for new drugs that are not innovative. In today’s world, innovation must be affordable. I, as a taxpayer, do not want the State to pay for anything that does not represent value, whether that’s a building or a medicine,” said Mr Lynch. He said there is no “one-size-fitsall” approach to reimbursement,

adding that the industry is open to examining “all options”, including looking at European pathways. “The use of real-world data is increasingly a feature of reimbursement systems. For that to work, there needs to be a willingness on the side of the State and industry to co-create registries and other tools that can be used to demonstrate effectiveness,” he said. This year, the extra budget for new medicines was just ¤10 million - less than half of 1% of the medicines budget or 1/20th of 1% of the total health budget. Most other Western European countries allow for a minimum of 2% to 3% growth to allow for demographic pressures and to provide for innovation. Ireland continues lag other western European countries on speed of access to innovative medicines. On World Health Day, IPHA published European data, based on 27 countries, that examined the wait times and rates of availability for 121 products licensed by the European Medicines Agency in 2015, 2016 and 2017. When it came to the availability of new medicines, we ranked 16th. Just 42% of new medicines licensed over the three years were available and reimbursed here last year. We ranked 20th out of the 27 countries for speed of access with Irish patients waiting, on average, 486 days for some new medicines.

Need to Boost Vaccination Rates Steps must be taken to reduce vaccine hesitancy and to dispel ‘damaging’ myths about vaccination – it has been claimed during World Immunisations Week. The organisation representing pharmaceutical innovators has called on the Government to include industry on a new alliance aimed at improving vaccination rates. The Irish Pharmaceutical Healthcare Association (IPHA), said it was vital to take steps to reduce vaccine hesitancy and to dispel “damaging” myths about vaccination. IPHA welcomed the initiative by the Minister for Health, Simon Harris TD, to form an alliance to promote the take-up of vaccinations. But industry should

be represented on the group, according to IPHA, along with medical professionals, educators, parents, patient advocates and policymakers. IPHA has launched a social media campaign, #VaccinesWork, aimed at raising public awareness about the importance of vaccination. The WHO estimates that vaccines save up to three million lives each year. With the exception of clean, safe drinking water, vaccination is one of the most successful and cost-effective public health interventions ever. However, its

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success is increasingly under threat as vaccination rates continue to fall below the required 95% uptake rate to ensure ‘herd protection’. A direct result of this is an increase in the number of global outbreaks of serious diseases such as measles. The best way to protect populations against these diseases is to vaccinate directly. Turn to page 21 for full details on a new and exclusive innovation within community pharmacy and the ability offer vaccinations to the public.

Locally, 1-in-5 deaths are due to smoking; 4-in-10 respiratory disease-related deaths and 3-in-10 cancer-related deaths are due to smoking. The estimated annual cost of smoking to the State including welfare costs is ¤10.7 billion. Tobacco smoking and exposure to second-hand smoke increase the risk of contracting many diseases. For instance, active and passive smoking affect the health of people’s lungs in multiple ways: Lung cancer: smoking is responsible for over two thirds of lung cancer deaths globally, and second-hand smoke increases the risk of developing lung cancer for non-smokers. Lung cancer is the leading cause of cancer death in most countries of the WHO European Region. Approximately 430 000 people died from lung cancer in the Region in 2018, and more than half a million new cases were diagnosed during that period. Chronic respiratory diseases, such as chronic obstructive pulmonary disease (COPD) and asthma: tobacco smoking is the leading cause of COPD, a condition that results in a painful cough and agonising breathing difficulties. It also exacerbates asthma, which restricts activity and contributes to disability. According to the latest available data, 3.6% of total deaths in the European Region were due to COPD in 2017. Furthermore, children exposed to second-hand smoke are at higher risk of developing frequent lower-respiratory infections and have a higher risk of suffering the onset and exacerbation of asthma, pneumonia and bronchitis. The campaign for WNTD aims to increase awareness about the particular dangers of tobacco smoke to lung health and the fundamental role the lungs play in the health and well-being of all people.


Every day in Ireland, over 200 people give up smoking. Help your customers to

Join the Quitters.

NICORETTE® 4mg Gum

ACTS FAST AND LASTS FOR HOURS* *Based on 25% reduction in cravings at nearly 3 hours. Nicorette Icy white 4mg Medicated Chewing Gum. For the treatment of tobacco dependence by relieving nicotine craving and withdrawal symptoms, thereby facilitating smoking cessation in smokers motivated to quit. Helping smokers temporarily abstain from smoking . In smokers currently unable or not ready to stop smoking abruptly. Gum may also be used as part of a programme to reduce smoking prior to stopping completely.. Dosage: Smoking cessation: The gum should be used whenever there is an urge to smoke. Not more than 15 pieces of the chewing gum may be used each day. If not successful after 12 weeks the patient should be encouraged to make a fresh attempt to stop smoking. Temporary Abstinence: See full prescribing information. Gradual cessation: See full prescribing information. Contraindications: Use in non-smokers, Use in persons hypersensitive to nicotine or any ingredient in the formulation. Special Warnings and Precautions: The benefits of quitting smoking outweigh any risks associated with correctly administered NRT. A risk-benefit assessment should be made by an appropriate healthcare professional for patients with the following conditions: - Cardiovascular disease: Dependent smokers with a recent myocardial infarction, unstable or worsening angina including Prinzmetal’s angina, severe cardiac arrhythmias, recent cerebrovascular accident, and/or who suffer with uncontrolled hypertension should be encouraged to stop smoking with non-pharmacological interventions (such as counselling). If this fails, Nicorette Gum may be considered but as data on safety in this patient group are limited, initiation should only be under close medical supervision. Renal and hepatic impairment: Use with caution in patients with moderate to severe hepatic impairment and/or severe renal impairment as the clearance of nicotine or its metabolites may be decreased with the potential for increased adverse effects. Gastrointestinal Disease: Nicotine may exacerbate symptoms in patients suffering from oesophagitis, gastric or peptic ulcers and NRT preparations should be used with caution in these conditions. Phaeochromocytoma and uncontrolled hyperthyroidism: Nicotine, both from NRT and smoking, causes the release of catecholamines from the adrenal medulla. Therefore, Nicorette should be used with caution in patients with uncontrolled hyperthyroidism or pheochromocytoma. - Diabetes Mellitus. Patients with diabetes mellitus should be advised to monitor their blood sugar levels more closely than usual when smoking is stopped and NRT is initiated, as reductions in nicotine-induced catecholamine release can affect carbohydrate metabolism. Patients with diabetes mellitus may require lower doses of insulin as a result of smoking cessation. - Smokers who wear dentures may experience difficulties in chewing Nicorette Gum. The chewing gum may stick to and may in rare cases damage dentures. Transferred dependence: Nicotine in any dose form is capable of inducing a dependence syndrome after chronic use and is highly toxic after acute use. However, dependence with Nicorette Gum is a rare side-effect and is both less harmful and easier to break than smoking dependence. Danger in children: Doses of nicotine tolerated by smokers can produce severe toxicity in children that may be fatal. Products containing nicotine should not be left where they may be handled or ingested by children.. Undesirable Effects: See full prescribing information for full list of undesirable effects. Immune System Disorders: Hypersensitivity - Common Anaphylactic reaction - Not known. Psychiatric Disorders – Abnormal Dreams – Uncommon. Nervous System Disorders: Headache - Very Common, Burning sensation, Dysgeusia, Paraesthesia – Common. Eye Disorders: Blurred Vision, Lacrimation increased – Common. Cardiac Disorders: Palpitations, Tachycardia - Not known. Vascular Disorders: Flushing, Hypertension – Uncommon. Respiratory, Thoracic and Mediastinal Disorders: Cough, Throat irritation - Very common. Bronchospasm, Dysphonia, Dyspnoea, Nasal Congestion, Sneezing, Throat tightness – Uncommon. Gastrointestinal Disorders: Hiccups, Nausea - Very common. Abdominal pain: Diarrhoea, Dry mouth, Dyspepsia, Flatulence, Salivary hypersecretion, Stomatitis, Vomiting – Common. Eructation Glossitis, Oral mucosal blistering and exfoliation, Paraesthesia oral – Uncommon. Dysphagia, Hypoaesthesia oral, Retching – Rare. Dry throat, Gastrointestinal discomfort Lip pain - Not known. Skin and Subcutaneous Tissue: Hyperhidrosis, Pruritus, Rash, Urticaria Disorders – Uncommon. Erythema - Not known. Musculoskeletal and Connective Tissue Disorders: Pain in jaw – Uncommon. Muscle tightness- Not known. General Disorders and Administration Site Conditions: Fatigue – Common. Asthenia, Chest discomfort and pain, Malaise – Uncommon. Allergic reactions including angioedema- Rare. MA Holder: Johnson & Johnson (Ireland) Limited, Airton Road, Tallaght, Dublin 24, Ireland. MA Number: PA 330/37/9 Date of Revision of the Text: June 2018. Legal Category: Products not subject to medical prescription. Further information available upon request from Johnson & Johnson (Ireland) Ltd.

IRE/NI/19-3714


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News

Vision for Health – Focusing on Medicines Reform A Vision for Health was published last month, the new manifesto from Medicines for Ireland, focusing on urgent reform of the Government’s medicines policy and procurement process. Owen McKeon, Chair of Medicines for Ireland and Country Manager Mylan, Mairead McGuiness MEP and Vice President of the European Parliament, Robert Watt, Secretary General, Department of Public Expenditure, John Given, Chief Pharmacist University and Avril Power, CEO of Irish Cancer Society

New manifesto calls for: • The publication of the Government’s long-promised National Biosimilars Policy At a launch briefing highlighting the above, calls were also made for a new medicines pricing agreement to be reached between Government and pharmaceutical manufacturers. Guest speakers at the event included John Given, Chief Pharmacist, Galway University Hospital, Averil Power, CEO of the Irish Cancer Society and Secretary General of the Department of Public Expenditure, Robert Watt. Medicines for Ireland, which represents Ireland’s generic, biosimilar and value added medicines sector, believes that the Government’s lack of clear medicines policy is still too heavily dependent on expensive branded medicines limiting the HSE’s ability to procure more affordable drugs, thereby limiting patient access to other life-enhancing treatments and continuing the HSE’s unnecessarily high level of expenditure on medicines. “We need to see a greater balance in how national medicine pricing agreements are negotiated with Medicines for Ireland, with the largest supplier of medicines to the HSE at the negotiating table, in addition to other key stakeholders such as patient representative groups. This will ensure that such agreement deliver more for patients and taxpayers whilst

expanding access and affordability for all”, noted Medicines for Ireland Chair Owen McKeon. The current national medicines pricing agreement, negotiated in private with the Irish Pharmaceutical Healthcare Association (IPHA), effectively blocks biosimilars manufacturers from competing with originator manufacturers in Ireland. Currently, the State is spending hundreds of millions of euros on expensive medicines, particularly biologics, despite the availability of more affordable, equally effective alternatives like biosimilars and generics, which could deliver savings to the HSE and better access to drugs for patients. Speaking at the event, Mr Watt said that the Government’s approach to medicines pricing and procurement has ‘improved’, he said. “Value for money for the taxpayer and consumers needs to be at the heart of all we do,” said Mr Watt. “If we overpay for drugs, that’s less we have for oncology services, less we have for disability services. The opportunity cost is something that we always need to keep in mind.” Medicines for Ireland chair Owen McKeon criticised the Government’s existing “one-sided” medicines pricing agreement.

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• A new national medicines pricing agreement that is negotiated with all medicines manufacturers, not just a select few • The introduction of quotas that mandate a minimum level of biosimilar and generic usage • The overhaul of the HSE’s High-Tech Medicines Scheme, including a framework for interchangeability and expansion of medicines on the scheme • A public information campaign that creates awareness around medicines procurement and policy, and the impact of this on patient care and cost

Also speaking at the event, John Given, Chief Pharmacist of Galway University Hospital, described how his hospital has already saved ¤2.8 million by switching just two medicines to a generic and biosimilar, respectively. He said that there is opportunity for an additional ¤2.4 million in savings by switching to four other affordable medicines.

Poor understanding of MS While 93% of people in Ireland claim to be aware of MS, more than 44% consider their understanding of the symptoms and details of the condition to be poor with nearly one third of respondents unable to list any symptoms related to MS. This new market research conducted in April 2019 by IPSOS/MRBI, was revealed to mark World MS Day on 30th May 2019 by MS Ireland and Novartis who join with MS organisations around the world as part of the ‘My Invisible MS’ (#MyInvisibleMS) campaign exploring public awareness around the invisible symptoms of MS and the impact it can have on day to day life. Although more than a third of the population (37%) claim to have a family member, friend, or loved one living with MS, and 66% of people in Ireland believe they have a good understanding of MS, there are still some key aspects of the condition that remain unclear. Nine thousand people and their family members live with Multiple Sclerosis across Ireland. Some of the symptoms of MS are immediately obvious. Reduced mobility is often the most visually apparent. Other symptoms such as fatigue, changes in sensation, memory and concentration problems are often ‘invisible’ symptoms and can be difficult to explain to others. Commenting on the launch of the market research findings, Professor Orla Hardiman, Consultant Neurologist at Beaumont Hospital, Professor of Neurology and Head of the Academic Unit of Neurology in Trinity College Dublin and the HSE National Clinical Lead for Neurology says, “It’s important that as a community we educate ourselves on the symptoms that affect the day to day lives of people living with MS, especially those that are not immediately apparent and less visible.”


Pharmacy Travels in Wider Direction New innovation launched in Ireland means community pharmacies are widening their healthcare remit

A recent Central Statistics Office study shows people are travelling more than ever before from Ireland, with 556,000 people making trips overseas in February 2019, up 13% on the previous year. An innovative new travel health service has been launched, meaning customers can now have their travel vaccinations administered at participating pharmacies nationwide. With pharmacy based travel health services already well established in the UK and US - this a natural step for community pharmacy in Ireland.

PHARMACYNEWSIRELAND.COM | 21


Taking the Next Step in Service Offering “We know that expanding the role of community pharmacists is key for the future of primary care in Ireland, and brings with it significant benefits for the wider health system in general. The response from pharmacists to this new service has been overwhelmingly positive.” It has long been argued that community pharmacists can, and should, play a wider role in the provision of wider healthcare services. This would, it has been said, improve patient outcomes and free up other frontline services to concentrate on more chronic areas of healthcare.

economies. While all patients traveling across geographic regions are recommended to receive a pre-travel consultation to consider their individual risks, many do not, or receive care and recommendations that are not consistent with current evidence-based guidelines.

Pharmacists have an important role to play in advising and educating the public about health protection measures such as immunisation, as well as an important role in implementing the national immunisation programme and providing vaccination services.

An innovative new travel health service has been launched, meaning customers can now have their travel vaccinations administered at participating pharmacies nationwide. The service was launched by MyClinic.ie

Rates of international travel are increasing annually, with particular growth observed in travel to Southeast Asia and to emerging

A recent Central Statistics Office study shows people are travelling more than ever before from Ireland, with 556,000 people making trips overseas in

22 | PHARMACYNEWSIRELAND.COM

February 2019, up 13% on the previous year. Pharmacies are one of the most accessible health service settings, not just in Ireland but worldwide. In addition to offering advice and education to those presenting with prescriptions of drugs for travel purposes, for example antimalarials, altitude sickness prophylaxis, travellers’ diarrhoea treatment, pharmacists are also a key point of contact for non-prescription product advice such as for anti-diarrheal, insect repellant, and sunscreen products. Online Travel Consultation The new service offering provided by MyClinic.ie provides a unique opportunity for pharmacists to expand their range

of services and build on skills they may have developed in providing influenza, pneumococcal and shingles vaccinations as part of their practice. Speaking to Irish Pharmacy News, Dr Daniel Clear, founder of MyClinic, said, “We are very excited to be providing the first travel health service of its kind in Ireland. “With Irish people travelling more than ever, and infectious diseases on the rise, we want to remove barriers to accessing appropriate advice and protection so that people can stay healthy when abroad. “We know that expanding the role of community pharmacists is key for the future of primary


• Medicines Administration (Parenteral) - live training session • Responding to an Emergency and Management of Anaphylaxis - online course • Delivery of a Vaccination Service – online course • Vaccine specific online training courses There are also a number of online training courses that pharmacists can avail of to help develop their knowledge of travel health. Boots Ireland have become one of the first pharmacies to sign up and have launched the services across Ireland. Irish Pharmacy News understands a number of additional chain pharmacies will also be launching in the coming weeks. Commenting on the new service Caoimhe McAuley, Pharmacy Director Boots Ireland said, “We are very excited to be the first pharmacy in Ireland to offer a travel vaccination service as the interest in visiting exotic and remote destinations is becoming increasingly popular amongst Irish travellers. Protecting the health and wellbeing of our communities is always at the heart of what we do. "Travelling and exploring new destinations is exciting but can also bring risks when coming into contact with diseases that don’t occur or which are not typically seen in Ireland. Thankfully many of these diseases can be prevented by vaccination. We are delighted to be leading the way in encouraging safer travel with our travel vaccination service."

care in Ireland, and brings with it significant benefits for the wider health system in general. The response from pharmacists to this new service has been overwhelmingly positive.”

The service is designed to be the most convenient and cost-effective way for people to access travel health consultations.

After completing MyClinic’s online travel health consultation, priced at ¤30, a GP will advise the customer of any vaccinations or anti-malaria tablets they should consider and issues the appropriate prescription.

Dr Clear adds, “The training is carried out in-house by the community pharmacy and is done so in line with current Pharmaceutical Society of Ireland (PSI) guidance. With that, it can take a number of forms.”

As well as advice from the GP, the customer also receives a personalised travel health pack by email, containing the most up-todate information to help them stay healthy on their trip. Once the consultation has been completed the customer is prompted to book an appointment at their chosen pharmacy to pay for the vaccinations and have them given by a pharmacist who has been specially trained to provide travel vaccinations.

An Irish First

“Often the pharmacist will be building on the skills they have developed delivering flu vaccines for example.” The PSI have these requirements for pharmacists delivering a vaccine service: • CPR (Adults and Children) Cardiac First Response Community Level (PHECC) or Heartsaver® CPR AED, AHA live training session

Interested pharmacies can contact MyClinic to start the registration process. By agreeing to provide the service the pharmacy undertakes that any vaccinations will be given by a pharmacist who has undergone the appropriate training. Once the pharmacy has signed up, they can begin directing customers to the MyClinic travel service where they will be able to select that pharmacy during the online consultation. The original signed prescriptions are then posted directly to the pharmacy, along with an electronic copy via secure email.

“The service has been designed to be the most convenient and cost-effective way to access travel vaccinations and appropriate travel advice. As expert healthcare providers, pharmacists are trusted by their patients to provide a range of primary care services, with travel health services being a natural extension of that role. “With waiting times for GP appointments at all-time highs, customers are embracing the convenience and cost-savings afforded by availing of these services online. The advent of technology-based options for accessing health care means that the choices available to patients are now greater than ever. “Community pharmacists are passionate, experienced healthcare providers with the skills and clinical training needed to provide a greater role in delivering primary care services. Using technology to expand the role of pharmacists through services such as this has benefits for the entire health system, not least the alleviating of pressure on overstretched GP practices.” He concludes, “Pharmacy based travel health services are already well established in the UK and US which makes this a natural step for community pharmacy in Ireland.” MyClinic launched in 2017 as the first platform in Europe to bring together the range of primary healthcare services online. Registration to MyClinic is free and provides users with a personal health record and interactive dashboard, where they can access video consultations with healthcare professionals, order repeat prescriptions, and avail of the latest in smart home blood testing and STI screening. Repeat prescriptions offered cover a range of common conditions, including acne, cystitis, thrush, male sexual health problems and various forms of contraception.  Prescriptions are sent by post within 24 hours, or directly to a pharmacy for sameday collection, if needed urgently. MyClinic provides a range of pharmacy-oriented services, including treatment for positive Strep Throat and blood tests that can be performed in-pharmacy.

Extension to Pharmacy Role

MyClinic operates a seven-day service, with a repeat prescription costing ¤20 and a video consultation with a GP costing ¤25, a significant saving on the ¤60 typically faced in a GP surgery.

Dr Clear adds, “We are keen to ensure independent pharmacies also sign up and would be actively encouraging them to consider training their pharmacists in this field.

Pharmacies interested in providing a travel vaccination service to the customers using the MyClinic service should contact info@myclinic.ie or call 01-514 3464.

After the consultation patients will be prompted to book their appointment with the pharmacist (if not already done so) to have the vaccines given.

PHARMACYNEWSIRELAND.COM | 23


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News

McCabes Pharmacy Celebrate 60 Years in Wexford McCabes Pharmacy marked a special anniversary recently with their store in Wexford town celebrating 60 years in business. Sherwoods Pharmacy opened on the 1st April 1959 and became McCabes Pharmacy in 2006. The celebrations saw generations of the past and present pharmacy team members come together in honour of this amazing milestone. Pictured below is the original owner Mr. John Sherwood with his wife Nancy, McCabes Pharmacy founder, Roy McCabe, current McCabes pharmacist Liam Riordan and Supervising Pharmacist Gavin Kneafsey. The current McCabes Pharmacy

team have over 100 years combined pharmacy experience, know their customers by name and are just as eager to continue to drive this well-known Wexford establishment into the future. Congratulations to the whole team, Georgina Cullen, Aoife O’Flynn, Sue Rothwell, Gavin Kneafsey, Liam Riordan, Amy Rossiter and Cora O Reilly. Here’s to the next 60 years.

John and Nancy Sherwood, McCabes Pharmacy Wexford Pharmacist Liam Riordan, McCabes Pharmacy Wexford Supervising Pharmacist Gavin Kneafsey and Roy McCabe, founder of McCabes Pharmacy

Pictured at the opening of the McCabes Pharmacy in 2006 are Bernie Riordan, Nancy Sherwood, Liam Riordan, John Sherwood, Roy and Margaret McCabe

Asthma deaths on the rise Two out of three people with asthma currently do not have an Asthma Action plan, according to a survey undertaken by the Asthma Society, launched by Minister for Health Simon Harris as part of Asthma Awareness Week. The research was conducted after recent figures for asthma deaths show they are on the rise. One person now dies every five days from asthma. The Asthma Society of Ireland are encouraging people to reduce their risk of a fatal asthma attack by getting an Asthma Action Plan. The survey was conducted April/May 2019, with 1,081 respondents. Asthma Society CEO, Sarah O’Connor, says, “It is truly frightening that asthma deaths are on the rise in Ireland – a person now dies every five days in Ireland from asthma. Our Asthma Management survey highlighted a huge lack of awareness of how to manage asthma. The survey results showed that, in the event of an asthma attack, most people wouldn’t know the necessary steps to take to save a life (the 5 Step Rule). 470,000 people in Ireland have asthma and 60% do not have their asthma in control, greatly increasing the risk of

suffering a fatal asthma attack. The Asthma Management survey found that: • Two out of three people with asthma do not have an Asthma Action Plan • Two out of three people with asthma have not spoken to their healthcare professional in the last six months • Only 63% of people surveyed knew there was a 5 Step Rule for managing an asthma attack • 69% people with asthma would not know the 5 Step Rule to manage an asthma attack • Half of people with asthma use their reliever inhaler more than the recommended twice a week • Three out of five people with asthma do not use their controller inhaler all year round • Nine out of ten people with asthma do not carry an Asthma Attack Card with them at all times

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• One in five people with asthma would not know the six most common symptoms of an asthma attack The Asthma Society also kicked off its first ever Asthma Roadshow during Asthma Awareness Week. The inaugural Asthma Awareness Week ran from 4-10 May, supported by Boots Ireland and GSK. Susan O’Dwyer, Pharmacy Strategy Manager for Boots Ireland says, “We are delighted to partner with the Asthma Society for Asthma Awareness Week. With our “Let’s Breathe Easy” consultations available year round our pharmacists are ideally placed to support people with asthma to better manage their medication and condition - providing advice on inhaler technique, asthma control and the creation of an Asthma Action Plan.”

IBD patients feeling ‘isolated’ New research from the Irish Society for Colitis and Crohn’s Disease (ISCC) has revealed that 75% of IBD patients feel isolated managing the condition on a day-to-day basis. Over three quarters (78%) feel that IBD has negatively impacted their mental health, with over half (52%) admitting to feeling exhausted when their IBD symptoms flare. It is estimated that at least 40,000 people across Ireland have IBD, while paediatric cases of IBD have increased three-fold in Ireland since 2003. The nationally representative research was conducted among 446 people living with IBD in Ireland and looked at the realities of life with IBD, as well as the support and resources available to sufferers. Unfortunately, the majority (65%) of people living with IBD feel there is stigma associated with the condition, and 58% of people would like access to support on a day-to-day basis from other people living with the condition. The vast majority (86%) don’t think Irish IBD patients have access to the necessary resources and information to manage living with the condition, particularly around access to information about clean accessible toilets, with 88% of IBD patients admitting to feeling anxious about the availability of toilets when they go somewhere new. In conjunction with World IBD Day last month, (Sunday, May 19th) the ISCC launched the new ‘IBDWELL’ mobile app to help address some of the concerns and difficulties for people living with IBD in Ireland. The app has been developed following an innovative hackathon process where members of the public gave up their time to help create practical solutions for those living with the chronic disease. The new ‘IBDWELL’ app has a variety of useful functions and support information to help improve the day-to-day life of those living with IBD.


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Beconase Hayfever nasal spray 50 micrograms per spray contains beclometasone dipropionate. For the prevention and relief of symptoms of Hayfever and other seasonal allergic conditions. Adults aged 18 and over: 2 sprays into each nostril twice a day. Max 8 applications per day (400 mcg). Seek medical advice if symptoms do not improve after 2 weeks. Do not use continuously for longer than 3 months without consulting a doctor. Do not give to persons under 18 years. Pregnant and breastfeeding mothers should not use without consulting a healthcare professional. Caution: Recent nasal injury or surgery. Side effects: Rare cases of hypersensitivity reactions. Unpleasant taste/smell, dryness/irritation of the nose and throat, raised intra-ocular pressure, nasal septal perforation. PA 1186/8/1. P. MAH: Chefaro Ireland Limited, The Sharp Building, Hogan Place, Dublin 2, Ireland. http://www.medicines.ie/medicine/7169/SPC/Beconase+Hayfever/ SPC: http://www.medicines.ie/medicine/7169/SPC/Beconase+Hayfever/. Further information is available on request to the holder of the authorisation or certificate, or in the summary of product characteristics relating to the product. Becodefence is a medical device.


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Oral Care in Ireland - Smile agus Sláinte

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inister for Health, Simon Harris TD and Minister for Employment Affairs and Social Protection, Regina Doherty TD recently published Smile agus Sláinte, the new National Oral Health Policy.

The plan will see the service evolve from a “diagnose and treat” to a person-centred, proactive and preventative approach available locally, in line with the vision as set out under Sláintecare. In this article, we take a look at the current state-of-play with regards to Ireland’s oral health agenda, and the role of community pharmacists in the management of common complaints. Oral disease impacts on the vast majority of the population and despite advances in preventive dentistry the prevalence of dental decay and gum disease remains high. At the frontline of healthcare, pharmacists and pharmacies have a substantial role to play in improving oral health. Pharmacists in the heart of any community are an ideal source of information and teams should be educated and knowledgeable in being able to provide consumers

with advice about caring for their oral health, by recommending which products may be more effective for their needs. Many people visiting a pharmacy are looking for pain relief and medication to rid themselves of toothache, mouth ulcers and other areas of discomfort in the mouth and jaw. Oral Health in Ireland Oral disease is one of the most common diseases in contemporary society. In spite of considerable advances in preventive dentistry, the vast majority of the population will have experienced both dental decay and gum disease by their early twenties. Advances in the prevention and treatment of oral diseases mean that most children born in this century will keep their teeth into old age, and the condition of these teeth will depend on how well they are looked after over a lifetime.

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The vital role our oral health plays in our daily lives, in terms of eating, speaking, smiling and socialising, is often overlooked but it is impossible to separate oral health from general health; behaviours that cause general disease are also implicated in oral disease. High sugar intake, for example, is linked to obesity, heart disease, diabetes and dental decay. Smoking is linked to cardiovascular disease, respiratory disease, gum disease and cancer, including oral cancer. In addition to sharing common risk factors, poor oral health appears to impact on general health. Research has shown a link between gum disease and heart disease; a link between gum disease in pregnancy and adverse pregnancy outcomes has also been reported, although further research is required to explain this association. Routines and Products There is more to oral hygiene than

a toothbrush and some toothpaste. Pharmacy teams need to be able to advise on brushing technique, as well as the types of product available to manage specific oral health problems, such as acid erosion, staining and gum disease It is important to brush twice daily for two minutes each time with a good toothbrush and a good whitening toothpaste, and to floss at least three times a week to prevent dark stains between the teeth. In fact, poor gum health has been linked with systemic disorders such as diabetes and heart conditions, so pharmacy teams should be aware of the link and the need to remind customers to have regular dental check-ups. Reinforcing the message about twice-daily brushing remains the most important priority and is one of the most effective ways of preventing dental decay.

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all vulnerable groups, including people in nursing and residential homes. Smile agus Sláinte will ensure that the local dentist will be the first point of contact for these groups with the HSE community oral healthcare services providing additional high-support care as required.

Speaking at the policy launch Minister Harris said, “Smile agus Sláinte provides the groundwork to transform oral health services over the next eight years; it embraces the same ideals as Slaintecare with the needs of people at the core and the provision of services in the local community paramount.”

The key actions contained in the Policy include:

Welcoming the policy, Minister Doherty said “I welcome the proposals contained in the oral health policy and believe that they will make an important contribution to the improvement of the oral health of the population in the future.

• Provision of preventative oral health packages for children and eligible adults • A focus on vulnerable groups with the development of appropriate oral health interventions and clinical care pathways • A full review of education and training to ensure that the skill levels of the profession are commensurate with today’s requirements Lifestyle Good oral hygiene is the cornerstone of dental health, but there are other lifestyle factors that also have an effect, such as diet, smoking, smokeless tobacco and alcohol. Most people don’t realise that their 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. Similarly, ice lollies are known to stain the teeth because of the amount of sugar they contain. Smoking is, unsurprisingly, another no-no for healthy mouths as it quickly dries out the mouth and introduces nicotine and tar. For customers who do smoke but want to mask bad breath, an alcohol-free mouthwash should be advised to kill bacteria. Alcohol is also a drying agent and will reduce saliva flow, in turn creating a perfect breeding ground for bacteria. Cold Sores Cold sores are caused by the herpes simplex virus. The first symptom is usually a burning or stinging pain on the lips or around the mouth, followed by pink bumps and small blisters that dry and crust over. Cold sores usually clear up by themselves within seven to

10 days without treatment, but a cool wet compress may help to soothe the irritation, as will applying a moisturising cream, such as petroleum jelly. Washing the area gently with a salt bath or wash can also help. OTC antiviral creams can ease symptoms and speed up healing time, but to be effective they need to be applied as soon as the first signs of a cold sore appear. Mouth Ulcers Mouth ulcers affect up to 20% of the population, particularly women and young people. They are usually white, red, yellow or grey in colour and inflamed around the edge. Mouth ulcers can be uncomfortable, especially when sufferers are eating, drinking or brushing their teeth, but they are usually harmless. Most mouth ulcers will clear up on their own within a week or two, but a GP or dentist should be consulted if the ulcer gets worse, lasts for longer than three weeks, or if the patient develops ulcers on a regular basis. Smile agus Sláinte Under the Policy, all children up to 16 years will receive eight oral healthcare packages including examinations, assessments, advice, prevention interventions, emergency care and referral as appropriate. Oral healthcare packages will also be provided for medical card holders over 16 years. The packages will be provided in a primary care setting by oral healthcare practitioners contracted by the HSE. There will be a particular focus on improved oral health services for

28 | PHARMACYNEWSIRELAND.COM

• Oral health promotion programmes for the entire population • The maintenance of the programme of water fluoridation There are three key reasons why a new national oral health policy is needed: • Improvements in health, including oral health status, in the general population at all ages have altered the type of healthcare and oral (dental) healthcare required. • Changing demographics and oral health challenges confronting vulnerable groups have resulted in inequalities in oral health status and in access to oral healthcare. • New technology, knowledge and philosophies in dental care have changed service delivery and now enable the delivery of complex care in primary oral healthcare settings. The decline in dental decay in Ireland has been mainly attributed to a number of factors, including the widespread use of fluoridated toothpaste since the 1980s and the protective presence of fluoride in public water supplies in Ireland since the 1960s. The decline in tooth loss and increasing maintenance of teeth has been attributed to changes in treatment philosophies, emphasising prevention as well as stabilising and reversing early dental decay. Minimal intervention techniques are increasingly used, supported by improved technology.

“I particularly welcome the initiative to extend dental services to children through the introduction of the concept of ‘packages of care’ for children from birth to 16 years of age. My Department provides approximately ¤55 million from the Social Insurance Fund for adult dental services under the Treatment Benefit scheme and consideration will be given to the possible expansion of this funding for insured adults, and their children, to synchronise and support the delivery of the proposals contained in the National Oral Health Policy.” Commenting on the development of the Policy, Dr Dympna Kavanagh, Chief Dental Officer at the Department of Health, said: “This is a comprehensive evidence based Policy which has been informed by extensive research and deliberations of oral healthcare professionals. For that reason I expect that it will be positively received by the dental community because it will not only facilitate better oral healthcare for everyone but will also support the continued professional development of the sector.” Professor Brian O’Connell, Dean of Dental Affairs in Dublin Dental University Hospital and Vice-Chair of the Oral Health Academic Research Group said that “Irish people value their smiles and want to keep their teeth healthy and functioning for life. The new Oral Health Policy recognises that maintaining good teeth throughout life is part of our total health and well-being. The Policy will promote oral health by facilitating regular access and choice of preventive care for all members of our society.” It is proposed that there will be a phased implementation of Smile agus Sláinte over the period 2019-2026. The ESRI has estimated that the oral healthcare packages approach contained in the Policy would cost approximately ¤80 million.


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News

Major Investment in Clinical Research A radical report ‘Future Investment in Clinical Research’, unveiled last month, calls for a major step-change to enable Ireland to increase its clinical research capability fourfold over the next five years. Professor Mark Ferguson, Director General Science Foundation Ireland and Chief Scientific Adviser to the Government of Ireland, Avril Kennan, CEO of Medical Research Charities Group and Professor Pat O’Mahony, Chief Executive, Clinical Research Development Ireland (CRDI)

selling point for the very large life sciences sector operating here in Ireland. While acknowledging the substantial investment made to date by Government in the clinical research infrastructure, the report sets out its vision and key recommendations for an integrated Irish clinical research system that drives excellence and innovation to further advance patient health and economic prosperity. The report advocates for a joint Government and industry funded programme to enhance and scaleup the national clinical research infrastructure that would deliver a significant increase in the number of international and multicentre clinical trials conducted in Ireland, offering increased access to new emerging therapies for Irish patients and generating an additional 3,000 direct and indirect jobs with gross value added of ¤200-¤300 million per annum. A wide range of leading experts in clinical research from patient representative bodies, academia, clinical research centres, healthcare delivery, funding

agencies and the Biopharma and MedTech industries were involved in the development of this strategic report, which outlines a roadmap of specific recommendations over a one to five year term. The report, shared at a seminar in Dublin, argues that a wellresourced and functioning clinical research system should be a fundamental component of the overall healthcare system, benefiting patients, the healthcare delivery system, research and academia. It is proven internationally that the more research-active a national health system is, the better the outcomes for patients. It is also a unique

Specifically, it recommends the development of this strategic infrastructure over five years calling for an initial investment of ¤22m into clinical research in Year One. It also confirms that the Biopharma and MedTech industries will match Government investment. The report also highlights that, on average, each patient participating in a clinical trial will generate a benefit of ¤13,500 to the economy. Additionally, the health service benefits from medicines worth an average of ¤5,899 per patient for those participating in clinical trials. According to Professor Pat O’Mahony, Chief Executive,

Clinical Research Development Ireland (CRDI), who chaired the Steering Committee, a wellresourced and scaled-up national infrastructure for clinical research offers more opportunity for patients to participate in trials, which provides for better patient outcomes overall. “Ireland is doing about a quarter of what we should be doing in the realm of Clinical Research – for example, in Denmark, which has the same population as Ireland, four times the number of clinical trials take place. Our life sciences sector has grown rapidly over the past half-century, to a point where it now has global significance. However, our clinical research system, infrastructure or performance do not compare with our growth in the manufacturing sector. A real opportunity exists here now, to enhance Ireland’s level of clinical research to its fullest potential. “We see internationally that outcomes for patients are always better in countries where clinical research is further advanced. It is proven that the more researchactive a national health system is, the better the outcomes for patients. For Ireland to emulate the success of other countries’ clinical research, further collaboration and investment is required. I thank all who have contributed to this report and look forward to engaging further with stakeholders and policy makers to action the various recommendations to benefit both Irish patients and the Irish economy.”

PMI welcome new Members Five new Executive Members have joined the Pharmaceutical Managers Institute (PMI) whilst the new President for 2019/2020 has been announced as Padraig Ryan, Sales Manager with Menarini. Margaret Drysdale, Business Unit Head for Genetic Diseases and Haematology with Takeda is the new Vice President. Mr Paul Reid, HSE Director General

3. Shane O’Connor, Key Account Manager - Sanofi 4. Fiona O’Hara, Director Medical Sales - IQVIA 5. Peter Tobin, Business Unit Manager Gastroenterology/ Oncology - Ferring

The new Executive Members are: 1. Deirdre Kelly, Country Manager Consilient Healthcare 2. Sharon Rice, Commercial Manager - United Drug

PHARMACYNEWSIRELAND.COM

The PMI is also inviting delegates to join them on June 27th, 2019 as the new Director General of the HSE, Mr Paul Reid, gives a briefing on what’s happening within the HSE, the plans for the coming

12 months and the challenges facing them. This is a fantastic opportunity to meet with the new DG, and hear his plans for the Department. The event is being held in Finnstown Country HouseHotel, Newcastle Road, Lucan from 7.30am-9am. For further details or to book tickets visit www.thepmi.com/events.


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Celebrating excellence at totalhealth Awards 2019

T

he fourth totalhealth Pharmacy Awards took place on Sunday 5th May in the Hodson Bay Hotel, Athlone. The event was attended by 270 members and partners of Ireland’s largest co-operative pharmacy group. Dáithí Ó Sé, RTE personality and Rose of Tralee host, returned to host this year’s celebration of the achievements of totalhealth pharmacies and team members.

The event gives totalhealth the opportunity to acknowledge the effort and dedication of their members, who work tirelessly to serve the needs of their local communities. Chairman of the Board, Rory O’Donnell, remarked ‘the success of our brand lies with our members and their teams. Tonight is about thanking them for continuing to live and breathe the totalhealth values of trusted local care, offering their patients the highest standard of service and care.’ Five awards were up for grabs on the night: • Pharmacy Technician of the Year Winners were: Katrina Owens, Brogan’s totalhealth Pharmacy, Boyle and Nicole Reeves, Banagher totalhealth Pharmacy • totalhealth Ambassador of the Year Winner: Leona Conlon, Riverstown totalhealth Pharmacy • Customer Service Pharmacy of the Year Winner: Rose Finlay totalhealth Pharmacy, Tullamore • Community Pharmacy Team of the Year Winner: Tully’s totalhealth Pharmacy, Castlere • totalhealth Pharmacy of the Year Winner: Peter Fox totalhealth Pharmacy, Birr Managing Director of totalhealth, John Arnold, was delighted with the success of the event. He commented, “We work for our members, so this event is just one small way of thanking them for their continued support and also to treat them to a well-deserved, fun night out. We’re particularly excited that tonight’s charity raffle, won by Mary Gurren in Curley’s totalhealth Pharmacy Ballyhaunis, generated ¤1,800 for Mayo Roscommon Hospice Foundation, a charity we are delighted to be supporting this year.” As well as being a fantastic excuse to get dressed up, the awards also allow totalhealth members to connect. Teams from right across the country travelled to Athlone to celebrate the brand and their colleagues’ achievements. totalhealth members are committed to supporting each other; the success of each independent pharmacy is integral to the success of the overall brand. totalhealth Pharmacy is one of Ireland’s largest symbol groups, comprising over 75 independent pharmacies, owned 100% by its members.

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1) Pharmacy Technician of the Year 2019 – Sponsor Greg Farrell, Accord with winner Katrina Owens, Brogan’s totalhealth Pharmacy, Boyle, Daithí O’Sé, Award Host, winner, Nicole Reeves, Banagher totalhealth Pharmacy, Offaly and Rory O’Donnell, Chairman, totalhealth Pharmacy Group. 2) Ambassador of the Year 2019 - Daithí O’Sé, Award Host, winner, Leona Conlon, Riverstown totalhealth Pharmacy, Tim O’Brien, McLernon’s Pharmacy Software and Rory O’Donnell, Chairman, totalhealth Pharmacy Group. 3) Customer Service Team of the Year 2019 Daithí O’Sé, Award Host, Graeme McInerney, RB, winner, Rose Finlay totalheath Pharmacy, Tullamore and the team at Rose Finlay totalhealth Pharmacy.

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4) Community Pharmacy Team of the Year 2019 – Winner Nial Tully, Tully’s totalhealth Pharmacy, Castlerea receiving the award from Sponsor Jean Tomkins, United Drug Healthcare, Rory O’Donnell, Chairman, totalhealth Pharmacy Group and the team at Tully’s totalhealth Pharmacy, Castlerea with Daithí O’Sé, Award Host. 5) Pharmacy of the Year 2019 – Winner, Peter Fox, Peter Fox totalhealth Pharmacy, Birr receiving the award from Sponsor Barry Fitzpatrick, Clonmel Healthcare, Rory O’Donnell, Chairman, totalhealth Pharmacy Group and the team at Peter Fox totalhealth Pharmacy, Birr with Daithí O’Sé, Award Host. 6) Board of Directors- totalhealth Pharmacy Group: Ollie McGuinness, McGuinness totalhealth Pharmacy, Roscommon, Michael Maher, Maher’s

totalhealth Chemist, Drogheda, Roisin Curley, Curley’s totalhealth Pharmacy, Ballyhaunis, Sheena Mitchell, Milltown totalhealth Pharmacy, Dublin, Daithí O’Sé, Award Host, Michelle Concannon, Concannon totalhealth Pharmacies, Athlone, Nial Tully, Tully’s totalhealth Pharmacy, Castlerea, Martin Kane, Johnstown & Kilmacud totalhealth Pharmacies, Dublin and Rory O’Donnell, O’Donnell’s totalhealth Pharmacy, Gweedore, Donegal. 7) Charity Donation to Mayo Roscommon Hospice: Ollie McGuinness Board Member, Mayo Roscommon Hospice & McGuinness totalhealth Pharmacy, Roscommon, Daithí O’Sé, Award Host, Mary Gurren, Curley’s totalhealth Pharmacy, Ballyhaunis, Joanne Hynes Chairperson Mayo Roscommon Hospice & Joanne Hynes totalhealth Pharmacy, Ballinrobe.

PHARMACYNEWSIRELAND.COM | 33


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Golden shield as a universal symbol of protection and standard of efficacy in EHC Easy to swallow film-coated tablet.2 Visit www.ellaonepharmacists.ie REFERENCES: 1. Glasier A et al. Lancet 2010; 375 (9714): 555-62. 2. HRA data on file: consumer swallowability research 2017

PRODUCT INFORMATION: ellaOne® 30 mg film-coated tablet (ulipristal acetate). Refer to the SmPC for further information. INDICATION: Emergency contraception (EC) within 120 hours (5 days) of unprotected sexual intercourse or contraceptive failure. DOSAGE: one 30mg tablet taken orally as soon as possible, but no later than 120 hours (5 days) after unprotected intercourse or contraceptive failure. Another tablet should be taken if vomiting occurs within 3 hours of intake. Can be taken at any time during the menstrual cycle. Not recommended for women with severe hepatic impairment. CONTRAINDICATIONS: Hypersensitivity to the active substance or excipients. SPECIAL WARNINGS AND PRECAUTIONS: Occasional use only. Use reliable barrier method after use until next menstrual period. If next menstrual period is delayed >7 days or is abnormal or suggestive symptoms occur then perform pregnancy test. Consider ectopic pregnancy. If pregnancy confirmed, woman should contact their doctor. Concomitant use with EC containing levonorgestrel not recommended. Does not contraindicate the continued use of regular hormonal contraception but reliable barrier method should be used until next menstrual period. Not recommended in severe asthma treated by oral corticosteroids. Concomitant use of CYP3A4 inducers [e.g. barbiturates (including primidone and phenobarbital), phenytoin, fosphenytoin, carbamazepine, oxcarbazepine, herbal medicines containing Hypericum perforatum (St. John’s wort), rifampicin, rifabutin, griseofulvin, efavirenz, nevirapine] not recommended (may decrease efficacy of ellaOne). Long term use of ritonavir not recommended. Not recommended for women who have used enzyme-inducing drugs in the past 4 weeks. Non-hormonal emergency contraception (i.e. a copper intrauterine device (Cu-IUD)) should be considered. Contains lactose. FERTILITY, PREGNANCY AND LACTATION: Not intended for use during existing or suspected pregnancy. Limited human data does not suggest safety concern. Does not interrupt existing pregnancy. No teratogenic potential was observed; animal data insufficient with regard to reproduction toxicity. Marketing Authorisation Holder maintains a pregnancy registry (www.hra-pregnancy-registry.com) to monitor outcomes of pregnancy in women exposed to ellaOne®. Patients and health care providers are encouraged to report any exposure. Ulipristal acetate is excreted in human breast milk; breastfeeding is not recommended for one week after intake. Breast milk should be expressed and discarded. A rapid return of fertility is likely following ellaOne use; regular contraception should be continued or initiated as soon as possible; subsequent acts of intercourse should be protected by reliable barrier method until next menstrual period. UNDESIRABLE EFFECTS: Always consult the SmPC before prescribing. Only the most common side effects and those which are rare but may be serious are listed below. Most commonly reported adverse reactions: headache, nausea, abdominal pain and dysmenorrhea. Common (≥1/100 to <1/10): mood disorders, dizziness, vomiting, abdominal discomfort, myalgia, back pain, pelvic pain, breast tenderness and fatigue. Rare (≥1/10,000 to <1/1,000): ruptured ovarian cyst. RETAIL PRICE: ellaOne 30 mg single film-coated tablet blister pack; € 35. MARKETING AUTHORISATION HOLDER: Laboratoire HRA Pharma, 15, rue Béranger, F-75003 Paris, France. Marketed in Ireland by: HRA Pharma UK & Ireland Limited, Haines House, 21 John Street, Bloomsbury, London, WC1N 2BF MARKETING AUTHORISATION NUMBER(S): EU/1/09/522/003. LEGAL CATEGORY: Medicinal product not subject to medical prescription. Date of last revision of text: October 2018 Adverse events should be reported. Reporting forms can be found at www.hpra.ie or email: medsafety@hpra.ie. Adverse events should also be reported to HRA Pharma UK & Ireland limited on Freephone: 1800 812 984 or email med.info.ie@hra-pharma.com


Women are more likely to seek healthcare advice and treatments more regularly than men are. They have unique and very different needs regarding their anatomical and hormonal makeup. Women also have unique psychological issues; they experience twice the rate of depression as men, regardless of race or ethnic background.

a customer to offer their assistance and support.

It is widely accepted that men don’t visit nearly as often as women, and find it more difficult to discuss their health issues.

Symptoms can either be a longterm or short-term occurrence, dependent on a number of triggers, from lifestyle choice to unprovoked illness. Common causes of bladder weakness, which are not unique to either women or men, include urinary tract infections, medication such as diuretics, being overweight – leading to extra pressure on the abdominal and pelvic muscles – and conditions such as diabetes or neurodegenerative diseases (for example, Alzheimer’s).

Men are no longer catching up with women in the life expectancy stakes and they will quite often ignore a problem than visit their pharmacy or healthcare professional. Pharmacists need to harness their knowledge to target men and advise on their health. This article takes a look at some of the most common health ailments presenting in the community pharmacy by both women and men. Women’s Health Statistics show that women are more likely to use primary care services than men: not only do they visit a GP on average six times per year compared with four visits for men, but they are much more familiar with the inside of a pharmacy, too – an average of 18 visits per year compared with men’s four. Many women’s health problems are still seen as embarrassing to discuss, and although brands are trying to reduce the embarrassment factor of purchasing items such as incontinence products, it’s vital that pharmacy staff are sensitive, and trained to look for ‘tell-tale’ signs of conditions that women might feel reluctant to talk about. Bladder Weakness Bladder weakness is a common problem for women and remains one of the fastest growing categories in pharmacy. Many women are still embarrassed about buying products to help, though. Many are opting to purchase bladder weakness products in a pharmacy, but for some it remains a topic that causes undue embarrassment and a reluctance to seek advice. As such, it is particularly important that pharmacists feel knowledgeable and confident when approaching

One in three women over the age of 40 experience bladder weakness at some point in their life, making it far more common than people may think. It is also common only to experience nocturnia – bladder weakness at night.

There are also links to smoking causing stress urinary incontinence from increased coughing. For many, the physical and hormonal changes that occur during milestones such as childbirth and the menopause – abdominal pressure during pregnancy and reduction in the quantity of oestrogen during menopause – can cause the pelvic floor muscles that keep the urethra closed to be weakened. With this in mind a full range of bladder weakness products should be displayed in pharmacies, ranging from a low level of support to the heavier incontinence pads. Customers should be able to browse the range of purposemade protective products and ask questions to counter staff, removing the need for lengthy GP waiting times. Pharmacies are trusted environments and customers feel it is a safer environment to purchase bladder weakness products, especially if seeking additional advice. This is especially advantageous as it allows pharmacists and pharmacy staff to build a rapport with the local community, understanding their needs and how to respond with meaningful advice that will enable them to live life to the full. Female Hormones Menorrhagia, or heavy periods that recur each month, are a problem when they stop a woman

undertaking her normal activities. A good indication that blood loss is excessive is if a woman says she is using an unusually high number of tampons or pads, she experiences flooding (heavy bleeding) through to her clothes or she needs to use tampons and towels together. In most cases, no underlying cause of heavy periods is identified but some conditions and treatments have been linked to menorrhagia, including uterine fibroids, intrauterine contraceptive devices, anticoagulant medication and polycystic ovary syndrome. The menopause is defined as the time when a woman stops having periods and is no longer able to get pregnant naturally. It occurs when a woman’s store of eggs depletes and oestrogen levels fall, usually between 45 and 55 years of age, with the average age being 51. Menopause symptoms typically continue for around four years after the last period. During the first stage, known as the perimenopause, periods start to become less frequent over a few months or years before they stop altogether, although sometimes they can stop suddenly. Around one in 100 women experience the menopause before 40 years of age or may have menopause triggered as a result of treatment for hormone-dependent cancer or gynaecological conditions. This is known as premature menopause. Pharmacists can provide a patient-centred approach to advising women about the menopause. Most women may simply want reassurance that the symptoms they are experiencing are normal or they may want advice or recommendations for treatment of their symptoms. Pharmacists are ideally placed to discuss symptoms alongside treatment options and their potential benefits and risks, or give simple lifestyle advice that could help to minimise symptoms. The menopause is a sensitive issue for many women who may not want to admit they are menopausal, so somebody might come in and say they are suffering from a symptom such as insomnia or memory loss. This is where pharmacy staff can use their skills to encourage them to talk and open up in confidence about what is really worrying them.

In addition to giving advice on the risks and benefits of taking HRT, pharmacists can also advise women on a wide range of alternative products that can help alleviate their symptoms. Maternal Health Healthcare during pregnancy can be a minefield for many women, with confusing and often contradictory information emerging on a regular basis. Pharmacists can help explain, reassure and demystify. With so much information available, it is important to help customers separate fact from fiction when it comes to keeping well during pregnancy and managing minor ailments once the baby is born. Given the wide range of pregnancy-specific vitamins and minerals now available, expectant mothers may be forgiven for thinking that vitamin supplementation is key to a healthy pregnancy. The role of folic acid in reducing the risk of neural tube defects and the value of vitamin D supplements in building bone formation in babies is supported by robust clinical data but there is no evidence to suggest a need for vitamin A supplementation in well-nourished pregnant women. In fact, vitamin A supplements should be avoided during pregnancy due to the risk of birth defects, while there is no compelling data to support the routine supplementation of any other vitamins or iron. Expectant mothers can be reassured that eating a good balanced diet during pregnancy, along with folic acid and vitamin D supplements, should be all that is required to ensure the best possible health outcomes for both themselves and their unborn child. Pharmacists can play an important role in offering education and advice to pregnant customers presenting in the pharmacy. For instance, pharmacists can ensure that pregnant patients are not receiving medications that are contraindicated during pregnancy, such as statins. Taking a prenatal vitamin during pregnancy is essential, and they are available as prescription and OTC products.

PHARMACYNEWSIRELAND.COM | 37


Because prenatal vitamins generally do not contain an adequate amount of calcium, it is essential for pregnant patients to have dietary sources of calcium or take a supplement. Vaginal Infections Bacterial vaginosis (BV) is a common, but poorly understood condition, caused by an imbalance of bacteria in the vagina. It is characterised by a white or grey discharge, with a strong fishy smell. BV doesn’t usually cause any vaginal soreness or itching and about half of women will have no symptoms. The condition isn’t serious for the vast majority of women, although it may be a concern if symptoms develop in pregnancy or in a woman with a history of pregnancy-related complications. BV is treated with a short course of oral antibiotics or an antibiotic gel applied inside the vagina. Some women may have repeated episodes of BV. Vaginal thrush is an infection caused by the candida albicans

fungus. Typical symptoms include itching and soreness around the entrance of the vagina, an odourless discharge, which may be thick and white or thin and watery, and pain during sex. The skin around the vagina can be red, swollen or cracked. It can be treated with a short course of antifungal medication.

fought with the clinical confidence of professional advice from the pharmacy personnel. Correct training of staff and adequate display of supplements will undoubtedly enhance sales and this is something to be taken seriously.

Women Walk this Way

Men, on the island of Ireland, experience a disproportionate burden of ill-health. Men don’t visit their doctor as often as they should, and not nearly as frequently as women, and are dying too young.

Creating a ‘Women’s Zone’ in a dedicated section of the pharmacy is one way pharmacies can increase visibility and footfall to women’s health product areas, increasing visibility and driving sales for products such as thrush relief. Women are increasingly aware of maintaining healthy lifestyles and their physical health and presentation. This provides pharmacies with an excellent opportunistic category as women tend to visit pharmacies more than they see their doctors. Of course, the challenge for community pharmacy is the competition in the category from health food shops and supermarkets, but this can be

Men’s Health

Male life expectancy (LE) is just 75.8 years (Republic of Ireland 75.1 years; Northern Ireland - 76.4 years)*. This is approximately 5 years younger than that of females and, for certain groups of men, it is younger still. While it is not possible to disaggregate male LE data for Socio-Economic Groups (SEG) in Ireland, data from elsewhere show that the gap in LE for men between the lowest and highest socio-economic groups is as high as 7.4 years. Therefore, it is probable that, for certain groups of men on the island of Ireland, their LE may be significantly lower than that reported. Underpinning men’s lower LE is the fact that men have higher death rates at all ages, and for all leading causes of death. While many of these conditions are preventable, their prevalence among men may, in fact, rise in the future. For example, it is predicted that by 2015 a third of all Irish men will be clinically obese, thereby increasing their risk of cardiovascular disease and diabetes in particular. Evidence of sex differences in the incidence, symptoms, and prognosis of a wide range of health problems is also well documented. Strategic healthcare, social, and economic policies are required to address the health inequalities experienced by men on the island of Ireland. In January 2009, the Republic of Ireland (RoI) became the first country in the world to publish a National Men’s Health Policy. This policy adopted a broad social determinants approach to men’s health, and identified areas of action for a range of government departments and agencies Pharmacies need to cater for male-specific or male-dominant issues, such as hair loss, athlete’s foot, sports injuries and digestive

38 | PHARMACYNEWSIRELAND.COM

problems, as well as targeted pharmacy services. This article takes a closer look at the Top Five health issues affecting the male health population. Lifestyle Factors According to the ‘Global Action on Men’s Health’ (GAMH), the most common cause of male death globally in 2016 was ischaemic heart disease followed by stroke and COPD. In fact, seven out of the 10 top causes of death for men were NCDs. Health practices, such as smoking tobacco, risky levels of alcohol consumption, a poor diet and delays in seeking appropriate healthcare are significantly implicated in NCDs. The male mortality and morbidity rates for NCDs, and other conditions, could be significantly reduced by a range of medical and public health actions, including better self-care. There is no easy way to talk about someone’s weight, but pharmacists can tactfully bring up the subject of obesity by talking about the associated health problems, particularly if there is something you know your customer is already experiencing. It is important to avoid the topic for fear of offending, as people may not know just how much obesity contributes to diabetes, heart disease, sleep apnoea, liver disease and even such things as male infertility. Men need to be convinced of the health benefits they gain by losing weight such as feeling fitter, the possibility of coming off medication, or reduced incidence of erectile dysfunction. Avoid talking about what men don’t want: for instance, they don’t like strict diets and some men are anxious about looking too thin. Male depression is also common. Different people have various symptoms of depression, which may include: • Feeling sad or ‘empty’ • Feeling hopeless, irritable, anxious or angry • A loss of interest in work, family or once-pleasurable activities, including sex • Feeling very tired, not being able to sleep, or sleeping too much • Not being able to concentrate or remember details


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Menoforce sage tablets Active Ingredients: One tablet contains 51 mg of dry extract from fresh Sage (Salvia officinalis L.) leaves. Indications: Traditional herbal medicinal product used for the relief of menopausal hot flushes and excessive perspiration exclusively based on long-standing use. Dosage and administration: Adults (18 years and over): One tablet daily. Not indicated in patients less than 18years. Contraindications: Hypersensitivity to sage preparations or any of the ingredients. Warnings and Precautions: If symptoms worsen or do not improve after 12 weeks, consult a qualified healthcare professional. Not recommended during pregnancy and lactation. This product may affect your ability to drive or use machines. If you are affected do not drive or use machinery. Contains sucrose. Pregnancy and lactation: This product should not be used during pregnancy and lactation. Side effects: No undesirable effects have been reported. Legal category: GSL. Registration Number: TR725/4/1. Registration holder: Bioforce (UK) Ltd, 2 Brewster Place, Irvine, Ayrshire KA11 5DD UK. Date of Preparation: November 2013.

Dormeasan Sleep Valerian-Hops oral drops Active Ingredients: 30 drops contains: 394 mg each of tincture from Valerian root (Valeriana officinalis L.) and Hop strobile (Humulus lupulus L.). Indications: Traditional herbal medicinal product used to aid sleep exclusively based on long standing use. Dosage and administration: Adults and older people: Take 30 drops in a little water or fruit juice half an hour before bedtime. As treatment effects may not be apparent immediately, the product should be taken for 2 weeks continuously. Contraindications: Hypersensitivity to any of the ingredients. Warnings and Precautions: Not suitable for children under 18 years of age. If symptoms worsens, or do not improve after two weeks, a doctor or qualified healthcare practitioner should be consulted. The product contains 62 vol % ethanol. This may be harmful for those suffering from alcoholism and should be taken into account in high risk groups. Combination with synthetic sedatives is not recommended. Avoid in patients taking other medicines known to interact with alcohol. Not recommended during pregnancy and lactation. Undesirable effects: Gastrointestinal symptoms. The frequency is not known. Legal category: GSL Registration number: TR 725/5/1 Registration holder: Bioforce (UK) Ltd, 2 Brewster Place, Irvine, Ayrshire KA11 5DD, Date of Preparation: May 2014.

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Atrogel Arnica Gel Active Ingredients: 1 g of gel contains 500 mg of extract (as liquid extract) of fresh Arnica flowers, equivalent to 120-200 mg fresh Arnica flowers. Indications: Traditional herbal medicinal product for the symptomatic relief of muscular aches, pains and stiffness, sprains, bruises and swelling after contusions exclusively based on long standing use. Dosage and administration: For cutaneous use only. Adults, children and older people: Apply 2-10 cm gently to the affected area 2 to 4 times daily. Contraindications: Hypersensitivity to any of the ingredients or members of the Asteraceae (Compositae) family. Warnings and Precautions: Do not exceed stated dose. If the condition worsens, or if symptoms do not improve within one week, or if adverse events not mentioned in the package leaflet occur, consult your doctor of pharmacist. Do not use on broken or irritated skin. Avoid contact with eyes and mucous membranes. Discontinue use if redness, irritation or dry skin occurs. Pregnancy and lactation: Use of the product during pregnancy or lactation should be avoided unless under guidance of a medical practitioner. Side effects: Common: contact dermatitis, itching, rash, dry skin. Legal category: GSL Registration number: TR0725/1/1 Registration holder: Bioforce (UK) Ltd, 2 Brewster Place, Irvine, Ayrshire KA11 5DD, UK. Date of Preparation: Jan 2015


Pharmacists are well placed to recognise depression in male customers as a consequence of requests for OTC products, such as sleep aids for early morning waking. Simply asking a man how he is feeling or even commenting ‘you don’t seem yourself at the moment – are things OK?’ could be all that they need to speak up about how they are. Once you have opened up a dialogue, there is a lot you can do to point your customer on the road to recovery or to more help via a referral to primary care. Male Pattern Baldness The most common type of baldness is male pattern baldness (androgenic alopecia). Most people recognise this type of baldness immediately. The hairline begins to recede at the temple, and the hair at the top of the head starts to thin out. After a period of time, the crown area may become completely bald, leaving a piece of hair around the back and sides of the head only. A recent study has found that 49% of young Irish men under the age of 30 believe themselves to be experiencing some form of hair loss. This figure is somewhat surprising, as hair loss typically corresponds to age, and in this category, just 30% of men should be reporting hair loss issues. Hair loss can be caused by a number of conditions, with some being more “permanent” than others. Hair lost due to Male Pattern Balding tends to be permanent if left untreated, whilst stress-related conditions like Telogen Effluvium tend to resolve themselves over time. Because hair loss may cause emotional distress and affect self-esteem, pharmacists and pharmacy staff should be supportive and empathetic to men experiencing it. In Ireland, finasteride and minoxidil are the main treatments for male pattern baldness. Pharmacists can assist patients experiencing hair loss by reviewing medication profiles and possibly identifying pharmacologic agents that may be associated with increased risk of hair loss. Prior to recommending the use of topical products, it is important to determine whether self-treatment is appropriate and whether the cause of the hair loss has been identified.

Customers to the pharmacy should always be referred to their GP if the cause of their hair loss is unknown or sudden. Prostate Cancer Prostate cancer most often occurs in men in their fifties and onwards. It can occur on rare occasions in men in their late forties. The risk of developing prostate cancer rises with age. In Ireland, prostate cancer is the second most common cancer in men, after skin cancer. Each year over 3,300 men are diagnosed with prostate cancer here. This means that one in seven men will be diagnosed with prostate cancer during their lifetime.

sporting injuries and provide specific advice to patients on their effective management, including the role of over-the-counter treatments, as well as when to refer for specialist assessment and treatment, can help many men steer clear of long-term muscular pain and joint damage.

With self-care being strongly promoted to the general public at the moment, now is the ideal time to not only encourage your customers to find a form of exercise that they enjoy, but also to remind them there is much they can do to look after themselves while they do it.

A worryingly high percentage of people simply ignore niggling sports injuries or treat them incorrectly, according to research. Research also show that men are three times more likely to injure themselves playing sport than women.

Pharmacy ‘Male’ Friendly

Some common sports injuries include: • Sprains,

Symptoms may include some or all of the following:

• Strains,

• A slow flow of urine.

• Bone fractures and breaks,

• Trouble starting or stopping the flow.

• Tendonitis (inflammation of a tendon),

• Passing urine more often, especially at night. • Pain when passing urine. • Blood in the urine or semen. • Feeling of not emptying your bladder fully. These symptoms may be caused by prostate cancer or they may be caused by other conditions, such as a harmless (benign) growth of the prostate gland called benign prostatic hyperplasia. It is also important to understand that early prostate cancer may not cause urinary symptoms, or any symptoms at all. Any customer who is worried should be advised to make an appointment with their GP. Pharmacist can play a vital role in educating patients on prostate cancer and different treatment options and answering related questions. Men should be educated regarding the need for routine screening. Men treated for prostate cancer should be advised and educated about potential complications and frequently assessed for possible side effects of therapies that may impact quality of life, including urinary incontinence, erectile disjunction, compromised bone health, and the inherent uncertainty of active surveillance. Sports Injuries Knowing how to identify common

40 | PHARMACYNEWSIRELAND.COM

• Cuts and bruises,

• Blisters, and • Head injuries. Most sprains and strains can usually be treated with self-care such as the PRICE technique (protection, rest, ice, compression and elevation), and should improve within six to eight weeks, although severe muscle strains may take longer. Leaving an injury untreated can lead to a once fixable problem having long-term, serious implications. While painkillers can be used to help ease any discomfort, advise customers to see their GP if they are in severe pain or if their injury is either not improving or getting worse. Topical analgesics are a popular and effective treatment for the sprains, strains and knocks that are part and parcel of playing sport, but it is crucial that the appropriate product is chosen for the needs of each individual. For example, when someone has suffered a sprain or strain, it should be treated with a cold or freeze product for the first 72 hours to help reduce swelling and inflammation and only when this period is over should heat be used to help increase blood flow to the affected area bringing oxygen, proteins and other nutrients to help promote healing. Topical NSAID products that offer an anti-inflammatory action together with pain relief are another option to help with muscle and joint aches and pains arising from sports injuries.

Pharmacists need to take stock of their stores and consider how they market to men. Men frequently perceive health and community services as feminine and feminised and as such, think it is not set up for them. Pharmacies interested in focusing on men’s health should consider the store’s colour scheme, layout, signage, product placement and the health information available. Are there posters or information leaflets displayed that have men on them? Do you have adequate stock levels of products that would appeal to men? Displaying this kind of information and advice in non-threatening retail settings may improve men’s health awareness and encourage men to visit. It is important to remember that men who are not motivated to engage with other parts of the healthcare system, such as their local GP, may still enter a community pharmacy for a range of over-the-counter or pharmacy-only medicines or treatments for minor injuries such as sports injuries. These encounters are a window of opportunity and staff in community pharmacies should be prepared for these opportunistic healthcare visits. • Men’s Health Forum Ireland

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42

News

Anita is an Employee Shining Star

Kit&Kaboodle at VIP Style Awards

Anita Meenehan of Mangan’s Pharmacy Newbridge was celebrating after winning her category at the recent Kildare Network Business Women of the Year Awards.

Uniphar’s beauty accessories brand Kit&Kaboodle was placed in front of 250 of Ireland’s most wellknown faces and shared across celebrity social media as the sponsor of the Most Stylish Online Influencer Award at the VIP Style Awards.

Anita was nominated, and won, in the “Employee - Shining Star” award category. Network Ireland Business Women of the Year Awards celebrate the excellence, professionalism, vision and leadership of its members. The event was held on May 24th, 2019.

The award was won by fashion, travel and lifestyle blogger Louise Cooney, who has 149,000 followers on Instagram. This was the second consecutive year that Kit&Kaboodle has sponsored this award. As part of its sponsorship, Kit&Kaboodle was promoted in VIP magazine and across its social media channels. It also had product on hand in the VIP Beauty Room to make sure celebrities had their lastminute essentials on the night. Other nominees for the award included Marissa Carter, Keilidh Cashell, Louise Cooney, Georgie Crawford, Triona McCarthy, Aideen Murphy, Eileen Style Queen and Bonnie Ryan.

Anita Meenehan, Mangan’s Pharmacy, Newbridge

Award winner Louise Cooney with Siobhan Flynn Marketing Director, Uniphar

Time to protect against Lyme disease Monday, April 29th, was Lyme Awareness Day, and the HSE Health Protection Surveillance Centre (HPSC) featured advice on how to protect against the disease. Now that summer is almost here, people who spend time outdoors – whether for work or leisure - should protect themselves and their families against Lyme disease, which is spread by biting ticks. While the typical manifestation of early disease is a skin lesion called erythema migrans, progression to more severe neurologic and cardiac sequelae can occur. When symptoms are identified early, there is a high cure rate with antimicrobial treatment. Most important, the disease is preventable with prompt identification and removal of all ticks and with other measures such as appropriate clothing and use of insecticides. Pharmacists can play a role in assisting in prevention and treatment of early disease. Specialist in Public Health Medicine at the HPSC, Dr Paul McKeown says, “Preventing Lyme disease means preventing tick bites. People are more likely to spend time outdoors in the spring

and summer months. Anyone who spends time outdoors should protect themselves against tick bites. This includes ramblers, campers, mountain bikers, people who work or walk in woodland, parkland and heathland, especially in grassy areas.” Ticks are present everywhere in Ireland, including both urban and rural areas and are active from spring to autumn. They are tiny spider-like creatures that feed on the blood of humans, animals and birds, and are more numerous and more active in the summer months. From April onwards is the time when we expect to see cases of Lyme disease most frequently in Ireland, because this is when ticks are most plentiful. Pharmacists may be alerted to

PHARMACYNEWSIRELAND.COM

the possibility of Lyme disease by questioning the patient about: • The likelihood of tick exposure (e.g. exposure to highly endemic areas, recreational/occupational activities, seasonal factors); • History of the tick bite (these may go unnoticed); • EM; • Flu-like symptoms, especially following tick exposure, a tick bite or EM; • Other focal symptoms and signs consistent with Lyme disease, including: o Neurological symptoms (e.g. facial palsy, unexplained radiculitis [nerve root inflammation]); o Joint pain and swelling;

o Meningitis, carditis and uveitis (although these are rare symptoms); o Chronic skin rashes. “Most cases of Lyme disease are very mild and many infected people may not have symptoms. The most common sign of infection is a skin rash (known as Bullseye rash or erythema migrans). In a small number of cases however, the infection can be more severe, leading to serious nervous system, heart and joint disease,” said Dr McKeown. Anyone who develops a rash or other symptoms should be referred to their GP and explain that they have been bitten by a tick. Those who think they may have been bitten by a tick and who develops a skin rash must be referred.


KIT&KABOODLE WENT DOWN A TREAT AT THE VIP STYLE AWARDS Kit&Kaboodle mingled with Ireland’s most stylish stars at this year’s VIP Style Awards, as proud sponsors of the ‘Most Stylish Online Influencer’ category at the exclusive event. Blogger Louise Cooney went away with the coveted award, while Kit&Kaboodle were on hand to provide some of Ireland’s most well known faces with their last minute beauty essentials.

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Topic Team Training – Hayfever 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. Dr Sarah O'Connor, CEO, Asthma Society of Ireland

• The impact of hay fever on work, school and leisure • How to avoid/minimise hay fever triggers • The danger of anaphylactic shock • Types of pollen and when they can cause symptoms during the year • How the pollen count varies with time of day and weather Actions:

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 Hay fever. Community pharmacists have a key role to play in the management of hay fever. Their role is especially important because the majority of medications used to treat it are available for purchase over-thecounter (OTC), allowing patients to self-select their own medications and bypass the pharmacists. Patients’ self-selection often results in suboptimal treatment selection, undertreated hay fever and poor clinical outcomes. In order for pharmacists to optimise the care for these patients in the pharmacy, pharmacists need to be able to identify patient cohorts who self-select and are at high risk of mismanagement. Hay fever in Ireland Just last month, asthma and hay fever sufferers in Ireland were warned of a potentially deadly "pollen bomb" which could cause life-threatening attacks. Met Eireann's pollen count forecast is showing high levels due to the unexpected good burst of hot weather. Sarah O'Connor, CEO of the Asthma Society of Ireland says, "Project pollen levels are high and, with pollen levels rising earlier than last year, people with hay fever really need to start managing the condition now, especially those with hay fever and asthma. "Hayfever is very misunderstood in Ireland and people often dismiss you as a hypochondriac or simply a complainer when you mention it.”

Hay fever (allergic rhinitis) is a common allergic condition affecting children and adults. A large proportion of the symptoms will be experienced during the summer because of grass pollen. It is also possible to have allergic symptoms to trees and weeds that pollinate at different times of the year.

shown that there are close links between food allergies, asthma, hay fever and eczema. A genetic tendency to develop allergies is termed ‘atopy’. Children with an immediate family history of allergies are at an increased likelihood of developing one, but not necessarily the same type as their family member.

Community pharmacists are well placed with their product and knowledge to recommend specific treatments for hay fever. Antihistamines are commonly used to treat mild symptoms, such as runny or congested nose, sneezing, and itching or watery eyes. These should always be nonsedating so they do not impact on an individual’s ability to carry out their day-to-day activities.

The progression of allergic disease from birth to late childhood has been historically described as the ‘allergic march’, meaning the natural order by which allergic disease develops over time. The first signs of an allergic disease seen in infants are usually a food allergy and eczema, with asthma and hay fever having a later onset.

Patient education should always be provided for correct use of nasal sprays and eye drops. Some simple advice on pollen avoidance: • Wear wraparound sunglasses and a wide-brimmed hat (reduces pollen exposure to the face and eyes). • Monitor the pollen count and plan the day to avoid being outdoors at peak pollen times. • Keep windows and doors closed at home, in the office or car, to stop pollen coming inside. • Avoid drying washing outside as pollen can brought inside on garments, bed linen, sheets. • Advise on washing or showering to those who have been outside to remove pollen from the skin and hair. It is common for allergic conditions to co-exist and research has

44 | PHARMACYNEWSIRELAND.COM

Consider: • Am I, my team,aware of guidance on the use of corticosteroids use in hayfever treatment? • Are the team trained in all OTC treatments available in the suitability to each patient group? • Does my team know what different sources of pollen are most likely to cause symptoms, and which symptoms they will cause? • Am I and my team educated on advice to offer in avoiding pollen? Key Points: Check your pharmacy team are aware and understand the following key points: • Hay fever affects at least one in five people • The wide range of hay fever symptoms

• Include POS with associated condition treatments such as asthma and other allergies • Ensure efficient sign posting to further help and advice or reputable sources for allergy testing • Keep products merchandised together, along with related products such as inhaler guides, to help build sales • Ensure that this important category is fully stocked at all times and merchandising plans are amended based on seasonal time of year • Ensure that I know the recommendations for each OTC treatment depending on the allergy • Train the team to meet all the above considerations Learning www.asthma.ie/hayfever - Further details on hay fever in Ireland and association with asthma.


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48

News

Pharmacy launches Self Care campaign The development and adoption of self care in the Irish health system needs to be an all year effort according to the Irish Pharmacy Union (IPU) and the Irish Pharmaceutical Healthcare Association (IPHA). The two bodies have launched a new self care awareness campaign, entitled ‘Be Well this Summer – Think Pharmacy’ designed to highlight the benefits to the public of looking after their health during the summer period. The campaign will be rolled out over a four-month period and will involve social media video content, as well as a series of posters to be displayed nationwide in retail pharmacies. It will actively promote self care throughout the summer as well as the valuable role of the pharmacist in supporting self care. Self care is defined as the care taken by people of their own health and wellbeing at the lowest level of complexity with advice from a healthcare professional. Self care

supports people to stay healthy, especially during more vulnerable times and empowers people to manage important elements of their own and their loved one’s healthcare needs. Previous research by Behaviour & Attitudes confirms that there is a clear desire from the majority of people (92%) to be involved in decisions about their own health and medication, with 80% saying that they see their pharmacist as a key partner in maintaining their health.

While many people are known to take a more conscious approach to self care during the winter months, and particularly during the flu season, this campaign is designed to highlight the ongoing benefits of self care throughout the year. The campaign will be advising the public to ‘Think Pharmacy’ in relation to a number of summer health matters, including hay fever, sun care and holidays.

eLearning Platform for Staff Training In support of their aim to provide the best in professional healthcare and advice, Allcare Pharmacy has rolled out an interactive online eLearning programme to make staff training easier and more convenient. Allcare Pharmacy trainer Eimear Nee demonstrating the new eLearning programme

“Pharmacies are a trusted source of advice for the public on medicines and health matters in the community,” said Eimear Nee MPSI, trainer with Allcare Pharmacy. “In order to uphold that trust, pharmacy teams have a responsibility to ensure that all information provided is accurate, clinically valid and in line with current evidence and best practice.”

Babies given formula milk instead of being breastfed are more likely to become obese, according to new research. A new Europe-wide study led by the World Health Organisation looking at 22 countries and more than 100,000 six to nine-year-olds found that even nursing babies for some of the time helped protect them from obesity. The breastfeeding study, the largest of its kind, was led by Dr Ana Rito of the National Institute of Health in Portugal and aided by Professor Cecily Kelleher from University College Dublin. The research showed while more than 77% of children in Europe are breastfed, in Ireland, nearly half of mothers (46%) have never done so. The WHO recommends that women should exclusively breastfeed for six months, if they can. It has a 2025 target to globally increase exclusive breastfeeding rates to 50% in the first six months of life. The global body says there needs to be more help and encouragement for women to breastfeed, adding that the marketing of formula milk has “misled” women into thinking it is better for their infants.

Allcare Pharmacy trainer, Eimear Nee MPSI created the content for each course and also provides voice-over for the training modules. They were developed together with eLearning specialists Olive Media. Over-the-counter training is the first course to be released and comprises 12 modules focused on conditions commonly encountered in community pharmacy and the associated treatment options available. It also provides information on legal requirements surrounding the sale of certain medicines.

Infant Nutrition on Obesity

Professor Cecily Kelleher, Principal at UCD College Of Health And Agricultural Sciences says, “We need to see more measures to encourage breastfeeding, like properly paid maternity leave,” said Dr João Breda, from the WHO European Office for Prevention and Control of Non-communicable Diseases.”

Fifteen multiple choice questions follow each module in the over-the-counter course to check the understanding of the most important points in each module. In addition, patient scenario-based assessments are contained at both the half-way point and end of the programme. The assessments support previous module learnings and reflect real customer interaction which

PHARMACYNEWSIRELAND.COM

pharmacy staff are required to manage on a daily basis. Activities are placed throughout the programme, directing the learner to carry out tasks or carry out supplementary reading to support their learning. A certificate of completion is available after successfully passing individual modules and a final certificate is issued on successfully finishing the programme.

Part of the WHO’s Childhood Obesity Surveillance Initiative (COSI), the study was presented at the European Congress on Obesity in Glasgow and published in the journal Obesity Facts. Researchers study looked at primary school children from 22 European countries, and asked their mothers if they had breastfed, for how long, and if they had done so exclusively without feeding their baby other liquids such as water.


Continuing Professional Development

CPD

CPD 103: MANAGING RHEUMATOID ARTHRITIS 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: Dr Maria Benito, BSc, MSc Physiol/Toxicol, PhD Mol Biol (inflammation/Immunology), MA, MAPCP

Management and Treatment of Rheumatoid Arthritis 60 Second Summary Rheumatoid arthritis (RA) characterised by persistent synovitis, systemic inflammation, and auto-antibodies (particularly rheumatoid factor and citrullinated peptide), is a chronic inflammatory disease that affects 1% of the general population and can lead to joint destruction. Estimates show that the condition effects 0.5 to 1.5% of the world’s population, being more prevalent in the West than in developing countries. Rheumatoid arthritis (RA) occurs as a result of the body’s immune system attacking the joints and causing inflammation of the lining of a joint and the tissues surrounding it. While 1% of the population suffers from rheumatoid arthritis1, about 80% of sufferers develop it between the ages of 35 and 50 therefore predominantly affecting individuals of working age. Research by Arthritis Ireland estimated the annual indirect cost of lost production time due to all forms of arthritis to be ¤1.6 billion, and found that 70% of individuals diagnosed with RA in Ireland were not able to work outside their home. Symptoms can initially develop quite slowly and can occur either as a single episode of stiff and painful joints which may last some months, or as an aggressive and destructive condition which progresses rapidly. Up to 30% of patients may present with non arthritis type symptoms without obvious joint swelling such as malaise (general feeling of being unwell), weight loss and myalgia (muscle pain).1 Depression can be a feature of RA.

Rheumatoid arthritis (RA) characterised by persistent synovitis, systemic inflammation, and auto-antibodies (particularly rheumatoid factor and citrullinated peptide), is a chronic inflammatory disease that affects 1% of the general population and can lead to joint destruction. Up to 500000 people in Ireland suffer from some form of arthritis. Arthritis is a general term used for the condition; however there are over 100 types of arthritis. The two most common types of arthritis are osteoarthritis and rheumatoid arthritis. Rheumatoid Arthritis (RA) is one of the most debilitating forms of the condition. Prevalence Estimates show that the condition effects 0.5 to 1.5% of the world’s population, being more prevalent in the West than in developing countries.a A recent estimate from Arthritis Ireland suggests there are as many as 40,000 individuals (1.22%) with rheumatoid arthritis in Ireland and that 70% of the rheumatoid arthritis affected are women.b Rheumatoid arthritis (RA) occurs as a result of the body’s immune system attacking the joints and causing inflammation of the lining of a joint and the tissues surrounding it. While 1% of the population suffers from rheumatoid arthritis1, about 80% of sufferers develop it between the ages of 35 and 50 therefore predominantly affecting individuals of working age. About 1 in 20 of affected people has a severe form of it with many joints affected. Up to half of all patients are unable to work within 10 years of diagnosis.2, 3

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.

• Approximately 75% of new diagnoses are of individuals who are working at the time of diagnosis.c •

The ability to work is affected in around 50% of individuals within 5 years of diagnosis d, with every third individual diagnosed with RA becoming completely work disabled.

Up to 85% of individuals with RA who are able to work will experience an average of 40 lost work days annually due to the condition.e

Rheumatoid Arthritis and Work

A further 18% will cease to work within 5 years of diagnosis due to a combination of RA and other factors such as depression.

Some of the figures below show the extent to which RA has a dramatic impact on the working population.

The factors shown above present a significant annual cost to the State’s economy.


CPD 103: MANAGING RHEUMATOID ARTHRITIS • Deformity Criterion Criteria 1-4 must have been present for ≥ 6 weeks

Definition

1. Morning stiffness

Morning stiffness in and around the joints, lasting at least an hour before maximal improvement

2. Arthritis of ≥ 3 joint areas

≥ 3 joint areas simultaneously have had synovitis observed by a physician

• Fatigue • Malaise • Fever • Weight loss • Depression

3. Arthritis of hand joints

At least 1 area swollen in a wrist, MCP or PIP joint

Causes of rheumatoid arthritis

4. Symmetric arthritis

Simultaneous involvement of the same joint areas on both sides of the body

5. Rheumatoid nodules

Subcutaneous nodules, over bony prominences, extensor surfaces or juxta-articular regions

6. Serum RF

Positive RF

7. Radiographic changes

Radiographic changes typical of RA in posteroanterior hand and wrist radiographs

The exact cause is unknown but there is a genetic link as RA tends to run in families. RA is three times more common in women than in men. It's common for the symptoms of RA to improve during pregnancy - this suggests that hormones and the immune system may be involved in triggering the condition. Certain lifestyle factors such as obesity and smoking can be factors. The risk of developing rheumatoid arthritis being almost twice as high in smokers compared to non-smokers.h For reasons unknown, RA onset is twice as common in winter than in other seasons.

≥ 4/7 Criteria satisfied = RA Research by Arthritis Ireland estimated the annual indirect cost of lost production time due to all forms of arthritis to be ¤1.6 billion, and found that 70% of individuals diagnosed with RA in Ireland were not able to work outside their home g. In terms of direct healthcare costs, rheumatoid arthritis also consumes considerable costs and resources in its management. If we compare Ireland to the UK (estimated 580,000 RA sufferers), where the fully allocated cost to the economy is estimated by NICE to be as high as £4.8 billion, (sick leave, welfare costs, treatment etc) then in terms of like for like measured costs, the total cost of RA to the Irish economy may be ¤462 million annually. What is rheumatoid arthritis? Arthritis means inflammation of the joints. The condition can progress swiftly to become severe and disabling in a short period of time. The disease primarily affects the synovial joints, resulting in pain, deformity and eventual functional limitation, RA also increases the risk to sufferers of development of other diseases together with a significantly increased risk of premature death. Rheumatoid arthritis (RA) is an autoimmune disease. Usually your body's immune system produces white cells and proteins called antibodies to destroy foreign substances such as viruses and bacteria. With autoimmune diseases, your immune system mistakes the body’s own tissue as foreign and attacks it, leading to inflammation. Symptoms of rheumatoid arthritis Symptoms can initially develop quite slowly and can occur either as a single episode of

stiff and painful joints which may last some months, or as an aggressive and destructive condition which progresses rapidly. Atypically it starts with the small bones of the hands and feet with discomfort and some swelling often being the first symptoms. Stiffness, especially in the morning is a classic symptom of RA, this stiffness often reduces during the day (for osteoarthritis, the symptoms tend to get worse as the day goes on). The hands, wrists, feet, ankles and knees are affected in over 80% of cases. The symptoms are often symmetrical meaning that both sides are affected equally (eg) both knees affected equally. In advanced cases of the condition, most joints are become affected. Rheumatoid nodules may develop; these are fleshy lumps resulting from synovitis that usually appear on hands, feet and elbows. These aren't painful but they can cause difficulty using hands.

Diagnosis of rheumatoid arthritis It is important to start treatment of RA early because the earlier it's started, the more effective it will be. However, there are a number of challenges to achieving this early diagnosis. If not treated, the condition may lead to serious disability. It can be difficult to diagnose RA because many other conditions may make the joints painful. People may feel the symptoms are minor or may be simply normal signs of aging. Symptoms are a good indicator of the condition. However X rays of joints and blood tests such as testing for the presence of a “rheumatoid factor” or an “anti-CCP antibody” can be more conclusive in diagnosing the condition. Formal diagnosis is based on the American College of Rheumatology (ACR) diagnostic criteria.

Up to 30% of patients may present with non arthritis type symptoms without obvious joint swelling such as malaise (general feeling of being unwell), weight loss and myalgia (muscle pain).1 Depression can be a feature of RA. RA is thought to be associated with an increased rate of cardiovascular disease and there is evidence of an increased mortality rate from heart related problems in RA patients.4

According to the ACR criteria for diagnosis of RA, at least four of the following symptoms must be present5:

In summary, the main symptoms of RA are:

4. Symmetrical swelling (ie) equal both sides

• Joint swelling

5. Rheumatoid nodules

• Pain/stiffness (commonly in morning and lasting more than one hour)

6. Presence of rheumatoid factor (rheumatoid factor is an auto-antibody which shows up in blood tests and it an indicator of arthritis)

• Weakness

1. Morning stiffness in affected joints lasting at least one hour 2. Soft tissue swelling of at least 3 joint areas 3. Swelling of finger, hand, or wrist joints


CPD 103: MANAGING RHEUMATOID ARTHRITIS 7. Erosion of bone which shows up in X-rays, particularly in hand, wrist or feet joints RA can be rapidly progressive in some patients. In these cases treatment must be started early to prevent irreversible joint and other damage. Indications that the disease is rapidly progressing include high ESR or C-reactive protein levels (indicators of inflammation in blood tests), early erosive damage on x-rays, increasing number of affected joints, disability early in the condition, high levels of rheumatoid factor and the presence of extra-articular features at diagnosis.2 Extra-articular features include non joint symptoms of RA such as damage to skin, heart, lungs, and eyes. The main goal of RA treatment is to control inflammation, relieve symptoms, and prevent joint and organ damage, and at the same time, improve physical function and reduce long-term complications. Actual treatment models are aimed to treat the inflammation early to control the disease and achieve remission, which is possible in many patients if the disease is recognised and treated early; however, some patients do not respond adequately to treatment. Currently, the new insights into the management of RA include treat-to-target approaches using targeted therapy methods with classic and novel treatments, and precision medicine. Despite a common clinical presentation, RA displays multiple pathogenic pathways, as suggested by the different responses triggered by agents that target cytokine inhibition, B cell depletion, or co-stimulation blockade. Preliminary studies suggest a correlation of synovial histologic patterns with response to therapy, although other evaluations of synovial structure and biomarkers have not proved to be of clinical value. Different lymphocyte subpopulations play a major role in the physiopathology of RA, such as regulatory T cells (Treg), T helper 17 (Th17) cells and regulatory B lymphocytes (Breg). Data highlight the relevance of phenotyping T and B cells as prospective value for the stratification of some biologic drugs. Medication-based therapies to treat RA involve several classes of agents, including non-steroidal anti-inflammatory drugs (NSAIDs) –which have become the standard therapy–, non-biologic and biologic disease-modifying antirheumatic drugs (DMARDs), immunosuppressants, and corticosteroids (GC). As second line therapy after the failure of the first for those patients without negative prognostic markers, the European League against Rheumatism(EULAR) recommends conventional syntheticDMARDs (csDMARDs), while

biological disease-modifying antirheumatic drugs (bDMARDs) or a Janus Kinase (JAK) inhibitor considered targeted synthetic disease-modifying anti-rheumatic drugs (tsDMARDs) as add-on therapy to background methotrexate (MTX) and other csDMARD is the recommended treatment for RA patients with negative prognostic markers. The first-line tailored biologic therapy recommends starting therapy with bDMARD and continuing with csDMARD. A combined induction therapy with MTX and TNFinhibitors (TNFi) seems to be associated with a higher chance of maintaining a low disease activity and increases the remission even after discontinuation of TNFi. Currently, anti-TNFi therapy etanercept and infliximab are the most cost effectiveness treatments for RA, although one third of patients do not respond to the first line biologic therapy with TNFi. In these cases, it is recommended to change the mode of action of therapy and switch to a second bDMARD an IL-6 receptor antagonist– such as sarilumab. Combination of TNFi and MTX offers better outcomes, but TNFi monotherapy triggers

higher clinical remission than csDMARDs including MTX, bDMARD and tsDMARD monotherapy. New therapies and perspective drugs Monoclonal antibodies: In order to develop new therapies for RA, key immune checkpoints in the synovial lesion has been taken into account, as well as the upstream immune dysregulation in cytokines, especially TNFi and IL-6, whose inhibition deliver a significant clinical response. Clinical trials have also demonstrated the efficacy of early treatment in the prevention of bone erosions years after initiation of treatment particularly anti-TNF therapy supporting the treat-to-target strategy. Antibodies are usually directed at proinflammatory cytokines and T or B cell receptors. B cell activation is crucial in the pathogenesis of RA and remains a relevant therapeutic target as studies have found a specific B cell factors profile in RA associated with autoantibodies, and increased proinflammatory cytokines IFNα, MIP1α, TNFα, IL-37, and GM-CSF and


CPD 103: MANAGING RHEUMATOID ARTHRITIS Mesenchymal stromal and stem cells: Despite the huge advances in RA treatments with immunosuppressive and immunomodulatory therapies, 30% of RA patients do not respond to DMARDs. Continuous research have led to promising results in stromal mesenchymal stem cells (MSCs) in vitro studies and in RA animal models, demonstrating the ability of MSCs to restore immune system activity and repair the RA damage. Currently, there are clinical trials on few phase I and II in RA patients resistant to conventional therapy.

type-I IFN. B lymphocytes and humoral immunity also play a key role in RA through anti-citrullinated protein antibodies(ACPA) and rheumatoid factor (RF) production. In a similar way to Treg, Breg represent a subpopulation of B cells with immune-regulating properties and play a role in peripheral tolerance by secreting IL-10. Sirukumab IL-6 inhibitor and olokizumab anti IL-6 antibody which selectively block the signalling involved in pro-inflammatory mediating response; ocrelizumab antiCD20 with greater B-depleting effects than rituximab, and ofatumumab than specifically targets a membrane-proximal epitope on CD20 molecule different from other anti-CD20 such rituximab and ocrelizumab. Rituximab that depletes CD20 lineages and co-stimulatory blockade with abatacept a chimeric (cytotoxic T lymphocyte-associated protein 4-immunoglobulin fusion protein (CTLA-IgG) have similar efficacy. Blocking IL-17, IL-1, BAFF B cell activating factor, also known as tumour necrosis factor ligand superfamily member 13B (encoded by TNFRSF13B), IL-21 and IL-20 appear less effective. Th17 lymphocytes a subpopulation of CD4+ T lymphocytes that produces the pro-inflammatory cytokine IL-17, unbolt the path for new treatment options for RA such as secukinumab or ixekizumab. Th17 cells seem to have a significant role first during the onset of RA and later as they may be influenced by treatments, increasing under MTX and decreasing in patients that do not respond to infliximab. Anti-IL-17 antibodies ixekizumab, secukinumab and brodalumab highlight the role of IL-17 in the pathogenesis of RA inflammation. Data suggests that CD24hiCD27+ B cells and Th17 cells may be useful as predictor biomarkers of therapeutic response and may guide the choice of tailored treatments, with the recommendation of prescribing abatacept if the patient has high CD24hiCD27+ B cells baseline level, whereas anti-cytokine therapy would be a better option in case of low initial level of Th17 cells.

FL-BsAb1/17 –a recombinant IgG-like bispecific antibody acting as interleukin1β and interleukin-17A inhibitor have showed to be more effective in controlling clinical manifestations of RA and reducing histopathological alterations in synovial, cartilage and bone in collagen-induce arthritis in mice than monovalent inhibitors anti-IL1 or anti-IL17. Furthermore, FL-BsAb1/17 was able to inhibit IL-1β, IL-17A, IL-6, TNF-α and anti-CCP antibody and down-regulate the expression of IL-1β, IL-17A, IL-6, TNF-α, MMP-3 and RANKL, decreasing the IL-6 induced by IL-1β and/ or IL-17A in fibroblast-like synoviocytes derived from RA patients. Anti-JAK: Janus Kinases (JAKs family: JAK-1, JAK-2, JAK-3 and TYK-2) are critical in the intracellular signalling of cytokines via signal transducers and activators of transcription (STAT), which induce the expression of many crucial genes in RA. Tofacitinib inhibits JAK-1 and JAK-3 and is the first tsDMARD treatment alone or in combination with other cDMARDs for moderate to severe RA in patients unresponsive to MTX. Baricitinib which selectively and reversibly inhibits JAK-1 and JAK-2 is a new promising therapy for moderate-severe RA effective in inhibiting radiographic progression, although there are yet some concerns for safety. Recently, the use of inhibitors of JAK pathways in early disease have showed substantial efficacy, although these tsDMARDs, are recommended only after a bDMARD failure. In non-respondent patients, the optional therapeutic option is to use new IL-6 antagonists. ABT-494 a selective JAK-1 inhibitor and VX-509 (Decernotinib) a selective JAK-3 inhibitor are in phase of experimentation at the moment.

MSCs regulate inflammation via adaptive and innate immune response –through inhibition of T and B cell proliferation, induction of Tregs, suppression of natural killer and dendritic cell maturation, and promotion of anti-inflammatory macrophages, mediated by prostaglandin E2, indoleamine 2,3-dioxygenase, nitric oxide, and IL-10, released in response to IFN-γ from activated immune cells. Nanoparticles: The bioavailability and the high dose necessary to overcome the clearance of the drug able to induce side effects and unjustified iatrogenic damage, are some of the limitation factors of current RA therapies. One of the most promising novel therapeutical approaches is based on the possibility of increasing the effectiveness of RA treatments through nanocarriers small liposomes molecules with selectivity for organs, tissues and cells that transport therapeutic agents and after systemic administration are selectively delivered to inflamed sites. In the process of making a decision for the treatment of RA, it is important to consider efficacy disease activity, radiologic damage, and other aspects such as comorbidity and safety. Studies has exposed that patients on bDMARDs endure a risk of tuberculosis and other serious infections, but do not have an increased risk for malignancies except for melanoma, and exhibit a reduced risk of sepsis triggered by TNF and mortality. However, there have been some recent reports linking biologic therapy with TNFi in RA patients with associated cancer risk. Advances in the development of new target therapies that modify the course of RA have allowed a significant reduction of symptoms, radiographic progression and improve in quality and life expectation; the efficacy of targeted therapies is also complemented by good safety profiles, even for novel therapies such as anti-JAK therapies and JAK inhibitors. However, research still continues to discover new pathophysiological mechanisms and factors involved in RA and ways to remedy the symptoms and progression of the disease. References available on request.


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Celebrating Excellence in Pharmacy

IRISH PHARMACY AWARDS 2019

Celebrating Pharmacy Excellence The 2019 Irish Pharmacy Awards – the benchmark for outstanding performance throughout Ireland’s community pharmacy industry The pinnacle of the pharmacy calendar, the Irish Pharmacy Awards, took place last month in the Clayton Hotel, Burlington Road, Dublin, recognising the work of community pharmacists and their teams and highlighting the positive impact of the profession on the public and on peers. To the public, pharmacy is the most accessible face of the healthcare service.

pharmacy is positioned, at the forefront of healthcare, improving the lives of people across the country. Over 650 guests attended the awards evening, cementing their place as the premier event of its kind in Ireland. Awards were given out across 16 categories, ranging from Self-Care to Community Pharmacist of the Year.

Pharmacy teams play a pivotal role as a community and health asset across Ireland, striving for excellence in public health care and driving delivery of services focused on prevention, health improvement and protection of their local communities.

Now in their eighth year, these awards are brought about by Irish Pharmacy News, Ireland’s best and most influential independent community pharmacy magazine, and showcase work which is fostering partnership working and shared learning whilst adhering to the core pursuits of pharmacy: excellence in health and innovation.

Much of this work goes unnoticed but the Irish Pharmacy Awards provide the opportunity to honour and applaud these inspirational and deserving professionals and teams. It is through their work that

Once again this year, submissions reflected a wealth of strong contenders displaying the talent and imagination that makes Ireland’s pharmacy industry so special.

These Awards truly are the Gold Standard of best practice with over 500 submissions received. The shortlisting process was therefore, extremely difficult - with some strong entries failing even to make it as finalists - but huge thanks must go to our independent judging panel, to whom the task fell to reviewing the entries and selecting the winners. An overriding opinion of the judging panel this year, was the phenomenally high levels of distinction displayed by all finalists, making their decision-making process this year harder than ever. Reflective of the impact these awards hold, was the Sanofi Pharmaton People’s Pharmacist of the Year Award, the only award which is both nominated and voted for, by members of the general public. Each of the six finalists this year were nominated for the award by their local community in recognition of their continued excellence of service throughout the years.

With a reach of over 500,000, over 10,000 votes were received via social media, email and website voting during the course of the campaign, it was an extremely close race with a mere 22 votes separating this year’s winner from the runner-up. Natalie Maginnis, Managing Director with IPN Communications said, “These Awards are considered to be the most prestigious in the industry. Every year we see huge increases in the quality and quantity of submissions, which is why winning one of these awards is so coveted. “On behalf of IPN Communications, I would like to congratulate all of this year’s finalists and winners. The Irish Pharmacy Awards are about recognising these pharmacy professionals and their teams showcasing excellence and dedication and we are delighted to be able to hear and share their stories, ideas and innovations.”


United Drug Business Development (Independent) Award Commons Road Pharmacy, Navan

Avene Counter Assistant of the Year Award Rose Cummins, Meaghers Pharmacy, Castletymon

McLernon Computers eHealth & Innovation Award Hiltons Pharmacy

BC Business Banking Innovation & Service Development (Chain) Award Boots Ireland

Clonmel Healthcare Business Development (Chain) Award Life Pharmacy Group

Sanofi Pharmaton People’s Pharmacist Award Audrey Kingston, Chemco Pharmacy, Co Laois

MediMarshal Community Pharmacist of the Year Award 2019 Jonathon Morrissey, Marron’s Pharmacy, Clane

GSK Self Care Award Remedi IFSC Pharmacy, Dublin

Life Pharmacy – Pharmacy Student of the Year Award Glenn Ryan, School of Pharmacy, Trinity College Dublin and McCabes Pharmacy Group

Teva Superintendent Pharmacist of the Year Award Ola El-Garawany, Lilly's Pharmacy & Health Store, Ratoath

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

JPA Brenson Lawlor Young Community Pharmacist of the Year Award Cormac Black, McCabes Pharmacy, Swords

Sudocrem Children Baby Health Pharmacy of the Year Award Keane’s CarePlus Pharmacy, Mullingar

RB Nurofen Rapid Relief OTC Retailer of the Year Award Boots Ireland

4Front Pharmacy & IPN Community Pharmacy Team of the Year Award McCauley Health & Beauty Pharmacy, Tralee

RB Nurofen Rapid Relief OTC Retailer of the Year Award Boots Ireland


Avène Counter Assistant of the Year 2019 Rose Cummins, Meaghers Pharmacy, Castletymon Rose Cummins, pharmacy assistant with Meaghers Pharmacy in Castletymon, was recognised for her contribution to the profession and received the Avène Counter Assistant of the Year Award for 2019. Rose Cummins is one of the longest standing team members in Meagher’s Pharmacy Group, dedicating an overwhelming twelve years of her to life to serving the community between two stores, Glenview and Castletymon in Tallaght. Rose has now been in Castletymon for seven years, a position she ‘thrives in’ within the store. Having grown up in the Tallaght area, Rose has an excellent knowledge of her customers, to whom she greets by name and with a smile on a daily basis. Customers are the centre of everything Rose does in her job and without doubt her most loved part of working in community pharmacy. “I have been with the Meaghers Pharamcy Group now for over twelve years and have really put everything into my role there. I have a great passion for my job and love working on the ground helping customers in our local community feel better about themselves and their health. “These awards are a tremendous way in which we can demonstrate to our communities the work that goes into ensuring excellence in the services they are accessing and the products available from their local pharmacy. It is a real honour to be recognised for that here tonight.” Charlotte Heckford, UK & Ireland Business Unit Director at Pierre Fabre Dermo-Cosmetique said, “It’s really important for us as a company to be involved with the Irish Pharmacy Awards to be able to honour and shine that spotlight on the vital work being carried out by counter assistants. Rose Cummins, Meaghers Pharmacy, Castletymon with Charlotte Heckford, UK & Ireland Business Unit Director at Pierre Fabre Dermo-Cosmetique

“We are very proud to be able to share in their knowledge and passion, for not only our own brands but all brands across Ireland, and their work in ensuring that the consumers and customers coming into community pharmacies are educated on the brands available to help them with their health and wellbeing.”

Rose Cummins, Meaghers Pharmacy, Castletymon with Charlotte Heckford, UK & Ireland Business Unit Director at Pierre Fabre Dermo-Cosmetique


GSK Self Care Award 2019 Remedi IFSC Pharmacy, Dublin 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. As the most central member of the healthcare team in any community, pharmacists and their teams are ideally placed to offer customers excellence in self-care. Once the need for self-care services within their community was identified, the Remedi Pharmacy team decided to set goals in order to meet those needs, including concentrating on public health, disease and lifestyle areas with the goal of creating a safe and professional environment, where customers can feel confident and their needs answered. Pharmacy Manager and Director, Aneta Walczynska says, “We identified number of self-care services required, that go beyond buying over-the-counter medicines. 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 self-care 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. Bryan Dunne, Customer Business Manager, Pharmacy Channel, GSK, adds, “For GSK, the Self Care Award is all about empowerment, especially for the consumer, in looking after their own health and wellbeing.

Bryan Dunne, Customer Business Manager, Pharmacy Channel, GSK with Aneta Walczynska and Jean Jose Del Alamo Remedi IFSC Pharmacy

“The role of community pharmacy is crucial to the overall enhancement of health of consumers and by supporting this award it enables GSK to align our core values with that of both pharmacy and the public within this key area.”

Aneta Walczynska and Jean Jose Del Alamo Remedi IFSC Pharmacy with Bryan Dunne, Customer Business Manager, Pharmacy Channel, GSK


KBC Business Banking Innovation & Service Development (Chain) Award Boots Ireland – Mole Screening Service Boots Ireland proved they lead from the front when it comes to offering services to their customers, winning the KBC Business Banking Innovation & Service Development (Chain) Award 2019. 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. Developed in conjunction with ScreenCancer, 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 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. Susan O’Dwyer, Pharmacy Strategy Manager with Boots Ireland stated after winning the award, “This is a great award for Boots Ireland to win. The Irish Pharmacy Awards presents us with the ideal opportunity to showcase all the range of innovations and direct care that community pharmacies are providing across the country.” “Thanks must also go to KBC Business Banking in their support of this award.”

Aidene Browne, Pharmacist and Susan O’Dwyer, , Pharmacy Strategy Manager, Boots Ireland with P.J. O’Brien, Area Manager, KBC Business Banking

Mr P.J. O’Brien, Area Manager, KBC Business Banking added, “As a Business Banking company, we are very focused on the professional sector and of course pharmacy forms a very significant part of that. We are proud to be associated with these awards, and to show support of this sector who demonstrate so much innovation and commitment to the health of their communities.”

Aidene Browne, Pharmacist, Bernadette Lavery, Managing Director, Susan O’Dwyer, Pharmacy Strategy Manager, Caoimhe McCauley, Director of Pharmacy & Superintendent Pharmacist, all with Boots Ireland with sponsor P.J. O’Brien, Area Manager, KBC Business Banking


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Sudocrem® Children Baby Health Pharmacy of the Year Award Keane’s CarePlus Pharmacy, Mullingar 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 in Mullingar has served the local community with medication and professional advice for over 10 years. In this time, the group has 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 their customers to trust the team’s recommendations and advice over the past number of years.

Keane’s CarePlus Pharmacy, Mullingar, winners of the Sudocrem Children Baby Health Pharmacy of the Year Award with Phil Osborn, National Account Manager at Teva Ireland

On accepting their award, Pharmacy Manager Robert Keane said, “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.” Phil Osborn, National Account Manager at Teva Ireland presented Robert with the award. He added, “Sudocrem is proud to sponsor the Children Baby Health Award. Community pharmacies have been supporting generations of Irish Mums & Dads offering expert knowledge and healthcare advice from new arrivals to the entire family. The early years are vital in order to ensure each new member of society are given the best opportunity to lead a happy and healthy life and community pharmacies have a central role to play, delivering the best in healthcare services for their customers and communities. It’s wonderful to say thank you to the teams of people who offer this advice and care every day.”


Pure Pharmacy Recruitment Community Pharmacy Technician of the Year Award Samantha Jones, Keane’s CarePlus Pharmacy, Enfield Samantha Jones, based in Keane’s CarePlus Enfield Road, won the Pure Pharmacy Recruitment Community Pharmacy Technician of the Year Award, making it the second win of the night for the Keane’s CarePlus Pharmacy team. Samantha joined the Enfield Road team in February 2018 and hit the ground running. With the basics of being a diligent, hard-working team player she reinvented the whole approach to improving customer relations and providing great services to customers. Picking up her award, Samantha said, “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.” Phyllis Wady, Managing Director of Pure Pharmacy Recruitment said, “The Irish Pharmacy Awards have become such a huge event within Ireland and Pure Pharmacy Recruitment are proud to be a part of that. We feel there are so many fantastic and talented technicians, pharmacists and support staff working here and we want to support them in both their careers and in receiving the recognition they so clearly deserve.” Samantha Jones, Community Pharmacy Technician, Keane’s CarePlus Pharmacy, Enfield with Phyllis Wady, Managing Director, Pure Pharmacy Recruitment

Phyllis Wady, Managing Director, Pure Pharmacy Recruitment and Samantha Jones, Community Pharmacy Technician, Keane’s CarePlus Pharmacy, Enfield


United Drug Business Development (Independent) Award Commons Road Pharmacy, Clogherboy, Navan Meath-based Commons Road Pharmacy in Clogherboy, Navan walked away on the night with the United Drug Business Development (Independent) Award. The pharmacy team at Commons Road, led by Pharmacist Laura Gilmartin, has embraced the opportunity to enhance their service offering to patients in numerous ways over the last twelve months. Whilst benefiting the community they serve, this has also impacted positively on the business as a whole. Laura accepted the award stating, “We are a fairly new business, which only opened its doors three years ago, so to win this award tonight is huge for us. This is a really important category and it is thrilling to know that our hard work has paid off. “We wanted to step out of our comfort zone, to think outside the box with regards to our service offering and do something different and in doing so we have been able to access all demographics and age groups within our community. “The role of community pharmacist is not just a job to me, it is a passion and a vocation.”

Padraig Cronin, Head of Strategic Planning and Development, United Drug with Laura Gilmartin, Commons Road Pharmacy

Padraig Cronin, Head of Strategic Planning and Development with United Drug stated, “As the major supplier to pharmacies in Ireland, we at United Drug consider community pharmacy to be the very core of the healthcare sector here. In particular, independent pharmacy plays a crucial part and that is why we are delighted to once again be associated with supporting this award category.”

Laura Gilmartin, Commons Road Pharmacy with Padraig Cronin, Head of Strategic Planning and Development, United Drug


JPA Brenson Lawlor Young Community Pharmacist of the Year Award McCabes Pharmacy’s Cormac Black won the JPA Brenson Lawlor Young Community Pharmacist of the Year Award for 2019, after impressing the judges with his display on ongoing dedication and commitment to the profession.

Cormac Black, McCabes Pharmacy, Swords

Cormac has been described as a young pharmacist that has brought a wealth of knowledge, enthusiasm and a dedication and commitment to improving both the role of the pharmacist and the services and level of care giving in McCabes Pharmacy. He has adapted exceptionally well to a busy pharmacy that can be a highly pressurised environment at times with its high volume of dispensing and high footfall. Said a colleague, “It is a tribute to Cormac to how much he has developed since completing his degree in 2016.” After receiving his award, Cormac told us, “This award and receiving the affirmation that comes with it means so much to me. It is a tremendous feeling to know that prestigious events such as these are looking over our shoulders and recognising what we do. “I believe that without these awards, we as pharmacists are doing our jobs on a daily basis, carrying out the same tasks without ever being able to benchmark or share our ideas. Even to know that what we are doing brings value and for me this is the pinnacle of everything I have achieved to date.” Bradshaw, Corporate Finance Partner with JPA Brenson Lawlor adds, “JPA Brenson Lawlor have been involved with community pharmacy for over 35 years from a grassroots level upwards. “Community pharmacy is our number one sector and we have been supporting Ireland’s young community pharmacists right throughout their career, it is important to us that they get a good start in their career and that we are here to guide them with that.”

Jason Bradshaw, Corporate Finance Partner with JPA Brenson Lawlor and Cormac Black, McCabes Pharmacy, Swords

Cormac Black, McCabes Pharmacy, Swords with Jason Bradshaw, Corporate Finance Partner with JPA Brenson Lawlor


RB Nurofen Rapid Relief OTC Retailer of the Year Award Boots Ireland Believing in putting customers first, Boots Ireland won their second category of the night, with the RB Rapid Relief OTC Retailer of the Year Award for 2019. The Boots team believe in “customers first and colleagues at the heart of everything we do” as a vision for how they want to do things. This strapline helps them to deliver a robust healthcare strategy, through the lens of their customers, ensuring that colleagues exude confidence and engage in great patient conversations in store and at all times. Customers choose Boots for their Healthcare needs because of the focus Boots put on ensuring their interactions are led by care, are informative and ultimately provide a solution which reduces or removes the root cause of the issue. Every interaction is important to the team, colleagues feel valued for the care they provide and are supported and encouraged to provide customers with the best experience. OTC Buying Manager Avril Farrell commented on accepting the award on behalf of Boots Ireland

Bernadette Lavery, Managing Director, Pamela White, Category Assistant, Conor O’Farrell, Positive Health Buying Manager, Nathalie Kalo, Assistant Buying Manager, Avril Farrell, OTC Medicines Buying Manager, all Boots Ireland, with Michael Graham, Head of Sales, RB Ireland

“As a healthcare-led business, winning this award is a fantastic acknowledgment of the hard work and dedication shown by the entire healthcare team based in Parkwest. The achievement itself serves as great source of motivation as we continue to strive towards delivering and sustaining a market leading and compelling healthcare proposition for our customers. We look forward to an exciting year ahead, one of which we expect to be brimming with innovation and inspiration.”

Nathalie Kalo, Assistant Buying Manager, Conor O’Farrell, Positive Health Buying Manager, Avril Farrell, OTC Medicines Buying Manager, Pamela White, Category Assistant, Bernadette Lavery, Managing Director and Michael Graham, Head of Sales, RB Ireland


AYA Vitamins Category Development Award CarePlus Pharmacy Group Focusing on a new skincare campaign led to CarePlus Pharmacy Group winning the AYA Vitamins Category Development Award 2019. CarePlus Pharmacy Group is Ireland’s fastest growing independent retail pharmacy group with 60 pharmacies open around Ireland. The CarePlus brand is at the heart of communities they serve, and they pride themselves on their commitment to deliver expert advice and services for customers’ health and wellbeing. Skincare is often thought of a category that revolves around beauty in pharmacies, but the primary focus for CarePlus on skincare is on advising customers on the best treatment and products for chronic skin conditions as well as generating awareness on the importance of UV index scales and the risk of UV damage to skin all year round. With a skincare campaign tagline of ’Be Skincare Aware’ CarePlus launched a campaign to explain how important and easy it is for customers to protect their skin. Una Shiel, Category Manager and Aisling Smith, Training Project Manager, both with CarePlus Pharmacy accepted the award on the night. They commented, “We are delighted to have won, this campaign is something we are passionate about and a really important category for us so we are overwhelmed with this success it has brought. “What is really special about this is receiving the recognition from our peers within the pharmacy industry, and we are very pleased to have won with such a key category that we have been focused on for the last couple of years.” David O’Brien, Commercial Director, Uniphar Retail Services said, “AYA is a new vitamins and supplements brand, specially developed by Uniphar and exclusive to Irish pharmacy. Innovation and category development are keys to future growth, hence why we are delighted to partner with the Irish Pharmacy Awards to support this important area of pharmacy.”

Una Shiel, Category Manager, Aisling Smith, Training Project Manager, both with CarePlus Pharmacy Group and David O’Brien, Commercial Director, Uniphar Retail Services

Una Shiel, Category Manager, Aisling Smith, Training Project Manager, both with CarePlus Pharmacy Group and David O’Brien, Commercial Director, Uniphar Retail Services


Life Pharmacy – Pharmacy Student of the Year Award Glenn Ryan, School of Pharmacy, Trinity College Dublin and McCabes Pharmacy Group Glenn Ryan, a Pharmacy student at the School of Pharmacy, Trinity College Dublin and with McCabes Pharmacy in Swords Pavillions, was recognised as a rising star of his profession, picking up the Life Pharmacy: Pharmacy Student of the Year Award at 2019. Described as someone who takes great pride in his role, Glenn treats every patient the same, knowing them all by first name and making sure they understand their medication. With excellent communication skills, his expanding knowledge, empathy, enthusiasm and caring nature won over the judges. Said a McCabes Pharmacy colleague, “Glenn will make an excellent pharmacist once he is qualified and will be an asset to any team he works with.” Commenting after receiving his award, Glenn said, “I really didn’t expect to win this award, especially given the high calibre of finalists I was up against and I would like to congratulate them all on their achievement also. “I made the decision to return to study pharmacy as a mature student and winning this award for me recognises the hard work that was involved in doing that. It’s the best decision I have made so far and I am really looking forward to my career in pharmacy.” Gerard Coffey, Chairman of the Life Pharmacy Group added, “Life Pharmacies aim to build lifelong relationships with their communities so we can help each and every person who comes to us to live better lives. We believe that’s the purpose of pharmacy and we want to recognise those who will soon join us in working towards that goal. “This award is for students who have exceeded expectations and Glenn has demonstrated that in abundance. Life Pharmacy is proud to sponsor this award and honour those who will ensure that our patients and our profession is in good hands.”

Glenn Ryan, School of Pharmacy, Trinity College Dublin and Gerard Coffey, Chairman of the Life Pharmacy Group

Glenn Ryan, School of Pharmacy, Trinity College Dublin


MediMarshal Community Pharmacist of the Year Award Jonathon Morrissey, Marron’s Pharmacy, Clane Jonathon Morrissey, Community Pharmacist and owner of Marron’s Pharmacy in Clane, ws recognised with the prestigious MediMarshal Community Pharmacist of the Year Award 2019. The MediMarshal Community Pharmacist of the Year accolade recognises Jonathon as a pharmacy professional who is defining the future standard of pharmacy through his excellence in practice. Via his contribution and leadership to the profession, Jonathon has demonstrated enhanced patient care and displaying the core values of pharmacies at the heart of every community in Ireland. Accepting his award on the night Jonathon said, “I was honoured to have even been put forward and shortlisted for this award, and to have won with my pharmacy team, colleagues, peers and family here is fantastic. It is always humbling to receive recognition for your work and interests in community pharmacy. “I love my patients. I always have. They are why I love doing what I do. They are why I teach this to other pharmacists because I think the pharmacy profession is amazing. We do not get enough credit for the unsung work we do and the efforts all pharmacists go to for their patients. We are not good at promoting our work. These awards are vital in enabling pharmacists to think differently about why they are in the profession they are in.” Tim O’Brien, Sales Executive with McLernon Computers said, “At McLernons we believe that community pharmacies are the unsung heroes of healthcare, and that is why we support events such as this, which provide a platform to celebrate excellence in the profession.” Jonathon Morrissey, Marron’s Pharmacy, Clane with Tim O’Brien, Sales Executive, McLernon Computers

Tim O’Brien, Sales Executive, McLernon Computers with Jonathon Morrissey, Marron’s Pharmacy, Clane


Teva Superintendent Pharmacist of the Year Award Ola El-Garawany, Lilly's Pharmacy & Health Store, Ratoath Lilly’s Pharmacy & Health Store’s Ola El-Garawany took the title of Teva Superintendent Pharmacist of the Year Award for 2019. Based in Ratoath, Ola was recognised for her work within the community, managing full responsibility for the pharmacy while also holding service clinics and assisting the rest of the pharmacy team. She is described as not only a professional who excels within her Superintendent remit, but as an approachable and caring healthcare professional to all her customers and staff. Still reeling from receiving her award Ola commented, “I am overjoyed and really delighted to have won this. I am proud for my team at Lilly’s Pharmacy & Health Store that we can take this home and demonstrate to our customers that the hard work has been worth it. “It has been really inspiring to attend tonight’s event, everyone in the room deserves the recognition as everyone within pharmacy gives the highest levels of effort to their jobs. The excitement is palpable and I have been humbled by listening to everyone’s innovations and efforts.” Paul Neill, Director, Generics & OTC at Teva Ireland said, “Teva Ireland has had a long relationship with the Irish Pharmacy Awards and in doing so we really recognise the vital role Superintendent Pharmacists play within community pharmacy and how important they are in driving standards and in ensuring that patients receive the best possible care from their pharmacists. “This is aligned with Teva Ireland’s approach, which is making sure that we enable better days for patients.” Ola El-Garawany, Superintendent Pharmacist, Lilly’s Pharmacy & Health Store with Paul Neill, Director, Generics & OTC, Teva Ireland

Paul Neill, Director, Generics & OTC, Teva Ireland and Ola El-Garawany, Superintendent Pharmacist, Lilly’s Pharmacy & Health Store


4Front Pharmacy & IPN Community Pharmacy Team of the Year Award McCauley Health & Beauty Pharmacy, Tralee McCauley Health & Beauty Pharmacy, Tralee, picked up the 4Front Pharmacy & IPN Community Pharmacy Team of the Year Award for 2019 at the recent Irish Pharmacy Awards.

Based in Manor West Retail Park in Tralee, the team understand and recognise the important role each member plays and values the different skills sets that each brings. The team in Tralee is

a blend of talents where each member is encouraged to give as much input as possible. Collecting the award on behalf of the team, Supervising Pharmacist

Brian Kearney stated, “Our team consists of a group of individuals who are all committed to providing the best possible service to our customers. We have worked tirelessly to grow the pharmacy business through initiatives targeted at educating and engaging with our customers on health issues. “We are all steadfast in our commitment to providing excellent patient care whilst also looking to provide that care in an inventive, engaging manner. We are delighted to receive this accolade tonight, a clear demonstration of what great team work can achieve.” Kelly Jo Eastwood, Editor of Irish Pharmacy News said, “In recognition of the value of Community Pharmacy teams, we invited 4FrontPharmacy to co-sponsor the Community Pharmacy Team of the Year Award with us. In our opinion, 4Front Pharmacy offers the highest quality, most engaging suite of pharmacy education modules in the market for pharmacy teams. “We are delighted to announce that on winning this award, the Tralee McCauley Pharmacy team will be awarded a scholarship for 10 premium subscriptions to 4frontpharmacy.ie, for a whole year of training - a scholarship worth ¤3,500. They will have access to more than 50 pharmacy education modules and each member of staff will be able to assess and validate their completion of each module and print their certificate of completion.”

Tracey Stack, Pharmacy Technician, Alison O’Brien, OTC Assistant, Leon Diggins, OTC Assistant, Brian Kearney, Supervising Pharmacist, McCauley Health & Beauty Pharmacy Tralee with Kelly Jo Eastwood, Editor, Irish Pharmacy News

Geraldine Ramage, Superintendent Pharmacist, McCauley Group, Brian Kearney, Supervising Pharmacist, Leon Diggins, OTC Assistant, Tracey Stack, Pharmacy Technician, Alison O’Brien, OTC Assistant and Luke O’Shea, Pharmacist, McCauley Health & Beauty Pharmacy Tralee team


Clonmel Healthcare Business Development (Chain) Award Life Pharmacy Group – Loyalty for Life 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 as costly to build a long-term 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 loyal 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 all stores. Paddy Colleran, Pharmacist and owner of Colleran’s Life Pharmacy in Charlestown, accepted the award on behalf of Life Pharmacy Group. He said, “I am delighted and honoured to accept this award for Life Pharmacy’s Loyalty for Life programme. These awards are a unique way to promote community pharmacy and really thrusts the work that we do into the public domain.” Martin Gallagher, Director of Marketing & Business Development with Clonmel Healthcare congratulated the winners saying, “It is very important for Clonmel Healthcare to be involved with the Irish Pharmacy Awards; we have been associated with the awards since their inception eight years ago.

Clonmel Corporate Ad 210x297mm_(new version).pdf

“We are particularly interested in pharmacy because they are the gatekeepers to public health, their interaction directly with the patient has become more involved over the years and they are looking towards the future and realising that the only way forward is future planning and forward business development.”

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Paddy Colleran, Pharmacist and owner of Colleran’s Life Pharmacy in Charlestown with Martin Gallagher, Director of Marketing & Business Development, Clonmel Healthcare

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Paddy Colleran, Pharmacist and owner of Colleran’s Life Pharmacy in Charlestown with Martin Gallagher, Director of Marketing & Business Development, Clonmel Healthcare CY

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Sanofi Pharmaton People’s Pharmacist Award Audrey Kingston, Chemco Pharmacy, Co Laois Portlaois Pharmacist Audrey Kingston was named the Sanofi Pharmaton People’s Pharmacist for 2019. The Chemco Pharmacist’s win came about as a result of a concentrated social media campaign across Ireland. Each of the six Finalists within Audrey’s category were nominated for the award by their local community in recognition of their continued excellence of service throughout the years. Members of the public then had the opportunity to vote for the winner. With a reach of over 500,000, over 10,000 votes were received via social media, email and website voting during the course of the campaign. It was an extremely close race with a mere 22 votes separating Audrey from the runner-up. “This means everything to me, most especially because I was nominated by my customers,” said Audrey on receiving her award. “My main focus is, and always has been, my customers. I make sure I am front of the counter every day and stay there. Connections are key in this industry, it’s vitally important that members of the public feel a connection to their community pharmacist and I make connections every day, with a wide range of customers. I enjoy being able to help solve problems, and in helping customers with their healthcare needs.” Tanya O’Toole, Head of Consumer Healthcare Ireland, Sanofi added, “Pharmaton is proud to sponsor the People’s Pharmacist Award because we know how hard pharmacists work to ensure they deliver the best for their customers and t heir communities.

Tanya O’Toole, Head of Consumer Healthcare Ireland, Sanofi with Audrey Kingston, Chemco Pharmacy, Portlaois

“Pharmaton is also about striving to be the best that we can be, even in the face of challenges, and so we are delighted to have the opportunity to recognise fantastic examples of pharmacists making a real difference in peoples’ lives.”

Tanya O’Toole, Head of Consumer Healthcare Ireland, Sanofi with Audrey Kingston, Chemco Pharmacy, Portlaois


McLernons Computers eHealth & Innovation Award Hiltons Pharmacy, Cornelscourt, Dublin Hilton’s Pharmacy in Cornelscourt Dublin were applauded for their work in showcasing innovative digital health solutions, as they picked up the McLernon Computers eHealth & Innovation Award 2019. Hilton’s Pharmacy integrated a self-service mobile app into the pharmacy’s workflow. This has reduced wait times in the pharmacy, made ordering prescriptions more convenient and helped patients improve their medication compliance. The app is very user friendly and is used by customers from 18 to over 80 years old. On winning this award for 2019, David Gilsenan, Pharmacist with Hilton’s Pharmacy said, “We developed a very simple app for communicating with our patients without realising how valuable it was or was to become. “These awards promote our services and push them out to the wider community. Everyone within pharmacy here tonight are doing different, innovative things and so this presents a fantastic opportunity to share in ideas and learn from each other.” Robin Hanna, Director with McLernon Computers said, “McLernons have supported the Irish Pharmacy Awards since their inception seven years ago because we believe that they shine a spotlight on the hard word, dedication and professionalism of community pharmacies up and down the country. “Community pharmacies are the bedrock of the health service, providing a first port of call to the worried well, to carers, and those with more severe or chronic conditions. “This year, we have slightly adapted the name of our award and its criteria in order to reflect the growing impact of eHealth and mobile technology in healthcare. These awards serve as an ideal platform from which pharmacists and their teams can shout their achievements from the rooftops.”

David Gilsenan, Pharmacist, Hiltons Pharmacy, Cornelscourt, Dublin with Robin Hanna, Director with McLernon Computers

Robin Hanna, Director with McLernon Computers with David Gilsenan, Pharmacist, Hiltons Pharmacy, Cornelscourt, Dublin


IPN Awards: The Best of Pharmacy

Awards The Irish Pharmacy

2019

Over 620 pharmacy and industry professionals were in attendance as winners across 16 categories were announced at the annual Irish Pharmacy Awards. Each year Irish Pharmacy News, Ireland’s only independent monthly publication for community pharmacy, celebrates and acknowledges the achievements of teams and individuals within the pharmacy profession. The 8th annual Irish Pharmacy Awards took place on Saturday, May 18th 2019. Hosted by Colm O’Regan, the awards ceremony took place in the Clayton hotel, Burlington Road, Dublin. The Irish Pharmacy Awards recognise the achievements of individuals and teams working in the community pharmacy sector; their dedication and innovation which positions the profession at the forefront of healthcare, improving the lives of people across the country. Pictured are some of those who attended.

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1: Fergus and Joyce McCauley, IQVIA 2: Charley Byrne, Mary Kearney, Denise O’Rourke and Lisa Synott, Adrian Dunne Pharmacy, Newtownmountkennedy 3: Tara and Martin Kelly, IPU 4: lodagh Conlon and Oonagh McCormack, Ryan’s Pharmacy, Kildare 5: Anthony O’Neill and Orla Boyle, Clarity Locums 6: Claire and Francis Kelly, Leahy’s Pharmacy, Tralee 7: Breda and Fergus Brennan, Barry’s Pharmacy, Sligo 8: Sarah Keogh and Nicole Purdy, McCartan’s Pharmacy, Portmarnock


Awards The Irish Pharmacy

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1: Treacy Bambury, Rebecca Kilfeather, Enda Lannon, Clare Lannon, Sinead McGettigan and Edel Cullen, Lannons Late Night Pharmacy 2: Dr Sarah O’Connor, Asthma Society Ireland and Alan Keating 3: The team from Uniphar 4: Dee O’Dwyer, Pharma Support, Andrta Rooney, Revive Active and Lilla Fogirty 5: Lorraine Brophy, Dervila McGarry, LloydsPharmacy and Laura Payne, United Drug 6: Barbara and Claudia Gilhooley, Keane’s CarePlus Pharmacy, Mullingar


Awards The Irish Pharmacy

2019

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1: Emer Lynch and Molly Burke, Pharmacy Students, School of Pharmacy, University College Cork 2: Bernie Walshe, Rosalene Harrington, Aine Shine, Caoilfhionn Scanlon, Elaine Dunne, Catherine Hanlon, Ben Hibbitts and Zoe Palmer, McCartans Pharmacy, Maynooth 3: Roisin Dowd O’Mahoney, Edel Marron, Jordan Marron, Jonathon Morrissey, David Collins, Genevieve Morrissey, Josie Lane and Des Marron, Marron’s Pharmacy, Kildare 4: Daniel and Meaghan Spencer, Hickey’s Pharmacy, Gorey 5: Sarah Jane Allen and Lynn Gaynor, McCauley Health & Beauty Pharmacy 6: The team from Stacks Pharmacy


Awards The Irish Pharmacy

3

2019

1

2

4

5

6

7

1: The team from McCabes Pharmacy, Swords 2: Niamh Loughlin, School of Pharmacy, Trinity College Dublin and Jess McNamara, School of Pharmacy, University College Cork 3: Leonora Kinsella and Aibhe McMackin, United Drug 4: 4) Diana Truta and Eoin Whelan, Hickey’s Pharmacy, Cork 5: Rachel Dungan, David McLean and Karen Ahern, 4Front Pharmacy Online 6: Claire Caufield, Suzanne Mallow, Emma O’Brien, Aisling Nugent, Cormac Crowe, Karen Birch and Louise Birch, Donnelly’s Pharmacy, Portmarnock 7: Aisling Quinlan and Paolo Iacoveli, PharmaConex


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The prominent role of the blood-brain barrier in stroke By Dr Maria Benito, BSc, MSc Physiol/Toxicol, PhD Mol Biol (inflammation/Immunology), MA, MAPCP

S

troke occurs when the blood supply to part of the brain particularly sensitive to oxygen starvation is interrupted or reduced, depriving brain tissue of oxygen and nutrients; within minutes, brain cells begin to die. Symptoms of stroke one of the leading causes of chronic disability and death in the world include paralysis or numbness of the face, arm or leg, headache, vomiting, dizziness or altered consciousness, vision, speaking, understanding or walking troubles.

The blood-brain barrier (BBB) consisting of endothelial cells, neurons, microglia and peripheral immune cells is not only a physical barrier separating the central nervous system (CNS) from periphery, but a dynamic and metabolic border that regulates traffic and plays a fundamental role in the maintenance of CNS homeostasis and normal neuronal function. In ischemic stroke, BBB disruption characterised by structural disruption of tight junctions (TJs) and increased permeability leading to cerebral edema, facilitates injury development and increases the risk of hemorrhage while compromising normal neuronal function; BBB disturbance

pathological condition in both ischemic and hemorrhagic stroke, is usually associated with poor patient outcome and limit the use of recombinant tissue plasminogen activator (tPA). Clinically, a stroke is an acute cerebrovascular accident can be caused by an obstruction of a blood vessel by a locally forming clot thrombosis; an obstruction formed elsewhere embolism, common in patients with atherosclerosis; lack of blood supply to the brain, due to systemic low blood pressure hypoperfusion; or an accumulation of blood within the cranial cavity haemorrhage. In practical terms, a stroke may

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be caused by a blocked artery ischemic stroke or the leaking or bursting of a blood vessel haemorrhagic stroke. Some people may experience only a temporary disruption of blood flow to the brain transient ischemic attack (TIA), which does not cause permanent damage. About 80% of strokes are ischemic strokes. The most common include thrombotic stroke a thrombus forms in one of the brain arteries due to plaque in atherosclerosis or any other artery stenosis and embolic stroke, which takes place when a blood clot formed somewhere else travels through the bloodstream and lodge in brain arteries.

Haemorrhagic stroke occurs when there is a rupture or leak in a brain blood vessel. Brain haemorrhages can result from many conditions including hypertension, anticoagulants, or aneurysms. Additionally, they can occur as a result of arteriovenous malformation. Types of haemorrhagic stroke include intra-cerebral haemorrhage where a blood vessel in the brain bursts usually due to high blood pressure, trauma, vascular malformations, use of anticoagulant medications, damaging brain cells, and subarachnoid haemorrhage where an artery near the surface of the brain burst generally due to an aneurysm and spilling in the cranial cavity, often indicated by a sudden and severe headache.


A transient ischemic attack (TIA) also known as a mini-stroke is a temporary period of symptoms similar to stroke due to a temporary decrease in blood supply to part of the brain when a clot blocks blood flow. Many factors can increase the risk of including overweigh, inactivity, alcohol, smoking, and drugs cocaine and methamphetamines, and also medical risk factor like hypertension, hyperglycemia, hyperlipidemia, diabetes, obstructive sleep apnoea, cardiovascular disease such as heart failure, heart defects, heart infection or abnormal heart rhythm, and previous history of heart attack or transient ischemic attack in addition to personal or family history of stroke. Hypertension exacerbates BBB breakdown and worsens the outcome of ischemic stroke, increasing infarct volume, potentiating white matter injury, and augmenting brain edema and cognitive deficits. Hyperglycemia is also a risk factor for intracerebral hemorrhage regardless of tPA treatment, which at least partially results from massive BBB opening. The process of how hyperlipidemia leads to BBB dysfunction remains largely unknown, but oxidative stress may play a role. Age, race, sex and socioeconomic status are other risk factors, with women suffering stroke at older age than men, but more likely to die from it at older age. Stroke can cause temporary or permanent disabilities, depending on how long the brain has been deprived of blood. Body paralysis due to loss of muscle control, dysarthria, dysphagia, aphasia including difficulty speaking, understanding, reading or writing, memory loss with difficulty thinking, making judgments, reasoning and understanding concepts, pain and numbness, and emotional and behavioural problems including social withdraw and depression may be frequent complications associated with stroke. Statistics show remaining mild to moderate functional deficits 44% and 35% respectively at 3 and 12 months after a stroke, with functional deficits including cognitive, speech, visual, sensory and motor underperformance, affecting patients’ quality of life, and associated with a substantial financial burden. Motor recovery after brain injury is a multifactorial process in which genetic, pathophysiologic, sociodemographic and therapeutic factors intermingle shaping the overall recovery. Assessment of the degree of ipsilesional corticospinal tract injury in acute stroke can be used to predict chronic motor deficits. Preventive medications or treatments to reduce the risk of

a second ischemic stroke or TIA include anti-platelet drugs such as aspirin, aggrenox low aspirin and dipyridamole combination, clopidogrel (plavix), and anticoagulants including heparin or warfarin to reduce blood clotting, and newer blood thinners to prevent new TIA or stroke caused by abnormal heart rhythm. An early treatment is imperative in order to improve the chances of survival, reduce complications, and have the best options of recovery. Emergency treatment for stroke however, depends on the type of stroke ischemic that requires a quick restore of blood flow, or hemorrhagic stroke that demands controlling the bleeding and reducing intracranial pressure, which might even need surgery. In the case of ischemic stroke, the gold standard treatment comprises recombinant tPA to dissolve the blood clot and restore blood flow. Other endovascular procedures include intra-arterial thrombolysis and stent retriever, depending on the size of the clot. Carotid endarterectomy or angioplasty with stents to remove plaque from the carotid are other procedures used to decrease the risk of further strokes or TIAs. For hemorrhagic stroke, the focus will be to lower the intracranial pressure with drugs that lower the blood pressure and prevent vasospasms, and counteracting the effect of warfarin or antiplatelet drugs in case that the patient currently uses them, and stop the bleeding, which sometimes involves surgery to remove the accumulated blood in order to release the intra-cranial pressure. Additionally, surgical clipping or endovascular embolization may be used to block blood flow to the aneurysm preventing its bursting and bleeding, whereas surgical removal or stereotactic radio surgery are used to remove arteriovenous malformation, if they have been the cause of stroke, to prevent another stroke. The recovery efforts will be later focus on regain functions that might have been affected by stroke, which will depend on which area of the brain has been disrupted and the amount of brain tissue damaged. If the left side has been involved, speech and language might be altered. Breathing, swallowing, balancing and vision may be additional consequences of stroke. About 12% males and 16% females stroke survivors have reported post-stroke depression at 3 months after stroke, which has been suggested to be due to the stroke-induced decrease in serotonin, dopamine and norepinephrine in the brain. Patients with co-morbidities especially with uncontrolled

diabetes and severe periventricular white matter disease are associated with poorer outcome after stroke. Several studies on genetic variations in stroke and cardiovascular risk have associated multiple single nucleotide polymorphisms (SNPs) with increased risk or severity of ischemic stroke. A number of gene products, such as Brain Derived Neurotrophic Factor (BDNF) polymorphism, a neurotrophic factors in the brain and is implicated in synaptic plasticity, learning and memory, Apolipoprotein E (Apo-E) which plays an important role in the growth and regeneration of central nervous system tissues and in modulating neuronal repair, remodeling, and protection associated with variability in recovery after ischemic stroke, Neurotrophic tyrosine kinase receptor, catechol-O-methyl transferase (COMT), and mitochondrial DNA gene variation may have potential influence on stroke recovery. TJ disruption with protein modification, translocation and degradation is a major reason underlying increased permeability of the BBB after ischemic stroke. The time course and degree of each process is determined by the severity of ischemic injury. Many agents with preclinical therapeutic efficacy in protecting against ischemic stroke, including BBB protection, have not been successfully translated into clinical use due to factors, including limitations in preclinical stroke models, risk factors and comorbid conditions. Future studies Important areas for further research in stroke recovery would include the optimization of post-stroke outcome prediction, particularly identifying specific biomarkers for recovery. The identification of motor recovery factors after stroke may provide insight into potential factors influencing recovery and might help to develop an individualised recovery therapy for patients, mostly depending on the severity and injury pattern. Tregs have a controversial role after ischemia. The pattern of Treg infiltration into brain and the role of T-lymphocytes including Treg and B-lymphocytes in injury progression and modulation of BBB permeability after ischemic stroke is a promising area for further investigation. Strategies that can promote endothelial and BBB restoration and repair after ischemic stroke that can be achieved through angiogenesis and division of ECs may also improve the recovery and outcome of patients.

BIBLIOGRAPHY • Alawieh A, Zhao J, Feng W. Factors affecting post-stroke motor recovery: Implications on neurotherapy after brain injury. Behav Brain Res. 2018 Mar; 340:94-101. doi: 10.1016/j. bbr.20 16.08.029 • Desilles JP, Meseguer E, Labreuche J, Lapergue B, Sirimarco G, Gonzalez-Valcarcel J, Lavallee P, Cabrejo L, Guidoux C, Klein I, Amarenco P, Mazighi M. Diabetes mellitus, admission glucose, and outcomes after stroke thrombolysis: a registry and systematic review. Stroke. 2013; 44(7):1915-1923. doi: 10.1161/ STROKEAHA.111.000813 • Helm EE, Tyrell CM, Pohlig RT, Brady LD, Reisman DS. The presence of a single-nucleotide polymorphism in the BDNF gene affects the rate of locomotor adaptation after stroke. Exp Brain Res. 2015:1-11. doi: 10.1007/s00221-015-4465-8 • Jiang X, Andjelkovic AV, Zhu L, Yang T, Bennett MVL, Chen J, Keep RF, Shi Y. Blood-brain barrier dysfunction and recovery after ischemic stroke. Prog Neurobiol. 2018; 163-164:144-171. doi: 10.10 16/j.pneurobio.2017.10.001 • Keep RF, Zhou N, Xiang J, Andjelkovic AV, Hua Y, Xi G. Vascular disruption and blood-brain barrier dysfunction in intracerebral hemorrhage. Fluids Barriers CNS. 2014; 11:18. doi: 10.1186/20458118-11-18 • Liu C, Wu C, Yang Q, Gao J, Li L, Yang D, Luo L. Macrophages Mediate the Repair of Brain Vascular Rupture through Direct Physical Adhesion and Mechanical Traction. Immunity. 2016a; 44:1162-1176. doi: 10.1016/j.immuni.2016.03.008 • Liu H, Wang Y, Xiao Y, Hua Z, Cheng J, Jia J. Hydrogen Sulfide Attenuates Tissue Plasminogen ActivatorInduced Cerebral Hemorrhage Following Experimental Stroke. Transl Stroke Res. 2016b; 7:209-219. doi: 10.1007/s12975-016-0459-5 • Loubinoux I, Kronenberg G, Endres M, Schumann-Bard P, Freret T, Filipkowski RK, Kaczmarek L, PopaWagner A. Post-stroke depression: mechanisms, translation and therapy. J Cell Mol Med. 2012; 16(9):19611969. doi: 10.1111/j.15824934.2012.01555.x • NINDS Stroke Genetics Network and International Stroke Genetics Consortium. Loci associated with ischaemic stroke and its subtypes (SiGN): a genome-wide association study. Lancet Neurol. 2016; 15(2):174-184. doi: 10.1016/S14744422(15)00338-5 • Prakash R, Carmichael ST. Bloodbrain barrier breakdown and neovascularization processes after stroke and traumatic brain injury. Curr Opin Neurol. 2015; 28:556-564. doi: 10.1097/WCO.00000000 00000248 • Stamatovic SM, Johnson AM, Keep RF, Andjelkovic AV. Junctional proteins of the blood-brain barrier: New insights into function and dysfunction. Tissue Barriers. 2016; 4:e1154641. doi: 10.1080/21688 370. 2016.1154641 • Stamatovic SM, Johnson AM, Sladojevic N, Keep RF, Andjelkovic AV. Endocytosis of tight junction proteins and the regulation of degradation and recycling. Ann N Y Acad Sci. 2017; 1397(1):54-65. doi: 10.1111/nyas.13346

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News

¤3m in cutbacks impacting on cancer care Cancer Trials Ireland has revealed that the €3 million cut in its grant is now having a direct impact on potentially breakthrough treatments being available for people in Ireland with cancer. Eibhlín Mulroe, CEO of Cancer Trials Ireland be reviewing data associated with a patient’s response to treatment and there is great comfort in that knowledge for patients on our trials.

Due to a 20% cut in the grant it receives from the Department of Health, every year since 2016, Cancer Trials Ireland has been unable to open trials in disease areas such as lymphoma, testicular and endometrial cancer which means people with these kinds of cancers cannot access the newest promising treatments. At the launch of Cancer Trials Ireland’s Just Ask Your Team campaign last month, ahead of International Clinical Trials Day 2019, which is dedicated to the many teams behind the 80+ cancer trials that are open in 16 hospitals around the country, Professor Bryan Hennessy, Clinical Lead at Cancer Trials Ireland said, “As a result of these continuing cuts, the number of people joining cancer drug trials each year is falling drastically. In 2014, before the 2016 cuts were introduced, 3% of

people in Ireland with cancer were on a cancer drug trial. Last year it was down to 1.5%. “This means that every year less people with cancer can access potentially effective treatment options when the standard treatments are not working. Cancer trials not only have a profound impact on the lives of people with cancer today, but they deliver in the medium and immediate term. “As an oncologist seeing patients every day, some of whom have no options left, continuation of these cutbacks is unjustifiable by any standards,” he said. Eibhlín Mulroe, CEO of Cancer Trials Ireland, added, “Trials can often be the best treatment option available for cancer patients and offer a higher level of oversight because of the team nature of clinical trials. Up to 20 people can

“Trials are also a very cost-effective way to provide cancer treatments as trial drugs are provided by pharmaceutical companies. For every ¤1 in Government grant we get, we can attract ¤3 in investment in trials. So, at a health policy and economic basis it’s a no-brainer,” she said. Cancer Trials Ireland’s Just Ask Your Team campaign aims to raise awareness of the many dedicated team of people that contribute to cancer trials in Ireland, and to encourage those with cancer, their family and friends to ask their local team about a trial that might be suitable for them. Cancer trial teams include people with cancer, their families and friends, cancer doctors and surgeons, research nurses, data managers, pharmacists, publicfunders, donors, pharmaceutical companies, and Cancer Trials Ireland’s research specialists, all of whom have a uniquely important role in the cancer trial team. The Just Ask Your Team campaign is part-funded by unrestricted grants from the pharmaceutical companies AbbVie, Bayer, MSD, Novartis and Pfizer.

Irish increase in Opiod Deaths Ireland has been named as one of six countries which have experienced a significant rise in the level of opioid-related deaths. A report, Addressing Problematic Opioid Use in OECD Countries, says Ireland has experienced a “surge in overdose deaths” from the drugs alongside the US, Canada, Sweden, Norway and parts of the UK, where related fatalities have increased by more than 20 per cent between 2011 and 2016. The report says it is a “mounting health and social crisis fuelled by the illicit drugs trade” as well as over-prescription by doctors. Figures provided by the Organisation for Economic

Co-operation and Development (OECD) show the rate in Ireland has increased from 41.1 per million in 2011 to 43.5 by 2016. Opioids come in two general categories: illicit types, with heroin being the most common, and prescription drugs, such as OxyContin, which have caused a widely publicised health crisis in the US. Despite the high profile epidemic in the US the report notes that general awareness of the issue elsewhere is relatively low.

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“Illicit opioids constitute a significant product of international illicit trade,” it says. “Heroin is a semi-synthetic opiate synthesised from morphine, and is the most prevalent illicit opioid worldwide.” More recently the emergence of fentanyl and fentanyl analogues have become increasingly prominent in the illicit drugs trade in many countries. Elsewhere, the over-subscription of opioid-based painkillers is considered one of the most important root causes of the crisis.

Decrease in Rotavirus Disease The HSE National Immunisation Conference has heard how the incidence of rotavirus disease in Ireland has fallen by 72% in Ireland since the introduction of the Rotavirus vaccine in 2016. Addressing health professionals including nurses and medical officers from the HSE vaccination teams, Sarah Jackson, Surveillance Scientist from the Health Protection Surveillance Centre, explained how the number of cases of rotavirus infection reported in Ireland has fallen from 2,305 cases in 2017 to 636 cases in 2018. “Most significantly, our latest reported uptake for Rotavirus vaccine is 90% and that is how we have achieved this success. Rotavirus infection is the most common cause of gastroenteritis in children in Ireland under the age of five years,” she said. “Most children will recover at home but some need to be admitted to hospital. Every year in Ireland almost 1,000 children under the age of five are admitted to hospital with rotavirus infection. The average length of time they spend in hospital is five days. Infants and young children can now be protected from this disease by the rotavirus oral vaccine.” Dr Lucy Jessop, Head of the National Immunisation Office explained, “Rotavirus is very infectious and can spread easily. It can be spread through hand to mouth contact, such as from touching toys, surfaces, dirty nappies or can be spread through the air from coughing and sneezing. The Rotavirus vaccine was introduced for all babies born on or after 1 October 2016 in Ireland. It is an oral vaccine given at two and four months of age when they are getting their other routine vaccines.” The conference also heard from Dr Suzanne Cotter and Dr Mary Ward, Specialists in Public Health Medicine on recent outbreaks of vaccine preventable diseases nationally.


News Positive Ageing Indicators for Ireland Nine out of ten adults in Ireland aged over 56 years are confident they have a friend or relative they can rely on, with 88% of older adults taking part in weekly social leisure activities, according to the second National Positive Ageing Indicators Report published by the Department of Health and launched by the Minister for Mental Health and Older People, Jim Daly TD. The report also shows that 32% of older adults are taking five or more prescription medicines on a daily basis. This year's report also includes supplementary indicators for two groups in Irish society not sufficiently represented in the initial indicator set in 2016: Irish Travellers and people with an intellectual disability. The indicators highlight some positive news about the lives of people ageing with intellectual disabilities. For example, 96% of people with an intellectual disability aged 40+ were involved in one or more social activity at least once a week, or that smoking and alcohol use was low in this population: 7% of people with an intellectual disability smoke and 62% never drink alcohol. On the downside, however, 85% of people aged 40+ with an intellectual disability were sedentary or under-active and almost three out of four people (74%) have poor bone health. Working in later life can have a significant influence on income levels and can be an indicator of better health and wellbeing, however indicators for Irish Travellers aged 40+ from Census 2016 show an employment rate of just 13%. 88% of older Irish Travellers have access to a piped water supply, and 56% of this group have good self-rated health (compared to a national average of 80%). However, 58% of Irish Travellers aged 40+ have a chronic disease and almost a third report difficulty dressing, bathing or moving around the home.

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First Skin Cancer Prevention Plan Aimed at tackling the most common type of cancer in Ireland, the first skin cancer prevention plan for Ireland was published as Irish Pharmacy News was going to press. Over 11,000 cases of skin cancer are diagnosed each year and the number of cases is projected to double by 2045. Minister for Health Simon Harris TD and Minister of State for Health Promotion Catherine Byrne TD launched the plan, which focuses on the fact that most skin cancers could be prevented. It addresses awareness of skin cancer prevention and has identified the priority groups as children, outdoor workers, those who participate in outdoor leisure activities and sunbed users. Speaking as he launched the policy, Minister Harris said, “Skin cancer is something that we don’t always think of when we hear that someone has been diagnosed with cancer but in fact it is the most common type of cancer in Ireland today with over 11,000 cases diagnosed each year. “With half of all Irish adults getting sunburned last year we need a radical rethink on how we think about the sun and tanning. What people really need to know is that most skin cancers could be prevented and the behaviours that we can adopt to protect our skin and our children’s skin.” The plan was developed by

the Department of Health in conjunction with the National Cancer Control Programme (NCCP) and key stakeholders including other Government Departments and national organisations representing priority groups, including the Irish Cancer Society, Marie Keating Foundation, the Irish Skin Foundation and Breakthrough Cancer Research. Minister Harris added, “Prevention is a cornerstone of our National Cancer Strategy as it offers the most cost effective, long term approach for cancer control. “The partnership approach of Healthy Ireland bringing all the key players together was critical to developing this plan for skin cancer and will be key to rolling out the plan to reverse the rising incidence of skin cancer and ultimately saving lives.” Research conducted for the plan showed that often people think it is a hot sun that causes skin cancer but in fact ultraviolet radiation UV is the main risk factor responsible for skin cancers. UV is emitted naturally from the sun even in cloudy conditions and also comes from artificial sources such as sunbeds. By adopting

skin protective habits, the majority of skin cancers caused by harmful UV exposure could be prevented. Dr Triona McCarthy, Consultant in Public Health Medicine from the National Cancer Control Programme (NCCP) said, “Over 1,000 people in Ireland are diagnosed with melanoma each year and over 10,000 with nonmelanoma skin cancer. These numbers are predicted to rise further but much can be done to reverse this trend. This Skin Cancer Prevention Plan outlines the actions we can take to create an environment where protection of our skin from excess UV radiation is the norm.” Speaking at the launch, Evelyn Cusack, Head of Forecasting in Met Eireann said, “Met Eireann actively supports the new Skin Cancer Prevention Plan and look forward to working with all partners in its implementation. We publish a daily UV index from April to September. People should become familiar with the index. Even on cloudy summer days the UV index can be quite high. Peak burn times are between 11am and 3pm so it’s particularly important that people take extra precautions then.”

National campaign on hay fever Life Pharmacy has completed its national hay fever advertising campaign. This is the third year Life have undertaken a hay fever campaign. Both 2018 and 2017 campaigns delivered significant sales results for allergy products with an increase of 76% over the two years. Pharmacists were placed at the centre of the campaign, which combined national and local advertising using outdoor media such as billboards and bus shelters and radio spots on national and local stations. Ad content was voiced by Life pharmacists and included advice and tips on prevention and treatment of hay fever. To promote Life pharmacies as sources of expert advice to the local community, in-store support including point of sale, customer leaflets and additional training for staff on providing advice and product recommendations was provided.

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Pharmaceutical Care of the Elderly

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reland is getting older, faster. The feat of an ageing population is considered a societal success – a measure of how health services successfully battle disease and of everimproving social conditions. But it brings its own problems.

The number of people in Ireland aged 65 and over has increased by 32.8% since 2007, a faster rate of growth than other EU countries. It is expected to have significant implications on healthcare demand and expenditure. The Central Statistics Office (CSO) estimates that by the year 2046, Ireland will be home to just over 5.6 million people. In its Key Trends 2016 report, the Department of Health said life expectancy has increased by almost 21/2 years in a little over a decade, and has been consistently higher than the EU average. A century ago it was about 50; today it is almost 77 for men and 82 for women. There is a clear opportunity for community pharmacists and their teams to lead best practice when it comes to supporting the ongoing health needs of older people.

We all know that an expanding older population is putting a lot of pressure on community services. Community pharmacies could prove to be the vital link by bringing their knowledge of older patients and skills into play more often and in new ways. Medicines are the most common healthcare intervention. There has been an increase in both the number and complexity of medicines available in the past 20 years. People are living longer and coping with multiple chronic diseases all treated with medicines. As health reforms move patients as close to home as possible for treatment, patients in the community will require support for increasingly complex medicine regimes. This, together with polypharmacy, presents challenges for the patient, in terms of taking medicines appropriately (medicine adherence), adverse

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drug reactions, and potential additional drug interactions as therapy becomes more complex.

infants, children and adults, can be affected by dysphagia. Those affected includes:

Throughout the consultations and focus groups process carried out for this Report, transitions of care were highlighted as a significant problem area for both patients and healthcare professionals. The role of the pharmacist, with their unique knowledge of medicines, will therefore be important in supporting patients to manage their medicines throughout their care pathway.

 50% of people with Parkinson’s Disease;

Common Medicines Management Challenges

 33% of people with multiple sclerosis.

There is a fairly high prevalence of swallowing difficulties in poly pharmacy patients visiting their local community pharmacy, highlighting the need for a better communication between patients and health professionals for addressing such issues. Anyone at any stage of their lives from

As dysphagia is not a single disease, but a symptom of an underlying medical problem, it is difficult to estimate how many patients are suffering from it. Stroke is considered to be one of the major causes of dysphagia. In many patients, the swallowing function will recover within two

 95% of people with Motor Neurone Disease;  68% of people with dementia in care homes;  65% of people who have had a stroke;


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months. In a small group, recovery of swallowing function may take many months to several years. In several cases of stroke patients this recovery does not occur. A sufferer may present to a member of the pharmacy team and identify that they are having difficulty swallowing medication. This is an opportunity to establish whether they have difficulty swallowing food or liquids and whether there has been any associated weight loss. A patient with these symptoms can then be referred via GP services to speech and language services. Knowledge of dysphagia and interpreting the various stages of fluid and consistency of foods can assist pharmacists in advising in the most appropriate and safe manner in administering medication to patients with dysphagia. Medication administration in people with dysphagia is complex. Key questions to ask • Is the medication necessary? • Is it making the swallow worse (dry mouth, confusion, reduced alertness)? • Could the medication actually be assisting the swallow? • If the medication is necessary what is the best method of drug delivery? This will depend on where the problem is in the swallowing process and the severity of the dysphagia. • Drug interactions, available formulations, enteral feed and tube/drug interaction are all important areas. Mechanical factors are also key, what bore is the tube, the smaller the gauge, the greater the risk of blockage. • For those who are able to take medication orally, are tablets feasible or not?

Managing Care of the Elderly As the world population ages, health systems globally will face the burden of chronic disease and polypharmacy management in older patients. Within efforts to identify the optimal model to care for older adults and to increase formation of effective interprofessional health care teams, pharmacists play important and distinct roles. Because older adults have multiple chronic conditions and often use polypharmacy, they are an ideal patient population for pharmacists’ interventions. Multiple studies point to the dangers of polypharmacy use among older adults, including potentially inappropriate medications (PIMs), anticholinergic burden, drug–drug interaction-related adverse drug reactions. The prevalence of polypharmacy use and inappropriate prescribing in the elderly is a global phenomenon reported in multiple countries. There is strong evidence for the role of pharmacists in providing geriatric care to reduce polypharmacy and clinical consequences of polypharmacy, including medication errors, non-adherence, adverse drug events, drug–drug interactions, urgent or emergent visits, and hospitalisation. Older patients most often suffer from chronic diseases, including asymptomatic conditions, such as hypertension and dyslipidemia. Pharmacists having extensive knowledge of medications to treat chronic conditions and an up-to-date stance on clinical guidelines can provide impactful care to older populations. Many barriers can be overcome by establishing strong pharmacist-patient relationships, monitoring drug use to ensure proper use, and creating a familial atmosphere in your pharmacy.

Date for your Diary The TOPRA Annual Symposium 2019 takes place in Dublin from 30 September to 2 October in co-operation with the HPRA. The theme for this year's event is: Europe at the forefront of global healthcare regulation: Driving innovation through convergent approaches in medicines, devices and veterinary regulatory affairs. The programme will cover topics such as the impact of technology on the regulatory profession, the new veterinary medicines legislation and the implementation of the medical device and in-vitro diagnostic Regulations. The TOPRA Annual Symposium is recognised as a first-choice key event in the European regulatory affairs calendar for anyone working in, or alongside, regulatory professionals. Further details can be found at www.topra.org

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No Free EHC in Sight The Bill to legalise abortion services in Ireland passed all stages in the Dáil at the end of December, but whilst women can now access abortion services from the start of 2019, they still have to pay to prevent the need for one, unless they are a Medical Card holder. It was revealed recently, that a Working Group is to be established to examine removing cost barriers to accessing contraception. The move was announced by Minister for Health Simon Harris as it is believed the group will examine the extent to which cost is a barrier to accessing reliable methods of contraception in Ireland. It will also look at whether there are other factors influencing ease of access to contraception which could be addressed. Some of the areas the group will look at include financial barriers, legislative barriers, regulatory issues, and contractual issues. Minister Harris has said he is aiming to provide emergency hormonal contraception free this year. The access to free contraception was a recommendation made by the Oireachtas Committee on the Eighth Amendment. Initial work within the department found that rolling out free contraception would involve changes to legislation. Availability in Pharmacy In December 2018 the Sexual Health and Crisis Pregnancy Programme (SHCPP) of the Irish Health Service (HSE), launched a national campaign in partnership with the Irish Pharmacy Union (IPU), with the aim to increase public awareness that EC is available to women directly from a pharmacist up to five days (and not only ” the morning after”) following unprotected sex. Women with medical cards can get the EHC pill free-of-charge directly from a pharmacist without the need for a prescription from their GP. This is an important public health measure and will remove any barrier to women getting timely treatment from their local pharmacy. Darragh O’Loughlin, IPU Secretary General, said,

“Emergency contraception is time-sensitive. Its effectiveness diminishes between the time of unprotected sex and the time of taking it, making it crucial that all women are able to access it readily when necessary. The convenience and accessibility offered by community pharmacies is therefore hugely valuable in helping to prevent a crisis pregnancy.” When it comes to which EC should be supplied, according to the IPU Emergency Hormonal Contraception (EHC) Protocol, Ulipristal acetate has been demonstrated to be more effective than levonorgestrel from 0-120 hours after unprotected sexual intercourse (UPSI) so it should be considered first-line oral emergency contraception unless contraindicated. The main reasons to give levonorgestrel instead of ulipristal acetate would be if the patient was taking liver enzyme-inducing drugs or was breastfeeding or was taking a progestogen, containing oral contraceptive or had severe asthma treated by oral glucocorticoids. Ulipristal acetate is effective up to 120 hours (5 days) after intercourse. Ulipristal acetate can be taken at any time during the menstrual cycle but evidence suggests that oral contraception is not effective after ovulation has taken place. Levonorgestrel is only effective up to 72 hours (3 days) after intercourse. Levonorgestrel can be taken at any time during the menstrual cycle but evidence suggests that oral contraception is not effective after ovulation has taken place. • IPN’s article in our May issue on the Role of Pharmacy in Emergency Hormonal Contraception incorrectly stated that the UK Faculty of Reproductive & Sexual Health issued an update on Emergency Contraception in May 2017. It was actually issued in March, 2017.


Don’t Miss Out on Life’s Precious Moments…

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BABY & MATERNITY For more than 60 years, Mustela has successfully developed products to nourish and protect both babies and their moms throughout the world. Mustela is Europe’s leading Mother and Baby Brand and is committed to safety first and foremost. Developed in collaboration with healthcare professionals, all of Mustela’s products are hypoallergenic*, high-tolerance and do not contain any parabens, phenoxyethanol, phtalates or alcohol.

The Graham Anthony Team offer high quality brands and products, Nationwide Training Programs, Excellent Customer Service, Efficient Delivery, Regular visits from Area Managers & Promotional Assistance. To find more about our products and services please contact us and we would be delighted to discuss our extensive range of beauty brands with you. REVOLUTIONARY NATURAL HAIR TREATMENTS PHYTO is an internationally renowned, natural haircare brand created by Patrick Ales, inventor of the “Blow Dry”. Amongst its vast product offering, PHYTO has ranges that include hair loss treatments, hair colouring and styling - all helping your customers reveal beautiful, healthy hair. INNOVATIVE ANTI-AGEING SKINCARE Founded in 1975, Lierac specialises in the correction of skin ageing and also of skin disorders that have been left untreated. Lierac is the #1 skincare brand in Italy, and #2 in France and has now brought its pioneering and innovative products to the Irish market.

DERMOCOSMETIC (UREA UP TO 50%) SVR Prescribed by dermatologists in some 45 countries and present at all major conferences, SVR has grown in size whilst remaining true to its values. An authentic, ethical and sincere approach combined with reliability and outstanding quality enabled the brand to bring leading skincare products to the market, for all skin types including the most sensitive. DERMOCOSMETIC (UREA UP TO 50%) Skeyndor is the number 1 skincare brand in Spain and is rated as one of the top 15 cosmetic brands in the world. “The Scientific Skincare” fundamental values reflect its progress, the ability to adapt constantly to new times and the confidence it has gained after working in the world of beauty for many years.

100% PURE SHEA BUTTER Developed with 100% shea butter, Institut Karité Paris has always tried to give every type of beauty, of any age, the benefits of shea. Because every type of skin has specific needs throughout a lifetime, IKP adapts its treatments to suit your needs at every stage. Made in France, IKPs products range from Hair Care, Face Care, Body Care to Men. NATURAL SOAP SINCE 1947 Nesti Dante formulates with quality, purity and integrity without compromise using traditional saponification The use of raw materials as whole neutral fats, both vegetable and animal, allows a qualitative selection of each individual material and, much more important, these Mustela is committed to healthy skin froma birth on*more andsoftening chooses qualitative material let us obtain richer and soapto thanks to ingredients, the presence of the glyceride fraction the fats.ingredients. Made with love and use safe, effective with a focus on innatural care in Florence, Italy since 1947.

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GOA harmoniously adorns and perfumes every 0%room in your home, 95% offering both a visual and an aromatic experience. 100% Parabens, From the bedroom to ingredients of (1) hypoallergenic Phthalates lounge and kitchen, it infuses your home withand a subtle yet intense naturalthe origin aromatic ambience that lasts for weeks.phenoxyethanol

SELF TANNING MUSTELA USES SUSTAINABLY AND The world’s largest independent tanning brand with over 25 years’ experience in discovering and manufacturing revolutionary tanning ETHICALLY SOURCED INGREDIENTS products. Fake Bake uses luxurious formulations that contain the highest

ingredients, is free protecting from artificial preservatives Because takingquality careofofpremium infants also means their livingand parabens and has clinical trials to back up all specialist claims including environment, Mustela makes every effort to minimize the impact of anti-ageing. its products on Humans and their Environment.

NATURAL WHITENING TOOTHPASTE A natural whitening & refreshing toothpaste, through its formula enriched with natural ingredients, SENSIBLAN is a paraben-free toothpaste with unique properties. Building on the action of chlorhexidine, a powerful antibacterial agent, it helps fight the formation of plaque and bacterial growth while reducing gum sensitivity. Iris Florentina helps restore the natural whiteness of teeth, and essential mint oils purify the mouth and maintain a fresh breath, with long-lasting results.

MEDI COSMETIC For over 35 years, Filorga has been a leading provider of antiageing solutions for both the medical profession and general consumers. Filorga prides itself on providing cutting-edge, nonsurgical, anti-ageing solutions that include line fillers, polyrevitalising injections (NCTF®), peeling and photo-stimulation (LED).

NASAL TREATMENT A complete range based on sea water for the treatment of the nasal mucosae. Isotonic Solution (for daily use) helps to remove and fluidify the mucus in case of colds and mucosa dryness. HYPERTONIC > Paraben > Phenoxyethanol SOLUTION (for acute phase) decongests and fluidifies in case of colds, A demanding rhinitis allergies, sinusitis and rhinosinusitis. Lauryl Sulfate > Phtalate > Ammonium formulation charter > Sodium Lauryl Sulfate > BHA > Cyclotetrasiloxane > Benzophenone HOME DIAGNOSIS > p-Phenylenediamine > Ethylhexyl The SELFCheck tests are home diagnostic kits that detect a range of and analogousm methoxycinnamate different problemts from, bowel health, menopause, multi-drug to compounds cholesterol test > Triclosan > Phenoxyethanol

DERMOCOSMETIC Uriage meets the needs of sensitive skin thanks to an internationally recognised dermatological expertise. Uriage Thermal EXTREMELY Water is the best thermal water available on the Irish market, as it is DRY SKIN 52 times richer than any other thermal water brand. Uriage has 25 SELFCheck home screening tests years of skin expertise, and develop products in collaboration with dermatologists from all over the world. AROMATHERAPY 100% pure & natural essential oils. Delarom has made the theory of PSORIASIS/ECZEMA, the influence of plant scentsINFLAMMATORY on VERY DRY &“aromacology”, ATOPY-PRONE SKIN, AVOCADO PERSEOSE(*) and mood, the basis of its product range, using primarily DERMATOSISbehaviour Mediterranean ingredients and valuable essential oils that are known • Strengthens the cohesion and organization for their calming, regenerative, antioxidant and intensively Avocado of the barrier: A line of new generation emollient care for extreme and long-lasting moisturising properties. Each Delarom product contains balancing, (a) • In pharmacy training • Medical visits to GP’s close to +32% Ceramides scents such as sweet orange oil, orange mint or petit • Strongand opening offers cutaneousstress-relieving comfort. RESTORES the functions of three skin barriers +49% pharmacy Involucrin (b) grain oil to rapidly boost your energy. • Ongoing Monthly Specials • Event support • Maintains hydration of the epidermis: COSMECUTICAL/ ACTS directly on the SENSORIAL inflammatory process • Competitive margins • Stock management but high ® Doctor Nadia Payot created Payot when she combined her medical +175% Transglutaminase (c) Perseose • Shelf Talkers, wobblers and strong importance on profitability of shelf skills with beauty as well as the 42-Movement Facial Protocol. At the +47% Hyaluronique acid (d) merchandising space PEREFECT FOR SKIN heartBABY of Payot is advanced Research & Development Laboratories, a • Maintains complement epidermal • Shop Fit brand design • Slowthe selling sku’s canofbe swapped team of scientists and passionate experts (dermatologists, pharmacist, • Assets for Facebook, Instagram, stem cells: within 6 months of purchase chemists and pharmaceutical specialists) working together to (e) 80%•Integrin α6 conserved after UV exposure Websites create effective cosmetic formulations respecting safety, control Incentives for consultants in and dermatological ethical standards. • PR support pharmacy Sunflower COSMECUTICAL/ GLYCOLIC • Monthly support with Area Manager • Choose fromOIL 16 top selling brands SUNFLOWER DISTILLATE Alpha H spent 20 years researching the essential elements the skin visits, office support • Activates PPARα receptors needs for optimal health. The products work to take the skin out of its comfort zone in order to make a difference that is evident and genuine. • Restores the level of filaggrin expression The effective delivery systems infuse the skin with active ingredients by Oil distillate +77% filaggrin (f) adjusting the pH to stimulate action at a deeper layer of the epidermis, • Regulates the level of kallikrein expression where new and vibrant cells are replenished and repaired. • Training Plan, as knowledge is key • Provide a list of Doctors, Health

0%

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Atopic Eczema is an increasingly common skin

problem that leads to extreme dryness, itchiness and skin discomfort that can be intense, affecting one out of five children. Caused by genetic and environmental SUPPORT FROM PHARMACY ROUGHNESS AND CALLUSES factors,SKIN it often appears at the age of three months -77% kallikrein Urea-based products different concentrations then improves after a fewwith years. The STELATOPIA to success Nurses and Antenatal classes SCIENTIFIC SKINCARE • Allow participation in incentives close to your area. which act according to the degree of roughness IDC is a high performance anti-ageing skincare brand that developed CONCENTRATION OF range helps to relieve the often uncomfortable • Be active on Social Media, post our • Follow merchandising guidelines Regen-16, a molecule complex combining the greatest diversity of UREA FOR KERATOLYTIC and flaking. PR, ACTION like shareON andROUGH comment. • Plan windows and hot spots cosmetic ingredients to their optimal dosages simultaneously targeting symptoms of this skin disorder and restore baby’s • Organise events which will be the 16 main mechanisms related to signs of skin ageing. With record SKIN AREAS. supported by GAD concentrations up to 43% CALMS of cosmetic ingredients selected among the SOOTHES, AND ELIMINATES healthy skin. best in the world, IDC goes beyond industry standards.

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(*) except bath oil (a) Analysis by thin-layer chromatography of ceramides extracted from Stelaskin reconstructed epidermis. 72-hour treatment with Avocado Perseose. (b) ELISA measurement of Involucrin in normal human epidermal keratinocytes as a proportion of the number of live cells estimated by MTT assay. 48-hour treatment with Avocado Perseose. (c) Immunolabelling of Transglutaminase on skin explants following delipidation using an ether/acetone mixture. 3-hour treatment with Avocado Perseose. (d) ELISA analysis of hyaluronic acid in the culture medium of normal human epidermal keratinocytes as a proportion of the number of live cells estimated by neutral red assay. 24-hour treatment with Avocado Perseose. (e) Immunolabelling of Integrin alpha 6 on skin explants subjected to UV.Treatment with Avocado Perseose 24 hours before and after UV irradiation. (f) Culture of human skin explants treated with Stelatopia for 24 h, and stimulated with a cocktail of Th2 cytokines for 24 h.

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Advising on Common Skin Conditions in pharmacy

C

ommunity pharmacists play a significant role in helping patients to maintain the health of their skin. From reducing the risk of sun exposure by recommending appropriate sunscreens to offering advice and education on the use of OTC medications, pharmacists frequently are the frontline health care professional for what is the bodyâ&#x20AC;&#x2122;s largest organ. Pharmacists are ideally positioned to advise customers about the importance of appropriate skin care. It is important for community pharmacists to be aware of skin disorders and cancer risks so they are able to help their patients by providing preventive and early-stage care. Skin care is area for which there is a considerable demand in primary

care for advice and support and some evidence suggests that many people with skin problems manage their condition through self-care. Pharmacists have the potential to facilitate effective self-care for patients with skin problems. Furthermore the chronic nature of many skin conditions emphasises the need for medicine management support to improve

outcomes for those with conditions such as eczema and psoriasis. Dry Skin Dry skin has become a major focus for pharmacists as the size of the aging population increases. Dry skin is caused by a decrease in water retention by the stratum corneum and is characterised by roughness, scaling, inflammation,

and itching. It is especially prevalent during the winter months and may be due to excessive showering with hot water or excessive use of soap. To prevent dry skin, customers should be advised to maintain skin hydration through adequate fluid intake, avoid hygiene products that dry out the skin, reduce fullbody bathing to every other day,

PHARMACYNEWSIRELAND.COM | 93


and avoid long, hot showers. To treat dry skin, there are several suggestions pharmacists can offer. Patients can apply oil-based emollients (eg, petrolatum and mineral oil) after bathing, or they may use colloidal oatmeal or bath oil while bathing to enhance skin hydration. Humectants, such as glycerin, draw water into the skin. More serious cases of dry skin may require a urea or lactic acid containing product. Acne An OTC consultation request for an acne product should be approached with empathy, as well as clinical knowledge, since acne is associated with significant psychological effects, including low self-esteem, social phobia, and depression. It is important when advising someone presenting to the pharmacy to dispel the myths associated with acne. It is not a condition of poor hygiene or diet, nor is it caused by stress, although severe stress may exacerbate the problem. It is just as important, though, to inform the patient that there are several factors that may cause or exacerbate acne: • Hydration (high humidity, excessive sweating) • Occlusive clothing, headbands, helmets • Touching the face • Dirt, cooking oil, coal tar, petroleum • Oil-based cosmetics (those containing lanolin, mineral oil, and cocoa butter); also hair dressings used by African Americans • Severe or prolonged stress • Premenstrual flare-ups It is also important to educate those with acne on how to care for their skin. Initially, nonpharmacologic therapy should be addressed. Sufferers should cleanse their skin twice daily with warm water, which will remove excess sebum from the surface of the skin. Discourage vigorous washing and the use of soaps that contain oil or medications. Medicated soaps spend very little time on the surface of the skin and are of little clinical value. Individuals should also minimise exacerbating factors, including preventing friction-induced irritation by using water-based cosmetics and/or shampoos and by avoiding picking or squeezing lesions. When assisting in selecting an acne product, the various treatment vehicles available should be considered. Creams are suitable for patients with sensitive or dry skin; gels are more appropriate for patients with oily skin. Lotions may be used on any skin type and spread well over hair-bearing areas.

Psoriasis Psoriasis, a chronic condition often associated with silvery scales over pink or red lesions, typically must be treated with prescription medications; however, mild cases may be self-treated. Self-treatment should involve the use of emollients and lubricating bath products formulated for dry, itchy skin. Topical corticosteroids remain the most widely used treatment for psoriasis due to their antiinflammatory, immunosuppressive, and antipro-liferative properties. If hydrocortisone is used, the patient may apply it sparingly to the affected area two to three times daily. When a salicylic acid product is used, the patient should soak the affected area in warm water for 10 to 20 minutes before application. Tinea Infections Pharmacists often encounter questions about superficial fungal infections, as many are easily treated with OTC medications. Tinea infections are classified according to their location on the body. Dermatitis Atopic: Atopic dermatitis is a recurrent, symmetric inflammatory condition often experienced by infants, children, and young adults. It begins on the cheeks and may extend to the rest of the face, neck, wrists, and hands. The most common symptoms include intense itching and skin so dry that patients often will complain that moisturiser is ineffective. To control their condition, sufferers must be educated about proper bathing habits. Bathing in warm (not hot) water should last no more than 5 to 10 minutes, and a mild cleanser should be used. Immediately after bathing, apply generous amounts of a moisturiser. In addition to proper bathing and moisturisers, wet compresses may be applied to the affected area for 20 minutes four to six times daily. Seborrheic: Seborrheic dermatitis is a chronic inflammatory skin disorder that is usually confined to areas of the head and trunk where sebaceous glands are prominent. Symptoms often include dull yellow/red lesions, oily/yellow scales, and itching. General treatment should consist of frequent cleansing with soap, which will remove oil from the affected areas. In addition, outdoor recreation, especially during the summer months, may improve the condition. Contact: Another form of dermatitis commonly encountered by community pharmacists

94 | PHARMACYNEWSIRELAND.COM

is contact dermatitis, which manifests itself as a rash that results from skin contact with an allergen or irritant. The primary symptom is profuse itching. When contact dermatitis occurs, the sufferer should wash the area well to remove the offending agent. If the area is oozing, the patient can apply compresses of cool tap water and aluminum acetate for 20 minutes four to six times daily. Skin Cancer Skin cancer is the most common cancer in Ireland. In 2017 it was estimated that there were an average of 10,857 skin cancers and 1,092 melanoma cases. But numbers are rising each year. Statistics show that more men than women develop skin cancer, probably because they work outdoors more and play sport. Melanoma is the most serious form of skin cancer. Approximately 75% of all skin cancer deaths are due to melanomas. Melanomas may appear suddenly. They are most frequently found on the areas of the face, neck, arms, upper back, and legs, but can occur anywhere on the body. If recognised early and treated properly, melanomas can be cured. If left untreated, melanomas in later stages can spread to other organs and lead to death. According to the National Cancer Institute, the first sign of melanoma is often a change in the shape, size, colour, or texture of an existing mole. Melanoma may also appear as a new mole or change in skin. Many skin care experts recommend the ABCDE method to help people look for and detect possible melanomas: A is for Asymmetry: Do different halves of the skin lesion look the same?

Steps that can be used to prevent or reduce the chances of melanomas include: • Always avoid excessive exposure to the sun, especially between the peak hours of 10am and 4pm. • Avoid using tanning beds or lamp devices. • Always wear sunglasses to protect the eyes, because melanoma can occur in the pigmented area of the eyes. • Always apply sunscreen 15 to 30 minutes before going outdoors to protect skin, and wear hats and protective clothing to protect against UV rays. Reapply sunscreen every 2 hours, especially if sweating. • Routinely examine the skin for changes in moles. • Always refer to the GP anyone who recognises any changes in their skin or a mole. Tanning Self-tanning has never been easier or quicker – with many products even doubling as high-spec skin care. It is no secret that exposure to the sun exposes people to greater risks, such as skin cancer and also heightens ageing around the face. With such a plethora of safe, self-tanning products now available there should be no excuses. Given adverse weather conditions and what we now know to be the inherent risks of excessive sun exposure, the question isn’t why, but how to achieve a convincing facsimile of a tan. Research has shown that Ireland is the second most voracious market globally (after Sweden but before the UK) for tanning products.

D is for Diameter: Melanomas usually are larger than the size of the eraser on a pencil (1/4 inch or 6mm), but they may sometimes be smaller when first recognised.

And the range of self-tanning products continues to expand, with offerings that work ever faster, are easier to apply and available in a growing variety of application formats and shades. In many cases, the undesirable side-effects of home tanning (ie, all those stained towels and bedlinens, victims of the rubbed-off guide colour) can be avoided. Since the big breakthrough of the gradual tanner, this category has evolved, through fast-drying and acting gels to in-shower wash-offs and mask iterations, many still based on the basic ingredient, dihydroxyacetone (DHA), often derived from sugar beets, which reacts with amino acids in the outer layer of the skin to form the brown pigment that mimics a suntan.

E is for Evolving: Look for any change that occurs in the size, shape, colour, or elevation and note any new symptom, such as bleeding, itching, or crusting/scaling.

The incorporation of serious skincare technology is another area where brands are breaking new ground, with a raft of new multitasking products, including those with anti ageing, firming and antioxidant properties.

B is for Borders: Do the borders of the lesion appear irregular, shaggy, or ill formed? The borders of an early melanoma tend to be uneven and the edges seem scalloped or notched. C is for Colour: Does the colour appear different throughout the mole or lesion? Having a variety of colours is another warning sign of a melanoma.


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News

Get Cycling for COPD The fourth annual ‘Get Breathless for COPD Cycle’, which aims to raise much-needed funds for COPD Support Ireland and pulmonary rehabilitation services, is now open for registration, and all pharmacists, doctors, allied healthcare professionals and cycling enthusiasts are invited to participate. Kildare footballer Kevin Feely, with Peter O'Toole, left, advanced nurse practitioner, St Michael's Hospital, Dún Laoghaire, and David Magee, right, medical advisor, A Menarini, at the launch of the ‘Get Breathless for COPD Cycle’. Supported by A.Menarini Pharmaceuticals and held in partnership with COPD Support Ireland, it aims to raise much-needed funds for COPD Support Ireland and pulmonary rehabilitation services. Photo by Brendan Moran/Sportsfile on the day support cyclists will be on hand – as will cyclists with all levels of expertise and experience. Supported by A.Menarini Pharmaceuticals and held in partnership with COPD Support Ireland, the 2019 cycle takes place

across the scenic Ring of Kerry on Saturday June 15th. The Ring of Kerry cycle covers approximately 170 kilometres, and

The Department of Health estimates that almost 500,000 people aged 40 years and over in Ireland have COPD, of whom over 200,000 have moderate or severe disease and only half are

likely to be diagnosed.[i] COPD Support Ireland is a national charity which advocates for patients and provides access to peer support and communitybased exercise programs.[ii] Francis Lynch General Manager, A. Menarini Pharmaceuticals Ireland, adds, “A.Menarini Pharmaceuticals is delighted to be involved with this positive initiative for the fourth year running. Since the first year of the cycle, in 2016, participants have helped raise over ¤43,000 for COPD Support Ireland.” To register for the cycle, and for all logistical information, visit: https:// www.giv2go.com/fundraisingevents/get-breathless-for-copd2019-127?page=1 [i] O'Connor, D., Hurley, M., McCormack, M. and O'Connor, P., 2018. Respiratory Health of the Nation 2018. Ireland: Irish Thoracic Society.

Growing conversations around Mental Health Pictured on the day were: Newstalk's Henry McKean; Laurent de Saint Sernin, General Manager Commercial Operations, Janssen Sciences Ireland UC; Lisa Wallace, Business Unit Manager, Janssen Sciences Ireland UC; Dominic Layden, CEO, Aware; Shauna O'Connor, Partner and Volunteer Support Officer See Change; Musical performers Glenn Murphy and Ronan Scolard.

Janssen, in collaboration with charity partners Aware and See Change, have launched a national campaign that aims to increase public awareness around mental illness. Ahead of their participation at Bloom in the Park 2019, the #GrowingConversations campaign will help promote open discussion to reduce stigma, increase the understanding around mental illness and the supports that are available.

Hero’s Welcome to Special Olympics Athletes Following their medal success at the 2019 World Games in Abu Dhabi, athletes from Special Olympics Ireland were given a hero’s welcome during their visit to official first aid partner, FIXXA First Aid. The World Games was the largest sporting and humanitarian event held in the world this year. The games are heavily supported by volunteers and donations, leading Uniphar’s FIXXA to get involved to ensure the Irish team is taken care of during the competition. FIXXA’s relationship with Special Olympics Ireland continues with a rollout of FIXXA Sports Kit first aid bags to each of the 317 Special Olympics clubs across Ireland. This will cover 7,985 athletes from 15 disciplines. “We’re incredibly proud of all the Team Ireland athletes who participated in the games,” said Siobhán Flynn, Marketing Director at Uniphar. “Our main goal is to support Special Olympics Ireland so they can do their best and it’s been a wonderful experience to witness their drive, determination and success.” Staff from Uniphar and Special Olympics Ireland help athletes Alan Power and Omer Teko load their new FIXXA First Aid bags

PHARMACYNEWSIRELAND.COM

Athletes Alan Power and Omer Teko, who visited FIXXA creator Uniphar, both won bronze medals at the games. Power was a participant in 4x100 metre relay, 5,000 metre race and 3,000 metre race. He won bronze in each of the races.Teko was the goalkeeper for the Irish 7-a-side football team that won bronze following a 7-2 win versus Estonia.


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Product News

NEW - FLECTOR 140MG DICLOFENAC SODIUMTISSUGEL MEDICATED PLASTER Windzor Pharma are delighted to announce the launch of Flector Tissugel Medicated Plaster. Flector is a prescription only plaster for local symptomatic treatment of pain, Flector Delivers locally an effective quantity of diclofenac from the plaster into the affected tissues under the site of application. Available from United Drug and Uniphar from 1st June 2019 For a copy of the SmPC or for more information please contact medical@windzorpharma.com

Pharmacy For Sale Long established family run pharmacy for sale. Situated on the Main Street of a busy Midlands town. Owner retiring. Comprises of business and freehold property. May be sold together or property leased. Spacious new building, well designed with modern fixtures and fittings, and own private staff car park.

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PHARMACYNEWSIRELAND.COM

CELEBRATING THE LAUNCH OF DERMEDIC® AN AWARD-WINNING BRAND In this special edition that is honouring this year’s winners and celebrating the continued success and innovation across the Republic of Ireland, we thought it was only fitting to keep this awesome positive momentum going by launching theglobal leader in dermatology – Dermedic® – an industry genius that is rapidly expanding on an International level and landing on pharmacy shelves across the country. Dermedic® is one of the fastest growing dermo-cosmetic brands dedicated to the pharmaceutical market with products now available in more than 30 countries worldwide. Our passion and knowledge allow us to gain the position of a strong player on the European market and we are proud to also be available in the Republic of Ireland as from June 2019. Dermedic® offers affordable specialist skin care products available from pharmacies which differ greatly from mass market cosmetics.They are recommended by health care professionals for sensitive, allergic and problematic skinconditions such as skin susceptible to acne, capillary, atopic or dehydrated skin; providing both prophylactic and complementary topical skin care solutions that can be used in conjunction with prescription treatments for numerous skin ailments. Dermedic® products are formulated by clinically trained and experienced dermatologists with a focus on patient wellbeing and pharmaceutical quality standards. The creation process of all products follows strict Good Manufacturing Practices (GMP) which guarantees the highest manufacturing quality; with all products made in the EU. Dermedic® is dermatologically and ophthalmologically tested. We pride ourselves with our ingredient selection. We use thermal water that is of high-grade purity that is sourced from an artesian spring located in Central Europeand with our unique patented formulations. The products support the enduring objective of dermatologists to restore the skin’s correct functioning, which is why their effectiveness is necessitated by the high expectations of skin care specialists. The trust placed Golden Cross Pharma in the Dermedic® brand is reflected in numerous recommendations by both dermatologists and paediatricians. Additional recommendations by experts and independent research institutes are to us a confirmation of the recognition of the brand. Get in touch with our team leader Mr Kurt Lowell on +356 99203439 and benefit from our introductory offers. More details available at www.dermedic.com


European Falsified Medicines Directive Compliance. Why Wait?  With the launch of the European Union’s Falsified Medicine Directive (EU FMD) on February 9, requirements for serialization, verification, and reporting are now an essential part of doing business within the EU. If you’re still looking for an EU FMD solution, or if your chosen solution is not up to the task, time is of the essence for your brand, for your business, and for the patients who rely on the medicines flowing through the EU supply chain.  This eBook is your guide to the post-launch EU FMD landscape, from regulatory updates to lessons learned to critical components needed for a successful solution. Learn how TraceLink’s vast experience and global digital supply network can help your business achieve compliance, overcome risk, and build value.

 Mobile app can be used with iOS and Android phones and tablets.  Your first pharmacy location can download and use the SmartRx Manager app for free.  The mobile app can be used anywhere in the pharmacy, speeding up the dispensing process. No fixed scanning hardware, use the app in the way that best matches your current workflow.  Pharmacy users are connected and verified through the TraceLink Network and with the application. Additionally, transactions are encrypted and stored in a secure web service that is GDPR compliant.

Read the EU FMD Post-Launch Guide

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MAMA MOBILE APPLICATION

Paperless Medication Management The MAMA Mobile Application is setting the standard within the healthcare sector in Ireland and the UK for medication administration management by making the move to a paperless environment a reality. Pharmacists, Nursing Homes and Doctors can now all work in tandem to deliver the highest levels of care for patients while maintaining the most rigourous compliance standards. MAR Charts and Cardex created during medication rounds are now all stored and signed electronically providing highly dynamic reporting, simplifying audit requirements and reducing costs significantly. Call us on 049-899-5000 to find out more about this revolutionary solution.

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